North East Ambulance Service

Nicholas Brown Excerpts

Wednesday 4th May 2016 Westminster Hall

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

I wish to make a brief contribution to the debate. It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) on securing a debate on a matter that is of importance throughout the north-east of England. This is an important service, run by good people under extraordinary pressure. To give an example, on Monday 7 December last year, there were 1,837 emergency calls to the service. That is equivalent to new year’s eve and was a 46% increase on the year before. That was accompanied by 1,664 calls taken by the 111 service.

The service is fast becoming a gateway to healthcare as others become more difficult to access and some, such as walk-in centres, are no longer there at all. Repeated requests to the public to call the service only in life-threatening situations can do only so much. I accept that a certain amount of problems are caused by hoax calls and other misuse of the service. People who do such things are completely irresponsible and stand to be condemned, but that is not at the heart of the problems faced by the service in our region.

I would like to touch briefly on a number of issues. The first is commissioning, which is not one of the strongest features of the Government’s national health service reorganisation. How focused are the commissioners on the service they are supposed to be in charge of? Are they working alongside the chief executive in a supportive and encouraging way? When has their role ever been reviewed or carefully considered by those in charge? There is a case for looking at that and at staff morale, as my hon. Friend rightly said, and asking ourselves why it is as it is. Surveys of the service show that 90% of staff are stressed. That is consistent with the picture that came from her address—and no doubt will come from colleagues—of a service that is trying to do its best under enormous pressure.

Like my hon. Friend, I welcome the establishment of the diploma of higher education in paramedic practice, which will start in September at the University of Sunderland. That two-year course has been created to try to meet the shortage of paramedics in the region as well as the national shortage. Evidence suggests that the grading of posts may be too low, and I would be interested to hear the Minister’s views on that. It seems odd that, in a region such as the north-east, where unemployment levels are still higher than the national average, there should be a persistent vacancy rate of between 10% and 15% in the service.

[Anna Turley (Redcar) (Lab/Co-op)]

One of the issues raised with me on recruitment challenges is that it costs £1,200 to get a driving entitlement for C1 vehicles. For many people, that cost is extremely prohibitive and constituents have said to me that that has put them off applying for those kinds of jobs.

[Mr Brown]

My hon. Friend is on to a good point. There is something odd if, in a region of higher than average unemployment, it is difficult to fill those vacancies not just in a single moment in time but persistently. We should look at all barriers to entry into the service. I accept what she said, but I harbour the thought that gradings may have been set too low and that there is a case for upgrading the job.

I have two other points to mention briefly. Legal highs are again putting more pressure on the service as young people in particular misuse them. I suggest that it is not a good idea to take them at all, but taking them results in the ambulance service being called out. There were something like 20 incidents, including a cardiac arrest, in a single day—8 February—and so far this year there have been about 300 call-outs because of the use of legal highs. I harbour the view that they should not be legal, but perhaps that is a different debate.

Finally, I want to mention the pressures that will be put on the service if the supported accommodation proposals that the Government are considering come to pass. If vulnerable people who are housed in projects and given support to lead their day-to-day lives are denied that support and left to their own devices, the consequence for the police, accident and emergency services at hospitals and ambulance services will be much greater, rather than lesser, pressure. That is not the right direction of travel for our society.

--- Later in debate ---

[Jane Ellison]

I intend to follow up on this debate with my colleague in the Department of Health, Lord Prior of Brampton, who leads on the topic, and I will follow up with the service itself. I will make sure that all points raised by hon. Members are drawn to its attention.

The root causes of the increase in demand often lie outside the hands of the ambulance service. NHS England’s review of urgent and emergency care is taking a system-wide approach to redesigning the way that care is delivered. It is important to look at the provision of ambulance services in that context. We need to ensure that people with life-threatening emergency needs are treated in centres of excellence to reduce risk and maximise their chance of survival and recovery. The first part of that is about relieving the pressure on emergency services.

