Community Pharmacies

Kate Green Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Jonathan Ashworth]

My hon. Friend has anticipated my argument—I could probably sit down now that he has put it so eloquently, but I shall plough on while I have the indulgence of the House.

I was saying that the right hon. Member for North East Bedfordshire had said that the cuts might lead to some 3,000 community pharmacies closing. Then, of course, the right hon. Gentleman left his post in the Department of Health, which we are all very sad about. Now we have a new Minister, and we are delighted to welcome the hon. Member for Warrington South (David Mowat) to his place—not least because in one of his first interventions when he was allowed out, he visited the Royal Pharmaceutical Society’s annual conference in September and said he was delaying the cuts. He said:

“I think it is right that we spend the time, particularly me as an incoming minister, to make sure that we are making the correct decision”.

He continued by saying that

“what we do is going to be right for you, is going to be right for the NHS and right for the public more generally.”

Well, if the Minister had left it there—with that U-turn—he would have won the praise of Labour Members.

Unfortunately, we then had a U-turn on the U-turn from the Minister. When the Minister came before the House last month we found out that, far from having listened, taken account of various consultations and decided to do what was best for the NHS, he intended to impose a 12% cut on current levels to pharmacy budgets for the remainder of this financial year—giving pharmacists just six weeks’ notice—and a 7% cut the year after that.

[Kate Green (Stretford and Urmston) (Lab)]

rose—

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

rose—

[Jonathan Ashworth]

Because she represents my mother’s home town, I will give way first to my hon. Friend the Member for Stretford and Urmston.

[Kate Green]

It is a privilege to represent my hon. Friend’s mother, and he, of course, knows my constituency well. The constituency has high levels of deprivation, and our primary care services face incredible pressure owing to unsuitable practice premises and the difficulty of recruiting GPs. Does my hon. Friend agree that with only seven weeks’ notice, it is impossible for GPs, other primary care providers and pharmacists to accommodate and make provision for these cuts in a way that will allow them to continue to support deprived communities in my constituency and, indeed, the constituencies of all Members?

[Jonathan Ashworth]

My hon. Friend is absolutely right. That is why the cuts have aroused so much opposition from not just Labour but Conservative Members.

NHS Funding

Kate Green Excerpts

Monday 31st October 2016 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for bringing Professor Briggs to meet me. He is an extremely inspiring man. He has established that every time someone has an infection during an orthopaedic operation, it costs the NHS £100,000 to put it right, but that is happening 0.5% of the time in the case of some surgeons and 4% of the time in the case of others. Dealing with variation of that kind is a way not just to reduce costs, but to avoid enormous human heartache.

[Kate Green (Stretford and Urmston) (Lab)]

NHS managers in Greater Manchester have made it clear that the pressures on the NHS are a function of pressures on the social care system and that costs are rising because of increases in the national living wage and the need to fund overnight cover. What is the Secretary of State doing to address those financial pressures on social care, given that the precept does no more than scratch the surface?

[Mr Hunt]

I agree that there are real pressures, although I should add that many Members were worried about some of the poor working conditions of people in the social care system and that 900,000 people on low pay in the system will benefit from the introduction of the national living wage. However, I agree that leaving people parked in hospitals when they should be being looked after in the community is financial nonsense. What is happening in Greater Manchester is one of the most impressive examples of health and social care integration in the country, and that must be the long- term answer.

Community Pharmacies

Kate Green Excerpts

Monday 17th October 2016 Commons Chamber

[David Mowat]

I will give the hon. Gentleman the commitment that no community will be left without a pharmacy.

[Kate Green (Stretford and Urmston) (Lab)]

I cannot impress strongly enough on the Minister the danger of these proposals. In my constituency the pressures on primary care are such that GP surgeries cannot recruit GPs and many practices are now not meeting Care Quality Commission standards because they are in old premises that are unsuitable. The thought that on top of that we would reduce the possibility for people to attend their local community pharmacy for simple healthcare needs is frightening. When the Minister publishes the impact assessment, will it provide any sort of reassurance and clarity that those complex primary care factors have been properly taken into account?

[David Mowat]

We have talked all afternoon about the need to protect access to GPs, and I repeat the point I made earlier: our proposals in the round should increase the degree to which pharmacists are linked into GP practices. The hon. Lady says that many practices are getting poor-quality assessments, but the fact is that over 80% of them are getting good-quality assessments, and we need that to continue.

The proposals we are setting out in the round are expected to make pharmacy access better than it is now, and the orientation of the pharmacy profession towards services and away from just dispensing should happen more quickly.

