Southern Health NHS Foundation Trust

Jeremy Lefroy Excerpts

Thursday 10th December 2015 Commons Chamber

[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.

[Jeremy Lefroy (Stafford) (Con)]

Behind each statistic is a person and a family, and the Secretary of State is right to say that finger-pointing should not be directed at clinicians alone; it is more important to consider the whole system and the culture in a trust. Will he encourage all trusts, and all medical and nursing schools, to make the Francis report on Mid Staffordshire compulsory reading? There is so much in there that could prevent such occurrences in future.

[Mr Hunt]

No one knows more about the Francis report than my hon. Friend, because of the direct impact that it had on his local hospital, and he is right to talk about that culture change. There is an interesting comparison with the airline industry: when it investigates accidents, the vast majority of times, those investigations point to systemic failure. When the NHS investigates clinical accidents, the vast majority of times we point to individual failure. It is therefore not surprising that clinicians feel somewhat intimidated about speaking out. People become a doctor or nurse because they want to do the right thing for patients, and we must support them in making that possible.

Junior Doctors Contract

Jeremy Lefroy Excerpts

Monday 30th November 2015 Commons Chamber

[Mr Hunt]

My attitude is very straightforward: I need to do the things that will make patients in the NHS safer, and I want to negotiate reasonably with anyone where there is a contractual issue that needs to be resolved. I think that the Government’s position has been reasonable. The vast majority of doctors will see their pay go up, and the pay for everyone else working legal contracted hours will be protected. This is a very reasonable offer that does a better job for patients, but it has been difficult to get through to the BMA. I urge the hon. Gentleman to talk to his friends at the BMA and to urge them to be reasonable and talk to the Government, whereby we could have avoided some of the problems.

[Jeremy Lefroy (Stafford) (Con)]

I thank the Secretary of State and the BMA for their work over the past few days in bringing this matter—I hope—to a resolution, and encourage that spirit in moving forward. May I suggest that the main way in which morale can be restored is to see that both sides are acting in the interests of patients and, in particular, patient safety, which is so vital to doctors and to all of us?

[Mr Hunt]

No one knows more about campaigning for patients than my hon. Friend, as he has done in his constituency, and I congratulate him on that. He is right. There does not need to be an argument on a matter such as this, because it unites the Government in what we want to do to make the NHS the provider of the safest care in the world with what doctors themselves want to do. The best way forward is to put aside suspicion and for both sides to recognise that we are trying to do the right thing for patients, for doctors, and for the NHS.

Antibiotics (Primary Care)

Jeremy Lefroy Excerpts

Monday 23rd November 2015 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

Let me begin by congratulating my hon. Friend the Member for Erewash (Maggie Throup) on securing this very well-attended debate on a very important issue. The hour is late, but there are a number of hon. Members in the Chamber, reflecting the importance of the debate, and they have made well-informed interventions. I will attempt to address all the issues raised, but if there is anything I do not get to I will look to write to hon. Members.

This debate is timely. Antimicrobial resistance awareness week, a news item in The Lancet and news from other countries, in particular China, have helped to underline the issue that, on occasion, can sound quite dry. If people wonder what the issue is, it has been aptly illustrated in recent weeks. The prescribing and use of antibiotics has a direct impact on antimicrobial resistance. As my hon. Friend made clear, it is one of the biggest global health challenges we face and I spend a lot of time talking about it to Health Ministers from other countries. The costs of antimicrobial resistance are very significant. The O’Neill review on antimicrobial resistance, commissioned by the Prime Minister, estimates that a continued rise in resistance by 2050 would lead to millions of additional deaths worldwide each year and an economic cost of up to $100 trillion worldwide. This is a really big issue.

My hon. Friend described exactly the problem we face in terms of the appearance and spread of bacteria that are resistant to treatment by current antibiotics, and the threat that poses to modern medicine. She provided some examples of that threat. Without effective antibiotics, medical advances such as organ transplants, and even minor surgery and routine operations, will become high-risk procedures. Procedures we assume can now be done as minor day surgery will suddenly become again a serious threat because of serious resistant infection. Antimicrobial resistance is a global problem that needs to be tackled at a national and global level to ensure antibiotics are used wisely.

As my hon. Friend and others will know, in 2013 we published the “UK Five Year Antimicrobial Resistance Strategy” to address this significant threat. It takes a “one health” approach, addressing human, animal, food and environmental aspects of antimicrobial resistance. The hon. Member for Strangford (Jim Shannon) is, as ever, in his place. On many occasions I disappoint him by saying that matters are England-only, but I am delighted to be able to confirm that this is a UK-wide strategy. We are working on it in close collaboration with Scotland, Northern Ireland and Wales. At the heart of our strategy is the need to use antibiotics more effectively. The key is how we change both public and health professional behaviour, and my hon. Friend described the challenge we face.

The English Surveillance Programme for Antimicrobial Utilisation and Resistance—just another one of those catchy little titles we come up with in the health world—is a very important programme. The 2015 surveillance report shows that general practice accounts for 74% of prescribed antibiotics. The number of antibiotic prescriptions in primary care has declined for the last two years and are now lower than in 2011. However, analysis of the data suggests that although there have been fewer prescriptions, higher doses or longer courses of antibiotics are being prescribed. Total use of antibiotics continues to increase in the NHS, albeit at a slower rate. We still have a significant challenge. It is a challenge for all of us and, as my hon. Friend said, behaviour change is right at the heart of how we tackle the problem, both for those who prescribe and for those who use antibiotics—both are crucial to our response.

