Oral Answers to Questions

Debate between Jeremy Hunt and Philippa Whitford

Tuesday 5th September 2023 Commons Chamber

[The Chancellor of the Exchequer (Jeremy Hunt)]

Good morning, Mr Speaker. Brexit was a choice made by the British people and it remains a big opportunity for the economy. Rather than relitigating that debate, this Government are committed to embracing those opportunities.

[Dr Whitford]

Prior to the EU referendum, the Bank of England warned that Brexit would seriously damage the UK economy, weakening the pound and causing inflation. The Government have now delayed import checks on animal and food products for the fifth time, because the costs would add to inflation. Does that mean the Chancellor finally accepts that Brexit is contributing to the UK’s cost of living crisis?

[Jeremy Hunt]

No, but of course we are sensitive about the timing of introducing those changes because of cost of living pressures. I am sad to have seen, since we last met in the House, the hon. Lady announce that she is stepping down; we have much in common on patient safety. On the NHS, she will know that because of Brexit an extra £14.6 billion is being directed to public services every year, including the NHS and including in Scotland.

Health and Care Bill

Debate between Jeremy Hunt and Philippa Whitford

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Dr Whitford]

It is not just that patients prefer to see a doctor long term. There are safety issues when locums in acute specialties move from hospital to hospital, particularly if they are dealing with an acute case. They do not know where things are or who to phone; passwords and phone numbers change. There is a real safety issue with having too many locum staff in the very exposed acute services.

[Jeremy Hunt]

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

[Jeremy Hunt]

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

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

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

[Dr Whitford]

All Governments in the UK are expanding medical school places and trying to train more students, but that has led to a shortage of foundation places. In the first two years after a doctor graduates, they are not allowed to practise outwith a foundation job, and they can never practise if they do not go through a foundation job. In the summer, about 400 young graduates were still struggling to find a place. It took 19 years from my entering medical school to my becoming a consultant surgeon. We need to think not just about medical school, but about the whole pathway.

[Jeremy Hunt]

The hon. Lady is absolutely right. Medical school, the foundation years and, as my right hon. Friend the Member for South West Wiltshire (Dr Murrison) said, the retention of staff—all those things need to be built into long-term planning and baked into the system.

That long-term planning strikes a contrast, if I may say so, with some of the short-termism that we have seen recently. Even in the recent Budget and spending review, the budget for Health Education England, which funds the training of doctors in this country, was not settled. Although I think that the proposed merger with NHS England is probably the right thing to do, I fear it will mean that the budget is not settled for many more months, at precisely the moment when the workforce crisis is the biggest concern for the majority of people in the NHS.

--- Later in debate ---

[Jeremy Hunt]

I thank the hon. Lady, who before entering this place spent her time campaigning to support NHS and care staff. She speaks with great experience, and I think that the fundamental point she makes is very important. Unless there is long-term strategic planning, when we have a priority such as the one we have at the moment of tackling the backlog, we will often make progress on that priority by sucking in staff from other areas, which then suffer. That is an unintended consequence which happened when I was Health Secretary, and I fear that it will happen again without a long-term strategic framework.

Amendment 10 has wide support. It is supported by 50 NHS organisations, including every royal college and the British Medical Association—an organisation which, to be honest, is not famous for supporting initiatives from me—and by six Select Committee Chairs and all the main political parties in this place. I am sure that the Government will ultimately accept it, because it is the right thing to do, but if they are intending to vote it down today, I would say to them that every month in which we delay putting this structure in place is a month when we are failing to give hope to NHS staff on the front line.

Let me end by quoting the Israeli politician Abba Eban, who said that

“men and nations behave wisely when they have exhausted all other alternatives.”

Let us prove him wrong today by supporting amendment 10.

[Dr Whitford]

I am delighted to follow the Chair of the Health and Social Care Committee, and, in this rather unnerving outbreak of consensus and good humour, to mirror his speech and add my support to his amendment on workforce planning.

It is important to remember that healthcare is not delivered by hospital buildings or fancy machines; it is delivered by people to people, which is why the most important asset in any health service is its workforce. As I pointed out in an earlier exchange with the right hon. Gentleman, we need a long-term view, because it takes a long time to train senor specialists. As I said to him, it took 19 years from my entering medical school to my becoming a consultant breast cancer surgeon. We will struggle to work out what specialties we might need in 20 years’ time, because medicine is evolving, but many aspects and many sectors of staff do not change. If we do not get even those right, we are constantly in a position of drought and thirst, and it is not possible for staff to evolve—to pick up new rules, to use new techniques and to develop new services.

Although this workforce strategy would apply only in England, I would encourage consultation with the Health Secretaries and the workforce bodies in the devolved nations, because junior doctors in particular tend to move around during their training. During the junior doctors’ strike, which the right hon. Member for South West Surrey (Jeremy Hunt) might remember rather painfully, I talked to students on the picket lines whom I had trained. People move around, and it is important that such a strategy does not end up just sucking staff out of the three devolved health services. Also, many aspects of medical training are controlled on a UK basis. Foundation places for new graduates are decided on a UK basis, for example, so it is important to take that wider view.

The workforce shortage is the biggest single challenge facing all four national health services across the UK. It has been exacerbated by the loss of EU staff after Brexit, with an almost 90% drop in EU nurses registering to come and work in the UK. Early retirements are being taken due to the Government’s pension tax changes, which, as has been highlighted, have not been sorted out and are resulting in senior doctors paying to go to work. There is only so long that they will continue to do that. Finally, there is the exhaustion of dealing with a pandemic for the past 18 months. This is why it is really important, when we talk about NHS recovery, to have a greater focus on staff wellbeing and on their recovery. There can be no recovery of the NHS without them. I am really disappointed to see how the clapping of last spring has turned to severe criticism and attacks directly from members of the public, from sectors of the media, and even from some Members in this place and members of the Government.

I shall now speak to my own amendments 40 to 43, which seek to tightly define the materials covered by the safe space protections as part of Health Service Safety Investigations Body investigations. The idea behind HSSIB was to learn from air accident investigations and to provide a confidential and secure safe space in which healthcare staff could be open and candid in discussing any patient safety incidents. I was on the pre-legislative scrutiny Committee, which was chaired by the hon. Member for Harwich and North Essex (Sir Bernard Jenkin), and the recommendations of that cross-party—and indeed cross-House—Committee were very clear: evidence gathered under the safe space protocols should be protected and disclosed to third parties only in the most pressing situations, such as an ongoing risk to patient safety or criminality. Despite that, there are aspects of this Bill that could undermine the principle of the safe space, and that is what I am seeking to amend.

Amendment 40 would define he safe space materials much more tightly, because it seemed as though anything that HSSIB was using would be covered by the safe space protocol and that exemptions would then be made, whereas it makes much more sense to be very clear about the materials that are defined as protected materials. Therefore, all the original clinical information—medical notes, etc—would still be available to all the other bodies to enable them to carry out their investigations as they do now.

Amendment 43 would remove the ability of the Secretary of State to use regulation at a later date to authorise the wider disclosure of protected materials beyond the provision that is finally passed in this Bill. Amendment 42 would remove the provision allowing coroners to require disclosure of protected materials, as this has already led to calls for access by other health bodies and even freedom of information requests, as I highlighted in my earlier intervention. If a coroner uses safe space materials in their report, that report is public. The question is: how are they going to handle that so that the safe space materials are not further disclosed? It is critical to defend this. It is important to stress that HSSIB does not limit anyone else’s access to original materials, but nor should HSSIB be seen as an easy way for other bodies to avoid doing the legwork and carrying out their own investigations.

HSSIB will not apply in Scotland, where the Scottish patient safety programme is focused more on preventing patient safety issues in the first place. My interest is purely personal, as a surgeon. I experienced the impact of the Scottish patient safety programme when it was introduced to operating theatres in 2007. It cut post-operative deaths by 37% within two years. It has subsequently been rolled out to maternity, psychiatry, primary care and all the main sectors. It has not just reduced hospital mortality, but prevented morbidity—such as pressure sores, leg thrombosis or sepsis, which all in their own way cost the NHS a huge fortune.

Health and Care Bill

Debate between Jeremy Hunt and Philippa Whitford

Report stage
Monday 22nd November 2021 Commons Chamber

[Jeremy Hunt]

I am happy to do that, because I know my hon. Friend has a great interest in social care issues. I feel conflicted by new clause 49. I think that what we will end up with after this measure will be a whole lot better for people on low incomes than what we had, because the means-test threshold will be raised from £23,000 to £100,000, and that is a very significant improvement. However, I have to be honest and say that it is nothing like as progressive as we had hoped, but it is a step forward. My concern when it comes to social care is that our entire debate is focusing on what does and does not contribute to the cap, when the fundamental problem in social care is the core funding to local authorities; that, though not a matter for this Bill, has a direct impact on the care received by our constituents.

I conclude by thanking the Government for their support for amendment 114. I will move it formally later, but I am not expecting to divide the House on it.

[Dr Whitford]

I initially want to touch on new clause 49. Like other members of the Bill Committee, I sat through hours and hours from September to November, and the Government have suddenly pounced on us with this at the last minute. It is such a complicated new clause, but it has not been interrogated.

It is quite clear that the Government’s original spin that no one would pay more than £86,000 for social care and no one would have to sell their house is completely misleading. All the accommodation costs are on top of this. As has been highlighted in the media and by Members in the Chamber, those with assets of about £100,000 will not see any real gain from this policy, while those sitting on assets of £500,000 or more will keep a lot of their wealth. That means it exacerbates the differences, and penalises those in the north of England and areas where house values are not so high. Basically, it is feeding the frenzy down here of people sitting on over-inflated house prices. As has been said, this is not levelling up, just doubling down.

The cap applies only to personal care, which means things like washing and dressing. That has been provided free in Scotland both within the care home and in home care since 2002. It was expanded in 2011 to provide more hours so that people with greater need could stay at home longer, and it was extended to those under 65 with care needs in April 2019. Scotland is the only UK nation that provides free personal care, and we see it as an investment. It is an investment that we spend 43% more per head on social care in Scotland, but it is an investment in people’s independence and their inclusion in society. The problem is that we spend far too much time talking about social care just as a burden, instead of actually seeing it from the point of view of the user.

The Scottish Government have already added an extra penny on taxation for medium and high earners to cover things such as our wellbeing policies, health or social care, but this Government’s plan to increase national insurance contributions will disproportionately hit low-paid workers and young workers. I would say that the biggest weakness of all, as we know from the original debate on the national insurance change, is that the funding is not going to go to social care initially; it is going to go to the NHS, yet it is social care that is in crisis. This is what is causing the pressure in accident and emergency, because people who are ready to be discharged simply cannot be, as the care support is not there. I do not think that this fixes the problem. There will actually be very little money, because a lot of it is going to go on capping the overall payment. I do not see social care benefiting from this at all, yet it is social care that needs investment more than anything else.

