Junior Doctors Contract

Mark Spencer Excerpts

Thursday 19th May 2016 Commons Chamber

[Mr Hunt]

I think my hon. Friend is right that that was the big sticking point. It was the BMA’s willingness to be flexible and negotiate on that that ultimately made an agreement possible, but it is also fair to say that the Government recognise that there are many other non-contractual issues in the way that junior doctors are trained and treated by the NHS, and we want to use this opportunity to put them right.

[Mark Spencer (Sherwood) (Con)]

I congratulate the Secretary of State on putting patients first, but does he recognise that there are still people out there whose operations were cancelled due to industrial action? Will he look to the future and consider whether front-line medical staff should have the right to strike and so put people’s health on the backburner or postpone their medical care?

[Mr Hunt]

I know that that is a view that some colleagues share. Doctors have obligations even now under the Medical Act 1983 not to take action that would harm patients, and under their responsibilities to the General Medical Council; they have to be aware of those. What I hope is that that question simply does not arise again. We are now having constructive discussions with the BMA; I think that is the way forward and I hope that neither I nor any future Health Secretary has to go through what has happened in the past 10 months.

NHS Bursaries

Mark Spencer Excerpts

Wednesday 4th May 2016 Commons Chamber

[Ben Gummer]

I am afraid that the hon. Gentleman is wrong on both points: more mature students are applying now than in 2010; and there are specific recommendations in the consultation to deal with mature students.

[Mark Spencer (Sherwood) (Con)]

Does this not demonstrate the Minister’s point? We have a choice: we either inspire people to aspire and give them the opportunity to enter the NHS by talking it up, or we take the opposite view, talk the NHS down by being negative, and put people off.

[Ben Gummer]

I do believe that. The Opposition were wrong back in 2010, and had we followed their advice, fewer people from disadvantaged backgrounds—precisely the people Labour was elected to represent and support—would be going to university. As a result of our taking forward brave proposals, in the teeth of much opposition, we have done more for the prospects of people from disadvantaged backgrounds than any Government dealing with this matter since higher education was reformed after the second world war.

I come now, I am afraid, to the motion tabled by the hon. Member for Lewisham East. It implicitly accepts that we have made progress. The fact that it is so anaemic in offering an alternative makes it clear that there is no alternative suggestion that she thinks would achieve the aims that she and I want: an increase in the number of students going into nursing and training, and of those coming from a diverse background. It also implies that she accepts, like me, that workforce planning over the last 10, 15, 20, 30 or 40 years has failed. I can say that, whereas she is not willing to, because everything we are doing now to correct workforce numbers—for example, the 5,000 additional GPs my right hon. Friend the Health Secretary fought the last election campaign on and will be delivering in the next few years—is the result of poor commissioning decisions made not under the coalition Government, or even in the latter years of the Labour Government, but under Governments 20 and 30 years ago.

The failure to predict the number of GPs needed, and the number and types of other professionals needed, lands us perpetually in this perverse situation where we are not accepting British students on to training courses at British universities and, as a result, are not creating the numbers of domestically trained nurses we need. In response to the inadequacies in care uncovered as a result of the Mid Staffordshire NHS Foundation Trust scandal and the failure of the Labour Government to provide the number of nurses needed in hospitals across the country, we are having to import nurses from abroad and to fill nurse places with expensive agency posts. That is something we are putting right now.

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[Mark Spencer (Sherwood) (Con)]

Welcome to the Chair, Mr Deputy Speaker. I am glad that your first act has been to call me to speak.

It is a pleasure to follow the hon. Member for Scunthorpe (Nic Dakin), for whom I have a great deal of respect. He always speaks with credibility and from experience. I am more than happy to acknowledge that there are many colleagues in the House with more experience than I have of working in the NHS, particularly my hon. Friends the Members for South West Wiltshire (Dr Murrison) and for Totnes (Dr Wollaston). My experience is as a customer or as a relative of someone who has been treated in the health service. I have to say that, to date, my experience has been nothing but positive. The treatment that our NHS continues to deliver to our nation is the best in the world, and Government Members can be immensely proud of that.

One of the things that I find most frustrating about our debates on the health service is the fact that the Opposition seem to think that they have a monopoly on caring for the NHS. Nothing could be further from the truth. Conservative Members care deeply about our health service and we do everything we can to support it.

It is worth saying that every Labour party election leaflet since the second world war has said, “We’ve got 24 hours to save the NHS before the Tories come into government.” It repeats that message every time. If we look at the facts, however, we will see that the truth is that the Prime Minister was the only party leader to enter the 2010 general election saying that he would protect the NHS budget. Others did not. In 2015, the Prime Minister was the only party leader who committed to the extra £8 billion support funding for the NHS when other Opposition parties would not back that figure. Today that figure has increased: this party is now backing the NHS with an extra £10 billion. We are also delivering on the aspiration of people like me, who are either customers or relatives of people who use the NHS, to get a high-quality service seven days a week.

Whenever we debate this issue, the difference between the two parties is one of credibility. The only way we have been able to deliver the extra £10 billion of funding to the health service is by having a credible economic plan that stands up to scrutiny. The great British public understand that and what it means to have a credible plan that can be delivered in government.

As a number of colleagues have said, we agree on a lot of things. No one can deny that both the Government and the Opposition acknowledge that we need more nurses, but we differ on the credible plan to deliver them. Members on both sides of the Chamber have made speeches today acknowledging the need to deliver extra nurses, but it is only Government Members who have a credible plan to make it happen. We cannot just hope it happens, or state that it will happen, without saying where the extra money will come from. The consequence of that would be to withdraw cash from front-line services, such as existing doctors, nurses, operating theatres and wards, and put it into training.