In August, the National Institute for Health and Care Excellence produced its stewardship guidelines for the health and social care system, which covered the effective use of antimicrobials, including antibiotics. We understand the pressures, as have been well described here, that primary care prescribers face every day. We know, as my hon. Friend the Member for Torbay (Kevin Foster) illustrated, that sometimes people expect to leave their doctor with a certain prescription, even if it is not the right thing. To support GPs, therefore, we have been working with the Royal College of General Practitioners to provide them with suitable tools to reduce levels of inappropriate prescribing.

Last week, research by Antibiotic Research UK found that doctors prescribed 59% more antibiotics in December than in August, despite many of the illnesses treated by antibiotics not being seasonal. That, too, touches on the challenges. One of the key resources doctors have at their disposal is TARGET—treat, antibiotics responsibly, guidance, education, tools—which is hosted on the RCGP website and aims to increase primary care clinicians’ awareness of the importance of antimicrobial resistance and responsible use. Health Education England continues to work with Public Health England to ensure that the competence and principles of prescribing antimicrobials are embedded throughout the professional curricula.

In a recent trial, the chief medical officer, Dame Sally Davies, wrote to a sample of high-prescribing GPs in England, explaining that their prescribing rates were significantly higher than those of other similar GPs and asking them to reassess their prescribing protocols. This intervention resulted in a 4% reduction in levels of prescribing in those practices. That is encouraging and more trials are planned. I put on the record the gratitude of this Government and Governments around the world to Professor Dame Sally Davies for the work she has done in spearheading not just our national AMR campaign but the international campaign. I have watched her galvanise whole countries to action on this subject. We are extremely lucky that she is leading the charge.

NHS England’s introduction of a quality premium on antibiotic prescribing for 2015-16 is another significant step. The purpose is to act as an incentive to reduce levels of antibiotic prescribing in both primary and secondary care. We are encouraged by the early results and expect a reduction in levels of antibiotic prescribing in the next set of data covering 2015-16.

We are not overlooking the consumers of antibiotics: the public. We need to improve their understanding about their appropriate use and are active participants in European antibiotic awareness day, which has just passed and which looks to engage the wider public. My hon. Friend the Member for Erewash highlighted the extremely important antibiotic guardian programme. We have set a target to reach 100,000 antibiotic guardians by next March. We also urge all colleagues—this is where MPs can be extremely helpful—to bring this up with their local NHS. If they ask about it, people will realise its importance, so I ask them to do so as part of their routine contact with local NHS institutions.

Public Health England, working in conjunction with the RCGP, has developed a range of patient information materials to help them think about how they care for themselves when they have a self-limiting infection, such as a cold, and when to consult a health professional. Critically, my hon. Friend referred to diagnostic testing, particularly the C-reactive protein test. I understand her frustration—sometimes it feels like things move rather slowly—but I hope that the attention the strategy has received illustrates our desire to move faster. In fact, the driving force behind the UK-wide strategy is about gearing up the whole health system to react more quickly.

Most antibiotic prescribing is done in the absence of a test to determine the nature of the illness and whether an antibiotic prescription is likely to help. Making better use of technology is a key part of our work. Greater access to and use of rapid diagnostic tests will help us to avoid unnecessary treatment and provide more targeted treatment where infections are diagnosed, which, of course, will mean better outcomes for patients.

[Jeremy Lefroy (Stafford) (Con)]

My hon. Friend might note that, in the case of malaria, the introduction of rapid diagnostic tests has substantially reduced the inappropriate use of important antimalarials.

[Jane Ellison]

That is an excellent illustration of the potential of rapid diagnostic tests, and of course we had exciting news on malaria recently.

In December last year, NICE recommended that GPs should consider carrying out C-reactive protein testing for people presenting in primary care with symptoms of lower respiratory tract infection if, after clinical assessment, a diagnosis of pneumonia has not been made and it is not clear whether antibiotics should be prescribed. I understand that the test is increasingly being used in primary care, although the evidence for its use is mixed and the role of normal clinical diagnosis remains critical.

We want the right test available in the right place, from patients’ homes and the high street to primary and secondary care. That work is being undertaken as part of the implementation of the UK antimicrobial resistance strategy. To further develop the use of diagnostics in clinical practice, we are investing £1.3 million of research funding through the National Institute for Health Research. That research is being undertaken by Cardiff University, focusing on GPs’ use of the C-reactive protein test to help to target antibiotic prescribing to patients with chronic obstructive pulmonary disease. It will be interesting to see how that research goes, and I am sure we will return to it.

In addition to the important work to improve appropriate prescribing, we should not forget the vital role of infection prevention and control—it was good to hear my hon. Friend the Member for Erewash note that. We have made significant progress, with dramatic reductions in some infections in recent years, but there is always more to do. We can make a significant contribution to that agenda by improving our ability to prevent infections in the first place. That includes work with NICE to develop clinical guidance and best practice information.

