Tobacco Products (Standardised Packaging)

Tony Baldry Excerpts

Thursday 3rd April 2014 Commons Chamber

[Sir Tony Baldry (Banbury) (Con)]

Does my hon. Friend agree that the House should always pay careful attention to advice from knights like Sir Cyril? Will she confirm that this is a forensic report that is based on the best evidence, and that the Government are approaching the matter entirely on the basis of the best science? Is not the answer to the hon. Member for Liverpool, Wavertree (Luciana Berger) that if the Government did not consult properly on the regulations, far from speeding up matters, it would delay them? I assure the hon. Lady that my colleagues in the Temple would be over the road with an application for judicial review before one could say ban on anything.

[Jane Ellison]

I very much welcome my right hon. Friend’s comments. He is in danger of becoming my second favourite knight of the day. I know that he speaks from personal experience. He is right to draw the House’s attention to the need to make policy carefully in this area. That is what we are proceeding to do. He illustrated the point better than I could have done.

Oral Answers to Questions

Tony Baldry Excerpts

Tuesday 1st April 2014 Commons Chamber

[Jane Ellison]

I did answer the question—I told the hon. Lady exactly how the NHS was performing. I have to say that Government Members slightly despair at the constant churlishness of Opposition Members who try to talk down the NHS and talk up a crisis. They are trying to talk the situation into fitting the rhetoric, but the NHS has performed really well this winter and many more people have been seen within the target. The average waiting time for someone to be seen is actually 30 minutes. The NHS has done well and she should join us in congratulating it on that.

[Sir Tony Baldry (Banbury) (Con)]

Does my hon. Friend agree that one of the ways to reduce pressures on A and E is to ensure that people do not go to A and E if they do not need to? Will she compliment the Oxford clinical commissioning group for the work that it is doing in Abingdon and is about to do in Banbury in setting up a primary triage unit at the entrance of A and E to ensure that those who need primary care get it, and that those who do not require A and E care get the proper and appropriate care?

[Jane Ellison]

I congratulate my right hon. Friend’s local CCG. Increasingly, I am seeing, right across the country, imaginative and innovative ways in which people, local clinicians, public health professionals and people in wider health services are looking at how we keep people who do not need to go to A and E out of A and E. Some of them are doing remarkable work. We will be celebrating that this week by recognising some of those unsung heroes who are doing that great public health work in our communities.

NHS Funding (Ageing)

Tony Baldry Excerpts

Tuesday 25th March 2014 Westminster Hall

[Sir Tony Baldry (Banbury) (Con)]

It is always good to submit to the chairmanship of a brother knight, Sir Edward. I congratulate my hon. Friend the Member for Suffolk Coastal (Dr Coffey) on her excellent speech, analysis and introduction, and on providing the House with an opportunity to consider this important subject.

However large the budget is for the national health service, money has to be allocated to local clinical commissioning groups through a formula. The easiest formula, of course, would be to allocate a certain amount of money per person so that for each clinical commissioning group we simply took the size of the population of both adults and children—a straightforward and transparent calculation. I suspect that since the start of the NHS, however, there has been a belief that the health needs of some people and groups within the community are greater than those of others, and that the NHS allocation formula should be adjusted to recognise those needs. I think it is clear to everyone that one of the most significant factors affecting demand and spending in the NHS is an ageing population.

Last Saturday’s Daily Mirror summarised the situation thus:

“More than half a million Britons are now aged over 90—an increase of a third in just 10 years.

Average life expectancy is now up to 78 for men and 82 for women, according to the Office for National Statistics.

Its figures showed there were 513,000 people over 90 in 2012. Of those, there were 372,290 women… And 141,160 men... The number of centenarians has also increased by 73% to a record high in the past decade. In 2012 there were 13,350 people over 100 in the UK.”

That is a lot of telegrams from the Queen. The Daily Mirror continued:

“It comes amid concerns over how the NHS will cope with an ageing population… A newborn boy can expect to live 78.7 years and a newborn girl 82.6.”

In Oxfordshire, according to the Office for National Statistics, on average, men aged 65 can expect to live a further 10-and-a-half to 13 years and women an extra 11 to 14 years. The Oxfordshire clinical commissioning group has calculated that the impact of demographic change in Oxfordshire will lead to an increase in costs of £54 million over five years. In Oxfordshire, the population of over-65s is expected to grow by 2.5% a year, so the proportion of the population aged 65 will grow from 15.8% to 18.2% by 2017 and to 25.2% by 2035. By 2035, more than a quarter of everyone living in Oxfordshire will be over 65. The proportion aged over 85 will grow from 2.3% to 3.4% by 2017 and to 5.6% by 2035.

I am not suggesting that the increase in Oxfordshire’s elderly population is necessarily significantly greater than in other parts of the country. What I am saying, however, is that an ageing population is a significant cost to the NHS and therefore the amount of funding for Oxfordshire should be much nearer to the average for NHS spending. The size of the difference between the clinical commissioning groups that are receiving the most money per head and Oxfordshire is too great and is unsustainable.

For a long time, I have been arguing that the NHS allocation formula does not give sufficient weight to the fact that we have a significant and growing ageing population. It is of course good news that people are living longer, but there is no doubt that older people on average have greater need for NHS support. We have been arguing that the formula for NHS allocations needs to be reformed to reflect more reasonably and fairly the number of elderly people in an area.

The facts and the needs speak for themselves. One would have thought that on an issue as self-evident as this, there would be a degree of cross-party consensus. Whether the significant number of elderly people is in Oxfordshire, Blackpool or any part of the country, they have similar needs. An average 80-year-old in Oxfordshire does not have significantly fewer needs than an 80-year-old in Bradford, Birmingham or Bermondsey.

