Oral Answers to Questions

Philippa Whitford Excerpts

Tuesday 11th October 2016 Commons Chamber

[Mr Dunne]

I can reassure my hon. Friend that there is considerable excess demand from UK-based students to train to become a clinician in this country—only half of those who apply to train in medical school are accepted at present—so we are confident that there will be plenty of take-up for those extra places. With regard to clinical placements, we are in discussions with universities, colleges and teaching hospitals to ensure that there are adequate numbers of places.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I welcome the 25% expansion in medical student places, but I reject tying that to the elimination of 25% of overseas doctors who currently work in our NHS. With 10% of posts unfilled and ever-rising patient demand, the Secretary of State must know that we will always need international graduates in the future. Does he not recognise that he is creating unrealistic expectations and conflict with this idea of a British-only medical service?

[Mr Dunne]

I am grateful to the hon. Lady for giving me the opportunity to set the record straight and stop this scaremongering, which is undoubtedly unsettling many of the very valuable doctors, nurses and other foreign nationals who are currently providing vital services to the NHS. Last week’s announcement was about adding more doctors to be trained who are UK-based. We are not changing any of the present arrangements for international students being trained here, or doctors and nurses working here.

[Dr Whitford]

The Government might not be changing their position right now, but with one in 10 posts currently unfilled, and given the rhetoric used last week, how does the Minister expect us even to retain foreign doctors, let alone attract them to fill those posts?

[Mr Dunne]

There was no rhetoric used. In making that announcement, my right hon. Friend the Prime Minister used no rhetoric whatsoever regarding the very valuable contribution of foreign clinicians to our health service, and that remains the case.

NHS Sustainability and Transformation Plans

Philippa Whitford Excerpts

Wednesday 14th September 2016 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I am sorry that this is such an acrimonious debate. I welcome the principle of the sustainability and transformation plans, as they are a key opportunity to reverse fragmentation and to reintegrate the NHS, but we have to get it right. To turn this whole matter into just a game of moving the deckchairs on the Titanic is something that we would all regret in a few years’ time. We are talking about a place-based approach, which is very similar to what we have in Scotland. I absolutely welcome it, but the places must be right—they need to cover the whole population and the geography must make sense. That is in the relationships of the organisations that are there, but we have to think of things such as public transport. There is no point plonking a community in an STP if there are no connections to it. How these places are designed is really important, as are the partners that are in them. All of this should be about integration and re-integration from acute care through to primary care and local authority care. We need single pathways and wrap-around patient-centred care.

[Andrew Gwynne]

I have some sympathy with what the hon. Lady is saying. Does she agree that that integration will not happen if any one part of those partnerships is severely underfunded? For example, she mentions local authorities. Many of the pressures in the NHS today are solely as a result of the severe underfunding of adult social care. Do we not need to ensure that the finances are in place for these STPs to work?

[Dr Whitford]

I totally agree with the hon. Gentleman. I was about to come on to that. However, it is not just the funding, but the entire model. The tariff model that we have at the moment rewards hospitals for doing more minor things, and punishes them for doing more acute things. Taking on more A&E cases and more complex cases, working harder and doing more make their deficits grow. Our problem is that we have all sorts of perverse incentives in the system that mean that organisations will still be looking out for their budgets and their survival instead of working together.

In Scotland, we got rid of hospital trusts and primary care trusts, and, since 2014, we have had integrated joint boards. Those boards were handed joint funding that came from health and the local authority, which meant that the whole business of “your purse or my purse” disappeared. They were then able to start to look at the patient’s journey and the best way to make the pathway smooth. That is what we want to see.

Having a shared vision of where we are trying to go to is crucial. That means that stakeholders—both the people who work in the NHS and the people who use it—need to believe in where we are trying to get to. Public conversations and public involvement are the way forward. We should not be consulting on something that has already been signed off, but involving people in what they would like the plans to be, as that would make those plans much stronger.

We need to make deep-seated changes to the system, as opposed to only talking about the money for the deficits. This is something that the Health Committee has been talking about for ages. The phrase “sustainability” has become shorthand for paying off the deficit. Of the £2.1 billion earmarked for sustainability and transformation, £1.8 billion is for deficits, which leaves only £300 million to change an entire system. I know that we talk about money a lot in here, and of course it is important, but we have far bigger sustainability issues than the £2.5 billion deficit in the NHS. We have an ageing population, and those people are carrying more and more chronic illnesses, which means that we have more demand, more complexity and more complications. That is one of the things that is pushing the NHS to fall over. On the other side of that, we have a shortage in our workforce; we do not have enough nurses or doctors, and that includes specialists, consultants, A&E and particularly general practitioners. Although the advice has been very much that finances were third, and prevention and quality of care were meant to come first and second in delivering the five year forward view, finances seem to be trumping everything else.

It is absolutely correct that health is no longer buildings; there are lots of methods of health that are bringing care closer to patients, and also some things that are taking patients further away from their homes. We have hyper-acute stroke units, and we have urgent cardiac units, where they will get an angiogram and an angioplasty that will prevent heart failure in the future. However, we cannot start this process there; we cannot shut hospitals and units to free up money to do better things. We have to actually go for the transformation and do the better things first. We have to design the service around the pathways we need—that wrap-around care for patients—and then work backwards. If more health and treatment is coming closer to the patient, at some point they will say, “Actually, I don’t go to the hospital very often. I want the hospital to have everything it needs when I need it.” Then we can look at the estate to see whether we have the right size of units and the right type of units in the right place. What concerns me is that the process we have seems to be the other way around—we are starting with hospitals, which is often a very expensive thing to do, and hoping it will deliver everything else.

[Norman Lamb]

rose—

[Dr Whitford]

I give way to Norman.

[Norman Lamb]

I am grateful to the hon. Lady for giving way, even if she used my first name. Does she share my concern that, out of the original sum allocated for this sustainability and transformation process, the vast bulk appears to be going, in effect, to propping up acute trusts that face substantial deficits, and that little is available for transformation?

[Dr Whitford]

As I said, the proposals leave only £300 million. We cannot transform a system on the scale that is being considered with £300 million.

As I said, the guidance talks about prevention. We need to be tackling health inequalities. We need to be focusing on health and wellbeing—and by that I do mean physical and mental wellbeing. We need to be strengthening public health—something else that has been cut. We need to be looking at the quality of health and care, and that means right across into social care. We must fund social care, because it can make a difference to things like delayed discharges. We are not even three years into the integration in Scotland—we are only two and a half years into it—but delayed discharges have dropped 9%. Yet, the last time the Secretary of State was in the Health Committee, they had gone up 32% in NHS England. So literally just moving things around and allowing one part of the system to fail will mean that the entire system fails.

[Dr Murrison]

I always listen with great care to what the hon. Lady has to say, and I agree with a great deal of it. Does she agree that part of the problem in England in relation to delayed discharges has been that we have seen a retrenchment of community hospitals and their beds, which have provided step-up, step-down care—intermediate care beds. Unfortunately, they are no longer available, which means inevitably that hospital discharges are delayed, with all the distress that causes.

