National Health Service (Amended Duties and Powers) Bill

John Pugh Excerpts

Friday 21st November 2014 Commons Chamber

[Clive Efford]

My hon. Friend is absolutely right. There are too many examples of money being wasted on the tendering process.

Those who suggest that what the Labour Government did can be compared in any measure with what this coalition has inflicted on our national health service are completely misguided. When the Labour Government were elected in 1997, we spent 5.2% of our GDP on our health services. In 2010, we had increased that to 8.6%. We increased the number of doctors by 48,000. We increased the number of GPs by 5,000. We increased the number of training places for doctors, which had been cut by the previous Tory Government. We increased the number of nurses by 70,000. We had the biggest hospital building programme in the history of the national health service. We rebuilt or refurbished every accident and emergency department in the country. When Labour left office, the NHS had the highest satisfaction ratings from its patients that it had ever had in its history. The NHS was in crisis in 1997, and Labour saved it. It is in crisis again now.

[John Pugh (Southport) (LD)]

Does the hon. Gentleman accept that Labour also guaranteed the private sector a fixed slice of NHS income in a way that the Bill does not do?

[Clive Efford]

The hon. Gentleman was on the Bill Committee for the 2012 legislation, and I wonder how many amendments he tabled to put those issues right. And he has the cheek to come here and ask questions about my Bill, which seeks to put right what he did not attempt to put right when he was on that Committee.

--- Later in debate ---

[Sir Tony Baldry]

My hon. Friend makes his own point very well in his own way. It is important for all of us to remember that the NHS is our NHS and our constituents’ NHS. It does not belong to any particular political party; it is a national heath service.

Alan Milburn concluded that the “major reforms”, which included working more closely with the private sector, would

“deliver real benefits for NHS patients”.

Chapter 11 of the NHS plan of July 2000, on “Changes in the relationship between the NHS and the private sector”, said:

“The NHS is a huge organisation. Using extra capacity and extra investment from voluntary and private sector providers can benefit NHS patients… The time has now come for the NHS to engage more constructively with the private sector”.

Under the heading, “The basis for a new relationship”, it went on:

“Ideological boundaries or institutional barriers should not stand in the way of better care for NHS patients…By constructing the right partnerships the NHS can harness the capacity of private and voluntary providers to treat more NHS patients…Under our proposals a patient would remain an NHS patient even if they were being treated in the private sector. NHS care will remain free at the point of delivery, whether care is provided by an NHS hospital, a local GP, a private sector hospital or by a voluntary organisation.”

[John Pugh]

The right hon. Gentleman is outlining a thread of continuity very well. Is it not strange that the principal adviser to Alan Milburn has now been appointed by this Government as the head of NHS England? Does that not show that there has been continuity from one Government to another with the same policies?

[Sir Tony Baldry]

I would hope, with an organisation like the NHS, that it would not become a political football—that there would be considerable continuity. The fact that the person now in post worked with a Labour Government on NHS proposals is a strong point rather than a weak one.

--- Later in debate ---

[John Pugh (Southport) (LD)]

It is a pleasure to follow the right hon. Member for Wentworth and Dearne (John Healey), and I agree with most of what he said, but probably not the conclusion.

It gives me pleasure that we are having this debate. I think we all accept that the Bill will not go right the way through Parliament and end up on the statute book by 2015. We know what will happen: private Members’ Bills are lining up behind one another, and most of them will hit the buffers. However, the Bill moves the NHS debate up a notch.

It is fashionable at the moment to regard the Health and Social Care Act 2012 as a disastrous mistake. In fact, I believe that view is now shared in the Treasury. I did not support the Act, and not for the usual reasons—that it was not in the manifesto or the coalition agreement and was sprung upon Parliament. Those were good reasons, but they were not my main reason, nor was it because I am awkward or I thought it was a good career move. It was not because I did not see some of the upside, which I am sure the Minister will rehearse later—the emphasis on public health, clinical involvement, health inequality and mental health, and a smidgen of democratic accountability.

