European Union (Withdrawal) Act

Debate between Sarah Wollaston and Jeremy Hunt

Wednesday 5th December 2018 Commons Chamber

[Mr Hunt]

We make charges to cover administrative costs, just as EU countries make charges for the administrative costs that our citizens incur when in their countries. What is really significant when it comes to generosity is the fact that we have made this offer unconditionally. We made it before any reciprocal offer was made by EU countries in return. That is a sign of how much we value the extraordinarily important contribution that these people make to our national life.

My hon. Friend the Member for East Surrey (Mr Gyimah), in a very dignified speech, raised the issue of Galileo. I regret that the EU has unwisely made it impossible for Britain to remain a full partner of the Galileo satellite communication system. Carl Bildt, the former Prime Minister of Sweden, has described the EU’s behaviour on this as

“strategic folly of the first order”.

So we will develop a plan for a sovereign system of our own, because when the EU rejects co-operation, the United Kingdom is perfectly big and confident enough to develop our own alternatives. But if this House rejects the declaration and the withdrawal agreement and we leave the EU without a deal, our security co-operation with our closest neighbours will be put at risk. The reason is that, in a no-deal situation, such co-operation would depend not on any agreement but on good will, and that could well be missing. At a time when threats are evolving and cross-border collaboration has never been more important, our law enforcement agencies would not have the guaranteed channels that they currently have for exchanging essential information with our EU neighbours.

[Dr Wollaston]

Does the Secretary of State agree, however, that another option would be to extend article 50, and that it is incorrect to present the House with a false choice in which we would automatically fall out on 29 March?

[Mr Hunt]

I had a conversation with my hon. Friend earlier this evening about how lively things are in her constituency. I think that if any of us asked our own constituents whether the right solution to the dilemmas we face would be to extend the agony by postponing the article 50 due date, they would be absolutely horrified. They want to get this over with. They want to get it resolved.

I mentioned the risks of a no-deal situation to our security, which were recognised by my right hon. Friend the Member for Preseli Pembrokeshire (Stephen Crabb) and my hon. Friends the Members for Ludlow (Mr Dunne) and for Banbury (Victoria Prentis). They all alluded to that issue.

In conclusion, when it comes to defence and security, irrespective of our membership of the EU, the lesson of history is clear. When Britain and Europe stand together against common foes, our combined strength deters our adversaries and keeps the peace. If we did not do that, our common security would be placed at risk in a way that would be wholly unnecessary. So let us grasp this opportunity for a new and different partnership, post Brexit, based on the essential truth that British and European security are indivisible and, whether inside or outside the legal structures of the EU, our common interests are best served by working together to protect the values we all cherish.

Ordered, That the debate be now adjourned.—(Jeremy Quin.)

Debate to be resumed tomorrow (Order, 4 December).

Oral Answers to Questions

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 19th June 2018 Commons Chamber

[Mr Hunt]

We have great teaching hospitals in Yorkshire and we have introduced five new medical schools. When we do the new workforce plan later this year, who knows? We may need more.

[Dr Sarah Wollaston (Totnes) (Con)]

Further to the point made by the hon. Member for Dudley North (Ian Austin), we know that the UK is a world leader in research into rare conditions, but that does not always translate into timely access to those treatments. The Secretary of State will know that there are many CFTR—cystic fibrosis transmembrane conductance regulator—treatments in the pipeline that could benefit people who are living with cystic fibrosis. Will he meet me to see how we can ensure that those are available in a timely manner for the people who desperately need them?

[Mr Hunt]

Of course I am happy to meet my hon. Friend. I recognise that this is one of the things that we are not good at at the moment. We have fantastic research, with amazing new drugs developed in this country, but our uptake can be painfully slow, and that is of course something that we want to put right.

NHS Long-Term Plan

Debate between Sarah Wollaston and Jeremy Hunt

Monday 18th June 2018 Commons Chamber

[Mr Hunt]

Thank you, Mr Speaker. The hon. Gentleman said just now that there is

“no such thing as a Brexit dividend”.

I have heard lots of other people say that from a sedentary position. But what did their leader say on 26 February? These were his exact words:

“and we will use the funds returned from Brussels after Brexit to invest in our public services and the jobs of the future”.

So who is right: is it the hon. Gentleman or his leader?

After paying the Brexit divorce bill this Conservative Government will use the contributions that would have gone to Brussels to fund our NHS—that is what the British people voted for. But the main reason we are able to announce today’s rise, one of the biggest ever single rises in the history of the NHS, is not the Brexit dividend but the deficit reduction dividend, the jobs dividend, the “putting the economy back on its feet” dividend, after the wreck left behind by the Labour party. Every measure we have taken to put the economy back on its feet has been opposed by the Labour party, but without those measures there would be no NHS dividend today; with the Conservatives you don’t just get a strong NHS, you get the strong economy to pay for it.

In the next few weeks, as Labour scrabbles around to raise its offer on the NHS, we will no doubt hear that it is offering more for the NHS, but when the Labour party comes forward with that offer, the British people will know that the only reason it has done so is that a Conservative Government shamed it into doing so with an offer far more generous than anything Labour was prepared to contemplate.

Another thing I have heard said about NHS funding is, “Whatever the Conservatives offer, we’ll match and do more,” but the trouble is that the opposite is true, because under this Government NHS spending in England is up 20% in the past five-year period, but in Wales it is up just 14%. That is to say that for every extra pound per head invested in England, in Wales it is just 84p, which is why people are 70% more likely to wait too long in A&Es in Wales. The right response to this statement would be for Labour to say that every additional penny though the Barnett formula will go into the NHS in Wales, but we did not hear that pledge.

The hon. Gentleman also talked about social care, and this matters. I fully agree with him that we need to have a strong plan for social care and that it needs to go side by side with the NHS plan, and we have made some important commitments to the social care sector today. But if he is going to criticise social care cuts, he might at least ask why austerity happened. It was not, as he continually suggests, because of an ideological mission to shrink the state, but to save our economy and create jobs so that we could reinvest in public services. The evidence for that is shown today, with the first ever five-year NHS funding plan, to go alongside a 10-year plan. This is a Conservative Government putting the NHS first and shooting to pieces his phoney arguments about Conservative values.

[Dr Sarah Wollaston (Totnes) (Con)]

I recognise and thank the Secretary of State for his tireless efforts in making the case for this funding uplift and for a long-term plan. Will he now go further and set out whether, as a result of the extra funding, we will see an end to capital-to-revenue transfers? Will he also set out the role of transformation funding, because we all know that that is essential to get the best from the resources that we are going to add?

[Mr Hunt]

My hon. Friend asks two important questions. As she knows, we have committed to phase out capital-to-revenue funding, because if we are to make the NHS sustainable in the long run, we urgently need to make capital investment in estates, technology and a whole range of new machinery, including cancer-diagnostic machinery and so on, and we will not be able to do that if we continually have to raid capital funds for day-to-day running costs. That was one of the main reasons why we decided that we had to put revenue funding on a more sustainable footing. My hon. Friend is absolutely right about that.

Transformation funding is also important, because when the five year forward view was published, pressures in secondary care and the acute sector meant that a lot of transformation funding was sucked into the hospital sector and we were not able to focus on the really important prevention work that can transform services in the long run. I am very sympathetic to the idea that we need, if not a formal ring fence, a pretty strong ring fence for transformation funding, so that the really exciting progress that we see in some parts of the country can start to spread everywhere.

Oral Answers to Questions

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 8th May 2018 Commons Chamber

[Mr Hunt]

That is a wise suggestion, and it is exactly the direction of our thinking in the social care Green Paper, which will have a significant chapter on housing. Integration is not just about integrating health and social care; it is also about other services offered by local authorities. I commend, too, the hon. Gentleman’s local authority of Redbridge: it is No. 1 in the country for user satisfaction with the social care system and No. 4 for carer satisfaction.

[Dr Sarah Wollaston (Totnes) (Con)]

One of the most pressing issues for those who depend on social care is resolution of the back-pay issue for sleep-in shifts. Will the Secretary of State update the House with his own estimate of the liability? The independent sector puts this liability collectively at around £400 million. Will he also update us on the progress being made, because he will know that many sectors are handing back their contracts and withdrawing?

[Mr Hunt]

I thank my hon. Friend for raising this serious issue, and I can reassure her that a lot of work has been going on inside the Government to work out how to resolve the issue. A court case is due that may have a material impact on those numbers, but we are continuing to work very hard and fully understand the fragility of the current market situation.

--- Later in debate ---

[Dr Sarah Wollaston (Totnes) (Con)]

Thank you, Mr Speaker. Will the Secretary of State commit to publishing the progress report on sugar reduction and the next steps strategy on the reformulation programme, so that the Health Committee can examine that when Public Health England appears before us on 22 May?

[Mr Hunt]

I had a conversation with Public Health England before questions this afternoon, and it committed to publishing that before that hearing.

Breast Cancer Screening

Debate between Sarah Wollaston and Jeremy Hunt

Wednesday 2nd May 2018 Commons Chamber

[Mr Hunt]

I thank the hon. Gentleman for his constructive tone, and I want to reassure him that each and every case will be looked at in detail. The sad truth is that we cannot establish whether not being invited to a screen might have been critical for someone without looking at their individual case notes, and in some cases, sadly, establishing a link will mean looking at the medical case notes of someone who has died.

It is important to explain that the reason for these estimates, which are much broader than we would like, is that there is no clinical consensus about the efficacy of breast screening for older women. As I understand it, that is because the incidences of cancers among older women are higher, but a higher proportion of them are not malignant or life-threatening, which makes it particularly difficult. It is also the case that breast cancer treatment has improved dramatically in recent years and so it is less important than it was to pick up breast cancer early. None the less, we believe it will have made a difference to some women, which is why it is such a serious issue.

The evaluations of the AgeX trial, which brought this to light at the start of the year, have been continued by Oxford University throughout the trial period. I am not aware of any evaluations shared with the Department that could have brought this problem to light, but obviously the inquiry will look into that. We need to find ways to improve oversight, and modern IT systems can greatly improve safety and reliability—in fact it was during the upgrading of the IT system that this problem was brought to light.

I will share with the hon. Gentleman the advice the Department received from Public Health England in January, which was the first time we were alerted to the issue, and we will certainly provide any extra resources the NHS needs to undertake additional cancer screening. One of our biggest priorities is that women between the ages of 50 and 70, when the screens are of their highest clinical value, do not find their regular screens delayed by the extra screening we do to put this problem right. He is right that one thing that has come to light is the regional variation in how the programme is operated. It was previously operated by the old primary care trusts, under the supervision of strategic health authorities, and then brought under the remit of Public Health England, but the regional variations have continued for a long time, so this problem will be worse in some parts of the country than in others. I undertake to keep the House fully informed.

[Dr Sarah Wollaston (Totnes) (Con)]

I thank the Secretary of State for the commitments and actions he has set out. Colleagues across the House will be thinking of the hundreds of thousands of women not called for their final screening test. They now need consistent, high-quality, evidence-based guidance so that they can make an informed choice about whether to take up the offer of screening. There is much material available setting out pictorially and clearly how they can weigh up the risks and benefits. Will he assure the House not only that a helpline will be in place but that it will be backed up with high-quality material available directly to patients and their GPs, many of whom will be directly counselling women following this news?

NHS Staff Pay

Debate between Sarah Wollaston and Jeremy Hunt

Wednesday 21st March 2018 Commons Chamber

[Mr Hunt]

If the hon. Gentleman wants a plan to give the NHS the funding it needs, can he explain why Labour in Wales has deprived the NHS of £1 billion of funding that it would have had if funding had increased at the same rate as in England? Far from Labour being vindicated, the House will remember that the pay restraint in the NHS for the past eight years was caused by the worst financial recession since the second world war, caused by a catastrophic loss of control of public finances.

The hon. Gentleman asks for some details. Today’s pay deal means that someone starting work in the NHS as a healthcare assistant will see their rate of pay over the next three years go up by 26%, nearly £4,000. A nurse with three years’ experience will see a 25% increase, which is more than £6,000 over three years. A band 6 paramedic with four years’ experience will see a £4,000 rise. On top of that, we are putting in a huge number of things that NHS staff will welcome, including, for example, statutory child bereavement leave and shared parental leave. Yes, we are asking for important productivity changes in return, but this is about the modernisation of NHS staff terms and conditions, which is good for them and good for taxpayers.

The hon. Gentleman asks where the money is coming from: it is additional funding from the Treasury for the NHS. It is not coming from extra borrowing. If he had been listening to the autumn statement, he would have heard that debt as a proportion of GDP is starting to fall this year for the first time. That is possible because we have taken very difficult decisions over the past eight years—they were opposed by the Labour party—that have meant 3 million more jobs and have transformed our economy out of recession into growth. None of that would have been possible if we did what his party is now advocating, which is to lose control of public finances by increasing borrowing by £350 billion. Let us just remind ourselves that countries that lose control of their finances do not put more money into their health services—they put less. In Portugal, the amount is down 17%, and in Greece, it is down 39%. The reason that we can announce today’s deal is very simple: this country is led by a Government who know that only a strong economy gives us a strong NHS.

[Dr Sarah Wollaston (Totnes) (Con)]

I warmly welcome today’s announcement of a well-deserved pay rise for NHS staff and, in particular, that this will be additional funding of £4.2 billion over three years, rather than it coming out of existing resources. I particularly welcome the focus on staff health and wellbeing, which was raised by the recent Health Committee inquiry into the nursing workforce. In particular, I ask the Secretary of State to go further and talk about what will be done on continuing professional development for NHS staff, because this was identified as a key factor in retention. He referred to it partially in his comments, but I wonder whether he could go further.

[Mr Hunt]

I thank my hon. Friend for her comments. Underneath this agreement, there is a very important new partnership between NHS employers and the unions to improve the health and wellbeing of staff through mental health provision and the implementation of the Stevenson-Farmer review, taking on board a number of points raised by the Health Committee, and through improved support for people with musculoskeletal conditions, because a lot of NHS work is very physical. However, she is absolutely right: professional development is also very important. By reforming the increments system that we have been using for many years, we will give staff the chance to see their pay go up in a way that is linked to their skills going up as well. That is something that many staff will welcome.

Medicines and Medical Devices Safety Review

Debate between Sarah Wollaston and Jeremy Hunt

Wednesday 21st February 2018 Commons Chamber

[Mr Hunt]

I thank the hon. Gentleman for his considered response and for its tone. Like him, I thank all the all-party groups who have worked incredibly hard to raise this incredibly difficult issue. Let me go through the points that he raised; he asked detailed questions, which I want to give a proper answer to.