We have strengthened the code of practice on the prevention and control of infections to clarify for providers the measures needed to ensure effective infection prevention and antimicrobial stewardship. We will also improve infection prevention and control by introducing an indicator, as part of local antimicrobial resistance implementation plans from April next year, to help CCGs. That will be another good opportunity, from the spring, to ask CCGs how their plans are going and whether they can explain what they are doing locally. It was good to hear Erewash CCG being cited. I am sure my hon. Friend will hold its feet to the flames, as will others.

Let me touch briefly on the international scene. It was good to hear my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) talk about India. I had the pleasure of talking to the Indian Health Minister about this very topic at the World Health Assembly in Geneva in May. Tonight’s debate is not about the international aspect, but I would be delighted if any Member wanted a debate focusing on that, because the UK can be proud of our record in that regard. To give one example, as part of our focus on global antimicrobial resistance, the UK has committed £195 million over five years to the Fleming fund, which will support antimicrobial and infectious disease surveillance in developing countries, where we know drug resistance has a disproportionate effect. We were delighted to see all 194 member states agree to the World Health Organisation’s global action plan at the World Health Assembly earlier this year. The Government are now working towards the UN General Assembly in 2016 and are continuing to champion this agenda there.

Let me conclude by reaffirming our commitment to delivering improvements in the way antibiotics are used in the NHS. I take the challenge that my hon. Friend the Member for Erewash has highlighted and we will make sure that the NHS hears that from tonight’s debate. The work we have undertaken, and are continuing to undertake, means that we now have significantly better data and information on how antibiotics are used in both primary and secondary care, but we have much more to do. I welcome tonight’s debate as a reminder of the task that lies ahead of us.

Question put and agreed to.

NHS (Charitable Trusts Etc.) Bill

Jeremy Lefroy Excerpts

Friday 6th November 2015 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

I rise in support of this Bill, which has been promoted by my hon. Friend the Member for Aldridge-Brownhills (Wendy Morton).

I simply wish to make one point about the enormous role that charities and volunteers play in hospitals, particularly those such as Great Ormond Street. I recall that when I was growing up in London my parents used to offer accommodation to the parents of children who were at Great Ormond Street because, as many speakers have said, these people would come from all over the country and accommodation in London, even then, was expensive—now, of course, it is extortionate. Therefore, it is vital that hospitals, particularly children’s hospitals, can accommodate parents, siblings and loved ones in order that they can be close to their children in these times of need. That is why it is so important that whenever we are looking at the movement of hospital services for children, as is happening in my constituency with some in-patient services going north to Stoke or south to Wolverhampton, real consideration is given to providing full access to the children for relatives and loved ones at all times of day or night, with proper accommodation being provided, whether by volunteers in the community or by the hospital trust itself. It is often the role of these charities, as well as the hospital itself, to do that.

I welcome this Bill and all the work done by the charities linked to all the hospitals mentioned today, particularly Great Ormond Street. They do a tremendous job and it is vital that this Bill is enacted at the earliest opportunity.

--- Later in debate ---

[Mr Rees-Mogg]

I am grateful to my hon. Friend for making that point; occasionally there are innovations that are welcome, and this is one of them. For those who do not know, I should add that in the draw No. 1 used to be done first but now No. 20 is the Bill done first. It is like a game show: it brings more tension and atmosphere into the proceedings. That is how it has worked and how the Bills have come out in the way they have.

This is a superb Bill. It is the reason why private Members’ Bills exist, because it is deregulating. It is such a wonderfully Tory Bill. It is a properly Conservative Bill, because it takes—[Interruption.] I am so sorry, but I could not quite hear what the hon. Member for Newport West (Paul Flynn) was saying from a sedentary position. I am happy to give way if he wishes to intervene.

Why is it such a wonderfully Conservative Bill? It is because of its fundamental deregulatory nature. We have built up a state where more and more powers have been gathered to the centre, where Whitehall has the rule over all it purveys. It tells people what they must do. When it says jump, people have to say, “How high?” It was of course a Labour Cabinet Minister who said, “The fact of the matter is the man in Whitehall really does know best.” It has to be said that that was in 1947, but the fundamental principle underpinning what the socialists believe remains the same: that control should be centralised; that if instructions and diktats come from on high, the government of the country will be better run; and that individuals are not the people who can best take charge of this.

We, as Conservatives, reject that fundamentally, and it is this philosophy that underpins the Bill. We take the view that the millions of random decisions taken by individuals over how they should lead their lives means better decision making, better allocation of resources and a more contented and unified society overall. By taking power away from the Secretary of State—removing appointments from his control—the Bill allows every charity across the country that is involved in supporting the health service to set out what is appropriate for its community, for its region, for its county and for its area. In Somerset, we may well want different approaches from that which is suitable for the centre of London. Different approaches will be wanted in Dorset, Devon, Sussex and Surrey. Even in Gloucestershire they may have some thought as to how they wish to approach these things. [Interruption.] And in Hampshire, that fine county. Hampshire, one of the great counties, which was on the right side when Alfred beat Guthrum, is always to be admired in these contexts. These charities will decide what is appropriate and suitable for them, how they appoint and whom they have.