The response time targets are being considered as part of NHS England’s review to ensure that they incentivise the most clinically appropriate response. My hon. Friend the Member for Berwick-upon-Tweed and the hon. Member for North Durham (Mr Jones) talked about having the clinically appropriate response in all contexts. I will ensure that we pick up on those points and draw attention to them. We hope to have advice from NHS England later in the summer on potential changes to ambulance standards in the context of that wider review of urgent and emergency care.

[Mr Nicholas Brown]

Will the Minister give way?

[Jane Ellison]

No, because I have an important point to make at the conclusion. If the right hon. Gentleman will forgive me, there might be another opportunity.

Ambulance services are vital to emergency care and the whole NHS. We all want to be sure that when loved ones suffer heart attacks or are involved in a serious accident, they will not be left waiting, although we have heard about some distressing cases. National targets in response to red, life-threatening calls exist to ensure that that happens, and we all have an interest in ensuring that the ambulance services perform well against them. I will follow up on the points made in the debate.

I draw hon. Members’ attention to the fact that a comprehensive Care Quality Commission inspection was carried out at the NEAS during the week commencing 18 April 2016. CQC’s formal report will be important for all hon. Members and Ministers to read. In the light of the strong feelings expressed in the debate, I think it would be appropriate for hon. Members whose constituencies are served by the NEAS to meet my colleague, the noble Lord Prior of Brampton, who leads on this portfolio, when the report is available to discuss. I hope that that will be helpful for hon. Members. In the context of that report, many of the points made this afternoon can be discussed with Lord Prior. I encourage all hon. Members to engage with the local NHS and to continue to work together to address the challenges in this critical element of our healthcare system.

If the right hon. Member for Newcastle upon Tyne East (Mr Brown) can make his intervention in less than a minute, he may do so now.

[Mr Nicholas Brown]

How does the Minister account for the rise in demand for the service?

[Jane Ellison]

I definitely do not think that that question can be answered in less than a minute. Much of the answer lies in the work that Sir Bruce Keogh is doing as part of the NHS’s wider urgent and emergency care review. It is vital that we get people the right care in the right place at the right time. It is a complex picture, of which ambulance services are just one piece. More will be said when we know more about that review later this year.

Question put and agreed to.

Resolved,

That this House has considered the performance of the North East Ambulance Service.

Oral Answers to Questions

Nicholas Brown Excerpts

Tuesday 7th July 2015 Commons Chamber

[Mr Hunt]

We will look at all the evidence. The evidence we have seen from other countries is very encouraging. Apart from ensuring that NHS patients and the public understand the cost of NHS care, one of the main reasons why we want to do that is to improve adherence to drug regimes by making people understand just how expensive the drugs are that they have been prescribed. We will of course look at all the international evidence.

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

16. NHS England consulted in the last Parliament not just once but twice on downgrading the economic deprivation part of the funding formula, which would have had the effect of taking some £230 million per year out of the primary care budget for the north-east and Cumbria. Will the Secretary of State give the House a commitment—we got one from the Minister in the last Parliament—that he will not downgrade the economic deprivation part of the funding formula?

[Mr Hunt]

I give an absolute commitment that economic deprivation will be a very important part of the funding formula, but the right hon. Gentleman will appreciate that things such as the number of older people in a particular area is as important in determining levels of funding. We are committed to reducing health inequalities, but that also means making sure that similar levels of care are available in similar parts of the country. That has not always been the case.

NHS (Five Year Forward View)

Nicholas Brown Excerpts

Monday 1st December 2014 Commons Chamber

[Mr Hunt]

It absolutely does. My right hon. Friend makes his point very powerfully. This year, the better care fund—a programme derided by the Labour party, which said that it would not work—has been a huge success, with a £5 billion integration of the health and social care systems. The enthusiasm that that unleashed encouraged me to propose today that we should go further, so that where both parties are willing, local authorities and the local NHS should consider jointly commissioning public health as well. There would be huge benefits if they chose to do that.

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

Is it still the Government’s case that the emerging deficits across the English hospital trusts can be dealt with by efficiency savings alone?

