Ealing Hospital

Justin Madders Excerpts

Tuesday 3rd May 2016 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate my hon. Friend the Member for Ealing, Southall (Mr Sharma) on securing this extremely important debate and on the eloquent way he introduced it. He is widely known in this place for championing issues on behalf of his constituents; his contribution today will only further enhance that reputation. He presented a comprehensive picture of his constituency, rightly highlighting the scandal of health inequalities there and his concern about the implications for patient safety of the Government’s proposals. He cited staggering figures for the growth in elderly population in his area—not unique, but by no means to be ignored. He expressed his concern that the most vulnerable and those whose children have long-term conditions will have to travel further to access services, with possible negative implications for their economic situation. It is clear from what he said that he and his constituents have lost confidence in the process.

I draw attention to the contribution from my hon. Friend the Member for Ealing Central and Acton (Dr Huq). She is new to this place but is fast gaining a reputation as a Member who assiduously represents her constituents. She described the Government’s response as intransigent. If that is her experience, I am sure it is no reflection of the effort she has put in. She compared Ealing to the city of Leeds, and it is unthinkable that a city the size of Leeds would not have such fundamental health services as those being discussed today. She described what has been presented to us over the past few years as a bad deal all round. As an academic, she has based her comments on the evidence she has seen, not on opinion. She and my hon. Friend the Member for Ealing, Southall both expressed concern that Ealing hospital is on the way out. Those were not careless comments thrown about for political gain but genuine anxieties born out of what they see and hear.

My hon. Friend the Member for Hammersmith (Andy Slaughter) correctly said that the sooner the business plan for further implementation is available, the better. He identified the lack of information as a factor that has made the situation far more difficult than it could have been. As he says, where there is a vacuum, something will fill it. In this case, the vacuum has been filled by rumours—rumours so strong that two of my hon. Friends have felt compelled to raise them here today. He said that transparency will help; I certainly agree with that. I also agree that our concerns are no reflection on the hard work and valuable contribution that our NHS staff make each and every day.

More than 100,000 people have now signed the petition to express their concern about service downgrades and what they see as a real threat to the future of Ealing hospital. Their concerns relate to the “Shaping a healthier future” programme, which was launched in 2011 by a group of what were then 10 primary care trusts,

“to reshape hospital and out of hospital health and care services in North West London.”

Following the abolition of primary care trusts, the North West London Collaboration of Clinical Commissioning Groups has led the programme. It has proposed a number of extremely significant changes, including the downgrading of accident and emergency services at a number of hospitals.

In 2013, Ealing Council’s health overview and scrutiny committee referred the programme to the Secretary of State, who concluded that changes to NHS services in north-west London should proceed. In a statement, the Secretary of State said that five of the nine hospitals—Hillingdon, Northwick Park, West Middlesex, Chelsea and Westminster, and St Mary’s—would provide comprehensive, seven-day-a-week acute emergency care. He also stated that A&E departments at Ealing and Charing Cross hospitals would remain open, although with what—as my hon. Friend the Member for Ealing Central and Acton pointed out—he euphemistically called changes to the “shape or size” of services. Those changes have probably not turned out as people hoped. Changes were recommended to replace the A&E services of Hammersmith and Central Middlesex hospitals with urgent care centres, which were subsequently implemented in September 2014.

In 2013, it was decided that maternity services would be consolidated on to six hospital sites and maternity deliveries at Ealing hospital would cease. We have heard from my hon. Friends how significant that has been for their communities. The maternity unit at Ealing hospital was closed in July 2015. It has now been recommended that in-patient paediatric services should also be moved to maintain appropriate staffing levels. These changes have, understandably, caused great public concern, which in 2014 led to Brent, Ealing, Hounslow, and Hammersmith and Fulham Councils establishing an independent commission under Michael Mansfield QC to review the impact of the changes to the north-west London health economy and to assess the impact of planned changes.

On 2 December 2015, the commission published its final report, which was extremely critical of the “Shaping a healthier future” programme, finding that inadequate consultation had been undertaken and that departments had been shut without providing adequate alternative healthcare. Its recommendations included halting the SHF programme and that local authorities should consider a legal challenge. The Government’s response states that they are

“clear that reconfiguration of front line health services is a matter for the local NHS.”

It is clear from answers to parliamentary questions and a Westminster Hall debate on 24 March that both the CCGs and the Government do not accept the review’s findings.

The principle that decisions should be made locally by clinicians is sound, but there seems to be an issue about accountability in this case, as there is a clear feeling among the public and local politicians that their concerns are simply not being heard. Those who gave evidence to the commission were not fly-by-nights. Many were working on the front line of the services under discussion. Indeed, they are the local clinicians the Government say should be making the decisions. What recourse do clinicians, the public and patients have if they disagree so fundamentally with what is being done as we have seen here?

The most successful service reconfigurations are those where consultation is most effectively carried out and where support from clinicians at all levels, local politicians and, of course, members of the public is secured. It is no coincidence that when public concern is at its present level in Ealing and the surrounding communities, we tend not to see successful changes in provision.

Such was the frustration and concern about the changes that four local councils thought it necessary to use local taxpayers’ money to commission an independent report. As my hon. Friend the Member for Hammersmith said, the local authorities involved have behaved responsibly in commissioning this report. I do not believe there is any suggestion that they have behaved irresponsibly, so surely the Minister must acknowledge that taking this extraordinary step means that something must have happened that deserves further examination.

I turn to some of the recommendations in the independent report. Serious concerns have been raised about the consultation in 2012. There has been no significant further consultation since. Given that we are now four years on from that point and that the scheme has undergone considerable changes, as has the demographic make-up of the communities, it seems reasonable to consider a further period of consultation.

Concern was also expressed in the Mansfield commission’s report and here today about transparency, particularly in the business case on which the SHF scheme is based. I would welcome the Minister’s observations on both points, and if, like me, she is not satisfied that there has been sufficient public involvement, will she step in and ensure that that takes place before further downgrades or closures and that it is genuine consultation predicated on release of the full business case? Genuine consultation cannot take place if vital information is withheld. Transparency is the key to meaningful engagement.

The commission was asked to look at deteriorating standards in three local NHS trusts that were consistently failing to meet key targets, including that 95% of patients attending A&E must be seen, treated and admitted or discharged within four hours. The Minister will be aware that after six years of a Conservative Government, February’s figures are the worst on record for A&E waiting times. The most recent figures confirm that all three NHS trusts covering this area are failing to meet their targets.

In major A&E units, London North West Healthcare NHS Trust saw just 76% of patients within four hours and Imperial College Healthcare NHS Trust saw 69.1%. Does the Minister agree with the commission that the closures of Hammersmith and Central Middlesex A&E departments are responsible for these appalling figures, or is the Government’s overall record to blame?

Finally, the other key principle to which all service reconfigurations should adhere is that they should be based on clinical rather than financial need. They must represent what is in the best interests of the patients who access the services and not simply be a tool to balance budgets at any cost. In this case, because the Government have fundamentally lost control of NHS finances with 75% of trusts now in deficit, local people are understandably asking whether the serious financial hardship that the trusts face is forcing the CCGs to consider changes that they otherwise would not. Can the Minister assure us that no decision will be made in this case or any other on the basis of finance alone and that the interests of patients will remain the central focus at all times? It is clear that public confidence has been lost in this case, and it is simply not good enough for the Government to wash their hands of it. We urgently need an acknowledgement of those concerns and concrete plans to address them.

[Graham Stringer (in the Chair)]

To clarify, the debate, although it started early, will finish at 2.30 pm. Could the Minister leave a minute or two at the end for the proposer?