One of my colleagues speaking earlier, I believe it was my hon. Friend the Member for Torbay (Kevin Foster), was talking about the risk that people would be appointed for nefarious political purposes, and of course that is what has always happened. In the 18th century, it was called jobbery. I always thought that was a good word because it so nicely encapsulates what happens as we get that corruption of baubles. The Government are the owner and disperser of baubles, and there is a corruption built in, as they give those baubles, initially, not to their friends specifically, but merely to those who are not opposed to them. In the case of somebody who is opposed, it would be “going too far” to allow an appointment to be made by the Secretary of State. It really “would not do” to appoint somebody on the other wing of politics.

[Jeremy Lefroy]

My hon. Friend shares my dislike of overweening Executive action. Does he agree that sometimes in this place, particularly on Report, too little time is given to Members to allow us to discuss the kinds of thing that the Executive wish to impose on us centrally?

[Mr Rees-Mogg]

I have great sympathy with what my hon. Friend says; it is so important that we have enough time. It is why Fridays are such a pleasure, because there is time to discuss a Bill in full and in the round, and to consider the principles underpinning it, the details of it, and what would happen to it if it were to be brought into effect. That is proper parliamentary procedure. I have such admiration for those great heroes of the 19th century—[Interruption]—talking of which I give way to my hon. Friend the Member for Beckenham (Bob Stewart).

Junior Doctors’ Contracts

Jeremy Lefroy Excerpts

Wednesday 28th October 2015 Commons Chamber

[Mr Hunt]

Yes, and I agree with that, but it would be equally rash and misleading to say there are no avoidable deaths. Professor Keogh was saying that lives could be saved if we tackled this. All these studies are saying that 15% more people die than we would expect if we had the same level of cover at weekends as we have during the week. Therefore, as he says, the moral case for action is unanswerable.

[Jeremy Lefroy (Stafford) (Con)]

The hospital to which my right hon. Friend referred earlier is in my constituency. The accident and emergency department has improved hugely over the past few years—well over 95% of patients are seen within four hours—and one reason for that is that it has consultant cover all the time. It is not open 24/7—we want it to be—but for the 14 hours a day that it is open, it has consultant cover all the time.

[Mr Hunt]

My hon. Friend is absolutely right. The fact is that this is a package designed to ensure that we eliminate the weekend effect, and it involves both junior doctors and consultants, because they both have their part to play.

NHS Reform

Jeremy Lefroy Excerpts

Thursday 16th July 2015 Commons Chamber

[Mr Hunt]

Of course. The hon. Gentleman has liaised very closely with the Morecambe Bay families over the period of the inquiry. I am happy to give him the assurance that they will remain closely involved.

I am very pleased that the hon. Gentleman says he does not want his party to be the mouthpiece of the BMA, but if that is the case, it needs to get behind the proposals that the Government are making today and say it supports them. We have not heard that from his party and that is what the public want to hear.

[Jeremy Lefroy (Stafford) (Con)]

The trust or place that has probably learned the most from Mid Staffordshire is Mid Staffordshire, or, as it now is, County Hospital, Stafford. Quality of care and performance has increased dramatically, with 98% and more patients seen within four hours at A&E. That is why we need a 24/7 A&E. May I urge the Secretary of State to ensure that the new independent patient safety investigation service is truly independent, despite being housed in the Monitor-Trust Development Authority building?

[Mr Hunt]

I thank my hon. Friend for the amazing work he has done in supporting County Hospital through the most unimaginably difficult circumstances. I put on record my thanks to the doctors and nurses working in that hospital who are doing a fantastic job. They have improved care. Many of them were working at the old Mid Staffs hospital and, even during the period of those problems, they were working incredibly hard and doing a very good job for patients. They did not want to be associated with any of the bad things that happened. They are a shining example to all of us. Yes, the independent patient safety investigation service needs to be independent, but I think trusts will welcome this measure. It will mean that a trust has a body, which is completely independent of anyone working in the trust, that it can call in. In a no-blame way, it can find out exactly what happened—a bit like a French juge d’instruction; that kind of principle. I think that will be really welcomed in the NHS, but independence is vital.

NHS Success Regime

Jeremy Lefroy Excerpts

Thursday 4th June 2015 Commons Chamber

[Ben Gummer]

I welcome my hon. Friend to her seat. I hope to make a whole series of visits soon and I will certainly talk to her about her hospital. She will have noted that the very first speech given by my right hon. Friend the Prime Minister was about the NHS. That reaffirms our commitment to the NHS. We were the only major party to commit to the NHS’s own plan for success over the next five years. That is why the Conservative party, to be frank, is the only one that can now be called the party of the NHS—[Interruption.]

[Jeremy Lefroy (Stafford) (Con)]

Will my hon. Friend confirm—[Interruption.]

[Mr Speaker]

Order. I want the hon. Gentleman to be heard.

[Jeremy Lefroy]

Thank you, Mr Speaker. Will my hon. Friend confirm that at the heart of the success regime will be the provisions of the Health and Social Care (Safety and Quality) Act 2015 on integration and quality?

[Ben Gummer]

It must have been a great pleasure for my hon. Friend to have taken personal possession of the 2015 Act, which he helped steer through Parliament and piloted himself. It is a significant contribution to the cause of patient safety, which lies at the heart of the Government’s vision for the NHS.

