Oral Answers to Questions

Debate between Liz McInnes and Jeremy Hunt

Tuesday 14th May 2019 Commons Chamber

[Liz McInnes (Heywood and Middleton) (Lab)]

Last month we saw the Trump Administration threatening to veto a UN resolution against the use of rape as a weapon of law unless all references to the reproductive rights of women were removed. Even more disgracefully, we saw the UN accept their demands. Can the Secretary of State explain why a President like that deserves the honour of a state visit?

[Mr Hunt]

With the greatest respect to the hon. Lady, who makes excellent contributions to debates in this House, I just wish that Labour got its priorities right. This is a party whose leader says that Hamas and Hezbollah are friends and refuses to go to a state banquet with the President of the United States. The resolution she talked about actually passed. The United Kingdom supported it. We do not agree with America on everything, but we do think we should show respect for its enormous contribution to world peace.

Oral Answers to Questions

Debate between Liz McInnes and Jeremy Hunt

Tuesday 8th May 2018 Commons Chamber

[Mr Hunt]

That is an excellent initiative from Scotland, and it shows why we all benefit from being in the United Kingdom together. Yes, we will look at it very closely.

[Liz McInnes (Heywood and Middleton) (Lab)]

In tackling childhood obesity, will the Health Secretary declare his support for Jamie Oliver’s AdEnough campaign and get rid of pre-watershed television advertising of junk food to our children?

[Mr Hunt]

That is one of a number of measures that we are looking at. We are absolutely determined to do something about this. One in 10 children starts school obese, and by the time they leave primary school the figure is one in five. We cannot wait any longer.

Breast Cancer Screening

Debate between Liz McInnes and Jeremy Hunt

Wednesday 2nd May 2018 Commons Chamber

[Mr Hunt]

I am very happy to make that commitment.

[Liz McInnes (Heywood and Middleton) (Lab)]

I hope that the independent review will investigate this, but is the Secretary of State aware of any instances of GPs inquiring why patients who should have had a final breast screen were not invited to have one?

[Mr Hunt]

That is a very good question. I am not aware of any such instances, but that is exactly what we want to look at in the review. It does seem strange that people who were expecting to be invited did not come forward, and that their not receiving an invitation did not set any hares running. That is one of the things that we need to look at.

Medicines and Medical Devices Safety Review

Debate between Liz McInnes and Jeremy Hunt

Wednesday 21st February 2018 Commons Chamber

[Mr Hunt]

I wish it was easy to give the hon. Gentleman a straightforward answer, but the truth is that there is much scientific disagreement about whether there is a causal link, which makes it difficult to give clear answers to his constituents and, indeed, to mine. I hope that the review will shed some clarity on the situation, because that is what many people want.

[Liz McInnes (Heywood and Middleton) (Lab)]

What advice has the Secretary of State sought from the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists and the Royal College of Pathologists? What involvement will those bodies have in the review?

[Mr Hunt]

Baroness Cumberlege has honorary fellowships at the Royal College of Nursing and the Royal College of Physicians, so she is well connected with all the organisations that the hon. Lady mentioned.

Oral Answers to Questions

Debate between Liz McInnes and Jeremy Hunt

Tuesday 19th December 2017 Commons Chamber

[Liz McInnes (Heywood and Middleton) (Lab)]

What funds are being made available to our mental health services to meet the additional demands placed on them by changes in the Mental Health Act 1983, which came into force on 11 December this year?

[Mr Hunt]

I can reassure the hon. Lady that we are putting a lot of extra funding into mental health— £575 million last year alone—to meet those and other obligations.

Oral Answers to Questions

Debate between Liz McInnes and Jeremy Hunt

Tuesday 14th November 2017 Commons Chamber

[Liz McInnes (Heywood and Middleton) (Lab)]

What safeguards will the Secretary of State put in place to ensure that NHS trusts do not finance the lifting of the pay cap by making staff cuts, downgrading roles or reducing terms and conditions under the guise of reforms?

[Mr Hunt]

NHS trusts are under pressure to make very ambitious efficiency savings anyway. We have listened carefully to their case that they would not be able to make further efficiency savings to finance an increase in pay beyond the 1% cap.

