(8 months, 1 week ago)
Commons ChamberI thank my right hon. Friend for her question. She will know that 70% of trading businesses only pay the lower corporation tax rate of 19%. That covers the vast majority of small businesses. I used to run my own business; I ran it for 14 years before I came into Parliament. I could not agree with her more: small businesses are the backbone of the British economy, which is why we are tackling the scourge of low payments and we rolled over the 75% discount on retail, hospitality and leisure business rates in the autumn statement.
Will the Chancellor confirm how much higher the tax burden is forecast to be at the end, compared with at the start, of this Parliament?
What I can confirm is that, as a result of the measures I took in the autumn statement, it will be lower at the end of the scorecard period than it would otherwise have been, and a lot lower than it would be under any Labour Government.
(8 years, 4 months ago)
Commons ChamberMy right hon. Friend is right to say that the public will be extremely disappointed that professionals are putting patients at risk in such a way, and it is extremely tragic that they are doing so. I am afraid that I think this is a crossing of the Rubicon—crossing a line in a way that has not happened before. I think it is totally tragic, and I support the concern of my right hon. Friend.
In his statement, the Secretary of State said that this was “in our manifesto”. This is about ideology, not about the NHS. If he cares about the NHS, will he hear the will of the House, contact the BMA straight after this statement and negotiate?
If by “ideology”, the hon. Lady means a commitment to make the NHS the safest, highest quality health care system in the world, I plead guilty to ideology. That is the NHS that I want, and that means a seven-day NHS in which we do not have higher mortality rates for people admitted at weekends. There was a time when the Labour party would have been prepared to take tough and difficult decisions to make things better for patients, but that day has passed.
(8 years, 4 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
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My hon. Friend is right. What patients want is a safe NHS where it does not matter on which day of the week they are admitted if something goes badly wrong. The big surprise here is that this is not something that the whole House can unite behind. It is something that people who believe in the NHS, as I think we all do, should strongly support. We are standing up for those patients, and I hope Labour, the party that founded the NHS, might do the same.
I would be grateful if the Secretary of State could update the House on any legal action against the Department, and on whether the Department will be defending it.
(8 years, 5 months ago)
Commons ChamberI thank my hon. Friend for his persistent campaigning on behalf of his local trust. He is right that there are big issues there. He is also right generally that the NHS has too rapid a turnover of chief executives. There is a new one, Stephen Eames, who is one of the top-rate NHS chief executives. The Care Quality Commission says that things are improving and mortality rates are going down. I will support my hon. Friend in every way I can to resolve the situation as quickly as possible.
As the Manor hospital is in special measures, Walsall mothers-to-be are being denied the right to choose to have their babies at that hospital. Will the Secretary of State confirm that there are safe staffing levels at the Manor and at other hospitals?
(8 years, 6 months ago)
Commons ChamberThe advantage of the special measures programme is that we tend to make much faster progress in turning round hospitals in difficulty than used to happen in previous years. My hon. Friend will know that, in the past five years, his local trust gained nearly 50 more doctors and more than 100 more nurses. We are making progress, but we need to do it much faster. The hospital will have my full support in getting these problems dealt with quickly.
Walsall NHS trust has been placed into special measures, so what immediate action can the Secretary of State take to ensure that the Manor hospital can recruit the vital staff in paediatrics and A&E that it now needs—not agency staff, but long-term fully employed staff?
The hon. Lady is absolutely right that one thing that can tip hospitals into special measures is having too high a proportion of staff from agencies so that a trust cannot offer the continuity of care that other trusts can. There have been an extra 83 full-time doctors at Walsall Healthcare NHS Trust over the past five years, along with 422 full-time nurses. An improvement director started this week and we are looking to find a buddy hospital, which is what I think will help most. When it comes to turning hospitals round the fastest, we have found that having a partner hospital can have the biggest effect, as with Guy’s and St Thomas’s for the Medway.