Hospital Services (South Manchester)

Kate Green Excerpts

Tuesday 8th September 2015 Westminster Hall

[Mr Graham Brady (Altrincham and Sale West) (Con)]

I congratulate the hon. Member for Wythenshawe and Sale East (Mike Kane) on securing this debate. It is a pleasure to be working alongside him, the hon. Member for Stretford and Urmston (Kate Green) and other concerned Members from Greater Manchester, who are deeply worried and troubled by the proposals being put forward in Healthier Together as a whole and for Wythenshawe hospital, the university hospital of south Manchester, in particular.

It gives none of us any pleasure to be here and to have to raise this debate, any more than it gives the consultants at Wythenshawe hospital any pleasure or satisfaction to have been pushed to the point where they felt that the only way to make their voices heard and ensure that their fears about patient safety in the longer term did not come to pass was to pursue the initial stages of judicial review. I could not agree more with the hon. Member for Wythenshawe and Sale East that that is not the way that any of us would wish to have this question resolved.

As the hon. Gentleman said, throughout the Healthier Together process, colleagues on both sides of the House have warned that the process was deeply flawed. The consultation undertaken over a three-year period is the worst instance of public consultation that I have encountered in my 18 years in this place. It moved immediately from discussion of warm platitudes about improved collaboration, and the better results that that can achieve, to a table of possible outcomes that was so complicated that no member of the public could hope to understand the implications. The whole episode raises some profoundly serious questions, both about the delivery of the best possible health services in Greater Manchester and about accountability in the delivery of public services and the ways we can ensure that the public view is properly heard and respected.

As the hon. Gentleman—my colleague—said, in Greater Manchester we are poised to embark on some very exciting changes, which, if got right, will make dramatic improvements in our delivery of health and social care and could provide not just a great improvement for our constituents but a model for many other parts of the country to follow. If instead we see this sort of flawed decision-making process proceed, the danger is that people will see devolving power and decision making to a more local level not as something that will empower them and give them a stronger voice but as something that will result in less accountability and is less likely to deliver for local communities. We need to ensure that the Government understand and the Department recognises that there would be a significant cost if this episode were allowed to damage wider public trust. All of us want more devolved decision making in Greater Manchester, but we want it done right, not in the deeply flawed way presaged by this process.

Not only was the consultation flawed—it appeared to be designed to obfuscate and confuse members of the public, rather than to be a genuine exercise in seeking public opinion—but the decision-making process at its conclusion was pursued in a way that is clearly unreasonable. I concur with the hon. Member for Wythenshawe and Sale East that, given the unreasonable nature of the process from beginning to end, there is every likelihood that, should judicial review be pursued to its conclusion, it will be successful. That is an important reason why we need people throughout the process—whether power now lies with the Department of Health or with the commissioning bodies—to get a grip on this problem and to try to bring it to a more satisfactory conclusion.

I do not want to go into enormous detail about the decision-making process—the hon. Gentleman has given a good survey of the technical questions that Healthier Together raises for UHSM—but we have seen clear support among the members of the public who responded to the consultation for Wythenshawe to be the fourth specialist hospital. Of course, the weight of responses cannot always be the factor that leads to a decision, but it is incumbent on those involved in any decision-making process to take public views seriously. If those views are to be discounted, that should be only on the most serious grounds and on the basis of clearly reasoned arguments.

I have two principal concerns about the grounds on which the weight of opinion was disregarded. First, there is the deeply spurious decision not to take account of the current standard of care delivered at Wythenshawe hospital. Any lay person and—I venture to suggest, having had many conversations with senior clinicians—any senior clinician would regard it as patently absurd to discount the hospital’s current clinical standards on the grounds that all the other hospitals are expected to reach the same standard at some point in the future so the standard is of no consequence. It is Orwellian to run policy and decision making in that way. I hope that the Minister will accept that that should give serious pause and serious cause for concern.

The second significant point, which the hon. Gentleman also raised, relates to the decision finally being grounded on the travel time for a relatively small population in High Peak—I am not saying this because my hon. Friend the Member for High Peak (Andrew Bingham) has had to leave the Chamber to go to a Committee. The failure properly to take account of the A6 relief road, which is now being built, and which will deliver flows of patients from High Peak to Wythenshawe in a much shorter time, is again, frankly preposterous.

