Acute Hospital Wards (Staffing)

Jeremy Lefroy Excerpts

Wednesday 15th January 2014 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I pay tribute to the dedication and commitment to safe staffing and minimum staffing levels that my hon. Friend the Member for St Ives (Andrew George) has shown over the last year. I have much enjoyed our many conversations about the matter, and although he understands that we have different views about the right thing to do, both he and we are coming from the right position, which is about ensuring that we properly respond to the scandals exposed as a result of the Francis inquiry into Mid Staffs and ensuring we support all staff and hospitals to look after patients.

[Jeremy Lefroy (Stafford) (Con)]

Given that one of the problems at Stafford hospital in the mid-2000s was a sharp reduction in the number of nurses in order to cut costs, will my hon. Friend and the Department of Health be looking at cases where trusts substantially reduce the number of nurses at one point to see whether that constitutes a risk to safety?

[Dr Poulter]

As I will come on to say, if my hon. Friend will bear with me, it is now a matter for the CQC to inspect trusts on issues such as quality of patient care and safety. I will outline those measures later in response to my hon. Friend the Member for St Ives.

It is important that we support staff as much as possible when they raise concerns, whether about minimum staffing levels or other quality-of-care issues—this was the point just raised by my hon. Friend the Member for Stafford (Jeremy Lefroy)—and to do that we are facilitating and enhancing a duty of candour on trusts to ensure a more candid and open approach and to ensure that staff who have concerns are better supported and are better able to raise them.

Turning specifically to the matters at hand, superficially the principle of minimum staffing ratios sounds seductive, but when it comes down to it, we will see that they do not guarantee safe staffing or care. For those reasons, the Government do not support them. The principle of good care is about having the right staff in the right place at the right time. As we will all be aware, the needs of patients can change not just daily, but hourly—a patient can rapidly deteriorate—and just having ticked a minimum-staffing box does not mean that the right care is necessarily being applied. The lesson to learn from Mid Staffs is that we followed the bureaucratic tick-box approach and that led to failings in care, and that just ticking boxes saying we have done something, however seductive or good it might sound, does not necessarily mean that patients are being treated right. That is a matter of clinical circumstances and the clinical judgment of staff.

Mid Staffordshire NHS Foundation Trust

Jeremy Lefroy Excerpts

Tuesday 7th January 2014 Westminster Hall

[Jeremy Lefroy (Stafford) (Con)]

Thank you very much, Mr Crausby, for calling me to speak. It is a pleasure to serve under your chairmanship. Given the interest of several colleagues from the Staffordshire area, with your permission I will take a number of interventions in the course of making my remarks.

On 18 December, the administrators of the Mid Staffordshire NHS Foundation Trust published their final report. It recommended the dissolution of the trust as soon as possible and the absorption of Stafford and Cannock hospitals into the University Hospital of North Staffordshire NHS Trust and the Royal Wolverhampton NHS Trust respectively. It also set out proposals for the services that would continue to be offered at both Stafford and Cannock. The total cost over three years would be £220 million, of which £63 million is revenue and £157 million capital.

Let me first address the proposal to dissolve MSFT. I believe that is the right thing to do. It will enable both Stafford and Cannock hospitals to work much more closely with larger specialist teaching hospital trusts. They will both then be able more easily to recruit clinical staff who see greater opportunities for skills development within a larger organisation working across two or more sites and overhead costs will also be reduced.

However, the administrators’ proposals do not go far enough in ensuring that the interests of those who currently use MSFT are fully taken into account. Monitor and the Secretary of State clearly need to state that the expanded trusts should immediately recruit suitable non-executive directors from the areas served by MSFT, such as Stafford, Cannock, Penkridge, Rugeley, Stone, Brewood and so on, to ensure that those areas are properly represented.

[Paul Farrelly (Newcastle-under-Lyme) (Lab)]

Under the proposals, the University hospital of North Staffordshire will take over Stafford hospital. North Staffordshire hospital has a deficit at the moment, caused by reopening beds to cope with blockages in A and E and in admissions. Does the hon. Gentleman agree that in taking over Stafford hospital, it is very important and in the interests of everybody—everybody in Stoke-on-Trent, Newcastle-under-Lyme and Stafford—that the University hospital of North Staffordshire has the prospect of attaining financial stability?

[Jeremy Lefroy]

I thank the hon. Gentleman for his intervention and I entirely agree with him. I would see the situation more as two hospitals coming together, but it is vital that the financial difficulties that UHNS is facing are sorted out. I particularly urge the Government to look at the private finance initiative cost, which is too great for that particular trust.

[Joan Walley (Stoke-on-Trent North) (Lab)]

I am most grateful to the hon. Gentleman for giving way and I congratulate him on securing the debate. May I point something out for the record, so that when the Minister comes to reply he can, hopefully, give cast-iron assurances about the financial input that will be needed for this reconfiguration to take place, addressing the issue that UHNS has identified—that the additional expenditure needed for service configuration is in the order of £28 million or £29 million, whereas the trust special administrator has said that only £13 million would be needed? Also, the trust special administrator has proposed a cost improvement programme of 8.5%, whereas Monitor has said that anything above 4.5% is dangerous. We need a very clear, detailed calculation and input from the Government as to how these extra costs will be met, also taking on board the issue about PFI.

[Jeremy Lefroy]

I thank the hon. Lady for her intervention and I entirely agree with that point. There is no point in Stafford’s merging with Stoke if the consequence is that we have a trust that will be financially failing in the future.

