Cities and Local Government Devolution [Lords] Bill

John Stevenson Excerpts

Wednesday 21st October 2015 Commons Chamber

[James Wharton]

I am happy to confirm that we are in discussions with local authority leaders in that area, but that leads me on the hon. Gentleman’s earlier comments about the geography. He has raised the point—and is perfectly entitled to do so—that this is a diverse area with rural and urban communities. I should make it clear, first, that we are talking about powers that are currently controlled in Whitehall and currently controlled nationally by public bodies and by Ministers here, and we are taking them closer to the people affected by them. Secondly, I must make it clear that we will not tell any area what its geography must be. We have left it for areas to come forward with proposals that they believe best suit the economic opportunities that exist in those areas.

[John Stevenson (Carlisle) (Con)]

Does the Minister think it would be in the best interests of the north-east to have an elected mayor?

--- Later in debate ---

[Mr Allen]

I would not ever wish to do to central Government what they have done to local government. I will therefore resist the temptation that my hon. Friend puts in my way. Sometimes, however, when we are being lectured about fiscal prudence, I ask myself: who has the triple A rating in this country? It is local government, rather than central Government. Who goes cap in hand to international lenders? Central Government. Who runs tight and balanced budgets? Local government. A central Government of any political colour who lectures local government should look in the mirror first.

I just want to mention one last new clause, new clause 16. It relates to having an institution, created by local government, as one of the What Works institutions that, thankfully, are now springing up across and outside government. They take the best possible practice out there and spread it around. A national-level inspectorate can tell local government what to do, but I am saying that there is a different model. We should draw up from the localities to national level something selected by the localities to spread best practice. We all want to do better and to hear who is doing the good stuff.

I will boast about the fact that the city of Nottingham has just come with the idea of an energy broker. Anybody can phone up and get the best deal—done. It will save people several hundred pounds a year. It is a not-for-profit service. As a Nottingham patriot, I could go on about our trams and many other innovations that we are introducing with two hands tied behind our back.

If we release people in the way I am describing, we can show them best practice and we can see what they are doing. I ask the Minister to consider that point very seriously. The Government have very generously created What Works institutions in policing and early intervention —I played a small part in creating the Early Intervention Foundation—and there are about 10 of them across the board. We need an organisation created by local government and that local government will respect—based in the LGA, the Department for Communities and Local Government or wherever—to give advice, offer evidence and fight local government’s corner. That is something for the Minister to take away and consider, and I hope it will reappear in the next of the two other devolution Bills I anticipate before 2020.

[John Stevenson]

I am grateful for the opportunity to say a few words about amendment 50, which I tabled. I will be interested to hear what the Minister says, but it is not my intention to press it to a vote.

As the Minister is well aware, I fully support the Government’s overall aims and intentions. It is sensible that this is an enabling Bill and that it allows the maximum possible flexibility. I think that it will lead to innovation and fresh thinking not just at the national level, but at the local level. Indeed over the past few years, local authorities have demonstrated that they are innovative and that they can change.

I appreciate that the Government want to reform local government with the support of local government. The Bill gives local government the opportunity to step up to the plate and embrace these opportunities. It gives local authorities the chance to take responsibility, to take on more powers and to achieve an awful lot more for their communities. I understand that the Government do not want to impose things on local authorities, but to discuss and negotiate with them in order to come to a deal that is beneficial for central and local government.

A key part of this change is not only about powers, but about governance and structure. There has been an extensive discussion about elected mayors, of which I am an enthusiastic supporter. Indeed, I believe that elected mayors should be the default position for all councils throughout the country. I will continue to support and encourage that idea. However, I accept that the Government want local areas to come up with their own solutions and ideas for change on both governance and structure. I understand the thinking behind that.

I do, however, have some concerns. If I may take this opportunity to be rather parochial, I would like to talk a little about Cumbria. I suspect that other areas face similar circumstances, but I will just discuss my own county. Cumbria has been described as a county that is over-governed and under-led. We have more than 380 councillors and seven councils, yet we have only half a million people. That system was created in 1974 and is now clearly not fit for purpose. It is recognised by everybody locally, including all the political parties, industry, business, the health service and local people, that it has to change, and that it has to do so soon if it is to be part of the devolutionary changes that are happening and to take the opportunities that are available to local government.

However, there is a potential problem. That is why I tabled amendment 50. I believe that it is wrong in a two-tier area for one authority effectively to have a veto over any change, even if it is a sensible and well-supported proposal made by the rest of the county and all the other districts. That allows one authority to stop popular and vital reforms going ahead. Anyone who understands Cumbrian politics will know that that is a distinct possibility.

