Antibiotic Resistance

Jeremy Lefroy Excerpts

Wednesday 15th October 2014 Westminster Hall

[Julian Sturdy]

I agree. Although I was only going to touch on that matter briefly, that does not mean that I do not recognise the impact on resistance from use of antibiotics in veterinary medicine. My right hon. Friend is right to mention the problems relating to resistance in the US, especially because the way that veterinary antibiotics are used there is quite frightening. In the UK and Europe, we use antibiotics differently. The Dutch are the example in that regard, and we have to learn from that. If we continue to misuse antibiotics, whether in human medicine or in the veterinary industry, resistance is bound to happen and that is bound to cause a problem, so we have to tackle it on both sides, although I want to focus on the human medicine side.

[Jeremy Lefroy (Stafford) (Con)]

My hon. Friend mentioned malaria and the treatments against it that have been discovered. He may know that, through misuse of the latest generation of artemisinin-based antimalarials, resistance to those is already coming up through Thailand and Burma and will possibly, eventually, get to sub-Saharan Africa, with devastating consequences, as was the case with previous antimalarials.

[Julian Sturdy]

My hon. Friend is right. I was going to touch on that. Multi-resistance is widespread around the world. He mentions antimalarials, but resistance is also apparent in relation to tuberculosis and there is emerging resistance to the antibiotics of last resort—the so called super antibiotics—the carbapenems, which are not licensed for use in farm animals on the veterinary side. That resistance is causing real concern.

Returning to the livestock sector for a minute, there is a tendency among some sections of the intensive livestock industry, and even some Governments, to dismiss almost entirely the contribution to resistance by veterinary use of antibiotics. This is a dangerous path to take, because although antibiotic use in farm animals may not be the main driver of resistance in humans, it is a still an important contributor, and we must recognise that.

--- Later in debate ---

[Jeremy Lefroy (Stafford) (Con)]

I congratulate my hon. Friend the Member for York Outer (Julian Sturdy) on taking the lead in the debate, and in the House previously. I congratulate, too, hon. Members from all parties, on setting out the issues clearly.

I want to concentrate on the second action point set out by my hon. Friend—a global network. I shall take malaria as an example—I declare an interest as chair of the all-party group on malaria and neglected tropical diseases—and will speak about what happened when resistance to malaria drugs spread around the world in the 1980s and 1990s. The drug that was most effective until then for the standard treatment of malaria was chloroquine. Quinine was of course a last resort, but chloroquine was used by most people. Resistance cropped up, initially in south-east Asia, spreading throughout sub-Saharan Africa, until there was little that most people who caught malaria could do, besides hoping it would be effective. In many cases it was not.

A new class of drugs was discovered, based on artemisinin, and a network called Medicines for Malaria Venture was set up. The previous Government were instrumental in setting up and supporting it, and the present Government have continued substantial support for it. As a result, even in 2008 there was a reasonable antimalarial drug pipeline. A couple of days ago in this place I had the pleasure of launching our group’s 2014 report, which had some helpful financial support from the Medicines for Malaria Venture. The pipeline has grown substantially in the six years since 2008. It has been remarkable to see not only that drugs have been coming through the pipeline, but that four of the six most commonly effective antimalarials at present have resulted from the venture. That is an example of what can be done by a multinational network, with Britain taking the lead. I urge the Minister to consider such an approach for antibiotics.

The chief medical officer, among others, has rightly referred to antibiotic resistance as a threat equivalent to the threat from terrorism. We see our work in international development as a means to combat many of the sources of terrorism. Unemployment around the world is a breeding ground for people who want to peddle violent and hateful dogmas. Where people have no jobs, ISIL uses that as an excuse to commit terrible acts. Terrorism is a threat, and so is antibiotic resistance. The problem is a global one, and relates to the global public good. Dealing with it would help the poorest in the world more than anyone else, and we could easily justify using overseas development assistance funding from the Department for International Development, alongside commercial and public health service funding, to fund a network such as the one I described. I urge the Minister to take as broad as possible an approach when she considers what sources of funding could be used to confront the threat. It cannot be exaggerated.

Regulatory Reform

Jeremy Lefroy Excerpts

Tuesday 9th September 2014 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

I rise to support the order in general, while wishing to raise some serious concerns in Stafford and further afield in Staffordshire. I will not rehearse the circumstances there, other than to say that two of our hospitals, Stafford and Cannock Chase, are currently being integrated, the first with the University Hospital of North Staffordshire and the second with Royal Wolverhampton hospital, while at the same time an inquiry is being held into the entire health economy in Staffordshire. It is characterised as a fragile health economy—which it absolutely is—and we await the report, due in the next few days, with keen interest.

Four CCGs in Staffordshire—Stafford and Surrounds, Cannock Chase, Stoke-on-Trent and North Staffordshire —have come together to commission cancer and end-of-life services. Like all Members, I have no problem with the idea of improving outcomes for cancer patients. Together with Macmillan, the CCGs have consulted heavily with local cancer patients, and that extremely valuable work has raised many concerns about the co-ordination of services in Staffordshire that I share—constituents have come to me with the same concerns. That is all well and good and I agree with that work.

We have very strong concerns, however, over the proposal for improving those services. As I understand it, everywhere else Macmillan has worked with CCGs and NHS England, a co-operative and collaborative approach has been adopted to improve the co-ordination of cancer and end-of-life services. CCGs have to commission services from many different providers—37 in Staffordshire, I believe—so it is a complex operation and I understand why they want to simplify it, but in Staffordshire, instead of saying to existing providers, “How can we work better together? Could someone take the lead and work with us to provide better cancer and end-of-life services?”, the services have been put out to tender for 10 years. These services are worth £120 million a year, which is £1.2 billion over 10 years.

I have two major concerns and plan to make a direct request to the Minister at the end of my remarks. First, an extremely large reorganisation and tender process are being imposed on a fragile health economy that is going through an extremely difficult amalgamation of two hospitals into other trusts which we must support and must be done properly to ensure patient safety and quality of care. However, one of the acute trusts, UHNS, which will be taking over Stafford hospital and will effectively—there is no other alternative—be the one providing acute cancer services in the area, has also expressed grave concern.

As a result of that concern, I and other colleagues from Stoke-on-Trent and elsewhere wrote to the CCGs asking them at least to suspend the process until the extreme fragility of the health economy had been made more robust as a result of the dissolution of Mid Staffordshire NHS Foundation Trust. To date, that has not happened. There have been public meetings. I addressed one, with others, on Saturday in Stafford. I do not want to do down the work done with many patients in my constituency and others who want to see improvements in cancer and end-of-life services. I do not want that work to be lost at all, but I believe there are other ways to ensure that the co-operation and co-ordination are better.

My second point is about consultation. The shadow Minister raised important points. Does consultation have to happen independently in each of the CCGs involved in the grouping, or will it be done en masse, in which case, will there be assurances that the consultation will be balanced across all the CCGs involved? In this case, as I say, we have had quite extensive consultation with patients, but at the meeting I addressed in Victoria park in Stafford on Saturday, one cancer patient raised his concern that he had not been consulted. Members of Parliament from the area have not been consulted; nor indeed have the main providers of acute cancer care in the area—the University Hospital of North Staffordshire and, for the time being, the Mid Staffordshire NHS Foundation Trust. They provide very good cancer treatment and care, although the co-ordination and other services such as psychological counselling, financial advice and so forth could be considerably better in some cases.

There are serious questions about the consultation with all relevant bodies. The Health and Social Care Act 2012 states that the clinical commissioning group

“must make arrangements to secure that individuals to whom services are being or may be provided are involved”

in various ways, including

“in decisions of the group affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact.”

I believe that that has not happened in this case. It must happen, which is why I am asking for at least a suspension of the process until it has happened.

Page 6 of the fifth report of the Regulatory Reform Committee on the draft regulatory reform order refers to

“concerns about possible loss of protection”

because

“Joint committees would be able to take majority decisions on behalf of their constituent CCGs and NHS England, and so individual CCGs”

might find themselves increasingly concerned during the process, as I know a couple of them are at the moment. They could find themselves still heavily involved, having committed substantial financial resources, but as a result of the consultation and listening to their patients and their members they no longer want to go ahead with the process. They would probably be outvoted.

I conclude by asking the Minister to look very closely at this issue, which was featured in Private Eye this week. I ask that some common sense be brought to bear on the situation, if possible, and I ask for a slowing down or suspension of the process until we have a better health economy in Staffordshire and until we are clearer about the consultation process that needs to happen.

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[Norman Lamb]

I fully understand that we should always be arguing the case for greater openness and for greater legitimacy and accountability. All I am saying is that the system that we inherited had no local legitimacy at all, and that this is a significant improvement.