[Kate Green (Stretford and Urmston) (Lab)]

I am sorry to make this point in the absence of the hon. Member for High Peak (Andrew Bingham), because I am sure that he would want to say something about it. However, is it not also the case that, in looking at the travel time, the failure to consider other options for High Peak patients, outside the Greater Manchester conurbation, also calls the decision into question?

[Mr Brady]

Yes, absolutely; that is an important point. Without venturing too far into the realms of legal opinion and the judicial review that we could face, what makes the decision so demonstrably unreasonable is the failure to take account of a known factor that will materially change the travel times on which that decision is purported to have been based.

Furthermore, it is questionable policy to proceed with such profound changes to services at the same time as another review was going on. It may be sensible to proceed with some of the shared service propositions for UHSM and Central Manchester—that may be the way forward and may lead to better outcomes for patients in both trusts, and it should certainly be explored—but seeking to arrive at agreement on that while the Healthier Together process was still to conclude was deeply questionable and is a source of serious concern for us all.

I will not rehearse the long list of outstanding tertiary services offered by Wythenshawe not only to Greater Manchester, north Cheshire and north Wales but far beyond. We are debating hospital services in south Manchester, but as the hon. Gentleman reminded us, we are also talking about a hospital that provides the most complex tertiary services for a much wider area. Clearly, therefore, the issue is more significant, and it is more important to get it right, than would be the case were the hospital providing important tertiary services merely for a local population.

The consultants who have spoken to me—I am sure that they have also spoken to my friends on the Opposition Benches—have been very clear. There is no question that they are trying to defend their own patch or their own empire; some are constituents whom I have known for many years, and many of them are at a point in their careers when they really do not need to be concerned about those things. Some are very eminent in their fields, and when they tell me that their concerns are purely about patient safety—they say that they are entirely open to sensible proposals for reorganisation, shared service agreements and so on, but that they are worried that the work being done at UHSM could be threatened and could, in the hon. Gentleman’s words, suffer death by a thousand cuts—I am inclined to take those concerns seriously.

To boil the consultants’ concerns down to the simplest level, their analysis is that the high level of complex tertiary services at Wythenshawe can continue into the long term only if it benefits from an equally high level of general surgical support to ensure that different, co-dependent services and procedures can always be provided in the safest way. The hon. Gentleman said very clearly and correctly that, in the consultants’ view, the provision of general surgery would remain at an appropriate level only if Wythenshawe remained a receiving centre for complex general surgery. If the same level of support is not present—we have all seen how this works—it will be only a matter of time before we find ourselves here again, with a new review suggesting that it really is not safe to perform heart and lung transplants at Wythenshawe, because it lacks the necessary general surgical support when complications arise.

The consultants make a powerful and plausible case. First, there is the procedural case that Healthier Together has been flawed and that the process and decision were unreasonable. I also find it compelling when they say that having a certain level of general surgical support is the only way to protect the complex services that are provided at the moment.

--- Later in debate ---

[Kate Green (Stretford and Urmston) (Lab)]

I am grateful to my hon. Friend the Member for Wythenshawe and Sale East (Mike Kane) for securing the debate. As you have heard, Mr Hollobone, the three Trafford MPs have been working closely together, and with clinical staff at the hospital at Wythenshawe, on our concerns about patient safety, which I want to highlight. Many of my constituents use Wythenshawe hospital as their local hospital, especially following the downgrading of services at Trafford general hospital two or three years ago as a result of the new health deal for Trafford. Indeed, when NHS managers were making the case for that, their argument was that Trafford residents would receive better, more expert care at Wythenshawe. To be told now that services in that hospital may also be downgraded will at least cause a further collapse in public confidence in the processes by which decisions about health service configuration are taken.

My constituents also rely on UHSM’s specialist services, about which we have heard much this morning. They are full of praise for the care that they receive. My hon. Friend the Member for Wythenshawe and Sale East spoke in detail about some of those specialties and I have had the great privilege of visiting some of the specialist teams at Wythenshawe and meeting staff. All are adamant that their success—and they are very successful and in many cases world-class teams—is due to their strong team-based approach and their reliance on the support of a full range of hospital services. Removing or downgrading any so-called ancillary services will have a direct effect on the specialties. It is for that reason that consultants at Wythenshawe have told us that they do not have confidence in the Healthier Together model and that in their view the specialties at Wythenshawe cannot continue to be operated safely under it.