When it comes to mesh, no EU country has banned its use. In my understanding, Australia and New Zealand have not introduced a full ban. We have taken very clear advice. We obviously have a responsibility to all patients, and the medical advice from the chief medical officer is clear that some women benefit from mesh, if it is appropriately used, so we are following that advice. However, the review will look at all the processes around mesh. We will publish NICE guidelines on persistent pain and ventral meshes—it is also important to say that meshes are used in men as well as women—and we absolutely have to get this right.

I fully accept the point that the hon. Gentleman made on the concerns of many patients and families about the findings of the expert working group. He will know that this is a very difficult, hotly contested area. We are not proposing to revisit the science, but we are giving Baroness Cumberlege full freedom to look at what the expert working group did and to come to her own views. We are not excluding her from looking at what happened, even though we think that it is important to accept throughout that we have to follow the science at every stage to get this absolutely right. We will be going forward with some important recommendations of the expert working group regardless, such as the yellow-card system.

One thing that is clear is that when people, whether clinicians or patients, have an immediate concern about a medicine, there is no easy way to raise that quickly. If women are raising these concerns all over the country, we need to find that out very quickly at the centre, so that we can take action more quickly than happened in this case. We will also be offering genetic testing to families who have suffered, or who think that they have suffered, as a result of Primodos.

On valproate, we will issue guidelines to clinicians. We also want to make sure that there is greater awareness among patients. We are changing the NICE guidelines and the labelling. When it comes to valproate, we want to push for this to be a contra-indication for women of childbearing age who are not taking effective contraception, because it is so important to get this right.

The hon. Gentleman made very important points about the public inquiry. We are asking Baroness Cumberlege to give us her considered view on the appropriate way forward in this case, and that, of course, has implications for the issue of compensation. What I would say is that we have a problem in our system, in that there is no proper process for deciding what next steps are appropriate. Is it an investigation by the Department of Health and Social Care and NHS England, or do we need a full statutory public inquiry? We particularly want her to look at whether we should have an independent process to evaluate what happened. In my time, and in the hon. Gentleman’s time, we have been approached by a lot of people who want public inquiries, but it should not simply be about the strength of lobbying. There needs to be a process, because there may be people who do not have a loud voice, who are equally worthy of a public inquiry, but who do not get considered in our system at that moment. That would not be right.

Baroness Cumberlege will report to Ministers, not to the MHRA, and there will be full consultation with the families affected by the three issues over the terms of reference. That is absolutely the right thing to do.

The hon. Gentleman made a final very important point about how we regain the trust of families deeply scarred by these issues. We can do it in two ways: first, by being open and transparent in everything we do in this process so that they can see we want to get to the bottom of it as much as they do; and secondly by recognising the fundamental issue that in the past when we have assessed these clinical medical safety issues the voice of patients has not been as strong as it should have been. We have to put that right, and I know that everyone in the NHS, as in the House, is committed to doing so.

[Dr Sarah Wollaston (Totnes) (Con)]

I welcome the Secretary of State’s statement and his ongoing focus on patient safety, which has added so much to the patient experience. I also welcome the fact that he is clearly representing the voice of patients when learning lessons. Many of those who, courageously, have come forward, including many of my own constituents, have been harmed in the private sector. Will he confirm that all patients, wherever they were treated, will be included within the review and that there will be a focus on clinical governance, not only in the NHS but in the private sector?

Oral Answers to Questions

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 6th February 2018 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

Following the recent inquiry by the Select Committee on Health into the nursing workforce, we absolutely welcome the new routes into nursing, including the new role of nursing associate. However, one of the issues highlighted strongly was the need to retain our existing nursing workforce as well as to recruit into it. Will the Secretary of State comment on that?

[Mr Hunt]

My hon. Friend speaks very wisely—we do need to be better at retaining our existing workforce. I think that is why the Treasury has given me extra latitude in negotiations on the pay rise—those discussions are currently happening—but we also need to be much better at flexible working and at recognising the challenges people have in their ordinary working lives.

Maternity Safety Strategy

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 28th November 2017 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

I warmly welcome the Secretary of State’s announcements today, including the move to allow coroners to investigate full-term stillbirths. Will he set out the current waiting time for post-mortems for infants because, as he will be aware, there is a shortage of the very highly specialised pathologists who carry out this vital work?

[Mr Hunt]

I do not have that information to hand, but I will find out for my hon. Friend and let her know.

Oral Answers to Questions

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 14th November 2017 Commons Chamber

[Mr Hunt]

The hon. Lady is absolutely right; that is totally unacceptable. Anyone who is a parent would say that it is far too long. That is why we decided to have a Green Paper on children’s and adolescents’ mental health, which we are hoping to publish very soon.

[Dr Sarah Wollaston (Totnes) (Con)]

In its annual “State of Care” report, the Care Quality Commission has highlighted that there are 4,000 fewer nursing home beds in England than there were in April 2015. What plans does the Secretary of State have to address the workforce and funding issues that lie behind this? Will he meet me to discuss the situation in my constituency and nationally?

[Mr Hunt]

I congratulate my hon. Friend on becoming Chair of the Liaison Committee. Of course, I am always happy to meet her, and the issue that she has raised is very important. Our figures show that the number of nursing home beds, as distinct from the number of nursing homes, is broadly stable. There is real pressure in the market, however, and there are real issues about market failure in some parts of the country, so I am more than happy to talk to her about that.

Oral Answers to Questions

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 10th October 2017 Commons Chamber

[Mr Hunt]

I would like to thank the hon. Gentleman for speaking out about mental health, like so many colleagues in this House, which makes a massive difference to the Time2Change campaign. It is unacceptable for someone to be waiting that long, and I do not want to stand here and defend it. I will certainly look into the individual case that the hon. Gentleman raises, but the fact is that many Members will know of similar cases. The money is starting to get through to the frontline. It is not just money, though; it is also capacity, and having trained mental health therapists—nurses; psychiatrists—and that is why we are boosting their training, too.

[Dr Sarah Wollaston (Totnes) (Con)]

As someone who is married to an NHS psychiatrist, may I start by paying tribute to all those volunteers, carers and professionals working in mental health on World Mental Health Day? Has the Secretary of State seen today’s briefing by the Children’s Commissioner, highlighting the vital importance of prevention and early intervention? Will he set out what steps he is taking to support a growing workforce—volunteers and professionals—working in prevention and early intervention?

[Mr Hunt]

My hon. Friend is absolutely right. I am aware of the report that she talks about. We know that half of mental health conditions become established before the age of 14, which is why early intervention is so important. In July, I announced an expansion in the mental health workforce—another 21,000 posts. A number of those will be in children’s mental health, to address the issues she raises.

Oral Answers to Questions

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 4th July 2017 Commons Chamber

[Mr Hunt]

If I may say so, that was a brilliant recovery. The hon. Lady is absolutely right to focus her attention on the performance of ambulance services. They are under pressure. They are hitting around 71% for their category A calls, and the target is to hit 75%. However, there are some bigger issues with the way those targets work, which we are looking at. Her ambulance service has just had a Care Quality Commission inspection.

[Dr Sarah Wollaston (Totnes) (Con)]

As a result of the capped expenditure process, the wider Devon sustainability and transformation plan is being asked to make £78 million of savings at short notice—within the next nine months. Does the Secretary of State share my concern about the impact on patients, the short timeframe and the undermining of savings already agreed by the STP? Will he meet me to discuss this matter and the wider CEP?

[Mr Hunt]

I am more than happy to meet my hon. Friend. The principle behind the capped expenditure process is that we should have fairness between patients in different parts of the country. We should not see patients in one part of the country disadvantaged because the NHS has overspent in their neighbouring area, but the way in which we implement the process must be sensitive and fair. We must ensure that we get it right.

NHS Shared Business Services

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 27th June 2017 Commons Chamber

[Mr Hunt]

Let me respond to those points. First, what happened at SBS was totally unacceptable. It was incompetent and it should never have allowed that backlog to develop, but before the hon. Gentleman gets on his high horse, may I remind him that SBS and the governance arrangements surrounding it were set up in 2008, at a time when a Labour Government were rather keen on contracting with the private sector? I know that things have changed, but the fact of the matter is that throughout this process our priority has been to keep patients safe. Transparency is nearly always the right thing; I am the Secretary of State who introduced transparency over standards of care in hospitals—[Laughter.] It is interesting that Opposition Members are laughing, as Labour was the party responsible for sitting on what happened at Mid Staffs for more than four years, when nothing was done.

Transparency is incredibly important but it is not an absolute virtue, and in this case there was a specific reason for that. If we had informed the public and the House immediately, GP surgeries would have been overwhelmed—we are talking about 709,000 pieces of patient data—and they would not have been able to get on as quickly as we needed them to with identifying risk. That was the priority and that is what today’s report confirms: patient safety was the priority of the Department and NHS England. I put it to the hon. Member for Leicester South (Jonathan Ashworth) that if he were in my shoes, and faced with advice that said that it was wrong to go public straight away as that would compromise the very important work GPs had to do to keep patients safe, he would have followed exactly the same advice. That is why, while I completely recognise that there is a potential conflict of interest with the Government arrangements, I do not accept that there was an actual conflict of interest, because patient safety concerns always overrode any interests we had as a shareholder in SBS.

The NHS is a large organisation. It has a huge number of contracts with both the public and private sectors, and no Government of any party can ever guarantee that there will be absolutely no breach of contract. However, what we can do is ensure that we react quickly when there is such a breach, which happened on this occasion, and that we have better assurance than we had on this occasion. I assure the House that the appropriate lessons will be learned.

[Dr Sarah Wollaston (Totnes) (Con)]

While Members from across the House will be relieved that so far no patients are identified as having been harmed by this appalling incident, will the Secretary of State set out what steps he is taking to ensure that this can never happen again?

[Mr Hunt]

Absolutely. There is a short-term and long-term lesson. The short-term point is that it is unlikely this would happen again because it was paper correspondence, and we are increasingly moving all the transfer of correspondence to electronic systems. The longer-term point is exactly that—[Interruption.] An Opposition Member mentions cyber-attacks; they are absolutely right to do so, because of course we have different risks. This clearly indicates that we need better checks in place, so that when we trust an independent contractor with very important work, we know that the job is actually being done, and that did not happen in this case.

Oral Answers to Questions

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 21st March 2017 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

The NHS mandate was published yesterday, just days before coming into force. Can the Secretary of State set out the reason for the delay, because it allows very little time for scrutiny of this important document by this House? Will he also set out how he is going to prevent money being leached from mental health services and primary care to prop up provider deficits, so that we can meet objective 6 on improving community services?

[Mr Hunt]

My hon. Friend makes very important points. The reason for the delay was because about a month ago we had wind that we might be successful in securing extra money for social care in the Budget, and we needed to wait until the Budget was completed before we concluded discussions on the mandate. Our confidence as a result of what is in the Budget has enabled us to make the commitments we have made in the mandate, including making sure that we continue to invest in the transformation of out-of-hospital care.

NHS Shared Business Services

Debate between Sarah Wollaston and Jeremy Hunt

Monday 27th February 2017 Commons Chamber

[Mr Hunt]

The hon. Gentleman is reasonable and sensible, but sadly those commendable sides to his character have not been on display this afternoon, not least because I answered a number of his questions before he read out his pre-prepared script. He said that there had been a catastrophic breach of data protection. Let me remind him that no patient data were lost and all patient data were kept in secure settings. I know that it is a great temptation to go on about the privatisation agenda, but may I gently tell him that, since SBS lost this account, this particular work has been taken in-house? It is being done not by Capita, but by the NHS—so much for the Government’s “relentless pursuit” of the private sector.

More seriously, the hon. Gentleman is quoted in this morning’s edition of The Guardian as saying:

“Patient safety will have been put seriously at risk.”

As he knows, patient safety is always our primary concern, but if he had listened to my response he would have heard that, as things stand, there is no evidence so far that patients’ safety has been put at risk. [Interruption.] Well, we have been through more than 700,000 documents, and so far, we can find no such evidence. We are now doing a second check, with GPs, on 2,500 documents—so a second clinical opinion is being sought—nearly 2,000 of which we believe will not show any evidence, and we are now going through the remaining ones.

Let me say that it was indeed totally incompetent of SBS to allow this incident to happen, and we take full responsibility as a Government, because we were responsible at the time. None the less, the measure of the competence of a Government is not when suppliers make mistakes—I gently remind the hon. Gentleman that that did happen a few times when Labour was running the NHS—but what we do to sort out the problem. We immediately set up a national incident team. Every single piece of correspondence has been assessed, and around 80% of the higher risk cases have been assessed by a second clinician.

The hon. Gentleman then went on to suggest that the Government have been trying to hide the matter. If he had listened to what I said, he would have heard that I did not follow the advice that I got from my officials, which was not to publicise the matter. I actually decided that the House needed to know about it. It was only a week after I was reappointed to this job last summer that I not only laid a written ministerial statement, but referred to the matter in my Department’s annual report and accounts. He said this morning that I played down the severity of what happened, but what did that annual report say? It said that a “serious incident was identified”, and it talked about

“a large backlog of unprocessed correspondence relating to patients.”

It could not have been clearer.

This Government have always cared about patient safety. We have listened to the advice of people—as the hon. Gentleman would have done had he been in office—who said that if we had gone public right away, GP surgeries could have been prevented from doing what we needed them to do, which is making detailed assessments of a small number of at-risk cases. That was why we paused, but as soon as we judged that it was possible to do so, we informed this House and the public and we stayed absolutely true to our commitment both to patient safety and to transparency.

[Dr Sarah Wollaston (Totnes) (Con)]

This is undoubtedly a very serious incident, but I welcome the detailed and thorough steps that the Secretary of State has taken to protect patient safety. However, he will know that there are ongoing problems with the transfer of patient records. GPs and hospitals spend endless hours chasing up results, investigations and letters on a daily basis. Is it not time that patients were given direct control of their own records, and will the Secretary of State provide an update on that to the House?

[Mr Hunt]

I thank my hon. Friend for her sensible contribution. She is right that, although the process of sending on these particular documents has been taken in-house, other parts of the contract were taken on by a company called Capita—[Interruption.] The hon. Member for Leicester South (Jonathan Ashworth) cannot stop, can he? Let me repeat that the work in question has been taken in-house. The other work, which is being done by Capita, has had some teething problems, of which we are very aware. We know it has been causing problems for GPs. The Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood) has been meeting Capita and people relating to that contract on a fortnightly basis to try to identify the problems.

My hon. Friend the Member for Totnes (Dr Wollaston) is right that the aim in the long run is to give people control of their records. I am proud that, under this Government, we have become the first country in the world to give every patient access to their own records online. From September, people will be able to do that without having to go to their GP’s surgery.