Turning to the main substance of the Bill, which is meant to some extent to unpick the damage and fragmentation of the Health and Social Care Act less than a decade on, I wish to express support for amendments 9 and 72. Many in the NHS, including me, will be glad to see the back of section 75 enforced tendering. Others in the Chamber know that it was the Health and Social Care Act that brought me into politics, as I just could not believe anybody thought what they were doing was a good idea. It is still clear from the pandemic that this Government are absolutely wedded to outsourcing services to private companies, and to the flawed notion that financial competition somehow drives up clinical quality. I am sorry, but that simply is not the case. As the Chair of the Health and Social Care Committee has highlighted, we have to focus on safety, on clinical audit, and on peer review if we want to drive up care quality for patients, not just on the money in the system.

The Government appear to have conceded that integrated care boards should be statutory bodies, as health boards have always been in Scotland, but partnership boards can include private providers, such as with Virgin Care in Bath. As the partnership boards will be involved in devising the local strategy for health services, that is likely to lead to a blatant conflict of interest, and I do not see a resolution to that. The NHS simply should be the presumed provider of health services. That is not just, as the shadow Health Minister said, because the NHS is in it for the long term, or for a quick contract, but because the NHS provides the training to nurses and doctors who are the vital workforce of the future. Private providers do not do that; private providers largely live off the NHS. As well as not training staff, where there are major problems or complications, patients inevitably end up in the intensive care unit of an NHS hospital.

In conclusion, for all the size of the Bill, and the scale that the reorganisation will involve for staff in the NHS, who we all know are frankly exhausted, the Government have failed to take the opportunity to repair fully the damage of the Health and Social Care Act 2012, and to recreate in England a unified public health system, such as the one we are lucky enough still to have in Scotland.

NHS Funding Bill

Debate between Jeremy Hunt and Philippa Whitford

Legislative Grand Committee & 3rd reading: House of Commons & Legislative Grand Committee: House of Commons & Programme motion: House of Commons & 3rd reading & Programme motion
Tuesday 4th February 2020 Commons Chamber

[Jeremy Hunt]

I can be honest with the hon. Gentleman and say that I regret not being able to build lots of hospitals around the country in that period, because funding was short. Now, however, we are in a different situation. It is important that we build these extra hospitals, but there will be some big challenges in ensuring that we do so.

[Dr Whitford]

I thank the right hon. Gentleman for giving way. I welcome his suggestion of a central design team, because the NHS is over 70 years old and we seem repeatedly to reinvent the wheel. Does he recognise that it is not just about building new hospitals, because maintenance has also been allowed to slide? There are leaking roofs and leaking sewers, and patients are still in hospitals that are basically not fit for use. Maintenance is most urgent.

[Jeremy Hunt]

I agree with the hon. Lady. Maintenance is a big issue in many hospitals. A number of hospitals are still essentially prefab buildings that should have been torn down a long time ago, and there are others where maintenance can solve the problem. I think we have to attack all of that, and I welcome the fact that there is a real commitment from the Government to do so.

Finally, I want to talk about new clause 4, which relates to whether the Government are giving enough to the NHS to meet the current waiting time targets for elective care, A&E, cancer and so on. I welcome the Opposition’s focus on this matter, because the public absolutely expect us to get back to meeting those targets. It was an important step forward for the NHS that we did bring down waiting times, and I have often credited the previous Labour Government for that happening, as I hope the Labour party will credit this Government for the focus on safety and quality in the wake of Mid Staffs. However, as we focus on safety and quality, I would not want to lose the achievements that were made on waiting times, because it is fundamental to all patients that they do not have to wait too long for care. Indeed, waiting times themselves can be a matter of patient safety.

NHS Funding Bill

Debate between Jeremy Hunt and Philippa Whitford

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Dr Whitford]

The right hon. Gentleman’s overall figure for health spend is correct, but the public health spend—as opposed to private patients—is only 7.5% of GDP, and that is the figure the public are interested in, not the figure including people who can afford to go private.

[Jeremy Hunt]

I suggest to the hon. Lady, whom I greatly respect, that the overall figure is actually what counts. I agree that public health spending matters, but it is absolutely the case that we are heading to being one of the higher spenders in our commitment to health. That is very significant and should not be dismissed.

Often, the debate about funding can distort some of the real debates that we need to have about the NHS. One of those is the debate on social care. If we do not have an equivalent five-year funding plan for social care, there will not be enough money for the NHS. That is because of the total interdependence of the health and social care systems. It is not about finding money to stop people having to sell their homes if they get dementia, important though that is; it is about the core money available to local authorities to spend on their responsibilities in adult social care. I tried to negotiate a five-year deal for social care at the same time as the NHS funding deal we are debating today. I failed, but I am delighted to have a successor who has enormously strong skills of persuasion and great contacts in the Treasury. I have no doubt that he will secure a fantastic deal for adult social care to sit alongside the deal on funding, and I wish him every success in that vital area.

The second distortion that often happens in a debate about funding is that while everyone on the NHS front line welcomes additional funding, their real concern is about capacity. The capacity of staff to deliver really matters. I remember year after year trying to avert a winter crisis by giving the NHS extra money, and most of the time I gave the money and we still had a winter crisis, because ultimately we can give the NHS £2 billion or £3 billion more, but if there are not doctors and nurses available to hire for that £2 billion or £3 billion, the result is simply to inflate the salaries of locum doctors and agency nurses and the money is wasted. Central to understanding capacity is the recognition that it takes three years to train a nurse, seven years to train a doctor and 13 years to train a consultant, so a long-term plan is needed. It is essential that alongside the funding plan, we have in the people plan that I know the NHS is to publish soon an independently verified 10-year workforce plan that specifies how many doctors, nurses, midwives, allied healthcare professionals and so on we will need.

Health and Social Care

Debate between Jeremy Hunt and Philippa Whitford

Thursday 16th January 2020 Commons Chamber

[Jeremy Hunt]

I thank the hon. Lady for raising that. We have made huge progress in sepsis care, and the vast majority of people who go to A&E now are checked for sepsis, but mistakes still happen, and I am sure that it affected her as it affected the families of the people I have talked about.

We must not be complacent about the things that go wrong. In the NHS, we talk about “never events”—the things that should never happen. Even now, after all the progress on patient safety, we operate on the wrong part of someone’s body four times a day. It is called wrong site surgery. When I was Health Secretary, we amputated someone’s wrong toe, and a lady had her ovary removed instead of her appendix.

[Dr Whitford]

I know that the right hon. Gentleman visited the Scottish patient safety programme to see in action the WHO checklist, which is designed precisely to prevent such events, so can he explain why the checklist was never introduced during his time as Secretary of State?

[Jeremy Hunt]

Actually, we do have WHO checklists throughout the NHS in England—I think they were introduced under Lord Darzi in the last Labour Government—but the truth is that even with those checklists, which are an important innovation, mistakes are still made because sometimes people read through lists and automatically give the answer they think people want to hear. This is why we have to be continually vigilant.

What is the solution? It is to ask ourselves honestly, when a mistake happens and when there is a tragedy, whether we really learn from that mistake or whether we brush it under the carpet. To understand how difficult an issue that is, we have to put ourselves in the shoes of the doctor or nurse when something terrible happens, such as a baby dying. It is incredibly traumatic for them, just as it is for the family. They want to do nothing more than to be completely open and transparent about what happened and to learn the lessons, but we make that practically impossible. People are terrified about being struck off by the Nursing and Midwifery Council or the General Medical Council. They are worried about the Care Quality Commission and about their professional reputation. They are worried about being fired. In order for a family whose child is disabled at birth to get compensation, they have to prove that the doctor was negligent, but any doctor is going to fight that.

The truth is that many of the mistakes that are made are not negligence, but we make it so difficult to be open about the ordinary human errors that any of us make in all our jobs. As we are not doctors and nurses, people do not generally die when we make mistakes. That shows the courage of entering that profession, and if we make it difficult for people to be open, we will not learn from those mistakes. That is why we need to change from a blame culture to a learning culture. That is also why, as we reflect on the devastating news that the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), gave the House last night that the Shrewsbury and Telford Hospital NHS Trust is now examining 900 cases dating back 40 years, we realise that the journey that the NHS has started on patient safety must continue. We should take pride in the fact that we are the only healthcare system in the world that is talking about this issue as much as we are, and if we get this right, we can be a beacon for safe healthcare across the world and really turn the NHS into the safest and highest-quality healthcare system anywhere.

NHS Long-Term Plan

Debate between Jeremy Hunt and Philippa Whitford

Monday 18th June 2018 Commons Chamber

[Mr Hunt]

My hon. Friend asks two important questions. As she knows, we have committed to phase out capital-to-revenue funding, because if we are to make the NHS sustainable in the long run, we urgently need to make capital investment in estates, technology and a whole range of new machinery, including cancer-diagnostic machinery and so on, and we will not be able to do that if we continually have to raid capital funds for day-to-day running costs. That was one of the main reasons why we decided that we had to put revenue funding on a more sustainable footing. My hon. Friend is absolutely right about that.

Transformation funding is also important, because when the five year forward view was published, pressures in secondary care and the acute sector meant that a lot of transformation funding was sucked into the hospital sector and we were not able to focus on the really important prevention work that can transform services in the long run. I am very sympathetic to the idea that we need, if not a formal ring fence, a pretty strong ring fence for transformation funding, so that the really exciting progress that we see in some parts of the country can start to spread everywhere.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I echo the comments made about the approach of the NHS’s 70-year anniversary across the four countries of the UK, having myself spent a fair chunk of those 70 years—perhaps slightly longer than I care to admit—working in the NHS.

Like most people present, I imagine, I absolutely welcome the additional funding, which has been described as bringing the UK to the same level of spending as France by 2023. In that description is, though, the admission that we do not spend the equivalent of what France spends right now. Indeed, we saw a deficit of almost £1 billion in 2017-18, despite transformation funding being sucked in to try to clear that deficit.

I echo what the hon. Member for Totnes (Dr Wollaston) said: is transformation funding on top of this funding? If it is just revenue funding, will there be a separate announcement about transformation funding? The Secretary of State also mentioned the need for prevention, yet we do not see any mention of money for public health. That is where we need to be doing prevention.

It is said that we need a 3.9% increase in social care spending, but that is not identified in the statement. If the Green Paper is to come only in the autumn, social care may not get real funding until next year. With the demographic challenge that the Secretary of State mentioned, that is just too far away. The NHS has faced, on average, an uplift of 1.2% over the past eight years, according to the King’s Fund. Taking it up to 3.4% brings it more in line with the traditional uplifts that we have seen, and yet, in actual fact, with an ageing population, the pressure is even higher. Hopefully, this will stop the slide of the NHS, but the NHS Confederation says that it is not possible to transform on this kind of money. It is, therefore, important that these other projects are looked at separately and are funded separately.

