NHS Winter Crisis
Philip Dunne Excerpts(6 years, 4 months ago)
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Jonathan Ashworth (Leicester South) (Lab/Co-op)
(Urgent Question): To ask the Secretary of State for Health to update the House on the NHS winter crisis.
The Minister of State, Department of Health (Mr Philip Dunne)
I thank the hon. Gentleman for applying to ask the urgent question as I agree that it is helpful for colleagues in the House to be updated on the current performance of the NHS during this challenging time.
We all know that winter is the most difficult time of the year for the NHS, and I start by saying a heartfelt thank you to all staff across the health and care system who work tirelessly through the winter, routinely going above and beyond the call of duty to keep our patients safe. They give up their family celebrations over the holiday period to put the needs of patients first. Those dedicated people make the NHS truly great.
Winter places additional pressure on the NHS and this year is no exception. The NHS saw 59,000 patients every day within four hours in November. That is 2,800 more every day compared with the previous year. The figures for December will be published on Thursday. We have done more this year in preparing and planning earlier than ever before. That means that the NHS is better able to respond to pressure when it arises. In the words of Professor Sir Bruce Keogh, the national medical director:
“I think it’s the one”
winter
“that we’re best prepared for. Historically we begin preparing in July/August. This year we started preparing last winter. We have, I think, a good plan.”
Let me tell the House about some of the things that have been done differently this year. We further strengthened the NHS’s ability to respond to risk, and the NHS set up the clinically-led national emergency pressures panel to advise on measures to reduce the level of clinical system risk.
We are supporting hospital flow and discharge. We allocated £1 billion for social care this year, meaning that local authorities have funded more care packages. Delayed transfers of care have been reduced, freeing up 1,100 hospital beds by the onset of winter. Additional capacity has been made possible through the extra £337 million we invested at the Budget, helping 2,705 more acute beds to open since the end of November.
We have also ensured that more people have better access to GPs. We allocated £100 million to roll out GP streaming in A&E departments and I am pleased that 91% of hospitals with A&E departments had this in place by the end of November. For the first time, people could access GPs nationally for urgent appointments from 8 am to 8 pm, seven days a week, over the holiday period. In the week to new year’s eve, the number of 111 calls dealt with by a clinician more than doubled compared with the equivalent week last year, to 39.5%, thereby reducing additional pressures on A&E.
We extended our flu vaccination programme, already the most comprehensive in Europe, even further. Vaccination remains the best line of defence against flu and this year an estimated 1,175,000 more people have been vaccinated, including the highest ever uptake among healthcare workers, which had reached 59.3% by the end of November.
We all accept that winter is challenging for health services, not just in this country but worldwide. The preparations made by the NHS are among the most comprehensive, and we are lucky to be able to depend on the extraordinary dedication of frontline staff at this highly challenging time.
Mr Speaker
Order. For a moment I thought that the Minister intended to treat this as though it were an oral statement, to judge by the length. I think it is fair and correct for those following our proceedings to point out that this is not an oral statement offered by the Government: it is a response to an urgent question applied for to, and granted by, me.
Jonathan Ashworth
It is always a delight to see the Minister, but the Secretary of State for Health should be here to defend his handling of the crisis, not pleading for a promotion in Downing Street as we speak.
I join the Minister in paying tribute to all those NHS staff working flat out. Many of them have said that this winter crisis was entirely predictable and preventable. When you starve the NHS of resources, when you cut beds by 15,000, when you cut district nurses, when walk-in centres are closed, when we have vacancies for 40,000 nurses, when you fragment the NHS at a local level and drive privatisation and when social care is savaged, is it any surprise that we have a winter crisis of this severity?
More than 75,000 patients, including many elderly and frail, were stuck in the back of ambulances for over 30 minutes in the winter cold this December and January. A&Es were so logjammed that they were forced to turn away patients 150 times. In the week before new year’s eve, 22 trusts were completely full for up to five days. The blanket cancellation of elective operations means that people will wait longer in pain, distress and discomfort. Children’s wards have been handed over to the treatment of adults. Of course, we do not know the full scale of the crisis, because NHS England refuses to publish the operational pressures escalation levels alerts revealing hospital pressures. Given Ministers’ keenness on duty of candour, why are OPEL alerts data not being collected and published nationally for England?
The Minister mentioned the winter pressures funding, but that money was announced in the Budget on 22 November. Why were trusts not informed of allocations until a month later? That is not planning for the winter: it is more like a wing and prayer. He will know that cancelling elective operations has an impact on hospital finances. What assessment has he made of the anticipated loss of revenue for trusts from cancelling electives? Will he compensate hospitals for that loss of revenue, or should we expect deficits to worsen? Can he tell us when those cancelled operations will be rescheduled?
The Prime Minister defends this crisis by saying nothing is perfect. Patients do not want perfection: they just want an NHS which is properly funded and properly staffed without the indignity of 560,000 people waiting on trolleys in the last year, in which operations are not cancelled on this scale, and in which ambulances are not backed up outside overcrowded hospitals. Patients do not just need a change of Ministers today: they need a change of Government.
Mr Dunne
I am glad that the hon. Gentleman mentioned the Secretary of State. I want to put on record my tribute to my right hon. Friend, who has served in that position for almost as long as Aneurin Bevan, who was the first Secretary of State for the NHS.
I am delighted to be here to respond to the hon. Gentleman, who, as usual, listed a cacophony of allegations, very few of which are directly related to the challenges that our hospitals face today—the increase in demand and pressure on our NHS as a result of a combination of the increase in population and challenges posed by demographics, as well as the weather and the presence of flu in many parts of the country, adding to the pressure on staff at this time of the year.
The hon. Gentleman asked several questions. On the funding issue, he is well aware that the £337 million announced in the Budget was allocated in December. His own local trust, which includes the Leicester Royal Infirmary, received £4.2 million. It is a great shame that he chose not to welcome that extra money for his local trust. The money announced in the Budget has been allocated, but we have kept £50 million in reserve to allocate this month if particular pressures that become apparent during the course of the month need addressing.
The hon. Gentleman asked about the impact of the cancelled operations. We do not know that operations are cancelled. There have been a few thus far; procedures and treatments are being deferred. It will not become apparent until after this period has finished how many actually do end up being cancelled, so it is not possible to calculate the financial impact on any of the trusts where deferral is taking place.
The hon. Gentleman referred to the situation as unprecedented. I gently remind him that we have a winter crisis of some kind or another every year. He will have been in Downing Street in 2009-10, when, as it happens, the then Conservative shadow Health Secretary chose not to try to take advantage of the near flu pandemic at the time because he recognised that there were operational pressures on the NHS and it was not down to him to score party political points. The hon. Gentleman has unfortunately chosen to do that. At that time, tens of thousands of elective procedures were cancelled to provide capacity to cope with the emergency at the front doors of our hospitals. So this is a routine way to deal with pressure coming through hospital front doors.
What distinguishes this year from previous years is that in the past elective procedures were cancelled within hours of operations being due to take place. Sometimes it was the day before and sometimes it was on the day. That caused patients considerable distress and gave rise to considerable problems for staff. We have set up the national emergency pressures panel to anticipate problems when we see the signals, and we can then give notice to patients that their procedures are going to be deferred. That is a much more humane and sensible way to do things and it provides much more opportunity for hospitals to cope with the pressures that are coming through the door.
Mr Kenneth Clarke (Rushcliffe) (Con)
NHS acute services have never been better and are among the best in the world. As the Minister just said, every year we have this slightly ritual exchange about winter pressures, but does he accept that the problems are changing because of the increased number of elderly people in the population and the increased urgency of the need to solve the problem of how to admit them promptly to the right part of the service and then discharge them properly and safely as soon as they are recovered? Will he advertise further to the many people who are not aware of it the availability of emergency GP services? Will he concentrate on the reform and integration of the community care system, the social care system and the primary care services and make sure that co-operation among them is steadily improved so that they can cope better in future years, because this problem is undoubtedly going to develop?
Mr Dunne
I am grateful to my right hon. and learned Friend for making those points. He brings to the House considerable experience of what it is like to be responsible for the NHS. He is absolutely right: the number of over-80s who are presenting to hospital A&Es is going up exponentially each year. Hospitals need to adapt the way that they treat such patients to try to keep them as healthy as possible so that they can live independently for as long as possible. That is why many hospitals are now introducing frail elderly units close to or at the front door of A&E departments so that they can turn around patients and avoid admissions. My right hon. and learned Friend is also right to point to the increasing integration between the NHS and social care that is necessary to encourage more people to live independently out of hospital and leave emergency departments for those people who are urgently ill.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I, too, pay tribute to staff across all four health services, where the normal pressures have been added to this winter by freezing weather and influenza. Scotland still leads in A&E performance across the UK, but we do not need to see four-hour data to understand the stress that NHS England is under. Thousands of patients have been held in ambulances for more than an hour outside A&E before they can even get in, which means that ambulances could not respond to other urgent calls, and that has obviously put other patients in danger. We have heard about patients being held in corridors for hours at a time, causing not just suffering and danger to patients, but enormous stress to those staff to whom we are paying tribute.
The Minister talks about the elderly population. We need to have beds for that population. England has halved its number of beds in the past 30 years, and now has only 2.4 beds per 1,000 population, compared with four in Scotland. Will he and the Secretary of State make sure that there are no further cuts in the sustainability and transformation reorganisation, and will they look at how they replace the money that has been cut from social care so that when elderly patients are ready to go home they can do so and free a bed for someone else?
Mr Dunne
As I have already said, the social care funding has gone up very significantly this year, and there is a second billion pounds to go into social care over the next two years. The hon. Lady is right to point to Scotland having a slightly better A&E performance than England, and the two countries are far better in performance terms than any other country that we regularly monitor, but she has to be a little careful when she talks about how Scotland is performing so much better. She talked about waits. It is the case that the over-12-hour trolley waits in England for November were half the rate of over-12-hour trolley waits in Scotland. We are providing information, and we are increasingly trying to be more transparent about the impact of winter on our health service in England. I strongly encourage her to take back to her colleagues in the Scottish Government the amount of data that is being published in England and to see whether they can try to match it.
Dr Sarah Wollaston (Totnes) (Con)
I join the Minister in thanking NHS staff and in commenting that there is nothing new about winter pressures in the NHS. What is different is that they are extending now into traditionally quieter months, and that the depth of those pressures is so much more profound over the current winter, because there has been a failure over successive Governments to plan sufficiently for the scale of the increased demand across both health and social care. Will the Minister think about the forthcoming Green Paper for social care and think about combining it with health, so that we can see this as a truly across-system approach? I would also like to reiterate the points made by the hon. Member for Central Ayrshire (Dr Whitford) about the role of bed-occupancy levels. Can the Minister tell us what the current bed-occupancy levels are in the NHS in England?
Mr Dunne
On the last point, I can confirm to my hon. Friend that, at Christmas eve, the bed occupancy rate was 84.2%, below the target of 85% that we set going into this particular winter period. Of course the rate fluctuates daily and I do not have the figures for the most recent days. We did at least start this holiday period in that position, which is a great tribute to the work done in preparing for winter. I wish to reiterate to her, as I did to my right hon. and learned Friend, the importance of the integration work being done through the sustainability and transformation partnership process between NHS organisations and social care providers. It is part of the solution for the longer-term arrangements that we need to put in place to try to make sure that people who are living longer live better, more healthily and in a more independent way out of hospital.
Mr Ben Bradshaw (Exeter) (Lab)
Where does the postponement of tens of thousands of operations leave the promise made by the Health Secretary to the Select Committee, the last time he appeared before us, that he would begin to reverse the very bad deterioration in routine waiting times for operations that we have seen in the past seven years?
Mr Dunne
Many areas of the country are doing very well with their waiting times. There are some—this tends to be concentrated in a relatively small number of trusts—where the referral to treatment targets are not being met, and need to be met. Part of the funding settlement achieved in the Budget in November is designed to bring down waiting time targets, to get more people treated within an 18-week period. That will clearly exacerbate the problem during this immediate period in which procedures are being deferred, but we hope that it will not last long.