The administrators rightly place emphasis on the need for swift action, and I believe that the dissolution of MSFT in the autumn of this year should be possible—indeed, it should be possible even earlier. In fact, I would go further. MSFT has improved greatly in recent years following the huge failings brought to light through the vital work of Cure the NHS and documented in the Francis report. Its recently published hospital standardised mortality ratio figures were the best in the west midlands, but it is fragile and finds it difficult to recruit in some areas. We need the overall arrangements to take immediate effect, even in shadow form. In recent weeks I have detected less engagement than is necessary, because of the uncertainties of the administration process. That needs to stop.

This is all taxpayers’ money. It is our national health service. It is time to work together.

[Andrew Griffiths (Burton) (Con)]

I congratulate my hon. Friend on securing this debate and on the work that he has done in recent years. He used the words “fragility” and “uncertainty”. He understands the fragility and uncertainty of the health care economy in Staffordshire. Queen’s hospital, in my constituency, is a Keogh hospital, which has huge financial debts and is struggling to survive. Does my hon. Friend agree that it is essential that this reorganisation takes place and is properly funded? If not, the knock-on effect on other hospitals, such as Queen’s, and on the wider health economy, could be damaging and have a domino effect, with other hospitals falling over.

[Jeremy Lefroy]

My hon. Friend is right. We must make sure that we do not jump from the frying pan into the fire. We must get to a sustainable condition for the health economy. These new overall arrangements must take immediate effect. I urge the Minister to make that clear today, to give the various managements confidence to get on with their work.

I shall make one final point about the future UHNS and the Royal Wolverhampton hospital. The Secretary of State has rightly emphasised patient safety and care since the publication of the Francis report. The new expanded trusts have the opportunity to become national leaders in zero-harm health care, so I urge Monitor and the Secretary of State to seize the opportunity to support them in doing so at this time. Let this administration not be a dry legal exercise. Let it be the chance for Stoke, Stafford, Cannock, Wolverhampton and Walsall to become, even more, shining examples of the best 21st-century health care.

[Mr Aidan Burley (Cannock Chase) (Con)]

I congratulate my hon. Friend on securing this debate. I do not think that any other hon. Member has had to deal with a local hospital issue as all consuming and difficult as the one in Stafford. I congratulate him, on behalf of everyone, on his tireless dedication to getting the best deal for his constituents.

My hon. Friend mentions Cannock Chase hospital, in my constituency—the other hospital run by Mid Staffordshire NHS Foundation Trust—which will be taken over by Wolverhampton as part of the administration process. I welcome the abolition of that trust, which left my hospital 50% empty and which, even as we speak today, has just closed Littleton ward, to decant nurses to Stafford to try to shore up the hospital there.

Does my hon. Friend agree that we cannot wait until later—until sometime this year; perhaps even the back end of the year—for Wolverhampton to take over running Cannock and for UHNS to take over running Stafford, and that we need to move to the new organisational structure as soon as possible? I mean weeks, not months, so that both of our hospitals can have a secure future and the staff can know that their jobs are safe.

[Jeremy Lefroy]

I agree. I welcome my hon. Friend’s huge support, both for Stafford and Cannock, throughout this process.

[Valerie Vaz (Walsall South) (Lab)]

I congratulate the hon. Gentleman on securing this debate. I know how hard he has worked and I echo the tribute of the hon. Member for Cannock Chase (Mr Burley).

The impact on the Manor hospital in Walsall has been immense, as the hon. Gentleman said. We have already had to open 70 beds, as well as attempting to open two wards. The hospital desperately needs £40 million. I have raised this matter frequently with the Minister. I should be grateful if the hon. Gentleman took that on board in his summing up and if the Minister looked at the Manor hospital—he has visited it, although I was not there when he did—to ensure that it gets the funds that it desperately needs, having taken the impact of the closure of accident and emergency at Stafford hospital.

[Jeremy Lefroy]

I am grateful. I place on the record my thanks to all the staff at all the hospitals—Stafford, Cannock, Wolverhampton, Walsall and Stoke—for all they have done through this difficult time.

Let me turn to the detail of the services, which comprises the bulk of the trust special administrators’ report. We have come a long way from 11 months ago. Then, the contingency planning team recommended removing A and E and all acute services from Stafford, as well as elective surgery from Stafford and/or Cannock. We now have proposals that retain elective surgery at Cannock and, indeed, foresee increased activity there. At Stafford, we retain 14/7 A and E, together with acute medicine, elective and some less serious non-elective surgery, day-case surgery and a large out-patient department.

As a result of the consultation, the administrators proposed a midwife-led unit for maternity, when their original proposals removed all childbirth from Stafford. The estimate is that some 90% to 91% of all current patient attendances would remain at Stafford and Cannock.

[Gavin Williamson (South Staffordshire) (Con)]

Most of my constituents and, I am sure, many of my hon. Friend’s, would find it deplorable if Stafford hospital did not have a consultant-led maternity unit. The pressure that that will place on so many hospitals—Walsall, Manor, New Cross, Queen’s or the University hospital of North Staffordshire—will be unsustainable. I urge Ministers to look at the issue again.

[Jeremy Lefroy]

I am most grateful to my hon. Friend. I will come to that important point.

I pay tribute to the work of Support Stafford Hospital, because the impact of its campaign has shown just how much the community values the services at Stafford and Cannock. I also pay tribute to the working group, which I set up, and all those who have worked with me on that to provide us with the detail on alternative proposals, some of which I shall outline.

There is no doubt that the administrators listened carefully to what was said in the consultation and made a number of changes in their final proposals. However, the proposals as they stand are insufficient. What I am setting out requires not a re-doing of all the work of the trust special administrator—given what I have said about the urgency of the situation, that would not be sensible—but a modification of the detail.