NHS Shared Business Services

Debate between Liz McInnes and Jeremy Hunt

Tuesday 27th June 2017 Commons Chamber

[Mr Hunt]

We are paying GP surgeries for the extra admin time that this is taking. That is designed to ensure that, where necessary, they can buy in extra resources to deal with the extra admin. The hon. Lady is absolutely right that we have to ensure that GPs’ core work is not compromised by the issue.

[Liz McInnes (Heywood and Middleton) (Lab)]

I used to work as a clinical scientist in the NHS, so I know only too well the harm that can be caused by the non-arrival of a test result. If a diagnostic test is performed and the result goes nowhere and is not seen by a clinician, as in this case, it is the same health outcome as if the test was not done at all. Will the Secretary of State stop trying to downplay the situation and own up to the seriousness of this scandal?

[Mr Hunt]

No one listening objectively could possibly say that I am, or that anyone on this side of the House is, downplaying this very serious situation. Since the issue came to light, we have instituted a review of 709,000 pieces of patient correspondence. We have identified the high-priority ones, of which there are 2,508. Two, and sometimes three, clinical tests have been done on all of them. No patient harm has been identified to date, but we are not complacent. We will continue the process until we have been through every single patient record with that thoroughness.

NHS Shared Business Services

Debate between Liz McInnes and Jeremy Hunt

Monday 27th February 2017 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. This is a very big part of our transformation plans for the NHS. Where the NHS does well internationally is in out-of-hospital records; our GP records are among the best of any country’s. GPs have done a fantastic job over the past 15 years in keeping all their records electronically, and they provide a lifetime snapshot of a patient’s history. Where we are less good is in our hospital records, where one can still find paper records in widespread use. That is not just very, very expensive but—he is quite right—unsafe at times.

[Liz McInnes (Heywood and Middleton) (Lab)]

I used to work in a pathology lab, and it absolutely pains me to think of those results generated by the hard work of pathology staff languishing in a warehouse somewhere, unseen by anybody. If GPs do not get lab results, they will ring the laboratory and ask for them, so has the Secretary of State made any estimate of the time wasted in phone calls from GP surgeries to pathology labs?

[Mr Hunt]

I am sure that, regrettably, because of what happened extra work was created for GPs. However, because of GPs’ commitment to their patients, it appears that in the vast majority of cases patient harm was avoided. When results do not come through that a GP is expecting, the GP chases them to make sure that the right thing is done for patients—but of course, as the hon. Lady rightly says, at the cost of extra work.

Mental Health and NHS Performance

Debate between Liz McInnes and Jeremy Hunt

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

I thank the hon. Lady for her work on the all-party group. I am more than happy to meet Dr Colgate. The purpose of the refreshed suicide prevention strategy is to try to ensure that we adopt best practice throughout the country. Some areas of the country are doing a very good job in suicide prevention, particularly in co-opting the public so that they understand that they can make a difference, too, but I am happy to explore with the hon. Lady what more can be done.

[Liz McInnes (Heywood and Middleton) (Lab)]

The Secretary of State rightly pays tribute to NHS staff, but the reality is that many of our NHS workers are now at breaking point. They continue to perform their work with care and compassion in spite of, rather than because of, any action taken by the Health Secretary. It is now time for him to act. What commitment will he give to investing properly in NHS staff, and to reversing the process of the deskilling, demoralisation and downgrading of NHS staff that he and his Government have presided over since 2010?

[Mr Hunt]

With respect to the hon. Lady, who I know cares passionately about the NHS and often asks me questions about it, we now have 11,400 more doctors and 11,200 more nurses in the NHS than in 2010. We protected the NHS budget in 2010, when her party wanted to cut it, and we promised £5.5 billion more for the NHS than her party was prepared to promise at the most recent election. Her characterisation of this Government as not being prepared to back NHS staff is utterly absurd.

CQC: NHS Deaths Review

Debate between Liz McInnes and Jeremy Hunt

Tuesday 13th December 2016 Commons Chamber

[Mr Hunt]

My hon. Friend makes a really important point. I will have discussions with the Minister responsible for social care, the Under-Secretary of State for Health, my hon. Friend the Member for Warrington South (David Mowat), about what we can do in the social care field. I am optimistic that we can do something, because if we make this part of the framework of the new CQC inspection regime—obviously, that has to happen with the consent of the CQC—we can create a very strong incentive for adult social care providers to do what we want and to follow what is happening in the NHS.

