Future of the NHS

Debate between Philip Dunne and Richard Drax

Thursday 20th July 2017 Commons Chamber

[The Minister of State, Department of Health (Mr Philip Dunne)]

It is a great pleasure to join you in the House for the last debate before the summer break, Mr Deputy Speaker.

I congratulate my hon. Friend the Member for South Dorset (Richard Drax) on securing this debate and commend his timing, as it is two days after we laid the Department of Health and NHS entities’ 2017 accounts before Parliament. He will note from what I am sure will be his diligent scrutiny of those accounts that provider deficits have been much reduced in the year that has just ended compared with the figure he cited for the previous year. That is a tribute to the focus of managers and trust leaders on securing the financial balance that the NHS as a whole has delivered over the past year.

To put all that in context, this is a time when more people than ever are using the health service. In 2016-17, some 23.4 million people attended A&E departments in England—2.9 million more than in 2010. The overwhelming majority of patients continue to be seen within four hours, and the NHS overall sees more than 1,800 more patients within the four-hour standard every day compared with 2010. In the previous year, the NHS carried out 11.6 million operations—some 1.9 million more than in 2010. That provides the context of the achievement and the treatments that have been given to patients throughout the land.

I am pleased that my hon. Friend recognised the excellent care that the NHS provides, which has been demonstrated for the second year running by the Commonwealth Fund report: in its international study published last week, the UK was ranked as the No. 1 health system in a comparison of 11 countries. That is a testament to NHS staff. The patients who benefit from those treatments rate their experience of care highly. The adult in-patient survey, which was released in May, shows that the majority of patients report that their overall experience was good, with 85% rating it as at least seven out of 10—a slight improvement on the previous year.

Looking to the future, which is the subject of the debate, the Government are committed to increasing the NHS budget to ensure that patients get the high-quality care they need. By 2020-21, NHS spending will increase by £8 billion in real terms from the 2015-16 baseline. That will deliver an increase in real funding per head of the population for every year of this Parliament. Nevertheless, my hon. Friend is right to point out that whatever funding we provide, it is important that we spend it to achieve the best possible outcomes for patients.

It is essential that we ensure that the NHS continues to make the most effective use of its resources to deliver high-quality patient care, so I recognise what I think was my hon. Friend’s motivation in securing this debate and raising this subject before the House rises for the summer recess. We all agree that it is important to target NHS funding to frontline services, which is why we are investing in the workforce and there are already more than 33,800 extra clinical staff, including almost 11,700 more doctors and almost 13,000 more nurses on our wards since May 2010.

NHS management is an important element of ensuring an efficient NHS, but of course we are keen to ensure that an increasing proportion of NHS funding goes to patient-facing services. Between 2010-11 and 2016-17, the proportion of the NHS pay bill spent on managers declined from 6.5% to 5.8%, which I am sure my hon. Friend will welcome. We are also reducing the number of people involved in management, which he called for. Between May 2010 and March 2017, the number of managers and senior managers in NHS providers and support organisations reduced from some 37,000 to around 31,000—I think that is similar to the effective percentage to which my hon. Friend referred. We are also looking to manage the rate of pay of senior managers, again to ensure that as much as possible is focused on the frontline.

It is important that we recognise that leadership is as important in the NHS as it is in any organisation—we must ensure that we have high-quality leadership across organisations. I for one am keen not to bash the managers in a somewhat traditional manner, but to recognise that high-quality leadership in our NHS organisations is important in driving high-quality performance for patients. That is why I have been working with the leadership academy in Health Education England to ensure that we have two things: a pipeline of talent so that we can identify quality individuals at the beginning of their careers in the NHS and track them as they pursue their careers, identifying the leaders of tomorrow, in a similar system to that with which my hon. Friend will be familiar from his service in the military; and some consideration of how we can get more clinicians involved in leadership roles in their organisations. Clearly, we have directors of nursing and medical directors in all provider trusts, but too few go on to take up the most senior leadership positions as chief executives.

[Richard Drax]

I am listening carefully to the Minister. Would it be naive to say that what we want to see is matron, in the form of Hattie Jacques, back on the wards and to hand far more administrative work, if that is the right phrase, back to clinicians, with whom it originally lay?

[Mr Dunne]

I am not keen to hand administrative work to clinicians, but I recognise that there is a role for ensuring that senior clinicians are present and in charge of activity in wards. That is the experience I am seeing as I visit acute hospitals around the country: senior members of staff, normally coming out of nursing staff —so they are a matron or other senior nursing officer—are responsible for what happens on their ward.

