Oral Answers to Questions

Yvette Cooper Excerpts

Tuesday 18th June 2019 Commons Chamber

[Matt Hancock]

I have had those discussions, and the Migration Advisory Committee has raised a specific concern about social care. We need to deliver better social care, with people coming from all around the world in addition to domestically trained people. I take on board my hon. Friend’s point.

[Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)]

Pinderfields Hospital in Wakefield has struggled to retain midwives. As a result, the trust has proposed to cut and close the popular midwife-led maternity unit in Pontefract. Local mums are up in arms, as it is completely unfair. We keep seeing this pattern. When the NHS is under pressure from austerity, from shortages or from management issues, it is the services in towns that are hit. What will the Secretary of State do to make sure we have enough midwives across the country so that we can keep Pontefract’s midwife-led unit open and so the NHS can continue to sustain services that are vital to our towns?

[Matt Hancock]

The right hon. Lady, as always, puts the case for Pontefract very powerfully. The truth is that we will need more nurses and more midwives, as well as other health professionals, over the next five years because we are putting in a record amount of funding. More people are needed to deliver better services, and I am happy to meet her to discuss this specific case. Coming from and representing towns myself, I understand the importance of keeping services such as maternity services close to the people they serve.

Interim NHS People Plan

Yvette Cooper Excerpts

Wednesday 5th June 2019 Commons Chamber

[Stephen Hammond]

Again, my hon. Friend was absolutely right at the start of his question to point out that this is a key stepping stone to making sure that the long-term plan works. He is also absolutely right to point out that we recognise and have taken extraordinarily seriously the difficulties that a number of clinicians have had with the pension tax changes. He will know from his time in the Department that we have been in continuous discussions with the Treasury about what options may be available. I have set out today that the consultation will propose a new 50:50 option for higher-earning clinicians to halve the rate of pension growth in exchange for halving contributions. I accept that that is only one part of the solution, but it is a step forward. I welcome contributions to the consultation, and I urge him and his consultants to take part.

[Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)]

In our area, GP practices have had serious problems recruiting, and one constituent has contacted me about surgeries being cancelled and having been told that the next routine appointment, for what is actually a serious condition, will be in August. My constituents cannot wait that long for GP appointments. Frankly, Ministers have had nine years to anticipate this crisis, and instead of making things better, they have in fact made things worse, with the King’s Fund warning that GP shortages could treble in the next five years. Frankly, the warm words the Minister has said are not urgent enough and not substantial enough to turn this around, so what is he going to do in the next six months to make a difference to my constituents, who are waiting far too long for important appointments?

[Stephen Hammond]

The right hon. Lady is right to be angry because her constituents should not be waiting that long. If she wishes to speak to me afterwards, I will take that up directly, with her, on behalf of her constituents.

The right hon. Lady says that we are not taking this seriously and not acting urgently enough. She will know that this interim people plan makes sure we will have not only more people recruited to the NHS, but more people wishing to stay working within the NHS. One of the key issues the NHS has faced is that a lot of people have decided not to work within it, and the key part of the people plan—this being the interim before the final is published later—is actually about ensuring we have more staff there. I reject what the right hon. Lady says. We are taking this seriously, and we are acting on it now.

Social Media and Health

Yvette Cooper Excerpts

Tuesday 30th April 2019 Commons Chamber

[Matt Hancock]

My hon. Friend is a man after my own heart on this. Am I convinced? I am convinced that social media companies have committed to it, and it is our job to keep them to those commitments. That is why I have pushed for a long time for a statutory regulator in this space, and I am delighted that the Government are bringing one forward.

For years, we in the House asked social media companies to do something, and there was an argument that, because they are global, we cannot really impact how their algorithms work. That is just rubbish. We are the legislator for this country—we set the rules, and we have a big role in setting the norms and expectations of what happens here. Just because a platform is global does not mean that it can be outside the rule of law of this country, so we will legislate in this space, and there will be a regulator that will be able precisely to keep track of those commitments and make sure that they are followed up. Having said that, the last two meetings have been positive, and we have seen changes as a result. What we have not yet seen is all this content being removed, so there is clearly a long way to go.

[Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)]

I welcome the work that the Secretary of State is doing. However, following the question of the hon. Member for East Worthing and Shoreham (Tim Loughton), a fellow member of the Home Affairs Committee, surely it is time to do much more on these algorithms, which push people into more and more extreme behaviour? I heard from a mum whose daughter had suffered from an eating disorder who was still being targeted with dieting videos on Instagram. That material was not too extreme to remove, but it certainly should not have been targeted at her daughter. The mum could get nothing done about it.

Our Select Committee staff set up a new YouTube account and were searching for news or politics, but they were increasingly targeted by extreme far-right material promoted by YouTube. Those algorithms push people to extremes—for profit. Surely it is time for much greater transparency and accountability on the entire business model and the way that it promotes all sorts of problems?

[Matt Hancock]

The short answer is yes. My responsibilities as Health Secretary are to do with the impact on health, especially mental health, and eating disorders and self-harm are part of that. A separate but connected matter is anti-vaccination messages, which are a type of misinformation, or in some cases disinformation —actively pushed false information.

The social media companies say that they are removing this material from being promoted. For instance, graphic self-harm imagery will be taken down from Instagram. Our challenge is to make sure that that is done properly, because ultimately only if social media companies change their algorithms can we make this happen. That is why the new regulator is so important.

Oral Answers to Questions

Yvette Cooper Excerpts

Tuesday 23rd October 2018 Commons Chamber

[Stephen Barclay]

First, may I pay tribute to my hon. Friend, who has campaigned assiduously on behalf of her constituents? She has lobbied me and the Secretary of State and made her case very powerfully to NHS leaders. There has been progress: three additional consultants have been hired and attempts made to recruit middle-ranking doctors to the trust, including from neighbouring trusts. We are making a significant capital investment in the Shrewsbury and Telford Hospital NHS Trust, and these changes must be seen in the light of that.

[Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)]

rose—

[Stephanie Peacock (Barnsley East) (Lab)]

rose—

--- Later in debate ---

[Matt Hancock]

My right hon. Friend makes a very important point, which is that, while we drive to ensure that the NHS is prepared as possible for this winter, it is incumbent on everybody to exercise their judgment, yes, to access the NHS where it is needed and important, but also to make sure that they bear a personal responsibility, too.

[Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)]

The Mid Yorkshire Hospitals Trust is proposing to close our midwife-led maternity unit, telling me that, while it is safe, unless it has 500 births a year, it is not value for money. Is that a new national standard for midwife maternity units, because if so it would close 90% of free-standing units? Will a Minister meet me on this matter, because it is unfair on local parents, and, frankly, we are sick and tired of losing services from our towns?

[Stephen Barclay]

I am happy to meet the right hon. Lady and to discuss the matter further.

Clinical Waste Incineration

Yvette Cooper Excerpts

Tuesday 16th October 2018 Commons Chamber

[Stephen Barclay]

My hon. Friend is absolutely right to focus on that. The key risk in respect of this supplier was that the NHS’s ability to continue to perform operations would be affected if it could not clear its clinical waste. I am happy to reassure her that all 17 trusts affected have been able to maintain their services, which ultimately is the key issue for patients and our constituents.

[Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)]

Can the Minister confirm that the staff are being offered TUPE transfers? I have heard from constituents who have been told that they are not, and clearly it is completely unfair for staff to be stuck in limbo like this. Can he say whether he has considered breaking up the contract and treating incineration separately, what the additional cost of the new contract might be and which part of the NHS is paying?