Sir Desmond Swayne (New Forest West) (Con)
Notwithstanding the increased funding for social care, does not the principal constraint remain the inability to discharge patients?
Mr Dunne
As I said in my initial response to the question, it is very important that we improve patient flow through hospitals. One of the critical features that enables this is ensuring that patients can be discharged when they are medically fit. We have put a huge amount of effort into this during the past nine months or so. I am pleased to say that some progress is being made, but we absolutely need to focus on this area. Again, there is huge variability between systems across the country. Some have virtually no delayed transfers of care, but the numbers of DToCs in other areas are much too high. We need to learn from the areas that are doing it right and introduce that in areas that are not.
Sir Vince Cable (Twickenham) (LD)
To progress beyond the tribal arguments about funding, what is the Government’s response to the 90 MPs from both sides of the House who have urged the Government to establish a cross-party consensus to agree a funding formula for integrated health and social care?
Mr Dunne
As the Secretary of State and the Prime Minister have said, we are always interested to hear ideas for improving the health service. At the moment, we have confidence in the five year forward view; that is the route that we are taking to bring the health service forwards and make it completely fit for the future. If the right hon. Gentleman has specific points that he would like to make, I am always ready to listen.
Helen Whately (Faversham and Mid Kent) (Con)
It has been an extraordinarily difficult winter for hospitals serving my constituents in Kent. May I, too, thank NHS staff for the efforts that they have made to provide the best possible care? I welcome the extra money from the Government that has helped to open extra beds out of hospitals and to employ extra staff, particularly GPs and A&E staff. Will the Minister looks carefully at future capital funding bids and at Kent’s proposal for a medical school, so that we are better prepared for future winters and have the buildings and staff that we need?
Mr Dunne
My hon. Friend is a consistent champion of efforts to improve health facilities in her constituency. I am acutely aware of the challenge of medical training places in Canterbury, which was one of the reasons that we met last year to discuss what could be done to encourage medical students to come to Kent. I am not able to give her any specific guidance on the allocation of new medical training places because that recommendation will be coming to me over the next few months from Health Education England. We look forward to making decisions on that, and I specifically included in the criteria that rural and coastal areas should have good representation.
Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)
The Minister will have seen the images of patients at Mid Yorkshire Hospitals NHS Trust sleeping on the floor because they could not even get a trolley, never mind a bed. We have had over 95% bed occupancy rates and a shortfall of over 200 nursing vacancies, and we will have a multimillion-pound budget shortfall by the end of this year. The Health Secretary and the Prime Minister have been repeatedly warned about this by nurses and doctors at Mid Yorkshire trust and across the country, by the public and by the NHS chief executive, yet they still decided to deny him the funding he needed at the Budget. How many more patients will have to sleep on the floor before this Government act?
Mr Dunne
I cannot comment on what the right hon. Lady says happened in her hospital regarding individual patients. I acknowledge that there has clearly been a lot of pressure on space for beds, which is in large part down to a multiplicity of factors including the high bed occupancy to cope with the high admission rate. I say gently to the right hon. Lady that her area has received £3.3 million to help to cope with winter pressures; that is not an insignificant amount. As to nursing vacancies, we absolutely recognise that we need to increase the number of nurses in this country, which is why we announced last October a 25% increase in nurses in training. That will start to take effect from next September. In addition, we have introduced the new alternative route into nursing of the nursing associate role, and we expect several thousand of those to start shortly.
Several hon. Members rose—
Mr Peter Bone (Wellingborough) (Con)
Does the Minister agree that the social care system is broken and that the leader of the Liberal Democrats is right that we are not going to solve the problem unless we all work together?
Mr Dunne
I do not think my hon. Friend will be surprised if I say no, I do not agree that the system is broken. I do accept that it requires more funding, and that is why more funding was provided. It also requires local authorities to work more closely alongside the NHS to try to share these problems and find solutions together.
Liz Kendall (Leicester West) (Lab)
The Minister said earlier that he did not know how many operations had been cancelled—maybe a few. Let me tell him that in one week alone 300 operations were cancelled in Leicester. I find myself unusually agreeing with the hon. Member for Wellingborough (Mr Bone)—social care is broken. Will the new Cabinet Office Minister be leading on the social care Green Paper, as the previous one did, and if not him, who?
Mr Dunne
I am glad that the hon. Lady has referred to the social care Green Paper, because that will be published this year, providing an opportunity for all Members to participate in it. It does not sit within my set of responsibilities, so I will come back to the hon. Lady on exactly who will be leading on it.
Maggie Throup (Erewash) (Con)
My constituents can access Derby and Nottingham hospitals. The two trusts have been allocated an extra almost £7 million for winter preparedness. Will the Minister reassure me and my constituents that there will be a full analysis of how that extra money is spent, so that we can learn lessons to make sure that we build on good practices for next year?
Bambos Charalambous (Enfield, Southgate) (Lab)
Is the Minister aware that on six of the seven days after Boxing day, all of north Middlesex hospitals’ general and acute beds were occupied? Does he agree that this state of affairs is totally unacceptable, that more investment is needed in our emergency health services and that much better planning is required for any future winter crisis?
Mr Dunne
I confirmed to the House at the beginning of my remarks that we believe that planning is essential. We started planning for this winter at the end of last winter, and I expect that we will continue to do so for the coming winter. As for what happens in individual hospitals with the individual pressures that they have, it is down to the local NHS leaders and clinicians to determine what capacity they need, and they need to plan for that, too.
Kelly Tolhurst (Rochester and Strood) (Con)
In Medway, we have seen great pressures in the system over the past few weeks. We have seen advance planning at Medway Maritime Hospital and extra funding going into the clinical commissioning group. Does my hon. Friend agree that the staff at the hospital have done an outstanding job so soon after coming out of special measures and that it is important that we should hold the CCG to account on where this money is spent?
Mr Dunne
I visited the Medway hospital when it was still in special measures and saw the pressures with the configuration of the A&E and the challenges that that posed to good patient flow. I am pleased that significant investment has already gone into Medway to try to resolve some of those physical characteristics. I absolutely agree that we should praise the staff of the hospital for the work that they have done in turning it around so well.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
Three months ago at the Health Committee, Jim Mackey, the head of NHS Improvement, told us that
“we are running tighter than any of us would really want to and we have not had the impact from the social care investment…that we had hoped for; so, it will be difficult—it will be very tight—over winter.”
The Government knew that this crisis was coming, and the social care investment to which the Minister has referred this afternoon has not been enough. Why have this Government not acted?
David Tredinnick (Bosworth) (Con)
Will the Minister congratulate the doctors and healthcare workers of Leicestershire on their excellent work over Christmas but recognise that the problems of A&E are not just about the supply of services, but about trying to reduce demand through triage, the involvement of the 111 service at A&Es and dealing with drunks who are abusing the old doctrine of a service free at the point of delivery?
Mr Dunne
I am very pleased to respond to my hon. Friend on a subject that is not always at the forefront of his mind. He is absolutely right to highlight the abuse of the health service by certain people—revellers—who turn up at hospitals in an unfit state to be treated. In some places, we have introduced holding areas to ensure that they do not disrupt the work of the hospital.
Norman Lamb (North Norfolk) (LD)
The Minister will be aware that the tragic case of the elderly lady who lost her life while waiting four hours for an ambulance is not an isolated one: there are constant failures of care across the country every day of the week. If he recognises that this is completely intolerable, will he not respond to the 90 MPs from across this House who have demanded that the Government get a grip and work, on a cross-party basis, to come up with a long-term solution?
Mr Dunne
I am always interested in what the former Health Minister has to say on these subjects, because he speaks with considerable authority. On ambulances, it is obviously unacceptable for there to be delays of that nature and leading to that kind of outcome, and we absolutely need to ensure that all trusts, when these incidents occur, look very carefully at trying to prevent them from occurring again. We have now—in part, in response to the pressures that the ambulance service has been under—set up a national ambulance control centre to try to help co-ordinate ambulance responses where services are not meeting the targets in certain parts of the country or our requirements in individual hospitals.
Andrew Selous (South West Bedfordshire) (Con)
It was back in 1994 that Germany got an integrated system of health and social care, with dedicated funding to pay for it. Will the Minister commit to moving forward, both at pace and at scale, with the sustainability and transformation partnerships, which are our answer to this problem?
Tracy Brabin (Batley and Spen) (Lab/Co-op)
May I press the Minister a little bit further on the photographs, which were taken by a constituent of mine, of people sleeping on the floor? These poorly people had been waiting on chairs for hours and had not been given a bed or a trolley. What I did not hear in his response was an apology. Is it not now time for the Minister to apologise to those affected?
Mr Dunne
The hon. Lady will have heard last week the apology from the Secretary of State to patients having operations postponed, and I am absolutely prepared to apologise today to patients who are not able to be treated as quickly as we would all like them to be treated. There are seats available in most hospitals, where beds are not available. I cannot comment on what happened in her individual case, but I agree with her that it is not acceptable.
Amanda Milling (Cannock Chase) (Con)
I pay tribute to all the staff who work at Cannock Chase Hospital. A key advantage of this hospital is that it does not deal with medical emergencies, so no elective operations have been cancelled. Does my hon. Friend agree that this clearly demonstrates the real value of Cannock Chase Hospital to local patients?
Mr Dunne
I absolutely agree with my hon. Friend that improving out-of-hospital capacity in our communities is vital. That includes capacity in medical centres and community hospital settings wherever they are outside the acute hospitals, which are inevitably under the most pressure at this time.
Mike Hill (Hartlepool) (Lab)
Constituents of mine recently waited several hours for an ambulance, owing to the North East Ambulance Service running at a high state of alert. What are the Government doing about the crisis in the ambulance service?
Mr Dunne
This financial year we have introduced the new ambulance response programme precisely in order to try to direct category 1 calls more rapidly, with conveyance by ambulance for those people who need it most. It is in the early stages of introduction in many areas, and we have yet to be able to analyse its impact. If my hon. Friend would like to write to me about the specific case he mentions, I would be happy to look into it for him.
Rachel Maclean (Redditch) (Con)
May I thank all the staff at the Alex Hospital in Redditch for doing an amazing job this winter? The hospital and the trust have been in special measures. I thank the Minister for his interest in my hospital and for the additional Government funding to address winter pressures. It is making a difference, with encouraging early signs in the elderly and frail unit in particular.
Mr Dunne
I congratulate my hon. Friend on her campaigning role in holding the Government to account for delivering on the capital injection of £29 million that we promised to the Worcestershire trust, of which the Alex is a key part. I reiterate to her that she should not rest until it has the money.
Mr Pat McFadden (Wolverhampton South East) (Lab)
The cancellation of thousands of elective surgery appointments simply shows that the Tories are doing what they have always done, which is forcing people to wait longer for their operations and rationing healthcare in that way. How will the Minister deal with the backlog that will be created in future months because of all the operations that have been put off?
Mr Dunne
I have to say that I am disappointed with the right hon. Gentleman. He was a Minister in the previous Labour Government, and in each quarter for which I have the figures, which go back to 2000, between 10,000 and 20-something thousand procedures were deferred or cancelled. This problem has affected this country’s health service every year, going back to the beginning of recorded data.
Robert Halfon (Harlow) (Con)
My hon. Friend will be aware that Harlow’s Princess Alexandra Hospital has among the highest rates of A&E use in England. That has been exacerbated by the winter crisis, which has caused significant pressures on the ambulance services, resulting in a constituent having to wait 10 hours for an ambulance over Christmas. Will my hon. Friend redouble his efforts to do everything possible to have a new hospital in Harlow, to help us with the infrastructure and ensure that Harlow has a hospital that is fit for purpose for the 21st century?
