Accountability and Transparency in the NHS

Neil Carmichael Excerpts

Thursday 14th March 2013 Commons Chamber

[Neil Carmichael (Stroud) (Con)]

This debate has been thorough and, at times, moving. I congratulate my hon. Friend the Member for Bristol North West (Charlotte Leslie) on securing it. I was impressed by the moving speech of the right hon. Member for Cynon Valley (Ann Clwyd) because it demonstrated the tragedy that lies behind this debate.

The Francis report is a disturbing document in many ways. The Prime Minister and the Secretary of State for Health are right that we should not be looking for scapegoats. I do not want us to find any scapegoats and I am sure that you, Mr Deputy Speaker, do not want us to find any scapegoats. We must remind ourselves what a scapegoat is: it is somebody who gets the blame for somebody else’s behaviour. The question that we must ask is who is responsible. That is at the core of this debate. If we cannot find out, we must produce a system that has a mechanism for responsibility.

When someone accepts responsibility, it is refreshing and empowering. If a manager avoids that responsibility, they are effectively acknowledging that they are weak and insufficient at their job. If someone cannot answer those questions and does not feel able to say, “The buck stops with me”, they are not doing their job properly. We need to think about that system of responsibility and accountability.

Can gagging be consistent with effective, decent line management? Absolutely not. A person is effectively saying that someone beneath—or even above—them cannot say what they need to say. A show cannot be run with that kind of mechanism, and we should certainly not be content with the number of gagging clauses we have heard about today. I welcome the end of gagging clauses, and pose the same question that others have asked the Secretary of State: is the move retrospective?

Line management is also about culture because we must be able to trust people when we ask for something to be done, and know that the message is getting out and is clear and fair. That is what good management is. It is not just an issue in the health service; it is an issue in any organisation, and that brings us to the overall question of governance. Governance applies everywhere and must be accessible, transparent and something in which people have confidence. As hon. Members have pointed out, there is far too much buck-passing and evasion, and that will not help us arrive at a decent culture for patients, which is what we should be focusing on. Of course we are right to talk about “patients” rather than “targets”, but we also need patients to feel comfortable with the system in which they are operating.

My hon. Friend the Member for Enfield North (Nick de Bois) made a good point about speaking out. Many of us can speak out and do so nearly every day on a variety of subjects. Some patients cannot, however, and need additional advocacy that sometimes does not come easily to them or their friends and family. Just imagine them in a management system in which people cannot listen or talk to each other, let alone take into account the views of patients!

We must have a change of culture and, as the old saying goes, a fish rots from the head. This is about leadership and shaping a culture that effectively manages to spread out everywhere. That culture must be inclusive, transparent and open and effective at empowering people at every level, rather than shutting them down and isolating them in systems that are too complicated to feel comfortable in.

Finally, I welcome the appointment of a chief inspector for hospitals. That is a necessary appointment and will make a huge difference. They must, however, look at the leadership of what he, or she, is inspecting. Leadership is fundamental and matters, and we must ensure it is responsible and accountable.

Oral Answers to Questions

Neil Carmichael Excerpts

Tuesday 15th January 2013 Commons Chamber

The Secretary of State was asked—

[Neil Carmichael (Stroud) (Con)]

1. What recent assessment he has made of the provision of treatment for vascular disease in England.

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

Despite the huge improvements that have been made over the last decade in the outcomes for people with cardiovascular disease, it is still one of the biggest killers in England and the largest cause of disability. That is why we are developing a CVD outcomes strategy, which will set out where there is scope to make further improvements in patient outcomes in this area.

[Neil Carmichael]

I am chairman of the all-party parliamentary group on vascular disease, which recently produced a report highlighting the need for early diagnosis and intervention, and the additional risks associated with obesity and diabetes. Is the Secretary of State willing to meet me and some of my colleagues to consider how we can improve outcomes for sufferers of vascular disease?

[Mr Hunt]

I thank my hon. Friend for his excellent work with the all-party group and for the group’s constructive response to our consultation on the outcomes strategy. I am more than happy to meet him and other representatives of the all-party group. With an ageing population and rising levels of obesity, we cannot be complacent about cardiovascular disease and have much to do.

