NHS in London

Paul Scully Excerpts

Thursday 24th March 2016 Westminster Hall

[Paul Scully (Sutton and Cheam) (Con)]

It is a pleasure to serve under your chairmanship, Mr Turner. I start by congratulating the hon. Member for Ealing Central and Acton (Dr Huq) on securing the debate. I was delighted to support her bid to the Backbench Business Committee to have the opportunity to debate this incredibly important subject. The NHS is source of great pride. Londoners are particularly protective of healthcare in their area, and none more so than the people of Sutton. I shall speak about my local area, but I think the story and the issues are the same throughout London.

For many years, people in Sutton have talked about St Helier hospital as the focal point of the community and of local healthcare. I serve as a volunteer at the hospital—I go regularly to feed people on the stroke ward—and I try to continue doing that even now I have been elected to Parliament, as it gives me a great opportunity to go in and see people on the front line. My family have also used the hospital. Before the last election, the right hon. Member for Doncaster North (Edward Miliband) weaponised the NHS. I tend to weaponise my mum’s use of the NHS. She has been brought in from sheltered accommodation, having taken a couple of falls, and when she injured her hand and fractured her hip, St Helier treated her really well. The hospital has a particularly good hip fracture unit that is renowned across London and, indeed, across the country.

Epsom and St Helier University Hospitals NHS Trust is predicted to run a deficit this year, despite hard work to try and break even, as it did last year. Opposition Members may use that as a brickbat to throw at the Government in respect of funding, but they fail to look at some of the symptoms behind what is happening in St Helier hospital in particular. The building has been crumbling for many years and is getting beyond use. For as long as I have lived in Sutton, which is about 26 or 27 years, there has been a political campaign, primarily by the Liberal Democrats in my area but involving other parties too, trying to “Save St Helier”—scaring people into believing that the hospital is to close imminently. Using the hospital as a political football has resulted in a failure to get some sort of consensus or agreement on how we can protect healthcare and build a really effective healthcare system in Sutton.

The trust has that deficit and the chief executive will need to tackle it without compromising quality.

[Clive Efford]

On the threatened closure of St Helier hospital, perhaps I have been in this place for longer than I should have been—[Hon. Members: “No!”] Thanks, I was hoping to get that response. I seem to remember that a Minister resigned in order to fight the campaign to defend St Helier hospital. He should have known what he was talking about, because he was a Health Minister at that time.

[Paul Scully]

Obviously he did not, which is why I won the election against him—[Interruption.] It is funny. I think the tale was that he resigned, but I do not know a lot of Ministers who would resign to save a hospital when they were one of the Ministers in charge. Others have reported that he was sacked. I do not know the truth, and I am not sure we will ever know.

[Stephen Hammond (Wimbledon) (Con)]

For the sake of clarity, I am in the next-door seat to my hon. Friend and many of my constituents look to St Helier hospital. An outrageous campaign was run by the Labour party in 2014, completely without foundation, about the hospital closing. It was at the time of the local government elections, when the Government, all the management of St Helier and all the board papers showed that there was no plan to close the hospital. It was exactly as my hon. Friend says: a scare story.

[Paul Scully]

I am grateful to my hon. Friend for making that point, and he is absolutely correct. It is why we need some degree of certainty. For many years now, we have had such things as “Better Healthcare Closer to Home” and “Better Services Better Value”—an alphabet soup of NHS changes, with no degree of certainty for residents or staff in that hospital. A lot of the BSBV review was clinician-led, but it was based on the premise that they wanted to concentrate consultants in certain places—in my case, at St George’s hospital in Tooting—because they did not have enough consultants in each of the different hospitals seeing enough of the more unusual cases; they wanted to concentrate expertise.

Imagine a whole load of politicians in Sutton telling residents time and again that the hospital is about to close, as my hon. Friend just said. Where would a newly qualified consultant want to go and practise? Would they want to go to a hospital that they are being told is about to close down, or would they go just up the road to one that receives all the plaudits and which has all the concentration of expertise? I know what I would do. If people talk down their local hospital and healthcare, it may become a self-fulfilling prophecy. They may be in danger of getting a result that is exactly the opposite of what they seek.

[Ruth Cadbury]

The hon. Gentleman is making a point, but some services have moved or closed without political problems because the people who used them and valued them realised that change was necessary. I suggest that the change in stroke and trauma services in recent years was right—fewer, larger, better. I also suggest that the opposition to changes the hon. Gentleman describes is caused by genuine worry that the solutions will not provide the adequate future service that we all want for London. In addition, in recent years we have seen a significant rise in population in London. We do not oppose that per se, but the health service in all its facets should be seen to be growing to accommodate that rising population.

[Paul Scully]

The hon. Lady makes some interesting points. There have been changes and closures in Sutton. The stroke service was one, and it made sense to provide immediate treatment at St George’s although it was further away, because those first few hours are crucial. Several smaller hospitals also closed over many years. However, I return to the changes and closures of A&E and maternity services to concentrate them at St George’s. Although it is only a few miles away, in rush hour traffic it takes those without the ambulance service’s blues and twos a long time to get to St George’s. If politicians were concerned, I would have thought they would do a more effective job than just trying to get tens of thousands of signatures on a petition aimed at the primary care trust. It took so long that the petition was still being presented two and a half years after PCTs were abolished in favour of CCGs. Effectively it was a data-harvesting exercise to extract a whole lot of email addresses that could be used in a political campaign and as a political football. The NHS is inherently political, but sometimes we must take the party politics out of it and focus on healthcare and what we have to do to best treat patients in a local area.

As I was saying, the St Helier building is fast becoming not fit for purpose, with 43% of the space having been deemed functionally unsuitable. That is no way to provide 21st century healthcare. The hospital predates the NHS by some time. The huge white building on a hill was used by German fighters to line up as they were coming to London on their bombing raids.

I look forward to plans being produced, using any capital funding we can attract from the Government in a cost effective way, so that it is not too onerous for the Treasury, to make use of all the component parts of the Epsom, St Helier and Sutton hospital sites. Businesses, the Royal Marsden hospital and the Institute of Cancer Research are sited there and the NHS is planning an exciting project—a London cancer hub—to attract even more world-class research. The Institute of Cancer Research and the Royal Marsden have a world-class reputation and it would be fantastic to expand it, but the Royal Marsden needs acute facilities to support treatment there. If we can use that huge space for healthcare for the borough as well specialist healthcare, that would be brilliant.

The “Save St Helier” campaign is great in theory, but there are some holes in the plans and there may be unintended consequences resulting in the opposite of what we want. With the “Better Services Better Value” campaign, the fact that St Helier sits between Kingston hospital, St George’s hospital, Croydon University hospital and Epsom hospital means it is always at threat because of the way the catchment area is designed. The trust is acutely aware of that. We want St Helier to be meshed into the London cancer hub with an integrated approach.

