Oral Answers to Questions

Lord Watts Excerpts

Tuesday 21st October 2014 Commons Chamber

[Caroline Lucas (Brighton, Pavilion) (Green)]

1. What progress he has made on negotiations relating to the potential effect of the Transatlantic Trade and Investment Partnership on the NHS.

[Mr Dave Watts (St Helens North) (Lab)]

6. What assessment he has made of the potential effect of the Transatlantic Trade and Investment Partnership on NHS services.

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

The Government’s aim and my central mission as the new Minister for life sciences is to accelerate access for NHS patients to the very latest diagnostic devices and drugs by making the UK the best place in the world in which to develop innovative treatments. The US is a world leader in medical technology and TTIP will help NHS patients get faster access to those innovations. Let me be clear: the treaty excludes the NHS from binding commitments. Parliament will retain sovereignty over how we organise and fund our health system and NHS England is free to decide how best to commission NHS services in the clinical interests of local patients, as it does today.

[George Freeman]

No, I will not confirm that, but the hon. Lady does not have to take it from me. She can take it from the people who are doing the negotiations. The US chief negotiator confirms that the United States has no provision in its trade agreements on health. The EU chief negotiator says:

“I wish… to stress that our approach to services negotiations excludes any commitment on public services, and the governments remain at any time free to decide that certain services should be provided by the public sector.”

[Mr Watts]

Before the election, there was a promise that there would be no top-down reorganisation of the NHS. Given the concern of the Opposition and the BMA, will the Minister meet the BMA to work out how we can get a cast iron assurance that these TTIP talks will not be used to privatise the NHS?

[George Freeman]

I will happily meet the BMA, but such a request is a bit rich coming from a Labour party that legislated to introduce competition in the health service and to pay private sector providers 11% more, which is now illegal under the Health and Social Care Act 2012. Let me be clear about this, and I can be no clearer than the Labour member of the all-party group for TTIP, who said that

“my direct discussions with the EU’s chief negotiator have helped produce an EU promise to fully protect our health service…TTIP could have no impact on the UK’s sovereign right to make changes to the NHS.”

Oral Answers to Questions

Lord Watts Excerpts

Tuesday 1st April 2014 Commons Chamber

[Mr Jeremy Hunt]

What I have learned is that the most important thing is to follow the scientific evidence. Where there is good evidence for the impact of Chinese medicine, we should look at that, but where there is not, we should not spend NHS money on it.

[Mr Dave Watts (St Helens North) (Lab)]

T7. How is the Government’s pledge to get hospitals operating on a seven-day basis going? Many GP commissioners are refusing to provide the funding for hospitals to provide that service.

[Dr Poulter]

As the hon. Gentleman will be aware, we are in negotiations with the British Medical Association and other health care unions about the future shape of the NHS consultant contract and junior doctors contract. We are determined to have a contract that remains fit for purpose in future and to reform the contract that we inherited from the previous Government, which was not fit for purpose. We will continue to work with the BMA to make sure that we protect the interests of patients and deliver better care.

Accident and Emergency

Lord Watts Excerpts

Wednesday 18th December 2013 Commons Chamber

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

I wish to discuss two topics. First, I want to raise the issue of funding for the North East Ambulance Service NHS trust, the rising use and cost of private ambulances and other ambulance pressures, and, secondly, I want to raise with the Minister the ongoing Monitor investigations into the two foundation trusts, that serve my constituents, the South Tees Hospitals NHS Foundation Trust and the Tees, Esk and Wear Valleys NHS Foundation Trust.

Over the past 18 months, the A and E department at the James Cook university hospital, which serves my constituency, has come under considerable pressure. In particular, in the run-up to last winter, there were problems with handover times, with ambulances and paramedics waiting up to two and a half hours to admit patients, despite the national target time being 15 minutes. I raised this matter last year with the Secretary of State for Health, who agreed that the situation was completely unacceptable, and with the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter),in a Westminster Hall debate on A and E provision in the north-east on 13 February 2013.

