National Health Service (Amended Duties and Powers) Bill

Joan Walley Excerpts

Friday 21st November 2014 Commons Chamber

[Clive Efford]

I should like to make some progress. The Bill is in four parts. Part 1 deals with the powers and duties of the Secretary of State. It reinstates the legal duty of the Secretary of State to promote a comprehensive national health service. It gives powers of direction to the Secretary of State over NHS England and local commissioners. It also requires the Secretary of State to put the needs of patients above those of the providers, or the market within which providers operate. It also provides that all contracts will be deemed to be “NHS contracts”. The significance of that is that they will not be subject to competition rules. All complaints will be dealt with within the framework of the NHS, with the Secretary of State having the final say—not lawyers or the courts.

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

I am grateful to my hon. Friend for giving way and for securing this private Member’s Bill. One urgent issue that we must address is that of the purchaser/provider split. Will he assure us that the proposals in this part of the Bill will mean that health services can be run purely on health grounds?

[Clive Efford]

The Bill does not attempt to rid the NHS of the purchaser/provider split. That would require a new top-down reorganisation of the national health service, which people in the NHS say they do not want. What I can say is that this Bill will create a framework in which NHS contracts are not open to competition rules. As long as the commissioners of services stay within the confines of the NHS contracts, they will not be open to competition. They will be compelled to do that by sheer cost, because if they step outside of NHS contracts they are then into European competition rules and will have to spend millions on lawyers and accountants to oversee the tendering process.

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[Dr Poulter]

In a moment I will address in a little more detail a couple of the points that were raised. I reassure my hon. Friend that the section 75 regulations that underpin the 2012 Act, which are almost identical to regulations that the previous Government were involved with, outline very clearly, under regulation 10, that integrated service, or encouraging co-operation between providers in the interests of patients should not be seen as anti-competitive. Regulation 15 makes it clear that Monitor cannot direct a commissioner to hold a competitive tender. There is strong support throughout those regulations, as there is throughout the 2012 Act, for integrated service delivery in the best interests of patients, where that is appropriate.

[Joan Walley]

Will the Minister give way?

[Dr Poulter]

I am going to make some progress—I hope the hon. Lady will forgive me—because Mr Deputy Speaker is looking at me.

Care Workers

Joan Walley Excerpts

Wednesday 5th November 2014 Westminster Hall

[Mr Smith]

Most certainly they are, and I will say more about that later. I support, and the House ought to support, the key action that Unison and others are calling for. First, the Government should make ending illegally low pay for care workers a key priority. Secondly, HMRC should be instructed and resourced to do a proper job in ending the widespread breaches of the national minimum wage. Thirdly, care providers and the councils that commission them should be named and shamed when they do not pay the minimum wage.

It is not just trade unionists, local councillors and those whose loved ones use care services who are concerned about all this. In preparation for the debate, I spoke to local private care providers, and I will share with Members some of the points they made. They told me that care workers’ salaries do not reflect the responsibility they have; that luck and money are all too likely to decide people’s quality of care; that too many staff are on poor contracts, but that often reflects poor profit margins; that zero-hours contracts can be a barrier to recruitment, but that some employees want them; that staff turnover is high because of the high cost of living and shortage of affordable housing, which is an issue in my constituency; and that pressure on council budgets—the point made by my hon. Friend the Member for Easington (Grahame M. Morris)—means that restricted funding is available for front-line care.

Local providers also drew my attention to the fact that in six out of 14 areas in Oxfordshire, the county council is offering rates of funding for front-line care that are below the living wage, even though it has rightly pledged to pay its own staff above the living wage. Providers also told me that upper-tier councils such as Oxfordshire, which are responsible for home care, have their hands tied by the local government squeeze. Members should remember that all these points have been put to me by providers.

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

May I, too, declare an interest, as a Unison member, and say how important it is that this issue has been flagged up in the debate? Given the concerns about this issue, should home care not be part and parcel of the discussions about the future of the NHS? We need to keep people out of accident and emergency and out of hospitals. If there is no care in the community, we will put more expense on the NHS and provide worse care. Does my right hon. Friend agree that, in discussions about the future of the NHS, we should make absolutely sure that these workers are paid a proper rate for the job and that travelling time is included? The Care Quality Commission has a vital role in this.

[John Robertson (in the Chair)]

Order. I ask hon. Members to keep interventions a bit shorter.

Special Measures Regime

Joan Walley Excerpts

Wednesday 16th July 2014 Commons Chamber

[Mr Hunt]

I am very happy to do that, and I pay tribute to the leadership of the trust. There is a new chief executive and, as I have said, I have met the chief nurse. It is a very large trust with two big hospital sites. There are some very big challenges to tackle, but they are making important progress, and, like my hon. Friend, I am keen to get them out of special measures as soon as we can.