[Mr Hunt]

There are huge pressures in the NHS. By the time of the election, we will have nearly 1 million more over-65s than there were at the last election. That means that people have to redouble their efforts to live within their means. At the same time people are trying to deliver the higher standards of care that we have talked about following the Francis review of what happened in Mid Staffs. It is challenging, but we expect all trusts to live within their budget. In all cases, they have recovery plans that we expect them to stick to.

Five Year Forward View

Nicholas Brown Excerpts

Thursday 23rd October 2014 Commons Chamber

[Mr Hunt]

I had a very enjoyable evening at the pharmacy business awards last night. Pharmacies have an important role to play, because they could save a significant number of A and E and GP visits. The single most important change—my hon. Friend and I have talked about this—is to make it possible, if a patient gives permission, for pharmacists to access their GP record so that they can see their medication history and ensure that they give them exactly the right drugs.

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

In the light of this report, is it still the Government’s case that the emerging English hospital trusts’ deficits can be dealt with by efficiency savings alone?

[Mr Hunt]

The Government believe that the NHS has to live within its means, as do individual hospitals. We recognise that that is challenging, and one of the reasons it is challenging is that in the past it has been too easy for hospitals trying to balance their books to cut corners, for example on nursing numbers in elderly care and dementia wards. We have a new inspection regime that has made it much harder to do that, which I think is a good thing, because it means that older people are getting the care they need. It also means a harder road to getting those deficits under control, however.

Oral Answers to Questions

Nicholas Brown Excerpts

Tuesday 21st October 2014 Commons Chamber

[Dr Poulter]

My hon. Friend makes an important point. Hospitals should always look to their own efficiencies first by improving procurement practices and freeing up surplus land to fund local schemes. His hospital has done that very effectively, and it has not pursued the policies of the previous Government, which have put so many trusts into difficulty.

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

Given the total forecast deficit across English hospital trusts, including PFI schemes, is it still the Government’s position that the situation can be dealt with by efficiency savings alone?

[Dr Poulter]

During this Parliament we are set to improve efficiency in the NHS and make £20 billion-worth of efficiency savings. There is much more that we can continue to do on improving hospital procurement practices, sharing business services across the NHS, and freeing up surplus land—which, as my hon. Friend the Member for Enfield North (Nick de Bois) outlined, is happening at his hospital. That is what we need to focus on in freeing up money for the front line.

Oral Answers to Questions

Nicholas Brown Excerpts

Tuesday 15th July 2014 Commons Chamber

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

12. What recent advice he has received on NHS trust deficits in England.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

We have regular conversations with the NHS Trust Development Authority and Monitor about the provider sector. For 2014-15, the TDA, NHS England and Monitor are establishing a joint package of support and financial improvement measures for some of the weakest local health economies.

[Mr Brown]

Even if the Department were able to achieve every possible efficiency saving, both Monitor and the King’s Fund are forecasting a substantial deficit in next year’s budget. What is the Department’s policy response to that? I understood that the Secretary of State ruled out charging in answer to an earlier question, so that leaves either applying more money to the problem or restricting the service.

[Dr Poulter]

The right hon. Gentleman asks a valid question about how to make efficiency savings. Under the previous Government, there was a requirement in 2009 to make £20 billion of NHS efficiency savings during this Parliament, which is being delivered at £4 billion a year. Improving procurement practice at hospitals, improving estate management, greater energy efficiency measures, ensuring more shared business services in the back office and reducing bureaucracy are all measures that will continue to ensure that the NHS meets the challenge and frees up more money for front-line patient care.

Oral Answers to Questions

Nicholas Brown Excerpts

Tuesday 10th June 2014 Commons Chamber

[Jane Ellison]

That is a very good point. This Government and this Secretary of State have championed transparency more generally, because we all believe that it is essential to our ability to build on the success of the health service and maximise its service to patients.

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

Am I right in understanding that the Minister has just announced a further delay? The key recommendation to the Government on children’s heart surgery, which was made in 2001, was that fewer units should be centres of excellence, because that was in the best interests of patients. Now, 13 years later, none of that has actually happened. Do the Government still accept the premise that fewer units should be centres of excellence, and will the Minister tell us what accounts for the delay?

