Care Homes

Phillip Lee Excerpts

Thursday 1st May 2014 Commons Chamber

[Norman Lamb]

I thank the hon. Gentleman for his urgent question and his supplementary questions, which are absolutely legitimate and important. I agree that it is incredibly important that we recognise that there is a lot of great care out there, with incredibly dedicated care workers doing a very difficult job, often in difficult circumstances and without great pay. It would be awful if they were all tainted by the actions of a few.

I am pleased that the hon. Gentleman recognises that the Care Bill can make a difference and improve standards. It allows for the introduction of a care certificate so that everyone will be required, for the first time, to have compulsory training and meet a standard of competence before undertaking unsupervised care work. Part of that will be on the job, as I think is right for such work, but it is essential that people meet that standard.

The hon. Gentleman made the essential point that relatives, loved ones and the users of services themselves need to be heard. One thing we have done in that regard through NHS Choices is introduce the ability for anyone to comment on care services in a care home or in domiciliary care and to put their comments online, so that there is no hiding place for unacceptable standards of care. People’s comments and the judgments of the CQC will be available for everyone to see through the NHS Choices website.

I hope I can reassure the hon. Gentleman in relation to his amendment to the Care Bill. I totally agree with him about the importance of being able to prosecute for corporate neglect, which we will address, but in a different way. We are introducing fundamental standards of care that every care provider, and indeed every NHS hospital, must meet in order to be registered with the CQC. Where those standards are not met and there are serious failures, and where there is culpability because of corporate neglect of the sort he describes, the providers will be prosecuted. The CQC will have the power to prosecute not only the company or trust, but individual directors. This is the first time that that has been made possible. The existing regime is flawed, because the CQC must first serve a notice before anything can be done, and if the company complies with the notice it cannot be prosecuted, which is hopeless. We are removing that so that we can move straight to prosecution, as was the intention of his amendment.

[Dr Phillip Lee (Bracknell) (Con)]

I fear that this case will not be the last. May I invite the Minister to think longer term? I have often reflected on why our society outsources the care of elderly loved ones to the state. In the longer term, with an ageing society, I wonder whether we are going to have to look after our elderly more at home. Is there any policy formation within the Department along those lines, because the last thing I would like to happen is see my relatives being treated in the way we have seen?

[Norman Lamb]

My hon. Friend makes a really important point. In ensuring that we have decent, civilised standards of care for older people, but also for people with learning disabilities and others in vulnerable positions, it cannot be any one party on its own that achieves that objective. It is a challenge for the whole of society, and we must recognise that. Government have their part to play in setting very clear standards and making it absolutely clear that where these standards are not met there are consequences. Through the integration pioneers that we have around the country, we are demonstrating that with better collaboration between statutory services and families, wider communities and neighbours, we can achieve better care for people. The state cannot do this on its own. It has a crucial role to play, but this is a challenge for the whole of society.

Stillbirths and Infant Mortality

Phillip Lee Excerpts

Wednesday 26th March 2014 Westminster Hall

[Tracey Crouch (Chatham and Aylesford) (Con)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Davies, although there is certainly no pleasure in the subject matter of this debate. The issue of stillbirth and infant mortality is a complete and utter tragedy for parents who lose their child. I have met a number of my constituents who have experienced the loss of a baby. Mothers, fathers and siblings have been devastated, left bereft and unable to comprehend what has happened and why. It was heartbreaking to meet them. However, what is equally heartbreaking is that here in the UK, which has arguably one of the best health services in the world, we have one of the highest rates of infant mortality in Europe and other parts of the developed world. It is shocking that we have higher infant mortality rates than countries such as Croatia, Lithuania, Estonia and Slovenia.

Sadly, unlike other countries we have barely seen any reduction in infant mortality rates in the last 20 years. Almost three quarters of child deaths under the age of 15 in the UK happen during the first year of a child’s life; more than half in the child’s first 28 days; and almost 40% in the child’s first week. These statistics do not include the one in 200 pregnancies in the UK that end in stillbirth. Stillbirths account for the death of a further 4,000 babies a year.

There are many reasons for perinatal, early neonatal and neonatal deaths, but I will concentrate today only on stillbirths and on sudden infant death syndrome or, as it is perhaps more commonly known, cot death. That is not because I have no interest in other forms of infant mortality, but so I can focus the Minister’s mind on a few actions that might make the difference sooner rather than later. That said, I wanted to give a wide title to the debate today because I am aware that colleagues have other issues they may wish to raise.

The figure of 4,000 stillbirths per annum is far too high. I cannot imagine the horror of having to go through labour knowing that your baby is already dead. I met one lady who gave birth to her son, Henry, at 38 weeks, but he had not grown for 16 weeks. In the intervening weeks, she had forged a bond with her unborn son, named him and planned a life ahead, but it was one that would never be fulfilled.

Our NHS is brilliant and our midwives are fantastic, but I have yet to meet a woman who has gone through pregnancy without seeing more than one midwife. One lady told me that she had seen 12 different midwives during her pregnancy, which sadly ended in stillbirth. She felt that all 12 of them had different ways of measuring her. I am not going to criticise the midwives—they do not deserve criticism—but we need to ensure continuity of care throughout gestation, to give mothers some peace of mind.

Research that the National Childbirth Trust carried out with the Women’s Institute last year into women’s experiences of maternity services highlighted the shocking statistic that 34% of women were not given the name and phone number of a midwife to contact with any concerns. We must do more to encourage people to go into midwifery, and I hope the Government’s pledge to increase the number of health visitors will help in that regard.

However, we also need to improve our standard monitoring and measuring systems, making the most of modern technology. In the case of poor Henry, who had not grown for 16 weeks, it was clear that the measuring was not as good as it could have been. I accept that not everyone agrees with me on this, but I believe that we should be looking to increase the number of scans expectant mothers receive. Having a scan at 12 weeks and again at 20 weeks is fine, but unless a mother is anticipating complications, those are the only scans she will receive.

There are examples of the successful use of increased measuring and monitoring. The Rainbow clinic at St Mary’s hospital in Manchester, which is funded by Tommy’s baby charity, has taken huge and groundbreaking steps forward in understanding the risk profiling of mothers, and it has a great success rate because of its extra monitoring and measurement. I would like to see its work rolled out. The clinic’s test on those who are deemed to be at risk—possibly due to previous multiple stillbirths or miscarriages, which we know increase the risk of future stillbirths or miscarriages—allows those in the “at risk” category to receive further monitoring and measuring in the third trimester, when placenta problems usually occur, to allow earlier delivery if necessary to prevent stillbirth.

These preventive measures involve awareness raising and risk profiling, followed by improved measuring, with new techniques and monitoring through an increased number of scans. They have led to a significant increase in healthy babies being born to women in the “at risk” group. Although the study at the Rainbow clinic is on a small scale, it has a very high success rate. However, the clinic does not have the funding to expand its work and I urge the Minister to examine its work and give it her full support.

I am not an expert on placenta. However, given that we know it starts to break down at 38 weeks but we do not induce mothers until 42 weeks—a point when we know women carrying later are more at risk of losing their baby—we need extra research into this process and to determine whether this delivery time frame is still viable. I will not dwell on that now, but it would be helpful if the Department examined both the risks and the benefits of reconsidering induction as late as 42 weeks. I have spoken to women who have had stillbirths and many of them raised this issue with me. There is genuine concern about the length of time that women are carrying babies for, particularly those at the higher risk end of the spectrum.

This issue is not all the responsibility of the NHS and it is important that we raise awareness of reduced foetal movements, so that expectant mothers can spot early signs of distress. The Count the Kicks charity has fabulous self-monitoring support, empowering mums-to-be with knowledge and confidence, including a mobile phone app and tips for dads. This understanding should be universal.

If a stillbirth does occur, it is important that the parents receive all the support they need. The third sector does an amazing job of providing advice and bereavement support for parents who lose a child before, during or shortly after birth. However, we need to ensure that parents receive good care from the health service, whether that is by ensuring the appropriate equipment is available—such as cameras and other equipment to take handprints and footprints, with staff available who know how to use it—or by providing access to all the literature and available support and advice, including bereavement services. We must also ensure that parents receive correctly handled treatment; we must remember to treat them as parents even if they do not have a baby.

