Covid-19 Update

Richard Drax Excerpts

Tuesday 24th March 2020 Commons Chamber

[Matt Hancock]

I will look into that point. The masks need to be clinically right; it is not for me to make that decision, but I will take this up with the chief medical officer.

[Richard Drax (South Dorset) (Con)]

May I personally thank my right hon. Friend and the Department for the rapid response he has given to every inquiry that I have made on behalf of my constituents? I also praise the NHS in Dorset and, of course, throughout the country for all the fantastic work that everyone is doing in the face of this appalling virus.

First, we are still having problems getting PPE; I heard the Secretary of State say that the phone line, to which he kindly referred me, is still the best way to try to follow up on that. Secondly, supermarkets are impossible to get hold of so that food banks can go online to request regular deliveries. Is there some way that we can get a message to all supermarkets to help out in that regard?

[Matt Hancock]

I am grateful to my hon. Friend for his first point. He is right that the hotline is the best way to sort out the PPE supply issues. I am told that it has already responded to more than 2,000 inquiries, is moving through inquiries fast and has a lot of people on the other end of the line to make sure that people can get hold of somebody. I shall take up the latter point with my right hon. Friend the Secretary of State for Environment, Food and Rural Affairs.

Wuhan Coronavirus

Richard Drax Excerpts

Tuesday 11th February 2020 Commons Chamber

[Matt Hancock]

The estimates vary and the answer is uncertain. There are promising signs of the very early stages of development seeing breakthroughs, but after the early stages of development, there need to be pre-clinical trials and then clinical trials to make sure that any vaccine is safe, especially given that—thankfully—the mortality rate from this coronavirus appears to be relatively low, at around 2%. Therefore, it is very important that a vaccine does not do more harm than good. I am pushing as fast as I can on the development of a vaccine, but I am also highly cognisant of the scientific advice and the need to ensure that it is safe.

[Richard Drax (South Dorset) (Con)]

On the point about mortality, leaked reports are coming out of China that the number of those who are dying is considerably higher than we first anticipated. Is that true? Is that what my right hon. Friend is hearing? Will he also tell the House, and thereby the country, who is most vulnerable? Who is most likely to be seriously affected by this terrible disease?

[Matt Hancock]

It is difficult in a country dealing with a very large-scale outbreak, as China is, for the information to be completely accurate. However, a report published in the last 48 hours of a study of 1,099 cases from China has demonstrated that in those cases, the number of children who have been affected and symptomatic is very small. That gives us hope—and some evidence—that the impact is largely on the elderly and frail, less so on people of working age and much less so on children, which is a very good thing for children themselves and for everyone else, because with the flu, if children are spreaders, they tend to spread fast. That is the latest scientific advice coming out of China, although given the nature of the challenges the Chinese health system is facing, it is difficult to get an entirely clear picture.

NHS Funding Bill

Richard Drax Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Matt Hancock]

That is clearly set out in the operational guidance to the NHS—that it must be. That will be auditable, and I am sure that my right hon. Friend will look to ensure that that has happened. This is an issue where the levers from the Secretary of State’s office to the NHS frontline are extremely well connected.

[Richard Drax (South Dorset) (Con)]

One way to ensure that patients can be best served is to make the software more compatible, and I know that my right hon. Friend is doing a huge amount to make that happen. Can he brief the House about where we are when it comes to making the system more compatible throughout the whole UK?

[Matt Hancock]

Yes. My hon. Friend makes a really important point. The issue is not just the quantity of money but how we spend it. Making sure that we get the best value for every pound put in is incredibly important. One way to do that is by using the best modern technology—ensuring that the different systems are required to talk to each other, for instance. We will be introducing a system with standards of interoperability mandating that the only systems that can be used are those that allow the information—appropriately and with appropriate privacy safeguards—to flow between different NHS organisations. People have had the experience so many times of informing one part of the NHS about what is going on and having to say everything all over again to another part of it. I want to end that.

--- Later in debate ---

[Simon Hoare (North Dorset) (Con)]

Let me be clear from the start that the Conservative party is clearly the party of the national health service, and the British public have trusted us with it for another five years as from December. The crucial point made by my right hon. Friend the Secretary of State, which I think is worth repeating, is that people can add noughts here, there and wherever they like, but new spending can only come from a firm, solid and growing economy. People can make all the promises they like about what they are going to do, but if the economy tanks, those promises are made out of pie crusts. I think that is why the British people have entrusted us with the health service.

I very much welcome the Bill, and hope that I can influence the Minister and his colleagues to think about where some of the new money can be spent. Let me canter through the North Dorset wishlist, if I may. For too long, health at the centre has ignored and underplayed the importance of rural community hospitals.

[Richard Drax]

My hon. Friend may canter as long as he likes, so long as he does not canter on to my patch.

[Simon Hoare]

I would not be seen dead in my hon. Friend’s patch. I have enough issues with my own.

There are two community hospitals in my constituency: Westminster Memorial in Shaftesbury and the excellent Blandford Community Hospital. I am a friend of both, and both friends’ organisations do a huge amount of vital fundraising work. The Minister is well apprised of the important role such hospitals play, particularly in rural settings after discharge from A&E, just before people can go home. Community hospitals need support and fresh attention.

Likewise—I am pleased that the Department prioritised this earlier in the year—community pharmacists play a huge and important role. I am told by our CCG that it is almost a cardinal sin to even consider this, but I would love to see a representative of the community pharmacies on the boards of each CCG, by mandate, because they have a vital role to play in our NHS family. As the previous chairman of the all-party parliamentary group on multiple sclerosis, may I also urge a greater rapidity with regard to the prescribing of medical cannabis?

NHS dentistry needs a fillip. I am often contacted by constituents about this—indeed, I was contacted by a lady from Stalbridge the other week who has now been trying to get on an NHS dentist waiting list for two years. That is simply not good enough when dental health is coming under pressure.

Speaking with another APPG hat on, I know that my right hon. Friend the Secretary of State is alert to the need for a speedy renewal of the health grant for those suffering as a result of thalidomide. That takes place in 2022-23. We all know the story of thalidomide; I am not going to rehearse it. We owe the victims of that scandal our support, and I hope that the grant will be renewed, either from new money from the Treasury in the comprehensive spending review or from the current NHS budget.