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

Having read the Care Quality Commission annual report and met the CQC, and seen in the report that in Stoke-on-Trent more than 20% of care homes have not been fit for purpose for a period of more than three and four quarters, may I welcome the inspection regime of care homes? Training and enforcement will be important.

May I refer back to the comments made by the hon. Member for Stafford (Jeremy Lefroy) in respect of Mid Staffordshire Trust and Stafford hospital, and to previous meetings we have had with the Secretary of State, his colleague in the House of Lords and the Prime Minister and say that, between now and September, we need to know categorically from the Treasury whether the Government are going to fund in full what the University Hospital of North Staffordshire trust says it will cost to run the new configured hospital services across the whole of north Staffordshire? Only when that happens can the Government say that they have solved the issues relating to Mid Staffordshire.

[Mr Hunt]

I thank the hon. Lady for her support for the new special measures inspection regime for care homes. With respect to the merger of UHNS and Mid Staffs, we will make sure that the funding is available that is necessary for that merger to happen. Money is not the issue. The issue is doing what the TSA asked to be done quickly and in full, and making sure that we have the right leadership across both hospitals on a long-term sustainable basis. I do not think it is about money; it is about taking rapid action to make sure there are stable services and that there is continuity of care.

Care Bill [Lords]

Joan Walley Excerpts

Tuesday 11th March 2014 Commons Chamber

Of course, the law—the previous Government’s National Health Service Act 2006, as amended by this Government’s Health and Social Care Act 2012—may already provide flexibility, and my new clause may be unnecessary. While Mid Staffordshire was going through its administration, I was told that the Secretary of State had no flexibility under the law, but when he made his decision two weeks ago, he accepted Monitor’s recommendations with a welcome addition—an instruction to NHS England to review how consultant-led maternity services might still be provided at Stafford. I and my constituents have been arguing that case throughout the administration, and I sincerely hope that NHS England will see how vital it is for consultant-led services to continue in a networked form within the University Hospital of North Staffordshire NHS Trust, of which Stafford hospital will now be an important part.

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

The hon. Gentleman is making well-informed comments about the whole issue we face. He says that the arrangements need to be looked at on another day, but surely our experience in Staffordshire and the complete confusion over a set of recommendations that have been accepted but cannot be implemented means that we ought to find some way to resolve the whole issue in this evening’s debate, not give the Secretary of State powers to close down general hospitals at random all over the country.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

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

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[Paul Burstow]

The hon. Gentleman anticipates my next point. It is far from clear how the judgment should be made that a trust is failing. In my view, the gateway to the process should be a narrow one, and it should be jealously guarded. My concern is that so many trusts are sitting on top of private finance initiative debt, and that hospitals could be at risk as a consequence. That debt amounts, over time, to about £70 billion; a significant burden has been hung around the neck of the NHS. I want to ensure that we have processes that can recognise and manage that without tipping organisations into crisis unnecessarily.

[Joan Walley]

Does the right hon. Gentleman agree that trust special administrators coming in and making recommendations, as they have done in the case of Staffordshire, can completely undermine the hospitals that are being asked to take over the failing hospitals? Such a process brings about no resolution to the problem at all.

[Paul Burstow]

I think the hon. Lady will find some sympathy for that view.

Local commissioners and trusts should be responsible for sorting out difficulties that could lead to a failure. Again, it needs to be clearer what happens at the pre-failure stage, and Ministers need to work with NHS England and Monitor to set out the pre-failure regime so that it is crystal clear what needs to happen to avoid triggering the TSA process. It might be argued, as Labour did in 2009, that when an NHS trust fails, there needs to be a fast way of making decisions about its future. Those decisions might have knock-on effects, but that should not mean that one trust’s failure triggers a wholesale re-engineering of local health services without proper checks and balances and accountability. Decisions about local health services should be taken by clinical commissioning groups.

I have tabled new clause 16 because I believe that two principles established by the Health and Social Care Act 2012 deserve to be protected. The first principle is—

Francis Report

Joan Walley Excerpts

Wednesday 5th March 2014 Commons Chamber

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

This debate, which is taking place 12 months after the publication of the Francis report, is long overdue and desperately needed.

[Mr Cash]

I endorse what the hon. Lady says. I think that I had to call 15 times for the report to be debated.

[Joan Walley]

I think that there has been an extraordinary degree of cross-party support from all Staffordshire MPs for efforts to get the matter on the agenda. When we look at the initial inquiry called by the Labour Government, its extension and then its translation into a full public inquiry by the current Government, and when we consider how quickly we as parliamentarians need to ensure that we hold the Government to account, we must recognise, as the hon. Gentleman says, that it has taken an extraordinary amount of time to get this debate.

