Health and Social Care

Jeremy Lefroy Excerpts

Monday 13th May 2013 Commons Chamber

[Mr Robin Walker (Worcester) (Con)]

It is a pleasure to speak in the debate on the Humble Address that was proposed so elegantly by my neighbour and hon. Friend the Member for Mid Worcestershire (Peter Luff), in whose speech I was named and suitably embarrassed. I was grateful for the kind tributes that were paid to my late father by my hon. Friend and the right hon. Member for Doncaster North (Edward Miliband), the Leader of the Opposition. I was keen to speak in today’s debate because what the Leader of the Opposition referred to as “that voice of moderation” and what my hon. Friend rightly identified as the middle way, the spirit of one nation conservatism, is not, as the right hon. Gentleman tried to suggest, unfashionable, but is at the heart of this Government’s programme and embedded in the Queen’s Speech.

“Efficiency with compassion” were the watchwords of my late father. He believed that a balance of the two was essential to meet the challenges of the hour and the needs of our country. I believe that the same is true today. Compassion has been shown by the coalition Government in introducing the Care Bill and by being the first to introduce legislation to cap social care costs. I spoke in the debate on last year’s Gracious Speech to express my disappointment that there was no such legislation and to support Opposition Members who were calling for it. It would be churlish of those who spoke out then not to recognise the enormous significance of the move in this Gracious Speech.

By setting a cap, albeit a higher one than many of us would have liked, the Bill will start the process of ensuring that nobody has to lose their home to pay for care. Setting a cap at any level should help the insurance industry to create products that protect thousands more people from that risk. The threshold, as the right hon. Member for Sutton and Cheam (Paul Burstow) pointed out, is key and will ensure that thousands more people are helped by the Government than would have been the case without the legislation.

This is not a theoretical far-off issue that we can put off tackling, but a real and painful issue that has affected our constituents for too many years. Hard-working people who have laboured and saved for years to afford the roof over their heads should not find that when they need care, their families are deprived of that asset. We all have constituents to whom that has happened. This is not, as some would like to pretend, a problem only for the rich. It affects everyone who owns a home and stands to lose it if the costs of their care are too great. Many of them are people who can afford to own a home only in retirement and many of them live in former council houses.

It was right of the Government to commission the Dilnot review and it is right to strike the balance that Dilnot acknowledged was needed between the cost of the policy to the public purse and the desperate need for a cap. Too many homes have been sold to pay for care. It is a tragedy that Governments of all colours have failed to act sooner to address the problem. It is greatly to the credit of the coalition that it is proposing the first part of a solution. I also draw the Minister’s attention to Macmillan’s ongoing campaign for further progress on free social care at the end of life, which was mentioned by my hon. Friend the Member for Truro and Falmouth (Sarah Newton).

Compassion is also being shown in the determination to improve the pensions of those who have spent years bringing up children, in the focus on preventing sexual violence across the world, and through tackling the impact of climate change, which will affect millions of the poorest people in the world. Compassion continues to be served by other ongoing policies of the coalition Government, such as the pupil premium, which directs funding to the most deprived pupils and helps schools to raise their attainment; the greater increase in the basic pension; and the increased investment in our NHS.

We have heard much from Labour Members about the pressures on our NHS and Ministers are right to have acknowledged the challenges faced in A and E and urgent care, but it is absurd for the Labour party to rail against pressures that have been building for years, including under its rule, and then to implement cash cuts in NHS spending in Wales, where that party runs the Government. The South Worcestershire clinical commissioning group will receive a £7 million increase in funding this year as a result of the coalition’s policy of increasing NHS spending. By coincidence, that is the amount by which the funding of Welsh health boards is being cut this year by the Labour Administration. On a recent visit to my local hospital, I saw some of the pressures on A and E, but I also saw how the coalition’s investment had enabled the retention of more nurses and how it will soon deliver a new clinical decisions unit that will help to alleviate some of the pressures.

We have heard much from the Labour party about the supposed privatisation of the NHS. I recently asked my local clinical commissioning group what amount of its budget goes to the private sector. Knowing that it has for some years, including under Labour, contracted certain operations, such as hip replacements, to private sector providers, I had presumed that the amount would be quite significant. I was surprised to find that the spending of the South Worcestershire clinical commissioning group in the private sector amounted to just 1.8% of its budget. That is less than its increase in spending this year. This Government are committed to efficiency and compassion in the NHS.

Compassion and efficiency are served by the emphasis on education in the Queen’s Speech. I would like to expand on that in more detail, but fear that I do not have time. We have heard excellent speeches from my hon. Friends the Members for Lancaster and Fleetwood (Eric Ollerenshaw) and for South West Devon (Mr Streeter) about the funding formula in health. I merely point out to the Government that addressing the funding formula in education is equally urgent.

[Jeremy Lefroy (Stafford) (Con)]

Will my hon. Friend acknowledge that that is an issue across many parts of England, including in my county of Staffordshire?

[Mr Walker]

I wholly agree with my hon. Friend. I will be in Staffordshire to meet the F40 group and its executive, who are campaigning for fairer funding and a more efficient system.

That brings me to the efficiency side of the equation. As a member of the Business, Innovation and Skills Committee, I would have liked to speak on the day of the debate that was themed on that portfolio. I regret that the Opposition chose to assign that theme to a Friday when I, like most other MPs, have many commitments in my constituency, including speaking to local businesses and schools.

There is a great deal in the Queen’s Speech to support business and increase efficiency in Government. The employment allowance is something that I have campaigned for and it will be extremely welcome to smaller businesses and entrepreneurs as it will reduce the cost of taking people on. I would like to have seen a Bill to reform business rates and will continue to push for further such reforms. The Bill to reduce regulation on business has been called for by almost every business organisation that I have met and will be universally welcomed, as long as it works.

The investments in infrastructure are sensible and necessary to support growth in our economy and to get Britain moving. Reducing the deficit is essential. For all the noises off that we have heard from the Opposition in this debate, they still have not got the point that the answer to a debt crisis cannot be to borrow more. When one invests, it is essential to invest well. The story of Worcester’s colleges is just one example. The previous Labour Government promised huge rebuilds costing tens of millions of pounds, but delivered nothing. This Government have delivered measured investments that have made a difference.