This is an opportunity to think about the future of the national health service, as my hon. Friend the Member for Watford (Dean Russell) said. We would all hold it in even greater esteem if all of us, as patients, were alert to the cost—the actual cost—of our medicines and our treatments. There would be far fewer medicines flushed down the loo and far fewer appointments missed if people knew the true cost to them, as taxpayers.

A number of hon. and right hon. Members have referenced the need to bolster preventive health still further. There is far more that we can do. Very often, the NHS is a national ill-health service; it merely picks up the problems that a more proactive preventive agenda could have solved. In that regard, I make a plea, in particular, for bowel cancer and prostate cancer—indeed, for the male cancers generally, which often get overlooked.

--- Later in debate ---

[Richard Drax (South Dorset) (Con)]

It is a pleasure to take part in this debate. May I congratulate those who have made their maiden speeches? May I also praise all those who work in the NHS in South Dorset and in Dorset generally? I concur with many of the things that my friend and colleague my hon. Friend the Member for North Dorset (Simon Hoare) said. I congratulate the Secretary of State, not least on his endurance capability. He was sitting on the Front Bench for so long and listening to us all, for which I am grateful, as I am sure all other colleagues are too.

My hon. Friend the Member for North Dorset rightly mentioned community hospitals, which are so important, certainly to rural constituencies. I know they are important everywhere, but they are particularly important to us. We struggled to keep open Swanage, but we have won that battle. Sadly, we have lost the beds on Portland, and all the facilities have gone to the hospital in Weymouth. The Portlanders—they are fiercely independent, and rightly so—jealously guard all that they have, and they are very sad that the beds have had to move. That was entirely due to the lack of trained staff, so that is one case highlighting the urgent need for more trained nurses.

In Poole, although it is not in my constituency, a decision was made by the clinical commissioning group to move the A&E to Bournemouth. For those who live in Swanage, that means a considerably longer journey— sometimes through rush-hour traffic in Bournemouth, which can be bad—or, alternatively, going to Dorset County, a journey that is slightly longer. I stress to the Minister that what we need down in Dorset is money to keep ambulances in their local towns and villages? For example, Swanage has an ambulance station. It was under threat, as I understand it; it is now not. That ambulance must remain in Swanage and available to Swanage people, so that it is not called from, say, Wareham, which would be a 20-minute journey down and a 20-minute journey back, making it over an hour to A&E, which simply is not on. I am working with the CCG to try to ensure that that is the case.

Finally, I will speak briefly—it is all the time I have anyway—about the Dorset County Hospital and its plans for a new A&E, which is desperately needed. I am afraid the figure is eye-watering: £62 million is needed completely to refurbish Dorset County Hospital A&E. What it has now—it is low roofed, there is no space and there is a shortage of places to move more beds to—means that people are really working in conditions that are not suitable for the demand placed on this hospital. Its budget is in balance, I am glad to say. It reckons it is going to draw even this year, but it is forecasting a loss of about £3 million to £5 million next year. What we would love from the Government is a little bit of attention to our rural acute hospitals, which seem to suffer because of the funding formula and various other things, and just a little bit more money. Let us face it, £3 million, £4 million or £5 million, when we are talking about a budget of billions, is not actually that much, but it would mean so much, certainly to our constituents in Dorset and to a vital hospital that everybody loves.

[Matt Western]

The hon. Member makes a very important point about rural provision and the difficulty for so many communities of accessing these services, particularly when people are dependent on public transport. My father and my mother used to live in South Dorset, near Swanage, and it took two hours to get to Bournemouth.

[Richard Drax]

Regrettably, we have had one or two cases where that has been repeated. The ambulance service has had a huge investment of 70 new vehicles, and I think 140 new staff are being trained as paramedics right now, all of which is very good news. The rurality issue—it is so often not taken into account when it comes to funding—has all too often been forgotten by Governments of all colours. Dorset has been at the bottom of many funding pools for a long time. On behalf of my constituents and all the constituents in Dorset, I implore the Minister, who is patiently sitting on the Front Bench, for a little bit more attention and just a tiny bit more money. That would make all the difference.

Oral Answers to Questions

Richard Drax Excerpts

Tuesday 19th February 2019 Commons Chamber

[Matt Hancock]

We care about securing the future of the NHS. That is why we are putting £20 billion extra into it over the next five years—£33 billion extra in cash terms. Yes, we will consider proposals being made for legislative changes, but what we care about is making sure that the NHS gets all the support it needs, and not just political nonsense.

[Richard Drax (South Dorset) (Con)]

Does my right hon. Friend agree that one of the vital components to ensure the long-term future of the NHS is community hospitals? Will he meet me to discuss what can be done to recruit more qualified staff, so that beds at the Portland Community Hospital can be reopened?

[Matt Hancock]

I would be very happy to meet my hon. Friend to discuss that, because community hospitals have a vital role to play in the future of the NHS as more care is delivered close to home.

Nurse Training

Richard Drax Excerpts

Wednesday 5th September 2018 Commons Chamber

[Richard Drax (South Dorset) (Con)]

It is a great privilege to be drawn for one of these end-of-day Adjournment debates, as they give Back Benchers such as me the opportunity to debate a subject dear to their heart. Tonight’s topic is fairly dry, but it is very important. I hope the House and those watching will forgive me if I plough into a lot of detail, because the detail is important on this issue. I welcome the Minister, for whom I have a high regard, to his place. Another advantage of these debates is that the poor Minister has to sit there and listen to me, and there is nothing he can do—he cannot escape. So I hope my words will fall on receptive ears.

This debate follows a recent public meeting on Portland hospital in my constituency; the beds at the island’s much-loved community hospital have been closed, but more on that shortly. We have heard it before, and it needs to be said again: we are facing a desperate shortage of nurses. Health Education England believes there are 36,000 nursing vacancies in England, whereas the Open University says it is 38,000 and the Royal College of Nursing gives a figure of 40,000. That last figure equates to an 11% vacancy rate, with learning disability and mental health nursing the most affected, followed by community nursing. These gaps may be filled by bank or agency staff on a temporary basis, but Health Education England estimates that 1% remain permanently unfilled. The knock-on effect places nurses under “relentless pressures”, according to a report this January by the Select Committee on Health. It added that

“nurses felt their professional registrations were at risk because they were struggling to cope with demand.”

