Oral Answers to Questions

Baroness Winterton of Doncaster Excerpts

Tuesday 7th February 2017 Commons Chamber

[Mr Hunt]

I am pleased that my hon. Friend raises that point, because when we discuss mental health we often talk about services provided by mental health trusts but do not give enough credit to the work done in primary care, both in community hospitals and by general practitioners, who have a very important role as a first point of contact. He is absolutely right to make that point.

[Dame Rosie Winterton (Doncaster Central) (Lab)]

Will the Green Paper look at the role that educational psychologists could play not only in providing support and assistance to young people with mental health problems but in preventive work? Cuts in local authority budgets have meant that the service has become quite fragmented, but there are practical ways in which it could be improved to help young people with mental health problems.

[Mr Hunt]

The right hon. Lady is absolutely right. We have looked into this and realised that there are two issues when it comes to improving children’s and young people’s mental health. The first is improving access to specialist care for those who need it. The other is prevention: the work that can be done by teachers within schools and in training people in mental health first aid. Those kinds of things can make a huge difference and we want to make sure we do them both.

NHS and Social Care Funding

Baroness Winterton of Doncaster Excerpts

Wednesday 11th January 2017 Commons Chamber

[Dame Rosie Winterton (Doncaster Central) (Lab)]

The debate so far has shown the huge level of concern from the public and NHS staff about the crisis in the NHS and social care. The hon. Member for Totnes (Dr Wollaston) reflected some of the views of the Select Committee, but I ask all Government Members to take those concerns seriously and not to dismiss them. All hon. Members must surely be receiving representations from staff and patients about what is happening locally.

I want to pay tribute to all the health and social care staff in Doncaster, in particular those at Doncaster royal infirmary whose work I have seen at first hand. I know how dedicated and committed they are to caring for patients in these most difficult of circumstances. At the end of December, they had managed to achieve 90% against the 95% target and had good ambulance handover times, as well as good support from the council and community partners, but they are facing real pressures and they are fearful about the pressures still to come, especially if, as predicted, there is a cold spell. That is why the mixed messages from the Secretary of State have been extremely damaging.

I was a Health Minister for four years and had responsibility for emergency care. I know how important it is to work with NHS staff to help to implement targets, and not to give the impression that the NHS is somehow giving up on those targets. The lead from the top is incredibly important. There has always been controversy about targets, but as a Health Minister I visited many, many A&E departments. There is absolutely no doubt in my mind that the A&E target led to improved care for patients and that it reduced waiting times dramatically. The evidence is clear: it shows that that is what happened. One striking thing about those visits was seeing how consultants, nurses, ambulance teams and all members of the healthcare team worked together. For example, they would work out protocols so that emergency nurse practitioners could take over some of the work previously done by consultants, to ease the burden and share the work among the team. Triaging—seeing who needed urgent treatment by a consultant and who could be seen by a nurse practitioner—became the norm.

I would ask staff, “Is the target getting in the way, or is it helping?”, and invariably the answer would come back, “It helps us to work together more effectively.” I vividly remember a nurse practitioner saying, “Please don’t abandon the target, because it is making the consultants sit down with us and look at the whole team.” For patients, the difference was crucial, as it was for practitioners’ working lives, because they were not having to see patients who had been sitting around for hours and were feeling thoroughly depressed and demoralised. That made a difference to the healthcare team as well, because it improved their working life as well as patient care.

[Dr Murrison]

Does the right hon. Lady agree that it is not so much meeting the target that is important as getting patients seen expeditiously and well? There is not an A&E department in this country that does not want to improve its position in the league table of response times. The difference that now applies, and which perhaps did not apply quite so much when she was a Minister, is that the level of informatics and comparison is much improved. I suggest to her, ever so gently, that while the four-hour target was important when she was a Minister, its importance has degraded over time, because everybody is trying to see patients more quickly.

[Dame Rosie Winterton]

I do not agree with the hon. Gentleman. The four-hour target led to much better diagnoses and much improved provision of the type of treatment that people needed, as well as better interaction with communities. And I want to come on to that point because the Secretary of State has been trying—perhaps the hon. Gentleman is guilty of this as well—to separate the target for A&E departments from what happens outside, whereas I see the importance of putting the two together. Providing alternative treatment, which is perhaps part of what the hon. Gentleman was getting at, means having proper support in the community. It was bringing those two things together that made it possible to achieve the target, so it was a driver.

