NHS (Contracts and Conditions)

Paul Scully Excerpts

Monday 14th September 2015 Westminster Hall

[Paul Scully (Sutton and Cheam) (Con)]

It is a pleasure to serve under your stewardship, Ms Vaz. It is also a pleasure to follow two fellow members of the Petitions Committee, including the Chair, the hon. Member for Warrington North (Helen Jones). The Petitions Committee is a new Committee, and we are feeling our way. As hon. Members have heard, we cannot debate no-confidence motions; petitioners cannot seek a vote of no confidence in a Secretary of State or anybody else. None the less, it is important that we reflect the views and concerns of people who raise substantive matters with us, and I am glad that we have the opportunity to do so today.

Confidence and good staff morale in the NHS are important. In my constituency, morale in our local hospital, St Helier, has been comparatively low for several decades, for a number of reasons. A reorganisation has been recommended in the past couple of years, which we have successfully fought off so far. The NHS clinicians wanted to move A&E, maternity services and children’s services to St George’s in Tooting. One of the reasons why they wanted to do so was the shortage of consultants in St Helier. They wanted to concentrate consultants’ time in St George’s, which is too far away for residents.

One of the big driving factors in that, to my mind, is the fact that over 20 or so years, our local hospital has been used as a political football. People have said, “St Helier hospital is due to close. We have got only a short time, and we have to save it. We have to fight for this, because it will close some time soon.” I do not know about you, Ms Vaz, but if I were a consultant looking to work in the NHS, would I want to go and work in a hospital that is always apparently under threat of closure? No, I probably would not. I would probably go to St George’s or one of the hospitals that are being talked up. I have seen at first hand how staff morale in the NHS can be fragile. The same thing has happened nationally as well. How many times have we heard that we have 24 hours to save the NHS? We keep seeing, hearing and reading that, time after time. It is important to build confidence.

We also have a manifesto commitment to deliver. We talked in our manifesto about having a seven-day NHS, and we have been elected as a Conservative Government, so it is important that we deliver our promises. We have to work with the profession to do that, however. Why do we want a 24-hour NHS? We have heard some of the arguments about safety and patient outcomes, and at the end of the day, patient outcomes are what it is all about. There is also an argument—although, as my hon. Friend the Member for Totnes (Dr Wollaston) described, it is a secondary priority, because we do not want to divert too many resources—for convenience and fitting in with people’s lifestyles, which I will come back to in a moment.

The 2003 consultant contract made the seven-day move a lot more expensive to deliver, so we need to change things. Consultants, as we have heard, can refuse to work weekends, but it is quite apparent that a great many do not choose to opt out. We are not saying in a broad-brush way that every consultant opts out of such working. None the less, we need to have a degree of consistency if we are going to move towards a seven-day NHS, because we want to make sure that the healthcare in hospitals around the country is as consistent as possible. Removing the opt-out will leave a new limit of working a maximum of 13 weeks in a year—one in four weekends—which still gives plenty of opportunity for family life and for flexibility in rotas, while delivering better patient outcomes.

The changes also recognise the need for proper reward in areas such as A&E and obstetrics, with higher-performing consultants able to earn a bonus of up to £30,000 a year, and with faster pay progression for new consultants. The hon. Member for Warrington North talked about support services, which are crucial for front-line consultants, doctors and nurses. I am pleased to hear that diagnostic services will be moving in the same direction so that patients can have quicker access to information and advice about their conditions.

I have talked about convenience, and GP services cannot be boiled down to some sort of retail operation such as late-night shopping or Sunday opening. None the less, we need flexibility. The 2004 GP contract led 90% of GPs to stop providing out-of-hours care at night and at the weekend. That contract, in many cases, helped to break the personal link between patients and those responsible for their care, which has been especially hard on elderly people. Caving in to the unions at that point effectively restricted GP services to a five-day service, which created extra pressure on A&E.