If we want to increase the number of nurses coming into the NHS, we should not restrict the number who can be trained. It seems obvious that the way to raise the number of nurses is to lift the artificial cap on the number that we can train. I welcome the fact that the Government are considering and consulting on their options and looking to ensure that there is no artificial cap, so that we can train as many people as are inspired to go into the nursing profession.

I reiterate my admiration for those people. People leaving full-time education enter nursing not because they want to be rich but because they care and they see it as a vocation. We need to support people who have that calling and who aspire to look after those in society who find themselves ill and in need of support. We must find a system that allows them to aspire to that, whatever their background and wherever they come from. They must be able to go through their training and reach the point where they can follow their vocation.

The arguments that are being deployed against the Government’s suggestions appear similar to the ones that we heard about student loans. We were told that those from a deprived background or from more challenging areas would be put off and would not be able to find a way through the system. We need to reflect on the evidence, which shows that the opposite has happened—the number of people from challenging backgrounds going to university has gone up, even though we were told that they would not be able to go.

At the end of the process, we need an NHS that can adapt and change. There is enormous social pressure on it, and there is the challenge of getting a balance between adult social care and healthcare as society gets older. When cash is short, we must spend it on front-line services—on the doctors, nurses and drugs that can improve the lives of people who need the support of the NHS. I look forward to the consultation, and I know that the team in the Department of Health will look at the responses. I hope that we get to the right place, and that we have more nurses at the end of the process.

Junior Doctors Contracts

Mark Spencer Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

I agree that the strikes are putting patients at risk. I think that what my hon. Friend means by the second part of his question is: what would have happened if we had just allowed the current contracts to roll over? The answer is that we would not have made progress towards a safer seven-day NHS, which will be of enormous benefit to his constituents and mine.

[Mark Spencer (Sherwood) (Con)]

Will the Secretary of State use the Dispatch Box this afternoon to appeal directly to junior doctors to ignore the militant BMA, to turn up to work tomorrow, to acknowledge that the Government have met the BMA over 70 times and made more than 70 concessions round the negotiating table, and to put patients first and make sure that my constituents get the level of health service, seven days a week, that they so deserve?

[Mr Hunt]

My hon. Friend speaks extremely wisely. I say to every junior doctor in the country that what they want from our NHS—safe service and safe care for patients across every day of the week—is what we want as well. This Government are committed to the NHS. We are this year putting the sixth biggest increase in resources into the NHS in its history, so we are putting our money where our mouth is. We want to sit down with the medical profession and make this work for patients.

NHS: Learning from Mistakes

Mark Spencer Excerpts

Wednesday 9th March 2016 Commons Chamber

[Madam Deputy Speaker (Mrs Eleanor Laing)]

The prize for perseverance and patience goes to Mr Mark Spencer.

[Mark Spencer (Sherwood) (Con)]

I am grateful, Madam Deputy Speaker, even if my knees are not.

I congratulate the Secretary of State on providing a protected space for doctors, so they will be able to be honest and upfront when things go wrong, and on striking the right balance so that relatives and people who suffer wrongs in the NHS get to the bottom of what went wrong, why it went wrong and why it will not happen again.

[Mr Hunt]

I thank my hon. Friend. That is the heart of what we want to do. He of course has been very closely involved in the improvements we are trying to make at his local trust. If his knees are in pain, I can recommend a very good GP surgery in his constituency, one he very kindly showed me during the election campaign.

Junior Doctors’ Contract Negotiations

Mark Spencer Excerpts

Monday 8th February 2016 Commons Chamber

[Ben Gummer]

We believe that last year about 500 junior doctors were operating on a band 3 payment, which equates to payments for hours of work that exceed what is specified in the working time regulations. That is a relatively small number within the NHS, but it is still significant, and for the doctors concerned, working those excessive hours is unsafe.

[Mark Spencer (Sherwood) (Con)]

Will the Minister join me in thanking the junior doctors who ignored the call to strike last time, and does he agree that the lack of condemnation from the Opposition demonstrates that they are putting their support for industrial action before my constituents and their healthcare needs?

[Ben Gummer]

I entirely agree. Rather like an arsonist who pours petrol on a fire and then runs to offer help to put it out, the Opposition have done very little to help to get the contract into the place where it needs to be, and to stop the industrial action. I am afraid that the patients whose operations will be cancelled this week will suffer partly because of the Opposition’s failure to take a firm stand.

Junior Doctors’ Contracts

Mark Spencer Excerpts

Wednesday 28th October 2015 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

I beg to move,

That this House notes the stalled discussions between Government and the British Medical Association (BMA) about a new junior doctors’ contract; opposes the removal of financial penalties from hospitals which protect staff from working excessive hours; urges the Government to guarantee that no junior doctor will have their pay cut as a result of a new contract; and calls upon the Government to withdraw the threat of contract imposition, put forward proposals which are safe for patients and fair for junior doctors and return to negotiations with the BMA.

It is a privilege to be opening a debate from the Opposition Dispatch Box for the first time, and I want to start in a way that is perhaps untypical for these debates. I want the Secretary of State and me to agree on something. I want him to join me in saying thank you to everyone who works in the NHS and in the care system in our country—not just the junior doctors who are the subject of today’s debate but all the staff who work day in, day out caring for our loved ones as though they were their own. So, to our doctors, nurses, porters, care workers and paramedics I say this: I know how hard you work; I know that many of you already work nights, weekends and even Christmas day, and for that we are hugely grateful.

I have called this debate today because I am deeply worried about the current stand-off between the Government and junior doctors. I am worried that a new Government-imposed employment contract will be unsafe for patients and unfair for doctors. I am worried that if the Health Secretary gets his way, he will fast become the best recruiting sergeant that the Australian health service has ever had.

[Mark Spencer (Sherwood) (Con)]

Does the hon. Lady therefore agree that the best course of action would be to get round the negotiating table again? Will she encourage the British Medical Association to come back to the negotiating table?