Meanwhile, any increase in nurse numbers is swallowed up by the demand for more of them. For example, although the number of new nursing positions created between 2012 and 2015 rose by 8.1%, the number of those who actually joined the profession increased by only 3.2%. What is the consequence? Well, obviously, costs rise. Temporary nursing staff are expensive, with NHS trusts paying an average of 61% more for every extra hour they worked compared with that paid for a newly qualified, full-time, registered nurse. A Freedom of Information Act request by the Open University in January revealed that, if the hours worked by temporary staff were instead covered by regular nurses, the NHS could save as much as £560 million a year. The independent health think-tank, the King’s Fund, revealed that on average NHS trusts were spending nearly 7% of their salary budgets on agency staff, with the figure rising to more than 25% in some cases. Dorset HealthCare, which covers my constituency, forecasts an overall spend of £4 million this year on agency staff alone. That is down from a staggering £12 million three years ago but still represents a significant share of the healthcare budget.

As I mentioned at the start, 18 beds were closed at Portland Community Hospital last month due to a lack of nursing staff.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for giving way: I sought his permission to intervene beforehand. He is outlining the shortage of nurses in his constituency, but there are nurse shortages in many other parts of the United Kingdom, including in Northern Ireland, which has a shortfall of some 1,800 in nurse numbers. Does he agree that the training of nurses must be a priority for trusts and the Department of Health and Social Care? Part of the way to attract new nurses is to show how we value our current nurses through decent pay and working conditions. It is important to ensure that nurses are regarded highly for the work that they do—and paid accordingly.

[Richard Drax]

I do not disagree with anything that the hon. Gentleman has just said, and I will come on to his points a little later in my speech. Of course all nursing staff should be appreciated and paid properly. One of the issues, as I shall describe in a minute, is the work environment, which is one of the factors leading to fewer nurses—or insufficient numbers—entering the profession.

Before the intervention, I was talking about my community hospital in Portland, where almost half of all nursing positions were unfilled this summer. Agency staff, costing as much as £58 per hour—and £135 per hour on bank holidays—were still hard to find. The trust’s chief executive, Ron Shields, for whom I have enormous respect, decided he could no longer safely keep the beds open. So, despite the understandable protestations from islanders who wish to keep their frail and elderly relatives close by, the beds were migrated to a hospital in Weymouth, where the nursing staff available can be consolidated. I suspect that that situation is not uncommon across the rest of the country.

The crux of the matter is the recruitment and retention of nurses. Recruitment depends mainly on training new nurses for the future. The numbers required are traditionally set by Health Education England, which then commissions the nursing places from further education and training establishments, including colleges, universities and the Open University. Standards are set and approved by the Nursing & Midwifery Council, ensuring uniformity across providers. Those establishments, in turn, invite applications, for registered nurses, nursing associates, nursing apprenticeships and Nurse First.

The first role requires a degree, the second a prior healthcare qualification, the third is a joint initiative between individual health trusts and further education establishments and the fourth is a new initiative for high-flying graduates and follows the lines of Teach First. The three-year degree option remains the main route into nursing. While many, including me, dispute the need for a degree, the Nursing & Midwifery Council says that that is to misunderstand modern nursing. Registered nurses are now an “officer class”, according to Geraldine Walters, the NMC’s director of educational standards, with much of the work for degree-level nursing now highly technical and demanding. In some cases, registered nurse prescribers replace doctors and indeed even run their own primary care clinics in London.

So far the nursing associates programme has been a success. In December 2017, 2,000 nursing associates were in training. This year, it is hoped that figure will be 5,000, rising to 7,500 in 2019. The Nursing & Midwifery Council is clear that more recruitment and widened access into nursing training are essential, as is the diversity of training provision.  The Open University, for example, provides for those who, for a variety of reasons, would not gain access to the profession via the traditional, campus-based route.

Since 2002, the Open University has offered a four-year registered nurse degree apprenticeship in addition to the straightforward apprenticeship. This is aimed specifically at existing healthcare support workers who welcome the chance to earn while they learn. So far, it has trained more than 1,000 applicants as registered nurses, with 940 more currently on the programme in England. One huge benefit to the scheme is that participating trusts seem better able to retain the nurses they have trained. Compare this with the 24% drop-out rate for student nurses on the degree course. As the NHS is the nation’s biggest contributor to the 5% apprenticeship levy, it would be odd for it not to participate.

The loss of the bursary scheme has been keenly felt, with the Royal College of Nursing saying that it is a serious own goal. It was a support package including tuition fees, a non-means-tested maintenance grant, a means-tested bursary itself, and other elements designed to help students with placement, travel and childcare costs. It was overwhelmingly popular, attracting more applicants than there were places. It was replaced by the student loan scheme, requiring students to borrow money to pay for their training.

The problem is that nursing is a vocational training and does not cater for school leavers unsuited to the profession. Significantly, following the removal of the bursary, the number of applications for nursing through UCAS has fallen by a third since March 2016. Although the Department of Health and Social Care says that there are 52,000 nurses in training—more than ever before—the number of those accepted on to courses is still down by 9.3% in England. That threatens the pipeline of new nursing talent and, at the very least, should and could have been anticipated. Much-needed mature applicants, many with care experience, are also deterred by the burden of debt and loss of earnings, and Ms Walters told me that these are exactly the people the profession needs. Mature applicants also tend to choose careers in specialist areas worst hit by the staffing crisis, such as learning disability and mental health.

New figures from UCAS show that applications for nursing degrees and from mature students are down by 33% and 42% respectively since March 2016. As the latter group are the very people who would be grateful for any support given, and probably remain in the organisation until retirement, Mr Shields suggests that trusts should provide some form of financial support in the absence of bursaries. A recent survey by the Open University showed the effect of the loss of the bursary on recruitment. Only 30% of nurses asked said they would have been willing to self-fund or partially self-fund their initial nursing education. In addition, more than half of those surveyed believed that applications would continue to fall.