In addition to the issues I raised with the Secretary of State, it became evident that James Cook’s A and E department struggled to manage with the pressure that winter placed on it. In January and February, South Tees Hospitals NHS Foundation Trust failed to meet its target of seeing 95% of A and E patients within four hours. With James Cook so clearly overstretched, I was surprised to discover in September that the Secretary of State decided not to award it, or any other hospital trust in the north-east, funding to alleviate pressures on A and E. It struck me as beyond belief that of the £250 million he awarded to 53 trusts, not a penny was to reach the north-east. Thankfully, following pressure from the Opposition, including in my Westminster Hall debate on north-east NHS services on 5 November, the South Tees trust is to receive £2.1 million, as announced earlier this month.

For weeks and weeks, however, I have received recurrent expressions of concern about the increasing use of private and voluntary ambulances in response to 999 calls in my constituency. I wrote to the North East ambulance service about two of these incidents. From its reply, it became clear that central Government funding cuts were eroding the blue-light service. It wrote:

“Each year we have discussions with our commissioners on the forecast number of incidents in the forthcoming year. The outcomes of these discussions for 2013-14 were that commissioners felt it necessary to set our income on activity for the next 12 months at a level less than we were forecasting... So for 2013-14, we have been contracted to respond to 376,000 incidents, although we are forecasting activity at an estimated 415,000. This means that any incidents above 376,000 will be funded on a one-off basis rather than as recurrent annual income. These arrangements do not allow us to enhance our own workforce plan because the money for the additional activity will not be available next year to fund the extra salaries”.

[Mr Dave Watts (St Helens North) (Lab)]

Is there not an element almost of secrecy taking over the NHS, with trusts not allowed to talk to MPs or tell them the facts and trusts’ financial details not being published? Does my hon. Friend agree that that is not healthy for the NHS?

[Tom Blenkinsop]

For that reason, I had to put in a freedom of information request to the trust to get the information I shall now detail.

According to that letter, our ambulance service will see more cuts, more private ambulances and possibly a less responsive service. It is not me saying this, but the chief operating officer of the North East Ambulance Service. In 2008-09, private ambulances attended 865 call-outs in our region, costing £86,118. In 2009-10, there were 1,816 call-outs, costing £151,112. In 2010-11, however, there were 6,429 such call-outs, costing £477,575. In 2011-12, there were 9,034 of these call-outs, costing £639,819, and in 2012-13, there were 13,524 call-outs of private and voluntary ambulances, costing £754,461. Since Labour left office, therefore, a fivefold cost increase in private ambulances has occurred in the north-east—these are funds going to private contract firms. It is obvious that from 2010 onwards an explosion of private ambulance usage by the trust has occurred, costing a huge amount of taxpayer funds. As the chief executive states:

“These arrangements do not allow us to enhance our own workforce plan because the money for the additional activity will not be available next year to fund the extra salaries, overheads and vehicles we need to meet the extra demand.”

The police and crime commissioner for Cleveland, Barry Coppinger, has said:

“The bottom line is that police officers are not medical professionals and should not be put in the position of having to transport patients to hospital. Police vehicles are unsuitable and unequipped; it not only puts undue stress on the patient, but also the officer who should be able to continue to fulfil policing duties on the ground… The downward trend in incidents from September to October relates to a policy change by senior officers”—

not the NHS—

“within the Force and a directive issued that officers should not transport patients to hospital unless there is an immediate risk to life. However, there have been five occasions in November of officers being forced to take patients for urgent medical treatment due to ambulance delays.”

I hope for a response from the Secretary of State or a Health Minister. I would be more than willing to talk to them about this subject, because it is a massive concern, particularly in the east Cleveland part of my constituency.

Managing Risk in the NHS

Lord Watts Excerpts

Wednesday 17th July 2013 Commons Chamber

[Andy Burnham]

The hon. Gentleman is doing what the Conservatives have been doing for quite a few weeks now, which is rewriting history. Does he recall the general chaos in A and E before 1997? Does he remember people waiting for hours on trolleys before they were seen or people spending a day in A and E departments? When we left government, 98% of trusts across the country were meeting the four-hour target. Sadly, we cannot say the same about the NHS on his Government’s watch.

