King’s College Hospital Foundation Trust

Lucy Frazer Excerpts

Tuesday 12th December 2017 Commons Chamber

[Mr Dunne]

The hon. Lady is right to identify pressures across the system, but it is also the case that when leaders change their position in a very short period of time and oversee a period of significant deterioration, the regulator has to take a view on whether those individuals are the right people to continue to lead that organisation. I think that that is what has happened in this case.

[Lucy Frazer (South East Cambridgeshire) (Con)]

Does the Minister think it would have been possible for the trust to have improved, notwithstanding its financial position? I ask in the knowledge that Cambridge University Hospitals went from special measures to outstanding in care and good overall.

[Mr Dunne]

My hon. and learned Friend highlights the special measures regime. We have introduced a financial special measures regime and, during 2016-17, the trusts that went through that regime—King’s went in only yesterday—improved their financial performance by £100 million overall over the year. The short answer is yes. It is possible to manage improvement through this regime, and that is what NHS Improvement is there to do—to help trusts that get into financial difficulties to manage their way out of them.

Social Care

Lucy Frazer Excerpts

Thursday 7th December 2017 Commons Chamber

[Jackie Doyle-Price]

I thank the hon. Lady for those comments. She highlights what is literally the Cinderella in this debate. It is appalling that so many children are acting as carers, stoically and fantastically but, as she says, to their long-term detriment. As a society, we would be failing if we did not do more to support them.

[Lucy Frazer (South East Cambridgeshire) (Con)]

The fact that we need to tackle the challenge of social care has cross-party support and agreement. It was in the manifestos of both main parties. In fact, the Labour party’s manifesto said that it wanted to implement change through “consensus” and that the issue transcended party politics. Would the Minister welcome a cross-party approach, rather than political point scoring?

[Jackie Doyle-Price]

I am very keen to approach this matter through consensus. To be frank, I do not think that we can deliver change without consensus. We have written to all-party groups in the first instance to engage with them. Over the course of the next six months, I hope to engage in conversations and discussions with Members from all parts of the House.

NHS Pay

Lucy Frazer Excerpts

Wednesday 13th September 2017 Commons Chamber

[Jonathan Ashworth]

I will make a little progress now, if I may. I promise I will take more interventions later.

I say directly to the Chief Secretary to the Treasury, who will be responding to the debate later, that if Ministers are given flexibility to set pay rates, and if the pay cap has indeed been abandoned, she also needs to grant the NHS the funding that it needs. The NHS is underfunded and it is going through the biggest financial squeeze in its history. On the published figures, head-for-head NHS spending will fall in the next year. Hospitals are in deficit, waiting lists are at 4 million, the A&E target is never met and the 18-week target has been abandoned. Hospital bosses are warning that there will not be enough beds this winter. Last winter, hospitals were overcrowded, ambulances were backed up and social care was at a tipping point. Some even characterised it as a humanitarian crisis. It is not good enough for the Chief Secretary to the Treasury just to grant “flexibility” and expect hospitals to fund a staff pay increase from existing budgets.

[Lucy Frazer (South East Cambridgeshire) (Con)]

If the hon. Gentleman does not get the increases he would like, will he support co-ordinated illegal action?

[Jonathan Ashworth]

The Labour party supports people taking legal industrial action, and if the hon. Lady supports public sector workers, she should be joining us in the Division Lobby later.

--- Later in debate ---

[Jonathan Ashworth]

I am grateful to the hon. Lady and I am grateful that she also signed the early-day motion. This issue may be debated further as hon. Members make their speeches today.

As we know, according to the Office for National Statistics, many public sector workers regularly work an average of 7.8 hours’ unpaid overtime a week, worth £11 billion to the economy. With the pay cap, the Government have effectively been asking them to do more and more on less and less. That is unfair.

[Lucy Frazer]

rose—

[Jonathan Ashworth]

I will make progress, if I may.

MPs on both sides of the House have spoken out against this pay cap. We would hope that they will join us in the Division Lobby, including the hon. Member for North Antrim (Ian Paisley). I pay tribute to my hon. Friend the Member for St Helens North for tabling early-day motion 132, which calls for an end to the NHS pay cap, and which we have picked up and adopted as our motion today.