My main reason for opposing the Lansley Bill was that I saw it as the logical conclusion of a trend that began under Mrs Thatcher, was carried on by Blair and survives to this day. That trend, fundamentally, is an attempt to run the NHS as a market—not a real market, of course, but an internal market; a funny sort of Alice in Wonderland market with none of the advantages of a real market and most of the downside. It is one where everything is free, but prices, wages and policies are set by the Government; where NHS bodies compete not just against the private sector but against one another; where, as others have said, integration and real efficiency often go out of the window; where strategic leadership just does not seem to exist, as the right hon. Member for Wentworth and Dearne said; where we struggle to deliver not products, as in ordinary markets, but entitlements; and where half the NHS, which we call commissioners, is billing the other half, which we call producers—that point has already been made—and bean-counters proliferate on either side and lock horns over bills.

In my view, the Health and Social Care Act was not so much about privatisation, or private industry helping to deliver NHS services—that was already happening under Labour—but primarily about marketisation. Some of course see that as a conspiracy—marketisation as the prelude to total privatisation—but I have to tell hon. Members that marketisation as a faith is still very much around, including on the Front Benches of most political parties, and is supported by practically every health think-tank we talk to.

The market, external or internal, tweak it as we may, simply cannot deliver entitlements and the moral objectives of the NHS in anything like an efficient manner. It cannot deliver to people the care that they need regardless of their means. Worse still, it solves none of the current problems of the NHS, which were largely parked in 2010—the financial pressures on the acute sector, which have come back to haunt us recently; the poor integration of services, which we have still not got right; and the separation of health and social care, which is unfinished business.

If I have a proposal to put to the House, it is that I would like to see the commissioner-provider split ended. That has been mentioned already. We moved an amendment at the Liberal Democrat conference to try to see whether and how that could be permitted. I would like to see the creation of local health boards, charged with integrating services and running them efficiently.

[Dr Huppert]

The amendment my hon. Friend is talking about was proposed by Cambridge Liberal Democrats, and I pay particular tribute to Councillor Kilian Bourke, who chairs the health committee in Cambridgeshire. It suggested allowing NHS commissioners and providers in a local area to form an integrated health organisation if that was what they wanted to do. Does my hon. Friend agree that that would achieve the benefits that he and I seek without the need to force through a massive top-down reorganisation? Would he urge the hon. Member for Eltham (Clive Efford) to accept such an amendment if the Bill made progress?

[John Pugh]

If the hon. Member for Eltham (Clive Efford) wished to talk about that, we could happily move away from the internal market where local circumstances required and demanded it. That would be an entirely sensible policy. I see no reason, though, why health boards should not procure goods and services based on simple best-value principles without all the competition legislation that has been vilified in the debate. They should be funded—as most services are—by capitation and according to local need, and they should be in some way democratically accountable, and I think we can get a genuine public service element back into the NHS. However, not every political party is advocating that at the moment, and some are steering in quite the opposite direction.

[Philip Davies]

The hon. Gentleman is making a thoughtful speech, as is typical of him. Does he agree that what we are dealing with today is an Opposition party in desperate straits that knows exactly what it is doing in using the word “privatisation”? It knows that people out in the country associate it with having to buy private health care, but actually nobody is proposing to change the fundamental ethos of the NHS, which is that treatment is free at the point of need. The Labour party is conflating the two as a desperate political tactic.

[John Pugh]

The hon. Gentleman is not altogether wrong, but if we are to continue to deliver, in stressed circumstances, a service that is free at the point of need, we cannot run the NHS as an internal market for ever. In fact, the NHS is already trying to morph into something different. We now have health and wellbeing boards, which mean that commissioners and providers get together to try to agree a local plan. They are struggling in every way to behave like a health board, but they do not have the executive powers to do so. There has been the move away from tariffs, which have been used to try to adjust the market, and we are now talking about whole-treatment costs. There is also talk about integration.

What is clearly entirely disruptive, though, is the intrusion of competition where it is not needed—where it is simply dogma; where it is seen as a panacea for producing good results, whether or not there is a good case for saying that; where it derails sustainable services; or where it becomes a central operating principle of the NHS. None of those things is particularly helpful.

I do not want to comment on TTIP, because I do not think it is well understood at the moment, but we will certainly need to look at how it plays into the competition agenda.

[John Healey]

If the hon. Gentleman or any other Members want to know a little bit more about TTIP, particularly the potential impact on the NHS and public services, we have a meeting of the all-party group on European Union-United States trade and investment at 2 o’clock on Monday, at which the EU chief negotiator will be on the panel alongside Dave Prentis, general secretary of Unison. The hon. Gentleman might like to come along.