I do not believe that such a modification would necessarily require more money than is currently proposed, although that remains to be seen, but it would be of huge benefit to many thousands of my constituents, and those of hon. Friends and other hon. Members. It will also ensure that both Monitor and the Secretary of State can fully comply with their legal obligations under the Health and Social Care Act 2012, in respect of health inequalities, as I will show later.

My proposal is that rather than cutting three areas of service in Stafford, those continue in a more cost-effective form, at least for two or three years. I, and the clinicians at Mid Staffs, consider that it will be quite possible to show how these services can be run across the two sites in Stoke and Stafford on a networked basis. The areas concerned are paediatrics, obstetrics and maternity and critical care.

First, the report proposes a reduction of the critical care unit to four beds. It says that the possibility of the highest level of critical care—level 3—should be maintained, but it is not clear how this will be possible without a rota for specialists in critical care. The critical care department at Stafford made its own submission to the consultation, which suggested a reduction in beds and a networked specialist rota. That seemed eminently sensible. Given that the CCU at Stafford is a net contributor and supports several other activities, I urge Monitor and the Secretary of State to determine that this model is tried for a period, during which it will, hopefully, be proven to operate well, clinically, operationally and financially.

The TSA’s final report also proposes, as my hon. Friend the Member for South Staffordshire (Gavin Williamson) mentioned, removing the consultant-led obstetrics and maternity service and replacing it with a midwife-led unit dealing with approximately 350 to 400 births a year. That is a step forward from the draft report, which proposed no childbirth at all at Stafford. However, my constituents and I do not believe that it is sufficient.

Currently, Stafford sees more than 2,000 births a year and that is likely to rise, with extensive house building, various new business parks being built and the doubling of the size of MOD Stafford, to mention but some developments, resulting, in the coming years—even with a MLU—probably in some 2,000-plus babies being born in other maternity units, mainly at Stoke and Wolverhampton. UHNS in Stoke already sees some 6,000 a year and its population is also growing. With at least 1,000 births, and probably more from Stafford, UHNS will probably approach 8,000, which is the number currently born at the largest unit in the country, in Liverpool.

The NHS rightly promotes choice for women about where to have their babies and the Prime Minister has spoken out against the trend towards ever larger units. Yet that is precisely what is being proposed here for women who are unable to use a MLU, due to the possibility of complications in childbirth. There would also be an impact on those who currently use UHNS and the Royal Wolverhampton, as their local units will become even busier—probably including Walsall as well—taking in women from a much wider area.

My proposal, and that of clinicians at Stafford, is to continue with the current service, fully networked with UHNS, while the impact of the current rise in both the population and birth rate is assessed. That would also enable the special care baby unit at Stafford to continue to support the regional intensive care network for babies, as it currently does. An added benefit would be that women will continue to have a local obstetric and gynaecology service, which I am sure the Minister will appreciate as he comes from that specialty. Again, that would relieve pressure on the larger University hospital of North Staffordshire and the Royal Wolverhampton hospital.

Thirdly, the TSAs propose to reduce the paediatric assessment unit to 14 hours a day from 24 hours a day and to do away with in-patient paediatric beds. There will be no paediatric rota, although A and E doctors will receive extra paediatric training and paediatric out-patient services will continue. The principal reason given by the TSAs is the national standards of the Royal College of Paediatrics and Child Health, which state that such services should be provided by a full consultant rota, which is usually between eight and 10 consultants, whereas at Stafford it is between five and six.

Let me be clear about the consequences: if the proposal is allowed to happen, the clear logic is that dozens of other paediatric units across the country that have similar numbers of consultants, or indeed fewer consultants, must be closed or have their activities drastically curtailed. Monitor cannot use the argument that that must happen at Stafford but not at other foundation or NHS trusts for which Monitor or the NHS Trust Development Authority are responsible, and neither can the Government.

The argument that all in-patient paediatric care should take place in the largest hospitals is not accepted by the general public. They fully understand why very sick children should go to specialist units; they do not understand why their local general hospital cannot receive sick children at night or for short stays, and neither do I. If experts at the Royal College insist on making that argument, however, let it be open, let it be consistent across the land and let it be agreed by all political parties. The proposal should not be implemented by stealth through a trust special administration that in no way arose because of the performance of the paediatrics department at Stafford.

I have one final point.

[Mr William Cash (Stone) (Con)]

I have been waiting for my hon. Friend to reach his conclusion so that I can say how much I support him in his endeavours on Stafford hospital, which affects my constituency of Stone. I had to fight so hard to get the public inquiry that has led to many of the changes, and I simply offer him many congratulations. I support pretty much everything that he says, and I believe that he has done an enormous service to his constituents through his work over the past few years.

[Jeremy Lefroy]

I am most grateful to my hon. Friend, and I return his compliments. He has likewise tremendously supported the trust and the work that has been done.

My final point is that the children and families who will be most affected by the paediatrics proposal are those on the lowest incomes. Such families are the least likely to have access to private transport to take their children nearly 20 miles to the nearest hospital at night. For them public transport in the daytime is often poor, and a taxi fare is beyond their means—certainly if they have to visit a sick child several times. I believe that those on low incomes should have fair access to health care, which both Monitor and the Secretary of State have a responsibility to ensure.

The paediatrics department at Stafford made an alternative proposal in its response to the consultation. That alternative was measured and understood the need to cut costs. The alternative proposal included a reduction in the number of in-patient paediatric beds, and consultants would have worked in a network across both of the new trust’s sites.