Mr Dunne
My right hon. Friend is another consistent campaigner in favour of improving the infrastructure and estate of his hospital. He has invited me to visit; I have seen it and I am well aware that the hospital trust has put in an application for a significant rebuild, which will be considered in the allocation of the next phase of sustainability and transformation plan funding.
Diana Johnson (Kingston upon Hull North) (Lab)
Up to 31 December, more than 400 patients had to wait an hour outside the A&E at Hull Royal Infirmary, and a further 1,000 had to wait half an hour. Has the time not come for the Minister to accept that the NHS does not have enough beds and to reverse the policy of cutting beds, which has happened under successive Governments? This Government need to take action now.
Mr Dunne
I indicated in my opening remarks that this Government have taken action. We have freed up the number of beds available through the DToC procedure, with an increase of 1,100 in the run-up to winter. We have also, as a result of the extra money we have been given, including the several million pounds given to the hon. Lady’s area, provided an additional 2,700 winter beds. The procedure for future bed closures has been made very clear by NHS England: it will not happen unless acceptable alternative community provision is available in the area.
Gillian Keegan (Chichester) (Con)
Western Sussex Hospitals NHS Foundation Trust, which runs St Richard’s Hospital in Chichester, provided excellent care over the Christmas period, despite a 9% increase in the number of patients since last Christmas. Does my hon. Friend agree that that is a tribute to excellent leadership, brilliant staff and innovative planning with other local community services to improve processes and anticipate this annual need?
Dr Paul Williams (Stockton South) (Lab)
I worked as a doctor on the NHS frontline last week. I saw elderly patients who would have been better off being looked after at home by community and social care, and people waiting far too long for ambulances. Cancelling non-urgent work just makes more patients suffer. What does the Minister say to the woman with Crohn’s disease who is in pain and has terrible symptoms now that the bowel operation for which she has already been waiting for six months has been delayed again? The only way she will get the operation now is if things get even worse and she becomes an emergency case.
Mr Dunne
I put on the record my appreciation of the hon. Gentleman’s role not only on the Health Committee but in undertaking shifts, as he mentioned. On deferred procedures, we have given very clear instructions that time-critical operations should not be cancelled—cancer operations should not be cancelled. Ultimately, it comes down to the clinical decisions that are made at each hospital about who they should treat and who they believe can wait.
John Stevenson (Carlisle) (Con)
Clearly there is pressure on the NHS, including on the Cumberland Infirmary in Carlisle. However, does the Minister agree that we must not lose sight of the positives, such as the £1.8 million investment in cancer equipment that has just gone into the hospital and the proposed £38 million investment in a proposed cancer unit, all of which are in the long-term interests of healthcare in Carlisle and Cumbria?
Mr Dunne
Cumbria is one of the parts of the country that has had persistent challenges in the delivery of healthcare. I am pleased that decisions have been taken over the past year or so, including those about investing in improving cancer facilities in Carlisle that my hon. Friend referred to, which we hope will address long-standing issues that have not been addressed under successive Governments.
Paula Sherriff (Dewsbury) (Lab)
Despite the best efforts of NHS staff, patients in my area routinely waited over 12 hours just to be seen at hospital. We have heard from my hon. Friends about patients having to sleep on the floor. Will the Minister therefore take this opportunity to say that he will halt all further downgrades and closures of services in my area at Huddersfield Royal Infirmary and Dewsbury and District Hospital until a full assessment of capacity has been undertaken?
Mr Dunne
A significant amount of funding—some £3.4 million—was made available to the hon. Lady’s area. Reconfiguration proposals are being driven by the STP process. It is down to local authority leaders and local NHS leaders and clinicians to determine what is the best configuration of services in their area.
John Howell (Henley) (Con)
In Oxfordshire, considerable effort is being put into growing home-based health and social care systems. Does the Minister accept that that will solve the problem of delayed discharges of care by preventing them in the first place?
Mr Dunne
I agree that prevention is an important part of the long-term solution to improve healthcare outcomes for the population. I believe we are on the cusp of some significant technological advances that will allow more treatment to take place at home and more diagnostic tests to be taken without the necessity of attending acute facilities. Oxfordshire is a good leader in that.
Ms Karen Buck (Westminster North) (Lab)
Of 106 emergency beds at St Mary’s in Paddington, 105 were in continuous occupation over Christmas. Not long ago, a ceiling collapsed in a ward in that hospital. It is coping with a £500 million maintenance backlog—the biggest by far in the country. Will the Minister meet me to discuss how St Mary’s Hospital will be assisted to cope with funding a maintenance backlog that, if things went wrong at the time of these pressures, would cause an absolute calamity?
Simon Hoare (North Dorset) (Con)
As my hon. Friend and his colleagues continue to wrestle with the conundrum of the merging of social care and healthcare, I urge him to keep at the front of his mind in his discussions with healthcare providers the importance of beds in community, district and cottage hospitals in providing a segue between acute settings and returning home.
Mr Dunne
My hon. Friend is a lively champion of the community hospitals in his area, which I know provide an important service, but I am afraid that I must again refer to the STP proposals and say that it is for local clinicians and health and local authority leaders to decide what is best in their area.
Mr Speaker
The hon. Member for North Dorset (Simon Hoare) should be doubly gratified to be acknowledged not merely as champion of the said hospitals but as a lively champion at that.
Lilian Greenwood (Nottingham South) (Lab)
Nottingham University Hospitals NHS Trust and the East Midlands Ambulance Service have both declared the highest level of alert in recent days. Despite the heroic efforts of NHS staff, emergency patients’ care, safety and dignity have been put at risk, and of course other patients have had their operations cancelled. Does this not confirm that the Government’s preparations and resourcing were too little and too late?
Huw Merriman (Bexhill and Battle) (Con)
Our fine GP surgeries around the country are facing the challenge of their neighbouring practices not being as well run, while many practitioners are choosing to retire because of our pension rules. Is it now time for the state to step in and provide practice where the private area will not cover?
Liz McInnes (Heywood and Middleton) (Lab)
Pennine Acute Hospitals NHS Trust, which serves my constituency, has advised the public to attend A&E for serious or life-threatening conditions only and the rest to visit the local pharmacist or call 111. What immediate help will the Minister give to community pharmacies and the 111 helpline to help them to cope with the increased demand?
Mr Dunne
The hon. Lady is absolutely right to point to the increased demand channelled in part through very local facilities such as pharmacies and NHS 111. The latter has seen a 21.5% increase in the volume of calls in the last month, but, despite that, has had nearly a doubling, compared with a year ago, of the number of calls dealt with by a clinician—just under 40%—which is very impressive.
Andrew Bridgen (North West Leicestershire) (Con)
On my behalf and that, I hope, of the hon. Member for Leicester South (Jonathan Ashworth), may I welcome the £4.2 million of additional winter funding for the University Hospitals of Leicester NHS Trust? To remind the Labour party what an NHS crisis really is, will my hon. Friend tell the House who was in charge at the time of the Mid Staffs crisis—
Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)
Royal Stoke University Hospital in my constituency faces a double whammy during this winter crisis: an estimated net cost of £8 million even with the Government’s investment of this period and the loss of income as a result of the cancelation of elective surgery where income has been put to one side. How does the Minister expect the Royal Stoke and the University Hospitals of North Midlands NHS Trust to meet that cost? Given that CCGs will now have a windfall because of cancelled operations, how will he make sure that that money is reinvested in community and acute services?
Mr Dunne
As I said earlier, it is our intent to review what has happened in relation to deferred procedures this month and over the winter, and we are monitoring that on a weekly basis. We will also keep under close review what happens with individual trusts as a result of the imbalance between income and expenditure.
Philip Davies (Shipley) (Con)
The Minister is a very good man and an excellent Minister, in my opinion, but what does it say about the priorities of the Government when they are allowing so many operations to be cancelled over the next few weeks, while also pouring more and more money every year into overseas aid? I say to the Government through the Minister that people are now angry about this in the country. Billions of pounds every year are being spent on overseas aid when it is so clearly needed by vulnerable people at home in the UK. Will the Government get a grip on this? They will be massively out of touch with public opinion if they do not.
Mr Dunne
Let me gently say to my hon. Friend, who is also an important champion of the hospital in his area—we had a meeting before Christmas to talk about allocating medical places—that deferred procedures have happened at the rate of tens of thousands a quarter for very many years. What we have done differently this time is give notice to patients and hospitals that they should rearrange their schedules weeks rather than hours or days in advance.
Mr Dennis Skinner (Bolsover) (Lab)
During this winter crisis, has the Minister ever stopped to think what a barmy idea it was to allow the clinical commissioning groups to close, or threaten to close, a number of community hospitals in all parts of Britain, including Bolsover and several others in Derbyshire? Will he now get to that Dispatch Box and reverse that barmy decision?
Several hon. Members rose—
Employment, Social Policy, Health and Consumer Affairs (Health) Council
Philip Dunne Excerpts(6 years, 4 months ago)
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The Minister of State, Department of Health (Mr Philip Dunne)
My hon. Friend the Parliamentary Under-Secretary of State for Health (Lord O’Shaughnessy) has made the following statement:
The Employment, Social Policy, Health and Consumer Affairs (Health) Council met on 8 December 2017 in Brussels. The UK was represented at the Health Council by Lord O’Shaughnessy, Parliamentary Under-Secretary of State for Health.
There were three main agenda items; the draft Council conclusions on health in digital society; the draft Council conclusions on the cross border aspects in alcohol policy; and pharmaceutical policy in the EU. There were a number of ‘any other business’ items.
The Council conclusions on both digital health and tackling the harmful use of alcohol were formally agreed and adopted at the Ministerial Health Council. On digital health the Commission welcomed the rapid implementation of the EU’s e-health infrastructure and clear public support for the sharing of health data. On cross border aspects of alcohol policy, the Commission highlighted their commitment to supporting member states’ efforts in tackling the harmful use of alcohol, acknowledging most powers are held at national level but emphasising commitment to deal with issues in a proportionate manner at EU level. The presidency and Commission acknowledged the recent ruling on Scotland’s minimum unit pricing policy and the UK Government stated they would closely watch implementation in Scotland and keep the policy in England under review. The UK welcomed the presidency’s work on alcohol policy, which needed to respect differences between circumstances in member states.
Under the ‘pharmaceutical policy in the EU’ agenda item, the Commission provided an update on current work including an evaluation of pharmaceutical incentives and proposals planned for 2018 on Health Technology Assessment (HTA). A number of member states outlined problems resulting in medicines shortages and the high prices of pharmaceuticals. The Netherlands and Belgium both outlined the benefits of the current BeNeLuxA initiative where member states could opt to work together on pharmaceutical pricing or on joint horizon scanning work.
As part of the AOBs, the UK thanked the Estonians for hosting the event in Brussels on AMR attended by Dame Sally Davies, UK Chief Medical Officer. Belgium spoke about medicinal products including Valproate and risks for pregnant women and whether pictograms should be used. There were also brief discussions on the state of health in the EU, the annual growth survey 2018, and the steering group on health promotion, disease prevention and management of non-communicable diseases.
Finally, Bulgaria outlined their priorities for their upcoming presidency in the area of health including healthy eating particularly for children and tackling challenges in pharmaceutical policy such as medicine shortages.
[HCWS393]
Oral Answers to Questions
Philip Dunne Excerpts(6 years, 4 months ago)
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Sir David Amess (Southend West) (Con)
The Minister of State, Department of Health (Mr Philip Dunne)
The autumn Budget committed to backing the NHS, so that by 2019-20, it will have received an additional £2.8 billion of revenue funding for frontline services, including £337 million for winter allocated last Friday and £3.5 billion of new capital investment by 2022-23 to transform the estate.
David Morris
I welcome the recent Budget announcement of billions more funding for the NHS, particularly the extra support to prepare for the winter. Will the Minister tell me what share of funding my local hospital will attain this winter?
Mr Dunne
My hon. Friend needs to be congratulated in this House on being a champion of the University Hospitals of Morecambe Bay NHS Foundation Trust. The trust has been through some difficulty, and he has stuck with it and supported it. I can confirm that the trust was allocated up to £2 million of funding last Friday; I congratulate it on that. I am sure that he would also join me in congratulating the trust on recently being awarded the title of the eighth most inclusive employer in the UK.