Understandably, in making any change to the funding formula, NHS England might wish for some cross-party consensus; sadly, it has clearly not been possible to find it. The shadow Secretary of State for Health has campaigned vigorously against any changes to the allocation formula that would better recognise the needs of those aged over 65. My hon. Friend the Member for Suffolk Coastal has done the House a service in securing from the chair of NHS England, Professor Sir Malcolm Grant, a copy of the letter sent to Sir Malcolm last December by the Labour shadow Secretary of State, who started his letter by saying:

“I wish to register the strongest possible concerns about proposed changes to NHS resource allocations being considered by your board on Tuesday, 17 December”.

The shadow Secretary of State sought to defend his resistance to allowing NHS funding to reflect more fairly the needs of the elderly in the community with a rather convoluted argument: that

“health care utilisation is not the same as healthcare need and resources should not be allocated based on demand levels rather than the level of need”.

Lewis Carroll and Alice in “Through the Looking Glass” would find it difficult to dissect what that sentence is meant to mean. I suspect that it is meant to mean all things to all people.

The Labour party has made it clear that it does not want any change to the existing allocation formula—a formula that in no way adequately reflects the local needs of an ageing population. I think it is fair to draw the conclusion that at the NHS England board meeting last December, faced with such hostility by the Labour party to any changes in the formula—I agree entirely with my hon. Friend who introduced the debate—NHS England simply bottled it. It made some changes, but it bottled introducing the original new formula proposed by—let us remember this—an independent committee, which had recommended much greater weighting for age. NHS England simply added an adjustment for what it described as “unmet need”, which it said was a particular issue in deprived areas, in effect negating any improvement in the formula to take account of the number of elderly people in a local area.

The consequence of not making reasonable provision for the number of elderly in a clinical commissioning area is that, under this year’s funding allocations, the CCG allocation for the NHS in Oxfordshire for 2014-16 will be the lowest amount of money of any clinical commissioning group in the country—£856 per head, at present. That compares with a national average—I stress, average—of £1,115 per head. By definition, many parts of the country will be above average. Oxfordshire is the third most underfunded CCG in the country, at nearly 11% below target. If, however, NHS allocations took proper account of the number of elderly, Oxfordshire’s NHS funding allocation would increase by an extra £57 per person.

Any NHS funding formula, of course, has to have appropriate regard to indices of deprivation, and I understand Labour’s wanting to stick with a formula that largely directs funds to parliamentary constituencies held by Labour MPs. It is absolutely no good, however, everyone’s acknowledging that one of the greatest pressures, if not the greatest, on the NHS into the future is the fact of an ageing population if that fact is not then fairly reflected in the funding formula. It is little wonder that the Oxfordshire CCG and the Oxford University Hospitals NHS Trust are both running at a deficit; Oxfordshire receives the lowest amount of money per head for the NHS of anywhere in the country, but, that notwithstanding, it has a significant and growing elderly population.

Care Bill [Lords]

Tony Baldry Excerpts

Tuesday 11th March 2014 Commons Chamber

I am sorry that the Secretary of State is not here, but I ask the Minister to pass on my message to him. The NHS does not belong to him to chop and change as he pleases. It belongs to everyone. He would do well to remember that. The way to achieve change is to involve the public early on, give them a meaningful say and build confidence in the clinical case for change. Clause 119 sets back that cause and will damage already fragile confidence in hospital reconfiguration. In the end, that is the most powerful argument against it. By shutting the public out, the measure risks creating a backlash against change in the NHS when it needs to change to survive. I appeal to Members on both sides of the House to think about that and to put constituency before party when voting on this crucial measure.

[Sir Tony Baldry (Banbury) (Con)]

I have left instructions for my body to be left to Oxford university medical school, partly because there is quite a lot of it, but also because I hope that, in that way, I can demonstrate that engraved on my heart are the words, “Keep the Horton General”. When the right hon. Member for Leigh (Andy Burnham) was Secretary of State for Health, my local general hospital was threatened with the downgrading of its maternity and children’s services. We went to the health overview and scrutiny committee, which referred matters to the independent reconfiguration panel. As a consequence, we now have consultant-delivered children’s services and a consultant-led maternity service. I, too, am slightly disappointed that the Secretary of State is not here to listen to the debate, because I am concerned about the proposals as someone who has had to contest the downgrading of hospital services.

I have some questions to put briefly to my hon. Friend the Minister. The “Dear colleague” letter circulated to us gives the impression that the powers in the proposals will be used only in exceptional circumstances, when services are clinically unsafe or when a trust is financially insolvent. However, hon. Members know that many trusts will end up with a deficit this year. I need the Minister’s assurance that the measures will be used in truly exceptional circumstances. They have been used only twice so far, in Mid Staffordshire and Lewisham. However, if TSAs are to be used simply if a trust moves into deficit, rather than going into a process of health overview and scrutiny committees and the Independent Reconfiguration Panel, that is a matter of great concern.

[Dr Poulter]

I hope I can reassure my hon. Friend on that now, before my closing remarks. The right hon. Member for Leigh (Andy Burnham) did his best to conflate routine service reconfiguration, which should be clinically led in the best interests of patients, with those in extremis measures, which have been used only twice in five years. They were used only in circumstances of extreme hospital failure when patients’ lives were at risk. There is a clear distinction. I hope my hon. Friend finds that reassuring.