[Dr Whitford]

I totally agree with the hon. Gentleman. I think it is about care in the home for those who are able to have that and convalescence for those who require it; that, basically, is the step up, step down. In my health board in Ayrshire and Arran, we have rebuilt the three cottage hospitals. They are now modern, state-of-the-art, small units. That means that our population has less far to travel and that older people will not, in the end, need to come to hospital. Now, we are still in that transition; those units are not doing everything they have the potential for—indeed, we are a rural population. However, certainly in Scotland, there is much more recognition that we need intermediate care between people being at home and being looked after by their GP, and people ending up in a very expensive acute unit. It is not just about finance; any Member who has been in hospital knows they do not want to be there, and nor do our elderly population. These levels of care are therefore crucial, and it is important that that grows out of the STPs. I see that as a crucial opportunity for the NHS, which cannot be missed.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Does the hon. Lady agree that there is a startling fact about the underfunding of social care that Ministers cannot get away from, whatever they do or say? We have heard today of the case of care workers who are suing the contractor that they work for because they were paid only £3.27 an hour. How can somebody be discharged from hospital in an adequate way when that is the domiciliary care that will be waiting for them? It was interesting to hear the former care Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), say this morning that

“we have not got the cost of…adult social care really sorted out.”

[Dr Whitford]

I totally agree with the hon. Lady. I am not sure whether she took part in the carers debate that we had not that long ago, where I pointed out that unless we develop social care as a profession, then we all face a fairly miserable time in our old age. Nursing is a profession that is recognised and valued, and caring for our older ill population should also be recognised. We need to recognise them, to give them time to do their jobs, to pay them adequately, and to give them a career development structure that means that we bring the best people up and get them running teams.

As I said, I am disappointed by the aggression on both sides of the House. I know that such a debate is always a good tennis match for point-scoring, but the development of the STPs is an opportunity to do things that everyone in this House would agree with. However, if it is not done properly—if it is just a fig leaf whereby we pretend that something is being done—the NHS will suffer and we will be the generation of politicians who moved the deckchairs on the Titanic.

--- Later in debate ---

[Dr Wollaston]

I thank the hon. Gentleman for his intervention. As I said, the plans that are produced at the end of the day will be better if we involve those who are using the services and those providing them, as well as those commissioning them, as we go along, rather than present a plan, even if it is a draft, as a fait accompli, because then it becomes a binary choice rather than one where people can make suggestions to improve the plans as they develop.

[Dr Philippa Whitford]

I know that Scotland is a lot easier to get around in population terms, although size and transport are not always that easy, but one of the mechanisms that the Scottish Government use when developing strategies is what they call the national conversation, whereby the ministerial team literally go walkabout and have meetings to hear from people directly before anything goes on paper.

[Dr Wollaston]

If we get too caught up in the process of consultation, we will not address the other serious hurdles in the way of STPs achieving their aims, chief among which is the issue of finance. The NHS is now in its seventh year of a historic level of austerity, and the average of a 1.1% annual uplift in funding for the NHS over the past six years represents an extraordinary challenge in the context of increasing demand. It is good that we are living longer, but we are doing so with much more complex conditions, and the treatments available to tackle them are more expensive. We need to be clear that, because of that, and even though the settlement for health has undoubtedly been generous in relation to other Departments, a significant gap is opening up in health, and the situation is even worse in social care.

Figures from the Association of Directors of Adult Social Services show that 400,000 fewer people are in receipt of social care packages in 2015-16 than there were in 2009-10, and not only are fewer people receiving social care packages, but those packages are smaller. Many STPs are about transferring care into the community. We need to make sure not only that the funding is available to provide those social care packages, but that we have the workforce to deliver them. The proposal in the area that I represent is to close two community hospitals that are used by my constituents. As a former rural general practitioner, I know just how important those facilities are to local people. They are special to them not only because of the step-up, step-down care that they provide and to which the hon. Lady has referred, but because these are the places that more people like to be at the end of their lives. They provide personal care and allow people, particularly those in rural areas who are doubly disadvantaged by not being able to travel to larger local centres, the opportunity to be treated closer to home.

--- Later in debate ---

[Richard Fuller (Bedford) (Con)]

Change in life is frequently a source of anxiety or downright scary. When people are young and change schools, when they get married or when they start a job, that change is scary. There is nothing scarier for a community than change in how its health services are provided, so perhaps it is not surprising that the NHS has found managing change to be one of the most profoundly difficult things to accomplish.

As the hon. Member for Central Ayrshire (Dr Whitford) mentioned, we frequently face substantial or overwhelming challenges in society, with people growing older and having more complex needs, and the requirement for more expensive equipment and supplies to meet ever increasing standards for and expectations of healthcare in our country. The NHS was presented with two options for change. One is radical and will meet those challenges in a fine future that offers great health outcomes for all, but sounds a little too scary. The other option is the incremental approach, which will move things along a little bit. It will not deal with the fundamentals but it will enable us to feel that we retain the institutions and structures with which we are familiar.

As someone who was born in Bedford hospital, grew up in Bedford and now represents Bedford, I am very familiar with each of the buildings and institutions in my community. To see them change is a very scary thing. When we consider processes of change, we have to recognise that the population start from that position of anxiety. It is therefore important that Members do not play on those anxieties. It is not effective opposition to create scare stories ahead of an outcome. That is not in the public interest. We can raise concerns, yes, but in a way that looks to the sensitivities of local situations. That is what I would like to focus on in my remarks: the specific circumstances of my part of the country.

I welcome the STP approach because of the integration of care with health and because it provides local authorities with a voice, for the first time, in decision making about local care choices. For the first time, the NHS will not be getting its own way, if this process lives up to the promise of local decision making. That will be helpful in getting local support and control. In my own locality, we have a cross-party community approach. We have a Liberal Democrat mayor, a Liberal-Labour group on the council and Conservative Members of Parliament. We are all united in an approach of wanting our voice heard on local care in the NHS. An STP is a way of us having that.

[Dr Philippa Whitford]

Would it not therefore have been more effective, particularly if there is cross-party working in the local authority, to have local consultation early on about what could be gained in exchange for what might be felt to be lost?

[Richard Fuller]

I very much appreciate the hon. Lady’s question, because it gets to my point. I am actually quite sceptical about what consultation means. She might not know that Bedford has been through a review process for our acute services. I was trying to measure the length of that process in terms of Members of Parliament for Corby: it preceded Louise Mensch becoming Member of Parliament, carried on through the whole period of Andy Sawford being Member of Parliament, and is now taking up the time of my hon. Friend the Member for Corby (Tom Pursglove). We do not involve Corby any more; it is now just Bedford and Milton Keynes. That process included consultation and participation, with the NHS saying that it wanted to listen to people. It consulted them, yes. Did it listen to them? No. It was the NHS’s own process. It ticked all the boxes, but it was a complete and utter disgrace to local accountability.

I do not have distrust of Pauline Philip, chief executive officer and leader of our STP, and I do not need to know everything. I want to know that our local authorities are having their voice heard in the process just as much as our local CCG, as they are our representatives. I feel relatively comfortable that the process will lead to options that are more acceptable to the population, because it involves local authorities as well as the NHS. We should, however, expect the outcomes of the process to be highly varied around the country. Some will be correct and acceptable, and will go forward. Others will be controversial, and others will be downright wrong. We should not curse this whole process across the country, because it achieves a difference in outcome in different parts of the country. We should be prepared to look at each on its own merits and judge them accordingly.