The interdependencies across the disciplines are wide-ranging, but, as we have heard this morning from both my hon. Friend the Member for Wythenshawe and Sale East and the hon. Member for Altrincham and Sale West (Mr Brady), the clinicians we have spoken to are clear that remaining a receiving centre for acute emergency surgery is at the heart of their ability to maintain the holistic care that is needed to ensure patient safety and specialties at UHSM. That is also borne out, for example, by some of the NHS’s national standards. The standard for thoracic organ transplants states the need for general surgical in-house support seven days a week. As we have heard, Wythenshawe is a—if not the—leading centre for transplant surgery in the north part of the country.

I recognise that the numbers of such highly complex specialist cases are small and that the vast majority of procedures and services currently provided at Wythenshawe could continue under the Healthier Together model. I am also happy to acknowledge the work that has been done by NHS managers in the Healthier Together team and acute trust and the commissioners, to look at ways in which the design can protect the expertise and specialism that we value. First, trying to manipulate the process to make a fundamentally unsafe model work is not the right way to proceed. Colleagues are right to say as they have this morning that we need to draw back and ensure that the model itself is correct, rather than trying to ameliorate some of its more dangerous elements. Secondly, it is not just a question of numbers and whether another half a consultant will resolve the problem. It is also about the ability to continue to attract, recruit, retain and develop the full range of professional skills; and about building and sustaining the strong multi-disciplinary teams that the consultants tell us are necessary. It is also, as we heard from my hon. Friend the Member for Wythenshawe and Sale East, about the ability to offer the rotations and varied experience that enable UHSM to function as a full teaching hospital.

Of course we all accept that the ambition of Healthier Together to raise standards across Greater Manchester is the right one. It is unacceptable that outcomes are so poor in Greater Manchester and so patchy across different hospitals and acute trusts, but the answer to that cannot be to put at risk one of the best performing hospitals in the conurbation—indeed, in the country—and its highly successful outcomes in the hope that other hospitals will, in time, rise to meet those outcomes. It is absolutely right that we want to see outcomes improved at all our hospitals in Greater Manchester, and very much so in the case of Stockport. I understand, however, that there is not even yet a guarantee that the resources will be available to enable the improvements at those other hospitals to bring them up to the standards currently achieved at Wythenshawe and, at the same time, we risk a deterioration in the outcomes that we enjoy at UHSM.

I am also concerned that the risk to safety could be exacerbated by the proposed governance arrangements. As things stand, UHSM and Central Manchester Foundation Trust—the two trusts that will be working together to deliver some of the services that are currently available at Wythenshawe—will each retain their own governing bodies. As we have heard this morning, some shared services have been agreed by the two trusts, for which I understand there will be a shared services board and a shared clinical standards board. For the rest, however, the model proposed for CMFT and UHSM will, effectively, create the largest single combined acute trust in the country, while retaining two separate governing bodies, creating potential for confusion, inconsistency and a blurring of accountability.

In my view, there are really serious and genuine questions about patient safety inherent in the Healthier Together model, and we all have an obligation to address those. As we have heard, the consultants are seeking to expose the risks, possibly via a judicial review, but given the nature of their concerns and the delays that a judicial review process would cause to getting the right health configuration for Greater Manchester, I believe we need to make sure that the process we follow now to reach the right decision is a health-led—clinically led—review of the issues.

When the Secretary of State kindly met my hon. Friend the Member for Wythenshawe and Sale East, the hon. Member for Altrincham and Sale West and me prior to the summer recess, we understood him clearly to say—and we appreciated this—that he would be prepared to intervene if safety were an issue. As we have heard this morning, the various concerns that have been expressed include safety concerns, and I hope that the Minister will say today how the Department intends to satisfy itself that those are being properly addressed.

One route might be—although this, too, would increase the risk of delay—to consider a referral to the independent reconfiguration panel. That would ensure a clinically led approach to the review of the decision, and we are familiar with that route in Trafford, given that it was followed as part of discussions on the new health deal for Trafford. Has the Department looked at that model, or will it? If that is not an appropriate route, will the Minister indicate other ways in which he can encourage a collaborative, clinically led pause and proper analysis of the situation within Greater Manchester, as the hon. Member for Altrincham and Sale West suggested?

None of the three MPs in Trafford wants to delay the changes that we desperately need in Greater Manchester to improve patient outcomes, but if the Minister is not able to give us assurances on behalf of the Department, I am quite sure that the legal action that the consultants are reluctantly considering will proceed. They will feel that they have no alternative, in the interests of their patients, but to ensure that this decision is properly challenged and exposed. I have to say, too, that given the concerns about patient safety that they, as clinicians, are highlighting to us as politicians, I will feel obliged, in the interests of my constituents, to support them.