Amendment 50 is not about allowing central Government to impose their will over what happens in Cumbria—I want to emphasise that. It is about stopping one authority denying progressive change that is in the interests of people throughout Cumbria. Cumbria is an obvious example of this problem because six of its authorities could be prevented from bringing about badly needed and well-supported reform by one maverick authority.

[Mr Rees-Mogg]

I am very interested in the point that my hon. Friend is making, but concerned that his proposal would undermine one of the principles behind what the Government are doing, which is to ensure that there is consent for the proposals. Does he feel that if what he is describing were to happen, it would be right to have a referendum to ensure that people were not having decisions made for them wrongly by the hierarchy above them?

[John Stevenson]

I do not feel that a referendum would be necessary, because the councillors on the various councils are the elected representatives of the people. My concern is that one authority might dig its heels in and prevent change that is in the beneficial interests of the rest of the council and all the other districts, particularly given that sacrifices will be made by those districts and the county council.

I ask the Minister to give serious consideration to what I consider to be a modest and sensible amendment. I look forward to him accepting it on Report.

[Mr Betts]

I agree with what my hon. Friend the Member for Nottingham North (Mr Allen) said about the need for a wider constitutional settlement. That was apposite, and at some point we will have to address those issues. I agree with his points about subsidiarity and taking that below the level of an individual local authority, and about encouraging the process down.

Fiscal devolution is a challenge, and Members have reflected different perspectives from different parts of the country. It is a challenge, but not one that we should duck. I am Chair of the Communities and Local Government Committee, on which the hon. Member for Carlisle (John Stevenson) sat in the previous Parliament. He made important and valuable contributions to our report. We found a way to take on board proposals from the London Finance Commission about the wider devolution of property taxes, while recognising the need to protect areas that will perhaps struggle to raise business rates and other property taxes easily, or to get back money from areas that simply watch property prices rise and receive enormous windfalls. We must have balance in the system.

The Committee has begun an inquiry into the workings of devolution and the Bill, but since then the Chancellor has made his announcement about the full localisation of business rates. The Committee will want to come back and look at how that will be done. I think most Members would support the principle behind such a move, but how will we implement it to ensure protection for poorer areas? How will we devolve more powers to local government to take account of the extra money made available as part of that process?

Operational Productivity in NHS Providers

John Stevenson Excerpts

Wednesday 1st July 2015 Westminster Hall

[Dr Offord]

We are talking about all the different staff. There are 300 different employment roles in the NHS, so we are talking about everyone across the NHS, but I hope later in my speech to come to the specifics of clinicians and the use of agency staff for that sort of role.

[John Stevenson (Carlisle) (Con)]

I congratulate my hon. Friend on securing this important debate. In my constituency in north Cumbria there is a hospital with a large number of agency staff, which has been a problem for some considerable time. I understand the need to employ agency staff, but does he agree that it would be far better to have staff employed directly by the hospital, as that would improve patient care and staff morale and also—to echo his point—improve the costs and productivity of that hospital?

[Dr Offord]

I certainly do agree with that point, and I hope to elaborate further on that. I also wish to touch on the use of bank nurses, or bank employees, who periodically work for parts of the NHS. I agree that for patient care it would be best to have full-time permanent staff who not only know the patients and the hospitals, but know the other employees they work with on a day-to-day basis.

Most worryingly, Lord Carter identified the fact that, in some of the 22 hospitals he surveyed, bank nurses are remunerated at a level that does not discourage them from remaining with, or moving to, agencies. I looked at the website of one of the trusts that took part in the review by Lord Carter and was surprised to see the range and number of bank employees—including, ironically, the position of the e-roster co-ordinator. I will not name that particular trust, as this debate is not a “name and shame” exercise, but I raise it to illustrate the point, because if such a role is vacant, what hope can there be to ensure that other clinical positions are staffed suitably?

The e-roster co-ordinator is in the best position to monitor employment and identify irregularities in work patterns to prevent fraudulent practices. The majority of people who work for the NHS are honest, but there are a minority who seek to defraud its resources. I want to highlight the types of fraud that occur. Such fraud involves staff and professionals who claim money for services not provided or more money than they are entitled to, or who divert funds to themselves. It can also involve external organisations that provide false or misleading information, including invoices, to claim money they are not entitled to. Some of these frauds can be fairly low value, but they can often cost the NHS hundreds of thousands of pounds.

One example is Michael Botham, a hospital worker in Stoke-on-Trent who claimed nearly £20,000 for shifts he did not work. He applied for work via a recruitment agency, AMG Nursing and Care Services, in October 2007. He was then assigned as an unqualified healthcare worker to Bucknall hospital in Stoke-on-Trent, where he worked in the complex needs ward. Most worryingly, it took a ward manager to identify an overspend and to report their suspicions about Botham to the trust’s local counter-fraud specialist team. When the team analysed his timesheets, they revealed that he had submitted false claims for work from 1 January to 26 July 2009, complete with forged authorisation. In fact, he had worked only one shift during that period.

