Oral Answers to Questions
Debate between Thérèse Coffey and Jeremy Lefroy(5 years, 11 months ago)
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The Parliamentary Under-Secretary of State for Environment, Food and Rural Affairs (Dr Thérèse Coffey)
Absolutely, which is why we have been pleased to provide Transport for London with funding. The Mayor has received additional funding for certain kinds of buses and other things to do; we just want him to continue to get on with it.
Jeremy Lefroy (Stafford) (Con)
Oral Answers to Questions
Debate between Thérèse Coffey and Jeremy Lefroy(8 years, 1 month ago)
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The Parliamentary Under-Secretary of State for Environment, Food and Rural Affairs (Dr Thérèse Coffey)
I welcome the hon. Lady to her place. We both represent coastal communities and we share the issue of flooding. She raises an important point. She will be aware of the Government’s commitment to spend £2.5 billion over six years, which has given the Environment Agency long-term funding. I will have to ask my hon. Friends in the Department for Communities and Local Government about her specific point on the recovery work and then write to her, but we are continuing to invest in such schemes, including in Cumbria, as she will be aware.
Jeremy Lefroy (Stafford) (Con)
Dr Coffey
I am pleased to report that woodland cover in England is at its highest since the 14th century—well before I was born—and we are committed to growing it even further by planting another 11 million trees over the course of this Parliament. The second phase of applications for the woodland creation planning grant has opened; the first phase generated plans for over 1,000 hectares of woodland. I ask hon. Members to continue to encourage schools to plant trees and to endorse our excellent scheme with the Woodland Trust, which I draw to the attention of the House.
NHS
Debate between Thérèse Coffey and Jeremy Lefroy(10 years, 9 months ago)
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Jeremy Lefroy
I have no doubt that some of those things will have caused increased pressure. That brings me nicely to my next point.
Dr Thérèse Coffey (Suffolk Coastal) (Con)
My hon. Friend may not be aware that a briefing was given by the College of Emergency Medicine to Members of Parliament. One of its representatives, I believe it was Dr Mann, was asked by hon. Members about the closure of walk-in centres and he replied that there was an initial blip but that levels went back to what they were before. So in his view those closures made very little difference.
Jeremy Lefroy
We do not have sufficient data on this. I urge the Government to examine how we can collect more data about the reasons why people come to A and E and whether their visits could have been prevented by other provision. I am sure that that can be done in some cases, but at the moment we are arguing at cross purposes because we do not have sufficient data.
Another point, on the lack of integration, relates to discharges. There is pressure on hospitals to discharge people, particularly the elderly, because of the pressure on beds. One GP in my constituency raised this issue, citing one of their patients who was improperly discharged and saying that they were very distressed at the condition in which they found him. Stafford hospital has come up with a solution, which it will implement shortly, whereby every patient with complex needs will not be discharged unless it is absolutely clear that they have proper care in the community to go to. We would expect that for all patients, and I am very glad that Stafford hospital is taking that up.
The final reason to mention is that patients are often confused about where to go, and I am therefore glad that the Government have undertaken a review of the classification of A and E departments. We have A and E departments, urgent care centres and minor injuries units, and we have various grades of A and E. We need a national classification that makes it clear what services people can get at which point. Often people turn up and find that they have come to the inappropriate place.
I also wish to make a few remarks about the competition matters that have been raised in the debate, and I do this from a local perspective. The trust special administrators for the Mid Staffordshire NHS Foundation Trust have proposed that Stafford hospital should merge with University Hospital of North Staffordshire in Stoke and that Cannock hospital should merge with Wolverhampton’s trust. That is the right solution, it is not being opposed and we are not finding any problem with competition law. There is a big difference between the acute and non-acute sectors. As the acute sector runs in a tight way around the country, it is very difficult to see how there can be much competition in provision within it, because that has been provided exclusively by NHS trusts up to now. Within the non-acute sector we have found in my constituency that, under competition rules, an NHS service that went to the private sector under the previous Government has come back into the NHS under this Government, because it was determined that the NHS would provide a better service. So this does work both ways; it does not always go the way some people think it might.
We must not lose sight of the real hard work that people are doing in A and Es up and down the country. Almost all the work that goes on there is incredibly good and is what our constituents need, but we must make sure that the points that I and others have outlined are dealt with, because with the demographics going the way they are, we will face increasing pressures year on year.
Accountability and Transparency in the NHS
Debate between Thérèse Coffey and Jeremy Lefroy(11 years, 8 months ago)
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Jeremy Lefroy (Stafford) (Con)
I wish to thank my hon. Friend the Member for Bristol North West (Charlotte Leslie) and the Backbench Business Committee for calling this debate. I particularly wish to remember all those in my constituency and elsewhere, and their loved ones, who suffered so grievously. I wish to pay tribute to those here today who campaigned to bring these things to light. I also thank the Prime Minister, the Secretary of State and all other hon. Members for their response to the report a month or so ago.
One of the main thrusts of the Francis report is to:
“Ensure openness, transparency and candour throughout the system about matters of concern”.