None of us wants to go down that route this morning. We hope that the Minister will be able to give us practical but reassuring commitments about a better way to resolve these very serious concerns, which, as we have heard, not only affect our constituents directly, but will be far-reaching, both immediately, in terms of the wider care that is provided at UHSM to patients well beyond the Greater Manchester conurbation, and in the long term to the credibility of the approach that is being taken in Greater Manchester and our ability to operate devolved healthcare effectively, as we all want.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

First, I thank and congratulate the hon. Member for Wythenshawe and Sale East (Mike Kane) on bringing this debate to the House. It is a particular pleasure to be answering him. His predecessor became something of a friend, and I know that he had a similar admiration for him and certainly a far closer friendship with him, so I feel honoured now to be answering, as one of my first clutch of Westminster Hall debates, a debate brought here by him.

As is so often the case with Westminster Hall debates, it is frustrating that the debate will not be more widely seen and understood by members of the public, because they would see Members of Parliament fighting hard for their constituents and constituencies, and speaking with great eloquence and detailed knowledge and understanding of complicated things. Those things are not necessarily within their professional expertise, but they have done the research and acquired the knowledge to be able to speak about them. And, most important, Members are speaking on a cross-party basis. If more people were to see that, they would see the value that they were getting from their representatives. I value very much the passion and the detail that the hon. Member for Wythenshawe and Sale East has brought to the debate, as I do that of other hon. Members who have spoken and the measured response that the shadow Minister, the hon. Member for Copeland (Mr Reed), has given.

I should say at the outset that I am rather more restrained from giving an expansive answer to the hon. Member for Wythenshawe and Sale East than I would normally be, because a letter before action has been issued and, although the Department of Health is not a party to any legal action, I would not like to prejudice something that did come about. I hope that the hon. Gentleman will not mind if I comment on those areas on which I can comment and then on the general principles that were raised. The hon. Member for Stretford and Urmston (Kate Green) specifically raised the general policy of reconfiguration. I can give her more detail about that and give, I hope, a narrative explanation of how I and the Department understand the process as it has gone on so far.

In the round, it is welcome that the hon. Gentleman and other hon. Members understand the importance of devolution. I agree completely with him that the turn of events in Manchester is of serious significance; it is of a generation-changing nature. It was good to hear my hon. Friend the Member for Altrincham and Sale West (Mr Brady) saying exactly the same thing. It is important that decisions that are taken at any stage by devolved administrations, whether they be clinical commissioning groups, local councils or health and wellbeing boards—or indeed the overview and scrutiny committees in the way they look at these decisions—inspire confidence in devolved decision making, rather than acting against it. Of course, reconfiguration and change normally cause some disruption and disquiet in areas not chosen as sites for new or increased activities. He spoke powerfully of the need for devolved powers, but I hope that he accepts that it is in the nature of such decisions that people will sometimes be disappointed.

I understand entirely why Wythenshawe, with the extraordinary range of specialisms, both secondary and tertiary, which the hon. Member for Wythenshawe and Sale East pointed to, and with a history famous not only in the north-west but across the country, should feel aggrieved that it was not one of the four centres chosen to be part of Healthier Together. It would be unusual if the world-respected clinicians and management at the hospital did not fight their corner, and it is appropriate that he should represent their concerns. I agree with everyone who has said that it would be extremely sad for the matter to go to judicial review. We certainly do not want that to come to pass, either in this consultation or elsewhere.

Before I talk in general about consultations, I want to bring the hon. Gentleman up to date on events in the past couple of days. I understand that there have been some constructive conversations between commissioners and clinicians at the hospital, and that discussions will continue about the relationship between tertiary specialties and the general surgery that, it is proposed, will be moved to one of the four sites. A conversation has begun and is continuing, so there is a glimmer of hope that the parties involved will not go to the courts on this matter, which is so important for patient safety and healthcare in Manchester.

I want to speak about the nature of consultations, and to respond to the shadow Minister’s entirely correct points about how a consultation should be conducted. As a constituency Member of Parliament, I, too, have been through a number of health consultations. Some are good, and some are bad, but I hope that we are generally getting better at them. I remember several, under the previous Administration—this is not a party political point, but I think that the process is generally iterative within government—which were particularly poorly conducted. To their credit, the previous Administration reversed some of the decisions.