As for where that money is to come from, I do not know how the Prime Minister kept a straight face when she talked about the Brexit dividend. The Institute for Fiscal Studies says that there will not be a dividend. The Office for Budget Responsibility talks about a £15 billion drop in public service and finances. I want to know how the rise will be funded. Will it all be just borrowing and tax rises? The Government should be honest about how they will fund this rise.

[Mr Hunt]

First, may I thank the hon. Lady for doing something that the shadow Health Secretary did not do, which is to welcome this £20 billion annual rise in the NHS budget? I completely agree with her about the importance of prevention, the importance of social care and the importance of making sure that we sustainably invest in transformation funding. The think tanks do disagree on what level of rise is necessary. Lord Darzi and the Institute for Public Policy Research said 3.5%; we are on 3.4%, which is not far off that. The IPPR went a little higher, but, like the hon. Lady, Paul Johnson said that this will stop the NHS going backwards.

With respect to overall funding levels for the NHS, the United Kingdom currently funds the NHS at the western European average as a percentage of GDP. That is not as high as France or Germany and it is true that, by the end of this five-year period, our funding will end up at broadly similar levels to those of France today, although of course it may change them over the five-year period.

I gently say to the hon. Lady that if that is a worry for her, she needs to explain to NHS users in Scotland why, when NHS spending has increased by 20% in England over the past five years, it has increased by only 14% in Scotland because of choices made by the Scottish National party. For every additional pound per head invested in the NHS in England only 85p has been invested in the NHS in Scotland. I hope that she makes a pledge, as I hope Labour does with its responsibility for Wales, that every extra penny that she gets through the Barnett formula will go to the NHS, because that is what the voters in Scotland want.

Breast Cancer Screening

Debate between Jeremy Hunt and Philippa Whitford

Wednesday 2nd May 2018 Commons Chamber

[Mr Hunt]

Yes, and I can reassure my hon. Friend that GPs will be briefed and that people will be referred for additional support to clinically trained staff at Macmillan Cancer Support and Breast Cancer Care. We have to be transparent with patients, however, about the absence of a clear clinical consensus on the efficacy of scanning for women in their 70s. The fairest thing is to explain that different people have different views and allow them to come to an individual choice, and that is what we are doing. It will of course cause considerable distress to those given that dilemma, but if anyone wants a scan, we will do that scan.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I thank the Secretary of State for my advance briefing, but, as a breast surgeon and co-chair of the all-party group on breast cancer, I gently take issue with his comment that we do not need to diagnose breast cancer early because of the changes in treatment. I would not like that message to stand: diagnosing early is still crucial.

Obviously this is horrendous for the women involved, but it will also create anxiety for women who are not aware whether they are involved and who might not have been part of the trial. Reassuring them will be a challenge. I welcome the independent review into how it happened and how it went so long without being picked up, and I am interested to know what will happen with the trial now—the loss of almost 500,000 women from it might have a major impact.

Given the normal pick-up rate of breast screening, approximately 2,500 cancers would have been picked up across England in the last round. As the Secretary of State says, this issue did not apply in Scotland, but some of the women affected might have moved and settled in Scotland, so when did he inform the Scottish Government?





The Secretary of State said that the Department knew in January. As far as I can establish, officers in Scotland were informed of a minor issue in March, were told only last week that it was actually more major, and were not told that it might affect women who now live in Scotland. There has clearly been preparation and talk about funding in England, but how many women who live in Scotland have been identified, and what efforts have been made to track them down? What preparations for funding or the expansion of services have been made for Scotland and, indeed, for the other devolved nations?

As was mentioned by the hon. Member for Leicester South (Jonathan Ashworth), radiology, and particularly breast radiology, is a huge shortage specialty. What funds will be provided to ensure that it can be delivered without messing up the normal system?

Will women who do not receive a letter in the next few weeks be able to telephone, or can the Secretary of State really guarantee that if they have not heard by the end of the month, they are clear? As a doctor, I find that a bit scary.

[Mr Hunt]

The hon. Lady has asked some important questions. I am sorry if what I said was not clear, but I do not think I said that there was no need to diagnose early. It is obviously incredibly important for cancer to be diagnosed as early as possible. What I said was that I had been advised that in many cases, because of advances in breast cancer treatment, it would not make a difference to the particular women affected in this case. I fully accept that in some cases it will, and of course it is very important to diagnose all cancers as early as possible.

I will find out from Oxford University the dates on which it expects to report the full outcome of the AgeX trial. Obviously we all want to hear the results as soon as possible. I will also inform the hon. Lady of the exact date on which Scottish Government officials were informed. Let me reassure her that if there are any additional costs to the Scottish health system, it will of course be recompensed.

We do not think that major pressures will be created in the Scottish screening programme, and we are confident that we will be able to contact everyone in the UK who is registered with a GP—whether in Scotland, Wales, Northern Ireland or England—by the end of May. We have had very productive discussions with Scottish officials about the IT exchange that will be necessary to ensure that women living in Scotland also receive their letters by the end of May. We cannot guarantee that every single one of them will have been contacted by then—some will have moved abroad, and some will not be registered with a GP for whatever reason—but we think that we can contact the vast majority, and the helpline will be open for anyone to call if they think they may have been affected.

Oral Answers to Questions

Debate between Jeremy Hunt and Philippa Whitford

Tuesday 20th March 2018 Commons Chamber

[Mr Hunt]

I will re-look at the issue and the response that the hon. Gentleman was given. The issue is that there is unevenness and unfairness in the rates charged to GPs whose surgeries belong to NHS Property Services. We are trying to make this fair across the country, but we also want to make sure that no GP surgeries close.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

With an ageing population, I, too, welcome the aim of integrating health and social care and developing population-based planning, as we have done in Scotland with health and social care partnerships, but the outsourcing of health service contracts to private providers in NHS England has led to more fragmentation rather than integration. Will the Secretary of State agree that we need to repeal section 75 of the Health and Social Care Act 2012 so that local commissioners can develop patient-centred services and not fear litigation if they do not put them out to tender?

[Mr Hunt]

We want to encourage the NHS to move towards more integrated services, and part of that is about contractual structures, but part of it is about funding, and I gently point out to the hon. Lady that 8% of the NHS budget in England goes to general practice and only 6.6% in Scotland, which is why there is an even bigger problem with GP surgeries closing in Scotland.

[Dr Whitford]

The many and varied new integrated care structures developing in NHS England have no statutory basis, yet in the future will control the entire health budget for a population. Does the Secretary of State accept that with another major NHS reorganisation we need debate and legislation in this place to get the structure and governance right?

Maternity Safety Strategy

Debate between Jeremy Hunt and Philippa Whitford

Tuesday 28th November 2017 Commons Chamber

[Mr Hunt]

I do not have that information to hand, but I will find out for my hon. Friend and let her know.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Last month’s debate on baby loss has been mentioned, and I too took part in it, although I have thankfully been spared the pain suffered by some Members of the House. Such a debate really helps to bring out for everyone on both sides of the House how important this issue is, and I do not think there will be anyone who does not welcome this statement and the ambition it shows.

In Scotland, we had a higher stillbirth, neonatal and perinatal death rate in 2012, but our new chief medical officer was actually an obstetrician, and that may have led to the change of focus in 2013, when she established the maternity and children quality improvement collaborative and the national stillbirth group—all as part of the Scottish patient safety initiative—as well as the neonatal managed clinical networks across Scotland. That has enabled us to drop our stillbirth rate by more than a quarter, and to drop our neonatal death rate by 50%.

This has been achieved despite the challenges we face of really difficult geography, including getting people off islands. It is easy to spot the woman who has a history of difficult births or to spot a woman with comorbidities, such as obesity or diabetes, but anyone who has been involved in birth knows that even the healthiest pregnancy can go wrong at the last minute. For us, as in rural parts of the north and west of England, there are transport issues in relation to how women with problems during labour are identified and transported if a higher specialism is required, and those issues must be looked at.

This is very much about the provision of neonatal services, including the movement of patients, and the availability of expertise and of neonatal intensive care units. However, as came out several times during the debate on baby loss, another issue is that of pre-term birth and stillbirth, so this is also about trying to change some of those things. After Scotland’s recent review in February, the focus will be on the consistent monitoring of growth, as a failure to thrive can identify a third of impending stillbirths; the continuity of care, which the Secretary of State has referenced; and especially smoking. Although the Secretary of State mentioned getting smoking rates down—and in Scotland, sadly, they are higher—the rate in the most deprived communities is more than four times that in the least deprived communities. That has an impact on every level of child loss.

Finally, on research, it is important that we learn, for example from the new information about women sleeping on their side in the last trimester. We need to fund the research to learn those things and then share the information—

[Mr Speaker]

Order. I have the highest regard for the hon. Lady, who is a considerable medical authority. I gave her a little leeway, but I say very gently that not only did she exceed her time by a minute, but she pursued her usual, rather discursive approach. In these situations, what is required is a question or a series of questions with a question mark or a series of question marks, rather than general analysis. We will leave it there for now. I say that in the most good-natured spirit to the hon. Lady.

I call Antoinette Sandbach.

Oral Answers to Questions

Debate between Jeremy Hunt and Philippa Whitford

Tuesday 10th October 2017 Commons Chamber

[Mr Hunt]

The hon. Gentleman is right to bring that up. One thing we can do a lot better is to improve the opportunities for flexible working. We have announced that we will be making new flexible working arrangements available to all NHS staff during this Parliament. We are also expanding programmes to encourage people who may have left the profession to come back into nursing.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I think everyone would welcome an expansion of nurse training places, but the Council of Deans of Health stated in June that no new extra places had been funded either in universities or, crucially, in hospitals, where 50% of the course is carried out. Will the Secretary of State clarify when that funding will be made available?

[Mr Hunt]

Next year.

[Dr Whitford]

Obviously we know that it takes quite some time to train a nurse, and one in 10 posts in England is vacant—that is twice the rate we face in Scotland. We also know that there is a 51% increase in nurses leaving the profession, a 96% drop in those coming from the European Union, and a limit on the use of agency staff, so where does the Secretary of State expect NHS England to find the 40,000 nurses it needs right now?

[Mr Hunt]

Let me just remind the hon. Lady that there are 11,300 more nurses on our wards than there were just four years ago, so we are increasing the number of nurses in the NHS. She mentions what is happening in Scotland. I gently remind her that nearly double the proportion of patients are waiting too long for their operations in Scotland as in England.

Oral Answers to Questions

Debate between Jeremy Hunt and Philippa Whitford

Tuesday 4th July 2017 Commons Chamber

[Mr Hunt]

Over those three Parliaments, I have learned to expect questions from my hon. Friend in a similar vein, and I commend him for his persistence in championing that cause. As he knows, I think the most important thing, with all such issues, is to follow the scientific advice.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

When the Government removed the nursing bursary and introduced tuition fees, the Secretary of State said that it was being done, as he has repeated this morning, to fund 10,000 extra student nurse places. The universities are saying that no extra places have been commissioned, however, so when will we see an expansion of student nurse training?