--- Later in debate ---

[Kwasi Kwarteng (Spelthorne) (Con)]

It is a great honour to be able to speak in this important debate. We have heard some very interesting contributions, and some contributions which were, perhaps, less constructive. I will not state publicly which are which, but I would like to take up what was said by the right hon. Member for Newcastle upon Tyne East (Mr Brown), who spoke of Labour’s commitment to meeting the OECD’s health spending average in 2001.

I think it perfectly acceptable, in a discussion of this kind, to point out that in 2001 the Labour Government had succeeded in running a balanced budget for four years, more or less, and we thought at the time that we had the money to meet that commitment. Having been a member of the Labour Government, the right hon. Gentleman will recall that over the next nine or 10 years we ran consecutive deficits, and as a consequence of policy that I happen to believe was misguided in many instances we had a deficit of £160 billion when the coalition Government took office in 2010. Given the circumstances, it was inevitable that there would be a constraint on finance, and that is something that we have to speak about.

If I recall correctly, the hon. Member for Central Ayrshire (Dr Whitford), whose speech I enjoyed very much, said that we kept talking about finance, and that it should be the third consideration. I wish it were as easy as that—I wish we could relegate finance to a subordinate, back-burner role—but I do not think that that would be fair to the country, or to our constituents.

[Dr Philippa Whitford]

Will the hon. Gentleman give way?

[Kwasi Kwarteng]

Forgive me; I cannot. The debate is very constrained now, in terms of time.

The right hon. Gentleman talked, obviously, about the budget constraints, but he also talked about the fact that we were not spending enough money. I think that the STPs present the opportunity for a serious engagement with what all Members recognise is an ongoing problem. We have a growing population and an ageing population, and inevitably, whether we like it or not, issues of finance and resources will become increasingly important.

I am pleased to learn that local consultation will be at the centre of the draft proposal, because that is essential, and it is what our constituents want. There are two hospitals in my area; one is just outside my constituency but many of my constituents go to it, while Ashford hospital is in the centre of Spelthorne. A number of the facilities have been downgraded—it has been a difficult time—but the borough council and I, as the local Member of Parliament, always tried to explain to residents what was driving the decisions and the changes that we sought to make, and they were broadly very understanding. I think that people throughout the country are very sensible when we explain to them and carry them with us, and that they take a measured view of health services. They realise that the old NHS of Nye Bevan and 1948 has had to evolve. I believe that they are much more open to evolution and change than many Members of Parliament.

The last point that I want to make is slightly negative. I have attended many debates of this kind—not necessarily on the health service, but on the economy and welfare—and all that I hear from Labour Members is the same old mantra: “Stop the cuts, more money.” That seems to be their sole solution to every single problem that we face as a country. It is said that to a man with a hammer, every problem is a nail. Labour Members seem to think that “Stop the cuts, more money” is the answer to everything, and I consider that entirely unconstructive. I find it very disappointing to hear no constructive ideas and no proposals for reform, and to observe no appetite for fresh thinking and absolutely nothing in the way of intellectual engagement with the real problems that we face as a nation. I find it very disappointing to take part in yet another debate and hear the same old mantra: “Stop the cuts, more money.”

Junior Doctors: Industrial Action

Philippa Whitford Excerpts

Monday 5th September 2016 Commons Chamber

[Mr Hunt]

As ever, my right hon. and learned Friend speaks incredibly wisely. Actually, his last comment goes to the nub of why this is totally extraordinary, unprecedented and completely unacceptable. It is true that the junior doctors have rejected the agreement that was reached in May in a ballot, and we have to accept that. There are all sorts of reasons why that might have happened, but the choice to escalate the industrial action and to call the worst strike in NHS history was made not by those junior doctors but by the BMA leaders. They made that decision about a contract that they themselves had described as being good and safer for doctors and patients only in May. How can they justify that? Is there not perhaps a desire to pick a very big fight?

We were making good progress over the summer in a whole series of dialogues in different areas to try to resolve some of the non-contractual issues that the junior doctors are worried about, but this action makes it virtually impossible to continue that progress, although we will try very hard to do so. My right hon. and learned Friend is absolutely right to say that this is completely unacceptable and damaging for patients. I am afraid that I am having to go through some of the very same battles that he had to go through when he was Health Secretary.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I know how difficult it will be for junior doctors to take part in the strikes that have been described, and I personally am really sad that we have come to this point. Does the Secretary of State recognise the anger and desperation among the junior doctors that have led us to this point? In my mailbag from junior doctors, two things stand out. One is that the threat of imposition was there right from the word go last summer, and it therefore felt like a threat rather than a negotiation. The other involves the misuse of numerical statistical data by translating it into a claim that it refers to avoidable deaths at weekends, even though there has been no evidence of avoidable deaths. The Secretary of State has not commissioned a review of cases that might show how many of those deaths were avoidable and whether a lack of junior doctors contributed to them. The real danger in the NHS at the moment is rota gaps. Doctors are being asked to do double shifts or to carry two pagers, which means that where there should be two doctors covering an area or a service, there is only one. That is a real, palpable danger right now.

The Secretary of State has said that he would employ extra junior doctors rather than spreading the same number more thinly, but where does he plan to get them from when we cannot even fill the existing posts? I welcome the focus on the four clinical standards that boil down to greater senior doctor review and access to diagnostics, but does he not think that we might have got further if we had started at that point last summer? He calls for a turn away from strikes and for getting around the table to co-operate and discuss these matters, so when is he going to meet the junior doctors to try to avert these strikes?

[Mr Hunt]

The hon. Lady is a doctor, and I would simply say to her, as I said to the shadow Health Secretary, that she needs to justify the claims that she constantly makes in this Chamber about a misuse of statistics. I have been very clear about when we can actually statistically say that a death is avoidable. The studies demonstrate clearly that a higher number of people are dying from weekend admissions than we would expect. What this Government will not do is sit and ignore those numbers, which are backed up in study after study. I think that we are doing the right thing, and as a doctor she should recognise that.

The hon. Lady has said time after time over the past year that the Government should lift the plans to impose the contract and get around the table and negotiate. She could today have given the Government credit for doing exactly that in May when we thought there was an opportunity to do a deal. We lifted the imposition of the contract and got around the table to negotiate a deal that turned out to be good for both sides. Having done that, the problem is that the same people with whom we negotiated the deal have decided to call the most extreme strike in NHS history, which is unacceptable.

Rota gaps are a real problem that we are trying to address by, first, ensuring that systems are in place for junior doctors to blow the whistle if they think that such gaps are unsafe for patients. That is why we have introduced guardians of safe working, and we are committed to that. Secondly, we want to ensure that there are people to fill those rota gaps by training more doctors. We are training 11,420 more doctors in this Parliament than in the previous and already have around 9,000 more doctors than in 2010. As a doctor, those are things that the hon. Lady should recognise.

Capsticks Report and NHS Whistleblowing

Philippa Whitford Excerpts

Wednesday 13th July 2016 Westminster Hall

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Unfortunately, this has been a repeating story since Bristol Royal Infirmary in the mid-’90s when Stephen Bolsin, the anaesthetist who raised that issue of poor survival of children having cardiac surgery, ended up in Australia. That has been a repeating theme. Regardless of the GMC telling us that it is our duty to step forward, whoever steps forward is always the one who is suspended or loses their job or suffers detriment in some way.