Community Hospitals

Neil Carmichael Excerpts

Thursday 6th September 2012 Commons Chamber

[Dr Wollaston]

Indeed I do, and there are many community hospitals that support first responders in the way my hon. Friend describes. That is an important role, and there is perhaps even an extended role in housing, where step-down housing can enable people to make the transition back to full independence. Indeed, there are many such roles.

What are the current barriers to providing the right care at the right time and in the right place? I would like the Minister to deal with five points. First, the biggest challenge we need to address is the tariff and tariff reform. She will know that most acute hospitals are paid through a system known as payment by results, which creates some perverse incentives, whereby acute hospitals want to hoover up as much activity as possible. Often, people are treated in an acute setting when they could be more appropriately cared for in a community hospital setting or at home. Can the Minister update the House on the progress we are making on reforming the tariff, by, say, working towards a “whole year of care” model or looking at other ways to remove the incentive in the system that means that people cannot be transferred into community hospitals or provided with the right care in the right place?

[Neil Carmichael (Stroud) (Con)]

I congratulate my hon. Friend on securing this debate and I entirely agree with her important point about the tariff and acute hospitals. I hope she agrees that it is also important to signpost patients to the right place, which, because we are talking about a caring issue, is in many cases a community hospital.

[Dr Wollaston]

I thank my hon. Friend for making that important point. Quite often patients are not aware of the full range of services available in their community hospitals. We can do far better in signposting them. It is also important that GPs understand and support those services and make referrals to the right place.

The second issue I would like the Minister to address is the community hospital estate. She will be aware that many community hospitals around the country are being pushed into ownership by NHS Property Services. However, there are examples around the country of community hospitals that are owned by their communities, for example, or by a social enterprise. If those hospitals are unable to have ownership of their premises, that can hold them back if they have ambitions to expand their roles in future. Obviously we want to reassure the public that these valuable community assets remain in public ownership, as it were, but we also want to ensure more flexibility in their ownership model. I would therefore be grateful if the Minister addressed that point.

Thirdly, there is an accountability issue. There are occasions where having multiple providers operating out of a community hospital can cause confusion. Situations can arise where, because everybody is responsible, nobody is responsible, and accountability can end up being shunted around the system. Does the Minister agree that it would make more sense to have a single body, or even individual, with overall responsibility for what happens to patients and the way in which care is organised in a community hospital?

Fourthly, I want to raise an important point that goes beyond community hospitals to the whole way in which we look at a primary care based system, namely the looming crisis in general practice numbers. For the first time we now have a vacancy rate for GPs of 12% in the south-west. On top of that, in about four or five years we will have a retirement bulge—I am afraid that I have not helped the situation—and we are also moving, quite rightly, from a three-year period for general practitioner training to a four-year period. All that coming together means that across the country, the south-west included, we will face a shortage of skilled practitioners both to deliver commissioning and to staff our community hospitals. We need their support. It would be a great shame if GPs who were enthusiastic about getting involved in commissioning and helping out in their community hospitals were unable to do so because of their clinical commitments. Can the Minister therefore update the House on how we are going to stop the problem, which has been going on for years, of too many medical students going into training in acute hospital specialties? We need more of them to go into general practice.

Finally, will the Minister support the Community Hospitals Association? It does a tremendous job. In 2008 it received a £20,000 grant to help set up a detailed database that documented not only where community hospitals are but what they do. At this time of change I hope she agrees that it is particularly important that we keep track of what they are doing. The CHA has also highlighted innovation and helped to spread best practice, so I hope that she will give it further support.

No debate about community hospitals would be complete without thanking the leagues of friends, which around the country have provided millions of pounds. They do not provide luxuries; we are talking about major building projects, equipment, funds for care, volunteers who come into the hospital—an extraordinary level of support. We could not manage without them in our community hospitals. I know that the whole House will want to join me in paying tribute to our leagues of friends.

This is a call to arms to people listening to the debate. If you value your community hospital, let your GPs know, let your commissioners know, let HealthWatch know, let your local health and wellbeing boards know. If we want community hospitals to be treasured, as we all do in the House, we need to make that very clear.

NHS Annual Report and Care Objectives

Neil Carmichael Excerpts

Wednesday 4th July 2012 Commons Chamber

[Mr Speaker]

Order. The hon. Gentleman should not keep shouting out. He has asked his question and had the answer. We will now move on.