It would be remiss of me, having spoken in the Back-Bench debate on an EU referendum some years ago, not to mention the amendment that has been tabled by many Back-Bench Members, which I hope will be selected for debate by the Chair. I was proud to support a motion that called for a European referendum two years ago. I welcome the fact that our Prime Minister has set out clearly that he will fight for a referendum at the next election and that he is pressing for a renegotiation of our relationship with the EU in the meantime. He was right to wield his veto, he was right to press for a reduction in the European budget, which many thought was impossible, and he is right to say that the people of this country need to be given a real choice. Like my right hon. Friend the Member for Mid Sussex (Nicholas Soames), I have every confidence that he will continue to succeed on this issue.

I regret that some in the media have sought to build the amendment up as a criticism of the Prime Minister. It is for that reason that I did not sign it. However, I do regret that we could not include an EU referendum Bill in the Queen’s Speech, not because I believe it could have succeeded against the arithmetic of this House and its current composition, but because the debate would have shown how out of touch the main Opposition party is on this issue. I shall therefore support the amendment if the chance arises, and I welcome the fact that in my party at least, it will be a matter of conscience and a free vote. Although the current media frenzy is trying to paint a picture of division, I am pleased that my party is united in its determination to change our relationship with Europe for the better.

In conclusion, it is a challenge for all Governments to balance efficiency with compassion, but for all the strains of coalition—and there are many—the coalition Government continue to govern in the national interest. Perhaps that is why, despite being mid term and despite visits in the weeks before the recent local elections from the leaders of UKIP and the Green party and the Leader of the Opposition, the party that won the greatest share of the popular vote across Worcester was none of those but the true one-nation party—the Conservative party.

I particularly welcome the historic and long overdue decision announced in the Gracious Speech to place a cap on the cost of social care. I am honoured to have spoken in this debate and I look forward to supporting the Government as they continue to press for a fairer and more prosperous Britain.

--- Later in debate ---

[Jeremy Lefroy (Stafford) (Con)]

It is an honour to follow the hon. Member for Barnsley Central (Dan Jarvis), with whom I entirely agree about standardised packaging for cigarettes. I also agree with those who have spoken in favour of a minimum price for alcohol on public health grounds.

The Gracious Speech contains many important measures that are likely to assist the economy in my constituency—not least the employment allowance, the reduction of the burden of excessive regulation and measures to make it easier to protect intellectual property. Unemployment has fallen in my constituency since the election, but there is still a great deal to do. The number of apprenticeships has risen, so I welcome the Government’s plans to ensure that it becomes

“typical for those leaving school to start a traineeship or an apprenticeship, or to go to university.”

As previous speakers have said, the Government are taking important long-term decisions on the financing of pensions and certain parts of social care. Those decisions, including the change in the state pension age, the introduction of a flat-rate pension and the capping of care home costs, aim to give more certainty in an increasingly uncertain world, and I shall return to that.

I shall be opposing one measure, I am afraid—the plan for High Speed 2. It is my belief and that of my constituents that both the concept and the business case are deeply flawed. My constituents cannot understand why a route is announced 13 years before work starts without a proper plan to compensate immediately those whose property has been rendered unsellable. I have visited and heard from constituents who must, for pressing personal reasons, move house now, but who simply cannot. I urge the Government to put in place a full, fair and speedy system of compensation or purchase of property to enable those constituents to carry on with their lives.

I now wish to concentrate on health and social care. First, I ask the Government to provide time for a full debate on the Francis report into the Mid Staffs NHS Foundation Trust. Important lessons have already been learned. The appointment of a dedicated inspectorate of hospitals is a major step—unusually, I must disagree with the hon. Member for Walsall South (Valerie Vaz)— as is the introduction of more practical teaching into nursing training.

However, there is much more in the Francis report that needs to be debated. The vital and important work that Julie Bailey and Cure the NHS did to highlight problems in care deserves a thorough hearing. Earlier, we were all moved by the speech made by the right hon. Member for Cynon Valley (Ann Clwyd), who is looking into the matter and takes it so seriously. We also need to look at how mortality statistics are compiled and used, as they are becoming important and controversial.

Secondly, I spoke about the importance of trying to give some certainty on basic needs in an uncertain world. That applies to health as much as to pensions and social care. The provision of a national health service free at the point of need probably provides more peace of mind to the people of this country than any other single thing that a Government could do, apart from ensuring security, law and order.

Health care affects each of us and does so, in different ways, throughout our lives. It is a common bond between us and contributes to social cohesion. Yet its long-term financing is on difficult ground. The Government have rightly protected NHS spending at a time when other budgets have had to be cut, but with a growing and ageing population, it is likely that we will need a real-terms increase in spending in the coming years.

There is little room to cut costs from other Departments. We have to find another way to allow controlled, efficient and effective increases in health and social care spending, to deal with the challenges posed by an ageing population while not cutting other essential public services. I encourage the Government, over a period of years, to look at turning national insurance into a national health insurance that, as now, is based progressively on personal income, and which will provide the funding for health and, eventually, social care. That would enable us to have a sensible discussion on the national insurance rate required to fund health and social care properly, separate from the wider debate on tax rates and tax policy.

Thirdly, I wish to raise again the question of emergency and acute tariffs, on which my hon. Friend the Member for South West Devon (Mr Streeter) spoke so eloquently. The continuing squeeze on them, coupled with the fact that activity greater than 2009 levels is paid at only 30% of the full tariff, is leading inexorably to financial difficulties for acute hospitals, particularly district general hospitals such as mine at Stafford. However, it is not only the smallest that are affected. Major trusts also face deficits. Even if they are not, they will have to pick up the work load if acute services are removed from their smaller neighbours. That situation cannot continue. The drift towards centralising all emergency and acute services in the largest hospitals has to be stopped—even reversed. It will mean much closer working between hospitals, as hon. Members have said, and perhaps the end of many smaller trusts, though not smaller hospitals. It will also mean that royal colleges will have to get a grip and stop the fragmentation of health care into more and more specialties that cover less and less. We need, as the head of a medical school said to me recently, to rediscover the importance of high-quality generalists. A publicly funded national health service can only survive on that basis. That does not mean that specialisms have no place in the NHS—of course they do—but they must not drive out good general medicine.