Antibiotics: Research and Development

Justin Madders Excerpts

Tuesday 26th April 2016 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Evans. I congratulate the hon. Member for York Outer (Julian Sturdy) on securing this extremely important debate, and on the knowledgeable and measured way in which he introduced it. I also commend his ongoing efforts to bring antibiotic resistance to the House’s attention since his election in 2010. As he said, he secured a Westminster Hall debate in October 2014 in which he called for co-ordinated action to be taken to tackle this issue. Today’s debate offers a valuable opportunity to take stock of progress since then, and to redouble our efforts to ensure that the right conditions are created to incentivise the development of the next generation of antibiotics.

The hon. Gentleman rightly said that something as minor as a grazed knee could claim lives. It is difficult to comprehend how that could happen, but there is a real risk that incidents of that sort will become commonplace in future. He cited the staggering statistic that of the 20 pharmaceutical companies that were originally developing antibiotics, only four are now in operation. He highlighted the tension between the need to encourage innovation and the financial uncertainty in this area of research. He also gave some interesting facts about regional variance in antibiotic prescription, about which I would like to learn more after the debate.

It was a pleasure, as always, to hear from my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick). He discussed tuberculosis from the perspective of both a member of the all-party group on global tuberculosis and the representative of a constituency that historically had severe problems with TB. He highlighted the increasing incidence of drug-resistant TB, and raised important questions that I look forward to hearing the Minister answer.

The hon. Member for Erewash (Maggie Throup) discussed the obstacles to the development of new antibiotics and the issue of inappropriate prescribing. She made a fair analogy with road deaths, as did my hon. Friend the Member for Poplar and Limehouse. The hon. Member for Strangford (Jim Shannon) made a valuable contribution. He was right to acknowledge and encourage the political leadership that is needed on this issue. He also made an important point about the side effects from treatments.

It was good to hear from my hon. Friend the Member for Cambridge (Daniel Zeichner), who brought a great deal of knowledge from his constituency and revealed the alarming statistic that the UK has gone from having 6% of the world’s clinical trials in 2010 to just 2% today. He echoed Jim O’Neill’s comments about pharmaceutical companies needing to look beyond the short term; I think we would all agree that that is an important challenge that we face. He also stated clearly that he believes that more should be done to encourage research and development in this country. We have been a leader for many years, and it would be a real shame if that position was under threat.

The debate is timely, as the Government-commissioned review on antimicrobial resistance is due to report next month. I pay tribute to the huge amount of work that Jim O’Neill and his team have undertaken. I hope that the conclusions of the review will lead to the far-reaching changes that we know are necessary, both in this country and around the world. Antibiotic resistance has been described by the World Health Organisation as the

“single greatest challenge in infectious diseases today, threatening rich and poor countries alike.”

The hon. Member for York Outer referred to the future as a nightmare scenario, and the WHO has also said that if we fail to act on antimicrobial resistance, by 2050 an additional 10 million lives will be lost each year to drug-resistant strains of malaria, HIV, TB and certain bacterial infections, at a cost to the world economy of $100 trillion.

As Dame Sally Davies set out in the foreword to the “UK Five Year Antimicrobial Resistance Strategy 2013-2018”:

“The harsh reality is that infections are increasingly developing that cannot be treated. The rapid spread of multi-drug resistant (MDR) bacteria means that we could be close to reaching a point where we may not be able to prevent or treat everyday infections or diseases.”

Despite that, so far, drug-resistant bacteria have not had anything near sufficient attention in terms of medical research.

It is easy to forget that it was less than 100 years ago that Alexander Fleming discovered penicillin after a piece of mould contaminated a petri dish at St Mary’s hospital, and it was not until the 1940s that the true era of antibiotics began. Despite an exponential increase in the use of antibiotics and an increasing awareness of the threat posed by antimicrobial resistance, since the year 2000 just five new classes of antibiotics have been discovered, most of which are ineffective against a number of resistant strains of bacteria, including Gram-negative bacteria.

We need to take a wide variety of steps to get to grips with the problem, including, of course, looking at how we address the long-term decline of the pipeline for new antibiotics through incentivising research and development, which I will come to shortly. We must also improve our focus on disease prevention, improving surveillance over drug resistance and tackling unnecessary antibiotic consumption. I will briefly address each of those matters in turn.

First, disease prevention, particularly in hospitals and care environments, is vital if we are to tackle antimicrobial resistance. Around 300,000 people a year get an infection while being cared for by the NHS in England—that is one in every 16 people treated by the NHS. As the Royal Society for Public Health said,

“it is alarming that the very place you would expect public health to be a high priority remains a breeding ground for life threatening infections.”

Despite improvements in recent years, the rate of healthcare-acquired infection in England has remained stubbornly high, while checks on compliance with hand hygiene best practice can only be described as inadequate. On 13 January, hand hygiene was the subject of a Westminster Hall debate, to which I responded on behalf of the Opposition. Will the Minister set out what additional steps have been taken since then to improve hygiene in all care settings? There is still a lot we can do to deny superbugs such as MRSA the opportunity to spread.

Secondly, we need to tackle surveillance blind spots in all parts of the world. As Jim O’Neill made clear,

“if we can’t measure the growing problem of drug resistance, we can’t manage it.”

We know that the technology exists to combine rapid diagnostics with data sharing, but we need to build consensus on precisely how that will take place. I would welcome any comments from the Minister on the steps being taken to improve surveillance, both in the NHS and internationally.

Thirdly, as the Science and Technology Committee found in July 2014, there is an urgent need to tackle unnecessary antibiotic consumption in healthcare and in farming, which is one of the key causes of antibiotic resistance. The Chair of the Select Committee at the time, Andrew Miller—my predecessor as MP for Ellesmere Port and Neston—called on the Government to take

“decisive and urgent action to prevent antibiotics from being given to people and animals who do not need them.”

Nearly two years on from that report, there is little evidence that such decisive and urgent action has taken place, or that all the Committee’s recommendations have been implemented. When the Minister responds, will he update us on what steps have been taken to reduce the unnecessary use of antibiotics? Although at the time of the report the Committee welcomed the launch of the O’Neill review by the Prime Minister, it cautioned against using that as an excuse or a reason to delay any progress. I hope the Minister will assure us that that has not happened.

The need to

“stimulate the development of new antibiotics, rapid diagnostics and novel therapies”

was one of the three strategic aims set out in the chief medical officer’s September 2013 report on the five-year antimicrobial resistance strategy. It was also one of the key recommendations of the Science and Technology Committee report. Although I welcome the renewed focus that today’s debate brings, I fear we are no closer to a solution than we were two and a half years ago. The barriers that existed to the development of new drugs have still not been addressed. I hope that today’s debate, and the final report of Jim O’Neill’s review, will provide the catalyst needed for meaningful action finally to be taken. As the hon. Member for York Outer said, a firm timetable from the Minister would be helpful.

The key issue is that in other medical fields, once a new drug is developed that significantly improves on previously available drugs, it quickly becomes the standard first choice for patients once it comes to market. However, as we have heard, a new antibiotic might not become the first choice until there was resistance to previous generations of drugs. Indeed, health officials logically seek to limit prescribing a new antibiotic drug, with the goal of delaying resistance for as long as possible. By the time that a new antibiotic becomes the standard line of care, many years or even decades are likely to have elapsed, bringing it near to or beyond the end of its patent life. If a company has spent tens of millions of pounds on its development, that would leave it unable to generate sufficient revenue and to come close to recouping its original investment. As the hon. Gentleman said, from that perspective, the system is certainly broken.