Oral Answers to Questions

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 7th February 2017 Commons Chamber

[Mr Hunt]

I will tell the right hon. Gentleman what we are doing about the underfunding. We are raising three times more from international visitors than when he was a Health Minister, and that is paying for doctors, nurses and better care for older people in his constituency and in all our constituencies.

[Dr Sarah Wollaston (Totnes) (Con)]

Given the Government’s stated objective of reducing health inequalities, will the Secretary of State set out how he will guarantee that those who are, for example, homeless or who have severe enduring mental illness—the most disadvantaged in our society, who are unlikely to have the required documentation—will receive the treatment they need?

[Mr Hunt]

I can absolutely reassure my hon. Friend. What we are doing is based on good evidence from hospitals such as Peterborough hospital, which has introduced ID checks for elective care and has seen absolutely no evidence that anyone who needs care has been denied it. This is not about denying anyone the care they need in urgent or emergency situations; it is about ensuring that we abide by the fundamental principle of fairness so that people who do not pay for the NHS through their taxes should pay for the care we provide.

Mental Health and NHS Performance

Debate between Sarah Wollaston and Jeremy Hunt

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

I am happy to respond to the hon. Gentleman’s comments and, indeed, to the comments of all Members, but I shall first say this about the tone of what he said. He speaks as if the NHS never had any problems over winters when Labour was in power. The one thing NHS staff do not want right now is for any party to start weaponising the NHS for party political purposes. I remind him that when his party runs the NHS, the number of people on waiting lists for treatments doubles, A&E performance is 10% lower and people wait twice as long to have their hips replaced. Whatever the problems are in the NHS, Labour is not the solution.

The hon. Gentleman talked about mental health, so let me tell him what is happening on that. Thanks to the efforts of this Government and the Conservative-led coalition, we now have some of the highest dementia diagnosis rates in the world. Our talking therapies programme—one of the most popular programmes for the treatment of depression and anxiety—is treating 750,000 more people every year and is being copied in Sweden. Every day, we are treating 1,400 more people with mental health conditions and we have record numbers of psychiatrists. The hon. Gentleman mentioned mental health nurses: in this Parliament we are training 8,000 more, which is a 22% increase.

All that is backed up by what we are confirming today, which has not been done before: the Government are accepting the report of the independent taskforce review—led by Paul Farmer, the chief executive of Mind—which commits us to spending £1 billion more a year on mental health by the end of the Parliament. That would not be possible with the spending commitments that Labour was prepared to make for the NHS in the previous Parliament. It is because of this Government’s funding that we are able to make such commitments on mental health.

The hon. Gentleman talked about the NHS and gave completely the wrong impression of what I said this morning. I was completely clear that all NHS hospitals are operating under greater pressure than they ever have. He should listen to independent voices, such as that of Chris Hopson—no friend of the Government when it comes to NHS policy—who is clear that in the vast majority of trusts people are actually coping slightly better than last year. However, we have some very serious problems in a few trusts, including in Worcestershire and a number of others. I can commit to him that we will follow closely the investigations into the two reported deaths at Worcestershire and keep the House updated.

The hon. Gentleman talked about social care, which is where, I think, his politicising goes wrong. Last year, spending on social care went up by around £600 million. At the last election, he stood on a platform of not a penny more to local authorities for social care, so to stand here as a defender of social care is, frankly, an insult to vulnerable people up and down the country, particularly to those living under Labour councils such as Hounslow, Merton and Ealing, which are refusing to raise the social care precept, but complaining about social care funding.

The hon. Gentleman talked more generally about NHS funding, but in the last Parliament it was not the Conservatives who wanted to cut funding for the NHS—it was his party. It was not the Conservatives who said that funding the five-year forward view was impossible—it was his party. Labour said that the cheque would bounce. Well, it has not bounced, and we are putting in that money.

In conclusion, it is tough on the NHS frontline. The hon. Gentleman was right to raise this issue in this House, but wrong to raise it in the way that he did. Under this Government, the NHS has record numbers of doctors and nurses and record funding. Despite the pressures of winter, care is safer, of higher quality and reaching more people than ever before. It is time to support those on the frontline, and not try to use them for party political points.

[Dr Sarah Wollaston (Totnes) (Con)]

I welcome the Secretary of State’s statement and the Prime Minister’s focus on mental health in her speech today. She spoke of holding the NHS leadership to account for the extra £1 billion that we will be investing in mental health. Will the Secretary of State set out in further detail how clinical commissioning groups will be held to account for ensuring that that money gets to the frontline so that we can deliver progress on parity of esteem?

[Mr Hunt]

Yes, I can do that. It is a very important point. We have had a patchy record in the NHS of ensuring that money promised for mental health actually reaches the frontline. The way that we intend to address this is by creating independently compiled Ofsted-style ratings for every CCG in the country that highlight where mental health provision is inadequate. Those ratings are decided by an independent committee chaired by Paul Farmer, who is responsible for the independent taskforce report, so he is able to check up on progress towards his recommendations. I am confident that, by doing that, we will be able to shine a light on those areas that are not delivering on the promises that this Government have made to the country.

Oral Answers to Questions

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 20th December 2016 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

The Health Committee has just published its interim report on preventing suicide. I thank all those who gave evidence to our inquiry and all members of the Department of Health advisory group. We support the strategy, but the clear message that we heard was that implementation needs to be strengthened. Will the Secretary of State meet me to discuss our report’s recommendations, and will he join me in thanking members of the Samaritans and other voluntary groups around the country who will be working tirelessly over Christmas, as they do every day, to support those in crisis?

[Mr Jeremy Hunt]

My hon. Friend speaks wisely. Christmas can be a very lonely time for a number of people, so we all commend the work of voluntary organisations that do so well. I would be delighted to meet her.

NHS Funding

Debate between Sarah Wollaston and Jeremy Hunt

Monday 31st October 2016 Commons Chamber

[Mr Hunt]

I start by welcoming the hon. Gentleman to his first urgent question in his new role. As I am a relative old timer in my role, I hope he will not mind me reminding him of some of the facts about health spending.

First, the hon. Gentleman said that the Government did not give the NHS what it asked for. Let me remind him that Simon Stevens, a former Labour special adviser—I know for new Labour, but he was none the less a Labour special adviser—said at the time of the spending review settlement last year that

“our case for the NHS has been heard and actively supported”

and that the settlement

“is a clear and highly welcome acceptance of our argument for frontloaded NHS investment. It will…kick start the NHS Five Year Forward View’s fundamental redesign of care.”

I will tell the hon. Gentleman who did not give the NHS what it asked for: the Labour party. At the last election, it refused to support the NHS—[Interruption.] I know this is uncomfortable for the new shadow Health Secretary, but the reality is that the party on whose platform he stood refused to support the NHS’s own plan for the future. As his question was about money, I will add that the Labour party also refused to fund it. The NHS wanted £8 billion; Labour’s promise was for additional funding of £2.5 billion—not £6 billion or £4 billion, but £2.5 billion, or less than one third of what the NHS said it needed. Even if we accept the numbers of the Chair of the Select Committee—and, as I will go on to explain, I do not—Labour was pledging over the course of the Parliament only around half of what this Government have delivered in the first year of the spending review.

The hon. Gentleman used other choice words, one of which was “spin”. I will tell him what creates the most misleading impression: a Labour party claiming to want more funding for the NHS when, in the areas where they run it, the opposite has happened. Indeed, in the first four years of the last Parliament, Labour cut NHS funding in Wales when it went up in England—[Interruption.] Yes, it did. Those are the official figures. That is in a context in which the Barnett formula gives the Government in Wales more than £700 more per head to spend on public services, so there is more money in the pot.

The hon. Gentleman talked about social care. May I remind him of what the shadow Chancellor at the time of the last election—Ed Balls, who is now sadly no longer of this parish—said? During the election campaign, he said of funding for local councils “not a penny more”. We are giving local councils £3.5 billion more during the course of this Parliament.

The hon. Gentleman talked about other cuts that he alleges will happen in A&E departments and other hospital services. I simply say to him that we have to make efficiency savings. I do not believe they will be on the scale he talked about, but how much worse would they have to be if the NHS got a third of the money it currently gets?

If the hon. Gentleman and his party think the NHS is underfunded, they need to accept that the policies that they advocated in the past two elections were wrong —they advocated spending less than the Conservatives. Until they are serious about changing their policy, no one will be serious about listening to their criticisms.

[Dr Sarah Wollaston (Totnes) (Con)]

I agree with the Secretary of State that prevention is better than cure, but he will know that achieving the aims of the five year forward view was dependent on a radical upgrade in public health and prevention. He will know that it was also dependent on adequate funding for adult social care. In addition, there are continuing raids on the NHS capital budget, and we need to put in place the kind of transformation that he and our sustainability and transformation partnerships wish to achieve.

Will the Secretary of State therefore confirm that he recognises the serious crisis in social care and the effect it is having on the NHS, and the effect that taking money from public health budgets is having? Although I accept that he does not agree with the Health Committee’s appraisal of the £10 billion figure, I am afraid I stick by those figures.

[Mr Hunt]

I have enormous respect for my hon. Friend. I respect her passion for the NHS, her knowledge of it and her background in it, so I will always listen carefully to anything she says. I hope she will understand that just as she speaks plainly today, I need to speak plainly back and say that I do not agree with the letter she wrote today, and I am afraid I do think that her calculations are wrong.

The use of the £10 billion figure was not, as she said in her letter, incorrect. The Government have never claimed that there was an extra £10 billion increase in the Department of Health budget. Indeed, the basis of that number has not even come from the Government; it has come from NHS England and its calculations as to what it needs to implement the forward view. As I told the Select Committee, I have always accepted that painful and difficult economies in central budgets will be needed to fund that plan. What NHS England asked for was money to implement the forward view. It asked for £8 billion over five years; in fact, it got £10 billion over six years, or £9 billion over five years—whichever one we take, it is either £1 billion or £2 billion more than the minimum it said it needed.

I think my hon. Friend quoted Simon Stevens as saying that NHS England had not got what it asked for. He was talking not about the request in the forward view, but in terms of the negotiations over the profile of the funding we have with the Treasury. The reason that the funding increases are so small in the second and third year of the Parliament is precisely that we listened to him when he said that he wanted the amount to be front- loaded. That is why we put £6 billion of the £10 billion up front in the first two years of the programme.

I fully accept that what happens in the social care system and in public health have a big impact on the NHS, but on social care we have introduced a precept for local authorities combined with an increase in the better care fund—[Interruption.] This is a precept, which 144 of 152 local authorities are taking advantage of. That means that a great number of them are increasing spending on social care. It will come on top of the deeper, faster integration of the health and social care systems that we know needs to happen.

On public health, I accept that difficult economies need to be made, but it is not just about public spending. This Government have a proud record of banning the display sale of tobacco, introducing standardised packaging for tobacco, introducing a sugary drinks tax and putting more money into school sports. There are lots of things that we can do on public health that make a big difference.

On capital, I agree with my hon. Friend about the pressure on the capital budget, but hospitals have a big opportunity to make use of the land they sit on, which they often do not use to its fullest extent, as a way to bridge that difficult gap.

Health Service Medical Supplies (Costs) Bill

Debate between Sarah Wollaston and Jeremy Hunt

2nd reading: House of Commons & Programme motion: House of Commons
Monday 24th October 2016 Commons Chamber

[Mr Hunt]

Yes. My hon. Friend makes an important point. The third part of the Bill will provide for much better data collection to allow that analysis to take place. We are also seeking to break down the barriers between the pharmacy sector and general practice. During this Parliament, we will be financing 2,000 additional pharmacists to work in general practice so that we can learn exactly those sorts of lessons.

[Dr Sarah Wollaston (Totnes) (Con)]

Further to that important point about biosimilars, and in welcoming this legislation and the opportunity to create savings for the NHS, will the Secretary of State also address the long-standing issues around Lucentis and Avastin? The hon. Member for Mid Norfolk (George Freeman) updated the House about the barriers in both domestic and European legislation that prevent the use of Avastin—it is not licensed for wet age-related macular degeneration—but the scale of savings could be so vast that there is a case for introducing measures in the Bill to allow for such issues to be addressed.

[Mr Hunt]

I am happy to look into that—some of my own constituents have been affected by that issue. I am not aware that there is scope to consider that important point in the Bill, but we should reflect on what we can do to deal with some of the anomalies in the drug licensing regime that lead to the unintended consequences that my hon. Friend talks about.

We have a statutory scheme for companies that are not in the PPRS that is based on a cut to the list price of products, rather than a payment mechanism on company sales. Since the introduction of the rebate mechanism in the PPRS, the volumes of drugs going through it have been lower than estimated. At the same time, the statutory scheme has delivered lower savings than predicted. The inequity between the two schemes has led to some companies making commercial decisions to divest products from the PPRS to the statutory scheme, further reducing the savings to the NHS.

Last year, the Government consulted on options to reform the statutory medicines pricing scheme by introducing a payment mechanism, in place of the statutory price cut, broadly similar to that which exists in the PPRS. Our clear intention was to put in place voluntary and statutory schemes that were broadly comparable in terms of savings. Of course, companies are free to decide which scheme to join and may move from one to the other depending on the other benefits they offer, but the savings to the NHS offered by both schemes should be broadly the same.

NHS respondents to the consultation supported our position, but the pharmaceutical industry queried whether the Government had the powers to introduce a statutory payment system. Following a review of our legislative powers, we concluded that amendments should be made to clarify the existing powers to make it clear that the Government do have the power to introduce a payment mechanism in the statutory scheme. The Bill does that by clarifying the provisions in the NHS Act 2006 to put it beyond doubt that the Government can introduce a payment mechanism in the statutory scheme. The Bill also amends the 2006 Act so that it contains essential provisions for enforcement action. Payments due under either a future voluntary or statutory scheme would be recoverable through the courts if necessary. That would include the power to recover payments due from any company that leaves one scheme to join the other.

The powers proposed in the Bill to control the cost of medicines are a modest addition to the powers already provided for in the 2006 Act to control the price of and profit associated with medicines used by the health service. The powers are necessary to ensure that the Government have the scope and flexibility to respond to changes in the commercial environment. The intended application of the powers will, of course, be set out in regulations. We will provide illustrative regulations to reassure the House that we will be fair and proportionate in exercising the powers.

Junior Doctors: Industrial Action

Debate between Sarah Wollaston and Jeremy Hunt

Monday 5th September 2016 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

I welcome the BMA’s suspension of next week’s damaging industrial action. It is clear from its statement that thousands of doctors had been in touch to say that they wanted to keep their patients safe. Doctors know that they cannot do so with full, rolling, five-day walkouts. Will the Secretary of State therefore join me in asking the BMA to ballot its members to hear their views before they proceed with the other proposed, damaging, five-day walkouts?