[Stephen Barclay]

The right hon. Lady raises an important point. I am happy to meet her to discuss these issues, given her constituency interest. I understand that she met members of staff on Friday. I very much urge HES employees who are listening to the debate to phone Mitie’s dedicated helpline and provide their details. The key issue is that Mitie has requested information from HES that it has not provided. To assess whether TUPE legally applies and the work patterns and issues of the staff involved, Mitie relies on HES providing information that, to date, has not been provided. The key issues in giving reassurance to staff are for them to contact the helpline and for HES to provide the information requested.

Dangerous Waste and Body Parts Disposal: NHS

Yvette Cooper Excerpts

Tuesday 9th October 2018 Commons Chamber

[Stephen Barclay]

I am grateful to my hon. Friend for her question, and I am happy to give her constituents an assurance that there has been no risk to patients at any point during this time. As for lessons learned, clearly we will need to look at some of the lessons, particularly what triggers a breach of contract. A series of contracts were held by a wide number of trusts with the supplier, and it is important that we look at what the notification periods are, what the monitoring and enforcement processes are, and what powers there are under the terms of the contract to ensure that the company is acting as it should.

[Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)]

We still do not have the basic facts about what medical waste is being held at the Normanton site, how far over the environmental limits it currently is, and what the timetable is for compliance. Perhaps the Minister would share that information with us. Does he not accept that it is a basic principle that, when dealing with any kind of public health or environmental health risk or incident, proper, full, factual information is provided to the public and the community at the earliest possible opportunity? You do not hide behind contractual negotiations. Does he accept that there is nothing in the contract negotiations that would have prevented him or the Health Secretary from providing some basic facts about those risks much, much earlier than today?

[Stephen Barclay]

On the split to which the right hon. Lady referred between clinical waste and other waste at the Normanton site—she rightly focused on that for her constituents—just under a third of the flow of waste to the site is clinical. Just over two thirds, in my understanding, is non-clinical. It is not the case that all the waste on the Normanton site is clinical waste. As I have mentioned, some media reports about what the term “clinical waste” constitutes are slightly different from the reality.

As for notification, I set that out in my written ministerial statement and in my comments today. The key focus is on maintaining the continuity of operations and service within the NHS trusts so that we are not in a position where clinical waste cannot be cleared from them. That is the focus, and that is why, given the commercial negotiations and the contingency arrangements that have been put in place, we came to the House today, and not at an earlier point.

NHS Winter Crisis

Yvette Cooper Excerpts

Monday 8th January 2018 Commons Chamber

[Mr Dunne]

My hon. Friend is a consistent champion of efforts to improve health facilities in her constituency. I am acutely aware of the challenge of medical training places in Canterbury, which was one of the reasons that we met last year to discuss what could be done to encourage medical students to come to Kent. I am not able to give her any specific guidance on the allocation of new medical training places because that recommendation will be coming to me over the next few months from Health Education England. We look forward to making decisions on that, and I specifically included in the criteria that rural and coastal areas should have good representation.

[Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)]

The Minister will have seen the images of patients at Mid Yorkshire Hospitals NHS Trust sleeping on the floor because they could not even get a trolley, never mind a bed. We have had over 95% bed occupancy rates and a shortfall of over 200 nursing vacancies, and we will have a multimillion-pound budget shortfall by the end of this year. The Health Secretary and the Prime Minister have been repeatedly warned about this by nurses and doctors at Mid Yorkshire trust and across the country, by the public and by the NHS chief executive, yet they still decided to deny him the funding he needed at the Budget. How many more patients will have to sleep on the floor before this Government act?

Contaminated Blood

Yvette Cooper Excerpts

Thursday 20th July 2017 Commons Chamber

[Jackie Doyle-Price]

I am keen to hear from all Members of the House and members of the public on how they feel the inquiry should be taken forward. That is the spirit in which we are embarking on this consultation.

[Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)]

I welcome the Government’s decision to hold this inquiry in response to the campaign led by my hon. Friend the Member for Kingston upon Hull North (Diana Johnson). I know that the Health Minister is acting in good faith, but over many years Department of Health officials have advised there is no need for the inquiry and no problem at the heart of the issue. Will she recognise that because of that it would have much greater credibility for many of those who have campaigned on this issue if the sponsoring Department were another Department—be it the Ministry of Justice or the Cabinet Office—if all the staff did not come from the Health Department, and if one of the other Departments could be involved in the consultation, the establishment and the remit. This is no criticism of her—I know she takes this very seriously—but I advise her to hand this one over to another Department and let them run with it instead.

[Jackie Doyle-Price]

I understand the right hon. Lady’s point and I repeat that the Cabinet Office is closely involved with this at this stage. I think she would consider it most remiss of me were I not to take a close interest as this consultation is taken forward. I cannot say this enough: it is essential that the way in which the inquiry is established inspires confidence in the people affected, and that is what we are trying to achieve through the consultation. As I say, we want to hear from them and we are completely open-minded as to which Department takes responsibility. For now, I want to have those conversations because I want to understand their concerns with what has happened with the Department of Health. As a Minister, I need to give that challenge.

Mental Health and NHS Performance

Yvette Cooper Excerpts

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

I think my hon. Friend’s constituents in Wales would be appalled by the reaction we have just had. Labour Members stand on their high horse in complaining about NHS care in England, but when he brings up poor NHS care in Wales, they tut and make noises as though they do not want to hear about it. If they care about NHS patients, they should care about them throughout the whole of the United Kingdom. I am afraid that that just shows the party political agenda. Yes, my hon. Friend is right: NHS care in Wales is worse, and Labour needs to do something about it.

[Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)]

I have been contacted by several constituents who have spent 14 hours in A&E waiting for a bed. As well as by social care cuts, we have been hampered by a shortage of A&E doctors. The Department of Health was warned that that would become a growing problem over five years ago, and the Health Committee warned about it again last year. When will this shortage of A&E doctors be ended by the Government—by the summer, by next year, by the following year? The Secretary of State has had seven years. When will he deal with the shortage of A&E doctors?

[Mr Hunt]

Let me tell the right hon. Lady what we have done about A&E doctors. Their number has gone up by 1,200 since 2010, which is an increase of over 50%. The number of A&E consultants has gone up by 500, which is an increase of over 20%. At the same time, we have recruited 2,000 more paramedics. As a result of those changes, our emergency departments are seeing—within the four-hour target—2,500 more people every single day compared with 2010. That is not to minimise the pressures in the NHS we have had over the winter or to say that there is not more that needs to be done, which is why I outlined a number of things in my statement.

Mid Yorkshire Hospitals NHS Trust

Yvette Cooper Excerpts

Thursday 21st July 2016 Commons Chamber

[Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)]

I wish those Members departing the Chamber a good summer and thank you, Mr Speaker, for granting me the final debate before the summer recess. I also welcome the new Minister to the Dispatch Box.

I called this debate, following the one brought a few months ago by my hon. Friend the Member for Dewsbury (Paula Sherriff), because she, I and many Yorkshire Members are deeply concerned about the staffing levels not just at the Mid Yorkshire trust but at other hospitals across Yorkshire and the serious effect they are having on our health service. We have warned Ministers before about this, but we are deeply concerned that nothing is yet being done. Things will get worse if action is not taken.

Last year, I was contacted by a constituent, Mr Fanshawe, whose mother-in-law, Edith Cunningham, had recently died at the end of a short illness in Pinderfields hospital. As well as dealing with the grief and bereavement, Mr and Mrs Fanshawe were having to cope with the deep distress and anger caused by the way in which Mrs Fanshawe’s mother was treated and the care she received, in her final days and hours, because of serious staff shortages at the hospital.

Nursing staff were so overstretched that, at one point, Edith Cunningham had to wait two hours for a bed pan—two hours for an elderly lady in distress—and one weekend she had to wait 25 hours to see a doctor. It became clear to the Fanshawes that the staffing shortages on the ward were such that they could not leave her, so they stayed; they did her bed pans, they fed her, and when the pressure mattress they had requested was brought up, they changed it themselves, because there was no one else to do it.