Fourthly, the Government need urgently to look at health allocations across the country, as my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) said. The welcome increase in public health funding where there are particular inequalities was meant to enable per head allocations to become fairer, but that has not happened. Currently, South Staffordshire receives at least £40 million per year below its recognised fair shares allocation, and that is making the work of local clinical commissioning groups even harder. The Government have committed themselves to addressing this, but it needs to be done this year or CCGs will find themselves in a very difficult position right from the outset.

Finally, it is vital that the Government listen to the public. On 20 April, it is estimated that 50,000 local people went on a local march and rally, which I had the honour of addressing, in support of Stafford hospital. They were speaking out against the idea that emergency, acute and maternity services could be removed, and were making the point that alternative services were too far away and, in any case, themselves under great pressure, and that the proposals did not take proper account of the increasing population and demography. All of that is common sense, and I hope that the administrators currently running Stafford and Cannock hospitals listen to that common sense, and that it is heard across the country.

Monitor has a chance, together with the trust development authority, to establish a sensible and long-lasting configuration for emergency and acute hospital services across the country that recognises the important role of our smaller, acute district general hospitals. That can be done and it must be done. The Government are tackling the long-term problems on pensions that we need to take on, and it is vital that we do the same for health and social care.

Mid Staffordshire NHS Foundation Trust

Jeremy Lefroy Excerpts

Tuesday 26th March 2013 Commons Chamber

[Mr Hunt]

If the right hon. Gentleman had listened to what I have said, he would know that the number of clinical staff has gone up by 6,000 since the last election, which would not have been possible had we cut the NHS budget, which is what Labour Front Benchers want. It is important to ensure that we have the right numbers in wards to care for people. That is exactly what the new chief inspector will look at. There is evidence that hospitals that have the highest and most respected standards of care ensure they have adequate numbers not just of nurses, but of health care assistants. The whole NHS needs to learn the lesson that it must not cut corners when it comes to care.

[Jeremy Lefroy (Stafford) (Con)]

My right hon. Friend’s welcome statement shows just how important the inquiry was, and how vital its lessons will be for patient care and safety. The royal colleges have a great responsibility. Will he call them together on a regular basis to discuss how they are checking and raising standards in their professions to ensure first-class care for patients?

[Mr Hunt]

First, I thank my hon. Friend for his extraordinarily tireless work and for the extremely measured and mature attitude he has taken to the problems in the hospital, which is on his patch. Hon. Members on both sides of the House welcome that. He is right about the role of the royal colleges. There are some challenging suggestions in the Francis report for some of those colleges, but when we are seeking to raise standards, it is important that setting up that scorecard for the new chief inspector happens with the help of the royal colleges, whose business it is to raise standards in the NHS.

Accountability and Transparency in the NHS

Jeremy Lefroy Excerpts

Thursday 14th March 2013 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

I wish to thank my hon. Friend the Member for Bristol North West (Charlotte Leslie) and the Backbench Business Committee for calling this debate. I particularly wish to remember all those in my constituency and elsewhere, and their loved ones, who suffered so grievously. I wish to pay tribute to those here today who campaigned to bring these things to light. I also thank the Prime Minister, the Secretary of State and all other hon. Members for their response to the report a month or so ago.

One of the main thrusts of the Francis report is to:

“Ensure openness, transparency and candour throughout the system about matters of concern”.

This is not the time to debate the Francis report fully—it was commissioned by the Government and it needs full and prompt consideration in Government time—but it is the time to say that the Francis report is of great importance. Mr Francis rightly dismisses the arguments of those who claimed at the time that the inquiry was unnecessary because Stafford hospital was a solitary exception—it was not. It may have been considerably worse than other places, but appalling standards of care have been revealed elsewhere.

The public inquiry has revealed complacency throughout the NHS and beyond; report after report detailed major concerns, which were either ignored or passed to others to deal with. What lay behind that? Perhaps it was a lack of willingness to shout and continue to shout for help when it was needed; or perhaps it was more often a fear of the consequences—the loss of one’s job or the removal of services from the local community.

Even just last week, when, as the shadow Secretary of State rightly said, a report to Monitor suggested removing most emergency, acute and maternity services from Stafford—something my constituents and I strongly oppose for reasons I set out in the House last week—there were those blaming Julie Bailey for the proposals. That comes on top of disgraceful threats—even death threats—that she has received over her work in revealing what Robert Francis, who should know if anyone does, calls the “disaster at Stafford Hospital”.

Let me make it clear that the proposals in the Monitor report are, in the main, a consequence of the financial and clinical pressures that all acute trusts, particularly the smaller ones, are facing. Stafford’s circumstances have done a little to hasten changes, but what happens at Stafford now will face all other such trusts in the coming years. That it is why it is so important that Monitor and the Secretary of State come to a good solution for Stafford, and indeed Cannock, and I will continue to work with them and with my hon. Friends on that. Nobody should take from the Monitor report the message that whistleblowing or more transparency will result in threats to their local services. Indeed, Monitor would be acting contrary to section 62 of the Health and Social Care Act 2012 if it acted in such a manner.

Let me raise another, perhaps more justified, fear of the unintended consequences of transparency. Only this week, I heard of a case where a patient could have a life-saving operation, but his chances of surviving it are only 50:50, yet without an operation he will die. Some surgeons are, even now, reluctant to take on the operation because if the patient dies, it will be counted against them in their personal mortality statistics. That is an unintended consequence of transparency, so transparency has to be balanced with understanding the context; otherwise, we will end up with a risk aversion that is so great that patients will suffer.

Transparency can also thrive only in a culture that is not led by blame. One of the doctors who gave evidence to Francis said:

“There was a blame-led culture, the culture being that problems had to be fixed or nursing jobs would be lost.”

How can we persuade the most suitable people to take up vital, often voluntary, roles on trust boards if their attempts to raise problems are met by blame or indifference? As my hon. Friend the Member for Southport (John Pugh) said, transparency must start right here in Parliament. He spoke movingly about moral purpose, and I agree with what he said.

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

I agree that we do not want to deter people from becoming board members, but surely my hon. Friend must agree that if things are still going wrong and the board is not holding the chief executive and the leadership to account, its members’ positions should be questioned.