What I have just given to the House was a warning of all warnings not to proceed with a reckless reorganisation at a time when the NHS was facing the biggest financial challenge in its history. Senior civil servants gave those warnings; the Government ploughed on regardless. That was a monumental mistake, combining the biggest ever financial challenge with the biggest ever reorganisation. Eyes were taken off the ball at the worst possible moment.

[Mr Dave Watts (St Helens North) (Lab)]

Does my right hon. Friend know when the Secretary of State last visited an accident and emergency unit? May I suggest, through my right hon. Friend, that he comes with me to my accident and emergency unit and sees the chaos he has created?

[Andy Burnham]

Promises were made before the reorganisation to my hon. Friend and his colleagues in St Helens, Knowsley and Halton about the future of the hospital, because there was concern that certain commitments would not be honoured by the new organisations. And it came to pass: they were not honoured. My hon. Friend asked whether the Secretary of State had been to an A and E. We know that he did not turn up at one until April, yet he had already stood up and criticised hospitals for “coasting”. How on earth could he make such comments when he had not bothered to get his feet on the ground to see what was happening in the NHS? Unbelievable.

The Government took a huge gamble when they proceeded with the reorganisation at a time of financial stress and in the teeth of opposition from the public and the professions. If the Secretary of State truly believes, as he said yesterday, that transparency is a disinfectant—he is nodding—and if he wants to show leadership from the front from today onwards, should he not now commit to publishing the risk register that accompanied the Government’s reorganisation of the NHS? [Interruption.] He claims again that this was all about the last Government, but let me explain the difference to him. This Government withheld the risk register in defiance of the Information Rights Tribunal and the Appeal Court. Is he proud of that? What message does he think that that sends to the boards of those NHS organisations that he is now asking to act with maximum transparency? I am afraid that it sends absolutely the wrong message. He will not foster the right culture in risk management in the NHS if there is one rule for the Department and another for everybody else.

Health and Social Care

Lord Watts Excerpts

Monday 13th May 2013 Commons Chamber

[Mr Hunt]

I agree with the hon. Lady that the amount of financial support is important. I gently say to her that her party wants to cut the NHS budget, which would make the situation vastly worse.

The Bill is a vital element of our plans to improve the lives of the frail and elderly and of people with long-term conditions and disabilities, but it is only one element. Other areas that do not require legislation will come together in a plan for vulnerable older people. The plan will consider all aspects of how we look after older people most in need of support from the NHS and social care system. It will look at how our hospitals are set up to support frail and elderly patients, particularly those with dementia, in emergencies. Of course, we must continue to give people with serious needs immediate access to highly specialised skill, but in many cases we could offer better alternatives outside hospital. That would improve clinical outcomes and reduce pressure on A and E departments.

Secondly, the plan will look at primary care—in particular, the role of GPs in supporting vulnerable older people. Active case management of vulnerable people is making a huge difference in some parts of the country and we will look at whether the primary care sector as a whole has the incentives, investment and skills to deliver that. We will also consider the provision of out-of-hours services and how to restore public confidence in them following the disastrous changes to the GP contract in 2004.

Thirdly, the plan will look at the barriers and incentives that prevent joint commissioning and stop people from getting joined-up care. In particular, it will consider the operation of financial incentives in the system, which can act as an unnecessary and counter-productive barrier. The Minister responsible for care, my hon. Friend the Member for North Norfolk (Norman Lamb), who is leading on integration, will announce further practical steps forward later this week.

I intend to announce the plan in the autumn, with implementation from April 2014. It will require a great deal of careful work, ask difficult questions and make tough decisions, but if it leads to more personal, more integrated and more compassionate care, it will stand alongside the Care Bill as an important step forward in reforming the care received by millions of people.

[Mr Dave Watts (St Helens North) (Lab)]

Does the Secretary of State agree that that can work only if social services budgets are increased? Where will the resources come from to deal with the problems we face, and will there be an increase in social services budgets to pay for the services we need?

