Oral Answers to Questions
Peter Kyle Excerpts(5 years, 2 months ago)
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Peter Kyle (Hove) (Lab)
The Secretary of State for Health and Social Care (Matt Hancock)
On 30 January, we announced that we will increase access to PrEP, doubling the number of people who can receive this potentially life-saving HIV prevention drug.
Peter Kyle
Funding for HIV prevention has become quite complex, with a complex mix of central funding and local authority funding. Cities such as Brighton and Hove still have the highest contraction rates outside London. Will the Secretary of State meet me and the Terrence Higgins Trust to understand how that is impacting us on the frontline and tell us what more can be done?
Matt Hancock
Of course I would be delighted to meet the hon. Gentleman to discuss this matter. In the long-term plan, we made it clear that we are looking at commissioning arrangements for sexual health services. I am delighted that the number of new cases of HIV has been falling and that we have been able to declare that by 2030 we want the UK to have zero AIDS. That is an achievable, but hard, goal, and I will work with anybody to make it happen.
The Minister for Care (Caroline Dinenage)
My hon. Friend is absolutely right about the need to support and enhance the protections for allied health professionals. One of the recent planned HCPC increases was to raise its annual fees by £16, but it would still remain one of the lowest of any of the UK-wide health and care regulators. It is also important to remember that regulation fees are tax deductible.
Peter Kyle (Hove) (Lab)
Matt Hancock
Thankfully, the recruitment both of nurses and doctors is going up, which demonstrates that people do want to work in the NHS, and so they should because it is an amazing place to work and it has a great mission, which is to improve the lives of everyone.
Draft Human Fertilisation and Emryology Act 2008 (Remedial) Order 2018
Draft Human Fertilisation and Emryology (Parental Orders) Regulations 2018
Peter Kyle Excerpts(5 years, 4 months ago)
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Andrew Percy (Brigg and Goole) (Con)
It is a pleasure to serve under your chairmanship, Mr Evans. On behalf of the all-party parliamentary group on surrogacy, I thank the Minister for the positive way in which she has engaged both with us as a group and with the surrogacy community. I also thank her for the positive language that she has used about surrogacy on numerous occasions, which is new from a Government Minister. Going back decades now, I think there has always been something of a nervousness in Government about the language used around surrogacy, but the Minister has been absolutely clear that surrogacy is a positive way of creating families, often for less conventional relationships. We thank her for that.
We also thank the Minister specifically for the NHS guidance that she issued through the Department, which several surrogates have already made use of. Imagine being a surrogate who is excited about a new birth but is forced by the hospital to hand over the child in a hospital car park or, worse still, is unable to see their own child after the birth. There is clearly still more work to do in this department, but this is clearly a positive step forward, and the surrogacy community welcomes it.
Similarly, I thank the Minister for the Government funding of the Law Commission review, which the APPG is very engaged in. We have taken evidence over the last few weeks from lawyers, intended parents, surrogates and others. This afternoon we will take evidence from Tom Daley, who went overseas with his partner because of the problems in the UK with obtaining a parental order. There is a lot more to be done on parental orders, particularly on the time it takes to get one in the UK. We look forward to those issues being addressed as part of the Law Commission review.
The APPG and the surrogacy community are happy that the draft order has at last been laid. It comes out of the September 2015 case of Re Z, in which the court was unfortunately unable to grant a single male applicant a parental order. There have been delays, some of which came about as a result of potential unintended discrimination that could have come out of the original wording. However, it was absolutely clear when the Minister laid the draft order before Parliament on 19 July this year that her language was very positive. That is to be welcomed.
As I said, laying the order has taken a long time, which has resulted in some people who would by now have become parents being unable to do so, while others have been forced overseas. It has also put the courts in a difficult position in several cases.
Peter Kyle (Hove) (Lab)
Does the fact that people have to travel abroad not indicate that this option is available to only those with resources and money? Vast swaths of the population who do not have the resources to travel abroad do not actually have access to surrogacy.
Andrew Percy
That is true in part. There is no doubt that, if people want to go to a model place for surrogacy such as California, it is a very expensive option, although the actual costs paid to the surrogate are generally the same as those in the UK; it is the medical costs and all the rest of it that pushes costs up. People are forced to go, if not to the United States, then to regimes in the world where the systems and protections for the surrogate, let alone the intended families, may not be of a standard that we would be comfortable with. That is why it is vital that we change the law in this country, so that surrogacy can become so much easier for those denied it at present.
Several other cases have come before the courts in which applications for parental orders have unfortunately had to be stayed, or other powers, such as wardship, have had to be used. Although we welcome the draft order, there are still some issues for single people moving forward, which I hope the Minister will confirm will be addressed as part of the Law Commission review. For example, under the remedial order, some single people will still be excluded from being parents, while a parent who is not genetically linked to the child will be unable to be granted a parental order. Similar issues could arise if an intended parent dies during the course of a surrogate pregnancy.