[Mr Hunt]

I always welcome the hon. Lady’s forensic interest in matters south of the border, but given that Scotland has just seen its first fall in life expectancy for over 100 years, she might want to think about her own constituents. With respect to the number of nurses, we now have more than 50,000 nurses in training, and we are confident that we will deliver a big increase in the supply of nurses to the NHS.

[Dr Whitford]

We still have a nursing bursary and we have no tuition charges, so the Secretary of State may want to explain why universities claim there are no additional places. In addition, we are losing almost half of junior doctors at the end of their foundation years. What action is the Secretary of State taking to find out why?

[Mr Hunt]

At the heart of this is the need to open up avenues for more flexible working for both doctors and nurses. If the hon. Lady followed what we have done in England—by successfully pioneering such working, we have reduced agency spend by 19% in a year, whereas it is still going up in Scotland—she might find the NHS in Scotland has more money to spend on her own constituents.

Oral Answers to Questions

Debate between Jeremy Hunt and Philippa Whitford

Tuesday 21st March 2017 Commons Chamber

[Mr Hunt]

I absolutely welcome that, and I know my right hon. Friend has personally championed it as a local MP. The historical mistake that those on both sides of the House have made is not to do long-term workforce planning for the NHS, and that is something we want to put right.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Plans to train more UK doctors are absolutely welcome, but the Secretary of State knows that it takes at least 10 years to train a doctor, so what is his response to the surveys by the British Medical Association and the GMC showing that, having been left hanging for nine months, 40% to 60% of EU doctors are thinking of leaving?

[Mr Hunt]

My response is the one I give many times in this House, which is to stress to all those doctors how valued they are as critical parts of the NHS. We do not see any evidence of the number of doctors joining from the EU going down. The NHS is one of the best health services in the world, and it is a great place for people from other countries to work and train.

[Dr Whitford]

The workforce is one of the biggest challenges right across the nations of the UK, and particularly in rural areas, as we heard earlier. With a 92% drop in the number of EU nurses coming to the UK and a 60% increase in the number who left last year, how does the Secretary of State plan to avoid an NHS staffing crisis immediately post-Brexit, before there is time to train anybody extra?

[Mr Hunt]

The hon. Lady needs to be very careful in her use of statistics, because she will know that one reason for the drop in the number of nurses coming from the EU is that prior to the Brexit vote we introduced much stricter language tests, as that is better for the safety of patients and a very important thing that we need to get right. We are very confident that nurses will continue to want to work in the NHS, because it is a great place to work.

NHS Shared Business Services

Debate between Jeremy Hunt and Philippa Whitford

Monday 27th February 2017 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for her sensible contribution. She is right that, although the process of sending on these particular documents has been taken in-house, other parts of the contract were taken on by a company called Capita—[Interruption.] The hon. Member for Leicester South (Jonathan Ashworth) cannot stop, can he? Let me repeat that the work in question has been taken in-house. The other work, which is being done by Capita, has had some teething problems, of which we are very aware. We know it has been causing problems for GPs. The Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood) has been meeting Capita and people relating to that contract on a fortnightly basis to try to identify the problems.

My hon. Friend the Member for Totnes (Dr Wollaston) is right that the aim in the long run is to give people control of their records. I am proud that, under this Government, we have become the first country in the world to give every patient access to their own records online. From September, people will be able to do that without having to go to their GP’s surgery.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I am sure that everyone across the House is glad that these 750,000 incidents have not, so far, resulted in patients suffering. Frankly, that is luck, rather than plan, for which we should all be grateful. This is yet another situation similar to that of Concentrix and others we have seen. When we are outsourcing and taking on these companies, what is the basis of the contract and what is the governance? The Secretary of State mentioned the other incidents of transferring data when a patient moves to another GP’s surgery, and that has also been an issue. When will data in England become more digital so that things are not sent by post? We have not used that method for several years in Scotland, and it is holding back the entire primary care and hospital system here. When will the Secretary of State’s vision for that come about?

[Mr Hunt]

The hon. Lady is always very good at telling the House things that Scotland does better than the NHS in England; there are, indeed, some. She is a little bit coyer about things that Scotland does less well than the NHS in England. If we put aside those issues, I think we can both agree that the sooner the NHS across the whole UK goes electronic, the better. That has been a big priority for this Government, and we have made big progress. More than two thirds of hospital A&E departments can now access a summary of people’s GP records, and we are going further every month.

Mental Health and NHS Performance

Debate between Jeremy Hunt and Philippa Whitford

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

Yes, I can do that. It is a very important point. We have had a patchy record in the NHS of ensuring that money promised for mental health actually reaches the frontline. The way that we intend to address this is by creating independently compiled Ofsted-style ratings for every CCG in the country that highlight where mental health provision is inadequate. Those ratings are decided by an independent committee chaired by Paul Farmer, who is responsible for the independent taskforce report, so he is able to check up on progress towards his recommendations. I am confident that, by doing that, we will be able to shine a light on those areas that are not delivering on the promises that this Government have made to the country.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

After the Health Committee’s recent inquiry into suicide, I absolutely welcome the extra funding for mental health. I am sure that the Secretary of State remembers some of the discussions that we had in that room.

I also pay tribute to the staff. Obviously, with my background, I know exactly what it is like when A&E is swamped and there is nowhere to put people. The staff across NHS England are not afraid of us discussing this topic and weaponising it. They are in tears; they are exhausted; and they are demoralised. They have never experienced a winter like this. Perhaps the Secretary of State will explain why his figures suggest 19 diverts and only two trusts in serious problems, whereas we are hearing from the Nuffield Trust that that 42 or 50 trusts are diverting, which is a third. That means that the problem is widespread.

I totally agree with the point about people going to A&E when they do not need to be there, but they are not the people who are three-deep on trolleys waiting for a bed for 36 hours—those are people who need a bed and who are there because they are ill. We have discussed sustainability and transformation plans and NHS sustainability on several occasions. The concern that people have is that, because there is not the money for a redesign, there will be A&E closures and bed cuts. I hope that this incident will show that that is simply not possible. It is not possible for the UK, particularly NHS England, to lose any more beds. In Scotland, we face the same problem of increased demand and shortage of doctors, yet 93.5% of our patients were seen within four hours in Christmas week. The president of the Royal College of Emergency Medicine estimates that in areas of England the figure is between 50% and 60%. That difference is down to how it is organised. It is the fragmentation and the lack of integration. There are things that can be done. We can use community pharmacies and GPs, and try to bring the NHS back together.

CQC: NHS Deaths Review

Debate between Jeremy Hunt and Philippa Whitford

Tuesday 13th December 2016 Commons Chamber

[Mr Hunt]

I thank my hon. Friend, who does a huge amount of work on patient safety, not least because of sadness in her own family’s experiences that gives her particular passion in this respect. This is absolutely about creating a just culture. Inspiring people like James Titcombe, who lost his own son at Morecambe Bay, talk far more eloquently than I can about the need to get this right. Part of that just culture is about justice for people who use the NHS in future, to whom we have a responsibility to learn the lessons and make sure that mistakes are not repeated. One of the really important things we need to get right is to make sure that when something goes wrong in one place, there is a national way in which the lessons can be conveyed right across the NHS as quickly as possible.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I welcome this statement and remember the discussion of this tragic case. Obviously the majority of people who go into hospital and die in hospital will be people who are simply too ill for us to save, but we must not be nihilistic in imagining that that applies to everybody. The particular failure here was that people with learning difficulties or mental health needs were somehow just set aside and not looked at.

I welcome the idea of a safety board; there will be lots of things that can be learned and shared in that. I slightly pick up the Secretary of State on what he said about the Scottish patient safety programme, which is a national programme that has been running since the beginning of 2008. Part of that was about breaking down all the barriers, very much like in the airline business—being on first-name terms and making it everybody’s business so that even the cleaner in the theatre feels they can point out that they think a mistake is going to be made, but then when something happens having these adverse case reviews. In my hospital, we also reviewed near misses, and I commend that. It means that there is a review when what might have happened would have been serious. Certainly in the cases that I have been involved in, the family have been involved repeatedly. That is really important.

I also welcome the idea of a safe place for whistleblowers. People who have raised issues in the past and have been appallingly treated by the NHS still stand there as a terrible example to those who currently work in the NHS, so there needs to be some ability to go back to these old cases and provide justice for people who have ended up losing their careers by trying to raise patient safety issues.

[Mr Hunt]

I thank the hon. Lady for her contribution. I recognise the progress made in the Scottish patient programme, and particularly the inspirational leadership of Jason Leitch, who has done a fantastic job in Scotland and some very pioneering work.

The hon. Lady made some good points that I will take in reverse order. On whistleblowers, I asked Sir Robert Francis to look at this in his second report. He concluded that it would be very difficult, if not impossible, to go back over historical cases, because the courts have pronounced and it is very difficult to create a fair process where legal judgments have already been made. However, I take on board what she says, and I do not think that that means that we cannot learn from what has happened in previous cases; they are very powerful voices.

The hon. Lady is absolutely right about near misses, and we will include that issue in the “learning from mistakes” ambition.

The hon. Lady is most right of all about people with learning disabilities. The heart of the problem is deciding when a death was expected and when it was unexpected. About half of us die in hospitals. As she rightly says, the vast majority of those deaths are expected, but when a person has a learning difficulty it is very easy for a wrong assumption to be made that they would have died anyway. That is a prejudice that we have to tackle, and one that Connor Sparrowhawk’s mother talks about extremely powerfully. We have to make sure that this is not just about lessons for the whole NHS, but particularly about ensuring that we do better for people who have learning disabilities.

Junior Doctors: Industrial Action

Debate between Jeremy Hunt and Philippa Whitford

Monday 5th September 2016 Commons Chamber

[Mr Hunt]

As ever, my right hon. and learned Friend speaks incredibly wisely. Actually, his last comment goes to the nub of why this is totally extraordinary, unprecedented and completely unacceptable. It is true that the junior doctors have rejected the agreement that was reached in May in a ballot, and we have to accept that. There are all sorts of reasons why that might have happened, but the choice to escalate the industrial action and to call the worst strike in NHS history was made not by those junior doctors but by the BMA leaders. They made that decision about a contract that they themselves had described as being good and safer for doctors and patients only in May. How can they justify that? Is there not perhaps a desire to pick a very big fight?