[Sir Tony Baldry]

I do find that reassuring, but I have a final question that I hope my hon. Friend will address when he winds up the debate. There has to be a trigger, but what will the trigger be for these extreme circumstances? In other words, what distinguishes a proposal for hospital reconfiguration, in which local people can go to the health overview and scrutiny committee and the Independent Reconfiguration Panel, from a crisis situation, such as occurred in Mid Staffordshire and may have occurred in Lewisham? We all have local hospitals and we all need to be able to explain to our constituents how we might find ourselves in the circumstances of these short-cut situations. We really need Ministers to make it clear to the House that these powers will be used in extremis, and I hope that my hon. Friend will address that point when he winds up.

[Jim Dowd]

I agree strongly with the sentiment expressed by the hon. Member for Stafford (Jeremy Lefroy) that no community should be subjected to the tender mercies of the trust special administrator regime. It is brutal, harsh, unfair, unreasonable and impervious to local knowledge or opinion.

Following the way in which most reports are presented, I shall start with my executive summary—my understanding of what happened in the South London Healthcare NHS Trust. The right hon. Member for Banbury (Sir Tony Baldry) was wrong. The special administrator was not appointed to Lewisham hospital. That is the very heart of the matter. He was appointed to the South London Healthcare NHS Trust, which is the adjoining trust, then comprising the Queen Elizabeth hospital in Woolwich, the Princess Royal university hospital in Orpington and Queen Mary’s hospital in Sidcup. He then decided to take a well-functioning, well-respected, well-performing and financially sound institution, in the shape of Lewisham hospital, and use it to deal with problems elsewhere.

In an Adjournment debate 18 months ago when the issue first occurred, I used the simile that it was like the administrator for Comet advising that the best thing to do, in the interests of Comet, was to close down Currys. That is exactly what the trust special administrator did.

Care Bill [Lords]

Tony Baldry Excerpts

Monday 10th March 2014 Commons Chamber

[Madam Deputy Speaker]

Order. Before I call anyone from the Back Benches, let me say that the shadow Minister has been most courteous in bringing her remarks to a conclusion when I indicated that that might be a good idea. It would also be a good idea, if Members wish to be courteous to their colleagues, if they would limit their remarks to some five minutes. That way everyone will get to speak. If anybody speaks for more than 10 minutes, I will remind them of the fact.

[Sir Tony Baldry (Banbury) (Con)]

I am not quite sure who to be bad-tempered with. As the House knows, I am not characteristically bad-tempered, but I think my bad temper should probably be directed at the usual channels, given that the timetable motion went through on the nod. We have to deal with 21 new clauses and 20 amendments on an important Bill in two hours, which by my calculation allows three minutes per clause or amendment. The hon. Member for Leicester West (Liz Kendall) spoke perfectly reasonably, given the number of amendments that have been tabled, but it is impossible to do justice to all this in two hours. The usual channels should bear in mind that some of us feel rather bad-tempered about the time provision. These things, as we all know, are agreed between the usual channels; it is not one side or the other that is responsible.

I wish to speak briefly about new clause 3. The Bill does fantastic things for carers, and I think it would be a real tragedy if, once the Bill completes its passage, carers or their advocates felt that it was a missed opportunity. I shall not repeat what my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) said. The Minister will doubtless say that clause 6 and the duty to co-operate deal with this point. Clearly, the duty to co-operate is very important for local authorities and the NHS. In the past, GPs may not have sought to identify carers as well as they could because they did not think there was much they could do for them. Now they will be able to ensure that there is a carer’s assessment. If the Minister intends to resist new clause 3, could he seek to ensure that we have statutory guidance for the NHS on the services that it should provide for carers?

I fully understand that for those aged over 75 the aim will be to have named clinicians, and those clinicians should, as part of their duty, ensure that carers are identified, but of course many carers, including young carers, are under the age of 75. It would be a real pity if the Bill missed this opportunity on carers. If we could have some statutory guidance on what the Minister, the Department and all of us expect the NHS to do to identify carers, we can then have a quick rendition of the “Hallelujah Chorus” and I will not be so grumpy.

[Hazel Blears (Salford and Eccles) (Lab)]

I shall do my best not to be grumpy and to be as quick as the right hon. Member for Banbury (Sir Tony Baldry). I wish to speak in support of new clauses 9 and 19. New clause 9 has support across the breadth of organisations from the Association of Directors of Adult Social Services to the Care and Support Alliance. It makes fundamental good sense, when setting up a new system, to have the ability to have an annual report about whether there is sufficient money in the system. Whichever Government are in charge, we need to know that. We are in danger of willing the ends but not the means for social care, and we have to make sure that this issue is kept under close review.

We all support the two fundamental principles of the Bill, which are about promoting individual well-being and moving towards a more preventive system. Those are commendable and high ideals, but if we do not have the funding in the system to be able to deliver them, the Bill will not achieve the potential that we all know is there.

I spoke on Second Reading about transformation, and I look forward to welcoming the Minister to Salford on Wednesday to show him how we are transforming the system for dementia care in the city by bringing together £97 million of our total health and social care budgets to try to squeeze every bit of impact out of every last penny to give better care for people with dementia. I hope he will be impressed, but more than that I hope he will help us to do this with his better care fund. That fund should be used for the transformation of our services at a time of austerity when we need more money in the system.

The second part of the new clause is about having a five-yearly review of eligibility criteria, which is essential—to be frank, I would like to see that happen more often than every five years. Eligibility criteria are now set at “substantial” instead of “moderate”, which means that in Salford 1,000 fewer families are being helped, and the heartache and misery that that causes are enormous. It also goes against the second fundamental principle of the Bill. If we do not have eligibility criteria at the right level, how can we transform the system to be preventive? If we only pick up people when they are in crisis, they are escalated into the acute sector, which costs a fortune. If we invest in lower level community-based interventions by social enterprises and voluntary groups, we can save money in the acute sector.

