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Valerie Vaz (in the Chair)
A digital debate took place on Twitter, ahead of today’s debate. Mr Speaker has agreed that for this debate members of the public can use handheld electronic devices in the Public Gallery, provided that they are silent. Photos, however, must not be taken.
Helen Jones (Warrington North) (Lab)
I beg to move,
That this House has considered the e-petition relating to contracts and conditions in the NHS.
It is a pleasure to serve under your chairmanship, Ms Vaz, and, in particular, to be debating the first petition to reach the debate stage under the new system for dealing with e-petitions. The original petition on the joint Government and Parliament website called for a vote of no confidence in the Secretary of State for Health. Fortunately for him—or unfortunately, depending on how people want to look at it—the Petitions Committee does not have the power to initiate a vote of no confidence, and so we decided that the debate should be on the issue underlying the petition, which was the contracts and conditions of NHS staff.
I might be joking about motions of no confidence in the Secretary of State, but the morale of NHS staff is not a joke. It is a long time since I last saw dedicated doctors, nurses and ancillary staff so demoralised and, sometimes, despairing. If we look at the current state of the NHS we can see why. A&E departments are in crisis and missed waiting time targets for the whole of last winter. GP services are struggling to cope, and patients find it harder and harder to get appointments. Last year, the deficit across trusts was nearly £1 billion; this year, that is predicted to double.
Yet despite all that, NHS staff work miracles every day. Who could not be proud of some of the achievements of our surgeons? Who could sit in an A&E department, as I unfortunately had to during the election, seeing the endless patience of NHS staff, and not be grateful to them? Who could watch paramedics dealing with an accident or reassuring a frail and confused elderly patient and not be ever grateful for the NHS? After the Olympic opening ceremony, I remember one American reporter said, “Oh, it’s just like praising UnitedHealthcare.” No, it is not. The NHS is not like UnitedHealthcare, thankfully, and that is why we value it.
NHS staff have been badly treated by this Government. Since 2010 pay increases have been deliberately kept low and last year we saw some staff being told that they could not have even a 1% increase if they were due to get an increment as well. The Government often talk about public services as if they were a drain on the economy, but they are not. Services such as the NHS are a huge contributor to our economy. It is completely wrong that, under this Government, tax is cut for millionaires but dedicated NHS staff are not even entitled to a decent pay rise.
Indeed, in the previous Parliament the NHS was told to make £20 billion of what the Government call efficiency savings but the rest of us call cuts. That is due to rise to £30 billion by the end of this Parliament. The NHS is struggling to cope with fewer and fewer resources but more and more patients. Many of the difficulties being encountered are of the Government’s own making. Ministers criticise spending on agency staff, but the Government’s first act on coming into office in 2010 was to cut nurse training places by over 3,000 a year.
Michael Tomlinson (Mid Dorset and North Poole) (Con)
I of course recognise the great work that NHS staff do, not least in Dorset, but is the official policy of the official Opposition now to lift pay restraint in the NHS?
Helen Jones
We made our policy quite clear in the last Parliament. In particular, we opposed the Government’s decision to curb 1% pay increases for NHS staff who were gaining increments. The hon. Gentleman really has to think about this: if there are fewer and fewer nurses in our hospitals—in particular, employment in the most senior grades is down by 3%—and we are spending millions on agency staff, something is going badly wrong. Hospitals are being forced to recruit nurses from abroad or spend on agency staff when we have thousands of people in this country who want to train as nurses but simply cannot get the training places that are available.
Helen Jones
In a moment. I want to make a little progress and finish this point.
That is a false economy. I make no criticism of the skills of the nurses we recruit from abroad, but it—
Helen Jones
In a moment. The hon. Lady will have to curb her impatience for a little while.
I make no criticism at all of those nurses’ skills, but it is much better to be employing people here in this country. The only people benefiting from the current situation are the companies that supply agency staff. Indeed, one, Independent Clinical Services, saw its profits more than double, from £6.2 million in 2010 to £16.5 million in 2013. In other words, what the Government have done is a textbook example of a false economy.
Helen Whately
Does the hon. Lady acknowledge that between May 2010 and May 2015 the number of qualified nursing, midwifery and health visiting staff increased by 2.1%, at 6,622 additional staff?
Helen Jones
I am grateful to the hon. Lady for reading that out, but I referred to nurses in hospitals. The number of nurses working in hospitals has fallen under this Government, particularly in the top grades. The failure to train and recruit enough permanent staff is putting a great strain on those staff already in post, who are having to deal with agency staff all the time to make sure that they know how things work in a particular hospital or ward. That does not offer continuity of care for patients.
Maria Caulfield
I declare an interest as a former NHS nurse—in fact, I still work as a nurse. I do not want to be political about this, because I want progress to be made on supporting the NHS, and particularly staff, but one of the single biggest factors in demoralising nurses and leading many skilled nurses to leave the practice was the last Labour Government’s change to the skill mix. That was crucial, because we were forced to cut our budgets, particularly on the wards, and junior nurses were left in charge of wards, instead of experienced senior staff nurses and sisters—
Valerie Vaz (in the Chair)
Order. I remind Members that interventions should be brief.
Maria Caulfield
Can I just say that it is the change to the skill mix that has demoralised nurses, and that did not happen under this Government?
