A and E (Major Incidents)

Kevin Barron Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. I congratulate the doctors and nurses who are working very hard in his local hospital and point out that there are a number of historical problems. The £71 billion of PFI debt is one of those and it means that more than £1 billion every year is diverted from the front line. We have done something about the top-heavy management structures and, as a result, across the NHS we have 9,000 more doctors and 3,000 more nurses. It is very important in this debate that we focus not only on short-term pressures but on dealing with the long-term issues in the NHS. That is what we want to do in his area and in every area.

[Kevin Barron (Rother Valley) (Lab)]

On 9 December, a member of my family was admitted to Rotherham hospital through A and E after a fall at home. She was told two days later by a doctor that there was no medical reason she should be in hospital. She spent her 93rd birthday, on 24 December, in Rotherham hospital and was discharged on Monday of this week, having at last got a care package together. Does the Secretary of State think that the cuts to Rotherham borough council’s social services have helped or hindered the situation?

[Mr Hunt]

We need to have much better working between the health and social care systems. If the right hon. Gentleman supports that, he should support the better care programme, which from April of this year will see co-operation between the local NHS and local authorities in 150 local authority areas for the first time. Instead, Labour is calling for that plan to be halted.

Physical Inactivity (Public Health)

Kevin Barron Excerpts

Tuesday 18th November 2014 Westminster Hall

[Kevin Barron (Rother Valley) (Lab)]

I congratulate my hon. Friend the Member for Blaenau Gwent (Nick Smith) on securing this debate. I do not want to repeat too much of what has been said. As people will know, I have had an active interest in public health for a number of my years in the House, and I have said on numerous occasions that the public health issues for the 21st century will not involve sanitation, fresh water supplies or bad housing, although unfortunately, in such a rich country bad housing still exists; they will have more to do with individual lifestyles and behaviour, including smoking, drinking alcohol in unhealthy amounts and other things. Inactivity is a major threat to public health in the 21st century.

My hon. Friend talked about the national health service being a sickness service. I have used it on many occasions, and for most of my life it has really been a national ill-health service. It reacts to people on the basis that there is something wrong, and we must move away from that. I say to the Minister that although I do not have many compliments to pay about the contents of the Health and Social Care Act 2012, moving public health into local government so that it becomes a part of local society was a proper thing to do. Also in that Act, although I have heard little about them since, were provisions on population health and how we measure it, and on health inequalities, from which constituencies such as mine suffer badly. I would like a lot more to be done on that issue.

There is a wealth of evidence clearly showing that an active life is essential for physical and mental health and well-being. A number of diseases, including cancer and diabetes, are affecting an increasing number of people at an earlier age, as are conditions such as obesity, hypertension and depression. Regular physical activity can guard against such conditions. We must enable people to take control of their current and future health.

Boosting parents’ understanding about active play and physical literacy is essential for children as well. My childhood was not spent on Xboxes, or even in front of television for much of the time. Most of the time, if the weather was right, we were outdoors, climbing trees or playing football on the street, and up to all sorts of things. We had a far more active life than my grandchildren do. Outwith activities such as football and so on, they lead a pretty sedentary life in front of televisions and in their play.

Being active increases quality of life at every age and increases everyone’s chance of remaining healthy and independent. The benefits do not stop there; there are many other social, individual and emotional reasons to promote more physical activity. Being active plays a key role in brain development in early childhood, and it is good for long-term educational attainment. Increased energy levels boost workplace productivity and reduce sickness absence.

As Members have hinted, the experience of other countries tells us that getting the whole nation active every day will happen only if we involve all sectors. Countries such as Finland, the Netherlands and Germany have turned their inactivity situation around—not in years, I admit, but in decades in places such as Norway. We all need to engage with such strategies in our communities. In order to make real and lasting change, we must take a long-term, evidence-based approach, building on what we know works, and embed physical activity into the fabric of daily life, making it an easy, cost-effective and normal choice in every community in England.

I will finish by giving an example. More than 20 years ago in my constituency, a then coal mining village called Thurcroft set up a programme with the local public health organisation called Thurcroft Healthy Hearts. It brought schoolchildren and pensioners together to discuss issues such as smoking. Inevitably, as it was a three-year programme, it ended after three years. Little evaluation of its benefits was done, although people were asked if they were happy with it and they said yes. However, from that programme came Thurcroft walking group. I walked with the group a couple of years ago. Its members are elderly people who have been meeting once a week to walk together, which has been to their general benefit. That is what we need more of in our society.

NHS Services (Access)

Kevin Barron Excerpts

Wednesday 15th October 2014 Commons Chamber

[Kevin Barron (Rother Valley) (Lab)]

We are here in the Chamber today in a week when we have seen health service workers on the picket lines for the first time in 30 years, and we have seen midwives out on strike for the first time in their history—we have had midwives working in the health care system in this country for 150 years, I think—yet most of the spat we have listened to up until now this afternoon has been about who bid what for Hinchingbrooke hospital and so forth. I wonder what people outside—not just people who work in the health service, but those who rely on it and do not have the option to go elsewhere, into the private sector—think about this situation.

We have a Government—if they had been a different Government, I would probably be saying the same thing—where the case for the defence we heard from the Secretary of State this morning about how well our health service is doing comes from independent experts in Washington. I have never in my 30 years in here heard someone doing that. Philadelphia lawyers are presumably the people saying that; I thought it might be a reference to Washington, County Durham, but, no, I assume it is Washington in the USA where people are saying we have got a good health service, not the British Medical Association or the royal colleges of nurses, GPs and everything else who constantly e-mail Members on both sides of this House about the state of health care in this country and the demoralisation of the staff—hence the first picket lines for 30 years. Here we have a Secretary of State who seems to think he can find somebody to defend him who is an independent expert from Washington DC. I think that it is shameful that the Secretary of State comes to the Dispatch Box and uses arguments like that.

Let me tell the Secretary of State—although he is not listening; he is engaged in other things—that everybody knew what was going to happen when this Government came to office in 2010.

[Mr Simon Burns]

rose—

[Kevin Barron]

I will give way to the right hon. Gentleman in a bit, because I may mention him, as he was a Minister at the time. This Government came to office and passed a Bill through Parliament that was going to introduce competition into the national health service and mean a massive reorganisation, and billions of pounds were going to be spent in doing that—billions of pounds that could have been spent elsewhere—and the case for the defence is, “We’ll make a billion pounds a year in this Parliament.” Well, it is not there yet, Ministers.

It was not just the reorganisation of the national health service that was mentioned. The Government also told us at the same time that they had got to make efficiency savings of 4% a year, something that the health service had never done, and something the public sector had never done. Indeed, people said at the time that the private sector had never done it either.

That is the situation we had when that Bill went through Parliament. They were warned about the consequences of that not just by politicians in the House, but by people who gave evidence to the Public Bill Committee. I served on it. The Bill was stalled and came back in again. Evidence after evidence came in saying what has happened was going to happen.

We have had massive reorganisation. I just wonder if the Secretary of State—if he is prepared to listen—will tell us how many of the 4,000 NHS staff who were laid off and paid redundancy were then re-employed by the NHS, some of them on massive six-figure sums. How much did that cost the NHS? How much did that take away from mental health services or other services that our constituents rely on? None of this is in the debate at all, and Ministers all know perfectly well what the situation is.

Week after week, we hear these platitudes from Ministers. The Secretary of State said not too long ago, “When you go into hospital, you’ll get a named consultant,” but what does having a named consultant matter to most people? Are they going to work seven days a week, 24 hours a day so we can phone and say, “Can we come and see you?” No one has mentioned the latest one we have had, which I thought was wonderful—

[Mr Hunt]

rose—

[Kevin Barron]

The Secretary of State can come in in a minute. This latest one is a consequence of a speech made by the Prime Minister: we are going to be able to see GPs seven days a week. Well, the Royal College of GPs does not think so. I say this to the Secretary of State: “We could see a GP, not far from this place, seven days a week until you lot got in.” We could do so in the Victoria NHS walk-in centre, and I used to go in there, as my GP is elsewhere, but it closed years ago.

We put in walk-in centres—sometimes in the face of opposition from GPs, I have to say. A GP objected to them in my constituency, as I raised in the House at the time, so some of them were saying they did not want them. They gave seven days a week access to GPs.

I understand that my time is up, Madam Deputy Speaker, but I want to finish by saying this: whatever happened at Hinchingbrooke or anywhere else, we never ever had to have competition law on the statute book. We have now. Do not tell me or anybody else out there that the Secretary of State has not got plans to privatise properly the national health service, because I am convinced that he has.

