Care Quality Commission (Morecambe Bay Hospitals)

John Stevenson Excerpts

Wednesday 19th June 2013 Commons Chamber

[Mr Hunt]

My hon. Friend speaks extremely wisely. One of the key issues raised by the Francis report was the fact that we have a form of accountability for doctors and nurses—it does not always work as well as it should—through the possibility of being struck off by the GMC and the Nursing and Midwifery Council, but there is no equivalent accountability for managers. In a way, that is what the chief inspector is going to do. That is why I was so keen that as well as looking at whether a hospital is safe or not, the chief inspector should rate hospitals with Ofsted-style rankings, which look clearly at the quality of leadership in every organisation. The score that a hospital or a trust gets from the chief inspector will ultimately be the determinant of whether or not an organisation is well led. That is why I think it will give the public vital information about leadership, which they do not have at present.

[John Stevenson (Carlisle) (Con)]

As the Secretary of State knows, there have been issues about patient care in the North Cumbria University Hospitals NHS Trust. I therefore fully support the introduction of a more robust CQC regime than the one that previously existed. What does the Secretary of State intend to do to ensure that failing trusts are taken over in a timely and efficient manner so that new leadership and new management may be put in place as soon as possible?

[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.

Oral Answers to Questions

John Stevenson Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Mr Jeremy Hunt]

May I just remind the right hon. Gentleman that there has been a real terms increase in NHS spending? That contrasts rather starkly with what was said by the Health Secretary under the previous Government. He said it would be irresponsible to increase health spending in this Parliament. We ignored that advice and NHS patients are benefiting.

[John Stevenson (Carlisle) (Con)]

T9. The food labelling consultation closed in August. Could the Minister indicate when the Government response is likely to be issued and confirm that the Government will not bring in unnecessary burdens on the food industry over and above those set out in European regulation?

[Anna Soubry]

This is an area that is important to the Government’s work. At this stage it is important to make sure that we do not over-regulate but that we work with industry and manufacturers. The four Governments across the United Kingdom will shortly issue a statement about front-of-pack nutrition labelling, and we expect to publish the formal response to this year’s consultation within the next few weeks.

Manufacturing

John Stevenson Excerpts

Thursday 24th November 2011 Commons Chamber

[John Stevenson (Carlisle) (Con)]

I am delighted to have the opportunity to take part in this important debate, and I congratulate the Members on both sides of the House who secured it. The subject is central to the economic well-being of this country. Manufacturing matters both locally and nationally.

On the local scene first, in my constituency of Carlisle there are five major manufacturing plants, as well as many smaller manufacturing businesses. Those five major plants are big employers; between them they employ between 3,000 and 4,000 staff, producing for national and international markets world-class products, such as Pirelli tyres, Carr’s water biscuits, Quality Street—whose tins of sweets we all have at Christmas—and, most important of all, the humble custard cream. Manufacturing also matters nationally, as it is a key part of our past and must be a key part of our future. We have to start making things again.

It was interesting to hear the shadow Minister, the hon. Member for Hartlepool (Mr Wright), talk about being an optimist and a pessimist, because before this debate, I concluded that our country has reasons to be pessimistic, reasons to be realistic, and, most important, reasons to be optimistic. If we are pessimistic, we can look back and consider that in 1980 manufacturing accounted for 24% of our economy, but the figure now is just 11%. Over the last 14 years we have lost 1.7 million jobs in manufacturing. We now rank between the sixth and the ninth largest manufacturing country, and we are sliding down that list. We rank 18th highest for machine tools investment, which is lower than Mexico. Germany has nine times more investment in plant and machinery than the UK, and many areas of our manufacturing have completely disappeared or have greatly reduced, such as textiles.

We have to be realistic. This country has less than 1% of the world’s population and we are no longer the engine-room of the world. Other countries will inevitably grow their manufacturing sectors and become larger manufacturing producers than us, and we have to accept that. We also have to accept that low-cost countries are hard to compete with in many ways. Technology and productivity also mean that fewer workers will often be required to produce the same amount of output. Although we must not lose sight of the fact that manufacturing is only part of our economy, it is important. Our trade gap was £100 billion but that reduces to about £37 billion when we take into account the surplus from services.

We have reasons to be optimistic about the future of manufacturing: Britain remains a major manufacturing country; manufacturing contributes £140 billion a year to our national economy and provides 55% of our exports; we remain a major force in aerospace and pharmaceuticals; and our manufacturing industry is innovative. We often forget about the food and drink industry, but it is our largest manufacturing sector, producing 15% of our output. It also produces 8,000 new products annually and it has survived the recession extremely well. Indeed, by 2017 it will need to recruit about 137,000 people just to replace those retiring.