[John Pugh]

If the right hon. Gentleman reminds me, I will endeavour to do so. What I am really hoping for, though, is a change in the conversation about the NHS so that we stop talking about the internal market—Labour Front Benchers have in a sense reneged on their involvement in that—and instead talk about how we should organise NHS services that will efficiently deliver the moral entitlements that people expect.

[Jeremy Lefroy (Stafford) (Con)]

I am grateful to my hon. Friend for giving way and to the hon. Member for Eltham (Clive Efford) for introducing this opportune Bill.

Does my hon. Friend agree that one problem with an internal market is the sheer complexity of tendering, which means that smaller organisations such as some in my constituency are simply not capable of matching up with the organisations that decide to tender for some of the contracts that are available?

[John Pugh]

My hon. Friend makes a good point. For those who are unsure about the benefits of the internal market, there is a way of addressing the problem, which is to allow individual health economies, in whatever area—Eltham or wherever—to opt out of the internal market if they can prove that there is a case for doing so. That could be put into legislation in a permissive form, so it would not be a top-down reorganisation, and it would allow people objectively and sensibly to test the benefits of the internal market against a more normal model of public service delivery, which I support, as I hope the hon. Member for Eltham does.

Tobacco Packaging

John Pugh Excerpts

Thursday 28th November 2013 Commons Chamber

[Jane Ellison]

That point came up during the consultation. To be clear, the review that we have asked Sir Cyril to undertake will cover the public health aspects of the policy. It will then be for Ministers to decide how to take forward the findings of the review and to make policy. The points that my hon. Friend and others have made will be borne in mind at that time.

[John Pugh (Southport) (LD)]

The Minister says that this is a complex matter, but I am a bit puzzled. What exactly is the downside of plain packaging, apart from fewer fags being sold?

[Philip Davies]

A left-wing, nanny state wallah like you would not understand.

Oral Answers to Questions

John Pugh Excerpts

Tuesday 26th November 2013 Commons Chamber

[John Pugh (Southport) (LD)]

T3. What measurable progress is being made in improving data sharing, not just between hospitals and general practitioners, but between the NHS and social services, to avoid bureaucracy and additional cost?

[Mr Hunt]

My hon. Friend has taken a great interest in this topic, and he is absolutely right to do so, because if we are to give integrated, joined-up care, in which people deal with NHS professionals who know about them, their medical history, their allergies and all the other important things, it is vital that, if they give their consent, their medical record can be accessed. That needs to be from GP surgery to hospital to social care system. Under the named GP policy that we have announced, there is a big opportunity for care homes to access GP records and keep them updated daily, so that GPs are kept in daily contact with how some of the most vulnerable people are doing.

Managing Risk in the NHS

John Pugh Excerpts

Wednesday 17th July 2013 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

Will the right hon. Gentleman give way?

[John Pugh (Southport) (LD)]

Will the right hon. Gentleman give way?

[Mr Hunt]

I will make some progress and then give way, because I want to come on to one of the main things that the right hon. Member for Leigh said, which was to criticise an NHS reorganisation that has put 8,000 more people on the frontline of the NHS.

The right hon. Gentleman said that that reorganisation cost £3 billion, when he knows full well that the National Audit Office shows that it will be half that amount. It will save £5.5 billion in this Parliament alone. For the avoidance doubt, it is that £5.5 billion saving that means we are now employing 1,000 more health visitors, 1,400 more midwives and 5,600 more doctors than at the previous election.

The right hon. Gentleman talked about the risk register. Let us look at what he said about publishing the risk register when he was Health Minister in 2007. These are his own words:

“Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents. This would inhibit the free and frank exchange of views about significant risks and their management, and inhibit the provision of advice to Ministers.”—[Official Report, 23 March 2007; Vol. 458, c. 1192W.]

I agree with him.

The right hon. Gentleman is right that pressures on A and E are building, so why does he oppose changing the GP contract to make primary care more accessible? Why does he criticise the extra £2 billion being put into joint commissioning by health and social care systems to reduce the number of delayed discharges? Why does he tell the NHS Confederation he supports the reconfiguration of services and then refuse to support every difficult reconfiguration, such as at Trafford or Lewisham?

--- Later in debate ---

[John Pugh (Southport) (LD)]

This debate is notionally about managing risk in the NHS, but it is actually about reputational risk for Secretaries of State. I genuinely feel sorry for all Secretaries of State, because it is very unlikely that nothing will go wrong on their watch. It is unlikely that the entire NHS will perform optimally, that there will be no significant variation in performance and that the NHS will deliver an absolutely perfect service.