[Jeremy Lefroy]

I would never disagree with that. I entirely agree with what my hon. Friend says, but there is a danger that there will be so much adverse scrutiny that people will be afraid to come forward. We must challenge that and say, “You have every right, as a board member, to raise whatever you want, whenever you want.”

As I was saying, we need a proper debate here in Parliament on health care in this country, one not constrained by party dogma or blind nostalgia. It is up to us to have that debate and, as a result, give clear direction, rather than simply to react to whatever is thrown at us. We need to debate, for instance, the nonsense of pretending that it is entirely the responsibility of local trusts to deliver. So much is out of their control, be it per-patient funding, which is still far too variable, clinical standards, which are set almost in a vacuum by the royal colleges, or the impact of the European working time directive on costs, rotas and training. We need to debate the impact of the large number of specialisations in the UK—we have 61 as against Norway’s 30—which is driving up costs and driving out vital general medical and surgical expertise. We need to debate emergency and acute tariffs, which have, for many years, meant that hospitals around the country are squeezed and face forced reconfigurations that may not be in the best interests of patients.

Robert Francis also says that one of the main principles is to:

“Make all those who provide care for patients—individuals and organisations—properly accountable for what they do and to ensure that the public is protected from those not fit to provide such a service.”

He also says:

“There must be a proper degree of accountability for senior managers and leaders.”

Accountability was sorely lacking at Mid Staffs. There were attempts to see that responsibility stopped with the board. As I have already said, that is based on the fiction that it is somehow entirely in control of its own destiny. It is not. That does not absolve the board or management, but the responsibility is shared by those who determine so much of the environment in which they operate, including us here. Professional organisations, for instance, have procedures that make it difficult to dismiss staff who are unsuitable. The Government signed up to the working time directive without preparing for the financial and manpower consequences. And for managers, and indeed politicians, targets became more important than care itself. Again, that is our responsibility.

I have already said how strongly I oppose the blame culture, and I am not going to start blaming, but accountability involves responsibility, and far too few people have taken sufficient responsibility in this case. We must reflect and they must reflect on the message that that sends.

Too many inquiries have been left to gather dust on Department shelves, and not just the Department of Health. I and my hon. Friends the Members for Cannock Chase (Mr Burley), for South Staffordshire (Gavin Williamson), Stone (Mr Cash) and Members further afield, all of whom are affected, will not allow this one to gather dust.

[Valerie Vaz (Walsall South) (Lab)]

It is a pleasure to follow the hon. Member for Stafford (Jeremy Lefroy) and to pay tribute to him for the dignified way in which he has represented his constituency during the Francis report.

I begin by thanking the Backbench Business Committee for securing this important debate. The NHS in England has a budget of £108 billion and employs 1.35 million people, with just under half of them clinically qualified, so it is right that accountability is at the centre of the NHS, for the people who work there, those who use it and those who fund it. I am sure that all my hon. Friends who have spoken and will be speaking in this debate do not see it as a chance to score political points or as background noise to denigrate an institution that was set up with the simple promise that is delivered every single day—that health care is free to everyone, irrespective of their ability to pay or of pre-existing conditions. It still operates as a service in which people are not judged on their illness but provided with a service.

I know that the debate is taking place against the background of the Francis report, but I wish to point hon. Members to a book that is about to come out—it is by Roger Taylor and called “God bless the NHS”. It was serialised in The Guardian last weekend. Roger Taylor says in the book:

“Paul Woodmansey was a senior doctor at Stafford throughout the period that things went wrong; He is mentioned by a number of patients for whom his department provided a haven of professional high quality care while standards in other wards collapsed.”

Let us not forget then that, even when a light is shone in a corner of the NHS where it is found to have failed the very people it was meant to help, there are areas of good practice.

Let us look at the background of this debate on accountability.

[Jeremy Lefroy]

I am sorry to interrupt the hon. Lady, but I would like to point out that the same Dr Woodmansey has been appointed as the new medical director of the Mid Staffs trust Stafford hospital. I welcome that, for the reasons that she has articulated.

Accident and Emergency Departments

Jeremy Lefroy Excerpts

Thursday 7th February 2013 Commons Chamber

[Patrick Mercer]

I totally agree. I would never dream of being critical of my hon. Friend, but I do think that this is such an emotive subject that we can be distracted from the realities by the fears these proposals raise.

I hope that I will speak for everybody who lives in semi-rural and remote areas—as I do, living north of Newark—and who depends on hospitals such as Newark. Newark no longer has an A and E. We, like many other parts of the country, are now at least 20 miles away from our nearest A and Es. Our nearest ones are at Lincoln County, Grantham or—extraordinarily and disgracefully—King’s Mill, which is part of the same private finance initiative with which Newark finds itself lumbered.

Newark sits on the A1 and is adjacent to the M1, and it also sits on the crucial and very busy east coast main line railway. The sorts of incidents the hon. Member for Barrow and Furness described in the nuclear industry could also arise on the road and rail networks in and around Newark, yet Newark has no A and E, in common with many towns of the same size in similar areas.

I do not understand why there has been such confusion over my A and E, and I ask the Minister to explain. If this has happened in Newark, I have no doubt that it happens elsewhere, and that it will continue to do so. Let me explain. When I returned to my home town of Newark in 1999, we had a department called “A and E.” Only subsequently did I find out that it was not an A and E at all; it was a sort of minor injuries unit with a big notice above the door saying “A and E.” Nobody had had the political courage to say, “Take that notice down.” That was nothing to do with the Labour Government or the coalition that subsequently came to power; it was to do with the staff in charge of the local NHS, who eventually grasped the nettle and said, “No, this is no longer an A and E.” The fuss caused was disproportionate.

For 10 years, nobody had had the courage to say, “This is not right; we are lying to the people of Newark.” Why was this allowed to happen? The Minister is a fellow Nottinghamshire Member of Parliament, so she knows about what happened at Newark, but I do not understand how A and Es can continue to function like this, and how the protocols of the ambulance crews that service A and Es can cope.

[Jeremy Lefroy (Stafford) (Con)]

Does my hon. Friend agree that we need clear national definitions of what emergency departments do? We currently have many different types of departments that are called A and Es. Some may have major trauma, others may not. Some may do acute stroke and heart attack; others may not. The Government must put in place a classification that is recognised across the country and, as my hon. Friend says, by the ambulance services.

