business of the house
Jeremy Lefroy Excerpts(11 years, 8 months ago)
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Jeremy Lefroy (Stafford) (Con)
The excellent statement this morning by my right hon. Friend the Secretary of State for Health on the Government’s response to the Francis report on the Mid Staffordshire NHS Foundation Trust shows just how important that inquiry has been and how the findings will help to change the NHS for the better for patients. I particularly welcome the emphasis on zero harm and quality of care, including the proposals for the training of nurses and for a chief inspector of hospitals.
The recent Care Quality Commission report on Stafford hospital was encouraging too—a hospital that failed so badly has now met the standards expected—and I thank the retiring chief executive Lynn Hill-Tout, staff, governors and board for all that they have done. Yet, just at the moment when the people of Stafford should be emerging from a decade or more of pain and uncertainty, we are faced with another huge challenge. The report to Monitor by the contingency planning team, published at the beginning of this month, recommended the removal of most emergency, acute, maternity and possibly even elective services from the Mid Staffordshire Trust which runs Stafford and Cannock hospitals.
This puzzles me. Emergency and acute admissions to hospitals in the west midlands are rising sharply and departments are at full stretch. Just last month—February—West Midlands ambulance service reported delays to its vehicles of more than 30 minutes on more than 1,000 occasions at the University Hospital of North Staffordshire. That is not a criticism of that hospital, just a reflection of demand. The proposal, however, is to remove a substantial amount of that capacity, which is already stretched: 300 acute beds at Stafford, in addition to the 250 that have already been lost at UHNS as a result of the new, smaller PFI hospital. In fact, at least 60 have had to be reopened at the old site, as demand is so great.
The reason given for this is, as always, that if we move care out of hospitals and into the community, the demand for emergency and acute admissions will fall. That is only half the truth. It will fall, but only from the much higher levels it would have reached. Moving care into the community will stop the need to provide much more extra emergency and acute capacity, but it will not allow for substantial reductions in that capacity. This is the flawed assumption under which NHS leaders seem to be working.
There is a squeeze on emergency and acute tariffs that started under the previous Government. I have raised this issue before and I will continue to do so, because unless it is addressed it will eventually result in dangerously low levels of emergency and acute cover in parts of the UK. It cannot be sensible for trusts that deal in elective work to pile up surpluses while many acute trusts, on which we all depend, struggle to cope with mounting deficits.
It would be nice to believe that all hospital admissions could be elective—that all work could be programmed to fit into an ordered day—but life is not like that, especially when we have large numbers of people living longer, which I welcome, and then becoming ill suddenly with acute, complex conditions. That is why I firmly believe, as do most of my constituents, that acute district general hospitals have an important role to play. Indeed, if they did not exist, we would probably decide to create them, precisely because they are the best place for the initial treatment of the elderly with complex, acute conditions, who could be close to home and to their loved ones.
We do of course need to learn the lesson of Mid Staffordshire and other places. Such district general hospitals are usually too small to sustain many of the specialist rotas that are needed, but the solution is not, as is proposed for Stafford, to cram all serious emergency and acute cases into already overstretched neighbours; it is to work closely with those neighbouring trusts—even become part of them—and thus enable clinicians to work across neighbouring sites. This solution has the merit of combining the benefits of scale with providing care close to patients.
I met Monitor two weeks ago, and I welcome the assurance I was given by the chief executive, Dr David Bennett, that the trust special administrator, shortly to be appointed, will consider options other than those recommended, which are wholly inadequate. Monitor has the chance to show how smaller, acute general hospitals can not only survive but prosper under the wing of a larger trust. If it does that, it will have done the NHS and our country a great service.
Business of the House
Jeremy Lefroy Excerpts(11 years, 9 months ago)
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Jeremy Lefroy (Stafford) (Con)
In April the people of the United Kingdom will fulfil their commitment to give 0.7% of GNI to the developing world, which I think all Members of the House will welcome. At the same time, the Small Charitable Donations Act 2012 will come into effect. May we have a statement, perhaps from the Economic Secretary to the Treasury, to explain how that will benefit those who donate to charities in all our constituencies?
Mr Lansley
My hon. Friend is right. I share with him, and with the House, the hope that that Act will give further support to charities. It is an essential part of how we support the charitable sector here and around the world. I am not entirely sure how we will mark it, but it will be a very important moment, because, despite the tough times we and others around the world are experiencing, we have demonstrated our generosity, and indeed our responsibility, to the poorest people right around the world by fulfilling, under the coalition Government, the long-held ambition of devoting 0.7% of our GNI to overseas development assistance.