I have had the misfortunate of having to use my local hospital’s A&E service four times in the past 18 months with my elderly mum and my wife. My wife stood on a six-inch spike in a park, and when she was writhing around in agony with a spike though her wellington boot, there were a lot of people in A&E who had experienced neither an accident nor an emergency. Those people did not know where to go, they chose not to go to the GP, the appropriate care was not signposted clearly enough, or the GP simply was not open. We need to address those pressures, and a seven-day service will help.

The proposal is part of our wider NHS reforms, which since 2010 have moved to bring patient decisions closer to patients. We need to provide services that patients want, rather than a Henry Ford one-size-fits-all approach—we need greater flexibility. We have largely moved away from that, so we need to continue the move towards a seven-day service and towards greater flexibility. A seven-day service fits in with people’s working practices, childcare and busy lives. There is also greater take-up of digital initiatives such as the NHS national information board, and people are being brought in to help support the greater use of technology.

Members have talked about the statistics on satisfaction with the NHS over the past few years. The Commonwealth Fund’s report in 2014—four years after the Conservative-led Government took over—showed that, according to the fund’s records, the NHS is the best-performing health service in 11 countries.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The hon. Gentleman has surely read the detail of that Commonwealth Fund report. Much of the data that were used data from the previous Labour Government.

[Paul Scully]

The hon. Gentleman will also find that the NHS improved over those years. We were second when the Labour Government were in power, so we have improved, and more data are still coming through. That is backed by public confidence, which has gone up by 5 percentage points to its second-highest level in the period covered by the report. The number of people in England who think that they are treated with dignity and respect increased from 63% in 2010 to 76% last year, according to Ipsos MORI. Record numbers say that their care is safe, and the number who think that the NHS is one of the best systems in the world has increased by 24 percentage points in the seven years since Mid Staffs. That is a great base from which to start, but we need to continue working with healthcare professionals to secure the seven-day NHS that we need and people want to see. Shouting and using the NHS as a political football will not get us very far.

[Helen Hayes]

The hon. Gentleman talks about the need to work with NHS staff. One of my constituents, who is a trainee anaesthetist, wrote to me in great detail with her concerns about the impact of the proposed contract change. At the end of her email, she said:

“As a final insult, Simon Stephens, Chief Executive of NHS England, has announced plans to pay for fitness classes for NHS workers, to improve our health and reduce absenteeism. NHS staff are screaming out to be cared for so we can care for others—by employing enough of us on fair contracts, with adequate resources to do our jobs well. Zumba will not achieve this.”

Although there is nothing wrong with employers investing in fitness classes for their employees, does the hon. Gentleman agree that, in a crisis situation, this is simply adding insult to injury?

[Paul Scully]

In his King’s Fund speech, the Secretary of State talked about working with professionals, including the British Medical Association and other organisations, throughout September. That example is why we need to keep the dialogue going. I have seen nothing substantive in speeches by Ministers to pitch them into conflict with the vast majority of NHS staff. It is about change management. Change is always difficult, but change we must do. We can achieve much more together.

[Maria Caulfield]

Does my hon. Friend agree that staff morale has been an issue for decades? I worked in the hospital in his constituency during the previous Labour Government, and what demoralises staff most is the NHS being used as a political football. Opposition Members are screaming, “We have found data!” But it is not their data; it is patients’ data and the staff’s data. We need to work together. I commend my hon. Friend for saying that we need to work together and stop using the NHS as a political football.

--- Later in debate ---

[Paul Scully]

We can take every small initiative, such as the fitness classes, and find offence because the NHS has a limited budget. When staff look at whether there will be a pay increase and what that pay increase and the conditions might be, they tend to find such examples if they are not happy with what is on offer. Obviously, I cannot comment on that particular example.

Change management is always difficult, but we need to change. I believe that we can achieve such change under the calm, professional stewardship of the Secretary of State and his ministerial team.