Attracting nurses back into the NHS after they have left is another crucial focus for recruitment. The return to practice campaign, run by the Nursing & Midwifery Council, which provides refresher training and a re-entry route back into the NHS, has already recruited almost 2,500 former nurses and is currently registering another 1,800. However, as the Health Committee report states,

“too little attention has been given to retaining the existing nursing workforce, and more nurses are now leaving their professional register than are joining it.”

The Committee cites many causes, including workload pressures, an inability to meet patient expectations, concerns about providing adequate care, poor access to continuing professional development, poor organisational culture, pay restraint and budget cuts. The impact of Brexit was another reason, although—interestingly—briefings from the Library show that overall EU staff numbers in the NHS have, in fact, fractionally risen since the referendum, with numbers of EU nurses falling by just 0.3%.

Another issue is the current pensions arrangements. Senior and experienced staff who might want to work beyond 55 are leaving because their pensions reduce in value if they stay on. Mr Shields has recently lost two senior and valued members of his team, and believes the Government must look at this urgently.

A partial solution to increase nurse numbers is to recruit from abroad, including Commonwealth countries. However, this was, until recently, severely limited by immigration rules, which were wisely relaxed in June after an intervention by the Home Secretary.

In December 2017, Health Education England published its draft health and care workforce strategy for England to 2027. “Facing the Facts, Shaping the Future” anticipates a significant shortfall in nursing numbers due to an increase in the number of posts needed. The Health Committee has emphasised that future projections of demand for nurses should be based on demographics rather than on affordability alone. A final workforce strategy is expected from Health Education England at any minute. Perhaps the Minister can enlighten us, as it was expected, as I understand it, at the end of July.

Finally, I thank all those who work in our NHS for the wonderful job they do, not least the fantastic teams in South Dorset.

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[Richard Drax]

I am listening carefully to my hon. Friend’s reply. He is absolutely right: Mr Shields instinctively would like to keep community hospitals. In rural parts of the country, and certainly in South Dorset, with an ever-increasing number of elderly people moving there, there is very much a feeling of, “Where are they all going to be?” Experience in the past has shown that the best place for an elderly person to recover is near their home in a cosy community hospital. The system works. As the beds go for the reasons I have explained—Mr Shields rightly had no choice but to do it, and it is true that the hospital will remain open—those fears will not just disappear overnight.

[Stephen Barclay]

My hon. Friend is right that being cared for close to home is in patients’ interests. I would actually go a step further and say that most patients want to be cared for and supported at home, if possible, because they are more likely to be mobile and to get up to make a cup of tea in their familiar surroundings. If that is not possible, they want to be in a community setting, but in that community setting it is better that they have access to a wider suite of services, including a consultant specialist, so that we can avoid the 43% of patients on average who are currently being treated in probably the most expensive part of the NHS family, the acute setting, where they are, for example, at greater risk of infection, notwithstanding the fact that since 2010, under this Government, the rate of hospital infections has halved. Even so, there can be muscle deterioration, or what one clinician called “PJ paralysis”. Staying in acute hospitals is often not in the best interests of an elderly patient, so treating them at home or in a community setting with the right support to reduce their length of stay is in their interests.

The crux of my hon. Friend’s remarks was a challenge as to what the Government are doing to tackle the need to recruit more nurses as we face a growing demographic. I remind him, as he is well aware, that the Prime Minister has committed to more funding for the NHS—a £20 billion-a-year additional funding package. There is a commitment to staff in the NHS through “Agenda for Change”, and the Government are introducing an increase in pay for nurses.

We are looking at additional pathways such as the nursing associate programme, which my hon. Friend referenced. There are 5,000 places this year and 7,500 next year. The programme enables people who perhaps thought they would not have the opportunity to be a nurse and were trapped in a particular role to have a ladder of opportunity and to move from roles such as healthcare assistant into that of nursing associate, with the option of then progressing into a nurse role.

We need to look at the nursing degree apprenticeship, and we are using the apprenticeship levy that the Government have introduced through the tireless work of the Minister for Apprenticeships and Skills. Again, that provides a great opportunity for people to progress within the NHS. We should also look at the measures the Prime Minister has taken on tier 2 visas—removing the cap—and recognise that attracting talent from overseas is an important part of addressing the concerns about recruitment raised by my hon. Friend.

We are looking at measures to give giving staff greater flexibility, such as through e-rostering, and using technology to provide greater certainty. There are also measures in relation to returning to work. Since 2014, 4,800 nurses have started on the return to practice programme to bring that talent back into the NHS. The Government are taking a whole suite of measures, because we recognise that there is a need for more nurses, exactly as my hon. Friend said.

[Richard Drax]

The Minister is being most kind and generous in giving way. Will the bursary return? I would have thought that the bursary was more likely to attract home-grown talent. I am not saying that nurses from abroad are a bad thing, because they are not—they all do a wonderful job—but we are always trying to train our own. If the Minister brought back the bursary, I would have thought that was more likely to attract people from this country.

[Stephen Barclay]

The problem with the bursary scheme was that it involved a cap on the number of places, so a massive number of people who wanted to be nurses were rejected and denied the life chance of being a nurse. The removal of the cap has allowed us to increase the number by 25%—an additional 5,000 places. That is 5,000 people who will have the opportunity to train as a nurse who did not have such an opportunity under the bursary scheme. It is also means that while they are training as a nurse, they will have a higher maintenance grant through the Student Loans Company than they did previously under the bursary system. I appreciate the concerns raised about the bursary, but this Government are all for giving people the opportunity to progress, life chances and the opportunity to increase their skills. The removal of the bursary scheme has allowed us to offer more people the opportunity to become a nurse, rather than fewer, as was the case under the bursary.

I do not want to choke off the opportunity for someone who aspires to be a nurse, but we should recognise that people want to progress at different stages of their lives. That is why the right option for some is to be a nursing associate. Some people may want to stay as a nursing associate, some may want to progress to being a nurse, and some may want to do a nursing degree apprenticeship. It is important that we offer the flexibility that people increasingly want in society so that they can pursue their careers at different rates and at different times.