In the review, “Securing New Drugs for Future Generations: The Pipeline of Antibiotics”, Jim O’Neill suggests a number of interventions to tackle the systematic issues that prevent the development of new antibiotics. He says that those interventions, which require political leadership at a global level, have the potential radically to overhaul the antibiotics pipeline. Will the Minister assure us that the Government will do everything they can to secure an international consensus? We have been told by report after report over the past decade how important tackling antimicrobial resistance is. I am sure Members from all parties will agree that it is time we started to put those findings into action. If the Government do the right thing and take action, they will have our full support.

Members have talked about the challenges, which are on a par with climate change, global terrorism and various other apocalyptic scenarios. It is a sad fact that generally our constituents talk about these issues only when they become everyday concerns. If that happens with antimicrobial resistance, we will have failed. We are all committed to ensuring that that does not happen; we certainly have a duty to do so.

Draft Medicines and Healthcare Products Regulatory Agency Trading Fund (Amendment) Order 2016

Justin Madders Excerpts

Monday 25th April 2016 General Committees

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Turner. I noticed that the Minister was slightly breathless. I am sure that that has something to do with his exertions yesterday, on which I congratulate him.

The Opposition support the order. We recognise that the technical amendments proposed for the MHRA are required to deal with the regulation of electronic cigarettes, particularly in respect of the revised tobacco products directive.

Despite the continuing long-term decline in the number of smokers over the past few decades, the latest estimates suggest that there are more than 100,000 smoking-related deaths each year, and Action on Smoking and Health has estimated that the cost to the NHS of smoking is between £2.7 billion and £5.2 billion a year.

In August 2015, Public Health England published evidence indicating that e-cigarettes are “95% safer than smoking”, pose

“no risk of nicotine poisoning”

and release “negligible” amounts of nicotine into the environment. The limited research that has been undertaken so far suggests that these products have a role to play in helping smoking cessation. They therefore need to be licensed by the MHRA to allow them to be sold officially as an aid to cease smoking and prescribed by the NHS. It is also important that regulations are in place to ensure that the products meet quality and safety standards.

In July 2015, the Government held a public consultation on implementing the revised tobacco products directive. We welcome the approach that has been adopted following the consultation, including the requirement for e-cigarette manufacturers to submit information to the Government about every product they sell, the requirement for health warnings on packages and the maximum cartridge size of 2 ml. It is also important that manufacturers that wish to supply their products without a medicinal licence will not be permitted to advertise them as an aid to smoking cessation. It should be noted that the regulation is supported by stakeholders such as Action on Smoking and Health, the British Medical Association and the Royal College of Physicians.

We welcome the order, but I have some questions that I hope the Minister will address when he responds. First, will he comment on the concern of some health stakeholders, which is identified in paragraph 3.16.7 on page 59 of the response to the consultation, that differences in terminology are beginning to emerge between the UK nations? What steps are the Government taking to work with the devolved Administrations to ensure that there is as little confusion as possible? That is particularly important when there are such rapid developments in these products.

Secondly, we support the use of e-cigarettes as an aid for smokers who are trying to quit, but so far the research has been limited. I hope that the commencement of the order will give us an opportunity to undertake larger-scale studies of the effectiveness of e-cigarettes as a smoking cessation tool. Does the Minister intend to review the regulations in this area when more research comes to light? Has there been any assessment of how many patients are likely to be prescribed e-cigarettes? At a time when public health funding is being cut, I am anxious that this should not be seen as a quick fix to plug the gap. Given that the most effective smoking cessation services involve behavioural support in addition to licensed products containing nicotine, it is important that the prescribing of e-cigarettes goes hand in hand with other support and is not seen simply as a replacement for it.

Finally, some health professionals hold that the expansion of e-cigarette use could contribute to smoking becoming normalised again. Does the Minister agree that that is a risk, and what steps is he taking to combat it?

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Mr Hunt]

With the greatest respect, we are trying to solve a problem that in Scotland is being ducked. We want a seven-day NHS with mortality rates that are no higher at weekends. There is no plan in Scotland to deliver that across the whole NHS. Rather than sniping, the hon. Lady should recognise that, in the interests of patient safety, we need to take difficult decisions. In the end, doctors will see that it is the right thing for them, too.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

First, on behalf of the Opposition, I associate ourselves with the comments made by Ministers about the tragic events in Brussels, and offer our condolences and solidarity to the people there.

Yesterday in Westminster Hall, there was a debate calling on the Health Secretary to resume meaningful contract negotiations with the BMA. The Health Secretary was not there—I do not know, but perhaps he was out buying a leaving present for the Chancellor—but if he had been, he would have heard his junior Minister confirm that, since the announced imposition, the Government have made no attempt to prevent further industrial action. They know more industrial action is coming. Do they not owe it to patients who would be inconvenienced by further strikes to get off their backsides and do something to prevent it?

[Mr Hunt]

The reason we made the decision to proceed with the new contracts is that we had independent advice that a negotiated settlement was not possible. On that basis, we decided that it was important to have certainty for the service by making clear what the new contract is. The contract that we decided on is one that strikes a mid-point between what the Government wanted and what the BMA asked for. It is a fair contract and a better contract for patients. The Labour party would support it if it was really on the side of patients.

BMA (Contract Negotiations)

Justin Madders Excerpts

Monday 21st March 2016 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Sir David.

I congratulate my hon. Friend the Member for Warrington North (Helen Jones) on the eloquent way in which she introduced the debate on behalf of the Petitions Committee. Under her stewardship, the Committee has gathered in a short space of time a reputation for allowing issues that are important to the public to be debated in this Chamber and for some great innovations in how democracy is dealt with in this place.

My hon. Friend helpfully set out the history and the research. She characterised as “rash and misleading” the conclusions drawn from such research about higher weekend death rates and staffing levels. We rightly say it is not easy to find a link between the cause and effect, as she mentioned in her opening remarks, but, despite a wealth of evidence showing that we cannot draw straightforward conclusions on cause and effect, the Secretary of State has proceeded on that basis. The proposals, which will see dramatic changes in how the health service will be run in the future, seem to be based on evidence that does not necessarily justify the conclusions drawn.

I will refer to contributions made by other Members. I congratulate the hon. Member for Morley and Outwood (Andrea Jenkyns) on being the only Conservative Back Bencher present. I know she is genuine in her concern about patient safety, but I was sad to hear some of the comments she made. I am afraid she repeated the mistakes that have characterised the dispute by demonising the BMA, portraying it as a militant faction. Let us not forget that these people have had 40 years without a strike, so can she not see that something has gone very wrong for them to decide to take industrial action and that they do have genuine concerns about patient safety?

I pay tribute to my hon. Friend the Member for Wirral West (Margaret Greenwood) on her contribution. She has great experience in this area and she spoke about the potential exodus of junior doctors that the proposals may mean. She rightly highlighted the serious questions about the proposals that need to be answered.

I am glad to see my hon. Friend the Member for Hammersmith (Andy Slaughter) still in his place. He spoke with great sincerity about how unhelpful the character assassination of certain members of the BMA has been and about how he believes—I believe most Members who have spoken tonight agree—that junior doctors are still willing and able to reach a compromise, but they have been met with an intractable Government.

My hon. Friend the Member for Hornsey and Wood Green (Catherine West) described what she considers to be a Government with a determination to sabotage the relationship with junior doctors. She has spoken to a number of constituents about issues of concern to them, and she was right to say—I wholeheartedly agree—that this is about valuing staff.