We were making good progress over the summer in a whole series of dialogues in different areas to try to resolve some of the non-contractual issues that the junior doctors are worried about, but this action makes it virtually impossible to continue that progress, although we will try very hard to do so. My right hon. and learned Friend is absolutely right to say that this is completely unacceptable and damaging for patients. I am afraid that I am having to go through some of the very same battles that he had to go through when he was Health Secretary.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I know how difficult it will be for junior doctors to take part in the strikes that have been described, and I personally am really sad that we have come to this point. Does the Secretary of State recognise the anger and desperation among the junior doctors that have led us to this point? In my mailbag from junior doctors, two things stand out. One is that the threat of imposition was there right from the word go last summer, and it therefore felt like a threat rather than a negotiation. The other involves the misuse of numerical statistical data by translating it into a claim that it refers to avoidable deaths at weekends, even though there has been no evidence of avoidable deaths. The Secretary of State has not commissioned a review of cases that might show how many of those deaths were avoidable and whether a lack of junior doctors contributed to them. The real danger in the NHS at the moment is rota gaps. Doctors are being asked to do double shifts or to carry two pagers, which means that where there should be two doctors covering an area or a service, there is only one. That is a real, palpable danger right now.

The Secretary of State has said that he would employ extra junior doctors rather than spreading the same number more thinly, but where does he plan to get them from when we cannot even fill the existing posts? I welcome the focus on the four clinical standards that boil down to greater senior doctor review and access to diagnostics, but does he not think that we might have got further if we had started at that point last summer? He calls for a turn away from strikes and for getting around the table to co-operate and discuss these matters, so when is he going to meet the junior doctors to try to avert these strikes?

[Mr Hunt]

The hon. Lady is a doctor, and I would simply say to her, as I said to the shadow Health Secretary, that she needs to justify the claims that she constantly makes in this Chamber about a misuse of statistics. I have been very clear about when we can actually statistically say that a death is avoidable. The studies demonstrate clearly that a higher number of people are dying from weekend admissions than we would expect. What this Government will not do is sit and ignore those numbers, which are backed up in study after study. I think that we are doing the right thing, and as a doctor she should recognise that.

The hon. Lady has said time after time over the past year that the Government should lift the plans to impose the contract and get around the table and negotiate. She could today have given the Government credit for doing exactly that in May when we thought there was an opportunity to do a deal. We lifted the imposition of the contract and got around the table to negotiate a deal that turned out to be good for both sides. Having done that, the problem is that the same people with whom we negotiated the deal have decided to call the most extreme strike in NHS history, which is unacceptable.

Rota gaps are a real problem that we are trying to address by, first, ensuring that systems are in place for junior doctors to blow the whistle if they think that such gaps are unsafe for patients. That is why we have introduced guardians of safe working, and we are committed to that. Secondly, we want to ensure that there are people to fill those rota gaps by training more doctors. We are training 11,420 more doctors in this Parliament than in the previous and already have around 9,000 more doctors than in 2010. As a doctor, those are things that the hon. Lady should recognise.

Junior Doctors Contract

Debate between Jeremy Hunt and Philippa Whitford

Wednesday 6th July 2016 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I, too, am disappointed by the outcome of the ballot yesterday. It has to be recognised that it reflects a real desperation and unhappiness among junior doctors, who are dealing with increased demand and pressure. They have felt that, at times, the tone of the negotiations has left a lot to be desired. The threat of imposition was there from the start, and they felt that hanging over them.

I welcome several things in the statement, and I absolutely welcome its very measured tone. I welcome the attempt to tackle the gender pay gap, to deal with unhappy foundationers and to limit hours. I would say that junior doctors’ biggest concern is rota gaps. In some specialties, the rate is as high as one in four, so one doctor covers the role of two. That is a real patient safety issue, and patient safety is meant to be the whole point of the contract. I welcome the fact that the contract will be phased in, and I call on the Secretary of State to ensure absolutely that, as this goes forward, he will learn, because junior doctors’ concern is about how we spread a short-staffed workforce across more days. I called for the contract to be phased in through a trial, and it is being phased in, but in a different way. We need to recognise the pain that the vote represents.

[Mr Hunt]

I thank the hon. Lady for her constructive comments, which are born of her NHS experience. She is right: we are phasing in the contract carefully to make sure that we learn lessons. She is absolutely right to talk about rota gaps. Unfortunately, the problem of rota gaps cannot be solved at a stroke on signing a contract; it has to do with making sure that we have a big enough supply of doctors in the NHS to fill those rota gaps. We now have much greater transparency about the safety levels that are appropriate in different hospitals; that is one of the lessons that we learned post Mid Staffs. We are investing more in the NHS in this Parliament. We recruited an extra 9,300 doctors in the last Parliament and we are increasing our investment in the NHS in this Parliament, so that we can continue to boost the doctor workforce in the NHS. In the long run, that is how we will deal with the rota gap issue; but unfortunately, that cannot be done overnight.

NHS Spending

Debate between Jeremy Hunt and Philippa Whitford

Wednesday 6th July 2016 Commons Chamber

[Ms Abbott]

rose—

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

rose—

[Mr Hunt]

I will give way first to the shadow Health Secretary, then to the Scottish health spokesperson.

[Mr Hunt]

That is, perhaps, not a question for me as a Government Minister to answer, but I take the hon. Lady’s point. I give way to the hon. Member for Central Ayrshire (Dr Whitford).

[Dr Whitford]

My question has already been answered.

[Mr Hunt]

The point that many of us made in the referendum campaign is that even the net figure—the more like £100 million net contribution that we make to the EU—is not a figure that we can bank on with any certainty because, even if it did materialise after an exit from the EU, it would be negated by the very smallest of contractions in the economy, which would itself reduce the tax base and the amount of public spending available. The Institute for Fiscal Studies said that that £100 million a week would be negated by a contraction in the economy as small as 0.6%. I do not think any of the economic forecasts said that the contraction would be as small as that; all of them said that it would be much bigger than that.

Junior Doctors Contract

Debate between Jeremy Hunt and Philippa Whitford

Thursday 19th May 2016 Commons Chamber

[Mr Hunt]

First, I very much agree with my hon. Friend in her thanks to Professor Dame Sue Bailey for the leadership that the Academy of Medical Royal Colleges has shown in the initiative that, in the end, made these talks and this agreement possible. I know it has been a very difficult and challenging time for the royal colleges, but Professor Bailey has shown real leadership in her initiative.

I also very much agree with my hon. Friend about the need to sort out some of the issues that have been frustrations for junior doctors—not just in the last few years, but going back decades—in terms of the way their training works and the flexibility of the system of six-month rotations that they work in. This is an opportunity to look at those wider issues. We started to look at some of them yesterday. I think there is more that we can do.

It is important that this is seen not as one side winning and the other side losing, but as a win-win. What the last 10 days show is that if we sit round the table, we can make real progress, with a better deal for patients and a better deal for doctors. That is the spirit that we want to go forward in.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I absolutely welcome this agreement, and I pay tribute to the Academy of Medical Royal Colleges for bringing it about. I do wish there had been some response to the letter that I and other Members sent before the all-out strike, because it was a genuine attempt to create a space that both sides could step into. However, I am glad that we have got to that stage now.

I welcome the recognition of the equality issues, which, to us and to many junior doctors, appeared to have been dismissed in the impact assessment. On the idea of flexible training champions in each trust, I myself was a flexible training senior surgeon—indeed, the first one in Scotland—and the idea of accelerated training is important. However, one concern I have is about childcare. If women junior doctors are going to be working longer, more antisocial shifts—I remember what I had to fork out for childcare—I would like to know whether the NHS will respond to that. Will that be in the form of crèche hours or support?

I welcome the fact that the hours guardian will be linked to the director of medical education and that there will be an elected junior doctors forum. One concern of junior doctors was that they would have no voice in relation to the guardian.

I also welcome the idea of using modern technology in rota-ing. At the moment, rotas are sheets of paper, and often no one looks at the shoulder from one rota to the next, so people can end up with the very long periods on call. However, one concern that remains is rota gaps. We do not have enough junior doctors, and we do not have enough junior doctors in the most acute specialties. How is the Secretary of State planning to re-establish a relationship? How is he going to recruit people to fill that gap? That was the core fear of junior doctors: a lack of doctors, with doctors simply being spread further. How are we going to recruit and retain doctors after the painful clash that has been going on for the last year?

[Mr Hunt]

I welcome the tone of the hon. Lady’s comments; we might have wished for a similar tone from the shadow Health Secretary. Let me address the comments of the hon. Member for Central Ayrshire (Dr Whitford) as constructively as she made them to me. She is right about flexible training. We have to recognise that the junior doctor workforce is now majority female, and that a number of family and caring pressures need to be taken account of. We need to do that for the NHS not only because it is the right thing to do, but because we will lose people if we do not. Those people will simply leave medicine, even though they have been through very extensive and expensive training.

We have to look particularly at the responsibilities of doctors with young children. One of the things that we announced yesterday was an obligation on trusts to take account of caring responsibilities. If, for example, a doctor wanted to work fewer hours in school holidays and more hours in term time, we cannot guarantee that a hospital would always be able meet those needs—the needs of patients always have to come first—but they could at least be taken account of, in the same way as they are in many other industries that operate 24/7. The hon. Lady is absolutely right to say that modern technology is key to that. An air steward or a pilot who works for British Airways can go on to an electronic system and choose the shifts and hours that they want to work. Because we have failed to modernise the NHS, we have seen a huge growth in agency and locum work, which is partly driven by the fact that it offers precisely the flexibilities that people need. These are important changes, and we intend to take them forward.

Oral Answers to Questions

Debate between Jeremy Hunt and Philippa Whitford

Tuesday 10th May 2016 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I too am glad that the Secretary of State has reopened talks with the junior doctors, but I am a little concerned by the claim that the only issue is Saturday pay, whereas the doctors tell me that they fear the danger of exhaustion. Has he seen the analysis by Cass Business School suggesting that it is impossible to avoid high levels of fatigue under the new contract?

[Mr Hunt]

What I have done in the new contract is precisely to try to address those issues by reducing the maximum number of hours that junior doctors can be asked to work every week from 91 to 72 and by stopping junior doctors being asked to work six nights in a row or seven long days in a row. These are important steps forward, and the hon Lady may want to look at Channel 4 FactCheck and other independent analysis of the safety aspects of the new contract which say that this contract is a safer contract.

[Dr Whitford]

I would just say that stating it does not make it happen. Junior doctors have looked at the rotas that have been put out as exemplars, and they will not be able to avoid high levels of fatigue. Does the Secretary of State not recognise that, now that we have more data suggesting that the weekend effect may just be statistical, we actually require clinical research because he does not know exactly what the problem is that he is trying to fix?

[Mr Hunt]

The new data that the hon. Lady has talked about have been heavily contested this week by some of the most distinguished experts on mortality rates in the country. Academics do sometimes disagree, but Ministers have to decide. The fact is that the overwhelming evidence—whether it is on cancer, cardiac arrests, maternity or emergency surgery, and whether it is in big studies, small studies, UK studies or international studies—is that there is a weekend effect. This Government are determined to do something about it, and I gently say to the hon. Lady that she might consider whether something similar should be done in Scotland.