We also need to take into account investment. There is investment going on in this country: £500 million from BMW; £192 million from Nissan; and the £55 million that Coca-Cola announced just yesterday. Business does want to invest in manufacturing and it wants to invest in Britain. I am pleased to hear the Minister being positive about manufacturing and demonstrating that the Government are interested in manufacturing and want to be proactive. I congratulate them on the “Make it in Great Britain” campaign, which is to be warmly welcomed.

We must also remember that the nature of manufacturing is changing. It is becoming more high-tech and more skilled, and that might be favourable to a country such as ours. In the future, there will be growing markets. We have talked about the BRIC countries—Brazil, Russia, India and China—but other countries in Asia give us opportunities for the future. As countries become wealthier, there is a diminishing gap between the emerging and the mature markets. That also gives us an opportunity to be more competitive in the global market and to tackle the new markets that are being created. So I believe that there are reasons to be optimistic about the future. To misquote Mark Twain, the reports of the death of manufacturing are greatly exaggerated.

What can we do and what do we need to do to ensure that British manufacturing has a prosperous future? Clearly there is no panacea, but a combination of issues and ideas can help manufacturing. Undoubtedly, the Government have an important role to play and it is good to be reassured by the Minister that they are aware of the issues in manufacturing and want to support it. I am talking about things such as reducing unnecessary regulation, adopting a sensible tax regime, the Government supporting, talking about and promoting manufacturing, and helping the supply chain and helping with energy costs. The Department for Business, Innovation and Skills is to be congratulated on its support for that.

We have had real successes. On skills, apprenticeships are being created up and down the country. The number has increased by 300 to 1,000 in my area, and that is to be welcomed. We have also seen the expansion of the university technical colleges and the targeted funding through the regional growth fund—for example, £2 million is going into Pirelli, with its plant in my constituency. Central Government form just one part of government; local government, which is another part, also has a role to play, for example, through the planning system. I welcome the changes in that area, but local government must take those opportunities, and be sensitive to business and help it. Local authorities are often property owners and they also have an opportunity to help business and support its development. Industry must also help itself. It must take responsibility for research and development investment, long-term planning and the training of its staff, and it must help to promote its own image. Engagement by the industry with councils, schools, colleges and universities is equally important.

I shall conclude by saying three things. First, I fully support and endorse the idea of my hon. Friend the Member for Hexham (Guy Opperman) that there should be a Minister for manufacturing. Such a person would be the champion for manufacturing, working across Departments and ensuring that manufacturing is heard and has a loud voice within government. Secondly, education and skills are vital, and I know that the Government are working hard in that area. I am talking about skills that industry actually needs: the skills that will help us to develop our manufacturing sector for the future. Finally, probably the most important thing we need is a cultural change. We need it in Government at a national and local level, in schools, in the press and in the public’s view of manufacturing. If we have a national cultural change, I believe that manufacturing can have a prosperous future.

Health Care (West Cumbria)

John Stevenson Excerpts

Wednesday 16th March 2011 Westminster Hall

[Mr Reed]

Before continuing, I ought to declare some interests. I shall be talking about the West Cumberland hospital today. Not only was I born there, but so was my wife and our four children; my nieces and nephews were all born there; and about a year ago it saved my life.

At best, the future provision of health care services in west Cumbria—indeed, in Cumbria in its entirety—is confused. Given the majority of representations that I have received, from ordinary people and medical professionals, at worst it is in crisis. Before the election, and immediately after it, the development of health care services in Cumbria was praised by the Secretary of State for Health and those sympathetic to his views as a model for the rest of the country. I shall return to this aspect in due course, but suffice it to say that the Secretary of State has stopped using Cumbria as an example of best practice; surely even he realises the chaos that is being caused there by the top-down, unwanted and unwarranted reorganisation of the NHS that he is inflicting on us.

First I shall give a brief history. In 2007-08, NHS Cumbria, the primary care trust for the area, undertook a huge public consultation under the closer to home initiative. It was an enormous task; 140,000 people contributed to the consultation, a huge proportion for any consultation, let alone for a county with a total population of just under half a million. It identified the need to redevelop the West Cumberland hospital and to integrate and improve primary care services as part of the closer to home deal.