My hon. Friend the Member for York Central (Rachael Maskell) spoke with great personal experience and exposed the massive dichotomy at the heart of the proposals. She rightly paid tribute to the staff who, by their good will, add so much more value to the NHS than will ever show up on a balance sheet. I agree with her that the dispute causes massive anxieties about what the future holds for recruitment and retention of our staff. She is right that industrial relations is about sitting down and getting into a constructive dialogue. I hope that, as many Members have said tonight, that is still possible.

The hon. Member for Central Ayrshire (Dr Whitford) spoke with the great experience that she brings to every debate on these matters. She correctly identified the Secretary of State’s wilful conflation of statistics. She highlighted that the ratio of trained nurses is a significant issue and gave good examples of how challenges were resolved in the past by dialogue in conflict—dialogue was raised numerous times by Members. She was right to ring the alarm bells about the fact that fewer than half of junior doctors apply to stay in the NHS and she talked with great knowledge about some of the current pressures in the system on finding staff.

Finally, I pay tribute to my hon. Friend the Member for Bristol West (Thangam Debbonaire). It is so good to see her back here and to hear from her about her recent personal experience of the NHS. She spoke with great passion and sincerity about the treatments and flexibility she was afforded by those staff. It is clear that she has received excellent treatment—she was hugely impressed by staff’s willingness to go that extra mile. The three words she highlighted should be reflected on by the Government: they need to treat staff respectfully, honourably and professionally. I could not agree more with that.

I am aware that in this Chamber we strive for a note of consensus, recognising that the main Chamber is where the theatrics, which do little to enhance Parliament’s reputation, tend to take place.

[Steve Brine (Winchester) (Con)]

They are right now.

[Justin Madders]

Yes, I am sure there are plenty of theatrics going on at this very moment. I will try to be measured in my response on behalf of the official Opposition, but it is our role to point out where we believe there are shortcomings in the Government’s approach, and on this occasion I believe that the Government have been found wanting. The sad reality is that we should not be debating this matter today at all. It could have been different if the Secretary of State had demonstrated a genuine desire to listen, engage and negotiate.

We all know that from time to time an employer will want to change the terms and conditions of their workforce. As a former employment lawyer, I know that change can be sometimes be difficult to deliver, but rarely—if ever—have I seen one side approach a negotiation with such stubbornness, intransigence and provocation. Whatever legal method the Government choose to draw this dispute to a conclusion, the reality is that it is far from over, and the well of resentment that has been built up by the Government’s approach will last for years. Everyone, including the BMA, has recognised the need to reform the current contract, but we have seen a Health Secretary giving the impression that he is looking for a fight, not a solution. In the past year he has described junior doctors as “militant”; implied incorrectly that they do not work weekends; insinuated that they are in some way to blame for deaths among patients admitted at weekends; questioned their integrity by suggesting that they may not be on hand to respond to a major terrorist incident; and insulted the intelligence of some of the brightest and best minds in the country by telling them that the 99% of them who backed industrial action had been somehow misled by the BMA.

I know how important junior doctors are to the smooth running of any hospital, how they consistently go the extra mile to deliver superb care—we heard that from many Members tonight—and how vital they are to the NHS’s future success. Yet they are repaid with insults. That is no way to treat any public servant, least of all those whose good will has kept our health service afloat as it has suffered from years of mismanagement and underfunding.

The dispute, unnecessarily inflamed by the Health Secretary, reached a new low last month when he claimed support for contract imposition from NHS leaders across the country only for many of them later to come out and confirm that that was simply not the case. That was the latest in a long line of statements he has made that do not stand up to any kind of scrutiny. Contrast that rapid evaporation of support when imposition was announced with the solidarity shown by representatives from every part of the health sector who believe that contract imposition was the wrong move to make. At least 10 professional groups, from the Royal College of Midwives to the Royal College of General Practitioners, have warned about the dangers of imposing a contract on junior doctors at a time when staff morale in the NHS is at rock-bottom.

If the Health Secretary, the self-styled patients’ champion, will not listen to the doctors and nurses, perhaps he will listen to the patients instead. The chief executive of the Patients Association, Katherine Murphy, said:

“The Government’s decision to impose contract terms on junior doctors is unacceptable. The health and social care system depends entirely on the great people who work in services across the community for the benefit of patients…It is clear that the acrimonious dispute over the junior doctors’ contract is unnecessary and damaging.”

Unfortunately, it appears that he is not listening to patients, either. He has tried to point the finger of blame at the BMA for the dispute, but if he wants someone to blame he should look no further than the mirror. His actions up to the decision to impose the contract are not those of someone trying to calm things down and reach a resolution: they are the very opposite.

What is in many ways just as unacceptable and unforgivable is the Health Secretary’s complete inaction after the decision was taken to impose the contract. A few weeks ago I asked him, in a written parliamentary question,

“what steps he has taken to avert further industrial action by junior doctors”.

The answer was quite telling. The truth is that since he announced imposition, he has not picked up the phone, opened his door or lifted a finger to try to avoid the most recent industrial action. There was virtually a month from the announcement of imposition to when the Government knew perfectly well that there was going to be further industrial action, but they did absolutely nothing to avert it.

We all need to remember that the NHS is ultimately there to serve patients, and they are now suffering because the Secretary of State has sat on his hands. It has been a complete dereliction of duty. Therefore, when the Minister responds, I ask him to confirm that the Government have not taken, and do not intend to take, any steps to prevent further industrial action.

I have some further questions for the Minister. Was a risk assessment of the effect on patient safety carried out before the decision was taken to impose the new contract? What assessment has he made of the likely impact of the contract on the recruitment and retention of junior doctors, given the crisis that the health service already faces? Does he accept that imposing a new contract that does not enjoy junior doctors’ confidence will further damage morale? Is he concerned by the 10-fold surge in inquiries by doctors planning to emigrate on the very day that the Government announced imposition? What legal advice did he take about how an imposed contract would work in practice? Will he tell the House when we will see the final terms and conditions? It is important for us to see that final detail, particularly as the BMA claims that a cost-neutral proposal was personally vetoed by the Health Secretary. We have never had an answer on that, so I should be grateful if the Minister would confirm whether the assertion is correct, and what the impediment to a deal was, given that it was cost-neutral and we already know that junior doctors work seven days a week.

The Secretary of State has sought, in recent months, to present the negotiation as a symbolic battle to unlock the delivery of a seven-day NHS. If that is the case, can the Minister explain why seven-day services are not mentioned once in the original heads of terms for the negotiations set out in 2013? The truth is that the Secretary of State only decided that the issue was about seven-day services half way through the negotiations when it was clear that doctors were going to put safety first, and he was looking for a way to divert blame away from his disastrous handling of the whole affair. Given that junior doctors already work seven days and seven nights a week, I cannot see how they can be the barrier to the safety of patients. Can the Minister name a single chief executive who has told him that the junior doctor contract is the barrier to providing high quality care 24/7? Even the chief negotiator whom the Secretary of State personally appointed, Sir David Dalton, says that changes to junior doctors’ contracts will have the least impact on arriving at seven-day working.

We all want a seven-day NHS, but no evidence has been provided about how the contract will do anything to further that ambition. Nothing coming even close to a credible delivery plan has yet been provided to set out how the seven-day NHS will be delivered. The truth is that the whole dispute has been used by the Secretary of State to detract from the challenges facing the NHS; those will only be harder to overcome thanks to his industrial relations approach, which is straight out of the Thatcherite 1980s playbook. Picking a fight with a group of people who will be critical to the future of the NHS is a mistake that I believe the Government will come to regret. The Secretary of State recently announced a number of measures aimed at making the NHS more open to learning from mistakes, and we of course support him in doing that, but when will he learn from his mistakes? When will he learn how to conduct a negotiation in a measured way?