At the heart of this debate is the need not only to discuss something that affects the whole country and Wales, as we heard from my right hon. Friend the Member for Cynon Valley (Ann Clwyd), but to see what lessons the three inquiries have to teach us. One of the Francis report’s main recommendations is that it is also for Members of Parliament to question ourselves on how we hold our own trust boards to account. In a way, we need the ammunition to be able to do that. I know that the previous Member for Stafford genuinely tried to get answers on what was happening at the time from the then trust board, but those answers were not forthcoming.

[Robert Flello]

If I understand the situation correctly, the previous Member for Stafford was lied to when he tried to inquire about those issues. How on earth are Members of Parliament, with the scant resources available to us, supposed to get to the bottom of things when we are being lied to?

[Joan Walley]

That encapsulates the problem of Members of Parliament trying to get to the bottom of what is happening but being denied the information. I think that the main thrust of the report is a call for transparency and openness, for freedom of information, so that we can get informed decisions being made at local trust board level on the future direction of policy. The issue is how that is constrained by the available finances. One regret is that the finances do not come into the Francis report to the extent they might. We know that at the local level those in charge of health services are trying to ensure that they deliver a service within the financial constraints.

[Mr Cash]

Does the hon. Lady accept that one great problem that beset the whole Stafford tragedy was the fact that it was integrally affected by a target-based culture? That was one of the main problems, which I hope we are now getting away from.

[Joan Walley]

It may surprise the hon. Gentleman to know that I agree with him, and that the target culture has a lot to answer for. We have moved on from that now, and we are looking at how to achieve the best possible health care within the available resources. As my right hon. Friend the Member for Leigh (Andy Burnham) said, it is important to have integration, cross-cutting services and collaboration. We must move on from the target culture to look at the best possible way to achieve high standards of service throughout the country and stand-alone services in localities.

I want to put on the record my concern that lives were destroyed and that many people and their families were severely affected by what happened as a result of the systemic failures in the Mid Staffordshire NHS Foundation Trust, and specifically at Stafford hospital. There are many lessons to be learned, and we owe it to them to ensure that we move on and get the right hospital services.

For the record, may I say that at the time I supported the call for a public inquiry? I say that from these Benches.

Whatever the mechanism, the heart of the matter is that we must learn the lessons and move forward. It is right to debate the broader issues, values and culture of the NHS. We must recognise that an integral part of that is the procedures to deal with a failing hospital. As we assess progress on the implementation of the Francis report, it is vital to hold the Government to account for their handling of the parallel process—the trust special administrator’s report. It is essential for those of us in Staffordshire to have clarity from the Secretary of State—I am sorry he is not in his place—on future arrangements for health care in Stafford. That is what most concerns me and I shall concentrate my comments on that.

Reference has been made to how fit for purpose the trust special administration process is. Is it just about finances, or is it about the broader health care that should be provided? Changes are being introduced in the Care Bill, which will come to the House on Monday. The Government must address how stuck we are with the TSA and the TSA reports, and whether they are broad enough to deal with breakdown and failure in individual hospitals. Obtaining a resolution on how current hospital services in Staffordshire are being taken forward is urgent. That is part and parcel of how we take forward the lessons that the Francis report identified.

For me, the most important paragraph in the Francis report’s terms of reference is identifying

“the lessons to be drawn from that examination as to how in the future the NHS and the bodies which regulate it can ensure that failing and potentially failing hospitals or their services are identified as soon as is practicable”.

On the trust special administrators, we should aim to identify what needs to be done in advance of a hospital failing. In Staffordshire, we are stuck with a procedure. A report was carried out and sent to Monitor, and there was public consultation, which took place only in the Mid Staffordshire area. It is a great concern that when a hospital—in our case, the University Hospital of North Staffordshire—makes a proposal to rescue some of Mid Staffordshire’s services, there has been no corresponding consultation in that area about the impact of the changed configuration of health services in north Staffordshire. That is a real failing and the Government should take it on board.

[Robert Flello]

My hon. Friend is being generous with her time. There is an issue, which the hon. Member for Cannock Chase (Mr Burley) talked about, of work going across to that hospital. The bizarre situation is that different treatments are at cost, more than cost or less than cost. It may be the case that work that ends up at the University Hospital of North Staffordshire is below-cost work, and that work that ends up at Cannock is above-cost work, so they will be a disparity in funding.

[Joan Walley]

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

[Jeremy Lefroy]

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

[Joan Walley]

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

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

I am sorry that I could not be here at the beginning of the debate because of other commitments. Will my hon. Friend pay tribute to the willingness of the University Hospital of North Staffordshire to engage with all MPs across party to resolve the situation? Should we not recognise that in ensuring arrangements for financial stability, there is still a gap of some £15 million to be bridged to ensure that we can proceed on the basis of stability that is needed for the benefit of everyone in north Staffordshire and Stafford?