--- Later in debate ---

[Dr Poulter]

If the hon. Lady has concerns about local commissioning decisions, she should take them up with local commissioners. Time forbids me from going into the rationing of services by the previous Labour Government. It is important that clinical services are now designed and delivered by front-line health care professionals, and if she is concerned about them, I am sure she will take that up with her local CCG.

The right hon. Member for Leigh (Andy Burnham) referred to a work force crisis in GP training. It is clear that under this Government 1,000 more GPs are now in training and working in the NHS than in 2010 when we came into government. If it is not accepted that that is good start, we have committed to training an extra 5,000 because we want more people working in general practice.

We have ensured that 1.3 million more people are being treated in A and E compared with the number in 2009-10. We have halved the time that people must wait to be assessed, and every day we are treating nearly 2,000 more people within the four-hour target compared with the number in 2010.

Competition was introduced into the NHS not by the Health and Social Care Act 2012 but by the previous Labour Government, of whom the right hon. Member for Leigh was a Minister. The Labour Government opened the door to private sector providers when they opened the first independent sector treatment centres in 2003. The Labour Government gave £250 million to private companies and independent sector treatment centres, regardless of whether they delivered that care. Labour was more concerned about giving money to the private centres than about ensuring that quality care was delivered. Labour paid independent private sector providers 11% more to provide the same care as NHS providers. That is Labour’s record on the private sector in the NHS—a record that shows that it is more committed to the private sector than any previous Conservative Government.

[Kevin Barron]

If that is the case, will the Minister—as a Back Bencher, he sat on the Health Committee—tell us why there were so many clauses in the Bill that introduced the Competition Commission and the Office of Fair Trading into our national health service?

[Dr Poulter]

The right hon. Member will be aware that Labour’s legislation, which gave the private sector the opportunity to tender for contracts, saw 5% of NHS activity—I believe that figure is correct—provided by the private sector at the end of the last Labour Government. In the Health and Social Care Bill, we wanted to stop the unregulated approach. We wanted greater emphasis on integration of health care services. It was not just about the private sector provider fixing someone’s hip and forgetting what sort of care was available when their hip had been repaired and they had gone home. It was about ensuring greater emphasis not just on competition and what was best for patients, but on integrated and joined-up services to ensure that people were properly looked after when they left a treatment centre. We stopped the cherry-picking of services that happened under Labour, and we are proud of that.

We will take no lessons from the Labour party on NHS finances. Labour was the party that crippled the finances of so many NHS trusts with PFI deals, and it was the party that during its final year in government saw the number of managers rise six times as fast as the number of nurses.

I am proud of this Government’s record on the NHS and I am proud of our record on integration. There will be a clear choice at the general election next year: a Conservative-led Government who have delivered for patients, a Conservative-led Government who have delivered on cancer services and a cancer drugs fund, and a Conservative-led Government who will continue to ensure better care for people with long-term medical conditions. We have a proud record on the NHS and I urge my right hon. and hon. Friends to oppose the motion.

Question put.

Patient Safety

Kevin Barron Excerpts

Tuesday 24th June 2014 Commons Chamber

[Mr Hunt]

I start by welcoming my hon. Friend to her new position as Chair of the Health Select Committee, which I think she will do brilliantly well. I also thank her for the fact that she had been talking about this issue long before she took up that post, and as someone who has worked in the NHS, she has always recognised its importance.

My hon. Friend is absolutely right to say that NHS staff should not wait until the outcome of the new Francis review before speaking out. My view is that the atmosphere is beginning to change inside the NHS. We are getting trust boards that are now spending much more time talking with safety, but the reason I wanted to have this review is that there are problems and issues across the world with people in health care speaking out, and nowhere has really embraced the culture of safety that we have in the airline, nuclear and oil industries, where concerns about safety are on a completely different level. I know that I have the wholehearted support of NHS staff in this mission; I think it is a shame that we do not have the support of the Labour party.

[Kevin Barron (Rother Valley) (Lab)]

In response to the Francis report in relation to the duty of candour, the Government said that it should be on institutions and not on individuals. Given that the Government appear not to want to bring in new regulatory bodies in relation to individual action inside the national health service, does the Secretary of State have any faith in the regulatory bodies currently looking after health professionals, given the state that Mid Staffs hospital ended up in?

[Mr Hunt]

We looked carefully at whether the duty of candour should apply to individuals, and we decided against that because we were worried about creating a legalistic culture in trusts. However, we are working with the regulatory bodies. The right hon. Gentleman is absolutely right to raise concerns, as they were indeed raised in the Francis report. Following on from my earlier response, one of the lessons that we learned from the airline industry is that pilots are professionally protected if they speak out, so on balance it is to their advantage to speak out rather than to shut up. As a result of that reporting of safety incidents, near misses and so on, the industry has achieved a remarkable reduction in accidents. I would like to see whether we can do the same thing in the NHS.

Oral Answers to Questions

Kevin Barron Excerpts

Tuesday 10th June 2014 Commons Chamber

[Mr Speaker]

Last but not least, I call Sir Kevin Barron.

[Kevin Barron (Rother Valley) (Lab)]

Will the Minister give us an update on the proposed licensing of e-cigarettes by the Medicines and Healthcare Products Regulatory Agency? Does her Department believe that e-cigarettes could be used in smoking cessation programmes?

[Jane Ellison]

When I brought the regulations before Parliament, we were clear that those e-cigarettes for which a medicinal claim is made must be subjected to medicinal licensing arrangements. Once they are licensed as medicine, they can be prescribed as part of NHS smoking cessation services.

Francis Report

Kevin Barron Excerpts

Wednesday 5th March 2014 Commons Chamber

[Kevin Barron (Rother Valley) (Lab)]

I reread the executive summary of the Francis report yesterday when I was on a train journey, and I decided that in today’s debate I would like to look at one of the most crucial aspects of his findings in respect of what happened at Mid Staffs.

On page 62, at paragraph 1.102, the summary states:

“The senior officials in the DH have accepted it has responsibility for the stewardship of the NHS and in that sense that it bears some responsibility for the failure of the healthcare system to detect and prevent the deficiencies at Mid Staffordshire sooner than it did. There is no doubt about the authenticity of their expressions of shock at the appalling story that has emerged from Mid Staffordshire. However, it is not possible to avoid the impression that it lacks a sufficient unifying theme and direction, with regard to patient safety, to move forward from this point in spite of the recent reforms put in place by the current Government.”

It goes on to say:

“Where there are perceived deficiencies, it is tempting to change the system rather than to analyse what needs to change, whether it be leadership, personnel, a definition of standards or, most importantly, culture. System or structural change is not only destabilising but it can be counterproductive in giving the appearance of addressing concerns rapidly while in fact doing nothing about the really difficult issues which will require long-term consistent management. While the DH asserted the importance of quality of care and patient safety in its documentation and its policies, it failed to recognise that the structural reorganisations imposed upon trusts, PCTs and SHAs implementing such policy have on occasion made such a focus very difficult in practice.”

It is my contention that we could probably say that of every reorganisation of the NHS, certainly in my three decades in politics.

The summary goes on to discuss the lessons learned and related key recommendations:

“The negative aspects of culture in the system were identified as including: a lack of openness to criticism; a lack of consideration for patients; defensiveness; looking inwards not outwards; secrecy; misplaced assumptions about the judgements and actions of others; an acceptance of poor standards; a failure to put the patient first in everything that is done.”

It goes on:

“It cannot be suggested that all these characteristics are present everywhere in the system all of the time, far from it, but their existence anywhere means that there is an insufficiently shared positive culture.”

Again, it is my contention that that sums up not just the past 30 years but perhaps the past 60 years of our national health service.

The summary goes on to say that achieving change

“does not require radical reorganisation but re-emphasis of what is truly important”.

All parties in the House should recognise that it is not the reorganisation but the re-emphasis of what is important that is significant. Paragraph 1.119 lists how that can be achieved:

“Emphasis on and commitment to common values throughout the system by all within it; readily accessible fundamental standards and means of compliance; no tolerance of non compliance and the rigorous policing of fundamental standards; openness, transparency and candour in all the system’s business; strong leadership in nursing and other professional values; strong support for leadership roles; a level playing field for accountability; information accessible and useable by all allowing effective comparison of performance by individuals, services and organisation.”

I was not surprised by any of that.