On any analysis the Secretary of State has failed. He has failed to win the trust of the very people who run our hospitals, and the support of patients and the public. The Health Secretary may be content with a legacy of failure, but the way in which he has alienated a whole generation of doctors is something we will have to live with for many years to come.

--- Later in debate ---

[Justin Madders]

Will the Minister give way?

[Ben Gummer]

I will in a second; I will just answer this point.

From that point, as many Members have pointed out, considerable progress was made through the negotiations that we had under ACAS from December 2015 to February 2016—far more progress than in the previous negotiating period, partly because the BMA knew that an imposition would have to come if there could be no agreement. As the shadow Minister will understand, at some point an employer needs to move both on issues where there is agreement and on those where there might not be.

The fact that the Secretary of State chose Sir David Dalton to lead negotiations undermines the argument that somehow he was not trying to come to a negotiated settlement. He asked one of the very best chief executives in the NHS to lead the negotiations on his behalf. Even Sir David Dalton was unable to come to a final conclusion of the negotiations with the BMA, because the BMA refused to discuss the last remaining substantive issue—the rates of Saturday pay.

Herein lies the rub: in the heads of terms of the talks it began through ACAS, the BMA had agreed to discuss Saturday pay rates, yet it withdrew that agreement at the end. Sir David Dalton was therefore forced to write to the Secretary of State saying that in his judgment, there was no prospect of agreement on the remaining matters because the BMA was refusing to discuss them. When the Secretary of State or any negotiator has no counterparty with whom to negotiate, it is impossible to negotiate.

Far from the title of the e-petition, which suggests that the Secretary of State has somehow been unwilling, he has been negotiating in good faith all through the period since 2013. It was the BMA, right at the last minute and at previous moments that has refused to do that. I myself have called on it a number of times, both personally and in public, to come back to the negotiating table.

[Ben Gummer]

I will not, because I know that the hon. Gentleman needs to go. I said that I would give way to the shadow Minister.

[Justin Madders]

The Minister is correct that considerable progress has been made in negotiations since the start of this year. The consensus seems to be that 90% of the contract was agreed. Does he not agree that it was therefore a great shame that a decision was made to impose the contract when just 10% of the issues were outstanding?

[Ben Gummer]

It is a great shame that we were unable to discuss those final things with the BMA, but as I have just explained, the BMA did not wish to discuss that final portion, even though it had agreed to do so in the heads of terms that were in front of ACAS at the end of November 2015. It was impossible to have that final discussion. That was not of the Secretary of State’s volition; it was a decision of the BMA’s junior doctors committee.

I turn to the point that my hon. Friend the Member for Morley and Outwood made, which Opposition Members discounted so quickly. At no point has the Secretary of State ever claimed that there is militancy among junior doctors as a whole, nor has he said that the BMA as a body has sought to wind up the dispute. In fact, if he had said that, it would have been entirely wrong. It is, however, true that the junior doctors committee, which is a small portion of the BMA—it is not the whole body, and we have just come to an agreement with the BMA on the general practitioners’ contract—has become radicalised in the past few years.

We know that the committee did not wish to discuss Saturday pay rates, not because of any inherent merit or otherwise in the arguments but because of the tantalisingly close prospect of an agreement with the Secretary of State—one that the committee had been fighting against. We know that that dispute existed, because even when we made a revised offer just after Christmas, the committee refused to discuss it before talking to its members and committing to a strike. There has been an impelling force within the junior doctors committee to take action, which, I am afraid, has disrupted the course of the negotiations and made it far harder to have an open and honest discussion with junior doctors.

We come to the issue of junior doctors being misled. They are very bright people who I know take an interest in the news and in the contract under which they will be working. I have no doubt about that. However, the British Medical Association—a trusted body—has claimed to its members that they are going to have a pay cut of 20% or 30%. Despite the fact that the NHS and we in this House have rejected that claim numerous times, it has been repeated. The hon. Member for Hornsey and Wood Green (Catherine West) repeated it today. That claim is untrue. It was made in the summer, and it is no wonder that BMA members were worried. If I were a junior doctor and someone told me I was going to have a 20% or 30% pay cut and would have to work longer hours, I would be extremely worried, and of course I would be angry. The fact is, however, that the claim was not true. The gravity of that untruth is such that it can still be repeated in this Chamber as if it were true.

Junior doctors, who no doubt informed the hon. Lady—I know she is not willingly misleading the House—still think they are going to have a pay cut of 20%. If we are still in an atmosphere where people believe they are going to have something that they are not, and that they will have to work more hours than they will, it will of course be difficult to come to a resolution until we allow things to calm down. That is why it is important to move to a point where junior doctors have the contract in front of them, so that they can see the effect on their working patterns and see that much of what they have been told is simply not true. We can then, I hope, move to a much better position in individual trusts where we can start discussing the existing problems that the hon. Member for Central Ayrshire mentioned, such as rotas, training schedules and the like.

I will address some of the individual points that hon. Members have made during this interesting debate. Apart from misrepresenting the shape of the negotiations as if somehow the Secretary of State had broken off talks, which he did not, the hon. Member for Warrington North questioned the research that led to the various statements that the Secretary of State and others—many of them clinicians—have made about the so-called weekend effect, or avoidable excess mortality attributable to weekend admissions. I should make absolutely clear where the link is. Almost any clinician in the NHS will recognise that we do not yet have the same consistency of care over the weekends that we do during the week in every hospital or every setting where we need it. We know that, and the hon. Member for Central Ayrshire made a similar point herself.

Our manifesto pledge was translated into the mandate that is reflected in all the contract negotiations that are going on, and it concerns one particular issue—the need to standardise urgent and emergency care—and nothing more. It is not about elective care; I have made that point several times to the hon. Lady. People who are admitted at weekends—including, to some extent, those admitted at the shoulder periods at the end of Fridays and especially on Monday mornings, because of inconsistency of care over the weekends—will then be able to expect the same standard of care, which will contribute to lower mortality rates as part of a wider package to reduce mortality attributable to weekends.

The drive for that comes from clinicians. It comes from the seven days a week forum convened by the Academy of Medical Royal Colleges, which reported at the end of 2012 and gave the Secretary of State and the whole service 10 clinical standards that it believed would help to reduce variation in weekend clinical standards. It is those standards that we seek to bring in across the service. The academy has said that four of them in particular are the most important for reducing variation. They relate to urgent and emergency care, and it is those standards that we seek to fulfil across the service.

--- Later in debate ---

[Justin Madders]

I am grateful to the Minister for giving way; I could tell that he was about to reach a crescendo. He has set out what he intends to do to reduce the temperature and avoid further industrial action. I have to say that I think his response was inadequate, but his central contention was that he hopes to persuade the majority of the BMA’s membership that the new contract is beneficial for them. To that end, can he confirm when the full details will be publicly available?

[Ben Gummer]

I expect the full details to be available shortly. The Secretary of State is studying, and will continue to study, the draft final terms, together with the equality impact assessment. It is important that when he has studied that assessment, he can make a judgment about whether any changes are necessary. Once that process has concluded, the final offer will be made, and that will be the point at which we proceed with the implementation of the contract. I hope very shortly to be able to give the hon. Gentleman a timetable for that. It is in my interests as well as his to see it happen as soon as possible, and I hope to be able to provide junior doctors with the reassurance that the contract will provide—that this is not the tragedy that they have been led to believe it is.