[Joan Walley]

I am conscious that many hon. Members want to speak. My hon. Friend has pre-empted two points that I want to make, so I will go straight to them.

If we accept that it is the trust special administrator’s report that is taking us forward in north Staffordshire in respect of the application by the University Hospital of North Staffordshire to take over Stafford hospital, there are two aspects to consider. The first is that there is a revenue shortfall of £4 million; and secondly, there is a capital shortfall of £29 million. I raised that matter at Prime Minister’s Question Time last week without realising that I was doing so prior to the written statement having been made available to the House of Commons. It is vital that the Government recognise that this gap must somehow be closed as the University Hospital of North Staffordshire moves forward, possibly under a new name, in taking on responsibility for this. In looking at the figures that have been put forward by the very diligent and committed directors and staff at UHNS, it is vital that the Government take account of the fact that in making a bid to take on services, those people know what they are doing, they have the expertise, and they know what changes will be needed for capital investment in Stoke and in Stafford. The gap should be closed; otherwise, Stoke-on-Trent will end up paying for the cost of bailing out Stafford hospital.

[Sir Tony Baldry]

Will the hon. Lady kindly explain to those of us who are not Staffordshire colleagues what the relationship is between the trust special administrator and the clinical commissioning group? It is helpful to try to understand who is running the NHS in Staffordshire, because what is happening there today may well happen in Oxfordshire tomorrow.

[Joan Walley]

It was suggested earlier that we might need a special debate, at length, solely on the trust special administrator, so that we can look at how this is being resolved in Staffordshire, and I would agree with that. There was also a suggestion in a previous debate that we need a debate solely on the Care Bill and its implications for changing that. Lots of different things are going on in parallel, but not in an integrated way. The real failure would be for the Government to allow the two procedures to go forward without understanding the changes made in the Health and Social Care Act 2012 which shift all the responsibility from the Secretary of State down to the commissioning bodies.

The hon. Gentleman is absolutely right. Here we are again trying to find some way of having a centralised Government system, when no matter what anybody says to the TSA or to anybody else, if the local commissioning group chooses not to go ahead and commission the services that the TSA has identified and the Government have said will be funded, those services will not be provided. I cannot understand how we are in this situation where we are not looking at all the implications of what is happening.

When the Government announced last week in a written statement that they had accepted in full the recommendations of the TSA’s report, I expected that, as a result, the UHNS would proceed quickly to implement what had been agreed in the hope that there would be a process to close the funding gap in one way or another.

The problem that I wish to give back to the Government and ask them to comment on in detail—the Secretary of State has had a detailed letter from me about this—is the uncertainty that arises as a result of the comments that were made by the Prime Minister and in a statement about obstetrics-led and consultant-led maternity provision in Stafford. On an emotional level, I absolutely agree that, as my right hon. Friend the Member for Leigh and the hon. Member for Stafford (Jeremy Lefroy) said, we need maternity services in situ that are easily accessible, and not only in Stafford but right across the country. However, my head says that the detailed financial arrangements that we currently have for maternity provision and the model that is apparently proposed do not allow for that kind of option.

We are therefore in a situation whereby people are, rightly, campaigning to have maternity services close to where they live, but the rigid procedures laid down either nationally or locally do not permit the additional funding for that. This is not just about having additional funding but about capacity in the form of trained, expert people able to deliver those services. If neither the funding nor the capacity is there, there is no point in any amount of hoping that we can have such maternity-led services in small district general hospitals, in whatever part of the country. The Government have to address that, but they cannot do so as part and parcel of the way in which they are taking forward the new configuration of health services across north Staffordshire. When the Minister replies, I want a very detailed response to the questions that I have asked the Secretary of State and given to his office, as he is aware; I am grateful for that.

The MPs concerned have met the Secretary of State and the Prime Minister to try to get some clarity on this. Until we get clarity, we cannot proceed to deal with the situation that we now have across mid-Staffordshire and in north Staffordshire. When is NHS England going to report on the further review? May we have a detailed time scale for that? To what extent will that delay the possibility of the UHNS board taking forward the new services? Already, 14 extra ambulances a day are bringing people from Stafford to Stoke-on-Trent, and staff are leaving Stafford hospital. We desperately need certainty about how this is being taken forward. When the Minister replies, the Government must set out in detail how they expect to be able to accept the TSA’s recommendations in full and then add an addendum without there being any mechanism to enable it to be implemented.

