NHS and Social Care Funding

Lord Harper Excerpts

Wednesday 11th January 2017 Commons Chamber

[Jonathan Ashworth]

My hon. Friend has had one bite of the cherry, so if he does not mind I shall make a little progress and then I will do my best to get as many people in as possible.

Does the Secretary of State agree—

[Mr Mark Harper (Forest of Dean) (Con)]

rose—

[Jonathan Ashworth]

I will give way in a few moments.

Does the Secretary of State agree that the four-hour standard is a reasonable proxy for patient safety? Does he agree that every breach of the four-hour standard can be regarded as a potentially elevated risk?

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[Jonathan Ashworth]

I pay tribute to the hon. Lady for the work she is doing on tackling loneliness. I know that all Labour Members very much appreciate the work she is doing on that, along with my hon. Friend the Member for Leeds West (Rachel Reeves). The Government amendment is conspicuous in not referring to all patients.

The Secretary of State did distinguish between “urgent” and “minor”—[Interruption.] The hon. Member for Beverley and Holderness (Graham Stuart) says I should get a haircut. Did he say that? No? I beg his pardon, but he heckles so much it is sometimes difficult to hear what he is saying. Can the Secretary of State tell us how he would define the difference between urgent and minor care for instances relating to this four-hour standard? Can he tell us what will be the minimum severity of physical injury or other medical problem which will be needed for a patient to qualify for access to an A&E? How will we determine these new access standards? How quickly will they be available? Will patients with visible injuries be exempt from a new triage system? If so, which injuries will qualify? If the Secretary of State is not moving away from this four-hour standard, he needs to clarify matters urgently, because the impression has been given that he is doing so. [Interruption.] Not by me, but by his own remarks in the House on Monday. If he is not moving away from that standard, will he guarantee that he will not shift away at all from it throughout this Parliament and that it will remain at its current rate?

[Mr Harper]

rose—

[Jonathan Ashworth]

I will give way to the former Government Chief Whip.

[Mr Harper]

I, too, was in the Chamber on Monday and I listened carefully to the Secretary of State then. He was challenged by the right hon. Member for Exeter (Mr Bradshaw) on the target and was asked whether he was watering it down. He said explicitly that “far from watering down” he was recommitting the Government to it. He was generous to the Labour party in saying that it was one of the best things the NHS did. I think that was very clear.

[Jonathan Ashworth]

Let me say to the former Chief Whip that the Secretary of State said that

“we need to be clear that it is a promise to sort out all urgent health problems within four hours, but not all health problems, however minor.”—[Official Report, 9 January 2017; Vol. 619, c. 38.]

The Secretary of State did not need to come to the House to make those remarks and set these various hares running, so the right hon. Member for Forest of Dean (Mr Harper) should make his objections not to me, but to the Secretary of State—

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[Mr Hunt]

I will give way on funding one more time.

[Mr Harper]

We had the debate at the election about the need for a strong economy to pay for the NHS, and the public decided that the Conservative party won that argument. May I give my right hon. Friend another example, from yesterday, from his friend Jeremy—the Leader of the Opposition? He proposed to cap high pay, but the top 1% of taxpayers pay 27% of income tax revenues. That proposal would cut the funding available to the NHS and damage the services that hard-working members of staff produce.

[Mr Hunt]

My right hon. Friend is right. That is the worst kind of gesture politics, because it may get the Leader of the Opposition a few votes or a few more Momentum supporters, but it would damage the NHS.

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[Mr Mark Harper (Forest of Dean) (Con)]

I am very pleased to follow the hon. Member for Liverpool, Riverside (Mrs Ellman). I am sorry that the hon. Member for Central Ayrshire (Dr Whitford) is no longer in her place. I particularly enjoyed her remarks, in which she set out a number of constructive policy suggestions, drawing on experience in Scotland, and suggested that we could reflect on them and improve the situation here.

It was disappointing to hear not a single policy suggestion in the shadow Secretary of State’s 33-minute contribution. He might reflect on that because the debate will not move forward otherwise.

The hon. Member for Central Ayrshire drew upon her clinical experience, but I also enjoyed the contribution of the right hon. Member for Doncaster Central (Dame Rosie Winterton) who, after a period of enforced silence as Opposition Chief Whip, drew upon her ministerial experience, demonstrating the value of ex-Ministers contributing from the Back Benches and bringing something to the debate.

I have reflected on the Labour motion before us today, which specifically talks about the four-hour target and funding issues, which I will touch on in my inevitably brief speech. As I said in an earlier intervention, I was in the House on Monday when the Secretary of State was clear in what he said and I do not understand why Labour Members fail to see that. He did not in any way water down the target. The right hon. Member for Exeter (Mr Bradshaw) challenged him and the Secretary of State specifically “recommitted the Government” to the target. He was actually generous in paying tribute to the Labour Government for having introduced it, saying that it was

“one of the best things about the NHS”—[Official Report, 9 January 2017; Vol. 619, c. 46.]—

and in no way resiled from it.

