NHS Trusts: Accountability

Steve Barclay Excerpts

Tuesday 10th July 2018 Commons Chamber

[The Minister for Health (Stephen Barclay)]

I commend my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) for bringing the important matter of NHS accountability before the House. No one who heard his remarks can doubt for one minute his passion both for the NHS and for ensuring that the services it provides meet the needs of his constituents. He is right in this month, when we mark the 70th anniversary of the NHS, to emphasise that the NHS belongs to the people—not to any specific party or group, but to the constituents it serves.

My right hon. Friend made a number of specific allegations. Having been a Minister, he will appreciate that, having brought those issues before the House in the way he has, it is difficult for me to comment on some of the specific points, but I commit to follow up with him after the debate on some of those issues. In particular, he raised a very concerning allegation regarding a constituent who had collapsed before 10 pm outside the urgent treatment centre. He is right that that centre should be open until 10 pm, so clearly that is a specific issue that I will be keen to explore with him.

My right hon. Friend raised concerns as to whether his constituents who have whistleblown have in practice been gagged. As you are probably aware, Madam Deputy Speaker, as a member of the Public Accounts Committee, I spent a considerable amount of time and effort on that issue. In response to concerns raised by the PAC during that time, in 2013, the Government introduced guidance that banned gagging orders and a legal duty of candour. As this is the first time I have been at the Dispatch Box since the ministerial reshuffle, I am sure my right hon. Friend will join me in paying tribute to the outgoing Secretary of State, who is now Foreign Secretary, who made patient safety a central tenet of his time in the Department and, as part of that, spoke up for whistleblowers and for the value they offer to the NHS.

[Sir Mike Penning]

I must apologise to my colleague, the now Foreign Secretary, who was so generous with his time in seeing me. I hope that the new Health Secretary will not get so upset when I am banging on his door—perhaps as much as I was on the previous Health Secretary’s door.

[Stephen Barclay]

I am grateful to my right hon. Friend for recognising that in the House. I think that is widely shared across the NHS.

It is right that the Government are bringing forward the draft Bill to place the Healthcare Safety Investigation Branch on a legal footing. Indeed, trusts should disclose any pay settlements to NHS Improvement. Therefore, on the concern to which my right hon. Friend brought the House’s attention—whether whistleblowers have been gagged and, if so, whether that has been induced through financial payment—both those breach the Government’s guidelines and they would need to be reported to NHS Improvement. If he is able to share any specific allegations after this debate, I will be keen to explore them.

My right hon. Friend expressed concern that service changes are “all in the hands of bureaucrats” and I must take slight issue with that.

[Sir Mike Penning]

Only slight?

[Stephen Barclay]

Well, I must take issue with that point. First, my right hon. Friend is well aware that the Government have four tests that apply to service change that ensure the voice of patients is heard and in particular that service reconfigurations are clinically led and done at a local level. I draw attention to the work that Professor Tim Briggs and Professor Tim Evans are doing through the “Get it right first time” initiative, which is all about driving through change to service provision through the leadership of national clinicians working with local clinicians in order to get that service buy-in.

[Sir Mike Penning]

I do not want to take up too much more of the Minister’s time, but I am afraid that, in parts of the country, certainly in mine, the requirement to consult is simply being ignored. I have given the House a classic example in which an urgent care centre was closed at night with no consultation at all. It took 18 months for a bogus consultation to take place on whether it should close at night. The changes are there to be seen by everyone. I know that the Minister is telling me all this in good faith but, as he has heard from colleagues on both sides of the House, on the frontline, in the real world, people are ignoring the guidelines, which is surely illegal.

[Stephen Barclay]

I shall just unbundle two separate points from my right hon. Friend’s remarks. First, his point that these changes are all in the hands of the bureaucrats collides with the Government’s own position, which is that there are four tests. What he is drawing out is not whether the guidance is there as a protection but whether it is being implemented operationally, and that obviously needs to be looked at on a case-by-case basis. Secondly, he and I debated this issue in some detail in an Adjournment debate in March, when this specific point was explored more fully. The urgent care centre in question saw an average of seven patients between midnight and 8 am, and an average of four between 10 pm and midnight. So in the period between 10 pm and the centre reopening at 8 am, an average of 11 patients were being seen. I suspect that that is why, at local level, the change was made. I appreciate that it was initially done on patient safety grounds, with the consultation following, as we explored previously.