The shadow Minister talked about alignment with health and wellbeing boards. I think that that will almost always be the case. In my county of Norfolk, there are several CCGs, but all are operating within a health and wellbeing area and a local health economy. There may be circumstances in which more than one health and wellbeing board area is being considered, and I think that that is the case within the Manchester area and the discussions that are going on there. But in most circumstances, the sort of collaboration that we are talking about will be consistent with the health and wellbeing board area.

The shadow Minister also asked how CCGs will be held to account for joint decisions. When they act in joint committee, they will be subject to the same duties as when they act on their own and the accountability they face will be exactly the same. It is very important to reiterate that point.

The hon. Lady also raised concerns about the issues that Healthwatch England has raised, and I stress that the Department, NHS England and Healthwatch England are working together to ensure that CCGs have the materials and resources they need to support their effective and accountable collaboration and that local healthwatch organisations and others are supported to hold the system effectively to account. Everything on our side is about facilitating accountability at a local level, not undermining it.

My hon. Friend the Member for Stafford (Jeremy Lefroy) raised concerns about the issues in his area. I think that it is fair to say that they are not directly related to the proposals under the order, in that his concerns are about issues under the current arrangements rather than any potential impact of the proposed change. I want to reassure him that nothing in the order in any way undermines effective accountability for changes. I think it would be dangerous for me to go down the route of responding to the points he raises about his local circumstances, and I suspect that you, Mr Deputy Speaker, would rule me out of order if I tried to do so.

[Jeremy Lefroy]

The point I wish to make is that in our case the group of CCGs that is seeking to put out to tender the commissioning of end-of-life and cancer services appears to be abrogating its responsibilities for commissioning. These are clinical commissioning groups, yet they seek to put out to tender the commissioning of vital services for our constituents for 10 years. One might be concerned that the groupings would seek to do more like that.

[Norman Lamb]

My hon. Friend expresses a concern about what is happening at present and he is absolutely right as a local Member to challenge, question and hold to account the clinical commissioning groups in his area, but I do not think that there is anything in the order that changes the arrangements about which he is concerned. Indeed, I think that streamlining the system so that there is more effective accountability and less opaque decision making is better for local people.

Concerns were raised that joint committees might not meet in public. Joint working does not need to mean that it will take place behind closed doors and exactly the same responsibilities will apply to CCGs when they work jointly as when they work on their own or through committees in common. Indeed, I understand that committees in common have already on occasion met in public and I would always encourage accountable organisations to operate in public wherever possible. That is the approach that I seek to advocate.

In response to concerns raised by my hon. Friend the Member for Stafford, let me make the point that the requirements for service change that apply to a CCG regarding any major proposal for change will still apply, including that for appropriate consultation. Joint committees might want to consult jointly to co-ordinate their communications to patients and the public where appropriate, but the duty remains on the clinical commissioning group and it must demonstrate that it is meeting it.

The hon. Member for Blackley and Broughton (Graham Stringer) again raised concerns about the process going on in Manchester and he and I debated the matter in the debate to which he referred. I stress that his concerns are about actions taken under the existing regime, with a committee in common, rather than under the proposals in the order.

The hon. Gentleman expressed worry about the appropriateness of the order under the Legislative and Regulatory Reform Act 2006, but both the Regulatory Reform Committee and the Delegated Powers and Regulatory Reform Committee judged that a satisfactory case had been made for the LRO and that the order met the tests under the 2006 Act, so his concerns are misplaced. Although he has legitimate and genuine concerns about the process in Manchester and whether it is right for local people, I suggest to him that accountability will be encouraged and improved if the new system is less opaque and more clearly set out in legislation than the existing one. All the things about which he worries are happening under the existing arrangements.

It is up to CCGs to set out terms of reference for any joint committee arrangement, such as the scope for decision taking, and arrangements for membership or voting. They may also determine situations in which a CCG would wish to withdraw from a joint committee arrangement. The hon. Gentleman was worried that one CCG might feel oppressed or bullied by others, but it could set the terms of reference so that it could withdraw in defined circumstances, so his concern is misplaced.

My right hon. Friend the Member for South Cambridgeshire spoke about important improvements in democratic accountability and clinical leadership in commissioning, and the benefits that that secures. He asked about collaboration on commissioning not only between CCGs, or between CCGs and NHS England, but, critically, with local authorities and public health bodies. Such collaboration is facilitated, and he and I share the view that we should try to promote a more permissive NHS health and care system within which local arrangements may be put in place to ensure that the resources available throughout the health and care system are used as efficiently as possible. We should encourage such joint commissioning, rather than putting blocks in its way.

My hon. Friend the Member for Bedford (Richard Fuller) rightly talked about the tension that exists between local decision making and clinical best practice. This approach is all about managing that tension, rather than trying to pretend that it does not exist. He made the vital point, with which I agree, that people want health decisions to be taken locally, and we should try to facilitate open discussion and debate about the difficult choices that we sometimes have to make, rather than taking power away from people, which just undermines confidence in the system.

My hon. Friend asked about unanimity, so I repeat that if a CCG wants to enter into a joint committee arrangement, and protect its position on behalf of its local community, it can insist that unanimity is the basis on which decisions are taken. That is entirely a matter for the participating CCGs.

My hon. Friend asked about the cost and burden of the existing arrangements. We all understand the possibility of legal challenge, and there can be complex arrangements that involve organisations going through hoops to ensure that they meet their legal duties, perhaps by going back to their CCGs so that a decision taken in a committee in common may be endorsed. The more complicated those arrangements, however, the greater the risk of legal challenge, and therefore the cost, so simplifying in law the basis by which CCGs and NHS England can come together to make joint decisions, should they want to, improves accountability, makes the system less opaque and reduces the risk of unnecessary costs. I totally agree with my hon. Friend that this is not about the burden of localism. Localism is a burden worth carrying; it is not to be avoided. The burden is bureaucratic complexity and the involvement of lawyers—I speak as an ex-lawyer. The more we can keep lawyers out of it, the better, and I am sure many hon. Members would agree.

My hon. Friend made the point that not all consequences may be known at the outset and that things may change, but CCGs can set the terms of reference to provide for that if they choose to. The measure is absolutely permissive; it does not impose anything on anyone.

My right hon. Friend—sorry, my hon. Friend the Member for Totnes (Dr Wollaston). I thought something might have happened as a result of her election to the Chair of the Select Committee, but it will happen in time, I am sure. I am delighted that she supports the measure. She made the perfectly legitimate point that we ought to be encouraging and facilitating working across boundaries, both of CCGs and of the different organisations involved in health and care, to get the best possible use of the resource available for any local area.

Finally, I repeat that we take on board the concerns of Healthwatch England. We intend to work with that body to ensure maximum accountability for the decisions taken as part of these joint committees.

Question put.

Special Measures Regime

Jeremy Lefroy Excerpts

Wednesday 16th July 2014 Commons Chamber

[Mr Hunt]

First, let me reassure the hon. Gentleman on the last point. The trust has made it absolutely clear that the change in A and E will not happen until it is safe. It is very unlikely that it will happen in the near or medium term. The reason I did not mention his trust is that the statement was about the 11 trusts that were put into special measures exactly a year ago and his trust was not put into special measures until just before Christmas. It, too, is making progress. It has employed 31 additional nurses, it has an excellent chief nurse, whom I have met on a number of occasions, it has had a new chief executive since April and there is an increase in patient satisfaction. However, there is still a long way to go because it is a very challenged trust with some deep-seated problems. We need to support it at every step of the way.

[Jeremy Lefroy (Stafford) (Con)]

Today’s statement and the appointment of the chief inspector of hospitals arise from the Francis report on Mid Staffs in my constituency. I am sure my right hon. Friend acknowledges the great improvements that have been made at Mid Staffs thanks to the hard work of staff and others, but he will also acknowledge that the situation remains fragile. Will he ensure that both Stafford and the University Hospital of North Staffordshire are given the full support they need to come together and implement the recommendations of the trust special administrators in full, as a minimum?

[Mr Hunt]

I pay tribute to the staff in Stafford hospital. I also make the point that, even through the four years when those terrible examples of care happened in the hospital, much excellent care was happening, too, and the hospital had dedicated and hard-working staff. This has probably been tougher for them than for anyone else in the whole NHS. I thank my hon. Friend for the way in which he has campaigned for his local hospital. No one could have done more for their local services. I agree with him that we must implement the very detailed recommendations of the TSAs quickly and in full, and ensure that we give every bit of support necessary to both Stafford and UHNS to ensure that that merger works.

Oral Answers to Questions

Jeremy Lefroy Excerpts

Tuesday 15th July 2014 Commons Chamber

[Dr Poulter]

The right hon. Gentleman asks a valid question about how to make efficiency savings. Under the previous Government, there was a requirement in 2009 to make £20 billion of NHS efficiency savings during this Parliament, which is being delivered at £4 billion a year. Improving procurement practice at hospitals, improving estate management, greater energy efficiency measures, ensuring more shared business services in the back office and reducing bureaucracy are all measures that will continue to ensure that the NHS meets the challenge and frees up more money for front-line patient care.