The right hon. Member for Sutton and Cheam (Paul Burstow) was a member of the Select Committee on Health in the previous Parliament between 2005 and 2010, and I had the privilege of chairing that Committee. In 2009 the Committee looked at patient safety in the NHS. We visited one of only four hospitals that were part of a patient safety project on how to look after patients inside hospitals, never mind outside. We looked at some of the major issues at the time, such as how different parts of the NHS interacted and their failure to communicate with one another properly. Much of the time they were working with different regulations, and occasionally the inspectorate was not sure what it was responsible for inspecting. This whole restructuring has been going on for a very long time, and it has been more confusing to people working inside.

I am pleased with how the Government have reacted to some of the Francis report’s main recommendations, but I take issue with them on one point. If we are to change the culture inside the NHS, we really need to look at the duty of candour. The Government have accepted the report’s recommendation on a duty of candour for organisations, but they have rejected the recommendation to extend that duty to individuals. I think that is fundamentally wrong.

I spent nine years as a lay member of the General Medical Council, which regulates doctors, and for the first few years I would sit on fitness-to-practise committees. I think that the only way we shall get change is if individuals have responsibility for the duty of candour, not just organisations. I believe that the Government have got that fundamentally wrong. If they really want to tackle the issues that led to the awful situation at Mid Staffs, they need that duty of candour to extend to individuals.

On the Government’s decision on the duty of candour, the Patients Association has stated:

“We question that if individuals are not already motivated by their own professional code, how will a duty on their employer encourage them to come forward?”

That is absolutely right. It continued:

“Without this fundamental change within the NHS, the Duty will just be providing lip service to the issue of patient safety and patients will struggle to see any real improvements.”

That is a big assumption, but on balance I agree. It is something that the Government, no matter who is in Richmond House, need to tackle throughout the NHS.

I have in my hand a copy of the Health Committee’s report on patient safety, which was published in July 2009. We looked at patient safety across the health care system and compared it with what was happening abroad. We visited New Zealand, which has a comparable health system—I accept that the country has only 4 million occupants, compared with our 60-odd million. We looked at why the culture here is the way it is, why people are not open and why they do not learn from mistakes that other health professionals have made. Often those mistakes are not reported because people fear they will get into trouble. We took evidence from the British Airline Pilots Association and learned that any mistake a pilot makes in an aeroplane is whizzed around the world so that other pilots understand it and learn the lessons immediately. That is not the case in our health service.

I want to mention two of the Committee’s findings from New Zealand. The first relates to investigating complaints. I do not think that leaving the duty of candour to organisations, as the Government suggest, will work well. New Zealand has a statutory body—I have mentioned it before in the House—called the Health and Disability Commissioner, which resolves complaints. People can go to the commissioner to request investigations, and they can do so anonymously if they do not want their colleagues to know about it. It is completely independent of the health care system. It works, and it has been working for many decades.

Another area we looked at in New Zealand—again, I accept that it is a very small country—was compensation and redress. I know from my experience of 30 years in Parliament that when people complain about something that happened to them in their local hospital that they are unhappy about, they are treated as if they are going to get into litigation and that it will cost a lot of money; immediately the barriers come up. That culture is not good for our health service, it is costing massive amounts of money for us as taxpayers, and it is certainly not good for the individual concerned. I do not know how many times I have been told that all the patient wanted was an admission that the hospital got it wrong and an apology; they did not necessarily want money. New Zealand has a redress system that some might call a no-fault liability system. Here, it would mean getting rid of lots of lawyers who make massive amounts of money and careers from public money for NHS litigation. Just those two areas hold back changing what is wrong in our system.

[Barbara Keeley]

I wonder whether my right hon. Friend has had similar cases to a difficult one that I had for months involving someone whose wife died in terrible circumstances at home. He was badly let down by the care she received and he wanted redress. He found that people were happy to have meetings with him and to talk to him, and were sympathetic and supportive, but whenever something was put in writing, it was absolutely dreadful. He was very offended and horrified by everything that was in writing, and that is the chilling effect of lawyers because they checked everything. It ruins the support that can be given after a difficult bereavement and when someone has a real case. Things can be said, but they cannot be written down.

[Kevin Barron]

I agree entirely. The system is defensive and people do not get a satisfactory response, but the lessons are not learned. Issues are not reported for fear of the consequences. The Minister is a doctor. He will know that if as a junior doctor he had seen a senior doctor doing something wrong and had gone public about it, it might have affected his career. Some young doctors’ careers have been affected. That is not good for the system, and it is certainly not good for patients.

I am a wholehearted supporter of the national health service and the way it is funded. There is none better in the world, and we can use it without question. It may be different in different parts of the country, but access to health care in this country is second to none in the world for the whole population as opposed to just those with money. Could it better? Yes, and what the Francis report said was a lesson for all of us, and for the national health service. We should change the culture, but we will not do that with reorganisation or by blaming one another in the Chamber for what is right or wrong. That just feeds the politics of the national health service. We must change the culture by putting the patient first, and after 60-odd years it is about time we did.

--- Later in debate ---

[Dr Poulter]

We are leading by example. As I outlined, the Secretary of State has accepted the TSA recommendation in full. A process is now under way involving NHS England and local commissioners. That was initiated last week. It is important that those conversations happen and that an update is brought forward in a timely manner. That is the right thing to do. It is not appropriate to rush decisions and processes because of a political agenda, rather than an agenda of benefiting the local patients and women concerned. I am concerned as a doctor and as a Minister that we must do the best thing by patients. Rushed decisions are not always the best thing for patients, because conversations need to happen between local commissioners and NHS England. I hope that the hon. Lady will be a little patient, because I am sure that the right decision will be made in due course.

There are three key areas in which the Government have taken forward the recommendations of the Francis inquiry: encouraging a culture of transparency and openness in the health care system; empowering front-line staff and encouraging good leadership in the NHS; and putting the patient at the heart of everything that the NHS does. As we have discussed, the patient was not at the heart of everything that was done at Mid Staffordshire for a period. That is why we have to learn the lessons and ensure, as best we can, that that cannot happen again.

On transparency and openness, it is important to highlight how we have already delivered on the recommendations of Robert Francis’s report. The CQC has appointed three chief inspectors for hospitals, social care and general practice who will ensure not only that the organisation is complying with the law, but that the culture of the organisation promotes the benefits of openness and transparency. Importantly, we now have clinically led inspections for the first time, which means that people who really understand what good care looks like will be in charge of the inspection process. That clinical leadership in the inspection process and at the heart of what the CQC does has to be of benefit to patients, and the Government are proud that we have delivered that.

We have also introduced a new statutory duty of candour on providers, which will come into force this year. It will ensure that patients are given the truth when things go wrong and that honesty and transparency are the norm in every organisation.

[Kevin Barron]

rose—

[Dr Poulter]

The right hon. Gentleman might wish to intervene in a moment, but first I will respond to his good points on the importance of the duty of candour. There is some disagreement between us, because he said that there should be a duty on individuals. He will be aware from his time at the General Medical Council that there is already a duty on professionals to act in the best interests of patients and raise any concerns about the quality of care. As a body, the GMC has learned lessons from Mid Staffordshire and reviewed its processes, but it is important to recognise that many front-line professionals at Mid Staffordshire tried to raise concerns. The culture at the trust was such that those in management positions did not always listen to them. If we want to support whistleblowers and people’s ability to speak out freely for the benefit of patients, that has to be done at organisational level. Health care professionals are already under a duty through their professional obligations, which I hope reassures the right hon. Gentleman.

The right hon. Gentleman has been in the House for many years and will remember that problems of people not being able to speak out freely in their organisations date back to the Bristol heart inquiry. Professor Kennedy, who oversaw that inquiry, noted that it was the cultural problem in that hospital provider that prevented people from speaking out. The problem was not that people were not prepared to speak out—they recognised their professional obligations; it was that there was a wish at a senior level not to recognise problems. That is what we need to tackle. We are now almost 15 years on from the Kennedy inquiry into Bristol—I was a law student at Bristol university at the time—and the NHS has perhaps not learned the lessons that it needs to. I am sure that putting a duty of candour on to NHS organisations will begin to get us where we need to be.

[Kevin Barron]

Will the Minister consider what I said about how an independent statutory commissioner could examine complaints about patients’ care, as happens in New Zealand? Will he get back to me about whether he thinks that is a good idea? The people who work in the institutions that he is talking about have no faith that anything can be changed.

[Dr Poulter]

I will talk about complaints a little later, but the right hon. Gentleman has made some important points. When we consider how to improve the delivery of care in our health service, it is important that we examine international comparisons. The system in New Zealand includes a different form of compensation, and perhaps that is partly why it has a more open culture—there could be many other factors. It is acknowledged much earlier in the process that something has gone wrong, and there is a genuine attempt to explain the situation to the family and say sorry. That is what good health care is all about.