[Heidi Alexander]

If the hon. Gentleman reads the motion, he will see that it talks about a return to the negotiating table, but the BMA and the junior doctors need to know that the Health Secretary is genuinely willing to compromise, and his performance over the past few months suggests otherwise.

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[Mr Hunt]

I am going to make some progress before taking any further interventions.

The question for a Government and for a Health Secretary is this: when we are faced with this overwhelming evidence—six studies in five years—should we take action or ignore it? We are taking action. That is why in July I announced that we will be changing the contracts for both consultants and junior doctors as part of a package of measures to eliminate the weekend effect. If we believe in the NHS, and if we want it to be there for everyone, whatever their background or circumstances, we must be able to offer every NHS patient the promise of the same high-quality care, whichever day of the week they need it.

Let me set out for the House what I have proposed. We announced ambitious plans to roll out seven-day services across the country, with better weekend staffing across medical, diagnostic and support services in hospitals, as well as better integration with social care and seven-day GP access. That will reach a quarter of the population by March 2017, and the whole country by 2020. For consultants, we proposed an end to the right to opt out of weekend working, replacing it with a maximum obligation to work one weekend in four. To its credit, the BMA’s consultants committee has agreed to negotiate on that.

For junior doctors, we proposed to reduce the high overtime and weekend rates, which prevent hospitals from rostering enough staff at weekend, and increase basic pay to compensate. We have made a commitment that the pay bill as a whole would not be reduced, and today I can confirm that not a single junior doctor working within the legal limits for hours will have their pay cut, because this is about patient care, not saving money. Incidentally, I made it clear to the BMA at the beginning of September that that was a possible outcome of negotiations, in an attempt to encourage it to return to the negotiating table. Rather than negotiating, it chose to wind up its own members and create a huge amount of unnecessary anger.

[Mark Spencer (Sherwood) (Con)]

Given the Secretary of State’s assurance, is there any reason why the BMA should not come back to the table and negotiate with him to solve this problem so that patients are safer at weekends?

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[Dr Whitford]

We will roll out a red carpet somewhere on the M74 and welcome them with open arms. The progression and migration in Scotland towards robust seven-day emergency care has been happening through a dialogue, not through a threat to impose a contract.

There are other things in this, such as the plan to change pay progression, which is currently on an annual basis, to recognise experience. That will be replaced with just six pay grades. Such a move will affect women in particular, because they tend to take a career break and they tend to work part-time, so they will get stuck at a frozen level for much longer. It may also be a disincentive to people to go into research, because they will be stuck on the same rung of the ladder for longer. We do not want that disincentive. We need to make sure that we are valuing how people develop and the experience they accrue along the way.

[Mark Spencer]

The hon. Lady is making a powerful case for dialogue. Will she join the Secretary of State in calling for the BMA to come back to the negotiating table or join the shadow Secretary of State in refusing to call for it to do so? Which will she do?

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[Mark Spencer (Sherwood) (Con)]

I am delighted to be able to take part in this most important of debates.

It is worth saying at the outset that the most important issue we face when talking about changing these contracts is patient safety. We do well to recognise that our No. 1 priority should always be patient safety, and about the service that the NHS delivers to the patients who require its health and assistance at the most important time of their life. In order to deliver the improvements, level of service and safety that we require, we need to have an engaged workforce who are willing and enthused about their work. It is important to recognise the challenges that NHS staff face and the long hours that they have delivered over a number of years, putting themselves at great risk, frankly, in working what would be regarded in any other industry as silly hours. We clearly need to change those working practices to make sure that patient safety is once again brought right to the top of the agenda.

It is important to recognise that these negotiations are not about cash. This is not about saving money or changing the system so that the Government can spread things thinner; it is about delivering an NHS service over seven days of the week to make sure that when someone has that moment when they need the NHS to step in to save their life or to help them, the service is there and able to deliver.

Junior doctors currently receive between four and five incremental pay rises, depending on the time they serve. In most other industries, increments in pay should be about qualifications and the way in which someone has worked through them, not simply about the amount of time they have served.

We must get to a point where we can deliver a seven-day NHS and eradicate the weekend effect. As hon. Members have mentioned, some patients are starting to change the way in which they engage with the NHS because they are concerned that, if they are admitted on a weekend, that will affect the care they receive. It is important to ensure that that does not happen. There will inevitably be changes to work patterns, and current contracts will have to change. At the same time the Government will ensure that there is extra pay for time that doctors work at weekends.

Oral Answers to Questions

Mark Spencer Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Alistair Burt]

Yes, the whole concept of out-of-hospital care involves an expansion of what is considered to be direct primary care, and it also involves other support services. I am aware of projects in which pharmacies are already connected directly to GP surgeries. We will be expanding some of the pilot work that has already been done. If my Twitter account is anything to go by, pharmacies are very keen to promote themselves and say what they can do for patients, and we will certainly be responding.

[Mark Spencer (Sherwood) (Con)]

Will the Minister pass on my thanks to the Secretary of State for visiting a GP surgery in my constituency in April? Will the Minister assure the House that during his tenure he will continue to visit GPs and to spread examples of good practice to other GPs who may have room for improvement?

[Alistair Burt]

I thank my hon. Friend for his question, and the Secretary of State will have picked up his thanks for the visit. Seeing GPs is really important. I will let the House into something that I am likely to say again, which is that my dad is a GP. I pay tribute to him, as he has just passed his 93rd birthday. I thank him and all other GPs for their devotion to practice and to looking after people so well. They are a vital part of the service. I will be keen and rather soft on GPs. I want to see them enjoy their profession as much as my father has enjoyed his.

NHS (Government Spending)

Mark Spencer Excerpts

Wednesday 28th January 2015 Commons Chamber

[Dr Poulter]

I am familiar with the hon. Lady’s constituency, having worked as a doctor at a hospital in the area. Her question is very disingenuous when we have increased the number of front-line clinical staff working in our NHS, investing in more staff to treat patients. We have also recently agreed with the unions a pay deal that will see the majority of NHS staff receiving a substantial increase in pay, thanks largely to their increments. Other staff will receive 1%.