There are also sad cases of, for example, women who have received cancer treatment, leaving them unable to use their own uterus or eggs. If they are single and use egg donation, they will not be able to receive a parental order. More work needs to be done to address some of those challenges, and I hope that will be undertaken as part of the Law Commission review.
I thank the Minister again for the incredibly positive way she has engaged. The draft order will enable more people to form families—it will enable more individuals to become part of the surrogacy family, to register with organisations such as Surrogacy UK and to get on with building their families.
NHS Long-Term Plan
Peter Kyle Excerpts(5 years, 10 months ago)
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Mr Hunt
My hon. Friend could not have put it better. The only surprise here is that having spent years and years saying that we should invest more in the NHS through the tax system, when the Government actually stand here and say that is what they are doing, the Opposition tell us that they are against it.
Peter Kyle (Hove) (Lab)
Whether it is mentioned by the Prime Minister, the Leader of the Opposition or anyone else, there is only one fact about the Brexit dividend, and that is that it does not exist. Will the Secretary of State tell all the staff in the NHS how much of the money announced today is contingent on the Brexit dividend, so that they can bank for the future based on how much will actually materialise come autumn?
Mr Hunt
I am very happy to tell the hon. Gentleman that all this money will materialise, because this is a Government that keep their promises. If he is so worried about the Brexit dividend, he should be speaking not to me but to his own leader, who said that he wants to
“use funds returned from Brussels after Brexit to invest in our public services”.
Have a word with him!
Cancer Treatment
Peter Kyle Excerpts(6 years ago)
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Peter Kyle (Hove) (Lab)
Thank you, Mr Speaker, for being present in the Chamber today. I know that you take the Chair most Thursdays, but I choose to interpret your presence today as a testament to Tessa. He is not in his place at the moment, but it is worth recognising that the Secretary of State was present not just during today’s debate but in the debate in the Lords. That was recognised by many of us and very much appreciated.
I want to start by talking about my mum, Joanna Kyle, later Murrell. In 2011, my mum presented to doctors with severe back pain, for which she was given medication but no further tests. In the 18 months that followed that visit, she went to doctors and clinicians and to hospital no more than a dozen times with the back pain, which never went away and only got worse. She was sent for numerous tests on her back, but on her final visit to the GP, when her husband said, “Please run more tests because the pain is not going away,” the GP simply replied, “Why on earth would I do that?” A week later, my mum collapsed. She was taken to hospital and diagnosed with stage 4 lung cancer. Within a month, she had died. Her mother had lung cancer, my mum had been a smoker earlier in her life—one would have thought that those were the sort of things that would have been picked up much earlier.
At the point at which my mum was diagnosed, she had only a 21% chance of living a year. If she had been diagnosed at the point at which she first presented to the doctors, in all statistical likelihood she would have seen me, her son, enter the House of Commons. There would have been a very good chance that she would have been here today or, most likely, outside enjoying the weather at her house in Devon.
My mum was not a complainer. She did not push herself forward, and she did not complain, thrust or make sure she got all the attention she needed. This is a good link from my mum to Tessa. Many people who do not know the relationship I have with Tessa might not see the link between my mother and Tessa, but for me it seems very logical. Tessa has always played a very strong and maternal role in my life, always—always—pushing me forward. For me, the link is an easy one. Tessa, too, is not a complainer, but my God she is a doer. She has always got things done and it is easy to pay tribute to her not just for her stellar career and achieving the Olympics but for her wonderful family. These debates in Parliament are the best testament to her, because amid the anguish of living with cancer, Tessa’s first instinct is to make life better for others.
Mr Tanmanjeet Singh Dhesi (Slough) (Lab)
Does my hon. Friend agree that although we pay tribute to the incredible bravery and determination of Baroness Tessa Jowell, we also need to pay tribute to the amazing work of Cancer Research UK, which has an impact not just in our country but around the world?
Peter Kyle
Of course I do. My hon. Friend makes an important point. Tessa, too, has been linking with many organisations, bringing them together and focusing attention on them but, just because that is so typically Tessa, it does not make it any less remarkable.
For brain cancer to be tackled, three things must happen. We need to sort out funding, innovation and the use of data, and I will speak about the data. The working group set up by the Department of Health and Social Care said that brain tumour patients would like
“their health data to be used for research to speed up development of new treatments. Regulators should respect these wishes.”
Lord Freyberg said in the debate in the other place that Britain has a “globally unique research asset” in the NHS. We have cradle-to-grave records covering millions of people, and examples from those records could revolutionise care and research. Those records need to be much better utilised.
That is the data at the very top, but we now see in America how Apple is revolutionising the use of health data down to the individual. Last month a dozen healthcare providers in the US partnered with Apple to provide health records directly on to patients’ phones via an app. The information is presented in a way that incentivises healthy choices and empowers patients not only to make the right choices but to have a more natural relationship with their health and health information, and with the professionals who provide it. With our NHS, we have infinitely more potential than any other country on earth to revolutionise health research and the way we manage and maintain our own health. We need far more ambition to realise that.