Junior Doctors Contracts

Debate between Jeremy Hunt and Philippa Whitford

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

My hon. Friend has spoken very wisely. She recently wrote, in The Guardian, something with which I profoundly agree: she wrote that there could have been a solution to this problem back in February, when a very fair compromise was put on the table in relation to the one outstanding issue of substance, Saturday pay.

I understand that this is a very emotive issue. The Government initially wanted there to be no premium pay on Saturdays, but in the end we agreed to premium pay for anyone who works one Saturday a month or more. That will cover more than half the number of junior doctors working on Saturdays. It was a fair compromise, and there was an opportunity to settle the dispute, but unfortunately the BMA negotiators were not willing to take that opportunity. I, too, urge them, whatever their differences with me and whatever their differences with the Government, to think about patients tomorrow. It would be an absolute tragedy for the NHS if something went wrong in the next couple of days, and they have a duty to make sure that it does not.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I welcome the absolute commitment that the Secretary of State has given today that this is only about seven-day emergency care, because in the past he has often seemed to move between elective and emergency care. However, Sir Bruce Keogh has criticised the imposition of the contract, and has said that what has lost consensus across the profession has been the conflation of the need for a robust emergency service over seven days with the junior doctors’ contract, when junior doctors already work seven days.

I think that people have also been upset by the use of statistics without analysis. It is not a case of extra deaths at the weekend, which suggests poor care, but a case of extra deaths among people who were admitted at weekends within 30 days. That is quite an odd formula, but we can think of factors that might contribute.

I support the four standards that the Secretary of State mentioned, but none of them relates to junior doctors. Number one is probably access to diagnosis: people lie in hospital over the weekend with no access to scans, and their whole pathway is delayed. When we conducted an in-depth audit of surgical mortality in Scotland, it identified issues such as the insufficient seniority of an operating surgeon and, later, the insufficient seniority of an operating anaesthetist. However, part of the problem is that we have not worked out what the problem is. The Secretary of State may go on about the four standards—about a senior review, 24/7 access to interventional care, and access to diagnostics—but that will not be changed by the junior doctors’ contract.

The Secretary of State calls on the BMA to listen to leaders. What about the 11 royal colleges that have written to him? In his letter to the leader of the BMA over the weekend, he highlighted the things that still need to be sorted out, and that means that there is a need to talk. There has been no talking for five weeks. Surely we should stop the imposition, get rid of the strike, go back to the table, and complete the talking.

[Mr Hunt]

I agree with the hon. Lady on one point: it is a total tragedy when the Health Secretary ends up with no other choice but to impose. Had we had sensible negotiations, that would have not have been necessary. She talked about the royal colleges. They say that the withdrawal of emergency care should not happen. Clare Marx, the president of the Royal College of Surgeons, has said that she personally would not and could not strike. I have tried to be very clear this afternoon about exactly what we are trying to do, and we have been clear on many occasions that this does not apply to elective care.

If the hon. Lady is concerned about the statistics, I would encourage her to read some of the 15 international studies covering stroke, cancer, emergency surgery and paediatric care, including the very thorough Fremantle study published last September. She is right to suggest that many of them talk about senior decision-makers being present. That could be a consultant, but it could also be an experienced junior doctor. As she knows, the term “junior doctor” is something of a misnomer because someone could have been a doctor for seven years and still be a junior doctor.

The hon. Lady also asked about the link with the junior doctor contract. The single outstanding issue is Saturday pay rates, as the BMA has confirmed in private emails that it has sent out. We need to make it possible for doctors to roster more people at weekends, and Saturday pay rates are obviously connected to that. What I have tried to do today is to show that the supply of trained doctors into the NHS will be going up during this Parliament, so we will not be depending on the current workforce to supply the additional Saturday cover in its entirety. There will be more doctors going into the NHS, which will spread the burden, and that is the way that we will get the safe NHS that we want.

Junior Doctors Contracts

Debate between Jeremy Hunt and Philippa Whitford

Monday 18th April 2016 Commons Chamber

[Mr Hunt]

My right hon. and learned Friend speaks with huge wisdom and experience. He makes a point about what happened under previous Labour Governments. He might also have said that those were the same Governments that gave us the current badly flawed contracts. Because those previous Labour Governments did not stand up to the BMA and because they ducked difficult decisions, we saw the pay bill balloon and some shocking failures of care. Leadership is not just about talking and negotiating; it is also about acting. That is what Ministers have to do, and in this situation we have a very simple decision to make after three years of talks: do we proceed with the measures necessary to deliver a seven-day NHS and better care for patients, or do we duck those decisions? This Government choose to act.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Yet again, I must pull up the Secretary of State. It is not a case of excess deaths at weekends; it is a case of people admitted at weekends dying within 30 days. He said the same thing again today, and it is being repeated over and over.

The Secretary of State has described, within the same pay envelope, having more doctors at weekends, not fewer during the week, and reducing a maximum of 91 hours to 72 hours. I do not see how the maths of that can possibly add up. We are not managing to cover the rotas that we have, and those rota gaps pose a danger to patients.

I was very disappointed that the equality impact assessment dismissed the impact on women and other people who train less than full-time as acceptable collateral damage. We are facing the first ever all-out strike next week, and I cannot believe that we are not in negotiations. We should be at the table trying to prevent that strike. May I ask the Secretary of State how he plans to get us out of this? He should come back to the table, because that is the only way in which an impasse can ever end.

[Mr Hunt]

Let me gently ask the hon. Lady how long she expects us to sit round the table. We have been trying to discuss this for three years. She asked how the maths added up. I will tell her how the maths adds up. It adds up because we are putting an extra £10 billion, in real terms, into the NHS over the course of this Parliament. Conservatives put money into the NHS. The Scottish National party, incidentally, takes money out of the NHS.

The hon. Lady referred to the equality impact assessment selectively. She normally pays very good attention to detail, but the paragraphs from which she quoted related to changes that were agreed to by the BMA. What she did not quote was paragraph 95, which says that the overall assessment of the new contract is that it is “fair and justified” and will promote “equality of opportunity”. Why is that? Because shorter hours, fewer consecutive nights and fewer consecutive weekends make this a pro-women contract that will help people who are juggling important home and work responsibilities.

Oral Answers to Questions

Debate between Jeremy Hunt and Philippa Whitford

Tuesday 22nd March 2016 Commons Chamber

[Mr Hunt]

As ever, my hon. Friend speaks with great knowledge about NHS matters, and she is right to say that some of the underlying issues have nothing to do with contractual terms but are about very big changes in the way that training has happened over recent years, in particular the loss of the firm system and the sense of camaraderie that was part of the deal for junior doctors in training. We would like to see whether we can rectify some things that have gone in the wrong direction, but we have not yet had the co-operation of the British Medical Association for that independent review, which is led by the highly respected Professor Dame Sue Bailey. I hope that the BMA will co-operate with that, because it is a big opportunity to sort out some long-standing problems.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

There are currently 4,500 gaps for trainees in the NHS. Junior doctors often have to cover those gaps, which can mean having to do extensive extra shifts, or even covering two roles at the same time. It looks as if that situation will get worse, because fewer than half of the most junior trainees have applied for ongoing training this year. Does the Secretary of State accept that that represents a serious threat to patient safety?

[Mr Hunt]

The purpose of the changes is to improve patient safety, and particularly to deal with the issue that we have higher mortality rates for people who are admitted to hospital at weekends than for those admitted during the week. Because of the confrontational approach taken by the BMA, it has been difficult to negotiate an agreement, but we are committed to doing the right thing. What is right for patients is also right for doctors. We have been talking about morale, and the biggest way to dent doctors’ morale is to prevent them from giving the care that they want to give patients, so we must sort that issue out.

[Dr Whitford]

I suggest that what is good for doctors is also good for patients, and if people are being texted four or five times a day and asked to do a second shift to cover for a junior and a senior post at the same time, that is not good for either. On 11 February the Secretary of State said that he was imposing the contract to bring stability to the NHS, but that has not exactly gone well. What is his plan to re-establish his relationship with junior doctors and get us back out of where we are now?

[Mr Hunt]

With the greatest respect, we are trying to solve a problem that in Scotland is being ducked. We want a seven-day NHS with mortality rates that are no higher at weekends. There is no plan in Scotland to deliver that across the whole NHS. Rather than sniping, the hon. Lady should recognise that, in the interests of patient safety, we need to take difficult decisions. In the end, doctors will see that it is the right thing for them, too.

NHS: Learning from Mistakes

Debate between Jeremy Hunt and Philippa Whitford

Wednesday 9th March 2016 Commons Chamber

[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.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I welcome the statement from the Secretary of State, particularly with regard to the establishment of medical examiners, which we have had in Scotland since last year. I, too, ask why there is a delay of another two years before that comes on stream. As a doctor, the thing that always seemed obvious to me was what might have made a difference with Shipman. Of all the things that have been enacted, someone reviewing deaths might have made that difference. I do not underestimate the importance of audit, and learning from routine audit, rather than depending on just whistleblowing.

In Scotland, we had an audit of surgical mortality in the 1990s. The first thing that that showed was the people dying who had not had a sufficiently senior surgeon involved in their case. That was discussed with the profession, and practice changed. Future years identified a situation with a consultant surgeon at the front line and a junior anaesthetist, but that, too, changed. The audit identified the lack of high-dependency nursing units for the sickest patients. I suggest that working with such an audit and the profession, as we have done for coming up to 20 years, would have allowed the evolution of a stronger, safer seven-day emergency service. I again call on the Secretary of State to commit to looking at a surgical approach, the things that are missing—access to scans and radiology—and perhaps more senior review and senior involvement. This is not about junior doctors and it is not blanket.

We also need to look at the ratio of staff. Francis and other research have shown the importance of nursing staff. Staff who do not have a minute to stop and think will make mistakes, and will not have time to report them. We need to make this easy. There must be a culture in which people have the time to minimise mistakes.

I have a final plea. The Secretary of State is offering more support to whistleblowers, but a review and reconciliation for those who have been badly treated in the past might give people more confidence that, if they step up and report something significant, they will not be hung out to dry, as has been the case previously.

[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.