[Neil Carmichael (Stroud) (Con)]

Does the Secretary of State agree that one of the lasting achievements of the Health and Social Care Act 2012 will be the integration of health and social care, which will be excellent news for people recovering from strokes or meningitis?

[Mr Lansley]

My hon. Friend is absolutely right. The Labour party completely ignores the fact that one of the central points is that the creation of health and wellbeing boards—I pay credit to my Liberal Democrat friends in the coalition for that—the involvement of democratic accountability and the opportunity to create joint strategies that integrate public health, social care and the NHS and impact additionally on the wider and social determinants of health will be absolutely instrumental in the improvement of services and health in future.

Oral Answers to Questions

Neil Carmichael Excerpts

Tuesday 27th March 2012 Commons Chamber

[Mr Lansley]

On both children’s and adult congenital heart services, all relevant clinical factors should be taken into account in the review, but I reiterate the point that I made to my hon. Friend the Member for Leeds North West (Greg Mulholland): the standards for those services do not require children’s and adult services to be collocated.

[Neil Carmichael (Stroud) (Con)]

15. What assessment he has made of the provision of vision screening for children.

[The Minister of State, Department of Health (Mr Simon Burns)]

The Department of Health has made no assessment of the provision of vision screening for children. However, the UK National Screening Committee, which advises Ministers and the NHS on all aspects of screening, has commissioned a national mapping exercise to look at how many primary care trusts offer vision screening.

[Neil Carmichael]

There is some evidence of variance across the country, with some PCTs not conforming to current arrangements. What thought has been given to how to improve the situation and iron out the variance?

[Mr Burns]

As my hon. Friend will be aware, the National Screening Committee recommends screening for visual impairment for children between the ages of four and five, and encourages all PCTs to follow those recommendations and ensure that children are screened. However, the Government are aware that, as my hon. Friend says, there are variations in the commissioning of vision screening across PCTs, and it welcomes the review that is being undertaken. We await its recommendations as regards those variations, but we hope that under the new arrangements, after the abolition of PCTs, there will be a far more uniform approach to commissioning and screening.

Social Care Funding

Neil Carmichael Excerpts

Thursday 10th November 2011 Westminster Hall

[Sarah Newton]

My hon. Friend makes a very good point, reminding us that people are living much longer, because the causes of mortality that prevented people from living so long in the past—especially cardiovascular disease and some cancers—are now more survivable, so people suffer from other conditions, which are sometimes far more complex to live with and to treat, especially diseases such as dementia and Parkinson’s. The fact that people are living well into their 80s and 90s and beyond 100 presents new challenges for the NHS and a range of other services—indeed, for society as a whole—so my hon. Friend makes a very good point.

The commission goes on to say that most people are unable to plan ahead to meet their future care costs. Assessment processes are unclear. Eligibility varies according to where people live, and there is no portability if people move between local authorities. The provision of information and advice is poor, and services often fail to join up. All of that means that people and their families often do not have a good experience.

[Neil Carmichael (Stroud) (Con)]

My hon. Friend is absolutely right in what she has said. One of the key tools is integrating the NHS with social care, so that we can have a much more seamless approach to caring for people, and they understand where they can go for support. I am talking about breaking down the unnatural barriers between local areas, as well as about the funding that is necessary and a more transparent understanding.

[Sarah Newton]

I am sure that that is right. It is certainly a point that the Dilnot commission and people who have responded to it have made. They are very supportive of the Government’s plans to integrate social care with the health service.

It is a major worry for most families that they cannot protect themselves against the very high costs of care. As my hon. Friend the Member for Montgomeryshire (Glyn Davies) pointed out, looking after people with dementia can involve very considerable costs. However, the availability and choice of financial products to support people in meeting care costs is limited.

--- Later in debate ---

[Neil Carmichael (Stroud) (Con)]

Thank you very much, Mr Robertson, for calling me to speak. It is a great pleasure and honour to speak in a debate such as this, and I congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on securing the debate to bring the issue of social care to our attention. As she said herself, the debate is also extremely timely, because tomorrow, of course, is Remembrance day and it is absolutely right that we remember those who achieved so much for the cause of freedom and for this country during the world wars and indeed afterwards.