I end with another quick word about Tessa, because I would not be here if not for strong women like Tessa pushing me forward way before I came to this place and way before I got into politics. In all those situations I knew Tessa and felt her guiding hand gently pushing me forward. She gave me the kind of mentorship that people need. I have articulated to her many times that it has always been a source of regret that we were never able to sit on these Benches together, because I believe hers is the sort of mentorship from which somebody like me would really benefit as they enter this place.
Tessa, to be here today in the same Chamber as you, and to be sharing these green Benches with you for these few moments, is something I will remember for the rest of my life.
Austerity: Life Expectancy
Peter Kyle Excerpts(6 years ago)
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Chris Ruane (Vale of Clwyd) (Lab)
I congratulate my hon. Friend the Member for Sheffield, Heeley (Louise Haigh) on securing the debate. The issue of stalling life expectancy, and indeed of falling life expectancy in some areas, is very serious. The hon. Member for South West Bedfordshire (Andrew Selous) talked about living within our means, but people in my constituency are dying early without their means.
We must reach out across the party political divide on this issue, because the constituencies affected are in poorer areas of the country, as has been mentioned, but they are not anomalies; many different parts of the country are affected. I will give an example. Life expectancy for females at age 65-plus has fallen over the past five years by 0.8 years in Stevenage and by 0.6 years in Cheltenham. Life expectancy for males at birth has fallen in my county of Denbighshire by 0.6 years and by 0.9 years in Bromsgrove. This issue affects a great many of our constituents, across the political divide and across the country. There must be the political will for us to understand the root causes of what has resulted in this debate.
Peter Kyle (Hove) (Lab)
Does my hon. Friend agree that what is responsible for this situation is not just the restraint in spending, but the way in which spending restraint and austerity have played out on the frontline? The issue is the withdrawal of mental health services for people living at home. It is the teaching assistants who have all but been removed. In particular, it is the impact on services that help people to stay at home and manage conditions and the cuts to frontline policing that have led to the evisceration of not just life chances, but life expectancy itself.
Chris Ruane
I agree. All those issues are part of the mix as to why we are seeing a decrease in life expectancy. It is a complex issue that needs further inquiry.
NHS Winter Crisis
Peter Kyle Excerpts(6 years, 4 months ago)
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Jonathan Ashworth
If I may make a little progress, because I have been generous, I will then try to take more interventions. I am conscious, however, that this is only a half-day debate.
The consequences of this crisis are not only for those in urgent need, but for everyone using the NHS. Let us be clear that this panic cancelling of elective operations means that patients will suffer. Not only will patients suffer longer waits for operations while in pain and distress, but they will wait for appointments with the uncertainty of not knowing what is wrong with them, and the knock-on effects on NHS services and the wider society are huge. Already, patients are facing a waiting times crisis with 4 million on the waiting list.
Jonathan Ashworth
Let me make a bit of progress.
A lost month will mean that thousands of patients across the country are stuck with their lives on hold. To call this “routine care” misses the fact that these are big issues for the individual patients affected. The young man awaiting heart valve surgery, who will have arranged time off work and for his family to be around to care for him, now has to cancel it all and does not know when his operation will happen. He also runs the risk of a deterioration in his heart function, which could lead to further hospitalisation in an emergency, adding to the pressures on our emergency services.
Jonathan Ashworth
The hon. Gentleman will know that the system is in such a state because of years of sustained underfunding. His answer would be a cross-party commission, a sort of royal commission, and I have huge respect for his contributions to these debates, but let us be clear that for eight years the NHS has not been getting the level of funding it should be getting in historical terms.
Peter Kyle
My hon. Friend is being very generous in giving way. Down in Sussex, patient transport was privatised and given to a company called Coperforma. Seven months after the contract was awarded, the company was stripped of it for its appalling practices and for completely underperforming in every way, shape and form. It now transpires that Coperforma has been given more money for seven months than it would have received if it had performed properly for a full year. Is that not indicative of the way in which the NHS is being run?
Mr Speaker
Order. May I appeal for brief interventions? I would just point out to the House that no fewer than 38 Back Benchers wish to speak, and even if the debate is allowed to run on beyond 4 o’clock, which is in the hands of the usual channels, probably half of them will not be able to do so. I say now that they will just have to sit, wait and hope—I am not publishing a list; we do not do so—but long interventions do not help.
HIV Treatment
Peter Kyle Excerpts(7 years, 1 month ago)
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Peter Kyle (Hove) (Lab)
I apologise for arriving late and missing the start of the debate, Mrs Main, but I was waiting to speak in the Prime Minister’s statement. It is a pleasure to serve under your chairmanship again. I long for the day when I can get called as quickly as my right hon. Friend the Member for Exeter (Mr Bradshaw), who gets called with such speed and alacrity.