My hon. Friend says that an independent review might be appropriate, and I say gently to him that we think that the right way to drive improvement across the NHS and help position it for the challenges of the future is to back the plans prepared by the leadership of NHS England with colleagues from across the system through the five year forward view. This is the NHS’s own plan for change and it lays out how the NHS can transform services and improve standards of care while building a more responsive modern health service. We are backing this plan, enabling the NHS to deliver Government objectives including seven-day services and improved access to cancer treatments and mental health services. We agree that the answer to the challenges faced by the NHS lies in modernising services and keeping people well and independent for longer.

The NHS is using the sustainability and transformation partnerships mentioned by my hon. Friend to deliver that vision through transformation across local areas. These are clinically led, locally driven and can deliver real improvements for patients. The five year forward view also announced the development of new care models and we are already seeing the results.

My hon. Friend referred to the announcement yesterday about the first allocation of capital funding for the most advanced STP areas, including Dorset, which covers his constituency. It is fortuitous that the largest single beneficiary of capital through the STP allocation was Dorset, and what a great day for him to secure this debate and give an albeit somewhat guarded welcome to that significant capital injection. I am aware that he has a number of issues with how that money will be spent.

[Richard Drax]

It was totally unguarded. I am extremely grateful, as I am sure all clinicians and all those who work in the NHS in Dorset will be.

[Mr Dunne]

That applause is on the record, and I am delighted that my hon. Friend takes that view.

We see this investment as backing the exemplar STP plans that have been published thus far, and we hope that other areas, whose plans are in less good shape, will be encouraged to look at those that have succeeded to see what they can do to follow their example for the next phase of the roll out in the coming years.

I will conclude with a couple of comments about how we drive efficiency through the NHS and make best use of resources. My hon. Friend referred to the Carter and the Naylor reviews. Carter is driving heavily towards using best practice and removing variability across the NHS, whether in clinical practice or in financial performance, in areas such as procurement. Alongside that, Naylor is looking at how we drive out inefficiency from back-office functions, from estates and from the facilities management element of running such a substantial network of hospitals and facilities across the country. There is scope to do more. That will appeal to my hon. Friend’s desire to put more resources on the frontline. We are looking at encouraging organisations to share back-office facilities—as he called for—to bring down cost and drive up efficiency and operational productivity, which is the right way to go.

I conclude by confirming that we are making good progress in small steps. We need to continue to make progress to try to raise the depth of the tread of the steps that we are taking to ensure that the NHS is fit to serve the health needs of this population for the future.

Question put and agreed to.

Ambulance Waiting Times

Debate between Philip Dunne and Richard Drax

Monday 17th October 2016 Commons Chamber

[The Minister of State, Department of Health (Mr Philip Dunne)]

It is a pleasure, Madam Deputy Speaker, to join you a little earlier than anticipated and to have you in your place presiding over this important debate.

I congratulate my hon. Friend the Member for South Dorset (Richard Drax) on securing the debate. I am grateful for this opportunity to discuss ambulance response times and to put on the record, as he did, my thanks to all those who work in ambulance services across the country, not just in the south-west. Ambulance services are a vital part of the healthcare system and provide rapid assistance to people in urgent need of help. We are all united in expressing our gratitude to them for the professional work that they do.

I acknowledge that the NHS is busier than ever. That is why we are backing the NHS’s future plan with an extra £10 billion by 2020-21, providing some of the funding that my hon. Friend concluded his remarks by calling for. The ambulance service is experiencing unprecedented demand in all parts of the United Kingdom, including, as we heard from the hon. Member for Strangford (Jim Shannon), in Northern Ireland. It is delivering over 3,400 more emergency journeys every day in England than in 2010. In the past year, calls to ambulance services in England rose by 400,000, from 9 million in 2014-15 to 9.4 million in the year ending in April. Including calls transferred from NHS 111, ambulance services deal with more than 10 million 999 calls every year.

The demands currently being placed on ambulance trusts mean that performance targets have been, and continue to be, under pressure. South Western Ambulance Service NHS Foundation Trust has seen a particularly sharp increase in demand for its services. In the year to date, there have been 11% more calls in the south-west than at the same time last year. These calls have led to over 1,800 face-to-face responses by the service, on average, each and every day. In June this year, the Care Quality Commission inspected the service, and recently published the report of its findings. Overall, the trust has been awarded a rating of “requires improvement”. Within this rating, there were some positive findings. In particular, the trust was rated as outstanding for being a caring service, and the majority of feedback from patients about their individual experiences was favourable. However, it was also deemed to require improvement for its emergency operations centres, emergency and urgent care, and patient transport services, on which my hon. Friend focused.