Helen Jones
I am afraid that I do not agree with the hon. Lady. What has demoralised most of the nurses I see is the cuts they have to cope with day in, day out, as well as the shortage of sometimes even basic equipment and the—
Helen Jones
In a moment. I need to make a little progress, because other people want to speak.
There is also the fact that this Government, rather than valuing NHS staff, consistently appear to undervalue them. The Government are now introducing further ideas. They want seven-day working in the NHS. I will come in a moment to what that means for hospitals, but let me look first at what is happening with general practitioners. In principle, everyone agrees that more out-of-hours care is a good idea—not least NHS staff themselves. The question is how the Government will fund and staff the extra working hours. Currently, we are increasingly short of GPs. In Warrington—on the Government’s own figures, before the hon. Member for Faversham and Mid Kent (Helen Whately) jumps up to read out her brief again—we have fewer GPs than we had—
Helen Jones
No. I need to make a little progress, because other people want to speak.
In Warrington, we have fewer GPs than we had in 2010—those are the Government’s own figures, not mine. Nationally, the number of unfilled GP posts quadrupled in the three years from 2010 to 2013. The Royal College of General Practitioners says there are severe shortages in some parts of the country and that in some areas—it quotes Kent, Yorkshire and the east midlands—we need at least 50% more GPs over the next five years just to cope with population increases. Now, when there are not enough GPs to ensure timely access to appointments on weekdays, it is difficult to see how the Government are going to extend GPs’ working hours without recruiting more staff.
Of course, the cost is also an issue. It is estimated that the costs of extending services beyond the current contract, with one in four surgeries opening late in the evening and at weekends, would be £749 million. That would rise to £1.2 billion if one in two practices were open longer. That is far in excess of the money currently in the GP challenge fund. If the Government intend to proceed without recruiting more staff, that will simply increase the pressures on the staff working already, leading to more burn-out, and it will be a downward spiral. We already know that many GPs are thinking of retiring early.
The Secretary of State has now turned his attention to not only GPs, but hospital doctors and consultants, who he says do not work weekends. Well, I have two consultants in my family, and that is news to me, because they certainly do work weekends. In fact, the Secretary of State so provoked hospital doctors that they took to Twitter under the #iminworkJeremy, posting pictures of themselves working at weekends, often after a 70-hour, five-day week.
Now, I reiterate that everybody accepts that out-of-hours care has to improve, but the Secretary of State needs to achieve that through consultation and by showing respect for the staff we already have. At the moment, he is guilty of muddled thinking; he has deliberately confused emergency care with elective care. Specialists in emergency care do work weekends; in fact, very few consultants opt out altogether—the figure is about 0.3%. Yet, the Government tell us that there are 6,000 extra deaths among people admitted at weekends. The Minister needs to publish the research on that and to go further, because correlation and causation are not the same thing.
Dr Sarah Wollaston (Totnes) (Con)
May I recommend that the hon. Lady read last week’s edition of the British Medical Journal, where the issue is set out very well by Professor Freemantle?
Helen Jones
Yes. I thank the hon. Lady for that useful suggestion. I will do so.
People who are admitted to hospitals at the weekend are much sicker than those admitted on weekdays, because we do not have elective admissions at the weekend.
Maria Caulfield
Does the hon. Lady have any suggestion as to why people are sicker at the weekend? Is it perhaps because they have been unable to get hold of their GP in the evenings or on previous weekends?
Helen Jones
I have just said the Government should publish their research and delve deeper into the figures. [Interruption.] Look, the hon. Lady knows that people admitted at weekend are, overwhelmingly, emergencies. That is the point. Their death rates cannot be compared with death rates on weekdays, when there is elective surgery—that is a basic point, which she needs to grasp.
If the Government really believe these things are happening, they need to find out why. As I understand it, death rates are taken over 30 days, so someone can be admitted on a Sunday and die 28 days later, on a Thursday. The Government need to prove cause and effect before they can make the link between admissions at the weekend and death rates. So far, however, we have not seen that from them.
Helen Jones
No, I need to make some progress.
What, exactly, is the Secretary of State trying to do? If he is trying to bring about a seven-day fully elective service, he needs to say so. As far as I am aware, no major health system in the world has managed to do that. If he is not trying to do that, he needs to tell us clearly—perhaps the Minister will do so when he winds up—which services he thinks should operate at the weekend.
The Secretary of State also needs to recognise that, to have the service he proposes, he needs not only more doctors, consultants and nurses on the wards, but back-up staff. Doctors operate by leading teams. If they do not have the ancillary staff—the people to do the MRI scans, the radiology and the lab tests—they cannot operate properly. We need to hear how the Secretary of State will implement his proposals. Will he recruit more staff, or will he worsen the terms and conditions of staff who are already not well paid, to introduce weekend working?
It might help to improve morale in the NHS if the Secretary of State refrained from attacking staff for not working at weekends, when they do, and actually negotiated with them sensibly. Staff know what is happening at the frontline, and they can best suggest the changes that need to be made.
Dr Rupa Huq (Ealing Central and Acton) (Lab)
We are discussing contracts and conditions. Does my hon. Friend agree that whistleblowing is another issue over which there tends to be silence? The last time there was a full debate on it in this place was 2009. It came up tangentially in 2013, in a debate on accountability and transparency, and it has appeared in statements—I think there was one last July and one earlier this year—but is it not time that we had a full and proper debate?