A pattern can be seen: critical care, maternity and paediatrics. There are sensible alternative proposals.

[Robert Flello (Stoke-on-Trent South) (Lab)]

I echo the sentiments of other hon. Members in thanking the hon. Gentleman for securing this debate. I also echo the sentiments of my colleague and near neighbour, the hon. Member for Stone (Mr Cash).

Before the hon. Member for Stafford (Jeremy Lefroy) concludes, I have two points. First, he is absolutely right that there are sound alternatives that need to be considered very quickly, and a proper process must be put in place. Secondly, the situation’s impact across the whole of north Staffordshire, and indeed the whole of Staffordshire, should not be underestimated. I hope he agrees that there is probably no right solution, but we must get as near as possible to a right solution.

[Jeremy Lefroy]

I entirely agree with the hon. Gentleman, and I appreciate his support and the support of colleagues from Stoke-on-Trent, Newcastle and across Staffordshire. We have worked together, which is a great achievement on a subject that can be political.

In conclusion, surely it makes sense to work through the proposed clinical networks while Stafford is joining the expanded UHNS—with things roughly as they are now—for a period of two or three years. I believe that those network solutions can work. If they prove as effective as the clinicians and I think they can be, we will have achieved the objective of securing services that are financially, clinically and operationally sustainable in Stafford, and indeed elsewhere, under the expanded UHNS. Such services would be welcomed by my constituents and would reduce the potential pressure on other hospitals, such as UHNS, the Royal Wolverhampton, Manor hospital in Walsall and hospitals in Burton.

Tobacco Packaging

Jeremy Lefroy Excerpts

Thursday 28th November 2013 Commons Chamber

[Jane Ellison]

I repeat that the Government are proceeding along the track that they laid out in the summer. We know that the Scottish Government have expressed clear views, and we will be working closely with all the devolved Administrations.

[Jeremy Lefroy (Stafford) (Con)]

I welcome the statement and trust that we will see a Conservative-led Government introduce standardised packaging. When that happens, will the Minister take the opportunity to step up health education on this subject?

[Jane Ellison]

My hon. Friend is right to remind us all that, even if the Government decide to implement the policy at the end of the review, there will still be many other things to be done in relation to this important issue. Major public health campaigns will proceed as they have been doing under Governments of all colours.

Mid Staffordshire NHS Foundation Trust

Jeremy Lefroy Excerpts

Tuesday 19th November 2013 Commons Chamber

[Mr Hunt]

Let me take the right hon. Gentleman’s points in turn. First, he will know, because this is what happened after the Bristol inquiry and the Shipman inquiry under the previous Government, that Governments do not always accept every single recommendation. What I have said today is that we accept all the principles behind every single one of Robert Francis’s recommendations. We are implementing 204 in full, and in respect of the 86 that we are not implementing exactly as he said, we are doing everything we can to make sure that we implement the spirit behind them, but we need to make sure that everything we do is workable in practice. Francis himself has said that it is a “carefully considered” response that is a “comprehensive collection of measures”.

On staffing numbers, which is an essential part of what we have to consider, if the right hon. Gentleman looks at the nursing hours per bed, he will find that they have gone up since 2010, not down. We recognise the crucial importance of front-line staff, which is why I gently say to him that we made some reforms to the NHS that meant that there are 5,500 more doctors on the front line and 8,000 fewer managers. What we also need is more nurses. That is why it is so encouraging that in response to what Robert Francis has said and the recognition throughout the NHS of the importance of compassionate care, we are getting a reaction from NHS trusts—not as a result of a direct ministerial decision, but because trusts themselves are recognising the importance of compassionate care. We think that is a very encouraging sign.

With respect to whether staffing levels should be mandatory, we agree that there are minimum recommended staffing levels, but they are not the same for every ward in every hospital. The minimum level might be one in six for an acute medical unit, one in four for a general medical unit, and one on one for intensive care. We took extensive advice on whether it would be appropriate to set a national minimum mandatory number. Not only is the chief nurse and leading nurses from across the country against this; the King’s Fund and the British Medical Association are against it. The BMA said something today in a statement which I never thought I would read in my lifetime—it said that the “Government is right” on this issue.

The right hon. Gentleman also opposed mandatory staffing levels back in 2011, although it is fair to say that in the House his position on this has changed. The important thing is that we allow local discretion to make sure that nursing levels are adequate, and that where they are not, that is exposed quickly so that there is no repetition of what happened at Mid Staffs.

On the regulation of health care assistants, every health care assistant will have to have a care certificate. Effectively, there will be a database which allows employers to check whether someone has such a certificate. That is a kind of register. The other reason for people talking about the regulation of health care assistants is that they want to make sure that if someone fails in their duty of care, they are not able to appear somewhere else in the country. That is why we have a vetting and barring scheme to make sure that that does not happen.

On the individual duty of candour, let us be clear: we want total candour about all avoidable harm, at every stage that it happens, anywhere in the NHS. We decided after much discussion that extending the statutory duty of candour to individual front-line clinicians would be likely to create a huge amount of bureaucracy and damage the culture of openness that we are trying to create, because everyone would constantly be worried about whether or not they were breaking the law. We decided that the right way to achieve the objective is through a professional duty of candour, which is much stronger than the current professional duty states. Critically—this is a key change—we decided to make sure that, just as airline pilots have protection if they speak out, if front-line NHS employees speak out, they too will get protection if there is a professional conduct case, and that openness at an early stage will be treated as a mitigating factor. That is really important in terms of changing the culture.