[Jeremy Lefroy (Stafford) (Con)]

Stafford hospital has struggled with deficits for many years, but it has substantially improved its care. On Friday, however, it was announced that 58 beds will be closed due to staff shortages. My constituents and others are extremely concerned that the trust special administrator’s plans, which the Secretary of State endorsed, to keep A and E, acute medicine and many other services at Stafford are at risk. Will the Minister reassure them and staff that that is absolutely not the case and that the TSA’s plans will be enacted as a minimum?

[Dr Poulter]

The most important thing in delivering local services is to ensure high-quality patient care and patient safety, so I would want the TSA’s plans to be delivered as quickly as possible to ensure that high-quality services are delivered locally and that patients’ best interests are protected.

Patient Safety

Jeremy Lefroy Excerpts

Tuesday 24th June 2014 Commons Chamber

[Mr Hunt]

I do commend that, and it is excellent to see CCGs taking responsibility, because they control the NHS budgets. I think that is an excellent initiative, and I hope that other CCGs follow suit.

[Jeremy Lefroy (Stafford) (Con)]

May I commend my right hon. Friend on the work he has done on patient safety, while gently suggesting that perhaps the long-term, or even medium-term, aim should be to eliminate avoidable harm, rather than just halve it? In my case, in Stafford, we have seen huge improvements in patient safety since the very difficult times a few years ago, but I ask my right hon. Friend to bear in mind the hospital’s current situation, which is fragile, and to ensure that it is not left to its own devices, but that all the support necessary to maintain patient services during this difficult transition is given.

[Mr Hunt]

No Member of this House has done more for their local hospital than my hon. Friend, and I commend him on what he has done. We certainly will not leave that hospital to its own devices; we are following very closely what is happening. I want to pay tribute to him, too, on the issue of safety, because when the Francis report came out, he was one of the earliest voices saying, “Yes, this is about compassionate care, but it is also about safety.” I do not at all rule out the aspiration of zero harm and zero avoidable deaths, but that is a point we will have to get to step by step, and I am very proud that we are taking the steps that we are today.

Tobacco Products (Standardised Packaging)

Jeremy Lefroy Excerpts

Thursday 3rd April 2014 Commons Chamber

[Jane Ellison]

My hon. Friend is right to draw attention to the fact that standardised packaging is complex and far from the plain brown paper packs sometimes portrayed. Sir Cyril mentions that issue and draws a clear distinction in his report. I would welcome my hon. Friend making a submission to the consultation about the impact of this measure on employment in his constituency. That will of course be weighed in the balance, but it is important constantly to remind the House of the enormous economic impact of the burden of disease on our population.

[Jeremy Lefroy (Stafford) (Con)]

I welcome and support the statement, but what about the 196,000 children a year who take up smoking and who will not desist as a result of this measure? Can my hon. Friend give any feedback on the success of the measures the Government have already introduced in education and other areas to stop children starting to smoke?

[Jane Ellison]

I welcome my hon. Friend’s support for the statement and thank him for it. In April next year, tobacco displays will be behind closed doors, and tobacco vending machines have been banned. He will know that a great deal of money and effort has been put into education, and we are starting to see the fruits of that as the number of smokers in our country has dipped below 20% for the first time. The Government are always open to ideas about effective measures that will stop children taking up smoking in the first place, and I am always extremely happy to hear from my hon. Friend about that.

Care Bill [Lords]

Jeremy Lefroy Excerpts

Tuesday 11th March 2014 Commons Chamber

Brought up, and read the First time.

[Jeremy Lefroy (Stafford) (Con)]

I beg to move, That the clause be read a Second time.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

With this it will be convenient to discuss the following:

New clause 16—Powers of local commissioners in relation to TSA recommendations—

‘(1) In section 65DA(1) of the National Health Service Act 2006 (Chapter 5A of Part 2: Objective of trust special administration) omit “objective” and insert “objectives” and omit “is” and insert “are”.

(2) After subsection (1)(a) insert—

“(b) the continued provision of such of the services provided for the purposes of the NHS by any affected trust at such level, as the commissioners of those services determine.”.

(3) After subsection 1(b) omit “(b)” and insert “(c)”.

(4) In subsection (2) of that section after “The commissioners” insert “of the trust in special administration and any affected trust”.

(5) In subsection (4) of that section after “the commissioners” add “of the trust in special administration and any affected trust”.

(6) In subsection (9) of that section after ““commissioners” means the persons to which the trust provides services under this Act” add “and the commissioners of services at any affected trust”.

(7) In section 65F insert—

“(2E) Where the administrator is considering recommending taking action in relation to another NHS foundation trust or an NHS trust which may become an affected trust, the administrator shall engage with the commissioners of services at any such NHS foundation trust or NHS trust in order to enable those commissioners to make decisions pursuant to the matters set out in section 65DA.”.

(8) In section 651(1)—

(a) after “action which the administrator recommends that the Secretary of State” insert “or the commissioners of any affected trust“; and

(b) after “should take in relation to the trust” insert “or any affected trust”.

(9) In section 65K add—

“(3) Where the final report contains recommendations for changes to be made to services provided by an affected trust, the commissioners of services at that affected trust shall make a decision within 20 working days whether they wish to undertake public and patient involvement regarding all or any of the recommendations and, if they are so minded, shall comply with any arrangements for patient and public involvement agreed by those commissioners under this Act before making any final decision concerning the said recommendations.”.

(10) In section 65KA add—

“(7) Where the final report contains recommendations for changes to be made to services provided by an affected trust, the commissioners of those services shall make a decision within 20 working days whether they wish to undertake public and patient involvement regarding all or any of the recommendations and, if they are so minded, shall comply with any arrangements for patient and public involvement agreed by those commissioners under this Act before making any final decision concerning the said recommendations.”.

(11) In section 65KB(1)(d) after “that” insert “to the extent that the report recommends action in relation to the trust in administration”.

(12) In section 65KB(2)(a) after “decision” insert “in relation to any recommendations made the in relation to the trust in administration”.

(13) In section 65O add—

“(4) In this chapter “affected trust” means—

(a) where the trust in question is an NHS trust, another NHS trust, or an NHS foundation trust, which provides goods or services under this Act that would be affected by the action recommended in the draft report; and

(b) where the trust in question is an NHS foundation trust, another NHS foundation trust, or an NHS trust, which provides services under this Act that would be affected by the action recommended in the draft report.

(14) In section 13Q(4) at the end insert “save to the extent required by section 65K(3) or 65KA(7)”.

(15) In section 14Z2(7) at the end insert “save to the extent required by section 65K(3) or 65KA(7)”.

(16) In section 242(6)(b) at the end insert “save to the extent required by section 65K(3) or 65KA(7)”.’.

This Clause ensures that all commissioners of services affected by a trust special administrator’s report have the right to define local specified services; clarifies that, save for the trust in administration, local commissioners remain the decision makers for services they commission; and restores public engagement for changes other than for a trust in administration.

Amendment 30, page 102, line 31, leave out clause 119.

Government amendments 35, 36 and 11 to13.

[Jeremy Lefroy]

I wish to speak to new clause 6, which stands in my name and those of hon. and right hon. Members from across the House.

The new clause would give the Secretary of State some discretion to amend details of the final recommendations from Monitor regarding the outcome of the administration of an NHS foundation trust. As the law stands—so I am advised—the Secretary of State must either accept or reject Monitor’s recommendations in full. If they are rejected, there is another lengthy period of reconsideration. The result is that even if the Secretary of State broadly welcomes Monitor’s recommendations but has concerns about some matters of detail, it appears that he has to reject everything.

I have tabled this new clause as a direct result of my experience representing a constituency that has undergone the very first trust special administration of a foundation trust. I hope it will also be the last—at least in its current format. It has been a hugely time-consuming and costly process, and I would not wish it on any other community, constituency or Member of this House. The new clause would slightly improve the process, but what I would much rather see is a total rethink of the way in which the basic tasks of a trust special administration are carried out, both for NHS trusts and for NHS foundations trusts.

In my view, the relevant legislation—introduced by the previous Government and continued under this one—is not fit for purpose, but that is a debate for another day. In the meantime, I simply urge Monitor and the NHS Trust Development Authority not to put any other trusts—whether they be NHS trusts or foundation trusts—into the current form of administration. I urge everybody to work together on developing a system that enables trusts that are too small, such as the Mid Staffordshire trust, to be dissolved without having to go into a rapid, short-term and wholesale redesign of services. It can be done and I am certainly willing to work with anyone who wishes to design a better system.

I will not go into the full details of the administration of the Mid Staffs NHS Foundation Trust—that is a subject for a full debate on another day—but I will simply point out that it was made a foundation trust in 2008 on the recommendation of Monitor after a lengthy process, and that it is now being dissolved in 2014 on the recommendation of Monitor after a lengthy process. In paragraph 4.269 of his inquiry report, Robert Francis says:

“There can be no doubt that the Trust should never have been authorised as an FT”,

which happened in 2008. There must be a better way of doing things.