Some consultations are well run, however, and have the support of large numbers of people in the community. I can only report on the information that I have received, but I am impressed by the support from local councils, from clinicians, from the clinical senate, from doctors and from management across Manchester for the Healthier Together programme, and for the size and scope of the consultation. As the shadow Minister and Opposition Members know, a consultation is not a plebiscite, so we cannot take the raw number of responses in favour of any particular solution as a “correct” response. It is important that all consultation responses are taken into account, and I have been assiduous in trying to make sure that the Healthier Together team—the commissioners—have listened to all consultation responses. I have urged them to engage as profoundly as possible with Wythenshawe to show that the responses have been listened to with care.

At the core of the proposal is a noble ambition: to save in excess of 1,000 lives over a five-year period. If Manchester were to match the best mortality rates achieved elsewhere in the country, 300 lives a year would be saved, which is nearly a life a day. The decisions being taken are difficult, but they will produce a considerable dividend not only for hundreds of potential victims of currently substandard care but for their families, extended families and friends. The prize is considerable, and it is worth striving after.

I agree with the shadow Minister that consultations need to demonstrate wide public engagement. I am impressed by the number of people involved in this consultation, which received some 29,000 written responses. There has been 18 months of consultation, and 23,500 people were involved in this specific part of the consultation. There are conflicting answers to the question of how to reduce mortality in Manchester; that has been clear even from hon. Members’ contributions. To mangle St Augustine, we are almost saying, “Let us have service reconfiguration and service improvement, but not yet.”

I do not fully agree with the suggestion made by my hon. Friend the Member for Altrincham and Sale West that consultations and service changes should happen sequentially. It would be impossible to run anything as complex as the health service, or, indeed, anything in government, if one were to take that approach. We must in this instance, as elsewhere, rely on the clinical judgment of commissioners. That lies at the very heart of the changes that the Government have made—both in our coalition iteration and in this new Conservative Government—towards relying entirely on the clinical basis for service reconfiguration. I must, therefore, bow to the judgment of clinicians in this and other instances, and I know that most Members here will want to do the same.

Although the shadow Minister has said that the proposal comes within the global need to try to do more with less—I do not want to rehearse the arguments about healthcare spending—I think that everyone has agreed that, in this instance, finance does not play a part. The chairman of the Manchester local councils made that explicit in his response to the consultation. This is actually about doing more better. There will always be a trade-off between travel times and sites, and clinical excellence. We would all like to have, right next to our house, a hospital with the full suite of tertiary expertise, but as we all know, a high throughput of patients would be required to maintain the necessary skills within clinical teams. Clearly, that would not be possible, so there has to be a balance between the number of sites and the distance that people must travel to them. That is the balance that the consultation and the proposal have sought to strike. In the majority of Manchester, it is believed that they have struck that balance correctly.

[Kate Green]

The Minister spoke a moment ago about the decision being taken by clinical commissioning groups—by clinicians. The problem is that a different group of clinicians, namely the consultants at Wythenshawe hospital, are offering a different opinion about patient safety from that of the commissioners. As politicians, I believe that we must take account of the fact that safety is being flagged up by clinicians. How does the Department reconcile the difference of opinion about patient safety between commissioners and consultants?

[Ben Gummer]

The hon. Lady is right to say that there are concerns from some clinicians at Wythenshawe hospital, and we should listen to those. There is an established process by which those concerns should be brought to bear. If she does not mind me running through the detail of how reconfiguration policy works, I am sure that she will find answers to some of the questions in her speech.

Our first principle is that the service changes should be led by clinicians, which is the point of the process. In this instance, the service changes are being led by 12 clinical commissioning groups coming together to discuss the future of 10 hospitals. The service changes will affect just under 1% of in-patients, and just under 20% of patients receiving general surgery, at Wythenshawe hospital. Within the context of Wythenshawe hospital as a whole, we are talking about a very small number of patients. I appreciate the hon. Lady’s concerns about the interrelationship with other specialties, but let us keep it in mind that this is a small number of patients.

Once the commissioners have come to their decision, there are two ways of resolving complaints from one party or another. The first is by a recommendation from the joint overview and scrutiny committee to the Secretary of State for Health—such a recommendation has not been made in this case—or by a referral to the Independent Reconfiguration Panel, which the hon. Lady mentioned in her speech. The Independent Reconfiguration Panel has made a number of recommendations in the past. That is no predictor of future performance, but at no point in the past, under any Administration, has a Secretary of State gone against the Independent Reconfiguration Panel’s recommendations. The point of both those exercises is to retain clinical ownership of decisions, albeit by different clinicians from those who made the original decision. If we go back to the bad old days, when decisions were made for political purposes following a clinical recommendation, we would not listen to clinicians in the round and, therefore, would make decisions on the wrong basis, possibly putting lives in jeopardy.