[Liz McInnes (Heywood and Middleton) (Lab)]

I, too, want to raise the issue of the appalling neglect in medical care at Pennine Acute. The report—the extremely damning report—only came to light following the persistence of Jennifer Williams, a journalist on the Manchester Evening News, and the bravery of a whistleblower at the trust. I know that the Secretary of State will do what he can to protect whistleblowers, but how will he enforce a no-blame culture and a culture of openness in a trust such as Pennine Acute that appears to have tried actively to suppress this extremely damning report?

[Mr Hunt]

There should be no hiding place for managers who neglect their legal responsibility, which is the duty of candour that we in this place passed into law in 2014. That is my first point. It is also important to be realistic about the ability to impose a culture on organisations by ministerial diktat, but we can achieve that because this is something that NHS staff want. In some ways, what is most worrying about Pennine is that Salford Royal, one of the best hospitals in the NHS, is virtually next door to it, but the transmission of learning at Salford Royal did not seem to penetrate even into a neighbouring hospital. That is why we must get much better at sharing learning between hospitals.

Junior Doctors Contract

Debate between Liz McInnes and Jeremy Hunt

Wednesday 6th July 2016 Commons Chamber

[Mr Hunt]

My hon. and learned Friend is correct to have raised that before and I can reassure him that we have subsequently started a very big piece of work to look at those exact issues. The difficulty is that throughout their training junior doctors are rotated every six months. That is particularly disruptive to family life or, for example, if they have a partner and one is sent to Sheffield and the other to Bristol. We are seeing what we can do to deal with that. The other issue that we are looking at is that of people who for family reasons discover that they have a caring responsibility, maybe for children or for a parent with dementia, and want to switch to a specialty that may not have quite so many unsocial hours, and whether it is possible to novate their training across from one specialty to another, which does not happen at present.

[Liz McInnes (Heywood and Middleton) (Lab)]

We are all congratulating each other on the measured tone of this debate, but Dr Johann Malawana has said in very measured tones:

“Given the result, both sides must look again at the proposals and there should be no transition to a new contract until further talks take place.”

Will the Health Secretary commit to hold further talks in order to avoid further conflict and the possibility that he may provoke further strike action if he does not? If he provokes further industrial action among the junior doctors, the blame will lie fairly and squarely at his open door.

[Mr Hunt]

Let me tell the hon. Lady the words that Dr Malawana actually said:

“I will happily state that I think this is a good deal.”

He talked about junior doctors benefiting from

“massively strengthened areas of safety precautions…equalities improvements, improvements to whistleblowing protection and appropriate pay for unsocial hours.”

He thought this deal was a big step forward. As I said, if I thought that there was any prospect of further negotiations leading to a consensus that could get the support of the BMA membership, that is what I would be doing, but my honest assessment of the situation—given that the people who most strongly opposed the Government recommended accepting this deal and still they were not listened to—is that there is no such prospect, and I therefore need to take the difficult decision that I have taken this afternoon.

Junior Doctors Contract

Debate between Liz McInnes and Jeremy Hunt

Thursday 19th May 2016 Commons Chamber

[Mr Hunt]

It is a great tragedy that the dispute unfolded in the way that it did, and I am sure that people with different agendas have not played constructive roles at various points. Given that we now have an agreement, I want to move forward positively and say that the lesson of the last 10 days is that when people sit down and negotiate about all the outstanding issues with a Government who are trying to make care safer and better for patients, we get a result that is good for everyone.

[Liz McInnes (Heywood and Middleton) (Lab)]

It is not the time to claim victory: this negotiated agreement now has to be put to the members of the British Medical Association. Will the Secretary of State acknowledge that his own refusal to negotiate exacerbated this crisis? Will he cease referring to the British Medical Association as a militant trade union, and will he heed the call from my hon. Friend the shadow Secretary of State for a period of silence in order to avoid antagonising the junior doctors still further?