Finally, we absolutely do need to resolve the issue of death certificates. It is important that we have an independent view to certify deaths. It is a question of finding a practical way to make sure that we do that, but we very much accept the spirit of what Robert Francis said.

Today I hope that we will find a way forward on all the problems that Robert Francis addressed in his response and that we have been thinking hard about. I urge the shadow Secretary of State to join Government Members in saying that this is a moment when the NHS can once again reach forward and aim to be the very best in the world, because the kind of measures that we are talking about are not happening anywhere else, and that is something of which we can all be very proud.

[Jeremy Lefroy (Stafford) (Con)]

I thank my right hon. Friend the Secretary of State for his statement and commitment. A culture of compassionate and safe care for all in the NHS must be the legacy of the Francis inquiry. It is the least that those who suffered from dreadful neglect, and their loved ones who campaigned for justice, deserve. Staff throughout Mid Staffordshire trust have made firm strides since then in improving that culture with clear results in patient care, but will my right hon. Friend be the patients champion and ensure that the NHS puts patients first and foremost?

[Mr Hunt]

That is the central change in culture that we need throughout the NHS. I pay tribute to my hon. Friend in particular, because he has had a more difficult challenge with respect to his local hospital than any hon. Member. He has campaigned for the people who use that hospital and for the staff there with great integrity and courage, which I commend.

I have never believed that there is a conflict or a choice between putting NHS staff first and putting the patient first. I have never met a doctor or nurse who does not want to put the patient first. The trouble is that we have created structures and incentives that make it difficult for front-line staff to do what they joined the NHS to do, which is to care for patients with dignity, compassion and respect. That is what we are trying to do in the changes today.

Urgent and Emergency Care Review

Jeremy Lefroy Excerpts

Tuesday 12th November 2013 Commons Chamber

[Mr Hunt]

Thank you, Mr Speaker.

The hon. Member for Lewisham East (Heidi Alexander) will know that her constituents have some of the best stroke survival rates in England because we reduced the number of hospitals in London offering stroke services from 32 to eight. I am not going to stand in the way of those changes if they save lives.

[Jeremy Lefroy (Stafford) (Con)]

I very much look forward to the review, which is urgent. Given that accident and emergency departments do not operate in isolation, will the Secretary of State assure me that the review will consider the whole system, including support services, critical care units and the availability of specialist consultants—particularly those in paediatrics—who need to be available for an A and E to function effectively?

[Mr Hunt]

No one has campaigned more assiduously than my hon. Friend for his local hospital, despite the incredible tragedies and difficulties that it has been through and the pressures that has created for the people of Stafford. He is absolutely right: if we are going to solve the problem, we must consider the system holistically and consider how different A and E departments can specialise services. We need much more of a hub-and-spoke system, rather than one where every A and E has to offer exactly the same menu of services. If we do that, we will save more lives and that has to be the right thing to do.

Managing Risk in the NHS

Jeremy Lefroy Excerpts

Wednesday 17th July 2013 Commons Chamber

[Andy Burnham]

I always took action when anything was brought to me. When mortality data on Basildon hospital were published, I immediately ordered an in-depth review of all hospitals in England, which led to warnings on five of the trusts on the Keogh list. Those warnings were inherited by the hon. Gentleman’s Government, but Ministers allowed those trusts to carry on cutting staff, and the same was true for the hospital in the constituency of my hon. Friend the Member for Denton and Reddish (Andrew Gwynne), even though it was subject to a warning about patient care. I think that Government Members have to look at themselves before making claims.

On the duty of candour, the final recommendation that we need to see progress on relates to the regulation of health care assistants, which is long overdue. If the Secretary of State took these three sensible measures, he would provide support to staff and reassurance to the public, but they are not in themselves the answer to the structural challenge the NHS faces. That brings me to my final point on the longer-term solution. I have thought long and hard about what happened at Stafford hospital and why we hear recurrent echoes of the same elsewhere in the NHS, with older people lost on acute hospital wards, disorientated and dehydrated. I believe that the problem goes far deeper than any regulatory solution. Governments of all colours have underinvested in social care over many years, and in the end we get what we pay for: a malnourished, minimum wage system that dishes out care in 15-minute slots, which is barely time to make a cup of tea, let alone exchange a meaningful word.

Looking after someone else’s parents should be the highest calling that any young person can answer. However, if we are honest with ourselves, the effect of decisions taken here in this House over many years means that the signal we are currently sending is that it is the lowest calling that a young person can answer. Some 307,000 care staff in England—20% of the work force—are on zero-hours contracts. That is an appalling figure. This situation cannot carry on. Good care cannot be provided on a zero-hours, here-today-gone-tomorrow basis.

The collapse of decent social care in England means that too many elderly people are drifting unnecessarily towards hospital. Our hospitals are becoming increasingly full of very frail, very elderly people, and that is not sustainable in either human or financial terms. That is why I have proposed—

[Jeremy Lefroy (Stafford) (Con)]

I understand what the right hon. Gentleman is saying about the situation of care assistants—their low pay and so on—but in Stafford some of the highest-paid people in the organisation showed the least compassion. It is not all about money, although money may come into it. Compassion does not have any regard to income.

[Andy Burnham]

I agree with the hon. Gentleman, and I respect the way in which he continues to pursue the issues arising from what happened in his constituency. Yes, it is not all about money, but it is about the message we send to the people working in our care system. If somebody does not have certainty about the money that they will bring into the family home from one week to the next because they do not know how many hours they will be working, how can we expect them to pass on a sense of security to those they care for? We will not get the care that we all want for everybody’s parents if we carry on with a system that is working as it is. I lay the blame with no one Government; as I said, all Governments have brought this situation about.