[Mr Mark Spencer (Sherwood) (Con)]

The Opposition appear to struggle with the concept that we can fund public services only if the economy is moving forward. The interest alone on the debts that the previous Government amassed would have been enough to build a hospital ward every 30 minutes.

[Dr Poulter]

My hon. Friend makes a very good point. On this side of the House we believe that when we spend public money we should do so efficiently and effectively. We have also made Government spending much more efficient—[Interruption.] Rather than heckling, the hon. Member for Liverpool, Wavertree (Luciana Berger) might do well to listen to what I am about to say, because efficient public spending should be a priority for any Government, although it certainly was not for the previous Government. Cabinet Office figures, endorsed by the National Audit Office, show that £14.3 billion of savings, relative to 2009-10, have been made across many areas of expenditure, including procurement, work force, major projects and transformation. That is £850 for every working household saved by this Government, and clearly shows that we are spending public money much more efficiently and wisely than Labour ever did when in office.

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[Mr Mark Spencer (Sherwood) (Con)]

It is a pleasure to follow the hon. Member for Islington South and Finsbury (Emily Thornberry).

It is a little sad, to be honest, to be having this debate today, because we could approach this issue in a much more mature way as politicians. Clearly there are enormous challenges facing our health service and our adult social care services, not only for this Government or the next, but for the two Governments after them. As politicians, we owe it to our constituents to have a mature debate about how we are going to avert the demographic time bomb that is heading our way. Frankly, we all have an interest in that. Just like the hon. Member for Nottingham East (Chris Leslie), we are probably going to need those services at some point. I hope I will not find myself in a bed next to him, but we could end up on the same ward.

It is worth saying that every Labour party election leaflet for the last 50 years has said, “You can’t trust the Tories with the NHS.” Yet we have had countless Conservative Governments over that period, and the NHS continues to thrive, to look after people and to offer its services.

[Grahame M. Morris]

The hon. Gentleman is saying that the NHS is safe in Conservative hands, but let me remind him that in 1997, when Labour came to power, there had been 18 years—a considerable length of time—of under-investment. Expenditure on the NHS was increased 300% by the Labour Government: from £30 billion to over £100 billion. Every accident and emergency unit was rebuilt and many hospitals were rebuilt, too.

[Mr Spencer]

That is where the hon. Gentleman’s party falls down. Labour Members obsess about cash and forget about clinical operation. That is why we ended up with crises such as that at Mid Staffs hospital, with people dying in their beds because of bureaucracy, target setting and obsession with process rather than the care of patients.

The Opposition also have an obsession with the private sector. My father had to have a new knee, unfortunately. He went to the local hospital, which happens to be the one that the constituents of the hon. Member for Nottingham East attend. Rather than being treated in the NHS Queen’s medical centre, he was sent to a hospital in Sherwood in his constituency, which looked after him very well. It was a private hospital and this was in 2008—under the previous Government. The NHS was making use of private services back then. It was very efficient and well delivered. I do not understand this obsession with the private sector. We need to remember that private companies make the drugs that the NHS uses; private companies make all the crutches and the ambulances; and GPs are, in effect, private companies. It works very well. As long as we can deliver a service that is free at the point of use and run in the most efficient way but with the highest levels of care and consideration, I think that is the right place to be.

[Barbara Keeley]

Let me return to my earlier point. Would the hon. Gentleman be comfortable if his constituents with cancer or those at the end of their lives had to contend with a totally privatised service? That is what we might have to contend with, because we might be faced with a 10-year contract to privatise all those services. It has never been done before, and it is highly risky—and the oncologists were not even consulted about it. We are not talking about supplementing; we are talking about private services replacing the NHS.

[Mr Spencer]

I thank the hon. Lady for that intervention. What my constituents who are in the unfortunate position of suffering from cancer care about is whether they are going to get better. Is the service going to deliver a service that makes them better and gets them over the disease? Frankly, if it does not cost constituents any money, and if the level of care and service is the highest, I think that is what really matters to them.

It is easy to stand here and talk. Politicians talk—they will always talk—but we have to look at what politicians do. This Government, to their credit, have in this Parliament put in an extra £12.7 billion. Let us compare that with how politicians have operated in Wales, where the budget has been cut by 8%. I think it says a lot to our constituents about how the NHS is going to be managed in future and how much we genuinely care about and want to support the NHS system.

[Helen Goodman (Bishop Auckland) (Lab)]

Is the hon. Gentleman not aware that central Government have cut the Welsh Government’s money by 10% and that health spending in Wales is now at an all-time high?

[Mr Spencer]

Of course, I am the first to admit that there is financial pressure within the system. The previous Government borrowed enormous amounts of money and ran up an enormous deficit. Any Government coming in at that time would have had to take difficult decisions, but the simple fact is that spending in England has gone up under this Government, while spending in Wales under the control of the hon. Lady’s party has gone down. There are some 850,000 extra operations a year taking place in our NHS by comparison with 2010.

The issue that upsets me most and has brought me to attend this debate is the state of my own Sherwood Forest Hospitals NHS Foundation Trust. It “benefited” from a PFI deal signed under the previous Government, which now costs the trust £40 million a year out of its budget. That is where we went wrong under the previous Government. Let us spin that out: we were fortunate enough to invest £320 million in a new hospital, but it will cost £2 billion in repayments. I put it to Members that they would get a better interest rate from Wonga than they would out of that PFI deal. If we look at what happened nationally, we find that £11 billion-worth of investment through PFI matches up with £55 billion-worth of repayments. That means £44 billion being taken out of the NHS because of the shocking PFI deals signed by the previous Government.