[Jane Ellison]

I understand the right hon. Gentleman’s frustration, but the review is very important. NHS England has confirmed that it will not be able to consult quite as early as it had wished, but it should be appreciated that this review is more comprehensive than the last one. For example, NHS England has developed a comprehensive set of commissioning standards which have never existed before. For the first time, the whole patient pathway will be covered, from foetal detection through childhood, into adult services and all the way to palliative care—on which one of my hon. Friends led a debate relatively recently—and bereavement.

It is always frustrating when things do not happen according to schedule, but what really matters is getting this right and being as transparent as possible. The level of engagement with stakeholders has been much more satisfactory than before, and we continue to make progress.

Health

Nicholas Brown Excerpts

Monday 9th June 2014 Commons Chamber

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

It is a pleasure to follow the hon. Member for Newbury (Richard Benyon). Let me begin where he left off. For the past two years, along with other Members of Parliament representing the north-east and Cumbria, I have been arguing against attempts to alter the health service’s funding formula and reallocate funding, taking it away from deprived areas with poorer health outcomes and giving it to more affluent areas with better health outcomes. Last year, the Government’s original proposals would have led to a reduction of £230 million in the annual health funding of the north-east and Cumbria. NHS England eventually opted for inflation-proofed increases for all clinical commissioning group areas, along with extra increases for some favoured clinical commissioning groups in more affluent parts of the country. I should welcome an assurance from the Minister that we will not have to go through that fight again.

The Government’s top-down reorganisation of the national health service is riddled with gaps and negative consequences. It has significantly increased pressures on A and E departments, which have now become the default places to visit if people need to see a doctor within days. It is no longer possible to make an appointment with a GP a day or so in advance, and many people have to wait several weeks for an appointment. There are arbitrary, cost-influenced restrictions on procedures and treatments, leading to a postcode lottery whereby some services are free in certain parts of the country but not in others.

Clinical commissioning groups are reported to have spent more than £5 million on competition lawyers to try to navigate competition law in relation to commissioning services. More than £1.4 billion has been spent on redundancies in the NHS, only for thousands of people to be re-hired under the new structures. I understand the latest figure is over 4,000. That point was made forcefully by my right hon. Friend the Member for Leigh (Andy Burnham) in his opening speech, and I support every word that he said.

There has to be an answer to this, and it is not coming from the Government. Health Ministers are increasingly hiding behind NHS England when it comes to big policy questions relating to the NHS, and more and more answers to parliamentary questions are being referred away from the Department and to unelected, largely unaccountable bodies. There is also the overarching issue of GPs’ now having key functions as commissioners, as well as functions as providers of services that are being commissioned. The obvious conflict of interest is corrosive to the ethical underpinning of the NHS.

I have the honour to represent the Freeman hospital and its internationally renowned heart units, including its high-achieving children’s heart unit. In the 2001 review of the Bristol children’s heart unit, Professor Sir Ian Kennedy clearly stated that England needed a smaller number of centres of excellence to undertake the complex, highly skilled procedures involved. No one has refuted his arguments, but, 13 years later, we are no closer to achieving the outcome that he said was desirable.

We cannot, and should not, let that issue drift. The Government have an obligation to set out a clear way forward that is compatible with Sir Ian’s recommendations, and to do so on the merits of the medical arguments and not on the basis of political expediency. The delays in addressing the issue over the four years of the current Parliament pose the risk that it will extend beyond the next general election, yet we are no clearer about the future of children’s heart units in England. Again, a response from the Minister on the issue would be welcome.

I want to raise the recommendations of the NHS Pay Review Body and the blocking of the recommendations by the Government. That decision comes after a two-year pay freeze and significant pay restraint following the two-year period. When factored against inflationary pressures, nurses’ pay has fallen by 10% in real terms over the past four years. Alongside that, contributions to the pension arrangements have increased, coming out of take-home pay.

