National Health Service

Steve Baker Excerpts

Wednesday 21st January 2015 Commons Chamber

[Mr Hepburn]

I am sure people in the area are extremely grateful for that statement of support and commitment and that pledge from the shadow Secretary of State. I only hope he will become Secretary of State.

The Government and the management of the NHS are not incompetent. They are acting deliberately. The 27,000 patients in Jarrow who now go to the walk-in centre will have to go to the doctors’ surgeries, where it is difficult enough already to get an appointment. That will only exacerbate the problem. When they go down to A and E, which is doing a terrific job, the situation will only get worse. The Government know exactly what they are doing. They are trying to sicken people of the NHS so that they can turn round and say, “The NHS is not working. We will bring in the private sector to help out and to take it over.” That is the policy of this Government.

[Steve Baker (Wycombe) (Con)]

Under the previous Government, my predecessor was not able to prevent the closure of A and E. If Labour is in government, I shall remember his speech today and the promise that was given to him, and I shall watch closely what happens.

[Mr Hepburn]

I can assure the hon. Gentleman that after that pledge I will certainly be watching the shadow Secretary of State when he gets in, to make sure our walk-in centre is still going.

Who gains from the present situation? Only two lots of people—the Tories, many of whom are up to their necks in involvement with private health care providers, and the profiteers, the health care providers, who are going to come in and cherry-pick the best services so that they can make profits. I welcome the shadow Secretary of State’s statement and commitment today. It will boost the morale of the people of the north-east who are so desperate to keep the service.

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[Paul Maynard (Blackpool North and Cleveleys) (Con)]

It is intriguing to follow the hon. Member for Rochester and Strood (Mark Reckless). I will leave my intrigue at that point and focus on the debate rather than him.

It is a shame that the shadow Secretary of State has left the Chamber, as I was about to say something relatively pleasant and polite about him—he will not hear it now. When he came up to Lancaster and Fleetwood a few weeks ago he joined me in praising my local A and E department, which had seen 97% of patients within four hours, the fifth best performance in the country that week. That is a superb achievement given the complex health economy in Blackpool. It is very rare that we are at the top of a league table for the right reasons in Blackpool, whether that is for football or for health care, so I welcome that.

It was interesting to note a more hidden and nuanced message in what the shadow Secretary of State had to say. The medical director of Blackpool Victoria says that between April and September 2014, 36% of those arriving at A and E did not need to be there. They could have received their diagnosis or treatment somewhere else, and the cost to the hospital was calculated at £842,000. The message I draw from that is that we still have an immense amount of work to do to ensure that people know where to go for the right treatment at the right time. It is, of course, incumbent on us to ensure that those alternatives are resourced, that people know where to go and that people have confidence in the alternatives.

We have not spoken enough today about pharmacies. Pharmacy trade bodies and the industry put so much into lobbying Members on both sides of the House, but I think it will require another decade or so of intensive lobbying of MPs before we finally get the message that it is far better to have first recourse to the local pharmacist to see whether one needs to go further in seeking appropriate health care. I rely on regular repeat prescriptions for my epilepsy, and I have saved myself many a GP visit by asking a question at my local pharmacy. We are overlooking the most basic corner-of-our-street access point for primary health care, and we should not forget it.

I want to praise another Member of a different political party from mine, and he is sitting on the Government Front Bench: the Minister of State has already been praised today for his approach to mental health care. It is warmly welcomed, particularly in a town such as Blackpool. Our new 74-bed harbour unit is about to open on the edge of the town. It has been long-awaited, and is much-needed following some of the appalling standards of care at the Parkwood unit over the past decade.

The Minister will know that he faces great challenges. I could easily have come here today and read out a number of immensely tragic cases involving young people not getting the appropriate mental health care. He still faces a battle with the profession, because clinicians differ over their assessment of this issue. I see far too many young people with some learning disorder who are somewhere on the autistic spectrum, where the clinician refuses to accept that they can both have a learning disorder and a mental health problem. They fall into that gap and are batted backwards and forwards between different providers. There must be a battle in the medical profession over how to reconcile those two different forms of clinical diagnosis.

Another point I want to raise—I have far more than I will be able to get into my remaining four minutes—was mentioned by my right hon. Friend the Member for Chelmsford (Mr Burns). I was struck by the shadow Secretary of State’s sudden enthusiasm for the walk-in centre in Jarrow—his instant commitment that it would be saved were Labour ever to come to power. We then heard from my right hon. Friend that these things are sometimes trickier than that—that there is more nuance, perhaps. We in this Chamber often think we know it all—don’t we? We think we know everything there is to know and that we can learn nothing from anybody else about anything in our constituency—that we are the sole experts of what is right. Occasionally it would be nice to listen to the clinicians. There might actually be a clinical argument for why a particular unit has to open, close or reconfigure, but all too often debates on the reconfiguration of services become a political football—which is exactly what my right hon. Friend was saying.

