NHS Funding

Robert Jenrick Excerpts

Monday 31st October 2016 Commons Chamber

[Mr Hunt]

The hon. Gentleman is looking at the record of this Government: we have 1,200 more doctors in our A&E departments, who are treating within four hours 2,500 more people every single day. We are also putting more money into the NHS and into the social care system. Addenbrooke’s is a hospital under great pressure, but it is determined to co me out of special measures and do its best for patients, and I salute all the staff, whom I much enjoyed meeting there on Friday. The one thing they would not want is the NHS budget to be cut from current levels.

[Robert Jenrick (Newark) (Con)]

The Secretary of State knows that over 50% of the deficit at my local trust, Sherwood Forest Hospitals NHS Foundation Trust, and 25% of all its annual revenue goes on paying off its PFI premium. Will the Secretary of State take this opportunity to look again at my trust and others? Will he also remind the House which party left that toxic legacy for my constituents?

[Mr Hunt]

I am happy to remind the House, as my hon. Friend requests, that we inherited this situation from the Labour party in 2010. Despite that toxic legacy, the people working in the Sherwood Forest hospitals have done an incredible job of turning the trust around since it was put into special measures a few years ago. I commend them on their progress, which I hope will bear fruit and allow the trust to come out of special measures soon.

Glenfield Hospital Children’s Heart Surgery Unit

Robert Jenrick Excerpts

Wednesday 19th October 2016 Westminster Hall

[Liz Kendall]

I thank my hon. Friend for raising that point. She is absolutely right. Many patients and their families have told me that they simply would not be alive if they had had to travel much further. If the proposal goes ahead, the east midlands will be the only region in the country without a children’s heart surgery unit. It does not have to be this way, because if we properly manage the number of referrals across the east midlands, there will be enough for Glenfield and other surgery units to keep going. It is a balance between getting the right numbers and having quick access to a centre.

[Robert Jenrick (Newark) (Con)]

I thank the hon. Lady for initiating the debate. May I reiterate the point made by the hon. Member for Ashfield (Gloria De Piero)? My constituents who have contacted me about the hospital live a long way from Leicester—some of them live virtually on the South Yorkshire border, many miles away—and have used the hospital not just for routine surgery but for emergencies. They already have to drive 60 miles to get to Leicester, but if they had to go to Birmingham or Great Ormond Street, it would put lives at risk.

[Liz Kendall]

I share the hon. Gentleman’s concerns. We have to be aware that it is not just about the essential, vital emergency care and surgery when it is a matter of life or death and whether children can reach a centre in time. It is also about ongoing care and support. It is not just that they have one or two operations when they are little; they need care and support right through into adult life.

We must remember that children are part of families, and families have obligations. They have other children they need to get to school and they have work commitments. To throw that up in the air when they have those arrangements and their children need ongoing care and support is denying those patients choice.

Junior Doctors Contract

Robert Jenrick Excerpts

Wednesday 6th July 2016 Commons Chamber

[Mr Hunt]

I am more than happy to do that. I think that the vast majority of junior doctors think that what has happened is a tragedy and are keen to move on. I hope they take seriously my assurances this afternoon that we will be monitoring every stage of the implementation of this contract, and if there are further things that we can improve, we will do exactly that, because we want a contract that is good for them and good for patients.

[Robert Jenrick (Newark) (Con)]

Weeks like the ones we have just lived through put other matters into perspective. With that in mind, I am sure the Secretary of State will agree with me that it is absolutely right for patients and the country that this dispute ends now. I was delighted to hear that he is now reluctantly going to move to phase in the imposition of the contract. Will he, in his usual conciliatory manner, now turn a page on this dispute, end it completely and build a new relationship with junior doctors and the new interim head of the BMA’s junior doctors committee?

[Mr Hunt]

My hon. Friend speaks very wisely. I would certainly very much like to do that. It does take two to tango, but the Government certainly want to do everything they can to work with all the leaders of the different bodies in the medical profession, partly for the reason my hon. Friend gave—that the country is very preoccupied with even bigger issues—but partly because there is so much pressure on the NHS frontline, and it is just counterproductive to exhaust so much energy on these disputes when we could talk our way around them and avoid them.

