National Health Service

Mark Reckless Excerpts

Wednesday 21st January 2015 Commons Chamber

[Mark Reckless (Rochester and Strood) (UKIP)]

My party believes in an NHS free at the point of use and funded out of general taxation. I support much of what is in the motion today. I, too, would question what it states about outsourcing, as it is not quite clear whether outsourcing will be based on hypothecation in relation to how much the mansion tax raises or on how much the Conservatives happen to be spending. I believe we need to decide the right amount to spend on the NHS and then to commit to it, rather than simply say it should be £2.5 billion above however much the Tories spend—either cutting or increasing. We should make a decision about how much the NHS needs and then fund it properly. I support the principle of joining up adult social care with the NHS, and I thought that the shadow Secretary of State made a persuasive case for a single budget.

[Ian Austin]

What does the hon. Gentleman think it tells us about his leader’s instincts when he said:

“I think we are going to have to move to an insurance-based system of health care.”?

Moreover, what does he think it tells us about his deputy leader’s instincts when he said that he wanted to

“congratulate the coalition government for bringing a whiff of privatisation into the…National Health Service…the very existence of the NHS stifles competition.”?

Does that not prove that ordinary people who rely on the NHS cannot regard UKIP as being in any sense on their side?

[Mark Reckless]

It proves nothing of the sort. The hon. Gentleman faces a very strong challenge from UKIP in his constituency from the excellent Bill Etheridge MEP. The policy of our party—[Interruption.] No, let me answer the point. Our policy is determined by our party as a whole. We are committed to an NHS free at the point of use and funded properly out of general taxation. [Interruption.] May I continue? I personally come from a mother and father who met in the NHS; the NHS and supporting it is in my blood. I believe in the NHS as I have described it, and I would appreciate the courtesy of people accepting the sincerity of what I say on that.

I am pleased to see the shadow Secretary of State still in his place as he has been throughout the debate, but when it comes to funding the social care budget, it is a moving target to determine what that budget is. We know the local government settlement for the year ahead, but not for beyond that. We do not know what either a Conservative-led or Labour-led Government might be able to, or choose to, spend on local government, or what proportion might be allocated to public health budgets. It thus strikes me as a significant risk to say, without greater clarity, “This is what the budget will be, plus the sum of £2.5 billion”—the figure selected by the shadow Health Secretary and his party, irrespective of what the baseline is.

[Steve Rotheram (Liverpool, Walton) (Lab)]

Can the hon. Gentleman be absolutely certain of what his party might or might not do should it ever—unfortunately—find itself propping up a Government? Can he assure us that the road to Damascus-style conversion that he is describing represents the view of the whole of his party, and not just his individual view?

[Mark Reckless]

Yes, I can give the hon. Gentleman that assurance. It is the view of my party, it is the view of the whole party, and it is my own personal view, which is core to my politics and what I came to the House to represent.

The Prime Minister said earlier that I came to the House week after week to discuss the NHS in Kent. Following what could perhaps be described as an endorsement of my approach from the Prime Minister, I now wish to raise some of the issues that have arisen in Medway. One of the problems with the motion is that it makes no mention of introduction of the new GP contract in 2004, which I believe has been a significant driver of increased demand for A and E services.

In Medway, where the proportion of single-handed general practices is significantly higher than the national average, the burden of out-of-hours care falls largely on an organisation called MedOCC. While I would encourage constituents to use MedOCC rather than A and E when that is appropriate, I have one or two concerns about the way in which it operates.

Like the hon. Member for Wirral South (Alison McGovern), we had a young child who was ill, and we sought an appointment. My wife telephoned MedOCC and we were offered an appointment at a particular time, but were then told that the wait would be an hour and a half. We said “If the wait will be an hour and a half, why do you not give us an appointment an hour and a half later than the one that you have just given us?” However, that was not allowed. We had to wait for an hour and a half, because that was the procedure, and that was the way it had to be. Although we went to the MedOCC clinic because we thought that that was the appropriate service, I would understand it if a constituent in the same circumstances decided to take his or her chances at A and E, where it might even be possible to be seen more quickly.