There are a lot of common themes when we look at Morecambe Bay, Mid Staffs and this case. In some of them, there has been the issue of trying to obtain trust status and going for cost savings. As the hon. Member for West Lancashire (Rosie Cooper) said, we have management chasing one goal while staff should be chasing a different goal: clinical quality. We see the stories of bullying and gagging and we see a coalface under pressure, with things going wrong and, if someone whistleblows, inevitably we hear of detriment: destruction to their reputation and perhaps loss of their job.

In an ideal situation we would rarely ever need to have a whistleblower. We need clinical audit, which audits not just the money but the quality of performance to give quality assurance. At one time here in England we had the Commission for Health Improvement, but that was got rid of back in 2004. When NHS Improvement came out, I thought that was like what we have in Scotland, which is called Healthcare Improvement Scotland, which we have had under one name or another since 2000. However, NHS Improvement just looks at the money, so we still have this business that the money is trumping the quality assurance.

That audit needs to be seen and problems need to be put right as soon as they are reported. Complaints should be seen as something that are used and looked at in every directorate meeting, which is something we do locally in my trust. Datix, which is used north and south of the border, is a way of trying to lower that barrier and to get people used to reporting every routine misstep, whether minor or major, bringing down the barriers to doing that and getting rid of any sense of hierarchy.

From our patient safety initiative in Scotland, we do things like using first names in theatre to try to get rid of that “fear of the prof” or fear of the consultant, so that an orderly who notices something going wrong feels able to speak up and say, “That is the wrong leg. I think we should check the paperwork again.” Once we get into a situation of having things going wrong, we need to enable any member of the team to easily draw attention to it. Traditional in surgery—this will be UK-wide—are morbidity and mortality meetings in which the whole unit will review any death or significant morbidity. That does not tend to exist in other specialties but it ought to—we ought to have it for every stillbirth and for deaths in other specialties. Maybe then we would know exactly how many deaths or major detriments were avoidable. That cannot be done with stats—we have to look at the cases. One of the things I set up in my unit was something we called, to make it easier for everyone, the difficult case review. Any team member—it did not matter who—could put a name in the book for the next difficult case meeting so that that case would be looked at.

Whistleblowers need internal support so they can go and not suffer detriment. We have had the Francis report and we have the freedom to speak up, and I commend the Government for setting up the national guardian system—we are doing something very similar—but what comes back from whistleblowers I meet is they are concerned that the person who has been appointed is an NHS manager. We have to have someone who is utterly outside the system. Most of all, we need to change the culture that is close to the frontline. Management must have clinical governance responsibility, not just financial governance responsibility, so that staff get used to raising issues that are then dealt with, learned from and changed, and that management see that as part of their role.

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[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

It is a great pleasure to respond to this debate that you are chairing, Mrs Main. I echo the compliments paid by the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), to the hon. Member for West Lancashire (Rosie Cooper). The hon. Lady has been very brave in pursuing this cause, which she has taken up on behalf of her constituents. I agree that it is striking that this matter would not have come to the fore had she not had very sad and unfortunate personal experience of the failure of care at Liverpool Community Health. I thank her for her persistence in the face of opposition, not just from the usual quarters but from places that might not have been considered to be inimical to a Labour party Member. That is why I particularly commend her for what she has done and for continuing to fight the cause for her constituents. It is absolutely true that as a result of what she has taken up on their behalf, the care being provided is now safer than it would otherwise have been. Sometimes we need to remind ourselves that doing this job is worth while, and she has done that in great measure for herself and other Members of Parliament.

I would like first to offer an apology. It is right that the Government recognise it when things go wrong even if they are not within the direct control of Ministers. Everything in the NHS is the responsibility ultimately of the Secretary of State and of the ministerial team, and I am sorry that the NHS in this instance let down the hon. Lady’s constituents. At the same time as saying that, I hope that she and other hon. Members recognise that it is partly through the measures put in place by the previous Government that we have been able to flush out some of the problems that she identified. It was a Care Quality Commission inspection, under the new regime, that really began to unearth the problems in LCH, and it has been the tougher management of failing trusts that has meant we have been able to bring reform to this trust quickly. Not all is perfect; not everything is right in terms of the CQC or of the Trust Development Authority or its new iteration, but we are a great deal further forward now than we would have been five years ago. To be completely fair, we would have been further forward five years ago than we would have been 10 years before that. We are on a journey, and I appreciate the collegiate atmosphere that has been created in this debate and elsewhere.

I will answer the specific points and questions, because I do not want to reiterate the excellent exposition given by the hon. Member for West Lancashire. She asks who polices HR departments. The simple answer is that the Care Quality Commission, in its well led domain, as it looks at organisations will continue to look at the quality of leadership within an organisation. I will talk in a second about the kinds of thing that I think it should be looking for in the new round of inspections that it will begin in due course.

The hon. Lady asks about the fit and proper persons test. As it is currently constructed, it is for boards to be judging people by the fit and proper persons test. That is the way I think it should be, and there is consensus on that, but clearly those boards need to be properly constituted and know what they are doing. I think that that gets to the crux of what she is saying.

To answer the point made by the hon. Member for Ellesmere Port and Neston about training for non-executive directors, that is, funnily enough, something we are actively looking at to try to improve the quality of boards precisely so that they can ask the questions that are needed, not just in terms of a fit and proper persons test but in order to hold their executive directors fully to account.

The hon. Member for West Lancashire asks about the need for a review, and I know that that is the main purpose of bringing this matter to the attention of the House. I have commissioned NHS Improvement to do a review or at least to ensure that a review happens. As she will be aware, there has been some discussion about the terms of reference for that. I know that Jim Mackey has talked to her about it; she is in communication with him. I, too, am in communication with Jim and I hope that in the course of the next few weeks I or my successor will ensure that that review is as robust as it needs to be. The hon. Lady knows my view on that, which is that I do not want something excessively expensive and excessively long, because that will serve no one’s interests. We need to get the balance right, so that it is timely and good value for money and we are not taking money out of the NHS that would be better spent on her constituents’ care. If we can get to the root cause of these problems in a timely and efficient manner, that will serve her and her constituents well. I commit myself to ensuring that that happens quickly.

The hon. Lady asks about conflicts of interest. As it happens, NHS England is looking at precisely that at the moment. It is an area that we need to be much better in. However, I hope that as we see an evolving NHS, which is far more about collaborative working than the purist approach to competition that was the drive under the original foundation trust mechanism set up in the early 2000s, it will be less of a problem than she correctly anticipates it might be in this instance.

The hon. Member for Central Ayrshire (Dr Whitford) makes a number of important observations about her experience in Scotland, but I am afraid she is wrong on two points. NHS Improvement is not just interested in money; it is very firmly an improvement agency that deals with quality as well as financial performance. She will know that the two do go hand in hand. The best run trusts tend to be those that look after their money as well as their patients. We can see that relationship in the CQC inspections and their relationship with deficits. I suggest that she speak to the director of quality in NHS Improvement, Dr Mike Durkin, who was moved across from NHS England precisely so that NHS Improvement could become a true quality organisation. I am sure she will know him from the past. He is a globally respected expert in the issues of quality and institutional learning.

The hon. Lady is also wrong to say that the national guardian was an NHS manager. She is one of the leading chief nurses in the NHS, and I am sad that she felt unable to continue with that role. The hon. Lady will be pleased to know that her replacement, Dr Henrietta Hughes, is also a clinician—a practising general practitioner. It is very important that we give the right message to whistleblowers, and that is as much the case in Westminster Hall as it is outside in the public space.