I have met the Mid Yorkshire trust and the Fanshawes, and the chief nursing officer has given them a full apology and made it clear that it was an unacceptable level of care and that it was the result of staffing shortages on ward 43 at the time. Since then, the trust has continued to work on a wide range of recruitment and staffing initiatives to improve the situation.

[Paula Sherriff (Dewsbury) (Lab)]

I thank my right hon. Friend for calling this important debate. As she alluded to, I had a debate on this issue in March, but sadly it appears that little progress, if any, has been made. Last week, I attended a patient safety walkabout on ward 2 of Dewsbury hospital, and once again patients raised issues of short staffing. Several patients had been told not to ring their alarm bell at night because there was only one member of staff on duty. The number of beds on the ward had been increased from 24 to 30, but sadly no extra staff had been brought in to accommodate the extra patients. I plead with the Minister: we need tangible progress to ensure patient safety.

[Yvette Cooper]

My hon. Friend is exactly right. We hear continually from constituents often saying the same thing: the nursing staff are wonderful, look after them and work immensely hard, but are overstretched; there are simply not enough of them to do the job they want to do.

The trust has recruited not just locally but from across Europe and India, which has sometimes raised language issues. It is looking at new ways to recruit from the local area, and in some areas, the number of vacancies has fallen. It has also put in place processes to switch staff around to make sure that gaps are filled every day. I welcome the commitment by the chief nursing officer and the chief executive to do everything they can to fill the staffing gaps, but it is still not enough.

We agreed with the trust that the Fanshawes and the local health watch should be able to do an unannounced visit to ward 43, talk to parents and report on what they found. I quote from their report:

“Patients... reported kindness and very good care. Patients generally agreed that staff are lovely but are ‘run off their feet’”.

They found that staffing levels were better than last year,

“but it is still often a struggle and only rarely does the ward have the right quota of staff”.

Just this week, I received another email from another family with a relative in ward 43 raising serious alarms about the level of staffing on the ward and the level of care that their relative was being given. There were not enough healthcare assistants or nurses to provide the basic care and support needed. That fits with the findings last year of the Care Quality Commission, which also raised concerns about safe staffing levels. Once again, we cannot pay sufficient tribute to the kindness and hard work of the staff at the trust. However, when they are stretched in all different directions, it is in the end the patients who lose out and the staff who are deeply concerned because they are not able to provide the level of care that they want.

I am concerned, too, about the financial pressures on the Mid Yorkshire trust. It is not the only trust where the money received is simply not enough to meet rising demand. I suspect that the Minister will have been briefed on some of the financial pressures and the squeeze facing the Mid Yorkshire trust. There is a risk of services being cut not for sensible medical reasons, but simply because it does not have the funding or the staffing to provide them safely.

It is even worse than that. Even where the Mid Yorkshire trust has budgeted for the staff, it cannot recruit or retain enough to deliver the services in the way it wants and the way our communities need. The latest figures from the trust list 150 nursing vacancies: that includes healthcare assistants and safety support workers, and amounts to about 12% of budgeted posts. The vacancy rate for nursing staff in the theatre department is 17%, and it is 20% in intermediate care. If we take account of holidays, maternity leave, sick leave, stress, and temporary secondments to other departments, the gaps are bigger. Monitoring by department in May, which looked at the actual staffing relative to the planned levels wanted, showed cardiology at only 76%, stroke rehab at 65% and short stay at 70%.

The trust also measured unavailability, which encompasses the percentage of contracted hours lost owing to staff absence, including for sickness and stress. When some staff are working so hard, and some are also being moved around from one department to another in order to cope with gaps elsewhere, facing further stress and uncertainty, it leads to higher levels of absence.

[Paula Sherriff]

I shall try to be briefer in this intervention. I was recently contacted by Dewsbury hospital, and was told that, on any given day, the minimum staffing level in the A&E department is eight qualified nurses and four healthcare assistants or unqualified nurses. On this occasion, there were three nurses and one healthcare assistant. I think that speaks for itself; clearly, it will have an impact on patient safety.

