Oral Answers to Questions
John Bercow Excerpts(11 years, 1 month ago)
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Mr Speaker
Order. I told the Secretary of State privately before, and I say it publicly now, that if he intends to devote part of his answer to talking about what happened under the previous Government, he can abandon that plan now and resume his seat. I suggest he resumes his seat.
Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab)
As part of this openness and transparency, will the Government improve their relations with the police and prison services, so that we can have a clearer idea of why people with mental illnesses are spending time in police cells or being sent to prison?
Mr Speaker
Order. I am always pleased to hear the hon. Gentleman, but I simply point out to him that Calderdale is rather a long way from Morecambe and Lunesdale. Calderdale is the subject of the question; therefore, it is essentially closed. I hope that that is helpful to him and the House.
Nick de Bois (Enfield North) (Con)
13. What progress has been made on implementation of the Barnet, Enfield and Haringey clinical strategy.
Mr Speaker
Order. I am grateful to the Secretary of State and colleagues, but as usual demand has exceeded supply and we must now move on.
Managing Risk in the NHS
John Bercow Excerpts(11 years, 5 months ago)
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Mr Speaker
Order. We must try to preserve some sense of order and decorum in this debate. The Secretary of State can be expected to answer only one intervention at once. It is unseemly and arguably discourteous of other Members to jump up and try to interrupt the Secretary of State when he is dealing with the previous intervention. Let us deal with that first. Members must show some sensitivity to that.
Mr Speaker
Order. In the light of the number of right hon. and hon. Members seeking to contribute to the debate, I am forced to impose a six-minute limit on Back-Bench speeches with immediate effect.
Oral Answers to Questions
John Bercow Excerpts(11 years, 5 months ago)
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Stephen Metcalfe (South Basildon and East Thurrock) (Con)
T8. In advance of the publication of the Keogh report later today, and following the revelations that Basildon hospital had one of the highest standard mortality rates following catastrophic failures, will my right hon. Friend assure the House and my constituents that he will support the new management regime in its attempts to improve the quality of care? Will he also tell the House if he found any evidence of a systematic attempt by the previous Prime Minister and the previous Government to cover up figures—
Mr Speaker
Order. The hon. Gentleman should not abuse topical questions to ask two questions, and he should be asking not about the policies of the previous Government, but about the policies of the present Government, on which I know the Secretary of State will briefly reply. We are grateful.
Mr Jeremy Hunt
We will, of course, give every support to the management at Basildon to turn around their hospitals. The wonders of modern technology have informed us that the shadow Health Secretary was wrong to say that there has been a decline in nursing numbers in Basildon: they have actually gone up by nearly 100 since the last election.
Hospital Mortality Rates
John Bercow Excerpts(11 years, 5 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I would like to make a statement about Professor Sir Bruce Keogh’s review of hospitals with high mortality rates, which is being published today.
Let me start by saying that in the health service’s 65th year, this Government are deeply proud of our NHS. We salute the doctors, nurses and other professionals, who have never worked harder to look after each and every one of us at our most vulnerable. We recognise that the problems identified today are not typical of the whole NHS or of the care given by many wonderful NHS staff; but those staff are the ones who are most betrayed when we ignore or pass over poor care. The last Government left the NHS with a system that covered up weak hospital leadership—[Interruption.]
Mr Speaker
Order. As is the normal practice, right hon. and hon. Members can expect extensive questions—as can the Secretary of State—but the statement must be heard.
Mr Hunt
Thank you, Mr Speaker. The last Government also failed to prioritise compassionate care. The system’s reputation—[Interruption.] This is uncomfortable for hon. Members. The system’s reputation mattered more than individual patients; targets mattered more than people. We owe it to the 3 million people who use the NHS every week to tackle and confront abuse, incompetence and weak leadership head-on.
Following the Francis report into the tragedy at Mid Staffs, the Prime Minister asked Professor Sir Bruce Keogh, the NHS medical director, to conduct a series —Interruption.] I know they tried to shout down whistleblowers such as Julie Bailey, but we are not going to let that happen here. The Prime Minister asked Professor Keogh to conduct a series of “deep-dive” reviews of other hospitals with worrying mortality rates. No statistics are perfect, but mortality rates suggest that since 2005, thousands more people may have died than would normally be expected at the 14 trusts reviewed by Sir Bruce.
Worryingly, in half those trusts, the Care Quality Commission—the regulator specifically responsible for patient safety and care—failed to spot any real cause for concern, rating them as “compliant” with basic standards. Each of those trusts has seen substantial changes to its management since 2010, including a new chief executive or chair at nine of the 14. However, although some have improved, failure or mediocrity is so deeply entrenched at others that they have continued to decline, making the additional measures I am announcing today necessary.