Business of the House
Jeremy Lefroy Excerpts(11 years, 11 months ago)
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Mr Lansley
My hon. Friend raises an important point. He and other Members might like to discuss this with the Backbench Business Committee. Debates of this character, enabling us to look at such issues, are often more suitable for Back-Bench time rather than Government time, given the way time is now structured in the House; nevertheless, I entirely understand and he quite properly raises the issue with sufficient time for it to be considered.
Jeremy Lefroy (Stafford) (Con)
Staffordshire university has a strong and growing partnership with Gulf college in Oman, as well as universities in Malaysia and China. May we have a debate on how to make the most of the vital partnerships between British universities and universities across the world and perhaps on how the Foreign and Commonwealth Office could be involved in that?
Mr Lansley
My hon. Friend makes an important point. I am not aware of an opportunity in the business immediately ahead of us for a debate of that kind. However, as he made clear, when we consider the ways in which higher and, indeed, further education are responding and marketing to other countries—including, for example, the simple fact, which one would not believe if one read some of the newspapers, that the number of applications to British universities from overseas this year has increased—I think we have an opportunity to continue pushing forward the trade relationships we have. Indeed, Ministers from the Foreign and Commonwealth Office are on the Front Bench listening to this, and I know they will take this issue forward as well.
HEALTH
Jeremy Lefroy Excerpts(12 years ago)
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Jeremy Lefroy (Stafford) (Con)
In September 2012 the Royal College of Physicians published a report, “Hospitals on the edge? The time for action”, which sets out starkly the challenges facing our acute hospitals. It begins:
“All hospital inpatients deserve to receive safe, high-quality, sustainable care centred around their needs and delivered in an appropriate setting by respectful, compassionate, expert health professionals. Yet it is increasingly clear that our hospitals are struggling to cope with the challenge of an ageing population and increasing hospital admissions.”
It highlights the consequences of failing to meet the challenges and refers to the history of my own trust. When the public inquiry reports next month, we will have the opportunity to consider its implications for the NHS. Today I wish to concentrate on the Monitor review of my trust in the light of the continuing rise in pressure on acute services that the Royal College of Physicians highlights.
There are three common themes that I hear in the NHS these days. The first is that we need to do much more in the community and at home and much less in acute hospitals, and that we must therefore close acute hospital beds and use the money in the community. Although I agree with the premise, I dispute the conclusion. Community care is essential, but it must work before it results in a reduction in admissions and lengths of stay. The fact that admissions are rising and, according to the RCP, the fall in length of stay has flatlined in the past three years, even rising for patients over 85, indicates to me that the shift to the community either is not happening fast enough or indeed will not happen as expected.
The conclusion also seems to ignore demography. In the area served by the Mid Staffordshire Trust, the population is expected to rise by some 10% in the coming 23 years. The number of people over 60 will rise by nearly half, and the number of those 75 and older—those most likely to need acute services—will double. I suspect that is the situation in many parts of the country.
Increasing admissions, rising and ageing population, flatlining length of stays—all of these indicate an increased demand for acute services in the coming 20 years, yet the talk is, and has been for many years, of further reductions in acute beds. It makes little sense to do that until community services and other medical advances mean that those beds are proved to be no longer necessary. In Stafford, there is a shortage of step-down beds, so rather than closing acute beds altogether why not keep them as community beds on the same site, leaving the door open for increasing acute services in the future, if and when the need arises?
The second theme is that we need to integrate primary and secondary care more closely. I agree, yet actions sometimes have the opposite effect. The previous Government took away the responsibility for providing 24/7 primary care cover from GPs. I regret that, as it detracts from integration. It may also be responsible for placing a greater burden on accident and emergency departments at night. If out-of-hours care is not to be the responsibility of GPs, let it be centred, where geographically possible, on acute and community hospitals. This makes better use of NHS premises and, by being adjacent to A and E or other emergency units, can help take the pressure off them while providing the hospital with extra income. That would certainly work at Stafford and Cannock.
Tariffs can produce strange results. The University Hospital of North Staffordshire has a block contract for A and E admissions. For any admission in excess of that, it receives only 30% of the tariff, so what is it supposed to do—reject emergency admissions on the basis that they will be loss-making? Of course not. I would propose that emergency departments are funded at what it costs to provide that service safely. In Stafford, the emergency department has a deficit of some £2 million per year based on throughput and tariff. The number of patients attending—more than 50,000—could not possibly be safely accommodated elsewhere. Surrounding hospitals are already at capacity, so it makes little sense to impose a national tariff, which inevitably results in a loss and which in turn puts pressure on the hospital to prove that it is sustainable.