Junior Doctors Contracts

Debate between Jeremy Hunt and Philippa Whitford

Thursday 11th February 2016 Commons Chamber

[Mr Hunt]

My right hon. and learned Friend speaks with great wisdom and also great experience. Many Members will remember how, when he was Health Secretary, the BMA put posters of him up all over the country saying “What do you call a man who ignores medical advice?”, and there he was, smoking his cigar. I am sure that there have been Labour Health Secretaries who have had similar treatment. He makes an important point, however. Under the new Labour Administration of Tony Blair, huge amounts of extra resources were put into the NHS but, unfortunately, because of the impact of contract changes in 1999, 2003 and 2004, weekend care actually became less effective, not more effective. Now, thanks to the tough decisions we have taken on public spending and turning the economy around, we have been able to give the NHS a funding settlement next year that is the sixth biggest in its entire nearly 70-year history. We are absolutely determined that, if we are putting that extra money into the NHS, it should come with reform that leads to better care for patients. That is the Conservative way, and we will not be deflected from it.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I should like to pick the Secretary of State up on some aspects of his statement. On Monday, I challenged the Under-Secretary of State for Health, the hon. Member for Ipswich (Ben Gummer) to step away from the term “weekend deaths”. The Freemantle paper does not show that; it shows increased 30-day mortality in people admitted at the weekend, and there is actually a lower mortality rate at weekends. The junior Minister said that the Secretary of State was really careful, but he has made that suggestion twice in his statement today, and I think that that is very misleading.

What should have come from the Freemantle paper and others is an attempt to understand why these things happen. The only study that gives a clear answer and backs up the Francis report is the Bray paper on 103 stroke units, which showed that the single most important factor was the ratio of registered nurses. We should know what the problem is before we try to fix it. The one group of staff that is there, along with the nurses, is the junior doctors. They are not the barrier to achieving the 10 standards.

I welcome the progress that has been made since last November. In a debate in this Chamber in October, the Secretary of State seemed relatively unwilling to go to ACAS, but progress has been made since the negotiations started, and particularly since Sir David Dalton became involved in the past month. I therefore found it incredible to see on the BBC this morning that, having achieved 90% agreement and following a tweet at 4 minutes past 8 saying that we should now get both sides back to the table, the Secretary of State was going to impose the contract.

The problem with the recognition of unsocial hours might increase the difficulty that we already have in recruiting people to the acute specialties: A&E, maternity and acute medicine. They are already struggling, and this might well make things worse. I also still have concerns about the role of the guardian. The problem is that a junior doctor at the bottom of a hierarchy will have to go and complain, and we can imagine how difficult that might be in a hierarchical system and how easily that doctor could be labelled a troublemaker. So there are still things to be dealt with. I welcome the progress that has been made in the last month, but this is absolutely not the time to pour petrol on the fire and then throw in the towel.

[Mr Hunt]

I welcome the tone of the hon. Lady’s comments. I do not agree with everything that she has said, and I shall explain why, but they were immensely more constructive than the comments that we have heard from other Opposition spokesmen. She is right to say that the studies talk about mortality rates for people admitted at weekends. There have been eight studies in the past five years, or 15 since 2010 if we include international studies. She is right to say that we need to look at why we have these problems.

The clinical standards state that when someone is admitted, they should be seen by a senior decision-maker within 14 hours of admission. They will be seen by a doctor before then, but they should be seen by someone senior within 14 hours. The standards also state that vulnerable people should be checked twice a day by a senior doctor. Now, across the seven days of the week, the first of those standards is being met in only one in eight of our hospitals and the second in only one in 20. That is why it is important that junior doctors should be part of the group of people who constitute those senior decision-makers—consultants are also part of it—and that is why contract reform is essential.

The hon. Lady is right to say that this is also about nurse presence, and the terms that we are offering today for junior doctors are better on average than those for the nurses working in the very same hospitals, and better than those for the midwives and the paramedics. That is why Sir David Dalton and many others say that this is a fair and reasonable offer.

With respect to A&E recruitment, the impact of the contract change we are proposing is that people who regularly work nights and weekends will actually see their pay go up, relatively, compared to the current contract. These are the people who are delivering a seven-day NHS and we must support them every step of the way.

William Mead: 111 Helpline

Debate between Jeremy Hunt and Philippa Whitford

Tuesday 26th January 2016 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. There is so much in this report, but we must not let some very important recommendation slip under the carpet, and that is one of them. We have a commitment to a paperless NHS, which involves the proper sharing of electronic medical records across the system. We have also instructed clinical commissioning groups to integrate the commissioning of out-of-hours care with the commissioning of their 111 services to ensure that those are joined up. It is a big IT project, and we are making progress. Two thirds of A&E departments can now access GP medical records, but she is absolutely right to say that it is a priority.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Like others, I add my condolences to the family. It is hard to imagine anything worse for a family to face. Like many deaths in the NHS, it is always sad to look back and see that it was a catalogue of missed opportunities and errors. One thing I should like to pick up on is the fact that young children are very hard to assess. It is quite hard for a doctor to assess them when they are actually seeing them; they can be running round one minute and then keeling over half an hour later. It is particularly hard to pick up clues about their health over the phone. When NHS Direct services were started throughout the UK, they were based in local out-of-hours GP centres, which meant that the nurse could just pass the phone and say, “Can you come and chat, because I am not sure.” We had rules in our local one that if a young child was involved, they got a visit from our mobile service. Instead of such cases being put through call centres, I hope that the Secretary of State will agree in this review to have some dissemination back to a local system, so that these cases can be accelerated easily to a clinician.

[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.

Southern Health NHS Foundation Trust

Debate between Jeremy Hunt and Philippa Whitford

Thursday 10th December 2015 Commons Chamber

[Mr Hunt]

I will do that, and I am very grateful to my hon. Friend for giving me the opportunity to do so. We see this situation all too often. There was a story in the Sunday newspapers about a family being shut out of a very important decision about the unexpected death of a baby. It is incredibly important to involve families, even more so in the case of people with mental health problems or learning disabilities. The family may be the best possible advocates for someone’s needs.

We need to change the assumption that things will become more difficult if we involve families. More often than not, something like litigation will melt away if the family is involved properly from the outset of a problem. It is when families feel that the door is being slammed in their face that they think they have to resort to the courts, which is in no one’s interests.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I echo what the Secretary of State said about family involvement, which should be routine in investigating an adverse event. It definitely takes the heat out of the situation.

There are two issues here. One is the shocking difference between 30% of adult deaths being investigated, and just 1% of deaths of people with learning disabilities, and Connor represents the human face of that, which is frightening. The second issue is about individual trusts being left to decide what and how much they investigate, and what they produce, because a much more systematic consideration of the data is required. NHS England publishes annual mortality figures. Strikingly, 16 trusts that were identified with higher than expected mortality levels also had higher than expected mortality the year before, yet it appears that no action was taken. The benchmark appears to be “average”, but if we have poor performance, that average is lower. We should set our aspirations higher than that.

[Mr Hunt]

The hon. Lady is absolutely right. The 30% figure was for people with mental health conditions, not for all adults, but I question why we are investigating only 30%—the highest figure at Southern Health NHS Trust—of unexpected deaths. These were not just deaths; they were unexpected deaths, and it is the duty of medical directors in every trust to satisfy themselves that they have thought about every unexpected death. We must reflect on these serious matters.

The hon. Lady is right about the need to systematise processes when there is an unexpected death, so that we do not have a big variation between trusts. The exercise that Sir Bruce Keogh is doing, going around all the trusts, is about trying to establish a standardised way of understanding when a death is or is not preventable. The hon. Lady has been a practising clinician, so I am sure she will understand that at the heart of this issue is the need to get the culture right. Clinicians should not feel that a trust will take the easy route and blame it all on them, rather than trying to understand the system-wide problems that may have caused a clinician to make a mistake in an individual instance, and that is what we must think about.

Junior Doctors Contract

Debate between Jeremy Hunt and Philippa Whitford

Monday 30th November 2015 Commons Chamber

[Mr Hunt]

I thank my right hon. and learned Friend for his robust support. I seem to remember that when he was Health Secretary posters were put up all over the country saying, “What do you call a man who ignores doctors’ advice”, with a picture of my right hon. and learned Friend. He knows exactly what this is all about. It is not just Conservative Health Secretaries: Nye Bevan and Alan Milburn went through this.

My right hon. and learned Friend is absolutely right: we will all be delighted if the strike is postponed. Incidentally, it begins at 8 o’clock tomorrow morning, not midnight—I must correct that. He is right: the Government’s focus is unremittingly on improving patient care. We have made it clear that any settlement has to be within the current pay envelope. The great sadness is that the vast majority of doctors are passionate about doing something about seven-day services. If only we had had the chance to negotiate from June, we could have avoided the situation we are in.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I, too, welcome the fact that the Secretary of State has been to ACAS and made the change to plain hours that would have resulted in hours between 7 o’clock to 10 o’clock on a Saturday being counted in the same way as the equivalent period during the week. That would particularly punish people who already work at weekends such as acute medical staff and doctors working in accident and emergency—the very people we need.

I welcome the fact that the Secretary of State has made that change. I should be grateful for clarification of whether the threat of imposition is there or not. The statement says that it has been removed, but in his reply to the shadow Secretary of State he implied that it has not been removed. It would be helpful if he clarified the position.

We keep talking about more people dying at the weekend. May I again stress that it is not excess deaths at weekends, implying that hospitals look like the Mary Celeste? It is excess deaths of people admitted at the weekend, who may die on any day of the week. Junior doctors already cover weekends. It is the additional services to diagnose and get people on their journey that we are discussing. We need to focus on that. Unfortunately, the Secretary of State, in previous statements, has moved from talking about excess deaths to talking about the consultant opt-out clause, which applies only to routine work—I am sorry, a toenail clinic on a Sunday will not save lives—but he needs to focus on strengthening the seven-day service for urgent cases, in which people are ill and where existing provision leads to excess deaths. Hopefully, we can make progress. I join the Secretary of State and everyone in the House in hoping that there is not a strike tomorrow.

[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.

Oral Answers to Questions

Debate between Jeremy Hunt and Philippa Whitford

Tuesday 17th November 2015 Commons Chamber

[Mr Hunt]

I absolutely give my hon. Friend that reassurance. There are no preconditions, and this morning I wrote again to the BMA to reiterate that point. Of course, if we fail to make progress we have to implement our manifesto commitments, but we are willing to talk about absolutely everything. I agree strongly with my hon. Friend that it will be difficult to avoid harm to patients during those three days of industrial action. Delaying a cancer clinic might mean that someone gets a later diagnosis than they should get, and a hip operation might be delayed when someone is in a great deal of pain. It will be hard to avoid such things impacting on patients, and I urge the BMA to listen to the royal colleges—and many others—and call off the strike.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

It is 40 years since the last junior doctor strike—before I even started medical school. Given the ballot tomorrow, does the Secretary of State regret the antagonistic approach that he took before the summer towards senior and junior doctors? Should he instead have worked with them and not threatened to impose a contract so as to reach a stronger emergency seven-day service?

[Mr Hunt]

I do not know what the hon. Lady thinks is antagonistic about holding reasonable discussions with doctors for three years to try to solve the problem of seven-day care. Those discussions ended with the BMA, after two and a half years, walking away from negotiations last October. We made a manifesto commitment to have a seven-day NHS and to do the right thing for patients, and we simply asked the BMA to sit round the table and talk to us about it. I am confident that we can find a solution.