Labour Members talk about the cost of our reorganisation being £3 billion, but that is frankly nothing by comparison with £44 billion. It is an enormous amount of cash that could be spent on doctors, nurses, cancer patients and putting our NHS services in the right place.

I am very fortunate that the Secretary of State has agreed to meet me and my hon. Friend the Member for Newark (Robert Jenrick) to try to help Sherwood Forest hospital trust out of the hole that the previous Government put it in. Hopefully, we can assist in dealing with the £40 million a year being sucked out of the trust.

I am conscious that other Members want to speak, so I shall end there. I am grateful for having had the opportunity to speak.

Oral Answers to Questions

Mark Spencer Excerpts

Tuesday 13th January 2015 Commons Chamber

[Caroline Nokes (Romsey and Southampton North) (Con)]

4. What progress his Department has made on its long-term plans for easing pressures on A and E departments and preparing the NHS for the future.

[Mr Mark Spencer (Sherwood) (Con)]

13. What progress his Department has made on its long-term plans for easing pressures on A and E departments and preparing the NHS for the future.

[Julian Sturdy (York Outer) (Con)]

15. What progress his Department has made on its long-term plans for easing pressures on A and E departments and preparing the NHS for the future.

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[Mr Hunt]

My hon. Friend is absolutely right. Part of the solution to the pressure in A and E is providing good alternatives, and in the last year for which we have figures, the 111 service took 12 million calls, which is three times more than the 4 million calls that NHS Direct took in its last year of operation, and 27% of people said that had they not called 111 they would have gone to A and E. That is a huge success.

[Mr Spencer]

The Secretary of State will be aware of the additional pressure on Sherwood Forest hospitals trust as a result of the £40 million a year disastrous private finance initiative deal signed by the last Government. Will he meet me, my hon. Friend the Member for Newark (Robert Jenrick) and representatives from the hospital to discuss how we might move forward and deal with this terrible PFI deal?

[Mr Hunt]

I am aware of the problems with that deal, signed back in 2005, which is now consuming 17% of the trust’s income. It would like to spend that income on more doctors and nurses, but it cannot because of the shockingly bad deal signed. I would be happy to meet my hon. Friend to discuss what is possible in the current circumstances.

Health Care Provision (Newark)

Mark Spencer Excerpts

Wednesday 7th January 2015 Westminster Hall

[Robert Jenrick (Newark) (Con)]

I start by thanking Mr Speaker for granting the debate and the Minister for replying this morning. I am also grateful for the attention of the Secretary of State, who visited Newark hospital last year. I thank my constituents and the Newark Advertiser, who have come here for the debate, and I thank my constituency neighbour, my hon. Friend the Member for Sherwood (Mr Spencer). Rather like the film “Groundhog Day”, the last debate on the subject was held two years ago to the day. The matter has moved on somewhat since then and progress has been made, to which I will refer shortly, but concerns remain. That is the reason why I return to the subject today.

I do not want to bore the Minister, but a little bit of history might be useful. I know that she visited Newark three times in May last year, but let me briefly guide her. We sit on the border between Lincolnshire and Nottinghamshire, and despite excellent north-south road and rail links, the community is relatively remote and rural, and it is bedevilled by poor roads and awful traffic. Newark is a growing town, with applications for thousands of new homes being considered as we speak and many more to follow, according to local growth plans. We have an older population, and the number of over-65s is likely to have doubled by 2026. I fear that Newark suffers from the Nottinghamshire health care model, which has been in place for at least a decade and a half. Centres of excellence have been created in places such as Lincoln, Nottingham and King’s Mill hospital, but not in Newark. For reasons of population scale, Newark hospital was linked to King’s Mill hospital some years ago. They were, and remain, uneasy bedfellows, because there are few natural connections and poor transport links between the two.

[Mr Mark Spencer (Sherwood) (Con)]

I congratulate my hon. Friend on securing this important debate. In the two years that have elapsed since the previous debate, one thing that has changed is the transfer of more than £80 million in private finance initiative payments from Sherwood Forest hospitals trust to its PFI holder. What impact is that having on Newark hospital and Sherwood Forest hospitals trust?

[Robert Jenrick]

I thank my hon. Friend for his campaigning on PFI and Sherwood Forest hospitals trust. I will return to that question later in my remarks, because it is one of the central issues affecting the trust’s ability to deliver good-quality health care not only for my constituents, but for his and for people throughout Nottinghamshire.

To return to my brief history lesson, the hospital delivers superb services, and it always has done, but those services have diminished relative to those that were offered in the recent past. In addition, as we have heard, King’s Mill is saddled with a devastating PFI that will be in place for 30 years. The problem is not new; it has been a hot potato in the Newark area since at least 2004, and there is a history of declining services including the loss of maternity care in the increasingly distant past. The PFI was put in place, and in 2010—bridging the previous and current Governments—the A and E department was replaced with a minor injuries unit. I say that, but the classifications in the NHS seem byzantine to us amateurs, and even if they are not designed to confuse us, they undoubtedly have that effect. The department called itself an A and E for the best part of 10 years, but it did not qualify to be one. It was always going to be extremely painful to change the department’s title and inform the community that the back-up available at the hospital was insufficient to be safely called an A and E and to have ambulances directed to it for the commensurate range of emergency situations.

In 2012, Monitor delivered an extremely critical report on the PFI and the trust, which includes King’s Mill and Newark hospitals. The report pointed out that Newark hospital was, at times, underutilised by some 55%, and it was closed for admissions after 6 pm. Good has come from that report, including new management and significant improvements at the trust. However, the trust, as the Minister knows, remains in special measures, with a corresponding impact on recruitment, retention and the reputation of the trust and its hospitals among my constituents and those of my hon. Friend the Member for Sherwood.