(8 years, 8 months ago)
Commons ChamberI agree with my hon. Friend, who has great knowledge of NHS matters. I simply say to junior doctors that this is not just about contracts and pay; it is also about training. Having consultants more available at weekends will help improve training for junior doctors. We will also need to look at continuity of training, which I think has been undermined in recent decades. If junior doctors are looking for a visible reflection of this Government’s commitment to the NHS, they should look at last week’s spending review statement and the extra resources we are putting into the NHS in very tight circumstances. This Government are backing the NHS, and we are doing everything we can to back junior doctors as part of that.
Thank you, Mr Speaker—I was standing.
The Secretary of State referred in his statement—in the last line of page 1 of the copy we have been given—to a “time-limited period” during which negotiations will take place. Is that a day, a week or a month? Will the contract be imposed after that?
I hope that the hon. Lady will understand that, because I very much hope that the BMA’s junior doctors executive committee will agree to go ahead with the agreement we have made with its negotiators, I do not want at this stage to go into further details about its contents. Obviously, the agreement will be published as soon as it is made, but I think that I would be pre-empting that decision by going into detail. It is a reasonable period of time for negotiations to take place.
(9 years, 1 month ago)
Commons ChamberI thank my hon. Friend because he leads by example as a first responder and does a fantastic job in his constituency—indeed, that role takes place at weekends. Paramedics and ambulance services operate a seven-day service. Nurses, paramedics and others who work in hospitals currently do not have an opt-out; consultants are the only ones who do. These measures will give ambulance services confidence that if they take someone to hospital at the weekend, there will be a proper senior consultant present and their patient will get in front of the right person. That will make their job all the more rewarding.
The Secretary of State has not outlined what steps should be taken to recruit, train and retain front-line staff who are key to patient safety.
We have big plans to recruit and retain staff, and those are being worked up by Health Education England. We think that we will need extra doctors to deliver seven-day care, just as we will need more GPs. We think we can afford that within the extra £10 billion that we are putting into the NHS, and we are ensuring that all the numbers add up. I am sure that I will inform the House once we have come to a conclusion.
(9 years, 1 month ago)
Commons ChamberI am sorry that my hon. Friend had to go to hospital at the start of the election campaign, but I congratulate her on being probably the only Member of the House to have launched their campaign from an NHS hospital ward. I trust that all the nurses voted for her as a result.
Inexplicably, the trust that my hon. Friend talked about was made a foundation trust in 2008, despite a number of problems that were not recognised. Since then, it has made dramatic improvements in its care, with more doctors and more nurses. I am delighted that it is on track to deliver better care.
How many of the hospitals in special measures have implemented recommendation 13 of the final Francis report on fundamental standards?
I would expect that all trusts have done so. If they have not, they will not come out of special measures. That is the benefit of a rigorous, independent inspection regime. Seven trusts have come out of special measures. I hope that the others will come out in due course, but that is not a decision for me; rightly, it is a decision for the chief inspector of hospitals.
(9 years, 2 months ago)
Commons ChamberI share my hon. Friend’s concern about what is happening at the Royal Stoke. Some of the care there was totally unacceptable; there should be no 12-hour trolley waits anywhere in the NHS. I have said that I support a full 24/7 A&E service at County hospital as soon as we can find a way of doing it that is clinically safe, and I will certainly work hard to do everything I can to make that happen.
Will the Secretary of State ensure that other local hospitals, such as the Manor hospital, which have had to take up the slack following the closure of A&E and maternity services also get some support?
(9 years, 6 months ago)
Commons ChamberThe hon. Gentleman makes an important point, but I hope I can reassure him, because NICE has published guidelines on safe staffing levels, although they are different for different parts of a hospital: in intensive care, it is 1:1; for less severe illnesses, it is one nurse to eight patients; and in other parts of a hospital, it is one nurse to four patients. Those are all published, and I hope they will help whistleblowers in Cornwall and elsewhere.