Francis Report

Tony Baldry Excerpts

Wednesday 5th March 2014 Commons Chamber

[Jeremy Lefroy]

I am most grateful to the hon. Gentleman, to all the Stoke-on-Trent MPs and to the hon. Member for Newcastle-under-Lyme (Paul Farrelly) for the way in which they have approached this matter together with us. We will be working with them under the new trust arrangement, with the University Hospital of North Staffordshire NHS Trust, and it is very important that we work together.

I refer to unity because the only way in which we will develop a health service fit for the 21st century is by showing that same unity of purpose nationally. I pay tribute to my hon. Friend the Member for Bracknell (Dr Lee), who is no longer in his place, for his remark about working together, and I absolutely agree with it. When the Prime Minister and the Leader of the Opposition, and later the Secretary of State and his shadow, have made their responses to the Francis report in the past year, they have been of the highest quality; they have shown a true appreciation of the gravity of the subject and the importance of a mature response.

[Sir Tony Baldry (Banbury) (Con)]

On the proposed reorganisation of services in Staffordshire, what is the role of the clinical commissioners? I thought that if we moved to a commission-based NHS, commissioners would determine what services were provided at which hospitals.

[Jeremy Lefroy]

My right hon. Friend makes an extremely important point. Indeed, the clinical commissioning groups have backed the changes, but the local population has not. The clinical commissioning groups are in a difficult position, because they have a budget, and the budget in Staffordshire, as in many other rural areas, is much lower than the national average for England. They are told that if they want to commission services that cost more than the tariff—as maternity services almost always do because maternity tariffs are simply not high enough—they will have to pay the extra. To some extent, the clinical commissioning groups are caught between a rock and a hard place. They may wish to commission those services, but in doing so they will have to stop commissioning others.

It is in the spirit of unity that I ask both the Secretary of State for Health and his shadow to visit Stafford and Cannock Chase hospitals to speak to patients and staff and to hear first hand what they have gone through. I also urge that same co-operation in approaching the long-term challenges facing our health service. The increasing specialisation of services—62 specialties as against 30 in Norway—is driving up costs and resulting in clinicians knowing more and more about less and less.

In Stafford, we have been told that we cannot continue with our consultant-led paediatric service, because we have too few consultants—five or six as opposed to the eight to 10 that the Royal College of Paediatrics and Child Health says are needed to maintain a rota. By that standard, some 50 or more other consultant-led departments in England should close. Instead of a proper national review with full political co-operation, however, we see the gradual picking off of departments in trusts that have financial difficulties. The same is true with maternity services.

I echo the point made by my hon. Friend the Member for Bracknell and urge the Government and Opposition to come together with the royal colleges and resolve this matter and much else. The British public are not stupid. They understand that they cannot have every service just around the corner. However, they do not understand why a consultant-led maternity department or paediatrics department in one place must close on safety grounds because it does not have a large enough rota, whereas another with a smaller rota remains open. They also understand the need for more services in the community, but the idea of “slashing” hospital budgets, as Sir David Nicholson is reported in The Guardian as saying, is both incomprehensible and deeply worrying to those whose A and E departments are heaving, whose wards are full and whose children face travelling long distances even to receive general treatment.

--- Later in debate ---

[Joan Walley]

I am conscious that many hon. Members want to speak. My hon. Friend has pre-empted two points that I want to make, so I will go straight to them.

If we accept that it is the trust special administrator’s report that is taking us forward in north Staffordshire in respect of the application by the University Hospital of North Staffordshire to take over Stafford hospital, there are two aspects to consider. The first is that there is a revenue shortfall of £4 million; and secondly, there is a capital shortfall of £29 million. I raised that matter at Prime Minister’s Question Time last week without realising that I was doing so prior to the written statement having been made available to the House of Commons. It is vital that the Government recognise that this gap must somehow be closed as the University Hospital of North Staffordshire moves forward, possibly under a new name, in taking on responsibility for this. In looking at the figures that have been put forward by the very diligent and committed directors and staff at UHNS, it is vital that the Government take account of the fact that in making a bid to take on services, those people know what they are doing, they have the expertise, and they know what changes will be needed for capital investment in Stoke and in Stafford. The gap should be closed; otherwise, Stoke-on-Trent will end up paying for the cost of bailing out Stafford hospital.

[Sir Tony Baldry]

Will the hon. Lady kindly explain to those of us who are not Staffordshire colleagues what the relationship is between the trust special administrator and the clinical commissioning group? It is helpful to try to understand who is running the NHS in Staffordshire, because what is happening there today may well happen in Oxfordshire tomorrow.

[Joan Walley]

It was suggested earlier that we might need a special debate, at length, solely on the trust special administrator, so that we can look at how this is being resolved in Staffordshire, and I would agree with that. There was also a suggestion in a previous debate that we need a debate solely on the Care Bill and its implications for changing that. Lots of different things are going on in parallel, but not in an integrated way. The real failure would be for the Government to allow the two procedures to go forward without understanding the changes made in the Health and Social Care Act 2012 which shift all the responsibility from the Secretary of State down to the commissioning bodies.

The hon. Gentleman is absolutely right. Here we are again trying to find some way of having a centralised Government system, when no matter what anybody says to the TSA or to anybody else, if the local commissioning group chooses not to go ahead and commission the services that the TSA has identified and the Government have said will be funded, those services will not be provided. I cannot understand how we are in this situation where we are not looking at all the implications of what is happening.

When the Government announced last week in a written statement that they had accepted in full the recommendations of the TSA’s report, I expected that, as a result, the UHNS would proceed quickly to implement what had been agreed in the hope that there would be a process to close the funding gap in one way or another.