This has, none the less, been a difficult period for the service and, in particular, for junior doctors, who have been led to have unnecessary worry as a result of a series of misrepresentations by their union. I hope that in the next few weeks and months we can allay their concerns, and I hope that we can then get on with the job that we are all mindful of the need to achieve, which is better quality of care whatever the day of the week, a reduction in avoidable mortality whatever the cause, and an improvement in our national health service.

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 9th February 2016 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

Yes, it certainly will. That is another reason why we hope to have 5,000 more doctors and 5,000 more allied health professionals working in general practice, to expand the primary care service by 2020.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

Today’s The Independent reports that a potential deal on the junior doctor contract was put to the Government that would have resolved junior doctors’ concerns without costing any more money and potentially avoided tomorrow’s industrial action. A source close to the negotiations told the newspaper:

“The one person who would not agree was Jeremy Hunt. Even though the NHS Employers and DH teams thought this was a solution he said no”.

So let me ask the Health Secretary a very direct question: have the Government at any point rejected a cost-neutral proposal from the BMA on the junior doctor contract—yes or no?

[Mr Jeremy Hunt]

The only reason we do not have a solution on the junior doctors is the BMA saying in December that it would negotiate on the one outstanding issue—pay on Saturdays—but last month refusing to negotiate. If the BMA is prepared to negotiate and be flexible on that, so are we. It is noticeable that despite 3,000 cancelled operations, no one in the Labour party is condemning the strikes.

Huddersfield Royal Infirmary

Justin Madders Excerpts

Tuesday 2nd February 2016 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. I congratulate the hon. Member for Colne Valley (Jason McCartney) on securing this extremely important debate, and on the eloquent and powerful way in which he set out the issues in his opening speech. We heard quite a remarkable volley of NHS-related slogans at the start. I aim to keep a copy of that Hansard extract in my pocket for future use at rallies and so on, such was the power and breadth of his comments. He deserves praise for the non-partisan way in which he presented the issues, and his passion for the local hospital, which he and his family have clearly used on a number of occasions, shone through. He spoke with great personal knowledge about the geography of the area and how it does not lend itself to the proposals, and he pointed out, quite rightly, a need for a wider, sub-regional focus on services.

I pay tribute to the contribution of my hon. Friend the Member for Dewsbury (Paula Sherriff), who spoke with typical passion and sincerity, and brought with her a wealth of experience from the health sector. She rightly questioned whether Halifax will be able to cope with the extra A&E visits, and we all ought to take note of her revelation that the ambulance service has not yet worked out the implications for its service.

My hon. Friend the Member for Huddersfield (Mr Sheerman) spoke with typical authority about how his constituents will be affected. His recounting of the history of healthcare in his area was highly informative. He rightly pointed out that the financial pressures that this trust faces are not unique and he was characteristically forthright about what he considered to be the failings of the local CCG.

I congratulate my hon. Friend the Member for Batley and Spen (Jo Cox) on her intervention. She spoke eloquently and clearly about how significant the issue is when she pointed out that an entire Kirklees Council area will be without its own A&E unit. She also astutely pointed out that the issue has ramifications far beyond the immediate CCG area.

All hon. Members who have contributed to the debate have clearly set out their constituents’ concerns about the proposals, which will fundamentally change how NHS services are delivered in Huddersfield, Calderdale and the surrounding areas. The question of how services are configured in the area has been the subject of discussion for some time, but found a new impetus on 15 January when Calderdale CCG and Greater Huddersfield CCG released the pre-consultation business case on a reconfiguration of hospital services across Calderdale and Kirklees. As we know, the proposal is to treat emergency cases at Calderdale Royal hospital in Halifax, while a newly built Huddersfield Royal infirmary will tackle planned cases. That will involve the closure of the A&E department at Huddersfield, which has understandably caused a great deal of anxiety locally and has been much of the focus of today’s debate.

It is not just hon. Members who have expressed concern. Stellar characters such as Patrick Stewart have joined in, and there has been a considerable reaction in the community. On 25 January, a paramedic was quoted in the Huddersfield Examiner expressing concerns that the proposals had the potential to create delays of up to an hour in taking a 999 patient to casualty. As we heard, a local statistician has warned that there could be an additional 157 deaths a year if the changes go ahead. It is hugely important that the CCG responds to those claims as part of the consultation process, as patient safety must be the primary consideration when any changes to health services are proposed.

It is clear from the pre-consultation business case that the changes are significant. As the risk assessment states,

“the most likely areas for negative impact is to those groups who are high users of accident and emergency services, such as younger, older people, and some ethnic groups.”

As the hon. Member for Colne Valley mentioned, the risk assessment also states:

“We understand that the population of Calderdale and Greater Huddersfield is ageing slightly faster in the rural areas than in urban areas. This means that new service models could place older residents at a slight disadvantage if the services they need to access are located further away than the services they are currently using.”

We know before we start that older people are more likely to be particularly affected by the proposal to close Huddersfield A&E, as they are more likely to live in rural areas that are further away from Calderdale Royal and, of course, they are far more likely to use emergency services. It is therefore vital that there is the widest possible consultation on these proposals and that the consultation is meaningful. I note from the business case that seven separate engagement exercises have so far been undertaken. However, not one of them has asked this simple question: “Do you want the A&E at Huddersfield Royal infirmary to close?” It is vital that residents are now given the opportunity to engage with those core issues through accessible methods.

Residents of Calderdale and Huddersfield may well be a little disappointed that we are even discussing this issue today. As my hon. Friend the Member for Dewsbury said earlier, residents will remember that in 2007, when in opposition, the Prime Minister visited, posed for photographs and spoke about having a bare-knuckle fight with the then Government to safeguard A&E services at Huddersfield Royal and many other hospitals. The Prime Minister’s attention has been elsewhere recently, so perhaps he needs to be reminded of those comments now. The Minister will know that when the Prime Minister visited Halifax last year, he promised to

“sort out the PFI mess and financial mess that they’re in.”

My hon. Friend the Member for Halifax (Holly Lynch) had hoped to be here today, but she has whipping responsibilities on the Energy Bill. She has been persistent in trying to hold the Prime Minister to account for that promise. I trust that the Minister will be able to set out what is being done to sort it out.

I am sure the Minister will also be gracious enough to acknowledge, as the hon. Member for Colne Valley did, that although the PFI deal was signed when Tony Blair was Prime Minister, much of the work and negotiating was done when John Major was in charge. I am sure the Minister will also agree that the residents of Huddersfield would be right to say that arguing about who is responsible takes us no nearer to finding a solution.

It would also be fair to say that the financial problems faced by the trusts are not solely down to the PFI deal, nor are they alone in facing such challenges. Despite the warm words on funding, a number of challenged trusts are now being asked to consider headcount reductions additional to the current plan. The truth is that the Government have lost control of NHS finances. By slashing social care budgets, they have created a crisis in the sector that is adding pressure to every part of the NHS. By completely mismanaging staff issues, they have created a crisis in recruitment and retention, leading to a surge in spending on agency staff. The report makes it clear that workforce issues are a factor in driving the need for reconfiguration. In 2010-11, the spend on agency staff at Huddersfield and Calderdale was £7.2 million; according to page 29 of the business case, this year the figure is forecast to be £21.2 million, an increase of 194% in just five years.

That issue is not unique to Huddersfield and Calderdale; it is a deeply worrying trend that we see replicated across the country. One of the key reasons for that increase, which again is set out in the business case, is recruitment, retention and vacancy challenges. An example of that is the Government’s decision, after taking office, to slash the number of nurse training places, which led to far fewer nurses qualifying than in previous years. The upshot of that, as the Royal College of Nursing and the Labour party warned at the time, is that trusts across the country are simply unable to fill all their vacancies and are left to rely on expensive agency staff. I ask the Minister, as I have asked him before, whether he will now accept that cutting the number of nurse training places was the wrong thing to do and is a fundamental cause of the increase in spending on agency staff.