[Mr Hunt]

The BMA should talk to its members much more because, as far as I could tell, the consultation over the summer showed that only a minority actually wanted this extreme series of rolling one-week suspensions of labour that the BMA supported in the end. Most junior doctors are perplexed and worried about the situation and would love to find a solution. There was a bitter industrial dispute, but we actually started a process through which trust was being rebuilt on both sides. In a series of meetings, I met the junior doctors’ leader to talk through the areas of her greatest concern and we made progress in addressing two of those four outstanding areas. Building that trust means actually sitting around the table and talking, not having confrontational strikes. I think that that is what most junior doctors want.

Junior Doctors Contract

Debate between Sarah Wollaston and Jeremy Hunt

Wednesday 6th July 2016 Commons Chamber

[Mr Hunt]

I welcome the hon. Lady to her place for the first statement to which she has responded and welcome her on the whole measured tone, with one or two exceptions. I will reply directly to the points she made.

First, the hon. Lady maintains the view expressed by her predecessor, the hon. Member for Lewisham East (Heidi Alexander), who is in her place this afternoon, that somehow the Government’s handling of the dispute is to blame. We have heard that narrative a lot in the past year, but I say with the greatest of respect for the hon. Member for Hackney North and Stoke Newington (Ms Abbott)—I do understand that she is new to the post—that that narrative has been comprehensively disproved by the leaked WhatsApp messages that were exchanged between members of the junior doctors committee earlier this year.

We now know that, precisely when the official Opposition were saying that the Government were being intransigent, the BMA had no interest in doing a deal. In February, at the ACAS talks, the junior doctors’ aim was simply to

“play the political game of…looking reasonable”—

their words, not ours. We also know that they wanted to provoke the Government into imposing a contract, as part of a plan to

“tie the Department of Health up in knots for…months”.

In contrast to public claims that the dispute was about patient safety, we know that, in their own words,

“the only real red line”

was pay. With the benefit of that knowledge, the hon. Lady should be careful about maintaining that the Government have not wanted to try to find a solution. We have had more than 70 meetings in the past year and we have been trying to find a solution for more than four years.

The question then arises whether we should negotiate or proceed with the introduction of the new contracts. Let me say plainly and directly that if I believed negotiations would work, that is exactly what I would do. The reason I do not think they will work is that it has become clear that many of the issues upsetting junior doctors are in fact nothing to do with the contract. Let me quote a statement posted this morning by one of the junior doctors’ leaders and a fierce opponent of the Government, Dr Reena Aggarwal:

“I am no apologist for the Government but I do believe that many of the issues that are exercising junior doctors are extra-contractual. This contract was never intended to solve every complaint and unhappiness, and I am not sure any single agreement would have achieved universal accord with the junior doctor body.”

The Government’s biggest opponents—in a way, the biggest firebrands in the BMA—supported the deal and were telling their members that it was a good deal, which got rid of some of the unfairnesses in the current contract and was better for women and so on. If the junior doctors are not prepared to believe even them, there is no way we will be able to achieve consensus.

If the hon. Lady wants to stand up and say that we should scrap the contract, she will be saying that we should not proceed with a deal that reduces the maximum hours a junior doctor can be asked to work, introduces safeguards to make sure that rostering is safe and boosts opportunities for women, disabled people and doctors with caring responsibilities—a deal that was supported by nearly every royal college. If the alternative from Labour is to do nothing, we would be passing on the opportunity to make real improvements that will make a real difference to the working lives of junior doctors.

The hon. Lady and I have a couple of the more challenging jobs that anyone can do in this Chamber. She has been in the House for much longer than I have, so she will know that. The litmus test in all the difficult decisions we face is whether we do the right thing for patients and for our vulnerable constituents, who desperately need a seven-day service. The Government are determined to make sure that happens.

[Dr Sarah Wollaston (Totnes) (Con)]

I welcome today’s statement and thank the Secretary of State for dealing with many of the extra-contractual issues that have blighted the lives of junior doctors. I join him in regretting the outcome of the ballot. Like my right hon. Friend, I welcome Doctor Ellen McCourt to her post. I know that my right hon. Friend will work constructively with the junior doctors committee to try to resolve the outstanding issues. In proceeding in a careful, measured way with the imposition of the contract, will he work to reassure the public that if patient safety issues arise during that process, he will deal with them?

[Mr Hunt]

I thank my hon. Friend for her measured tone and for being an independent voice throughout the dispute. I spoke to Dr Ellen McCourt earlier this afternoon. I appreciate that she is in a very difficult situation, but I wanted to stress to her that, as I told the House this afternoon, my door remains open for talks about absolutely anything and that I am keen to find a way forward through dialogue. I had lots of discussions with Dr McCourt when we were negotiating the agreement in May, and I know that she approached those negotiations in a positive spirit.

We have set in place processes, and that is one of the reasons why Professor Bailey recommended phased implementation—so that if there are any safety concerns, we can address them as we go along. The Minister with responsibility for care quality, my hon. Friend the Member for Ipswich, is leading a process that will keep looking at the issues to do with the quality of life of junior doctors. NHS Employers is leading a process that will look in detail at how the contract is implemented. Absolutely, the point of the changes is to make care safer for patients; we will continue to keep an eye on this to make sure that it does so.

Oral Answers to Questions

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 5th July 2016 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

Prevention of ill health has to be given a higher priority if the NHS is to meet the challenges set out in the five year forward view. Central to that will of course be the childhood obesity strategy. Has the Secretary of State had any discussions with the Prime Minister about the strategy’s future? Is he in a position to take over the strategy should No. 10 become distracted?

[Mr Jeremy Hunt]

I welcome my hon. Friend’s close interest in ensuring that this important agenda does not get swept aside. I can assure her that we have had many discussions inside Government about what to do. There is a strong commitment to take it forward as soon as possible, and I hope that she will get some good news on that front before too long.

Junior Doctors Contract

Debate between Sarah Wollaston and Jeremy Hunt

Thursday 19th May 2016 Commons Chamber

[Mr Hunt]

The hon. Lady is wrong today, as she has been wrong throughout this dispute. In the last 10 months, she has spent a great deal of time criticising the way in which the Government have sought to change the contract. What she has not dwelt on, however, is the reason it needed to be changed in the first place, namely the flawed contract for junior doctors that was introduced in 1999.

We have many disagreements with the BMA, but we agree on one thing: Labour’s contract was not fit for purpose. Criticising the Government for trying to put that contract right is like criticising a mechanic for mending the car that you just crashed. It is time that the hon. Lady acknowledged that those contract changes 17 years ago have led to a number of the five-day care problems that we are now trying to sort out.

The hon. Lady was wrong to say that an all-out strike was necessary to resolve the dispute. The meaningful talks that we have had have worked in the last 10 days because the BMA bravely changed its position, and agreed to negotiate on weekend pay. The hon. Lady told the House four times before that change of heart that we should not impose a new contract. What would have happened if we had followed her advice? Quite simply, we would not have seen the biggest single step towards a seven-day NHS for a generation, the biggest reforms of unsocial hours for 17 years, and the extra cost of employing a doctor at weekends going down by a third. We would not have seen the reductions in maximum working hours. We would not have seen many, many other changes that have improved the safety of patients and the quality of life of doctors.

The hon. Lady was also wrong to say that the previous contract discriminated against women. In fact, it removed discrimination. Does that mean that there are not more things that we can do to support women who work as junior doctors? No, it does not. The new deal that was announced yesterday provides for an important new catch-up clause for women who take maternity leave, which means that they can return to the position in which they would have been if they had not had to take time off to have children.

The hon. Lady asked what would happen if the ballot went the wrong way. What she failed to say was whether she was encouraging junior doctors to vote for the deal. Let me remind her that on 28 October, she told the House that she supported the principle of seven-day services. As Tony Blair once said, however, one cannot will the end without willing the means. The hon. Lady has refused to say whether she supported the withdrawal of emergency care, she has refused to say whether she supports contentious changes to reform premium pay, and now she will not even say whether doctors should vote for the new agreement.

Leadership means facing up to difficult decisions, not ducking them. I say to the hon. Lady that this Government are prepared to make difficult decisions and fight battles that improve the quality and safety of care in the NHS. If she is not willing to fight those battles, that is fine, but she should not stand at the Dispatch Box and claim that Labour stands up for NHS patients. If she does not want to listen to me, perhaps she should listen to former Labour Minister Tom Harris, who said:

“Strategically Labour should be on the side of the patients and we aren’t.”

Well, if Labour is not, the Conservatives are.

[Dr Sarah Wollaston (Totnes) (Con)]

I congratulate both sides on returning to constructive negotiations and on reaching an agreement. I pay particular tribute to Professor Sue Bailey and the Academy of Medical Royal Colleges for their role in bringing both sides together. I welcome the particular focus, alongside the negotiations around weekend pay, on all the other aspects that are blighting the lives of junior doctors. I welcome the recognition that we need to focus on those specialties that it is hard to recruit to and on those junior doctors who are working the longest hours, as well as the focus on patient safety.

However, we are not out of the woods yet. We need junior doctors across the country to vote for this agreement in a referendum. May I add my voice to that of the Opposition spokesman on health to say that what is needed now is a period of calm reflection? We need to build relationships with junior doctors into the future. Will the Secretary of State comment on his plans for building those relationships with our core workforce?

[Mr Hunt]

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

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

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

Oral Answers to Questions

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 10th May 2016 Commons Chamber

[Mr Jeremy Hunt]

The answer, regrettably, is that for many years we have not got our act together. That is why I have changed the system of incentives for trusts to make sure that they get a premium for identifying EU nationals they treat and that we can then recharge the treatment to their home countries. We are, as a result, now seeing significant increases in the amount we are reclaiming from other countries.

[Dr Sarah Wollaston (Totnes) (Con)]

Community hospitals are immensely valued by the communities they serve. Will the Secretary of State meet me to discuss the proposals for south Devon, which will particularly affect my constituents living in Dartmouth and in Paignton?

[Mr Hunt]

Yes, I am happy to do that. I have a number of community hospitals in my own area. It is really important that even as the functions and jobs that community hospitals do inevitably change, we recognise that they have a very important long-term future in the NHS.

Junior Doctors Contracts

Debate between Sarah Wollaston and Jeremy Hunt

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

The shadow Health Secretary can do better than that. She talked about the judgments that I have made as Health Secretary, so I will tell her what is a judgment issue—it is whether or not you back a union that is withdrawing life-saving care from your own constituents. Health Secretaries should stand up for their constituents and their patients, and if she will not, I will.

The hon. Lady also talked about the trust of the profession. The Health Secretary who loses the trust of the profession is the Health Secretary who does not take tough and difficult decisions to make care better for patients—something we have seen precious little evidence of from the hon. Lady or, if I may say so, her predecessors.

The hon. Lady also talked about putting oil on a blazing fire. What, then, does she make of the shadow Chancellor’s comments recently when he said:

“We have got to work to bring this Government down at the first opportunity…Whether in parliament, picket line, or the streets, this Labour leadership is with you”?

Yes, it is with the strikers, but also against the patients. Labour should be ashamed of such comments from the shadow Chancellor.

Let us deal with the substance of what the hon. Lady said. She talked about her proposal for pilots. If this was a genuine attempt to broker a deal between all the parties, why was it that the first the Government knew about it was when we read The Sunday Times yesterday morning? The truth is that this was about politics, not peace making. If she is saying that we should stage the implementation of this contract to make sure we get it absolutely right, I agree. That is why only 11% of junior doctors are going on to the new contract in August. She says she wants more independent studies into mortality rates at weekends, but we have already had eight in the last six years, pointing to the weekend effect. How many more studies does the hon. Lady want? Now is the time to act, to save lives, and to give our patients a safer NHS.

The hon. Lady talked about legal powers, which we discussed in the House last week. The Health Act 2006 makes very clear where my powers are to introduce a new contract, either directly or indirectly, when foundation trusts choose to follow the national contract.

I have given very straight answers today. Will the hon. Lady now tell us yes or no? Will Labour Members now tell us yes or no? Do they or do they not support the withdrawal of life-saving care from NHS patients? Last week, the hon. Lady’s answer was “no comment”. Well, “no comment” is no leadership. Labour used to stand up for vulnerable patients, but now it cares more about powerful unions. It is the Conservatives who are putting the money into the NHS, delivering a seven-day service for patients, and fighting to make NHS care the best in the world.

[Dr Sarah Wollaston (Totnes) (Con)]

There are only losers in this bitter dispute, but those who have the most to lose are patients and their families. Tomorrow people will visit hospitals to see those whom they care about more than anything in the world, and will ask themselves why the doctors on the picket line are not inside looking after the people they love. May I ask the British Medical Association directly whether it will show dignity, put patients first, and draw back from this dangerous escalation? May I ask all sides, whatever provocation they may feel, to put patients first in this dispute?

[Mr Hunt]

My hon. Friend has spoken very wisely. She recently wrote, in The Guardian, something with which I profoundly agree: she wrote that there could have been a solution to this problem back in February, when a very fair compromise was put on the table in relation to the one outstanding issue of substance, Saturday pay.

I understand that this is a very emotive issue. The Government initially wanted there to be no premium pay on Saturdays, but in the end we agreed to premium pay for anyone who works one Saturday a month or more. That will cover more than half the number of junior doctors working on Saturdays. It was a fair compromise, and there was an opportunity to settle the dispute, but unfortunately the BMA negotiators were not willing to take that opportunity. I, too, urge them, whatever their differences with me and whatever their differences with the Government, to think about patients tomorrow. It would be an absolute tragedy for the NHS if something went wrong in the next couple of days, and they have a duty to make sure that it does not.

Junior Doctors Contracts

Debate between Sarah Wollaston and Jeremy Hunt

Monday 18th April 2016 Commons Chamber

[Mr Hunt]

Well, if planting a story in a newspaper is reprehensible, I do not think many Members of this House would survive the scrutiny of the hon. Gentleman’s very high code of moral conduct for long. Let me say this to him and to all Labour Members: we should be honest about the problems we face in the NHS, whatever those problems might be, and we should not sweep them under the carpet. One problem that we face—not the only one—is the excess mortality rates for people admitted at weekends. There was a time when Labour Members would have recognised that their own constituents were the people who depended most on services such as the NHS and who had the most to gain from a full seven-day NHS. Labour Members should be supporting us, not opposing us.