Indeed, I think the shadow Secretary of State said in his remarks that the Secretary of State had somehow talked about ensuring that the target applied only to those with urgent health problems and that he had somehow said that secretly outside the House. However, I have looked carefully at the Secretary of State’s oral statement, given in the House just two days ago, and he was explicit about ensuring that the four-hour standard related to urgent health problems. He specifically referenced Professor Keith Willett, NHS England’s medical director for acute care, and said that

“no country in the world has a”—

four-hour—

“standard for all health problems”.—[Official Report, 9 January 2017; Vol. 619, c. 38.]

The target is for urgent health problems, and if we are to protect vulnerable patients, that is what we need to ensure—it is incredibly valuable.

The motion also relates to social care funding, so I want to talk about the charge that the Opposition keep making about local authority decisions. It is entirely true that the coalition Government had to make savings from local government budgets in the previous Parliament owing to the previous Labour Government’s lack of preparation following the dramatic financial crisis. We inherited a budget deficit of 11% and had to make such savings, but local councils had choices in the decisions they made about where the cuts fell. Gloucestershire County Council prioritised spending on adult social care, stating that it was the single most important service that it delivered. The budget related not only to older people; a third of it went on provision for adults with disabilities, including learning disabilities. The council protected that budget in cash terms, which is one reason why we are one of the best performers in the region and have low delayed patient discharge from the acute sector. While I do not pretend that there are no problems—of course there are challenges—the hard-working health and social care staff do an excellent job.

[Toby Perkins]

I am grateful to the right hon. Gentleman for giving way, but his comments about local government are ludicrous. The cuts that local government faced were far greater than those to any Department. The Government cannot introduce that level of cuts and then say to local government, “You have to decide what you cut.” Of course that was going to lead to social care cuts.

[Mr Harper]

The point that I was making is that my local authority also faced significant cuts and had to make choices. It chose to prioritise adult social care as the single most important service that it delivered, so it had to make difficult cuts in other areas. However, the choice to put adult social care at the top of the list of priorities was the right choice six years ago and remains the right choice today. If councils chose to put adult social care at the bottom of their list, that was not the right decision.

There is no acute A&E department in my constituency, but it is served by A&E departments in Gloucester and Cheltenham. I visited the new chief executive at Gloucestershire Hospitals NHS Foundation Trust and met some of the staff in the A&E department—the hospital has had its challenges—and she is working hard with her management team on turning around the performance of A&E, which has not been up to scratch. I talked to her about the processes they are putting in place, and I am confident that, with the hospital’s hard-working staff and improved leadership, they will be able to hit the targets that the Government have asked them to meet.

[Alex Chalk (Cheltenham) (Con)]

I joined Gloucestershire police on a night shift last Saturday, and I went to Gloucestershire royal hospital A&E, too. I saw professional and compassionate staff offering care in no doubt pressured circumstances. Does my right hon. Friend agree that the current STP process in Gloucestershire must be the occasion to enhance capacity elsewhere in the county and that that must include bolstering and enhancing A&E provision at Cheltenham general hospital?

[Mr Harper]

The whole point of the STP process is to ensure that we have capacity across the health sector. One important thing that the Secretary of State talked about is the other changes to the health and social care system—indeed, that is mentioned in the Prime Minister’s amendment, which is why I will support it. In that I agree completely with the Chair of the Select Committee. We have to look at the two things together.

Unlike what the hon. Member for Central Ayrshire (Dr Whitford) said, in Gloucestershire we are lucky to have a single CCG and a single county council, which work well together with lots of joint working, and they increasingly want to bring health and social care together. That is exactly what the Chair of the Select Committee said, it is the right thing to do and it is what the hon. Member for Central Ayrshire said is being done in Scotland to help deliver a better service.

My hon. Friend the Member for Cheltenham (Alex Chalk) is right that, the more we can improve capacity in the system to ensure that people can access primary care where they need it and can access social care where they need it, we will take pressure off the accident and emergency system. Indeed, when I visited the A&E department, it had a good triage system in place, with general practitioners based in the department to ensure that people with conditions that can be treated by general practice are signposted and treated in an appropriate setting, rather than damaging the service’s ability properly to deliver acute care to those who really need it. We need to consider such steps, going forward.

[Dr Murrison]

Would those people fall within the four-hour target? That lies at the heart of the debate. Should the four-hour target cover both urgent and more elective problems that people present to casualty departments?

[Mr Harper]

I do not know the detail of how the statistics are measured, but the important thing is to ensure that people who walk through the front door of an A&E department but who do not need urgent care receive care in the appropriate setting and are properly signposted, whether to community pharmacies, general practice or the information services that the NHS provides online or on the telephone. It is about making sure that people go to the right setting. The Government acknowledge that that is not perfect at the moment, and they are doing a lot of work to improve it in the future.