Sir David Amess
Does my hon. Friend share my delight at the £41 million capital allocation that was announced in the recent Budget? Does he agree that that huge sum will enable us not only to maintain the present excellent services at Southend hospital, but to enhance and develop them further for the benefit of all local residents?
Mr Dunne
My hon. Friend has worked tirelessly with his neighbouring colleagues in Essex to secure not only the £41 million to which he refers. In fact, that figure is a component of the £118 million capital allocation made to the Mid and South Essex Sustainability and Transformation Partnership area in the Budget. This will provide significant investment not only in his local hospital in Southend, as he as mentioned, but in Basildon and in Broomfield Hospital in Chelmsford. I am sure that he and his colleagues in Essex welcome that.
Ruth George (High Peak) (Lab)
My local clinical commissioning group in north Derbyshire has been placed in special measures by NHS England. It has been forced to cut £16 million over just six months and to bring forward the closure of the Spencer ward in Buxton before any proper alternative is in place due to a lack of funding. Does the Minister not agree that the Budget funding is too little, too late?
Mr Dunne
The hon. Lady will be aware that the special measures regime was introduced to help trusts that are having difficulty in meeting quality performance standards to improve their quality. They receive support from NHS Improvement in order to do that. If she would like to write to me with the specific details of her trust’s situation, I would be happy to take up the case. But as far as I am concerned, her trust is on an improvement journey.
Sir Vince Cable (Twickenham) (LD)
Given that about a quarter of the additional funding goes to patients with neurological conditions—from strokes to Parkinson’s —what steps is the Minister taking to reduce the often appalling delays between the onset of disease and access to occupational and physical therapy? Will he agree to meet a charity from my constituency of Twickenham called Integrated Neurological Services, which is saving lives and money by drastically reducing that timeline?
Mr Dunne
The right hon. Gentleman will be aware that centralising cardiac services in particular into acute cardiac hospitals is having a significant impact on improving access to treatment by reducing the time it takes to get diagnostic tests and initial treatment, and is therefore saving lives. Specialisation is working in London and in other parts of the country where it is being applied. I am sure that he would welcome the recent allocation to Kingston Hospital of up to £1.3 million to help with winter pressures.
Mr Philip Hollobone (Kettering) (Con)
The Minister visited Kettering General Hospital earlier this year and saw for himself that a record number of patients are being treated with increasingly world-class treatments. Will he confirm that the hospital will get £2.6 million to cope with winter pressures this year?
Mr Dunne
My hon. Friend never fails to highlight the success of Kettering General Hospital. I am delighted to confirm that £2.6 million will be available for that hospital this winter. We are working hard with the hospital management, through the special measures regime, to improve performance in that trust.
John Cryer (Leyton and Wanstead) (Lab)
Bed occupancy rates across London last winter were running very near to 100%, including at Whipps Cross University Hospital in my constituency. With the much-vaunted extra funding, what will the bed occupancy rate have been by the end of this winter?
Mr Dunne
Bed occupancy rates are high at this time, not least following the recent cold snap, which has put additional pressure on hospital trusts. We have used some of the funding provided in the March Budget to increase the rates of delayed transfers of care to improve patient flow throughout all hospitals, and that has led to a slight reduction in bed occupancy in the run-up to winter.
Iain Stewart (Milton Keynes South) (Con)
Mrs Anne-Marie Trevelyan (Berwick-upon-Tweed) (Con)
The Minister of State, Department of Health (Mr Philip Dunne)
I can confirm that the health and wellbeing overview and scrutiny committee has submitted a request for a review by the Independent Reconfiguration Panel. I understand that officials have reverted to the committee to clarify the terms of the referral. Once that has come through to the Department, I am sure that the review will take place.
Neil Gray (Airdrie and Shotts) (SNP)
Mr Marcus Fysh (Yeovil) (Con)
There are many very committed individuals working in health and social care services in Somerset, but one challenge is getting enough registered nurses into the system to allow them to integrate. What can the Minister do to help to get more registered nurses?
Mr Dunne
My hon. Friend will be aware that last week we published the workforce strategy. One major focus was on meeting the Secretary of State’s commitment to increase the number of registered nurses by 25% and to broaden the routes into nursing. There is a commitment to expand the nursing associate role, which is helping to provide opportunities, through an alternative route, for healthcare support workers to become registered nurses.
Mr Alistair Carmichael (Orkney and Shetland) (LD)
Nigel Huddleston (Mid Worcestershire) (Con)
Will the Minister provide an update on efforts to move Worcestershire Acute Hospitals NHS Trust out of special measures, and on the status of the promised £29 million for much needed capital improvement programmes?
Ms Angela Eagle (Wallasey) (Lab)
On admissions to hospital for malnutrition, will the Minister tell me what has been happening at Wirral University Teaching Hospital? Admissions for malnutrition went up from 21 in 2009-10 to 707 in 2014-15. They went up again to 728 and this year currently stand at 586. That seems very, very high. Can anyone tell me what is going on? If not, will Ministers write to me to explain these huge figures?
Dame Caroline Spelman (Meriden) (Con)
I would like to thank the Minister for listening very sensitively to the victims of Paterson, the rogue surgeon, many of whom are constituents of mine. Does he agree that the evidence from the Hillsborough inquiry is that a bishop-led inquiry can indeed get justice and closure for victims? Will he join me in wishing the Bishop of Norwich great success in getting a good outcome from this inquiry?
Mr Dunne
I pay tribute to my right hon. Friend for her role in helping to support the victims, many of whom, as she said, are constituents of hers. We are pleased that Bishop James has agreed to take on this inquiry. Bishops provide the ability to empathise with victims and their families, which might not always be the case with judge-led inquiries. As she rightly points out, the Hillsborough inquiry was led by a bishop, but so too is the current Gosport inquiry, while the Morecombe Bay inquiry was led by Bill Kirkup, rather than a judge.
Jessica Morden (Newport East) (Lab)
Those with erythropoietic protoporphyria cannot be exposed to sunlight or even some artificial light without extremely painful and violent skin reactions. Trials of the drug Scenesse have proved life-changing for constituents such as James Rawnsley, who, for the first time, can now take his kids to school and go on holiday. The decision to make it available on the NHS will be taken soon. Please will the Minister look at it?
Andrew Selous (South West Bedfordshire) (Con)
I warmly welcome the extra £1.1 million to help with winter pressures at Luton and Dunstable Hospital, and I can tell the ministerial team that the merger with Bedford Hospital is proceeding well, but it needs £150 million of capital. May I ask that favourable consideration be given to that in the allocation of the £3.5 billion announced in the Budget?
Mr Dunne
My hon. Friend will be aware that the Chancellor provided a package of £10 billion in the Budget last month to be invested in the NHS, of which £3.9 billion will come from the Treasury. All bids for capital are being assessed through the STP prism. The proposal that his area will be making will be assessed against others. As far as I am aware, no such proposal has yet been made to NHS England, but it will obviously be looked at in due course.
Paul Masterton (East Renfrewshire) (Con)
May I thank the ministerial team on behalf of my constituent Susan Bradley for finally laying the remedial order for single-parent surrogates, and can they assure me that they will do everything they can to get it through Parliament as quickly as possible?
Mr Dunne
An all-party parliamentary group has been established this week, I believe, to take this issue forward, and I look forward to speaking to that group, if invited, next month. The remedial order will follow due parliamentary process, which involves its being laid for 60 days and then, after an interval, for a further 60 days.
Steve McCabe (Birmingham, Selly Oak) (Lab)
There have been 15,000 violent assaults on mental health workers in the west midlands over the last five years. What is the Government’s response to the Care Quality Commission’s opposition to routine searches of all mental health service users for weapons on admission or return to acute in-patient units?
Martin Vickers (Cleethorpes) (Con)
The patient transport service in northern Lincolnshire is contracted to Thames Ambulance Service Ltd, which is failing miserably to perform to an adequate standard. Will the Minister meet me, along with my hon. Friend the Member for Brigg and Goole (Andrew Percy) and other neighbouring Members, to discuss what influence the Department can bring to bear?
Several hon. Members rose—
Health and Care Workforce Strategy
Philip Dunne Excerpts(6 years, 5 months ago)
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The Minister of State, Department of Health (Mr Philip Dunne)
I wish to update Parliament that on 13 December 2017, Health Education England published the consultation “Facing the Facts, Shaping the Future”, a draft health and care workforce strategy for England to 2027.
This draft strategy is for consultation with stakeholders and the public more widely and is the product of the whole national health system, including NHS England, NHS Improvement and Public Health England.
It announces system-wide reviews to assess the impact of technological changes on clinical professionals and on how best to support the informal workforce—made up of family, friends, carers and patients themselves—in the future.
Further information on the consultation and how to participate can be found at: https://www.hee.nhs.uk/our-work/planning-commissioning/workforce-strategy .
A copy of the draft strategy can be found at:
http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2017-12-14/HCWS345/
[HCWS345]
South Tyneside Hospital
Philip Dunne Excerpts(6 years, 5 months ago)
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The Minister of State, Department of Health (Mr Philip Dunne)
I congratulate the hon. Member for South Shields (Mrs Lewell-Buck) on securing this debate about the future of South Tyneside Hospital. I pay tribute to the emotion she showed in standing up for her constituents, but I have to say that I was disappointed by the tone she adopted, particularly at the start of her remarks. Frankly, her allegation of conspiracy—trying to paint the issue as some kind of dastardly plot to privatise the health service, for which there is not a shred of evidence—is scaremongering that will undoubtedly alarm residents in her area. That rather undermined the force of her quite proper concern for her constituents, so I am sorry that she chose to characterise her position in that way.
I welcome, however, the hon. Lady’s support for the staff at her hospital and join her in congratulating them on their work. Despite significant pressures, South Tyneside NHS Foundation Trust is performing very well for the vast majority of patients under its care. She pointed out the performance in A&E. The trust is one of the few in the country to be performing at and above the four-hour waiting target, but that is not the only area in which it is performing well. It is also one of the few trusts across the country to be meeting all of the eight cancer targets, as well as the referral to treatment waiting time targets—again, that is unusual at present—and all the diagnostic targets. It is therefore one of the best-performing trusts in the country, and I think the hon. Lady and I will be on the same page on that.
The trust and its neighbour, the City Hospitals Sunderland NHS Foundation Trust, recently formed an alliance known as South Tyneside and Sunderland Healthcare Group. That is why the group is looking at a reconfiguration of services across the two trusts to remove unnecessary duplication and improve the sustainability of services to ensure that the local population’s healthcare needs are well looked after across the range of activities.
Ultimately, as the hon. Lady knows, any service changes at South Tyneside Hospital will be a matter for local health authorities. All proposed service changes should be based on clear evidence that they will deliver better outcomes for patients. The changes should also meet the four tests for service change: they have support from GP commissioners; they are based on clinical evidence; they demonstrate public and patient engagement; and they consider patient choice. In addition, NHS England introduced this year a test on the future use of beds that requires commissioners to assure it that any proposed reduction will be sustainable over the longer term and that key risks such as staff levels are addressed.
Mrs Lewell-Buck
The Minister says that both hospitals are working together to create safe healthcare for both populations. However, how does shutting down a maternity unit and a special care baby unit with hardly any notice at all help to create that environment? Surely they are failing the task they have been handed.
Mr Dunne
I am coming on to explain precisely why there was an emergency shutdown of that facility because the hon. Lady’s characterisation does not quite represent what happened. I will go into that in some detail to try to reassure her and her constituents about the reasons behind this sudden—and, we hope, temporary—closure.