[Mr Hunt]

There is currently a difficult environment for public finance, for which the hon. Gentleman’s party bears considerable responsibility. The Labour party has given up on the budget; it says it wants to cut the NHS budget. We say that these changes are possible without cutting the NHS budget and in dealing with the inefficiencies caused when care is not joined up. Taken together, the measures represent more progress in three years than the Labour party made in 13 years. They represent our determination to prepare the country for the consequences of an ageing population.

--- Later in debate ---

[Andy Burnham]

I could not agree more with my right hon. Friend. All over the country, we hear that A and E is under intense pressure. Such is the importance of these services to every community that changes should be made only if there is a compelling clinical case to support them. If clinicians can demonstrate that more lives will be saved and disability will be reduced by changing A and E services, I think every Member should have a moral obligation to support them, but when the changes are financially driven—my right hon. Friend knows this better than anybody, as the Secretary of State has downgraded a successful A and E in Lewisham to deal with problems in another trust—that simply will not do. A and E units in west London, for example, are being closed one after another. That is not good enough, and neither is it good enough in Greater Manchester, where huge changes are planned. These changes must be clinically driven, not driven by finance, which is what we are seeing under this Government.

[Mr Watts]

rose—

[Andy Burnham]

I will give way one last time, before making some progress.

[Mr Watts]

I am grateful to my right hon. Friend, who is rightly concentrating on A and E units and social care. Does he agree with me that many hospitals around the country are facing a financial crisis, too, where the Government are refusing to fund anything other than consultancies? In my area, that has meant spending hundreds of thousands of pounds to tell us what we already knew—namely, that my hospital is underfunded.

[Andy Burnham]

That is what happens when a market is set up in the NHS, pitting one hospital against another in open competition. That is what is beginning to take hold in the NHS, where the Government waste money on consultants and all the other things that come from bidding for contracts. That is a direct effect of the legislation they pushed through. This reorganisation and the budget cuts I mentioned a few moments ago are providing a toxic mix. This is why for 32 weeks running, the NHS in England has missed the Government’s own lowered A and E target for major units. It really is time that the Health Secretary got a grip on the issue. We hear that last week he was trying to hatch a panic plan to deal with the A and E crisis. That is the reality of what was going on behind this threadbare Queen’s Speech: the Health Secretary was trying to cobble together a plan to deal with the A and E problems, weeks after we had first raised the issue in the House.

We hear of an e-mail leaked by an NHS finance officer which said:

“The SoS would like to announce tomorrow that £300m-400m is being invested to solve the A&E problem. We have spent most of the day trying to hold him off doing this.”

The Health Secretary seems to have forgotten that his powers to intervene were given away by his predecessor. He no longer has the power to mandate the NHS to do what he wants; the NHS can now “hold him off”. I am afraid that he looks weak. He has no response to what is happening to A and E departments. And where is the “£300 to £400 million” plan? It has not materialised. That is proof that when the Government surrendered their powers of control over the NHS, the Health Secretary surrendered his ability to do anything about the problems that we now face.

It is just as bad when it comes to staffing. We hear that nurses’ posts continue to be lost. Nearly 5,000 have been lost since the Government came to power, and according to the findings of a survey published yesterday, nurses fear that further tragedies could happen as a result of staff losses. That should set alarm bells ringing throughout the Department of Health. The Care Quality Commission has said that one in 10 hospitals in England does not have adequate staffing levels. The Health Secretary nods. I am glad that he accepts that, but, again, what is he going to do about it?

I welcome the fact that the Care Bill will contain measures relating to the Francis report, and I will work with the Health Secretary on that, but let us get to the crux of the issue of safe staffing levels, because that is the most urgent problem facing the NHS. The Health Secretary nods again. Let me make him an offer. If he introduces a benchmark—if he specifies minimum staff to patient ratios—we will support him, and the measure will go straight through the House. I shall wait for him to respond to that offer, and to ensure that the recommendations of the Francis report are properly implemented.