It is important for an out-of-hours service—in our case, MedOCC—to be flexible and responsive, and to be operated in a way that makes it an attractive and appropriate alternative to A and E, and I shall develop that point further when I meet members of the clinical commissioning group on Friday.

[Rehman Chishti]

The hon. Gentleman and I share the same hospital in Medway. Will he join me in welcoming the extra £13.4 million that has been given to its A and E department, the extra £6 million of winter funding, and the additional £10 million that has been given to the CCG to help to improve local health services?

[Mark Reckless]

I do indeed welcome those sums; I pressed for them strongly. I was particularly delighted by the provision of that £13.4 million for the rebuilding of the A and E department, which I think is essential. I am now campaigning for the provision of a further sum of approximately £20 million so that the hospital can build what it describes as an “emergency village”, consisting of short-stay medical wards around the A and E to improve the throughput of patients and the quality of care.

I have also helped the hospital with its efforts to ensure that patients are referred more appropriately, and are not necessarily sent to A and E. If a GP refers a patient to hospital and that patient has a known condition, surely it is better for the patient to go to the relevant ward than to be pushed through A and E, which is not an appropriate environment for someone who has already been assessed by a GP. Similarly, A and E is rarely the right environment for people suffering from dementia. It is best for action to be taken at the nursing home or by GPs, possibly based alongside A and E, who can make a speedy assessment and transfer the person to an appropriate treatment area. I am also pleased by the decision to end the so-called Star system in Medway A and E. The idea was that someone would be assessed by a senior clinician before it was decided what should be done, but that was not happening within a sensible time scale. That system has now been replaced by nurse-led triage, which I think will work better.

I am also grateful for the support we have received from other hospitals, notably the Homerton, which has an excellent A and E department. Medway has benefited from secondments there. It is important that those secondments and that support are integrated with the permanent staff in Medway hospital and the clinical director lead for emergency medicine is key.

We have had extra consultants appointed in emergency medicine at Medway hospital, which I strongly welcome, but I must mention the terms and conditions of emergency doctors. It is an extraordinarily demanding specialty and doctors working in it rarely have the opportunity to take on private work, which is a consideration for some but not all doctors when they make their choice of specialty. To encourage more doctors to come in to this field, should we consider changes to the lockstep consultant contract so that doctors in the extraordinarily demanding area of emergency medicine can perhaps receive more pay than others who are in specialties that are not as extraordinarily demanding, to which some might have been attracted by the potential for private earnings that they could not make in emergency medicine?

The Secretary of State tells me that what is actually required is more holidays for A and E doctors. That might be the case, but it would require pulling more doctors in to emergency medicine to cover for colleagues on holiday. I question a system in which high numbers of agency staff are used for a day or a week. Hospitals with problems in A and E and that have problems attracting people can fill places with those staff by paying very high rates, but they do not necessarily gel as a team or provide support in anything but the short term. We need to make emergency medicine attractive for doctors.

Finally, on the question of Monitor and the CQC, Medway hospital is a foundation trust. That happened in a largely box-ticking and financial exercise under the previous Government that ignored the death rate being one in 10 higher than it should have been, as mentioned by the hon. Member for Gillingham and Rainham (Rehman Chishti). Although Monitor has been reasonably sensible in its approach to Medway, it cannot come and run the hospital. We had to look to the board to do that. Similarly, the CQC has made some sensible interventions, for example on A and E, but in 2012 it said that Medway was a good hospital that was meeting all its standards. I believe that many of the problems we are seeing were in place then but were not identified by the CQC. My party wants to replace some of the alphabet soup of bureaucracies and regulators, such as Monitor and the CQC, with directly elected health boards that could, we believe, oversee these things better.