Secretaries of State have to get a whole raft of things right. They have to get the funding, the appointments, the regulation and the legislative framework right, and when something goes wrong, they have to get the troubleshooting right as well. They also have to keep a whole raft of health professionals happy, including pharmacists, dentists, GPs, nurses, midwives and health visitors, as well as patients from the age of nought to 90. Surveying that task, I think we have to agree that it is mission impossible.

The two things that will afford a Secretary of State the most protection are, first, good regulation and inspection, and secondly, the professional commitment, engagement and dedication of health professionals including doctors, nurses, ambulance staff and, dare I say, managers—or, as they are they are sometimes referred to in this place, bureaucrats. I think we all acknowledge the need for good management in the NHS.

We have been appallingly badly served by the regulators. Let us take the Care Quality Commission—where do I begin? And what about Monitor? Yesterday, we had the statement on the Keogh report. Before that, we have had statements on Mid Staffs and Morecambe Bay. Although not many people have acknowledged it yet, the majority of the hospitals involved are foundation trusts, and were inspected by Monitor. The majority were given a positive, green risk rating in 2010. What does that tell us about foundation trust status and its benefits? What does it tell us about Monitor, and the CQC, as regulators? Bizarrely, we seem to have given those bodies, which do not seem to be wholly competent, an increased role in the health service over the past couple of years.

The only other protection from serious embarrassment that is available to a Secretary of State is the fact that the NHS survives most things. There is a huge amount of professional commitment from NHS staff. Ironically, however, that can be undone by unwise, poor, tick-box, target-chasing and clinically unjustified regulation. That applies across the NHS and, I would suggest, across public services as a whole. Regulation and inspection, if ill-advised, can undermine professional standards, with disastrous effects for individuals and institutions. Certainly, those who know anything about Ofsted will know that Ofsted can do that, and I am sure that the CQC has done it. The Government have also done it through distorting priorities or simply by inspecting the wrong thing. The truth is that we need to work more with the grain of professional judgment, to listen to it more and not assume that it is always a self-serving producer interest. We can encourage the best and challenge the worst, without disparaging professional ethics.

Recently, the Government have got themselves into a sort of enviable no-lose situation with regard to the public services. If policies are supported by professionals, it proves that the Government are right. If on the other hand policies are opposed by professionals, it proves that the Government are challenging the provider interest and are right again—so they can never be proved wrong. My simple point—it is the only one I really want to make—is that if Governments were not always so easily persuaded that they were right, we would get a whole lot less wrong.

Oral Answers to Questions

John Pugh Excerpts

Tuesday 16th July 2013 Commons Chamber

[Anna Soubry]

First, I pay tribute to Kick Ash. I am more than happy to meet those youngsters; they seem to be doing a very good job. Secondly, we are not in anybody’s pocket. I am sure the hon. Gentleman can say he is not in the pocket of any trade unions either. This is an important decision, but we have not made it yet; we are waiting to see how things develop in Australia, and as I say, good laws are based on good, sound evidence. That is the way forward.

[John Pugh (Southport) (LD)]

Is the high evidential threshold being set for the plain packaging proposals to be applied across Government legislation or only where lobbyists are involved?

[Anna Soubry]

I am rather disappointed at that question from my hon. Friend. I can assure him that the Government take all these issues very seriously. I am proud of our emerging record on public health, but as I say, we have yet to make a decision, because, quite properly, we want to see what happens in Australia, and of course we are also waiting to see what happens elsewhere, notably in Ireland, where the Irish Government intend to introduce this policy. It might or might not be successful.

Health and Care Services

John Pugh Excerpts

Wednesday 3rd July 2013 Commons Chamber

[Mr Dorrell]

I am sure that my hon. Friend will forgive me if, faced with an estimate of £103 billion, I do not go through every £70,000 of expenditure. However, he has made his point.