A good example is the stroke unit in Blackpool. It has been a controversial addition because it was designed to serve the entire north-west. Patients were coming down the M6 from south Cumbria, past four or five other hospitals, to get higher quality treatment in Blackpool. As the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) chuntered during the Secretary of State’s speech, the important point is that it was about outcomes. People were going to have a better chance of survival if they went to the stroke unit in Blackpool rather than their local A and E. Yet when that was debated, it was very hard to tease out the medical arguments in favour of this innovation, because all too often we were more concerned about focusing on saving bricks and mortar in our own backyards rather than on what is actually best.

[Steve Baker]

Does my hon. Friend agree that the two brands in the NHS that the public really understand above all are A and E and GPs, and all the time we are talking about A and E we are getting away from the fact that sometimes care is better provided in a specialist stroke or heart centre?

[Paul Maynard]

My hon. Friend makes an important point, which is that so many different terms are used and answers given in this Chamber and elsewhere about where patients need to go. What they actually want is reassurance and confidence that when they go somewhere they will get the right treatment at the right time that solves their problem. They do not want it to be overcomplicated, and neither do we.

We have heard a lot of criticisms of this Government’s health reforms—they seem to be very unpopular on the Opposition Benches in particular—but let me highlight two that have been very good. One of them goes back to my younger days—when I had a finer figure, perhaps. My first proper job—Opposition Members will not like this—was as a health policy officer in the Conservative research department in 1999, so I listened with delight to the right hon. Member for Holborn and St Pancras (Frank Dobson) telling me all about the wonders of his time, because I scrutinised it quite carefully on a daily basis. I used to get a monthly present from the Association of Community Health Councils for England and Wales in the form of the London “Casualty Watch”, a monthly census of trolley waits in London accident and emergency departments. It was a pretty thick document. The census detailed page after page of trolley waits of more than 24 hours, and it was a shocking indictment of how Labour was running the NHS at that time.

That situation led to one of the Labour Government’s most shameful decisions: to abolish community health councils. I know that many Labour Members are embarrassed about that even now. One of the great things about our health reforms is that we have brought back Healthwatch, which has proved to be a thorn in the side of local health providers, of Members of Parliament and of the Government. We have brought back the ability of ordinary patients to affect the nature of the care in their communities. That is happening right now in Blackpool, and it is making a difference. I am delighted about that.

Another positive element involves putting public health matters into the local council. As I have said, Blackpool faces immense public health challenges, but putting Dr Rajpura, our local director of public health, into the council has been a tremendous success. It has helped to pull together all the disparate strands within the town as we face those challenges. Again, this has happened only as a result of our health reforms.

Another example that I want briefly to mention is the fact that some of our local nurses at the hospital have spun out their rehabilitation service into a community interest company called Spiral, which is now winning awards for the quality of its patient care. I am concerned that, if Labour were to reverse all these changes, the good things we have achieved would be washed away and lost, and the people who would suffer would be my constituents, including those who have turned to Spiral for their rehabilitation. That is my real concern.

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[Steve Baker (Wycombe) (Con)]

I begin by paying tribute to the staff and leadership of Buckinghamshire Healthcare NHS Trust. The trust went through special measures as a result of the Keogh review, when it was found to have high mortality, and they have done a sterling job of turning the trust around. On my visit recently with my right hon. Friend the Secretary of State for Health, I found a renewed enthusiasm and optimism in the trust, and I am very grateful to the staff and leadership for delivering that outcome.

When the right hon. Member for Leigh (Andy Burnham) opened the debate, he asked for shared solutions, striking a markedly different tone from the usual partisan pose. I shall suggest some shared solutions later in my speech. But normal service quickly resumed. The right hon. Gentleman spoke of stories of failure. There are, of course, some stories of success, and I shall mention a few. England’s NHS has the best measured emergency care performance of any western nation, according to NHS England. Dr Sarah Pinto-Duschinsky, director of operations and delivery for NHS England, said:

“In the week ending December 28th A&E attendances were up more than 31,000 on the same period last year, meaning we successfully treated more patients in under four hours than ever before.”

I will come to why in a moment.