The Government should not treat individual increments as if they were pay rises. Forty-five per cent. of nurses do not receive an increment. The Government should not set the NHS Pay Review Body recommendations to one side. They are wrong to insist instead on an offer of a 1% non-consolidated payment for this year, followed by a 2% non-consolidated payment for the following year. If nothing else happened at the end of this period, the nurses would be substantially worse off than they are today. These are pressing issues for the national health service.

I should like to make a more general point about the Queen’s Speech’s failure to touch on the most significant problem facing the north-east of England. Unemployment in the region remains the highest in the country, at 10.1%. Despite recent national falls in unemployment, it remains stubbornly high in the north-east.

The unemployment rate for the region has actually increased in 2014. There is a continued need to create sustainable well-paid jobs through private sector economic development in the region. The tragedy is that the parties do not quarrel about this: we agree on what needs to be done. The issue is doing it. Youth unemployment remains high and more needs to be done to open up opportunities to work and training.

Four years ago, the Government made sweeping changes to the delivery of economic development in the English regions. The Government’s reorganisation is not working for the north-east of England. Apart from the projects that were already under way under the last Labour Government, the present arrangements have little to show. Governments often make their largest mistakes in their first 100 days. Having abolished the regional development agency and Business Link, the Government have spent the last four years trying to set up structures that will carry out the functions that those bodies used to undertake, and in our region the efforts so far have achieved very little. This matters because it is our region’s core problem.

The Government’s original idea was that the new localism contained the answer to the north-east’s economic development questions. The coalition Government argued that the setting up of new locally based bodies would be the right way to provide economic development at local level. Over the past four years, the means has become the end. All energies have been focused on those structural questions. The purpose for which they were originally intended has been almost completely lost sight of. A single Minister needs to get a grip of these arrangements, which now span a range of different Departments, and force them to focus on specific economic development initiatives.

These are important issues. Now that the House has committed itself to fixed-term, five-year Parliaments, it is likely that all future final Sessions will have something of the character of this one. There is something unsatisfactory about it all. I feel that some of the big questions and the attendant debate are slipping away from Parliament.

Oral Answers to Questions

Nicholas Brown Excerpts

Tuesday 14th January 2014 Commons Chamber

[Mr Hunt]

Let us look at those facts for last week and compare them with the facts in the identical week when the right hon. Member for Leigh (Andy Burnham), the shadow Health Secretary, was Secretary of State. When he was Secretary of State, 362,462 people were seen within four hours. Last week, we saw 365,354 people—3,000 more people—within the target. A and E is doing better under this Government than it ever did under Labour.

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

3. How many mesothelioma cases are being treated by the NHS; what strategies have been adopted for treatment and prevention of mesothelioma; and if he will make a statement.

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

In 2011, 2,238 people were diagnosed with mesothelioma. NHS England has set out guidance on the diagnosis, treatment, care and support of patients with that serious disease. That will deliver access to high-quality and consistent services across England. Both clinicians and patients are involved in the development of the guidance. UK legislation requires the active management of asbestos in buildings to prevent further exposure.

[Mr Brown]

The number of full-blown mesothelioma cases is expected to peak next year and then decline. The Department of Health is best placed to say whether that is happening. Will the Minister assure the House that the Department is carefully monitoring the situation and is in close contact with the Health and Safety Executive with a view to ensuring that our public protection measures are adequate for the challenge we face?

[Jane Ellison]

The right hon. Gentleman is right to say that it is a very serious situation, and we of course keep a very close eye on it. Higher-risk work with asbestos must be licensed by the HSE, which has recently published an updated approved code of practice, “Managing and Working with Asbestos”. The code provides guidance and practical advice to companies, because we do not want more people being exposed in the way that so many have been in the past.

NHS Funding (North-East and Teesside)

Nicholas Brown Excerpts

Tuesday 5th November 2013 Westminster Hall

[Tom Blenkinsop]

Yes, the cumulative effect of all the funding allocations in different areas is very worrying. If those allocations are all reduced, my genuine worry for my constituents, and for constituents across the north-east, is that all the hard work and financial effort in Teesside in the past 15 years to reduce cardiac risk, bad outcomes for cancer, and other problems will be undermined, and we will not build on the momentum gathered over the past 15 years.