I know there are many who have sympathy for getting rid of the pay cap. The reason that many in the House have sympathy for getting rid of the pay cap is that in all our constituencies we have met nurses, very directly at our advice surgeries, or indeed in lobbies at Parliament, who have told us that the cap has meant they have seen a 40% real-terms drop in their earnings since 2011.

--- Later in debate ---

[Jonathan Ashworth]

My hon. Friend is absolutely right. The Tories have been running the NHS for seven years now. It is going through the biggest financial squeeze in its history and we have some of the worst waiting times on record.

The hon. Member for Croydon South should note that the NHS Pay Review Body’s March report said that

“public sector pay policy is coming under stress. There are significant supply shortages in a number of staff groups and geographical areas. There are widespread concerns about recruitment, retention and motivation that are shared by employers and staff side alike.”

Again, NHS Providers said that

“seven years of NHS pay restraint is now preventing them from recruiting and retaining the staff they need to provide safe, high-quality patient care. The NHS can’t carry on failing to reflect the contribution of our staff through fair and competitive pay for five more years.”

We agree. Addressing NHS pay and lifting the pay cap are crucial to addressing the retention and recruitment crisis now facing the NHS.

[Lucy Frazer]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

I have given way to the hon. Lady once and I have been generous, so I hope she will forgive me if I do not give way again.

We have heard several examples of what vacancies in the NHS mean for services. We have heard about the walk-in centre in Wirral, but Macmillan Cancer Support warned last week that bigger workloads and vacancies in key roles are creating “unrelenting pressure” on the cancer care workforce and that some cancer patients are attending A&E because they cannot get help elsewhere. I have mentioned midwifery, and this summer we revealed that almost half of maternity units closed their doors to patients at some point in 2016, with understaffing often used as the justification. Earlier this year, I revealed FOI requests that showed a rising number of cancelled children’s operations, with 38% of trusts citing workforce shortages as the reason for those cancelled operations. Visit any hospital and doctors will talk about rota gaps, and the latest NHS staff survey reveals that 47% of staff view current staffing levels as insufficient to allow them to do their job properly.

Not only is the pay cap unfair on hard-working staff who are struggling to make ends meet, but it is unfair on patients, who suffer the direct consequences of under-staffed, overstretched services. We look forward to the Health Secretary telling us how he will use his newfound flexibility. We look forward to his telling us what remit he will set for the NHS Pay Review Body in the coming days. He has had all summer to think through his response to these demands. I know that he got into a big argument with Professor Stephen Hawking, but we will leave that there. The Health Secretary sets the remit—he tells the pay review body what it is able to provide—so we look to him to tell us what he is going to ask it to provide. We want him to tell us today when he will publish the remit letter.

--- Later in debate ---

[Peter Dowd (Bootle) (Lab)]

Regrettably, I do not have much time to go through Members’ speeches, but I want to draw attention to the maiden speech by my hon. Friend the Member for Portsmouth South (Stephen Morgan)—a Pompey boy. There are two victories in Portsmouth: HMS Victory and my hon. Friend’s victory, for which I thank him. He mentioned Arthur Conan Doyle’s time as a doctor in Southsea; if the Tories had their way, this country would be going back to Victorian times.

Some 5.4 million people work in the public sector—including members of my family; my wife and daughter work in the NHS, as I did for many years—and they provide services that are crucial to the good running and, literally, the order of the country. They provide the armed services that protect our country and the protection that this House enjoys day in, day out; they provide the services that educate and look after our children; and they provide the services that care for our disabled citizens and senior citizens. They provide services that we barely notice until things go wrong, such as traffic problems, floods, weather damage, public health emergencies and much more. Some 1.6 million of those people work in the NHS, providing the services that look after the physical and mental health of our—yes, our—constituents.

[Lucy Frazer]

Will the hon. Gentleman give way?

[Peter Dowd]

I will come back to the hon. Lady in a moment.

NHS workers are the subject of today’s debate, but we must not forget workers in the rest of the public sector. In fact, I believe that NHS workers would be dismayed if we focused only on their pay situation. Why would they be? Because they spend their professional lives looking after others. I take NHS workers’ commitment incredibly seriously, unlike that hon. Member on the Government Benches who laughs at nurses, doctors and allied professionals. That is the sort of thing we get from the Tories.