Peter Kyle
I long for that day as well, but that is in the lap of the electorate. I also thank the hon. Member for Finchley and Golders Green (Mike Freer). He heads up some incredible work by the all-party group, which has provided remarkable and concise information that is usable not only within the sector, but by a great number of people, to advocate for the challenges of people living with HIV and AIDS and to help to explain the broader issues people face. The reports are read by a great many individuals, and not only by experts in the subject, which is a credit to him. His wide-ranging speech—the last three quarters that I caught—was exceptional, and I am grateful to have been here for it.
I represent the city of Brighton and Hove, which has more than four times the national average HIV contraction rates and people living with HIV. That places an additional onus on me to give voice to both the sector and the individuals who live with this long-term condition. I am a representative for that city and for the gay community. When I was on the board of Pride, I spent a lot of time trying to understand the fabric of the support services going to people living with HIV, and I have done so with even more enthusiasm and dedication since being elected as an MP.
I am proud that we have incredible preventive work in Brighton and Hove. THT, Stonewall and local groups, co-ordinated through the LGBT Forum, have done remarkable work on prevention. It is a sadness that they do not have all of the tools that they call for, including PrEP, at their disposal. I know that the issue has been aired by other Members today, so I will not go into any more detail on that, but the grassroots and the people working on the frontline in Brighton and Hove are absolutely enthusiastically calling for that.
Thangam Debbonaire (Bristol West) (Lab)
I, too, wish to add my thanks to the hon. Member for Finchley and Golders Green (Mike Freer). Does my hon. Friend agree that having such a confusing and complex mix of commissioners and authors of standards for prescribing does not help to establish the consistent commissioning of drugs such as PrEP, which he has mentioned and which would help so many people not only in his own constituency, but in Bristol West?
Peter Kyle
Bristol and Brighton share many of the same characteristics in terms of demography and the numbers of people living with the long-term condition of HIV/AIDS. I agree with my hon. Friend wholeheartedly. The hon. Member for Finchley and Golders Green made the point very well about the split that was created in the Health and Social Care Act. It is having an impact on communities and I hope Ministers will finally realise that that needs to be prioritised.
In the work I have been doing with the people who deliver frontline services, I have learnt that the people who live with HIV/AIDS often have complex needs. The landscape for provision is also complex and moves from prevention to treatment. As my right hon. Friend the Member for Exeter mentioned, people are living into old age with HIV—that is not entirely new, but it is a fairly recent development. We should celebrate the fact that people now live into old age with HIV, but it presents us and our health service with very complex challenges.
I too have met people living into their 70s and 80s with HIV, who, when they were first diagnosed pre-1996, were given just weeks to live. There is an additional challenge for such people, as hinted at by my right hon. Friend. Many of those people are not only vulnerable because of the comorbidities and complex health challenges that they may have, both physical and emotional, but many of them spent all of their money when they thought they had a very short time to live, so they are additionally vulnerable because of their financial position. That means those individuals need the holistic care that they deserve.
The hon. Member for Finchley and Golders Green spoke well about the split created by the Health and Social Care Act 2012. I have seen its direct impact on support for people living with HIV. Some people are failing to get the comprehensive care that they need. That is leading, first, to individuals with complex needs not getting the comprehensive care they need, and, secondly, to providers of comprehensive care not getting the funding they need to provide the services. That is causing a terrible ruction in the provider landscape for HIV. Specifically with regard to Brighton and Hove, I am referring to the Sussex Beacon—I shall talk more about that in case the Minister is not aware of its fantastic work.
First, it is important to describe the general health landscape in the city of Brighton and Hove, which is in crisis. We have a hospital, a clinical commissioning group and an ambulance trust in special measures, as well as patient transport services whose privatisation was botched, and which were then renationalised, all within six months. On top of it all seven GP surgeries have closed in the past 12 months. The service is comprehensively in crisis. However, there is one jewel in the crown—the Sussex Beacon, which was established as a hospice in 1992, to provide end-of-life care for people who were dying because of HIV and AIDS. It has flourished and evolved as the needs of the client group have changed and evolved over time. It is a remarkable organisation, providing preventive, outpatient and inpatient services, and more than 2,000 bed nights a year.
Last year the Care Quality Commission said that the Sussex Beacon is outstanding. It is one of the true beacons of health in the community, and I am proud that it exists to provide comprehensive, holistic and tailored care for individuals living with HIV. It is incredibly important to the community. Because of the split, however, no one agency is taking overall responsibility for funding the Sussex Beacon any more—not the local authority, and not any of the funding agencies designated to do so by central Government. As a result, its statutory funding has fallen by £400,000 a year. That funding gap is bringing an extraordinary organisation to its knees.
In Brighton and Hove politics there is a rainbow coalition. The three MPs are each from different parties, but last year we united in writing, along with the leader of the council, to the Health Secretary, to point out how extraordinary the work of the Sussex Beacon is, and what the dangers are. We pointed out what would happen if all its client group—people with extremely complex needs who were used to and are deserving of specialist care for the special challenges they face—were to be transferred from somewhere rated outstanding to somewhere in special measures, such as a hospital struggling to cope with the patients it has at the moment. Before the general election, the Health Secretary took time to come to Brighton and visit the Sussex Beacon for a photoshoot, as did the Prime Minister when she was Home Secretary on another occasion. Sadly, neither had time to respond to the letter about the dangers that the service will face in future. It was passed on to another agency in the Department of Health for a response.