[Dr Sarah Wollaston (Totnes) (Con)]

We are eight days away from an unprecedented full walkout of junior doctors, including the withdrawal of emergency care. Our constituents want to know whether they will be safe on the strike days. Will the Secretary of State and the shadow Secretary of State join me in calling on the BMA at least to exempt casualty departments and maternity units from this walkout? We know that, even with goodwill arrangements in place to bring people back in when hospitals are overwhelmed, the delays will cost lives.

Junior Doctors Contracts

Debate between Sarah Wollaston and Jeremy Hunt

Thursday 11th February 2016 Commons Chamber

[Mr Hunt]

I welcome the tone of the hon. Lady’s comments. I do not agree with everything that she has said, and I shall explain why, but they were immensely more constructive than the comments that we have heard from other Opposition spokesmen. She is right to say that the studies talk about mortality rates for people admitted at weekends. There have been eight studies in the past five years, or 15 since 2010 if we include international studies. She is right to say that we need to look at why we have these problems.

The clinical standards state that when someone is admitted, they should be seen by a senior decision-maker within 14 hours of admission. They will be seen by a doctor before then, but they should be seen by someone senior within 14 hours. The standards also state that vulnerable people should be checked twice a day by a senior doctor. Now, across the seven days of the week, the first of those standards is being met in only one in eight of our hospitals and the second in only one in 20. That is why it is important that junior doctors should be part of the group of people who constitute those senior decision-makers—consultants are also part of it—and that is why contract reform is essential.

The hon. Lady is right to say that this is also about nurse presence, and the terms that we are offering today for junior doctors are better on average than those for the nurses working in the very same hospitals, and better than those for the midwives and the paramedics. That is why Sir David Dalton and many others say that this is a fair and reasonable offer.

With respect to A&E recruitment, the impact of the contract change we are proposing is that people who regularly work nights and weekends will actually see their pay go up, relatively, compared to the current contract. These are the people who are delivering a seven-day NHS and we must support them every step of the way.

[Dr Sarah Wollaston (Totnes) (Con)]

I know colleagues across the House will want to join me in thanking junior doctors for the valuable work they do for patients across the NHS. [Hon. Members: “Hear, hear.”] I hope that they will look very carefully at the improvements in the offer, with a 13.5% increase in the basic rate and the very important safeguard that will discourage over-rostering at weekends by giving them premium rates if they have to work more than, or including, one in four weekends. I hope the BMA will also recognise and welcome the very important appointment of Professor Dame Sue Bailey to lead an inquiry into all the other aspects that lead to discontent with junior doctors. I wonder if the Secretary of State agrees that what we now need is to move forward in a positive spirit that brings this dispute to an end, takes the temperature down and recognises that we all want the same thing: safety for patients.

William Mead: 111 Helpline

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 26th January 2016 Commons Chamber

[Mr Hunt]

I hope I can reassure the shadow Health Secretary on all the points she raised.

First, there has been a sustained effort across the NHS since September 2013 to improve the standard of safety in the care we offer in our hospitals. An entirely new inspection system was set up that year. It has now nearly completed inspections of every hospital, and it has caused a sea change in the attitudes towards patient safety. Sepsis is one of the areas that is looked at. In particular it is incredibly important that when signs of sepsis are identified in A&E departments the right antibiotic treatment is started within 60 minutes. That is not happening everywhere, but we need to raise awareness urgently to make that happen, and that inspection regime is helping to focus minds on that.

On top of that—I will come to the issues around 111, and I agree that there are some important things that need to be addressed—a year ago I announced an important package to raise awareness of sepsis. It covers the different parts of the NHS. For example, in hospitals a big package on spotting it quickly has been followed from December 2015, with NHS England publishing the cross-system sepsis programme board report, which is looking at how to improve identification of sepsis across the care pathway.

The hon. Lady is right to raise the issue of faster identification by GPs. That is why, in January 2015, I announced that we will be developing an audit tool for GPs, because it is difficult to identify sepsis even for trained clinicians, and we need to give GPs the help and support to do that. We are also talking to Public Health England about a public awareness campaign, because it is not just clinicians in the NHS, but it is also members of the public and particularly parents of young children, who need to be aware of some of those tell-tale signs.

So a lot is happening, but the root cause of the issue is understanding by clinicians on the frontline of this horrible disease, and it does take some time to develop that greater understanding that everyone accepts we need. I can reassure the hon. Lady, however, that there is a total focus in the NHS now on reducing the number of avoidable deaths from sepsis and other causes, and that is something the NHS and everyone who works in it are totally committed to.

With respect to 111, there are some things that we can, and must, do quickly in response to this report, but there is a more fundamental change that we need in 111 as well. One thing we can do quickly is look at the algorithms used by the call-handlers to make sure they are sensitive to the red-flag signs of sepsis. That is a very important thing that needs to happen. NHS 111 has in some ways been a victim of its own success: it is taking three times more calls than were being taken by NHS Direct just three years ago—12 million calls a year as opposed to 4 million—and nearly nine of out 10 of those calls are being answered within 60 seconds.

When it comes to the identification of diseases such sepsis, we need to do better and to look urgently at the algorithm followed by the call-handlers. Fundamentally, when we look at the totality of what the Mead family suffered, we will see that there is a confusion in the public’s mind about what exactly we do when we have an urgent care need, and the NHS needs to address that. For example, if we have a child with a high temperature, we might not know whether they need Calpol or serious clinical attention.

The issue is that there are too many choices, and that we cannot always get through quickly to the help that we need. We must improve the simplicity of the system, so that when a person gets through to 111, they are not asked a barrage of questions, some of which seem quite meaningless, and they get to the point more quickly and are referred to clinical care more quickly. We must simplify the options so that people know what to do, and that is happening as part of the urgent emergency care review. It is a big priority, and this tragic case will make us accelerate that process even faster.

[Dr Sarah Wollaston (Totnes) (Con)]

I join colleagues from across the House in sending deepest condolences to William’s parents. I welcome the Secretary of State’s response that he will put into action the recommendation from today’s report. May I draw out one aspect that has not been touched on so far, which is the comment in the report that out-of-hours services did not have access to William’s clinical records, and that had they been able to do so they would have seen how many times a doctor had been consulted, and that that would have been a clear red flag? Will he reassure me that that matter will be addressed across the NHS, so that all services have access to patients’ clinical records—of course with their consent?

[Mr Hunt]

My hon. Friend is absolutely right. There is so much in this report, but we must not let some very important recommendation slip under the carpet, and that is one of them. We have a commitment to a paperless NHS, which involves the proper sharing of electronic medical records across the system. We have also instructed clinical commissioning groups to integrate the commissioning of out-of-hours care with the commissioning of their 111 services to ensure that those are joined up. It is a big IT project, and we are making progress. Two thirds of A&E departments can now access GP medical records, but she is absolutely right to say that it is a priority.

Oral Answers to Questions

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 5th January 2016 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

Nobody wants to return to the days of exhausted junior doctors being forced to work excessive hours, and the Secretary of State will know that that is why junior doctors have expressed concern about the potential impact of removing financial penalties from trusts. Will the Secretary of State set out what has happened during the negotiations to reassure the public and doctors about patient safety?

[Mr Jeremy Hunt]

I hope I can reassure my hon. Friend, because we have said that we will not remove financial penalties when doctors are asked to work excessive hours. To quote from the letter that I received from the chief negotiator about our offer to the British Medical Association:

“Any fines will be paid to the Guardian at each Trust, allowing them to spend the money on supporting the working conditions or education of doctors in training in the institution.”

Southern Health NHS Foundation Trust

Debate between Sarah Wollaston and Jeremy Hunt

Thursday 10th December 2015 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

The allegations in the draft report about Southern Health are deeply disturbing, and I welcome the steps that the Secretary of State has announced. In particular, I am pleased that he will not treat this as an isolated incident. The key findings of the draft report show that in nearly two thirds of the investigations, there was no family involvement. Will he immediately send the message out to all trusts that it is vital to involve family members, particularly when we are talking about those who cannot speak for themselves?

[Mr Hunt]

I will do that, and I am very grateful to my hon. Friend for giving me the opportunity to do so. We see this situation all too often. There was a story in the Sunday newspapers about a family being shut out of a very important decision about the unexpected death of a baby. It is incredibly important to involve families, even more so in the case of people with mental health problems or learning disabilities. The family may be the best possible advocates for someone’s needs.

We need to change the assumption that things will become more difficult if we involve families. More often than not, something like litigation will melt away if the family is involved properly from the outset of a problem. It is when families feel that the door is being slammed in their face that they think they have to resort to the courts, which is in no one’s interests.

Oral Answers to Questions

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 17th November 2015 Commons Chamber

[Mr Hunt]

What exactly would the hon. Lady say to her constituents who are not receiving the standard of care that they need seven days a week, and will she stand side-by-side with them, or with a union that has misrepresented the Government’s position? We have been clear that there are no preconditions to any talks, except that if we fail to make progress on the crucial issue of seven-day reform, we of course reserve the right to implement a manifesto commitment. That must be the way forward, and I urge the British Medical Association to come and negotiate rather than grandstand, so that we get the right answer for everyone.

[Dr Sarah Wollaston (Totnes) (Con)]

I am deeply concerned about the impact on patient care caused by the proposed three days of industrial action, including two days of a full walk-out. Will the Secretary of State say what advance preparations are taking place to ensure patient safety? Will he reassure the House that there are no preconditions that will act as barriers and to which the BMA has to agree before negotiations can take place?

[Mr Hunt]

I absolutely give my hon. Friend that reassurance. There are no preconditions, and this morning I wrote again to the BMA to reiterate that point. Of course, if we fail to make progress we have to implement our manifesto commitments, but we are willing to talk about absolutely everything. I agree strongly with my hon. Friend that it will be difficult to avoid harm to patients during those three days of industrial action. Delaying a cancer clinic might mean that someone gets a later diagnosis than they should get, and a hip operation might be delayed when someone is in a great deal of pain. It will be hard to avoid such things impacting on patients, and I urge the BMA to listen to the royal colleges—and many others—and call off the strike.

Oral Answers to Questions

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 13th October 2015 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

Delayed publication of evidence is as damaging as non-publication, which is why we rightly expect clinicians, researchers and managers to publish their evidence and data in a timely and transparent manner. It is a matter of great regret to the Health Committee that we started our inquiry today without access to the detailed and impartial review of the evidence that we need to make a contribution to this inquiry. Will the Secretary of State please set out when he will publish it?

[Mr Jeremy Hunt]

I agree with my hon. Friend about the importance of transparency and publishing in a timely manner. I will look again at the planned publication date for the report she wants to see, which will be published so that Parliament can debate it properly. The normal practice is for advice to Ministers to be published at the same time as policy decisions are made, as happened with the Chantler review and the Francis report.

NHS Reform

Debate between Sarah Wollaston and Jeremy Hunt

Thursday 16th July 2015 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

I welcome the Secretary of State’s vision of an NHS that is empowered to focus more fully on the people and communities it serves and that is more transparent, less bureaucratic and as safe on a Sunday as it is on a Wednesday, and I welcome his comments about culture change. Does he agree that meeting that challenge will also depend on financing? As welcome as the extra £8 billion announced in the Budget is, will he join me in urging colleagues to ensure that as much of that as possible is front-loaded, because it is so necessary for the transformational changes he has talked about? In encouraging leadership across the NHS, will he ensure that the changes that are needed at a local level, and the systems we can integrate for the benefit of patients, can be introduced more quickly and effectively?

[Mr Hunt]

I thank my hon. Friend for her important comments, and for sitting through a very long speech I gave this morning. We are trying to achieve many things. At their heart, as she rightly says, is a recognition that culture change does not happen overnight. She is right that the profiling of the extra money that the Government are investing in the NHS is important, because we need to spend money soon on some things, such as additional capacity in primary care, as in two to three years’ time that will significantly reduce the need for expensive hospital care. We are going through those numbers carefully. She is also right that local leadership really matters. I know that she will agree, especially as she comes from Devon, that leadership needs to be good at a CCG level as well as a trust level, because CCGs have a really important role in commissioning healthcare in local communities. That is an area where we need to make a lot of improvements.

Oral Answers to Questions

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 7th July 2015 Commons Chamber

[Mr Hunt]

The important thing is that that work happens. NICE did a very good job in delivering safe staffing guidance for acute wards. It is important to recognise that that guidance was interpreted as being about simply getting numbers into wards, but the amount of time that doctors and nurses have with patients is as important. The work will continue and we are proud of the fact that we are dealing with the issue of badly staffed wards. We will continue to make progress.

[Dr Sarah Wollaston (Totnes) (Con)]

In trying to reduce waste as part of the drive for efficiency savings identified in the “Five Year Forward View”, the Secretary of State spoke recently about the possibility of putting a price label on high-value items in prescriptions alongside a label saying that they are paid for by the taxpayer. Will he reassure the House that such a measure would be carefully piloted and evaluated first, so that we can avoid any unintended consequences for those who might consider discontinuing very important medication?

[Mr Hunt]

We will look at all the evidence. The evidence we have seen from other countries is very encouraging. Apart from ensuring that NHS patients and the public understand the cost of NHS care, one of the main reasons why we want to do that is to improve adherence to drug regimes by making people understand just how expensive the drugs are that they have been prescribed. We will of course look at all the international evidence.

Maternity Services (Morecambe Bay)

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 3rd March 2015 Commons Chamber

[Mr Hunt]

I think we can trust the CQC’s view that the care in the maternity unit is safe, but the hon. Gentleman is absolutely right to draw attention to the issue of the barriers between doctors and midwives, which is striking. That goes back a very long time: there seemed to be a kind of macho culture among the midwives to do with not letting the doctors in, which probably led to babies needlessly dying, which is the great tragedy. Making sure that that culture is changed, so that the patient’s needs are always put first, is obviously a massive priority. I know that the trust has made great strides in that area, but we all understand too that it takes time to change culture, and we need to support it as it goes on that journey.

[Dr Sarah Wollaston (Totnes) (Con)]

I join the Secretary of State in paying tribute to James Titcombe and all the families who have fought so long for answers. I also thank Dr Kirkup for his excellent report. I welcome the action that the Secretary of State has announced today, but can he add to that list by saying whether we can bring forward having medical examiners to look into the cause of death before the end of this Parliament and, if not, say what the barriers to introducing that much overdue reform are? Will he also touch on recommendations 20 and 21 in the report, which refer to the need for a national review of maternity and paediatric services in areas that are remote, isolated and hard to recruit to? Indeed, the report goes further and says that the problem extends beyond those services. This is an issue we need to address to improve safety without deterring recruitment in these areas.