[Dr Philippa Whitford]

The feedback that I have had from whistleblowers is that they see the new replacement national guardian as someone who is in an NHS manager role, and they feel that that is not sufficiently independent for the national guardian for whistleblowers. They are talking about the new guardian.

[Ben Gummer]

The new guardian is a practising GP and her office is deliberately set aside from the Department of Health; it is not part of our structures. The purpose of that is to ensure that the person is independent. I hope that that will give confidence to whistleblowers. I have asked her to make a decision on the helpline, because it is important that she makes that decision, not I, in the future.

Finally, I come to the questions asked by the shadow Minister. He talks about FT status. Much was right about the drive for foundation trusts, but a lot of things went wrong. We saw that at Mid Staffs and we have certainly seen it in this instance. I think that he will have noticed a far more considered approach to the FT pipeline in the past few years than previously. I know from experience of my own hospital, which failed to get FT status but is now a very good hospital, that the two do not necessarily correspond.

In all of this, we have to strike an important balance whereby we ensure that hospitals are performing while spending public money properly. The best hospitals and community care organisations do that by energising their staff, eradicating bullying and harassment and ensuring that people are free to speak up and exercise the duty of candour. That is why the thrust from the Department in the past 18 months to two years has been about living the values of the Francis inquiry. We have been putting that into practice in terms of the duty of candour, the whistleblowing apparatus that we have set up, and freedom to speak up.

We are at the beginning of a long journey. There is much to do to make the NHS the world’s largest learning organisation, but we have begun that process. I hope that the report that comes out—the further clinical review for the hon. Member for West Lancashire and her constituents—will be a further step on that journey, not just to correct and expose the failings in her area, but to ensure that the system as a whole, including the Department of Health, learns from them so that they are not repeated elsewhere and we continue to make the NHS the best healthcare organisation in the world.

Junior Doctors Contract

Philippa Whitford Excerpts

Wednesday 6th July 2016 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I, too, am disappointed by the outcome of the ballot yesterday. It has to be recognised that it reflects a real desperation and unhappiness among junior doctors, who are dealing with increased demand and pressure. They have felt that, at times, the tone of the negotiations has left a lot to be desired. The threat of imposition was there from the start, and they felt that hanging over them.

I welcome several things in the statement, and I absolutely welcome its very measured tone. I welcome the attempt to tackle the gender pay gap, to deal with unhappy foundationers and to limit hours. I would say that junior doctors’ biggest concern is rota gaps. In some specialties, the rate is as high as one in four, so one doctor covers the role of two. That is a real patient safety issue, and patient safety is meant to be the whole point of the contract. I welcome the fact that the contract will be phased in, and I call on the Secretary of State to ensure absolutely that, as this goes forward, he will learn, because junior doctors’ concern is about how we spread a short-staffed workforce across more days. I called for the contract to be phased in through a trial, and it is being phased in, but in a different way. We need to recognise the pain that the vote represents.

[Mr Hunt]

I thank the hon. Lady for her constructive comments, which are born of her NHS experience. She is right: we are phasing in the contract carefully to make sure that we learn lessons. She is absolutely right to talk about rota gaps. Unfortunately, the problem of rota gaps cannot be solved at a stroke on signing a contract; it has to do with making sure that we have a big enough supply of doctors in the NHS to fill those rota gaps. We now have much greater transparency about the safety levels that are appropriate in different hospitals; that is one of the lessons that we learned post Mid Staffs. We are investing more in the NHS in this Parliament. We recruited an extra 9,300 doctors in the last Parliament and we are increasing our investment in the NHS in this Parliament, so that we can continue to boost the doctor workforce in the NHS. In the long run, that is how we will deal with the rota gap issue; but unfortunately, that cannot be done overnight.

NHS Spending

Philippa Whitford Excerpts

Wednesday 6th July 2016 Commons Chamber

[Ms Abbott]

rose—

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

rose—

[Mr Hunt]

I will give way first to the shadow Health Secretary, then to the Scottish health spokesperson.

[Mr Hunt]

That is, perhaps, not a question for me as a Government Minister to answer, but I take the hon. Lady’s point. I give way to the hon. Member for Central Ayrshire (Dr Whitford).

[Dr Whitford]

My question has already been answered.

[Mr Hunt]

The point that many of us made in the referendum campaign is that even the net figure—the more like £100 million net contribution that we make to the EU—is not a figure that we can bank on with any certainty because, even if it did materialise after an exit from the EU, it would be negated by the very smallest of contractions in the economy, which would itself reduce the tax base and the amount of public spending available. The Institute for Fiscal Studies said that that £100 million a week would be negated by a contraction in the economy as small as 0.6%. I do not think any of the economic forecasts said that the contraction would be as small as that; all of them said that it would be much bigger than that.

--- Later in debate ---

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

God, the pressure.

We recognise that this figure of £350 million a week chimed with people in the country, because people are concerned about the funding of the NHS. The Secretary of State for Health talks about an extra £8 billion going forward, plus the additional £2 billion that was added to that, which was for bailing out massive debts. However, that is a change of description. Normally, funding is described as being for the Department of Health, but that is just NHS England. Public Health England and Health Education England were facing cuts of £3.5 billion. Therefore, the extra money going forward is only £4.5 billion. We have heard Members talk about their local trusts being in deficit. This is now so widespread, it cannot be blamed on management.

Despite the fact that the NHS somehow always managed to come out just in the black up to April 2013 and has been careering into the red ever since, the Secretary of State never seems to accept that this is to do with the Health and Social Care Act 2012 changes and the huge administration costs of outsourcing and fragmentation. The Secretary of State lays the blame for all this with agency staff.

Given the debate that we have just had on EU nationals working in this country, particularly in our public services, I have to say that we could be facing an absolute meltdown. We have 50,000 nurses and doctors from the EU in the NHS, and almost 80,000 careworkers. The Minister for Immigration hinted that those who have been here for over five years can stay, but that their benefits and rights may not be quite the same. So my husband, who is from Germany, can stay, but is his pension going to disappear? He has worked here for 30 years, but what protections will he no longer have? What about the people who have been here for less than five years—the high-flying researchers, academics or medics —who could go somewhere else? Do the Government really think that these people are just going to sit at home with their families until the last possible minute? No, we are going to lose them, and agency costs for nurses and doctors will go through the roof. For social careworkers, it will not matter: they do not earn over £35,000, so they are unlikely to get to stay, and we are unlikely to be able to replace to them.

As well as the fact that the £8 billion we always hear about is not actually £8 billion, we know that local government has faced huge cuts and, as was referred to earlier, that social care is where the real problem lies. The NHS money is just going to haemorrhage out the back door.

The £350 million a week figure that was painted on that bus was a disgrace. The shadow Health Secretary, the hon. Member for Hackney North and Stoke Newington (Ms Abbott), talked about it being an Eton game, but I think that it was an Eton mess. People were just playing with the facts. The rebate was not included. Public service payments, such as the common agricultural policy and regional funds, were not included. However, as the Secretary of State says, when we get down to the £110 million or so a week, that does not include all the other benefits that support the NHS and our economy. How much will it cost us to take part in Horizon 2020? How much does Switzerland have to pay to be part of this?