Perhaps people felt that we were crying wolf, but we were not. The trustees of the Sussex Beacon have issued a warning that they will start to shut services from June this year unless the funding gap is closed. Staff have been put on notice of redundancy. We are in the last chance saloon for that fantastic organisation, which is celebrated beyond Brighton for the services it provides. I urge Ministers to consider the specific challenges it faces. The Minister will know what an achievement it is in today’s health environment to get an outstanding rating for something so complex, meeting such complex needs. Because of the nature of the debate, she will know that the people who use the services count on them in a heartfelt, emotional and dependent way. It is an extraordinary service and I urge her to look directly at the challenge and see what the Government can do. Once the service is lost it will be gone forever, and will not be coming back.
I labour the point for two reasons: because I am a Member of Parliament for the area that the Sussex Beacon serves and one of its patrons, but also because it speaks to the challenges that comprehensive providers face in an environment in which funding has become very specialised and very narrow. Comprehensive providers are struggling to find their feet in the new environment. What is happening to the Sussex Beacon is relevant to the broader challenges faced by the sector, in the broader health environment.
NHS Provision (Brighton and Hove)
Peter Kyle Excerpts(7 years, 6 months ago)
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Caroline Lucas (Brighton, Pavilion) (Green)
This debate is intended to highlight the ongoing NHS crisis affecting my constituency and the city of Brighton and Hove and to outline solutions to what is far more than a purely local problem. The concept of a publicly funded national health service is at risk, and the situation in Brighton and Hove reveals a whole host of systemic problems that stem in large part from the Health and Social Care Act 2012. Patients and staff are being let down in my constituency and elsewhere, and it is more than likely that the additional strain of the winter months will further exacerbate the crisis.
The picture I will paint of the situation in Brighton and Hove is deeply worrying. It encompasses our hospital, our GP provision, our ambulance services and our community care. Those services are held together by incredibly dedicated staff, who often work well beyond the hours for which they are paid to keep things going. I want to thank and pay tribute to each and every one of them. Despite their tireless efforts, however, the overall picture of health and social care in Brighton and Hove is chaotic, not because of a lack of hard-working staff, but mainly as a result of two things: harsh funding cuts and an increasingly fragmented structure based on marketisation and the increasing commercialisation and privatisation of our NHS.
I will provide a quick overview. Our local hospital, the Royal Sussex, is in special measures for both quality and finance. As of July, over 9,000 people had been waiting for more than 18 weeks to start treatment—the worst recorded among 185 providers and the 208 clinical commissioning groups that submit data nationally. Over 200 people have been on a waiting list for more than a year.
While I am talking about the hospital, let me quickly put on the record the fact that I am very grateful that we are soon to have a brand new building—we certainly need it. The hard-working staff in that hospital are operating in a building that stems from before Florence Nightingale; it is the oldest estate in the whole NHS. At the same time, it is undertaking increasingly complex work for the whole of Sussex as a major trauma centre for the wider region.
Peter Kyle (Hove) (Lab)
My neighbour mentions that we are constructing a new wing to the hospital and a bunch of other services locally. Does she agree that the fact that this is going to create an additional administrative burden and challenges for staff, including clinical staff, means we have to get this situation in Brighton and Hove right now, otherwise the additional burden could just be too much for the system locally?
Caroline Lucas
I am grateful to the hon. Gentleman, as he anticipates exactly what I am going to say. Of course we need new bricks and mortar, but we also need finances for the services inside them. We desperately need a central funding settlement that recognises the unique pressures on our hospital, so that the systems can be updated. For example, we need a computerised records system—this is not rocket science but we desperately need it. We need increased capacity, particularly for accident and emergency, because we are now serving a much wider region, as a result of being a central trauma centre. With debts currently of about £45 million, Brighton and Sussex University Hospitals NHS Trust is facing a situation that is simply unsustainable.
That is just one example, but there are plenty of other examples of what is going wrong in the health service in Brighton and Hove. Patients in the city have seen six GP practices close so far this year alone. When The Practice Group announced that it was walking away from its contract to run five surgeries in the city, the decision was largely a financial one. With almost 11,500 patients registered, the disruption and uncertainty was widely felt, and other nearby surgeries were simply expected somehow to manage increased patient numbers. NHS England was not required to step in to help because of the terms agreed with The Practice Group. The fact that this type of contract is no longer permissible was of little comfort to the patients forced to find a new GP with whom to register. I particularly recall the constituent who contacted me after a sixth surgery, Goodwood Court, was closed and who was unable to visit the emergency drop-in clinic at Brighton station for an urgent inhaler prescription because of a disability. That is just one individual, among many, who has experienced unnecessary, unhelpful anxiety and distress as a result of the Government’s NHS policies.