Health Services in Staffordshire

Jeremy Lefroy Excerpts

Wednesday 3rd June 2015 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

Thank you very much indeed, Madam Deputy Speaker, for calling me to speak, and I congratulate you on your re-election, which is much deserved. I welcome the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), to his post, which is also greatly deserved.

With your permission, Madam Deputy Speaker, I will take interventions from colleagues, as the subject of the debate affects their constituents.

Staffordshire and Stoke-on-Trent face some serious challenges in the provision of healthcare in the coming months and years. Although some of these issues concern the County hospital in my constituency of Stafford, which, together with Cannock Chase hospital, was the subject of a trust special administration, I also want to examine the broader situation. I will touch on emergency and acute services, community provision, cancer and end-of-life care, general practice and the financing of the health service.

Accident and emergency services in Staffordshire have been under the spotlight in recent days, with reports of pressure on the A&E department in the Royal Stoke University hospital and statistics showing that the hospital has had the highest number of 12-hour waits in recent months. At the same time, the A&E department at the County hospital in Stafford has been treating patients in under four hours more than 95% of the time in many of the most recent weeks.

It has seemed both necessary and clear to my constituents for a long time that returning the County hospital’s A&E department to a 24-hour service would both relieve some of the pressure on the Royal Stoke University hospital and improve overnight services for the 300,000 people in the County hospital’s catchment area. So I welcome the Secretary of State’s support in this House yesterday for restoring the 24/7 A&E service

“as soon as we can find a way of doing it that is clinically safe”.—[Official Report, 2 June 2015; Vol. 596, c. 439.]

Safety, of course, is paramount; I am the sponsor of the Health and Social Care (Safety and Quality) Act 2015, and it is absolutely right that safety is paramount. Therefore, will the Minister say what steps have already been taken and when we can expect to see progress on this issue?

However, the problems at the Royal Stoke are not simply the result of additional patients from the Stafford area. As I understand it, they also arise from the long-term trend in rising emergency admissions, particularly of older people, and difficulties in discharging patients to their home or to community beds.

I understand that last week’s report about the possible closure of up to 100 community beds in north Staffordshire is not accurate. Nevertheless, there are real concerns about the future of our community hospitals. Any reduction in beds is likely to lead to further delays in the discharge of patients and have a knock-on impact on the A&E department at the Royal Stoke, which would affect my constituents as well as those of other hon. Members.

[Fiona Bruce (Congleton) (Con)]

I commend my hon. Friend for securing this debate and I share his concerns, particularly because these issues also affect my constituents in Congleton. One of them has written to me expressing concern that cardiac patients needing to be urgently

“transferred to The Royal Stoke immediately on arrival at our local hospital A&E, Leighton”

can be at serious risk as a result of the additional pressures on services. Indeed, he says that if this issue is not resolved

“fatalities may be the consequence.”

[Jeremy Lefroy]

I thank my hon. Friend. She makes a point that I think will be echoed by other hon. Members in the area.

The reason given for the potential closure of the community beds was that more care would be provided at home, but how precisely will that be done? I have to declare an interest in that my wife works as a GP in Stoke-on-Trent. From what I hear, community nursing teams sometimes have difficulty in managing the workloads they have at the moment, so where will the extra capacity come from? Surely it would be more sensible, before those beds disappear—if indeed they are scheduled to disappear—to ensure that the extra community nurses are in place and to show that there is a clear reduction in the need for such beds. I urge the Minister to question any proposed reduction in community beds—even if it is not of the order mentioned in the press last week—at a time when they seem to be most in need.

I will now turn to acute services in general. The University Hospitals of the North Midlands Trust has recently announced the closure of in-patient oncology and haematology at the County hospital. In future, there will be outpatient chemotherapy treatment, but in-patients will be seen in the Royal Stoke hospital. This move was not dealt with in any detail during the public consultation on the proposals of the trust special administrator, nor was it mentioned by the NHS in its information about the changes in services provided to my constituents or to those of my hon. Friends the Members for Cannock Chase (Amanda Milling) and for Stone (Sir William Cash), and my right hon. Friend the Member for South Staffordshire (Gavin Williamson) who are affected.

From a visit to a patient on the oncology unit at the County hospital last week, it was clear to me that the service was not only very busy, but greatly appreciated. Constituents have written to me saying how important it was to have the unit relatively close, so that they could be with their family through stays which were very difficult and often lengthy. Why move what is appreciated and working well? I understand that there are staffing problems, but surely those could be tackled. I ask the Minister to look at this again.

[Sir William Cash (Stone) (Con)]

Does my hon. Friend welcome the statement made by the Secretary of State for Health the day before yesterday regarding the question of agencies and the absolute necessity to make sure they do not rip off the health service? May I also congratulate him not only on his splendid victory, but on the fact that he has just collected the Act of Parliament that he so successfully piloted last year?

[Jeremy Lefroy]

I thank my hon. Friend. He has been a huge support in all these matters, which have at times been extremely difficult. He is absolutely right. I have come across cases of agency workers charging absolutely extortionate fees. I could give the Minister in private—he would be shocked to hear them—one or two examples of what I consider to be close to blackmail.