I want to echo the point made by the hon. Member for Worsley and Eccles South (Barbara Keeley), who is the chair of the all-party group on social care. She made the point that we need to think very carefully about social care funding and that it is important to take an all-party approach to it, because it will affect many people for an extremely long period. We are talking, obviously, about elderly people, but everybody gets old and this is a long-term policy, with long-term implications.

We have to embed a set of policies—a framework, really—that can last, because one point that keeps coming up when we discuss the funding of social care is that we do not really know how to plan and we do not know, as individuals, what sort of structures will be in place; consequently, many individuals do not plan. The Government have a huge opportunity effectively to create the reasons why people can plan for their retirement and, as they arise, their care needs.

As other speakers have suggested, Dilnot makes it clear—or at least, implicitly clear—in his report that the sort of measures that he is talking about, including the ceilings that would apply before people have to pay for care and so on, will effectively create a situation where people are planning financially for their forthcoming care needs. We need to remind everybody of that when we discuss this issue in increasing detail, as a White Paper and so on arrive on the table.

In my constituency, I visit care homes quite frequently and I have often been asked to meet people who have just celebrated or are about to celebrate their 100th birthday; a huge number of people in my constituency reach that age. When I first started visiting them, it was really quite an honour, because members of my family never get to 100—although, obviously, they are going to.

[Kelvin Hopkins (Luton North) (Lab)]

The hon. Gentleman could be the first.

[Neil Carmichael]

That is very kind. [Interruption.] Hon. Members are all very optimistic.

[Glyn Davies]

It might be a good point to throw into the debate that, a fortnight ago, I visited a woman who was having her 108th birthday. The interesting thing about her—I think it contributed to her longevity—was that she had been a member of the Conservative association ever since she was allowed to join in 1928.

[Neil Carmichael]

Well, we certainly have experience in our Conservative association back at home. An interesting thing about my constituency is that I came across somebody who was 106. She wanted to make a complaint and she came up to me at some speed. I did not think it was anything to do with the care she was getting, and it was not: she had received a birthday card from Her Majesty the Queen every year for the past six years, but unfortunately she had received the same one each year, and she wanted a different one.

As that story shows, we have an ageing population, and that brings challenges, of which dementia is obviously one. More and more people are experiencing dementia, not just because they have it but because a family member has, and that can be just as challenging. We need to prepare the ground because an increasing number of people have dementia.

[Mrs Helen Grant (Maidstone and The Weald) (Con)]

One million people will have dementia by 2025. Does my hon. Friend agree that this terrible disease must have a proper place in any funding review or funding reform?

[Neil Carmichael]

That is exactly the theme I was about to develop, so I will simply agree with that excellent point.

In my constituency, we are promoting the “Write it Down” campaign. If somebody thinks they or a member of their family is getting dementia, but they are not quite sure, it is a good idea for them to write down sequences of events, because that will trigger a recognition or an acceptance that they or their loved one are forgetting things. The campaign is gaining quite some traction in my constituency, and I recommend that hon. Members promote it in theirs. Gloucestershire is getting quite a lot of accolades for the campaign, and families are successfully using this tool to diagnose dementia, which, we should remember, is not an easy thing to do.

I want to talk briefly about carers. Their role has been mentioned, and rightly so, because they do an enormous amount, and their numbers are huge. A fact that is sometimes overlooked, however, is that a lot of carers are surprisingly young, and some still go to school. We need to bear that in mind.

[Kelvin Hopkins]

The hon. Gentleman is making an important point. In my constituency, I have been visited by a group of people with young family members who suffer from dementia. A number of people develop dementia when they are quite young.

[Neil Carmichael]

Absolutely. I take the point that young people can also have dementia—that is certainly true—but the point I was making was that young people are caring for people once they return from school. That is a measure of the challenge we face in dealing with the role of carers, so the Government have to think carefully about the structures around carers and about the ability to give these people appropriate support and respite.

[Barbara Keeley]

It is good for us to be concerned about young carers, but is the hon. Gentleman concerned about the loss of education maintenance allowance? When I talked to the young carers project in my constituency, it told me that all but one of its young carers had been receiving EMA, and they were really afraid that they would lose all their incentives to stay in education. There is therefore an issue about support for young carers.