The Government have taken a whole range of measures. I mentioned the “Agenda for Change” pay award, under which the pay of a healthcare assistant will go up by 26%, or nearly £4,000, over the next three years. A nurse with between three and four years’ experience will receive a 25% increase, which is more than £6,000 over three years, and a band 6 paramedic with between three and four years’ experience will have a £4,000 rise over three years. Again, as my hon. Friend mentioned, that recognises the hugely valuable contribution that staff make to the NHS.

I touched on the fact that we are looking at specific areas in which we recognise that there are issues and referred to the postgraduate golden hellos as a way of targeting recruitment. I have also said that we have lifted the cap on tier 2 visas. Under the existing arrangement, 40% of tier 2 visas were actually going to the NHS, but we have none the less lifted the cap.

I pay tribute to my hon. Friend’s campaigning on behalf of South Dorset. He is always assiduous in speaking to Ministers and raising concerns on his constituents’ behalf. We are repurposing services, but we are moving beds to where there will be better support, and these are some of the changes that will deliver an NHS fit for the future. I am happy to continue discussions with him so that we ensure the NHS continues to serve his constituents with first-class care.

Question put and agreed to.

NHS Long-Term Plan

Richard Drax Excerpts

Monday 18th June 2018 Commons Chamber

[Mr Hunt]

The reason why we took what I fully accept was a very difficult decision was that we wanted to fund the training of an additional 5,000 nurses every year. When there is a reform of higher education funding, there is always an initial dip in applications. In this case, record numbers of 18 to 19-year-olds applied, but there was a dip among mature students. That is why we have introduced the apprenticeship route. We need to make sure that that works if that dip is to be reversed.

[Richard Drax (South Dorset) (Con)]

I welcome my right hon. Friend’s statement. Like all colleagues in the House, I am a great supporter of community hospitals. Under the latest Dorset clinical commissioning group review, Portland Community Hospital is to be replaced with a medical hub on the island. Will the extra money allow the CCG to review the review, and perhaps save hospitals such as Portland Community Hospital?

[Mr Hunt]

Obviously, that would be for the CCG to look at; it will focus on anything that allows it to focus on prevention and not cure. I do not know the specifics of that case, but in general there is a strong and important role for community hospitals, although not always doing exactly the same things they have done in the past. Often, they can become local NHS hubs, offering a wide range of services. That tends to be the best way to preserve their future.

Future of the NHS

Richard Drax Excerpts

Thursday 20th July 2017 Commons Chamber

[Richard Drax (South Dorset) (Con)]

Before I start my speech, may I thank you, Mr Deputy Speaker, the Speaker and all the office staff, the police and everyone else who takes care of us here? I wish them all a very happy summer recess, when they all go off on their holidays. We are extremely grateful for all that is done.

First, I thank and praise all those who work in the NHS, especially those on the frontline. Secondly, it would be inappropriate of me not to pay tribute to our able and competent Front-Bench team, who face some extremely difficult challenges within the NHS. My speech today is in no way at all a criticism of the Government; it is purely based on my own observation and the observations of others, in part in Dorset but also from around the country. I hope Ministers will forgive and indulge me as I honour one of my election pledges and bring this matter to the Government’s attention.

As I said, in essence I am responding to my own observations and to those of the many people I have spoken to, who work either in or around the NHS. I, we and they are proud of our NHS, and rightly so. As Nigel Lawson, the former Chancellor, so memorably said, “It’s the nearest thing we have to a national religion”.

The NHS will be 70 years old next year; it is the world’s fifth largest employer, with 1.5 million employees; and it serves a population of the United Kingdom of more than 54 million people. The total budget for NHS England is a staggering £117 billion. The three founding principles of the NHS—that it is available to all, free at the point of delivery and based upon clinical need rather than the ability to pay—still stand. Last week, the US-based Commonwealth Fund health think-tank found the NHS to be the best, safest and most affordable healthcare system of the 11 countries it analysed, for the second time in a row. That is a record to be proud of.

However, the NHS is, to some degree, a victim of its own success. That same study placed the UK second from bottom for clinical outcomes. So what to do? Politicians take a scalpel to the NHS at their peril. The consequence is that only sticking plaster is used to meet changing circumstances. Medical advances, longer life-spans and soaring healthcare costs have outpaced resources, and the situation can only get worse.

A recent Public Accounts Committee report found that the financial performance of NHS bodies had deteriorated, with NHS trusts seeing their deficits almost treble to £2.6 billion in a single year, 2015-16. Plugging those deficits will not be easy. Addressing the shortage of nurses and GPs, coping with a strained adult social care system, responding to an overstretched A&E service and countering ambulance waiting times all require careful thought and perhaps further review.

I am a former soldier and we used to say in the Army that time on reconnaissance is never wasted, so a visit to the frontline—in my speech—is instructive. A senior doctor on my Dorset patch despairs at the “army of office staff” who leave every evening on the dot of 5 pm, while work in the hospital, which he emphasises has always been a seven-day service, rolls on. He believes that administrative staff could be cut by about 25% without affecting patient care.

That senior doctor says the so-called “bed bureaus” in most hospitals are a case in point. When a patient is admitted, doctors must book a bed through bed managers—there is one per shift, so three per day—who, in turn, inform the ward sisters, who were themselves once responsible for the beds on their wards. In fact, the bed managers are often very senior nurses who have been promoted out of their clinical roles into well-paid managerial jobs. Formerly, such senior nurses were an invaluable source of knowledge and training for junior nurses, but it now seems there is a risk that their hard-earned skills will be wasted in administrative roles.

To be fair, the NHS says that managers have been cut by 18% since 2010. However, in the view of the senior doctor I am referring to, there is still ample opportunity better to share back-office functions across regions, especially in commissioning services, purchasing and postgraduate medical education for doctors. For those who are unaware, newly qualified doctors apply to a regional deanery for further training in foundation years 1, 2 and 3. That deanery remains responsible for their rotations until they choose their clinical specialty, three years after qualifying. Therefore, my doctor source asks, why are there education managers, deputy education managers and deputy assistant education managers in most hospitals he has worked in? In addition, he points out that nurses are efficiently certified and accredited by their own system, so they do not need in-house education managers, either.