That is why I have proposed the full integration of health and social care with one service looking after the whole person and all their needs, physical, mental and social. I hear the Government increasingly borrowing our ideas and our language, and I have no objection to that. However, here is my challenge to the Minister of State, who has been roused by that statement: he cannot speak the language of integration while legislating for fragmentation and competition. We are hearing reports from across the country of sensible collaboration between secondary, primary and social care being blocked by the competition provisions of the Health and Social Care Act 2012. Torbay, the beacon of integrated care, fears that any qualified provider may break up its celebrated model. That has led the Minister to suggest in the Health Service Journal that his integrated care pilot area might be offered exemptions from the Act’s competition provisions. Surely that is the clearest admission from the Government that the Act they passed is a barrier to the change that the NHS needs. Collaboration or competition? Integration or fragmentation? In the end, they have to make a choice; they cannot have it both ways. If the Minister is serious about this, the last offer I make is that we will work with him to fast-track repeal of the competition provisions of the Health and Social Care Act.

Today I have made some positive suggestions about a way forward for the NHS. It is now up to the Government to decide what they want to do. In the past few days, we have seen a glimpse of a Government prepared to run down the NHS, still the country’s best-loved institution, for their own political ends. If, from here on in, they intend to continue with that approach, they will be pursuing a very dangerous path. It will cement an impression in the country that some people have already formed—that the Secretary of State is running down the NHS to erode public confidence in it and to soften it up for privatisation. People suspect that that is the real agenda. Only today, we learned of six NHS trusts preparing for a major expansion in private work under privatisation freedoms given to them by this Government.

Nye Bevan said that there will be an NHS for

“as long as there are folk left with the faith to fight for it.”

I can tell all Government Members that they have not knocked the fight out of me, and I suspect there are millions out there ready to rally to the same cause. People rely on an NHS that puts patients before profit, and Labour will always defend that. This week the Government have revealed their hand and it is nasty. They should pull back or get ready for the fight of their lives.

Oral Answers to Questions

Jeremy Lefroy Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Jeremy Hunt]

I hope that I can reassure the hon. Lady, because the conditions for accessing that £3.8 billion fund are absolutely clear. Local authorities will not be able to access it unless they can promise to maintain services at their current levels. They are allowed to make financial efficiencies, as is the NHS, and everyone needs to look at that, but not if it means a deterioration in services.

[Jeremy Lefroy (Stafford) (Con)]

Being able to be visited frequently by one’s loved ones is a vital part of improving care for vulnerable older people in acute settings. How is closeness to home being taken into account in any service changes proposed by Monitor or the NHS Trust Development Authority?

[Mr Hunt]

First, I congratulate my hon. Friend on the admirable way he sticks up for his constituents in Stafford in incredibly difficult circumstances. I think that the whole House recognises what he has done. Secondly, in answer to his question, there is always a balance to be found, because we all recognise that, all things being equal, people would rather be treated nearer to where they live for exactly the reasons he gave. We also need to ensure that people get the best care when they arrive at hospital, which is why it is very important to go through these difficult processes to work out where that balance lies.

Hospital Mortality Rates

Jeremy Lefroy Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

It is funny how Labour Members like to accuse Government Members of making party political points, but then misrepresent the reality that there are 8,000 more clinical staff throughout the NHS than when their Government were in power.

[Jeremy Lefroy (Stafford) (Con)]

As my right hon. Friend says, transparency is vital. Stafford hospital has improved substantially since the spotlight was shone on it, although we are not complacent at all. One of the real problems we face is that good clinicians avoid management positions. What plans does he have to encourage young clinicians to undertake professional management training so that they can move into senior management positions in the course of their careers?

[Mr Hunt]

As ever, my hon. Friend speaks wisely, because we know a key point is that we need more good clinicians to go into management positions throughout the NHS. I am in close discussions with the NHS leadership academy, which this Government set up, to determine what more can be done to guarantee that able clinicians who pass muster and go into management can get a job at the end of that process. In addition, we have to encourage people to go into challenging trusts, rather than always being attracted to the best trusts. Such a change has been managed in the schools system, so we need to achieve that in health as well.

Stafford Hospital

Jeremy Lefroy Excerpts

Thursday 4th July 2013 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

Thank you, Madam Deputy Speaker, for this opportunity for a debate on Stafford hospital.

On 31 July, the administrators of the Mid Staffordshire NHS Foundation Trust will present their proposals for the future of health services at Stafford and Cannock hospitals. They, as well as Monitor, to which they report, and the Government, have a tremendous opportunity to show the way forward for the NHS as a whole, which celebrates 65 years this week. This trust special administration is the first under the Health and Social Care Act 2012 and is a chance to show how emergency, acute and maternity services can continue to be provided affordably, locally, safely and to the highest standards. We are also talking about the administration of a trust that has been the subject of intense scrutiny since the revelation of appalling standards of care in some parts of Stafford hospital in the period to 2009. Since then the improvement has been marked, as the Care Quality Commission has evidenced, although there is no complacency about that on our part.

When tens of thousands of people marched through Stafford on 20 April this year to a rally that I had the honour to address, along with the Bishop of Stafford, we were showing just how much we value the services provided at Stafford and Cannock. We were also expressing our concerns about the future—a future that the contingency planning team’s report, which came out earlier this year, said was unlikely to include the provision of most acute, emergency and maternity services in Stafford, even though our maternity services have some of the best outcomes in the country. When the trust special administrators produce their report, I hope they will provide us with complete access to the data on which they worked, as well as the assumptions made—something that did not happen with the contingency planning team.