Junior Doctors’ Contract Negotiations

Robert Jenrick Excerpts

Monday 8th February 2016 Commons Chamber

[Ben Gummer]

Sir David Dalton has also made it clear that we have to reform all contracts. One can place the balance where one wishes, but it is important that we reform the juniors’ and the consultants’ contracts together, so that they can fit within the service of a piece. It is wrong, for instance, to have a junior on duty taking decisions at the weekend and not be covered by consultants supervising and helping with those decisions. We need to ensure that there is consistency of rostering through the week and at the weekend involving both juniors and seniors.

[Robert Jenrick (Newark) (Con)]

I represent many junior doctors. I have met them and I have tried to represent their views to the Government, but I have always taken the view that my primary responsibility is to the patients of the NHS. One of those patients, a constituent of mine, emailed me this week to say that a consequence of the strike would be the

“cancellation of my wife’s biopsy, planned for this week, without which her already shortened life will be shorter”.

Will the Minister, the shadow Minister and the whole House join me in condemning this strike? It will achieve nothing. It is a distraction from the negotiations, which need to continue, and it will put the lives of my constituent and others across the country at risk.

[Ben Gummer]

I cannot possibly add to the comment made by my hon. Friend, and I just hope the shadow Secretary of State takes note.

Junior Doctors Contract

Robert Jenrick Excerpts

Friday 20th November 2015 Commons Chamber

[Alistair Burt]

First, we will avoid the language of “fight” and the sense that this has become an industrial dispute, although there are elements of one, given how the BMA has behaved over the negotiations. As far as the public are concerned, however, this is not an industrial dispute: it concerns them very deeply. They appreciate and value their doctors, they want to have their treatment and they want to be safe. People must talk. The BMA, which withdrew arbitrarily from the negotiations, needs to take up the Secretary of State’s offer and start talking. We all know that ultimately this will be ended by talking. Whether that happens today or after 1 December is entirely up to the BMA. I repeat that the Secretary of State is right to be spending this morning dealing with the potential consequences of the action suggested, and I still wait to hear from any Opposition Member that they reject strike action by doctors.

[Robert Jenrick (Newark) (Con)]

When I was a lawyer, I was involved in a number of arbitrations and mediations. Does my right hon. Friend agree that it is highly unusual to go straight to arbitration or to ACAS if there have not been normal negotiations? In this case, as with all other negotiations, the best practice is for the parties to get around the table, and, if that fails, then to go to ACAS, but not to waste time in the interim.

[Alistair Burt]

My hon. Friend is absolutely right. As the Secretary of State has also made clear, we need to restart the negotiations, which are based on independent recommendations that the BMA looked for and took part in. As he says, the normal procedure is that, if the negotiations do not work, conciliation is available, as the Secretary of State has said. However, we cannot say negotiations have broken down if they are not taking place. I am sure that everyone in the Chamber wants the negotiations to continue and will urge junior doctors in their constituencies to recommend that the BMA restarts them immediately so that we can move this forward and end the threat of strikes that no one wants.

NHS: Financial Performance

Robert Jenrick Excerpts

Monday 12th October 2015 Commons Chamber

[Ben Gummer]

I answered that point entirely accurately and categorically, and on behalf of the ministerial team I refute the allegation.

[Robert Jenrick (Newark) (Con)]

My local trust in Nottinghamshire, Sherwood Forest, is in a very bad financial position—one of the worst in the country. The primary reason is the appalling private finance initiative deal we inherited from the previous Labour Government, which consumes 17% of the trust’s annual budget. Would a new Parliament be an opportunity for the Government to look again at those appalling PFI contracts, particularly those that affect trusts such as mine that are in special measures?