The hon. Lady has raised clinicians’ concerns about the effect on tertiary services, which are impressive at Wythenshawe hospital. All I can say is that NHS England has undertaken a thorough clinically-led review of all tertiary services at the hospital and has concluded that the changes to general surgery for stomach and bowel accidents will not adversely impact on the tertiary specialties available at Wythenshawe hospital. That is the advice that the Department has received from clinicians at NHS England. I have described the other options open to parties in Manchester, and I reaffirm that, even if it might suit some Members present to take that decision-making process out of clinical hands at whatever level and to vest it in the Department, it is not a direction that anyone on either side of the House ultimately wishes to take. We must therefore trust the opinion of clinicians in the bodies that have made those decisions so far.

NHS Reform

Kate Green Excerpts

Thursday 16th July 2015 Commons Chamber

[Mr Hunt]

It will, Mr Speaker.

My hon. Friend’s idea is really interesting, and I am happy to take it up and explore whether we need to replicate that immunity so that we can get to the truth more quickly in a no-blame context.

I thank my hon. Friend for the work of the Public Administration Select Committee. I think it is true to say that we would not have the new patient safety investigation service, modelled on the air accidents investigation branch, which has worked so well in the airline industry, if it had not been for the work of PASC. It brought the idea to my attention and it was a good idea, and I know that he will help me make sure that it is a success in practice as well.

[Kate Green (Stretford and Urmston) (Lab)]

I support the comments of my neighbours, the hon. Member for Altrincham and Sale West (Mr Brady) and my hon. Friend the Member for Wythenshawe and Sale East (Mike Kane). Three years ago the new health deal for Trafford resulted in the reduction of overnight and weekend services at Trafford General hospital on the basis that patients would receive better specialist care at Wythenshawe hospital. Does the Secretary of State understand that local people feel that the process has been chaotic, opaque and unresponsive to their concerns, and will he undertake to review the decision as a matter of urgency?

[Mr Hunt]

I thank the hon. Lady for the responsible approach that she took to the changes at Trafford general. Of course, I will listen to her concerns carefully, alongside those of her colleagues, and take them up with the NHS. Perhaps if she comes to the meeting that I am organising for her colleagues, that will provide an opportunity for me to do that.

Health and Social Care

Kate Green Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Hunt]

My hon. Friend has an excellent hospital, which I hope to visit at some stage. A third of the hospitals that are in deficit have PFI debts that make it much harder to get back into surplus. That is a persistent problem, and we are doing everything we can to help them deal with it.

The reality is that hard-working NHS staff have made terrific progress in incredibly tough circumstances in recent years. More than a million more operations were performed last year compared with five years ago, yet fewer people are waiting more than 18 weeks for their operation. Seven hundred thousand more people were treated for cancer in the last Parliament than the one before. Despite winter pressures, we have the fastest A&E turnaround times of any country in the world that measures them. There is more focus on safety than anywhere in the world post Mid Staffs, with 21 hospitals in special measures, seven that have exited special measures, and improvements in quality and safety at all of them.

There are more doctors and nurses than ever before in the history of the NHS. Public satisfaction with the NHS was up 5% last year; dissatisfaction is at its lowest ever level. The independent Commonwealth Fund found that under the coalition the NHS became the top performing health system of any major country—better than the US, Australia, France and Germany. That is not to say that there are not huge challenges, including the fact that by the end of this Parliament we will have a million more over-70s, so we need important changes, especially a focus on prevention, not cure. That means much better community care for vulnerable people so that we get help to them before they need expensive hospital treatment. Part of that is the integration of health and social care, which the right hon. Member for Leigh deserves credit for championing. It also means transformed services through GPs, including the recruitment of more GPs to expand primary care capacity, and a new deal that puts GPs back in the driving seat for all NHS care received by their patients.

[Kate Green (Stretford and Urmston) (Lab)]

The Secretary of State is right to emphasise the need for greater resourcing and support for GPs. What steps is he taking to help GPs with earlier diagnosis of complex cancers? Early diagnosis leads to more effective treatment and less need for hospitalisation.

[Mr Hunt]

The hon. Lady is right. This week we saw the results of the international cancer benchmarks study, which showed that our GPs take longer than GPs in Norway, Sweden, Canada and Australia to diagnose cancers, and we still have a survival rate that lags. This needs urgent attention. The chief executive of Cancer Research UK is putting together a cancer strategy for the Government that I hope will address this issue. We will bring the results of that to the House.