My new clause 6 would give the Secretary of State the power to accept the broad thrust of Monitor’s recommendations in the unhappy event of any future administration, giving her or him discretion to alter their detail without having to reject them in their entirety. The new clause therefore offers the Secretary of State flexibility and discretion in what is too rigid a process. I think that any Secretary of State would welcome that. A constant theme of the Ministers whom I have heard in my short time in Parliament has been that such and such an amendment would introduce too much inflexibility into the law. I am therefore doing exactly what Ministers long for, which is to offer them such flexibility.

--- Later in debate ---

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. Ms Walley, in fairness, interventions must be very short.

[Jeremy Lefroy]

I am grateful to the hon. Member for Stoke-on-Trent North (Joan Walley) for playing an extremely important and constructive role in this whole matter. She has been very supportive, and she makes some extremely important points. We need to look at the whole issue of administration, to which I will come in a few moments.

The Secretary of State’s decision to introduce the addition has given me considerable comfort about new clause 6, which I tabled before his decision, not being necessary. He does not seem to consider himself entirely constrained by the law into only accepting or rejecting Monitor’s recommendations in full; there is clearly room for proposing changes to details while still accepting the main thrust about the dissolution of a trust.

We shall of course need to see the results of the NHS review of consultant-led maternity services. If, as I hope, they are retained as a vital part of the regional health service—together with the level 1 special care baby unit, which serves a much wider area—it is important that finances are put in place to ensure that they are sustainable. I would therefore welcome clarification from the Minister about how the Department of Health now interprets the law.

If the Secretary of State’s decision on Mid Staffordshire demonstrates that the law allows for positive changes to the details of recommendations without Monitor having to go through another lengthy and legalistic process at a time when, as in the case of Stafford, a hospital is in a very fragile state, I welcome that fact, and new clause 6 will be unnecessary. However, if the Minister wants confirmation of the flexibility set out in the new clause, I would be happy for the Government to accept it or something similar.

Finally, to return to the question of trust special administrations, I believe that they are the right way to dissolve the legal entity of a foundation trust, but they are most certainly not the right way to redesign clinical services. That is not to criticise Monitor generally or the trust special administrators in the case of Mid Staffordshire—I believe that they acted within the remit given to them by this House—but we as a House did not get it right either in 2006 or in 2012. I urge a complete rethink, starting today.

[Andy Burnham (Leigh) (Lab)]

I rise to speak to my amendment 30. When the coalition came to office, it made a series of grand promises about future changes to hospital services. The coalition agreement proclaimed:

“We will stop the centrally dictated closure of A&E and maternity wards, so that people have better access to local services.”

GPs were to be put in the driving seat and given the power to shape local services. That was then; now we have a Secretary of State who has not just failed to stop centrally dictated closures but wants to legislate to make them much easier. What a difference four years make.

Clause 119 allows a hospital to be closed or downgraded simply because it happens to be near a failing one. It denies local people a meaningful say in those life and death decisions. It creates an entirely new route for hospital reconfiguration—top-down and finance-led. It subverts the established process in the NHS, which requires that any changes to hospitals should first and foremost be about saving lives, rather than saving money. It puts management consultants, not medical consultants or GPs, in the driving seat. By any reckoning, it represents a major change of policy from the one originally set out by the coalition.

--- Later in debate ---

The process and the consultation were atrocious. I stood outside a public meeting where 100 people were trying to get into a packed hall in which there were already 300 people. The police had to be called to escort the trust administrator into the room.

[Jeremy Lefroy]

In our case, we had a public meeting where about 400 people were outside trying to get into a meeting of 1,500 people.

[Heidi Alexander]

The experiences in Stafford and in Lewisham have probably been very similar. Multiple public meetings were run in a chaotic and haphazard fashion, and if I had not intervened in this particular meeting in Catford to try to calm the audience down and enable them to ask questions, I am not sure whether it would have been able to proceed.

We have heard about the quality of the consultation in Lewisham. The fact that the online consultation did not include a direct question about the closure of accident and emergency services and maternity services at Lewisham hospital beggars belief. My constituents were asked whether they agreed that acute services should be consolidated on four instead of five sites in south-east London. It is no wonder they came to me asking, “Where is the question about Lewisham A and E?” As my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) said, the consultation contained no direct question about the sale of two thirds of the land. There was a question about the sale of land at the hospitals that were placed in administration, but there was no such question about Lewisham hospital. We must be under no illusion that if clause 119 had been on the statute book at the time the administrator made recommendations about Lewisham hospital, its full A and E, its full maternity service and its excellent paediatric unit would now be closing.

Many people have said to me that I am somehow against change in the NHS, but nothing could be further from the truth. We have already heard about the successful changes to stroke care in the capital. They did not come about overnight, or over 45 nights or 75 nights; they came about as a result of clear and calm consultation and communication with residents. They came about as a result of clinicians, not accountants, being in the driving seat. The public rightly care about their NHS and the local health services to which they have access. As I said on Second Reading, that is because people experience the best and the worst moment of their lives in our hospitals. It is right that they have their say in a process that is fit for purpose, but an extended and augmented TSA process, which the Government propose through clause 119, is not the right way to take decisions of such significance and which excite such public interest.

The Government have tried to spin clause 119 as some sort of clarification of existing policy. That is nonsense. It is a direct result of the Lewisham hospital case that was heard in the courts. We know that the previous Government produced guidance that said that the TSA regime should not be used as a back-door approach to reconfiguration. This is a fundamental change in policy. It removes the legal protection that currently exists for successful hospitals located adjacent to failing hospitals that have been placed into administration.

The Government also claim that such a process would be used only in exceptional circumstances, but how do we know how often it will be used in future? I press the Minister to respond to the point made by the shadow Health Secretary about whether he has had any discussions with his officials about other hospital trusts being placed into administration and about applying the unsustainable provider regime elsewhere.

--- Later in debate ---

[Nick de Bois]

Yes, indeed. Again, I am trying to be as balanced as I can. I recognise that no single institution can stand in isolation, and I think that that is broadly accepted. However, to make decisions within 40 days on institutions, when we do not know which institutions will be affected or how they will be affected, is demanding too much of a service that is so valued by the public.

[Jeremy Lefroy]

Does my hon. Friend accept that there are some extremely important issues that cannot be resolved in 40 days, or even 400 days? For instance, the royal colleges are prescribing services that require more and more consultants to run rotas, which means that in district general hospitals it becomes even less possible to provide these kinds of services. These things are taken out of the hands even of politicians.

[Nick de Bois]

Indeed. My hon. Friend makes his point very well and I bow to his superior judgment.

I am also concerned about a point that was raised earlier. As everyone knows, I have absolutely no clinical or medical background, and it has always come as a surprise to me that I have spent so much of my time in the Chamber talking about these subjects. In business, there is a fairly simple calculation that assesses the solvency of a business; the strict definition is if someone is not able to meet their liabilities or knows that they are not able to do so in the short term, they are considered insolvent. They then go into administration and the processes kick in.

We are talking about a very different picture here in which a judgement has to be made about institutions that may or may not be considered unfit to continue. Under those circumstances—however much I accept that there are good intentions and not the devious plots that are being suggested—it means that much is left open to doubt. Therefore, it is with a very heavy heart that I will be on the other side when we go into the Lobby—when I have worked out which side that is. But I do so based on my 10 years of experience of what has been a very difficult exercise in my constituency.

--- Later in debate ---

[Dr Poulter]

I am very pleased that my right hon. Friend is reassured. I pay tribute to the tremendous work that he has done throughout the passage of the Bill in scrutinising and pushing the Government to ensure that we produce better, and good, legislation. I commend him for the work he has done on that.

It is important to point out that clause 119 makes a number of changes to strengthen patient, public and commissioner involvement in the process. In concluding, I shall draw out its important aspects. First, the clause would extend the public consultation period from six to eight weeks so that the public and others in the wider health economy can give their views and improve the recommendations. It would also give the administrator more time than the previous Labour Government did to produce draft recommendations, extending the period from 45 to 65 working days.

Secondly, the clause would allow a more holistic view to be taken of the wider local health system by allowing an administrator to make wider recommendations, but only as long as those recommendations are necessary for, and consequential on, primary recommendations about the failing trust.

Thirdly, the clause would widen consultation to affected trusts, their staff and commissioners. In addition—I thank my right hon. Friend the Member for Sutton and Cheam for suggesting this—we are providing in amendments 11 and 12 greater public and patient representation in the regime by requiring the administrator to consult local authorities and healthwatch organisations. That will ensure that the voice of local communities is at the front and centre of the administrator’s final recommendations. This important clause makes sure that patients and local commissioners are properly consulted. Indeed, we make sure that Healthwatch is put at the heart of everything that happens. The clause also improves arrangements for the administrator in seeking the support of commissioners affected by their recommendations, as we have discussed. That means that an administrator could develop recommendations that provide a solution for the future of failing trust services, ensuring that all those affected are fully involved. That has to be the right action.