This time, the process was thorough, expert-led and consisted of planned, unannounced and out-of-hours visits, placing particular weight on the views of staff and patients. Where failures were found that presented an immediate risk to patients, they were confronted straight away, rather than waiting until the report was finished. We will be publishing all the reports today, alongside unedited video footage of the review panel’s conclusions—all of which I am placing in the Library. Today I will also set out the actions the Government are taking to deal with the issues raised. I would also like to record my sincere thanks to Sir Bruce and his team for doing an extremely difficult job very thoroughly and rapidly.
Sir Bruce judged that none of the 14 hospitals is providing a consistently high quality of care to patients, with some very concerning examples of poor practice. He identified patterns across many of them, including professional and geographic isolation, failure to act on data or information that showed cause for concern, the absence of a culture of openness, a lack of willingness to learn from mistakes, a lack of ambition, and ineffectual governance and assurance processes. In some cases, trust boards were shockingly unaware of problems discovered by the review teams in their own hospitals. Today I can therefore announce that 11 of the 14 hospitals will be placed into special measures for fundamental breaches of care. In addition, the NHS Trust Development Authority and Monitor have today placed all 14 trusts on notice to fulfil all the recommendations made by the review. All will be inspected again within the next 12 months by the new chief inspector of hospitals, Professor Sir Mike Richards, who starts work today.
The hospitals in special measures are as follows: Tameside Hospital NHS Foundation Trust, where patients spoke of being left on unmonitored trolleys for excessive periods and where the panel found a general culture of “accepting sub-optimal care”; North Cumbria University Hospitals NHS Trust, where the panel found evidence of poor maintenance in two operating theatres, which were closed immediately; Burton Hospitals NHS Foundation Trust, where the panel found evidence of staff working for 12 days in a row without a break; and North Lincolnshire and Goole NHS Foundation Trust, where the panel identified serious concerns in relation to out-of-hours stroke services at Diana, Princess of Wales hospital. The panel also witnessed a patient who was inappropriately exposed where both male and female patients were present. [Interruption.]
The list continues: United Lincolnshire Hospitals NHS Trust, where there were a staggering 12 “never events” in just three years and the panel had serious concerns about the way “Do not attempt resuscitation” forms were being completed; Sherwood Forest Hospitals NHS Foundation Trust, where patients told of being unaware of who was caring for them, and of buzzers going unanswered and poor attention being paid to oral hygiene; East Lancashire Hospitals NHS Trust—[Interruption.]
Mr Speaker
Order. We cannot have a running commentary on the statement as it is delivered. I remind the House that last Wednesday—when there were scenes of grave disorder manifested by Members on both sides of the House—the public reaction to that exceptionally bad behaviour was understandably negative. I appeal to right hon. and hon. Members on both sides of the Chamber to show courtesy and restraint. They can rely upon me to protect their interests—if they were here on time for the statement—to question the Secretary of State, but the statement must be heard.
Mr Hunt
The panel also highlighted issues of poor governance, inadequate staffing levels and high mortality rates at weekends at East Lancashire Hospitals NHS Trust. Patients and their families complained of a lack of compassion and being talked down to by medical staff whenever they expressed concerns.
The remaining hospitals in special measures are as follows: Basildon and Thurrock University Hospitals NHS Foundation Trust, where there were seven “never events” in three years and concerns over infection control and overnight staffing levels; George Eliot Hospital NHS Trust, where the panel identified low levels of clinical cover, especially out of hours, a growing incidence of bed sores and too much unnecessary shifting of patients between wards; Medway NHS Foundation Trust, where a public consultation heard stories of poor communication with patients, poor management of deteriorating patients, inappropriate referrals and medical interventions, delayed discharges and long accident and emergency waiting times; and Buckinghamshire Healthcare NHS Trust, where the panel found significant shortcomings in the quality of nursing care relating to patient medication, nutrition and observations, and heard complaints from families about the way patients with dementia were treated.
For those 11 trusts, special measures mean that each hospital will be required to implement the recommendations of the Keogh review, with external teams sent in to help them do this. Their progress will be tracked and made public. The TDA or Monitor will assess the quality of leadership at each hospital, requiring the removal of any senior managers unable to lead the improvements required. Each hospital will also be partnered with a high-performing NHS organisation to provide mentorship and guidance in improving the quality and safety of care.
Three of the 14 hospitals are not going into special measures. They are the Colchester Hospital University NHS Foundation Trust, the Dudley Group NHS Foundation Trust and the Blackpool Teaching Hospitals NHS Foundation Trust. Although there were still concerns about the quality of care provided, Monitor has confidence that the leadership teams in place can deliver the recommendations of the Keogh review and will hold them to account for doing so.