The pressure on social care has also had a significant impact on acute hospitals, says this doctor. Like hospital administrative staff, care home staff are available to assess prospective new residents only during office hours, leaving A&E departments—often with elderly patients who are not strictly emergencies—to languish until Monday morning. Occupational therapists are also unavailable until Monday morning, meaning patients cannot be sent home because their homes cannot be certified as safe. In addition, A&E departments are frequently overwhelmed by patients suffering from mental health issues.

The under-16s pose a particular problem, certainly in Dorset, because the office hours of the children’s mental health assessment service are from 9 to 5, Monday to Friday. Most young patients present at night, when stress, depression or suicidal thoughts tend to rear their ugly heads. An A&E doctor is unable even to prescribe a sedative. Instead, dedicated nurses must be found to watch the young patient constantly until Monday morning, when a child psychiatrist can see them.

In addition, the NHS internal market, which has been with us since John Major’s Government, has also had unintended consequences. Procuring goods and services across a region, rather than restricting individual commissions to each small trust, would save millions, says this doctor. So what can be done? Clearly, the current situation is unsustainable in the longer term. The right hon. Member for Birkenhead (Frank Field), if I may paraphrase him, has said that the NHS is so rapacious that it could probably never be satisfied. However, there must be another solution.

Healthcare spending is protected relative to other public services, but increasing demand and costs surely demand we think a little more out of the box. As I have mentioned, hospital deficits reached £2.6 billion in 2015-16, negating the benefits of any funding increases. Projections from the Office for Budget Responsibility suggest that spending on healthcare could rise from 7.4% of GDP in 2015 to 8.8% in 2030-31, which is the equivalent of a real increase in spending of £100 billion.

The Office for National Statistics predicts that the proportion of people aged 65 and over will increase from the current level of 18% to 26.1% in 2066, with over-85s tripling to 7.1% over the same period. A study by the King’s Fund found that financial pressures have affected access to services and quality of patient care, while the Care Quality Commission’s latest report concluded that the quality of care provided across England varies considerably.

When compared with member countries of the Organisation for Economic Co-operation and Development, the UK spends less per capita than France, Germany, Sweden and the Netherlands. We also perform poorly on many acute care indicators, with worse outcomes for stroke victims, heart attacks, and cancer survival over five and 10 years. With more people, better and more expensive technology and greater expectations, the pressures will continue to grow.

A significant new House of Lords report, “The Long-term Sustainability of the NHS and Adult Social Care”, describes a “culture of short-termism” across successive Governments. Interestingly, the report calls for a new political consensus on the future of the health and care system via

“cross-party talks and a robust national conversation.”

I do not entirely agree, but I will come on to that later.

The report concludes:

“Short-term funding fixes will not suffice. Neither will tinkering around the edges of service delivery.”

It made three recommendations: that there should be radical service transformation, with more integrated health and care services in primary and community settings; that there should be long-term, stable, predictable and adequate funding for the NHS and adult social care; and that there should be immediate and sustained action on adult social care, with urgent funding to alleviate the crisis in NHS hospitals. It is not just the Lords who have an opinion; these are coming in thick and fast from across the political spectrum, including from the King’s Fund, the Barker commission, the Nuffield Trust, the Health Foundation, the Public Accounts Committee, the Care Quality Commission and a number of parliamentary Select Committees.

To be fair, a good start has been made. The Health and Social Care Act 2012 abolished primary care trusts, to be replaced by 44 clinical commissioning groups, responsible for commissioning the majority of NHS services. Since 2015, those in turn have developed local sustainability and transformation plans, as part of the NHS five year forward view. The STPs are blueprints for better integration of GP, community health, mental health, cancer care and hospital services, focusing on more joined-up working with home care and care homes. The Government are to be congratulated on all of that. I am delighted and touched that this week Dorset’s STP has been awarded more than £100 million by the Government. Dorset is also one of eight areas nationally to announce an accountable care system, which will fast-track these improvements, especially taking the strain off A&E departments and making GP appointments easier to get. It will share in a £450 million pot. The STPs are, say NHS England,

“a starting point for local conversations”.

We all hope so. Dorset’s CCG is currently poring over responses to its public consultation which closed in February. Some of its proposals, including moving A&E services from Poole to Bournemouth, and losing community hospital beds on Portland and at Wareham, I find difficult to accept.

Inevitably, some of the CCG’s remit must be to find savings. Various suggestions have been made in the past: the Carter review in 2016 found that £5 billion could be saved through shared procurement and back office support; the Naylor review in 2017 concluded that better management of the NHS estate could generate £5 billion and provide land for 26,000 new homes; and the Wachter review suggested that better IT systems would help. Whatever savings are made can then be reinvested in the NHS’s most precious asset of all, those on the frontline, where there are genuine concerns.

A House of Lords report described the lack of an appropriately skilled, well trained and committed workforce as the

“biggest internal threat to the sustainability of the NHS”.

A shortfall of some 10,000 GPs across the UK is predicted by 2020. At the same time, hundreds of GP practices are in danger of closing because 75% of their doctors are aged over 55. Nurses are wooed now with flexible hours and school-friendly schedules, but the abolition of the nursing bursary earlier this year has seen the number of applicants applying to start nursing degrees this October fall by 23%. I know from my own research into ambulance waiting times that the ambulance trust covering my constituency is having trouble both recruiting and retaining staff.

We all agree, in all parts of this House, that the NHS is a unique national treasure, to be protected, sustained and nurtured, but it cannot remain a sacred cow, untouchable at any cost. So why do we not hand this problem to an independent panel, totally divorced from politicians, and ask it to see how we can make better use of the £117 billion that we spend? From what I have heard and seen, I simply cannot believe there is not a better way of running our beloved NHS. The will from those in all parts of the House is there, so let’s be bold, take politics out of it, simplify the way the NHS is run and channel more resources to the frontline.

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

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

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

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

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

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

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

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

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

[Richard Drax]

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

[Mr Dunne]

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

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

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

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

[Richard Drax]

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

[Mr Dunne]

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

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

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

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

Question put and agreed to.