[Mr Hunt]

I am afraid I can only commit now to us introducing independent medical examiners as soon as possible. We are wholeheartedly committed to this. It is incredibly important for relatives, because where they have a concern about a death and possibly a mistake being made in someone’s care in their final hours, the availability of an independent examiner has been shown in the trials we have run to be very effective, so we are committed to doing that.

I should have answered the shadow Health Secretary on the point about a review of maternity services, because he raised it as well. NHS England is doing that review; we have already announced that to this House. Today it is publishing the terms of reference of that review. That is important, because there has been a big debate inside the health service—a debate with which many people will be familiar—about what the minimum appropriate size for maternity and birthing units is, and we need to get to the bottom of the latest international evidence.

Jimmy Savile (NHS Investigations)

Debate between Sarah Wollaston and Jeremy Hunt

Thursday 26th February 2015 Commons Chamber

[Mr Hunt]

Thank you, Mr Speaker. I did want to give a full response to the shadow Health Secretary, but I am happy to address any other concerns he has at a later stage.

[Dr Sarah Wollaston (Totnes) (Con)]

The Secretary of State has set out in the starkest terms the extent of the vile abuse perpetrated by Savile. It is also chilling to note in Kate Lampard’s excellent report that between 60% and 90% of child abuse is still going unreported. Those who perpetrate it are adept at adapting their mechanisms, and recommendation 9 in the report mentions the extent to which abusers use social media to abuse children on hospital sites. Can the Secretary of State tell the House whether he is going to implement recommendation 9, and if so, how that will happen?

[Mr Hunt]

Yes, we are; that is very important. We absolutely accept the principle that all hospitals must have explicit policies on the use of social media. We must do everything we can. It is difficult to stop people going on to Facebook, for example, but when it comes to internet access by children, there are things that we can do, and we will absolutely be implementing that recommendation.

Oral Answers to Questions

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 24th February 2015 Commons Chamber

[Mr Hunt]

I do not disagree with it, but I will tell the hon. Lady why we are missing that one target. Incidentally, we are hitting the seven other targets. We are treating and diagnosing so many more people, with 560,000 more diagnoses every year. That means that in this Parliament we are treating 700,000 more people than were treated in Labour’s last Parliament, saving 1,000 more lives a month. If the hon. Lady looks at some of the other things that Cancer Research UK says, she will see that it welcomes that strongly.

[Dr Sarah Wollaston (Totnes) (Con)]

7. What assessment he has made of the implications for his policies of Her Majesty’s Treasury’s costing of free social care at the end of life.

NHS Major Incidents

Debate between Sarah Wollaston and Jeremy Hunt

Wednesday 28th January 2015 Commons Chamber

[Mr Hunt]

In the right hon. Gentleman’s desperate desire to weaponise the NHS, I am afraid that Labour has sunk to new depths today. He said in the media this morning that the Government had put news management over patient safety. That is ironic coming from him, given that so many officials testified to Francis about the pressure they were put under not to come out with bad news when he was Health Secretary. Even the head of the Care Quality Commission was roasted because she wanted to publish details of the problems that were happening in the NHS under Labour and he did not want that to happen when he was Health Secretary. That news management stopped the moment he walked out the door, and those days are over.

As confirmed by NHS England this morning, this was an operational decision; it was nothing to do with Ministers. This was the local NHS doing its best to get good guidelines out in a tough winter. [Interruption.] It is a local decision. The right hon. Gentleman is the man who talks—he did not deliver this in office—a lot about integration. It is absolutely right that a local hospital should talk to the rest of the local NHS to check about the impact of any decision it makes on major incidents, to make sure that patients are treated safely—is he now saying to this House that local hospitals should not talk to the rest of the NHS? That is what these guidelines say. This was a period when we had 16 major incidents, but that number has gone right down because performance on accident and emergency is significantly—[Interruption.] This is the underlying point, because the reason we have fewer major incidents is that A and E performance has got better. This is the week when we discovered that public satisfaction with the NHS jumped five points last year. This is the week when NHS unions have put patients first by suspending their strike, and Labour focuses not on patients, but on politics. On patients, he did not want to talk about the Welsh ambulance service publishing its worst ever figures, although the Labour leader says that we should be looking at what is going on in Wales.

Let us be clear: where Labour runs the NHS we have double the number of people waiting at A and E; double the number of people waiting too long for ambulances; and 10 times the number of people waiting for their operations. We have seen Labour today in Wales and Labour before covering up around Mid Staffs, ignoring patients and weaponising the NHS for political advantage—has the right hon. Gentleman not proved today that Labour is still not fit to run the NHS?

[Dr Sarah Wollaston (Totnes) (Con)]

Our hard-working NHS staff and, more importantly, patients need to have absolute confidence that the Secretary of State will never lean on operational decision making in these circumstances and will always allow that decision making to take place at the appropriate local level, backed, if necessary, by national guidance.

[Mr Hunt]

My hon. Friend is absolutely right to say that. It is why many people in the NHS will be so astonished to hear the shadow Secretary of State, who presided over a culture where precisely that kind of leaning from on high happened, making it difficult for people to make those local operational decisions in the interests of patients, now trying to make a political point. This was a local decision and it was confirmed today that Ministers had no involvement in it, and Labour should stop trying to score political points.

Oral Answers to Questions

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 13th January 2015 Commons Chamber

[Mr Hunt]

I think we need to look at the emergency medicine contracts. One thing said by the College of Emergency Medicine—I have a lot of sympathy with this view—is that emergency doctors want not more money, but the right to the same holidays that other doctors get. It is the time off that is important to them. They have to work 24/7 and they get extremely tired; they want some compensation for that in being able to spend extra time with their families. We are getting more people into emergency medicine, but we should look at anything we can do to make it better.

[Dr Sarah Wollaston (Totnes) (Con)]

NHS staff are working extraordinarily hard to deal with not only the extra demands, but the increased complexity of patient cases in all parts of the urgent care system. Will the Secretary of State set out what more can be done to make sure that people access the right part of the system and that all parts of the system work together?

[Mr Hunt]

As a former GP, my hon. Friend understands this issue better than most. For me, the single most important thing for patients with the most complex needs, particularly for vulnerable older people, is having a system where the buck stops with a doctor. Someone must be accountable for ensuring that such people get the right care wrapped around them. We have brought back named GPs for all over-75s this year as a first step, but there is much more to do.

A and E (Major Incidents)

Debate between Sarah Wollaston and Jeremy Hunt

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

First, let me thank the right hon. Gentleman for this opportunity once again to go through the plans that we have in place to support the NHS and to reiterate the gratitude of the whole House to NHS staff for what they are doing under huge pressure at the moment. Let me start by telling him where I agree with him. I agree that what happens in the social care system is closely linked to what happens in the NHS. That is why, from June last year, meetings have been happening in 140 local authority areas between the local NHS and local authorities to work out how best to plan for winter. The result of that planning process, which is funded by £700 million of Government support, is extra doctors, extra nurses, extra beds and new plans in every area. I am absolutely satisfied that that money is making a difference. Every day in our A and E departments, 2,500 more people are being seen within four hours than was the case four years ago when the right hon. Gentleman was Health Secretary. The local structures worked last year, and they are working now. Now is the time to get behind them and to support the local NHS.

In a letter that the right hon. Gentleman wrote to me yesterday, he talked about Government failure. This is not the time to play politics—[Interruption.] Perhaps Opposition Members will listen to this. The head of NHS England, Simon Stevens, a former Labour special adviser, said yesterday

“the NHS, the Department of Health and local clinicians have done everything that could reasonably be expected”

to put in place plans over the last weeks. If the right hon. Gentleman will not listen to that, perhaps he will listen to Rob Webster, who runs the NHS Confederation, a representative body of all NHS organisations. He says that we should be grateful for the huge effort NHS staff have put in over the past few weeks and that it is not the time to play political football.

The right hon. Gentleman talked about ambulances, where we are putting in £50 million of support this winter, and some changes proposed by the Association of Ambulance Chief Executives, which he was informed about three months earlier than they came to public light. This is what the AACE said:

“We have been surprised by some of the reaction today given that over the last three months the principles of what we are proposing…have been shared with Labour…and we have received no negative feedback”.

What did the right hon. Gentleman say? He said it was a panic decision to relax 999 standards. There was no panic, no decision, no relaxation of 999 standards; I did what any Health Secretary should do: I simply asked for clinical advice on what would be best for patients. He chose to frighten the public, to scaremonger for party political purpose. Is it not time the Labour party, for once, thought about the impact on patients of the kind of things it is saying in the press?

The right hon. Gentleman then talked, and the Leader of the Opposition has talked, about the causes of these challenges being the reforms this Government introduced in this Parliament. Let me say to him that the one part of the UK that introduced these reforms, England, happens to have the best A and E performance and the one part of the UK that has most set its face against these forms, Labour-run Wales, has one of the worst performances. If he wants to do something about A and E pressures, instead of trying to make political capital in England, he should be getting Labour to turn things round in the one place it does run the health service—Wales. He should be backing this Government’s support for the NHS in a difficult period that has meant more doctors, more nurses, more people being seen quickly, more operations, long-term support and a plan for our NHS; it should not be politics and scaremongering ahead of an election.

[Dr Sarah Wollaston (Totnes) (Con)]

May I join the Secretary of State in warmly thanking NHS staff, who are stepping up to meet the extraordinary increase in demand for their care and expertise? Will he reassure the House that in meeting this extraordinary, complex challenge, they will not be made to chase targets, as we know that that was distorting clinical priorities in Mid Staffs, and that clinical staff should always feel absolutely confident that they have his support to place clinical priorities first and foremost?

[Mr Hunt]

My hon. Friend is absolutely right about that, and it is very important. Targets matter, but not targets at any cost. It is worth remembering that, over the four years we were seeing the tragedy unfold in Mid Staffs, it was meeting its A and E target the majority of the time. So it is very important that patient safety is the priority. That is why we have to support NHS trusts when they have major incidents and why we have to make it clear that, although targets matter, trusts need to be sensible and proportionate in their efforts to meet those standards.

UK Ebola Preparedness

Debate between Sarah Wollaston and Jeremy Hunt

Monday 5th January 2015 Commons Chamber

[Mr Hunt]

May I first thank the right hon. Gentleman for the constructive tone of his comments and the official Opposition’s willingness to work closely with us on this very important issue? Let me cover some of the important points that he made.

The right hon. Gentleman is right that the disease is continuing to progress in those countries. We now have a total of 7,905 reported deaths, and there are 20,206 reported cases, which is likely to be an underestimate. There are some early—I stress, early—signs that the rate at which the disease is reproducing itself is beginning to fall to about the level where it is stabilising. However, those are early signs, and the truth is that we still need to do a huge amount of work to bring the disease under control.

We think that it is absolutely vital to proceed as quickly as possible with the vaccine that the right hon. Gentleman mentioned, and I can tell him that we currently have three vaccines in the first phase of clinical trials. We have made some changes to speed up the process by which they can be used in the field, and DFID has put in £1.34 million to establish a joint research fund with the Wellcome Trust, so we are making progress on that front.

It has been impossible to get supplies of ZMapp—the drug given to the other Ebola patient treated in the UK, Will Pooley—because it is grown using genetically modified tobacco plants, so there is a time constraint. Clinically, we do not yet know whether it was significant in Will Pooley’s recovery. We have tried other experimental treatments on Pauline Cafferkey, including using some of the plasma from Will Pooley, and we hope that will have an effect.

The review by Save the Children is being conducted in conjunction with Public Health England staff in Sierra Leone, and I hope that it will report in the next few days. We are obviously keen for them to report as quickly as possible, but we do not want to put them under pressure not to do a thorough report. I am satisfied with current protective arrangements on the basis of our clinical evidence, but as we saw with the screening arrangements, with a disease such as Ebola we must constantly keep an open mind about the best ways of dealing with things, and we will look carefully at what Save the Children recommends. I am satisfied with the protections in place for NHS workers in the UK on the basis of advice from the chief medical officer, and we will obviously also look at what happened in the US. At the moment we do not believe that the personal protective equipment suits have been breached, but we must keep an open mind and see what other evidence comes forward.

On the screening procedure, our clinical protocols were followed when Pauline Cafferkey arrived, but organisationally I do not think that it was as smooth as it needed to be. There were a lot of people to deal with, and because it was over the Christmas period we probably did not have as many people to do that as we needed, which meant that those coming for screening needed to wait longer than we would have liked. However, on the basis of revised protocols, and to ensure that we do not repeat this situation—nine more volunteers are coming back this Sunday and 60 more the following Sunday—the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), and the chief medical officer have been to inspect what is happening, to ensure that we learn the necessary lessons. Other volunteers have said that they think the screening procedure is working smoothly. This was a relatively isolated incident, but we must learn the lessons.

On expanding screening to other airports, I will look into whether Glasgow airport was informed and let the right hon. Gentleman know, but we have obviously learned from this event the importance of close working with the Scottish Government, and that has worked very well.

Finally, the right hon. Gentleman mentioned the active monitoring of people who come back, and I think that we have the best system. We are not only actively monitoring those who have been tested for having contracted the disease, but actively monitoring anyone in the high-risk groups. Of the 2,495 people who have been screened since we set up the process, 54 have been identified as having had direct contact with Ebola patients and as being in the high-risk group, and we have an enhanced monitoring process for them. Everyone else is informed exactly what to do if they develop feverish symptoms, which is what happened with Pauline Cafferkey.

I again thank the right hon. Gentleman for his constructive approach to this issue.

[Dr Sarah Wollaston (Totnes) (Con)]

I join the Secretary of State in paying tribute to Pauline Cafferkey and all NHS volunteers, aid workers, staff at DFID and Public Health England for the work they are doing to keep us safe in the UK by fighting Ebola on the front line in west Africa at great personal risk. I also thank him for updating the House so succinctly on the improvements to the screening protocols, so that everyone will be screened if they have symptoms, not just a temperature. Will he update the House on the vaccines and say whether there has been any progress on the provision of rapid screening for Ebola? Will he reassure us that he will not follow the knee-jerk response that we have heard calls for from some quarters, which is to quarantine all NHS staff, because of the unintended consequences of such an approach?

[Mr Hunt]

I thank my hon. Friend for her constructive comments and I agree with what she has said on this issue. Some 678 health care workers have contracted Ebola since the outbreak of the disease, and of those nearly 400 have died, the vast majority African. That shows how incredibly brave front-line workers are, and perhaps the fact that—tragically—we have someone in this country who has contracted Ebola is a good way of reminding ourselves that many hundreds of other people have already been in this situation. They are all incredibly brave. We are proceeding as quickly as we can with the possibility of having a much speedier Ebola test, which would obviously be helpful for the screening process.