Helen Jones
Whistleblowing in the NHS, as in other areas, is an important issue. It is important to protect staff who blow the whistle to protect their patients, which is their duty. Perhaps my hon. Friend will initiate a debate on that; I am sure we would welcome that.
When the Secretary of State talks about NHS staff and doctors, let us remember that the starting salary for a junior hospital doctor is £22,636. It is not a huge amount when someone has spent years in medical school and works many hours, and often has to deal with seriously ill patients. However, the Secretary of State proposes to change their contracts to take away the extra payments for weekend working, which will effectively mean a huge pay cut. The Scottish Executive will not do that, and that will lead to the ridiculous situation in which two doctors doing exactly the same jobs in different hospitals either side of the border will be on two rates of pay.
As for consultants, I have heard complaints from the Government that Labour raised their pay rates. Yes, we did, and I am proud that we did. I will give the Minister the reason, which was set out very clearly by Frank Dobson, who was formerly my right hon. Friend the Member for Holborn and St. Pancras. In the City there are people who probably messed about for most of their time at school and played noughts and crosses at the back of the class, and who can make millions. Across the road there will be someone who was probably the cleverest kid in their class and has worked for years in training—often someone who is at the cutting edge of medical development. Yes, those people deserve a decent rate of pay for their skills, training and responsibility.
The Government also forget that consultants’ time is allocated in two blocks: direct clinical care and supporting professional activities. Those two together make up the 40-hour week. SPA time is for such things as mentoring, quality improvement and teaching. Some consultants go on to do more teaching and research, perhaps, but they are doing extra work on top of the 40-hour week, which increases their pay. Consultants’ basic pay ranges from £70,249 to £101,451, so the Secretary of State needs to explain how he can tell us that consultants are paid £118,000 a year. How does he calculate that figure, and what is included in it?
If the Government really want more consultant time on the ward, they could look at some of the things that do not need to be done by doctors, but which doctors currently do because of lack of back-up staff. The Government always talk as if non-clinical staff in hospitals are somehow superfluous and an extravagance. That is not correct. Without the right staff, doctors and nurses are forced to take time from clinical care to do some of their jobs. For example, many doctors whom I have spoken to now collect their own data for audit and input it themselves. That is a job that a competent clerk should be doing—not a consultant. I found one hospital where there is one secretary to a group of 25 consultants. Writing letters takes consultants away from clinical care.
I found one place where the IT equipment is so old that it takes six minutes to boot up, and often collapses, with the loss of the data. If the Government really want more doctor time on the wards they should consider those issues as well, and think about the other staff. As an example, if an operating theatre does not have a full complement of staff, there is no one to send out with the patient who is in recovery, and a doctor must go with them. That slows the turnaround time for theatres, and staff are told that their turnaround time is not good enough.
I say again that it takes a team of people to run the NHS, not just doctors. Let us also remember that the NHS depends on many staff who earn very low salaries. As doctors would be the first to say, those people are an essential part of the team. The NHS Pay Review Body could see a case for some adjustments to unsocial hours pay—and I have not met any staff who do not see a case for that; but it noted that both the Department of Health and NHS employers said that the cost of unsocial hours premiums makes the delivery of seven-day services prohibitive. The Minister must tell us whether the Government will try to deliver seven-day services by cutting the pay of staff again. The review body said that that could risk the morale and motivation of staff.
Recently we have had a few soundbites from the Government, but no clear mechanism showing how they will set out to do what they say they will do. They have pledged an £8 billion increase in NHS funding by 2020. Even taking them at their word—and some of us are rather sceptical—that is the bare minimum to keep existing services going. [Interruption.] If the Minister’s Parliamentary Private Secretary, the hon. Member for Winchester (Steve Brine), will stop chuntering from behind the Minister, I will wind up my remarks. [Interruption.] PPSs, as I told someone once before, are meant to be seen, not heard.
The Minister needs to make it clear what services the Government will run and what staffing arrangements they will put in place. They can put more doctors on the ward, but that will be useless without the back-up staff. It is not surprising that one surgeon in the #iminworkJeremy campaign posted a picture of himself mopping out his operating theatre at the end of the day. That was very good of him, but is it the best use of a consultant surgeon’s time? Above all, the Secretary of State and his Ministers need to stop attacking the people who work in the NHS, and to try to work with them in a climate of mutual respect. It is not hospital doctors, GPs, nurses, lab technicians or cleaners who have caused staff shortages in the NHS; it is the Government. Those staff members did not introduce the disastrous Health and Social Care Act 2012. They are not the people requiring huge cuts in our hospitals and other services. Unless the Government are prepared to recruit more nurses, doctors and ancillary staff, more and more pressure will be put on existing staff, who will suffer burnout. It will be a downward spiral.
When I worked in teaching, a wise old head teacher said to me, “People say that the first thing you have to do in a school is ensure that the children are happy; but no—the first thing you should do is ensure the staff are happy. If the staff are happy the children will be well taught.” That is something that can be applied in many areas. I tell the Minister honestly that he needs to take note of the anger among staff that generated the petition, take it on board, stop denigrating them, and deal with them properly and sensibly, to achieve what the Government have set out to achieve.