This is where I believe the Committee has held the Government to account, although not always comfortably for the Government of the day. There is no solution to the Nicholson challenge purely through adjusting the numbers—to use a non-emotive phrase. It has been reported to the Committee that in the first two years of the Nicholson challenge, 73% of the efficiencies that have so far been delivered are attributable as follows: 16% to pay freezes, which is the point made by my hon. Friend the Member for St Ives (Andrew George)—yes, holding down wages does reduce the cost of delivery and is, in the short term, a form of economic efficiency, but it is not a long-term solution to the Nicholson challenge—and, most implausibly, 45% to just changing the tariff between the commissioner and the provider. That is not an efficiency; that is an internal transfer, a bookkeeping entry, accounting, make believe. Another 12% over the two years is put down as “other”, which is an old accounting technique for concealing not very much, usually.

[John Pugh (Southport) (LD)]

Was the right hon. Gentleman able to establish exactly how much was saved through smarter and better procurement?

[Mr Dorrell]

That is not listed, and so is probably among “other” and is not very much towards £5 billion. The 4% efficiency gain translates to £5 billion of recorded savings. The two biggest items are £2.5 billion through tariff efficiency and £850 million through pay freezes. We have not yet made much progress towards the process of reimagining care which, from a Committee standpoint, we regard as so important.

I do not propose to detain the House by going through the detail of what reimagined care needs to look like, but the headlines are clear and becoming increasingly familiar. It is complete nonsense for us to imagine that community health and care can be provided efficiently to a high quality if we retain the distinction between primary health care, community health care and social care. Primary care is divorced from community health care purely as a result of a political fix by Nye Bevan and the British Medical Association in 1947. I was not born in 1947—indeed, not many Members were born in 1947. How much longer do we have to live with the structural absurdity that was not even a plan in 1947? It does not look like much of a plan now. Reimagining high-quality efficient care to enable people to live longer, healthier and fuller lives and avoid going to hospital unnecessarily is the core challenge that the Committee believes needs to be put at the door of policy makers in the Department of Health and in NHS England.

I will conclude by picking out two key recommendations from the Committee’s report, and I am pleased to be able to say that one has been picked up by the Opposition. I am pleased to endorse their policy of developing the role of the health and wellbeing boards—created by my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), the former Secretary of State for Health—as the agencies best placed to develop genuine reimagination at local level of what fully integrated, joined-up health and social care should look like. It is often described as the Burnham plan. I am happy to endorse it, because the Select Committee wrote it first and we did it building on the institution created by the coalition through the Health and Social Care Act 2012. I strongly endorse the development of the health and wellbeing boards, and so, I believe, do my colleagues on the Committee.

Joining up budgets and creating single commissioning budgets through the health and wellbeing boards is only part of the answer if that single budget then allows resources to leech away through the local authority system without checks on the limits of the definition of the services that are being secured. That is why our report recommends not just joined-up budgets and the development of the health and wellbeing boards, but an extension of the ring fence, which so many of my colleagues on the Conservative Benches do not like, so that it covers not just NHS spend but social care spend too. We did that because it makes no sense to make the case for a single health and care system, and then imagine that transfer of resource out of the NHS budget into the social care budget as free to be spent anywhere else in the local authority world.

The commitment to a ring fence makes sense only in the context of a single integrated service if it covers the whole of the integrated service. That is why I strongly welcome the announcement made by my right hon. Friend the Secretary of State for Health that increased resources from the NHS budget would be made available to social care, but only—as he made clear to the Committee yesterday—subject to that resource transfer first satisfying NHS England and Ministers, who are ultimately accountable to this House, that it will be used for social care and not for other local authority services.

I have sought to identify what I regard as the key issue facing the health and care system—the Nicholson challenge—and to recognise that it is not just about economics, but about quality. The only way we can respond to those two challenges is by rethinking a set of institutions that grew up for a different world and a different time. I welcome the fact that the Committee’s recommendations and analysis, which have been developed over three years, have been endorsed both by Labour Front Benchers, who have picked up our proposal on health and wellbeing boards, and by the coalition in the announcement my right hon. Friend the Secretary of State made last week about resource transfer, subject to an effective ministerial guarantee of a ring fence. If the Select Committee has done nothing else, it has identified common ground on which those on the Front Benches seem to be gathering.

--- Later in debate ---

[John Pugh (Southport) (LD)]

It is an honour to follow the hon. Member for Easington (Grahame M. Morris). We all appreciate his style, even if we do not share his conclusions and his fears. Let me also congratulate the right hon. Member for Charnwood (Mr Dorrell) on the Health Committee’s excellent report. Indeed, I congratulate all the Committee’s members, who must be among the most diligent and assiduous members of any Select Committee in the House, and many of whom are in the Chamber now.