Francis Report: Update and Response

Kate Green Excerpts

Wednesday 11th February 2015 Commons Chamber

[Kate Green (Stretford and Urmston) (Lab)]

The Secretary of State has said that trusts are becoming more transparent in relation to data, and of course that is welcome, but data alone may not provide full information for patients. In 2011, Trafford general hospital had very poor standardised mortality figures, but, thanks to the assiduity of my constituent Mr Dennis Wrigley, we now know that they were due to a recording error. How will the Secretary of State encourage trusts not just to provide raw data, but to contextualise the data and tell patients what they might mean?

[Mr Hunt]

I hope the hon. Lady will be pleased to know that we have now made it a criminal offence to supply false or misleading information, but let me respond to the broad point that she has made, because I think it is important.

The publication of data is indeed welcome, but we do not want it to cause the entire NHS to focus on gaming the system, or changing the way in which data are collected in order to make its organisation look better. The purpose of data is to identify issues. The CQC then makes rounded judgments on the performance of institutions, which are based not just on data but on visits and conversations with patients, doctors and nurses. I think that that system can provide us with the best understanding of how well those institutions are actually doing.

A and E (Major Incidents)

Kate Green Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

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

[Kate Green (Stretford and Urmston) (Lab)]

What is being done to address staff well-being during this exceptionally pressured period? Repeated pressure on A and E—with staff being required, or volunteering, to do extra shifts—does in the end put pressure on staff, and may cause burn-out and risk to patients. What is being done to attend to that issue?

[Mr Hunt]

There are two things. First, as I am sure the hon. Lady does, I take every opportunity to praise the work being done by staff through a very difficult and challenging period. Secondly, the practical way in which we can most help them is to try to recruit more staff where we possibly can, and to make sure that resources are not a barrier to recruiting more staff. We have about 5,000 more nurses in hospitals compared with 12 months ago, and that has made a difference.

A and E and Ambulance Services

Kate Green Excerpts

Thursday 18th December 2014 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. I commend the care at Worthing hospital. As he will know, I try to go out on the NHS front line and take part in a shift most weeks, and the very first hospital I went to was Worthing hospital, where I thought the care was excellent. He is right that it is about close working; people in care homes who end up going to A and Es when they could have been better looked after at their care home is probably top of the list of admissions to hospital that we could avoid, because we know the vast majority of those people will end up being admitted to hospital if they arrive at an A and E. That is often not the best thing for people with late-stage dementia, for example, so my hon. Friend is absolutely right and I want to reassure him that that is a big focus of our efforts this winter.

[Kate Green (Stretford and Urmston) (Lab)]

Mrs J, an elderly constituent of mine, waited two hours following a fall for an ambulance that should have reached her in 30 minutes. The Secretary of State will be aware that there have been similar cases, not least the one described to the Deputy Prime Minister by my hon. Friend the Member for Bolton West (Julie Hilling) at Prime Minister’s questions last week. Two calls were made to the North West ambulance service in respect of Mrs J, and one was received from NWAS one and a half hours after the first report, explaining there would be a delay in getting an ambulance to her because of pressures in the system. While it is welcome that the family and carers were kept informed about what was going on, is it not a symptom of terrible pressures in the system that routine operating procedures now have to include call-backs to explain delays?

[Mr Hunt]

The hon. Lady is right, and there is particular pressure in the ambulance service across the country. We are putting in £50 million of winter-pressures money to help address those issues. Where there are unavoidable delays because of other emergencies at the same time, it is important to get the communication right, and I do not think we do that as well as we should. There are times when we could give more specific information about the likely arrival times of ambulances, according to the algorithms used by 999 and 111 call-handlers. That would keep the public better informed. That is something we are looking at.

Oral Answers to Questions

Kate Green Excerpts

Tuesday 21st October 2014 Commons Chamber

[Jane Ellison]

I would be happy to meet the hon. Gentleman and discuss this important issue for his constituents.

[Kate Green (Stretford and Urmston) (Lab)]

The NHS Litigation Authority is piloting a new approach to improve feedback and learning in response to allegations of negligence. Will the Secretary of State say how patients can find out what feedback the NHSLA has given to individual trusts and how the trusts have responded?

[Dr Poulter]

The hon. Lady raises an important issue, which is that the NHS Litigation Authority often picks up on things when they do not go well and when the communication between patients and trusts has broken down. That is one of the things that need to be put right. I will look into the matter and write to her, because it is important that when things go wrong patients are supported in the right way and the lessons are learned.