Dr Sarah Wollaston (Totnes) (Con)
It is a pleasure to serve under your chairmanship, Ms Vaz, particularly as recently you were a fellow member of the Select Committee on Health. For the record, I am married to a full-time NHS forensic psychiatrist, although one might say that I do not have a dog in this fight, because he already works weekends.
It may help the House if I comment quickly on the background. I thank Professor Freemantle and his team for their excellent updating of the data following the last analysis of data in 2009-10. He and his colleagues carried out the exercise again based on data from 2013-14, and it may help if I put some of that in context. What he shows is that 1.8% of NHS patients will die within 30 days of admission. It is important that we look not only at the data relating to what happens within a few days, which he has also analysed, but at the longer-term data. He shows a very real effect: if someone is admitted to hospital on a Friday, there is a 2% increase in the risk that they will die within 30 days; if they are admitted on a Saturday, the increase is 10%; if they are admitted on a Sunday, the increase is 15%; and if they are admitted on a Monday, the increase is 5%. Those are relative, not absolute, statistics and are on a background rate of 1.8%, so it is important that we do not alarm people unduly with those data. However, they mean, very importantly, that around 11,000 more people die if they are admitted between a Friday and a Monday, relative to what we would expect had they been admitted on a Wednesday.
That is extremely important, and the Secretary of State is absolutely right to take that very seriously, but we need to look at it in its wider context. Is it simply because a different group of people are being admitted in the middle of the week than are being admitted at weekends? Is it because they are a sicker group of people? Both of those are true, which is why it was important that Professor Freemantle made adjustments for those kinds of data. He showed that even if we take account of the fact that there are genuinely sicker people coming into our hospitals at the weekend, the effect was still present, but it was reduced. There was a 7% increase on a Saturday and a 10% increase on a Sunday, so it was still important. As for people admitted to hospital for routine procedures, it was shown that the nearer it gets to the weekend, the more their chances of mortality increase.
To go back to my earlier point, the Secretary of State is absolutely right to take this issue seriously. This is not just an effect in Britain; it is observed internationally, but it matters. Yes, those people are sicker, and yes, a different group of people is coming in, but there is also the issue of what we should do about it. We must not give the impression that all those 11,000 deaths are preventable. We have to be very careful not to rush into action that leads to a levelling down, rather than a levelling up. We want to bring the data up as far as we can, but when hospitals have done a deep analysis of the deaths that have occurred within 30 days of people being admitted at weekends, it is sometimes very difficult to say what could have happened differently.
We need to look at this issue, but it is not just about consultant presence. Senior supervision at weekends is undoubtedly part of it and is very important, but other issues are at stake. Is there access to diagnostic tests? We need to look beyond this being just about consultants; it is about nursing staff, too. We have to be careful not to shift resources into trying to sort out one part of the issue—consultant presence—because if that means a continuation of a worrying trend of shifting resources out of primary care, we could inadvertently end up with a sicker group of people coming into hospitals at weekends. In other words, we have to be very careful about the balance and potential unintended consequences of what we do.
Undoubtedly, at the root of all this—this issue would face whoever was sitting behind the Secretary of State’s desk—are the issues of financing and resources for the NHS. I hope, as we come closer to the spending announcements, that as much as possible of the £8 billion announced will be front-loaded, so that some of these issues can be addressed. Resourcing and how we spread it across the wider NHS lies at the heart of this question, and it is important that we do not focus entirely on hospitals.
I want to talk more widely about the seven-day NHS. I hope that the Secretary of State will look carefully at what that is for. Is it about trying to reduce that excess weekend mortality? Yes, it should be about that. Should it be about reducing avoidable, unnecessary admissions to hospital? Absolutely. We know that people do not want to be in hospital. It is a dangerous place for someone to be if they do not need to be there, particularly if they are frail and elderly and would be better looked after in the community, so yes—let us reduce avoidable admissions.
Should the seven-day NHS be about accessing the kind of specialist advice that makes a real difference to people’s lives? I am very conscious that this House debated on Friday whether people should have the right to medical assistance in ending their life. It was a controversial debate. I think the House made the right decision, but there was absolute consensus within that debate about the need for greater access to specialist palliative care advice. I would include that kind of thing in a seven-day NHS, because people’s quality of life at the end of their life has an extraordinary impact not only on them, but on their whole family. Seven-day services should be about addressing quality, and I would love the Minister to comment further on how we can bring about sustainable funding for specialist palliative care. That is absolutely part of what we should be doing on seven-day services.
However, there is another aspect, which is more difficult. When resources are very restricted, should we prioritise access to primary care out of hours for people who would prefer to be seen at the weekend than mid-week? I am sure we all understand that—in our busy lives, it is sometimes difficult to take time off work—but it might not be the priority when resources are tight. I speak as someone who, before I came to this House, was a clinician in rural Dartmoor in a two whole-time-equivalent practice. It was a very rural setting, and if we were to try to provide an 8-till-8 service on Saturdays and Sundays for routine GP appointments—if we were, as this is sometimes presented to the public, to enable people to see their doctor at any time—the cost would be enormous. There are extra costs involved in manning surgeries at those times, and there are also issues to do with staff availability.