We have heard that the NHS can be somewhat bureaucratic. A few years back, I was at a hospital that closed—Queen Mary’s hospital for children. It was eventually sold for a secondary school and housing in Sutton, but it took two years and £1 million in legal fees for two public bodies, the local authority and the NHS to agree terms. The lawyers got the money and children were not educated there for another two years at a time when there was a shortage of school places. Cutting through that bureaucracy and making sure we get the healthcare we want without having to go through the 11 tiers to which my hon. Friend the Member for Harrow East (Bob Blackman) referred would be fantastic.

We have heard a little about the difficulties of getting GP appointments and how infrastructure in London does not always keep up with planning and the need for housing. Sutton is no different. Worcester Park is one of the densest wards on the border with Kingston and has two vets but no GPs. I am not sure what that tells us about Worcester Park, but there is certainly a lack of planning somewhere.

I live in Carshalton and the one Liberal Democrat MP who was here is my MP. There is a health centre and it is a good example of how we might roll things up across Sutton and other areas. Two practices have come together in a purpose-built building with a shared practice, so it is slightly easier to get an appointment, although it may be not with one’s named doctor, but with one of their colleagues. People can wait to see their named doctor, or they can get a reasonably quick appointment if it is an emergency; they can have blood tests, antenatal care and vaccinations. I recently had a rabies vaccination there—for a trip to Burma, not because of the prospect of facing hostile Opposition Members. The range of facilities helps to keep people away from A&E.

I have visited several pharmacies in my local area. They are concerned about closures, but the Minister has talked about putting in extra funding and integrating the pharmacy service as an alternative first port of call.

[Dr Huq]

I understand that the block grant that pharmacists receive for things such as driving around delivering medicines is being cut by 6%.

[Paul Scully]

My understanding is that that may vary from pharmacy to pharmacy. It is important that, however the block grant is carved up, we can offer the range of services in any area. I was at a pharmacy last week that had a needle exchange programme, but another just round the corner does not offer that. It is important to have a range of services in a given area.

[Heidi Alexander]

The hon. Gentleman is referring to community pharmacies. One of the latest estimates of the Government’s proposals is that up to 3,000 community pharmacies could close. What impact does he believe that would have on his constituents?

[Paul Scully]

The pharmacists raised that with me last week, and I am meeting a delegation of them next week as well. Rather than an estimate, I want to see more detail on that to work out how we can give pharmacies more information, data and space to use their consulting rooms, to make them the true first port of call. It occurs to me that people tend to look to their GP when they are ill, whereas pharmacists—especially the ones that deliver and go into people’s homes—can see people in their homes and get indicators that may predict other illnesses. Any preventive measures that can be taken through community pharmacists would be very useful.

In conclusion, I come back to the fact that I really do not want to see hospitals and healthcare used as a political football in Sutton or across London. I want to ensure that we have excellent healthcare in St Helier, but this is not about saving St Helier per se. It is about saving and protecting local healthcare, so that every one of the 190,000-odd residents in the London Borough of Sutton can get easy access to a GP, a community pharmacy, A&E, maternity services, children’s services, daycare and the whole range of services in their local area. I want to ensure that they can do that not in a building that is making them feel worse by its very nature, design and crumbling fabric, but in a building that is designed to help them get better.

Sutton has made one innovation particularly well. It is one of two trusts in London that is running a vanguard scheme in nursing homes. That kind of innovation is really interesting: a group of nursing homes have got together in Sutton with the hospital trust; there are ward rounds in the nursing homes, so that the patients do not have to go into hospital. Although hospital is the best place to get treatment, it is not usually the best place to recuperate. The more we can work effectively out in the field—in people’s homes and in care homes— the better. I want that collection of innovations to develop over the next few years for excellent healthcare in Sutton.

--- Later in debate ---

[Mike Gapes (Ilford South) (Lab/Co-op)]

I am particularly pleased that you are in the Chair today, Ms Buck, because I am going to refer to St. Mary’s hospital and the Imperial College Healthcare NHS trust, which saved my life. You know it very well. This is my first speech or question in the House—apart from my earlier interventions —since November. My neighbour, the hon. Member for Ilford North (Wes Streeting) referred to my extended break. It was not voluntary or by choice.

I had been at a concert at the Royal Albert Hall—in fact, Jools Holland saved my life, because if I had not gone to the concert I would not have had friends with me during the events of that November evening. I was rushed by ambulance initially to Chelsea and Westminster hospital, where I collapsed. They scanned me and decided that I had such a serious ruptured thoracic aneurysm that they had to transfer me by ambulance to St Mary’s hospital in Paddington. I came to in the ambulance and I have a vivid memory of going down the ramp out of the ambulance into A&E at St Mary’s, where about 10 people were waiting. They ran me in the trolley straight into the operating theatre, where the consultant said, “I hope you don’t mind. We have injected you with the anaesthetic, but do you mind if we cut the shirt off your back, because we have got to start straight away? The anaesthetic will take a moment to work.” Then I heard a female voice saying, “I know this is hurting, but I’m sorry, I’ve got to do this.” Then I was unconscious.

I had a total of eight weeks in St Mary’s hospital, with five and a half weeks in the intensive care unit, for nearly three of which I was in an induced coma. I had a series of operations on my heart and a tracheostomy, which is an interesting experience whereby a tube is permanently inserted—or it seems as it if is permanent; fortunately it is not there any more. I had other operations while I was there, as well, so I am a bit bionic. I have not yet flown anywhere, and I am waiting to see what will happen to the metal detectors at the airport, because I have some stents that might cause some complications.

I was at the hospital this morning and they were pleased with my progress, so I am able to be back here in Parliament. I want to say thank you to all the staff —the consultants, the senior and junior doctors, the cleaners, the people who gave me my food, all the nursing staff, and the physiotherapists. They initially got me walking with a Zimmer frame, with oxygen cylinders first at 100% and eventually at 28%; they managed to get me to walk up some stairs, so I could be sent home. I pay tribute to them because it is a bit of a miracle that I am here today—I have been told that by at least two consultants. Most people who go into hospital with what happened to me do not come out, so every day from now on is a bonus.

I went in on a Friday night, in the early hours of Saturday morning—a weekend. We must not let anyone say we do not have a seven-days-a-week NHS. I have seen it. I have been cared for seven days a week, looked after and fed seven days a week, for two months. I have had the most excellent treatment. I have seen the 8 o’clock in the morning shift come on and then the 8 o’clock at night shift—12-hour shifts. I have seen the turnaround. Whether I was in the intensive care unit, the Charles Pannett ward or the Zachary Cope ward, I have seen the dedication and commitment of the staff. They come from all over the world. The nurses who treated me included a man called Riad, a Palestinian from Jordan, who was fascinated to know that I had been in Amman with the Foreign Affairs Committee four days before I went into hospital. There were nurses from Malaysia, the Philippines, Ireland, Ilford and many other places around the world.