Botham also claimed payment for four shifts at Bradwell hospital, part of the same trust, in January 2009. Again, he had not worked those shifts and the authorising signatures were also false. In total, the trust overpaid £19,362 as a result of his false claims to the agency, which invoiced the trust in good faith on a weekly basis, but subsequently, to its credit, offered to pay back its fees of £3,956.50. This is a clear case of an individual deciding to defraud the NHS, but what is concerning is that the problem emerged only as a result of the scrutiny of another member of staff whose role was not to look for fraud.

NHS Success Regime

John Stevenson Excerpts

Thursday 4th June 2015 Commons Chamber

[Ben Gummer]

I take this opportunity to congratulate the hon. Lady on her entry into the House and on her maiden speech, which I enjoyed listening to in the Queen’s Speech debate. In England we are addressing the issues surrounding social care and its integration with the health service. That is why we have introduced the £5 billion better care fund. Under the success regime, far from looking at structure, we are trying to see how we can better link up services. That is why local councils will be a key partner at the table in the discussions.

[John Stevenson (Carlisle) (Con)]

I welcome the announcement, which I see as an opportunity to review the whole health economy in north Cumbria. It is a chance to review the strengths and weaknesses of health care and patient care in and around Carlisle and north Cumbria. However, will the Minister confirm that this will not hinder other developments, such as the acquisition of the Cumberland infirmary by Northumbria NHS Trust?

[Ben Gummer]

It is such a pleasure to see my hon. Friend return to the House. I know that he has been a tireless campaigner for the people of Carlisle. The success regime, as I said in answer to previous questions, will look at every single part of the local health economy, and every single partner in those discussions will be locally based or national regulators and NHS England.

A and E (Major Incidents)

John Stevenson Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

To my knowledge, over the past few weeks there have been 15 major incidents, including internal ones. Three have now been stood down, making a total of 12 at the moment.

[John Stevenson (Carlisle) (Con)]

The Cumberland infirmary in Carlisle is coping and improving. However, to improve more quickly, it needs to conclude the acquisition by Northumbria Healthcare NHS Foundation Trust as soon as possible. Will the Secretary of State do everything he can to help to achieve that, as I believe it will lead to better health care, both in A and E and generally, in Carlisle?

[Mr Hunt]

I am very sympathetic to my hon. Friend’s view. Indeed, I have spoken to him about it on several occasions. I very much hope that the merger can go ahead as soon as possible.

NHS (Five Year Forward View)

John Stevenson Excerpts

Monday 1st December 2014 Commons Chamber

[Mr Hunt]

Let us take one example. The better care fund has meant that for the first time—this did not happen in 13 years under Labour—local authorities are sitting around a table with the local NHS, working out how to jointly commission care for the most vulnerable patients in the community. That is a huge step forward. The hon. Gentleman should talk with the people in his local authority, because he will hear about the incredible progress that is being made. This is not pie in the sky; it is £2 billion of new money for the NHS. That will make a big difference to doctors and nurses in Huddersfield, just as it will everywhere else.

[John Stevenson (Carlisle) (Con)]

I welcome the announcement of additional funds for the NHS and give my support to the Minister for putting patients first and driving up the quality of care. However, does he agree that it is not all about money and that quality, committed and motivated staff are central to a successful NHS, as is good leadership and management, particularly at the local level?

[Mr Hunt]

My hon. Friend is absolutely right. For every hospital in difficulty—he has had many discussions with me about his hospital, which is going through a very difficult period—there is another with the same funding settlement that is able to deliver good care with motivated staff. Leadership is extremely important for motivating staff, and the one thing that staff say matters most to them is having leaders who listen to what they say and, when they have concerns, take them seriously. That is a change that we are beginning to see throughout the NHS.

Oral Answers to Questions

John Stevenson Excerpts

Tuesday 25th November 2014 Commons Chamber

[Dr Poulter]

I can reassure the hon. Gentleman that, in the words of the medical directors of all the hospitals affected, there is a very high level of clinical support for the programme across north-west London, and the changes will save many lives each year and significantly improve the services that are available to local patients. I hope that is reassuring to the hon. Gentleman and to local patients.

[John Stevenson (Carlisle) (Con)]

Running a deficit can demonstrate short-term problems which, once resolved, will allow a trust to return to balance. Does my hon. Friend agree that there must be flexibility in the system, particularly for trusts such as North Cumbria, which have been in special measures?

[Dr Poulter]

It is absolutely right that trusts such as North Cumbria need to face up to challenges when those affect the quality of patient care, and that the focus of Care Quality Commission inspections and special measures is to drive up standards of care. It is also important that we continue to invest and support trusts where we can. That is why we are pleased to be increasing the NHS budget by £15 billion during this Parliament.