[Dr Phillip Lee (Bracknell) (Con)]

I congratulate my hon. Friend on securing this debate. As someone who has professional first-hand experience of dealing with parents who have had a stillbirth, I know that it is an emotive topic but it is essential that we discuss it. Recently, Scotland produced a report outlining that its infant mortality rates are improving and it appears that it has a different approach to education, assessment and analysis of at-risk groups.

[Tracey Crouch]

I am grateful to my hon. Friend for his intervention. It was a coincidence that the Scottish Government released their statistics on infant mortality yesterday, which showed that Scotland now has the lowest infant mortality rates in the United Kingdom. It has managed to do that by introducing some of the measures I have already proposed in this debate, such as extra monitoring, extra targeted intervention and support for those at highest risk. That work should be rolled out across the United Kingdom.

We must be very clear about the bereavement services and support that people receive. A local charity in Kent, Abigail’s Footsteps, is working with the Royal College of Nursing to establish a national standard of bereavement training that it would like to see universally implemented. That is absolutely fantastic. On top of that, however, one of the best ways to accomplish good care in all the areas I have mentioned is to create the job specification of bereavement midwives within the NHS. This suggestion is supported by Sands, the leading stillbirth and neonatal deaths charity. I fully support this proposal and urge the Minister to consider introducing a nationally recognised job specification for bereavement midwives, which I believe would ensure the best possible mental health of, and support for, parents whose babies die before, during or shortly after birth.

I am aware that people have suggested that this will be an additional cost to the NHS, but we need to remember that the cost to the NHS of supporting people with mental health concerns, as well as loss of productivity because they have lost a child, is significant—some £1.5 billion to £2.5 billion. Therefore, an early investment in such support services will make a massive difference.

A bereavement midwife would be familiar with all relevant policies and procedures. They could ensure that all protocols are up to date and that relevant paperwork and equipment is always available; ensure that there are high standards in bereavement care in every relevant hospital department; and liaise with others within the hospital, such as chaplains, neonatal and paediatric pathologists and mortuary staff. They would also be able to promote good communication and building relationships with primary care providers such as GPs, as well as external bodies, including the registrar of births and deaths, and to ensure that patients have access to all appropriate available support and literature.

We are lagging behind on stillbirths, and I think the Minister will agree that we need to do more. I have outlined just a few suggestions that would help, as proposed by those who work in maternity care and who have suffered the loss of their own baby during pregnancy.

As tragic as a stillbirth is, the sudden death of a baby who was born, named, taken home and then fell asleep never to wake again is something I cannot even begin to imagine. Sudden infant death syndrome, or cot death, was dramatically reduced due to the outstanding success of the “Back to Sleep” campaign that the Government launched in the mid-1990s. The campaign, reminding parents that babies should sleep on their back, not side or front, was highly successful and led to an outstanding drop in the number of cases of babies who died of sudden infant death syndrome. As a result of that campaign, the number dropped from five babies a day in the mid-1980s to five babies a week, where it has stubbornly remained ever since, even 20 years later.

Access to information is vital. The first thing we need to do is reinstate the literature that new mothers used to receive when they left hospital with healthy babies. Unfortunately, the helpful “Safer sleep” guide was caught up in the Cabinet Office’s bonfire of public sector communications, and now new mothers are expected to rely on other organisations providing information. The Bounty pack is brilliant, although it is not necessarily immediately available or universal; however, the information provided in it could be life-saving. Risk profiling is essential if we are to reduce SIDS. Mothers need to understand the dangers of alcohol, smoking, vitamin deficiency and obesity, both during and after pregnancy, as a matter of course and not just as an optional extra, because those are the biggest causes of preventable perinatal death.

The Lullaby Trust and Bliss do wonderful work together and are helping my own local authority in Medway, which has multiple areas of deprivation, to identify risk and support professionals targeting intervention. This is essential. The statistics speak for themselves. The cross-party report published recently by colleagues, entitled “1001 Critical Days”, found that 26% of babies in the UK are estimated to be living within complex family situations, which can heighten the risks for a baby’s well-being, and that drug and alcohol problems affect more than 109,000 babies. Targeting resources at higher-risk families, parents and babies will help to reduce SIDS. It is essential to ensure that support and information are there for those who have premature babies, have babies young, or who are living in complex situations.

Furthermore, if we are really going to tackle infant mortality and reduce our embarrassingly high rates, we need to support, encourage and promote breastfeeding and improve access to “Healthy Start” vitamins, which are currently only accessible via named chemists. These should be available at all chemists. Investment should be made in both universal and targeted services, as recommended by the Healthy Child Programme. Where targeting has not made an impact—for example, vitamin D supplementation—universal approaches should be considered if they are also cost-effective. We need to highlight the message that this is not an optional extra, but is vital to ensuring foetal welfare.

We must improve awareness of smoking cessation services and the harm caused to unborn children by smoking. Similarly, we need to ensure that people understand the dangers of smoking for those who have been born. We must also do more to discourage binge drinking during pregnancy. I was shocked to learn that 18% of women still binge drink—that is, drink more than six units in one session—while pregnant, often leading to foetal alcohol syndrome.

I know I have not covered everything in this debate, but I hope it is a useful start. I thank the Royal College of Paediatrics and Child Health, Tommy’s, Sands, Kent Sands, Bliss, the Lullaby Trust, Abigail’s Footsteps, Together for Short Lives, the National Childbirth Trust, the Women’s Institutes and Bounty for their briefing materials in advance of this debate. I thank, in particular, the mothers and fathers I have met who have spoken movingly about their own personal tragic experience.

The Prime Minister said he wants to make sure that Britain is the best place to end life. Today, I am calling for us to work together to make Britain the best place to start life and give every expectant mother all the support they deserve. I look forward to the Minister’s response and the contributions of other Members, and thank them for taking the time to be here this afternoon to discuss this important issue.

[Tim Loughton (East Worthing and Shoreham) (Con)]

It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) on an excellent speech and on raising the profile of this much neglected but hugely important subject for many of our constituents who have been through the pain of stillbirth, infant mortality or perinatal mortality.

I am, slightly shamelessly, going to use this debate as a further opportunity to plug the ten-minute rule Bill that I put before the House on 14 January, with the support of my hon. Friend and other hon. Members. I am pleased to see the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison) here, as she sat in on that ten-minute rule Bill. I am glad that her colleague at the Department of Health has now, I hope, agreed on a meeting to take that forward; some of us can take constituents affected by stillbirth to that meeting and see whether we can bring about the change in the law that I will come back to in a minute.

I echo the accolades that my hon. Friend the Member for Chatham and Aylesford bestowed on all the organisations that have an interest in this matter and have for many years, quietly but assiduously, been campaigning for better care for people bereaved by stillbirths or who lose their children at an early age, giving support and advice, and campaigning for improvements and changes in the law.

This is quite a complicated area. Although the debate is entitled “Stillbirths and Infant Mortality”, we talk about neonatal deaths, perinatal deaths and post-neonatal deaths—those deaths between 28 days and a year after birth—as well as infant and stillbirth mortality rates. However, across all those fields the record of the United Kingdom is not good. My hon. Friend contrasted the UK’s record with the great progress made on sudden infant deaths, particularly on cot deaths, during the “Back to Sleep” campaign. A concerted, focused and well promoted campaign led to a decrease of more than two thirds in the horrific spate of cot deaths that afflicted so many families. It is perplexing and worrying that, although there has been some progress in reducing mortality rates across the board, pre and post-birth, they still remain alarmingly and unacceptably high, certainly compared with European partners.

Total perinatal mortality rates now stand at some 7.4 per 1,000 live births in this country. In comparison, the figure for Finland, which has the best record on this front, is 3.2 per 1,000 live births, and even Portugal, which has challenging questions to face about infant health, has a rate of 3.8 per 1,000 live births. We are still way behind. An awful lot of those perinatal mortalities, particularly the stillbirths among them, remain completely unexplained.