[Patrick Mercer]

My hon. Friend has clearly been reading my notes, as that is exactly the point I am going to make. If we look at the composition of the anti-tank platoon of the 1st Battalion, The Royal Anglian Regiment and the composition of the anti-tank platoon of the 3rd Battalion, The Parachute Regiment—I know that you, too, think a lot about these matters, Mr Deputy Speaker —we will see that they are identical; they have the same weapons, the same troops, the same kit and so forth. There is no difference between them. Why, therefore, do we have this byzantine set of organisations in our NHS, so that an A and E can be a sort of an A and E, perhaps, or not an A and E at all, or an MIU-plus—or have a notice outside its door that is wholly misleading?

Why do ambulance services not have a standard set of operating procedures? Why do they call them protocols? Why do protocols vary? Why are not the staff correctly, and centrally, trained to understand what an A and E delivers, so they can know when they arrive at a hospital that the casualty they are carrying will receive the sort of treatment an A and E should deliver? More to the point, why are those ambulance crews not in a position to understand that, perhaps, town X’s A and E—or MIU, or whatever—cannot cope with a certain sort of injury? As a result of all this confusion, we waste time, resources and lives. This is not the province of party politics. Party politics is not worth a damn when it comes to the lives of our constituents.

I recognise, and most people recognise—even the nay-sayers, the negatives, the people who still want a policeman in every village and the return of the home guard, and even those in Newark who do not understand that we are not going to have a general hospital there—that we are never going to have A and Es, in all their glory, returned to towns the size of Newark. However, despite asking for commonality, I ask the Minister to recognise that there has to be flexibility, although I appreciate that that sits uncomfortably with my last point. The Minister understands the country and its dreadful road systems. May we please take a flexible view of these things? Could clinical cases be assisted in places such as Newark, so that minor injury units can indeed provide other critical services than those they currently provide? We do not need to be hidebound by these things, but we do need to be regulated. We do not need to be narrow-minded, but we do need to understand that different communities have different needs, and that roads in particular impose different travelling times and different strains on ambulance services across the country.

A great deal of noise and fuss is made all the time about the A and E, the critical services and the minor injuries unit in Newark, but that is only a fraction of what our hospitals do. It was widely bruited about in Newark until recently that the hospital was going to close, and yet on Monday I helped to open a new ward there. It is not a critical ward, and it has nothing to do with the minor injuries unit or the A and E; none the less, it is an exceedingly important part of the hospital, nine-tenths of which does not deal with critical matters.

NHS Commissioning Board (Mandate)

Jeremy Lefroy Excerpts

Tuesday 13th November 2012 Commons Chamber

[Mr Hunt]

Some will be, some won’t be, but the hon. Lady should not underestimate the computer literacy of people who are adopting the internet at breakneck speed, including the 40% of pensioners who now do their banking online.

[Jeremy Lefroy (Stafford) (Con)]

I welcome my right hon. Friend’s objectives, particularly on the quality of care and—I would add—patient safety, which is so important. With an ageing population—a 50% increase in the number of over-60s by 2045 has been predicted—equality of access will require most clinical services to be close at hand. How does he expect to hold the board to account over its duty to reduce inequalities of access?

[Mr Hunt]

The waiting time targets are among the board’s responsibilities under the mandate. Having care close to home is a key priority for many patients, often because they think that the quality of care will be better, if it is at a local hospital or—even better—in their own home. One major change resulting from the increased role for GPs under the mandate will be much better support for domiciliary care, which will enable people to live at home for longer.

health

Jeremy Lefroy Excerpts

Tuesday 18th September 2012 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

May I, too, welcome the Minister to his place? Last week, two decisions were taken affecting the Mid Staffordshire NHS Foundation Trust, which covers the Stafford and Cannock hospitals. The first was the decision by Monitor to undertake a review of the trust’s finances. The second was the decision of the commissioners not to reopen the accident and emergency department at night, although the trust had said that it was in a position to do so. What is common to both decisions is that there has been no consultation so far with my constituents or those of my hon. Friends the Members for Cannock Chase (Mr Burley), for Stone (Mr Cash) and for South Staffordshire (Gavin Williamson). These are their health services, which is why I have established a working group specifically to look at Stafford hospital, so that my constituents can make their proposals and views clear, both to Monitor and to the commissioners.

As hon. Members will know, there has been a public inquiry into the failings of Stafford hospital, especially those in the period 2005 to 2009, although the failings go back much further. The Francis report in 2010 exposed shocking care, particularly of the elderly and vulnerable. The public inquiry, which looks at why the NHS and others failed to pick up these problems, is due to report later this year, so I will not comment on that. The time of publication will be the time for very careful and mature reflection on what happened and how the NHS must change in response. As a senior member of the Royal College of Physicians said to me, it is the most important inquiry into the NHS in two or three decades.

Standards at Stafford hospital have improved considerably in the past three years, although there is no room for complacency. The Care Quality Commission recently lifted all its remaining areas of concern and the accident and emergency waiting time target has been met for the first time in a long time. There remains a substantial financial deficit, however, with an operating deficit of some £16.5 million last year and one of £15 million predicted for this year. At this point, I thank the previous Secretary of State for Health, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), who is in his place as Leader of the House, and the former Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), for their steadfast support for the trust as it sought to recover, as well as the staff of the hospital and those from the Ministry of Defence who helped out at A and E for a few weeks.

The financial problems facing the Mid Staffordshire trust that Monitor wishes to tackle arise, in my analysis, from three sources. The first is underuse of the estate in Stafford and Cannock. It is essential in my view, and that of my hon. Friend the Member for Cannock Chase, that both hospitals remain open, but the estate must be used efficiently as money that is needed for services is being spent on empty property.

Secondly, the consequences of the events at Stafford mean that patients who would normally attend Stafford no longer do so. Confidence in the hospital needs to return, and that confidence must be based on real progress. There are welcome signs that that is happening, but it will take time.

Thirdly, and most importantly by far, endemic problems face medium-sized acute trusts across the country. Mid Staffordshire is far from unique and that is where the Monitor review is vital as it has the chance to establish a sustainable model for district general hospitals around the country. There seems to be a view gaining currency that all medical care in the future will either be highly specialised or general, based in community hospitals, which will squeeze out the medium-sized acute hospitals. Not only does that not accord with the evidence, it goes against the wishes of the public.