This is a proportionate response in line with the findings of the review. Inevitably, there will be widespread public concern not just about these hospitals but about any NHS hospital, and some have chosen to criticise me for pointing out where there are failures in care, but the best way to restore trust in our NHS is transparency and honesty about problems, followed by decisiveness in sorting them out. The public need to know that we will stop at nothing to give patients the high-quality care they deserve for themselves and their loved ones. Today’s review and the rigorous actions that we are taking demonstrate the progress this Government are making in response to the Francis report. I shall update the House in the autumn on all of the wide-ranging measures that we are implementing, when the House will be given a chance to debate them in Government time.
The NHS exists to provide patients with safe, compassionate and effective care. In the vast majority of places it does just this, and we should remember that there continues to be much good care even in the hospitals reviewed today. Just as we cannot tolerate mediocre or weak leadership, we must not tolerate any attempts to cover up such failings. It is never acceptable for Government Ministers to put pressure on the NHS to suppress bad news, because in doing so they make it less likely that poor care will be tackled.
We have today begun a journey to change this culture. These 14 failing hospital trusts are not the end of the story. Where there are other examples of unacceptable care, we will find them and we will root them out. Under the new rigorous inspection regime led by the chief inspector of hospitals, if a hospital is not performing as it should, the public will be told. If a hospital is failing, it will be put into special measures with a limited time period to sort out its problems. There will be accountability, too: failure in the NHS should never be a consequence-free zone, so we will stop unjustified pay-offs and ensure it will no longer be possible for failed managers to get new positions elsewhere in the system.
Hand in hand with greater accountability, there will be greater support. Drawing inspiration from education, where super-heads have helped to turn around failing schools, I have asked the NHS Leadership Academy to develop a programme that will identify, support and train outstanding leaders. We have many extraordinary leaders such as David Dalton in Salford Royal and Dame Julie Moore of University hospital Birmingham, but we need many more to provide the leadership required in our weaker hospitals.
At all times, this Government will stand up for hard-working NHS staff and patients who know that poor care and weak leadership have no place in our NHS. It was set up 65 years ago with a pledge to provide us all with the best available care, and I am determined that the NHS will stand by that pledge. We owe its patients nothing less. I commend this statement to the House.
Mr Speaker
Order. Mr Irranca-Davies, you look as though you are about to explode. I am worried about you. I think you probably need to have a lie down or to take some sort of medicament—it might be of benefit to you. You must calm yourself.
Mr Hunt
The right hon. Gentleman talked about being partisan and party political. It is not party political to highlight poor care; it is doing the right thing for patients.
Let us look at what independent people have said about Labour’s time in office. Roger Davidson, the former head of media at the CQC, said that
“there were conversations between the CQC and Ministers to the effect that the CQC would not cause any trouble…The message that ‘we don’t want bad news’ infected the whole organisation”.
Professor Brian Jarman—[Interruption.] I think Opposition Members might want to listen to this, because it is what independent people are saying. Professor Jarman, who invented hospital standardised mortality indices, said that
“the problem was ministerial pressure, even from Number 10.”
This is most damaging: the right hon. Gentleman talked about what Barbara Young, Labour peer and head of the CQC, said under pressure from the Labour Whips, but what did she say under oath to the Francis inquiry? She said that
“the government hated the idea…the regulator would criticise it… We were under more pressure, I think, when Andy Burnham became minister, from the politics.”
That is what a Labour peer said. These people are not Government supporters—at least, not of this Government —but were trying to do their job in exposing poor care and the right hon. Gentleman stopped them.
The right hon. Gentleman talks of spin, but I will tell him who had to fight hardest against spin: the whistleblowers he tried to shut up. What do they say? James Titcombe, who tragically lost his son at Morecambe bay, tweeted that
“you made big mistakes Andy, it’s time you admitted it.”
Julie Bailey, who lost her mother at Mid Staffs, said that Labour crushed the culture of care from the NHS. [Interruption.] Deb Hazeldine, from Mid Staffs, who lost a relative, said that the shadow Secretary of State was trying to “defend the indefensible”—[Interruption.]
Mr Speaker
Order. It is very difficult to imagine how anyone can hear these exchanges. The content of questions and answers is to be determined by Members, but I gently remind the House of the need for good order and that this is not a debate. There will be debates, but this is not a debate but a statement on which there is questioning, to which there is then a ministerial answer. This is not an opportunity for general speechifying but for responses to specific questions made with economy so that I can accommodate all interested colleagues.
Mr Hunt
Thank you, Mr Speaker. I would have hoped that the Opposition would want to listen more respectfully to what whistleblowers said about their attempts to expose poor care.