We have heard a lot from Labour Members about the trust special administrator regime. Let us remember that this was their provision and their regime. We are putting in place measures that are true to their intentions when they put this in place, so that a trust is not thrown to the wolves when it meets their circumstances of severe failure. We will make sure that we always act in the best interests of patients. The right hon. Member for Leigh (Andy Burnham) is good at playing politics and good at spin. I am a doctor. I will always do what I believe is in the best interests of patients, and that is exactly what clause 119 will achieve.

[Jeremy Lefroy]

I beg to ask leave to withdraw the clause.

Clause, by leave, withdrawn.

New Clause 16

Powers of local commissioners in relation to TSA recommendations

‘(1) In section 65DA(1) of the National Health Service Act 2006 (Chapter 5A of Part 2: Objective of trust special administration) omit “objective” and insert “objectives” and omit “is” and insert “are”.

(2) After subsection (1)(a) insert—

“(b) the continued provision of such of the services provided for the purposes of the NHS by any affected trust at such level, as the commissioners of those services determine.”.

(3) After subsection 1(b) omit “(b)” and insert “(c)”.

(4) In subsection (2) of that section after “The commissioners” insert “of the trust in special administration and any affected trust”.

(5) In subsection (4) of that section after “the commissioners” add “of the trust in special administration and any affected trust”.

(6) In subsection (9) of that section after ““commissioners” means the persons to which the trust provides services under this Act” add “and the commissioners of services at any affected trust”.

(7) In section 65F insert—

“(2E) Where the administrator is considering recommending taking action in relation to another NHS foundation trust or an NHS trust which may become an affected trust, the administrator shall engage with the commissioners of services at any such NHS foundation trust or NHS trust in order to enable those commissioners to make decisions pursuant to the matters set out in section 65DA.”.

(8) In section 651(1)—

(a) after “action which the administrator recommends that the Secretary of State” insert “or the commissioners of any affected trust“; and

(b) after “should take in relation to the trust” insert “or any affected trust”.

(9) In section 65K add—

“(3) Where the final report contains recommendations for changes to be made to services provided by an affected trust, the commissioners of services at that affected trust shall make a decision within 20 working days whether they wish to undertake public and patient involvement regarding all or any of the recommendations and, if they are so minded, shall comply with any arrangements for patient and public involvement agreed by those commissioners under this Act before making any final decision concerning the said recommendations.”.

(10) In section 65KA add—

“(7) Where the final report contains recommendations for changes to be made to services provided by an affected trust, the commissioners of those services shall make a decision within 20 working days whether they wish to undertake public and patient involvement regarding all or any of the recommendations and, if they are so minded, shall comply with any arrangements for patient and public involvement agreed by those commissioners under this Act before making any final decision concerning the said recommendations.”.

(11) In section 65KB(1)(d) after “that” insert “to the extent that the report recommends action in relation to the trust in administration”.

(12) In section 65KB(2)(a) after “decision” insert “in relation to any recommendations made the in relation to the trust in administration”.

(13) In section 65O add—

“(4) In this chapter “affected trust” means—

(a) where the trust in question is an NHS trust, another NHS trust, or an NHS foundation trust, which provides goods or services under this Act that would be affected by the action recommended in the draft report; and

(b) where the trust in question is an NHS foundation trust, another NHS foundation trust, or an NHS trust, which provides services under this Act that would be affected by the action recommended in the draft report.

(14) In section 13Q(4) at the end insert “save to the extent required by section 65K(3) or 65KA(7)”.

(15) In section 14Z2(7) at the end insert “save to the extent required by section 65K(3) or 65KA(7)”.

(16) In section 242(6)(b) at the end insert “save to the extent required by section 65K(3) or 65KA(7)”.’. —(Mr Jamie Reed.)

This Clause ensures that all commissioners of services affected by a trust special administrator’s report have the right to define local specified services; clarifies that, save for the trust in administration, local commissioners remain the decision makers for services they commission; and restores public engagement for changes other than for a trust in administration.

Brought up, and read the First time.

Question put, That the clause be read a Second time.

Francis Report

Jeremy Lefroy Excerpts

Wednesday 5th March 2014 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

I was told by a senior member of the medical profession that the two Francis inquiries were the most important look at the NHS for at least two decades. He was right. The first, which was commissioned by the previous Government, revealed what Robert Francis describes as the

“appalling suffering of many patients”

primarily caused by a serious failure on behalf of the trust board, which did not listen sufficiently to patients or staff and failed to tackle an insidious negative culture involving a tolerance of poor standards. The second report, from the public inquiry commissioned by my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), described how

“a system which ought to have picked up and dealt with a deficiency of this scale failed in its primary duty to protect patients and maintain confidence in the healthcare system.”

It is a tribute to those who fought long and hard against the odds to have the inquiries and reports instituted by the last two Governments that their importance is recognised.

[George Freeman]

Does my hon. Friend agree that one of the most shameful episodes highlighted by the Francis report is the consistent and persistent neglect of the whistleblowers in the service who tried to raise the issues that were being hidden, and the systemic neglect of their interests? Many of them are still suffering, and this is still going on in Wales today. Will he invite the shadow Secretary of State to acknowledge that the problem is ongoing?

[Jeremy Lefroy]

I agree. The treatment of whistleblowers has been a disgrace, not just at Mid Staffs but in many other places. I have seen consultant contracts from way back that have prevented their raising issues even with their Members of Parliament, and I am glad to say that sort of thing is coming to an end. I want to try to focus as much as possible on the Francis report, however, as I believe there are many important lessons that all of us, including me, have to learn.

As the Health Committee has said, as a consequence of the issues I have outlined,

“a healthcare system established for public benefit and funded from public funds risks the undermining of its guarantees of safety and quality.”

It is my sincere hope that we never have the need for another inquiry of this nature. This should mark a watershed in the NHS—a time when patient safety and high-quality compassionate care is the rule, delivered through a positive and caring culture, underpinned by safety and quality management systems through our health service and backed by openness and accountability, which I am sure many Members will speak about later. It is thus that we can respect the memory of those who suffered at Stafford, but also in many other places across the UK, as the work of the right hon. Member for Cynon Valley (Ann Clwyd) has shown.

The Francis reports, and particularly the accounts of patients’ experiences, should be required reading for all medical and nursing students. I ask the Secretary of State to confirm that he will pursue that with Health Education England.

Robert Francis, for whom I have the greatest respect for the calm and understanding way in which he conducted the inquiry, made 290 recommendations, but I shall concentrate on his essential aims. He writes of fostering a common culture of putting the patient first. It is sad that he must write that, but it is necessary. However, before we rush to find fault with a service which has lost its way, let us just consider the society in which it operates, starting with ourselves. Can we honestly say that we always put our constituents’ interests first? What about others in the professional and business worlds? When self-interest and personal fulfilment are so often lauded, why is it that we expect the NHS to be so very different? Saying that is neither to excuse nor to lower the bar, but to understand how difficult it is in some circumstances to maintain that highest of standards. Ensuring that patients come first when dealing with several very ill and distressed folk, perhaps at 2 o’clock in the morning, takes more than just compassion. I am not downplaying compassion in any way—it is essential—but the underpinning of quality and safety systems carried through as second nature is also required. It means ensuring that the leadership is on call to provide extra help as soon as it is needed. It demands the strength to speak out for what is not acceptable and an openness to admit when there are problems. Without the systems and standards, the supportive leadership, the strength and the openness, not even an angel can always put patients first, much as they would wish to.

There has been much debate about staffing levels, and rightly so. Although the problems at Stafford went far beyond numbers, there is no doubt that cuts contributed to them. When I was first selected as parliamentary candidate in 2006, the trust had a £10 million deficit. It wanted to achieve foundation trust status and needed to balance its books, and part of its solution was to reduce the number of nurses. I should have questioned that, as should others, but we accepted the trust’s assurances that it would not harm patient care. I say to all right hon. and hon. Members that one thing that must come out of this report is that each of us must be emboldened to challenge our local trusts when they make statements such as, “This won’t harm patient care”, despite their cutting 100 or more nurses. The approach to staffing management and data publication used at Salford Royal NHS Foundation Trust has been held up as an example of good practice in staffing by the Health Committee and the Secretary of State, so let us act and adopt it everywhere.

I recall that when I was first elected to this House, I was shocked at the tone and content of some of the responses by the NHS to complaints. Not only did they take several months to arrive, but they were sometimes complacent, and they certainly lacked compassion and understanding. That has, for the most part, changed considerably for the better—it certainly has in Stafford. The overwhelming message I receive from my constituents who need to complain is that they are not interested in compensation, but they are interested in a better NHS for everybody. So let us approach the complaints system from their premise, not that of lawyers. That is the responsibility of the chief executive, who should review all complaints, and personally read and sign all response letters. The Secretary of State responds to several complaints each week personally and in this, as in many other ways, he sets the example.