We also have to add miscarriages to the figures, which apply only to the official recognition of stillbirths as embryos born dead after 24 weeks. Those figures, of course, do not include miscarriages, yet more than one in five pregnancies in this country ends in miscarriage, which means that more than a quarter of a million of our constituents are affected by miscarriages each year. The problem is huge.

Most miscarriages happen in the first three months of pregnancy. Some women may hardly know that they have had a miscarriage, and some may have miscarriages without knowing they were pregnant in the first place, but many women, including some constituents who have come to me since I presented my ten-minute rule Bill, have miscarriages well into their pregnancy, when the grief, trauma and distress of losing a hoped-for child is that much greater.

The way in which we support women who have been through such experiences is also worrying. Research by the Miscarriage Association found that 45% of women who have experienced a miscarriage did not feel well informed about what was happening to them. Only 29% feel that they were cared for emotionally, and nearly four out of five, 79%, received no aftercare. We know that at least one in six women—a very large number—experience some form of perinatal mental health problems. That has a great cost, socially and emotionally to those women and financially to our national health service. It is a false economy not to ensure that we support those women, whether they have suffered a miscarriage early or late, or whether they have suffered a perinatal mortality either before or after birth.

[Dr Lee]

On the subject of false economies in the national health service, historically we have spent significant sums on antenatal care without a lot of evidence to support that expenditure. Does my hon. Friend agree that we need to concentrate resources in the appropriate hands? We need appropriately staffed maternity units—there are worrying statistics about midwifery-led versus obstetric-led maternity services—and by doing that we can address our infant mortality rates, which compare poorly with those of our European neighbours. As politicians, we must also accept that doing that would involve reconfiguring services. There would be fewer maternity units and perhaps more obstetricians.

[Tim Loughton]

My hon. Friend has great hands-on experience, and he knows a lot more about this subject than I do. He opens a far greater debate on the accessibility of maternity services. I am sure I am not alone in having marched and campaigned for the retention of midwifery-led maternity services at a local hospital. Interestingly, the biggest growth in mothers giving birth at that hospital has been among those who live outside the Worthing catchment area. Those mothers choose to go to the hospital.

[Dr Lee]

I want my hon. Friend to know that I campaigned to close my local midwifery-led unit because it was not delivering many babies—it was delivering less than one baby a day. I have real concerns about the potential for increased infant mortality in such midwifery-led units.

[Tim Loughton]

It is horses for courses. I am glad to say that my maternity unit delivers well in excess of 3,000 babies a year. It is a centre of excellence, and the customer votes with her feet by choosing to go there from outside the area. My hon. Friend is absolutely right that the assessment of units must be primarily based on the quality and safety of care for mothers, but I fear we are straying slightly beyond stillbirths and infant mortality rates into the availability of maternity services and hospitals. You would not want us to go there, Mr Davies.

My hon. Friend also raises an interesting point about delivering services in the most appropriate way. There are certain constituencies of women and certain parts of the country where the problem is that much greater. To take one of the classifications, the infant mortality rate in the UK overall is 4.4 deaths per 1,000 live births, but the variations for mothers born outside the United Kingdom are worrying. For babies of mothers born in the Caribbean, the figure more than doubles to 9.6 deaths per 1,000 live births. For babies of mothers born in Pakistan, the rate is 7.6 deaths per 1,000 live births, and so on.

There are also regional variations, particularly for perinatal mortality overall. In the south-west, the figure is 4.7 deaths per 1,000 live births, but in the north-east it is 5.8 deaths per 1,000 live births—a 23% difference. Why are there those differences? We simply do not have enough research; we have not commissioned and are not doing enough research to find out why certain types of women and certain geographical locations are faring worse. Such research would enable us to focus, say, additional scans or support services, or whatever is required, to ensure that we make the best use of our NHS resources. My first call is for there to be rather better research across perinatal mortality.

Francis Report

Phillip Lee Excerpts

Wednesday 5th March 2014 Commons Chamber

[Andy Burnham]

Time is against us, I am afraid.

The Secretary of State is wrong if he thinks that top-down regulation is the only answer. It cannot prevent things from going wrong in the first place. The Secretary of State should accept all the recommendations of the Francis report, including the recommendations that are designed to change the culture at a local level.

Let me now turn to the future of Stafford hospital, and address the point made by the hon. Member for Stone (Mr Cash). If there was one thing that the people of Stafford deserved after what had been a long and painful process, it was the legitimate expectation that, at the end of that process, they would see a fully functioning local hospital that was both safe and sustainable. That is why I believe that the conclusion of the trust special administrator process is both wrong and unfair on them. It will result in a significant downgrade of the hospital, and there is still no clarity in regard to important services such as maternity.

The issue of the future of Stafford hospital goes to the heart of the handling of the inquiry and the decisions made about it. When I arrived at the Department of Health in June 2009, the official advice that I received was that I should not hold any further inquiry into what had gone wrong, because it would distract the hospital from the essential task of making immediate improvements. I could not accept that advice, because I believed that we needed to get to the full truth of what had gone wrong. That is why I appointed Robert Francis to conduct an independent inquiry. However, I stopped short of a full public inquiry because I had been warned that such an inquiry could destabilise the hospital and prevent it from making improvements. The Secretary of State nods.

That is the advice that I was given, but I told Robert Francis that he could come back to me and ask for powers to compel witnesses to appear before him if he felt that that was necessary. He came back to me to say that he felt that he had had all the co-operation that he needed. Indeed, he had had more, because of the nature of the inquiry that I had set up.

As the Secretary of State will recall, after the first Francis report I commissioned a second-stage inquiry into regulatory systems. I did not disagree with the coalition’s decision to upgrade it to a full public inquiry, as that was always a finely balanced judgment, but I did warn at the time that the hospital would need further support, given what a full public inquiry would entail. I do not believe that it has been given that support. Worse, the administration process that it has undergone has been brutal. I do not believe that there is a district general hospital in the land that could survive a three-year public inquiry followed by financial administration. The Labour party’s view—informed by the Lewisham and Stafford examples—is that the Government are misusing the administration powers created by the last Government to drive through reconfiguration on cost rather than clinical grounds, and we will therefore move to delete those powers from the Care Bill next week.

[Dr Phillip Lee (Bracknell) (Con)]

The right hon. Gentleman has alluded to the sustainability of district hospitals. In the light of the Francis report and the dreadful care failings at Mid Staffs, I would suggest—and I am sure that others would agree with me—that part of the problem was that we were trying to offer care over two sites to a relatively small population. The right hon. Gentleman agrees with me that reconfiguration of acute care in particular is on the horizon. Does he also agree that, in view of the political difficulties of acute reconfiguration and the ultimate closures of departments, a cross-party approach is long overdue?

[Andy Burnham]

The hon. Gentleman makes a very important call, and I think he is right: hospitals are going to have to change, and the sooner we all wake up to that fact, the better. I would also say to him, though, that hospitals cannot be changed top-down, as I believe his Government are trying to do with clause 119 of the Care Bill: a power to drive through financially driven reconfiguration and create a twin-track route outside of the normal, established process. The normal process creates local oversight and scrutiny at democratic level, and independent judgment on changes from the Independent Reconfiguration Panel. That is the established route and it should not be bypassed. I say that while agreeing with the hon. Gentleman that we do need a cross-party approach.

I believe we owe it to the people of Stafford to support their hospital and maintain as many services there as possible. If the Secretary of State were to visit Stafford and sit down with people on the Support Stafford Hospital group, as I have done, he would hear a real sense of injustice from them that their hospital has been dragged down by a barrage of negative publicity. Will the Secretary of State confirm today whether Stafford hospital will continue to have a maternity service? Rumours and nods and winks are no good; people need to know. What will he do to ensure that the people of Stafford do not have to travel miles to get basic services? I can tell the House that I will continue to argue for the fullest range of safe services at Stafford, as that has been my consistent aim throughout this entire process.