National Health Service Funding

Richard Drax Excerpts

Tuesday 22nd November 2016 Commons Chamber

[Richard Drax (South Dorset) (Con)]

I congratulate my right hon. Friend on the calm and dignified way he is dealing with this debate, as compared with the Opposition. May I put in a plug for local community hospitals, not just in my constituency but right across the country, and how vital their retention is for good quality care in the future?

[Mr Hunt]

I thank my hon. Friend, who himself personifies calm and dignity. Community hospitals are indeed extremely important. Their role may change, but they will none the less continue to be a vital part of provision in most of our constituencies.

NHS Funding

Richard Drax Excerpts

Monday 31st October 2016 Commons Chamber

[Mr Hunt]

Well, that was the tone of the hon. Lady’s question, and setting her face against all changes may not be the right thing for her constituents.

[Richard Drax (South Dorset) (Con)]

Does my right hon. Friend agree that patients get better in a cosy environment in community hospitals, and can he give me an assurance that he will love and maintain them for as long as he is in post?

[Mr Hunt]

I am sure that no one could do a better job of loving and maintaining community hospitals than my hon. Friend. Community hospitals have an important role to play. I have three excellent ones in my constituency. At best, they represent the change we need to see in the NHS, which is personalised care closer to home, but that does also mean that they sometimes need to change the way they deliver services within a building even if the NHS logo remains firmly on the outside of that building.

Ambulance Waiting Times

Richard Drax Excerpts

Monday 17th October 2016 Commons Chamber

[Richard Drax (South Dorset) (Con)]

It is a pleasure to address the Chamber under your chairmanship, Madam Deputy Speaker. It is also a pleasure to see in his place my hon. Friend the Minister of State, Department of Health, who is a very able Minister.

My speech is not an attack on the Government per se. It is my job as the MP for South Dorset to stand up and speak for people without fear or favour. In my six years as MP, I have seen the ambulance service increasingly struggle, and I hope that any information that I impart will lead to the improvement of the service.

I pay tribute to the men and women of the ambulance service, whose professionalism, dedication and selflessness have saved countless lives. People’s ability to dial 999 in an emergency in the expectation of receiving urgent and expert medical help has long been one of the NHS’s treasures. Now, it is the ambulance service itself that is facing an emergency. In the year to May 2016, ambulance response times hit a record low. Not a single one of the 10 ambulance trusts in England met the target of reaching 75% of incidents within eight minutes. Worryingly, the current national average for a response within eight minutes is 68%. This trend has grown over the past four years, which is the period for which the Government have published response figures.

Ambulance control rooms across the country are buckling under the twin strains of increased demand and dwindling resources. The increased demand is undeniable. Last year set a new record, with 10.8 million ambulance call-outs in 12 months—a staggering number. The London control room alone now fields 5,000 calls for ambulances every single day.

The numbers show that emergency calls for ambulances have risen by 6% year on year for 10 years. This has not been helped by the fact that people are finding it harder to see their GP, meaning that they fall back on A&E. Although we can debate the causes, the fact remains that there are simply not enough vehicles, paramedics and clinicians to cope with the increase in workload. At the same time, the resources available have been cut or frozen. Six of the 10 English ambulance service trusts are currently in deficit, having overspent their budget, despite making efficiencies. East Midlands Ambulance Service NHS Trust alone had a £12 million deficit last year.

In my constituency, efficiency savings have directly affected the South Western Ambulance Service NHS Foundation Trust, which I shall refer to from now on as the trust. An ambulance call-out in the trust now costs 2.5% less than last year. The trust covers Bath and north-east Somerset, Bristol, Cornwall and the Isles of Scilly, Devon, Dorset, Gloucestershire and South Gloucestershire, Somerset, Swindon and Wiltshire—a huge predominantly rural land mass covering 20% of England. I highlight the trust’s area of responsibility because it is the most rural of all the ambulance trusts and the area is one of the most sparsely populated, which means longer distances, higher fuel costs, patients who are harder to locate and hospitals that are more spread out. This means that ambulances need to be parked at intervals across the region, as I see all the time.

Achieving response times and meeting budget targets under such circumstances is a challenge. It is not just the increased demand and reduced resources that are creating the problems; the target culture does not help. Though well intended, targets can skew both priorities and outcomes. For example, to meet target times, a fast-response paramedic on a motorbike or in a car might be sent to a critical incident that would almost certainly require ambulance transportation to hospital. Those red-category incidents include life-threatening emergencies such as cardiac arrest, where survival depends on swift and specific action. Sending the wrong resource in such a case might well tick the target box on response times, but the eventual outcome might not be so satisfactory. For example, if responders reach a patient only one second short of the eight minutes, it is considered a success, even if that patient dies.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing this matter to the House. In 2014-15, the Northern Ireland Ambulance Service met its eight-minute deadline in only 60% of cases. Such problems beset all of us across the United Kingdom—here on the mainland and in Northern Ireland. Does he agree that it may be time to share those experiences and also ideas about how we can make things better across the United Kingdom? If we can do that together, to see what improvements we can make, we will all benefit.

[Richard Drax]

I entirely concur. As I said at the start of my speech, I am not here to condemn the Government, because they have the most appalling situation to deal with, given rising costs and all the things we know about the health service. Yes, more integrated systems, which the Government are working on, are definitely part of this. As I will say at the end of my speech—perhaps I will say it now—we really ought to think about the whole NHS and how it is run, not just the ambulance service. We need to do that free of politicians, with expert advice being sought from non-politicians—those who know how the health system works, not least the clinicians—so that we can re-look at this whole situation. We have enough money, but we have not spent it particularly wisely in every case.

Let me just go back to my example—you might well have lost the thread, Madam Deputy Speaker—about the target times for red-category incidents. I was saying that if responders reach a patient only one second short of the eight-minute target, it is considered a success, even if that patient dies. Conversely, it is deemed a failure if a patient lives, but help has arrived just one second over the eight-minute response time. Worse, the trust is marked down for it.