[Paul Farrelly]

Does my hon. Friend agree that the Francis report is all about patient safety? What happened at Stafford is a blot on the history of the NHS from a patient safety point of view. North Staffs hospital has reopened beds to cope with the crisis in A and E and admissions on the grounds of patient safety and therefore already has a deficit. The overriding concern of patient safety must mean that any solution for Stafford involving North Staffs has to be financially stable.

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[Joan Walley]

I agree that the Francis report is absolutely about patient safety. It is also about financial viability. Unless the Government respond very speedily, set all this out in detail, and arrange for there to be proper talks on it, there is a real danger that we could end up transporting the tragedy that happened in Mid Staffordshire elsewhere. We need urgent clarity on this at the earliest possible opportunity.

Other aspects that I wished to raise include the whole issue of special needs and the way in which Staffordshire county council is closing down day service centres without having had a proper assessment of what is needed, putting added strain on hospitals. That comes back to the points made in the Francis report about integrating services, and so on and so forth. If this debate means that we can at least get some clarity about the position with regard to the UHNS taking forward services at Stafford hospital, then it will have been worth while.

[Several hon. Members]

rose—

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[Mr Cash]

I am extremely glad that my right hon. Friend has made that point. The zero-harm policy is so important, and I am grateful for that specific intervention. It will make Ken Lownds’s day. I also pay tribute to people all over the country who have taken up the message and sought to improve the health service in their areas. This has turned into a national campaign, and the Secretary of State deserves great credit for the way he has helped to co-ordinate it.

I was, and remain, completely amazed that the right hon. Member for Kingston upon Hull West and Hessle, and Patricia Hewitt, were not even asked to give evidence to the inquiry. I still find that completely staggering to my way of thinking. I know that the right hon. Member for Leigh was asked to give evidence, and did, but I place the point on the record because I found it extraordinarily difficult to understand then, and I still do now.

I have constantly and repeatedly called for the resignation of Sir David Nicholson. I know he is retiring soon and that that resignation will not happen, but I repeat my concern, as I did in evidence to the inquiry, because the whole target-based policy was very much tied up with his approach to these matters. Indeed, in the last of, I think, about 600 paragraphs of his evidence to the inquiry, he referred in the last two lines to the fact that the Member of Parliament for Stone, Mr Bill Cash, had raised the question of his involvement in target-based policies. He said that there were arguments on both sides of the equation regarding target-based policies, but I do not agree with that. I do not think target-based policies were the right way to go, and I am glad that the hon. Member for Stoke-on-Trent North (Joan Walley) agreed with me. As I pointed out in my evidence to the inquiry, such policies had a terrible effect on the attitude of Monitor regarding the financing issues that provided 39 of the 45 or so questions put by William Moyes to the foundation trust when it received its approbation—something it should never, ever, have got. I say to the right hon. Member for Leigh that through the mechanism of the Department—I cannot point precisely to chapter and verse—the fact that the foundation trust got such status was also the product of a misjudgment by the Government at the time.

I have already referred to correspondence in an intervention, but in the prime ministerial guidelines of 2005, under the previous Government, it was clearly stated that when Members of Parliament write to Secretaries of State and other senior Ministers, they are entitled to receive a full, comprehensive response—personally—from that Minister. I found that wanting during this process. I was glad to note, however, that in the course of evidence to the inquiry, the situation moved from what appeared to be resistance to going down that route, to an acceptance that—to paraphrase from the evidence given by the chief executive of the Department of Health—from now on, when a Member of Parliament writes with a letter from a constituent, and explains that things have not gone properly regarding that constituent’s health problems, there is a mechanism to ensure that the issue is dealt with properly. I will not have to go into all that today, because it has been rectified.

In my evidence, I also raised the issue of whistleblowing. I also tabled amendments to the then health legislation, calling for the repudiation of gagging clauses and providing that any chief executive who endorsed them and got his legal advisers to agree to them should be dismissed. That is another area that has been dealt with, so we are making progress. I very much endorse the views expressed on both sides of the House about having unity across the Floor of the House, as far as we can achieve it, on the central principles.

I agree with what my hon. Friend the Member for Stafford said about the issue, although I have a difference, not of opinion but of emphasis, because my constituency is very rural, and access to the artery of the M6 is not easy. It can be difficult to reach, especially at night, because it can be a long way through small rural lanes, to access the M6 and the University hospital of North Staffordshire or hospitals in Wolverhampton. That is my caveat on that.

We have made enormous progress. I am glad that the Mid Staffs foundation trust is being dissolved, and that—as my hon. Friend the Member for Stafford said—the Prime Minister, at a recent Prime Minister’s questions, backed plans, in as many words, for consultant-led maternity to continue at Stafford hospitals. That service, plus paediatric services, critical care and a 24-hour emergency service, is necessary for constituents in Stone and the rest of Staffordshire. I will work with my hon. Friend to ensure that that is delivered.