On 30 November, as the hon. Lady pointed out, the delivery of high-risk births at South Tyneside District Hospital was suspended due to staffing pressures. A number of urgent safety protocols were put in place to accommodate a very small number of low-risk deliveries over the weekend of 2 and 3 December. Since 4 December, all maternity services have been temporarily suspended at South Tyneside Hospital on patient safety grounds. The trust did not take this decision on its own initiative. It sought advice from the Northern Neonatal Network and the heads of midwifery services for the north-east of England. Their unanimous clinical view, based on all the evidence available at that time, was that births should be temporarily suspended in the interests of the safety of mothers and babies.
The trust has about 70 hospital-based staff who are directly affected, who have all been asked to report for duty as normal. The staff are working with the trust to contact the 165 women currently affected to ensure that safe alternative arrangements are made. The trust has been in close contact with neighbouring units and has had overwhelming support from NHS partners across the system. Women have been choosing to deliver in Sunderland, Gateshead and Newcastle, with a number of women opting for a home birth.
The trust is working closely to make sure there is an individual plan for each patient and that there is clear communication between the healthcare professionals involved with their care. The trust aims to reopen the special care baby unit for low-risk births when a safe staffing level has been established.
I now want to dwell on the specific staffing challenges that have precipitated this action. South Tyneside NHS Foundation Trust has been contending with the challenge of safely staffing the special care baby unit over many years, so this situation has not just crept up on it. When the Care Quality Commission visited in May 2015 and rated the trust overall as requiring improvement, inspectors raised serious concerns about its special care baby unit staffing arrangements. Since 2015, the trust management has made relentless efforts to mitigate these staffing issues. Regular recruitment has taken place for permanent vacancies in the special care baby unit and paediatric emergency care over the past two years, with the latest round taking place only this month.
Contrary to the hon. Lady’s allegations of a long-standing conspiracy to compel the unit to close, I want to give her the facts about that unit as I understand them. In recent months, chronic staff sickness has reduced the six full-time equivalent specialist neonatal nurse workforce in the special care baby unit to just four full-time equivalent staff. That has resulted in an unsustainable situation, with the remaining nurses working many extra hours each week to ensure safe staffing on the unit. One of the four remaining nurses then became ill, exacerbated by work pressures, and that led to unsustainable staffing levels to keep the unit open. It has not been possible for the trust, however hard it has tried over the past two and a half years, to fill the rota. It has not been possible most recently to use bank and agency staff to do so, given the very specialised skills required by neonatal nurses in the special care baby unit. This decision, although difficult, was driven by very clear clinical advice that put the safety of mothers and babies first and foremost, and also took account of the health and wellbeing of hospital staff, to whom the trust also owes a duty of care.
The hon. Lady referred to the consultation that has taken place in recent months over the path to excellence.
Mrs Lewell-Buck
I thank the Minister for giving way again, but I am really disappointed. I can see that he has the official lines from the trust and the CCG, but did he not listen to what I said? Regional groups made this decision, not local groups. The unit is now at the full staff complement at which it has been historically. In short, there is no staffing problem there right now. Midwives are sitting doing admin work when they could be delivering babies.
Mr Dunne
I was referring to the special care baby unit. My understanding is that the staffing levels at the neonatal unit are as I have just described to the hon. Lady. If she has other information, I will happily go back to the trust tomorrow to ask whether it has managed to fill those slots. There is no intention of keeping the maternity unit for normal births suspended for any longer than is necessary.
I will touch on an area that the hon. Lady did not mention specifically, because a similar situation occurred in relation to stroke services in the region. I want to put that into context to help her to understand why the decision was taken.
Since December 2016, any patient requiring acute care for a stroke has been taken to Sunderland. This decision was taken to ensure patient safety because South Tyneside also had a significant staffing challenge in its stroke unit. In fact, it had only one part-time physician, who was single-handedly assessing and treating incoming stroke patients. The stroke unit faced significant pressures in maintaining a sufficiently staffed nursing rota to support that clinician to maintain the patient safety required for stroke patients.
The benefits of centralising high acuity stroke care have been shown in Manchester, London and other parts of the country where reduced mortality and a more efficient use of resources have resulted in better care for patients. Most other parts of the country have either implemented similar changes or have plans to do so. Centralising stroke care into a smaller number of larger units provides the opportunity to ensure that there are specialist nurses and doctors available to manage patients at all times, and to provide access to imaging and other investigatory facilities immediately as they are required. I will illustrate what that means to patients, who are at the heart of these changes.
Across the NHS in England, 84% of stroke patients now spend the majority of their hospital stay in a specialist stoke unit, compared with 60% in 2010. This has led to excellent progress in the treatment of stroke over recent years. More than 93% of stroke patients across England now receive a brain scan within 12 hours of their arrival at hospital, with more than 50% screened within one hour. That is a huge improvement since 2010, when 70% of patients waited up to 24 hours for a scan. The concentration of stroke services and specialist units has helped to save lives.
The workforce challenges experienced by South Tyneside Hospital are being proactively addressed in the long term through the path to excellence programme that the hon. Lady mentioned. This is a five-year transformation programme for healthcare services in South Tyneside and Sunderland, and a localised response to the Northumberland, Tyne and Wear and North Durham STP of which she was so critical. The public consultation for the path to excellence programme ran from 5 July to 15 October. The areas of service under consultation were maternity and women’s healthcare services, including the special care baby unit; stroke care services; and children and young people’s urgent and emergency services. Before the CCGs make their decision, they will consider all the feedback gathered during the consultation from all stakeholders, including the hon. Lady and other hon. Members. The CCGs are also holding a number of public engagement sessions between now and February, in which I strongly encourage her to participate. An extraordinary meeting of the CCG’s governing bodies will be held in February 2018, in public, for the two CCGs to make their final decisions.
The hon. Lady mentioned the Save South Tyneside Hospital group. I am aware that the group is active in campaigning against any reconfiguration of healthcare services between the two hospitals. I hope that I have helped to clarify to her that no decisions will be made on reconfiguration until the responses to the path to excellence consultation have been thoroughly analysed.
Mrs Lewell-Buck
The Minister’s analysis of the Save South Tyneside Hospital campaign is incorrect. We want safe, decent healthcare for people in South Tyneside. We are campaigning for equitable, safe healthcare.
Mr Dunne
I am sure that that is the objective. It is also the objective of the trust to ensure that sustainable, high-quality services are available to the populations of the areas served by both hospitals.
The South Tyneside NHS Foundation Trust now faces a challenging task in ensuring that the two hospital trusts, through the path to excellence process, remove any unnecessary duplication and improve sustainability. It is important that the trusts work well together, with the local community and with their commissioning groups, to ensure that any plans that they have are communicated clearly to local populations. [Interruption.] The hon. Lady says that that is not happening. It is incumbent on the trusts to engage properly with their local communities. I am sure that they will be watching this debate and taking note of the comments that she and I are making. There should be full public engagement, and as I have identified, that will continue right up until the decision of the CCGs in February.
I conclude by simply saying that it is incumbent on all of us who represent our local communities to get engaged —the hon. Lady is doing this with her campaign group—with the people who are responsible for making decisions. That is the local NHS in her area. [Interruption.] She indicates that she is engaged with her local NHS. I am pleased to hear that, and I ask her to encourage all other MPs to get engaged in a constructive way, to find the best solution for their local residents that will put patient safety at the top of the list.
Question put and agreed to.
Healthcare Optimisation Plan: Kirklees
Philip Dunne Excerpts(6 years, 5 months ago)
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Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
The Minister of State, Department of Health (Mr Philip Dunne)
It is a pleasure, as always, to serve under your chairmanship, Mr Hollobone. I am conscious that there is the possibility of a vote coming rather earlier than we had anticipated; in which case, I will try to ensure I do not use up all the available time. I congratulate the hon. Member for Dewsbury (Paula Sherriff)—Dewsbury, Mirfield, Denby Dale and Kirkburton, but I will use Dewsbury for shorthand—on securing the debate and securing the support of the hon. Member for York Central (Rachael Maskell), who made a compelling case today. She referred to our recent meetings on this subject and previous debates on it in the Chamber, demonstrating her clear commitment to the cause.
It is no secret that the NHS faces significant challenges. All the Opposition Members who spoke referred to some of the financial pressures currently acknowledged as affecting the NHS. However, I do not think they quite recognised that the NHS’s own five year forward view identified some significant challenges that need to be addressed in relation to the way in which the nation supports the healthcare of the population as a whole. Throwing money at it inexorably is not always the right solution. Some difficult choices have to be made about the way in which the public lead their lives. What we can do, through a combination of public health support, advice and education, to encourage the public to lead healthier lives is an important responsibility of Government. It is important for individuals to help to ensure that they lead long, independent lives in as healthy a condition as possible.
Rachael Maskell
The five year forward view was put in place long after people established lifestyles either of being overweight or of smoking. To penalise them after the event was not the intention of the five year forward view. That strategy is about improving people’s health, whereas this programme is about causing health to deteriorate.
Mr Dunne
I do not accept that. It is important that we use all the tools at our disposal to encourage the public to lead healthy lives where possible. These measures form part of the suite of measures that are necessary to bring that about.
The Government have backed the five year forward view. Opposition Members raised the issue of finances. We have committed to a real-terms increase in funding through the spending review period. Most recently, in the Budget only last month, we committed an additional £2.8 billion on top of the £8 billion real-terms increase by 2020. We are providing significant extra resource, but we recognise that different areas of the country will face different challenges and so will develop different approaches to how they use their resources most effectively in patients’ interests. That will inevitably involve making difficult decisions. It is right that we trust local NHS organisations, clinically led, to make those decisions, rather than second-guessing them centrally.
Having said that, we have set certain expectations of the system, one of which is that blanket bans on treatments are completely unacceptable and incompatible with the NHS constitution. That is why I refute the challenge from Opposition Members to say whether or not we are imposing rationing on the NHS. The local management responsible for the NHS in their areas have to respect the constitution and should not introduce blanket bans, but they do have to look at ways to provide care for their populations in a manner that lives within the budgets they have been provided with.
Paula Sherriff
I have listened to the Minister carefully. Can he explain why he feels it is acceptable that someone in Wakefield could have surgery, while someone nine miles away in Dewsbury could not? They might both be smokers, and the surgery would be carried out by the same surgeon, probably in the same hospital. Are we not in danger of going into a very big postcode lottery once again?
Rachael Maskell
To put this into the context of how it is working in reality, patients who do not meet the thresholds are automatically put through a system, and therefore it is completely in breach of the NHS constitution. There is no individual input about the clinical needs of a patient.
Mr Dunne
I will come on to that. We are talking primarily about what is happening in North Kirklees and Greater Huddersfield CCG areas, which have not yet implemented this policy. I will explain why I do not think that that should be the case.
On the healthcare optimisation plan, I take the gentle chiding from the hon. Member for Ellesmere Port and Neston (Justin Madders) about the way in which the NHS describes proposals. I have some sympathy with what he says about the way in which language is used, but this is a plan to encourage greater public health among the population of North Kirklees and Greater Huddersfield CCG areas, for which they are responsible. I talked to the CCGs in preparation for the debate and was advised that they do not see this as a blanket ban on treatment. I have emphasised to them that they should not do so and that there should not be a blanket ban on treatment.
I will describe the proposals, as I understand them. They have been developed by the CCGs since autumn 2016, and the objective is that patients who are overweight with a body mass index of 30 or above will have 12 months to lose at least 10% of their overall weight or to reduce their BMI to less than 30, while patients who smoke will be encouraged to take up to six months to quit smoking before undergoing routine surgery. Those who quit smoking for four weeks or achieve their target weight loss will be able to be referred for surgery under the policy.
The development of the plan coincided with the UK’s childhood obesity strategy and the proposed introduction of the soft drinks industry levy, reflecting the Government’s commitment to tackling the major public health problems affecting large sections of society. The hon. Member for Dewsbury and the hon. Member for York Central recognised the need to address the obesity crisis in this country. I am grateful for their support and that of the Opposition spokesman, the hon. Member for Ellesmere Port and Neston. I think we are united in recognising that something has to be done about this. I hope they support the proposals that the Government have made for the obesity strategy and the considerable progress we have made in reducing smoking since 2010. Hon. Members have made the point that the policy should not be at the expense of treatment if treatment is urgent or, if there is no treatment, it might lead to degradation of the health condition of the patient subject to the policy.