Perhaps the most unseemly aspect of the last year has been an attempt by some to politicise the failing at Stafford. That has created a climate of fear in the NHS that may make it even less likely that doctors and nurses feel able to report mistakes or poor care and achieve the culture change that the Francis report advocated. I would like to remind those on the Government Benches that this stands in stark contrast to the way the previous Government handled the care failures they inherited from the Government before them at Bristol and Alder Hey, and also the Shipman murders. At Bristol, doctors raised concerns but were not listened to. Parents whose children had died or suffered brain damage were ignored. For a long time nothing was done. It was in 1997 that the General Medical Council finally started to investigate what had gone wrong at Bristol. I say to those on the Government Benches, for goodness’ sake please remember and take the long view on these issues. Let us all use these moments by making them a catalyst for change in the NHS.

NHS staff report to me that they now feel a climate of fear and an intensification of the blame culture, with the talk of uncaring nurses, lazy GPs and coasting hospitals. We have seen HSMR—hospital standardised mortality ratio—figures misused by Government spin doctors to generate misleading headlines that have damaged struggling hospitals. It even got to the point where a group of senior clinicians and managers felt compelled to write to The Guardian at the end of last year, calling on the Government to call off the attack dogs. They feel that there is an attempt to magnify the failings of the NHS and run it down, and that it is linked to a drive towards more privatisation.

What the NHS needs to address some of the major issues that the Francis report raised is the ability to collaborate and integrate. The great sadness is that the Health and Social Care Act has placed it on the opposite path, towards competition and fragmentation. We now have the unbelievable spectacle of the Competition Commission intervening for the first time to prevent sensible collaboration between hospitals. The logical consequence of “any qualified provider” is more and more providers dealing with one person’s care. This is a recipe for cost, complexity and fragmentation.

I am clear that the market is not the answer to 21st century care. Instead, we need services based around the individual, starting in the home, with all barriers to integration are removed. That is essential if we are to rethink the care of older people as the Francis report invites us to do, and this shows the big difference between those on this side of the House and those on the Government Benches. They talk about integration but have instead legislated for fragmentation. Only by repealing the Health and Social Care Act will we put that right, put the right values back at the heart of the NHS and build an NHS ready for the 21st century.

Acute Hospital Wards (Staffing)

Phillip Lee Excerpts

Wednesday 15th January 2014 Commons Chamber

[Andrew George (St Ives) (LD)]

I am delighted to have secured this important debate on the staffing of acute hospital wards, on which I know the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter)—I am pleased to see him in his place—is aware I have been campaigning for a number of years.

The pressures on acute hospitals have, without question, intensified over the past couple of decades. There are now a third fewer general and acute hospital beds than there were 25 years ago. The past decade alone has seen a 37% increase in emergency admissions. An increasing number of older patients are being admitted to hospital: 65% of admissions are of people over the age of the 65. These patients are more likely to present more complex and multiple comorbidities, and the increased demand on acute care and the increased complexity of patients’ needs will have a knock-on effect, including placing greater demand on hospital resources and increasing pressure on registered nurses, doctors and other health care professionals. It will also, of course, have an effect on patient care itself.

I intend to concentrate on the staffing levels of registered nurses. Although much of the health debate has become obsessed with changing and tweaking management tools for commissioners—for example, by incentivising health systems with payment by results and more sophisticated tariffs, creating new pathways of care and, as far as the previous Government were concerned, wasting billions on fancy information technology systems—front-line nurses are often run ragged and overstretched on hospital wards.

The background or history to this debate goes back to the case of Graham Pink, who was sacked by Stepping Hill hospital in Stockport in 1990 for speaking out about poor staffing. I raised the matter as long ago as 2001 with John Hutton, now Lord Hutton, who wrote in response to a question from me:

“The work force commitments to recruit additional nurses, doctors and therapists in the NHS Plan take account of the need to increase the number of staff necessary to deliver diagnosis and treatment within the agreed clinical standards set out in the National Service”.—[Official Report, 17 July 2001; Vol. 372, c. 114W.]

There was therefore recognition in 2001 about the need to increase the complement of staff within NHS hospitals.

Since that time, there has been an acceleration of activity. To a certain extent, that activity was stimulated by the publication on 6 February 2013 of the Francis report on Mid Staffordshire NHS Foundation Trust, which has been debated a great deal in the House and elsewhere. As a member, as the Minister once was, of the Select Committee on Health, I know that it has exercised our consideration on many occasions.

To respond to the concerns about the arguably inadequate registered nurse staffing levels in many acute hospitals, the Safe Staffing Alliance has been formed with members from the Royal College of Nursing, the Patients Association, the Florence Nightingale Foundation and many other bodies. In an important launch on 12 May, it released a statement on the risk of excess deaths, indicating that the risk was significantly increased by lower registered nurse to patient ratios. I met the Minister on 14 May, after which I submitted a substantial file of evidence to back up the argument in favour of improving those ratios.

On 16 July, Professor Bruce Keogh published his study on 14 hospitals. Certainly one of its key themes was the inadequate registered nurse to patient ratios on wards, which caused concern within those hospitals, and that has been debated on many occasions. On 16 August, Professor Don Berwick published a very significant report on patient safety, from which the same theme arose that we cannot achieve safe patient outcomes if we do not have adequate safe staffing levels.

On 9 October, the Safe Staffing Alliance held a reception, which I was pleased to host, and I tabled early-day motion 643 on safe staffing on 29 October. The Government have since responded, with the National Quality Board—headed by the chief nursing officer, Jane Cummings—publishing a “How to” guide on using the right tools to establish safe staffing levels on hospital wards. On 19 November, the Government responded to the Francis report, as did the Health Committee on the same date, and announced further initiatives to address the issues, which I will come on to in a moment.

The question is how bad the problem is now, when there is so much attention on it. Interestingly, a report in the Nursing Times this week stated:

“Serious concerns over staffing levels and patient safety were raised last week at four hospitals in different parts of the country”

as a result of Care Quality Commission reports. A number of CQC reports in recent years have highlighted inadequate staffing levels.

[Dr Phillip Lee (Bracknell) (Con)]

One of those CQC reports was on Wexham Park hospital, which serves part of my constituency. There have been reports of pretty woeful nursing standards, particularly on acute medical wards. Does the hon. Gentleman agree that part of the challenge is that we have too many acute hospitals in the 21st century to deliver the appropriate care that we would all want our constituents to receive? A reconfiguration of hospital services, with fewer acute sites, would allow proper staffing of acute medical wards.

[Andrew George]

The hon. Gentleman speaks with great knowledge on this subject. Of course, we have fewer acute hospitals than we used to have, but we still have serious staffing problems. On its own, that idea is not the answer, but it does need to be considered if we are to address the issue of patient safety.

As the hon. Gentleman rightly says, the report on Wexham Park hospital stated that CQC inspectors found evidence of regular short staffing on “almost all wards” and a culture in which

“staff did not always feel they could raise concerns”.

The inspectors concluded that the trust was more focused on “responding to…targets” than on

“ensuring that overall patient experiences were positive”.

The article in the Nursing Times states:

“Despite a previous CQC warning in May, almost all the wards inspected were found to be regularly short staffed. Staff did not always feel they could raise concerns, with a number expressing concerns about bullying and harassment, the CQC said.”

The article states that there were similar problems at Bradford Teaching Hospitals NHS Foundation Trust and that, last Wednesday,

“Belfast Health and Social Care Trust declared a ‘major incident’ at its Royal Victoria Hospital due to a backlog of A & E patients. At one stage, 42 people were waiting on trolleys.”

A hospital porter, Pat Neeson, is quoted by the BBC as saying that he was

“fed up watching our nurses cry”

as a result of long-standing A and E pressures. There are significant pressures in many hospitals. Although those examples have been in the press this week, we all know that the problem is not exclusive to those hospitals.

This is also a political issue. The question is whether the reports implicate uncaring nurses or whether the problem is that there are not enough nurses on hospital wards. The Prime Minister has become involved in this issue through his presentation of the Francis report to the House last year and what he has said elsewhere. On 6 January 2012, he said:

“If we want dignity and respect, we need to focus on nurses and the care they deliver. Somewhere in the last decade the health system has conspired to undermine one of this country’s greatest professions.”