Let me respond to what the right hon. Gentleman says. He says that Labour tackled the problems, but the evidence shows the opposite. We talked about Tameside earlier, but what about Basildon? There were high death rates for nine years under Labour—in every year since 2001. Half the staff said they would not want their own friends and family treated there. Ministers received 237 letters between 2005 and 2010, yet what did the CQC do? It rated the hospital as “good” and within four weeks Ministers were shamed into launching an investigation into high mortality rates—[Interruption.]
Mr Speaker
Order. I have tried to explain the position calmly—[Interruption.] Order. I shall do so once more. I think the Secretary of State will appreciate that he has been asked questions about present arrangements to which we need pithy replies, not a lengthy statement about events of the past that happened before he had responsibility. We cannot have that. If that is what he is planning to read out, we will simply move on. A brief conclusion to his answer is now required and sought by the House.
Mr Speaker
Order. My impression is that the Secretary of State is now seeking to treat of matters since May 2010 and he must be given the opportunity to do so, with colleagues and people outside being able to hear the answers.
Mr Hunt
Thank you, Mr Speaker.
What does the right hon. Gentleman do when I criticise the lack of rapid progress in tackling failure in our hospitals? He criticises me for making an unbelievable statement and states that there are no coasting hospitals, but today proves that he is wrong. What is unbelievable is his total refusal to admit that it is not just a question of coasting hospitals, but a Labour party that has coasted for too long on its reputation on the NHS.
Finally, the right hon. Gentleman says that we are trying—[Interruption.] This is difficult for Labour Members to hear, so let us get to the point. He says that we are trying to run down the NHS. Let me say this: if we did not believe in the NHS, we would not be tackling these problems. The best way to support the NHS is not to ignore poor care, not to muzzle the CQC, not to ignore requests for public inquiries and not to ignore warnings constantly. If founding the NHS is considered Labour’s proudest achievement, today is its darkest moment as a Labour Government are exposed as caring more about their own reputation than about our most vulnerable citizens in the NHS—[Interruption.]
Mr Speaker
Order. Has the Secretary of State finished his answer? He has. We are grateful and I thank him for saying that he has finished.
Mr Speaker
Order. I remind the House of the long-established and generally adhered-to convention that Members who were not present at the start of a statement do not rise to question the relevant Minister. That has long been regarded as a discourtesy, and it should not happen. I have a list of Members who arrived late, but I hope that they will not render it necessary for me to draw attention to the fact. I ask those who arrived late, in all courtesy, not to rise to their feet.
We will now make progress as expeditiously as we can, led by the Chair of the Health Committee.
Mr Stephen Dorrell (Charnwood) (Con)
Those who want to make the case for change in an organisation—and, after the Francis review, who can doubt the need for change in parts of the national health service—must first demonstrate the need for change. Does this review not build on the distinguished record of both Bruce Keogh and Sir Brian Jarman in demonstrating the need for change in parts of our national health service?
Alan Johnson (Kingston upon Hull West and Hessle) (Lab)
Thankfully, the quality of Sir Bruce Keogh’s report is vastly superior to that of the statement that we heard from the Secretary of State. Is it not the case that Sir Bruce Keogh—[Interruption.]
Mr Speaker
Order. I am very concerned about the fact that someone shouted something, and I think I heard a word that was unparliamentary. I did not see an individual who was responsible, and I do not know who was responsible, but I simply say to the House—[Interruption.] Order. It is no good people burbling on about whistleblowers from a sedentary position. Let us lower the temperature, and have orderly exchanges. [Interruption.] Order. I remind the House that I called the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) to ask a question. Let us do him the courtesy of hearing the conclusion of that question.
Alan Johnson
Is it not the case that Sir Bruce may have given us a blueprint for better regulation, provided that the Secretary of State faces up to his responsibility and ends the tawdry and squalid attempts by his party to denigrate his predecessors?
Margot James (Stourbridge) (Con)
I warmly welcome my right hon. Friend’s break with the culture of cover-up that has been so prevalent in the past. I reject absolutely the shadow Health Secretary’s claim that the Dudley Group NHS Foundation Trust’s performance has deteriorated since 2010—[Interruption.]
Mr Speaker
Order. The hon. Lady is asking a question, but I have distinctly heard Members—in some cases identifiable Members—trying to shout her down. That should not happen on either side of the House. If she wishes to continue with her question, she may do so.
Margot James
Thank you, Mr Speaker.
I reject the shadow Health Secretary’s claim. The new leadership that was appointed to the trust in 2009 found deep-seated problems there. Does my right hon. Friend the Secretary of State welcome, as I do, the positive notes in Sir Bruce Keogh’s report about that new leadership’s abilities, and Sir Bruce’s finding that the overall work force at our trust are
“committed, loyal, passionate, caring and motivated”?