The fact is that we in London depend on a pool of staff who have come to our city from all over the world to help us, to save us and to keep us well. We must never forget that. It is why the Home Office needs to understand that London’s success as a global city depends on the workers in London being healthy. As Anne Rainsberry told us in the meeting with London Labour MPs the other day, 20% of the people treated in London do not live in London. London serves the whole community. The vascular facilities at St Mary’s take patients from all over. I was told that even if I had had the heart problem in Ilford, I might still have been transferred to St Mary’s. The unit has patients from Southend, Newport in south Wales and even from Gibraltar.

That indicates to me that we have to retain the staffing levels and level of expertise in our specialist hospitals and in our specialist departments within London hospitals. That is not possible, as my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier) pointed out, if people cannot afford to live in London and if most newly trained nurses seek jobs elsewhere within two or three years. It is not because they do not enjoy their work, but because they cannot afford or are fed up with two or three hours of travel every day.

We have to deal with the problem, and it requires the new Mayor of London, all our local authorities and the Government to look at it seriously. It also requires the Home Office, after the European referendum, to think again about the absurd position where we will cut off our nose to spite our face by making it impossible in a shortage period to recruit people to certain occupations because of the £35,000 threshold.

[Paul Scully]

The hon. Gentleman is making an incredibly powerful speech and I am grateful to hear about his personal experience. On the shortage of nurses, while it is preferable to train people domestically, does the hon. Gentleman agree that where we cannot fill those places, the shortage occupation list—it is devised by the Migration Advisory Committee, which has placed nurses on the list—goes some way to mitigating the £35,000 criteria?

[Mike Gapes]

The interesting thing is that NHS nurses were not originally on that shortage list. There had to be a lobbying campaign to get them put in because of the stupidity of the people in the Home Office who drew up the list. The fact is that the £35,000 figure will present a problem. Obviously, it will not present a problem in recruiting doctors from abroad, but it is a significant problem in recruiting nurses and other people at lower wage levels. We need to raise that issue, because it will be damaging in the long term.

Of course we need to train more nurses, but to do so the Government need a consistent policy. It takes several years to train a nurse. It is not something that can be switched on and switched off. The other issue is retention. Large numbers of nurses leave our NHS and go and work in other countries. Just as we take nurses from other countries, so British nurses go abroad. There is no reason why that should not be the case; it is a global health economy and the reality is that if we do not pay the lower paid staff in the NHS what they need, we will not recruit sufficient numbers of people to do those jobs.

NHS Bursary

Paul Scully Excerpts

Monday 11th January 2016 Westminster Hall

[Paul Scully (Sutton and Cheam) (Con)]

I beg to move,

That this House has considered e-petition 113491 relating to the NHS Bursary.

As of this morning, the petition had 154,390 signatures, which shows the depth of feeling and the concern that student nurses have about the proposed policy. Before the debate, we had a fantastic listening exercise, which involved a number of student nurses and other representatives of the health industry, many of whom are here in the audience. Having filled the Public Gallery, we even have an overspill room elsewhere on the estate where the debate is being shown on television. It is a testament to the importance of the matter that so many Members of Parliament are attending the debate.

[Stephen Pound (Ealing North) (Lab)]

I am in no way being critical of the hon. Gentleman, who deserves a great deal of credit for what he has done, but does he agree that instead of using the expression “the health industry”, it might be better to say “the health profession”?

[Paul Scully]

Of course it would be. The hon. Gentleman is absolutely right; forgive me.

Let me read the petition for Hansard. The title is “Keep the NHS Bursary” and it says:

“At the moment, student nurses do not pay tuition fees, and receive a means tested bursary during their training. We are required, by the NMC, to have done at least 4,600 hours whilst studying, at least half of which are in practice.

Student nurses often work alongside our studies, like most students. But unlike most students, we work full time hours in placement for around half the year, and spend the rest of the time in lectures, without a summer holiday, or an Easter break, as well as completing our assignments. Taking away the NHS Bursary will force more student nurses into working 70 hour weeks, as many already do, it will compromise our studies and most of all, our patient care.”

I am sure that everybody here appreciates the work that nurses do in the NHS. I have had had to go to hospital many times with my family. My daughter was born prematurely and had to have a lumbar puncture within hours of birth; my son had his thumb set after he had dislocated it playing rugby—just opposite the local hospital, fortunately—and nurses tended incredibly patiently to my mother when she fractured her hip after a fall late on a Saturday night.

We know the endless hours that nurses work and the endless patience that they show in tending to us when we most need them, and when we are at our most vulnerable. It is important that we pay tribute to them for the work that they do. We must also pay tribute to those who want to enter the nursing service. They do so as a vocation and out of love; they do not do it for preferment, large salaries or anything like that. They do it to pay back and to serve us as members of the public, and for that we are very grateful.

Nurses do incredible work, which is more complex than ever. Many nurses are taking on more responsibilities, whether in adult nursing, child nursing, learning disability nursing or mental health nursing. Often, these days, they have to tell doctors what to do and how to lead on treatment.

[Mr Jim Cunningham (Coventry South) (Lab)]

I congratulate the hon. Gentleman on securing the debate. Does he agree that we are not just talking about student nurses? We have problems with trainee doctors at the moment, and the situation with the education maintenance grant. There is a big problem, particularly in the medical profession—and outside it, in relation to young people—with the future of care.

[Paul Scully]

We can always talk about the NHS and the future of care, but we have three hours for this debate, and I suspect most hon. Members want to speak, so I will limit my comments to nurses. I will quickly outline the current system and talk about why I believe it needs to change, then we can debate exactly how it might change.

There are various elements to the NHS bursary. There is a non-means-tested grant of £1,000 per year. There is a means-tested bursary to help with living costs of up to £3,191 for students in London living away from home, £2,643 for students outside London living away from home, or £2,207 for students living at home. Other bursary elements include an extra week’s allowance for courses that run for longer than 30 weeks and three days each academic year. As we heard at the event that we held before the debate, the majority of such courses last considerably longer than 30 weeks; they are often up to 42 or 43 weeks a year. Tuition fees are paid directly to the higher education institution by the NHS. Students can also apply for a non-income-assessed reduced rate maintenance loan from Student Finance England of between £1,744 and £3,263, depending on their circumstances. That loan is reduced in the final year of the course.

Why change? The current system, as some, but not all, student nurses, prospective student nurses and those in higher education institutions that train nurses agree, does not always work as well as it might for students or universities.