No matter how good, well trained and dedicated staff are, things will sometimes go wrong in a health service. When they do, it is important that we are open and honest with patients and that we do our best to put things right if we can, or explain and apologise if we cannot. That is why we believe that the duty of candour needs to exist at organisational level. Of course, I am happy to write to the right hon. Gentleman, or meet him if he would like to talk through some of the issues that he raised today. He makes good points, and I know that he does so on a completely apolitical basis because he has the best interests of the health service at heart. We might disagree on other issues, but on this one it is worth having a meeting to discuss his views further.

Subject to the passage of the Care Bill, a new criminal offence will be introduced to penalise providers who give false or misleading information where that information is required to comply with statutory or other legal obligations. It means that those directors or other senior individuals, including managers, who consent to, connive in, or are negligent regarding an offence committed by the provider could be subject on conviction to unlimited fines or even custodial sentences. We must ensure that managers and those running the health and care service in a health care provider provide information in an honest and transparent way that is always in the best interests of patients.

Importantly, we are introducing through the Care Bill a single failure regime to ensure that failure is not only about the financial sustainability of the trust, but about whether a health care provider is providing good care, and the quality of that care. One problem in the past with the trust special administration regime has been that it is rarely used. When it is used, however, it is important to ensure that it is there to protect patients. Often in the past it was used only in a way that focused on financial failure. One important lesson to learn from Mid Staffs is that there should be a failure regime that also considers quality of care. Hospitals are not just about good accounts; they are primarily about delivering good care, which is why we need a single failure regime. My right hon. Friend the Secretary of State has been a tremendous advocate for the importance of quality of care in trust, and he should be commended for that. Thanks to him, we are now ensuring that we improve the TSA regime in that way.

Children and Families Bill

Kevin Barron Excerpts

Monday 10th February 2014 Commons Chamber

[Philip Davies]

I have said I am not going to give way. The hon. Gentleman can listen for once.

Moreover, this is totally and utterly unenforceable. What on earth are we doing saying to the police, whose resources are already stretched, that all of a sudden this should be a new priority for them to undertake? Have they got nothing better to do than go up as close as they can to a moving car to see whether there happens to be a small child in the back seat? Of course, this is not just about small children but all children. How on earth does the driver prove that the person in the back of the car is over 18 rather than under 18? What happens when the driver throws the cigarette away and the police have to try to prove whether they were smoking when they were pulled over? The whole thing is completely unenforceable. It is gesture politics of the worst kind, with Ministers and shadow Ministers trying to flex their health zealotry at all these health organisations and saying, “We’re tougher on these matters than the others.”

Standardised packaging—it is not plain packaging, as some people say—is also nonsense. In many cases, the standardised packaging is more colourful than the existing packaging, so this measure will not do anything for the people who say that all the colourful packaging encourages people to smoke. It is already the case that cigarettes cannot be displayed in large shops. What on earth is the point of having plain packaging for products that are already behind a counter and cannot even be seen? Again, the whole thing is complete nonsense.

All these arguments are arguments for banning smoking altogether. If people had the courage of their convictions and said, “We should ban smoking altogether”, I would at least have some respect for them, but they dare not say that that is what they want to do, even though we know it is their real agenda. While cigarettes are a legal product, brands should be free to use their own branding on the packs. Standardised packaging would simply be a triumph of the nanny state that would presumably soon be followed by plain packaging for alcohol, sweets, crisps, and all the foods that supposedly lead to obesity. Once we have gone down this road for one thing, why would we not have plain packaging for everything? We know, particularly given the current Ministers and shadow Ministers, that that is what it would quickly lead to.

I have tabled three amendments to Lords amendment 124 to try to make it more sensible. The Lords amendment states that the Secretary of State can make regulations if he believes that they

“may contribute at any time to reducing the risk of harm to…the health or welfare of”

children—I repeat, “may” contribute. This gives the Secretary of State the authority to make a decision on a whim just because he happens to think that it might make a difference. My first amendment would change “may” to “will” so that he would need to have some evidence for making a change rather than just doing it on a whim.

The second amendment relates to regulations. Under Lords amendment 124, the Government are saying that they can make lots of provisions and as long as some of them are capable of having a positive effect, that is fine. They can propose 10 ridiculous things and two sensible ones, and the regulations allow them to do it as long as some of them are sensible. My amendment says that “each” provision that they want to bring in should be capable of making a difference, not just the odd one or two in a whole series.

The Minister said that it would be a constraint on the Minister’s power to accept my amendments. Well, I make no apology for trying to constrain the Minister’s power. That is what the House of Commons is all about—trying to make sure that sensible decisions are taken based on evidence, not just on the latest whim of the nanny state brigade whom she has listened to. We are supposedly here to try to defend the freedoms of people in this country. This Government want to trample over every single one of those freedoms. It makes me wonder what is the difference between having Labour or this Government in charge. I expect no better from Labour, but I did expect an awful lot better from a supposedly Conservative-led Government.

[Kevin Barron (Rother Valley) (Lab)]

Listening to this debate, I could have heard the same things said in 2006 when the House came to a decision on smoking in public places. That is public health legislation which the Prime Minister says is good legislation, although he did not vote for it at the time. I hope that Members will bear that in mind.

I hope that Members will also bear in mind, as we always must when considering such legislation, that currently in the UK over 100,000 people a year die prematurely from smoking tobacco. I support the amendment, which will, I hope, further restrict the use of tobacco not just by young people but, in turn, by adults. As the Minister said, two thirds of people who start smoking are young when they do so, and it is addictive.

One of my points relates to what the Minister said about e-cigarettes not being sold to people under the age of 18. Some people argue that e-cigarettes are a gateway to tobacco use, but the organisation that I have worked with on this over many years—Action on Smoking and Health, which the hon. Member for Shipley (Philip Davies) clearly admires—says that there is no firm evidence for that at this stage; it is doing another survey this year. The important thing is that over 2 million people are using e-cigarettes, some of them so that they smoke less tobacco and some so that they smoke no tobacco. I agree with the Minister that we should view them as a medicinal product—as part of the family of nicotine replacement therapies. That should be our approach in stopping these awful deaths from smoking. VAT on nicotine replacement therapy products is currently 5%. If e-cigarettes were also licensed and charged at the same rate, that would benefit everybody.

I support what the Minister said about proxy purchasing. This has not yet been addressed and it should have been. Alcohol and tobacco are harmful, depending on how they are used, although alcohol is not as bad as tobacco.

We have debated standardised packaging many times in the House and heard the arguments about printers being affected, and so on. The hon. Member for Shipley said that standardised packages are very complicated, and of course they are. I hope that we will have better safeguards to stop people engaging in contraband activities. There is no way that this measure will do anything other than stop people advertising on cigarette packets the products that cause all these premature deaths.

I support the Government and the Opposition on banning smoking in cars with children. Enforcement is always an issue, and we accept that. When I first started driving, people had to have seat belts in cars but did not have to wear them, and only one person in four did so. When the law was changed, 90% of people started wearing them practically overnight. This is about changing habits. We could not have a worse situation than somebody in a confined space like a car smoking cigarettes when children are there.

Everybody said that the ban on smoking in public places would never be enforced. I was on the Health Committee when we had that debate and we went to Dublin to look at what had happened in Ireland. A guy there tried to get publicity by saying, “I’m going to be smoking in this pub tonight. Will you come down and get me?” However, there were very few problems with enforcement and the same is true of us now. We have not seen all the details, but, as far as I am concerned, the provision is a further step towards protecting young people and future generations from premature death as a result of ill health, and we should support that.

[Mr Charles Walker]

My concern about the Lords amendment is that we are in danger of criminalising otherwise very loving parents. We should guard against that. It would be appalling if people who have been good parents in every other way found themselves being criminalised as a result of smoking in a car when their children were present.

I hear the argument about seat belts and it is perfectly and entirely reasonable for the Government to set the terms of their use on the road. If the Government decide that someone who wants to drive on a road has to wear a seat belt, that is highly reasonable. I suggest that, if the Government really are determined to press ahead with banning smoking in cars, that is exactly what they should do: they should ban the consumption of alcohol in cars by any person of any age and ban smoking in cars by any person of any age. That would be a much more honest approach, because, as I have said, if we go down this road we will be criminalising hundreds of thousands of parents. Will a repeat offender—someone who has been penalised three or four times—have their children taken into care because they are deemed to be an abusive parent?