Oral Answers to Questions

Lucy Frazer Excerpts

Tuesday 7th February 2017 Commons Chamber

[Chris Green (Bolton West) (Con)]

3. What progress he has made on improving hospitals in special measures.

[Lucy Frazer (South East Cambridgeshire) (Con)]

10. What progress he has made on improving hospitals in special measures.

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

In the last four years, 31 trusts have been put into special measures—more than one in 10 of all NHS trusts. Of those, 16 have now come out, and I congratulate the staff of Addenbrooke’s and all at Cambridge University Hospitals NHS Foundation Trust, which came out of special measures last month.

Let me also take this opportunity to thank Professor Sir Mike Richards, who has announced his retirement as chief inspector of hospitals. His legacy will be a safer, more caring NHS for the 3 million patients who use it every week. He can feel extremely proud of what he has achieved.

[Mr Hunt]

I am happy to do so. It is a fantastic example of what is possible in challenging circumstances with a lot of pressure on the frontline, so the staff should feel proud. Trusts put into special measures go on to recruit, on average, 63 more doctors and 189 more nurses and see visible improvements in the quality of patient care.

[Lucy Frazer]

The Secretary of State is right to congratulate Addenbrooke’s, which came out of special measures in the last month due to the dedication of its staff, but we still need to reduce pressure on the A&E. One way of doing that is to increase care locally in rural hubs. Does the Secretary of State agree that money spent on the minor injuries unit at Ely’s Princess of Wales hospital would be money extremely well spent?

[Mr Hunt]

I remember visiting my hon. Friend in Ely last autumn, and I know how much she campaigns and cares for her local health services. The Cambridgeshire and Peterborough CCG knows the importance of Ely’s minor injuries unit. It is setting up some public engagement meetings, but if any changes are deemed necessary, I reassure her that there will be a formal consultation before anything happens.

NHS and Social Care Funding

Lucy Frazer Excerpts

Wednesday 11th January 2017 Commons Chamber

[Jonathan Ashworth]

I thank my hon. Friend for correcting the record about that debate in Westminster Hall.

The Secretary of State denies that he is going to water down the A&E target; we welcome that, but we will watch carefully to ensure that he does not sneakily water it down throughout the remaining years of the Parliament. Will he tell us what he expects to happen next as we go through the winter? Weather warnings have been issued, and we could be heading for a cold snap. Will he update us on what urgent preparations he is putting in place to ensure that the NHS can cope? Is the NHS prepared for a flu outbreak, and what is his assessment of whether overstretched hospitals will be able to cope if there is one? It appears that, so far, Ministers have been burying their heads in the sand, but that will no longer do.

[Lucy Frazer (South East Cambridgeshire) (Con)]

My right hon. and learned Friend the Member for Rushcliffe (Mr Clarke) and my hon. Friend the Member for Lewes (Maria Caulfield) both made the point that the issues in the NHS are historical. On Radio 4 this morning the right hon. Member for Leigh (Andy Burnham) said he accepted that the previous Labour Government had not spent the right amount of money on social care. Will the hon. Gentleman accept that these issues are historical—they are not new—and that Labour does not have all the answers?

[Jonathan Ashworth]

The hon. Lady refers to history; under this Government the NHS is going through the largest financial squeeze in its history. When we had a Labour Government, we more than doubled investment into the NHS.

Community Pharmacy in 2016-17 and Beyond

Lucy Frazer Excerpts

1st reading: House of Commons
Thursday 20th October 2016 Commons Chamber

[David Mowat]

Yes, I can reassure my hon. Friend on that. Indeed, I can make the specific point that the 25% that make up the largest pharmacies will not be in the access scheme; it is directed more at smaller pharmacies.

[Lucy Frazer (South East Cambridgeshire) (Con)]

The Minister is right to identify that those areas with fewer pharmacies will benefit from protection, not only because the travel time to a pharmacy will be longer, but because the travel time to all support services will be longer. Will he therefore confirm that pharmacies in my rural constituency will benefit from the access scheme?

[David Mowat]

I do not have the specifics for my hon. and learned Friend’s constituency in front of me. We have published the full list and it is in the Vote Office, and I am sure that when she has a look at it she will find that some pharmacies in her area are protected.

Cambridgeshire CCG and UnitingCare Partnership

Lucy Frazer Excerpts

Monday 18th January 2016 Commons Chamber

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

I congratulate the hon. Member for Cambridge (Daniel Zeichner) on securing the debate and thank the Members who are present, including my hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald)—I know that he has an interest in the matter—for attending. I also pay tribute to all those working on the frontline in the NHS in East Anglia, particularly at this time of year, when pressures are at their greatest.