What support will the Secretary of State give to trusts to ensure that safe staffing levels are implemented, given that they might need extra resources?
We have protected—indeed increased—the NHS budget in real terms at the time of the biggest financial crisis since the second world war, so I think the Government have done what they can to make resources available. However, improving care is not always about money, and some hospitals manage to staff their wards safely and achieve financial balance. In fact, hospitals that practise safe care tend to be in a better financial position than ones that do not, so safe care and good finances actually go together.
(9 years, 6 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
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My hon. Friend is absolutely right. I have spoken to the chief executive of the hospital, and I must say that she and her staff are doing a good job in turning around a very difficult situation. What they want is support. We have issued sensible guidance that tells hospitals that if they declare a major incident, they must take account of the impact on the rest of their local health economy. A responsible Opposition would support such guidance, and not to try to turn it into a political football.
The Manor hospital had to declare a major incident due to inordinate pressure from the closure of Stafford A and E. That is not a local issue, but a national one. When will the Secretary of State provide the hospital with the extra money to absorb the closure of Stafford A and E?
I can reassure the hon. Lady that we have provided a huge amount of extra money to deal with the problems in the wake of what happened at the former Mid Staffs Trust. We are continuing to give every support we can to Walsall and Stoke and other trusts. We have more doctors and more nurses and major changes are happening. The problem in Mid Staffs went on for four long years, and we do not want to wait that time before sorting out the problems.
(9 years, 7 months ago)
Commons ChamberThese things are decided independently by NHS England, which made the decision on the basis of which CCGs were most off their target allocation and on social deprivation and the number of older people. I remind the hon. Gentleman that there are many older and vulnerable people in the south, too, and they need a fair settlement from the NHS. That is why the decision was made.
The College of Emergency Medicine says that the extra money the Secretary of State has given is not reaching A and E. What steps is he taking to ensure that the money does not stay with the CCGs, but actually goes into A and E?
I have had a number of discussions with the College of Emergency Medicine and what it actually says is that the system is working pretty well—[Interruption.] Well, that is what the College of Emergency Medicine says. The country’s A and E doctors welcome the fact that with the winter pressures money, there are now 800 more doctors and 4,700 more nurses, but we always want to make sure that the money is getting through as quickly as possible, so if the hon. Lady has any particular examples, I would be happy to look into them.
(9 years, 8 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
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The College of Emergency Medicine gave the Secretary of State a 10-point plan in 2013. Will he say which of those 10 points he has enacted?
We have enacted, or started to enact, every single one of them. Some of them take a bit longer—the contracts for A and E consultants, for example, which we want to ensure are attractive enough to encourage people to want to become A and E consultants. I am pleased to say that we have made some progress on that and are now getting the recruits coming into A and E that we want to see. Other things are starting to happen this winter—more co-location of GP services at A and E front doors and better discharging procedures from hospitals. We have been working very closely with the College of Emergency Medicine, which has been a great help to us in devising these winter plans.
(9 years, 9 months ago)
Commons ChamberI thank my hon. Friend for raising that point. The last Labour Government did leave us with one of the lowest cancer survival rates in western Europe, which is one of the reasons why we introduced the CDF. Unfortunately, the current Labour Government in Wales are continuing with those policies, which is why 6,500 Welsh cancer patients were admitted for treatment in English hospitals last year. [Official Report, 12 January 2015, Vol. 590, c. 5-6MC.]
So will the Secretary of State then publish the assessment of the CDF by the chemotherapy intelligence unit before 7 May 2015?
We are, on the NHS, the most transparent Government in history, and I can see no reason why we would not publish that. We are very proud of what the CDF has achieved. We are very proud that the level of cancer diagnoses has increased by more than 50% compared with what it was under the previous Labour Government, and so we are finally starting to win the battle against cancer.
(9 years, 10 months ago)
Commons ChamberWill the Secretary of State explain why NHS England has entered into a contract with a company based in Kent to provide GP services, when my constituents have just seen a string of locum GPs at a higher cost to the NHS?