[Joan Walley]

Does the hon. Gentleman agree that there could be some inconsistency between those two conflicting things unless we get immediate clarity from the Government about the time scale in which they will be taken forward?

[Mr Cash]

That point will have been taken on board by the Secretary of State, who is in his place. One of the good things about the present Secretary of State is that he does listen. He takes things on board and follows them up. Some Secretaries of State do not always do that—they nod, but they do not necessarily do that.

[Joan Walley]

In that case, I wonder whether the hon. Gentleman would like to invite the Secretary of State to come to the Dispatch Box and tell us when the timing will be resolved, because we have this continuing uncertainty.

[Mr Cash]

I shall not engage in a vicarious ping-pong match with the hon. Lady. The point has been made and taken—I see that the Secretary of State is nodding—and I know that other people wish to speak, so I shall try to bring my remarks to a close.

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[Joan Walley]

I have listened carefully to the Minister’s response to the various contributions that have been made throughout the debate since 1.15 pm. I hope that he will respond to the points that I made about the current situation in Mid Staffordshire and north Staffordshire before he goes on to the generalities of the Francis report. Does he accept that it was a bombshell when we heard last Wednesday that the recommendations of the trust special administrator had not been accepted in full? We are in a state of limbo. Will he tell the House what is the state of play of arrangements in north Staffordshire and Stafford? We need to know that and cannot deal with the uncertainty.

[Dr Poulter]

Again, I will not deviate from the general theme of the debate and try your patience, Mr Deputy Speaker. The recommendation of the trust special administrator was that consultant-led services were to be transferred away from Stafford and that there would be a midwife-led unit for Stafford. I am sure that Members on both sides of the House are great proponents of midwife-led units and of increasing the choice that is available. The Secretary of State has made it clear that he accepts the TSA recommendations in full and that local commissioners will have to do a health economy review to assess whether capacity is available elsewhere, before services are moved in the way that was envisaged by the TSA. The Secretary of State has asked NHS England to work with local commissioners to identify whether consultant-led obstetrics could be safely sustained at Stafford hospital. That only happened last week. We will update the House in due course and perhaps statements will be made by NHS England.

[Joan Walley]

rose—

[Dr Poulter]

I have given a very helpful reply to the hon. Lady, but I will give way once more.

[Joan Walley]

I say to the Minister and the Secretary of State that the use of the phrase “in due course” causes great concern. The new arrangements need to be in place in September 2014. Any delay to the acceptance in full of the recommendations in the TSA report will cause great uncertainty. The Government need to show that they are doing what the Francis report recommended and leading by example. Will they do that in the case of north Staffordshire and Mid-Staffordshire?

[Dr Poulter]

We are leading by example. As I outlined, the Secretary of State has accepted the TSA recommendation in full. A process is now under way involving NHS England and local commissioners. That was initiated last week. It is important that those conversations happen and that an update is brought forward in a timely manner. That is the right thing to do. It is not appropriate to rush decisions and processes because of a political agenda, rather than an agenda of benefiting the local patients and women concerned. I am concerned as a doctor and as a Minister that we must do the best thing by patients. Rushed decisions are not always the best thing for patients, because conversations need to happen between local commissioners and NHS England. I hope that the hon. Lady will be a little patient, because I am sure that the right decision will be made in due course.

There are three key areas in which the Government have taken forward the recommendations of the Francis inquiry: encouraging a culture of transparency and openness in the health care system; empowering front-line staff and encouraging good leadership in the NHS; and putting the patient at the heart of everything that the NHS does. As we have discussed, the patient was not at the heart of everything that was done at Mid Staffordshire for a period. That is why we have to learn the lessons and ensure, as best we can, that that cannot happen again.

On transparency and openness, it is important to highlight how we have already delivered on the recommendations of Robert Francis’s report. The CQC has appointed three chief inspectors for hospitals, social care and general practice who will ensure not only that the organisation is complying with the law, but that the culture of the organisation promotes the benefits of openness and transparency. Importantly, we now have clinically led inspections for the first time, which means that people who really understand what good care looks like will be in charge of the inspection process. That clinical leadership in the inspection process and at the heart of what the CQC does has to be of benefit to patients, and the Government are proud that we have delivered that.

We have also introduced a new statutory duty of candour on providers, which will come into force this year. It will ensure that patients are given the truth when things go wrong and that honesty and transparency are the norm in every organisation.

Oral Answers to Questions

Joan Walley Excerpts

Tuesday 14th January 2014 Commons Chamber

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

T4. Given that tomorrow Staffordshire county council intends to confirm devastating cuts to services for those with special needs, including the closure of the purpose-built Kidsgrove day centre in my constituency, does the Secretary of State agree that it is time now for the council to wait and at the very least share its detailed needs assessment and future action plan before forcing these cuts through?