Last year, in the light of the Francis report, the Government proposed that all trainee nurses should have one year’s experience as a health care assistant before they become fully qualified. The Prime Minister said:

“We have said in the light of that report that nurses should spend some time when they are training as healthcare assistants in the hospital really making sure that they are focused on the caring and the quality and some of the quite mundane tasks that are absolutely vital to get right in hospital”.

The question is whether the problem is the attitude of nurses or nursing numbers.

The Safe Staffing Alliance suggests that there are excess deaths as a result of there being insufficient nurses. Some people ask how many excess deaths there are. Given the statistics and methodologies that are available, academic statisticians would blanch at suggesting what the figure might be. I have been cautioned by House of Commons statisticians and the academics who back up the Safe Staffing Alliance about ever doing so. It is suggested that there were at least 20 excess deaths per annum in hospitals with unsafe average staffing. The RN4CAST survey of 32 English hospitals, including more than 400 wards, showed that 43% had registered a nurse staffing ratio of more than 1:8.

There are about 240 acute hospitals. I have been heavily cautioned by the House of Commons Library and other statisticians not to extrapolate a figure, and I appreciate that I am doing what academic statisticians would never do, but I am going to step off the tightrope of academic equivocation and be a brazen politician and suggest only an indicative figure. While surrounded by so much caution and so many caveats—I do not have time to list them all—the number of excess deaths will be higher than zero and much lower than the approximately 248,000 patients who die each year in acute and community hospitals. Taking those statistics together, the indicative figure would be 4,000 excess deaths in acute hospitals in England. Clearly, this issue needs to be seriously addressed.

All the review reports last year showed that nurse staffing was a critical issue to prevent poor care, and they absolutely corroborate the research findings of the link between registered nurse staffing and quality of patient outcomes. The National Institute for Health and Clinical Excellence has been commissioned to give guidance on acute ward nurse staffing by July and it will look at validating methodologies. I have spoken to Professor Gill Leng of NICE and it is clear that it will be conducted on a robust evidential basis.

The Berwick report, the Nursing and Care Quality Forum and the Council of Deans have all publicly endorsed never having more than eight patients per registered nurse on acute wards, based on current known evidence. A number of trusts are now displaying nurse staffing on boards at ward level, with some trying to ensure that they take account of the “never more than eight” standard. A lot of action is being taken to address this issue.

As well as avoiding excess deaths, the issue needs to be addressed by health care economists, too. Recent evaluations in Perth, Australia, which has mandated levels of safe staffing, show that investment has more than paid for itself in reductions in patient harm, fewer bedsores, less complications and infections, and fewer falls. California, which has the same arrangement, has shown a 25% reduction in readmissions. These are important benefits, which health economists need to look at when they address this issue.

Jane Cummings, the chief nursing officer, has looked at the issue and I will read a key quote from her in the National Quality Board report:

“There has been much debate as to whether there should be defined staffing ratios in the NHS. My view is that this misses the point—we want the right staff, with the right skills, in the right place at the right time. There is no single ratio or formula that can calculate the answers to such complex questions. The right answer will differ across and within organisations, and reaching it requires the use of evidence, evidence based tools, the exercise of professional judgement and a truly multi-professional approach. Above all, it requires openness and transparency, within organisations and with patients and the public.”

My concern about this kind of management babble, and those who possess the presentational skills to get away with it, is that it throws a warm comfort blanket around the issue and creates a cloud of obfuscation. We need some of the hard lines proposed by the Safe Staffing Alliance, and we need fundamental standards below which no service should fall.

I have given the Minister advance notice of my questions. Does he accept that there are still a significant number of hospital settings where the number of registered nurses on duty is insufficient to ensure patient safety, professional standards and morale among many in the nursing profession? Does he agree that the Safe Staffing Alliance proposal for a fundamental standard of never less than one registered nurse to eight patients would be a useful tool for inspections and act as a benchmark for management to use, alongside other safe staffing tools? Does he agree that the CQC should in future concentrate more on using safe staffing tools and clear measurements of how many registered nurses are on a ward? Does he agree that as part of future work force planning, hospital managers should not conflate or blur the distinction between registered nurses and advanced care practitioners? Finally, without pre-empting NICE’s conclusions this summer, what can Ministers do to guarantee that hospital boards follow, or at least apply, its proposed guidance? I look forward to his response.

Accident and Emergency

Phillip Lee Excerpts

Wednesday 18th December 2013 Commons Chamber

[Dr Phillip Lee (Bracknell) (Con)]

On 27 December 1999, I and two other junior doctors embarked on a ward round at Wexham Park hospital in Slough. We had 72 patients to see that day, and it took us 13 hours to get round to them all. I say that because it was 14 years ago, yet I am hearing that this is the A and E crisis to end all crises. Every year, doctors in the national health service are worried and concerned about the pressures that the winter will bring to bear, and I do not think that this year is any different from 1999.

I want to try to be a bit challenging today and, in view of the motion, perhaps a bit counter-intuitive. We have too many casualty departments in this country. We should look at the mortality statistics—the likelihood of survival. I would say to the hon. Member for Wigan (Lisa Nandy) that, if my grandfather went into hospital, I would want him to go into the one where he had the best chance of survival, not necessarily the one down the road. I do not know about her hospital, but a large number of hospitals in this country unfortunately do not deliver the best care or the best mortality statistics. We need to reflect on that without trying to score petty political points about a variety of different issues.

[Grahame M. Morris]

I want to query the hon. Gentleman’s point about this crisis not being anything unusual. The Government’s own Health and Social Care Information Centre has published figures showing that the number of visits to A and E departments in England has risen by 11% in four years to 21.5 million attendances, which is 60,000 a day. The numbers are clearly increasing, and our argument is that that is partially the consequence of the Government policy of cutting social services.

[Dr Lee]

There has actually been a 37% increase in emergency admissions over the past decade, while 65% of hospital admissions are of people over 65. Dementia is doubling as we speak, and 25% of the NHS budget will be spent on diabetes by 2025. I am sorry, but to try to suggest that the genesis of the challenge we face has been during the three years of this Government is simplistic. The most polite way to put it is that the hon. Gentleman is making a simplistic argument.

[Kate Green]

I do not disagree with the hon. Gentleman about our wanting a configuration of services that ensures that patients get the best possible care and saves lives, but does he not agree that, if changes have to be made, transition planning and resources to support the transition are absolutely vital components of success? I have to tell him that, in relation to the reconfiguration we have just gone through in Trafford, I simply have not seen such resources put in place.

[Dr Lee]

I agree with the hon. Lady that the plans for many of the configurations have been somewhat made up on the hoof. They have usually been created and pushed by a series of local issues—such as 19th or 20th-century buildings that can no longer deliver 21st-century health care—but I recognise the need for a plan, and I will come back to that at the end of my speech.

I fear that a perfect storm is looming at the moment. [Interruption.] If the hon. Member for Eltham (Clive Efford) will allow me, I will come on to what I think we need to do. The perfect storm is that we have infrastructure that is not fit for purpose, too many hospitals that we cannot staff properly—one of the contributory factors in Mid Staffordshire was poor staffing levels, because it was trying to work over two hospital sites for a population that is not big enough to support one—and an ageing and increasingly obese society, as well as changes in people’s attitudes to pain and suffering and to seeking health care.

I have not yet heard a speech about the type of presentations occurring in casualty departments. Such presentations are rarely accidents and are extremely rarely emergencies. We must ask ourselves how we can address that. I am standing here with a dreadful cold and feeling pretty lousy. I have seen hundreds of patients who have presented to me as a GP or in A and E feeling like I do, but I will not go either to my GP or to A and E, because I understand that I have a viral infection that will get better by itself. The problem at the moment is that people just rock up at A and E because they think that it is the only place they will get seen, and no one questions whether they should just not bother turning up.

[Nicholas Soames (Mid Sussex) (Con)]

I am following what my hon. Friend is saying very carefully. Does he agree that part of the problem with A and E is the tremendous back-up of people who are admitted, and the inability to discharge people who ought not to be in hospital?

[Dr Lee]

Yes, we need to integrate. The shadow Front-Bench team is right to call for more integration, which is part of the issue.