[Maria Caulfield]

Will the right hon. Lady give way?

[Dame Rosie Winterton]

I give way to the hon. Lady, who I know has some experience of this.

[Maria Caulfield]

In my experience of trying to meet the four-hour target, it is often—or was in the past—prioritised over everything else, including patient care and clinical need. It was sometimes abused, with huge pressure put on staff to meet the target, and as a result patient care suffered. I saw that myself.

[Dame Rosie Winterton]

It is always important to look at the feedback from clinicians, and I did that as a Health Minister. It started during my time as a Minister, and I remember that we had constantly to consider whether there was a clinical reason for reducing the 95% target. It became clear that some patients needed longer to be assessed owing to their particular condition. In such cases, I could see why the target might need to be reduced, but that was based on clinical need. By contrast, the impression given last week was, “My goodness! We’re going to have to cope with some winter pressures. Let’s reduce the target in order to meet it,” rather than there being an assessment of clinical need. That sent completely the wrong message to the NHS. I think it was the wrong thing to do.

I want briefly to set out some areas in which we can bring the community input together with what is happening in emergency departments to reduce some of the pressures. The first point was that made by my hon. Friend the Member for Leicester South (Jonathan Ashworth), who spoke from the Front Bench. Good social care is vital to ensuring that people do not end up in A&E. I have previously raised problems with the Government’s current proposition to, in a sense, move responsibility for raising money to local councils. That is particularly unfair in areas such as mine, which simply cannot raise the same amount of money through a council precept as better-off areas can. It simply does not work. We need it probably more than any other area, but we will be less able to raise the money.

On shortages, I have been talking to senior NHS staff in Doncaster, and there are real problems with emergency care staffing. They tell me that although more doctors are being trained—I accept that—it will take years for them to come through. The single most effective step we can take to ease pressure on A&E departments is immediately to increase funding for social care, because it would keep people out of A&E departments, and it could be done straightaway. The personnel are out there; the Government just need to increase the funding, as my hon. Friend said from the Front Bench.

We also have to look seriously at the problem of GP shortages. As others have said, if patients are waiting three weeks to get an appointment with a GP, they are bound to end up in A&E. This needs to be addressed very quickly, with proper forward looks at exactly where the gaps are in GP services. I have said before that PCTs—now clinical commissioning groups—or NHS England should be able to take over practices and employ salaried GPs. That would make a huge difference.

Furthermore, on community pharmacies, if people are confident that going to a pharmacy will save them a visit to A&E, again that will relieve pressure on the system. I hope, therefore, that the Minister will assure us that he is looking seriously at the community pharmacy forward view, which sets out how pharmacies can be integrated into the NHS and social care.

Briefly on mental health, the Prime Minister answered a question today about mental health and the crises that people can get into, which mean that they end up in A&E. She talked, in particular, about young people. I urge the Minister to consider the role that educational psychologists can play in children’s mental health and in keeping them out of A&E.

It was my experience as a Health Minister that we needed people on the ground locally to help organisations across the spectrum—local government through to social care, pharmacies, GPs and ambulances—to work with A&E departments, yet the £2 billion reorganisation that removed PCTs and strategic health authorities has made it much more difficult to drive through the necessary changes. I hope, therefore, that the Minister will look very seriously at what has happened, because local knowledge can be vital.

On the basis of the Secretary of State’s contributions, it seemed that he was trying to use every excuse not to face up to the reality of what is happening. I think that sends a terrible message to NHS staff. I hope that, as a result of today’s debate, the concerns raised will be taken on board by Ministers and the Secretary of State and that they will come back to us with a proper plan that recognises the problems and offers real solutions.

[Several hon. Members rose—]

Oral Answers to Questions

Baroness Winterton of Doncaster Excerpts

Tuesday 20th December 2016 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. Clinical leadership is important, but so is openness to the skills of other industries—particularly engineering skills, with which he is very familiar—that can help us to get processes right so that we improve care and safety for patients.