I am sure my hon. Friend will be pleased to know that we are undertaking a range of initiatives to meet these challenges. Sir Bruce Keogh’s review of the NHS urgent and emergency care system is tackling the root causes of demand. Under that review, ambulance services will be transformed into mobile treatment centres. As a result of significant advances in technology in recent years, an ambulance presenting at a patient’s home, or to wherever it is called to treat them, is in a far better position to provide more care without, in many cases, the need to transfer them to hospital. There is greater use at the front end of “hear and treat”, which closes calls with advice over the phone, and “see and treat”, which treats patients on the scene without onward conveyance. This is all happening as a result of the greater integration with the rest of the health system that my hon. Friend called for. The CQC recognised the trust as one of the highest performing in England on “hear and treat”, which enables clinicians to assess and triage patients over the telephone and close the call without the need to send an ambulance.

As part of the wider review, under the ambulance response programme that my hon. Friend mentioned, NHS England is exploring ways in which to change responses to 999 calls by the ambulance service to help improve patient outcomes and help ambulance services better to manage demand. The first element of the ARP is “dispatch on disposition”, which was first piloted in London and in my hon. Friend’s local trust area in the south-west. “Dispatch on disposition” gives call handlers more time to make a clinical assessment of 999 calls that are not immediately life threatening, ensuring that the most appropriate response, based on clinical need, is sent to each incident first time. Early analysis shows benefits for patients from “dispatch on disposition”, and I have recently accepted advice from NHS England to extend this pilot to all trusts to help inform the independent evaluation.

My hon. Friend focused much of his speech on his, I think, personal aversion to targets, and on some of the perverse consequences that can arise. Under the second phase of the programme, we are piloting new clinical codes in ambulance services in Yorkshire, the west midlands and the south-west. The codes are used by ambulance services to determine the appropriate response for each emergency call they receive. The trial seeks to ensure clinically appropriate responses to each presenting condition while making the best use of our ambulance resources.

The programme has clinical leadership at its heart and will be independently evaluated by the School of Health and Related Research at the University of Sheffield, which my hon. Friend acknowledged. The evaluation report will be laid before Parliament once the Secretary of State has made a decision on whether any changes are needed to the ambulance standards. The most seriously ill patients will continue to receive an eight-minute response under the programme, and a pre-triage system is being used to ensure that life-threatening cases are identified quickly and efficiently. Good progress continues to be made with the programme and NHS England will make recommendations to Ministers in due course.

[Richard Drax]

My hon. Friend is very generous in giving way, especially after I had so much time. I have just one question. Yes, my natural instinct is against targets; I do not like them, but I understand why we have to have them. When ambulance trusts or hospitals are fined for not meeting targets, would it not be more logical to look into the reason why and ask the executives, whoever they may be, to sort it out? If they cannot do so, can we then sack them? If the conclusion is that it is a matter of giving more money to help towards achieving the target, obviously it should be given.

[Mr Dunne]

My hon. Friend will be aware that the clinical commissioning groups around the country commission services from ambulance trusts. I am sure he will have looked into the experience of the CCG in his constituency to see whether it believes it is getting the service that his constituents and its patients require. I can speak for my area, where a change to the disposition of response vehicles, particularly ambulances, was proposed by the ambulance service. A trial period took place, and the CCG was persuaded that it needed to provide more money to the ambulance service to fund additional crews to improve coverage. It is specific to individual areas, but CCGs need to work with ambulance trusts to ensure that the relevant standards are achieved.

The South Western Ambulance Service established an action plan in response to the CQC report to identify activities to improve its performance and demonstrate the benefits of the ARP, including addressing staffing and fleet requirements, and working with A&E departments in hospitals to which it conveys.

My hon. Friend made some startling observations about the challenges and consequences of extended handover times, and his examples were instructive. It is clearly a problem when ambulance crews are unable to discharge their patients into emergency departments as efficiently as they would like. NHS Improvement is working with local commissioners and trusts to tackle those problems, including handover delays, when they present a continuing problem. The amount of time lost to handover delays at hospitals is a significant concern in the south-west service, as he indicated. He mentioned an aggregate figure. The figure I have is that, on average, 60 hours per day were lost to handover delays in August 2016. In July, a regional workshop was run by NHS England and the Emergency Care Improvement Programme, attended by the South Western Ambulance Service, acute providers and commissioners. A set of actions to address handover delays were agreed upon and a plan to implement them is being developed. Hopefully he will see the benefit of that shortly.