Special Measures Regime

John Stevenson Excerpts

Wednesday 16th July 2014 Commons Chamber

[John Stevenson (Carlisle) (Con)]

May I reiterate my support for my right hon. Friend’s policy of putting patients at the centre of the NHS? Clearly I am disappointed that North Cumbria Trust continues to remain in special measures, particularly given the hard work of the staff and management there. However, will the Secretary of State assure me that if the trust, with the support of Northumbria, produces a robust action plan to address the issues that have been raised, a re-inspection by the CQC can happen sooner rather than later?

[Mr Hunt]

No one is keener than my hon. Friend and I to get the trust out of special measures as quickly as possible, and I thank him for the many representations he has made with respect to North Cumbria. I know that the trust is disappointed not to come out of special measures, but it is now rated good in terms of being caring, and the CQC said in July that the staff were supportive to patients and those close to them, so some encouraging things are happening at the trust, and we will do everything we can to help it to go the final furlong.

Patient Safety

John Stevenson Excerpts

Tuesday 24th June 2014 Commons Chamber

[Mr Hunt]

There are definitely times when an independent investigation is needed, and a number of them are going on in the NHS at the moment. The first thing, however, is to talk to the trust and get it to deal with the particular issues being raised and to create a culture in which trusts are willing, enthusiastic and keen to do that. Today is an attempt to deal not only with what happens when things go wrong with whistleblowers, but with how to create the right culture in the first place.

[John Stevenson (Carlisle) (Con)]

I commend the Secretary of State for his desire to put patients at the centre of the NHS. Does he agree that patient safety in places such as North Cumbria can be ensured not just by quality medical care, but by good-quality leadership and management? Would he therefore agree that we need quality management throughout the NHS that is confident about being open and transparent?

[Mr Hunt]

I would agree with that, and I am grateful to my hon. Friend for talking to me on many occasions about the issues at North Cumbria hospital and for sharing his determination to turn things around— [Interruption.] I find it extraordinary that Labour Members are making all this noise. My hon. Friend will know that that hospital had to give £3.6 million in compensation to just one person because of an appalling mistake when Labour was in power. They should be welcoming these changes, not criticising them.

Oral Answers to Questions

John Stevenson Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Andrew Bridgen (North West Leicestershire) (Con)]

8. What recent progress he has made on improving the performance of hospital trusts placed in special measures.

[John Stevenson (Carlisle) (Con)]

9. What recent progress he has made on improving the performance of hospital trusts placed in special measures.

--- Later in debate ---

[Mr Hunt]

I know that my hon. Friend takes a very close interest in what happens at his hospital and I think that progress is being made in turning it around. What will be of concern to my hon. Friend is that, as far back as 2005-6, Burton’s mortality rate was 30% higher than the national average—it was even higher than that at Mid Staffs—and yet the problem was not sorted out. We are sorting it out.

[John Stevenson]

As the Secretary of State is aware, North Cumbria trust is in special measures. We have on our doorstep a potential solution to our problems, namely Northumbria trust. Will the Secretary of State give me an assurance that everything possible will be done to get North Cumbria out of special measures at the earliest opportunity and, much more importantly, that every support will be given to Northumbria in is acquisition of North Cumbria?

[Mr Hunt]

I can give my hon. Friend both assurances because Northumbria has been doing a huge amount to help North Cumbria turn itself around, including installing its patient experience systems to ensure that patients are treated with the dignity and respect that they deserve. The problems have been around since 2007 and he can tell his constituents that we are finally turning them around.

Hospital Mortality Rates

John Stevenson Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Speaker]

Order. I am keen to accommodate as many remaining colleagues as I can, but I point out to the House that I must have some regard to the Second Reading debate on the Defence Reform Bill, so economy in questions and answers is now of the essence.

[John Stevenson (Carlisle) (Con)]

I welcome the Keogh report. Patients should come first and patient care should be at the centre of our health service. Over the past 10 years, sadly, there has been a clear lack of leadership and management at North Cumbria University Hospitals NHS Trust, so I am not surprised by the report. However, there is a possible solution to improve health care in north Cumbria: the acquisition of the hospitals by Northumbria Healthcare NHS Foundation Trust. Will the Secretary of State work with me, the regulators and Northumbria to ensure that the acquisition proceeds as quickly as possible so that the people of Cumbria and Carlisle get the best possible health care?

[Mr Hunt]

I very much hope that that acquisition can proceed and I agree with my hon. Friend that it is the way forward. Although we have to ensure that that happens properly, Northumbria can give North Cumbria the leadership that it badly needs, so the process would be positive.