I visited several practices in my area over the summer recess, and I see there genuine concern about not only the GP workforce, but the wider primary and community care workforce. We have to be very careful. If we prioritise issues such as making it possible to have a routine appointment from 8 till 8 on Saturdays and Sundays—much as I can see merit in that—it will take resources away from the other things on that list of four. We should focus on other priorities on this stage and be clear that there are other risks, such as undermining other out-of-hours services.
I would like the Secretary of State to be very clear about what he means by a seven-day NHS when it comes to primary care, and about how we will make those fair funding decisions and divide the cake, so that we get the very best for people. We absolutely have to address the excess mortality, but we have to look at the reasons behind the data to be realistic about what we can achieve. We have to make sure that we bring the quality up and that we do not inadvertently end up bringing it down by having sicker people coming into hospital, which is one of the drivers of the data that we are trying to address.
Many Members want to speak, and I, along with colleagues, have the opportunity to question the Secretary of State at the Health Committee tomorrow, so I will draw my remarks to an end. However, I hope that those points can be addressed.
Paul Flynn (Newport West) (Lab)
I will speak briefly, because unfortunately I cannot stay until the end of the debate. First, I thank those who signed the petition. It is a genuine vox pop, not something that any party brought to the House. A large number of people signed the petition because there was genuinely an explosion of anger. It is absolutely right that we listen to those voices and ensure that they are heard in the House, and that this debate should take place. It is the first debate of its kind—the first debate from the Petitions Committee. There is another one in a fortnight’s time, on a subject that terrifies MPs. We hide our heads under the pillow to avoid talking about it, but the public are very happy to talk about it in great numbers. That subject is the idea of legalising cannabis so that people here can enjoy the benefits enjoyed in many other countries that do not have a neurotic policy that is self-defeating and actually increases cannabis harm. But that is the second debate, which is coming up. This is a great innovation by the House.
The two previous speakers in this debate made very illuminating speeches. I agree with almost every word that has been said. Of course, we genuflect before the expertise and good sense of the hon. Member for Totnes (Dr Wollaston). She is someone else who has come to the House as a candidate elected not so much by a party as by a popular vote. Let us hope that politics is changing.
The issue that I worry about greatly is how we behave as political parties. We seem to be indifferent to, or unconscious of, the effect of our words. The use of soundbites, scares and fearmongering is extremely damaging, and it happens so often with the health service. The Daily Mail, about a year ago, had three page 1 headlines all about the health service in Wales. There was no way in which news values, or the problems that arose, which were hugely exaggerated, justified those headlines, but they were there for a political purpose: to denigrate the health service in Wales, under Labour, and to boost the chances of the Conservative party getting votes in the election.
I believe that there is an element of that in this case. Many speeches by the Secretary of State contain valuable, intelligent thoughts about how to improve the health service. If there is some statistical blip that shows there is a problem somewhere—something that is unexpected— of course it should be followed up, but not by an hysterical headline that has one effect, which is to add greatly to the anxiety of patients who are about to go into hospital. As the hon. Lady said, that is a terrifying experience, and people suffer greatly from anxiety beforehand. If they are told that there is a 16% greater chance of dying at the weekend, that anxiety and fear is greatly multiplied.
The Government should not be out to win favour and get votes in—to win popularity—by the sensationalist way in which they introduce this subject. It has rebounded on them with this petition and the reaction from those involved. It is right that we in this House should be aware of what is written in tweets and blogs. The reaction was there, and it is right that this should be brought to the House. One doctor put his payslip online. Karan Kapoor posted a letter alongside the payslip on Facebook, and it has now received hundreds of comments of support and thousands of shares on the social network. He wrote:
“My on calls per month add approximately 120 hours of work in addition to my normal working week. This is made up of being on call one day per week and one weekend in 5—5pm on Friday to 8am on Monday. Simple maths says that works out as £2.61 per hour—significantly less than the minimum wage let alone the living wage.”
The evidence was there—and came out in great abundance—of anger at what the Secretary of State was saying, and the misguided and inaccurate picture that he was giving of life in the health service at weekends.
Another tabloid story suggested that we MPs get privileged treatment when we go to hospital. I was rather astonished by that, so I searched the story to find out which hospital gives us privileged treatment, and I discovered that it is St Thomas’s. Well, the only hospital that I have ever been in during the 80 years of my life is St Thomas’s, and I went there as an MP and there was certainly no privileged treatment. I was, quite rightly, treated the same as anyone else. I was stuck in a cubicle and waited there for hours and then stayed overnight in a ward, and rightly so. But the press will believe only negative stories about MPs. That goes on.
I would like to ask the Minister this. A long time ago there was, I recall, another gimmick that a Health Secretary used: he force-fed a beefburger to his young child, when we were all terrified of catching Creutzfeldt-Jakob disease from eating beef. That seemed a very unwise thing to do. It is not new for people to use fearmongering and gimmicks to advance political causes. The one question is a simple one. If we are to increase the services at weekends, where will the staff come from? Are we suddenly going to magic up special weekend surgeons? If we improve the service at weekends, we have to reduce the service in the week. Perhaps the Minister can explain that to us.
Helen Whately (Faversham and Mid Kent) (Con)
I welcome the fact that in this House we are talking about the NHS workforce, because that is one of my greatest concerns for the future of the NHS. In my role on the Health Committee, tomorrow and on other days I will be asking questions about the future of the workforce.