That perfect storm is coming and I suspect it will hit this or the other side of 2020, when we will have such an ageing society with such expectations, and a creaking infrastructure that is not able to deliver the best care that can be delivered.

Given the time available, I shall be brief, but we need to have a cross-party plan. I suspect that we have twice as many acute hospitals as we need, and that we probably need only about 100 in England and Wales. The population served by each acute hospital should be about 500,000, 600,000 or 700,000, which is nine or 10 constituencies, so we would not all be able to come to the Chamber to defend our local district general hospital. I am sorry, but those days have passed. If you think that I am a maverick, I am backed up by every single royal college, the King’s Fund, the NHS Confederation—I could go on. Therefore, we need to deal with the issue.

I recognise that the politics is very difficult. I think that we should convene a cross-party committee and have a cross-party understanding. We will have to do that at some point in the next five to 10 years, and it would be remiss and wrong of us as an institution to ignore that reality. I am tired of sitting here and listening to hon. Members trying to score political points on this issue. Of course we can argue about the funding of health care and there is scope to debate philosophical differences about health care provision, but when it comes down to it, we need a hospital infrastructure that can deliver the best acute emergency and surgical care to everybody at their time of need. I fear that we do not have that.

We need to integrate social care with health care. There are some models—Cambridgeshire has embarked on a very good plan—but it needs to happen up and down the country. We need seven-day-a-week care, but to staff that appropriately, we need fewer hospitals. We will not be able to have seven-day-a-week consultant care on every district general hospital site in this country. I wish I had a bit longer, but I will conclude. I think that we really need to raise the bar, because everyone in this country wants the best care for all.

Managing Risk in the NHS

Phillip Lee Excerpts

Wednesday 17th July 2013 Commons Chamber

[Dr Phillip Lee (Bracknell) (Con)]

The title of the debate, “Managing risk in the NHS”, is very important. Indeed—although this may not be a topic for today—we ought to start thinking about the whole concept of risk and what patients will accept in terms of risk, especially given that everyone now has access to information via the internet. Invariably, the first thing someone puts into Google is the thing they are least likely to be suffering from as a consequence of the symptoms they are experiencing, so it is extremely important that risk is discussed much more with the patient population. As the right hon. Member for Holborn and St Pancras (Frank Dobson) said, it is extremely difficult to be a GP and to try to manage the demands being placed on the health service when people are coming in thinking that their headache is a brain tumour and so on.

It is particularly appropriate that I am speaking in this debate, because today the Care Quality Commission has published a report on Heatherwood and Wexham Park Hospitals NHS Foundation Trust. I am surprised that the hon. Member for Slough (Fiona Mactaggart) has not taken the opportunity to speak in this debate as a consequence. The report highlights significant concerns about the trust and the care of patients. None of the concerns was news to me: I approached the then Health Secretary about them in June 2010; I spoke to Monitor, whose chief executive told me, remarkably, that he had no concerns whatsoever and nothing had come across his radar about the trust; and I also spoke to Cynthia Bower in September 2010 about them. I say that because Monitor and the CQC were clearly not fit for purpose and doing their job of finding out what was wrong with hospitals.

I recognise the current Secretary of State’s desire to have a chief inspector of hospitals, and I wholeheartedly support him on that concept. However, I counsel colleagues on both sides of the House that if we start looking properly at the performance of hospitals, we will, judging by the list of experiences that the right hon. Member for Cynon Valley (Ann Clwyd) has just shared with the Chamber, have plenty more stories to deal with about hospitals, and how they fail or are failing.

I wish to concentrate primarily on legacy and the genesis of these problems, which probably blight both parties. A hospital does not suddenly become a problem in the space of a couple of years; that can occur over a number of decades. The problem we have in this country is that a large number of our hospitals are not fit for purpose. There is a legacy of poor location, not only because the land was often bequeathed, but because the buildings are often not fit for purpose. That is the particular problem at Heatherwood, and with its theatres, as was highlighted in the CQC report.

There is also a legacy in respect of the district general hospitals in general. They have had their day and we do not need them any more; we need regional specialist hub hospitals such as the one I have been proposing for the Thames valley for the past three to four years. I say that because if we are trying to provide care, it is incredibly difficult to mitigate risk when the theatre is not fit for purpose or when the hospital cannot be staffed appropriately. Labour Members have made much mention of nursing numbers, but the issue is much bigger than that; it is about the quality of the clinicians. Most clinicians have to specialise and sub-specialise, and the only way in which we will be able to provide the very best care in the 21st century is by having fewer acute hospitals. All the royal colleges share that opinion; I am not cornering that market. The flip side, however, is that we will have more community hospitals and more community care, which can only be a good thing.

If I were allowed to advise Members, I would tell them to be cautious on the issue of end-of-life care, because it will be extremely difficult to provide that in an increasingly ageing society. We are going to have some very difficult decisions to make for people in their 90s and for people over 100. There is no easy solution to this. The Liverpool care pathway was probably an honourable approach to try to take. I am not saying that it was perfect, but there was a desire to do the right thing in its implementation.

The reconfiguration is necessary and, for it to be appropriate, it will need cross-party support. We are not going to get anywhere by trading insults and taking political positions over various hospitals. Quite a few hospitals are not fit for purpose, with some in Conservative seats, some in Labour seats and some in marginal seats. If those of us who are interested in this topic truly want to improve care for all, we really need to remove party politics from the reconfiguration debate and engage in a cross-party discussion about where these hospitals should be. If we did that, if we managed to build some new hospitals—I suspect that we will have to build quite a few, because, as I said, the problem with a number of established hospitals is that their locations are inappropriate, as is certainly the case in my part of the world—and if we could come to a consensus and some agreement on this, we would be bequeathing to future generations a hospitals sector to be proud of. We do not have one to be proud of, however. We heard that mortality rates have been going down, but of course that is the case, because we are getting better at medicine, but with that come challenges regarding the end of life.

[Charlotte Leslie]

Does my hon. Friend have any information about how Britain’s reducing mortality rate compares with that of comparable European countries?

[Dr Lee]

I do not have such information to hand, but it would be interesting to compare our mortality rates for various conditions with those of Germany, Holland and France over the past seven to 10 years to determine whether there has also been a decline in those countries. It is difficult to claim that it was just the investment of money that led to reduced mortality rates in this country. I do not rule out the fact that the investment was a factor, but I suspect that the decline was due to advances in medicine and technology, and indeed in the skill base of consultants.

If we reconfigure, consultants will have a larger throughput of patients. It is interesting to note that Tameside covers about 175,000 patients—not enough—that Basildon and Thurrock covers about 300,000 or so, and that Mid Staffs covers about 225,000. Hospitals should cover a minimum of 500,000 people, if not 750,000, if they are truly to deliver the best acute and surgical care. The staff, especially the consultants, will want such a throughput of patients so that they can maintain and enhance their skills, and thereby improve mortality statistics. I therefore conclude by begging the Government and the Opposition to take the party politics out reconfiguration so that we can secure a hospital sector of which we can be proud for the next five decades.

Hospital Mortality Rates

Phillip Lee Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

If the issues are around staffing, we will sort those out. If the issues are around leadership, we will sort those out. If the issues are around clinical practice, we will sort that out. My commitment to the House is that we will do what it takes to sort out these failing hospitals.

[Dr Phillip Lee (Bracknell) (Con)]

In 2006 the then Labour Government purchased 49% of Dr Foster, the intelligence unit from which a lot of these mortality data are emanating. Does the Secretary of State agree that for Secretaries of State from that point onwards to be claiming they were unaware of the data seems a bit rich?

[Mr Hunt]

There were repeatedly high mortality rates in all these 14 hospitals, and it took the public inquiry that Labour did not want to demonstrate to the world just how important hospital standardised mortality ratios are. They are the smoke alarm that was ignored in the case of Mid Staffs, and which could have led to the prevention of thousands of tragedies if we had taken action earlier. That is why we immediately insisted on this review by Sir Bruce.