On the occasion of our last debate on the estimates, I made the huge strategic mistake of trying to talk about the estimates, and was ruled out of order for doing so. That was a schoolboy error. I shall therefore draw a veil over the £50 billion of expenditure that we are notionally considering, and limit myself to a few brief observations.

The bottom line is that the NHS faces huge demographic and financial problems. Having wasted two years reorganising it, we have now secured universal agreement on what we must do. The way forward seems clear to me, and it seems good. We must integrate care, reduce the cost burdens on the acute sector, and remodel the acute sector to allow that to happen. We must encourage self-management and co-management of chronic disease. As was pointed out by the hon. Member for Easington, we must encourage local co-operation. We must share data: that is very important, but it has not been mentioned so far. We must pool resources—that has been mentioned—and develop networks for the treatment of strokes, cardiac conditions, cancer and so on. No one disagrees in the slightest with that analysis.

There is general support for personal health budgets, which were mentioned by the hon. Member for Bosworth (David Tredinnick), although it is not entirely clear whether they will complicate or solve the financial challenges that we face. There are other no-brainers on which we happily agree. We want to encourage medical research, and we want better public health.

The goal is clear, and there is little argument about it in the Select Committee or in the House. What is not clear, however, is exactly how all this is going to happen. We refer frequently to a string of laudable actions: empowering patients, conducting pilots, providing incentives for integration and co-operation, issuing mandates—that is rather a new thing—setting quality standards, establishing frameworks, and commissioning services. A word that we do not use much however—although it was heard in the speech of the hon. Member for Easington—is “management”. That has become almost a discredited word. We talk about disease management, but we are less happy to talk about system management, except when we talk about micro-management. The sin of non-delegation is clearly a bad thing, but references to management tend to occur only in that context. We boast about culling managers, but what we need now is good executive management. If we are to implement the aims to which we have all signed up, we shall need not more managers, but better management and better managers.

Ministers, and Governments in general—all Governments—have recently been rather good at thinking up policies, making announcements and changing structures, labels and names, but at times they appear to have forgotten that the main business of Government is to govern, and to engage in the day-to-day business of making things happen. They neglect the day job, or become unaware of the need to carry it out. That is the reason for the constant gap between announcement and delivery. That is why there is all the teasing at Prime Minister’s Question Time about programmes that are announced but not implemented.

I was delighted when the Secretary of State sent Department of Health officials into hospitals for work experience, so that they could observe real-time implementation. The Under-Secretary of State himself has real experience of hospitals, and knows what it is like to suffer under the policy mandates of a variety of Governments. However, there is a vacuum at the moment. There is a lack of local levers, which prevents us from achieving the integration at local level that we want. There is a gap in local leadership, especially when it comes to making integration happen. There are more organisations around, but there is less strategic control and command. As we heard from the hon. Member for Easington, the strategic health authorities have gone.

When taken to task about problems of that kind, many people—including, possibly, the members of the Health Committee—cite the health and wellbeing boards, saying that they are crucial to making it all happen and bringing it all together. I wish them luck and I hope that they can do that, but they are a variable mix at present. They are not kitted out or resourced to be proper health boards. They have no genuine executive power, no budget and no real authority.

We need people who can get the local networks right, get the parts of the NHS machine working together, and ensure that procurement is organised rationally, data are shared, resources are pooled and good practice is spread. We need people who can get a grip on the new agenda and see it through. However, on the current landscape, it is not obvious who those people are, or whether they have the capacity to do what is needed.

Care Quality Commission (Morecambe Bay Hospitals)

John Pugh Excerpts

Wednesday 19th June 2013 Commons Chamber

[Mr Hunt]

My hon. Friend speaks well. Even under the current system, when problems are identified they seem to fester without being properly addressed. Under the new single failure regime for hospitals, when failure is identified there will be a maximum period of one year to sort it out or the board’s trust will be suspended. There will be a cut-off which does not exist at present to make sure that the local NHS, the trust board and, in the end, even Ministers bite the bullet when there are problems so that we do not allow them to continue.

[John Pugh (Southport) (LD)]

After Francis, after the Health and Social Care Act 2012, are we not asking a deeply dysfunctional and damaged organisation to shoulder additional responsibilities? Is not that in itself risky? In the Secretary of State’s statement he mentions “potentially criminal prosecution” of providers. Exactly who will be prosecuted? Managers? Clinicians? Board members? And exactly on what charge?