There is an enormous degree of hypocrisy in this House. I am pleased to say that I am a teetotal non-smoker. There are many people in this place who want to ban smoking because they think it is not done by very nice people, but they are much more relaxed about alcohol because of their own habits. If Members are genuinely concerned about the welfare of children, they need to realise that alcohol is the problem, not tobacco. Hundreds of thousands of children have their lives blighted by alcoholic parents and the problems associated with alcohol, yet we never talk about that in this House, because some Members think, “We, as nice people, drink.” I am extremely concerned about the direction of travel.

My final point—I know that others want to speak—is that we will drive another wedge between the police and those they are policing if we implement this provision. It is nonsense. We will expect the police to intervene and that will further widen the gap between them and those they are policing. That should be avoided and we should be very careful about widening that gap.

Mrs M. Barnes (NHS Treatment)

Kevin Barron Excerpts

Thursday 6th February 2014 Commons Chamber

[Kevin Barron (Rother Valley) (Lab)]

I thank Mr Speaker for allowing me to raise this subject in today’s Adjournment debate. I understand that he makes the decision on a Thursday afternoon.

I wish to discuss the treatment of a constituent of mine, Mrs Monica Barnes, who lives in the village of South Anston. I have been dealing with her over many years now, regarding different aspects of her health care, but my reason for wanting to speak today has to do with what has been recorded on her patient records at the Kiveton Park medical centre and the effect it may have had on her clinical treatment.

Mrs Barnes wrote to me on 5 July 2002. She said:

“Whenever I have attempted to obtain treatment some reference to litigation past or present has shown itself in my medical records and/or in letters of referral from the GP. This clearly shows there to be discrimination in my case. This time reference is made in the Patients Summary to the court case. See copy sent to me in very small print, enclosed.”

I have indeed got the patient’s summary. It is dated 18 January 2001. On the bottom, it says “await judges ruling”. My constituent contacted the Information Commissioner, and a letter was sent to the practice manager on 5 September 2002. It contained the patient’s summary and the court case entry. It said:

“In order for me to assess the practice’s compliance with the First Principle, I would be grateful if you could confirm whether individuals are made aware that personal data about them may be disclosed to other health professionals in the course of their care and treatment and the extent of such disclosures. In particular, could you please confirm whether such data as were disclosed in Mrs Barnes’ case are disclosed to other health professionals as a matter of routine, which of the conditions in the Schedules the practice is relying upon in order to make any such disclosure and whether individuals are made aware of the disclosure. Given that Mrs Barnes did not expect this, I would also welcome confirmation of these issues with regard to her case. If there is no legitimate basis for holding and disclosing the data in question when Mrs Barnes did not expect such processing, it is likely to be in contravention of the requirements of the First Principle.”

Mrs Barnes received a reply from the Information Commissioner on 6 March 2003. I have to say that the Information Commissioner had to write to the practice on 16 December to remind it of the letter it had been sent on 5 September 2002 about what was held on Mrs Barnes’s record.

Mrs Barnes received a reply from the Information Commissioner. It said:

“I understand that having considered its relevance to your patient summary records, the practice has removed the entry which states “court case”. (I have requested that the practice ensures that this does not appear elsewhere in your medical records).”

That was dated 6 March 2003. Presumably, my constituent would have been quite happy with such a positive reply. The letter went on to say:

“Consequently, on the balance of probabilities it does seem that the data in question is not relevant and is excessive for medical purposes. It is also our view that on the balance of probability it does seem that it was not necessary for the practice to disclose the details without your consent, when you did not expect this.”

That is a pretty firm statement that the Information Commissioner felt that it was wrong for the records to have been kept in such a way.

In the autumn of 2010, Mrs Barnes decided to join another practice in central Rotherham that had been built in the walk-in centre that had been opened. Her medical records were requested by the South Riding Health Services Support Agency, an organisation that I had never heard of in my 20-odd years as an MP, and they were sent on 3 November before being sent on to the new practice in Rotherham town centre. When Mrs Barnes visited her new doctor in November 2010, the practice had her medical records but on her next attendance her new GP said that he did not have them. Mrs Barnes told me that she was prompted to investigate their whereabouts.

In 2011, Mrs Barnes asked me to write to the chief executive of NHS Rotherham, who wrote back to me on 11 March saying that he had had the case investigated by his complaints officer who confirmed that the notes were sent on 3 November. The chief executive went on to say:

“However, I am informed that shortly after forwarding the medical records…the…practice received a letter from the Information Commissioners office advising them that the amendments were to be made to Mrs Barnes’…records. In order to comply with the Commissioners advice, the notes had to be retrieved from Mrs Barnes’ current GP via the SRHSSA. Whilst it is acknowledged that the Kiveton Park practice had Mrs Barnes’s medical records for several weeks, it is important to note that implementing the Commissioner’s advice was onerous.”

The chief executive wrote to me on the basis that the submission from the Information Commissioner had come in around November 2010, when my constituent was moving to another GP’s practice.

I then received a letter from NHS Rotherham on 1 June 2011, which accepted that the Information Commissioner’s advice was given in 2003 and not more recently, as mentioned in the chief executive’s letter. That was the reason for the retrieval of the records from her new GP, as it was felt “prudent” that the medical records should be reviewed for absolute accuracy. The two doctors concerned verified that the removal of information as advised by the Information Commissioner had been carried out.

Mrs Barnes referred her case to the ombudsman. She wrote to me in October 2011 setting out a number of instances in which she believed discrimination might have taken place and said in that letter:

“When I assessed my medical records at the Sheffield Northern Hospital in June 2011, I discovered that reference to court case etc, was still to be found in my patient summary.”

It seems clear to me that the advice of the Information Commissioner given in 2003 was not adhered to. The instruction was to remove that reference from her medical records in the practice and anywhere else it might appear.

I got involved with the Parliamentary and Health Service Ombudsman on Mrs Barnes’ behalf and corresponded with the office in December 2012. The ombudsman had earlier refused to investigate the case until the medical practice had the opportunity potentially to offer Mrs Barnes some compensation. That did not materialise, for whatever reason. My understanding was that the insurers might have wanted to consider the case and decide whether to take any action. In a letter to me in December 2012, the ombudsman asked Mrs Barnes for further clarification in three areas. The first was whether she had considered taking a legal remedy and why she might not have chosen to do so. The second was the level of compensation she hoped to recover. The letter said:

“The Ombudsman does not operate a tariff system and we are very much guided by what people hope to achieve. The levels of financial redress we may be able to recommend are modest when compared to sums that could be recovered by legal action and it is helpful for us to know whether we would be likely to meet the financial outcomes a complainant has expressed. This helps to ensure that they can be quickly directed to the most appropriate route to consider their concerns and helps to avoid complainants being dissatisfied at the outcomes we may be able to offer.”

The third point related to how Mrs Barnes felt that she had suffered damage as a result of the practice’s failings.

Mrs Barnes came back to me on this matter and we discussed in some detail how she should respond. In March 2013, I wrote to the assessor at the health service ombudsman saying that Mrs Barnes and I continued to be unhappy with the handling of her case. I reminded them that a letter I had received from them on 28 March 2012 stated that

“the Ombudsman will not normally consider a complaint unless the NHS organisation concerned has had a reasonable opportunity to resolve the complaint”.

I then went on to say that in relation to their letter dated 11 December, Mrs Barnes did not wish to go down the legal route because of the potentially high costs involved.

In relation to the ombudsman’s comment about the compensation that Mrs Barnes would wish to recover, as I have already pointed out, I said that

“she cannot risk going down the legal route because of the cost. Consequently, she feels the only route she has open to her is to go through the Ombudsman”.

I then said that I would appreciate it if they could be more specific about what level of financial redress they may be able to recommend if they were to settle the case for her. They told me that they had no tariff, which I quite understand.

On the third point, I reiterated that Mrs Barnes had previously provided them with information on how she felt about the damage suffered as a result of the practice’s failings. It was not just the one incident; there were many other incidents in the letter that I received from Mrs Barnes at the time.

Further correspondence took place between Mrs Barnes and the ombudsman, and in a letter to them, no doubt in her frustration, she said:

“I refuse to involve clinical negligence solicitors due to my having taken legal action against a particular hospital in the past with no outcome.”

Hence, presumably, the reference on her patient record. She went on to say:

“The only people who seem to benefit from litigation are the solicitors themselves. I refuse to further fill their pockets and barristers’ pockets with taxpayers’ money.”

That quote was used in a letter sent to me dated 18 June from the ombudsman’s office. Also in that letter it was stated:

“Mr and Mrs Barnes complaint correspondence referred to a number of other interactions with NHS Care that did not involve the practice since around 1990 and were not part of our considerations”.