Mr Speaker
Order. I am keen to accommodate as many remaining colleagues as I can, but I point out to the House that I must have some regard to the Second Reading debate on the Defence Reform Bill, so economy in questions and answers is now of the essence.
John Stevenson (Carlisle) (Con)
I welcome the Keogh report. Patients should come first and patient care should be at the centre of our health service. Over the past 10 years, sadly, there has been a clear lack of leadership and management at North Cumbria University Hospitals NHS Trust, so I am not surprised by the report. However, there is a possible solution to improve health care in north Cumbria: the acquisition of the hospitals by Northumbria Healthcare NHS Foundation Trust. Will the Secretary of State work with me, the regulators and Northumbria to ensure that the acquisition proceeds as quickly as possible so that the people of Cumbria and Carlisle get the best possible health care?
Tobacco Packaging
John Bercow Excerpts(11 years, 5 months ago)
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Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Anna Soubry
As I have explained, there has been no change of policy at all. What we have decided to do, based on the consultation, but most importantly based on what the Australian Government have done, is to look at that evidence as it emerges. I have spoken to the Australian high commissioner—[Hon. Members: “Oh!”] Hon. Members on the one hand claim that this is serious—
Mr Speaker
Order. Let us try to lower the decibel level. Questions should be heard with courtesy, which, to be fair, I think they have been, and the answers must be heard with courtesy.
Anna Soubry
I think this is important. I also spoke with one of the leading experts who have been involved in the legislation in Australia, and I was quite surprised that even after about three or four months, they could not give me a picture of any emerging evidence. That is why we need this time. I believe all good legislation should be based on firm, good strong evidence.
Anna Soubry
I am grateful to my hon. Friend, and it was a great honour to meet members of his family. My own father died, after a lifetime as a heavy smoker, from lung cancer, so we are all well aware of the health risks. My hon. Friend makes the good point about what we are doing specifically to stop children from taking up the habit. I have explained about vending machines. Of course, there is also an EU directive; although it may not find a great deal of favour with some Members on my side of the House, it is a very good directive. Work began on it only a few weeks ago, which will mean, for example, that we will not—[Interruption.] The hon. Member for Streatham (Mr Umunna) is chuntering, Mr Speaker, and it is not always very helpful, as I know.
Mr Speaker
Order. So the hon. Lady knows. Was she perchance speaking as a practitioner?
Mr Speaker
I am grateful to the hon. Gentleman for his point of order. My understanding was that the Minister was asked whether she would meet representatives of the tobacco industry and she indicated that she did not intend to do so. I do not think that she was making any wider claim about what had happened with other Ministers or on previous occasions; she was simply signalling that it was not her intention to meet them. If the Minister wants to speak, she is welcome to do so.
Mr Speaker
I think the position is now clear; the Minister has kindly committed to write to the hon. Gentleman.
Health Services (North-West)
John Bercow Excerpts(11 years, 5 months ago)
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Mr Speaker
Order. We must have order from those on the Opposition Front Bench, and I know that the Secretary of State will want to respond to the questions asked of him. I just remind the House that it is not a generalised debate; it is a statement and a response to questions.
Mr Hunt
Absolutely, Mr Speaker. I think that it is very important that on both sides of this House we have consistent arguments. It is very important to the questions that I was asked that I remind the right hon. Gentleman of what he said when he was Health Secretary. “I am disappointed,” he said, that politicians
“are going around Greater Manchester undermining the clinically-led process”.—[Official Report, 30 March 2010; Vol. 508, c. 620.]
The local medical director says that these changes will save—[Interruption.]
Mr Speaker
Order. The temperature needs to fall. This is a very highly charged matter, there is considerable sensitivity about it, it is extremely important and we want to hear what the Secretary of State has to say. When he has said it, everybody will get a chance to come in, but please let us lower the decibel level. We certainly do not want to imitate what happened to the considerable discredit of the House yesterday.
Mr Hunt
The other point the right hon. Member for Leigh (Andy Burnham) made was that we should not make these changes to A and E services when those in other hospitals are under pressure. It is important that I remind the House of what he did when he was Health Secretary. After 2004-05, Labour missed its A and E targets in 12 quarters but closed or downgraded 12 A and Es. Now, in Wales, the A and E target has not been met since 2009, yet Labour is embarking on a big reconfiguration programme with his full support. So it is one policy when Labour is in opposition, another when it is in power. There is one person who agrees with the right hon. Gentleman, and he was campaigning in Trafford on Friday—Len McCluskey. When it comes to a choice between supporting local doctors or the unions, the Opposition support the unions.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
On a point of order, Mr Speaker.