Health and Care Services

Phillip Lee Excerpts

Wednesday 3rd July 2013 Commons Chamber

[Mr Dorrell]

I do not wish to detain the House for the whole of the time available for this debate, but my hon. Friend raises an important question about how that demand is made up. The interesting thing about the drivers of demand—rising expectations, the cost and availability of modern medicine and the implications of an increasingly elderly population—which each new Front-Bench spokesman reveals as a newly discovered truth, is that they were first discovered by Rab Butler when he became Chancellor of the Exchequer in 1951. He set up a commission to ask whether the health service was an insupportable burden. The conclusion reached then, and by every successive Government since, in this and in similar processes in other countries, is that demand can be met, but it requires a serious analysis of the nature of the demand and how resources are used effectively to deliver it.

There is a danger in discussing health and care as if they were purely an economic question, especially for those of us who have been employed in the Treasury—like you, Madam Deputy Speaker, and me. There is a danger of sounding like a Treasury Minister and implying that the economic questions are the only issues in this regard. I need only offer names to the House to demonstrate that economics is not the only issue here—Winterbourne View, Mid Staffordshire and Morecambe Bay. Our system faces huge challenges, not just to do with economics but in respect of the quality of service that is delivered on a daily basis. Put simply, it is not enough just to go on delivering the service as it is now because, too often, it fails. Implicit in the Nicholson challenge is the requirement to face profound quality challenges, as they exist in the system, at the same time as squaring the financial circle I have been describing. In some quarters, it is suggested that that is a counsel of despair—that the circle is unsquareable.

The Committee disagrees, which is why the report states, at paragraph 30:

“At a time when steadily rising demand for health and care services needs to be met within very modest real terms funding increases for the NHS and even tighter resource constraints on social care, the Committee remains convinced that the breadth and quality of services will only be maintained and improved through the full integration of commissioning activity across health and social care.”

In other words, it is the Committee’s cross-party view that it is the integration—the reimagining of what health and care need to look like—that is the answer to the questions posed both by the Nicholson challenge and the quality challenges implicit in the names that I mentioned. It is important to be clear why that is the Committee’s view.

Efficiency, as implicit in the context of the Nicholson challenge, is not just about buying a bit more cleverly or holding down costs. It is about understanding what the demand is that we are trying to meet and putting in place the structures—incidentally, I do not mean the management structures—for the delivery of care that are likely to be able to meet the demands placed on them, not over the last 50 years but over the next 20. It is reimagining and driving a process of change through the health and care system that is the only realistic challenge to the financial and quality challenges that I have articulated.

[Dr Phillip Lee (Bracknell) (Con)]

Talking of efficiency, is my right hon. Friend as shocked as I am to hear that the Department of Health spent almost £74,000 on outside consultancy to prepare for just one Public Accounts Committee hearing? If that is the case, the Department might want to lead from the front on efficiency.

[Mr Dorrell]

I am sure that my hon. Friend will forgive me if, faced with an estimate of £103 billion, I do not go through every £70,000 of expenditure. However, he has made his point.

This is where I believe the Committee has held the Government to account, although not always comfortably for the Government of the day. There is no solution to the Nicholson challenge purely through adjusting the numbers—to use a non-emotive phrase. It has been reported to the Committee that in the first two years of the Nicholson challenge, 73% of the efficiencies that have so far been delivered are attributable as follows: 16% to pay freezes, which is the point made by my hon. Friend the Member for St Ives (Andrew George)—yes, holding down wages does reduce the cost of delivery and is, in the short term, a form of economic efficiency, but it is not a long-term solution to the Nicholson challenge—and, most implausibly, 45% to just changing the tariff between the commissioner and the provider. That is not an efficiency; that is an internal transfer, a bookkeeping entry, accounting, make believe. Another 12% over the two years is put down as “other”, which is an old accounting technique for concealing not very much, usually.

--- Later in debate ---

[Dr Phillip Lee (Bracknell) (Con)]

The nature of this debate is such that one can talk about anything to do with the NHS, be it local or national, in the context of the estimates of costs. The figures in the documents are immense—£1 billion here, £50 billion there; perhaps we need to plant some money trees in this country—and will only increase, as we all know. It has been interesting to listen to Members on both sides of the House this afternoon. Everybody accepts that demands are rising. Obesity is increasing—26% of adults are obese and the proportion is rising—and our population is ageing, so that by 2030 almost 25% of the population will be over 60. On top of that, there are advances in medical technology and the costs thereof to deal with—today’s cancer drugs can cost upwards of £5,000, £6,000 or £7,000 per month per patient.

Given those demands and costs, maintaining the current service will inevitably become nigh on impossible. I sense, even in the Chamber, and certainly outside it, that the public are beginning to realise that. I will say a few words about that before going local and discussing some of the things I have been suggesting in my region, and “region” is the key word here, rather than constituency.

The figures are really quite shocking. It has been suggested that by 2025 around 25% of the NHS budget will be spent on type 1 and type 2 diabetes alone. Only this morning a colleague told me that he had been diagnosed with type 2 diabetes. It affects all groups in society. Around 21% of the population smoke and around 28% of the adult male population drink too much—the figure is about 20% for women.

The number of prescriptions in 2009 was 886 million. The total cost of the NHS drugs budget in 2009 was between £13 billion and £14 billion, and it increases by £600 million each year. We are getting cleverer at inventing new drugs and classes of drugs, so I suspect that those costs will continue to increase, because it is human nature for someone to want the very best drug, the drug that will cure their cancer or extend their life.

Cases of dementia are set to double over the next 10 years, which will have a profound impact on health and social care. There will be a huge impact on the economy, as families will increasingly have to spend more time looking after the vulnerable, rather than going to work. The ramifications are immense.

I have detected some recognition in the Chamber today, particularly from my right hon. Friend the Member for Charnwood (Mr Dorrell), that there needs to be some cross-party agreement on this. I suspect that we will be arguing over the next 10 to 15 years about how we pay for health care. I have been brave enough to suggest that relying solely on general taxation to fund health care is not practical in the medium to long term. It is difficult politics—trust me, I saw my Twitter account explode at that point—but I think that we are likely to have a debate on that, and an argument, across the House, and that is as it should be.

However, where we should not disagree is about the way health care is structured in this country. I think that for both parties—it is a plague on both houses—the introduction of the market into hospital health care and the use of private finance initiative contracts, particularly over the past 10 years, has made it extremely difficult to reconfigure hospitals in certain parts of the country, which is unfortunate.

I have also heard that the introduction of competition law and its possible implications with regard to reconfiguration is also looming large in the national health service. Government Front Benchers might want to look at that, because I am persuaded—I have spoken about this on many occasions—that in future we will need fewer acute hospitals but more community hospitals. The majority of care will increasingly be offered closer to home, or indeed in the home, but the clever stuff, such as the life-saving stuff shown in the television series that the BBC is currently broadcasting on Thursdays, cannot and will not be offered in the number of district general hospitals that we currently have. Anybody who thinks that it can be does not understand. I suggest that it is increasingly becoming good politics to save lives, not to defend the indefensible, and I think that Members on both sides of the House should reflect on that.

One example from that television series was a nasty accident involving a head-on collision 30 minutes north of Addenbrooke’s hospital. The injured did not go to the local hospital, which had recently opened, because it could not care for them; they went 30 minutes down the road to be treated at Addenbrooke’s. In other words, a hospital that had been built in the past few years was already not fit for purpose. We should reflect on that.

Reconfiguration is essential, and it has been shown—not least in respect of London stroke services—to save lives and improve care. That should be replicated across the country.

[Mr Kevan Jones]

The hon. Gentleman is speaking a lot of sense. The stroke unit in the north of County Durham has just been specialised, and the results are already showing the benefits, although in parts of the region there was a lot of opposition to the move.

Does the hon. Gentleman think that long-term health should be managed not only by doctors but by pharmacists and others, who can play a key role?

[Dr Lee]

I am pleased that services are improving in County Durham; as the hon. Gentleman knows, I have family roots in his part of the world that go back centuries. I am not persuaded of the role of pharmacies, although I am persuaded of the role of pharmacists. I distinguish between the two because I personally think that all GP surgeries should be dispensing drugs. I do not see why the taxpayer should be subsidising pharmacies.