[Dame Rosie Winterton (Doncaster Central) (Lab)]

Does the Secretary of State agree that if the board of Doncaster and Bassetlaw Hospitals NHS Foundation Trust agrees to establish a teaching hospital today, that will enable the trust to train its doctors of tomorrow so that they are more able to move into clinical leadership roles as quickly as possible?

[Mr Hunt]

I thank the right hon. Lady for her question and welcome Doncaster hospital’s aspirations and ambitions. Any final decision will obviously be a matter for the NHS and Health Education England, but it is very encouraging that it is reaching for the stars in this way. Yes, we do need to train more doctors, and I hope that the hospital can make a good contribution.

Social Care Funding

Baroness Winterton of Doncaster Excerpts

Monday 12th December 2016 Commons Chamber

[David Mowat]

I do agree. I had a discussion with the Care Quality Commission on the dataset that is reported, and I hope that over the next months and years we can improve how we do that.

[Dame Rosie Winterton (Doncaster Central) (Lab)]

I think that the Minister completely missed the point made by my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) from the Front Bench about the unfairness of asking councils to deal with the problem. A 1% rise in council tax in Doncaster raises 21% less than would the same rise in a council in the Prime Minister’s constituency. Does that not mean that the problem is being pushed on to the areas that can least afford it?

[David Mowat]

The right hon. Lady would be right that I had missed the point, had I not said that that issue is addressed by how we distribute the additional better care funding, which uses a formula that takes into account relative need.

National Health Service Funding

Baroness Winterton of Doncaster Excerpts

Tuesday 22nd November 2016 Commons Chamber

[Jonathan Ashworth]

This is exactly the sort of point that we are making; my hon. Friend is absolutely correct. That is why we need to look carefully at all these STPs. Of course, we do not know much about them at the moment, because all we see is glossy brochures that tell us that everything is going to be all right and not to worry. We want transparency. The Secretary of State should insist that every single STP is published and that we have the details of the cuts that will be made in our communities.

[Dame Rosie Winterton (Doncaster Central) (Lab)]

rose—

[Jonathan Ashworth]

I give way to my right hon. Friend the former Chief Whip.

[Dame Rosie Winterton]

Is not one of the problems with local planning the recruitment of GPs and the lack of GPs locally? Would it not help if we were to amend the Health and Social Care Act 2012 so that clinical commissioning groups and NHS England could provide directly salaried GPs instead of being prevented from doing so, as is the case at the moment? That is a practical example of something that would save money and increase the local provision of GP services.

[Jonathan Ashworth]

My right hon. Friend is absolutely right. Morale among GPs is at an all-time low. She identifies another problem that has emerged because of the 2012 Act. I hope that the Minister will respond to her important point.

Community Pharmacies

Baroness Winterton of Doncaster Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Jonathan Ashworth]

The right hon. Gentleman is an extremely experienced former Health Minister, possibly the most extreme—[Laughter.] He is definitely not an extremist, but he is possibly the most experienced Conservative former Health Minister apart from, perhaps, the right hon. and learned Member for Rushcliffe (Mr Clarke). It is very noble of him to try to get the Minister off the hook, but the fact remains that he was the one who said that 3,000 pharmacies would close, and we will continue to remind Ministers of that.

[Dame Rosie Winterton (Doncaster Central) (Lab)]

rose—

[Jonathan Ashworth]

I will give way to the former Chief Whip, but then I will make some progress.

[Dame Rosie Winterton]

Doncaster pharmacists have told me that at least 20 pharmacies in the town will close as a result of the cuts. That is their estimate, on the ground. They have also told me that the Government should sit down with pharmacists and engage in meaningful discussions about pharmacy delivery. For example, setting up a minor ailments service and cutting the drugs budget could possibly save the NHS £5 million in Doncaster and £650 million overall.

[Jonathan Ashworth]

My right hon. Friend is absolutely correct. She was not only an exceptional Chief Whip but an exceptional pharmacies Minister in the last Labour Government, and she knows how foolhardy it would be to make cuts in the pharmacy sector.

