Oral Answers to Questions

Debate between Maria Caulfield and Helen Jones

Tuesday 1st November 2016 Commons Chamber

[Maria Caulfield (Lewes) (Con)]

12. What steps her Department is taking to improve safety in prisons.

[Helen Jones (Warrington North) (Lab)]

16. What steps her Department is taking to improve safety in prisons.

NHS (Contracts and Conditions)

Debate between Maria Caulfield and Helen Jones

Monday 14th September 2015 Westminster Hall

[Helen Jones]

We made our policy quite clear in the last Parliament. In particular, we opposed the Government’s decision to curb 1% pay increases for NHS staff who were gaining increments. The hon. Gentleman really has to think about this: if there are fewer and fewer nurses in our hospitals—in particular, employment in the most senior grades is down by 3%—and we are spending millions on agency staff, something is going badly wrong. Hospitals are being forced to recruit nurses from abroad or spend on agency staff when we have thousands of people in this country who want to train as nurses but simply cannot get the training places that are available.

[Maria Caulfield (Lewes) (Con)]

Will the hon. Lady give way?

[Helen Jones]

In a moment. I want to make a little progress and finish this point.

That is a false economy. I make no criticism of the skills of the nurses we recruit from abroad, but it—

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[Helen Jones]

I am grateful to the hon. Lady for reading that out, but I referred to nurses in hospitals. The number of nurses working in hospitals has fallen under this Government, particularly in the top grades. The failure to train and recruit enough permanent staff is putting a great strain on those staff already in post, who are having to deal with agency staff all the time to make sure that they know how things work in a particular hospital or ward. That does not offer continuity of care for patients.

[Maria Caulfield]

I declare an interest as a former NHS nurse—in fact, I still work as a nurse. I do not want to be political about this, because I want progress to be made on supporting the NHS, and particularly staff, but one of the single biggest factors in demoralising nurses and leading many skilled nurses to leave the practice was the last Labour Government’s change to the skill mix. That was crucial, because we were forced to cut our budgets, particularly on the wards, and junior nurses were left in charge of wards, instead of experienced senior staff nurses and sisters—

[Maria Caulfield]

Can I just say that it is the change to the skill mix that has demoralised nurses, and that did not happen under this Government?

[Helen Jones]

I am afraid that I do not agree with the hon. Lady. What has demoralised most of the nurses I see is the cuts they have to cope with day in, day out, as well as the shortage of sometimes even basic equipment and the—

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[Helen Jones]

Yes. I thank the hon. Lady for that useful suggestion. I will do so.

People who are admitted to hospitals at the weekend are much sicker than those admitted on weekdays, because we do not have elective admissions at the weekend.

[Maria Caulfield]

Does the hon. Lady have any suggestion as to why people are sicker at the weekend? Is it perhaps because they have been unable to get hold of their GP in the evenings or on previous weekends?

[Helen Jones]

I have just said the Government should publish their research and delve deeper into the figures. [Interruption.] Look, the hon. Lady knows that people admitted at weekend are, overwhelmingly, emergencies. That is the point. Their death rates cannot be compared with death rates on weekdays, when there is elective surgery—that is a basic point, which she needs to grasp.

If the Government really believe these things are happening, they need to find out why. As I understand it, death rates are taken over 30 days, so someone can be admitted on a Sunday and die 28 days later, on a Thursday. The Government need to prove cause and effect before they can make the link between admissions at the weekend and death rates. So far, however, we have not seen that from them.

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[Maria Caulfield (Lewes) (Con)]

Thank you, Ms Vaz, for giving me the opportunity to speak in this debate. I am a passionate supporter of a seven-day-a-week national health service. That might take many formats; it is not a one-size-fits-all situation, so what works in my constituency might be different from what works in someone else’s.

I will not repeat what many of my colleagues have already said, but I think that we need an honest debate. There are difficulties to get over; my hon. Friend the Member for Totnes (Dr Wollaston) in particular has described them. We will have to work together and compromise on certain things, but if we do not debate the issue and find a resolution, patients will die from lack of access to good out-of-hours care. We need to tackle it. To be 16% more likely to die just because of the day of the week one is admitted to hospital is not good enough in this day and age.