During a period of record and sustained funding for the NHS, the public reluctantly agreed to a reduction in the number of beds at the West Cumberland hospital. I have no doubt that the Minister will say that beds do not equal services, and I accept that from the outset. Negotiations with the public were incredibly difficult, but the change was accepted with two provisos. First, the reduction in the number of beds would result in more complex surgery and tertiary-level care coming back to Cumbria from the north-east, taking place at the Cumberland infirmary in Carlisle; that would reduce travelling times for people in my constituency and west Cumbria and help with family concerns for those requiring tertiary-level services.

Secondly, the reduction would effectively result in the building of a new hospital on the site of the West Cumberland hospital. The hospital would retain its acute status, its consultant-led maternity, paediatric and anaesthesiology services, develop specialisms not available at Carlisle, and develop its teaching function. Crucially, it would be surrounded by a network of refurbished or even entirely rebuilt community hospitals in Millom, Keswick, Cockermouth and Maryport, with a brand-new health centre in Cleator Moor; together, they would be able to deal with an increased level of primary-care needs, to allocate resources better, to sign-post acute care when necessary and, importantly, to provide care closer to home.

After real difficulties, hospital consultants from both hospitals in north Cumbria—the West Cumberland hospital in Whitehaven and the Cumberland infirmary in Carlisle—began to forge an effective working relationship with local GPs. I brokered many of their meetings, chaired them and tried to help navigate a route towards an integrated provision of local health services in west Cumbria—one that was outcomes driven in the best interests of patients and that would underpin the future professional and economic stability, viability and sustainability of the local NHS. I believe that it was achieved, albeit imperfectly.

Collectively, the local community and primary and acute medical practitioners were developing a model that would best fit Cumbria. I am delighted to see my hon. Friend the Member for Workington (Tony Cunningham); he had a huge part to play in those developments. So advanced was the relationship, and so strong was the plan, that we were able to insist that a publicly funded, privately operated clinical assessment and treatment centre was not introduced in the area. We knew that it would destabilise the local NHS. My right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson), then Secretary of State for Health, listened and did as we asked. It seems that times have changed—and significantly for the worse.

A funding package was developed for west Cumbria, through the west Cumbria strategic forum, and the principle of “west Cumbria proofing” was consistently implemented by the previous Government. That funding was meant to provide £100 million for the West Cumberland hospital and up to £80 million for the community health facilities that I mentioned earlier. Do the Government and the Department of Health remain committed to “west Cumbria proofing”, and the memorandum of agreement that underpinned it?

After the election, these moneys were arbitrarily withdrawn, despite the fact that demolition had already begun on the site of the West Cumberland hospital. The events in my constituency on 2 June 2010 caused me to ask the Prime Minister to visit the hospital and to see for himself the extraordinary clinical work being undertaken by the accident and emergency team in the face of quite unprecedented events. I also used the opportunity to lobby for the money that had been taken from us. Eventually, the Department of Health returned £70 million to the project.

[John Stevenson (Carlisle) (Con)]

Finance is obviously an important part of health care in north Cumbria. Does the hon. Gentleman agree that the PFI scheme has been a burden to the area?

[Mr Reed]

I would like to examine our PFI scheme forensically and try to discover why other PFI schemes around the country work so well. What is it about the Carlisle scheme that causes such difficulties for the health economy of our area? However, the burdens that it imposes pale in comparison with the GP fundholding system that we face.

The North Cumbria University Hospitals NHS Trust remains committed to its £20 million investment. However, the abolition of the north-west regional development agency and the instruction from Downing street that incomplete projects were to have RDA funding withdrawn has led to a £10 million shortfall in the new-build budget. Will the Minister please reinstate that missing £10 million? If not, will she and her Department help me to identify money to cover that shortfall from other sources—even, perhaps, not from the Department of Health? Can she help expedite the detailed business case approval for the West Cumberland hospital?

Already £10 million down, the trust and NHS Cumbria have also been instructed to make 4% annual recurring cuts. That would be an incredibly difficult situation for the west Cumbrian health economy at any time, but we have not yet approached the real horror that threatens to hole it below the waterline.

At Prime Minister’s Question Time today, the Prime Minister made a Freudian slip when referring to GP fundholding. The Department of Health prefers to call it GP commissioning, but GP fundholding is the practice that brought hospitals to their knees and that almost bankrupted the NHS in the 1980s and 1990s. That is precisely what GP commissioning is. There is all the difference between GPs commissioning and designing services in an integrated way with their hospital colleagues, and GPs being forced to hold the purse strings for the provision of each hospital service upon which their patients rely.