As the hon. Gentleman has described, the contract between Cambridgeshire and Peterborough CCG and UnitingCare Partnership has very recently been terminated. I need to say right away that NHS England has launched an investigation into the circumstances surrounding the contract. Its terms of reference are to establish, from a commissioner perspective, the key facts and root causes behind the collapse of the contract in order to draw out any recommendations and lessons to be learned. I understand that the CCG is also undertaking a review, as is right and proper.

We should let the NHS complete that process. I hope that nothing I say today can be taken as an assumption that Ministers have in any way prejudged the outcome of that process. Clearly there are different views about what has happened, and I want to wait for the reports of the reviews before deciding what, if anything, needs to be done, either by the NHS or by the Government. Once the reports are published, Ministers will be briefed on their conclusions. I am happy to invite the hon. Gentleman to that meeting, although I cannot say today exactly when it will take place. I know that he is in regular contact with his local NHS, and I encourage him to keep that up.

The core scope of services in the contract with UnitingCare was acute unplanned hospital care for older people—those 65 and over—older people’s mental health services, older people and adult community services and a range of supporting voluntary sector services. The underlying principle was to create an integrated care pathway between all these services. The UnitingCare service model was designed by local clinicians during the procurement process and had a high degree of local health and social care support. Its detail and assumptions were subsequently ratified by two independent auditors. It was designed to: join up services around the patient and reduce service fragmentation; to focus on better outcomes for patients and carers, rather than activity levels; to invest in out-of-hospital services in order to better address the needs of a rapidly ageing and growing population; and to deliver £170 million of savings to the local health economy by 2020 by reducing inappropriate emergency admissions to hospital and inappropriate A&E attendances.

UnitingCare began introducing those new services with an investment of £5.4 million over the first six months of the financial year. They included a number of important local improvements, such as: care based around neighbourhoods, with 17 neighbourhood teams working closely with GPs; access to specialist services, with neighbourhood teams and the support of four integrated care teams to offer more specialist care; a 24/7 helpline, called OneCall; urgent care and support, with joint emergency teams to assess and treat people most at risk of admission to hospital; health and wellbeing, with voluntary organisations working together; a single view of the patient record, called OneView, providing professionals with a summary of all information about a person’s health; and a health analytics service to target interventions at those most at risk of admission.

To achieve those improvements, a contract was needed between the provider and the CCG. The main components of the contract were: a new framework for improving outcomes; a new contracting approach to align incentives in a better way; a five-year contract term; and a new lead provider, UnitingCare. It was therefore a high-value contract; it had a total value of around £800 million. Having taken legal advice, the CCG went to open procurement, using a standard three-stage process—pre-qualification, an invitation to submit outline solutions, and an invitation to submit final solutions. The CCG prospectus set out the CCG budget and the evaluation criteria. It was a contract entered into in good faith. This included submitting bids within the CCG budget. The CCG budget incorporated forecast population growth, an acuity factor, and QIPP—quality, innovation, productivity and prevention—savings for each year.

In 2014, there was in some quarters, as the hon. Gentleman said, concern that the process was “stealth privatisation”. Clearly no one, on any objective criteria, would agree that that was the case; it was merely, as he said, a service reconfiguration placed with a not-for-profit company set up by local health providers. The boards of Cambridge University Hospitals NHS Foundation Trust and Cambridgeshire and Peterborough NHS Foundation Trust held the firm belief that only by introducing radical change led by the NHS would the local health economy under the CCG become viable for patients, staff and the respective trusts across the region. For that reason, they decided to submit a joint bid and, following commercial and legal advice, opted to create a limited liability partnership to fulfil the role of prime vendor, as required by the CCG.

The CUHFT and CPFT consortium was appointed as preferred bidder at the end of September 2014. In October, it formed UnitingCare LLP to hold the contract. The strategic projects team was appointed as procurement adviser to the CCG through a competitive process and its role was to manage the procurement process. The strategic projects team is a specialist unit hosted by the Arden and Greater East Midlands commissioning support unit, which has substantial experience in managing complex procurements. The CCG also appointed legal advisers, Wragge Lawrence Graham, and financial advisers, Deloitte, to support the procurement process.