Although I am encouraged by the progress made in treating complaints, I am less confident about accountability.

[Mr Cash]

Does my hon. Friend accept that it is clearly stated in the prime ministerial guidelines of 2005 that when somebody writes to a Minister who has responsibility, including the Secretary of State, the relevant Member of Parliament is entitled to receive a personal letter that comprehensively and efficiently deals with the question at issue? Does my hon. Friend also agree that, regrettably, that did not happen in all instances when matters were raised with regard to Stafford hospital?

[Jeremy Lefroy]

I thank my hon. Friend for that intervention and for all the work he has done on this issue. It is salutary for all of us to remember that when we get such a letter it often represents probably another 10 people who did not write to complain because they do not want to affect the NHS. We should treat each letter of complaint as being of immense importance.

I said that I am less confident about accountability, so let me say why. This is not just a question of the resignation of executives within a trust or the NHS when things go badly wrong, although it remains astonishing to me that no one has had the courage to do this given that the failings in Stafford were so clearly systemic; it also concerns the approach of the professional bodies representing nursing and clinical staff. The Francis inquiry saw evidence of poor co-operation with the General Medical Council from other organisations, including royal colleges, even though serious matters of fitness to practise and patient safety were involved; they almost put the practitioners above the patients. Those representing the medical and nursing professions are accountable to the public first and foremost. The best way of maintaining public confidence in their professions is to ensure that they treat their members who are not fit to practise in a firm, fair and swift way; cases of doctors or others being suspended for months or even years are too frequent.

Before I discuss Stafford specifically, may I just make a few remarks about hospital standardised mortality ratios? The Francis report states that Professor Jarman

“made it clear that it is not possible to calculate the exact number of deaths that would have been avoidable, nor to identify avoidable incidents…The statistics can only be signposts to areas for further inquiry.”

I urge all those who handle HSMRs to do so with care. They are extremely important as guidelines, and it was absolutely right that they were the first statistics that showed up the need for the Healthcare Commission inquiry, but to extrapolate numbers from them can be difficult and the evidence does not necessarily bear it. We have seen examples of that happen.

[Kate Green (Stretford and Urmston) (Lab)]

I am grateful to the hon. Gentleman for mentioning that point. Does he agree that an important task of public education needs to accompany the transparency around such statistics, because they are complicated and, as he says, they are a signal but not a whole story in and of themselves? Has he any suggestions as to how we could enlarge that public education and understanding.

[Jeremy Lefroy]

I thank the hon. Lady for her intervention, but that task is probably beyond my competence. I agree that we should use HSMRs and respond to their signals, but we should not say that they are the final judgment on specific numbers. Any HSMR that looks difficult and looks as though it needs to be investigated must be investigated—it is much better to do so than not to do so.

I will now discuss my own constituency, which, along with those of my hon. Friends the Members for Cannock Chase (Mr Burley), for Stone (Mr Cash) and for South Staffordshire (Gavin Williamson), has probably been the most affected. The spotlight has been on Stafford hospital for several years now, and it has been an extremely difficult time for those who raised their concerns, such as Julie Bailey and Cure the NHS, which were dismissed in a very offhand way by the NHS system and for which they endured abuse; it has also been extraordinarily testing for the many people working at that hospital and the one in Cannock, who have tried to carry out exemplary care at a time when the spotlight has been on them. They have, by and large, brought excellent care to patients, despite what has been going on around them. Understandably and rightly, the Care Quality Commission carried out an unannounced visit on the very day last week when it was announced that the Mid Staffs trust would be dissolved, so hon. Members can understand the sort of pressures that staff have faced. The great improvement that has been made has been recognised by the CQC and, most importantly, by patients and their loved ones. There is no complacency; there are still instances that should not happen, and the hospital and the trust are determined to ensure that they learn from all those. For Stafford and Cannock, however, it has also been a time of coming together and putting aside differences, as tens of thousands of people have worked together to save our hospitals and their services.

I will not dwell at length now on the process, the administration and the dissolution of the trust announced last week, but I will seek a debate on it, because some of the points made by the Opposition spokesman, the right hon. Member for Leigh (Andy Burnham), are fair in respect of the way the process works—or does not work. I have been critical of it and will continue to be so. I will, however, dwell on the unity. I have marched twice, not only with people who have had wonderful care at Stafford, but with some who have told me that they, too, experienced very poor care at Stafford but wish, for the sake of everyone, to see both patient safety and care improved, and services protected. Last week, the trust’s dissolution was announced, and although most services will continue, I continue to oppose decisions that mean the potential loss of consultant-led maternity services, consultant-led paediatrics and in-patient paediatrics. I will continue to fight for those services, because I believe they are essential in a hospital and a place that is at least 30 km away from the nearest other possibilities for patients. I urge NHS England, in particular, to take the consultant-led maternity review very seriously indeed.

[Robert Flello]

I pay tribute to the hon. Gentleman and the hon. Member for Stone (Mr Cash) for the work they have done. On those maternity and other services at Mid Staffs, may I say that the hon. Gentleman has support in Stoke-on-Trent South?

[Jeremy Lefroy]

I am most grateful to the hon. Gentleman, to all the Stoke-on-Trent MPs and to the hon. Member for Newcastle-under-Lyme (Paul Farrelly) for the way in which they have approached this matter together with us. We will be working with them under the new trust arrangement, with the University Hospital of North Staffordshire NHS Trust, and it is very important that we work together.

I refer to unity because the only way in which we will develop a health service fit for the 21st century is by showing that same unity of purpose nationally. I pay tribute to my hon. Friend the Member for Bracknell (Dr Lee), who is no longer in his place, for his remark about working together, and I absolutely agree with it. When the Prime Minister and the Leader of the Opposition, and later the Secretary of State and his shadow, have made their responses to the Francis report in the past year, they have been of the highest quality; they have shown a true appreciation of the gravity of the subject and the importance of a mature response.

[Sir Tony Baldry (Banbury) (Con)]

On the proposed reorganisation of services in Staffordshire, what is the role of the clinical commissioners? I thought that if we moved to a commission-based NHS, commissioners would determine what services were provided at which hospitals.

[Jeremy Lefroy]

My right hon. Friend makes an extremely important point. Indeed, the clinical commissioning groups have backed the changes, but the local population has not. The clinical commissioning groups are in a difficult position, because they have a budget, and the budget in Staffordshire, as in many other rural areas, is much lower than the national average for England. They are told that if they want to commission services that cost more than the tariff—as maternity services almost always do because maternity tariffs are simply not high enough—they will have to pay the extra. To some extent, the clinical commissioning groups are caught between a rock and a hard place. They may wish to commission those services, but in doing so they will have to stop commissioning others.

It is in the spirit of unity that I ask both the Secretary of State for Health and his shadow to visit Stafford and Cannock Chase hospitals to speak to patients and staff and to hear first hand what they have gone through. I also urge that same co-operation in approaching the long-term challenges facing our health service. The increasing specialisation of services—62 specialties as against 30 in Norway—is driving up costs and resulting in clinicians knowing more and more about less and less.

In Stafford, we have been told that we cannot continue with our consultant-led paediatric service, because we have too few consultants—five or six as opposed to the eight to 10 that the Royal College of Paediatrics and Child Health says are needed to maintain a rota. By that standard, some 50 or more other consultant-led departments in England should close. Instead of a proper national review with full political co-operation, however, we see the gradual picking off of departments in trusts that have financial difficulties. The same is true with maternity services.

I echo the point made by my hon. Friend the Member for Bracknell and urge the Government and Opposition to come together with the royal colleges and resolve this matter and much else. The British public are not stupid. They understand that they cannot have every service just around the corner. However, they do not understand why a consultant-led maternity department or paediatrics department in one place must close on safety grounds because it does not have a large enough rota, whereas another with a smaller rota remains open. They also understand the need for more services in the community, but the idea of “slashing” hospital budgets, as Sir David Nicholson is reported in The Guardian as saying, is both incomprehensible and deeply worrying to those whose A and E departments are heaving, whose wards are full and whose children face travelling long distances even to receive general treatment.

[Andrew Griffiths (Burton) (Con)]

I thank my hon. Friend and neighbour for giving way, and I commend him for his work on this issue. He will know that Queen’s hospital in Burton has dealt with some of the overflow from Stafford hospital following the closure of facilities and services there. Does he share my concern that the special administrators have not met any of the management at Queen’s hospital, and have ignored its letter of concern, stating that closure of the emergency department will mean that it will require an additional 18 to 34 beds? The hospital has heard nothing in response to that letter.