Wherever we can avoid it, we do not want to use locum GPs or nurses or agency doctors, because they are much more expensive—our spend on that is far too high—but sometimes when there are issues of patient safety we need a quick solution. That is what has happened in response to the Francis report: as well as recruiting 5,000 additional nurses on a permanent basis, we are using extra agency nurses. However, we hope to bring those numbers down.
(10 years, 1 month ago)
Commons ChamberNo, I am not. That is why earlier this week we asked Sir Robert Francis to do a follow-up review to his public inquiry to determine what else needs to be done to create a culture of openness and transparency in the NHS. We have come a very long way as a society in terms of our understanding, but there is more work to be done. It is also very important, as I said in my statement—I know everyone would agree with this—that we do not undermine the brilliant work done by volunteers in hospitals and that we do not create a kind of bureaucratic morass that makes it impossible for that really important work to be done. However, I know we can do better than we are at the moment and important lessons need to be learned.
The Secretary of State has been very gracious in his apology given that he was not Secretary of State at the time. Might I make one further practical suggestion? Will he speak to the Prime Minister about perhaps appointing a Minister to co-ordinate all these reports across the public institutions?
I reassure the hon. Lady that that responsibility lies with the Home Secretary, and the Home Office has a cross-governmental committee that will bring together all the lessons from all the reports. My first priority is to ensure that we are doing everything we can to make NHS patients safe, but there are much broader lessons to be learned. That is being led by the Home Office.
(10 years, 9 months ago)
Commons ChamberI am delighted to do that. As these are the last Health questions before Christmas, all of us would want to pay tribute to the voluntary organisations that do an extraordinary job of making sure that vulnerable older people do not get lonely over the Christmas period. It is heroic what they do—when we are with our families, they are looking after other people—and we should salute them all.
22. One way to ease the pressure on the NHS is by not handing the £2.2 billion underspend back to the Treasury. Will the Secretary of State consider using it for the NHS?
(10 years, 9 months ago)
Commons ChamberThe College of Emergency Medicine has consistently called for an increase in emergency doctors, because there has been a 50% shortfall over the past three years. What plans has the Secretary of State to address that concern?
I met the College of Emergency Medicine yesterday to discuss those issues, among others. We have 300 more doctors working in our A and E departments than we did three years ago, but the hon. Lady is absolutely right that we need more, because 1 million more people a year are going through A and E than there were in 2010. Part of the challenge is to make A and E a more attractive profession for doctors. They might work long shifts and antisocial hours, which can make it unattractive. We need to find a way of dealing with that.
(10 years, 11 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
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I thank my hon. Friend for making that point. It cannot be said enough how hard A and E staff in particular work—antisocial hours in very challenging conditions. Many hon. Members will have seen that in their local hospitals. With respect to the capital allocations, I hope that the House has a sense from today that we are looking to solve the long-term problems facing A and E departments, as well as giving immediate help for this winter and next winter, so of course we will look carefully at the business case put forward by his local hospital for capital.
The Royal College of Physicians, the College of Emergency Medicine and others have already come up with a 10-point plan for what to do about emergency care. That is the professional view. When will the Secretary of State act on it?
(11 years, 1 month ago)
Commons Chamber4. What plans he has to implement the recommendation of the Francis report on safe staffing levels.
We agree with Robert Francis that there is a need for evidence-based guidance and tools to inform appropriate staffing levels. We have set out a number of recommended actions to support appropriate staffing levels in “Compassion in Practice”—the nursing, midwifery and care staff vision and strategy for England.
I thank the Secretary of State for his answer, but Robert Francis said in his report that minimum safe staffing levels lead to helping patient safety. If the Secretary of State agrees with Robert Francis, why does he not implement that recommendation now?