Much information about the costs of the current services, staffing details and timescales could not be provided by the CCG to UnitingCare until it was at preferred bidder stage. As a result, UnitingCare’s bid was heavily caveated and based on assumptions. To illustrate this point, at the time of preferred bidder award status, there were 71 outstanding clarification questions from the procurement process. The contract signed between the CCG and UnitingCare also included several protection clauses to be utilised in the event of the financial distress of either party. Subsequent to contract signature, additional clauses were agreed that allowed for the rapid exit of the contract in the event of the financial destabilisation of either party. With these protections in place, trust boards, the CCG and Monitor allowed the contract to be signed in November 2014 and for the necessary mobilisation activities to facilitate service commencement on 1 April 2015.

There were clear improvements in patient care. For example, in November 2015 emergency admissions for over-65s reduced by just short of 8% compared with the previous year and by 9% when taking into account population growth; admissions of more than two days’ duration for people over the age of 65 reduced by 14%; and A&E attendance reduced by 3.2% when taking into account population growth. However, in December the contract was terminated by mutual agreement.

[Lucy Frazer (South East Cambridgeshire) (Con)]

As my hon. Friend says, there were advantages to this project and it produced good outcomes. If it is a good concept, will the Department of Health support the services that so need to be provided?

[George Freeman]

My hon. and learned Friend makes an excellent point. The service is currently being continued, albeit by the CCG rather than through the company that was created for the purpose. As she says, the reforms that were put in place were the right reforms. Indeed, they were led by local clinicians and designed with that in mind.

Mental Health

Lucy Frazer Excerpts

Wednesday 9th December 2015 Commons Chamber

[Lucy Frazer (South East Cambridgeshire) (Con)]

Does the hon. Lady welcome the Government’s commitment to introducing waiting time standards so that patients do not have to wait a long time to get access to a talking therapy? This Government introduced that measure, but the Labour Government did not.

[Luciana Berger]

The Labour Government created the services in the first place. In order to introduce a waiting time standard those services have to exist, which was not the case previously. We had to address the chronic underfunding of mental health that existed pre-1997, and we introduced the improving access to psychological therapies programme, of which we are incredibly proud. As things develop, it is right that those waiting time standards come forward. The Labour party had waiting time standards in place for all consultant-led services, which included physical and mental health. I am proud of that fact but disappointed that in too many cases the same equality is not also applied to mental health. If the Government are serious about fair access to cost-effective mental health treatment, they must address that fundamental disparity. That is why we are calling on the Government to commit to ensuring that all patients, regardless of whether they need a drug, a physical health treatment or a psychological therapy, have the same rights.

Junior Doctors’ Contracts

Lucy Frazer Excerpts

Wednesday 28th October 2015 Commons Chamber

[Heidi Alexander]

I will not give way, as I am going to make some progress.

Junior doctors are not just the first-year trainees fresh out of medical school. They are also the senior house officers and registrars with 12 or 15 years of experience. Junior doctors account for almost half of all doctors in hospitals and the vast majority already work nights and weekends. The responsibilities they carry are huge. Take the junior paediatric doctor working in accident and emergency who emailed me last week. Some of the things she does, I could never ever do. In her email, she said:

“I am in charge of teams resuscitating dying children regularly. I have had to make the decision to stop resuscitating a dying child. I have had to tell parents that their child is going to die. I have been the only doctor trying to stick a tiny breathing tube into a baby born 16 weeks early and weighing 600g at 3 in the morning.”

How is it right that she should face the prospect of being paid less? She is not asking to be paid more. She is just asking to be paid the same and to keep the safeguards that prevent her from being stretched even further.

[Lucy Frazer (South East Cambridgeshire) (Con)]

I do not think that any of us dispute the fantastic work that doctors do day in, day out, but we need to debate the motion that the hon. Lady has proposed. She said there were three points that she wants to put to the Secretary of State, but she failed to mention the one in the last line of the motion, which is that she wants proposals to be put forward that are “safe for patients”. Given that there was an article just last month on 5 September in the BMJ, put together by seven experts, including three professionals, that said that there was a clear association between weekend admission and worse outcomes for patients—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I am sorry, but hon. Members should know that interventions should be short. You cannot make a speech in an intervention, and that should be a lesson for us all. Many Members want to speak and I want to get everybody in.