The problem that I wish to give back to the Government and ask them to comment on in detail—the Secretary of State has had a detailed letter from me about this—is the uncertainty that arises as a result of the comments that were made by the Prime Minister and in a statement about obstetrics-led and consultant-led maternity provision in Stafford. On an emotional level, I absolutely agree that, as my right hon. Friend the Member for Leigh and the hon. Member for Stafford (Jeremy Lefroy) said, we need maternity services in situ that are easily accessible, and not only in Stafford but right across the country. However, my head says that the detailed financial arrangements that we currently have for maternity provision and the model that is apparently proposed do not allow for that kind of option.

We are therefore in a situation whereby people are, rightly, campaigning to have maternity services close to where they live, but the rigid procedures laid down either nationally or locally do not permit the additional funding for that. This is not just about having additional funding but about capacity in the form of trained, expert people able to deliver those services. If neither the funding nor the capacity is there, there is no point in any amount of hoping that we can have such maternity-led services in small district general hospitals, in whatever part of the country. The Government have to address that, but they cannot do so as part and parcel of the way in which they are taking forward the new configuration of health services across north Staffordshire. When the Minister replies, I want a very detailed response to the questions that I have asked the Secretary of State and given to his office, as he is aware; I am grateful for that.

The MPs concerned have met the Secretary of State and the Prime Minister to try to get some clarity on this. Until we get clarity, we cannot proceed to deal with the situation that we now have across mid-Staffordshire and in north Staffordshire. When is NHS England going to report on the further review? May we have a detailed time scale for that? To what extent will that delay the possibility of the UHNS board taking forward the new services? Already, 14 extra ambulances a day are bringing people from Stafford to Stoke-on-Trent, and staff are leaving Stafford hospital. We desperately need certainty about how this is being taken forward. When the Minister replies, the Government must set out in detail how they expect to be able to accept the TSA’s recommendations in full and then add an addendum without there being any mechanism to enable it to be implemented.

--- Later in debate ---

[Sir Tony Baldry (Banbury) (Con)]

It is a great pleasure to follow the right hon. Member for Rother Valley (Kevin Barron) who has chaired the Select Committee on Health and who made some extremely important points about accountability. This has been an interesting debate, much of which has focused—understandably, given its title—on what is happening in Staffordshire a year on from the Francis report into Mid Staffs trust. It is also understandable that considerable cross-party concerns have been raised about the NHS in Wales. The Francis report applied to the whole of England, and I want to make some observations as a non-Staffordshire Member of Parliament who has benefited from it.

Much has happened during the last year—for example, the appointment of Stuart Rose, former head of Marks & Spencer, to advise the Government on leadership. His brief is to explore how the 14 NHS trusts placed in special measures can be helped to tackle concerns about their performance. David Dalton, chief executive of the Salford Royal NHS Foundation Trust, is exploring how NHS providers can collaborate in networks or chains, effectively building on an initiative last autumn in which high-performing NHS hospitals were invited by the Secretary of State to provide support for hospitals placed in special measures.

I suspect that much remains to be done to tackle relational aspects of care, including ensuring that patients are treated with dignity and respect and are able to communicate effectively with doctors and other staff. Indeed, the NHS as a whole, including GPs, will probably need to do a lot more in future to support patients to manage their own health and well-being and involve them as partners in care. Sir David Nicholson, the head of NHS England, who retires shortly, has described this concept as “the empowered patient”—in essence, the need for us all to get better at managing our own health problems to reduce the burden on hospitals.

Everyone has had to learn lessons as a consequence of the Francis inquiry, but it is not appropriate or, indeed, fair, continually to castigate those working in the NHS, whether they be nursing staff or managers. On the contrary, we need to ensure that NHS staff are supported to do the job for which they have been trained. Not unreasonably, as in other aspects of life, there will be a close correlation between staff experience and patient experience. Patients receive better care when it is given by staff working in teams that are well led and where staff consider that they have the time and resources to care to the best of their abilities. One reason ward sisters have always been so highly valued is that they are an extremely good example of team leaders, as experienced nurses who have developed, and are able to pass on, a culture in which patients are treated with dignity and respect, and who motivate their colleagues to do the same.

If we are to have an NHS fit for the 21st century, we need continually to attract talent into it. We will not do that if people consider that those working in the NHS are all too often set up to fail. We also need to improve efforts to attract clinicians into leadership roles, as advocated by Roy Griffiths way back in 1983. As a senior and much-respected clinician and physician, Sir Jonathan Michael has been able to achieve as chief executive of Oxford University Hospitals NHS Trust much that I suspect could not have been achieved by a chief executive who was not a clinician. We should value the role of managers in the NHS instead of constantly criticising them. Successful leadership in the NHS needs to be collective and distributed rather than residing in just a few people at the top of NHS organisations. The involvement of doctors, nurses and other clinicians in leadership roles is essential.

The NHS is an organisation that is constantly evolving. The NHS of today is very different from the NHS of 30 years ago, when my father retired as a consultant physician, and the NHS of 30 years ago was very different from the NHS on the day that it began. Both my parents worked in the hospital service on day one of the NHS, my father as a young registrar and my mother as a theatre sister. There is a danger that our perceptions of the NHS, and of what hospitals should look like, become frozen in time, with James Robertson Justice as a snapshot of hospital care. The type and nature of illnesses that hospitals are having to treat changes over the years; so too, therefore, does the hospital layout. I recollect that my father had four Nightingale wards, two male, two female, with 15 beds along each wall and 30 beds to a ward, filled almost entirely with patients dying from lung cancer. Lung cancer is still a killer, but not in anything like the numbers then. We need to recognise that hospitals are changing. In that regard, I very much welcome the work of the Royal College of Physicians through its future hospital commission—an initiative that has not received anything like the publicity and debate that it merits.