The Government have allocated an additional £700 million to cope with winter pressures. The College of Emergency Medicine said:

“This represents the largest annual additional funding yet seen.”

In the course of this Parliament, the NHS budget will have increased by £12.7 billion in cash terms. This additional winter pressures funding has paid for 2,500 additional beds in acute and community treatment and the equivalent of 1,000 doctors. There are almost 1,200 additional A and E doctors, including an additional 400 A and E consultants and 1,700 additional paramedics since 2010. Some 850,000 more operations are being delivered by the NHS each year compared with 2010, and numbers waiting longer than 18, 26 and 52 weeks to start treatment are lower than they were under the previous Government. It cannot reasonably be said that that is a continuous record of failure. There are considerable successes under this Government.

In an intervention on my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard), I mentioned branding. One of the things that we could do is continue to tell patients that they should go where treatment can best be provided, but we see that patients stubbornly insist on going to hospital. The brand A and E is well understood; people know that if they have an urgent problem, they can go to A and E. It will take years of persuasion before people behave differently, and I do not think we should keep on persuading people to want something other than the preference they are clearly displaying by their behaviour, which I shall return to.

Let us not forget the legacy that the Government have had to cope with, including the grievous financial position that they inherited. Let us not forget that around the world special monetary measures are still in place to ensure that Governments can keep spending. We have had problems with patient care. I alluded earlier to the turnaround in Buckinghamshire; across the country, there have been special measures and turn- arounds. The BBC reported that a probe into whistleblowing has been swamped by people getting in touch. The Government have had to deal with an enormous range of cultural problems and turnarounds.

That brings me to solutions—first, funding. In Buckinghamshire there are pockets of real poverty. In my constituency in Micklefield, Castlefield, Oakridge, Bowerdean and Disraeli there are—by anyone’s standards —pockets of poverty and deprivation, but we suffer on funding because of how it has historically been calculated. It is time for us to look seriously at where the demands on A and E are coming from, and to reorientate funding towards the human factors producing that demand—that is, ageing. Where there are older populations, they should be properly funded. It is a simple matter of treating people humanely, decently and—dare I say it—equally.

Secondly, it is time for us to take seriously the documents of NHS England. I am talking about not just the urgent care review, which I have in my hand, but the “Five Year Forward View”. What we see emerging now is a clear vision of where places such as Wycombe should go. It is becoming increasingly obvious to me that we will never manage to achieve the return of an old-style A and E to Wycombe hospital. The clear reason for that, as set out by NHS England, is that the NHS is moving in a different direction. The urgent care review includes a clear model of future urgent care, with major emergency centres, emergency centres and urgent care centres.

I am not able to tell the hospital trust and the clinical commissioners what they should do, but if I could I would now have a clear understanding from NHS England’s own documents of what should be done in Wycombe. We have a very expensive public finance initiative hospital, and we need to make the most of it for the 20 years-plus that are left to run on it. We should have an urgent care centre, an enhancement of the current minor injuries unit, a pharmacy, GPs, social services, nurse practitioners, and a full set of services and diagnostics in Wycombe named in a way that the public can understand. We should be proud of the centre and encourage people in Wycombe to present there if it is the best thing for them to do. We should not turn off the 111 service, and we should provide the services that people need in the places where they present.

We cannot go on for ever pretending that we will re-educate the public to want something different; that is not going to happen. I am not suggesting that we have an enormous new surge in admissions—nobody wants that. What we should recognise is that the vast majority of people, when they are in difficulty, want quick reassurance. If the people of Wycombe were in charge, they would want our hospital to have a full range of diagnostic and treatment facilities available to them all year round, giving them peace of mind. They would not want poor quality care. I think most people would accept being stabilised and moved to the place that could give them the best care.

We have a heart attack and stroke unit. I do not suppose that many people in Aylesbury, where there is an A and E unit, would be very happy if they realised that in the event of a heart attack or stroke, they would be coming to Wycombe. But that is the point. A huge amount of confusion, waste and anxiety is being wholly unnecessarily created despite the fact that NHS England, through the forward view document and the review of urgent care, has set out a clear trajectory on how to give the public peace of mind and the right treatment in the right place—yes, close to home, but also making best use of the PFI hospitals, which are a millstone around the NHS’s neck. We should do the absolute best we can to get best value for money, which means a new generation of urgent care centres in places such as Wycombe.