[Mr Hunt]

Let us be absolutely clear: there was never a refusal to negotiate on the Government’s side. We have now developed a lot of trust between the Government and the BMA leadership, but until that point it balloted for industrial action without even sitting down and talking to the Government, and it refused to discuss the issue of weekend pay premiums, which was the crucial change we needed for a seven-day NHS. It was when the BMA changed its position in those areas that we were able to have constructive talks, and that is why it deserves great credit for coming to the table and negotiating—something it had not wanted to do previously—and that led to the solution.

Junior Doctors Contracts

Debate between Liz McInnes and Jeremy Hunt

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

I thank my hon. Friend, who eloquently makes the point that this is a moment of opportunity for the NHS. We have been through some terrible problems at Mid Staffs and a number of other hospitals where there were serious issues with the quality of care, and now we are going on a journey to make the NHS one of the safest healthcare systems in the world. That means facing up to these problems, not ducking them, and that is what is going to happen for the time that I am Health Secretary.

[Liz McInnes (Heywood and Middleton) (Lab)]

The junior doctors I have spoken to are concerned about unsafe staffing levels and unworkable rotas as a result of the imposition of this contract. They ask me to make it clear to patients and to the public that the two strike days are nine hours in length and will last from 8 am until 5 pm, and that emergency care will be provided by consultants. The solution is in the Health Secretary’s hands: withdraw the imposition of this contract and get back round the negotiating table.

[Mr Hunt]

As I have said many times, were we to do that we would be giving the BMA a veto over a manifesto commitment, and no union should have a veto over what an elected Government do. I hope that what I said in my statement will give comfort to the hon. Lady and some of her constituents that we are increasing staffing levels in the NHS to deal with the extra pressures. With regard to unworkable rotas, perhaps she will go and tell the BMA to sit round the table and talk to its local trust managements so that we can get those rotas to work, because the way to sort out these problems is to sit down and discuss them.

Junior Doctors Contracts

Debate between Liz McInnes and Jeremy Hunt

Monday 18th April 2016 Commons Chamber

[Mr Hunt]

I absolutely agree. It is entirely legitimate to disagree with the Government of the day about contract reform—we have tried to make the case as to why that reform is important—but it is wrong for patients to pay the price for that disagreement. While the NHS can cope with the withdrawal of labour for elective care, it is a much bigger deal when emergency care is withdrawn, and people throughout the NHS are extremely worried about the impact of that. Doctors should also worry about how the public will view their profession if they proceed with this wholly unnecessary step.

[Liz McInnes (Heywood and Middleton) (Lab)]

I am glad the Secretary of State has come to the Chamber to answer the urgent question—I witnessed for myself his eagerness to get here as he sprinted across Portcullis House.

There is a real lack of clarity in this debate. “Agenda for Change” staff get paid a premium rate for working unsocial hours. Foundation trusts’ freedom to set rates allows them only to improve conditions and pay, not to diminish them. May I add that 98% of those who voted in the BMA’s ballot supported industrial action, including the full withdrawal of labour? May I suggest that the Secretary of State arm himself with the facts and get back round the negotiating table?

[Mr Hunt]

The hon. Lady is right that I sprinted here—I was a little concerned that Defence questions might not last the full hour, although they did, and I am sure Mr Speaker is pleased about that. The point I would make about the ballot, which did receive the overwhelming support of junior doctors, is that it happened before they knew what the deal on the table was. On the heated issue of Saturday premium rates, we ended up with a proposal where the Government agreed to pay premium pay on Saturdays for any doctors who work one Saturday or more a month. At the moment, therefore, we have this extreme step—the withdrawal of emergency care—to boost the pay of doctors who work less than one Saturday a month. I think many members of the public will say that that is not proportionate.

Junior Doctors Contracts

Debate between Liz McInnes and Jeremy Hunt

Thursday 11th February 2016 Commons Chamber

[Liz McInnes (Heywood and Middleton) (Lab)]

Can the Secretary of State clarify something in his statement for me? He says that “those working one in four Saturdays or more will receive a pay premium of 30%. That is higher on average than that available to nurses, midwives, paramedics and most other clinical staff”. The staff he cites will be employed on bands 4 to 9 under “Agenda for Change” terms and conditions. If they work Saturdays, they receive plain time plus 30% for working then, so can the Secretary of State tell me how he has calculated an average? I do not understand his mathematics.