I agree with my hon. Friend that we do not want a knee-jerk response on quarantining people who come back. The contribution of NHS volunteers and health care workers from western countries in fighting the disease in Sierra Leone, Guinea and Liberia is critical. Some 1,500 people from the NHS have volunteered, but they volunteer on the basis that we will follow proper clinical protocols, meaning quarantining people when it is clinically necessary to do so, but not doing so when it is not necessary. If we are to keep their confidence, we must be proportionate in our response.

NHS (Five Year Forward View)

Debate between Sarah Wollaston and Jeremy Hunt

Monday 1st December 2014 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

I warmly welcome the statement. The extra funds for the NHS constitute a clear endorsement of Simon Stevens’s excellent “Five Year Forward View”. I particularly welcome the announcement of multi-year budgets and investment in patients’ ability to control their own records. Will the Secretary of State confirm that the process of creating paperless NHS hospitals will move seamlessly from primary to secondary care, and will be controlled by patients themselves?

[Mr Hunt]

The commitment to a paperless NHS is not a commitment to the creation of paperless hospitals by 2018; it is a commitment to the creation of a paperless NHS so that, with patients’ consent, information can flow seamlessly between different parts of the system. The interface between primary care and secondary care, and social care, is a very important part of that process.

Ebola

Debate between Sarah Wollaston and Jeremy Hunt

Monday 13th October 2014 Commons Chamber

[Mr Hunt]

I thank the shadow Health Secretary for the constructive tone of his comments. That is totally appropriate and I am grateful. I will start with the point on which he finished, because the most crucial thing we can do to protect the UK population is deal with the disease at source and contain it in west Africa. That is why I am working extremely closely with the International Development Secretary, and she is working closely with me because the role of NHS volunteers is important. The right hon. Gentleman is absolutely right: the initial international response has focused on taking the three worst affected countries and giving them a partner country in the developed world to help them—we are helping Sierra Leone, America is helping Liberia, and France is helping Guinea.

That has worked up to a point, but we need more help from the rest of the international community. I had a conversation earlier today with US Health Secretary Burwell. We talked about a co-ordinated international response for the whole of west Africa, because we will not defeat this disease if we operate in silos. We need to recognise that this disease does not recognise international boundaries; the right hon. Gentleman was absolutely right to make that point.

Let me try to give the right hon. Gentleman some of the information he requested. First, he is absolutely right to raise the issue of the protection of health workers. That has to be our No. 1 priority both here in the UK and abroad. That is why we are building a dedicated 12-bed facility in Sierra Leone that will give the highest standards of care, equivalent to NHS standards of care, for health care workers taking part in the international effort to contain the disease there. That is also very relevant to health care workers here: events in both Spain and the US will have caused great concern.

I am satisfied that the official advice to health care workers is correct. The Centers for Disease Control and Prevention in the US, the US equivalent of Public Health England, believes that breaches in protocol led to the infection of the US nurse—the case we have seen in the media recently—but it is investigating that. The advice is always kept under review and if that advice changes we would, of course, respect that. It is important that we follow the scientific advice we have, but that the scientists themselves keep an open mind on the basis of new evidence as it emerges. I know that they are doing that.

The right hon. Gentleman talked about the full range of figures. He is absolutely right to say that we will maintain public confidence in the handling of this by being totally open about what we know. The reason we have stuck carefully to the formula of “a handful of cases” is because it is genuinely very difficult to predict an accurate exact number. Let me say this: we would not have used the formula of “a handful of cases” if we thought that the number of cases over the next three months would reach double figures. However, it is also important to say that that was a current assessment. That assessment may change on the basis of the evidence. I will, of course, keep the House informed if it does change.

The right hon. Gentleman talked about screening. It is important to deal with a misunderstanding. Why did the policy change on Thursday? The answer is that it changed because the clinical advice from the chief medical officer changed on Thursday. Her advice changed not on the basis that the risk level in the UK had changed—she still considers it to be low—but because she said that we should prepare for the risk level going up. That is why we started to put in place measures, but they are not measures primarily intended to pick up people arriving in the UK who are displaying symptoms of Ebola. We think that most of those people should be prevented from flying in the first place. The measures are designed to identify people who may be at risk within the incubation period of developing the disease, so that we can track them and make sure they get access to the right medical care quickly.

As I mentioned, we think we will reach 89% of people arriving in the UK from the affected countries. We will continue to review that. If the numbers increase and the risk level justifies it, we have contingency plans to expand the screening, for example to Birmingham and Manchester. The reason we have included Eurostar at this early stage is because there are direct flights from those three countries to Paris and Brussels, from where it is easy to connect to Eurostar. We will use the tracking system for people who are ticketed directly through to the UK in order to identify, where we can, people who then independently get a Eurostar ticket. It is important to say that because they are changing the mode of transport in Paris and Brussels, tracking is not as robust as it would be for people taking a direct flight to the UK. We will not be able to identify everyone, which is why we need to win the support of people arriving in the UK from those countries, so that they self-present, in their own interest, to give us the best possible chance of helping them if they start contracting symptoms.

I am satisfied that the Trexler beds and the negative isolation rooms are safe both for health care workers and in preventing onward transmission. They use different systems—one of them is a tented system and the other is based on people wearing personal protective equipment —but I am satisfied that both of them are safe. I will continue to take advice on that. It is very important that ambulance staff know that someone is a potential Ebola case, so that they wear the PP equipment.

As we will not be able to identify everyone who comes from the affected countries, it is important that the 111 service knows to ask people exhibiting the symptoms of Ebola whether they have travelled to those affected areas. The right hon. Gentleman asked what those symptoms are. They are essentially flu-like symptoms, but they are not dissimilar to the symptoms someone might exhibit if they had, for example, malaria. That is why it is important to ask for people’s travel history and whether they have had or may have had contact with people who have had Ebola, in order to identify the risk level.

We would like to continue using ZMapp for people in the UK who contract the disease, but that is subject to international availability. It might not be possible to get it for everyone, because there is such high international demand, but we will certainly try.

In terms of the development of a vaccine, we are doing everything we can to work with GSK to bring forward the date when a vaccine is available. Indeed, we are considering potentially giving indemnities if the full clinical trials have not been conducted.

[Dr Sarah Wollaston (Totnes) (Con)]

May I welcome the Secretary of State’s statement and pay tribute to all the staff who are giving him professional detailed scientific advice? I join him in paying tribute to all the NHS personnel, our forces personnel and diplomatic staff putting their own lives at risk in west Africa.

I am particularly pleased to hear that those individuals returning to the UK or coming to the UK from west Africa will be able to access support in a timely manner and in a manner that does not put other individuals at risk in crowded health care settings. Will the Secretary of State say more about the testing arrangements, which I hear are going to be at Porton Down? Does he have any plans to make further testing centres available so that testing can happen more rapidly?

[Mr Hunt]

I thank my hon. Friend for her comments and her support for the statement. I want to pay particular tribute to the chief medical officer and Dr Paul Cosford at Public Health England, who have done an enormous amount to make sure we develop the right policies, which are both proportionate and enable us to prepare for the future. The Government are hugely grateful for their contribution.

We are satisfied that the testing arrangements at the PHE facility at Porton Down are adequate to the level of risk, but one of the reasons why I wanted to announce to the House the current estimate of the number of Ebola cases we are dealing with in the UK was to make the point that we will continually keep those arrangements under review should the situation change. We need to recognise in a fast-moving situation such as this that it might well change, and I will keep the House updated, but in such situations the resilience of all those very important parts of the process will be checked.

NHS Investigations (Jimmy Savile)

Debate between Sarah Wollaston and Jeremy Hunt

Thursday 26th June 2014 Commons Chamber

[Mr Hunt]

I thank the shadow Health Secretary for the constructive tone of his comments. Many of the suggestions he has made are very sensible. We will take them away and look at them, but I will go through a number of them now. First, we will indeed make sure that all Savile’s victims get the counselling they need. I think that it has been made available to them, but it is absolutely right to double-check that they are getting every bit of help they need and that we are taking all reasonable steps.

I hope that what has happened today will be, in its own way, another landmark for all victims of sexual abuse in giving them the confidence that we are changing, not just as an NHS but as a society, into being much better at listening when people come forward with these very serious allegations. It hits you time and again when reading these reports how many people did not speak up at the time because they thought that no one would believe them. We are not going to change that culture overnight, but we have to be a society that listens to the small person—the person who might get forgotten and does not feel they are important in the system.

On the claims for compensation, the right hon. Gentleman is absolutely right to say that the first draw for those claims will come from the Savile estate. I hope I can reassure him, however, that, as we have said, the Government will underwrite this so that if there are any claims that are not able to be met by the estate we finance them from the public purse. We think it is important that we should do that, although Savile’s estate is the first place to start, for obvious reasons.

The right hon. Gentleman is right to say that if there is evidence that people have criminally neglected claims that were made at the time or behaved inappropriately—even if it is not a matter for the law and they behaved in a way that could make them subject to disciplinary procedures in NHS organisations—that should be addressed. We will urge all NHS organisations to look carefully at anyone who is mentioned in the reports. Of course, the police will, naturally, look at the evidence against any individuals, who of course have the right to due process, which everyone in the House would accept.

On the specific point about the behaviour of one Minister and what it suggested about the motivation for Savile’s approval for his job at Broadmoor, my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke), who was Secretary of State at the time, has said that that behaviour would be indefensible now and that it would have been indefensible at the time. I agree with him. Everyone must be held accountable for the actions they took.

We are doing a great deal to make sure that all NHS staff are trained to feel more confident about speaking out. The Mid Staffs whistleblower Helene Donnelly is now working with Health Education England to see what needs to change in the training of NHS staff in order to change that culture.

On the new disclosure and barring scheme, we are already doing work to examine the reason for the drop in the number of people who are being barred from working with children. The Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb) is looking into that. I have given this a lot of thought and it is important to say that in the current environment, were we to have another Savile, it is likely that the disclosure and barring scheme would bar him from working with children and in trusts, but that is not certain because he was never convicted of a crime. The Criminal Records Bureau checks would not have stopped that, but it is possible for the disclosure and barring scheme to prevent people from working with children and vulnerable adults even if they have not committed a crime. For example, their employment track record may show that they were dismissed for doing things that raised suspicions. It is also important to make the point—I think everyone in the House will understand this—that it is not possible to legislate to stop all criminal vile activity. What we depend on for the disclosure and barring scheme to work is a culture in which the public and patients feel able to speak out and staff listen when they do so, in order that these things surface much more quickly.

Finally, the question of whether any further inquiries are necessary will, of course, be considered. The first step is to let Kate Lampard do her full report. At this stage, she has not drawn together all the different inquiries and tried to draw lessons from the system as a whole. I asked her to do two things. The first was to verify independently that the reports of NHS organisations were of the necessary quality, and I think she has done that superbly. The second stage of her work is to see what lessons can be drawn from the system as a whole. We need to hear what she has to say about that and, indeed, what the Department for Education and the BBC learn from their reports, and then we will come to a conclusion about whether any further investigations are needed.

[Dr Sarah Wollaston (Totnes) (Con)]

May I join the Secretary of State in paying tribute to the victims? They were not silent. What today’s reports show is that very many people witnessed—even directly condoned—some deeply inappropriate behaviour. How could it ever be acceptable for a celebrity to be able to watch female patients showering? Will the Secretary of State join me in sending a message to NHS staff that they should always raise concerns if they witness such behaviour and that they will be protected if they do so?

[Mr Hunt]

I am absolutely happy to do that. I wholeheartedly agree with my hon. Friend’s comments. The NHS needs to move to a system where it is the norm rather than the exception to report, and where NHS staff feel comfortable that reporting any concerns is an absolutely normal part of their job. She is right to say that one of the most disturbing things in the reports is the clear evidence that some people helped Savile in what he did—for example, that people were escorted to his private room in Broadmoor—which is very shocking. That is why it is very important that everyone is vigilant. I totally agree with what she said.

Patient Safety

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 24th June 2014 Commons Chamber

[Mr Hunt]

We talk about many things and there will always be political differences between Opposition and Government Members, but I would have thought that on patient safety, on saving patients’ lives, on dealing with the issue that once a week in the NHS we operate on the wrong part of someone’s body and on other terrible issues, there might be a degree of consensus. It is incredibly disappointing that, again, the right hon. Gentleman has chosen to make a political football out of something that should be above party politics.

Let me go through the right hon. Gentleman’s points. This morning in the radio studios, I talked about fulfilling a pledge that I made to the House in my response to Francis—that we would publish staffing data, something that he never did when he was in power. We have done that for 6,700 wards throughout the country, because we want to end the scandal of short staffing that happened on his watch and directly led to Mid Staffs.

I am delighted to come to the House. I have made a written ministerial statement. I often come to the House and I am delighted that the right hon. Gentleman has raised this issue. As he has raised some specific points, I need to address them. He quoted what the outgoing president of the Royal College of Psychiatrists said, but he failed to mention what the incoming president said this morning, which was to praise the remarkable work done by this Secretary of State and his Ministers to raise the issue of mental health.

The right hon. Gentleman talked about the Commonwealth Fund. Let us look at that. When he was Secretary of State, we fell from being top-rated in the world to being second. We are now back on top. He has spent the past four years saying that under the coalition Government the NHS is going to rack and ruin. Someone who is independent has now looked at it and said that we are the best in the world. The right hon. Gentleman should reflect on that before he starts to criticise and run down the NHS.

Let us talk about agency nurses. I am very proud of the fact that, in just over a year, we have 5,900 more nurses on our wards. That is an increase of 4,000 nurses across the system compared with when Labour was in power. Why is that? It is because we are doing something about the issue of safety and compassionate care—issues that the right hon. Gentleman repeatedly swept under the carpet when he was Health Secretary.

Finally, let me make this point. We are doing something that is a world first today: we are publishing staffing data on a hospital-by-hospital, ward-by-ward basis. Yes, we are also publishing which hospitals do not have an open and transparent reporting culture. Creating transparency about failures has, I am afraid, become one of the biggest dividing lines in this House. I think it is a very great shame that every time I raise the issue of poor care in the NHS, the right hon. Gentleman accuses me of running down the NHS and softening it up for privatisation, when what I am actually doing is standing up for patients, which is what he should have done when he was Health Secretary.

[Dr Sarah Wollaston (Totnes) (Con)]

I welcome today’s announcements. Unsafe care in the NHS carries not only a terrible personal cost, but a terrible financial cost—£1.3 billion a year in litigation alone—and I welcome the announcement of Sir Robert Francis’s review. Will the Secretary of State use this opportunity to reassure NHS staff that they do not need to wait for the outcome of that review, and that if they raise concerns about unsafe practice, not only will they be protected, but they would be failing their patients if they failed to do so?