[Dr Whitford]

Claiming in July that senior doctors do not work outside 9 to 5 was perhaps felt to be antagonistic. Contrary to the figures quoted by the hon. Member for Dudley North (Ian Austin) last Monday, A&E figures for NHS England are 5% below those in Scotland. With such disappointing figures before we even get into winter or face a work-to-rule, and in the presence of eye-watering deficits, how does the Secretary of State plan to support hospital trusts through the winter?

Junior Doctors’ Contracts

Debate between Jeremy Hunt and Philippa Whitford

Wednesday 28th October 2015 Commons Chamber

[Dr Whitford]

I totally agree. I also agree with the Secretary of State about patient safety. There is no one in the profession who does not want a seven-day emergency service that is strong and responsive to the needs of unwell patients, but we keep moving from people who are ill to routine services. He has said we must not call them avoidable, yet he just referred to 200 avoidable deaths a week, which is exactly what Bruce Keogh described as “rash and misleading”, and people object to that. There are no excess deaths at the weekend; the issue is with people admitted at the weekend, usually for radiology or investigation. Scotland has been moving on this for the last decade, by working with the profession, not pulling out the pin and throwing a grenade.

[Mr Jeremy Hunt]

For the sake of clarity, the 200 avoidable deaths are not about the weekend effect specifically, but come from the Hogan and Black analysis, which found that 3.6% of hospital deaths in England had at least a 50% greater chance of having been avoidable, which is separate from the weekend effect—the higher mortality rate among people admitted at weekends. None the less, where there are avoidable deaths—where death rates look higher than they should be—we have an obligation to do something.

[Dr Whitford]

I agree that it is important to investigate, but it is also important to understand the cause of the problem. A lot of the problem at Mid Staffs was the ratio of registered nurses to patients. That was echoed by Bray in his review of 103 stroke units, which showed that additional consultant ward rounds at weekends had no impact on death rates, while a better ratio of registered nurses reduced them by a third. We need to know the problem before spending billions trying to solve the wrong thing.

Oral Answers to Questions

Debate between Jeremy Hunt and Philippa Whitford

Tuesday 13th October 2015 Commons Chamber

[Mr Hunt]

Once again, I thank my hon. Friend for his persistent campaigning on behalf of Kettering general hospital. It is a very busy hospital under a great deal of pressure, and I know that people work very hard there. The Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), who has responsibility for hospitals, met campaigners from Kettering recently to discuss this issue, and I will bring the matter up with Monitor as well.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

The Department of Health’s own figures show a dramatic change, from a £500 million surplus to a £100 million deficit in 2013, following the introduction of the Health and Social Care Act 2012. That deficit moved to £800 million last year and we have heard in the past week that it stood at more than £900 million from the first quarter of this year. Does the Secretary of State recognise that this situation has been exacerbated by the outsourcing and fragmentation of the NHS, which involves spending money on shareholder profits and tendering bureaucracy, rather than on patients?

[Mr Hunt]

I do not. That Act meant that we reduced the number of managers and administrators in the NHS in England by 19,000, saving the NHS £1.5 billion a year. The reason for the deficits that the hon. Lady talks about is that, around the same time, we had the Francis report on Mid Staffs, and hospitals in England were absolutely determined to end the scandal of short-staffing. However, agency staffing is not a sustainable way of doing that, which is why we are taking measures today to change that.

[Dr Whitford]

The Francis report recognised the problems of nursing levels. As hospitals will not be able to use agency staff or immigrant staff, how does the Secretary of State suggest they tackle the nursing ratios in hospitals?

[Mr Hunt]

If the hon. Lady looks at what has happened with permanent full-time nursing staff, she will see that the numbers have gone up in our hospitals by 8,000 over the past two years, so there are alternatives. We need to do more to help the NHS in this respect, and I will be announcing something about that shortly.

NHS Reform

Debate between Jeremy Hunt and Philippa Whitford

Thursday 16th July 2015 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for her important comments, and for sitting through a very long speech I gave this morning. We are trying to achieve many things. At their heart, as she rightly says, is a recognition that culture change does not happen overnight. She is right that the profiling of the extra money that the Government are investing in the NHS is important, because we need to spend money soon on some things, such as additional capacity in primary care, as in two to three years’ time that will significantly reduce the need for expensive hospital care. We are going through those numbers carefully. She is also right that local leadership really matters. I know that she will agree, especially as she comes from Devon, that leadership needs to be good at a CCG level as well as a trust level, because CCGs have a really important role in commissioning healthcare in local communities. That is an area where we need to make a lot of improvements.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I have to declare an interest: like most doctors, I am a member of the British Medical Association.

I commend the Secretary of State for his announcement about a national officer for whistleblowers. Shona Robertson, Scotland’s Cabinet Secretary for Health, announced this in June, and we are taking action on the Francis report in the same direction. It is vital that members of staff feel they have someone to speak to if things are not going well, and that if they are not being responded to locally there is an independent voice that they can go to.

With regard to seven-day services, the excess deaths of people who are admitted at weekends is recognised and abhorred by the vast majority of doctors. I do not know anybody who gets up and works the hours we do and does not care that someone did not do well. However, I think we are blurring the lines between the elective and emergency systems. The sickest people the Secretary of State mentions—those who run the risk of dying if admitted on a Friday or a Sunday—are not part of the elective system but of the out-of-hours emergency system. It is suggested that hospitals are like the Mary Celeste and there are no doctors. In fact, any service with an emergency component runs 24/7, but there is a multi-disciplinary team. Sometimes patients will be stuck on a ward because they cannot get access to a scan or there is no physiotherapist to help them recover from their stroke.

We are already working towards solving this in Scotland. We are doing so in a more collaborative way, and that is important. There is no resistance to that, because it is recognised that we need all parts of the service. This is different from people coming in for a routine check-up on a Sunday when that does not result in a detriment to them if it is not available. The biggest shortage we have is in human resources—doctors, nurses, physios, occupational therapists and radiographers. I recommend that the Secretary of State separate these two aspects. The first is that hospital consultants did not get the option to opt out of 24/7 care for emergency patients in the contract, whereas GPs did. It is a matter of providing, funding and setting up a full service with all that is behind it to deal with ill patients seven days a week, no matter when they come in.

The other aspect is trying to get value for money. If we have invested in expensive machines and theatres, we want them to work as many days a week as possible so that we get value for money, but that must be secondary to the first priority, which is looking after sick people. I suggest that the Secretary of State starts talking about the two aspects on separate tracks and not crossing backwards and forwards, and that this should be collaborative. I echo the hon. Member for Totnes (Dr Wollaston) in saying that we require the money to be front-loaded so that we get it to start changing the service now.

[Mr Speaker]

Order. May I gently say that from now on we are going to have to enforce the time limits on Opposition responses to ministerial statements much more strictly? Otherwise they eat into the time available for other colleagues. The shadow Secretary of State has five minutes in response to a 10-minute statement and the third party spokesperson has two minutes. That really does have to be adhered to as a matter of course from now on.

Oral Answers to Questions

Debate between Jeremy Hunt and Philippa Whitford

Tuesday 7th July 2015 Commons Chamber

[Mr Hunt]

I am very happy to do that. My hon. Friend is right to point out that the solution to the problem is not just about expanding the number of appointments offered by GPs, although we are doing that; it is also about looking at the very important role that pharmacists and other allied health professionals have to play in out-of-hospital care.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

The Secretary of State mentions recruiting 5,000 extra GPs, but I note in a recent speech that that was downgraded from a guarantee to a maximum. With 10% of trainee posts unfilled and the BMA’s recent survey suggesting that a third of GPs will leave in the next five years, is that not going to be difficult? Has the Secretary of State had any consultation with the BMA and the royal college to ask why they are leaving?

[Mr Hunt]

It will be difficult. The commitment has never been downgraded: we always said that we needed about 10,000 more primary care staff, about half of whom we expected to be GPs. We have had extensive discussions about the issues surrounding general practice, such as burn-out, the contractual conditions and bureaucracy. We are looking at all of those things. The commitment is to increase the number of GPs by about 5,000 during the course of the Parliament, and that is a very important part of our plan to renew NHS care arrangements.

[Dr Whitford]

I assume the Secretary of State is aware that two of the pilot sites for the seven-day, 8 till 8 working—one in north Yorkshire and the other in County Durham—have abandoned the project owing to poor uptake by patients, with only 50% of appointments used on a Saturday and only 12% on a Sunday. Given that they found that it had a detrimental effect on recruiting cover for out-of-hours GP urgent services, does not he feel that this needs a rethink and that consultation with the profession and looking at cover would be of most benefit?

[Mr Hunt]

The hon. Lady is presenting only a partial picture. In Slough there are about 900 more appointments every week as a result of the initiative for evening and weekend appointments. Birmingham has dramatically reduced the number of no-shows and Watford has reduced A&E attendance measurably. Some really exciting things have happened, but of course we will continue to consult the profession to make sure that the programme works.

Oral Answers to Questions

Debate between Jeremy Hunt and Philippa Whitford

Tuesday 2nd June 2015 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right to draw attention to that issue. We have plans to train another 5,000 GPs across the country. In the last Parliament, we increased GPs by about 5%. We need to go much further, as part of a real transformation of out-of-hospital care.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

How does the Minister intend to find the 5,000 extra GPs when many surgeries throughout the United Kingdom cannot fill the spaces that they have, and how does he plan to fund it? The proposals appear to only fund the setting up of seven-day-a-week, 8 till 8 GP services and not running costs—and these are big running costs.

[Mr Hunt]

I welcome the hon. Lady to her place. We do need to find these extra GPs and we will do that by looking at GPs’ terms and conditions. We need to deal with the issue of burnout because many GPs are working very hard. We also need to raise standards in general practice. In the previous Parliament, an Ofsted-style regime was introduced, which is designed to ensure that we encourage the highest standards in general practice. That is good for patients but also, in the long run, good for GPs as well.

[Dr Whitford]

Just so that the Secretary of State is aware, it takes 10 years to produce a GP, so that will not be an immediate response. The £8 billion that the Conservatives have suggested they will add by 2020 was just to stand still, not to fund a huge expansion, and as change, which the NHS requires, costs money, can the Secretary of State perhaps give us an indication of what extra we may expect in the next two years?

[Mr Hunt]

Well, I can, but may I gently say that under this Government and under the coalition we increased the proportion of money going into the health budget, whereas the Scottish National party decreased the proportion of money going into the NHS in Scotland? The £8 billion is what the NHS asked for to transform services, and that will have an impact, meaning that more money is available for the NHS in Scotland. I hope the SNP will actually spend it on the NHS and not elsewhere.