Paula Sherriff
I thank the Minister for his generosity in giving way. Does he agree that the decision must be made by a surgeon? That is so important, because they are highly trained and are surely the ones who can come to a decision on whether the patient can wait.
Mr Dunne
I will come on to that. The short answer is that I agree that the relevant clinicians should make those decisions.
Going back to where the CCGs are in this process, as I said earlier, they have not yet introduced the proposal. They have been working with the local population and with Healthwatch Kirklees, and have held a number of engagement events with local authorities and interested stakeholders to try to understand the reaction of those parties to the proposal. An engagement event was conducted in March and April of this year, and one with Kirklees Council in August and September of this year.
The CCGs have listened and responded to some of the points made. They have made several changes to their original proposals, including exempting children from the programme. They also recognise the limitations—amusingly identified by hon. Members in their contributions—of using BMI as a measure of body weight. Therefore, for example, people with high muscle mass should be excluded from the BMI calculation for the reasons that were well explained earlier in the debate.
The CCGs are including safeguards in the proposals, and they intend that, in exceptional circumstances, normal individual funding request processes will continue to apply. Hon. Members have criticised that as imposing an undue obligation on the individual to seek that route to secure treatment. That is effectively an appeal mechanism that applies across the NHS and is a well-worn and well-understood path for clinicians to support individual funding requests for patients where needed, which we should continue.
Both the hon. Member for Dewsbury and the hon. Member for York Central used the expression “lives at risk”. I would gently say that there is absolutely no intention that policies such as this should lead to lives being at risk. They are about trying to put individuals in a position where their own circumstances would lead to better outcomes from the proposed surgery. The hon. Ladies have called for evidence supporting the proposition —it was raised by the hon. Member for York Central when we met at the end of last month. I have asked for that evidence. A number of research papers support the propositions made by the CCG, in particular on the question whether obesity at the time of surgery is associated with a wide range of problems. Sustaining weight loss is the key. Rapid weight loss followed by rapid weight gain clearly do not help the patient, but the evidence from the research papers provided to me is that maintained weight loss or cessation of smoking undoubtedly and clearly have clinical benefits for the patient. There is evidence to support that.
I will come back to the point raised earlier on by the hon. Member for Dewsbury and the hon. Member for York Central, but I absolutely recognise that the clinician primarily responsible for the care, whether that is the GP or the secondary clinician, should have discretion to ensure that a referral is made, should a non-referral of a patient or a delayed procedure outweigh any benefits from a period of improving health and reducing risk factors prior to a routine operation. We will encourage the CCGs to ensure that that is in their final proposals, once those are made.
Justin Madders
The Minister says he will encourage CCGs to listen to clinical advice when making referrals. Is there any mechanism by which he will actually ensure that that happens?
Mr Dunne
As the hon. Gentleman knows, CCGs are subject to appraisal and are accountable to NHS England, which is accountable to Ministers. It is not for Ministers to direct individual CCGs as to how they should enact their policies, but there is a route through which we can provide some encouragement to NHS England to ensure that these policies reflect its national position. That is what we will do.
On where the process is, in October the two CCGs presented details of the proposed plans to Kirklees Council’s health and social care scrutiny committee. The committee requested that the CCGs undertake a further six weeks of engagements, especially with hard-to-reach communities in the area of the hon. Member for Dewsbury. The CCGs have assured me that they are committed to that further engagement with the local community to ensure that the plan is fit for purpose, so there is a continuing opportunity to reflect on the revised iteration of the proposals. I am also advised that the CCGs have not yet made firm decisions on the plans. Instead, as a result of the engagement with local stakeholders, they are considering four options, and variations on the four options, for implementing the proposed plan, including not proceeding with the programme, which remains on the table.
Those options include: first, a phased approach, beginning with applying the programme initially only to patients who smoke and subsequently rolling it out further to obese patients if appropriate; secondly, only implementing the plan for smokers; thirdly, introducing health optimisation periods across clinical thresholds and pathways, in line with NICE guidance; or fourthly, moving away from implementation of the plan as previously defined and focusing on a strengthened education campaign to reinforce the benefits to patients of stopping smoking and losing weight. Those options remain on the table and there will be a further period of engagement. A decision on which option will be taken forward is due to be made by the CCGs in January, and further engagement on the implementation of the recommended approach will then take place later in the new year.
I said earlier that the plan is not a blanket ban on treatment. Instead, the intention is to encourage patients who are obese or who smoke to lose weight and/or quit smoking. There is evidence that that will have benefits, in terms of both surgical outcomes, as I have said, as well as reduced risk for general medical conditions, and there are clearly also benefits to patients’ general health in the long term. Hon. Members can be assured that the CCGs are providing support to the patients on weight loss and smoking cessation, and have agreed to invest £133,000 a year in such services to account for any health optimisation-related increase in uptake.
The hon. Member for Dewsbury asked how we will assure that the plan is in accordance with national guidelines. As she would expect, NHS England has been closely reviewing this and similar proposals where they have been made to ensure that there is robust supporting clinical evidence and appropriate safeguards. The Government expect NHS England to ensure that the responsible CCG is not breaching its statutory responsibility to provide services that meet the needs of the local population. I can confirm to hon. Members that NHS England has had ongoing discussions with both CCGs about the health optimisation plan and will continue to do so to ensure that it works in the best interest of patients. That is the right approach, in terms of both protecting patients and both encouraging the population to put themselves in a condition to maximise the benefits from surgical procedures, without allowing CCGs to introduce an inappropriate blanket ban.
NHS England carries out regular assurance of CCGs and holds them to account through the CCG improvement and assessment framework to ensure that they are fulfilling their statutory requirements, and NHS England can and will intervene if a CCG is failing to discharge its key responsibilities. NHS England’s regional teams also have regular discussions with CCGs about their commissioning activities and plans.
It is important in a debate like this, in which there are allegations of there being a postcode lottery, that we recognise that it is down to clinicians at a local level, through their CCG bodies, to make decisions that affect their local population, rather than, as has happened in the past, central diktat from Whitehall. Those may lead to perverse consequences and a less relevant healthcare capacity and treatments for patients on the ground.
Rachael Maskell
The Minister is being very generous with his time. Is it not important in a national health service that we use the very best clinical evidence on how to produce the best outcomes for all patients? Falsely drawn boundaries should not have any relevance to the kind of treatment people receive.
Mr Dunne
The hon. Lady will recognise that there are different health challenges in different areas, reflecting patients’ differing needs. Encouraging the public to stop smoking and to reduce their weight is, as she acknowledged, an ambition that is shared by Members across the House and across clinical leads.
Mr Dunne
I will not let the hon. Lady intervene again because, amazingly, I am about to run out of time, despite what I said at the beginning. I have taken a lot of interventions.
I conclude by assuring hon. Members that we are paying close attention to what is happening in Kirklees and Greater Huddersfield, and York Central. Other areas of the country may be considering similar proposals, and we need to ensure that it is done in a responsible manner, whereby clinicians stay at the heart of making referrals where appropriate and retain that discretion. We will not get to the situation that the hon. Member for Dewsbury described in her opening remarks, in which she said that people’s lives will be put at risk by policies such as this. That is not the case.
King’s College Hospital Foundation Trust
Philip Dunne Excerpts(6 years, 5 months ago)
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Ms Harriet Harman (Camberwell and Peckham) (Lab)
(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the resignation of Lord Kerslake as chair of the King’s College Hospital NHS Foundation Trust.
The Minister of State, Department of Health (Mr Philip Dunne)
I would like to begin by paying tribute to Lord Kerslake, whom I have met in his role as chair of King’s, which he has served with great commitment for two years during a period of significant challenge. While we may differ on some matters of policy, this should not blind us to the service that he has given to the NHS.
The context of Lord Kerslake’s departure from King’s is the very real financial challenges faced by the trust and the way in which these have or have not been addressed. A number of other trusts have similar challenges, but none has deteriorated as far or as fast as King’s, especially in the past few months. This is why it was placed into financial special measures by NHS Improvement yesterday.
There has been a consistent pattern of financial projections by the trust that have not been met during Lord Kerslake’s tenure as chairman. In 2016-17, a planned deficit of £1.6 million deteriorated over the year to an actual deficit of £59.6 million. For the current year, a budget deficit of £38.8 million was agreed in May. At month 5, the chairman confirmed to NHS Improvement that the trust was on track to meet this deficit, but by October there had been significant deterioration in the trust’s position, with a projected deficit of £70.6 million at October—£32.l million worse than planned. NHS Improvement was informed last week that this had deteriorated further to a mid-case projection of a deficit of £92.2 million, which would be £53.4 million worse than the original planned deficit. Indeed, Lord Kerslake indicated that the final position could be even worse.
King’s is receiving substantial financial support from the Department of Health. During this financial year, the trust is receiving £135 million of support to maintain frontline services. That is the second highest level of support across England. Both the level of deficit and the speed of deterioration are unacceptable, as I am sure all hon. Members will agree. Although no trust or hospital is an island, it is right that those charged with leading it should take responsibility for such results. The chief financial officer and chief operating officer both resigned last month, and, as we know, Lord Kerslake left on Sunday.
The trust will now receive even more support with the appointment of a financial improvement director. The organisation will be required to implement a plan to improve its finances, which will be closely monitored by NHS Improvement. On top of special measures and subject to due process, NHS Improvement intends to appoint Ian Smith as a new and experienced interim chair for King’s to take control of the organisation’s position.
Ms Harman
Does the Minister not realise that the problem at King’s is not the leadership, any more than it is the growing number of patients or the dedicated staff? The problem at King’s is that there is not enough money. He shows no recognition of the fact that over the past two years, King’s has already cut £80 million—double the rate that other hospitals have had to cut—and taken on an ailing trust to help out the wider NHS. King’s is now being told that it has to make even further cuts. How can it keep its A&E waiting times down, prevent waiting lists from growing and continue to meet cancer targets if it goes on to make further cuts?
Will the Minister face up to the fact that problems caused by lack of money are simply not going to be solved by blaming the leadership? King’s is an amazing hospital and a specialist world centre of research, which is also there for local people. It was there after the Grenfell Tower fire and the terrorist incidents we have had in London. Is it too much to ask the Government to recognise the reality of the situation and pull back from imposing further cuts, which will make patients suffer? No amount of changing the faces at the top will make that difference. It is the Minister’s responsibility.
Mr Dunne
The right hon. and learned Lady said on the radio yesterday,
“just because they’re the regulator, when these judgments have to be made, doesn’t mean that they are actually right”.
I have to ask her about that, in the light of the comments made by NHSI, the regulator. I will give her a couple of quotes. Jim Mackey, who was until recently the chief executive of NHSI, has said:
“Honestly, I don’t think they have in my time hit a single set of their re-forecasted numbers”.
The current chief executive, Ian Dalton, has said that no other trust in the country
“has shown the sheer scale and pace of the deterioration at King’s”.
This is not just about the numbers; it is about the way in which the trust is managed.
Chris Philp (Croydon South) (Con)
The right hon. and learned Lady has just asked questions concerning funding. Will the Minister confirm that NHS spending is at a record level, and that the Budget on 22 November provided a further £6 billion to support our NHS?
Mr Dunne
I am grateful to my hon. Friend, because I can confirm that the NHS is receiving record levels of funding, in advance of the plan that was agreed with the NHS chief executive for the five year forward view. That was front-loaded for the five years, so the NHS has received increases of funding for the first three of those five years over and above what was requested.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
Lord Kerslake has said that the Government are
“simply not facing up to the enormous challenge the NHS is currently facing”.
We agree. The Nuffield Trust has today called King’s
“the canary down the coalmine”
for NHS finances. Hospitals across London and beyond have been forced to cut costs by 4% a year since 2011, yet the report that Ministers commissioned from Lord Carter advised that trusts should find savings of 2% a year.