We recognise that there is currently a shortage of paramedics nationally. As my hon. Friend mentioned, the south-west area is no exception. A number of initiatives are being implemented to address that, from recruitment campaigns for ambulance staff and paramedics, to training schemes to upskill the existing workforce. In the CQC report, it found that South Western Ambulance Service has an appropriate mix of skills to provide a safe service, and that, where staff numbers are below planned levels, the trust is making good efforts to recruit new staff.

At the end of September, there were 1,568 ambulance paramedics at the South Western Ambulance Service, almost double the number of ambulance paramedics there in 2010. That is an impressive achievement, but there remains a vacancy rate at the trust of just over 3%, equivalent to 134 members of full-time staff. Health Education England is working with the College of Paramedics and has invested more than £2 million in a two-year paramedic pre-degree pilot, through which potential paramedic students are recruited into roles providing structured care in urgent and emergency care settings. Health Education England is also providing funding to ambulance services to invest in their existing workforce, train ambulance technicians to become paramedics, and upskill paramedics to advanced or specialist paramedic level.

In the south-west, Health Education England has provided £350,000 in funding to help retain staff so that they stay longer than my hon. Friend indicated they have in the past, and to improve engagement and provide the opportunity to train with the very latest equipment. I am pleased to note that 100% of the trust’s rapid response vehicles and dual-crew ambulances are funded to have a paramedic on board. In the six months to May 2016 there was, on average, a paramedic on almost 92% of all A&E conveying vehicles. The service is approaching the level for which it is funded, and I hope those initiatives ensure that there are sufficient paramedics to hit that 100% target.

In addition, to help to reduce system pressures, NHS England is undertaking a public information campaign about urgent care services. My hon. Friend urged us to do that to encourage the public to present at the right place and do the right thing. In particular, he referred to the use of NHS 111 as a front door to the integrated urgent care system to help improve its credibility as the place to get initial advice, rather than people dialling 999.

To conclude, I again emphasise that ambulance services are vital to emergency care and the NHS as a whole. We all want to be sure that, where loved ones suffer heart attacks or are involved in a serious accident, they will not be left waiting for medical help to arrive. The initiatives being taken in response to the record demand facing the urgent and emergency care system will ensure that patients continue to receive the quality care that they need.

My hon. Friend concluded his remarks by asking for a new approach to the integration of NHS services, to which I would add the integration of NHS services with social care services. He could have been describing the sustainability and transformation plans that are currently being finalised by health areas across the country for presentation to NHS England by the end of this week. They are bottom-up plans prepared by clinicians and senior management within NHS organisations alongside local authority organisations responsible for social care, which is precisely what my hon. Friend called for. I am pleased to say that, under this Government, that is being delivered.

Question put and agreed to.

Shipbuilding on the Clyde

Debate between Philip Dunne and Richard Drax

Monday 25th April 2016 Commons Chamber

[Mr Dunne]

I am grateful to the right hon. Gentleman for focusing his question on that important subject, and I agree that the workforce on the Clyde are highly skilled; indeed, I make a point of meeting the trade union representatives of shipbuilders on the Clyde, and I did so last month. The short answer to his question is yes. The five offshore patrol vessels—three of which are in build, and two of which we added as part of the SDSR—do provide continuity between the Type 45s and the aircraft carrier blocks, as they finish being produced on the Clyde, and the beginning of work on the Type 26s.

[Richard Drax (South Dorset) (Con)]

I welcome the news of the new-build ships. We still do not have enough, but we are going in the right direction. May I ask that no HM ships currently serving be withdrawn before and until any new ship is built and commissioned?

[Mr Dunne]

I think my hon. Friend is referring to the Type 23 class of frigates. The Royal Navy’s intention is that the new vessels replace Type 23s on a like-for-like basis as they come out of service.

Oral Answers to Questions

Debate between Philip Dunne and Richard Drax

Monday 25th February 2013 Commons Chamber

[Richard Drax (South Dorset) (Con)]

T4. I understand that it costs about £14 million a year for HMS Bulwark’s sister ship, HMS Albion, to sit in Portsmouth doing not very much. Given the Prime Minister’s new-found enthusiasm for spending on our armed services, may I suggest that some of the money be used to put this wonderful ship to sea—if for no other reason than to help the Department for International Development?

[Mr Dunne]

The Prime Minister has always been enthusiastic in his support for defence, but as my hon. Friend knows, in October 2010, as part of SDSR 2010, we outlined plans to place one of our two landing platform dock vessels at extended readiness, while holding the other at high readiness for operations. HMS Albion entered a period of extended readiness in late 2011, and according to current plans will remain at Her Majesty’s naval base Devonport until her upkeep is completed in 2016. At that point, HMS Bulwark will go into extended readiness and HMS Albion will be placed at high readiness for operations.