[Ben Gummer]

Across the country, trusts are struggling under the load of poorly negotiated PFI contracts. It is worth remembering that when the Labour party speaks about all the money it put into the NHS, a large part of it was borrowed via PFI—that part which was not borrowed as part of Government debt. The important point about PFI is to try to address each contract in turn. The Department is looking at this on an ongoing basis, not only as it concerns old contracts but in the letting of new ones.

Jimmy Savile (NHS Investigations)

Robert Jenrick Excerpts

Thursday 26th February 2015 Commons Chamber

[Mr Hunt]

I do think it is very important to have good sex education in schools and that we make sure that all children understand when a boundary has been crossed and when they need to speak out. That is an important lesson from this report.

[Robert Jenrick (Newark) (Con)]

May I draw the House’s attention to another report published today, that concerning Rampton hospital in my constituency? Jimmy Savile was given almost unrestricted access to one of the UK’s most highly secure hospitals, which adds another layer to the matter. Rampton hospital contains some of the UK’s most dangerous patients. One of the most concerning issues in the Rampton report is that for staff his activities were described as an “open secret” but that management may not have known about them. If that finding is credible—it does not ring true with colleagues at the hospital I have spoken to—and is to be believed, would the Secretary of State give thought and resources to how we deal with whistleblowing and reporting in these most closed and secretive environments, where it seems to be the most important to have an open culture?

[Mr Hunt]

My hon. Friend speaks wisely. There were four separate disclosures of sexually inappropriate behaviour by Savile in separate incidents, not with patients, but with other people, including a young child. My hon. Friend is right: it is not just about mandatory reporting; it is also about making sure that when that reporting is done by a member of staff, something actually happens. That is part of the reason we need to do this consultation properly, because it is about making sure that the right actions are taken by people who are able to take those actions. That clearly did not happen in this case.

Oral Answers to Questions

Robert Jenrick Excerpts

Tuesday 24th February 2015 Commons Chamber

[Dr Poulter]

I am very happy to meet the hon. Gentleman, but he will be aware that the move away from the historical funding formula towards a per head or capitation formula is a move in the right direction. If there are certain local concerns, I am very happy to meet him to discuss them.

[Robert Jenrick (Newark) (Con)]

May I commend the Government on raising the priority for dementia in their announcement last week? Will the Secretary of State and the Department of Health put all their resources behind towns such as Newark, which are trying to establish themselves as dementia-friendly towns and are working with shopkeepers, banks and the business community to make it easier for older people with dementia to lead fulfilling lives?

[Mr Jeremy Hunt]

I commend my hon. Friend on his work in that area. People with dementia want to lead as normal a life as possible, and being able to go out to the shops is one very important thing they want to continue to do. We now have 1 million dementia friends in this country. That is a great step forward, and with his help we will do even more.

Oral Answers to Questions

Robert Jenrick Excerpts

Tuesday 13th January 2015 Commons Chamber

[Jane Ellison]

These are clearly difficult local questions that local health leaders need to look at. If there is a particular issue the hon. Gentleman would like to draw to our attention, we will certainly be able to examine it. I recognise that unique geography is involved, but steps are already being taken by NHS England to try to close some of those gaps and to deal with those challenges that smaller hospitals face, working with Monitor and looking at, for example, the tariff regime. I encourage him to look at that, too.

[Robert Jenrick (Newark) (Con)]

11. What proportion of 111 calls resulted in an ambulance being called in the most recent period for which figures are available.

[The Minister of State, Department of Health (Norman Lamb)]

There were just short of 882,000 calls triaged by the NHS 111 service in England in November 2014, and 99,808 of the calls—11.3%—had an ambulance dispatched.

[Robert Jenrick]

I thank the Minister for that response, and I am grateful for the earlier response to my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes), which is very reassuring. Any Member who has spent time with paramedics, as I have in Newark, knows that this is a hot topic for them. So we would appreciate any extra reassurance the Minister can give that the algorithms that lie behind the 111 service, and the level of clinical involvement in it, can be improved, with experience, to create a sensible number of cases going to accident and emergency.