[Mr Jeremy Hunt]

I am very happy to look into the issue that the hon. Lady raises. Obviously, some very big changes are happening in the Staffordshire health economy, and the purpose of those is to improve services for everyone, so if she gives me the details of her concerns, I will happily look at them.

Mid Staffordshire NHS Foundation Trust

Joan Walley Excerpts

Tuesday 7th January 2014 Westminster Hall

[Jeremy Lefroy]

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

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

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

[Jeremy Lefroy]

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

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

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

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mr Crausby. It is also a great pleasure, as always, to respond to my hon. Friend the Member for Stafford (Jeremy Lefroy) and, indeed, to all hon. and right hon. Members who have contributed to and supported this debate, which raises an important issue for patients and constituents, not just in my hon. Friend’s Stafford constituency, but across Staffordshire and the wider region.

It has been an incredibly difficult time for local patients and staff at the Mid Staffordshire NHS Foundation Trust. I entirely agree with my hon. Friend that the trust has come a very long way since the terrible events exposed by the inquiries and the Francis report last year. My hon. Friend has walked the journey every step of the way with his constituents and with the patients, and he should be congratulated and commended on his strong and superb advocacy of the needs of local patients, of all his constituents and of the families of those who were treated appallingly by the trust in the past. He should also be congratulated and commended on his strong advocacy for the improvements and the high-quality care that is now being delivered by parts of the trust today. I am sure we would all like to put on record our congratulations on his advocacy and on the work done by him and my hon. Friend the Member for Stone (Mr Cash), who for many years has also been a strong champion of local patients.

In responding to some of the points that have been raised today, it is important to talk a little about the trust’s background to provide some context. The trust has been operating at a deficit for some time, and certainly since 2009. In April 2013, the trust reported a deficit of £14.7 million. As my hon. Friend the Member for Stafford alluded to, that position is expected to get considerably worse. As a proportion of the trust’s turnover, the deficit forecast for 2014 is higher than that of almost any other trust in the country. For the past two financial years, the trust received approximately £20 million a year in support from the Department of Health. Without that funding to supplement its income, Mid Staffs would have been unable to pay its staff.

The contingency planning team sent into Mid Staffs in late 2012 concluded that the trust was delivering services at a cost substantially higher than most other trusts in the country. A key challenge faced by the trust is the recruitment and retention of staff and the high cost of temporary staff, which is no wonder, given that it must have been a very demoralising time for those working in the trust when there have been ongoing investigations into events that took place in the past. Additionally, some of the trust’s services are operating with consultant numbers significantly below Royal College guidelines. The 2012 contingency planning team reported that, despite improvements in clinical services, the trust is unlikely to be able to achieve the required cost savings without adversely affecting the quality of care provided to patients.

On the reasons why the special administration process has been set up, it is important to take the initial report into account and to recognise that we are where we are today because of that report. In cases such as this, where a trust is facing substantial financial challenges, it is crucial that action is taken quickly to secure services for patients and ensure that high-quality patient care can still be delivered. The special administration process for foundation trusts offers a time-limited and transparent framework for resolving the problems of a significantly challenged trust. Like the regime for NHS trusts, the special administration process is intended to be used only in the most serious circumstances.

As my hon. Friend the Member for Stafford is aware, Monitor made the decision to place Mid Staffs into special administration on the basis of the 2012 work. The CPT’s first report concluded that Mid Staffs is not financially or clinically sustainable in its current form and recommended the appointment of administrators as the best option for identifying the changes required in the years going forward to continue to secure high-quality patient care. Acknowledging the serious financial challenges facing the trust, the Secretary of State wrote to Monitor giving his support for the appointment of the trust special administrators.

It is worth touching briefly on the work of the trust special administrators at Mid Staffs. The TSAs have been in place since April last year, and they have had two tasks. First, they had to take over the day-to-day running of the trust. Secondly, they have had to work with the trust’s staff, commissioners, providers and other local stakeholders to develop a plan for services. The work undertaken by the TSAs builds on the earlier conclusions of the CPT and only strengthens the case for urgent change. If no action is taken, the TSAs estimate that Mid Staffs’ annual deficit will exceed £40 million in four years.

[Joan Walley]

I am conscious of the amount of time left to reply to the specific points made by the hon. Member for Stafford (Jeremy Lefroy) and in interventions, so will the Minister ensure that the issues flagged up will be responded to in detail in this debate?

[Dr Poulter]

I will of course respond to those that I can, but as the hon. Lady will be aware and as I will set out later, the TSAs’ report is currently with Monitor—I would expect it to be recommended to the Secretary of State by the end of this month—so it would be inappropriate for me to comment on it at this stage. I hope she understands that it would be wrong for me to make assumptions about a report that has not yet been submitted to the Secretary of State.