The current pattern of acute care is based on the model of district general hospitals providing comprehensive emergency and elective services for relatively small populations—a model developed back in the 1970s. A whole number of factors are changing that model. For example, advances in medical technology mean that it is now possible to treat many patients much more speedily and less invasively. Hysterectomies that might previously have involved a woman patient remaining in hospital for up to 10 days can now be performed through keyhole surgery involving a much shorter stay. There is clear evidence from the Royal College of Surgeons that specialisation can achieve better outcomes. Indeed, the concept of the general surgeon, or surgeon specialising in general medicine, is now pretty much obsolete. Almost all surgeons practising in the NHS today specialise, to the benefit of their patients, in surgery on a particular part of the anatomy.

On the other side of the equation, there are significant demographic changes, resulting in increasing numbers of elderly people. The elderly population is set to expand exponentially as we post-war babies, with much longer average life expectancies than our grandparents, start to reach our 70s and 80s. Many more frail elderly people have long-term medical conditions and an increasing number of people have multiple long-term conditions and—that terrible word—comorbidities.

I therefore very much support the 11 core principles of the Royal College of Physicians’ “Future hospital” report. We need to ensure that NHS patients are at the centre of care—what Robert Francis described as a “patient-centred culture”. We need to ensure that the NHS provides a seven-day-a-week service and that hospital trusts have a 24/7 approach. It is clearly unacceptable that mortality rates are significantly higher for patients admitted into hospitals at the weekend. GP out-of-hours services need to be improved and co-located, and hospital emergency departments need to integrate the urgent care pathway.

At the Horton general hospital in my constituency, an emergency medical unit is being developed to help strengthen the A and E unit and its rapid medical assessment capabilities and to try to ensure that people go to A and E only if they really need to. The links between generalist and specialist pathways are being strengthened, but I suspect that the 24/7 approach will lead to some reconfiguration of services, although that should not necessarily mean that they will become more remote. For example, Horton hospital now has a daily fracture clinic throughout the week and a renal dialysis unit, because it makes more sense for those services to be delivered there. However, emergency abdominal surgery is now carried out at the John Radcliffe hospital in Oxford.

In all of this, we need to remember that whoever is in government, and whichever political party or combination of parties is running the country, we need collectively to face the Nicholson challenge of saving significant amounts of money in the running of the NHS. If we cannot manage the Nicholson challenge, the NHS simply will face a black hole in funding and will fall, more or less, into managed decline.

Indeed, in a recent press report, Sir David Nicholson is reported as predicting that, if the NHS does not pursue a number of reforms, including enhanced primary care, more GPs and more specialisms, it faces

“a £30 billion hole in funding by 2021”,

which is certainly within the political life expectancy of many of us in this House. He also observed, rightly, that

“the NHS is not frozen in aspic for us to worship as some great thing—it will decline and it will die if we don’t recognise the choices that are available to us now”.

Over the past year, following the publication of the Francis report, there has been considerable progress, including towards greater openness and transparency in the health service, including the implementation of a new statutory duty of candour. England now leads the world in transparency and openness about surgeons’ clinical outcomes, so patients can access their surgeons’ outcomes for particular procedures or operations, such as hip replacement. There has been considerable improvement in the Care Quality Commission’s inspection model, the Government have ensured that a named consultant is in charge of someone’s care throughout a hospital stay, and there is clear recognition that the NHS needs to provide a seven-day-a-week service.

We need to move forward with a health service that puts patients at the centre of care. A number of years ago, nursing was made increasingly a graduate profession, but whether one is a graduate doctor or a graduate nurse, patients still need tender loving care. I do not think that my mother, when she was a ward sister, was ever too proud—or considered it not to be part of her role, if necessary—to ensure that patients were comfortable in bed, to give them a bed bath, to make sure that they were eating properly or, if they should die, to ensure that they were laid out with dignity and care.

There have been concerns about health care support workers and we should welcome the recent review by Camilla Cavendish, which has made a number of recommendations on the training of and support given to health care assistants and how that can be improved. Health care assistants do extremely valuable work in hospital. They should be valued and properly regulated.

Last Friday I attended an open day for care workers, which was organised by Oxfordshire county council because, given the ageing population, we are going to need many more health care workers in hospitals and nursing homes and to give domiciliary support.

We have yet to see the full benefits of commissioning and the extent to which commissioners can help improve and monitor the quality of NHS care. One thing that has interested me in this debate is the issue about who actually runs the NHS, because I assumed that once we had commissioning bodies, they would drive where the money was spent. We have also yet to see the full benefits of the new governance arrangements in the NHS, and of ensuring more joined-up working between the NHS and other providers, such as through health and wellbeing boards. Healthwatch Oxfordshire is certainly still getting into its stride as an organisation.

I hope that the House will have an opportunity, in a Back-Bench business or Westminster Hall debate, to discuss the Royal College of Physicians report on the future hospital programme. It is in the process of establishing development sites, which will implement and further develop the recommendations made in its report. I certainly hope that it will consider the Horton general hospital as one of those development sites, not only as one of the smaller general hospitals in the country, but as a hospital that serves a large geographical catchment area.

As Chris Ham, the chief executive of the King’s Fund has observed, high-performing health care organisations

“benefit from continuity of leadership, organisational stability, and consistency of purpose”.

I suspect that, having learned the lessons of Mid Staffordshire, we now need to concentrate on ensuring that there is continuity of leadership, organisational stability and consistency of purpose in the NHS.