[Alex Cunningham (Stockton North) (Lab)]

Hospitals across the country rely on recruiting nurses from as far afield as the Philippines. If these new measures are introduced, does the hon. Gentleman think that that dependence will increase or decrease?

[Paul Scully]

I would hope that it decreased. I will touch on some of the costs of recruitment later. Students who receive bursaries under the current structure have less to live on than other students, despite the fact that their courses are longer. They face particular financial hardship in the final year, when funding is reduced. In one London university in 2012-13, 63% of the entire hardship fund went to NHS-funded students, which goes to show how much the system is of concern, and in need of investigation and reform.

Funding for nursing and physiotherapy degrees is lower than for any other subject in higher education, even though the courses put much greater demands on universities than many other courses in areas such as quality assurance, laboratory space and simulation kit. Universities receive less than the courses cost to deliver in many instances. There is a cap on the number of bursaries, and more than half the people who want to train to be nurses are turned away.

In changing the system from a bursary to a loan structure, the Government propose to remove the cap on places, and they expect the reforms to provide up to 10,000 additional nursing and health professional places during this Parliament. Some people who are concerned about the withdrawal of the bursary are worried about students having no money. Even now, many students, especially in London, with its high housing costs, say that the bursary nowhere near covers their living expenses.

[Stella Creasy (Walthamstow) (Lab/Co-op)]

One thing that concerns many of us is the fact that the students we are talking about are not the same as many other students. They tend to be women or people who are returning to nursing. Does the hon. Gentleman agree that the cost of living issue—especially as those people are more likely to have dependents or existing commitments that they are trying to fund while studying—makes the change to the bursary system all the more worrying, because it will prevent even more people from being able to study to become nurses?

[Paul Scully]

I thank the hon. Lady for that intervention. In a little while, I will cover some of the issues that particularly affect nursing, and look at why some of the concerns about the nursing course are acute for those people. Let me conclude the remarks I was making a minute ago. The loans system, according to the Government, will cover the cost plus more, increasing the money available for living costs by about 25%. Looking at the structure, it seems that there are two avenues of concern. Some issues are particular to nurses, as the hon. Member for Walthamstow (Stella Creasy) suggested, but there is also a general student loan debate—rehearsing the student loan debate the House had some years ago, before I was elected. The issue has not affected some prospective nurses, although some have completed a first degree, and I will come on to that in a second.

I will touch on the student loan debate, although it is not something that we need to go over again, having discussed it at some length in various media and in the House a few years ago. When I talk about the debate, I always recommend that people look up Martin Lewis, the financial expert who runs the MoneySavingExpert.com website. He is not uncritical in his acceptance of the current tuition fee regime and loan structure, but he comes up with some interesting mythbusters. For anybody considering the prospect of taking out a loan before studying, he is well worth a read. He talks about not confusing the cost and the price tag of a degree because the main practical issue is how much people have to pay having graduated, rather than the top line figure of the debt. I will go into that in a second. Repayment is effectively based on salary, and repayment costs are 9% of everything someone earns above £21,000. For example, a nurse on a band 5 salary would pay about £5.73 a month in student loan repayments. It is not an up-front cost.

[Liz McInnes (Heywood and Middleton) (Lab)]

I thank the hon. Gentleman for his comments about Martin Lewis. May I just ask whether Martin Lewis advised the Government when they proposed the plans for the NHS bursary scheme?

[Paul Scully]

I am a new Back-Bench MP so I was not around then, but I know that Martin Lewis was on a Committee at some point afterwards to determine relationships, but I will take advice on that.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

May I just clarify that figure of paying £5 a month, which is £60 a year? At £60 a year, that loan would never ever come close to being repaid over 30 years—over a whole working life.

[Paul Scully]

That is on a band 5 salary. I would expect nurses to increase that. The point of the student loans system is that it is a finite time period of 30 years.

[Andrea Jenkyns (Morley and Outwood) (Con)]

I am on the current student loans system as I only graduated a couple of years ago. I am paying it back out of my salary and I am thankful for the opportunity to do that. Does my hon. Friend agree that the current system for nurses limits the number of applicants? The new system, rather than denying thousands of applicants the opportunity to study healthcare subjects at university, will release more people into the system so that we have more nurses. It will also help to sort out the problem of reliance on expensive agency staff and overseas applicants. We will have more home-grown nurses with the new system.

[Paul Scully]

I totally agree with my hon. Friend. The new system will certainly help with overseas applicants and agency staff and, as is the aim, it will release extra people into the profession. One concern that we need to address and that I will touch on a little bit later is about the placements and opportunities available after graduation. It is important to ensure that those opportunities are there for nurses. There is no point having a paper-based exercise if there are not enough positions for nurses.

[Tulip Siddiq (Hampstead and Kilburn) (Lab)]

My reading of surveys and academic studies shows the complete opposite of what the hon. Member for Morley and Outwood (Andrea Jenkyns) said. The different funding arrangements for healthcare courses means that they attract applications from a diverse range of people. The average age of people applying is higher than that of most students—higher than 28. Does the hon. Member for Sutton and Cheam (Paul Scully) think that changing the funding arrangements will deter people from different backgrounds from applying for these courses?

[Paul Scully]

I do not believe so. There were similar predictions for students in general when the student fee loan system came in, but that did not happen. People thought that student numbers would decline. They have not; they have increased. I do not believe that diversity in university courses in general has declined and I do not see any reason why that should be the case with nursing, although I understand the concern. A number of people have raised that concern both in Twitter conversations that we and nurses have had and in a number of events that have been held in the lead-up to this petition debate, including the one immediately before the debate. I understand the concern but I do not see the evidence.

[Helen Jones (Warrington North) (Lab)]

The hon. Gentleman will have heard, as I did, in the discussion that we just had with many student nurses that many of those going into the profession are mature students. Sometimes they already have debts from previous degrees or they have families to keep. If we are to maintain diversity and encourage people with considerable life experience to enter the profession, we must incentivise them to do so and not load them with more debt.

[Paul Scully]

I will just complete my comments regarding student loans in general, but then I will come directly to the hon. Lady’s point because it is one of the issues particular to nurses that I mentioned a little while ago. Student loans in general do not go on credit files, so the only way that a loan, credit card or mortgage company will know if someone has a student loan is if they ask for it. Obviously, for bigger loans, they tend to ask. Student debt is not accounted for by mortgage lenders in terms of the total amount owed, although they will look at the affordability of the loan and at an applicant’s outgoings. When tuition fees and student loans were first introduced, the Council of Mortgage Lenders confirmed that lenders would not use that or add that total debt to the amount owed when they considered mortgages.

[Dr Whitford]

Is it not the case that the Financial Conduct Authority has announced that the size of someone’s student loan will affect their ability to get a mortgage and will be taken into account?