The hon. Member for Newport West (Paul Flynn) has just made a very important point: what is said in the House really matters; words matter. I want to talk briefly on the subject of confidence. What really matters for the NHS is patient confidence and public confidence in the NHS. I note that last year, public confidence in the NHS in England went up by 5%, and that is at a time when the NHS is more transparent than ever before about the standard of care. It is being incredibly open about things going wrong as well as things going right, so the public know that problems are no longer being swept under the carpet. In fact, that may be one reason why public confidence has gone up: problems are being investigated and sorted out.
I have to say that I was quite staggered that the hon. Member for Warrington North (Helen Jones) questioned the mortality figures so much and was questioning the value and importance of seven-day working. As we have heard and as the BMJ—
Helen Jones
What I said, if the hon. Lady was listening, was that the Government have to dig behind those figures and find out the reason for them. Correlation is not causation. That is a very basic principle when we are looking at things such as that, and I would be grateful if she did not attribute to me words that I have not said.
Helen Whately
The hon. Lady is correct to distinguish clearly between correlation and causation, but I did feel that the tone of her remarks seemed to question the evidence of increased mortality over weekends and out of hours. I will say that I agree with her on the need for increased investment in IT to enable the clinical workforce to spend more time on clinical work. I agree with her on that point.
I have observed over recent years that the Secretary of State has championed the NHS. He has fought for its budget to be protected at a time when many other budgets have been cut. He has secured the Chancellor’s commitment to an extra £8 billion of annual funding by 2020, and he has truly focused on patients and clinical quality over finances and structures. I wonder whether any other Secretary of State has spent as much time with his sleeves rolled up in hospitals, not just listening to the sound of bedpans but actually emptying them.
I am a supporter of the Care Quality Commission and observe that three years ago it was close to collapse, but it is now widely praised, particularly by the acute sector. I know that GPs are unhappy about the inspections, but 70% of providers say that the CQC’s inspections have given them information that has helped to improve their service. That has been supported by the Secretary of State.
Along with that focus on quality and transparency, the Secretary of State is to be applauded for trying to improve the culture of the NHS—to make it more open, supportive and connected and to ensure that NHS leaders are in touch with patients and staff.
Helen Hayes (Dulwich and West Norwood) (Lab)
If the Secretary of State is doing the marvellous job that the hon. Lady suggests, why did so many of the front-line staff in our NHS, who work so hard day in, day out, take to Twitter to express their lack of confidence in him?
Helen Whately
I believe that the Secretary of State has done a good job of driving the NHS in the right direction, and I know that a large proportion of the workforce have been very supportive of him.
We are all in this room because we value the NHS, but we must not be complacent. We have to recognise when it lets people down. It is intolerable that if someone has the misfortune to get ill and be admitted to hospital at the weekend, they may be more likely to die. I am not going to repeat the statistics on that, because my hon. Friend the Member for Totnes (Dr Wollaston) helpfully updated us, and I suspect that my figures are not as recent as hers. She made a strong case, as have others, for why the NHS needs to have proper seven-day care, which must include the support services mentioned by the hon. Member for Warrington North.
The Royal College of Surgeons strongly supports seven-day care. It has said that one reason why outcomes are worse at weekends is that patients are less likely to be seen by the right mix of junior and senior staff; that such patients experience reduced access to diagnostics; and that earlier senior consultant involvement is crucial. Research from the NHS National Health Research Institute shows that 3.6 more specialists attend acutely ill patients on Wednesdays than on Sundays. More senior doctors need to be available at weekends—not just on call, as many consultants are at the moment, but present in hospitals.
The changes should not be about getting doctors to work intolerable hours, and that is not what is being proposed. As has been mentioned, only a small proportion of consultants exercise their opt-out. One could argue that the changes to the workforce, and to the consultant contract in particular, are about bringing the contract into line with what is actually happening. Looking at the terms of the workforce gives us an opportunity to ensure that there is an appropriate package for doctors in A&E, where there are large numbers of vacancies. That is the case in hospitals in and around my constituency in Kent, which is an area with a high proportion of out-of-hours work. It also gives us an opportunity to ensure that clinicians are recognised and rewarded for taking on management and leadership responsibilities. We really need clinicians to step up and take on those responsibilities. It gives us an opportunity to make sure that consultants are treated as professionals who take responsibility for their patients, their team and the whole service that they provide.
The NHS faces an incredibly tough time over the next five years. It faces rising demand for its services and rising expectations, and even with an extra £8 billion on its way, things will have to change. Senior doctors, along with senior nurses and other health professionals, will have to lead those changes. When I worked in hospitals grappling with the challenges of transformation, ideas came from everyone: junior doctors, senior doctors and patients. When it comes down to it, consultants, matrons and senior staff have to lead from the front and make things happen. They often face opposition from colleagues, so they need to be courageous and put in extra hours.
To ensure that that happens, and to get the NHS from where it is now to where we want it to be in five years’ time, there has to be a sense that we are all in it together. We cannot have a situation in which doctors blame managers and politicians, while politicians and managers point fingers at doctors. We absolutely have to move on and focus on doing what is best for patients, and what will achieve the best clinical outcomes. We have to build trust among all who are involved in healthcare and work out how we can have, and how we can afford, excellent care seven days a week, day and night. We have to support the healthcare professionals—consultants, nurses, managers and everyone else who is going to make that happen.