This is going to cost a lot of money. The Secretary of State said that it would take a 0.06% fall in GDP to negate the £100 million, but economists estimate that the fall will be between 1% and 3%. We do not want that to happen, but all the experts agreed that that was the likely outcome.

Like most people in Scotland, I absolutely believed in the remain campaign, but to me there was a poverty to the debate. Why are we having these two debates today instead of before 23 June? We had very little open discussion of the issues in this place. One of the problems is that we have never talked about anything good that we have got from the EU in the past 40 years. Of course, I have been lucky—I got my other half from the EU—but, to be honest, most of us have had many gains. We have cleaner air and cleaner water, and we have tackled acid rain. We have cleaner beaches. We have a single European medicines agency, so new drugs get to patients quicker. That agency is located here in London, but it is unlikely to remain here.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I always listen very carefully to what the hon. Lady says, but is she not being a little unfair on the United Kingdom? I seem to remember that the Clean Air Act 1956 set the bar for the European Union in the regulation of one of the areas that she has identified—namely, the cleanliness of the air that we breathe.

[Dr Whitford]

I was not on the planet in 1956, so I do not quite remember. We know from the recent cheating that there is a lot more work to be done on the control of car emissions, which cause a lot of ill health, but some of the progress in that area has come from EU regulation. Problems such as poor air quality and climate change cannot be dealt with by one country alone; we need to work together. In a health sense, we have had massive gains in the past 40 years, but politicians have never talked about that.

The EU has been a great whipping boy. All that the public have heard about the EU in the last 40 years is, “It wasnae my fault; the EU made me do it,” or stories about straight bananas. That is the responsibility of everyone who has had access to a microphone or spoken in this place about the EU. We should not be surprised that when people had the £350 million figure drummed into them by it being on that bus and on the news every night, they would fall for it. The mainstream media have a lot to answer for in not challenging these figures and not asking, “Exactly what is your plan? Exactly where is that money going to come from?” We should not blame people who want extra money for the NHS for wishfully accepting those claims, even when the cracks appeared around the edges.

Part of the problem has been the quality of the debate. Several of my colleagues warned people who believed in remain not just to go for a “Project Fear” type campaign, and I think that running such a campaign was a mistake. People think that “Project Fear” worked in Scotland, but in actual fact Better Together support started, as a percentage, in the mid-60s and fell to 55%. We started at 27%, and we ended up at 45%. “Project Armageddon” clawed back a little bit in the last two weeks, when we were told that the supermarkets would go and the banks would go, and that we would have no money and no food to buy, but a negative campaign of saying that the sky will fall does not lead to success.

[Mike Weir]

Does my hon. Friend agree that difference was that the yes campaign in Scotland came forward with a positive vision to combat “Project Fear”, but that was totally lacking in the EU referendum?

[Dr Whitford]

I thank my hon. Friend for that remark. If we had spent more time reminding people honestly of what the EU has brought us, which includes all the people who have been working in our health and social care services, we might have helped them to realise that we have been gainers, not losers.

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

The hon. Lady is absolutely right in the case that she is setting out. Is not part of the reason why people voted the way they did because they actually wanted to give additional money and resources to an NHS and social care system that has been badly starved of cash? That is particularly true of social care. People have seen their elderly relatives being unable to get the help, the aids and the adaptations that they need in the home, which piles pressure on to the NHS. They wanted the NHS to have that cash.

[Dr Whitford]

I totally agree. Of course, we all want the NHS to have more money. It is the United Kingdom’s single most prized possession and creation. The problem is that we did not counter the argument that it was struggling because people from the EU were taking up the appointments and the beds. EU nationals are much more likely to be looking after us than to be standing in front of us in the queue. There is an absolute responsibility on us all, particularly on the missing members of the leave campaign. This is very much a case of a big boy doing it and running away—very, very quickly.

[Andrea Jenkyns (Morley and Outwood) (Con)]

As somebody who was in the leave campaign, I think it is important that we remember that we worked across parties on it, whichever side we were on. In Yorkshire, I worked with colleagues from the Green party, the Labour party and UKIP, although I did not work with the SNP, obviously. It is the responsibility of both camps. I have seen “Project Fear” in both camps.

We need to move on from this now. It is pure economics. If we are pulling out of the EU, as the public have voted to do and as I am personally happy that we are doing, we must make sure that we start talking Britain up; otherwise we will talk ourselves into a recession. Members on both sides of the House need to pull together and talk Britain up. At the end of the day, both sides could have handled this better.

--- Later in debate ---

[Dr Whitford]

I totally agree. It is just that the paucity of the debate has allowed such an inaccurate figure to endure.

We are where we are. Going forward, we need to look at the realities and what the economy will allow. But there are challenges. I ask the Secretary of State to speak to his colleague in the Home Office and try to deal with the issue of EU nationals working in the NHS. The cost of replacing them with agency staff will be absolutely crippling.

Oral Answers to Questions

Philippa Whitford Excerpts

Tuesday 5th July 2016 Commons Chamber

[Ben Gummer]

The Home Secretary is well aware of the enormous contribution that EU nationals make to the NHS. We all have a duty to undo the damage done during the referendum campaign and the poisonous atmosphere that exists in some parts of our communities and to thank personally—I will be doing so myself—EU nationals working in the NHS for their hard work and dedication so that they feel valued by each and every one of us.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

There has been a 27% surge in trainee applications to NHS Scotland because of the conflict around the junior doctors contract in England, and now doctors and academics from the EU are not taking up posts here because of the Brexit vote. With a one-in-four rota gap in many specialties, how does the Minister plan to sustain the current service, let alone extend it?

[Ben Gummer]

As much as I admire and like the hon. Lady, my opposite number on the Scottish National party Benches, I think that the behaviour of some of her colleagues in Scotland during the junior doctors dispute was not in the spirit of concord by which we try to establish relations with the devolved Administrations. I do not recognise the figures she quoted about junior doctors—I am glad that we have recruited well in this country during this difficult period—but I know that she will want to thank the British Medical Association for its work in bringing the dispute to an end. I hope that in the next few days we will come to a conclusion suitable for everyone.

[Dr Whitford]

I thank the Minister for that and for his welcome to EU nationals here, but with the Secretary of State merely repeating what the Immigration Minister said yesterday and given what the Home Secretary has said, does he not understand the urgent situation facing EU nationals working here? With more than 100,000 of them, do we not want to give them security of residency now to avoid haemorrhaging vital staff from the NHS?

[Ben Gummer]

The Home Secretary said she was confident we could get a deal ensuring that they could stay, but we need a new Prime Minister able to start the negotiations caused by the decision of the British people on 23 June. I say in my capacity as a Health Minister— the House has heard from other Members, including the Secretary of State—that we have full confidence in the EU nationals working in the NHS and wish to praise their contribution, which makes the NHS a better organisation.

Carers

Philippa Whitford Excerpts

Thursday 9th June 2016 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I pay tribute to the hon. Member for Eastleigh (Mims Davies) for securing this debate in carers week. Frankly, one week in the year is not enough; carers care for more than just one week in the year. I will talk predominantly about informal carers—the people who are looking after family—but we should also remember the people who work in the care industry, because they support the carers and the people who need caring for. We have problems getting high-quality care because we do not value those people. We pay them very poorly. They work for companies that often treat them badly. Pay for travel time may not be included, and they may be doing 15-minute visits. These jobs are therefore short term and temporary, and people get out of them as soon as they have the opportunity. Unless we turn this into a profession that is valued and respected and includes development—as we have done with nursing, over the years—our relatives and loved ones will not be cared for by people who actually want to do the job. I would just like to open with that.

