Care Bill [Lords]
Debate between Jim Dowd and Dan Poulter(10 years, 9 months ago)
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Dr Poulter
My hon. Friend makes a good point, which has been made by Government Members throughout this debate. Under the previous Government, in particular, many people felt that things were done to them with their local NHS, rather than done in the best interests of local patients. Importantly, decisions were very rarely made with clinical leadership under the previous Government. Proper patient consultation and patient engagement did not take place. I have a list with me of maternity units downgraded under Labour; it is right to say that individual reconfiguration decisions need to be looked at on their merits, but there was a long and tragic history under the previous Government of the public, patients and local clinicians not being properly engaged in the process. That is why our Government have introduced a better process whereby, as my right hon. Friend the Member for Chelmsford (Mr Burns) pointed out, decisions about local health care services under our 2012 Act are led now by clinicians through the clinical commissioning groups. We now have health and wellbeing boards, which is an important step forward in better joining up and integrating the health and care system that we all believe in, and in ensuring that democratically elected local authorities have more oversight of our health and care system. Those are important steps forward and this Government should be proud of them. They indicate that decisions should be made locally for the benefit of local people, and that is how things routinely happen.
The trust special administrator regime is not used lightly; it is used in extremis, which is why it has been used only twice in the past five years.
Dr Poulter
Let me make a little progress, because I have been generous in giving way.
Let us consider the following:
“The vast majority of trusts perform well, but in the rare instances where that is not the case, there must be transparent processes in place to deal with poor performance.”—[Official Report, 8 June 2009; Vol. 493, c. 544.]
I completely agree with those words—the right hon. Member for Leigh (Andy Burnham) used them when he described the purpose of the regime to this House in 2009. This is Labour’s regime, which it now tries to disown in opposition. The TSA regime is only ever used as the very last resort, and provisions in the Care Bill will introduce, importantly, a new role for the Care Quality Commission for triggering the regime when there has been a serious failure of quality; the emphasis will now be on quality, rather than merely on financial failure.
Clause 119 respects the coalition agreement that routine service changes will be locally led; it is about protecting patients and ensuring we can act rapidly and effectively in their best interests in examples of extreme failure. It may therefore be helpful if I set out some of the changes and improvements we are making to the regime under clause 119.
Dr Poulter
I do need to make some progress, as I have been generous in giving way. If hon. Members will let me make some progress, I may give way again a little later.
Clause 119 was introduced following calls to the Government by key stakeholders representing NHS providers—the Foundation Trust Network and the NHS Confederation. Like us, they recognise the experience of how the regime has operated. They know that issues of financial and clinical sustainability of health services nearly always cross organisational boundaries, and they were clear that the Labour Government’s regime needed amendments to make it effective in the spirit that the right hon. Member for Leigh intended when he created it in 2009. Let me read out again what was said in the impact assessment to the 2009 TSA regime—his regime. It states:
“NHS Trusts…are not free-floating, commercial organisations.”
It also says:
“State-owned providers are part of a wider NHS system.”
We fully agree with that, and that is what we are ensuring we take into account in the TSA regime. That is what clause 119 is about. Clause 119 would extend the remit of a TSA to make recommendations that may apply to—
Dr Poulter
I have repeatedly read out supporting evidence from the previous Government and from the impact assessment that showed that they recognised that the regime had to take into account the wider health economy. It is not my fault or the fault of hon. Members on the Government Benches that Labour’s legislation was not properly drafted, and that it did not do what it intended—
HEALTH
Debate between Jim Dowd and Dan Poulter(12 years ago)
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Dr Poulter
My hon. Friend is absolutely right and I pay tribute to him for taking the time to go out with the ambulance service and see first hand the problems that have been experienced in some parts of Suffolk and Norfolk. There have been problems with the handover time at some hospitals in the east of England and that is clearly unacceptable, because if the ambulance and hospital staff are engaged in lengthy handovers, it means that other patients are not being treated and seen in a timely manner. Those issues need to be addressed by some trusts in the east of England.
My hon. Friend the Member for Waveney has written to the ambulance service and his letter was made available to my noble Friend Earl Howe. In it, he highlighted the trust’s decision to publish more performance information online from February and stated that it was important that that was done by geographical area to ensure that there is greater transparency in the quality of response data in areas such as Beccles and Bungay, relative to more urban areas such as Ipswich. That is an important point. I urge him and my hon. Friend the Member for Suffolk Coastal to continue pushing for transparency in the ambulance service’s data, and to continue their fight for improved response times for more rural areas of Suffolk and Norfolk. I know that my noble Friend Earl Howe would be happy to meet hon. Members to discuss the matter further.
Let me turn to the issues that were raised by the other three Members. I will be brief, Mr Deputy Speaker, because I take your hint. My hon. Friend the Member for High Peak (Andrew Bingham) raised concerns about a number of ambulance stations, including one in Buxton. I know that my hon. Friend the Member for Staffordshire Moorlands (Karen Bradley), who lives in a nearby constituency, shares those concerns. A review is currently taking place. We all welcome reviews if they are going to improve the quality of care for patients and improve ambulance response times. However, there are local concerns that the review must take into account issues such as rurality and the difficulties that patients on high land or in harder-to-access areas have in accessing all types of health care services.
I note the concerns that the review is making proposals that do not necessarily take account of those factors. My hon. Friend the Member for High Peak has put those concerns on the record today. If that has happened, I echo his concerns, because it is important, in the review of any service, that issues such as rurality and difficult-to-access areas are taken fully into account. This is, of course, a local health care decision. If he wants to discuss the matter further with Ministers, we are happy to discuss it with him.
The hon. Member for Lewisham West and Penge (Jim Dowd) put across his strong advocacy for Lewisham hospital. I trained in south Thames and have colleagues who work at Lewisham hospital. We all know that Lewisham faces particular challenges. It has demographic challenges, given its difficult population groups with considerable health care needs, and great health care inequalities. It has a large migrant population, which brings particular health care challenges and means that people do not always have English as a first language. Such people need to be looked after properly. It is important that those issues are taken into account during the discussions.
I take on board the concerns of local staff that they are being drawn into the big financial concerns with South London Healthcare NHS Trust. However, we also have to recognise that no one hospital operates in a vacuum. We must ensure that hospital services and the care that is provided reflect the needs of the wider geographical area. My right hon. Friend the Secretary of State will be looking into these issues.
Dr Poulter
I will take an intervention very quickly, but I am pressing on Mr Deputy Speaker’s patience.