I do not dispute the need to concentrate highly specialised care in larger hospitals where consultants in each specialty are available around the clock. That has happened for some time. However, there is an increasing and substantial need for emergency and acute care, particularly for the elderly, which is much better given as locally as possible and in close co-ordination with social care services. District general hospitals such as Stafford remain the best place for that.

Monitor therefore has an excellent opportunity to work together with the people of Stafford and Cannock to show how a medium-sized acute trust can flourish in the tough financial climate we face. Indeed, Monitor has a duty to do so under section 62 of the Health and Social Care Act 2012, which states that its main duty

“in exercising its functions is to protect and promote the interests of people who use health care services by promoting provision of health care services which…is economic, efficient and effective, and…maintains or improves the quality of the services.”

It also states that:

“In carrying out its main duty, Monitor must have regard to the likely future demand for health care services.”

The last paragraph is very important as not only is the population of the area predicted to rise substantially in the coming years, but there will be a greater demand for acute care.

It may be argued that none of Monitor’s duties requires that services be provided locally. I reject that. To provide services locally is economic, efficient, effective and an intrinsic part of their quality, so Monitor has a duty to promote health care services that are as local as possible. We also need to be very careful in the definition of the word “services”. In the debate in Committee on what was then clause 69, I said that

“it is extremely important to have clarity on what constitutes a service. Services can be salami-sliced down to very small items or, as others have said, they can be an agglomeration. One could say that, in an acute hospital, a service is not only the accident and emergency, but some—not necessarily all—of the other wards associated with it. That might constitute a block of service or, under other definitions, several services. How will Monitor interpret that word?”––[Official Report, Health and Social Care Public Bill Committee, 22 March 2011; c. 943.]

[Gavin Williamson (South Staffordshire) (Con)]

Everyone in Staffordshire knows how hard my hon. Friend has fought on behalf of Stafford hospital. Does he agree that the closure of Stafford A and E at night will put an increasing burden on many other local hospitals, including New Cross hospital in Wolverhampton and the University hospital of North Staffordshire?

[Jeremy Lefroy]

I entirely agree. Of course, the hon. Member for Walsall South (Valerie Vaz) has the Manor hospital in her constituency, too, and I pay tribute to the work done by her hospital, by my hon. Friend’s hospital in New Cross and by Stoke and Burton hospitals.

So, how will Monitor interpret the word “services”? To date, as far as I am aware, we do not know the answer to that question. I want to make a very clear case that Monitor must, in the case of emergency and acute services, view the matter in the round and not engage in accountancy-based salami slicing. One cannot separate an A and E from a medical admissions unit, a surgical admissions unit, a paediatric admissions unit, an intensive care unit and the related diagnostic and therapeutic services. They must be considered as a service block. Of course, there will be a difference between the block in a district general hospital and that in a major specialist hospital, as the latter will cover emergency and acute events that a district general hospital cannot.

That brings me to the question of the accident and emergency department at Stafford, which has been closed between 10pm and 8am since 1 December last year. Today a petition is being presented in Downing street to urge the reopening of the department at night. Up until Sunday 16 September, 4,381 patients who would have been treated at Stafford at night have gone to other hospitals. To put that in perspective, the A and E department treated 51,000 people in 2011-2012. That is more than 4,000 patients who could not use their local acute hospital in an emergency when previously they could. We need to see them back at Stafford.

The reason given for closing the A and E department at night was that it was not safe for 24/7 reopening. Subsequent events have proved that to be the right decision as the department was close to breaking point. However, a set of criteria were given for reopening and the trust considers that, after much hard work, they have now been met, although there are concerns about sustainability. The commissioners have decided not to go ahead with night-time reopening but instead to pursue what they call a model of 24/7 emergency and urgent care. My constituents and I were very disappointed with that, because, nearly 10 months after night-time closure, we still do not have an A and E 24/7 but also because we do not have details of what that emergency and urgent care model might be. What are the similarities and differences between emergency and urgent care and A and E as traditionally understood? That needs to be made clear, not just in Stafford and Cannock but everywhere such a model is proposed.

The commissioners’ statement made it clear that even while A and E was closed, children, maternity and GP cases continued to be received at Stafford at night. They are also working on how to bring back to Stafford the 15 or so patients who currently have to go elsewhere each night. That is welcome and sounds similar to the service prior to closure. So what is different? Can we not return to an open-door 24/7 service with effective triaging to filter out the unnecessary attendances that place a strain on emergency departments everywhere?

Mid Staffordshire trust may be exceptional in the long hard road it has to travel to regain the confidence of local people—and it has come a long way down that road—but it is not exceptional in the pressures it faces as a district general hospital. The Government have a chance to show how district general hospitals can thrive, providing emergency, acute and elective services to their people, working closely with social care and with the specialist hospitals in their neighbourhood.

EU Working Time Directive (NHS)

Jeremy Lefroy Excerpts

Thursday 26th April 2012 Westminster Hall

[Jeremy Lefroy (Stafford) (Con)]

I congratulate my hon. Friend the Member for Bristol North West (Charlotte Leslie) on pursuing this matter with vigour over many months—indeed, for more than a year.

I first became aware of the problem of doctors’ hours, particularly those of junior doctors, about 29 years ago when I started to go out with one, because I never saw her. I am happy to say that she is now my wife—and now complains that she never sees me, but that is another issue. In those days, many doctors worked what were called one-in-three or one-in-two shift patterns. There was even a celebrated one-in-one shift pattern right here in London, although I forget at which hospital, which meant that the junior concerned was in the hospital for six months, 24/7, without coming out unless the consultant allowed him or her—in those days, usually him; I am glad that, these days, it will probably more often be her—to leave the hospital. Those days, thankfully, are gone. I remember the doctor to whom I am now happily married working non-stop through a weekend. I wondered, in the end, however good a doctor was, whether patient care and safety was given sufficient consideration, and frankly it was not. That was so across the NHS. As all hon. Members have said, we are not going back to that stage: we will not and should not. This debate is not about that.

I also bring into play my experience as the Member of Parliament for Stafford, where, I am glad to say, things in the local hospital are improving steadily. We expect to hear about Stafford, and the whole NHS, in Robert Francis’s report later this year. Great efforts have been made to improve patient care and safety in my local hospital.