[Mr Hunt]

I am happy to do that. The contract that we are going to implement gives junior doctors who work more than one in four Saturdays—so one in three Saturdays —a higher premium of 50%, so when taken on average, it is a higher premium for working on a Saturday.

Oral Answers to Questions

Debate between Liz McInnes and Jeremy Hunt

Tuesday 9th February 2016 Commons Chamber

[Mr Jeremy Hunt]

The Government have made a huge and significant assessment of the cost of overseas people using the NHS, and we think that there are £500 million of recoverable costs that we do not currently recover. When it comes to the EU, the biggest problem that we have is that we are able to reclaim the costs of people temporarily visiting the UK, but we do not do so as much as we should because the systems in hospitals are not as efficient as they need to be. We are sorting that out.

[Liz McInnes (Heywood and Middleton) (Lab)]

T5. Despite the prevalence of pancakes in Parliament today, I am pleased to be asking a food-related question. A recent opinion poll performed by Diabetes UK showed that three quarters of British adults think food and drink manufacturers should reduce the amount of saturated fat, salt and sugar in their products. Does the Minister support introducing mandatory targets for industry to reformulate food and drink products to help people to eat more healthily, and will that form part of the Government’s childhood obesity strategy?

Southern Health NHS Foundation Trust

Debate between Liz McInnes and Jeremy Hunt

Thursday 10th December 2015 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. It seems wrong to draw any crumbs of comfort from the awful things in the draft report, but we can draw some comfort from the fact that the NHS itself is commissioning hard-hitting reports that do not pull any punches—the new CQC inspection regime does exactly that. I commend all the staff at Medway hospital who have worked so hard to raise the standard of care over the last few years. I know it has not been easy for them.

[Liz McInnes (Heywood and Middleton) (Lab)]

The Secretary of State has not yet mentioned the role of the medical examiner. Does this latest tragedy not illustrate that the introduction of a national system of medical examiners, as recommended by the Shipman, Mid Staffs and Morecambe Bay public inquiries and supported by the Royal College of Pathologists, is now long overdue?

[Mr Hunt]

I agree with the hon. Lady. It was also a recommendation of the Francis report that the coalition Government committed to implementing. We will tell the House shortly what our plans are on this front.

Oral Answers to Questions

Debate between Liz McInnes and Jeremy Hunt

Tuesday 13th October 2015 Commons Chamber

[Tulip Siddiq (Hampstead and Kilburn) (Lab)]

17. What additional financial support he is making available to the NHS to help it deal with winter pressures.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Some £400 million in resilience money has been invested in the NHS for this winter. Learning from previous years, we have put this money into the NHS baseline for 2015-16 so that the NHS can plan effectively at an earlier stage.

[Liz McInnes]

I thank the Secretary of State for his response. In my constituency we have an excellent and much-used facility—a walk-in centre in Middleton town centre—which is now threatened with closure. Will he support our campaign to keep it open? Does he agree that its closure would create more A&E attendances and increase winter pressures on our acute services?

[Mr Hunt]

I welcome the question and understand the hon. Lady’s concerns about the changes. She will understand that we do not direct these changes centrally and they are decided locally. One of the things we have to try to do is deal with the confusion a lot of people have at a local level as to what they should do when they have, for instance, a child with fever at the weekends and whether they require a GP, an urgent care centre or an A&E department. I would ask all CCGs to be very careful to make sure they sort out that confusion so NHS patients know exactly what they should do.

NHS Reform

Debate between Liz McInnes and Jeremy Hunt

Thursday 16th July 2015 Commons Chamber

[Mr Hunt]

My hon. Friend speaks with great knowledge about health matters, because of her previous job. [Hon. Members: “McKinsey.”] Yes, McKinsey, which does some important work for the NHS. She is absolutely right that we need to be able to discharge into the community on all seven days, and it is important that the primary care and social care systems are part of that change.

[Liz McInnes (Heywood and Middleton) (Lab)]

When does the Secretary of State intend to implement the recommendation of the Royal College of Pathologists and introduce the role of medical examiner, to provide independent scrutiny of deaths? That has been repeatedly delayed, despite the success of five pilot schemes and the fact that it was recommended in the Francis report.

[Mr Hunt]

That is an important recommendation, and the Government support it. We intend to implement it, but there are costs involved, which we are going through as part of the spending review process.