[Norman Lamb]

I pay enormous tribute to the paramedics, who are working under a lot of pressure. The survey results, which showed that about 27% of people who have used 111 say that they would have gone to A and E had it not been available, are a considerable reassurance. However, we need constantly to seek to improve the service, and the urgent and emergency care review pointed to refining the 111 service so that, ultimately, people could get access through to a GP, doctor or nurse, to ensure that they receive the right guidance at the right time.

Health Care Provision (Newark)

Robert Jenrick Excerpts

Wednesday 7th January 2015 Westminster Hall

[Robert Jenrick (Newark) (Con)]

I start by thanking Mr Speaker for granting the debate and the Minister for replying this morning. I am also grateful for the attention of the Secretary of State, who visited Newark hospital last year. I thank my constituents and the Newark Advertiser, who have come here for the debate, and I thank my constituency neighbour, my hon. Friend the Member for Sherwood (Mr Spencer). Rather like the film “Groundhog Day”, the last debate on the subject was held two years ago to the day. The matter has moved on somewhat since then and progress has been made, to which I will refer shortly, but concerns remain. That is the reason why I return to the subject today.

I do not want to bore the Minister, but a little bit of history might be useful. I know that she visited Newark three times in May last year, but let me briefly guide her. We sit on the border between Lincolnshire and Nottinghamshire, and despite excellent north-south road and rail links, the community is relatively remote and rural, and it is bedevilled by poor roads and awful traffic. Newark is a growing town, with applications for thousands of new homes being considered as we speak and many more to follow, according to local growth plans. We have an older population, and the number of over-65s is likely to have doubled by 2026. I fear that Newark suffers from the Nottinghamshire health care model, which has been in place for at least a decade and a half. Centres of excellence have been created in places such as Lincoln, Nottingham and King’s Mill hospital, but not in Newark. For reasons of population scale, Newark hospital was linked to King’s Mill hospital some years ago. They were, and remain, uneasy bedfellows, because there are few natural connections and poor transport links between the two.

[Mr Mark Spencer (Sherwood) (Con)]

I congratulate my hon. Friend on securing this important debate. In the two years that have elapsed since the previous debate, one thing that has changed is the transfer of more than £80 million in private finance initiative payments from Sherwood Forest hospitals trust to its PFI holder. What impact is that having on Newark hospital and Sherwood Forest hospitals trust?

[Robert Jenrick]

I thank my hon. Friend for his campaigning on PFI and Sherwood Forest hospitals trust. I will return to that question later in my remarks, because it is one of the central issues affecting the trust’s ability to deliver good-quality health care not only for my constituents, but for his and for people throughout Nottinghamshire.

To return to my brief history lesson, the hospital delivers superb services, and it always has done, but those services have diminished relative to those that were offered in the recent past. In addition, as we have heard, King’s Mill is saddled with a devastating PFI that will be in place for 30 years. The problem is not new; it has been a hot potato in the Newark area since at least 2004, and there is a history of declining services including the loss of maternity care in the increasingly distant past. The PFI was put in place, and in 2010—bridging the previous and current Governments—the A and E department was replaced with a minor injuries unit. I say that, but the classifications in the NHS seem byzantine to us amateurs, and even if they are not designed to confuse us, they undoubtedly have that effect. The department called itself an A and E for the best part of 10 years, but it did not qualify to be one. It was always going to be extremely painful to change the department’s title and inform the community that the back-up available at the hospital was insufficient to be safely called an A and E and to have ambulances directed to it for the commensurate range of emergency situations.

In 2012, Monitor delivered an extremely critical report on the PFI and the trust, which includes King’s Mill and Newark hospitals. The report pointed out that Newark hospital was, at times, underutilised by some 55%, and it was closed for admissions after 6 pm. Good has come from that report, including new management and significant improvements at the trust. However, the trust, as the Minister knows, remains in special measures, with a corresponding impact on recruitment, retention and the reputation of the trust and its hospitals among my constituents and those of my hon. Friend the Member for Sherwood.