This debate is happening because all hon. Members are concerned about patient care and safety, not because we are all anti-Europe or want to find some fault with the European Union. It so happens that, in this case, the EU is causing the problem. Therefore, we have to bring that into the mix.

We introduced the European working time directive into the NHS with too little forethought. One reason in particular comes to mind. As we have heard, we needed some 4,000 extra doctors to take up the extra work that was required due to the imposition of the EWTD. Where were those doctors to come from? I pay credit to the previous Government for setting up several new medical schools, including one at Keele in Staffordshire, which are beginning to provide a stream of excellent new qualified doctors into the NHS. That is a positive step, but there was a disconnect between the timing of those doctors coming into the system and the European working time directive’s coming into force in the NHS in 2009. That has caused a major problem that I will mention briefly later.

I do not want to go into all the details, because hon. Members have covered them well. Suffice it to say that the categorisation of on-call time is one of the most important factors. As we have heard, Denmark, Greece, Ireland, Poland, Slovenia and Spain all have different ways of allowing on-call time to be counted: not as full hour for hour; perhaps as partial hour, or not at all; using a form of words such as “It’s training, not work”—I would hesitate to say that there is a difference between training and work—or using a contract-based rather than a person system.

There is a problem, however, although it is not one dreamt up by parliamentarians. Let me quote from a letter that I received from the Association of Surgeons in Training in the west midlands last year, which first brought the issue to my attention in detail, although I had been aware of it in general. Mr Henry Ferguson, who is the west midlands representative, wrote as follows:

“The EWTD is putting surgical patients at risk by producing thin layers of medical cover with frequent handovers. There are not enough surgeons to cover shift rotas and therefore there is inadequate staffing, particularly overnight and at weekends. Due to this shortfall, more locum doctors are needed to cover gaps in NHS shift rotas… Unless the restriction to a 48-hour working week is solved, the next generation of consultant surgeons will be short of experience.”

That is absolutely the case. I have spoken to friends who are consultant surgeons and they reckon that perhaps up to two years of training is lost. Surgeons, in effect, have to be trained for two years longer under the current scheme than under the old scheme. There is also a knock-on effect, if we are to have surgeons who are ready to fulfil the high expectations that we rightly have of them.

What are the consequences? I have already referred to training, and the figure of 65% of surgical trainees saying that training has suffered has already been quoted. My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) talked about the problem of handover, which I link to the loss of continuity of patient care under the general heading of patient safety. Under the old system, one consultant and one firm would be responsible for a patient all the way through the journey through the hospital. Yes, there were problems and not everything went right, but we knew who was responsible for the patient. As we have heard, however, handovers can cause a tremendous loss of data in some cases, particularly when they are done between people who are extremely tired—certainly the ones handing over are tired, after many hours at work. The cost, too, has already been referred to; in my own hospital, a locum was apparently paid £5,667 for 24 hours’ work. That case is not exceptional, and we have heard other, equally astonishing ones.

Finally, returning to recruitment and the disconnect between the time of a new flow of doctors coming through from our medical schools and the implementation of EWTD in the NHS, I have already referred to the problems caused. In my own hospital in Stafford, for instance, as well as in many others throughout the country, we are seeing a real problem in getting doctors, particularly for emergency departments. As my hon. Friend the Member for Bristol North West said, we fear that certain specialties will become less and less attractive. Medical students now will rightly look at what offers not only a chance of a really fulfilling career but, at the other end, a good work-life balance. If they see that certain specialties do not, they will reject them and we will continue to see shortages.

We have heard some excellent suggestions from my hon. Friend on the way forward—recategorisation of on-call time, a section-wide opt-out, perhaps, or legislation allowing certain professions to work at higher minimum hours per week—and all such things should be looked at. I am grateful to see in his place the Minister who has done so much for the NHS in the two years since he took office. I very much urge him, however, to work even harder than he is already is to ensure that patient care and safety are put at the heart of the NHS in that most important respect.

Oral Answers to Questions

Jeremy Lefroy Excerpts

Tuesday 27th March 2012 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

T8. Could my right hon. Friend indicate how he proposes to use his welcome new duty to reduce health inequalities under the Health and Social Care Bill?

[The Minister of State, Department of Health (Mr Simon Burns)]

I am extremely grateful to my hon. Friend for that question. As he will be aware from his time on the Bill Committee this Government have for the first time in the 64 years of the NHS put into legislation a duty to reduce health inequalities. That will be done through the NHS Commissioning Board and clinical commissioning groups, each being under a duty to have regard to the need to reduce inequalities in access to and the outcomes of health care. The Secretary of State will also have a wider duty to have regard to the need to reduce inequalities relating to the health service. That will include his duties for both the NHS and public health. It is a great step forward and I am surprised that the previous Government did not think of doing it during their 13 years.

Health and Social Care Bill

Jeremy Lefroy Excerpts

Tuesday 28th February 2012 Commons Chamber

[Mr Lansley]

The hon. Lady will have to look at the amendments tabled in the other place tomorrow.

[Jeremy Lefroy (Stafford) (Con)]

Will my right hon. Friend detail for the House how the Bill will help to improve patient safety and quality of care, which are so important to my constituents and those of everybody in the House?

[Mr Lansley]

I am grateful to my hon. Friend, because there are a number of ways in which I think this issue will be important. First, for the first time, how we improve patient safety will be published in a consistent way, as one of the five domains of the outcomes framework. Secondly, that will be demonstrated by achievement—for example, we have the lowest ever levels of methicillin-resistant Staphylococcus aureus and clostridium difficile infection. Thirdly, the NHS Commissioning Board, which will be established under the legislation, will take national responsibility for the delivery of patient safety, linking it directly to commissioning, whereas in the past the National Patient Safety Agency was an organisation on its own and was not directly linked to the exercise of commissioning responsibility.

NHS Risk Register

Jeremy Lefroy Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Andy Burnham]

Of course, there are lessons to be learned for those in all parts of the House when the Francis report is published, and I can say, on behalf of Labour Members, that we will learn those lessons. However, this Bill goes to the heart of what happened in that case, because it is about autonomy in hospital services, and we know that when one makes an organisation autonomous it can sometimes fail as well as get better. I cannot understand how the Government can be legislating before they have even waited to hear the conclusions of the public inquiry that they set up. Surely that has implications for the Secretary of State’s Bill. Why has he not waited to hear what it says so that it can be properly reflected in the design of the service that he is creating?