Care Bill [Lords]

Joan Walley Excerpts

Monday 16th December 2013 Commons Chamber

[Andy Burnham]

I pay tribute to my right hon. Friend. She and the people of her community stood up to an arrogant Government, and won a victory for every community that was worried about the future of its hospital. One would have thought that, following humiliation in the courts, the Government would have backed off gracefully, but no: here comes the Secretary of State again today, like someone who, having been caught breaking in through the back door, has the brass neck to return and try to force his way in through the front. Well, we will not let him get away with it. We give him notice that clause 118 is wrong, that it is an affront to democracy, and that we will oppose it every step of the way.

Hospital reconfiguration should always be driven by a clinical case first and foremost, but clause 118 paves the way for a new round of financially driven closures. It rips up established rules of consultation and the clinical case for change. It allows the Secretary of State to reconfigure services across an entire region for financial reasons alone, which means that no hospital, however successful, is safe. The House needs to stand up to this audacious power grab by the Executive.

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

The clause introduced in the House of Lords gives extra powers to the trust special administrator. Are we not now faced with a complete contradiction? Rather than clinical commissioning groups commissioning services, the TSA will commission long-term services, and there has been no proper consultation. In Mid Staffordshire and North Staffordshire, for example, we have had a consultation procedure that has taken no account whatsoever of services in North Staffordshire.

[Andy Burnham]

That illustrates the confusion that is currently at the heart of the NHS. No one knows who is in charge of anything. What if CCGs and the boards of foundation trusts disagree with the conclusions of the TSA? How will that be resolved? Were we not told that doctors were sovereign? Were they not supposed to decide everything? Was that not the big call when the Government introduced their Bill? It seems that that is no longer the case: everything can be done “top down” by the Secretary of State. It takes power away from every Member and could be used as a back-door way to railroad through unpopular changes.

The real danger of the proposal comes when it is seen in the context of the competition regime created by the Health and Social Care Act 2012. Of course, it is sometimes necessary to make changes to local health services beyond just a failing trust. That is best done through partnership and collaboration, but such sensible changes are now being blocked by the market madness imposed by the Act. We recently saw the ludicrous spectacle of the Competition Commission intervening in the NHS for the first time to stop the sensible collaboration between Bournemouth and Poole. Since when did competition lawyers decide what was best for patients?

Mid Staffordshire NHS Foundation Trust

Joan Walley Excerpts

Tuesday 19th November 2013 Commons Chamber

[Mr Hunt]

We will absolutely do that. We are in the process of a very big consultation to ensure that we get the definitions of the fundamental standards absolutely right, but we also want to try to create a culture that means we do not get to that point in the first place. One of the problems we had with the current system is that the definition of success for a hospital tended to be about meeting waiting time targets and financial balance, rather than caring for patients properly. We want to re-engineer the system through the new inspection regime so that a hospital cannot be good or outstanding unless it is delivering good or outstanding care.

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

What happened at Mid Staffordshire must never be allowed to happen again, but given that safe staffing levels will depend on adequate resources, can the Secretary of State give an assurance that there will be a debate in the House in Government time on the successor arrangements for Mid Staffordshire and for the University Hospital of North Staffordshire?

[Mr Hunt]

As the hon. Lady knows, we are going through a process at the moment and the trust special administrator is drawing up detailed plans, so it is premature to say what will happen, but we will of course keep the House well informed and there will be plenty of opportunities for her to question me, or anyone else she wants to question, about any decisions that are eventually made.

Oral Answers to Questions

Joan Walley Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Mr Hunt]

I understand my hon. Friend’s concerns and I know that there is a large elderly population in Worthing. I thought it was an excellent hospital with a fantastic atmosphere when I went and did part of a shift there. The winter pressures money went to the third of A and E departments that are struggling the most, so it is probably a compliment to his hospital that it did not receive it. We felt that with limited funds we had to concentrate resources where they were going to have the most impact. I hope that he understands why we had to make that difficult decision.

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

This week, the report of the trust special administrator in respect of Stafford hospital is being presented to Monitor. Given that the preferred option is that the University Hospital of North Staffordshire should in some way take over, will the Secretary of State urgently meet all Members of Parliament for the north Staffordshire area to ensure that health care in north Staffordshire, where we already have a deficit of £31 million with an extra £18 million set to come over, will not be destabilised?

[Mr Hunt]

We are acutely aware of those concerns. In any reconfiguration, and particularly in this one, we want to ensure that there is no instability in the local health economy. We have given the trust special administrator a little longer to come up with a plan for Stafford hospital to try to secure local agreement, so I have not had a recommendation yet and I am going to wait and see what he says.