To return to the hospital and bring us closer to the present day, some services, including those related to hips and knees, have been removed in recent years following the Keogh report and the imperative, we were told, to ensure that services are matched to appropriate levels of staffing and back-up. The trust is in the process of refocusing Newark on day case services and diagnostics. We all understand that the transformation of services takes time to implement, and the period of change has seen some underutilisation. I suspect that that period has gone on too long. Furthermore, there have been problems about directing patients to the appropriate hospital and ensuring that that hospital is Newark if the services are still available. I have lost count of the number of times that constituents have told me that they were not offered Newark hospital or had to ask for it specifically, when we know that the hospital delivers the necessary services. That contributes to underutilisation and must be resolved once and for all.

On top of those difficulties, East Midlands ambulance service received a concerning inspection report by the CQC at the beginning of 2013, which found it to be underperforming in four of the six central measures. As medical professionals agree that the most serious emergency situations are best treated by fully staffed and equipped general hospitals, the imperative becomes greater to have an ambulance service in north Nottinghamshire with the capacity to respond swiftly and meet the appropriate timings for our constituents. Furthermore, residents complain about the length of time taken to repatriate those who are no longer critical but who require rehabilitation or some further care closer to home. That is made all the worse and more onerous by the long journeys and expensive bus fares required for relatives to visit.

To bring my history lesson to a close, I want to report some positive developments of late. In 2013, a new 13-bed ward, the Fernwood recuperation and rehabilitation unit, opened. The Bramley children’s unit, new cardiac services and an endoscopy suite have all opened. The CT scanner at the hospital, which had reached the end of its natural life, is—admittedly after some pressure—to be replaced. The trust has appointed a new director, Mrs Jacqueline Totterdell, with the specific objective of bringing Newark hospital up to full capacity in the range of services that it provides. This week, the trust and the clinical commissioning group have announced a capital investment of more than £500,000 to enhance the facilities of the minor injuries unit, providing a better patient experience and more consultation rooms, and integrating the MIU with out-of-hours GP services. That development is the successful result of an application to the Prime Minister’s challenge fund.

Those developments are refreshing and should be celebrated. They confirm that the old rumours in the town that the hospital was to close are unfounded. The trust has made that clear. They also suggest a welcome degree of focus on the hospital by the trust and the CCG, which I hope will continue and which must intensify. I praise the clinical leader of the CCG, a respected Newark doctor named Dr Mark Jefford, for his role in that.

Where do we go from here? My objective, which I am sure that my hon. Friend the Member for Sherwood shares, is to ensure that Newark and north Nottinghamshire have health care provision of the highest possible quality delivered as close to home as is safe. I gave this debate the title “Health Care Provision (Newark)”, as distinct from the previous debate, to emphasise the fact that my interest is precisely that. My interest is not in bricks and mortar, and it is not driven by nostalgia or false science.

I return to the emergency provision. We still hear forlorn voices talking about the reopening of an A and E unit, but no one who understands the problem could think for a minute that Newark will have an A and E unit. I want to make it clear that that really is not the issue at hand. The issue is whether the present MIU or urgent care centre—whatever one wishes to call it—adequately reflects the fundamental remoteness of Newark and the surrounding area of Nottinghamshire, and whether anything can safely be done to provide a higher degree of emergency provision. Again, terminology gets in the way but, for the sake of argument, let me call it MIU-plus—in other words, providing sufficient support to enable Newark hospital to take a greater proportion of the so-called green cases. One can argue about what the proportion might be but, clearly, any material increase in the types of cases that paramedics could safely bring to Newark hospital, or that the hospital accepts from those walking into the MIU, would result in a range of benefits: shorter journeys to hospital for those in Newark and rural areas; less pressure on the ambulance service; and greater convenience for patients and their relatives. The benefits would surely be felt throughout Nottinghamshire and Lincolnshire and would take pressure off overstretched A and E departments.

In my time as a Member of Parliament, I have argued that, if a clinical case can be made, there is no reason why such an MIU-plus should not be introduced at Newark hospital. I have sought the advice of the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who, without detailed knowledge of the circumstances, pointed me in the direction of a hospital in Hexham where GPs, local authorities and the hospital trust have integrated to a degree to preserve and enhance services in a remote area.