However, it is not just about the impact on patients and their relatives; it is also about the impact on staff. Tribute has rightly been paid in this debate to staff, senior consultants and doctors who work long hours and come in at weekends. Many of them do so unofficially because they are dedicated, but I want to represent staff who work out of hours because it is part of their contract. I have been a nurse for more than 20 years. I have worked in the community on weekends, when patients without access to a GP have needed painkillers or an urgent dressing and it is difficult to get hold of a doctor. I have been in charge of wards on weekends and nights, when patients tend to be sicker because as medicine has progressed, patients who are well are often discharged earlier, so those left in hospital are often sicker than they would have been a decade ago.

Along with the reduced skill mix that I highlighted earlier, the pressure on nurses, healthcare assistants and other ancillary staff is huge. Two or three staff on night duty with a poorly patient who is septic might have one doctor on call handling four or five other wards, who might have 10 admissions that night to see to first. The staff will have expanded their skills so that they can cannulate the patient, take their bloods and send them off to the labs, but that is the limit of what they can do. It is hugely stressful. I know from having been in charge of a team of nurses on nights how difficult it can be.

That cannot continue. It is not good for patients—we know that their mortality and morbidity rates get worse—and it is not good for staff or for their morale. I have seen nurses in tears after a busy night shift during which we could not care for a patient the way we should have, because we had no access to senior medical advice. Yes, it is possible to phone the consultant on call and have a chat with them, but nothing beats having the advice of an expert who can interpret an X-ray or blood results and who can help junior medical staff prescribe the right antibiotics.

A great example introduced in the past couple of years is the acute oncology service, which has transformed out-of-hours care for cancer patients. As a sister in a research unit not far down the road, I know what a difference that has made to my patients. For some reason, patients tend to get really poorly at half-past 4 on a Friday afternoon, come what may. I have been so pleased with that service, which is now available up and down the country and offers trained senior nurses, doctors and a whole team of people who can assess a patient and get treatment going. For conditions such as sepsis, it is life-saving. Those with spinal cord compression can have a scan urgently and be started on steroids straight away. That is the difference between a patient being able to walk during the last six months of their life and being bed-bound.

That is out-of-hours care at its best, but of course difficulties and contentious issues will arise when renegotiating contracts. It is not just about consultants and senior staff. Proper out-of-hours care will require support services such as radiologists, radiographers and pharmacists. My hon. Friend the Member for Banbury (Victoria Prentis) spoke about the perfect week; I could talk to hon. Members day in, day out about how many patients we kept in hospital over the weekend because we could not access drugs to send them home. That is not a great use of hospital resources, but more importantly that is not a great experience for patients and their relatives.

Support services make a huge difference, but my plea is that we do not use the debate as an opportunity to score political goals. We have to work together. If we do not work cross-party on this, we will be here in 10 years’ time. Patients will lose out and their families will lose loved ones if we do not make a difference. It will not be easy. Nobody will be happy about working different hours. We are not asking people to work more than 40 hours a week; we are just asking people to work differently. We are not even just talking about how we work, but about a systems change in the culture of the NHS, so that the patient at half-past 4 on a Friday afternoon does not think, “What lies ahead for me this weekend?” I urge hon. Members on both sides of the House to be as constructive as possible.

[Helen Jones]

I am grateful to the hon. Lady; she has been most generous in giving way. She says that she is not expecting NHS staff to work more than 40 hours a week; did she mean to say that? Many of them already work more than 40 hours a week. Is it now Government policy that no one in the NHS should work more than 40 hours a week?

[Maria Caulfield]

The hon. Lady is being disingenuous.

[Helen Jones]

Answer the question.

[Maria Caulfield]

Of course. I have worked more than 40 hours a week; many staff do. We are not asking staff to work more hours—we have been very clear—but we are asking staff to work differently. I do not think that there is anything wrong with that if it provides a better service for the patient and takes the pressure off those front-line staff who are without radiology support, laboratory support and senior cover support. I ask the hon. Lady to support the measures and work with us, so that we can work with healthcare professionals to achieve that. They need senior support out of hours, because they need someone to interpret test results, make decisions to discharge a patient and break bad news when results are not good, and they need senior expertise to refer to others to move the process forward. My plea is that is we all work together.

I welcome the debate this afternoon. It is good to have it. I am pleased that healthcare professionals flag up issues, because I do not want policies to be steamrollered in, as they have been in the past, and for us to sit here 10 years later reaping the results. I welcome the seven-day-a-week initiative and the move to change the culture and the system, so that ultimately patients see improvement in patient care.