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[Jeremy Lefroy (Stafford) (Con)]

It is a pleasure to follow such thoughtful speeches, in general, on this subject. I thank all the staff at the accident and emergency departments that serve my constituents, whether at County hospital in Stafford, Royal Stoke University hospital, New Cross hospital in Wolverhampton, or Manor hospital in Walsall.

On many occasions in the House over the past few years, the tragic events in my constituency have been referred to. Whenever they are referred to from now on, I would like people to acknowledge the enormous progress to improve health services that has been made in Stafford at what is now County hospital and throughout my constituency. It is absolutely vital that we remember what is happening now as well as where we have come from. Let us not forget that out of the Francis report has come the tremendous emphasis on patient safety and compassionate care that is vital for all our constituents. I do not want Mid Staffs to be used just as shorthand for something that was clearly very poor care; it should also be shorthand for the huge improvements that have been made by the people working there and the NHS staff in many other hospitals throughout the country.

I would like to look in a bit more detail at what this motion proposes and the reasons we are currently suffering from the huge demand on accident and emergency services, particularly in relation to out-of-hours GP services and delayed discharges. Regarding the pressures on A and Es, it has rightly been said that there are 600,000 more attendances every year, but we are finding that there are 4,000 more admissions every week—some 200,000 a year. That indicates the seriousness of the situation, because people are not admitted to hospital unless they are in a fairly serious state or seriously unwell. It shows that we are now entering a phase in which the baby boomer generation needs more acute care. We welcome the fact that people now live a lot longer, but the fact is that when people get ill in later life, they tend to be acutely ill and to have complex needs, and that results in their admission to hospital.

The right hon. Member for Holborn and St Pancras (Frank Dobson) mentioned the ratio of beds to population in the UK. We have one of the lowest ratios in Europe—we have a very efficient health service—but the idea that we can get an even lower figure is pie in the sky. In fact, we ought to go marginally in the opposite direction. We should certainly consider increasing the number of beds. Let us not forget that our patient stays in hospital are shorter than most comparable figures across Europe.

We need to bear in mind that we will get more and more admissions, and we need to have the capacity for that. As I remember only too well, I argued a few years ago that the design for the new hospital in Stoke-on-Trent would make it too small; indeed, it is too small, and we are now increasing the number of beds there.

The King’s Fund has said that only 55.4% of patients say that they know whom to contact for out-of-hours services, and such a lack of information or lack of clarity has already been mentioned. We need something straightforward and simple, and frankly, it must be available 24/7, because emergencies happen 24/7. That is why I have pushed for my A and E to reintroduce 24/7 care, rather than its current 14/7 care. People have to look at the clock to check whether it is nearly 10 pm, and then ask themselves whether the A and E will still be open or whether they will need to go elsewhere. They avoid going to another hospital because our A and E is so good, so they delay going until 8 am, by which time they may be in a worse condition. If the facility is for emergencies, it needs to be open 24/7. I welcome the fact that we will soon get an overnight doctor service. A and E needs to return to 24/7 not only in my case, but in other centres that do not offer a full-time service.

[Steve Baker]

Does my hon. Friend agree that putting GPs into such centres provides the possibility not only of having integrated care, but of treating most people who present overnight, when an A and E consultant might not be available?

[Jeremy Lefroy]

I entirely agree, which is why I welcome the introduction of an overnight doctor-led service at the County hospital in Stafford, even though I would like such services to go further. A parent whose child is sick with a temperature may not want to be a burden on the ambulance service by calling one out but will still want to be seen at that time, rather than having to wait until morning, so being able to go to such a service gives them reassurance. If the child is particularly unwell, they can then be referred to a specialist centre, but otherwise the parent can be reassured that they can wait until the morning. Such matters are vital for our constituents.

It is, indeed, a problem to get GP appointments, and it is vital that the issue is sorted out. There are wide discrepancies. In the practice I attend, I can get an appointment the next day not just because they want the local MP to be seen, but because they are very well organised and their patient load is not huge. That is simply not the case in other practices, and some people in my constituency have to wait two or three weeks for an appointment. The problem must be sorted out, and there must be evenness across the country.

GP surgeries put an additional pressure on A and Es. The statistics show that the patients of some GP surgeries attend A and E far less often than those of other surgeries, because such GPs take the time to have longer appointments and take the trouble to go through problems and deal with them on the spot, whereas others are more inclined to say, “I haven’t got the time, so you had better go to A and E.” The statistics show that for some GP surgeries the ratio of patients attending A and E is almost twice that of others in the same area and with the same demographic.