Care Bill [Lords]

Tony Baldry Excerpts

Monday 16th December 2013 Commons Chamber

[Sir Tony Baldry (Banbury) (Con)]

I think that the whole House would agree with the right hon. Member for Salford and Eccles (Hazel Blears) that we must all try to ensure that our constituencies and communities are, so far as is humanly possible, dementia-friendly. I welcome the opportunity to contribute to the debate, not least in my capacity as the Commons chair of the all-party group on carers. I trust that the House will understand that that is why I intend to focus my comments specifically on carers’ needs. Other parliamentary colleagues will talk in detail about other aspects of the Bill, such as the national eligibility threshold, personal budgets and other important issues relating to the social care system. They are all important, but in the time available to me I want to focus on the needs of carers. I may well not be able to say all that I would like to say in the time available, and in those circumstances I will put the full text of the speech on my website, www.tonybaldry.co.uk—even those of us who have been in this place for 30 years can keep up with new technology.

I welcome the Care Bill and the fact that it contains significant new rights for carers, including stronger rights for an assessment of their needs and a clearer entitlement to services for carers and those for whom carers care as a result of any such assessment. I also welcome the fact that as well as introducing new rights for carers the Bill consolidates their existing rights. Over the years, a number of Bills have enhanced carers’ rights. All the recent ones have been private Members’ Bills, taken through the House with the support of organisations such as Carers UK and the all-party group on carers, so I welcome the fact that this Bill consolidates carers’ rights in a single piece of legislation. Clause 1 sets out the well-being principle, which is a hugely welcome overarching duty that will place individual well-being at the heart of the new reformed social care system.

The Bill has, of course, already enjoyed detailed consideration and scrutiny in the other place. It is to the Government’s credit that they have already introduced a number of further concessions, not least those for young carers, following the hard work of parliamentarians and the National Young Carers Coalition. Good progress has of course been made to enhance the rights of young carers through an amendment to the Children and Families Bill, which delivers four key improvements for young carers: the simplification of the legislation on young carers’ assessments; the extension of the right to an assessment of needs for support to young carers under the age of 18 regardless of whom they care for; the fact that it has been made clear to local authorities that they must carry out an assessment of a young carer’s needs for support on request or on the appearance of need; and the provision of appropriate links between legislation for children and for adults to enable local authorities to align the assessment of a young carer with an assessment of an adult they care for. The amendment works closely with the provisions in the Care Bill that focus on a whole-family approach to support, and that is all welcome progress.

There are three further issues, however, that I hope Ministers will consider as the Bill makes progress. First, it places new duties on local authorities to provide information and advice services, which are very welcome and will enable carers to access vital information and advice earlier. As part of the enhanced right for carers, the Bill places a new duty on local authorities to undertake a carer’s assessment for all carers. It is also good news that under clause 2 local authorities must have regard to the importance of identifying carers in their populations with unmet needs with the aim of early intervention and prevention of future needs, but the clause does not mention the NHS. Neither the Care Bill nor the health and social care legislation places any responsibility on the NHS to identify carers.

Ministers might say that there is a co-operation clause, clause 6, that requires health bodies to co-operate with local authorities on all clauses in the Bill, including the that on identifying carers, but the way that clause is drafted gives rise to serious concerns that the onus will remain on local authorities. That could well mean that carers will receive very little help from health bodies in certain parts of the country. It is a matter of common sense that for many carers their point of contact with the wider world and the person with whom they will discuss their wider caring responsibilities will be health professionals, such as their GP.

Macmillan Cancer Support estimates that there are nearly 1 million carers of people with cancer in England, half of whom are not receiving any support as carers, notwithstanding the substantial impact on their lives. It is a matter of common sense that carers of people with cancer come into contact mainly with health professionals who are simply not identifying them as carers, which as a consequence means that only 5% of the nearly 1 million people caring for people with cancer receive a carer’s assessment. Half of carers of people with cancer are not receiving any support in return for giving an average of almost 15 hours of care each week. As the number of cancer patients is likely to double from 2 million to 4 million over the next 15 years or so, so too will the number of carers.

Part of the reason why carers of people with illnesses such as cancer are not receiving any support is that three in five people providing unpaid care to loved ones with cancer do not consider themselves to be a carer. They thus lack awareness of carers’ rights, such as the local authority carer’s assessment, which is crucially important because it is the gateway for carers to get statutory support. There needs to be an explicit requirement in the Bill for health bodies to identify carers with unmet needs, with the aim of early intervention and support. Neither the Care Bill nor the Health and Social Care Act 2012 sets out any responsibility for the NHS to identify carers, which is surprising, given that this was something the Government specifically called for in their care and support White Paper, where they outlined the requirement for

“NHS organisations to work with their local authority partners . . . to agree plans and budgets for identifying and supporting carers.”

The first point that I therefore wish to impress on the Minister is that the Bill should specify that local authorities need to work with health bodies in order adequately to identify carers with unmet needs and provide sufficient services for them, and that there should be a duty on the NHS to identify carers. GPs need to see support for carers of their patients as also being part of their job, because in supporting the patient’s carer, GPs are also supporting the patient. There is, I suspect, a need for a national framework, or guidance, on how the NHS can better identify and support carers.

The second point that I wish to raise is a difficult one. The Government are introducing new and much appreciated rights for carers of adults through the Care Bill, and for young carers in the Children and Families Bill, but parents of disabled children under 18 are not included in either Bill. It is worth reminding ourselves of the recommendations of the Law Commission to strengthen the rights of parent carers in line with other carers, and to consolidate these rights in new legislation.