Mr Speaker
Order. We cannot have points of order in the middle of a statement. The Secretary of State has been asked specific questions and I know that he will now respond without any delay to those specific questions and nothing more. Other Members wish to contribute and there is other business. The Secretary of State is an extremely important man, of course, but there are a lot of other people involved, too, and we need to get on and hear them. I call the Secretary of State to respond briefly.
Mr Hunt
Thank you for that rare compliment, Mr Speaker.
The right hon. Member for Leigh asked a specific question about travel and I will ask the local NHS trusts to work closely with the overview and scrutiny committees to ensure that proper arrangements are put in place for people who have to travel further. He asked me about deferring the decision until the Healthier Together programme for the whole of Greater Manchester was decided, but the IRP specifically said that it would be wrong to defer the decision—the point is that local doctors are saying that doing so would not be safe for patients, and that is why I am accepting the advice.
The NHS is a great institution, but we have to take difficult decisions sometimes. The proposals will help patients, but I am afraid that the right hon. Gentleman is interested only in politics.
Mr Hunt
I thank the right hon. Gentleman for his wise words. If we level with the public about these difficult changes, they do understand that there are times when they get a better outcome even if they have to travel further. Perhaps the most dramatic example of that has been how trauma services have been centralised on fewer hospitals. Even after incidents as dramatic and dangerous as road traffic accidents, people are not necessarily taken to their nearest A and E. They are stabilised and then they are taken to an A and E that has the equipment that is necessary to give them the treatment that is most likely to save their lives. The right hon. Gentleman is right to say that.
I absolutely followed and would always want to follow the procedures of the House with respect to advance notice of statements. The request for a statement went in only last night. The Speaker made his decision this morning. I am delighted that the hon. Member for Stretford and Urmston (Kate Green) is here and I hope she is allowed to speak. I said to her on the phone this morning that I am willing to meet her separately to go through any concerns that she has. [Interruption.]
Mr Speaker
Order. I thank the Secretary of State for his courtesy. I know the right hon. Gentleman well, and I know that he would not seek for one moment to mislead the House. He was trying candidly to respond to the right hon. Member for Blackburn (Mr Straw). For the avoidance of doubt, let us be absolutely clear. I can quite accept that the Secretary of State requested, within the Government machine, permission to make a statement today. However, the House will wish to be aware that I myself was aware of the request to make a statement only this morning. Let us be clear about that.
Tim Farron (Westmorland and Lonsdale) (LD)
There is a strong clinical case for the concentration of vascular services in Cumbria and Lancashire at three sites, but is it not ludicrous that the three that have been chosen are so geographically located that one is virtually on the Scottish border, then there is a gap of almost 100 miles, and then there are two that are nine miles apart? Does not that leave south Cumbria and north Lancashire dangerously under-provided for? Given the current difficulties, shall we say, at Morecambe Bay, does not robbing Morecambe Bay of those skills and that expertise make a difficult situation potentially even worse?
Mr Speaker
Order. May I say to the hon. Member for Lewisham East (Heidi Alexander) that I am sure that she would not seek to use this statement as a back-door method of talking about health services in Lewisham? If she wishes to expatiate on health services in the north-west, we will hear from her.
Heidi Alexander (Lewisham East) (Lab)
I am grateful, Mr Speaker.
The Health Secretary repeatedly said that changes will be made at Trafford only if the neighbouring hospitals that have to take additional patients are consistently meeting their waiting time targets for A and E. Will he define “consistently” and clarify exactly what he means by that? Will it apply to all A and E reconfigurations throughout the country?
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
On a point of order, Mr Speaker.
Mr Speaker
I say to the hon. Lady that it is only exceptionally that points of order are taken between statements, and if they are taken they must relate to the matter just discussed, which I rather suspect hers will. I am not going to have a general debate; I shall take one point of order from the hon. Lady.
Ms Abbott
I am grateful to you, Mr Speaker. Is it in order for a Secretary of State for Health to announce the closure of another Member’s A and E, which is a very serious matter for all MPs, without making any effort whatsoever to even advise the Member concerned that they might wish to attend the Chamber the following day?
Mr Speaker
It is quite simple. The short answer is that nothing disorderly has taken place. The Secretary of State is entitled to come to the House and make a statement at a time of his choosing. I have experienced a great many Ministers in my time in the House. Different Ministers adopt different approaches. In some cases Ministers have conversations with Members in advance—I know that the Secretary of State himself has done so on other occasions—and signal an intention to make a statement, or the possibility of a statement, at a particular time, but on other occasions they do not do so. On the strict question of whether it is in order, I can confirm that the Secretary of State’s conduct is not disorderly. Beyond that, it is for hon. and right hon. Members to make their own assessment of the handling of the matter. There is scope, as with so many matters, for different points of view. I think that is the fairest thing I can say.