Finally, the Government’s moves to devolve spending power and decision making to local areas, particularly given what will happen in Greater Manchester, to bring health and social care together is the way forward, and I have certainly encouraged my local authority, as it leads the formulation of our devolution proposals, to make an ambitious ask of the Government on health. I hope the Government will look at that very seriously in the months ahead.

Mental Health and NHS Performance

Lord Harper Excerpts

Monday 9th January 2017 Commons Chamber

[Mr Mark Harper (Forest of Dean) (Con)]

I welcome the Prime Minister’s announcement and the Secretary of State’s confirmation of extra support for mental health. I particularly welcome the review to be led by Lord Stevenson and Paul Farmer. As they carry out that review on improving businesses’ ability to support people with mental health problems, will they particularly look at how we can help smaller businesses—those that perhaps do not have the human resource expertise that larger businesses may have—to make sure that people with mental health problems stay in work and are able to get back into work when they fall out of it? They are the biggest single category of disabled people not currently working, and we could make a huge difference.

[Mr Hunt]

My right hon. Friend will of course know that from his distinguished time as a Minister in the Department for Work and Pensions. He is right. The central problem we are trying to address is that if someone, for example, stops going to work and is signed off work because of severe depression, that is bad for the individual and also bad for the business. Too often, what happens at the moment is that it then becomes entirely the NHS’s responsibility to get that person back to work; the business says, “Well, it’s not our responsibility anymore because they’re not turning up.” With a little bit of help from the business, we could get the person back to work much more quickly, meaning that they recovered more quickly and the business would not lose someone important. That is what Dennis Stevenson and Paul Farmer will be looking into.

CQC: NHS Deaths Review

Lord Harper Excerpts

Tuesday 13th December 2016 Commons Chamber

[Mr Hunt]

I thank the hon. Lady for her contribution. I recognise the progress made in the Scottish patient programme, and particularly the inspirational leadership of Jason Leitch, who has done a fantastic job in Scotland and some very pioneering work.

The hon. Lady made some good points that I will take in reverse order. On whistleblowers, I asked Sir Robert Francis to look at this in his second report. He concluded that it would be very difficult, if not impossible, to go back over historical cases, because the courts have pronounced and it is very difficult to create a fair process where legal judgments have already been made. However, I take on board what she says, and I do not think that that means that we cannot learn from what has happened in previous cases; they are very powerful voices.

The hon. Lady is absolutely right about near misses, and we will include that issue in the “learning from mistakes” ambition.

The hon. Lady is most right of all about people with learning disabilities. The heart of the problem is deciding when a death was expected and when it was unexpected. About half of us die in hospitals. As she rightly says, the vast majority of those deaths are expected, but when a person has a learning difficulty it is very easy for a wrong assumption to be made that they would have died anyway. That is a prejudice that we have to tackle, and one that Connor Sparrowhawk’s mother talks about extremely powerfully. We have to make sure that this is not just about lessons for the whole NHS, but particularly about ensuring that we do better for people who have learning disabilities.

[Mr Mark Harper (Forest of Dean) (Con)]

As chair of the all-party parliamentary group on learning disability, for me the most chilling phrase in the foreword of the report was when Mike Richards and his team said:

“We found that the level of acceptance and sense of inevitability when people with a learning disability or mental illness die early is too common.”

Will the Secretary of State put on the record what Mike Richards says in the report, namely that there can be no tolerance of treating the deaths of people with learning disabilities with any less importance than the deaths of any other patient in the national health service?

[Mr Hunt]

I am happy to put on the record the fact that those words have the Government’s wholehearted support. I credit my right hon. Friend for his work leading the APPG. I commissioned the CQC report because a year ago we had a report by Mazars on what happened at Southern Health, which said that only 19% of unexpected deaths were investigated and that that fell to 1% for people with learning disabilities. That cannot be acceptable, and it is why it is so important that we act on today’s report.

Oral Answers to Questions

Lord Harper Excerpts

Tuesday 15th November 2016 Commons Chamber

[Nicola Blackwood]

Current restrictions on the advertising of less healthy food and drink in the UK are among the toughest in the world, so I am pleased to reassure the hon. Gentleman and his constituents on that fact.

[Mr Mark Harper (Forest of Dean) (Con)]

May I draw the Minister’s attention to some excellent leadership from the private sector? Lucozade Ribena Suntory, which is based in my constituency, announced last week —rather buried in the news from the United States of America, I am afraid—that it was going to take 50% of sugar out of its soft drinks by reformulating all its new and existing products. That demonstrates really good leadership and is an example to other companies.

[Nicola Blackwood]

I welcome my right hon. Friend’s question. He is absolutely right. We very much welcome the actions of not only Lucozade but Tesco in cutting the sugar in their drinks. It is proof that doing so is possible and meets the expectations of many consumers.