[Yvette Cooper]

My hon. Friend is right, and these are the sort of individual examples that we increasingly hear about from our constituents—from both staff and patients. I have heard from staff in intensive care and in paediatrics who are deeply worried about the pressures and responsibility on them lest something should go wrong on their watch as a result of understaffing. They are deeply concerned that they will be unable to provide the care that is needed and are worried about the implications.

The trust’s planning guidance suggests that it can cope with up to 22% of the contracted hours not being provided and still provide a safe service. Beyond that, it shows that significant problems are likely to be encountered in delivering the right level of care. Overall, however, the gap is not 22%, but 26% for registered nurses and 30% for registered midwives. In A&E, the average shortfall in contracted hours is 30% and there is a similar 30% shortfall in children’s services. On some wards, the proportion of temporary staff from agencies and the NHS banks is particularly high. On acute assessment wards, 20% of the nursing staff are agency staff. On the short-stay wards, 11% of the nursing staff and 33% of the healthcare assistants are from agencies and the bank.

It is not just about the pressures on nursing staff. Senior staff at the Mid Yorkshire trust say that they are doing a huge amount of work to address the nursing shortages, but they are even more worried about the shortage of doctors—not just at Mid Yorks, but across Yorkshire. According to the Royal College of Physicians, 14% of the consultant posts at the Mid Yorkshire trust are vacant. In A&E and neurology, there is a particular problem, and there are regular and significant gaps in the contract rota for junior doctors. Some 15% of the acute medicine rota is not filled by contracted staff, and it is 18% for the emergency medicine rota, 20% for the anaesthetics rota and 20% for the surgery rota.

In practice, the trust is having to fill the rotas either with consultant staff acting down in more junior posts, or with locum staff. It is a choice between doing that and cancelling operations, or turning ambulances away. The trust is, of course, is committed to providing the best service that it can provide and not letting patients down, but locum care means that medical staff do not have the relationships or the knowledge of the system that would enable them to do the best possible job, and it costs far more as well. Because the trust cannot recruit enough contracted staff, its average spend on agency doctors in the first three months of the current financial year was £1.5 million a month—and, as we know, it is a trust that faces significant financial pressures. So what is it supposed to do?

However, this does not apply only to Mid Yorkshire Hospitals NHS Trust. In the country as a whole, two in five vacant consultant posts went unfilled last year, according to the Royal College of Physicians. In the north of England, there are serious staff shortages in our hospitals. That is what we hear from our constituents. My hon. Friend the Member for Dewsbury spoke of appointments being cancelled and waiting times being affected. What troubles me particularly is the fact that there is now a 20-week wait for the pain clinic. Because of staffing problems, patients who are suffering pain and could be supported and helped are having to wait 20 weeks to be seen.

What are the Government doing about this? All too often Ministers shrug their shoulders and think that it is someone else’s problem, or that someone else will sort it out. I contacted the Secretary of State in 2010 and 2011 saying that the training numbers that were being set by the Yorkshire and Humber Deanery, particularly for A & E, were not enough, and were certainly not enough to meet rising demand, but nothing was done. Given the scale of rising demand for healthcare and given our ageing population, far too few doctors are being trained. There is also a significant and serious regional disparity, with bigger shortages in the north and the midlands.

It is incomprehensible, given all those pressures, that the Government should choose this moment to pick a major fight with junior doctors that ends up demoralising them, and drives many of them to consider either going abroad or leaving the profession altogether at a time when we need every doctor we can get.

The Department of Health is also taking a massive risk when it comes to nursing staff. It is ending nursing bursaries, although in areas like ours that means that many people who could have become great nurses will be put off because they are worried about the debts that they will incur, and about not being able to afford the training. It is also refusing to give a proper assurance to the thousands of European Union citizens who work in the NHS—our trust has often recruited such people because of the shortages at home—that they can stay and fill those crucial posts.