We were also making it clear that we cannot see how other, neighbouring hospital trusts, which are already under so much pressure, could cope with substantial numbers of additional patients who would have to come for treatment, travelling considerable distances on routes that are not well served by public transport.

[Gavin Williamson (South Staffordshire) (Con)]

Does my hon. Friend agree that if we do not keep a strong core of services in Stafford and at Cannock, the consequence for other trusts could be a deterioration in the care they can give patients, which would be highly detrimental for patient care right across Staffordshire?

[Jeremy Lefroy]

I entirely agree with my hon. Friend. Many people, including those with more experience of these matters than I have, have said the same.

The coincidence of the publication of the Francis report—which was commissioned by my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), whom I am glad to see in his place—and Monitor’s contingency planning team report into the future of services at Stafford and Cannock was, I have to say, unfortunate. Both organisations were running to independent timetables, but the coincidence gave rise to the incorrect impression that the proposed downgrading of services at Stafford was somehow the direct consequence of the failures in care until 2009. Let us be absolutely clear: it is not. In fact, the financial problems of the trust are long standing. It should never have been granted foundation trust status by Monitor back in 2008.

However, the impression that exposing poor care somehow resulted in threats to services had a double effect. First, blame was completely unjustifiably put on those who spoke out. Secondly, the impression was given that if people speak out in future anywhere else, local services might be at risk. The result is that Stafford has experienced ups and downs in the last few months. They include the wonderful coming together of a community of all ages and a group supporting the services at the hospital working across the political divide. Sadly, however, we have also seen cases of threatening behaviour against Julie Bailey and members of Cure the NHS, who courageously brought the serious problems at Stafford to light. I will not mince my words: it has been heartbreaking to hear people—good people, with the welfare of the community at heart—on opposite sides of an argument that should never have happened.

At the same time, hundreds of people in the community have put in a huge amount of time and effort to support Stafford hospital. I want to mention some by name. They include Sue Hawkins, Cheryl Porter, Karen Howell, Brian Henderson, Diana Smith, James Cantrill, Chris Thomas, James Nixon, Councillors Mike Heenan, Rowan Draper and Ann Edgeller, and Ken Lownds—who has put in a huge amount of expert work—together with my hon. Friends the Members for Stone (Mr Cash), for Cannock Chase (Mr Burley) and for South Staffordshire (Gavin Williamson).

But I wish to focus on the future, and I am going to concentrate on Stafford hospital although Cannock, too, is vital. Stafford is one of the many small district general hospitals up and down the country that play a vital part in our emergency and acute infrastructure. The number of acute beds has fallen substantially in the past 20 years, including in Staffordshire. The new PFI-funded hospital that opened recently in Stoke has 250 fewer beds than its predecessor, although it is none the less a wonderful hospital. We all welcome the fact that the length of hospital stays has fallen sharply, to an average of less than four days, but a report from the Royal College of Physicians published last year pointed out that there is little room for further reduction. Indeed, as the population begins to age, the average length of stay might start to creep up again.

The only way to manage acute beds, even at the current capacity, is to ensure that people do not have to be admitted in the first place. I am sure that we all want to see that happen, but it will depend on expanded community provision and the better integration of health and social care. That will happen, but it is not happening yet. Even when it does, my firm belief is that although it might halt the increase in demand for acute services, it will not reduce it at this time of a rising and ageing population. The Government are listening to experts who say that we need substantially increased rail capacity by 2035, so I am sure that they will also listen to the experts who say that we cannot cut any further the local and regional capacity for emergency, acute and maternity care. I say to Monitor and to the Government that Stafford is ready to be a national leader in such integration, with patients and the provision of the highest quality of care put first. However, that demands time and co-operation.

The first element of co-operation involves a larger acute trust. In the case of Stafford, the obvious partner is the University Hospital of North Staffordshire in Stoke. Working with UHNS as one team will bring advantages to both hospitals and both communities. For Stafford, the chance to become part of a university hospital will be an exciting prospect. We already welcome third, fourth and fifth-year medical students from Keele university medical school, and they report that they value the experience of working in a busy district general hospital. For the clinical staff at Stafford and at Stoke, the chance to work as a much bigger team across two sites would bring greater opportunities for them to develop their skills and experience. Frankly, for Stafford, it would also ensure that there was much less chance of a return to the complacent culture of the past that the Francis report identified as a major problem in parts of the hospital. For Stoke, which is already under considerable pressure as a result of the reduction in beds and has had to reopen up to 100 old ones, coming together with Stafford would offer welcome additional capacity. It would also create a larger catchment area, which would make some specialties that are currently marginal at Stoke much more viable.

But this would not be easy, as UHNS also has a substantial deficit and a PFI cost that is frankly unsustainable. I urge the Government to do everything within their power to cut the cost of UHNS’s PFI so that the 750,000 and more people who would rely on a combined major acute trust—whether in Stoke, Newcastle-under-Lyme, Leek Stafford, Cannock or further afield—can continue to have access to services delivered as locally as possible.

[Mr Aidan Burley (Cannock Chase) (Con)]

I congratulate my hon. Friend on securing this timely debate as we await the final report from Monitor at the end of this month. We must oppose any serious downgrading of Stafford hospital, but the other hospital that was poorly managed by the former Mid Staffordshire NHS Foundation Trust was Cannock Chase hospital, which has been mismanaged to the point that 50% of its hospital buildings are currently lying empty. There is therefore a threat to its future. Does my hon. Friend agree that any solution provided in the report at the end of the month must involve Cannock hospital being fully utilised, and Stafford hospital not being downgraded?