[Sir Mike Penning]

This is a hugely emotive issue. Yes, the excuse was that the centre was closing at night on grounds of patient safety because it could not get a GP there, but it does not take 18 months to turn round and say, “Oh, by the way, the numbers weren’t there in the first place and that’s why we had to close the centre.” That was the excuse 18 months after it had been closed at night times. Whether the numbers are right or not—they are hugely contested by my constituents—it cannot be acceptable that no consultation took place for 18 months.

[Stephen Barclay]

As I have said, we did explore these issues in some detail in March, and I absolutely respect the conviction with which my right hon. Friend is championing the interests of his constituents.

In the spirit of balance, I draw my right hon. Friend’s attention to the fact that a number of enhancements have also been made, including the introduction of a number of bookable appointments through NHS 111, which includes a clinical assessment service to ensure that patients’ needs are medically assessed; the addition of near patient testing for some conditions, reducing waiting times and reducing the need for patients to attend Watford Hospital; and an improved IT system meaning that medical staff will be able to access patient records if they give their consent. The clinical commissioning group also expects the service to expand to include a greater skill mix of other professionals such as pharmacists, emergency care practitioners and community nursing staff, and to provide access to mental health services. This is not a static situation. Some improvements have been made, but I absolutely take on board the concerns that my right hon. Friend has raised.

My right hon. Friend has raised concerns about the hiring of leadership positions, particularly two chief executive roles. He will be aware that this point was also raised by the hon. Member for Blackpool South (Gordon Marsden) in respect of the chair of Blackpool Victoria Hospital in an Adjournment debate only last week. I also note that the right hon. Member for Warley (John Spellar) and the hon. Member for Coventry South (Mr Cunningham) have raised similar issues. It is right that the views of constituency Members should be taken on board as part of any consultation, because Members of Parliament interact with a wide spectrum of their electorate and they are obviously well placed to feed into such consultations. As a Minister, that is something I take very seriously, and working on the cross-party basis, I am always keen to hear from colleagues when concerns arise.

That goes back to my right hon. Friend’s point about trust. Issues in terms of pay need to be balanced. On the one hand, we need to recognise the complexity of senior leadership roles. We are dealing with hospital trusts that often have budgets running into the hundreds of millions of pounds. These are senior, complex, challenging roles that need to attract talented individuals. At the same time, those salaries and that remuneration need to be balanced with the wider values of the NHS. There is a live discussion about what the right level of remuneration is to attract talent while not being out of step with the NHS values that both sides of the House recognise.

I turn now to my right hon. Friend’s point about the new hospital site and capital investment in the STP area. He will be aware that the same STP currently has a significant new build proposal at Harlow. My right hon. Friend the Member for Harlow (Robert Halfon) is assiduous in championing that proposal, and I met with the chief executive of that trust—

[Sir Mike Penning]

That is in Essex.

[Stephen Barclay]

It is in the same STP area.

[Sir Mike Penning]

My constituents will not know what STPs are. At the end of the day, the new site is in Essex, on the east Hertfordshire border, which is nowhere near my constituency. There is no tangible benefit when the debate is about a new hospital in west Hertfordshire.

[Stephen Barclay]

I beg to differ from my right hon. Friend on that, because this gets to the crux of the issue. The NHS must evolve. It has to move with technology and with the skills mix. Alongside the significant funding injection that the Prime Minister announced at the Royal Free Hospital, the NHS must also deliver productivity. At the specialist level, such as oncology or neuroscience, we often have populations of 3 million that need to be treated. Look at the footprint of the Christie NHS Foundation Trust, for example.

If we look at the other end, we need to deliver more care in the home and not have acute trusts soaking up so much investment. We need dynamic reconfigurations without acute trusts being the sole focus of our attention. We need service changes but—this goes to the core of my right hon. Friend’s remarks—they must be taken forward with clinical leadership and in a way that delivers trust.

I am happy to continue to engage with my right hon. Friend’s specific allegations on a case-by-case basis.

[Dr Caroline Johnson]

The Minister talks about dealing with things on a case-by-case basis, so I wonder whether he will consider Grantham’s A&E, which has had to close overnight for nearly two years, to see what can be done to facilitate its reopening as soon as possible.

[Stephen Barclay]

Again, I am happy to consider that issue. I have been up to visit the United Lincolnshire Hospitals NHS Trust and have met the chief executive and the leadership team, so I am aware of the issues, which are partly due to geography. However, we are straying slightly away from Hemel Hempstead.

As I said, I am happy to engage with my right hon. Friend the Member for Hemel Hempstead on his specific allegations. It is important that service changes are done at the local level with clinical leadership in a way that builds trust, and I will continue to engage with him in the weeks and months ahead.

Question put and agreed to.