To return to the hospital and bring us closer to the present day, some services, including those related to hips and knees, have been removed in recent years following the Keogh report and the imperative, we were told, to ensure that services are matched to appropriate levels of staffing and back-up. The trust is in the process of refocusing Newark on day case services and diagnostics. We all understand that the transformation of services takes time to implement, and the period of change has seen some underutilisation. I suspect that that period has gone on too long. Furthermore, there have been problems about directing patients to the appropriate hospital and ensuring that that hospital is Newark if the services are still available. I have lost count of the number of times that constituents have told me that they were not offered Newark hospital or had to ask for it specifically, when we know that the hospital delivers the necessary services. That contributes to underutilisation and must be resolved once and for all.

On top of those difficulties, East Midlands ambulance service received a concerning inspection report by the CQC at the beginning of 2013, which found it to be underperforming in four of the six central measures. As medical professionals agree that the most serious emergency situations are best treated by fully staffed and equipped general hospitals, the imperative becomes greater to have an ambulance service in north Nottinghamshire with the capacity to respond swiftly and meet the appropriate timings for our constituents. Furthermore, residents complain about the length of time taken to repatriate those who are no longer critical but who require rehabilitation or some further care closer to home. That is made all the worse and more onerous by the long journeys and expensive bus fares required for relatives to visit.

To bring my history lesson to a close, I want to report some positive developments of late. In 2013, a new 13-bed ward, the Fernwood recuperation and rehabilitation unit, opened. The Bramley children’s unit, new cardiac services and an endoscopy suite have all opened. The CT scanner at the hospital, which had reached the end of its natural life, is—admittedly after some pressure—to be replaced. The trust has appointed a new director, Mrs Jacqueline Totterdell, with the specific objective of bringing Newark hospital up to full capacity in the range of services that it provides. This week, the trust and the clinical commissioning group have announced a capital investment of more than £500,000 to enhance the facilities of the minor injuries unit, providing a better patient experience and more consultation rooms, and integrating the MIU with out-of-hours GP services. That development is the successful result of an application to the Prime Minister’s challenge fund.

Those developments are refreshing and should be celebrated. They confirm that the old rumours in the town that the hospital was to close are unfounded. The trust has made that clear. They also suggest a welcome degree of focus on the hospital by the trust and the CCG, which I hope will continue and which must intensify. I praise the clinical leader of the CCG, a respected Newark doctor named Dr Mark Jefford, for his role in that.

Where do we go from here? My objective, which I am sure that my hon. Friend the Member for Sherwood shares, is to ensure that Newark and north Nottinghamshire have health care provision of the highest possible quality delivered as close to home as is safe. I gave this debate the title “Health Care Provision (Newark)”, as distinct from the previous debate, to emphasise the fact that my interest is precisely that. My interest is not in bricks and mortar, and it is not driven by nostalgia or false science.

I return to the emergency provision. We still hear forlorn voices talking about the reopening of an A and E unit, but no one who understands the problem could think for a minute that Newark will have an A and E unit. I want to make it clear that that really is not the issue at hand. The issue is whether the present MIU or urgent care centre—whatever one wishes to call it—adequately reflects the fundamental remoteness of Newark and the surrounding area of Nottinghamshire, and whether anything can safely be done to provide a higher degree of emergency provision. Again, terminology gets in the way but, for the sake of argument, let me call it MIU-plus—in other words, providing sufficient support to enable Newark hospital to take a greater proportion of the so-called green cases. One can argue about what the proportion might be but, clearly, any material increase in the types of cases that paramedics could safely bring to Newark hospital, or that the hospital accepts from those walking into the MIU, would result in a range of benefits: shorter journeys to hospital for those in Newark and rural areas; less pressure on the ambulance service; and greater convenience for patients and their relatives. The benefits would surely be felt throughout Nottinghamshire and Lincolnshire and would take pressure off overstretched A and E departments.

In my time as a Member of Parliament, I have argued that, if a clinical case can be made, there is no reason why such an MIU-plus should not be introduced at Newark hospital. I have sought the advice of the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who, without detailed knowledge of the circumstances, pointed me in the direction of a hospital in Hexham where GPs, local authorities and the hospital trust have integrated to a degree to preserve and enhance services in a remote area.

Members of the management and leadership of the trust and CCG with whom I have discussed the matter over the past couple of months take a different view. They think the system would be extremely difficult to implement safely. I would be grateful if the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison) gave me her view, today or in the future, on exactly how realistic the proposal is. Members of the public seeking an outcome not wholly dissimilar to the one I have described have written to various authorities, including Ministers and NHS England, but have been unable to gain their opinion on that route. I admit to banging on about this, continuing a line of argument that has been made unsuccessfully for some time, but I raise it again because it is strongly felt by my constituents. I seek the Minister’s guidance and, of course, the ear of the trust and the CCG.

As I have already described, the heart of the problem in Newark and Nottinghamshire is the interlocking concern about the adequacy of the MIU and the performance of our ambulance service. East Midlands ambulance service has new leadership, a new chair in Mrs Pauline Tagg and acting chief executive in Mrs Sue Noyes. The ageing fleet, which I have seen myself, will be upgraded, including with welcome new vehicles for north Nottinghamshire. The trajectory appears to be upwards, which is welcome. Any support that the Minister and her Department can give to EMAS and its leadership would be greatly appreciated.

I recently spent time with paramedics and was hugely impressed. They face the challenge of operating in a large geographic area. A and E is under strain, and a contributing factor is the very limited circumstances in which paramedics are able to take patients to Newark. Whatever one’s view on that, there is a lack of clarity on those circumstances. I am told by one source that a lad breaking his arm on a football pitch, suffering no other major symptoms, could be taken to Newark, but I am aware of plenty of cases in which paramedics could not take such patients there or have been turned away. I am told that the number of circumstances in which paramedics may take patients to Newark has increased, yet I have seen a crib sheet in ambulances that appears to show that the number has decreased by two. I do not know the rights or wrongs—I am not a clinician, so I cannot say—but that must be cleared up urgently. Fundamentally, the rurality of Newark and north Nottinghamshire needs to be addressed with adequate ambulance capacity,

Finally, I will address the PFI debt, which my hon. Friend the Member for Sherwood mentioned. Monitor expressed concern about the financial situation of Sherwood Forest Hospitals NHS Foundation Trust. The trust signed its £320 million PFI deal for the redevelopment of King’s Mill hospital in November 2005, and in 2012-13 the trust’s PFI cash outflow was £42.5 million, which equates to 17% of the trust’s income. If ever we needed an example of a terrible PFI deal and debt, this is it.