Does the Minister agree with NHS Providers, which warns that the saving hospitals have been ordered to find
“risks the quality of patient care”?
He will know that, by September this year, 83% of acute hospital trusts were in deficit to the tune of £1.5 billion. Does he agree that these deficits, across London and beyond, are a consequence of Government underfunding, cuts to tariffs and the failure to get a grip of delayed transfers of care because of the £6 billion of cuts to social care? Does he expect delayed transfers of care to increase in the coming weeks, and will trusts again be ordered to cancel elective operations this winter?
Before the Budget, the NHS argued publicly for an extra £4 billion in revenue a year. Why did the Chancellor refuse to give the NHS the extra funding that Simon Stevens asked for? Lord Kerslake has said that our NHS faces the
“tightest spending figures in recent times”.
Does that not mean that, as at King’s, there will be continued hospital deficits, growing waiting lists, greater rationing of care, the dropping of the 18-week target, more privatisation and an NHS pushed to the brink because of this Government’ persistent underfunding? Do patients not deserve better?
Mr Dunne
I think the hon. Gentleman’s critique would have a shade more credibility if he acknowledged that, before the 2015 election, the then shadow Health Secretary indicated that he wanted £5.5 billion less for the NHS than my party was offering. If we had followed that prescription, the financial position of the NHS would be far worse.
The hon. Gentleman asked about delayed transfers of care. In March, the Chancellor gave an additional £2 billion to the adult social care system, precisely targeted on reducing DTOC, and significant progress is being made in freeing up beds across the system. He also asked about NHS funding in the most recent Budget. The Chancellor awarded an additional £2.8 billion in revenue support for this year, next year and the following year, and a further £3.5 billion of capital to support programmes.
Stephen Hammond (Wimbledon) (Con)
As a London MP, I know that other hospitals that have faced challenging situations have put in place improvement plans and met the targets set by NHSI. If the regulator had not acted yesterday, would it not have been letting down other London hospitals and my constituents?
Mr Dunne
My hon. Friend is quite right. There has to be a sense of responsibility and accountability for delivering on budget deficits—if they are deficits—that have been agreed between the regulator and the trust. That is happening up and down the country, and it would be unfair on other trusts and other areas of the country if one trust was allowed to get away with its performance unchecked.
Martyn Day (Linlithgow and East Falkirk) (SNP)
The key to this question has to be ensuring sustainable delivery of the NHS. The Minister may wish to look at the model in Scotland, where we have boosted investment and listened to the needs of our healthcare workers. By stark contrast, the UK Government seem intent on burning their bridges with NHS staff with their cost cutting and special financial measures. When will the UK Government wake up and realise that their ideologically driven austerity threatens the very future of our NHS?
Bob Blackman (Harrow East) (Con)
My local hospital trust, based on Northwick Park Hospital, has had to make some very difficult decisions to make itself more efficient and to reduce its deficit, and it has done so under excellent leadership. Does my hon. Friend know whether decisions were taken at King’s to keep to the deficit target? Were efficiencies made, and how effective were they?
Mr Dunne
What is particularly disappointing about King’s is that it does have a cost improvement programme, but regrettably, it has not been able to keep to it. It is particularly surprising that, as recently as October, the senior leadership team indicated that they were on track to meet their deficit, which palpably, as we now realise, was not the case.
Helen Hayes (Dulwich and West Norwood) (Lab)
King’s College Hospital is in my constituency, and I can tell the Minister that the roots of this current financial crisis go back to 2013, with the collapse of the South London Healthcare NHS Trust and the decision to incorporate two additional hospitals, which were failing in their services, into the King’s trust without adequate funding to support that decision. This has been followed by year-on-year, real-terms revenue cuts and next-to-zero capital funding, while demand and need in our community is going up all the time. Instead of scapegoating a well-respected public servant, will the Minister listen to his wake-up call and look again at holding a full review of the finances for King’s College Hospital, and will he give the trust the resources it needs, so that the exceptional doctors and nurses who work for it can deliver the care and treatment that patients need and deserve?
Mr Dunne
I share the hon. Lady’s support for the clinicians and professionals working in her trust, who are doing the best job they can in admittedly challenging circumstances. I do not accept her characterisation of a lack of capital provided to King’s. I have been there myself and seen some of the building work going on. I am happy to look at the circumstances surrounding what happened in 2013, but they are not as relevant to today’s situation as the way the trust’s financial management has deteriorated in recent months.
John Howell (Henley) (Con)
What has NHS Improvement said about this, and what has it recommended that King’s should do?
Mr Dunne
As I have indicated, the chief executive of NHS Improvement said yesterday that no other trust
“has shown the sheer scale and pace of the deterioration at King’s. It is not acceptable for individual organisations to run up such significant deficits when the majority of the sector is working extremely hard to hit their financial plans, and in many cases have made real progress.”
That is from the regulator responsible for putting the trust into special measures for now.
Chuka Umunna
The “brutal reality”—to use the Minister’s words—is that the staff at King’s, which also serves my constituency, are doing all they can in impossible circumstances. If we are honest about this, we on both sides of the House have perpetuated the fiction for too long—over decades—that we can have Scandinavian levels of public services on American levels of taxation. That is why I ask him to heed the call of the hon. Member for Totnes (Dr Wollaston), and many others across the House, and set up a proper convention to look at what is a sustainable model, not just for King’s but for the whole NHS, so that our constituents can continue to get the services they deserve.
Mr Dunne
I share the hon. Gentleman’s support for the staff, and I have already paid tribute to the hard work and commitment that they are showing to their local population. His question regarding a royal commission is rather beyond the scope of this urgent question and rather above my paygrade.
Maria Caulfield (Lewes) (Con)
We do have a problem with NHS managers; not only are there too many of them, but many lack clinical skills, which is probably why they make so many bizarre decisions. On Lord Kerslake’s watch, £715,000 was spent off payroll last year on an interim director, and £30,000 a month was spent on temporary managers. There is a problem with this scandalous waste of taxpayers’ money.
Mr Dunne
My hon. Friend takes a close interest in what is happening in London’s hospitals, where she regularly works shifts. From time to time, there is a need for some interim managers to fill vacancies and gaps, but she is absolutely right that we have taken significant action to limit the excessive amounts that some have been paid. The amounts have now been capped and are being driven out of the service, and the interim mangers are being encouraged to take up substantive positions.
Kate Hoey (Vauxhall) (Lab)
I pay tribute to the staff at King’s, who have looked after so many of my constituents so well. Does the Minister agree that one thing we have to learn from this is that when a trust takes over a failing hospital, the challenges and difficulties can be much more than people have said, and the money given has not always been spent as it should have been? Does he also agree that just appointing a former head of the civil service to chair a trust does not necessary mean that they will have the attributes to do the job and that sometimes they are so busy doing other jobs that they might just take their eye off the ball?
Mr Dunne
In relation to the hon. Lady’s first point, I think that the experience has been variable; some outstanding trusts have taken on failing hospitals and managed successfully to turn them around, and others have found it more of a challenge. I accept that it is specific to the circumstances, and we are looking to learn from the various experiences to ensure that we encourage the right trusts to buddy up with those that are in trouble. In relation to her second point, I gently point out that Lord Kerslake has been providing advice to the NHS, and he has been spending a considerable part of his time providing advice to the Leader of the Opposition on a whole range of non-NHS-related topics.
Mrs Cheryl Gillan (Chesham and Amersham) (Con)
Following on from the hon. Lady’s question, King’s College Hospital NHS Foundation Trust is indeed a significant organisation and it requires very firm leadership. I understand the chairman who has resigned from his position also held seven remunerated roles other than that chairmanship and four non-financial positions. Will the Minister assure the House that any future chairman will be looked at very closely to ensure they have the capacity to lead an organisation of this size successfully?
Mr Dunne
My right hon. Friend makes a very valid point. We need to ensure that chairmen who go into trusts that have challenges have the capacity to do that job. I will be looking to ensure that NHS Improvement challenges Ian Smith, if he is appointed, to check that he has sufficient capacity to undertake the role. My understanding is that he does.
Sir Edward Davey (Kingston and Surbiton) (LD)
Will the Minister ask NHS Improvement to produce a report on what has happened at King’s, so that Parliament can look at the report to learn the lessons and to find out who was right?
David T. C. Davies (Monmouth) (Con)
Is it not the case that what we have here is one of Labour’s top advisers jumping in a blaze of politically motivated publicity before being pushed out for woeful financial mismanagement?
Mr Ben Bradshaw (Exeter) (Lab)
The Minister quoted selectively from the chief executive of NHS Improvement, who also made it absolutely clear he did not think the NHS has enough money overall. In the real world, as opposed to the fantasy world inhabited by Conservative Ministers, Simon Stevens, the head of the NHS, has repeatedly told the Health Committee that the NHS cannot do what the Government are asking it to do with the current money. Is it not clear that there will be no £350 million a week extra for the NHS? There will be less, because of the impact of Brexit and the economic incompetence of this Conservative Government.
Sir Desmond Swayne (New Forest West) (Con)
What was he paid and where is he going next?
Clive Efford (Eltham) (Lab)
The Minister has to accept that when the Government stepped in with South London Healthcare NHS Trust in 2013, they imposed their own interim director, just as they are now doing at King’s, and imposed the restructuring of south-east London health but never, ever funded it. That has led to the crisis at King’s today. The buck stops with the Tories. You just cannot trust the Tories with the NHS.
Matt Warman (Boston and Skegness) (Con)
Is not the reality that any politically motivated resignation such as this leaves the NHS, the hard-working staff and the patients all worse off?
Mr Dunne
All those who assist the NHS in a non-executive capacity do so with the best motivations. I would not question Lord Kerslake’s motivation for wanting to undertake this role. As to the suitability of all the individuals appointed to these positions, that will be variable because there are so many organisations across the NHS. I would not like to make any comment about political motivation in relation to this departure.
Andy Slaughter (Hammersmith) (Lab)
Imperial College Healthcare NHS Trust is also running a large deficit—it is not just King’s. The Government’s solution is to demolish Charing Cross hospital, when admissions have gone up 11% in the past two years. We are on our fourth chief executive in five years. The last one left to run NHS Improvement before he could even meet local MPs. When are the Government going to get a grip and fund the NHS properly, rather than blame everybody else for the problem?
Mr Dunne
I share the hon. Gentleman’s concern about trusts that have a revolving door of senior leadership. One thing we are looking to do is to encourage a larger cadre of leadership people in the NHS and more clinicians to become leaders, so we have more consistency of skills and better trained leaders across the NHS. I do not think the departure of Ian Dalton from Imperial has anything to do with the subject of King’s College, or indeed with the funding of the NHS.
Rachel Maclean (Redditch) (Con)
Is it not the case that in any senior public service appointment within the civil service, a basic requirement is political neutrality and non-partisanship? Is there a question for the Committee on Standards in Public Life with regard to this particular appointment?
Mr Dunne
The NHS is the largest organisation in the country and everybody who works in it will have their own political views and persuasions. Very few of them are brought to the board table. It is the case that when in government parties on both sides appoint individuals with political representation from the other side, so I think we have to be balanced about this. I would gently point out that Lord Kerslake sits as a Cross Bencher, although he may provide advice to one party more than another.
Karin Smyth (Bristol South) (Lab)
Does the Minister believe that the duty of candour extends to NHS leaders?
Robert Jenrick (Newark) (Con)
Does my hon. Friend agree that one upshot from the noble Lord’s resignation is that he will have more time on his hands to use his proven financial prowess to prepare implementation manuals for the Leader of the Opposition?
Mr Dunne
My hon. Friend is very ingenious with his question. Clearly, there will be more time available for Lord Kerslake to take on his other responsibilities. The Leader of the Opposition might like to look very closely and keenly at the financial performance of the organisation over which Lord Kerslake has taken responsibility before he adopts any of his other advice.