Our emergency ambulance service was placed in special measures on 29 September following a Care Quality Commission report that rated it as “inadequate”. The inspectors praised front-line staff, but identified unsafe levels of staffing, as well as poor procedures and leadership. The city’s mental health services, especially those serving children and young people, are overstretched and underfunded. Adult social care services in Brighton and Hove face ongoing cuts, despite the cost to individuals and the NHS. That means that over the next four years the city council is looking at potential cuts of £24 million and the complete privatisation of the remaining council adult social care, day centres, carers and so on.
I have lost track of the number of times that Ministers assert they are investing record amounts in the NHS, yet conveniently fail to mention the record amounts they are simultaneously cutting from local authority budgets that are supposed to cover essential care services for vulnerable people.
Caroline Lucas
I am sure that The Argus will be sad to see itself relegated to the seat behind me.
The subcontractor is a company called Docklands Medical Services Ltd. This is apparently a phoenix company for the aforementioned Docklands. As I understand it, the new company seems to be suggesting that it was acceptable for it to operate under the Care Quality Commission licence that was issued to its predecessor, the bankrupt Docklands. The application process for a licence is carefully designed to ensure that standards for vehicles and other safety checks and safeguards have been met. Just allowing a new successor or phoenix company to inherit a licence is setting the bar dangerously low, exposing patients and staff to unacceptable risks.
As a result of this debacle, our struggling hospital trust—yes, the one in financial special measures—has incurred £171,000 of private ambulance costs so far this year to plug the gap left by Coperforma and its subcontractors. To recoup this cost, the trust has, quite rightly, invoiced the clinical commissioning group, which appointed Coperforma. No doubt other trusts similarly affected will have done the same, with serious consequences for the CCGs’ budgets and, therefore, for the money available for other services. Whichever part of the Department of Health ends up footing the Coperforma bill, it represents an unforgivable waste of money and resources, and their diversion away from patient treatment and care.
I trust that the Minister will agree that patients in Brighton, Pavilion or anywhere else should not be paying the price for the failure of private companies that are profiting from NHS contracts. Will he therefore ensure that the CCG is not out of pocket in turn as a result of Coperforma’s mismanagement? I would also like his Department to stop passing the buck when it was his Government who passed the legislation that required services such as non-emergency patient transport to be put out to tender. It is unacceptable for no one in the Department of Health to know whether a fleet of 30 ambulances were properly licensed to transport Sussex patients for three months over the summer. When the Minister responds, will he tell us whether he agrees?
Peter Kyle
Is it not extraordinary that the contract was awarded in the first place? Coperforma and the whole underlying supply chain have underperformed and failed patients from the very first day that they took over the contract, and they continue to do so today. The service cannot be returned to where it was before, because the ambulance trust that it was taken from is also in special measures and now no longer has the capacity to take it over. Is not the lesson from this experience that if such a contract is outsourced, the Government must make sure that due diligence is done correctly so that patients do not suffer in this way?
Caroline Lucas
I am grateful to the hon. Gentleman for his contribution and I entirely agree. When I have talked to staff of the CCG, they have acknowledged that they are using an off-the-peg contract that is not suitable for such a service, and that there have therefore been problems in the system as well as with the company, which is not providing the service that people in our city deserve.
The Minister of State, Department of Health (Mr Philip Dunne)
I congratulate the hon. Member for Brighton, Pavilion (Caroline Lucas) not just on securing this debate but on doing so on a day that enabled her to get through her entire speech and take interventions from the hon. Member for Hove (Peter Kyle) and my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton)—a considerable achievement.
The hon. Lady has a long-standing interest in health outcomes for her constituents, as we all do in the House. I would like to join her at the outset by highlighting the excellent work carried out every day by all those who work in the NHS, not just in her constituency but equally in my own and across the country. Before addressing the specific points that she made, I should like to give the House an overview of the NHS in her constituency. Brighton and Hove clinical commissioning group covers a geographical area of approximately 34 square miles, with a patient population of some 300,000. It commissions a wide range of healthcare services including from the main local acute trust, Brighton and Sussex University Hospitals NHS Trust, with a regional teaching hospital working across two sites in Brighton and Haywards Heath. I understand that the trust treats over three quarters of a million patients every year, and it recognises its growing role as a developing academic centre.
The hon. Lady has asked, not for the first time, for more funding to improve services and facilities in Brighton. I am pleased that she recognised the capital investment of more than half a billion pounds that is under way at the Royal Sussex County Hospital, replacing some very old buildings, as she said, and supporting the service quality improvements planned by the trust. I was a bit disappointed that, in his intervention, which came around the time that she referred to that capital investment, the hon. Member for Hove did not acknowledge that that is a significant investment in the facilities at the heart of health provision in Brighton.
The Government created the Care Quality Commission to shine a light on good and bad healthcare up and down the country. Its independent inspection teams provide a vital function on behalf of patients and everyone in England in challenging how hospitals, GP surgeries, care homes and all other healthcare providers are delivering to the standards we should all expect.