That is an important point, and I agree with it. This complaint was about the issue of what was on Mrs Barnes’s medical record and how it may have been used by others if they had seen what was on that.

After further correspondence, I received a letter from the director at the ombudsman’s office in August 2013 after a review had taken place of the action/inaction of the ombudsman’s decision not to progress the complaint. That letter stated that when I wrote to the ombudsman on 24 June 2013 I had said that Mrs Barnes was unhappy with the decision because she did not have the money to take the case to court. It was said that Mrs Barnes had previously told the ombudsman that she was not prepared to put money into the pockets of solicitors and barristers, but not, so far as I can see, that she could not afford to take legal action.

The letter continued:

“However, while a person’s ability to pay legal costs is relevant in cases such as this, it cannot be the sole factor. Mrs Barnes is seeking damages for personal injury that she says she has sustained at the hands of a number of clinicians over more than 20 years and her claim arises from an action for which the law provides a specific remedy. In the circumstances we agree with our original decision that the matter is properly for the courts and is not one we should investigate.”

[Dr Julian Lewis (New Forest East) (Con)]

This is a very complicated case and I just want to be sure that I understand exactly what the ombudsman is recommending. My understanding is that the ombudsman is recommending that a lady who has had a lot of trouble because she once previously went down the legal route should, instead of pursuing a complaint about that with the ombudsman, go down the legal route all over again. Have I got that right, or am I missing something?

[Kevin Barron]

The hon. Gentleman is absolutely right. What gets me about the last two letters more than anything else is the fact that they are completely contradictory. The first states:

“Mr and Mrs Barnes’ complaint correspondence referred to a number of other interactions with NHS care that did not involve the Practice since around 1990 and were not part of our considerations”.

The last letter basically states, “No, we aren’t going to pursue any action at all. We’re not going to look at it.” It then states—I am sorry to repeat this, but I think that it is important—that

“Mrs Barnes is seeking damages for personal injury that she says she has sustained at the hands of a number of clinicians for more than 20 years”.

They are completely contradictory.

It seems to me that the parliamentary ombudsman, which is also taxpayer funded, has not only made contradictory statements, but handled Mrs Barnes’ case in a negative way. As we discussed when she and her husband visited my office, which they did on several occasions, this was not about what had or had not happened to her with the medical professional over the years; it was about what had been held on her personal records. In 2003 the Information Commissioner said that that was wrongly done and suggested it should be removed. We then found out that in 2010 the records were scooped back in again when they moved to another practice. I can only assume that the chief executive of NHS Rotherham did not know about the Information Commissioner’s decision at the time, because the second letter I received from the chief executive stated that it was more recent than he had been led to believe and that the records had been brought back from the new practice because they had just received information from the Information Commissioner that they had to change them.

I am deeply concerned about the situation. My constituent has effectively been railroaded into a situation she does not want to be in, and that she should not have to be in. Indeed, the British taxpayer has been railroaded into a situation that I do not think it should be in. My constituent said, not with my blessing—I give it my blessing now, though—that far too many people are forced into litigation in this country, at taxpayers’ expense, rather than following common sense by sitting down, looking at the problem and deciding what should be done sensibly, not feeding the law courts.

I have to tell the Minister that I am deeply disappointed that the Parliamentary and Health Service Ombudsman—I know that it is not directly a part of Government—can be run in that way and make those contradictory decisions. It seems to me that its decision is this: “We don’t have to do anything, so we’ll force her back to litigation if she does not want to go. That’s the end of the matter.” That cannot be correct, and I would like to know whether the Minister agrees.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I congratulate the right hon. Member for Rother Valley (Kevin Barron) on securing the debate and commend him for all the work he has done on behalf of his constituent, and for the work he did in the previous Parliament, before I was a Member, as Chair of the Health Committee. I know that he has a long and distinguished record of fighting on health issues in the House, for his constituents and more generally. I also congratulate him on his recent knighthood. I am sure that the House will echo those congratulations.

We can all agree that good-quality patient care is expected, regardless of which part of the country we live in, and that all patients should expect it. I pay tribute to the NHS staff in the right hon. Gentleman’s constituency for the work that they do.

I am sorry to hear about the difficulties that Mrs Barnes has experienced and that she is dissatisfied with the quality of the care she has received. It is never acceptable for a patient to receive anything less than the very best treatment and service from our NHS. However, I am sure that all hon. Members will appreciate that the provision of local health care services is a matter for the NHS locally and that the Department of Health and Ministers do not play a role in directly investigating individual localised health care complaints, which should, quite rightly, be investigated without political interference to ensure that there is no question of bias. There is an NHS complaints procedure to resolve concerns and to help local NHS organisations to learn from the experiences of their patients. On the anniversary of the Mid Staffordshire scandal and the Francis inquiry, it is right that we reflect on the fact that we have to learn from things that have gone wrong in our health service and make sure we put them right for the benefit of future patients.

I understand that, as the right hon. Gentleman outlines, Mrs Barnes has been pursuing this matter for many years and has made use of the NHS complaints system, up to and including the health service ombudsman, on a number of occasions. I also understand—this is an important point in the context of the ombudsman and other issues—that a number of the concerns that Mrs Barnes raises about her care relate to events involving non-NHS health care. I should make it clear that what I say relates to the NHS, and not to health care providers working outside the NHS with whom Mrs Barnes may have decided to undertake treatment.

It is relevant at this stage to say a few words about how the ombudsman system works.

[Kevin Barron]

I accept, to some extent, the Minister’s point about the wider issues, which were not a matter of referral to the ombudsman. However, a constituent might often go to the private sector needing to get things done because they are in pain, for example, and might then see a consultant they could also see under the NHS. Often the staff are the same people, and there is no great difference between the clinicians they meet. Does he agree with that?

[Dr Poulter]

The right hon. Gentleman is absolutely right. It is difficult, in terms of the care pathway, for any patient to draw these distinctions. However, the NHS complaints procedure relates to NHS care, and the ombudsman’s role is as a public sector ombudsman. That goes to the heart of some of the difficulties we are talking about.

If a complainant is dissatisfied with the outcome of their complaint locally, they have the right to take it to the health service ombudsman, whose office was set up under the Health Service Commissioners Act 1993. When complaints are escalated, it is important that they are investigated independently, free from the political process, to ensure that there is no question of bias. The health service ombudsman is completely independent of the Department of Health, the Government, and the NHS. It is therefore difficult for me to comment on the ombudsman’s decisions directly.

If a complainant is dissatisfied with the ombudsman’s decision, they may make use of her own complaints process. The recourse open to anyone after the ombudsman has made a final decision is to seek a judicial review. During the entire complaints process, we assume that patients would take legal advice whenever they think it necessary. That is in their best interests and, in some cases, it is often important that patients have advice from a completely independent source.

If, on the basis of the legal advice received, patients decide to commence legal action against the NHS, that is, of course, to be expected. The House will understand that I cannot comment on legal advice given to patients, including Mrs Barnes, as that is entirely a matter between the patient and her lawyer. Complaints about lawyers are not a matter for the Department of Health or the NHS, nor for this House to consider in this context. I am aware that Mrs Barnes has exhausted all the legal remedies open to her. Her case has been considered by a number of courts, including the Court of Appeal, and has on each occasion been rejected. It goes without saying that these matters will have been considered carefully by the various judges involved, and I should not and will not cast any doubt on their judgments.

[Dr Poulter]

My hon. Friend will be aware that patients have open access to their records and can request to see them, but it is not for a patient forcibly to remove relevant clinical information from them. I am not sure whether that was the case in these particular circumstances, but I hope to be able to reassure the right hon. Member for Rother Valley.

It is worth pointing out that, during the long line of litigation, in 2007 Mr Justice Simon said, following a hearing, that

“this is not a case of professional conspiracies by the medical or legal professions; it is a case where the balance of the evidence before the Court fell decisively and conclusively in favour of the defendant”,

meaning the NHS. There is a long history of legal rulings that make that point clearly. Indeed, I understand that the NHS Litigation Authority obtained cost orders in its favour for that case, although it was unable to recover its costs. I reassure the right hon. Gentleman, however, that I shall look into the issues he has raised about the ombudsman and the Information Commissioner and write to him about them.