[Paul Scully]

Well, I think a lot of it is down to affordability. [Interruption.] No, there is a big difference. Someone might have an amount of £50,000 or something like that, for example, but it is about the repayment. Whether someone is paying £5 or £50 a month, that is the figure that lenders will look at to work out whether they can afford to repay the loan. As I said right at the beginning, that top line figure is not the crucial one. The crucial one is actually the amount that someone will pay out of their salary each and every month.

Looking at the current case and at positions that are particular to nurses, we have talked about the fact some people going into the nursing profession may already have a degree and are doing a second one. There are mature students. The average age of those applying to study is about 28 or 29. I believe I have covered my take on people’s concerns about the diversity of the workforce changing.

Under the current rules, people cannot usually access the student loans system if they have already done a degree to the same level. The view of the Council of Deans of Health is that the Government should make those courses exempt from that rule. I will be interested to hear what the Minister says about whether that is the case. If it is, in the new system, people would be able to access student loans if they wanted to—that would be an equivalent or lower qualification exemption. As repayment amounts are based on salary and not on the total loan, the amount repaid would be the same whether someone has one or two loans. Effectively, that makes it a graduate contribution, not a traditional loan. The system is slightly different from a graduate tax, which was discussed a few years ago, because it is finite—it finishes after 30 years, and a graduate tax, as we might have had under other suggestions, would have carried on going past a graduate’s retirement. As I said to the hon. Member for Hampstead and Kilburn (Tulip Siddiq), the introduction of tuition fees and loans for other degree courses has not led to a drop in applications and has not affected the diversity of applicants.

[Clive Lewis (Norwich South) (Lab)]

One of the chief concerns that many student nurses have when listening to these proposals is that, unlike many other students who can take second jobs to help pay back their student loan, student nurses are sometimes working up to 40 hours a week for the NHS. They have no opportunity to make any other money to be able to pay off a student loan, but that is not taken into account. Student nurses are very different from any other group of students, which is not taken into account by the proposal.

[Paul Scully]

The hon. Gentleman has not listened to what I have said, because the whole point about the loan system is that the loans will not kick in until after a student has graduated, so the repayments will not start until that point. Student nurses will not be making any repayments while they are studying and doing those placements, but I absolutely take the point that nursing is a very different proposition from a normal degree in so much as placements take up 37 or 38 hours a week and beyond, which is a considerable strain on nurses.

[Paul Blomfield (Sheffield Central) (Lab)]

The hon. Gentleman cites the example of the introduction of fees for other university students, but does he acknowledge that the impact has been patchy and that the one group that has been significantly discouraged from going into higher education as a result of those fees is mature students? Mature students are particularly well represented among nursing, midwifery and allied professions, which we encourage.

[Paul Scully]

It is beholden on us to explain the system to mature students, because I see no reason why they should be discouraged.

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

The hon. Gentleman says that he sees no reason for mature students to be discouraged, which perhaps demonstrates that the Department has not done a full impact assessment. What impact assessment did the Department do before the Chancellor made these proposals in the autumn statement?

[Paul Scully]

The hon. Lady is asking the wrong person. Perhaps the Minister will respond to that question a little later.

The idea of placements came out of our discussion prior to the debate with the student nurses, who have taken time out to come to London today from as far as Liverpool and elsewhere. We talked about bursaries, and it would be a more honest description to call them a salary because these people are working hours in what are supposed to be supernumerary positions but are often not. There are student nurses sitting in the Public Gallery, and we have one person here from Brighton who explained how he was saving children’s lives prior to Christmas—it is not a supernumerary position when someone is working with babies. We have other people in critical roles who are working with patients on a range of issues, so we need to be straight about the pressures on nurses and how we reward them.

[Alex Cunningham]

I thank the hon. Gentleman for giving way to me for a second time. He is talking about bursaries being like a salary. Student nurses are doing real work when they are training on the wards, so are they entitled to some sort of payment for the real work that they are doing while they are training on the wards?

[Paul Scully]

Absolutely. We are talking about bursaries, but I would rather be straightforward and call it what it should be, which is a salary.

[Alex Cunningham]

Will the hon. Gentleman give way?

[Paul Scully]

I will not give way. I am aware that I have been talking for quite a long time, and I am sure that a lot of hon. Members want to speak. With placements, student nurses have less time than other students to do another job because, although it is 50% placement time in theory, they are effectively working 37 or 38 hours a week, so it is difficult for them to have another job to raise money for their living costs, especially as their courses last for 42 weeks a year—many other courses last for only 30 weeks a year.

[Gavin Robinson (Belfast East) (DUP)]

Will the hon. Gentleman give way?

[Paul Scully]

I will give way to the hon. Gentleman because I have not yet given way to him previously.

[Gavin Robinson]

I am grateful to the hon. Gentleman, who is being generous with his time. He is making a key argument for introducing a salary for student nurses to remove the burdens and the levels of debt, rather than charging them tuition fees. Does he agree that the right argument is that bursaries were introduced to incentivise people and to encourage those who would otherwise be dissuaded from training for this noble vocation, thereby removing the burdens and the over-reliance on overseas students? Our Health Minister in Northern Ireland, Simon Hamilton MLA, has decided that he will not remove or scrap the bursary for just those reasons.

[Paul Scully]

I would rather that we re-examined the overall system and reconsidered how we work with student nurses to give them a fair salary. I would rather it be more straightforward, open and transparent, rather than calling it a bursary. Bursaries are effectively gifts, which can be taken away. If someone is working hard in a position that is not supernumerary, we need to examine that. At the end of my speech, when I talk about the petition, I will say that this is the start of an exercise. This is a welcome time to have the petition, because student nurses and the 154,000 people who signed it can help to shape the policy over the next academic year ready for whatever is in place for the 2017-18 academic year and beyond.

[Andrea Jenkyns]

We have talked about nursing being a vocation, but does my hon. Friend agree that teaching and being a doctor are also vocations? This proposal puts nurses on the same system as for teachers and doctors—nursing is a vocation, too.

[Paul Scully]

Absolutely.

[Nic Dakin (Scunthorpe) (Lab)]

The hon. Gentleman is spelling out the case clearly. He will recognise that the introduction of fees for the teacher training year has led to a decrease in the number of people coming forward for teacher training. Perhaps that is a lesson that needs to be learned for student nurses.

[Paul Scully]

I thank the hon. Gentleman for that intervention.

I will bring my comments to an end with a few questions. The system needs to change. Not everyone agrees with me, but a number of people, even people who want to keep a sense of the bursary system, believe that the bursary system is not perfect by any stretch of the imagination. The petition, and the discussion around it, is the beginning of the process feeding into that change. Even those who are not happy with the proposed loan structure can help to shape the system over the next few months—in reality, it will have to be ready for the academic year after next—so that it is ready for students applying for the 2017-18 academic year. Whatever the final structure, student nurses must understand what they are applying for, how they will be funded and what the repercussions will be for repayments. We have a few months to work on it and to raise issues with Ministers.