I give a cautious welcome to some of the Health Secretary’s measures to deal with health tourism, but let me issue two caveats. First, it is important not to overstate the nature of the problem, and secondly, it is essential for health practitioners not to be turned into immigration officers. In March, when asked how much health tourism was costing the NHS, the Health Secretary said:

“I don’t want to speculate… but… we have heard… it’s £200 million.”

On the same day, the Prime Minister’s spokesman said he believed that the figure was more like £20 million. Perhaps the Health Secretary could account for the difference—or did he just add a zero?

Winterbourne View

Lord Watts Excerpts

Tuesday 30th October 2012 Commons Chamber

[Norman Lamb]

It struck me when I listened to the story of that family that I would like to meet them if they are interested in having that discussion. Just as it is essential that people with learning disabilities have their say, it is critical that the family is involved in the discussions before the commissioning takes place, so that they are partners in the decisions that are taken in respect of those individuals.

[Mr Dave Watts (St Helens North) (Lab)]

Can the Minister reassure the House that there are sufficient inspectors to go around those establishments during the day, during the evening and at night to ensure that standards are maintained?

[Norman Lamb]

Inspections are essential to ensure that we identify where problems exist. The role of the Care Quality Commission is critical in that respect. We need to do more to open up those establishments to public view. One role that the new local HealthWatch can take is to go into care homes, nursing homes and so on to see for itself. The more there is a culture of openness, the less likely it is that abuse will take place.

Mental Health (Approval Functions) Bill

Lord Watts Excerpts

Tuesday 30th October 2012 Commons Chamber

[Andy Burnham]

We need to look carefully at those trends. I remember the moment when my thinking about mental health changed. It came when I was Secretary of State for Health and I received the Bradley report on mental ill health in the criminal justice system. I recall the moment when I read the statistic that seven out of 10 young people in the system have some form of undiagnosed or untreated mental health problem. My jaw dropped and at that moment I realised that we were seriously failing many thousands of people by failing to give them the support they needed when they needed it, and so they went into detention and down a path of failing to fulfil their potential. That is a terrible indictment of our life today. In addition, the level of prescribing of anti-depressants has almost doubled over the past decade. We are issuing almost 40 million prescriptions for anti-depressants, which suggests to me that insufficient alternatives to medication are available in our communities and people are being given very old-fashioned, outdated interventions by the authorities which are not meeting their needs. That is why we cannot allow this complacency any more and why we need a modern approach to good mental health care.

[Mr Dave Watts (St Helens North) (Lab)]

My right hon. Friend is absolutely right when he says that mental health has been the poor relation of the health service, but does he agree that, within that mental health service, children’s mental health services have often been the poor relation again? Does he hope that the Government will address specific services for children who need mental health services?

[Madam Deputy Speaker (Dawn Primarolo)]

Order. As important as the debate is, the wider considerations of mental health and its treatment are not actually the subject for today—that is the Bill before us. So in rising to answer his hon. Friend’s problem, I am sure that the shadow Secretary of State will come back to the specifics of the Bill.

National Health Service

Lord Watts Excerpts

Monday 16th July 2012 Commons Chamber

[Andy Burnham]

This is what happened: when they came into government, they had a cynical policy of a moratorium, and they went up to Chase Farm hospital to announce it, saying, “There will be no cuts and no closures at this hospital.” They traded and touted for votes in that constituency for years on the back of that issue, and now that hospital is going to close. They delayed the reconfiguration and then they delayed the savings that came to the NHS. It was disgraceful, and people will have seen through it.

[Mr Dave Watts (St Helens North) (Lab)]

I wish my right hon. Friend well in trying to hold this Government to account. The NHS is paying consultancy fees all around the country: hundreds of thousands of pounds are being wasted, and the Government are refusing to publish the information. They are also bullying many of the trusts. How are we going to get the information out when the Government are doing this?

[Andy Burnham]

My hon. Friend is absolutely right about the waste of money the Government have brought into the NHS through this reorganisation. The total is over £3 billion. That is simply unjustifiable at this time. Staff who had been working in primary care trusts are either being re-employed as consultants or are going into clinical commissioning groups. This is such a waste of money at a time when the NHS needed every penny to maintain standards of patient care.