Another question is raised: if these important services are moving, without mention in the information to my constituents, are other moves planned of which we have no information? The loss of emergency surgery, consultant-led maternity, full level 3 critical care and in-patient paediatrics was—even if most were the wrong decisions—at least clearly set out and communicated with my constituents. These acute in-patient services were not. What we therefore need, and what I have been asking for since last summer, is a clear summary of exactly what services will be available and where.

Of course, this is primarily the responsibility of the UHNM Trust. However, it is grossly unfair to place this burden entirely on it. It has been asked to do a huge job in bringing together two acute hospitals, one of which has been the subject of a major public inquiry. It needs the full support of the NHS through the NHS Trust Development Authority and NHS England. I am asking the Minister to make it his responsibility to do precisely that.

I will now turn to the tender for cancer and end-of-life services throughout the west of Staffordshire and Stoke-on-Trent. The proposal has been developed by NHS England, the four clinical commissioning groups covering North Staffordshire, Stoke-on-Trent, Stafford and surrounds, and Cannock Chase, and Macmillan Cancer Care. The objective is clear: to improve cancer outcomes, which are currently below the average for England and well below the European best, so that survival rates are among the best in England by 2025 and subsequently among the best in Europe.

[Andrew Griffiths (Burton) (Con)]

I commend my hon. Friend for securing this debate and for the fantastic work he has done over the last five years, both for his constituents and for people across Staffordshire. We welcome the work he does, and I am sure he would join me in thanking the doctors, nurses and clinical staff across Staffordshire who have worked so hard to get improved care across our county. Does he agree that we still have a fragile healthcare economy in Staffordshire? I managed to secure £8 million for East Staffordshire CCG thanks to the help of the previous Health Minister, but that is for just one year, so does my hon. Friend agree that we need to move towards fairer funding in Staffordshire?

[Jeremy Lefroy]

I entirely agree with my hon. Friend and reiterate his remarks about the excellent work done in my constituency by staff at the County hospital to recover the situation, which a few years ago was extremely difficult, to one where the quality of care offered is of a very high standard.

To return to cancer and end-of-life services, the real concern has been over the method being used. To quote Macmillan:

“We think a procurement process is the best way to integrate the fragmented cancer and end of life services we have in Staffordshire. A procurement process is needed because at the moment there is no one organisation with overall control of cancer or end of life services.”

My argument has always been: in that case, what are CCGs for? They are there to commission, so why can they not commission? In the last Parliament, we gave them the ability to work together to procure services, so why cannot the four CCGs involved, together with Macmillan, simply make that happen? The answer I was given at the time was that the constraints on CCGs’ own administration costs—a reducing amount of funding per head—meant that it was impossible. Sometimes I am puzzled. We see this all over Government and have done for many years and across many Departments: we constrain spending on so-called bureaucracy and then, in order to get necessary things done, pay large sums of money to consultants to do precisely the kind of bureaucratic work that we forbid the experts from doing—in this case the CCGs—but, because it is called consultancy or programme work rather than overheads, it is allowed. There is a problem that needs to be solved—I do not deny that—and it affects the lives of my constituents and those of other Members, so it must be solved.

Macmillan says about the first two years of the contract:

“The main responsibility of the integrator will be to address the current inadequate data about pathway activity and the real cost of this activity. Much increased investment over the last decade has arguably been wasted by poor contract accountability and a lack of reliable data and analytics.”

That is important, but it is a research and advisory role. I have no problem with the CCGs calling in experts to offer them such research and advice, whether it is a private company, university or, indeed, another arm of the NHS. A fee will be paid for that work. Again, I have no problem with that, but I would like the Minister to say how much it is likely to be. As local MPs, we have a right to know, on behalf of our constituents, or at least have a rough idea.

According to Macmillan, after 18 months the integrator —I would say consultant—will be expected to

“present a more detailed strategy as to how they expect to achieve improved service outcomes. If the evidence is robust, arrangements will be made for all contracts to be transferred to the Service Integrator from the beginning of year 3. If not, the contract with the Integrator could be terminated and the Service integrator will be required to repay all (or a significant part) of their fee to date.”

That is where I do not see the logic. What makes an organisation that is good at research and advice the right body to run cancer services for our constituents? Why can it not simply be thanked for its advice and that advice, if it is good, be followed by the CCGs, working in co-operation with the providers? The risk is that the vital work that patients, the CCGs and Macmillan have done, with the very best of intentions, will be damaged by contractual arrangements that do not make sense and may put a private organisation with a somewhat different ethos in charge of commissioning NHS providers for services, rather than the other way round.

I have no problem at all with a private organisation producing a much better plan for cancer and end-of-life services, nor do I have a problem with social enterprises or private providers being involved in delivering certain elements of that plan, as they do now and have done under Labour, coalition and Conservative Governments. However, I do not see the logic in the organisation producing that plan becoming another bureaucratic tier between the CCGs, providers and patients. I therefore ask the Minister to take up the proposed contract with the CCGs.

The state of general practice is gradually becoming critical in our area. Many GPs are retiring or approaching retirement. I welcome the Government’s plans to train more GPs, but we will also have to train more medical students or rely on recruiting from overseas.