I have a few specific questions for the Minister that come from the petition. How will specialist courses remain viable under the change? Podiatry, for example, tends to be undersubscribed—places on podiatry courses have to go through clearing year in, year out—so it is important that we consider how we can have viable courses for the services that we need.

Will trusts, especially foundation trusts—foundation trusts have proved that they can work through their own budgets by virtue of being given foundation status—be given the freedom to help repay student loans as part of a pay package, as was suggested by the Council of Deans of Health? As a result of that, what more can we do to retain nurses in the NHS after graduation, perhaps through contract agreements, rather than seeing them move abroad? Will there be enough placements to take on the proposed increase in the number of trainees? We spoke about that a little earlier.

[Matthew Pennycook (Greenwich and Woolwich) (Lab)]

The hon. Gentleman is being extremely generous in giving way so often. Can I press him on that point? Leaving aside the threat of deterring people from entering the profession, we get the sense from what the Government have said that the infrastructure or provisions are in place for those training places. For example, every new nurse and midwife on a training programme needs a supervised or assessed mentor. What sense is there that those people are in place? If he cannot answer that, perhaps the Minister can. The threat is that we will encounter a bottleneck or that the places will simply not be there, assuming that people apply in the first place.

[Paul Scully]

The hon. Gentleman might not be surprised to know that I cannot answer that, so I will pass it on to my hon. Friend the Minister, who I am sure will cover it when he sums up.

As I said earlier, I ask the Minister whether there will be an exemption for loans taken out to cover a second degree. Also, what arrangements will be made for placement expenses, which are a concern for many people going through the process? In Parliament a few years ago, there was some discussion about unpaid parliamentary interns, and a number of changes were made. Greater accountability through the media has led many Members of Parliament to change their practices so that, rather than just getting unpaid interns to do a load of work, they are paying a reasonable wage, even if it is not the full-on salary that someone else might get.

As I have mentioned, the people doing placements are largely not supernumerary. They mostly do full-on nursing work, to our benefit as patients. I will be grateful to hear what the Minister has to say about placement expenses.

[Stephen Pound]

The hon. Gentleman is being extremely generous. I am sure that I am not the only person to congratulate him on bringing this extremely important matter before the House. On the basis of my 10 years’ experience working at Middlesex hospital, may I say that nurses are in an exceptionally unusual position? They cannot simply come and do five days and then go home. Accommodation is an issue. Nurses’ homes such as John Astor House at the Middlesex are long gone. How on earth can we ask student nurses or potential student nurses to come to one of the major five teaching hospitals in London—there are now four, obviously, since the Middlesex is gone—without giving them any support or assistance with accommodation? Nurses’ homes do not exist anymore. With respect, nurses need more at the moment, not less.

[Hon. Members]

Hear, hear!

[Paul Scully]

Well done to the hon. Gentleman for getting audience participation. What I will say in conclusion is that the changes will strike home by giving people more money in their pockets for living expenses. I appreciate that the housing situation in London is particularly acute, but the whole intention of the proposed change is to ensure that student nurses have more money in their pockets to cover their living expenses in a difficult situation where the budget is limited.

I will leave it at that, because I know that a number of hon. Members want to speak. I will be interested to hear the Minister’s view when he sums up.

--- Later in debate ---

[Mark Durkan (Foyle) (SDLP)]

It is a pleasure to take part in this important debate. I commend the hon. Member for Sutton and Cheam (Paul Scully) for introducing it as a Petitions Committee member. He had the difficult task of framing the wider debate by drawing attention to a number of the background and contextual issues in the way that he felt was fairest and on the broadest issues. Many of us are in-filling the debate with a different emphasis, taking account of some other considerations.

As a Northern Ireland MP, I am conscious that this debate is about the bursary scheme for the NHS in England. Of course, the scheme recruits students from Northern Ireland who are undertaking courses in England, and as a devolved Administration we also have our own variant of the scheme. In previous contributions on this subject, the hon. Member for Ilford North (Wes Streeting) has raised the question of whether there will be an immediate Barnett consequential to this change to the NHS in England. Even when we get the answer from the Treasury, it changes over time. I have served as a devolved Finance Minister, so I know that in one instance the Treasury will tell you that there is no Barnett consequential, but then a year or two later some new thinking will mean that there is and that the vice has been tightened. Its usual rule of thumb is, “We’re the Treasury; we don’t need a reason,” so it can change at will.

Although, as the hon. Member for Belfast East (Gavin Robinson) said earlier in an intervention, the current Health Minister in Northern Ireland has properly set his face against going down the same road as the UK Government on the bursary scheme, the fact is that a significant change such as this has the potential to become the predictable text of future devolved policy. It has a conditioning effect by creating a context, and even when devolved Administrations resist such policy changes it usually adds to their costs, which makes the choice not to make the change harder. There is usually policy opportunity cost elsewhere as well.

We need to ask where the rush to this policy change has come from. Two lines in the autumn statement have heralded a significant change. We are told that a consultation will start this month, so will the Minister tell us how serious, thorough and far-reaching that consultation is going to be? Will it include a comprehensive consideration of all the implications of the change and a proper consultation on all the shortcomings and benefits of the current scheme?

Those of us with concerns are not coming here with a “Little House on the Prairie” picture of how the existing scheme operates. We are not pretending that nursing students and students in the allied health professions currently have a sweet life. They clearly face many serious pressures, but we heard from the hon. Member for Sutton and Cheam that the pressures, difficulties and life costs justify the change. In my view, they justify taking great care with any change. We need to address the problems that exist without creating new problems or compounding the existing ones, for exactly the reasons mentioned by other Members, including the hon. Member for Isle of Wight (Mr Turner), who described the implications of changing to a loan-based system.

We must recognise that the roots of nursing education have historically been very different from those of other education. It is only recently that we have seen the well motivated move to ensure that nursing and the allied health professions are truly recognised as professions of degree standard. The problem is that some people take that to mean that we should treat the bursaries in the same way as any other student loan and that that should be the norm. We know, for the reasons that Members have set out, that it should not. The students in question are not just in training but in service in a real, pertinent and highly pressurised way, which means that they do not have the options for covering their maintenance costs that other people have, and that their time is much more precious. Given their life circumstances, they have responsibilities that students on many other courses do not, so we are not comparing like with like.