The business case also refers to sickness rates being a worrying 5.3% in the clinical directorate, with by far the main causes being anxiety, stress and depression. Sickness rates are high and retention rates are low because the NHS workforce are, frankly, demoralised. I look forward to hearing what the Minister intends to do to improve the position, as many of the challenges facing this trust pervade throughout the NHS.

Draft General Dental Council (Fitness to Practise etc.) Order 2015

Justin Madders Excerpts

Tuesday 19th January 2016 General Committees

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Gillan.

The fitness to practise process is not working effectively at the moment, so although I will raise a few points, some of which the Minister has already addressed in his opening remarks, and I hope he will be able to deal with the others when he responds, we will not object to the order today. However, we have wider concerns about delays in the reform of health and social care regulation, as well as the performance of the General Dental Council.

As it stands, it takes up to 18 months for a fitness to practise complaint to be dealt with by the General Dental Council. This is bad for professionals, bad for patients and their families and causes unnecessary distress to everyone involved. Not only is the process too slow, it is also too expensive, with cases costing an average of £78,000 to resolve, so we welcome the thrust of the order, which will address a long-standing need to improve and speed up the complaints-handling process and will potentially deliver savings of £2 million to £2.5 million per annum.

We are a little disappointed, however, that the order fails to guarantee the independence of the fitness to practise function, which is crucial if the new process is to acquire the confidence of patients and the profession. I can see the attraction of case examiners deciding whether complaints move forward at the end of the investigation stage in a manner not dissimilar to many other regulatory regimes, but I hope the Minister will agree that how that works in practice will need an early review, which is vital in the context of the recent review into how the GDC has conducted itself.

A report, published on 21 December, was commissioned by the GDC following concerns raised by a whistleblower that certain processes were compromising the independence of the investigating committee’s decision making. Some of the report’s conclusions are deeply concerning. It found that there were inappropriate interventions and undue influence by investigating committee secretaries during investigating committee meetings, as well as the amendment of decision documents without appropriate authorisation. In the light of the report, it could not be more important for the process to be fully independent and to be seen to be independent of the GDC. I am therefore sure that the Minister understands the deep reservation—he acknowledged it during his opening comments—that is felt among the profession that new case examiners can also be employees of the GDC. Given the concerns that were expressed only a few weeks ago, I will be grateful if the Minister sets out how professionals can possibly be assured that this process will be truly independent and how he proposes to monitor the new system to ensure that patient and professional confidence is upheld.

The success of the proposed system will also rely on the calibre, qualifications and appropriate training of the individuals carrying out the new function. To quote another finding of the review:

“The approach taken by the GDC to recruiting, training and supervising the Investigating Committee Secretaries is likely to have contributed to the development and continuance of objectionable practices.”

The Minister addressed that in his opening remarks, but what assurances can he provide that the new officers will be supported in the right way once the process is under way and, crucially, that they will always be from the same profession as the individual whose case is being examined? While the order has the potential to bring about much-needed improvements, a satisfactory response should be provided to those legitimate concerns to secure the confidence of professionals and patients.

Turning to wider issues, while the order will improve some of the procedural problems, we should be in no doubt that a complete overhaul of the GDC is what is really needed. The GDC is Britain’s most expensive and least efficient healthcare regulator. In the Professional Standards Authority’s 2014-15 performance review, the GDC failed to meet eight of the 24 standards of good regulation and, crucially, fully met only one of the 10 standards relating to fitness to practise processes. In comparison, the General Medical Council met every one of the 24 standards. During the debate on the order in the other place, the Minister, Lord Prior, acknowledged that the Government are concerned about the GDC’s performance, that the recent reports are worrying and that the profession lacks confidence in the GDC. Will the Minister set out what the Government are doing to address that? Does he have full confidence in the GDC’s ability to carry out its vital functions?

The order is necessary only because the Government continue to kick into the long grass the health and social care regulatory reforms that we have been discussing for some time. I am aware that when the reforms to fitness to practise were first proposed almost five years ago, the Government’s response was that they were not prepared to introduce secondary legislation because they had already asked the Law Commission to produce a new legislative framework, reforming all health and social care regulators. However, those draft regulations were published back in April 2014 and have been gathering dust on the Secretary of State’s desk ever since. A Bill is not even in the pipeline, which is partly why we are here discussing the current condition of the GDC. Will the Minister set out today when the Government will finally move forward with the wider health and social care regulatory reform that has cross-party support and is desperately needed?

--- Later in debate ---

[Justin Madders]

I am grateful to the Minister for his explanation, and I agree that the processes are similar to those of other regulatory bodies. We certainly hope that efficiencies will result from the order. The point that the hon. Member for Lichfield and I were making is that it is about the perception of the investigators’ independence. That is critical, particularly given the history of this particular body.

[Ben Gummer]

On the hon. Gentleman’s wider point about the reform of healthcare regulation and why it is happening through section 60 orders at this stage, I understand his frustration. I hope I can reassure him by referring to my written ministerial statement just before Christmas, in which I outlined that we are hoping to take forward the Law Commission’s report and look at the work that the Professional Standards Authority for Health and Social Care has put together on the reform of professional regulation, to see whether there is an ideal combination of the two pieces of work.

I have discussed the order at length with the regulators. They are content with the way we are going, and we will enter a period of extensive consultation, which I hope will lead to substantial reforms. However, that can be done only on a consensual basis. I very much hope to involve the Opposition in that work, because it is clearly important that healthcare regulation remains a non-partisan issue.

That takes me to another point that the hon. Gentleman raised: how we will guarantee the independence of the case examiners. I understand, especially given the recent history of the GDC, that he wants to ensure that independence in the first years. The Professional Standards Authority for Health and Social Care has proved itself a worthy guardian of healthcare regulation in the past few years. Its reports, one of which he quoted in his speech, give an accurate picture of the state of healthcare regulation. It will audit the new system with assiduity and report back in its annual review about whether it is working.

My hon. Friend the Member for Lichfield referred to the fees gathered by the General Dental Council, which have increased in several of the past few years. I understand from the PSA’s last report that the GDC’s performance has improved somewhat over the past year, but it certainly has a great distance to make up. It is not for me to determine fee levels for healthcare regulators. However, with a number of fees having gone up recently, I made clear to all the regulators when we met last that I expected them to do everything within their powers to either freeze fees or, where they find can efficiencies, pass them back to their members if possible.

[Ben Gummer]

I can assure my hon. Friend that the order will be cost-saving for the General Dental Council—the estimated savings are £2.5 million. It depends slightly on whether the increase in referrals to the GDC continues. If it does, that saving will be eaten up in the increased resources required to process claims. However, if the number of incidents stays the same or reduces, I agree: the logic would be that the GDC might find space to reduce the fees it charges to its members. That is exactly what I have encouraged all the regulators to look at—how can they make justice quicker, which is good for everyone? If they save money in the process, which should only be a secondary consideration, it should be passed on to their members. In some regulated professions, many people, such as nurses or associated healthcare professionals, are not on high wages, and the fee levels make a difference. The regulators are aware of my views, and I put them as strongly as I can without infringing on their independence.

I hope I have answered every one of the shadow Minister’s points.

[Justin Madders]

indicated assent.

[Ben Gummer]

I think that is a yes. If there are no more questions, I will sit down. I hope that the Committee will endorse this section 60 order.