We have heard a lot of detailed statistics about informal carers. Across the UK, 10% of people—6.5 million—are involved in caring. In Scotland, the proportion is higher, at 17%. People often do not identify themselves. Those carers are not always the same people, because there is a turnover—a change—every year of one third, or 2.1 million people. Some of them, as the hon. Member for Strangford (Jim Shannon) mentioned, will be people caring for loved ones at the end of their life. When we lose that loved one, although we may face other challenges, we leave the informal care group, but other people take up that role. The same number of people—more than 2 million—enter and leave the role of informal carer each year.

We have heard about the cost that informal carers save the state. If we were to replace them with professional staff, the cost would be almost greater than that of the NHS, but how do we treat the people who deliver that care? A third of them live in poverty. That is because we have tangled things up so much around carer’s allowance, and we never seem to have a “health in all policies” view, so on different days of the week we make decisions that absolutely counteract each other.

My hon. Friend the Member for Ayr, Carrick and Cumnock (Corri Wilson)—I hope I got that right—mentioned some of the changes that have been made, including to the personal independence payment and the employment and support allowance work-related activity group. Perhaps the Government think that those changes send people back to work, but the reality is that many of the people affected, particularly where mental health or waxing and waning illnesses are involved, will not get back to work. That household will simply become more impoverished. We need to realise that that has an impact. If someone cannot afford to do things, their quality of life goes down. People who are caring— 1.3 million of them for more than 50 hours a week—already have a pretty tough life without having to deal with poverty on top of everything else.

We have heard that carer’s allowance is some £62 a week; it is pretty insulting that that is less than jobseeker’s allowance. People tend to spend six or nine months on jobseeker’s allowance, but they may depend on carer’s allowance, along with other benefits, for much longer than that. To pay someone, in essence, £62 a week for the hours that they put in is derisory. In Scotland, if I may correct the hon. Member for Strangford, we are not just considering raising carer’s allowance to £72 a week; that is a commitment. It will become the same as jobseeker’s allowance. Even that is very much a baseline. It does not recognise what those people need.

Of course, there are people in caring situations for whom money is not an issue, because they have a pension or large amounts of savings, but they are not the generality of cases, if a third of carers are in poverty. Half of them have used up all their savings and have had to borrow. A quarter of them have had to re-mortgage their home. That all adds stress to people who contribute massively to society.

We have well over a million older carers, as the hon. Member for Bexhill and Battle (Huw Merriman) mentioned. What has not been mentioned in this debate is that people on retirement pension do not qualify for carer’s allowance. That seems bizarre, because one of the biggest groups of carers is people who are retired. In the past, people would have been caring for a partner as they became more frail, but as people are living longer, we are retiring people who are caring for a parent, or for a parent and a partner. The hon. Member for Eastleigh spoke of caring for little ones and older ones, but we actually have people who are caring for older ones and much older ones. That is massively challenging.

At the other end, we have heard mention of young carers, who are defined as those under the age of 16. They are completely excluded from carer’s allowance as it starts only at the age of 16, yet those children again play a major role and suffer major detriment. They will often be in a poor household, because the parent—as it usually is—for whom they are caring will have suffered from the various cuts to support. Their parent may have a physical or mental illness, may suffer from addiction, or may in other ways not be the parent in the family. If 12 and 13-year-olds are carrying that burden, and cannot afford to go on a school trip, and do not have time to do the little Saturday job or paper round that allowed the rest of us to invest in the height of fashion, we are allowing their quality of life to be lowered still further.

Young adult carers are defined as being 16 to 25. If they are students, they are automatically excluded from carer’s allowance, regardless of the fact that a quarter of them work more than 20 hours a week. If they work less than 35 hours a week, they do not qualify for anything. If they are official students, they qualify for nothing.

We have all these pockets of people who are working really hard, yet we as a state are offering no support to them. That is the minimum that we should be doing. They will still be doing a hard job and putting in long hours that save the country masses of money. We should all feel ashamed that they can have to choose between eating and heating, and that there are young people who have no opportunities and know that their job opportunities will be limited by going through that. Obviously, given my health background, I have looked at the health of these people, and they are twice as likely to be ill. Indeed, 8% of them are on disability living allowance as was, so we have someone who has frailty caring for someone else who has frailty.

One fifth of the people who are putting in more than 50 hours a week are not getting any services because, as has been mentioned, they do not identify themselves as carers, no one else identifies them as carers, and they have no idea where they should go to get help. I back the call that this should be part of the health service’s duty. If a doctor diagnoses someone with advanced cancer or dementia, or a child with disability, they should ask, “Who are the carers here?”. That is part of the primary care role in Scotland, but I am not sure what the roles are in England. Certainly, as part of the quality framework in Scotland, there must be that discussion. There is still room for improvement in our communities on that. People simply see themselves as looking after their family, but actually, they are looking after all of us.

We know that the ageing population will increase. We already have 800,000 people with dementia, who are being looked after by 670,000 carers. At the moment, 60% of us will be carers at some point. As the numbers increase, all of us must expect to spend a portion of our lives as a carer. If that always causes massive detriment to our work, our ability to do anything and our quality of life, we will have allowed the quality of life of everyone to deteriorate.

For women, there is a disproportionate hit, because 60% of carers are women, and one in four of those women will end up giving up work. As was mentioned, they end up in part-time, low-quality, low-paid jobs, and they do not get promotion. Right at the end, they get a rubbish pension, which, as we have heard in many debates in this Chamber, may be plucked out from underneath them. That is the last slap in the face. With modern technology, we should be able to have more home working and flexible working to allow people with talent and skill to remain active and have a career, even if they face a few years of having to commit to caring for someone. As we go into the future, whether we are carers or not, as politicians we need to make sure that we provide the basic funding and services to support carers as they support those who need help.

As individuals, we need to do more in our communities. We have heard mention of carer-friendly communities. I was honoured last Saturday to be part of the launch of one of my local towns, Prestwick, as a dementia-friendly community. It was a fantastic event, and the turnout of the community at the market cross for music, food, cupcakes, fiddling and singing by the wonderful Musical Minds choir, which is made up of people with dementia, was fantastic. The community is already coming forward, and local businesses have undergone training.

Within that, we have a group called Crossroads, which supports carers and allows them little informal breaks, so that they can try to keep some of themselves. Women are used to being recognised as somebody or other’s wife and somebody or other’s mother once they have got past being so-and-so’s daughter. The problem for somebody facing this intensity of care is that they can feel like they disappear altogether—that they as a person have no outside view at all. Their hobbies are gone and, as was mentioned earlier, their friends are gone.

It is important, not just as politicians and people in families, but as members of our communities, that we value and recognise carers if they are out and about, and accept the person they are caring for, no matter if they are a bit loud, if their wheelchair gets in the way, or if they need time to get on the bus. If we accept the person they are caring for, the carer will also feel more accepted in our communities. Basically, I call on everybody, because we all have a role to play.