Where has the support for the change come from? Has it come from the professional bodies that represent nurses, midwives, physiotherapists, speech and language therapists, occupational therapists, dieticians, radiographers, chiropodists and podiatrists? No, it has not. They have real concerns about the implications of the change for their members and the services they work in. Has it come directly from the employers? Health service employers in Northern Ireland, including in my constituency, constantly talk about workforce problems and the huge pressure to fill places and keep services running. A new radiotherapy unit has opened in a hospital in my constituency, and there will be huge pressure on it to employ and sustain radiologists for the future. Health service employers in Northern Ireland are acutely conscious of the pressures, but none of them has said to me that they believe this change will solve the problem.

The change seems to be sponsored mostly by the Council of Deans of Health, which is responsible for education, because it will perhaps solve a problem for universities. Universities look at their numbers and their funding and ask what the change will do for their economics, given that they have a key role in educating health service professionals. It will solve a problem for them, but not for the services that are meant to be supported or the professions. We must include in the consultation those whose voices have not been listened to and who have not canvassed and pushed for this change. Their voices must be heard, which is why this debate and others like it are so important.

The hon. Member for Sutton and Cheam said that something has to give and that the bursaries need to be changed. At one point, he actually said that one reason why bursaries are not good is that they can be taken away, as though that was an argument against bursaries. It is pretty cheeky to justify a proposal to take bursaries away by saying that we should do it because they can be taken away.

[Paul Scully]

Forgive me, I was talking about the title and the semantics. “Bursary” is a bit of a misnomer when, as had been said, it is more like a salary, albeit an inappropriately low one.

[Mark Durkan]

I take the hon. Gentleman’s point, which resets the context of his comments. I gladly acknowledge that clarification.

Just as we should not presume that bursaries are a given and cannot be taken away, people cannot afford to presume that the assurances about the loans-based policy are a given. The current rate of 9% of earnings over £21,000 can change—we must remember that the registration fees for people in the nursing and midwifery service have been hiked up. The Government’s justification for that significant hike in percentage terms is that they have been raised from a fairly low base. When people hear the argument that some students will not pay much of the loan or the whole loan, many fear that more money will be sought in the future in comparative and relative loan repayments. People cannot rely on the assurances that have been given and some of the other arguments that have been made. I hope the Minister is able to convince us that the consultation will look at all those issues and that they will be answered properly.

--- Later in debate ---

[Paul Scully]

Before I make some general points, I would like to clarify the disparity in the repayment figures that the hon. Member for Sheffield Central (Paul Blomfield) and I were talking about. I was talking about people at the lower end of band 5. When people first join the profession, the repayment is about £5 a month. I think the hon. Gentleman was talking about the higher end of band 5. I believe that the £900 average that has been discussed relates to a point about midway through band 6, at about £31,000. We are talking about 9% of everything that someone earns over £21,000. It will be two years before this system comes in, then there will be three years of study, then it will probably take about 13 years for someone to go up the grades. It will be 16, 17 or 18 years before it is possible to talk about an average repayment of £900 a year.

This has been a fantastic debate. I am grateful to the Minister for the comprehensive response that he has given us and his commitment to answer in writing the points that have not been answered today.

I thank my hon. Friend the Member for Isle of Wight (Mr Turner) and the hon. Members for Ilford North (Wes Streeting), for Sheffield Central (Paul Blomfield), for Foyle (Mark Durkan), for Heywood and Middleton (Liz McInnes), for Coventry North East (Colleen Fletcher) and for Paisley and Renfrewshire North (Gavin Newlands), as well as the Front-Bench spokesmen, the hon. Members for Central Ayrshire (Dr Whitford) and for Lewisham East (Heidi Alexander) and of course the Minister, who represents Ipswich. However, the highlight for me was the speech of my hon. Friend the Member for Lewes (Maria Caulfield), because she argued her case incredibly articulately and brought a lot of experience to the debate. What is a fantastic addition to the House is a sad loss to nursing in my constituency, where she practised. It was a great shame to lose her from there, but it is fantastic to have her in the House as a colleague.

I thank the petitioners and the participants in all the listening events and various other events organised by Parliament, the Petitions Committee and a number of nursing organisations. If I may speak to them through you, Mr Evans, the Chairman of the Petitions Committee, the hon. Member for Warrington North (Helen Jones), always describes e-petitions as the beginning of a campaign—a process—not the end of it. I know that the audience at the debate and people who have followed things on Twitter, on the television and on ParliamentLive will go away with different conclusions. They may not agree with the conclusions that we have come up with today, but I hope that they can at least take individual points, focus on them and respond in the consultation that the Government are about to undertake to help improve the policy and the lot of prospective nursing students. The proposals are about increasing the number of nurses while ensuring that they have a better level of funding for living expenses while they are studying. I am sure that people will take away enough from the debate that they will be able to raise matters with the Minister, to make the process a far more comprehensive and productive experience over the next few months.

Question put and agreed to.

Resolved,

That this House has considered e-petition 113491 relating to the NHS Bursary.

Junior Doctors Contract

Paul Scully Excerpts

Monday 30th November 2015 Commons Chamber

[Mr Hunt]

Let me tell the hon. Lady what the failure was: it was setting up a contract for junior doctors in 2003 that has made it impossible for hospitals to roster proper care at weekends. The duty of a Secretary of State is to put right those historical wrongs so that patients are safe.

[Paul Scully (Sutton and Cheam) (Con)]

Tomorrow I am due to go to St Helier hospital to meet some of the doctors on the picket line. I am sure that we all agree that it would be far better if tomorrow, instead, the doctors were there working and their representatives were talking to Government representatives. Does my right hon. Friend agree that in talking to the BMA, there is genuine room for negotiation and agreement on many of the details?

[Mr Hunt]

I have always believed that a negotiated agreement will be better for doctors, patients and the NHS, because I am sure that the BMA has value that it can add in the negotiating process to make sure that we implement the spirit and not just the letter of what the Government want to do. I agree with my hon. Friend, and I hope that we can enter into constructive, serious negotiations.

NHS (Contracts and Conditions)

Paul Scully Excerpts

Monday 14th September 2015 Westminster Hall

[Paul Scully (Sutton and Cheam) (Con)]

It is a pleasure to serve under your stewardship, Ms Vaz. It is also a pleasure to follow two fellow members of the Petitions Committee, including the Chair, the hon. Member for Warrington North (Helen Jones). The Petitions Committee is a new Committee, and we are feeling our way. As hon. Members have heard, we cannot debate no-confidence motions; petitioners cannot seek a vote of no confidence in a Secretary of State or anybody else. None the less, it is important that we reflect the views and concerns of people who raise substantive matters with us, and I am glad that we have the opportunity to do so today.

Confidence and good staff morale in the NHS are important. In my constituency, morale in our local hospital, St Helier, has been comparatively low for several decades, for a number of reasons. A reorganisation has been recommended in the past couple of years, which we have successfully fought off so far. The NHS clinicians wanted to move A&E, maternity services and children’s services to St George’s in Tooting. One of the reasons why they wanted to do so was the shortage of consultants in St Helier. They wanted to concentrate consultants’ time in St George’s, which is too far away for residents.