NHS Sustainability and Transformation Plans

Baroness Winterton of Doncaster Excerpts

Wednesday 14th September 2016 Commons Chamber

[David Mowat]

No, I will not. I have only four minutes left, but the hon. Lady, who worked with me on the Public Accounts Committee, can come and see me.

It is also true to say that if we achieve all those things, there will be lower hospital admissions and more humane and timely discharges. That might save money, but it is not being driven by the need to save money. It is driven by care needs because that is the right thing to do.

Let me deal quickly with the STP process. We have been told that it is a secret process and a Trojan horse for privatisation, and we have heard that we are not going to consult. Well, let us talk about consultation first. The right hon. Member for North Norfolk (Norman Lamb) made some good points about the difficulties involved in change programmes on which proper consultation does not take place. However, we must have something on which to consult that is reasonably agreed and reasonably stable, because if we do not, we shall give rise to expectations that cannot necessarily be fulfilled—in both directions, positive and negative.

When the STPs come back in October after being signed off, they will be consulted on. A document that will be in the House of Commons Library by the end of the week will describe in detail how all the stakeholders will be consulted and what we will do, but in any event—this point was made by my right hon. Friend the Member for Chelmsford (Sir Simon Burns)—no consultation and no engagement will take away the statutory commitments, the need for configurations to be looked at properly, and the requirement for nothing to proceed that has not been locally agreed.

We were told that the plans were secret. In fact, they were so secret that they were announced in December 2015, in the NHS planning guidelines. They were so secret that 38 Degrees, which was responsible for the principal leak, obtained its information from the websites of the organisations that were keeping it all secret. If we ever do something in secret in future, it really will be done better than this.

The STP process is complex. It will not work equally well in all the locations, and there will be issues to resolve. Some plans, if they are not adequate, will not be proceeded with in the same way as others. I say this to Members, however: we need you to engage with the process—

[Dame Rosie Winterton (Doncaster Central) (Lab)]

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

Question agreed to.

Main Question accordingly put.

Junior Doctors’ Contracts

Baroness Winterton of Doncaster Excerpts

Wednesday 28th October 2015 Commons Chamber

[Ben Gummer]

I cannot because I have to conclude.

They are precisely the offers that were made privately both by the Secretary of State and negotiators in their discussions with the BMA. Our frustration is compounded by the fact that right from the beginning of this process, we have sought in the new contract to eradicate the slew of injustices in the current contract which make life unfair, and in some cases unbearable, for junior doctors.

Let me give a few examples raised by hon. Members, including my hon. Friend the Member for Finchley and Golders Green (Mike Freer). It is unfair that doctors who take time out for valuable medical research receive precisely the same increments as colleagues who might take time out to do something completely unconnected with their training and with service to the NHS, and the same increments as those who take time out altogether from the health service, working only part-time perhaps to develop a career in business or another field. They retain the same increments and basic pay through their career as the doctor who works diligently five, six, sometimes seven days a week, progressing through their training, passing their exams—yet getting exactly the same level of pay as the doctors who do not.

The greatest injustice arises for doctors from the perverse incentives in this contract—for example, hospital management choosing to use the current contract to avoid difficult decisions in rostering staff, paying doctors to work unsafe hours rather than getting to grips with the roster they should be putting in place to ensure safe care for patients.

Let me make it clear to the hon. Member for Denton and Reddish (Andrew Gwynne), who spoke for the Labour party, that the reductions so far since the 2000 contract are a result not of the penalty payments put in place as part of that contract, but of the working time regulations which have made a significant impact on the working hours of doctors, and quite rightly so. Does he not see the logic of his own argument? There are still doctors in the national health service who are working dangerous hours despite the fact that there are penalties in place to stop them doing so. By extension, the only way we can ensure that we have a proper, safe working environment in the NHS is to ensure, once and for all, that in contract and through review, and by exposure to regulatory bodies, junior doctors are not permitted to work unsafe hours. When we are asked whether we back the mis-statements by some of the people involved in this debate, or whether we encourage people to—

[Ms Rosie Winterton (Doncaster Central) (Lab)]

claimed to move the closure (Standing Order No.36).

Question put forthwith, That the Question be now put.

Question agreed to.

Main Question put accordingly (Standing Order No. 31(2)), That the original words stand part of the Question.