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

Is that not all the more outrageous because a former Health Minister, the right hon. Member for Chelmsford (Mr Burns), gave a clear assurance at Health Question Time on the Floor of the House that the importance of the deprivation part of the calculation would not be downgraded? We asked for a clear assurance, and we were given a clear assurance. That assurance is not compatible with the current consultation.

[Tom Blenkinsop]

My right hon. Friend predicts the final part of my speech. I hope the Minister will take the opportunity to put our fears to rest. Unfortunately, the information that I have received to date does not reassure me.

--- Later in debate ---

[Dr Poulter]

Not at the moment. The independent Advisory Committee on Resource Allocation, or ACRA, as hon. Members have mentioned in the debate, historically has advised that the funding formula should be readjusted to take into account demographics and the increased health care needs of older populations in other parts of the country. The Government, however, in the past chose to maintain support for deprivation as a factor in health care funding, but the decision is now not one for the Government. It is now for NHS England to listen to the independent advice, but I would find it strange were there a sudden change in the funding formula that did not factor in deprivation, as done in the past.

It is important to set the record straight. The decision is not political; in the past, the Government preserved a weighting for deprivation, but now the decision will be taken separately by NHS England. Its decision will be made on the basis of clinical need, although of course deprivation will be a factor.

[Mr Nicholas Brown]

I asked the Minister’s predecessor for a clear assurance that he would not downgrade the importance of economic deprivation in his resource allocation formula. The Minister’s predecessor, once he had consulted the Secretary of State at Health questions, then said:

“Yes, I can give that assurance.”—[Official Report, 12 June 2012; Vol. 546, c. 167.]

It is impossible to misunderstand what was being said. What weight can we put on that now?

[Dr Poulter]

My predecessor was in place when setting the resource allocation was in the Government’s gift. As the then Minister made it clear, a weighting in the formula for deprivation would be preserved—he stood by his word and that weighting was preserved. NHS England, not the Government, now sets the funding formula—to avoid political interference—and those in NHS England, in conversation, have made it clear that they also value a weighting apportioned to deprivation.

--- Later in debate ---

[Dr Poulter]

The hon. Gentleman is right in saying that had the Government followed the advice of the Advisory Committee on Resource Allocation in the past, we would potentially have cut the budget for the north-east. I can reassure him that we maintained the resource allocation budget, and the north-east has received an increase in real terms. Those are the facts. He may want to create political smoke, but there is none. We preserved and increased funding to the north-east for patients in Opposition Members’ constituencies and in those of my hon. Friends.

[Mr Nicholas Brown]

Will the Minister give way?

[Dr Poulter]

I will not give way again.

The hon. Member for Middlesbrough South and East Cleveland is being very disingenuous in the points that he is making, and I have put the record straight: health care funding has increased under the present Government. If I give way again, perhaps he will explain why the shadow Secretary of State said it would be irresponsible to increase the health care budget in real terms. We all think that would be irresponsible in the current environment.

I turn to local services in the hon. Gentleman’s constituency. When we discussed the matter earlier this year, he raised specific concerns about Guisborough, East Cleveland and Redcar hospitals. He did not put on the record the fact that matters have improved considerably since that meeting with me and local commissioners. Guisborough urgent care centre is open from 9 to 5 on Mondays to Fridays and from 8 to 8 at weekends. East Cleveland urgent care centre is open from 9 to 5 on Mondays to Fridays and from 8 to 8 at weekends, and Redcar urgent care centre is open 24/7. There are currently no vacancies for clinical staff that affect opening hours, which have been aligned to match service and patient need. The centres will continue to evaluate the situation.

It is worth highlighting that three additional nurses were recruited to support the urgent care centres in June 2013, and they are now at full complement, apart from one vacant clinical lead post to which the trust is continuing to try to recruit. It is looking at better ways to manage staffing. In response to concerns raised by the hon. Gentleman, there are now fully functioning urgent care centres. There is a 24/7 service in Redcar and additional staff working at those centres. That is good progress and it is disingenuous of him to suggest otherwise.