Dr Huq
I just wanted to ask where the hon. Lady would place management consultants in that. The NHS in north-west London has spent, I think, £13 million this year alone on Saatchi and Saatchi, and various other groups. I just wondered where she would place that in that trajectory. Hopefully, it will be something we can all agree on.
Helen Whately
I want to make the important point that we in this House need to support the NHS in doing what it needs to do to make the substantial changes that it faces over the next five years. That means supporting managers, supporting doctors and supporting nurses. Let us not try to be divisive.
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.
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.
Jo Churchill (Bury St Edmunds) (Con)
We have a wonderful resource in the national health service, but it cannot be preserved in aspic. I am lucky enough to have been treated by these wonderful consultants, which is why I am here. Society and medical technologies are changing at an alarming pace. The importance of the central asset of NHS staff cannot be overestimated, and the interest from my colleagues today shows how much Government Members value them. I am the daughter of a nurse, and I am the mother of a health professional. I get berated long and hard on how tough things were, as my hon. Friend the Member for Lewes (Maria Caulfield) alluded to, and how tough things are. That is a constant state, but let us be realistic: there will be a deficit this year of enormous proportions. Rather than throw in yet another figure, we know the deficit is large, and we know it is a problem.
Do I believe the premise of this petition? No. Important decisions have to be made if we are to focus on the primary need of patient outcomes. The question is how we treat people efficiently, effectively and with compassion. Hospital managers and consultants may say that the changes will deliver a 21st-century model of care that will safeguard both the patient interest and the cost-effectiveness of services, but that is quite wordy and is making everything the same problem. We do not all have the same problem. I completely concur with my hon. Friend the Member for Totnes (Dr Wollaston) on rural GPs. There are rural GPs in my constituency who are already feeling stretched, and asking them to deliver two more days of cover—seven days in total—with no more staff is not the answer. We must link training and recruitment, and we must work on a delivery mechanism that means not only the 5,000 extra GPs that we have promised but less box-ticking to free up their time, which would not go amiss. It has been said that we do not have enough GPs, but it takes five years to train a GP. Anyone who starts university now will not be qualified by the end of this Parliament. We are dealing with the legacy of the tail end of the Labour Government, which is one reason why we do not have enough doctors.
I am from a business background, and I ask simply how we can do more with less. Do I believe that the way to achieve better care in our hospital settings is not to have access to seven-day patient services? No, I do not. Do I think that if a child is knocked off their bike on a Saturday or a dad has a heart attack on a Sunday, doctors and nurses should struggle to deliver optimal service without the important back-up of diagnostic services? No, I do not. Why is it that, although an acute bed costs about £900 a night, patients in our hospitals cannot be admitted or discharged as easily on Saturdays and Sundays as on Mondays and Thursdays? One problem is that we cannot discharge. It is not all about who is coming in the front door; it is also about who is going out the back door. It is a real strain.
Victoria Prentis (Banbury) (Con)
My local trust, Oxford University Hospitals trust, has recently started a “perfect week” scheme, in which it makes all resources available to all those who work in the hospital system. It has discovered that one main barrier to discharge on Saturdays and Sundays is that pharmaceutical staff are not available at all hours of the day and night. Would it be possible to roll out that concept of a perfect week elsewhere?
Jo Churchill
It is a very good idea. The lack of pharmacy provision in hospitals is often cited as one obstacle to patient discharge. The cost of not discharging someone on a Friday, meaning that they use a bed on Friday, Saturday and Sunday, is £2,700, which is a lot of money.
Helen Jones
The hon. Lady was not in the House when we debated this Government’s change to local government finance, but at the time, many of us warned that it would hit social care and impact on our hospitals. Does she accept that hospitals are having great difficulty discharging patients, not only at weekends but during the week, because social care is not available for them?
Jo Churchill
I would say that it is a mixed picture. What I am picking up from care homes in my constituency is that some wards do it more effectively than others, with better services and things better locked together. Although I accept that there may be a problem, again, I look to the leadership.
I gave birth to some of my children on a Saturday and Sunday. Their entrance did not appear any less special to the obstetrician than those of my children who appeared midweek. I am not consultant-bashing; this is reality. The NHS has been delivering consultants and staff who provide outstanding service, but one cannot deny the statistic that patients’ chance of survival is less if they are admitted to a hospital at the weekend. Even if we extrapolate from those figures to account for the fact that the people admitted at the weekend are often very poorly, and often very elderly, they tell us that there is a problem. It would be remiss of this or any Government not to ask why or to investigate the situation and consider how to provide solutions.
I will not talk about people’s pay or anything else; we have done that. Instead, I shall focus on the petition, which in my view is neither constructive nor helpful. I would like the Government to learn from the best practice of consultants and their teams. Brilliant ideas are out there if we can only harness that best practice. For example, at the virtual fracture clinic at my West Suffolk hospital, a consultant told me that he has cut the number of times that patients must visit the hospital. Work can be done remotely; even discharges can be done on the phone, and those who need further specialist help can be sent on. We need to have honest conversations about the NHS. We need to use its finite resources, including staff, more sensibly if we are to survive.