Once at the hospital, ambulance crews face yet another target: they must hand over their patient to the emergency department within 15 minutes. Anything over 30 minutes incurs a fine, although it is not applied to all areas and is capped by the trust’s commissioners. Yet, handovers can be achieved only if there are available beds and bays in the emergency department, which in turn can free up space only by transferring patients to wards or into surgery. That flow—from ambulance to emergency department to ward and, hopefully, to home and recovery—simply is not happening, because beds are not being cleared. The so-called bed blockers—the chronically ill and often elderly patients—languish in hospital beds because there simply is nowhere else for them to go. Without enough community care outside the hospital to discharge them to safely, there is no alternative, and so if the wards are full—they often are—there is gridlock. Regrettably, we have all become accustomed to the sight of ambulances lined up outside the emergency department with their crews tending to their patients until they can be handed over. In August this year, ambulances delivered patients to the Royal Bournemouth hospital’s emergency department 650 times. The 30-minute handover target time was breached 91 times, and in eight cases patients waited for more than two hours.

It is perhaps not surprising that ambulance crews feel demotivated and demoralised, and A&E staff are equally under pressure. They are all attempting to do their best—everyone recognises that—but perhaps that is in a system that sets them up to fail. Unsurprisingly, the attrition rate in the ambulance service in England is running at 11% a year, leading to each ambulance service having to replace more than one in 10 of its call handlers, drivers, clinicians or paramedics. I am told that these invaluable, experienced professionals eventually buckle under the physical and emotional demands of their jobs, often leaving for the better hours, conditions and pay offered by GP surgeries and clinics. The retention of staff is notoriously difficult in A&E departments, too, for similar reasons. A recruitment crisis now faces the ambulance service and A&E departments. Yet, for these most dedicated and professional workers, without whom the NHS would grind to a halt, there is little light on the horizon. Instead, and extraordinarily, fines are imposed on the cash-strapped services employing them.

Hold-ups from ambulance to A&E represent a waste of precious resources; in the trust’s area, that amounts to a staggering 5,000 hours per month, and the south-west’s hospitals are by no means the worst performing in England. For that reason, the trust and the Yorkshire and west midlands ambulance services have been trialling a new response programme. The aim is to get the right resource to the right incident first time. Rather than sending a response vehicle to meet a target, more time is taken to identify the reason for the call-out. Something that is life-threatening, such as strokes and heart attacks, will inevitably need an ambulance transfer to hospital, whereas a less serious case can be dealt with by a paramedic. Members might have thought that that sounds like common sense, but it seems to me, and I think to many, that targets, in part, get in the way of common sense. Sheffield University will report on the results of the programme. Interestingly, Wales is already using the system, with a 75% success rate, and Scotland is starting trials now.

Inevitably, waiting times for ambulances are increasing as pressures mount. Regrettably, there are consequences for the patient and, of course, their family and friends. Less well known are the physical and verbal assaults on ambulance staff. In the trust’s area alone, those have doubled in 12 months—that situation is, I am told, untenable. Death threats have been made to control room staff, while physical injuries have included a broken jaw and a career-ending attack with a baseball bat. Often, drink and drugs are to blame; sometimes, mental health issues, pain, sheer anxiety and frustration make relatives and friends lash out. I am not, for one second, condoning that behaviour—in fact, I condemn it—but I am just trying to explain it. I have some experience of this with constituents who are devastated when they do not get the emergency response they expect—when we dial 999, we do indeed expect a speedy response.

Ambulance service staff are united in calling for a formal, ongoing public information campaign that tells the public not only when to call an ambulance but what to expect when one is called. With the number of calls continually outstripping the number of ambulances available, expectations need to be managed. I would be grateful if the Minister expanded a little on that when he answers. By way of example, in Dorset and across the whole trust area, 58%—nearly 60%—of 999 calls do not result in patients being sent to A&E at all, and 14% of callers are treated and advised over the phone.

Calls to make funding for ambulance services and A&E a special case chime with calls for increased social care provision to free up beds in hospitals so that a flow can be re-established. That is particularly important in Dorset and the south-west, where so many pensioners choose to live.

I would like to share some observations from Mrs Fiona Smith, who is the manager of Milton Court sheltered housing in Poole, which is not in my constituency. Her charges, who are all in their 80s and 90s, live independently and successfully in their own homes, with support services provided by the company. If they suffer heart attacks or strokes, the ambulance arrives within 10 minutes, she says, but if they fall down, the importance of the incident is downgraded by call handlers due to immense pressure from other incidents. Mrs Smith recently waited for more than four hours with a frail 96-year-old lady who remained lying on the floor with a broken hip because protocols would not allow staff to lift her. Mrs Smith is at pains to point out that she is not criticising the ambulance staff; she simply believes that there is insufficient funding and staff. Her advice to me and the Government, and to others, is that we need to get our priorities right.

I know there is no short-term solution to the picture I have painted, and I sympathise enormously with the Government’s plight. In the past, Governments of all colours have had this massive problem, which is growing as the population gets older and lives longer, and the cost of medical care rises. More joined-up care is one way forward, as the hon. Member for Strangford (Jim Shannon) suggested. I praise the clinical commissioning group in Dorset, which is working with all GPs and hospitals to try to ensure that a more joined-up care approach is working. I believe that that is happening across the country, and I am sure the Minister will expand on that. This is a vital way forward that will solve some of the problems.

Perhaps, as I hinted—I do not know whether the Minister can expand on this—we need to re-examine the whole NHS, rather than just picking on particular bits of it. Now and in the past, when politicians and Secretaries of State sometimes feel that that things need to be done—and they do—they unfortunately fail to look at the whole picture. This is not a criticism of our current Secretary of State, for whom I have high regard; I think he is doing an extremely good job in difficult circumstances. However, perhaps now is the time—as we see, to a certain extent, the writing on the wall and the warning signs flashing—for us to sit down and have another look at how the NHS is run. I leave that point with the Minister and his Department. I can only recommend that politicians are kept out of that debate until such time as ideas are put forward to us, because inevitably we would have to make the final decisions.

I end as I began by praising the staff of the ambulance service in the south-west, not least those who serve us in South Dorset and do a fantastic job. I have met many of them and cannot praise them enough. I now look to the Minister to expand on what I have said in the hope that there is some light at the end of the tunnel, and perhaps a little more money at the bottom of the bucket.

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

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

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

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

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

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

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

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

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

[Richard Drax]

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

[Mr Dunne]

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

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

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

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

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

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

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

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

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

Question put and agreed to.