[Jim Shannon (Strangford) (DUP)]

In Health questions this week, an issue close to my heart was raised about GP numbers and how many doctors are choosing to become GPs. We have similar issues in Northern Ireland. The difficulties in Staffordshire have been outlined, but they are mirrored across the whole of the United Kingdom, and particularly in Northern Ireland. Could any steps be taken to encourage more doctors to become GPs, thus dealing with the problem of the massive number of patients that each doctor has, because we are getting to the stage where doctors will not be able to cope?

[Jeremy Lefroy]

I am grateful to the hon. Gentleman, who hits the nail on the head. It is vital to increase the number of medical students and those training as GPs. I know that the Government want to do that and are committed to it, but I believe they need to expand the number of medical school places.

What plans do the Government have for expanding the number of medical school places and ensuring that those trained stay and work in the NHS, particularly in those areas that are running short of GPs? A seven-day personalised service is an ideal, but those GPs who take the care of their patients extremely seriously—and that is the vast majority of them—are already working extraordinarily hard. The European working time directive most certainly does not apply to GPs, even if it does to the rest of the NHS, and if it were to apply, our family doctor service would fall apart.

Finally, I wish to address the financing of the NHS in Staffordshire. All parts of it are under strain. The KPMG report showed, although some of its solutions have rightly not been accepted, that there is a serious problem. The answer is not to be found in short-term fixes, whether they be in Staffordshire or elsewhere. The NHS England 2020 plan—tough though it is—gives us the opportunity to think long term. Yesterday, I argued in this place for a cross-party commission, including the medical professions, on the future of health and social care and its provision and financing for the 20 or 30 years beyond 2020. I repeat that call today, and I urge the Minister and his colleagues to take up the challenge.

--- Later in debate ---

[Ben Gummer]

That is precisely the point that I made to the clinical commissioning groups when I spoke to them yesterday. I appreciate its importance, and not just on the basis of my own experience of representing an urban seat in a largely rural county.

My hon. Friend the Member for Stafford raised the issue of community beds. I need not advise him to exercise caution when it comes to believing everything that he reads in the press. However, there will be consultation about any changes that do take place, and I know that the Trust Development Authority and the commissioners will work together to ensure that they take place in a coherent fashion. Following my forthcoming meeting with chief executives and the TDA commissioners, I shall be happy to meet my hon. Friend and others to discuss changes in services if that will help to allay his concerns.

I have had detailed discussions with commissioners and NHS England about haematology and oncology services. Although there was a thought that they had been mentioned in original documents, I must say that I, too, found such mentions to be lacking. I am afraid problems of that kind are often encountered in the NHS, and that, in the past, consultations have not been as full or as pertinent as they should have been. I have asked the NHS again to consult specifically on those services, and also to engage in a full and proper consultation with patients and local groups. The same will apply to any other services that may come into question. I take my hon. Friend’s point about the need for a list of services, and I will pass it on to the CCGs, because I think it is important.

[Jeremy Lefroy]

I am most grateful to the Minister. It is very good news that there will be proper, extra consultation. As I said earlier, last week I visited a patient whom I know, and saw the excellent service that is currently being provided. It would be a real loss—more than that, a tragedy—were that service to be moved.

[Ben Gummer]

I stress that it is not for me to design the outcome of that consultation, because the whole point of what we are trying to do is to allow clinicians to make that decision, but they must consult properly. The same pertains for A&E. My right hon. Friend the Secretary of State has said that round-the-clock A&E services—I know he has made this point specifically to my hon. Friend—could return to Stafford if clinically safe to do so.

There is a need for quality services to be delivered immediately, however, and that is why I am concerned also about the situation at Stoke, where issues clearly need to be addressed in the immediate term. I wrote yesterday to the chief executive of the University Hospitals of North Midlands NHS Trust to arrange a meeting with him, local commissioners and the TDA to see what can be done immediately to help improve the emergency services at Stoke. I will of course speak to my hon. Friend following that meeting to bring him up to date on the conclusions of that discussion.

I also understand from the local NHS that the plans are resilient and will deliver better services, and that the work is being led by CCGs and local authority commissioners. They are redesigning the Staffordshire health and social care economy to ensure that patients enjoy the benefits of a safe, high-quality and financially sound service in the long term. That is their assurance to me. My job, and my hon. Friend’s, is to ensure that they fulfil their promise.

My hon. Friend brought up two separate issues more generally about agency nurses and consultants, and he will have seen the announcements made by my right hon. Friend the Secretary of State yesterday and today about them. Both go to the heart of the matter my hon. Friend raised and demonstrate how we in this Government are prepared to move rapidly on the matters facing the NHS in the early days of this Parliament to ensure that we can deliver the excellence in healthcare that we know our constituents deserve and wish for.

The Minister for Community and Social Care, sitting beside me, has heard my hon. Friend’s comments on GP numbers. That is a challenge throughout England and in my constituency, and one that we hope to address in part by the 5,000 additional general practitioners whom we hope to recruit in the next five years. We will, however, bring forward a range of measures to ensure that general practice not only survives but flourishes in the years to come.