[Jeremy Lefroy]

I entirely agree with my hon. Friend, and I congratulate him on the huge amount of work that he has put into ensuring that Cannock Chase hospital can be better utilised.

The second part of co-operation involves community services. Instead of seeing acute hospitals as buildings into which people disappear and then re-emerge at some point, let us make them a full partner in community services. In fact, they should be a hub for those services. Stafford, Stoke and Cannock can be groundbreakers in this, and set an example to the rest of the country. In Stafford, we long for the chance to show the country that we provide the highest standards of care, and that we will never again let patients be treated in the shocking way that many experienced in the past.

[Andrew Bridgen (North West Leicestershire) (Con)]

I thank my hon. Friend for giving way, and I commend him for bringing this issue to the Floor of the House. Does he agree that we have a national health service, and that any loss of services at Stafford could send out ripples that would affect services at Burton-on-Trent—also in Staffordshire, and also a hospital under some financial pressure that services a large proportion of the medical needs of my constituents in North West Leicestershire?

[Jeremy Lefroy]

As usual, my hon. Friend makes a powerful point—that this debate is not just about a relatively small district general hospital, because it will have ripple effects. We have a pretty efficient national health service, but it does run on tight margins, so that if we take one acute hospital out, it could have effects right across the whole region. Local clinical commissioning groups have a vital part to play, and I want to pay tribute to the good work they are doing in developing community services in Stafford.

The third element of co-operation comes from Monitor itself. Under the Health and Social Care Act 2012, Monitor now has responsibility for setting tariffs, including those for emergency and acute services. It would be rather strange if Monitor were to continue the programme introduced in 2009 of constant 4% year-on-year real cuts in tariffs, and then be forced to pick up the pieces of acute foundation trusts around the country that fall into deficit as a result of the tariff cuts it has made. Monitor has the chance to challenge the assumption that acute services can continue to squeeze out annual efficiencies—in some cases, and not just in Stafford—of up to 7% a year, while elective services enjoy a relative feast.

Monitor has the opportunity to ensure that the necessary changes to the provision of acute services are done in such a way that will allow acute services to continue to be provided locally. Monitor itself could become an excellent example of joined-up government, and in doing so carry out its legal requirement under section 62 of the Health and Social Care Act 2012 to promote the

“provision of health care services which…is economic, efficient and effective, and…maintains or improves the quality of the services.”

Finally, the national Government have a vital role to play in co-operation.

[Joan Walley (Stoke-on-Trent North) (Lab)]

I am most apologetic about arriving late to this debate and not having the opportunity to hear the opening part of the hon. Gentleman’s speech. To find a long-term solution for health care in Mid Staffordshire and in North Staffordshire, it is vital that the Minister refers in his reply to the best way of ensuring that the emergency services and all the other services that people want can be retained. That can be achieved only if we have a proper collaboration between the University hospital of North Staffordshire, which must be at the front of—

--- Later in debate ---

[Jeremy Lefroy]

I would like to place on record my thanks to the hon. Member for Stoke-on-Trent North (Joan Walley) for her co-operation on this issue. She has really been of great help.

As I was saying, the national Government have a vital role to play in co-operation. Well distributed emergency and acute care is part of our national health infrastructure; it cannot be left entirely to local or even regional bodies to determine what is provided. My constituency and those of my hon. Friends the Members for Stone, for Cannock Chase and for South Staffordshire host the M6, the M6 toll road and both routes of the west coast main line and are also scheduled to host HS2. Stafford’s critical care unit provides a value supplement to the larger ones in Stoke, Wolverhampton and Walsall, in case they are under great pressure. There is a strong argument for such vital infrastructure to be funded nationally rather than being dependent on local CCGs, which, in the case of those in South Staffordshire, the Government have recognised receive considerably less than their fair funding share.

The administration of Mid Staffordshire is a great chance for Monitor, through the administrators, to show that it is listening to and acting on the concerns of my constituents about the need for vital emergency, acute and maternity services to remain at Stafford. This provides, too, an excellent opportunity for the Government to show first how they have responded to the Francis report by putting patients first, and secondly how the 2012 Act is not, as some would have it, about fragmentation and privatisation, but about co-operation and quality of care for the patients who must be at the heart of the NHS.

A and E Departments

Jeremy Lefroy Excerpts

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

Once again, the Labour party opposes every single cut made by this Government then tries to pretend that it is serious about getting the deficit under control. On this point, I remind the hon. Lady that the NHS is giving £7.2 billion of support to the social care system for health-related needs, precisely in order to ensure that services are not compromised. Where they have been compromised, we are looking into it and we are disappointed about it, but we continue to monitor the situation and to urge local authorities to ensure that they discharge their responsibilities properly.

[Jeremy Lefroy (Stafford) (Con)]

As my hon. Friend the Member for St Ives (Andrew George) said, we cannot divorce emergency care from the provision of acute beds. The Secretary of State mentioned the fact that an increasing number of patients with acute illnesses are going into hospital. May I urge him to look carefully at any proposals to reduce the number of acute beds anywhere in the country, because I believe that we shall need them all?

[Mr Hunt]

My hon. Friend makes an important point. I commend him for the extremely responsible and committed way in which he has been keeping an eye on what is happening in his local hospital. He is absolutely right to suggest that, before implementing any big reconfiguration, we need to be certain that what we are doing will improve patient care and not damage it. I will continue to ensure that that is the case.