[Jeremy Lefroy]

I am grateful to my hon. Friend for making that point, which is one of the things that needs to be discussed. I am talking about special administrators liaising with other trusts such as the University Hospital of North Staffordshire NHS Trust, the Burton Hospitals NHS Trust, Walsall Healthcare NHS Trust and the Royal Wolverhampton Hospitals NHS Trust. We are part of an integrated health economy; what affects one affects many others in the region.

Many in the profession have put it to me that we are at risk of gradually losing the skills of general medicine and surgery. That is not to downplay specialisms, because they are vital. However, unless we maintain our district general hospitals, with their ability to deal with the majority of non-specialist cases, we will end up with our specialist hospitals being overwhelmed and without doctors with vital general skills.

It would be disingenuous of me to make such points without raising the matter of NHS funding. The Government are right to have maintained NHS funding in real terms during extremely testing times. They are also right to insist that waste is rooted out. Payments of thousands of pounds to locums for a shift are not uncommon. I could cite many other examples, but there is no time. There is little doubt in my mind that we need to allocate a little more of our GDP to health than we do currently, as we are below the level in France and Germany. However, that is a question for lengthy debate on another day.

As I have said in the House before, we need to take the NHS budget out of general Government spending and convert national insurance into a national health insurance, which will still be progressive and still based on payment according to income, so that we can maintain a first-class health service alongside a competitive tax system.

The Francis report is already having an important and positive effect on the national health service and will do so for years to come. I pay tribute to my right hon. Friend the Health Secretary and his team for all they have done on that and the seriousness with which they have taken the matter. The emphasis on the safety of patients and quality of care seems obvious to us now, but sadly it was not always a priority. The report not only provides answers and makes recommendations, but asks fundamental questions about the future of our NHS. I have tried to outline some of those questions today. I urge all parties to come together to tackle them for the good of our nation.

--- Later in debate ---

[Joan Walley]

My hon. Friend makes a good point, and I see nods on both sides of the House. We have a tariff system and there are extra needs in more vulnerable and deprived areas. The nonsense in accident and emergency services is that hospitals are criticised and penalised for treating too many patients when we have seen how GP appointment systems are breaking down. That goes back to the recommendation in the Francis report that NHS provision should be looked at in the round and in its entirety. The trust special administrator just looks at the detailed finances and the assumptions that underpin the finances. That is wrong, and that is what we should concentrate on.

[Jeremy Lefroy]

Does the hon. Lady agree that there is a serious problem with acute tariffs that have generally been cut by 4% in real terms every year, and have been for some time under this and the previous Government, compared with the tariffs for elective cases that seem to result in much more profitable work for hospitals? The more acute care a hospital provides, which is vital for the local population, the less likely it is to be financially sustainable.

[Joan Walley]

I agree, and in the many meetings that north Staffordshire MPs have had with the University Hospital of North Staffordshire, the hon. Gentleman has made that point, as we all have frequently. We have also said that it is incumbent on us to relay that to the Government, because unless there is a shift and some recognition that the funding assumptions are flawed, no matter who is on the trust board of any new hospital, they will never be able to provide the necessary genuine health care.

--- Later in debate ---

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I believe that the Francis report is becoming a major turning point in the life of our national health service, which is one of our great institutions and is probably treasured above every other institution that the British people hold dear. The Francis report has moved the NHS from being a rather impenetrable bureaucracy into something that is much more fallible, human and compassionate.

The Francis report highlighted the failings at Mid Staffordshire NHS Foundation Trust and stated that they were very much the result of a failure of leadership. As Francis said:

“The patient voice was not heard or listened to, either by the Trust Board or local organisations which were meant to represent their interests. Complaints were made but often nothing effective was done about them.”

Damningly, he found:

“There is no evidence that the substance of any complaint was ever raised with the Board.”

I shall come back to that point later. He also said:

“Such an approach completely ignored the value of complaints in informing the Board of what was going wrong, and what, if anything, was being done to put it right.”

As Members have been saying, this reflected a culture of denial about failings and complaints not just at Mid Staffs, but across much of the NHS. We know that the problems were wider than this one trust. In a report last year the parliamentary and health service ombudsman, whose office is the responsibility of the Committee that I chair, the Public Administration Select Committee, carried out a survey of 94 trusts from across England and found that only 20% of boards were reviewing learning from complaints and taking resulting action to improve services; less than half were measuring patient satisfaction with the way complaints were handled; and less than two thirds were using a consistent approach to reviewing complaints data. One other finding, from memory, was that only 2% of trusts were considering complaint handling as a strategic issue to consider during a trust board awayday.

[Jeremy Lefroy]

Will my hon. Friend share his reaction to the news that the parliamentary and health service ombudsman is taking far more seriously complaints brought to her and instigating far more investigations than two or three years ago?

[Mr Jenkin]

Yes, I welcome that. My Committee works closely with the PHSO, Dame Julie Mellor. I paid a visit to the PHSO’s office in London last week and listened to some of the complaints coming in by telephone. We have a lot to learn from the way she is changing things, but there is a lot we need to do to bring the institution of the ombudsman into the 21st century. My Committee is working on a report to be published shortly, which will make recommendations on that.

The role of boards in the leadership of NHS trusts has not been given sufficient attention. Many boards are changing their practices and improving, but the research that we have been given suggests that the chairman of the board of a trust is the most important person in setting the tone of the organisation. We inherited a system where executives took all the decisions and the role of boards was to oversee. No. In the private sector, the chairman of a company, even the non-executive chairman of a company, is the most crucial person for setting the tone, the values and the atmosphere in the organisation. We need to lay much more emphasis on the leadership of trust boards.

The Francis report prompted the NHS, Government and Parliament to question the prevalent management culture in the NHS, and it is the main reason why we are looking not just at the ombudsman, but doing an inquiry into how complaints are handled not just by the NHS, but by Government Departments and across public services. As part of our inquiry we took evidence from Sir David Nicholson, the chief executive of NHS England, and Chris Bostock, head of NHS complaints at the Department of Health.

The ombudsman told us that she found what she called a “toxic cocktail” within some NHS hospitals which combines a reluctance by patients, carers and families to complain, with a defensiveness on the part of hospitals and senior staff to hear and address those concerns. In oral evidence to our inquiry, Sir David accepted that when he said:

“I do think there is a real issue about defensiveness and a lack of transparency in the way that we work”,

and he accepted that complaints are important for learning and improving.

A great deal has been said in this debate about processes, procedures, legal sanctions, rules and accountability, but those are for when things go wrong. What we want in our health service is a culture of listening, understanding, caring, learning and supporting. I shall say a little more about that. Sir David said that the need for openness is not always recognised in the NHS. He went on to say that

“we are publishing lots of data and information and people can connect together through social media and all the rest of it, things are opening out, but the leadership of the NHS…is having difficulty coming to terms with that and”—

a rather nice little understatement—

“is slightly behind it.”

He accepted that that came down to leadership and culture. In a powerful admission from somebody who has been at the heart of the NHS for so long, he said:

“Undoubtedly, in broad terms, the NHS leadership is not equipped to handle some of the big issues that are coming forward, so we need to tackle that leadership. We need to work really hard on the culture of the system overall, because as you are going through that transition the importance of setting the right tone from top to bottom of the organisation is increasingly important…You need to make sure that you are learning the lessons and getting innovation from the system as a whole.”

I am bound to add that, at the end of the session, I asked him about his own leadership. It is a credit to him that he explained that the diagnostic process that NHS leaders go through had been applied to him. He said:

“What it said about me was that first of all I was strong on the pace-setting. Give me a target and I will make it happen…Secondly, the feedback was that I was good at setting out a vision of what the future might look like. My weaknesses were around facilitating and coaching, and actually they are the issues that in a modern NHS will be much more highly prized than perhaps the last one.”

I know that Sir David Nicholson has come in for an awful lot of stick and criticism, but there was a degree of self-knowledge there, and he expressed much regret in front of our Committee for what he had missed.

Francis recommended changes to the law, and the Government are implementing those recommendations. However, I agree with the Select Committee on Health that enshrining duties and standards of care in statute is simply not enough. In fact, statutory changes are almost irrelevant to the day-to-day life of people working in the NHS. The word we hear often is “culture”, and that is what needs to change and is changing. The key change needs to be to attitudes and behaviour within the NHS, particularly among those in leadership positions, who set the tone of the organisation that they lead. Leadership is central to that—not just the leadership of trusts, but leadership across the organisation at all levels.

The Secretary of State is right to emphasise the importance of compassion in the NHS and the need to support those who are required to show compassion every day. Management need to feel and respect that compassion and reflect it in how they treat their staff, otherwise, as one colleague said to me, patients become objects, not people. The way health care staff feel about their work has a direct impact on the quality of patient care as well as on an organisation’s efficiency and financial performance. If those in the upper tiers of management are not also involved in feeling compassion for the patient, they place too great a burden of compassion on front-line staff. The people on the front line need support from those up the management chain, and compassion has to come from the top.