I appreciate that at a time when we are enhancing and hopefully improving special educational needs in the Children and Families Bill, the question arises whether every parent whose child receives a statement of special educational needs should be considered a parent carer, and I suspect that Ministers would probably respond that in straitened financial circumstances it simply is not possible to give financial support to a child with special educational needs through that system, and at the same time give financial support to their parents as parent carers.

On the other hand, I hope Ministers and the House will appreciate, as I am sure we all do, that for a parent of a seriously and severely disabled child, or a child with serious and severe learning difficulties, those responsibilities as a parent and as a carer can completely take over their life, with little respite. I hope that there will be an opportunity in the Public Bill Committee to consider whether it is possible to give targeted support to parent carers whom, as a matter of common sense, I think we would all recognise merit consideration as carers.

My third point is that the Bill perhaps needs greater clarity to ensure that carers are not wrongly charged for services provided to the person they care for. I know that ministerial colleagues have said that this is not their intention, but I suggest that that is not yet clear enough. Social workers and carer support workers will in due course have to use this legislation to decide on the one hand what is a carer’s service, and on the other what is a service for an older and disabled person. I suggest that this needs to be defined with greater clarity so as to prevent confusion or disputes. I would suggest that we should remove from local authorities any ability to charge for carers’ services. Not surprisingly, many carers are shocked to find, given the support and contribution they are making to caring for a loved one and the amount they are saving the state with the care they provide, that they are being charged for carers’ services.

I hope that during the passage of the Bill through the Commons, the Government will give consideration to these three points relating to carers, but I re-emphasise that overall the all-party group on carers very much welcomes the significant new rights for carers in the Bill, including stronger rights to an assessment of their needs and a much clearer entitlement to services for them and those they care for as a result of such a carer’s assessment.

Oral Answers to Questions

Tony Baldry Excerpts

Tuesday 26th November 2013 Commons Chamber

[Mark Menzies (Fylde) (Con)]

6. What progress his Department has made on improving out-of-hospital care for frail elderly people.

[Sir Tony Baldry (Banbury) (Con)]

13. What progress his Department has made on improving out-of-hospital care for frail elderly people.

[Nick de Bois (Enfield North) (Con)]

17. What progress his Department has made on improving out-of-hospital care for frail elderly people.

--- Later in debate ---

[Mr Hunt]

My hon. Friend is not the only person to welcome that change. After months of telling the House that this was nothing to do with the A and E problems, the shadow Health Secretary said on the “Today” programme that he welcomed the change and that it would make a difference to A and E. So I welcome the return of the prodigal son with great pride and pleasure. For my hon. Friend’s constituents, this will mean that there will be someone in the NHS who is responsible for ensuring that they get the care package that they need. That is incredibly important, because when people are discharged from hospitals, the hospitals worry about whose care they will be under. This change will provide that crucial link and make a real difference.

[Sir Tony Baldry]

Does my right hon. Friend agree that the 2004 GP contract did enormous damage to the relationship between GPs and their patients, and that the recent changes agreed with GPs should ensure much more proactive care of our most vulnerable constituents and ease pressure on A and E departments?

[Mr Hunt]

I agree with my hon. Friend, and I am pleased that the shadow Health Secretary also agrees with him in welcoming the reversal of that disastrous contract. The personal relationship between doctor and patient is at the heart of what the NHS stands for, and at the heart of that is a responsibility to ensure that people get the care they need. That is what we need to get back, and I think that the change will make a big difference to my hon. Friend’s constituents.

Changes to Health Services in London

Tony Baldry Excerpts

Wednesday 30th October 2013 Commons Chamber

[Sir Tony Baldry (Banbury) (Con)]

Does my right hon. Friend agree that, difficult though it may be, all NHS trusts will have to live within their budgets, because, with both Front Benches effectively having agreed public spending limits for several years to come, the amount of money that can be spent on the NHS will be finite whoever is in government?

[Mr Hunt]

My hon. Friend speaks wisely. Let us bear in mind the challenges facing north-west London, which are similar to those across the country, including in Oxfordshire. In the next two decades, its population is predicted to increase by 7%, and life expectancy has risen by three years in the last decade alone. Furthermore, the uncertainty over public finances means that the trust cannot bank on substantial increases in the NHS budget, so it has to do the responsible thing and look for better, smarter, more efficient ways to use that money to help more people. It has been brave and bold in doing this, and I think that many other parts of the country will take heart from what has happened today and come forward with equally bold plans.

Accident and Emergency Departments

Tony Baldry Excerpts

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

We are determined to do what is right for the people of Lewisham and of south London. Let me be clear: the problems of South London Healthcare NHS Trust were not addressed by the right hon. Lady’s Government when they were in office. We are addressing them, and sometimes those decisions are difficult, and sometimes they are not popular with local people. I took the decision that I did because it will save about 100 lives a year. I think it was the right decision, and I want to ensure that I do the right thing by her constituents.

[Sir Tony Baldry (Banbury) (Con)]

The extra £10 million for the Oxford University Hospitals NHS Trust to deal with winter pressures is very welcome. Sir Jonathan Michael and his team have already made it very clear that they will open a significant number of new beds this winter and take on a significant number of new members of staff. The Oxfordshire clinical commissioning group is already working hard on enhancing primary triage, so that fewer people have to go to A and E. Would it not be better if we just let NHS managers—the NHS—get on with this, rather than the Opposition continuously shroud-waving every winter, in the hope there might be some failing that could shore up their flagging opinion polls?

[Mr Hunt]

We have not heard any kind of policy from the Opposition today, or any suggestion as to what they would do differently. We have presented to the House a package of short-term and long-term measures, designed to address the immediate and the underlying challenges. It is a very comprehensive package, but it is going to be a very tough winter and I would urge all responsible politicians from all parties to row in behind the package, which I think will make a very big difference on the front line.