Question put and agreed to.

Hand Hygiene: NHS

Justin Madders Excerpts

Wednesday 13th January 2016 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Alan. I congratulate the hon. Member for Amber Valley (Nigel Mills) on securing this important debate. I also pay tribute to the hon. Member for Morley and Outwood (Andrea Jenkyns), who chairs the all-party parliamentary group on patient safety and has been a passionate advocate on the issue. Indeed, infection prevention was the first subject that the APPG decided to focus on. She referred to the startling answer given by an RCN representative at our first meeting that no nurse, in her experience of some 20 years, had been disciplined for failing to wash their hands. I do not know whether that is because this system is, by its nature, self-policing, but it raises questions about whether the issue is treated with the appropriate importance that we would all agree it should be.

There have been excellent contributions today. My hon. Friend the Member for Bridgend (Mrs Moon) and the hon. Member for Strangford (Jim Shannon) rightly said that washing hands after coughing and sneezing is such a simple thing to do, yet so many of us fail to do it. My hon. Friend the Member for Bridgend mentioned the devastating effects that CMV can have, and how easily it can be prevented. There were also excellent comments from the hon. Member for Central Ayrshire (Dr Whitford), who spoke from her personal experience with remarkable candour about which health professionals have the most to do to catch up in this area. She is right: this is all about the culture in which our health professionals work.

During my Christmas break, I spent a Saturday night shadowing an emergency medicine consultant at the Countess of Chester hospital. It was an incredibly busy environment, and the pace was relentless. Despite the extremely challenging circumstances faced by staff, there was a continual focus on hygiene at every stage. Hands, as well as equipment, were constantly cleaned and sanitised before and after every contact with patients. Indeed, I am now something of an expert at cleaning trolleys.

My experience, however, was not an isolated one. The importance of compliance with hand hygiene is something that NHS staff treat with a high level of importance, and it is worth recognising that, despite the difficulties highlighted today, most staff in the NHS do the right thing and do a fantastic job.

Despite the improvements in recent years, the rates of healthcare-acquired infections in England remain stubbornly high, with what can only be described as inadequate checks on compliance with hand hygiene best practice. As the hon. Member for Amber Valley said in his opening remarks, around 300,000 people per year—or, to put it another way, one in 16 people—get an infection while being cared for in the NHS in England. As he rightly pointed out, if that was our experience at a restaurant, we would not consider it acceptable.

As well as the devastating impact on the patients who are immediately affected, those infections have a significant financial impact on the NHS—the most recent reliable estimate derived from the Plowman report puts the figure at £1 billion per year—and lengthen hospital stays.

The growing threat of antimicrobial resistance adds to the seriousness of the matter and the urgent need for the Government to act. Antimicrobial resistance-associated deaths are projected to increase 2,000-fold by 2050. A report by the World Health Organisation states that resistance is very frequent in bacteria isolated in healthcare facilities and that, at present, antibiotic-resistant bacteria are the cause of over half of all surgical site infections.

Given the clear scientific evidence that good hand hygiene by health workers reduces infections, and in particular MRSA, it is clear that hospital workers are on the frontline against this threat. We therefore need more action to bring about improved hand hygiene to avoid problems in future.

Of course, not all hospital-acquired infections are preventable, but it is believed that around 30% could be avoided by better application of existing knowledge and good practice. It is also widely accepted that good hygiene practice in hospitals is the single most effective method of preventing the spread of infections. That was recognised by NICE in early 2014 when it issued a new quality standard, which included six statements designed to reduce infection rates, with the central aim being that all patients should be looked after by healthcare workers who always clean their hands thoroughly, both before and immediately after contact or care.

While those aspirations are laudable, since the publication of NICE’s guidance, the positive progress made in recent years appears to have stalled, and in some cases possibly reversed. The most recent figures I have seen make worrying reading, with C. diff showing no reduction in the past year, the rate of MSSA increasing and the rate of MRSA increasing by a worrying 14%. For all its aspiration, the NICE guidance is seriously flawed, not least because it relies upon monitoring by direct observation by nurses, which not only takes up valuable nursing time but has been found to overstate compliance rates.

The chief inspector of hospitals for the Care Quality Commission, Mike Richards, has drawn attention to the inaccuracy of local hand hygiene audits. The high compliance rates reported by hospitals simply are not supported when we look at the levels of hospital-acquired infections. We have heard that the compliance rate is more likely to be 18% to 40%, rather than the 90% to 100% reported by hospitals. As the hon. Member for Amber Valley set out with great clarity, there are possibly a great number of reasons for such a discrepancy, and there seems to be an element of self-fulfilment about how assessments are carried out. The trials that have been undertaken to ensure that there are more accurate data have also been shown to improve compliance with best practice.

The introduction of electronic monitoring equipment at Burton hospitals NHS foundation trust was found to improve hand hygiene compliance by 50% within three months. I would therefore welcome an expansion in the use of data and electronic monitoring, and I would be grateful if the Minister could set out in his response how he intends to address that. There is clearly a role for the Care Quality Commission. A key element of every inspection needs to be an assurance that proper checks on hand-washing are carried out. The greater use of data would also enable a new era of transparency to be ushered in. Patients should have the right to meaningful information about hand infection control and hygiene.

Another cause of the recent increase in infection rates is the chronic shortage of nurses on many hospital wards and the increased use of agency staff, caused in part by the Government’s decision to slash the number of nurse training places after taking office in 2010, as well as the worrying retention trends. Significantly, when there is a high turnover of staff, it is much more difficult for best practice to be instilled, monitored and ingrained into the culture of a hospital. I hope that when the Minister responds, he will say a little more than he was able to last week at the Dispatch Box about improving the retention rates for nursing staff.

Finally, as well as improving practices within the NHS, we need to improve hand hygiene among the public at large. Studies have shown that, despite awareness about good hand-washing practices being widespread, one in five people do not wash their hands after using the toilet. According to the Royal Society for Public Health, one of the major barriers has been an assumption by people that they do not carry any diseases. However, on average, studies have shown that hands can carry about 3,000 different bacteria, so we also need to explore what more we can do to improve good hand-washing practices among the public. The cross-party Handz campaign, which was launched by the hon. Member for Morley and Outwood, has already done very good work to raise awareness of these issues, and I hope it will provide a catalyst to drive forward improvements both inside and outside the NHS.

Oral Answers to Questions

Justin Madders Excerpts

Tuesday 5th January 2016 Commons Chamber

[Ben Gummer]

The hon. Lady should look at the facts. March 2015 saw a record number of nurses in the NHS—319,595. We are increasing the number of nurse training places. We are able to increase them by considerably more than we could have done otherwise, as a result of the reforms to student finance that bring nurses into line with teachers and other public sector professionals.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It would be good to hear the Minister concede that it was a bad idea back in 2010 to cut the number of nurse training places. Even today we are still training fewer nurses than we were in 2009. Not only have this Government failed to recruit enough nurses, they have failed to retain them too: last year there was a 12% increase in the number of nurses leaving hospitals. With staff morale already at an all-time low, why does the Minister think it is right that nurses should be burdened with a lifetime of debt to pay for his Government’s mistakes?

[Ben Gummer]

The hon. Gentleman raises a reasonable point about attrition rates: they have remained too high for too long. One of the things we are undertaking at the moment is to talk intensively with universities to see how we can reduce attrition rates. We have had some success in some areas, but I want to see far more. It is important that students stay on their courses as much as possible. Of course, many go into community nursing. I would be prepared to write to the hon. Gentleman about further actions we are taking on attrition rates.