Children’s Heart Surgery
John Bercow Excerpts(11 years, 6 months ago)
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Mr Speaker
Order. On the assumption that Dr Lee has now put his phone away, may I say to Members that they should not stand to speak while at the same time fiddling with a phone? It is multi-tasking in a way that is perhaps a tad discourteous. We do, however, want to hear from Dr Lee, who is a distinguished physician, so let us hear from him.
Dr Phillip Lee (Bracknell) (Con)
My apologies, Mr Speaker. As someone who has long argued for the reconfiguration of acute and surgical services, I consider the management of this clinical consolidation to be of great importance. Does the Secretary of State agree that best clinical outcomes should be the primary driver of any reconfiguration and that there is a need for a national plan for the reconfiguration of all acute and emergency services? If such a plan were drawn up, it should receive cross-party support.
Oral Answers to Questions
John Bercow Excerpts(11 years, 6 months ago)
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Dr Poulter
The right hon. Gentleman is absolutely right—there is almost an outbreak of consensus across the Dispatch Boxes on this issue. We both recognise, rightly, that there is a long-term challenge in providing more integrated, joined-up care to better look after older people. However, it is ironic that he should raise that concern, because a previous Minister in the other place, the noble Lord Warner, has made the case very clearly that the previous Government failed to invest adequately in elderly care throughout their time in office. That is why this Government—I hope that we can count on the right hon. Gentleman’s support for this—are investing in health and social care, more integrated services at a local level through health and wellbeing boards and—
Mr Speaker
Order. The answers are too long. They need to get shorter, because we have a lot to get through. It is very simple and very clear.
John Pugh (Southport) (LD)
Given that we have the lowest ratio of intensive care beds in the EU, what are the Government doing to monitor possible risks in future?
Mr Speaker
Order. I am sorry; demand always exceeds supply at Health questions, rather as in the health service, so we must now move on.
A and E Departments
John Bercow Excerpts(11 years, 7 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
A and E departments are under great pressure, and the whole House will want to pay tribute to the thousands of doctors, nurses and health care assistants who work extraordinary hours in very challenging conditions. They are there for us when we need them, and we owe them a great debt.
More than 1 million more people visit A and E every year compared with just three years ago—those are additional numbers—and the simple fact is that if growth continues at that rate it will be unsustainable. It also means that when there are short-term pressures on the system, such as a very cold winter, teething problems with NHS 111 or bank holidays, the system cannot cope as well as it needs to and the quality of care is affected.
Let us be clear: A and Es are currently hitting the 95% target. The latest figures show that 96.3% of patients are seen within four hours, and people are waiting on average 55 minutes for treatment. However, if A and E services are to be sustainable, we need both short-term and long-term measures to address the underlying causes of the pressure they are under.
Last week, NHS England announced that it would change the basis on which tariff money for certain A and E cases is spent. For the first time, hospitals will have a say in how money is spent to alleviate demand when that money is withheld for numbers exceeding the 2009 baseline. We also need to address more fundamental issues, which is why I announced to the House on 13 May that the Government will publish in the autumn a vulnerable older people’s plan that will tackle those long-term underlying causes of pressure in our A and Es, particularly for the frail elderly who are the heart of many of the issues we face in both quality of care and service performance.
The changes the Labour Government made to the GP contract took responsibility for out-of-hours care away from GPs. [[Interruption.] Labour Members may not like to hear the facts about the consequences of those changes, but let us go through them—they asked the question. Since those changes, 90% of GPs have opted out of providing out-of-hours care, and they got a pay rise in addition. As a result of those disastrous changes to the GP contract, we have seen a significant rise in attendances at A and E—4 million more people are using A and E every year than when the contract was changed. As researchers from the university of Nottingham found, to give just one example, a reduction in out-of-hours services provided by patients’ usual family doctors is a direct cause of increased A and E attendance by children.
There are other issues too, including the lack of integration with social care, and vulnerable patients being discharged from hospital with no one co-ordinating proper health and social care to support them in their own homes. That lack of integration was something else that the previous Government failed to address over 13 long years.
Then there are the problems inside A and E departments caused by the disastrous failure of Labour’s IT contract. When people are admitted to A and E departments, the departments are unable to see their medical records, which could have an enormous impact—[Interruption.]
Mr Speaker
Order. First of all, the Secretary of State should not have to shout to be heard. Secondly, the more heckling there is, the slower progress tends to be. I want to accommodate colleagues, but as a matter both of courtesy and of practicality the Secretary of State should be heard in silence.
Mr Hunt
We will address those problems inside A and Es and the system-wide issues. It is not all about the GP contract, but that is a significant part of it, because confidence in primary care alternatives is a key driver in decisions on whether to go to A and E. We will take responsibility for sorting out those problems, but the Labour party must take responsibility for creating a number of them.