The third theme is that medicine is becoming increasingly specialised, so most work will inevitably migrate to large specialist units. There is truth in this belief, but there is also danger. There are 61 approved medical specialties in the UK, compared with 30 in Norway. As the RCP says, this has
“rendered the provision of continuity of care increasingly difficult.”
For older people, who often have complex and multiple needs, this can result in poorly co-ordinated care. This has not been helped by the introduction of shift-based systems under the new deal and the European working time directive, to replace the teams that took responsibility for individual patients. Specialisation also means that there is a much smaller pool of staff from which to select for each post.
If we were to design from scratch a hospital where those who will need it most— the elderly, as the statistics show—will receive safe and caring care for their complex needs as close to home and loved ones as possible, integrated into primary and community care, we would end up with something pretty much like the district general hospitals and community hospitals up and down the country, such as Stafford and Cannock.
This is not an argument for no change. I believe there must be much closer working between the larger and smaller trusts, for instance, and much more sharing of common services than at present. But it is a warning that national tariffs are not impartial arbiters. They generally work, I believe, against acute care.
Jim Dowd
I am following what the hon. Gentleman is saying most carefully, as this is part of the problem that we experience in Lewisham. Does he feel, as I do, that instead of reflecting the needs of the population across the country and providing services that correspond with that, the Department of Health is trying to implement a template or a framework of its own making and inflict it on the nation?
Jeremy Lefroy
I thank the hon. Gentleman for his intervention. I am not convinced that that is the case at all. I believe Ministers are listening and are considering matters very carefully, but there is a danger, of course, that a template will be inflicted. The hon. Gentleman and I both earnestly trust that that will not be the case.
As I said, I believe that national tariffs are not impartial arbiters. They generally work against acute care, and there is a risk that the constant pressure which they are placing on acute care, particularly in district general hospitals, will make much of the sector unsustainable, yet without it, we do not have an NHS.
Finally, I wish to raise a specific point about Monitor’s review of Mid Staffordshire. Clearly, the population served by the trust is a very important consideration. The trust’s 2011-12 report said that it was around 276,000, yet I have heard reports that the Monitor team considers it to be as low as 220,000 and therefore potentially too small to sustain certain services. The facts that I have clearly support the trust’s figure, not the one that I have heard rumoured.
I have spoken much today about figures, because they are an important part of the Monitor review, but more important is the quality of services, for which Monitor also has a legal responsibility. Early next year, the Secretary of State will bring to the House the report of Robert Francis QC from his public inquiry into Mid Staffordshire. Julie Bailey and the Cure the NHS group, who from their own experiences brought to light the harm that was done, have set out radical and clear ideas for turning the NHS the right way up, with the patient at the top, not the bottom—right first time with zero harm to each and every patient. That is something which caring, hard-working staff in our NHS in Stafford and Cannock—where waiting times and mortality rates are improving, although there is much to be done—and right across the country went into the NHS to provide.
The NHS, as the right hon. Member for Wentworth and Dearne (John Healey) said, and the nursing and medical professions must make it clear that there is no place for anyone for whom quality patient care does not come above all else. The regulations must show that.
The Monitor review is an opportunity for Stafford and Cannock hospitals to become a model of how to provide sustainable high quality emergency, acute and community care to a mid-sized population. If Monitor succeeds in achieving this there and elsewhere, as the hon. Member for Lewisham West and Penge (Jim Dowd) mentioned, it will have done the nation a great service, and I am sure the Minister will be remembered as someone who played a major part in improving our NHS. I urge Monitor to rise to the challenge.
Grahame M. Morris (Easington) (Lab)
I thank the Backbench Business Committee for making this debate possible before the Christmas recess. I shall raise an important issue, access to advanced therapeutic radiotherapy. I have raised this previously and I make no apology for doing so again. I intend to keep raising it until my constituents and those all across the country have proper access to advanced and innovative therapeutic radiotherapy systems.
I remind the House that prior to the Conservative party conference the Prime Minister pledged that from April next year cancer patients who need innovative radiotherapy will get it. That pledge was confirmed to the House by the Secretary of State for Health on 23 October and by the Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry), who has responsibility for cancer services, in written replies on 30 October.
The Department of Health’s press release on 8 October expanded on the Prime Minister’s statement, indicating that a new £15 million cancer radiotherapy innovation fund was being created, drawn from the underspend of the cancer drugs fund. I bring to the House’s attention the fact that the £200 million cancer drugs fund has been under-spent by an average of £150 million each year since it was established. That was reported to the House on 16 April 2012—column 134W in Hansard.