[Neil Carmichael]

This is certainly becoming a surprisingly wide-ranging debate. We have thrashed out the issue of EMA very carefully and thoroughly in the House of Commons—indeed, those of us on the Education Committee produced a useful report on the subject—but the Government have to think about wider issues in connection with post-16 education and so on. However, that is a separate issue; the important point here is that people who are going to school are carers, and I want the Department of Health to register that.

Another important aspect is the number of people with Parkinson’s. That problem is increasing all the time, and it is right that we focus our attention on it. The reason I mention such difficulties—not to the exclusion of others—is that it is important that we think carefully about personalised budgets so that people get tailor-made provision that they are happy with, and so that we join the NHS up with social care. I made that point in an intervention on my hon. Friend the Member for Truro and Falmouth but I want to repeat it, because part of the answer is to ensure that fewer people end up in hospital, and we can do that by ensuring that the social care structure spots problems before they become serious or overwhelming and prevents problems from starting in the first place. If the social care system dovetails completely with the NHS system and is accessible and transparent, people who need care, and families with members who require care, will feel they are being properly listened to.

[Glyn Davies]

Let me make a point in the form of a question. It touches on several of the issues that my hon. Friend has just mentioned, and particularly on Parkinson’s disease. Does he share my concern that once people enter a care home, there is not the same awareness of the need to look for dementia or Parkinson’s disease as there is outside? There is not the same awareness of the onset of those diseases, because people are deemed just to be elderly, when in fact they are suffering from an illness.

--- Later in debate ---

[Neil Carmichael]

That is a good point. Earlier I mentioned the problem of diagnosing difficult illnesses —I obviously focused on dementia, but there are others. My hon. Friend is exactly right.

One theme that I have been picking up in care homes in my constituency is that increasingly, people do not enter care homes until they are older and actually need care because of their various illnesses. The pressure on care homes is therefore intensifying as a result of the changed profile of the people going into them. That has obviously put pressure on care homes’ finances, and there are differences between those that are supported by private provision and those supported by local authority provision. We need to explore thoroughly the question of the funding arrangements for care homes, and that should be part of the process that we get involved with as we move towards the publication of the White Paper.

My hon. Friend the Member for Portsmouth North (Penny Mordaunt), who is now out of the Chamber, mentioned commissioning, which is critical. Local authorities need to commission with a huge amount of sophistication, and they need to be fully aware of how to specify what they are commissioning for. The one good thing about the county council in Gloucestershire is that it is embracing the personalised care theme vigorously, but I would like to make one point. All personalised care is excellent if it is properly specified and funded, but we must be sure that the assessment process is fair. I constantly seek reassurance that that will be the case.

In my remarks I have signalled two general points that I think are important. First, we need to think long-term. We do not want a party political dingdong about this. We need carefully considered, thoroughly researched and above all well-meaning outcomes in the provision of care for elderly people, because we are setting foundations that should, I hope, last decades. Secondly, we must not think of the issue in terms of various silos providing care, while we hope for the best. We must be more holistic. As people grow older they will want to get access to different things. They do not want to be channelled by various bureaucratic systems. They want, effectively, to consider their options and decide for themselves, and they hope that when they cannot decide for themselves there will be a mechanism, in their family or through advocacy, to enable them to maximise the quality of their life for as long as possible. In the end, that is in all our interests. First and foremost we must create a system that people recognise as decent, fair and honourable.

NHS Care of Older People

Neil Carmichael Excerpts

Thursday 27th October 2011 Westminster Hall

[Margot James]

I welcome that intervention because whenever one is preparing for a debate such as this, one is conscious of how much more there is to say than one has time for. I was not intending to draw too many conclusions on what needs to change in society. I was concentrating on what needs to change in the domain that we are discussing, but perhaps the hon. Lady would care to call for a debate on the topic to which she has referred. I am sure that we could fill an afternoon with such a discussion and I should be delighted to take part.

[Neil Carmichael (Stroud) (Con)]

One matter that needs to be thought about carefully in this debate if not elsewhere is, of course, the integration of the NHS and social care, because that will help the process along and deal with many of the issues to which my hon. Friend is referring.