In conclusion, I thank once again my hon. Friend for bringing so carefully and diligently these important matters to the House’s attention. It has allowed us to explore some of the wider issues facing the national health service. I hope I have provided him with a few points of consolation and also reassurance on how the Government and local health commissioners will proceed with the matters that he has raised. If he has any further complaints, problems, wishes or desires about his local health service, he should come to me. That invitation extends to his colleagues in the county of Staffordshire as well.

Question put and agreed to.

Oral Answers to Questions

Jeremy Lefroy Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Ben Gummer]

I am sorry to hear that the hon. Gentleman has had that experience with NHS England. My hon. Friend the Minister for Life Sciences will want to speak to him about that; if it is the case, it is clearly unacceptable. As the hon. Gentleman will have heard from my previous answer, we are hoping to get quick decisions from NHS England on the interim commissioning guidance this month, and I am pushing hard for a decision from NICE as soon as possible this year, so that we can get interim guidance from it.

[Jeremy Lefroy (Stafford) (Con)]

3. What progress he has made on the implementation of the trust special administrators’ proposals following the dissolution of Mid Staffordshire NHS Foundation Trust.

[The Secretary of State for Health (Mr Jeremy Hunt)]

We are putting the terrible tragedy of the old Mid Staffs behind us, and I congratulate my hon. Friend and the staff at the hospital on their superb efforts under a great deal of pressure. We are also investing over £300 million in the Staffordshire health economy, and the local trust and commissioners are making good progress on implementing the recommendations made by the trust special administrators.

[Jeremy Lefroy]

I thank my right hon. Friend for his reply. He will have seen the reports over the weekend on the severe pressure on accident and emergency services at the Royal Stoke University hospital, while Stafford’s County hospital A&E often meets the 95% four-hour target. The trust special administrators assured us that the Royal Stoke would have the capacity to cope with additional patients from Stoke and Stafford. Given that that is not the case, will the Secretary of State ensure that A&E in Stafford is reopened to operate 24/7 as soon as is clinically possible?

[Mr Hunt]

I share my hon. Friend’s concern about what is happening at the Royal Stoke. Some of the care there was totally unacceptable; there should be no 12-hour trolley waits anywhere in the NHS. I have said that I support a full 24/7 A&E service at County hospital as soon as we can find a way of doing it that is clinically safe, and I will certainly work hard to do everything I can to make that happen.

Health and Social Care

Jeremy Lefroy Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

It is an honour to follow the hon. Member for Lewisham West and Penge (Jim Dowd), and to have heard such excellent maiden speeches from so many Members today: the hon. Member for Central Ayrshire (Dr Whitford); my hon. Friends the Members for Vale of Clwyd (James Davies) and for Eastbourne (Caroline Ansell); the hon. Member for Bristol West (Thangam Debbonaire); and my hon. Friends the Members for Eastleigh (Mims Davies), for Colchester (Will Quince) and for Telford (Lucy Allan). I apologise if I have forgotten any new Member.

I welcome the Gracious Speech and in particular I welcome its one nation approach. It is so important that this focus on bringing our country together remains throughout this Parliament and beyond, not only for the nations of our country—important though they are—but for all people, through cutting inequality, achieving full employment and supporting communities.

I welcome, too, the emphasis on working people, but it must be the widest-possible definition of working people. Yes, it must include employees, but the self-employed, parents who choose to stay at home to bring up their children and carers, particularly in this carers week, who commit themselves to their loved ones, are all working people. So when we speak of helping working people get on, let us ensure that it includes the widest possible definition.

The Gracious Speech mentioned supporting home ownership and giving housing association tenants the chance to own their own home. I want to see increasing home ownership, but I also want to see an increased number of social and affordable homes to rent, and any social housing that is sold needs to be replaced one for one, with the associations involved being properly compensated.

I represent Stafford and much of my election campaign was, understandably, taken up with health. My constituents have been through an extremely difficult time with the local NHS. They have seen great improvements in quality, but also a loss of services, which is a subject that I shall address with your permission, Mr Speaker, in an Adjournment debate later this week. I ask that Mid Staffs not be used continually as an example of historic poor care, but that instead we talk about learning the lessons from the Francis report, recognising the huge improvements made since then in Stafford and elsewhere, as we have heard today.

I welcome the five-year NHS plan and the Government’s commitment to fund it, but we need to go further. Let us use the five years of this Parliament to set up a cross-party commission to look at health and social care for the next 20 to 30 years. We have the opportunity to look at its provision, integration and financing. The shadow Secretary of State mentioned the need for the Law Commission’s draft Bill on regulation to be introduced, and I agree. The Health and Social Care (Safety and Quality) Act 2015, which I introduced into the House in the last Parliament, made a start on this work, but it needs to be completed.

Finally, it is essential, as the Queen’s Speech promised, that the Government continue to play a leading role in global affairs. People around the world look to the UK to take a lead on international development and co-operation and on human rights. Economic success is, of course, important, but it is not everything. I want the UK to be known for the seriousness with which it takes its global responsibilities to the poorest. I will mention just four areas: jobs, of which we need 1 billion around the world in the next decade; climate change; health systems and combating disease; and, of course, extremism.

This Parliament faces many challenges, but we should never forget, as one constituent reminded me during the election campaign, that we live in a wonderful country. If we truly strive, as we do, to bring our nation together, we will ensure that this remains a wonderful country for our children and grandchildren.