Members of the management and leadership of the trust and CCG with whom I have discussed the matter over the past couple of months take a different view. They think the system would be extremely difficult to implement safely. I would be grateful if the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison) gave me her view, today or in the future, on exactly how realistic the proposal is. Members of the public seeking an outcome not wholly dissimilar to the one I have described have written to various authorities, including Ministers and NHS England, but have been unable to gain their opinion on that route. I admit to banging on about this, continuing a line of argument that has been made unsuccessfully for some time, but I raise it again because it is strongly felt by my constituents. I seek the Minister’s guidance and, of course, the ear of the trust and the CCG.

As I have already described, the heart of the problem in Newark and Nottinghamshire is the interlocking concern about the adequacy of the MIU and the performance of our ambulance service. East Midlands ambulance service has new leadership, a new chair in Mrs Pauline Tagg and acting chief executive in Mrs Sue Noyes. The ageing fleet, which I have seen myself, will be upgraded, including with welcome new vehicles for north Nottinghamshire. The trajectory appears to be upwards, which is welcome. Any support that the Minister and her Department can give to EMAS and its leadership would be greatly appreciated.

I recently spent time with paramedics and was hugely impressed. They face the challenge of operating in a large geographic area. A and E is under strain, and a contributing factor is the very limited circumstances in which paramedics are able to take patients to Newark. Whatever one’s view on that, there is a lack of clarity on those circumstances. I am told by one source that a lad breaking his arm on a football pitch, suffering no other major symptoms, could be taken to Newark, but I am aware of plenty of cases in which paramedics could not take such patients there or have been turned away. I am told that the number of circumstances in which paramedics may take patients to Newark has increased, yet I have seen a crib sheet in ambulances that appears to show that the number has decreased by two. I do not know the rights or wrongs—I am not a clinician, so I cannot say—but that must be cleared up urgently. Fundamentally, the rurality of Newark and north Nottinghamshire needs to be addressed with adequate ambulance capacity,

Finally, I will address the PFI debt, which my hon. Friend the Member for Sherwood mentioned. Monitor expressed concern about the financial situation of Sherwood Forest Hospitals NHS Foundation Trust. The trust signed its £320 million PFI deal for the redevelopment of King’s Mill hospital in November 2005, and in 2012-13 the trust’s PFI cash outflow was £42.5 million, which equates to 17% of the trust’s income. If ever we needed an example of a terrible PFI deal and debt, this is it.

The trust operates with one hand tied behind its back. In December, my hon. Friend and I asked the Secretary of State for Health whether he would review the trust’s finances as it is both in special measures and suffering the consequences of a disastrous PFI deal. He agreed to do so, and I ask the Minister to make good on that promise. PFI contracts are complex and the options available to the trust to reduce the current burden—whether that be some form of refinancing, the buying back of debt or addressing parts of the contract not yet or inadequately executed—are complex and require analysis. The trust has limited resources to devote to the analysis required, which would presumably require the help of outside specialists. Are the Minister and the Department willing to sponsor, by which I mean pay for and support with advice, a full review of the PFI deal, with the objective of presenting options to the trust that can be reviewed and, I hope, implemented? I make that request with the full support of the trust’s chief executive. Such support would make a difference to the trust, my constituents, my hon. Friend’s constituents and the constituents of many other north Nottinghamshire Members who have not been able to join us this morning.

In addition to my specific questions, I leave the Minister in absolutely no doubt of the importance to my constituents of Newark hospital and of health care provision in north Nottinghamshire. Newark hospital is much loved. I was there on Christmas morning, and patients and their relatives had the utmost respect for the wonderful staff. My constituents, and people across Nottinghamshire, want an inspiring vision of what their health care provision will look like, but a vision without substance is an illusion. My constituents now want a credible plan in which they can believe, a plan that ensures that health care continues to improve for them and for future generations in this growing and rural community. That, in essence, is what we seek today.