The Health Minister confirmed on 30 October that the pledge meant three specific things: patients would have access to appropriate radiotherapy wherever they lived; the new national Commissioning Board would be responsible for funding; and intensity-modulated radiation therapy, known as IMRT, stereotactic ablative radiotherapy, know as SABR, and stereotactic radiosurgery would be included.
Since the Prime Minister’s pledge, the Department of Health has contacted all cancer centres to inform them that the cancer radiotherapy innovation fund is a revenue fund only and that its use is to be focused on getting as many centres up to the standard of delivering 24% access to IMRT by April next year. In a letter to all cancer centre chief executives on 17 October, the cancer tsar, Sir Mike Richards, stated that only four of the 50 centres were reaching the 24% requirement set by the national radiotherapy implementation group.
In a letter to all radiotherapy service managers on 25 October, the national cancer action team stated that the cancer radiotherapy innovation fund was to be used effectively so that the Prime Minister’s pledge could be honoured and that if they are not delivering IMRT at the required 24% they were to submit an action plan by the end of November indicating how they would achieve that.
The letter also stated that the radiotherapy service managers could access initial funding of up to £150,000 to help them reach the target. However, the Health Minister, when questioned about funding for the pledge on 30 October, told the House that there would be no extra or ongoing funding similar to the cancer drug fund for commissioners to draw on and that any capital funding requirements would have to be met from the current £300 million bulk purchase fund announced earlier this year. In other words, there was no extra money. It seems to me that the pledge cannot be met, in terms of both revenue and capital.
Over the past two years adequate revenue funding has never been available to local commissioners to fund all the radiotherapy patients who have needed it. I know that full well from cases in my constituency. There is no indication that the new national Commissioning Board is to receive any additional funding. Without extra money, how will it fund care for the new 8,000 to 10,000 cancer patients the Prime Minister claims his pledge will help?
I would like to consider capital for a moment. I received an e-mail last night from the charity Breast Cancer Campaign, which indicated that, given the current age profile of the linear accelerators in England, an additional 147 new LINACs will be needed by 2016, at an average cost of £1.5 million. I want to ask the Minister how those will be funded. There are simply not enough advanced radiotherapy systems in the NHS to deliver the pledge. The Department of Health has admitted that only four of the 50 cancer centres are able to deliver IMRT to the required standard. At full capacity they could treat between 1,200 and 1,500 patients a year.
There are only four systems in the NHS delivering SABR up to the required standard, as the Minister has confirmed in written answers, and I have been to see one of the machines in St Bartholomew’s. At full capacity they could treat 1,000 patients a year. There is only one Gamma Knife in the NHS delivering stereotactic radiosurgery—in Sheffield—and at full capacity it could treat around 300 patients a year. With no extra capital available to fund new machines, it will be impossible for patients in most of England, including my region, to be treated by the NHS. There are some machines in the private sector, but the treatment is very expensive.
I am asking not for more money for cancer care, but for a more equal distribution of resources. The Department of Health is telling commissioners that radiotherapy, in conjunction with surgery, is very effective, curing 70% of all cancers. I have come here neither to lambast the Minister, nor to condemn him with faint praise; I have come bearing gifts, as it is Christmas, in the form of a potential solution. If the total underspend from the cancer drugs fund was transferred to radiotherapy in each of England’s regions, the systems could be upgraded with the most advanced radiotherapy equipment by 2015, which would enable constituents in my region and across the country to access life-saving therapies and allow the Prime Minister to fulfil his pledge.
Business of the House
Jeremy Lefroy Excerpts(12 years, 1 month ago)
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Mr Lansley
As a one-nation Conservative, I believe that we are a one-nation Government. If the right hon. Gentleman wanted any more evidence of that, he would have paid more attention to the announcements made by the Deputy Prime Minister last Friday, I think, on regional growth 3, which will support the kind of innovative investment in the north of England that is integral to its economic development.
Jeremy Lefroy (Stafford) (Con)
Not only has the number of jobseeker’s allowance claimants in Stafford fallen by 14% since April 2010, but we have just had the welcome news that a record 272 new companies were formed in the first six months. May we have a debate on how to support these new companies, so that they create the jobs and pay the taxes we need?
Mr Lansley
My hon. Friend makes an important point, and I am happy to say that those figures are reflected in many constituencies across the country. Stafford is clearly working well, and I applaud what they are doing there. Yes, I hope we will have the opportunity, not least in the debate on the Growth and Infrastructure Bill, to see how we are creating that kind of environment. I would draw particular attention to the work being done through the youth contract and apprenticeships to ensure that young people are finding the kinds of jobs with skills training attached that will enable them to support industrial development in the future.