One of the big driving factors in that, to my mind, is the fact that over 20 or so years, our local hospital has been used as a political football. People have said, “St Helier hospital is due to close. We have got only a short time, and we have to save it. We have to fight for this, because it will close some time soon.” I do not know about you, Ms Vaz, but if I were a consultant looking to work in the NHS, would I want to go and work in a hospital that is always apparently under threat of closure? No, I probably would not. I would probably go to St George’s or one of the hospitals that are being talked up. I have seen at first hand how staff morale in the NHS can be fragile. The same thing has happened nationally as well. How many times have we heard that we have 24 hours to save the NHS? We keep seeing, hearing and reading that, time after time. It is important to build confidence.

We also have a manifesto commitment to deliver. We talked in our manifesto about having a seven-day NHS, and we have been elected as a Conservative Government, so it is important that we deliver our promises. We have to work with the profession to do that, however. Why do we want a 24-hour NHS? We have heard some of the arguments about safety and patient outcomes, and at the end of the day, patient outcomes are what it is all about. There is also an argument—although, as my hon. Friend the Member for Totnes (Dr Wollaston) described, it is a secondary priority, because we do not want to divert too many resources—for convenience and fitting in with people’s lifestyles, which I will come back to in a moment.

The 2003 consultant contract made the seven-day move a lot more expensive to deliver, so we need to change things. Consultants, as we have heard, can refuse to work weekends, but it is quite apparent that a great many do not choose to opt out. We are not saying in a broad-brush way that every consultant opts out of such working. None the less, we need to have a degree of consistency if we are going to move towards a seven-day NHS, because we want to make sure that the healthcare in hospitals around the country is as consistent as possible. Removing the opt-out will leave a new limit of working a maximum of 13 weeks in a year—one in four weekends—which still gives plenty of opportunity for family life and for flexibility in rotas, while delivering better patient outcomes.

The changes also recognise the need for proper reward in areas such as A&E and obstetrics, with higher-performing consultants able to earn a bonus of up to £30,000 a year, and with faster pay progression for new consultants. The hon. Member for Warrington North talked about support services, which are crucial for front-line consultants, doctors and nurses. I am pleased to hear that diagnostic services will be moving in the same direction so that patients can have quicker access to information and advice about their conditions.

I have talked about convenience, and GP services cannot be boiled down to some sort of retail operation such as late-night shopping or Sunday opening. None the less, we need flexibility. The 2004 GP contract led 90% of GPs to stop providing out-of-hours care at night and at the weekend. That contract, in many cases, helped to break the personal link between patients and those responsible for their care, which has been especially hard on elderly people. Caving in to the unions at that point effectively restricted GP services to a five-day service, which created extra pressure on A&E.

I have had the misfortunate of having to use my local hospital’s A&E service four times in the past 18 months with my elderly mum and my wife. My wife stood on a six-inch spike in a park, and when she was writhing around in agony with a spike though her wellington boot, there were a lot of people in A&E who had experienced neither an accident nor an emergency. Those people did not know where to go, they chose not to go to the GP, the appropriate care was not signposted clearly enough, or the GP simply was not open. We need to address those pressures, and a seven-day service will help.

The proposal is part of our wider NHS reforms, which since 2010 have moved to bring patient decisions closer to patients. We need to provide services that patients want, rather than a Henry Ford one-size-fits-all approach—we need greater flexibility. We have largely moved away from that, so we need to continue the move towards a seven-day service and towards greater flexibility. A seven-day service fits in with people’s working practices, childcare and busy lives. There is also greater take-up of digital initiatives such as the NHS national information board, and people are being brought in to help support the greater use of technology.

Members have talked about the statistics on satisfaction with the NHS over the past few years. The Commonwealth Fund’s report in 2014—four years after the Conservative-led Government took over—showed that, according to the fund’s records, the NHS is the best-performing health service in 11 countries.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The hon. Gentleman has surely read the detail of that Commonwealth Fund report. Much of the data that were used data from the previous Labour Government.

[Paul Scully]

The hon. Gentleman will also find that the NHS improved over those years. We were second when the Labour Government were in power, so we have improved, and more data are still coming through. That is backed by public confidence, which has gone up by 5 percentage points to its second-highest level in the period covered by the report. The number of people in England who think that they are treated with dignity and respect increased from 63% in 2010 to 76% last year, according to Ipsos MORI. Record numbers say that their care is safe, and the number who think that the NHS is one of the best systems in the world has increased by 24 percentage points in the seven years since Mid Staffs. That is a great base from which to start, but we need to continue working with healthcare professionals to secure the seven-day NHS that we need and people want to see. Shouting and using the NHS as a political football will not get us very far.

[Helen Hayes]

The hon. Gentleman talks about the need to work with NHS staff. One of my constituents, who is a trainee anaesthetist, wrote to me in great detail with her concerns about the impact of the proposed contract change. At the end of her email, she said:

“As a final insult, Simon Stephens, Chief Executive of NHS England, has announced plans to pay for fitness classes for NHS workers, to improve our health and reduce absenteeism. NHS staff are screaming out to be cared for so we can care for others—by employing enough of us on fair contracts, with adequate resources to do our jobs well. Zumba will not achieve this.”

Although there is nothing wrong with employers investing in fitness classes for their employees, does the hon. Gentleman agree that, in a crisis situation, this is simply adding insult to injury?

[Paul Scully]

In his King’s Fund speech, the Secretary of State talked about working with professionals, including the British Medical Association and other organisations, throughout September. That example is why we need to keep the dialogue going. I have seen nothing substantive in speeches by Ministers to pitch them into conflict with the vast majority of NHS staff. It is about change management. Change is always difficult, but change we must do. We can achieve much more together.

[Maria Caulfield]

Does my hon. Friend agree that staff morale has been an issue for decades? I worked in the hospital in his constituency during the previous Labour Government, and what demoralises staff most is the NHS being used as a political football. Opposition Members are screaming, “We have found data!” But it is not their data; it is patients’ data and the staff’s data. We need to work together. I commend my hon. Friend for saying that we need to work together and stop using the NHS as a political football.

--- Later in debate ---

[Paul Scully]

We can take every small initiative, such as the fitness classes, and find offence because the NHS has a limited budget. When staff look at whether there will be a pay increase and what that pay increase and the conditions might be, they tend to find such examples if they are not happy with what is on offer. Obviously, I cannot comment on that particular example.

Change management is always difficult, but we need to change. I believe that we can achieve such change under the calm, professional stewardship of the Secretary of State and his ministerial team.