The trust operates with one hand tied behind its back. In December, my hon. Friend and I asked the Secretary of State for Health whether he would review the trust’s finances as it is both in special measures and suffering the consequences of a disastrous PFI deal. He agreed to do so, and I ask the Minister to make good on that promise. PFI contracts are complex and the options available to the trust to reduce the current burden—whether that be some form of refinancing, the buying back of debt or addressing parts of the contract not yet or inadequately executed—are complex and require analysis. The trust has limited resources to devote to the analysis required, which would presumably require the help of outside specialists. Are the Minister and the Department willing to sponsor, by which I mean pay for and support with advice, a full review of the PFI deal, with the objective of presenting options to the trust that can be reviewed and, I hope, implemented? I make that request with the full support of the trust’s chief executive. Such support would make a difference to the trust, my constituents, my hon. Friend’s constituents and the constituents of many other north Nottinghamshire Members who have not been able to join us this morning.

In addition to my specific questions, I leave the Minister in absolutely no doubt of the importance to my constituents of Newark hospital and of health care provision in north Nottinghamshire. Newark hospital is much loved. I was there on Christmas morning, and patients and their relatives had the utmost respect for the wonderful staff. My constituents, and people across Nottinghamshire, want an inspiring vision of what their health care provision will look like, but a vision without substance is an illusion. My constituents now want a credible plan in which they can believe, a plan that ensures that health care continues to improve for them and for future generations in this growing and rural community. That, in essence, is what we seek today.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It is a pleasure to serve under your chairmanship, Mr Turner. I apologise for being a stand-in for the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter). I know he has previously debated these issues with my hon. Friend the Member for Newark (Robert Jenrick), whom I congratulate on securing this debate. It was a pleasure to go to Newark to campaign for him during the by-election. Literature that we all delivered told us that he would be a doughty campaigner, with health at the heart of his campaigning and his representations on behalf of his constituents. He has evidently made good on that promise in his relatively short time in the House. I am very aware of his dedication to ensuring that the health needs of his constituents are met. It is also a pleasure to see my hon. Friend the Member for Sherwood (Mr Spencer), who is another assiduous local Member and a valued colleague who has the health concerns of his constituents at heart.

This debate is a welcome chance to discuss local health care matters. I know both my hon. Friends regularly meet local health leaders, which is right. The depth of knowledge that comes across from both Members this morning is the result of that engagement. I encourage such engagement because it allows Members to be best placed to bring their constituents’ concerns to the House.

I recognise, as does my hon. Friend the Member for Newark, the hard work and dedication of NHS staff in his and other constituencies. He rightly describes them as wonderful, and it is excellent to hear that he was with them over the Christmas break. More than 4,000 staff are employed by Sherwood Forest Hospitals NHS Foundation Trust alone, in addition to the thousands who work in primary care. We thank them for their service at a time when we know they are under pressure.

It is all too easy to overlook primary care’s essential contribution to health care provision. The local GP or pharmacist is the key health care provider for many people. I will talk about the local hospital in a moment, but that foundation of good primary care is important. I am delighted that, through the Prime Minister’s challenge fund, Newark and Sherwood CCG is working with the hospital, local GP practices and Central Nottinghamshire Clinical Services, the out-of-hours provider, to improve access, reduce complexity for patients and ensure a sustainable staffing model. Given the pressure on the system over the Christmas and new year period, we can see only too well the importance of that work and the challenge fund in finding new ways to provide primary care access. In 2014, Mansfield and Ashfield CCG and Newark and Sherwood CCG were awarded a total of just over £1.8 million from the Prime Minister’s challenge fund, which was part of a £5.2 million collaborative funding bid that was spent in this financial year.

My hon. Friend is right to make Newark hospital the heart of his speech. Although there is legitimate concern, much of the worry caused for patients and the public in Newark has simply been unnecessary. I know he realises this but, for the record, the number of patients being treated is increasing. In 2012, the number was about 131,600; it increased to almost 133,500 in 2013. There is also more day care surgery, as my hon. Friend mentioned. The number of out-patients’ appointments is increasing and the number of specialities offering appointments at Newark is up. There is also improved provision for children.

I quite understand, however, why my hon. Friend wants to emphasise the need to keep building on that progress. He focused much of his speech on the minor injuries unit and urgent care centre. I can only sympathise with him with regard to navigating a way through terminology, because I am well aware that some terms mean different things in some parts of the country and that our health economy, because of its sophistication, is sometimes quite complex. It is therefore incumbent on all of us—Ministers, local health leaders and so on—to try to cut through that complexity as much as possible to make clear to local people what they can expect to get in a particular facility, what they would go there for, and where that facility fits into the local health economy, as well as the fact that it is part of a plan.

Newark provides consultant-led out-patients’ services, planned in-patient treatments, day-case procedures, diagnostic and therapy services and the MIU-UCC. My hon. Friend spoke about the need to increase the range of services. He is right to do so and to put forward his constituents’ concerns. As he outlined, there are plans to enhance the services offered at Newark hospital through the Newark strategy. He gave a history lesson at the beginning of his speech; I am well aware that there have been a number of strategies, but the current Newark strategy is being implemented, and I am encouraged by what I heard, in preparing for the debate, from local senior leaders. However, he is right to say that progress must be maintained.