This is not the time to debate the Francis report fully—it was commissioned by the Government and it needs full and prompt consideration in Government time—but it is the time to say that the Francis report is of great importance. Mr Francis rightly dismisses the arguments of those who claimed at the time that the inquiry was unnecessary because Stafford hospital was a solitary exception—it was not. It may have been considerably worse than other places, but appalling standards of care have been revealed elsewhere.
The public inquiry has revealed complacency throughout the NHS and beyond; report after report detailed major concerns, which were either ignored or passed to others to deal with. What lay behind that? Perhaps it was a lack of willingness to shout and continue to shout for help when it was needed; or perhaps it was more often a fear of the consequences—the loss of one’s job or the removal of services from the local community.
Even just last week, when, as the shadow Secretary of State rightly said, a report to Monitor suggested removing most emergency, acute and maternity services from Stafford—something my constituents and I strongly oppose for reasons I set out in the House last week—there were those blaming Julie Bailey for the proposals. That comes on top of disgraceful threats—even death threats—that she has received over her work in revealing what Robert Francis, who should know if anyone does, calls the “disaster at Stafford Hospital”.
Let me make it clear that the proposals in the Monitor report are, in the main, a consequence of the financial and clinical pressures that all acute trusts, particularly the smaller ones, are facing. Stafford’s circumstances have done a little to hasten changes, but what happens at Stafford now will face all other such trusts in the coming years. That it is why it is so important that Monitor and the Secretary of State come to a good solution for Stafford, and indeed Cannock, and I will continue to work with them and with my hon. Friends on that. Nobody should take from the Monitor report the message that whistleblowing or more transparency will result in threats to their local services. Indeed, Monitor would be acting contrary to section 62 of the Health and Social Care Act 2012 if it acted in such a manner.
Let me raise another, perhaps more justified, fear of the unintended consequences of transparency. Only this week, I heard of a case where a patient could have a life-saving operation, but his chances of surviving it are only 50:50, yet without an operation he will die. Some surgeons are, even now, reluctant to take on the operation because if the patient dies, it will be counted against them in their personal mortality statistics. That is an unintended consequence of transparency, so transparency has to be balanced with understanding the context; otherwise, we will end up with a risk aversion that is so great that patients will suffer.
Transparency can also thrive only in a culture that is not led by blame. One of the doctors who gave evidence to Francis said:
“There was a blame-led culture, the culture being that problems had to be fixed or nursing jobs would be lost.”
How can we persuade the most suitable people to take up vital, often voluntary, roles on trust boards if their attempts to raise problems are met by blame or indifference? As my hon. Friend the Member for Southport (John Pugh) said, transparency must start right here in Parliament. He spoke movingly about moral purpose, and I agree with what he said.
Dr Thérèse Coffey (Suffolk Coastal) (Con)
I agree that we do not want to deter people from becoming board members, but surely my hon. Friend must agree that if things are still going wrong and the board is not holding the chief executive and the leadership to account, its members’ positions should be questioned.
Jeremy Lefroy
I would never disagree with that. I entirely agree with what my hon. Friend says, but there is a danger that there will be so much adverse scrutiny that people will be afraid to come forward. We must challenge that and say, “You have every right, as a board member, to raise whatever you want, whenever you want.”
As I was saying, we need a proper debate here in Parliament on health care in this country, one not constrained by party dogma or blind nostalgia. It is up to us to have that debate and, as a result, give clear direction, rather than simply to react to whatever is thrown at us. We need to debate, for instance, the nonsense of pretending that it is entirely the responsibility of local trusts to deliver. So much is out of their control, be it per-patient funding, which is still far too variable, clinical standards, which are set almost in a vacuum by the royal colleges, or the impact of the European working time directive on costs, rotas and training. We need to debate the impact of the large number of specialisations in the UK—we have 61 as against Norway’s 30—which is driving up costs and driving out vital general medical and surgical expertise. We need to debate emergency and acute tariffs, which have, for many years, meant that hospitals around the country are squeezed and face forced reconfigurations that may not be in the best interests of patients.
Robert Francis also says that one of the main principles is to:
“Make all those who provide care for patients—individuals and organisations—properly accountable for what they do and to ensure that the public is protected from those not fit to provide such a service.”
He also says:
“There must be a proper degree of accountability for senior managers and leaders.”
Accountability was sorely lacking at Mid Staffs. There were attempts to see that responsibility stopped with the board. As I have already said, that is based on the fiction that it is somehow entirely in control of its own destiny. It is not. That does not absolve the board or management, but the responsibility is shared by those who determine so much of the environment in which they operate, including us here. Professional organisations, for instance, have procedures that make it difficult to dismiss staff who are unsuitable. The Government signed up to the working time directive without preparing for the financial and manpower consequences. And for managers, and indeed politicians, targets became more important than care itself. Again, that is our responsibility.
I have already said how strongly I oppose the blame culture, and I am not going to start blaming, but accountability involves responsibility, and far too few people have taken sufficient responsibility in this case. We must reflect and they must reflect on the message that that sends.
Too many inquiries have been left to gather dust on Department shelves, and not just the Department of Health. I and my hon. Friends the Members for Cannock Chase (Mr Burley), for South Staffordshire (Gavin Williamson), Stone (Mr Cash) and Members further afield, all of whom are affected, will not allow this one to gather dust.