[Margot James]

I thank my hon. Friend. That is a very good point. The integration of health and social care should, with the weight of joint commissioning behind it, make quite a difference. My speech has concentrated on care in hospitals, but I hope that other hon. Members will bring out issues to do with care at home and other aspects of what the NHS delivers.

I shall go through my list of recommendations briefly. On nutrition, the Age UK report, “Still Hungry to Be Heard”, advocated that ward staff needed to be “food-aware”. Training should include nutrition and the importance of assistance with meals when needed. I agree with these recommendations. Older people should be assessed for signs of malnourishment on admission, during their stay and on discharge. Hospitals should introduce protected mealtimes. Where they are using a red tray system, which involves a red tray being given to patients who require assistance with eating, staff should be trained in how to use it. It sounds as though that system works well where it is used properly.

--- Later in debate ---

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

It is a pleasure to serve under your chairmanship, Mr Betts. I congratulate my hon. Friend the Member for Stourbridge (Margot James) on securing the debate through the Backbench Business Committee, and all hon. Members who supported the call for it—as I did.

I do not pretend to be a health care professional, even though I use the title “Dr”. Nor do I profess expertise in that area. However, the care given to those older people who need it—I tend to use the word “elderly”, although it may not be politically correct—is important. Usually, the start and end of life is when we use NHS care the most, and those people should be given the best care possible. We should make sure failures are dealt with, and we should speak up about them in Parliament.

Given the time constraints, I had thought of spending a little time on talking about the terminally ill. Hon. Members may know that I have introduced a ten-minute rule Bill on the provision of hydration and nutrition. We have also had Westminster Hall debates about palliative care in eastern England, and I recognise the valuable work that is done. However, it is right to focus on the Care Quality Commission report and individual hospitals, so that our constituents know we are speaking up for them, and so that their voice is heard in Parliament.

My hon. Friend the Member for Stourbridge went into great detail about the CQC report, and the hon. Member for Worsley and Eccles South (Barbara Keeley) went into detail on a particular case. The view of representatives of the Royal College of Nursing, given in informal discussions, about evidence given or sentiments expressed in submissions to the Francis inquiry, was telling. There was concern about leadership and about how people would be treated if they stood up and spoke up for patients—that they would be ignored, or, worse, demoted. I am sure that that shocked the nursing profession and other people, and I recognise that attempts are being made to deal with that, so I do not mean to be condemnatory.

My constituency has the 15th highest proportion of pensioners. Some 55% of my constituents are over 55, so the issue we are discussing is important there. The constituency also covers two primary care trusts—NHS Suffolk, and Great Yarmouth and Waveney—and we have three hospitals that provide care. They are the Norfolk and Norwich university hospital, Ipswich hospital and James Paget university hospital. I am afraid that two of those were on the list of failing hospitals and, understandably, local residents were very upset. That is reflected in the number of complaints made to me, or copied to me, about people’s experiences when they are trying to get care.

As to Ipswich, after the first failure, I and my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) met the chairman and director of nursing. I was impressed straight away that the director of nursing recognised absolutely that there had been failings. That recognition and acceptance of failings was important to me. The suggestion was made at the time that not all the staff accepted, initially, that there were failings, and that the feedback was met with an element of rejection. However, every member of staff quickly recognised that things had to change.

An action plan of changes and improvements to local ward leadership was set out, and fresh training was provided. A high focus was put on that, including additional support for patients with dementia. The hospital was inspected on a second occasion and, although the report has not yet been formally issued, I understand that it will pass—it should be congratulated on that—that a marked improvement was noted and that patient satisfaction was much higher.

[Neil Carmichael]

It is worth distinguishing between acute and community hospitals. That would inform the debate, because, obviously, chronic and non-chronic conditions are different. It would be helpful to know which hospitals are which, and whether that will help us to think about the subject.

[Dr Coffey]

Ipswich hospital is a district general hospital, if that helps my hon. Friend. It provides acute care, and is not just focused on community care. I want to say thank you and well done to the director of nursing and all the medical teams at the hospital for the changes they have made.