Delayed discharges have often been referred to in this debate. The figure was relatively stable until the start of 2014-15, but since then the total number of delays has risen by 19%. The King’s Fund analysis suggests that delays attributable to NHS services have risen from 60% to 68%, whereas those attributable to social care have fallen from 35% to 26%. It states:

“This suggests that capacity and workforce issues, particularly in nursing homes and non-acute services”

—within the NHS—

“are becoming more important than social care funding”.

I find that very interesting. I do not know on what evidence it is based, but the King’s Fund is a respected institution and we must look at what it says. It implies that there is an issue with integration not just between the NHS and social care, but between acute NHS services and non-acute NHS services.

So what should we do? First, we have to recognise that there will be increasing demand for complex acute care and, hence, for accident and emergency services. A and E departments therefore need to remain open and to expand. I welcome the fact that the A and E in Stafford will double under the investment plans. Secondly, we need clear pathways for out-of-hours care, rather than complicated pathways that are difficult to understand. Thirdly, we need clear information relating to those pathways. Fourthly, we need to do much more work on access to GPs and must look much more closely at the results of GPs in avoiding A and E admissions among their patients. Finally, we need to make integration a reality, not just between health and social care, but within all NHS services and social care.

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[Chloe Smith (Norwich North) (Con)]

It is instructive, as always, to follow the hon. Member for Dudley North (Ian Austin), and I thank him for his exposition of the positions set out around the Chamber this afternoon. I also welcome the comments of my hon. Friend the Member for Wycombe (Steve Baker) in picking up on the needs of areas that might not normally be viewed as deprived, but that need attention none the less. Norwich is one such city, because it contains wards and areas of serious deprivation. I have argued on behalf of GP surgeries that serve those wards, and there is a genuine question about the way our national structures and funding serve those areas.

[Steve Baker]

Is it not odd how people who are obsessed with inequalities take levels of aggregation that hide the real suffering of individuals and families?

[Chloe Smith]

My hon. Friend makes a wise point.

Tomorrow, I am visiting a walk-in centre and the hospital that serves my constituents. When I am there, I shall be explaining, as I have several times in the House recently, my support for the NHS in Norwich and across Britain, my thanks for what the staff are doing and my understanding of what the patients, my constituents, need from the NHS.

I want to make three points in the debate. My first point is that, as many hon. Members have said this afternoon, the NHS is under unprecedented demand. It does it no disservice to acknowledge that and bring it into the debate. I for one welcome the decisions that allow for increased numbers of doctors and nurses in urgent care—that is true in the Norfolk and Norwich University Hospitals Trust; for an increased number of operations to be carried out each year—that is true everywhere in the country; and for increased hours at GP surgeries. I recently learned to my pleasure that Norwich doctors will apply for the next round of the access fund. They have not done that before and it is very welcome. The Government have made the fund available and it could be of great benefit to patients in my area.

I am also grateful to the Government for the decisions made early—earlier than ever before—that have allowed for winter pressures to be dealt with. Again, that directly benefits the area of Norfolk that contains the Norfolk and Norwich hospital. I am particularly pleased that the use of that funding will be planned jointly with local authorities through the system resilience group. That is incredibly important. I will turn to that kind of joined-up working in my final remarks.

Let me make a point about the motion. We have heard wise contributions from Back Benchers on both sides of the Chamber. For example, my hon. Friend the Member for Stafford (Jeremy Lefroy) rightly asked us not to use the name of his area as a shorthand. He is right that we ought to look much deeper. As a further example, the hon. Member for Wirral South (Alison McGovern) rightly spoke eloquently about mental health. Unfortunately she is not in the Chamber, but I am sure she will be back before the winding-up speeches. I intervened on her to ask why the motion does not refer in its own right to mental health; it is a great shame that it does not. The motion is 10 lines of overblown and fly-blown rhetoric. It asks for an NHS that is “fit for the future”, but makes no mention of mental health being equal to physical health, which I believe strongly. Mental health and physical health should be equal in word and deed, and in budgets. Indeed, I have been discussing that with the Minister recently through parliamentary questions.

The truth is that the motion is rather sad and inadequate. It betrays even the usual standards of political football that are played on Opposition days. The right hon. Member for Leigh (Andy Burnham) said in his opening speech that it is time for honesty. To that end, we would like to know whether his party leader believes in “weaponising” the NHS. To that end, we would like an end to the shabby leaflets on the NHS that go around the country.

I would have liked mental health, which is an important topic, to replace the waste of words in the motion. The motion is a pathetic reuse of the tired and crumbling money-making policy—the mansion tax—that not even all Opposition Members agree with.