Mr Hunt
The right hon. Gentleman says, “Forget Wales,” but why has he never once been prepared to condemn the appalling failures in A and E in Wales, caused by the Welsh Labour Government’s decision to cut NHS spending by 8%? What he says would have some credibility were he at least prepared to condemn what has happened in Wales, but he never does.
The right hon. Gentleman asks for the evidence, and I will tell him. Patrick Cadigan of the Royal College of Physicians says that the pressures on A and E are caused because many people assume that, after 5 pm, the lights in the NHS go out everywhere except A and E departments—a direct consequence of those disastrous 2004 changes to the contract. Nottingham university conducted an independent study, and last year’s GP patient survey found that only 58% of patients know how to contact their local out-of-hours service, 20% find it difficult to contact their out-of-hours service, and 37% feel that the service is too slow—problems that we are trying to address. Perhaps he should visit some A and E departments and talk to consultants, doctors and nurses, because they will tell him that the changes to the GP contract, which he says have nothing to do with the pressures on A and E, have had a huge and devastating impact.
He talks about taking responsibility for these problems. Let us see if he is prepared to take responsibility. Is he prepared to take responsibility for the target-at-any-cost culture in some parts of the NHS under Labour, which led to the disaster of Mid-Staffs? Is he prepared to take responsibility for the IT failures that mean that A and E departments cannot access GP records? Will he nod his head if he is prepared to take responsibility? [Interruption.] He is not prepared. Is he prepared to take responsibility—
Mr Speaker
Order. Let us get this back on track. There are two very simple points: first, those on the Opposition Front Bench should not be yelling at the Secretary of State; secondly, for the avoidance of doubt, the responsibility of the Secretary of State is to answer questions, not ask them.
Mr Speaker
Order. I have told the Secretary of State what the position is. It is not for argument or debate. His responsibility is to get on with answering in the way the House of Commons expects.
Mr Hunt
And I would always seek to do so, Mr Speaker.
Finally, the right hon. Gentleman constantly seeks to run down the performance of the NHS. Where is the recognition of the outstanding performance of the NHS under this Government: the fact that under this Government 400,000 more operations are happening every year than under Labour; the fact that the number of people waiting for more than a year for an operation has gone down from 18,000 under Labour to fewer than 1,000 under this Government; the fact that MSRA rates have been halved; and the fact that mixed-sex wards have nearly been eliminated? We will stick up for the great achievements of our NHS and we will not allow people to run it down. However, we will also tackle problems honestly and ensure that we address crises, many of which were caused by the previous Government.
Mr Andrew Love (Edmonton) (Lab/Co-op)
In 2009, long after the GP contract was introduced, accident and emergency units were hitting their 98% target. The Secretary of State has reduced that target to 95%, but we are now hearing that units around the country are not even achieving that. How can that possibly be? What steps is he going to take to deal with the situation?
Mr Speaker
The Secretary of State appears to have managed to make the hon. Member for Hammersmith (Mr Slaughter) smile. The occasion should be noted.
Mr Hunt
Thank you, Mr Speaker. That is probably the nicest thing you have ever said to me. I shall dine out on it.
The answer to the question from the hon. Member for Edmonton (Mr Love) is that the changes in the 2004 GP contract are not the only cause of pressure on A and Es, but they are a significant cause. They set in train a process of declining public confidence in GP out-of-hours care, which has fuelled the growth in A and E attendances, and that growth has continued so that in the three years since 2009, attendances have gone up by more than 1 million. That is why those changes are having a significant impact on A and E services.
Mr Hunt
I always welcome discussions with the devolved Administrations to see what we can learn. Better triaging at the point of entry to A and E is certainly one of the things that makes a difference between A and E trusts that are managing to meet their targets despite very high pressures and those that are not.
Mr Speaker
I am grateful to the Secretary of State, the shadow Secretary of State and the 40 Back Benchers who contributed to the debate on the urgent question.
Health and Social Care
John Bercow Excerpts(11 years, 7 months ago)
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Mr Hunt
I am going to make some progress.
Over the summer, we will consult on proposals to make the system fairer and ensure that people who should pay for NHS services do in fact do so. That will also help to ensure that our NHS remains sustainable at a time of tight public finance.
These proposals represent our commitment to ensuring a compassionate, fully integrated and sustainable system of health and social care built entirely around the needs of the patient. They represent a commitment to the NHS and social care system, which lies at the heart of our determination to make Britain the best country in the world to grow old in. [Interruption.]
Mr Speaker
Order. It is not altogether obvious whether the Secretary of State is giving way or has concluded his speech. [Interruption.] He has concluded his speech. It is usually helpful to have some indication of that.