[Mark Durkan (Foyle) (SDLP)]

Just as we must not lose our recognition of people, or identify them just by their disability, the fact that they need care or the fact that they are carers, it is important that we recruit carers to contribute to thinking on public policy—and not just when it relates to care issues; often, carers are disfranchised and disconnected from society because of their caring commitments. All of us at all political levels need to do more to engage carers, so that they contribute to a range of public policies.

[Dr Whitford]

I thank the hon. Gentleman for his contribution. I refer him back to the comments of my hon. Friend the Member for Paisley and Renfrewshire North (Gavin Newlands) about the Carers Parliament in Scotland, which looks at young carers, young adult carers and older carers. When they consult, the Scottish Government make great efforts to pluck people out of the voluntary world to come and tell them how it really is, because unless we hear how it really is, we are not going to fix it.

We all have a duty, including the Government, to look more at health in all policies. We cannot fix everything, but we should not be adding poverty on top of all carers’ other challenges.

NHS Commissioning (Pre-Exposure Prophylaxis)

Philippa Whitford Excerpts

Tuesday 7th June 2016 Commons Chamber

[Jane Ellison]

I thank my hon. Friend for his kind words. I take this issue extremely seriously. He is right to say that we face a challenge in relation to HIV rates, and particularly, as I said, STI rates in the high-risk MSM community. I stress again that while it will no doubt have an important part to play, PrEP is not a silver bullet for sexual infections, particularly in some of those high-risk groups. It is important to understand that. We have to continue to look at a whole range of measures. When I recently met the chief executive of the Terrence Higgins Trust, we touched on this.

As my hon. Friend says, we have a meeting coming up. I apologise for not responding to the shadow Minister’s question about meeting stakeholder groups. Of course I will meet all the key stakeholder groups. I have already had some formal and some informal discussions on this, but of course I am very open to having further such discussions. Stakeholders were involved in the process that NHS England has been involved in. NHS England has made its position clear, and there is a matter due to go before the courts on which I will not comment further. Yes, I will engage on this. Yes, of course I accept that we need to do more, and of course we all share the concerns about rising HIV infection rates, particularly among the MSM community. I too lost friends to the AIDS epidemic that my hon. Friend mentions. I take this issue extremely seriously, but we have to follow a sensible process, and that is what the Government are doing.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Anyone in this House will be glad to see the results of the PROUD study and the 85% reduction in new infections. However, there is more to understand, in that we did not see a good response in heterosexual women. While over 40,000 HIV sufferers in the UK are men who have sex with men, 60,000 are heterosexual or bisexual, predominantly of African origin, and we need to think of them in this regard.

My main complaint is on the failure to go through a process of looking at clinical evidence and cost-effectiveness and then making a decision. Why was the company not encouraged to get through this earlier and go to NICE? I do not understand why we are only going to NICE now, because that gives the answer that we need. It is relatively poor of NHS England to have made the decision on the basis of, “It’s not our job—it’s your job.” That is the most insulting bit for the community. In Scotland, our Cabinet Secretary asked it to go through the European Medicines Agency, which it applied for in February, and then the Scottish Medicines Consortium. It is on the right path now, but that is where we should have gone first.

[Jane Ellison]

It is probably worth clarifying that we asked NICE to undertake an evidence review, not a technology assessment. What drugs are licensed for are matters for drug companies to address. The Government do not initiate the process on whether a drug is licensed— the drug company must initiate it. It also worth noting that when a drug is licensed for a new purpose, as would be the case for Truvada in PrEP, the company could apply for the patent to be extended to cover this new use. Again, that is something that the drug company would do.

On the hon. Lady’s first point, I agree that we need to consider the impact on women in the circumstances she described. That is one of the arguments for carefully planning this pilot programme and taking those sorts of factors into account.

Junior Doctors Contract

Philippa Whitford Excerpts

Thursday 19th May 2016 Commons Chamber

[Mr Hunt]

First, I very much agree with my hon. Friend in her thanks to Professor Dame Sue Bailey for the leadership that the Academy of Medical Royal Colleges has shown in the initiative that, in the end, made these talks and this agreement possible. I know it has been a very difficult and challenging time for the royal colleges, but Professor Bailey has shown real leadership in her initiative.

I also very much agree with my hon. Friend about the need to sort out some of the issues that have been frustrations for junior doctors—not just in the last few years, but going back decades—in terms of the way their training works and the flexibility of the system of six-month rotations that they work in. This is an opportunity to look at those wider issues. We started to look at some of them yesterday. I think there is more that we can do.

It is important that this is seen not as one side winning and the other side losing, but as a win-win. What the last 10 days show is that if we sit round the table, we can make real progress, with a better deal for patients and a better deal for doctors. That is the spirit that we want to go forward in.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I absolutely welcome this agreement, and I pay tribute to the Academy of Medical Royal Colleges for bringing it about. I do wish there had been some response to the letter that I and other Members sent before the all-out strike, because it was a genuine attempt to create a space that both sides could step into. However, I am glad that we have got to that stage now.

I welcome the recognition of the equality issues, which, to us and to many junior doctors, appeared to have been dismissed in the impact assessment. On the idea of flexible training champions in each trust, I myself was a flexible training senior surgeon—indeed, the first one in Scotland—and the idea of accelerated training is important. However, one concern I have is about childcare. If women junior doctors are going to be working longer, more antisocial shifts—I remember what I had to fork out for childcare—I would like to know whether the NHS will respond to that. Will that be in the form of crèche hours or support?

I welcome the fact that the hours guardian will be linked to the director of medical education and that there will be an elected junior doctors forum. One concern of junior doctors was that they would have no voice in relation to the guardian.

I also welcome the idea of using modern technology in rota-ing. At the moment, rotas are sheets of paper, and often no one looks at the shoulder from one rota to the next, so people can end up with the very long periods on call. However, one concern that remains is rota gaps. We do not have enough junior doctors, and we do not have enough junior doctors in the most acute specialties. How is the Secretary of State planning to re-establish a relationship? How is he going to recruit people to fill that gap? That was the core fear of junior doctors: a lack of doctors, with doctors simply being spread further. How are we going to recruit and retain doctors after the painful clash that has been going on for the last year?

[Mr Hunt]

I welcome the tone of the hon. Lady’s comments; we might have wished for a similar tone from the shadow Health Secretary. Let me address the comments of the hon. Member for Central Ayrshire (Dr Whitford) as constructively as she made them to me. She is right about flexible training. We have to recognise that the junior doctor workforce is now majority female, and that a number of family and caring pressures need to be taken account of. We need to do that for the NHS not only because it is the right thing to do, but because we will lose people if we do not. Those people will simply leave medicine, even though they have been through very extensive and expensive training.

We have to look particularly at the responsibilities of doctors with young children. One of the things that we announced yesterday was an obligation on trusts to take account of caring responsibilities. If, for example, a doctor wanted to work fewer hours in school holidays and more hours in term time, we cannot guarantee that a hospital would always be able meet those needs—the needs of patients always have to come first—but they could at least be taken account of, in the same way as they are in many other industries that operate 24/7. The hon. Lady is absolutely right to say that modern technology is key to that. An air steward or a pilot who works for British Airways can go on to an electronic system and choose the shifts and hours that they want to work. Because we have failed to modernise the NHS, we have seen a huge growth in agency and locum work, which is partly driven by the fact that it offers precisely the flexibilities that people need. These are important changes, and we intend to take them forward.