(11 years, 3 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
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My hon. Friend rightly draws attention to the importance of the ambulance service, which is also feeling the pressure on A and E departments. We need to help the ambulance service to do its job better too. One thing that it always strikes me would make a huge difference to ambulance services is if staff could access the GP records of someone they were picking up on a 999 call, so that they would know that the patient was a diabetic with mild dementia and a heart condition, for instance. That kind of information can be incredibly helpful. I hope that by sorting out the IT issues with which the last Government struggled, we can help ambulance services to do that.
The Select Committee on Health heard evidence today from the College of Emergency Medicine about a 50% shortfall in trainee doctors and consultants. On average, trusts—I was going to say PCTs—spend £500,000 on locums. What does the Secretary of State intend to do about that?
We certainly intend to address A and E departments’ recruitment issues, which I recognise are one of the causes of the pressure. Over-reliance on locum doctors is not a long-term solution to improving the performance of A and E departments either, so those are both areas that we will be looking at.
(11 years, 5 months ago)
Commons ChamberFirst, I thank my hon. Friend for his extraordinarily tireless work and for the extremely measured and mature attitude he has taken to the problems in the hospital, which is on his patch. Hon. Members on both sides of the House welcome that. He is right about the role of the royal colleges. There are some challenging suggestions in the Francis report for some of those colleges, but when we are seeking to raise standards, it is important that setting up that scorecard for the new chief inspector happens with the help of the royal colleges, whose business it is to raise standards in the NHS.
I thank the Secretary of State for his statement, and we welcome the continuation of this discussion at the Health Committee. One of the recommendations of Francis was for the Secretary of State to look at the overlap between the CQC and Monitor, both of which were involved and have accepted they were part of the failings. Under the new inspection regime, will the chief inspector report to the Secretary of State or to the NHS Commissioning Board?
Neither. The chief inspector will report to the CQC. The hon. Lady is right that one of the problems is the overlapping roles and the confusion of roles. What we are announcing today is a significant change in the responsibilities of the CQC. It will no longer be involved in putting right problems in hospitals: its job will simply be to identify problems, so it is not compromised in its ability to be the nation’s whistleblower-in-chief. The responsibility for putting right problems will lie with Monitor, the NHS Trust Development Authority, the NHS Commissioning Board and the wider NHS system. We want to make sure that the chief inspector is unconstrained and unconflicted, when his or her team goes into hospitals, from shouting loudly if there is a problem and continuing to shout loudly until it is solved.
(11 years, 7 months ago)
Commons ChamberHow will the Secretary of State assess the effect of the cancer drugs fund on cancer survival rates?
(11 years, 9 months ago)
Commons ChamberThere is something critically important in the mandate that will do that, which is that by making the NHS operationally independent we are giving commissioning responsibilities to local GP-led groups for the first time, and GPs understand the importance not just of primary care but of prevention. So I think we will see much more innovation, along with the co-operation that the NHS has with local authorities and the new health and wellbeing boards, to make sure that there is a much bigger focus on prevention than there has been in the past.
Will the Secretary of State confirm that if there is an underspend in the NHS Commissioning Board financial allocation, that will stay in the NHS and not go back to the Treasury?
As the hon. Lady knows, we manage our finances extremely carefully but we do have underspends. We try to minimise them and there has been a real-terms growth in spending—actual money spent in the NHS, compared with Labour’s plans. In the first year of the review there was a real-terms increase and we will continue to manage NHS finances with a commitment to protecting the budget, which did not ever happen when the right hon. Member for Leigh was in post.
(11 years, 10 months ago)
Commons ChamberGiven the apparent increase in spending in the NHS and the £4 billion surplus, will the Secretary of State look at lifting the pay restraint for lower-paid workers, to increase morale and boost productivity?
The £12 billion increase in spending on the NHS under this Government, which the right hon. Member for Leigh (Andy Burnham) thought was irresponsible, means that we will be able to do a lot more for patients, but there is also rising demand. If we do not have that pay restraint, we will not be able to meet the needs of an ageing population.