[Mr Hunt]

The criminal sanctions apply to boards for withholding information about safety breaches at their trust, and as I mentioned earlier, we are considering whether those sanctions should apply below board level. We want to wait for Professor Berwick’s advice on that, because there is a balance between proper accountability for mistakes and the need to create that culture of openness, where people report mistakes that they might see a colleague making, which might not happen if they were worried about criminal prosecutions. I want to take the advice of an expert on that.

Oral Answers to Questions

John Pugh Excerpts

Tuesday 11th June 2013 Commons Chamber

[Mr Speaker]

Order. The answers are too long. They need to get shorter, because we have a lot to get through. It is very simple and very clear.

[John Pugh (Southport) (LD)]

Given that we have the lowest ratio of intensive care beds in the EU, what are the Government doing to monitor possible risks in future?

Accident and Emergency Waiting Times

John Pugh Excerpts

Wednesday 5th June 2013 Commons Chamber

[John Pugh (Southport) (LD)]

The last time I was in A and E I had hit myself on the head with a 300 lb iron bar—don’t ask why. I had a lump the size of an egg, but no lasting damage, apparently. The time before I was involved in an accident on the M1. I was not driving the car, but I ended up in North Hampshire A and E. My latest visit was with my mother-in-law who had had a suspected heart attack. I use those cases to illustrate that although nobody wants to go to A and E, people end up there for a whole range of reasons. Either they have a genuine accident and emergency, or they fear that they have had an accident or emergency and need informed triage, or they have a problem and simply do not have anywhere else to go. I suspect that we are looking not at increased pressure because of a huge number of accidents and emergencies—although there are many elderly people, which will increase the number—but at a big increase in cases to triage and in the number of people with nowhere else to go.

I note that the situation is not inferior to that before 2004, but in relative terms I am prepared to admit that it is a crisis. So far the debate has been about whose fault that crisis is. We cannot say that the situation is entirely due to the GP contract and the extraction from out-of-hours service, but we could say that that will not help. We cannot say it is down to the strange decision to replace midstream NHS Direct with the 111 service, but that will not help. We cannot say it is all down to a massive reorganisation of the NHS and the siphoning off of millions into redundancy payments, but clearly that will not help. We cannot say it is due to the closure of walk-in centres. They were often paid for by the PCTs of the past and are not necessarily popular with GPs, but their closure will certainly not help. We cannot say that the situation is due to the absence of strategic health authorities, although in the past those authorities often forced ambulance trusts and hospitals to work seamlessly together, not just gaming their own targets and looking at performance indicators. They helped to stamp out trolley waits, parking up and needless diverts, but the absence of a strategic oversight is clearly not going to help. We cannot say that the failure of our system to deal with chronic alcohol abuse is the sole reason, but as the hon. Member for Totnes (Dr Wollaston) pointed out, it is not helping. The fact that we do not link treatment to successful rehab certainly does not help.

What would help, as we all agree, is rapid progress towards the integration of health and social care, proper community budgeting, stopping unnecessary admissions, increasing co-operation and resource efficiency, and making better use of hard-pressed social services budgets. This was the big-ticket item in the in-tray in 2010—the holy grail. There was also the instability of the acute sector. It is a genuine pity that well-intentioned people in this place spent the first two years of the Parliament wrangling about a largely pointless, if not positively unhelpful, reorganisation. Never mind missing A and E targets because of the stupid, adversarial, arrogant and hubristic culture of this place, where each successive Government feel obliged to do everything in a new way: it is not just A and E that missed the target; we missed the target.

A and E Departments

John Pugh Excerpts

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

I am not blaming any doctors; I am blaming the Labour party for making disastrous decisions in office. We are addressing the issues that his party failed to address. If Southampton is not meeting its A and E targets, that is unacceptable. We are talking to all the hospitals struggling to meet those targets, but they all say—I am sure that people in Southampton would say this as well—that we need to look at the fundamental issues, which are barriers between the health and social care systems, poor primary care alternatives and problems inside hospitals with how A and E is handled. We are addressing all those issues.

[John Pugh (Southport) (LD)]

Better co-ordination of ambulance trusts and A and E departments is essential, but it will not happen by accident. Are we not now missing the strategic health authorities, given that ambulances are being sent to units already working at full capacity?