The strategy includes Newark hospital being a centre of excellence for a broad range of services, including diagnostic, rehabilitation and so on. A number of new developments are already in place and a £500,000 development to make structural changes to the MIU is planned, which will make urgent care simpler and increase the range of Newark-based services.

As I said, I will take this debate as an chance to emphasise that if there is a lack of clarity locally—I can understand that there might be—local health leaders and all of us who work in and around the health system must work hard to ensure that the public, who are the users and end recipients of our excellent NHS services, really understand what is being offered. It is vital that they do.

The plans I mentioned include provision of additional consulting rooms, so that health care staff, including hospital staff and GPs, can work alongside each other instead of at separate locations. Building for that should start in April, which is really encouraging and testimony to my hon. Friend’s efforts to keep this a front-foot issue. Such evidence of the hospital’s long-term future is extremely welcome and should be reiterated.

With regard to the suggestion that more ambulance patients might be taken to Newark hospital, I understand that the local NHS has identified safety concerns with that. The level of emergency care was reviewed locally in 2013 as part of the development of the Newark strategy. As I know that my hon. Friend will appreciate, a patient’s diagnosis will not always be clear when the ambulance crew first arrives at the scene, so more comprehensive diagnostics are required—diagnostics that often need to be done in a main centre before a serious condition can be excluded.

I am told by the local NHS that the conveyance of all green ambulance calls to Newark would result in a limited improvement in ambulance response times, but I hope that it has looked at that carefully, has heard what my hon. Friend said today, and is giving proper weight to that. I know that for both my hon. Friends, the safety of their constituents is a paramount concern. They will know that for the Secretary of State for Health, the safety and quality of our health system is a touchstone issue in this Parliament, and we have debated significant safety concerns in recent years. When local clinicians believe that there are safety risks, it is important that their opinions carry weight and that we listen to those concerns closely.

My hon. Friend the Member for Newark has already discussed with the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich, whether hospitals elsewhere might provide helpful examples for both Sherwood Forest Hospitals NHS Foundation Trust and Newark hospital. Hexham was mentioned as one such example. While parallels can be drawn, an exact comparison cannot, as my hon. Friend the Member for Newark acknowledged. There are some similarities between the services offered at those sites, but Hexham is a larger site with a more remote community. I note, however, what he said about his constituency being mixed, with some areas being much harder to get to owing to their road services.

GP services are offered at Hexham, and the new extension at Newark will enable that to happen in my hon. Friend’s constituency, which will be welcome. As he is also aware, decisions on local services, including urgent and emergency services, are a matter for local NHS leadership because they are the people, working with elected representatives, who know the local community best. The local NHS is clear that decisions about services will be based on patient safety and sustainability, which, having seen some of the problems uncovered in this Parliament in cases such as Mid Staffs, is what we all want as the foundation on which we build.

[Mr Spencer]

It is good to hear that progress is being made, but the elephant in the room remains the £40 million a year in PFI payments. Until we solve that problem, the challenges will remain. In the time remaining, will the Minister discuss that?

[Jane Ellison]

I will; in fact, that is on my next page. My hon. Friend is right to bring me to that. On the trust’s financial position, as my hon. Friends have mentioned, Monitor assessed Sherwood Forest Hospitals NHS Foundation Trust in 2012 and identified issues that had contributed to its deteriorating financial performance. The trust signed its £326 million PFI deal under the previous Government in November 2005 for the redevelopment of King’s Mill hospital. The trust’s PFI cash outflow equates to some 17% of its annual income, which is clearly a substantial amount. The operating costs for that scheme are inflating with the retail prices index by about £1.5 million a year. My colleagues are therefore right to raise that considerable concern.

The trust has received ongoing financial support directly from the Department of Health: it received £28 million in 2013-14 and £26 million in 2014-15. However, as my hon. Friends realise, it is important that I emphasise that such funding is not sustainable as it takes resources away from other areas. We therefore clearly need a better solution.

The trust forecast a financial deficit this year, but Monitor does not have any immediate concerns about the sustainability of services at Newark hospital. I put that on the record as a note of reassurance for my hon. Friend the Member for Newark. The trust recognises the challenge that its PFI payments present—that has come out clearly in my discussions—and it accepts that the solution lies in the full involvement of all partners in the local health economy. The Better Together programme for Nottinghamshire goes some way towards achieving sustainability, and local commissioners continue to work with Monitor and NHS England, as they need to, to find a solution.

I am aware that there have been suggestions locally that Sherwood Forest Hospitals NHS Foundation Trust should look at the route taken by Northumbria Healthcare NHS Foundation Trust and buy out its contract. However, the overall PFI deal for Sherwood Forest is much bigger than Northumbria’s, so a similar buy-out would incur a far greater cost. That is a note of caution.

The Department and the Treasury have discussed a range of options to reduce the cost of PFI projects in general, using public sector capital, including buying senior debt and terminating contracts completely. It is however for individual trusts to be clear about what options they have considered and to bring proposals forward.

Looking around the country, it is clear that the individual schemes have complexities, in terms of when they were signed, effective pricing and risk profile, so it is important both that such matters are looked at carefully at a local level and that the Department is engaged early on by trusts and foundation trusts when they develop their proposals, which will then be considered carefully by the Department of Health and the Treasury—and Monitor, if required—on a case-by-case basis for value for money and affordability. That is what happened in Hexham.

In the time left, I want to assure my hon. Friend the Member for Newark that my right hon. Friend the Secretary of State, as he said last year, will be happy to consider any proposals brought forward. We are very much open to that.

I am left with little time to comment on the ambulance services, other than to say that although we acknowledge that there are some big challenges, a resilience plan is in place and we will monitor that carefully. I end by congratulating my hon. Friends the Members for Newark and for Sherwood on bringing this important topic once again to Ministers’ attention.