[Jeremy Lefroy (Stafford) (Con)]

Given that the right hon. Gentleman opposed the public inquiry at the time, will he now agree with Government Members, particularly the Secretary of State, that it was vital that it took place and that the lessons be learned?

[Andy Burnham]

One of my first acts as incoming Health Secretary was to commission Robert Francis QC to conduct an independent investigation into the events at Stafford on a local level. [Interruption.] Government Front Benchers are saying that it was not a public inquiry. They are right, but let me explain why. I did not commission a full public inquiry because, in my judgment, such an inquiry at that time, with all the glare and focus that it would bring to the hospital, would distract the hospital from its more immediate priority of making services safe as quickly as possible. I said to the chairman of the independent inquiry that if, at any time, he wanted to come back to me and ask for powers to compel witnesses, I would be well disposed towards receiving such requests. Given all the events that have taken place, to hear that the hospital is again having difficulties—that the A and E department is temporarily closed—gives me genuine cause for concern that the fundamental and far-reaching problems there have not been adequately addressed. That should concern us all.

I was talking about the risks identified by the NHS Northamptonshire and Milton Keynes risk register regarding the loss of capacity and problems in carrying out statutory functions resulting from the chaos caused by the Bill.

--- Later in debate ---

[Jeremy Lefroy (Stafford) (Con)]

The subject of this debate is risk within the NHS, specifically that associated with the Health and Social Care Bill. I want to address the matter with specific reference to Stafford hospital. My constituents, whether patients, relatives, loved-ones or NHS members of staff, have been through a great deal over the past few years. There is tremendous support for a quality acute hospital and the services that it provides in Stafford, including full-time emergency care, which it currently does not provide. The existence of that support is evidenced by a petition signed by 20,000 people. Those people need to know that the Bill will not hinder but support their ambition. I would like to show why it will support it.

The other great legislative influence on the future provision of NHS care in the coming years will be the report from the Robert Francis public inquiry into all the aspects of the troubles that surrounded the hospital. I am glad that the Secretary of State ordered that inquiry. He deserves credit for doing so. Indeed, his predecessor as Secretary of State, the right hon. Member for Leigh (Andy Burnham), also deserves credit for ordering the previous inquiry, which drew many valuable conclusions. Since those came to light, they have had a great impact on the Health and Social Care Bill. I will give three examples.

First, the Bill places a duty on the Care Quality Commission—the successor to the Healthcare Commission—and Monitor to work together closely. As Francis said, the absence of that duty was one reason for the troubles at Stafford and why the trust got the authorisation that it should not have got. Secondly, clause 2 places a duty on the Secretary of State to improve and promote quality throughout the NHS, which is vital. Thirdly, the Bill will strengthen local accountability for health services.

Francis will report soon—possibly while we are still considering the Bill—and as the right hon. Member for Exeter (Mr Bradshaw) said, we have to ensure that as many of those recommendations as possible are addressed in the Bill or very soon afterwards, perhaps in other legislation. A senior member of the Royal College of Physicians described the report to me as undoubtedly the most important review of the NHS in the past two decades, so it is vital that its recommendations are carried through.

In Stafford, we have seen at first hand the risks within the NHS. These risks, and their consequences, predate the Bill. The greatest risks that any health care system has to address are the safety of patients, the quality of care and the financial sustainability of services. The three are inextricably linked.

[Mr Marcus Jones]

Does my hon. Friend agree that part of the problem with Stafford hospital is the same as the problem at the George Eliot hospital in Nuneaton, Warwickshire? A PFI hospital built in close proximity has been a huge drain on the local health economy and has starved smaller district general hospitals of resources.

[Jeremy Lefroy]

I want to come to that point, although I should point out that people are grateful for the new hospitals built under PFI. I would not take anything away from that. It is the financial arrangements around them that have caused problems in some cases.

Much more work needs to be done on tackling the risk of harm to patients and ensuring patient safety. Local accountability, which the Bill strengthens, is important. Clinical commissioning groups will not commission services for their patients if they do not have confidence in them, but they have a responsibility to work with those providers so that confidence can be restored—they should not just ditch them. Transparency in the reporting on and reaction to adverse and serious incidents is improving, but under the Bill, with the health and wellbeing boards, HealthWatch and the CCGs, there will be groups taking a direct interest in what is happening in their local area.

Since the troubles at Mid-Staffordshire, all parties have focused on quality of care. I welcome the improvements at Stafford. There is still much more to do, but the staff have done a tremendous job moving things forward. However, there is a serious problem nationally, as was highlighted by the recent CQC report commissioned by the Secretary of State. We would all agree that it is not acceptable that elderly and vulnerable people are left unattended when they need help in hospital. We still get such cases, even today. That is why the Health and Social Care Bill’s requirement for the Secretary of State to improve the quality of services is so welcome. Making that a requirement will not in itself solve the problem, but it will ensure that the Secretary of State has a legal duty to deal with problems in the quality of care.

Then there is the question of financial risk. In Stafford, we face the problem at first hand, with a £20 million deficit this year. I am grateful to the Government for supporting us in that, and for their support in so many other places. However, we face great challenges, along with many other small acute trusts across the country, and we would under any Government. Let me make it clear: acute district general hospitals are an essential part of the health economy of this country, wherever they are. For the sake of towns and smaller cities across the country, we must, as a Parliament, find a model for them that works. Clause 25 of the Bill enhances local involvement in the commissioning of services. That will help the process, but it will need to be a robust process. When the consultations that are envisaged take place, they must be real, and they will be real: CCGs live in the communities for which they will be commissioning and they should know more than anybody about what their patients need.

The final risk cannot be legislated for, and no risk register will ever deal with it. If compassion for patients is lacking—if they are seen as numbers, not as people; if the elderly and vulnerable are considered a burden and somehow less important than the young and fit—we will have failed, however well funded our services are, however strong and shiny our new hospitals are, and however complete our risk register is. However, I am confident that we will not fail.

[Several hon. Members]

rose—