Referring to nurse training, the Minister who responded to the debate initiated by my hon. Friend the Member for Dewsbury a few months ago said:

“Within the current spending envelope…it is simply not going to be possible to achieve the numbers that we wish to see.”—[Official Report, 21 March 2016; Vol. 607, c. 1354.]

That is not good enough. We need enough nurses, and enough doctors, to provide the care that our constituents need and deserve. That cannot simply be left to Mid Yorkshire Hospitals NHS trust, or to any individual trust in the country.

So many of the issues are linked, whether we are talking about the training numbers on which the deaneries decide or decisions made by the Department of Health that have an impact on morale, pay or incentives throughout the country. We now need a regional action plan setting out what the Government are going to do, and what NHS England is going to do, to address the serious shortages of both nurses and doctors in Yorkshire, because unless something is done, something serious will happen to patient care. I do not want to warn again about this, as I did some years ago, but it still has not been sorted out, and that is not fair on patients in Yorkshire and throughout our area.

In the case raised by Mr Fanshawe, Edith Cunningham had a family who stepped in and looked after her while she was in hospital, but many more patients do not have families who can fill the gaps and step in. So for the sake of all of those patients, and for all of those who we—all of us in all parts of the House—will want to get the best possible care, I urge Health Ministers to get a grip on this and get us the regional action plan we need, before patient safety is affected.

[The Minister of State, Department of Health (Mr Philip Dunne)]

May I start my remarks by saying what a pleasure it is to be here this evening for my first opportunity at the Dispatch Box in my new role at the Department of Health?

I congratulate the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper) on securing this debate on a subject that I know is close to her heart and that of her neighbour, the hon. Member for Dewsbury (Paula Sherriff), who it is good to see here supporting her in the Chamber this evening. I congratulate the right hon. Lady in particular on securing this debate, the last opportunity to raise a subject in the House this side of September.

I am well aware that this is a matter of significance to Members of Parliament and obviously to the local populations they represent. I think the hon. Member for Dewsbury recently persuaded the Mid Yorkshire trust to have a public meeting to discuss these issues locally, and I congratulate her on doing that, and hope it was helpful in at least raising some of these issues.

The problem of staff shortages at Mid Yorkshire is well known, and it is recognised not just by local Members of Parliament, but was demonstrated by evidence recorded by the CQC through its inspections over recent years, not just the most recent one. Having said that, there are of course examples of good care within the trust, and I would like to add my voice to that of the right hon. Lady who acknowledged that from the comments of, I think, the Fanshawe family, who pointed out that the quality of care provided by the nursing and other staff in the hospital is very high where they are in a position to do that. I pay tribute to everyone who works in the trust—in the hospitals there—in the admittedly somewhat challenging circumstances they find. I draw attention in particular to the maternity services and children’s services, where the standards are acknowledged to be high.

There is no hiding the fact that there are problems, however, and I am not here to do so. Unsafe care was found in the most recent CQC inspection last summer, published in December last year. That is clearly the most potentially serious of its findings. This is a long way from being a high-performing trust, which is what we would all like our trusts to be. While the CQC report shows the trust had responded to previous staffing concerns and is actively trying to fill posts, there are acknowledged areas of significant nurse staffing shortage affecting patient care and treatment, particularly on the medical care wards and in community in-patient services and specialist palliative care.

The right hon. Lady may not appreciate hearing this, but the fact remains that responsibility for staffing in hospitals in her constituency sits squarely with the board of the Mid Yorkshire trust. Trusts have a duty to ensure they have the numbers and skill mix needed to deliver quality care, patient safety and efficiency, taking into account local factors such as acuity and case mix.

[Yvette Cooper]

But what if there just are not enough A and E doctors or neurology doctors to fill the posts? If they advertise them, charge around the country recruiting for them and they still cannot get the doctors in, what are they supposed to do?