It is no surprise to me that Boots was the biggest ever private equity buy-out in the history of British industry, given that the taxpayer is outside the front door: “Come here for your amoxicillin, and while you’re here you can get your shampoo, conditioner and royal jelly.” I am not convinced about the role of pharmacies in the longer term; pharmacists most certainly have a role and should be included. Community pharmacists should be checking drugs, particularly when patients have polypharmacy—when they have a multitude of medications, another pair of eyes is always appropriate.

To return to the reconfiguration, in my locality we have a number of district general hospitals. Historically, Bracknell itself has been under-served by acute services since it was created in the late ’50s or early ’60s. We have seen services diminish in the area for a variety of reasons and under Governments of both parties, and we are sensitive about that.

Before I was elected as Member of Parliament for Bracknell—I stress that it was before I was elected—I suggested as part of my campaign that we needed to close hospitals in the area and consolidate to improve clinical outcomes. I am not aware that my result at the election was adversely impacted by that. Having worked in the area as a GP for a number of years and looked after 50,000 patients, I guess that people trusted what I was saying, and I recognise that.

I was trying to argue that we could consolidate acute services on a single site and improve community hospital services in appropriate locations around the region. I stress the word “appropriate”, as the problem is often that, for a variety of legacy reasons, hospitals are in inappropriate locations. They are not often on motorways, but on land bequeathed before the war. In my part of the world, the Astor family bequeathed the land for Heatherwood hospital. The local farmer outside Slough bequeathed some land because his daughter was looked after well. People thought, “Okay, we’ll build a hospital in the middle of a farm field nowhere near the population that it seeks to serve.”

There is a legacy problem. There is some need to close and relocate, while in some parts current locations can be enhanced. In my locality, there is the problem with Heatherwood hospital. I must put on the record something bizarre that frustrates me. It is “blue on blue”; if I was in a defence debate, it would be called friendly fire. The Royal Borough of Windsor and Maidenhead has called for a judicial review of the relocation of a minor injuries unit just three miles down the road, would you believe, to Bracknell—an urban centre in a better location and away from a place opposite the Royal Ascot racecourse. That judicial review will delay the move and cost money. I find that baffling and bizarre. It is evidence of the problem that I guess all colleagues of both political colours experience in local politics with regard to health care and trying to change services for the improvement of clinical outcomes, because it is not about cost, although obviously that is a factor, but about improving clinical outcomes. That frustrates me, and I will certainly be dealing with it robustly in local terms. At the moment, it is in the best interests of the general public to have fewer acute hospitals.

[Andrew Percy (Brigg and Goole) (Con)]

My hon. Friend is making an interesting point. Does he agree that in applying solutions such as those he is espousing, we must be careful that we do not apply an urban solution to rural areas? Moving an A and E three miles might be acceptable, but moving it 30 miles would not be acceptable to a lot of us.

[Dr Lee]

My hon. Friend is right: in a rural location the distances become further. I do not know the particular situation in his region, but I would suggest that there are probably location issues with regard to existing hospitals.

Moving neatly on, that is why—yes, you heard it here first: a Conservative calling for a Soviet-style central plan—I have called for a national plan for acute and emergency care. By definition, we cannot have a market interfering in that; we need to look at it in the round and say, “Where would we put these hospitals? Where are the motorways? What is the population density? Where is the rural location? Where is the urban location?” The problem is that if we reconfigure in isolation—I have seen this locally—it has a knock-on effect on other hospital services which then say, “Where are we getting our patients from?”

We should have a national plan that everyone from both parties has bought into. We should have—dare I say it?—a cross-party party committee looking into this. We should take it out of the political exchanges that we all engage in. We know what is going to happen in certain quarters in 2015—it will become a political football. I know that my hon. Friend the Minister is very aware of this. That is dreadful when we are talking about saving lives. Let us try to take this out of party politics. We can have robust exchanges, on principle, about payment, about how services are commissioned or not commissioned, and about whether there should be top-down reorganisation, but the fundamental question of where hospitals—acute and community hospitals—are located should be decided nationally; otherwise we could have perverse decisions whereby some services wither on the vine and we end up with gaps in emergency and acute care across the country. I make a plea for some cross-party activity on this.

Let us put the national health service’s budget into context. This country has debts and liabilities in excess of five times the size of our economy, and the situation is getting worse. Almost 40% of spending is on health and welfare, and it is growing. We know that that will happen; we have heard it this afternoon. Let us be realistic: there is only so much we can afford. I genuinely want a service that is based on clinical need. I genuinely want somebody to arrive at the appropriate location and get the very best care available. I fear that if we continue along this path of denial as regards how the service is paid for and, more important, structured, we will end up with more and more scandals. There are more in the pipeline. The chief executive of Tameside hospital has just resigned.

The public out there want more from us. They want us to make some difficult decisions, for sure, but using evidence, not party politics. I make that plea to everybody. If we can do that, we can structure a service that becomes the envy of the world; it is not that at the moment. However long I end up staying in this House, if that is achieved in the time I have been here, I will retire a happy man.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Before I call the Front Benchers, may I remind Members that if they are going to bring mobile phones into the Chamber they must be on silent and that they should not wait for them to ring? This is not the first time I have said that, but I certainly want it to be the last. Has the hon. Member for Strangford (Jim Shannon) taken that on board? Excellent.

Care Quality Commission (Morecambe Bay Hospitals)

Phillip Lee Excerpts

Wednesday 19th June 2013 Commons Chamber

[Mr Hunt]

As I understand it, the terms of reference, the way it is conducted and the timetable for the review happening at the moment are being set independently, but we should give every support to the people doing that review to make sure that they have access to the clinical expertise they need.

[Dr Phillip Lee (Bracknell) (Con)]

I very much welcome the Secretary of State’s desire to see published appropriately contextualised surgical outcome data for each surgeon. Those surgeons, however, have to work within structures created by managers, so in the interests of transparency would he support the publication of each manager’s performance so that the public can see where failure is taking place? First, that could prevent the merry-go-round of jobs, Cynthia Bower being the classic example. Secondly, appropriate financial penalties can be applied to the said managers if they fail, as they clearly have done in Morecombe.

[Mr Hunt]

My hon. Friend speaks extremely wisely. One of the key issues raised by the Francis report was the fact that we have a form of accountability for doctors and nurses—it does not always work as well as it should—through the possibility of being struck off by the GMC and the Nursing and Midwifery Council, but there is no equivalent accountability for managers. In a way, that is what the chief inspector is going to do. That is why I was so keen that as well as looking at whether a hospital is safe or not, the chief inspector should rate hospitals with Ofsted-style rankings, which look clearly at the quality of leadership in every organisation. The score that a hospital or a trust gets from the chief inspector will ultimately be the determinant of whether or not an organisation is well led. That is why I think it will give the public vital information about leadership, which they do not have at present.

Children’s Heart Surgery

Phillip Lee Excerpts

Wednesday 12th June 2013 Commons Chamber

[Mr Speaker]

Order. On the assumption that Dr Lee has now put his phone away, may I say to Members that they should not stand to speak while at the same time fiddling with a phone? It is multi-tasking in a way that is perhaps a tad discourteous. We do, however, want to hear from Dr Lee, who is a distinguished physician, so let us hear from him.

[Dr Phillip Lee (Bracknell) (Con)]

My apologies, Mr Speaker. As someone who has long argued for the reconfiguration of acute and surgical services, I consider the management of this clinical consolidation to be of great importance. Does the Secretary of State agree that best clinical outcomes should be the primary driver of any reconfiguration and that there is a need for a national plan for the reconfiguration of all acute and emergency services? If such a plan were drawn up, it should receive cross-party support.

[Mr Hunt]

May I commend my hon. Friend, because he is one of the few Members of this House who has been prepared to campaign for changes in acute services in his own constituency, which might not necessarily be what his constituents would want? He has shown considerable bravery on this issue. I will mention his idea of a national plan for acute and emergency services to Sir Bruce Keogh, who is carrying out the review of emergency services as part of the vulnerable older people plan. We definitely need to have a different national approach to service reconfigurations.