Margaret Greenwood (Wirral West) (Lab)
It is abundantly clear that the Government are accelerating the privatisation of our national health service by reducing supply in the NHS to create demand for private health insurance. We do not want a US-style health insurance here. Will the Minister please give the NHS the money it needs?
Mr Dunne
I cannot understand how the hon. Lady can make such an interpretation from any discussions that have been held, either in this urgent question or further afield. The Government have just given an additional £2.8 billion over and above that asked for by the chief executive of NHS England when he set out the five year forward view and up to £10 billion of capital. This is nothing whatever to do with privatisation.
Robert Courts (Witney) (Con)
Will the Minister confirm that the trust has been in discussions with NHS Improvement with regards to reducing its deficit for some time and that the forecast of double the deficit is an unacceptably poor standard of financial leadership at a time when other trusts have made great successes in improving patient care and finding successors?
Mr Dunne
My hon. Friend is quite right. There are financial pressures across the NHS in England. We have been very clear and very open about that. Some trusts are managing within those financial challenges and other trusts are not. That is in large part down to the rigour and leadership given to those trusts. Unfortunately, in this trust there has not been sufficient of either.
Ms Marie Rimmer (St Helens South and Whiston) (Lab)
Given the financial incapacity problems currently affecting the NHS, is it right or fair that individual acute trust leaders should be removed from their post when surely their perceived failures are part of wider systems issues and funding pressures?
Mr Dunne
The hon. Lady is right to identify pressures across the system, but it is also the case that when leaders change their position in a very short period of time and oversee a period of significant deterioration, the regulator has to take a view on whether those individuals are the right people to continue to lead that organisation. I think that that is what has happened in this case.
Lucy Frazer (South East Cambridgeshire) (Con)
Does the Minister think it would have been possible for the trust to have improved, notwithstanding its financial position? I ask in the knowledge that Cambridge University Hospitals went from special measures to outstanding in care and good overall.
Mr Dunne
My hon. and learned Friend highlights the special measures regime. We have introduced a financial special measures regime and, during 2016-17, the trusts that went through that regime—King’s went in only yesterday—improved their financial performance by £100 million overall over the year. The short answer is yes. It is possible to manage improvement through this regime, and that is what NHS Improvement is there to do—to help trusts that get into financial difficulties to manage their way out of them.
Andrew Bridgen (North West Leicestershire) (Con)
Given the noble Lord Kerslake’s much publicised association with the current Labour leadership, should it come as any surprise that the trust he was chairing would run out of taxpayers’ money? Is not the truth that he jumped and squeaked before he was pushed?
Mr Dunne
My hon. Friend is right to highlight the sources of advice that the Leader of the Opposition seeks to take. He will need to reflect on that, as will the shadow Chancellor. In connection with this particular situation, it is the case that NHS Improvement spoke to Lord Kerslake last week to ask him to consider his position.
Paterson Case
Philip Dunne Excerpts(6 years, 5 months ago)
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The Minister of State, Department of Health (Mr Philip Dunne)
Ian Paterson, a consultant breast surgeon who was employed by the Heart of England NHS Foundation Trust (HEFT), and had practising privileges in the independent sector at Spire Parkway and Spire Little Aston, was found guilty in April this year of 17 counts of wounding with intent. He was sentenced to jail for 20 years.
The Government are appalled by the actions of Ian Paterson and the harm that has affected a significant number of patients. The disclosures about the seriousness and extent of his malpractice are deeply and profoundly shocking.
The Government committed to ensuring lessons were learnt in the interest of patient protection and safety, both in the independent sector and the NHS.
Today, I am announcing the establishment of an independent, non-statutory inquiry into the circumstances and practices surrounding Ian Paterson that have affected so many patients. I have asked the Right Revd Graham James, Bishop of Norwich to chair the inquiry.
The inquiry should be informed by the victims of Paterson and families’ concerns, and seek to learn from their experience. Therefore, the inquiry will look at the local care and treatment for private patients in the Solihull area, and review current and past practices to establish if safeguards for patients treated at independent healthcare providers have fallen short of the standards the public have a right to expect. This will help to inform the broader lessons applicable to care provided by the independent healthcare sector across the country.
The inquiry is likely to consider issues including, but not limited to:
the responsibility for the quality of care in the independent sector; appraisal, revalidation and multi-disciplinary working in the independent sector;
information sharing, reporting of activity and raising concerns between the independent sector and the NHS;
and the role of insurers of independent sector providers (including sharing of data), and arrangements for medical indemnity cover for clinicians in the independent sector.
The inquiry will also draw on issues raised in previous relevant reports about Paterson.
It is not intended to revisit the evidence that we already have about Paterson and that led to his conviction.
The terms of reference and other arrangements relating to the inquiry will be published in due course after a period of engagement.
The inquiry will be formally established from January 2018 and will report in summer 2019.
I am confident that Bishop Graham will oversee a thorough and independent non-statutory inquiry and deliver his recommendations swiftly.
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Employment, Social Policy, Health and Consumer Affairs Council
Philip Dunne Excerpts(6 years, 5 months ago)
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The Minister of State, Department of Health (Mr Philip Dunne)
My hon. Friend the Parliamentary Under-Secretary of State for Health (Lord O’Shaughnessy) has made the following statement:
The Employment, Social Policy, Health and Consumer Affairs Council will meet on 8 December in Brussels.
For the health part of the meeting there will be three main agenda items on the draft Council conclusions on health in digital society; the draft Council conclusions on the cross-border aspects in alcohol policy; and pharmaceutical policy in the EU—which will cover the following:
Report on the state of paediatric medicines in the EU— 10 years of the EU paediatric regulation—information by the Commission.
Issues related to European patients access to treatment—information from the Romanian delegation.
Lack of drug availability in Greece—information from the Greek delegation.
Under any other business, there will also be reports on:
Valproate and teratogenic medicinal products—information from the Belgian delegation.
State of health in the EU—information from the Commission, OECD, and the European observatory.
Annual growth survey 2018—information from the Commission.
Steering group on health promotion, disease prevention and management of non-communicable disease—information from the Commission.
Outcome of the high-level meeting “AMR: One Health Action Plan and evidence-based policy making” (Brussels, 23 November 2017)—information from the presidency.
Work programme of the incoming presidency—information from the Bulgarian delegation.
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Congenital Heart Disease Services
Philip Dunne Excerpts(6 years, 5 months ago)
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The Minister of State, Department of Health (Mr Philip Dunne)
We are today making a statement on the decisions taken by NHS England at its board meeting on 30 November 2017 regarding future commissioning arrangements for adults’ and children’s CHD services in England, following its review of and full public consultation on these services.
CHD services are a specialised service currently commissioned by NHS England. There have been concerns about these services, especially children’s congenital heart surgery, which date back to the early 1990s and which have been the subject of a number of reviews.
Heart surgery is becoming ever more complex and technically demanding. Surgeons now operate on babies that may be only hours old and will in the future be able to operate on babies before they are born. This demands a highly skilled and experienced team of doctors and nurses able to operate on sufficient numbers of patients to maintain and improve their skills. It also requires that a wider range of other specialist children’s services are also present on the same hospital site. This determines what medical care is available by the bedside for a child in a critical condition, which is important because many children with CHD have multiple medical needs.
The new congenital heart disease review was established in July 2013, and on 23 July 2015 the NHS England board agreed the standards—almost 200 in total that cover the entire patient pathway. These standards were collaboratively developed over a two-year period by patients and their families and carers, clinicians, commissioners, and other experts. They were the subject of extensive public consultation, and all the views put forward were considered before the standards were finalised.
Patients and their families told NHS England that while it was a good thing to have standards, they only really mattered if they ensured that they were met. Following a self-assessment of providers against these standards, NHS England announced in July 2016 that it was minded to make a number of changes in the way it commissions CHD services. NHS England set out proposals to implement the standards, and asked for views in a full, formal, public consultation that ran between 9 February 2017 and 17 July 2017.
With this review, NHS England has been asking how we can take the good service we have today across the country and turn it into a truly great service for the long term; a service fit for the 21st century. When its proposals are implemented, patients and their families can be confident that they will be able to access the very best CHD services in the world, regardless of where they live.
Having noted the results of the consultation, and in order to support the full implementation of the standards, NHS England agreed a number of recommendations regarding future commissioning arrangements for CHD services in England at its board meeting on 30 November 2017. It also agreed proposals for full implementation of all the standards, and confirmed its support for recommendations regarding better information, funding for formal CHD networks and the development and delivery of a rolling peer review programme that will cover all of the standards at all trusts.
The following recommendations were considered and agreed by the NHS England board at its meeting on 30 November 2017:
for Liverpool Heart and Chest Hospital NHS Foundation Trust to provide level 1 adult CHD services in the north-west, with Manchester University Hospitals Foundation Trust providing the full range of level 2 adult CHD services as an integral part of a north-west CHD Network;
to continue to commission level 1 CHD services from University Hospitals of Leicester NHS Trust, conditional on the trust achieving full compliance with the standards in line with its plan to do so and demonstrating sufficient progress within required timescales;
to note the outline proposal presented by the Royal Brompton and Harefield NHS Foundation Trust for how full compliance against the standards might be achieved; to confirm that NHS England should work with RBH and other potential partners on the full range of options for delivering a solution that could deliver full compliance with the standards and ensure the sustainability of other connected services; and to continue to commission level 1 CHD services from the trust, conditional on the trust demonstrating sufficient progress within required timescales;
to continue to commission level 1 CHD services from The Newcastle upon Tyne Hospitals NHS Foundation Trust until at least March 2021, with NHS England to consider further the future commissioning of both the trust’s advanced heart failure and transplant services and its level 1 CHD services;
to cease to commission level 2 CHD services, including cardiology interventions in adults with CHD, from the following trusts: Blackpool Teaching Hospitals NHS Foundation Trust, Imperial College Healthcare NHS Trust, Nottingham University Hospitals NHS Trust, and University Hospital of South Manchester NHS Foundation Trust (note, this trust has now merged with Central Manchester University Hospitals NHS Foundation Trust to form Manchester University NHS Foundation Trust, which will be providing level 2 adult CHD services under the recommendations).
This will mean that in future level 1 CHD services in England will be provided by the following hospitals:
Alder Hey Children’s Hospital NHS Foundation Trust (children’s services) and Liverpool Heart and Chest Hospital NHS Foundation Trust (adult service)—subject to the conditions described by NHS England;
Birmingham Women’s and Children’s Hospital NHS Foundation Trust (children’s services) and University Hospitals Birmingham NHS Foundation Trust (adult service);
Great Ormond Street Hospital for Children NHS Foundation Trust (children’s services) and Barts Health NHS Trust (adult service);
Guy’s and St Thomas’ NHS Foundation Trust (children’s and adult services);
Royal Brompton and Harefield NHS Foundation Trust (children’s and adult services)—subject to the conditions described by NHS England;
Leeds Teaching Hospitals NHS Trust (children’s and adult services);
Newcastle Hospitals NHS Foundation Trust (children’s and adult services)—subject to the conditions described by NHS England;
University Hospitals Bristol NHS Foundation Trust (children’s and adult services);
University Hospitals of Leicester NHS Trust (children’s and adult services)—subject to the conditions described by NHS England; and
University Hospital Southampton NHS Foundation Trust (children’s and adult services).
And that in future level 2 CHD services in England will be provided by the following hospitals:
Brighton and Sussex University Hospitals NHS Trust (adult service);
Manchester University NHS Foundation Trust (adult service);
Norfolk and Norwich University Hospitals NHS Foundation Trust (adult service);
Oxford University Hospitals NHS Foundation Trust (children’s and adult services);
Papworth Hospital NHS Foundation Trust (adult service).
The commissioning of CHD services in England is a matter for NHS England. The Government will continue to hold NHS England to account as NHS England takes forward the recommendations of its review. Full details of NHS England’s recommendations, including its implementation proposals, are available on its public website.
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