[Mr Dunne]

I will come on to what we are doing nationally to try to make sure we have an adequate number of trained professional clinicians to meet the needs around the country.

It is important to recognise that while nationally some standards are set for safe staffing ratios, which were referred to by the hon. Member for Dewsbury, these are not a hard-and-fast rule and never have been. They are guidance rather than statutory requirements, and this position has not changed. Trusts have to use their judgment and focus on quality of care, patient safety and efficiency, taking into account local factors such as case mix rather than just numbers and staffing ratios. It is not a case of meeting a particular staffing ratio or getting to a particular figure and thinking that the matter is resolved. There must be enough staff—as both hon. Members are saying—to meet the needs of the patients, and it is a matter for the clinicians on the spot to make a judgment on that.

Nationally, demands on our staff across the NHS are rising, and more patients are being cared for than ever before. That is as true of Mid Yorkshire as it is of anywhere else in the NHS. Last year, across the Mid Yorkshire Hospitals NHS Trust, 232,966 patients were seen, compared with 194,119 in 2009-2010. That is an increase of more than 15% over the past six years. There were also some 4,685 more diagnostic tests carried out in May this year than in May 2010. Activity levels are therefore rising considerably.

[Mr Dunne]

It is well recognised across the country that the tendencies in A&E include a significant proportion of people who should not be there and who should be being dealt with elsewhere in the system. The reasons for that are legion; it is not all down to pressures on GPs. Much of it is down to members of the public increasingly seeing their hospital as the place to go. We have a big educational job to do across the country on that, and it behoves all of us to help to relieve the pressure on A&E by encouraging patients to get their health needs seen to in the most appropriate place, whether through a pharmacy or a GP, or through other community services.

I want to touch on the question of funding. It is not all about money, but money plays a part. As a result of the funding settlement that we have secured for NHS England, the Wakefield clinical commissioning group will receive £488.8 million in 2016-17—the current fiscal year—which represents a cash increase of just over 3% compared with the previous year. In cash terms, that is a £21.7 million increase—a significant increase compared with previous years. For North Kirklees, the other CCG that commissions the work of the trust, there was also an increase in the current year to £237.1 million, representing a 2.49% increase compared with 2015-16, or just a shade under £12 million. That increase is substantially greater than the deficit reported by the Mid Yorkshire trust for last year. Of course, the commissioning funds do not all go to the trust, but the health economy in the area has received a significant cash injection.

Ensuring that we have the right number of nurses —I shall start with nurses—is a vital move towards achieving the Government’s objective of having a fully seven-day NHS by 2020. Nationally, we already have 11,800 more nurses, midwives and health visitors than we did in May 2010. The number of nurse training places has increased by 14% over the past three years alone, with further increases planned in the current year. More than 50,000 nurses are currently in professional training, which includes working and learning in hospitals through placements. However, the current funding system means that two out of every three people who apply to a university to do a nursing degree are not accepted for training. That is one of several reasons why trusts such as Mid Yorkshire find it difficult to recruit.

In 2014, the last full year for which I have statistics, universities were forced to turn down 37,000 nursing applicants. As a result, the NHS suffers from a limited supply of nurses and must rely on expensive agency staff and overseas workers, as referred to earlier. That is one reason why, earlier today, the Government announced their response to the public consultation on plans to place trainee nurses in the same system as all other students, including teachers and doctors. That response has been placed in the Library.

[Yvette Cooper]

I thank the Minister for his generosity in giving way. Will he confirm that the reason universities were forced to turn down so many would-be nurses was that the Government did not fund enough places? I realise that he is new to the Department and will not have had a huge amount of time to investigate staffing levels around Yorkshire, but when he goes back to the Department I urge him to look at whether there could be a Yorkshire action plan on recruitment. We have a regional problem that is worse than the national problem—although it will be replicated in other regions.

[Mr Dunne]

I will come to how we will respond when I conclude my remarks, but the right hon. Lady is quite right to point out that the problem is not unique to this particular trust and must be seen in a regional context.