Oral Answers to Questions

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 25th February 2014 Commons Chamber

[Mr Hunt]

It is a pleasure—I think for the first time—to take a question from someone who might be one of my constituents in Godalming. However, I do not agree with the hon. Gentleman that the process has been shambolic. The programme has been in place for 25 years, so it is important to understand that this big public debate is happening because this Government did something that the previous Government did not do: we said that if we are going to use anonymised data for the benefit of scientific discovery in the NHS, people should have the right to opt out. We introduced that right and sent a leaflet to every house in the country, and it is important that we have the debate—[Interruption.] The right hon. Member for Leigh (Andy Burnham) complains, but he did not want to give people the right to opt out when he was Health Secretary.

[Dr Sarah Wollaston (Totnes) (Con)]

The Secretary of State will be aware of the report in The Daily Telegraph setting out how hospital episode statistics data were sold to insurance companies, which were able to match that information with credit ratings data. Nothing will undermine this valuable project more than a belief that data will be sold to insurance companies, so will he set out the way in which he will investigate how that sale was allowed to happen and categorically reassure the House that there will be no sale of care data to insurance companies?

[Mr Hunt]

My hon. Friend is absolutely right to raise that issue and I am happy to give that assurance. That incident is one of the reasons why we set up the Health and Social Care Information Centre through the Health and Social Care Act 2012, in the teeth of opposition from the Labour party. Following the establishment of the centre, the guidelines in place mean that such a thing could not happen. She is also right that it is important that we reassure the public because, let us not forget, it was this important programme that identified the link between thalidomide and birth defects, that identified that there was no link between MMR and autism, and that helped to identify the link between smoking and cancer, so it is vital that we get this right.

Mid Staffordshire NHS Foundation Trust

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 19th November 2013 Commons Chamber

[Mr Hunt]

As the hon. Lady knows, we are going through a process at the moment and the trust special administrator is drawing up detailed plans, so it is premature to say what will happen, but we will of course keep the House well informed and there will be plenty of opportunities for her to question me, or anyone else she wants to question, about any decisions that are eventually made.

[Dr Sarah Wollaston (Totnes) (Con)]

I warmly welcome the Secretary of State’s statement, which will help health professionals to get on with their jobs and improve openness and transparency across the NHS. I particularly welcome his recognition of the important role played by the 1.3 million health care assistants across health and social care. In implementing the vetting and barring scheme, will he ensure that individuals looking after people at home or in outside institutions can access that list to ensure that they have health care assistants who comply with the fundamental standards?

[Mr Hunt]

That is a very good point. I will take it away and look at whether that will be possible, because there is a powerful logic behind making that happen. As my hon. Friend has mentioned health care assistants, I would like to highlight the brilliant work they do, along with so many NHS staff. It has been a very challenging year for them to read about these examples of poor care, which are as shocking to them as they are to us. I agree that now is the time to get behind the people on the front line, who really want to change the culture for the better.

Changes to Health Services in London

Debate between Sarah Wollaston and Jeremy Hunt

Wednesday 30th October 2013 Commons Chamber

[Mr Hunt]

I hope the hon. Gentleman will be pleased that today the death sentence on A and E at Ealing has been not just reprieved, but cancelled; it will keep its A and E. The definition of A and E is not something that politicians decide. We said in the statement that what the A and Es at Ealing and Charing Cross contain must be consistent with Professor Sir Bruce Keogh’s review of A and E services across the country, which they will be, and that any changes made in service provision must have full consultation with his constituents, which will happen. On the basis of an IRP report that simply says, “More work needs to be done,” I cannot answer all his questions, but I hope I can give him greater certainty than he had this morning that there will be an A and E for his constituents in Ealing.

[Dr Sarah Wollaston (Totnes) (Con)]

Clinically led, evidence-based changes to services save lives. That is straightforward and clear. It is also clear that we have to make these changes happen if we are to live within our means and the health service budget. How are we going to make reconfigurations such as this one more straightforward, because the cost and time are unacceptable? Likewise with mergers, how are we going to streamline this process?

[Mr Hunt]

My hon. Friend speaks wisely. It concerns me, as it does her, that these processes take so long. When it comes to changes in A and E and maternity services, exhaustive public consultation is necessary, because they cause such great public concern, but we also need to deal with these issues in a much more timely way, particularly when it involves sorting out the problems of failing hospitals. I agree with her, therefore, and I am looking at what can be done to speed up all these processes, while retaining the appropriate consultation with the public.

Accident and Emergency Departments

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

The fact is that one thing we need to do is to address why people go to A and E instead of the alternatives, such as walk-in centres. Communication about the alternatives to A and E is not as good as it needs to be. We are addressing those issues, but I must say to the right hon. Gentleman that the previous Government failed to address this problem when he was Health Minister and the difficult issue of the reconfiguration of services was never fully grasped. We are grasping it and that is why Professor Sir Bruce Keogh is undertaking his review right now.

[Dr Sarah Wollaston (Totnes) (Con)]

I congratulate the Secretary of State on his welcome stand on continuity of care and the role that that plays in reducing A and E admissions. Could he go further in stating how he will ensure that we have more doctors trained from medical school in both A and E and general practice?

[Mr Hunt]

My hon. Friend is right and staff recruitment is critical. We have already said that we want another 2,000 GPs and are considering whether that is enough. We recognise the fact that general practice is very stretched, that we need GPs to offer more services and that we need more people to do that. Professor Keogh’s review is considering A and E departments, and one thing we are asking is why we are one of the only countries in Europe to have an emergency medicine specialty. Other countries do not do that and ask all doctors to spend time in A and E. We are also considering what we need to do to make A and E a more attractive profession for people to go into, given the antisocial hours that come with the territory. That is not an easy problem to solve, but we recognise that it is incredibly important that we crack it.

Care Quality Commission (Morecambe Bay Hospitals)

Debate between Sarah Wollaston and Jeremy Hunt

Wednesday 19th June 2013 Commons Chamber

[Mr Hunt]

I could not agree more with my right hon. Friend. What happened beggars belief, and I very much agreed with his comments on that on the radio this morning. The point about duty of candour is that there will be a criminal liability for boards that do not tell patients or their families where there has been harm and that do not tell the regulator; boards will have a responsibility to be honest, open and transparent about their record. That has to be the starting point if we are going to turn this around.

[Dr Sarah Wollaston (Totnes) (Con)]

The public will be horrified, but probably not surprised, to hear that Ministers were leaning on the CQC not to criticise NHS hospitals. Leadership has to start at the top, so will the Secretary of State confirm that he will be fearless in standing up for whistleblowers and those protecting patients in the NHS? [Interruption.]

[Mr Hunt]

I thank my hon. Friend for that. She is absolutely right to say that the biggest responsibility Ministers have when faced with such tragedies is to be open and transparent about the scale of the problems; otherwise, they will never be addressed. Let me put it this way: people who love the NHS and are proud of it are the people who most want to sort out these problems when they arise. That is why it is incredibly important that we are open and candid. [Interruption.] The right hon. Member for Leigh (Andy Burnham) has stood up and criticised me in the media every single time I have given a speech drawing attention to some of the problems facing the NHS. He needs to be very careful every time he does that, because I will continue to do this, and I do it because I want the NHS to get better and believe it can be better.

A and E Departments

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

I agree that there have been teething problems with 111 and we are addressing those problems. [Hon. Members: “ Teething problems?”] There is laughter on the Opposition Benches. We are hitting our A and E targets at the moment, and 111 is available in more than 90% of the country. We are dealing with those teething issues, but I take on board the right hon. Gentleman’s point. The 111 service needs to be quicker at getting advice to people from a GP or a nurse. The fundamental issue with 111 is that giving the public an easy number to remember has highlighted how inaccessible GP out-of-hours services have become. We have to address that if we are to restore public confidence in 111.

[Dr Sarah Wollaston (Totnes) (Con)]

If someone cannot get an appointment with their family doctor, they are undoubtedly more likely to end up in A and E, but does the Secretary of State agree that we will not increase capacity in primary care unless we address the work force shortage in general practice and broaden the skill mix of those who can see people in primary care?

[Mr Hunt]

I agree with my hon. Friend. Under this Government, we have 6,000 more doctors than we had under Labour, but we need more people going into general practice as well. [Interruption.] Yes, the training might have started under the Labour Government, but the funding happened under this Government, and it would not be possible if we cut the budget, which is what the Labour party still wants to do. She is right to point out those issues, however. One way of making general practice more attractive is to restore the personal link between GPs and the people on their list and a sense of personal responsibility and accountability. We need to find the right way of doing that, given the pressures on general practice at the moment, and I hope to work with her and many others to do that.

Oral Answers to Questions

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 16th April 2013 Commons Chamber

[Mr Hunt]

It is an additional 4 million since the disastrous changes to the GP contract and an additional 1 million since the last election.

[Dr Sarah Wollaston (Totnes) (Con)]

In Brixham in my constituency, 94% of five-year-olds are protected against measles. Just up the road in Totnes the figure is only 70%. There are many reasons for the variation, but does the Secretary of State share my concern that if parents believe they are protected by, for example, homeopathy products, they might be less likely to use an evidence-based treatment? Will he make an unequivocal statement that such products will not give any protection?

[Mr Hunt]

I am happy to do so and thank my hon. Friend for bringing up the issue. There is no scientific evidence whatsoever that homeopathic products can provide protection against measles. The right thing to do is to get two doses of the MMR jab. As I said earlier, anyone whose children, whatever their age, have not had those two doses should contact their GP.

Immigrants (NHS Treatment)

Debate between Sarah Wollaston and Jeremy Hunt

Monday 25th March 2013 Commons Chamber

[Mr Hunt]

The Government are not going to take any lessons in overblown rhetoric when Labour Members talked about this problem for 13 years and did absolutely nothing about it. What was missing from the right hon. Gentleman’s remarks was a proper apology for Labour’s total failure to control our borders during a period in office that saw a quadrupling of net migration. We do not know how many people are residing in this country illegally, but in January the London School of Economics published a report stating that it could be nearly 900,000 people, in which case the cost will not be a few millions but many, many times that. In 13 years, Labour did not change eligibility for access to free NHS services and did nothing to improve the collection of proper dues from people coming from outside the European Union.

The £20 million figure that the Prime Minister’s spokesman used this morning is the amount of uncollected debt that is owed to the NHS by foreign nationals. If the right hon. Gentleman had listened to my response, he would know that we believe—of course it is impossible to get exact figures on this because of the total mess that the previous Government created—that we identify less than half the people who should be paying for NHS care and collect less than half the money that should be collected.

Of course we will work with very closely with Scotland, Wales and Northern Ireland to ensure a co-ordinated approach. If the right hon. Gentleman had listened to what I said, he would have heard that the exemption for emergency care and for public health issues will remain in place, which is extremely important.

Let me finish by talking about A and E issues. The reality is that the LSE estimates that about 70% of those living illegally in the UK live in London, where A and Es happen to face some of the biggest pressures. University College London Hospitals NHS Foundation Trust opened a new A and E only in the past few years and it was built for a capacity of 65,000 people a year, but it is now seeing 120,000 a year. If the right hon. Gentleman’s Government had done something about this rather than talk about it, A and Es across London would not be facing the pressure they are now facing.

[Dr Sarah Wollaston (Totnes) (Con)]

Will the Secretary of State publish the names of those trusts that are abjectly failing to identify and recover charges from those who are not entitled to free care?

[Mr Hunt]

My hon. Friend makes a reasonable point. Part of the problem is that when we should be identifying someone as a foreign national who should pay for their NHS care, that does not happen a lot of the time because of the incentives in the system. Under the NHS improvement initiative, which is taking place in London at present—it is worth looking at that closely, because it has a lot of promise—there is a centralised collection of debt from foreign nationals who owe the NHS so that that does not become the responsibility of individual hospitals, which is something that is putting them off registering people as eligible for their NHS care.

Social Care Funding

Debate between Sarah Wollaston and Jeremy Hunt

Monday 11th February 2013 Commons Chamber

[Mr Hunt]

I am afraid that what the hon. Lady says sums up the attitude of the Opposition; they thought it was wishful thinking to try to solve this problem, whereas we are getting on with a solution. We do not have those financial products available at the moment, but the whole point of these structures is that we will help to create a market in which it is possible to have them. The point of the cap is to allow the hon. Lady’s constituents, even people on lower incomes, to plan and make provision, not only for costs of more than £75,000, but for any costs they have up to £75,000. In combination with that, we are increasing the threshold for Government support from £23,000 to £123,000.

[Dr Sarah Wollaston (Totnes) (Con)]

I warmly welcome today’s statement, particularly the rise in the asset threshold, as I well remember my former patients’ shock when they realised that for anything over £23,250 they would have to meet their entire costs. However, may I ask the Secretary of State to look again at the impact there will be on rural local authorities, for example, Devon’s, which has the fifth oldest population in England?

[Mr Hunt]

I will certainly do that, and I am grateful for my hon. Friend’s comments. I would just say that it is in some of those areas with the highest proportion of older people that the impact of the current lottery in care provision is so dramatic and needs addressing so quickly. I therefore hope that her constituents will welcome the certainty in these proposals, but I will certainly look at and identify whether any particular issues are raised in rural areas.

NHS Commissioning Board (Mandate)

Debate between Sarah Wollaston and Jeremy Hunt

Tuesday 13th November 2012 Commons Chamber

[Mr Hunt]

Let me say to the hon. Gentleman that we have 17,000 fewer managers than when his party was in power. We also have 3,500 more doctors and there are more clinical staff in the NHS today than when his party left office, so I think the record speaks for itself. There is not a climate of fear—I reject that. There is an understanding that the NHS is under a lot of pressure, with an ageing population and more people using and needing its services every year. That is why today’s package is so important to support the NHS in delivering what the public need.

[Dr Sarah Wollaston (Totnes) (Con)]

At long last, the NHS will be operationally independent, and genuinely clinically led. I welcome the mandate: it is an excellent and ambitious target for the NHS. Will the Secretary of State reassure the House that, in these challenging times, efficiencies made in the NHS will be genuinely reinvested in patient services?

[Mr Hunt]

My hon. Friend, as a GP, will recognise from the mandate that a lot of the improvements that we need in the NHS are in primary care. The budget for the NHS is protected, but demand for services is going up, so we need to make these changes. I will give her one example where I think that this is particularly important. The number of hours it will save GPs if the majority of prescriptions are ordered online, which does not happen at the moment, could transform life for more than 8,000 GP surgeries up and down the country.