The CQC has identified that the local NHS in the hon. Lady’s constituency faces some challenges. I acknowledge that the confluence of inspection reports—they have come at around the same time to several of the different providers and commissioners in her area—is an unusual challenge to correct for the benefit of local residents. In stark contrast, as my hon. Friend the Member for East Worthing and Shoreham said, next door, there is the outstanding-rated Western Sussex Hospitals NHS Foundation Trust, which serves residents of West Sussex. As she pointed out, Brighton and Sussex University Hospitals NHS Trust was rated inadequate earlier this year by the CQC. To support its recovery, NHS Improvement placed the trust into special measures.
Peter Kyle
I am grateful to the Minister for giving way so early in his speech. He mentions that there has been an unusual confluence of reports. I would suggest that the unusual thing is that each of the reports indicates extreme failure in many different parts of our health system in Brighton and Hove, from the ambulance trust and six GP surgeries, as was brilliantly outlined by the hon. Member for Brighton, Pavilion (Caroline Lucas), right through to the hospital trust—all in special measures, and the hospital in financial special measures. That is the unusual thing. I suggest that the health economy in Brighton and Hove is now bankrupt.
I suggest to the Minister that he does not do his thinking on his feet now, but would he consider arranging for his Department to appoint someone to our city who can take an overview of what is right and what is wrong in our city, of the funding and of the relationship between the different health bodies and the local authority? Let us bring together all the health systems, figure out what is wrong and how we can bring them together to solve all the problems. The fractures have got too much.
Mr Dunne
I will not take up the hon. Gentleman’s invitation to think on my feet, but I will refer later to the sustainability and transformation plan, to which the hon. Lady referred, which is providing a forum for much closer collaboration across the NHS within an area. Clearly, it is a much larger area than Brighton itself, but it is going some way towards meeting the kind of analysis that he is looking for. I will also touch on the individual trust support that is being offered by wider NHS groups to provide additional qualified medical and managerial support to help to solve the problems.
Mr Dunne
I thank the hon. Lady for her intervention. I am going to move on, but I acknowledge her point. I hope that, in part, the STP will focus the attention of the wider area to support the new trauma centre that is being established. That is part of the purpose of the STP, although, like her, I have yet to see the full details.
I think we all recognise that patients deserve the highest quality care and we expect the trust to take action to ensure the root causes of the CQC concerns are addressed. NHS Improvement has confirmed that the trust has developed a recovery plan and as part of a package of support for the trust for being in special measures, NHS Improvement has appointed an improvement director and a board adviser.
We should also acknowledge along with the trust’s challenges the fact that there are good things going on in Brighton. We should praise the team that delivers services for children at the Royal Alexandra children’s hospital in Brighton as the CQC rated them as outstanding for being innovative and well led.
Emergency care services at the trust are not as we would expect, as the hon. Member for Brighton, Pavilion identified. With support from the national emergency care improvement programme, a clinically led initiative that offers intensive practical help to trusts looking to improve their emergency services, NHS Improvement is working closely with local clinicians to make a difference for the people of Brighton and Hove seeking emergency care. The trust is also developing plans to create capacity to support delivery of the planned care standards.
As the hon. Lady said, on Monday of last week NHS Improvement announced that the trust has entered financial special measures, a programme launched by the regulator that provides a rapid turnaround package for trusts and foundation trusts that have either not agreed savings targets with local commissioners or planned to make savings but deviated significantly from this plan in their quarterly returns. As part of financial special measures, the trust will agree a recovery plan with NHS Improvement. The trust will also get support from and is held accountable by a financial improvement director.
The hon. Lady also referred to the challenges faced by the ambulance services in her constituency and the area. In addition, South East Coast ambulance service was recommended for special measures by the CQC in its inspection report published last month. NHS Improvement acknowledges that there are wide-ranging problems across the trust, including in governance structures and processes, culture, performance and emerging financial issues. NHS Improvement has agreed a support package for the trust, which was formalised on 9 August this year, and includes a formal peer support relationship with a neighbouring ambulance trust that is rated good by the CQC.
As part of the support package, NHS Improvement has also appointed an interim chair and will appoint an improvement director in due course.
Peter Kyle
For the second time, I am extremely grateful to the Minister for giving way. We focus the onus for improvement on the delivery bodies in the Brighton and Hove area. NHS Improvement and the CQC have been outlining plans and their responsibility is to instigate this improvement, but does he accept that NHS Improvement is also under scrutiny in how it unfolds this improvement programme and that if improvements do not happen fast enough it will also be culpable? Some of the dates for improvement have already passed without the improvements being made.
Mr Dunne
The hon. Gentleman will recognise that NHS Improvement only came together in April of this year when the two previous regulators, Monitor and the NHS Trust Development Authority, were combined. It is to a degree finding its feet in working out how best to assist trusts that get into difficulty. It has introduced a number of different schemes for different types of challenge, and we have touched on the care challenge and the financial special measures challenge. It is also undertaking a five-point A&E improvement plan to focus particularly on challenges in emergency care. It is fair to say that it is early days in seeing how NHS Improvement undertakes its functions, but we have every confidence that it will be able to assist trusts in dealing with these challenges.