[Kevin Barron]

I appreciate that. I know that there is some history to the case of Mrs Barnes, but in my humble view—I understand that the ombudsman and politicians should not get mixed up—this specific issue is not about what happened in the courts. It is about what did or did not happen at the request of the Information Commissioner. My reading of the situation is that it could have been managed and handled by the health service ombudsman and compensation could have been paid. In my view, the ombudsman sat back, possibly because of the history to which the Minister has just referred, and thought, “It’s got to go to litigation and that’s it.” When other avenues were closed off, the ombudsman’s office could have managed the situation, but it seems to me that it backed off, looked at the whole history of the case of Mrs Barnes and said that it had to go to litigation. I think that is unfair and that the ombudsman’s office could have handled things much better and smarter on behalf of my constituent.

[Dr Poulter]

I note what the right hon. Gentleman says. I have committed to looking further into the issue and to writing to him, and I hope that will reassure him further about the processes that have been followed in this case.

As I said at the outset, I am very sorry to hear that Mrs Barnes is unhappy at the care and treatment she has received from the NHS. I am also aware that, over the years, she has been seen and treated in a private capacity on a number of occasions, which, as we have discussed, complicates the issues, because it can make it difficult to establish whether the responsibility sits with the NHS—as part of either the ombudsman’s process or the NHS complaints procedure—or elsewhere. Her case has also been considered by the courts on a number of occasions and I have alluded to their conclusions.

I understand that Mrs Barnes made full use of the various NHS complaints processes, but remains dissatisfied, which we have discussed in detail today. Accordingly, she has involved the health ombudsman, but the outcome has not been as she would have wished.

As I have said—this is worth repeating—the ombudsman is independent of Ministers, the Department of Health and the Government. An option open to anyone dissatisfied with the ombudsman’s actions is judicial review, but it is not to be embarked on lightly and those considering doing so should ensure that they take legal advice.

I wish Mrs Barnes well and I appreciate the intentions of the right hon. Gentleman and his strong advocacy of her case.

Question put and agreed to.

NHS

Kevin Barron Excerpts

Wednesday 5th February 2014 Commons Chamber

[Mr Hunt]

I understand my hon. Friend’s frustration. This is the shadow Secretary of State who said that it was irresponsible to maintain the NHS budget at its current levels and who actually believes that it should be cut, and he has stuck to that position. It is not possible to make such investments by following the right hon. Gentleman’s advice.

The right hon. Gentleman talked a great deal about competition, and I am afraid that his comments about that also showed a wilful disregard for the facts. He raised two distinct issues, and he was right to do so, because they are important. The first relates to mergers. NHS hospitals often need to concentrate services for clinical and safety reasons, but the involvement of the Office of Fair Trading and the Competition Commission is not a result of the Health and Social Care Act 2012, as the right hon. Gentleman alleged. As he well knows, it is as a result of powers that they have under Labour’s Enterprise Act 2002. All my Front-Bench colleagues agree with me that we must ensure that when those powers are exercised, they are exercised in a way that is in the best interests of patients. For that reason, I have had useful discussions with both the Competition and Markets Authority—which is replacing the OFT and the Competition Commission—and Monitor about how their respective roles can be clarified.

[Kevin Barron (Rother Valley) (Lab)]

If the Secretary of State believes that, can he explain why the Health and Social Care Act contains a section stating that any mergers of NHS trusts must be referred to the Office of Fair Trading and the Competition Commission?

[Mr Hunt]

Yes, I can explain that. When drafting the Act, my predecessor wanted to ensure that investigations would not be carried out by both Monitor and the Competition Commission. [Interruption.] If Members wish me to answer the question, I will happily do so.

If we repealed the Health and Social Care Act—as the right hon. Gentleman has often argued should happen—the Competition Commission and the OFT, or the Competition and Markets Authority, would still have the power to stop mergers, under the Enterprise Act. The right hon. Gentleman should get his facts right before presenting his arguments.

Secondly, the Health and Social Care Act did not introduce new rules in relation to procurement. For all the efforts of the right hon. Member for Leigh to convince people otherwise, clinical commissioning groups observe the same procurement requirements as applied to primary care trusts. Labour may have made many mistakes in office, and the right hon. Gentleman may have shifted his own views dramatically to the left, but it will not do for him to try to seek cover for that by attaching blame to the Health and Social Care Act.

--- Later in debate ---

[Kevin Barron (Rother Valley) (Lab)]

First, I thank my right hon. Friend the Member for Leigh (Andy Burnham) for tabling the motion, because it gives us an opportunity to examine the whole issue of competition. Hon. Members will recall that I intervened on the Secretary of State on the subject of when competition came in to health care in this country, and he said that it had always been there. The hon. Member for Stafford (Jeremy Lefroy) and the right hon. Member for Sutton and Cheam (Paul Burstow) will recall, as they served on the Committee for the Health and Social Care Bill, that when I intervened on the right hon. Member for Chelmsford (Mr Burns), a Minister at the time, to ask what the Competition Commission and the Office of Fair Trading had got to do with the mergers of NHS trusts, he did not answer me. I asked that question during a clause stand part debate and he did not know that the question was coming. It was not part of an amendment and it was not flagged up to the advisers as being something likely to happen. I raised it on several occasions in that Committee and on the Floor of the House during an Opposition day when he was winding up, and he did not answer me then either.

We have now got the answer, and it came in November. My right hon. Friend mentioned what the then outgoing NHS chief executive said to the Health Committee last November. Commenting on the new rules, he said:

“I think we’ve got a problem, which may need legislative change.”

Of course, that is absolutely right, because we had legislative change when the Health and Social Care Act 2012 came in—that is the truth. It changed statute: it meant that the OFT and the Competition Commission can interfere in health care. That is what it did and that is what it was meant to do. That is what the Opposition questioned and voted against at the time—that is the truth.

My right hon. Friend talked about the cost of all this in terms of the Freedom of Information Act and the millions of pounds spent on external competition lawyers. My local Rotherham hospital has spent tens of thousands of pounds on London lawyers, and for what? There is no prospect of a merger or anything else. This money is seeping out of the local health pot, just so that advice about competition law can be got from lawyers based in London. This is real: if people want to do anything, they are going to have to take legal advice about doing it. That is the truth.

I have to say to my right hon. Friend the shadow Health Secretary that he may have an ally in the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb). I am told that he said last week:

“I have a problem with OFT being involved in all these procurement issues…I think that’s got to change. In my view it should be scrapped in the future.”

I wait to see how he is going to address these things—if he did indeed say that—when he winds up this debate. If he did say it, I agree with him, as would many others out there.

I wish to make a couple of other points, one of which is about what happened in Bournemouth and Poole, where a merger was blocked by the Competition Commission last autumn. When it was blocked, the chief executives of the Bournemouth and the Poole hospital trusts said in a joint statement that they were “deeply disappointed” by the decision. They said:

“The benefits of merger, which included increased access to consultant care and new patient facilities, will now be much more difficult to deliver, which is disappointing for both our patients and staff.”

They went on to say:

“We recognise that the Competition Commission has a statutory role to perform”—

my argument is that it never had such a role before a change in the law—

“and specific criteria which it must use to assess benefits, but we believe that the outcome of the process is fundamentally wrong. The assessment of the merger was always weighted to put competition ahead of benefits to patients, and we do not believe the NHS is best served in this way.”

The Government amendment to our motion today states that

“clinicians are in the best position to make judgements about the most appropriate care for their patients.”

That is not the case in Bournemouth and Poole. The Competition Commission has decided, against clinicians’ wishes, to stop the merger going ahead. That is the truth, and that is how we should read the amendment. It is false in what it says. It then goes on to say that it

“notes that the rules on tendering are no different to the rules that apply to primary care trusts.”

That is not true. The rules changed when the Health and Social Care Act was passed. That is why competition and changes in the health service are matters for lawyers now. [Interruption.] The hon. Member for Bournemouth East (Mr Ellwood) might represent one of the hospitals, but his hospital and his local clinicians stopped the merger because the Competition Commission said that it was wrong. This is about competition law, and not about providing patient services.

[Mr Tobias Ellwood (Bournemouth East) (Con)]

This came in in 2002.

[Kevin Barron]

Let me touch briefly on the matter that is in today’s press. The Secretary of State said that we had to keep people out of A and E; he is absolutely right. If I made an addition to our motion today, it would have been around the issue of alcohol. Alcohol is a major problem in accident and emergency departments throughout the land. It used to be an issue on Friday and Saturday nights, but now it is an issue seven nights a week in cities. Not that long ago, the Prime Minister said that the Government were considering putting a minimum price on a unit of alcohol to reduce binge drinking and to improve public health. Today we had an announcement from the Minister for Crime Prevention, the hon. Member for Lewes (Norman Baker)—not from the Department of Health—that the Government are to ban the sale of cheap alcohol in England and Wales because they want to cut back on alcohol-related crime. People who work daily with the problems of alcohol and alcoholism have expressed views on the matter. The Alcohol Health Alliance, which includes the medical royal colleges, said that the impact of the ban on selling at below duty plus VAT would be negligible. It will affect about 1.3% of sales.