In contrast, James Paget hospital, in the constituency of my hon. Friend the Member for Great Yarmouth (Brandon Lewis), has failed a second inspection. The second report showed improvements, but not consistent improvements. There were still minor concerns in several areas, and continued moderate concerns on meeting nutritional needs and the management of medicines. The second report is complimentary about staff and training, and, as my hon. Friend the Member for Stourbridge has already mentioned, the hospital was cited in a Nursing and Midwifery Council report as having good training levels. To reinforce that point, the CQC suggested that patients’ needs were generally met. At times it was possible that not all the staff were available or deployed in the most effective way, but generally patients had the staffing appropriate to their needs. The third inspection has taken place. Its outcome is not yet formally known, and the hospital has not received the draft report, but I have not heard positive vibes so far.

As to my interaction with the leadership, I must say at the outset that I recognise that it was limited. My hon. Friends the Members for Waveney (Peter Aldous) and for Great Yarmouth have taken a much greater role, because a relatively small number of patients from my constituency go to the hospital in question. After the first inspection, however, I was assured that the failures were just a blip, and that things were already under way. Doubt was cast on the quality of the inspection carried out by the CQC—that was said to me by the chairman of the hospital trust. I did not accept that, because those CQC inspections are intended to be a snapshot and to take a view. Frankly, if one patient experiences bad care, that is an automatic failure. I think that hon. Members would recognise that.

I was reassured, however, by the expectation of changes, which were under way; but, as I have mentioned, the second inspection continued to find failings in dealings with older patients. I did not meet the hospital manager and chairman after the inspection, but my colleagues did and I was not reassured by the report of that meeting. Yet again it seemed that doubt was being cast on the validity of the CQC inspection by the chairman of the trust—though not, I understand, by the chief executive.

We three MPs have together agreed a course of action to press the hospital on its improvements for our constituents, and it has responded. As I said, a third inspection has been held, and I am highly concerned that a third failure will be reported. Monitor has now issued a red governance rating, which I believe is automatic, but I understand that it has also had conversations with the leadership. I have received copies of constituents’ complaints, and seen a whistleblowing letter from GPs from the consortium Health East. The letter says:

“As a group of concerned GPs we have been forced to pursue this whistle blowing option, because we are concerned that our new GP consortium ‘Health East’ may fail to be successful due to the failings of our main, acute provider the James Paget University Hospitals NHS Foundation Trust.

Health East will be depending on the Trust to provide the acute care for most of our patients and we have lost confidence in the ability of its leadership to correct its current failings. Please act quickly before we have yet another Mid Staffs on our hands.”

It ends:

“We apologise once again for having to take this whistle blowing option, but we need you to put pressure on appropriate organisations to put the issues right before our patients suffer.”

I do not suggest that someone going into the hospital will automatically suffer poor care, but that is the reaction of GPs who are expected to work with patients to ensure that they receive the best care.

In the circumstances, it is my role to press the leadership of the James Paget hospital on constituents’ behalf. In particular, the chairman of the hospital trust should consider his position. I appreciate that the financial risk at the hospital is low, and that that may reflect good financial governance, but patient care is key. The chairman has provided useful leadership, but—after two failed care inspections and with the possibility of a third—it is time for him to step aside and allow new leadership to come forward.

I will apologise to the chairman of the trust, because although I sent him a communication about what I would say in this debate, I could not speak to him personally. I should also say that I do not make my suggestion on behalf of my hon. Friends the Members for Waveney—who is in his place—and for Great Yarmouth. I do not make such a call lightly, but there is concern that patients may be reluctant to go to that hospital. Perhaps that is not a widely-experienced feeling, but often people worry about going to a particular hospital because of the perception of concern. We cannot afford that, and must not stand quietly by without expressing a view.

I have spoken for 10 minutes and understand that others want to speak. There are other issues, such as community care and confidence in that. My hon. Friend the Member for Central Suffolk and North Ipswich and others, including myself, have pressed the case about ambulance services and response times. Some of our constituents live more than an hour from the nearest hospital, so concerns about failure to respond within the eight-minute target are appropriate. I am meeting Ministers another time to discuss that matter.

I do not make the request that I made about the James Paget hospital in Parliament lightly, but I believe that it is necessary for the safety, well-being and protection of patients in Suffolk Coastal.