Finally on the South East Coast ambulance service, NHS Improvement is also undertaking a capability and capacity review and will provide the trust with support with its finances. The hon. Lady mentioned the problems with the non-urgent patient transport service provider. This has clearly been a very difficult time for its staff and for some patients, as she has highlighted. My understanding is that the High Weald Lewes Havens CCG has overseen the implementation of plans to ensure continuity of service, and has recently appointed a specialist transport adviser to look into the resilience of the contract and to explore options to strengthen this further.
The provision of the services is, quite rightly, a matter for the local NHS. The hon. Lady asked who is responsible for monitoring contracts. The reality is that the CCG is the statutory NHS body with responsibility for the integrity of the procurement, as well as for managing the contract. It has powers within the standard NHS contract to intervene where a contractor’s performance falls below what is expected.
NHS Bursaries
Peter Kyle Excerpts(8 years ago)
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Ben Gummer
The hon. Lady is welcome to contribute to the consultation. She is doing so now, although sadly we heard no solutions or alternative proposals. I intend to set out not suggestions, but a clear announcement of our plans, the reasons for them, and how we will enact them over the year to come.
Peter Kyle (Hove) (Lab)
The Opposition have proffered many solutions to the Government. Just last week, we suggested a cross-party solution to the doctors crisis, but it was thrown back in our Front-Bench team’s face. Here is another solution: will the Minister speak to colleagues in the Department for Business, Innovation and Skills to see whether the apprenticeship levy, which the Government are taking from all large employers, could be spent on subsidising nurses to tackle the funding challenges?
Ben Gummer
The hon. Member for Ilford North (Wes Streeting), who has concerns about the proposals, has discussed the matter with me several times and offered some useful suggestions about the detail. I have accepted his points and incorporated them into our thinking. I am very willing to listen to people from across the House when they come with helpful suggestions, and I am sure that the Minister for Skills, my hon. Friend the Member for Grantham and Stamford (Nick Boles), would be interested in the hon. Gentleman’s contribution about the apprenticeship levy. The way not to do it, however, is to come to the House with a series of criticisms but not one suggestion, nor any money to provide for the increased number of training places in the plan.
We should make these changes not only for reasons of social equity, though that is the foremost reason; not only to produce 10,000 additional training places in our university system; and not only because we have a broken planning system, which otherwise would remain broken—even people as intelligent as the hon. Member for Lewisham East cannot predict how many nurses, doctors and allied health professionals we will need in 20 or 30 years, or the skills they will need. Even were it not for all those things, it would still be important to do this, because of the changes it will make to the quality of training we can provide to nursing graduates. Across the rest of undergraduate training, universities have been released to innovate and improve their courses. Satisfaction levels have gone up and drop-out rates have fallen; consequently, people are getting a better experience.
We have not, however, been able to spread those advantages to nurses, who, I am afraid, remain trapped in a system that is prescriptive and does not take account of the skills that they and their future employers will need. By releasing universities from their straitjacket, we can make significant improvements to the quality of the training they provide.
Junior Doctors Contracts
Peter Kyle Excerpts(8 years ago)
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Mr Hunt
My hon. Friend speaks very wisely and also from experience on these issues. He is right. I have tried to make the point in my statement that a seven-day NHS is not just about junior doctors—it is about the whole range of services; it is about consultants, diagnostic services, general practice. As we seek to move towards a seven-day NHS, we will also be expanding the NHS workforce to ensure that the current workforce does not bear all the strain by itself. This is an opportunity. We have had lots of comments today about morale. I simply say this: the way to improve morale for doctors is to enable them to give the safest possible care to patients. At the moment, much of the frustration from doctors is that they do not feel able to give the safe care they would want to. We want to change that and to work with the BMA to make that possible.
Peter Kyle (Hove) (Lab)
So far the Secretary of State has not grabbed the opportunity presented to him from across the House—I am talking about a cross-party solution—with both hands. If patients were at the centre of his thinking, he would have done so. He has told the House that he has not done so, because he read about it in The Times rather than getting a phone call. If the right hon. Member for North Norfolk (Norman Lamb) agrees to call his mobile and tell him anything that he wants to hear—whisper sweet nothings into his ear—will he agree to have the conversation and call off this strike?
Mr Hunt
I have to say that the right hon. Gentleman never whispered sweet nothings in my ear, and he certainly has not done so since being in opposition. With regard to doing what it takes, let me tell the hon. Gentleman directly that we have been trying to solve this problem for three years, with 75 meetings, 74 concessions and three independent processes. We have been doing everything we possibly can to solve this problem. What we have is a very intransigent and difficult junior doctors committee of the BMA, which has refused to negotiate sensibly. In that situation, the Health Secretary has a simple choice: to move forward or to give up. When it comes to patient safety, we are moving forward.