Eric Appleby, the chief executive of Alcohol Concern, said:

“The idea that banning below-cost sales will help tackle our problem with alcohol is laughable, it’s confusing and close to impossible to implement. On top of this, reports show it would have an impact on just 1% of alcohol products sold in shops and supermarkets leaving untouched most of those drinks that are so blatantly targeted at young people. The government is wasting time when international evidence shows that minimum unit pricing is what we need to save lives and cut crime.”

I could go on, but suffice it to say that the Government have completely dumped the idea that alcohol is a threat to the public health of this country. The measure will not stop people bingeing. It will not stop alcohol-fuelled people turning up at A and E. The truth is that some 50% of people who turn up at A and E get no treatment at all. We should be looking at the societal effects that are driving people into A and E departments—whether it is closure of walk-in centres or the fact that too many people are falling down because they have had too much to drink and believe that they have a right to block up A and Es and potentially slow down treatment for those who are facing an emergency. The Government are ducking the issues related to alcohol and are ducking the problems in A and E departments up and down the land. It is about time they showed some courage and did something positive. Alcohol is a public health issue, not a crime issue.

--- Later in debate ---

[Paul Burstow]

That is absolutely right. For example, in continuing health care there is often a great deal of contestability that leads to discharge delays, but they are NHS-caused delays. I am not saying that the NHS should be blamed any more than social services, but I want some honesty about how the figures are presented as they do not bear close scrutiny in the argument made by the right hon. Member for Leigh. His solution is simplistic, too. It is good to have a debate about competition policy—I remember Labour Ministers trumpeting the introduction of the first competition policies in the NHS and the establishment of the competition and collaboration committee in the Department of Health. Labour established those policies.

Monitor’s role is to protect the interests of patients—that is what it says in the Health and Social Care Act 2012—not to promote competition. The idea that we can solve the problem by sweeping away Monitor opens the doors to competition red in tooth and claw. Of course, the Competition Act 1998, the EU’s competition legislation and procurement law would still apply without any of the fetters, barriers or protections that Monitor can and should be providing in its role as the regulator of competition in the NHS.

[Kevin Barron]

It is interesting that the right hon. Gentleman says that, because he knows from his time on the Health Committee that European competition law is not used in any health care system across the European Union.

[Paul Burstow]

The problem is that EU competition law was brought into our law through the 1998 Act. That was what opened this particular box, and by bringing Monitor into the picture and giving it the mission of protecting the interests of patients, we put that issue back in its box—and the right hon. Member for Leigh would sweep that away.

Hospices (Children and Young People)

Kevin Barron Excerpts

Wednesday 18th December 2013 Westminster Hall

[Mr Kevin Barron (Rother Valley) (Lab)]

I congratulate the hon. Member for Pudsey (Stuart Andrew) on securing this debate. I will try to keep my contribution as short as possible as other hon. Members want to speak. First, I think it right and proper to say a few words about Bluebell Wood children’s hospice in North Anston in my constituency. It is in 6.5 acres of land that was regenerated after closure of the local coal mine, and has its own exclusive access road. Its highly specialised care team look after children with a vast range of complex medical needs and support the whole family on their life journey, offering short respite breaks, day care provision, community support, crisis intervention and end-of-life treatment and care.

Families often come to Bluebell Wood hospice exhausted after caring for a child with a life-limiting condition requiring 24-hour, seven days a week care. It is there to help, and offers respite care to the whole family and gives them the opportunity to spend quality time together knowing their child is in safe hands. It gives families the chance to recharge their batteries and to come and go as they wish. It is a relaxed, fun and happy place to be, where brothers, sisters, mums and dads can enjoy the fun and games. Its motto is “living with love and laughter”.

The hospice provides eight beautifully appointed bedrooms for children and young people as well as accommodation for families. It also has two end-of-life suites, “Primrose” and “Forget-Me-Not”, which are self-contained accommodation suites where parents can stay after their child has passed away. The deceased child can stay in a special adjoining room to be close to them. They can stay until the funeral, giving family and friends the opportunity to visit at any time. The staff are also on hand to help the family with any funeral arrangements if necessary.

The hospice boasts a music room, messy play room, sensory room, cinema room, soft play area, teenage room and Jacuzzi. It is surrounded by beautiful and tranquil gardens, including a dragonfly remembrance garden, which was built by Alan Titchmarsh and was featured on his ITV programme, “Love Your Garden”. It offers care and support for children and young people with a shortened life expectancy, both in their own homes and at the hospice. There are only 43 children’s hospices in the country and Bluebell Wood cares for more than 170 children from south Yorkshire, north Derbyshire, north Nottinghamshire and parts of north Lincolnshire.

Fundraising for the hospice started in 1998 after the death of an 11-year old boy, Richard Cooper, who had a rare degenerative disease and longed for care and support outside a hospital environment. The charity was established, and community support to build a children’s hospice in south Yorkshire was quickly forthcoming. After a lot of fundraising and working with families in the community for two years, Bluebell Wood children’s hospice proudly opened its doors to children with life-limiting conditions on 19 September 2008.

[Fabian Hamilton]

I would like to pay my own tribute to Bluebell Wood, as well as Martin House, both of which I know. Does my right hon. Friend agree that one of the best ways in which all hon. Members here can help to support the hospice movement—as he and the hon. Member for Pudsey (Stuart Andrew) have done—is to come and support the all-party group on hospice and palliative care, which meets regularly in this place, at least every three months, and brings together professionals from hospices all over the country? Will he please endorse the request to attend those meetings and support the all-party group?

[Mr Barron]

I am a member of the all-party group—indeed, I am an advocate of all-party groups—and I believe that bringing together professional people from the hospice movement leads to advancement and educates us about what is happening out there in the real world.

Bluebell Wood has 90 employees, including the care team and administrative staff, and currently more than 350 active volunteers. The hospice and I are extremely proud of them. It would not be the place it is today without them. They work on reception and in the kitchen, they help with the housekeeping and administration, they dig the gardens, paint rooms and help in the shops, to name but a few tasks they carry out. The hospice has eight shops in the surrounding region which raise funds. They are based throughout south Yorkshire, and there is also one over in Derbyshire, in Bakewell. I want to point out to the Minister that it costs more than £3 million for Bluebell Wood.

[Mr Nigel Dodds (Belfast North) (DUP)]

I join in congratulating the hon. Member for Pudsey (Stuart Andrew) on securing this important debate. Would the right hon. Member for Rother Valley (Mr Barron) allow me to offer my thanks and support, on behalf of my constituents, to the Northern Ireland children’s hospice, which looks after 600 life-limited children and young people, and to the volunteers and staff there? The recent announcement by the Minister of Health in Northern Ireland to allocate £2.3 million towards the hospice movement, including the adult hospice in my constituency, has proved an enormous boost to all those involved in looking after the terminally ill in Northern Ireland.

[Mr Barron]

The right hon. Gentleman makes his case very well. As I was saying, Bluebell Wood costs £3 million a year. I notice that my hon. Friend the Member for Rotherham (Sarah Champion) is in the Chamber today; she was the chief executive at Bluebell Wood hospice until what I think I could call her “elevation” to become the hon. Member for Rotherham just over 12 months ago—I see that she is not too sure about that phrase. Bluebell Wood costs £3 million a year and as we know, adult hospices in England receive an average of about 34% of their funding from Government. Children’s hospices typically receive much less Government funding—somewhere in the region of 15% of their running costs—although some get next to nothing, and I have to say that Bluebell Wood falls into that category. It receives 5% of its funding from Government and, were it not for the volunteers, the rest of it would not be there at all. It certainly would not be in the shape that it is now, providing that vital service, not only in the hospice itself, but at home.

In the summer of 2010, the Government set up a review of palliative care funding and in July 2011, they published a report, which I recognise stated that there is

“a stunning lack of good data…for palliative care in England.”

I know that finding a tariff, finding out the right costs and what should be paid is very difficult, but the national health service is, far too often, taking decisions without evidence. I see a need for that evidence to be collected.

Pilot sites were offered in November 2011, and I do not know how many sites were set up in March 2012. Can the Minister say when those pilots are likely to have enough good data that we are able to take real decisions about how the NHS, although it should not take over hospices such as Bluebell Wood, should perhaps contribute a bit more to the vital care that those children, young adults and families receive in hospices?