Maternity Services (Morecambe Bay)

Debate between Liz McInnes and Jeremy Hunt

Tuesday 3rd March 2015 Commons Chamber

[Mr Hunt]

Dr Mike Durkin will be delighted that he has been promoted and given a knighthood for his wonderful work on patient safety, but it has not happened yet, even though he certainly deserves it. I thank my hon. Friend for his understanding of the complexity of these issues and the importance of the need for culture change. The work of his Committee has not been to scratch around the surface; it has tried to think hard about the solution. He is absolutely right that we need to end regulatory confusion. We now have a strong CQC, which is doing incredible inspections and is trusted across the system. However, we need a system in which people can get independent external advice quickly, which is why he was right to alert me to the potential of an air accidents investigation branch equivalent. I hope that is something that could be helpful for the ombudsman as well.

[Liz McInnes (Heywood and Middleton) (Lab)]

I am pleased that the Secretary of State has declared his intention to implement the medical examination review. The president of the Royal College of Pathologists, Dr Suzy Lishman, has said that introducing such a system would

“improve patient care whilst reducing harm and saving money”.

She went on:

“If bereaved relatives get the answers that they need around the time of death, if all their questions are answered then, then they don’t feel the need to sue the NHS to get the answers they deserve.”

She has also said that it is “incomprehensible” that the recommended changes have not been implemented. Will the Secretary of State explain why there has been so much delay? From his answer to a previous question, I understand that he is not able to commit to implementing the reforms during the time of this Government.

[Mr Hunt]

With the greatest respect, I say to the hon. Lady that if she is suggesting that we have done nothing on this important issue over the last few years, nothing could be further from the truth. We have been trialling the right system; we think the trials have worked; and we want to make sure that we implement this in a way that is consistent with the many other things we are doing to improve patient safety, including proper case-note reviews of deaths in order to understand the level of avoidable hospital deaths and what we can do to bring the rates down. This is a priority for the Government, and we remain wholly committed to it.

Francis Report: Update and Response

Debate between Liz McInnes and Jeremy Hunt

Wednesday 11th February 2015 Commons Chamber

[Mr Hunt]

Absolutely. I have visited George Eliot hospital, and observed a few beds in the A and E department. One of the most inspiring things about it is that it came out of special measures by developing a strong link with University Hospitals Birmingham NHS Foundation Trust—under the leadership of Dame Julie Moore—which enabled it to learn very quickly what changes were needed. The “buddying” of trusts in difficulty with high-performing trusts is one of the measures that have worked the best.

[Liz McInnes (Heywood and Middleton) (Lab)]

I am pleased that the report mentions support for the right of NHS workers to speak up. When I was a Unite workplace rep in the NHS, I spent much of my time giving support and advice to workers who asked about blowing the whistle on malpractice. Does the Secretary of State recognise the vital advisory and supportive role provided by trade unions in the NHS, and will the Government cease their attacks on trade union facility time?

[Mr Hunt]

I agree that unions have an important role, but this should not have to be about unions. Regardless of whether a hospital has unions, people should be able to contact someone independent if they feel that their concerns about poor care are not being listened to, and that person should be enthusiastic about listening to what they say.

Five Year Forward View

Debate between Liz McInnes and Jeremy Hunt

Thursday 23rd October 2014 Commons Chamber

[Mr Hunt]

I congratulate my hon. Friend on finding every opportunity to promote integrated care. What the report says is that we need much more person-centred care. It welcomes the kind of models that we see in Tower Hamlets, where the new clinical commissioning groups, led by inspiring leaders such as Sam Everington, are carrying out social prescribing. GPs are actually prescribing social solutions to problems as well as medical ones. This report is a big stepping stone towards that type of integrated care.

[Liz McInnes (Heywood and Middleton) (Lab)]

In my constituency last year, 23,000 people were unable to see their GP within a week. What, if anything, will these plans do to address that crisis?

[Mr Hunt]

I welcome the hon. Lady to her place. This report says something with which this Government very strongly agree, which is that we need to reverse the shift that there has been over many decades of investment away from community care towards hospital care. It is really important that we focus on the role of GPs. We do not want to force all GPs to become employees of hospitals, but we would like to back them, so we have brought back personal responsibility for GPs for every single NHS patient as an important first step in that direction.