Business of the House
Jeremy Lefroy Excerpts(12 years, 5 months ago)
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Sir George Young
This refers to a debate that took place yesterday when the Deputy Leader of the House mentioned that specific consequence. The House has made a clear decision when to sit on Tuesday, but we will look at the consequences for tours and see whether we can find some way through to make sure that those who want to visit the House are able to do so.
Jeremy Lefroy (Stafford) (Con)
The 2010 Browne report recommended that an efficient national scheme be set up through the student finance system to encourage past graduates to contribute to university endowment funds. May we have a debate on this subject and the progress on that?
Sir George Young
I cannot promise an early debate before the House rises, but my hon. Friend makes an important point. I can only suggest that when the House returns in September he applies for a debate in Westminster Hall, so that he can pursue this particular avenue and deal with it at greater length.
Business of the House
Jeremy Lefroy Excerpts(12 years, 6 months ago)
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Sir George Young
I understand my hon. Friend’s concern. My understanding is that the disabled facilities grant is aimed specifically at families such as the one that he has mentioned to enable them to stay in their own home. In the last spending review, we sought to ring-fence the DFG money so that the resources were available to ensure that people did not have to move home if their existing home could not cope with a particular disability. I will make inquiries with the Department for Communities and Local Government to see whether there is any action that we can take to help his constituents.
Jeremy Lefroy (Stafford) (Con)
Constituents of mine have been through the considerable distressed of seeing their son’s killer in an area from which he was excluded by bail conditions, yet he was not returned to prison. May we have a debate on the rights of victims in those circumstances?
Sir George Young
It sounds as though it was a matter for the court in the first instance, when it discovered that the bail conditions had been broken, to return the offender to jail. However, I understand the concern of my hon. Friend’s constituents, and I will raise the circumstances that he mentions with my right hon. and learned Friend the Justice Secretary to see whether any action ought to be taken to ensure that bail conditions are properly enforced.
Business of the House
Jeremy Lefroy Excerpts(12 years, 6 months ago)
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Sir George Young
A large number of hon. Members presented petitions on behalf of their constituents, which is a perfectly proper thing to do. It is a matter for the House authorities what amendments are selected when the Finance Bill comes back to the Floor of the House and, indeed, what amendments are proposed in Committee. On the hon. Lady’s direct question, I have no knowledge of any private undertakings that may have been given on this subject.
Jeremy Lefroy (Stafford) (Con)
Following the theme of caravans, a company in my constituency lost a day’s production because a mobile home and two caravans turned up and camped on its premises. The people involved told my constituents that they needed £500 in cash or more vehicles would be coming to join them. The police were sympathetic to my constituents’ case, but said that this was a civil matter. May we have a debate about the sanctions against intentional trespass?
Sir George Young
I am not a lawyer, but what my hon. Friend has described sounded to me a little bit like criminal behaviour—trespassing on someone’s land and then demanding money to go away. I would like to share this issue with my right hon. Friend the Home Secretary to see whether there is a combination of civil or criminal penalties available to cover the circumstances that my hon. Friend has described. I understand how disruptive it must have been to have that presence in an industrial estate.
Business of the House
Jeremy Lefroy Excerpts(12 years, 7 months ago)
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Sir George Young
I commend my hon. Friend’s initiative in saving the lido in Brighton. I cannot promise a debate on the matter, but I will ask the Secretary of State for Culture, Olympics, Media and Sport whether there is a role for him to play in this movement. My hon. Friend might also like to contact the Backbench Business Committee about holding a debate, as I am sure that there are other hon. Members who share his concern.
Jeremy Lefroy (Stafford) (Con)
May we have a debate on the importance of collaboration between universities and business in supporting growth? Staffordshire university has just been specially commended by the Higher Education Funding Council for England for its work led by Sandra Booth and her team.
Sir George Young
I commend what is happening in my hon. Friend’s constituency. It is important for universities to be in touch with business so that they can focus their courses on the skills that industry needs, and I am delighted to hear of the collaboration taking place in Staffordshire.
Business of the House
Jeremy Lefroy Excerpts(12 years, 9 months ago)
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Sir George Young
If such a measure requires legislation, the Finance Bill has its Second Reading when we come back and there may be an opportunity for the hon. Lady to raise the matter.
Jeremy Lefroy (Stafford) (Con)
May we have a debate on the importance of the teaching of foreign languages to export performance, so that we can ensure that young people such as those who participate in the excellent Stafford and Stone young enterprise programme can spearhead the UK’s export growth in future?
Sir George Young
I very much hope that schools and colleges give priority to foreign languages that will help us win exports in competitive world markets. I commend the work in my hon. Friend’s constituency, where that is clearly seen as a priority.