Reform of Social Care

Neil Carmichael Excerpts

Monday 4th July 2011 Commons Chamber

[Mr Lansley]

My hon. Friend makes a very good point, and I hope we will be able to take up and develop that during the coming weeks.

[Neil Carmichael (Stroud) (Con)]

Does my right hon. Friend agree that in a modern, responsive and caring social care system, we need more transparent and effective decision making and improved integration with the NHS, so that the person in need of care can navigate their way around the system?

[Mr Lansley]

I agree with my hon. Friend, and in his county the early implementation of health and wellbeing boards, which are to be legislated for under the Health and Social Care Bill, will provide precisely that opportunity for the integration of health and social care services.

Southern Cross Healthcare

Neil Carmichael Excerpts

Thursday 16th June 2011 Commons Chamber

[Paul Burstow]

The hon. Lady is long on critique but very shallow when it comes to how she would approach this differently. Last week, I set out in a written ministerial statement the approach that the Government were taking. We also dealt with this extensively at last week’s Health questions.

The hon. Lady asked about the 3,000 job losses that are being proposed as part of redundancy measures by Southern Cross. Let us be clear: it has a statutory obligation to declare a ceiling for the number of job losses that may—I repeat, may—take place in the business. I have asked the CQC to undertake additional inspections to address concerns arising from the proposed job losses, and that has already been put in place.

The hon. Lady talks about cuts in social care spending but glosses over the fact that this Government, through the spending review, agreed to an unprecedented transfer of resources from the national health service to support social care, with £2 billion extra going into social care by 2014.

We might agree that we need to learn lessons from what is happening to Southern Cross, in respect of regulation and how we ensure a stable and successful social care sector for the future. That is why the Government are committed to an overhaul of social care and to bringing forward a White Paper to set out the plans in due course.

[Neil Carmichael (Stroud) (Con)]

Does the Minister agree that the fundamental problem was a flawed business model that was allowed to exist for far too long under the previous Government?

[Paul Burstow]

My hon. Friend is right to draw attention to that. It is oft commented in the financial pages of our media that that is one reason why this company is in this position and why such a restructuring is necessary. However, I take heart from the joint statement that was issued yesterday following the meeting between the landlords, the company and the lenders. It suggests that a clear route map is being worked out that will ensure continuity of care. That is what all Members of this House must want. We must all be interested, ultimately, in the welfare and interests of the residents in those homes.

Information Technology (NHS)

Neil Carmichael Excerpts

Tuesday 14th June 2011 Westminster Hall

[Neil Carmichael (Stroud) (Con)]

I congratulate my hon. Friend the Member for South Norfolk (Mr Bacon) on the important and fascinating debate. The detail he went into about the past 10 to 15 years was striking.

[Annette Brooke in the Chair]

There are some key issues that we need to consider. Procurement on this scale has to be properly thought out. The purposes of the project itself have to be properly defined. The question of value for money is obviously a key one. Let me go back to the introduction of the fax machine to illustrate my point. When the fax machine was first launched, lawyers found it difficult to accept that instant results could happen. They went through court cases to test the validity of a fax result, because it could deteriorate and so on. None the less, the problems had little to do with the technology and rather more to do with the culture of lawyers. There is a thread running through this whole sorry episode. We need not only better information sharing in the NHS, but the right culture and desire for it. Above all, we need a real reason for the system. I have been to one or two meetings about this whole scheme, and I have never yet really heard a proper description of its central purposes, except of course to exchange information. Obviously, one of the purposes is integration. I am talking about integrating the systems and the parts of the NHS that need to talk to each other rather more than they do at the moment.

Yesterday, I went to the Care Week event in the Jubilee Room and I met several carers, all of whom had similar stories to tell. One said, “The person I have been caring for has been going to two departments, but neither of them knew about each other.” That is the sort of cultural issue that we must tackle and think about when we talk about IT. The real danger about IT is that people think it is a good idea so they must use it and apply it, but it is actually the other way round. We must be careful and set out the proper parameters and purposes for this IT project, and ally it to value for money. My hon. Friend’s story shows that that has not been happening. We need to be much more careful about procurement, setting out commissioning requirements, understanding the need for cultural change, and properly looking at these contracts.