High-quality, patient-centred care depends on managing staff well, involving them in decisions, listening to what they have to say, developing them and paying attention to the physical and emotional consequences of caring for patients. Funnily enough, that point was made by a commercial witness to the Public Administration Committee’s inquiry into complaint handling, Mark Mullen, the chief executive of First Direct. He told us that

“there is a relationship between how you treat your people and how you ask or expect or want your people to treat their customers…it is virtually impossible to create a positive outcome with customers unless you have created a positive relationship with your own employees.”

I wish to leave the House with that serious thought—how NHS staff feel about their work has a direct impact on the quality of patient care, as well as on efficiency and financial performance. That is what this is about.

I am taking a close interest in the NHS leadership academy, which the Secretary of State referred to. It clearly has a clear role to play, although it is very small at the moment. It deals only with potential trust chief executives—senior leadership in challenging roles. It is early days, and we need to involve the academy with trust boards, trust chairs, the leadership of NHS England and even the Department of Health. The academy must give priority to the values of compassion, openness and transparency, listening to and learning from complaints and accepting and learning from failure. It is not about people going off to Harvard, learning how to develop fantastic strategies and coming back with a personal vision that they impose on their organisation. That is not the kind of leadership the NHS needs, and indeed, such leadership does not work in business either. That is true not just for a few leaders, but for every leader of every team in every trust and GP practice in NHS England and the Department of Health. It is a much bigger agenda for the NHS leadership academy than currently envisaged, but we need that ambition if there is to be speedy and permanent change in the culture of the NHS, the attitudes of the people in it, and the way they behave.

There is a great deal of excellent practice in the NHS, as in most large organisations, but it does not seem to be gathered in any systematic way so that learning can be shared. One consequence of that is that there does not seem to be a shared understanding of the kind of leadership that makes excellent practice more likely. Despite the scale and complexity of the health service, there is a common commitment to compassionate, safe, sustainable care among clinicians, managers, trusts, chairs and regulators, which could be the foundation for building a shared understanding of good leadership and practice. None of this will be a quick fix, but many building blocks of good practice are already in place. Gathering that learning together would strengthen and hearten leadership across the NHS. I believe that that is the real role of the NHS leadership academy as it builds its capacity, and I look forward to its developing in the future.

Oral Answers to Questions

Jeremy Lefroy Excerpts

Tuesday 25th February 2014 Commons Chamber

[Norman Lamb]

The review being undertaken by NHS England will report in March. I agree that that situation is intolerable, but I have made it very clear on many occasions that there is an institutional bias against mental health in the NHS. Interestingly, the Health Committee report on deficits in 2006-07 specifically made the point that mental health was particularly targeted, so that always happens when NHS finances are tight. However, it cannot happen, because there has to be parity of esteem, including in the way in which money is distributed in the NHS.

[Jeremy Lefroy (Stafford) (Con)]

In Stafford hospital, many young people with mental health problems are extremely well treated in normal in-patient wards. That should not be the case, but no other facility is available. What will happen if those in-patient beds are no longer there?

[Norman Lamb]

As far as possible, we should be trying to ensure that children with mental health crises can remain at home; it does not make sense, in very many cases, to put them into in-patient care. However, we have made it clear, as has NHS England and as was confirmed in the crisis care concordat last week, that beds should be locally available whenever they are needed.

NHS

Jeremy Lefroy Excerpts

Wednesday 5th February 2014 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

First, I want to praise all those who work in accident and emergency departments up and down the country to provide a vital full-time 24/7 service locally and nationally. Many Members have already pointed out that it is almost a year since the Francis report was published. Its reception in the House demonstrated one of the best examples of cross-party respect from the Prime Minister and the Leader of the Opposition and, subsequently, from my right hon. Friend the Secretary of State and the shadow Secretary of State. I would like to see that cross-party support being built on.

I should also like to praise the Secretary of State for the work that he has done to take the recommendations forward. He has mentioned some of them today, including those relating to the chief inspector of hospitals, to social care and to general practice. Many more aspects of the report have already been mentioned, and there will no doubt be more to come. I must stress, however, that we need to have a proper debate on the Francis report now, one year on, in Government time in the House, to see where we have got to.

I also pay tribute to all those people who did the work that enabled the Francis report to come about. They include Julie Bailey, Helene Donnelly and the many others who worked with Cure the NHS, and all those in Stafford hospital who have subsequently responded to the report to make the hospital a place that I am proud to say now provides some of the best care in our region, including those in the A and E department. We have, however, lost our 24/7 A and E department; we now have a 14/7 A and E department. That is something that we are going to have to look at again; we need to look at how we are to cover the out-of-hours emergency care in our area. Nevertheless, we now have some of the best A and E care in the region, because it is consultant led. We now have sufficient consultants to cover that service.

I want to make four points that I believe need to be taken fully into account in this debate on A and E services. The first is about doctors. The Secretary of State has already mentioned the problem with recruiting people into emergency medicine. It is not seen as the most attractive career, perhaps because of the shift work involved. We need to look at the whole training structure. Perhaps it would be better for trainee doctors to spend more time in accident and emergency departments in their foundation years. Perhaps we should add a third foundation year in order to enable them to spend more time in A and E, because that is surely where they will learn most about this kind of medicine.

We also need to look carefully at the role of specialisms in the NHS. Although that would be the subject for a whole other debate, it is very important, because we have more than 60 specialisms in this country, compared with about 20 in Norway. Their increasing role means there is a need to maintain a full-time specialist rota of up to 10 consultants, which is placing increasing stress on the finances of the NHS. That is true in A and E, as elsewhere. That is a subject for another day, but it is a very important point.

Another area to mention is demographics, although I will not go on at length about it because the facts are known to us all. In Staffordshire, we are expecting the number of over-85s to double and the number of over-60s to go up by 50% in the next 25 years. There is no doubt that we have reached a tipping point, particularly as the baby boomers enter their retirement years, and that is not recognised. It is not just a straight line graph; there is a bit of exponential growth in the number of older people now coming in to our hospitals. That is to be expected.

[Yasmin Qureshi]

I agree with everything the hon. Gentleman has said so far. Will he also consider the fact that A and E waiting time rises have also been caused by: the effect of walk-in centres closing; the closure of NHS Direct and its replacement by the botched 111 system, which has not helped anyone; and a real cut in adult care, which has meant that a lot of elderly people have been taken to hospitals, instead of being cared for at home, and they cannot be released unless they have somewhere safe to go to?

--- Later in debate ---

[Jeremy Lefroy]

I have no doubt that some of those things will have caused increased pressure. That brings me nicely to my next point.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

My hon. Friend may not be aware that a briefing was given by the College of Emergency Medicine to Members of Parliament. One of its representatives, I believe it was Dr Mann, was asked by hon. Members about the closure of walk-in centres and he replied that there was an initial blip but that levels went back to what they were before. So in his view those closures made very little difference.

[Jeremy Lefroy]

We do not have sufficient data on this. I urge the Government to examine how we can collect more data about the reasons why people come to A and E and whether their visits could have been prevented by other provision. I am sure that that can be done in some cases, but at the moment we are arguing at cross purposes because we do not have sufficient data.

Another point, on the lack of integration, relates to discharges. There is pressure on hospitals to discharge people, particularly the elderly, because of the pressure on beds. One GP in my constituency raised this issue, citing one of their patients who was improperly discharged and saying that they were very distressed at the condition in which they found him. Stafford hospital has come up with a solution, which it will implement shortly, whereby every patient with complex needs will not be discharged unless it is absolutely clear that they have proper care in the community to go to. We would expect that for all patients, and I am very glad that Stafford hospital is taking that up.

The final reason to mention is that patients are often confused about where to go, and I am therefore glad that the Government have undertaken a review of the classification of A and E departments. We have A and E departments, urgent care centres and minor injuries units, and we have various grades of A and E. We need a national classification that makes it clear what services people can get at which point. Often people turn up and find that they have come to the inappropriate place.

I also wish to make a few remarks about the competition matters that have been raised in the debate, and I do this from a local perspective. The trust special administrators for the Mid Staffordshire NHS Foundation Trust have proposed that Stafford hospital should merge with University Hospital of North Staffordshire in Stoke and that Cannock hospital should merge with Wolverhampton’s trust. That is the right solution, it is not being opposed and we are not finding any problem with competition law. There is a big difference between the acute and non-acute sectors. As the acute sector runs in a tight way around the country, it is very difficult to see how there can be much competition in provision within it, because that has been provided exclusively by NHS trusts up to now. Within the non-acute sector we have found in my constituency that, under competition rules, an NHS service that went to the private sector under the previous Government has come back into the NHS under this Government, because it was determined that the NHS would provide a better service. So this does work both ways; it does not always go the way some people think it might.

We must not lose sight of the real hard work that people are doing in A and Es up and down the country. Almost all the work that goes on there is incredibly good and is what our constituents need, but we must make sure that the points that I and others have outlined are dealt with, because with the demographics going the way they are, we will face increasing pressures year on year.