I was talking about rationing, and let me focus on cataract surgery. GP magazine has found limits on cataract surgery in 66% of PCTs. The Royal National Institute of Blind People found that 58% of PCTs are using visual acuity thresholds to restrict surgery. This is the evidence, so the Secretary of State had better start listening. What has happened since those restrictions on cataract operations have been introduced? Unsurprisingly, the number of cataract operations in England fell by over 12,000 between 2010 and 2011. That is a direct result of the new restrictions. There is no less need, however. Thousands of older people need such procedures, but they are now being forced to live with very poor sight.

This is truly a false economy. Cataract surgery is one of the most cost-effective procedures carried out by the NHS. It helps people live independently and have a quality of life, and research has shown that in the last two years poor vision has been a factor in 270,000 falls by people aged 60 or over. This is the rationing by cost that Ministers have repeatedly denied is happening. So let me ask the Secretary of State again: does he agree with these restrictions on cataract surgery? If he does not, will he take immediate action to lift them?

Care and Support

Lord Watts Excerpts

Wednesday 11th July 2012 Commons Chamber

[Mr Dave Watts (St Helens North) (Lab)]

It is clear that the Secretary of State is moving on from causing chaos in the NHS to causing it in the care service. Given the crisis in the budgets of social services, will he set up an independent body to look at how much money local authorities require to provide high-quality social care?

[Mr Lansley]

I am sorry, but the hon. Gentleman simply demonstrates his ignorance of what is in the White Paper. Those who work in social care, those who represent care users, care recipients and carers want the changes in legislation and in support to focus on looking after people. That is absolutely our agenda. We know that there are funding needs. That is why, in the spending review, we have provided the sums that I have set out. That will enable local authorities to maintain their eligibility to care. This year, only six authorities have reduced their level of eligibility to care from moderate to substantial.

NHS Annual Report and Care Objectives

Lord Watts Excerpts

Wednesday 4th July 2012 Commons Chamber

[Mr Lansley]

My hon. Friend makes an important point. When the shadow Secretary of State was attempting to suggest that there were trusts in trouble across the country, he might have had the humility to admit that the hospital trusts in the greatest difficulty are the ones that were saddled with unsustainable debt by the Labour Government’s poorly negotiated PFI projects. He might have instanced Peterborough and Stamford Hospitals NHS Foundation Trust. Monitor wrote to him and his colleagues, telling them that that PFI project should not have proceeded. The Labour Government went ahead with it anyway and it is now unsustainable.

We have been very clear. We have gone through a process of identifying where trusts can manage, not least with us assisting them. In the latter part of last year we identified seven trusts that we will step in and support if we believe that they are otherwise unable to restore their finances to good health. It will entail about £1.5 billion of total support for them to be able to pay for their PFI projects. Where there are opportunities for renegotiation we will exercise them, but unfortunately it is in the nature of coming into government that we inherit what the previous Government left us. We were left with 102 hospital—[Interruption.] The shadow Secretary of State says from a sedentary position that they were our PFI schemes. No NHS PFI scheme was signed before the Labour Government took office in 1997. Two years ago we inherited 102 hospital projects with £73 billion of debt, yet the Opposition thought that in the years before they had used taxpayers’ money to build these new hospitals. No, they did not. They saddled the NHS for 30 years with that debt.

[Mr Dave Watts (St Helens North) (Lab)]

Talking about waste, will the Secretary of State explain why his Department has wasted hundreds of thousands of pounds on consultancy fees looking at my acute trust, and why his Department refuses to publish the reports? Could it be that they are a complete waste of time?

[Mr Lansley]

In the year before the election the Department of Health spent about £110 million on consultancy and we reduced it to £10 million. I will tell the hon. Gentleman about waste. In the past two years we have already racked up £1.4 billion of administration savings across the NHS—money that goes straight back into the front line. The Department is having to do work in relation to the hon. Gentleman’s hospital at Whiston only because of the PFI deal that his Government signed before the last election. We will have to help St Helen’s and Knowsley trust deal with that debt in the future.