Will the Minister tell us what limit, if any, will be placed on GPs’ remuneration under the new system? Does she have any fears relating to soaring salaries and the fact that the bond of trust between patient and doctor could become severed as a result? Does she have any concerns with regard to the imbalance now between GPs and their acute colleagues and does she think that that will affect future recruitment and the provision of services within the NHS?

With GP fundholding effectively in place in Cumbria—in shadow form—we are witnessing a massive cut to the North Cumbria University Hospitals NHS Trust and to the West Cumberland hospital. Last year, the hospitals trust provided acute hospital services worth some £183 million across its sites. Under GP fundholding, that is being reduced, in the space of one year, to £153 million, which is bound to affect the provision of acute hospital services at the West Cumberland hospital. Does the Minister agree that such a financial hit cannot be absorbed without affecting front-line services?

The shortfall has plunged the trust into chaos. It is now unable, not unreasonably, to meet the foundation trust status qualifying criteria deadline of 2013-14 and that has caused it to seek a merger with another trust or any other willing provider. I hope that the Minister will be able to tell us categorically what the Department means by “any other willing provider”. Minutes from meetings of senior consultants across the North Cumbria University Hospitals NHS Trust, which have been leaked to me, show that those consultants fear that this could result in the closure of the West Cumberland hospital. That would be—as the cuts are—the direct consequence of centrally imposed, top-down Government policy in the NHS.

Will the Minister guarantee that she will not let that happen and that the current level of services will only be added to and not taken away from? Will she agree to arrange a meeting between the Secretary of State, concerned local clinicians and me to hear the case in detail? Will she also grant the trust extra time to meet the foundation trust qualifying deadline so that a merger can be avoided? A merger of trusts is not in the interests of the trust itself or any other trust being asked to take it on. If not, will she guarantee that no other trust or willing service provider will reduce the services provided by the West Cumberland hospital? In short, will she commit today to ensure the delivery of the closer to home programme, which my constituents and those of my hon. Friend the Member for Workington have been consulted on and reached agreement on?

What of our local community hospitals and planned health centre? Will the Minister guarantee that the money for those facilities will be provided by Government, or financially facilitated, very soon, so that these long promised and keenly anticipated investments can take place? What is the status of the programme to rebuild and replace our community hospitals in west Cumbria and provide a new health centre in Cleator Moor? Does the Minister agree that the closer to home initiative will collapse if these facilities are not forthcoming and that a deal will then have been reneged upon? Were that to happen, the sense of betrayal would be profound and the consequences significant.

The West Cumberland hospital was the first new hospital in this country to be built by the NHS after its creation. Right now, it risks becoming the first casualty of what many see as the stealth privatisation of the NHS by a right-wing Government implementing centrally driven health policies that command no democratic mandate or clinical support. As I speak, Bevan will be turning in his grave. I am asking for help, compromise and understanding of the problems facing the future of health service provision in west Cumbria. There is still time to put that right and I hope that the Minister and the Government will see sense.

Oral Answers to Questions

John Stevenson Excerpts

Tuesday 25th January 2011 Commons Chamber

[Mr Lansley]

Well, I do not wish to embarrass the chief executive of the NHS, but actually, he told me he made an error—he was referring to health visitors, not midwives, when he was talking to the Public Accounts Committee. We are short of health visitors precisely because, through the life of the last Government, the number was continuously going down, and we are going to recruit more. Actually, we share the last Labour Government’s commitment to increase the number of midwives, not least because of the increase in the number of births, and to do so in pace with that. As a consequence, in conversations that the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), and I have had with the Royal College of Midwives, we have made it clear that we will do all we possibly can. We already have more midwives in training than at any other time in our history.

[John Stevenson (Carlisle) (Con)]

T4. As Ministers are aware, GPs in north Cumbria are supportive of GP commissioning and are already working hard for its success. However, given the rural nature of the area, what support will be given to the local hospitals to ensure that they can provide secondary health care within the new regime, when they have to accommodate the additional costs of providing health care in a rural environment?

[Mr Lansley]

Yes, I entirely endorse what my hon. Friend says about GPs in Cumbria. They are indeed very forward-looking and show that, even under the last Government, practice-based commissioning was demonstrating its benefits, and we are building on that. I mentioned earlier the duty in the Health and Social Care Bill on the NHS commissioning board to reduce inequalities in access to health care. That will be important for rural areas. The pricing arrangements, led by the commissioning board and Monitor, must also take into account varying costs associated with the delivery of care in different localities.