We have 1.4 million great people working in our NHS, and 1.6 million people working in our social care sector. That is one tenth of this country’s population. We all agree that a seamless pathway between the two is the best future, but I leave Members with this question. If we cannot discuss a way forward that allows us to accept change, understand and develop new ways of working, we may struggle to look after the burgeoning health population, and there may be more than contracts to think about.
Maria Caulfield (Lewes) (Con)
Thank you, Ms Vaz, for giving me the opportunity to speak in this debate. I am a passionate supporter of a seven-day-a-week national health service. That might take many formats; it is not a one-size-fits-all situation, so what works in my constituency might be different from what works in someone else’s.
I will not repeat what many of my colleagues have already said, but I think that we need an honest debate. There are difficulties to get over; my hon. Friend the Member for Totnes (Dr Wollaston) in particular has described them. We will have to work together and compromise on certain things, but if we do not debate the issue and find a resolution, patients will die from lack of access to good out-of-hours care. We need to tackle it. To be 16% more likely to die just because of the day of the week one is admitted to hospital is not good enough in this day and age.
However, it is not just about the impact on patients and their relatives; it is also about the impact on staff. Tribute has rightly been paid in this debate to staff, senior consultants and doctors who work long hours and come in at weekends. Many of them do so unofficially because they are dedicated, but I want to represent staff who work out of hours because it is part of their contract. I have been a nurse for more than 20 years. I have worked in the community on weekends, when patients without access to a GP have needed painkillers or an urgent dressing and it is difficult to get hold of a doctor. I have been in charge of wards on weekends and nights, when patients tend to be sicker because as medicine has progressed, patients who are well are often discharged earlier, so those left in hospital are often sicker than they would have been a decade ago.
Along with the reduced skill mix that I highlighted earlier, the pressure on nurses, healthcare assistants and other ancillary staff is huge. Two or three staff on night duty with a poorly patient who is septic might have one doctor on call handling four or five other wards, who might have 10 admissions that night to see to first. The staff will have expanded their skills so that they can cannulate the patient, take their bloods and send them off to the labs, but that is the limit of what they can do. It is hugely stressful. I know from having been in charge of a team of nurses on nights how difficult it can be.
That cannot continue. It is not good for patients—we know that their mortality and morbidity rates get worse—and it is not good for staff or for their morale. I have seen nurses in tears after a busy night shift during which we could not care for a patient the way we should have, because we had no access to senior medical advice. Yes, it is possible to phone the consultant on call and have a chat with them, but nothing beats having the advice of an expert who can interpret an X-ray or blood results and who can help junior medical staff prescribe the right antibiotics.
A great example introduced in the past couple of years is the acute oncology service, which has transformed out-of-hours care for cancer patients. As a sister in a research unit not far down the road, I know what a difference that has made to my patients. For some reason, patients tend to get really poorly at half-past 4 on a Friday afternoon, come what may. I have been so pleased with that service, which is now available up and down the country and offers trained senior nurses, doctors and a whole team of people who can assess a patient and get treatment going. For conditions such as sepsis, it is life-saving. Those with spinal cord compression can have a scan urgently and be started on steroids straight away. That is the difference between a patient being able to walk during the last six months of their life and being bed-bound.
That is out-of-hours care at its best, but of course difficulties and contentious issues will arise when renegotiating contracts. It is not just about consultants and senior staff. Proper out-of-hours care will require support services such as radiologists, radiographers and pharmacists. My hon. Friend the Member for Banbury (Victoria Prentis) spoke about the perfect week; I could talk to hon. Members day in, day out about how many patients we kept in hospital over the weekend because we could not access drugs to send them home. That is not a great use of hospital resources, but more importantly that is not a great experience for patients and their relatives.
Support services make a huge difference, but my plea is that we do not use the debate as an opportunity to score political goals. We have to work together. If we do not work cross-party on this, we will be here in 10 years’ time. Patients will lose out and their families will lose loved ones if we do not make a difference. It will not be easy. Nobody will be happy about working different hours. We are not asking people to work more than 40 hours a week; we are just asking people to work differently. We are not even just talking about how we work, but about a systems change in the culture of the NHS, so that the patient at half-past 4 on a Friday afternoon does not think, “What lies ahead for me this weekend?” I urge hon. Members on both sides of the House to be as constructive as possible.
Helen Jones
I am grateful to the hon. Lady; she has been most generous in giving way. She says that she is not expecting NHS staff to work more than 40 hours a week; did she mean to say that? Many of them already work more than 40 hours a week. Is it now Government policy that no one in the NHS should work more than 40 hours a week?
Maria Caulfield
Of course. I have worked more than 40 hours a week; many staff do. We are not asking staff to work more hours—we have been very clear—but we are asking staff to work differently. I do not think that there is anything wrong with that if it provides a better service for the patient and takes the pressure off those front-line staff who are without radiology support, laboratory support and senior cover support. I ask the hon. Lady to support the measures and work with us, so that we can work with healthcare professionals to achieve that. They need senior support out of hours, because they need someone to interpret test results, make decisions to discharge a patient and break bad news when results are not good, and they need senior expertise to refer to others to move the process forward. My plea is that is we all work together.
I welcome the debate this afternoon. It is good to have it. I am pleased that healthcare professionals flag up issues, because I do not want policies to be steamrollered in, as they have been in the past, and for us to sit here 10 years later reaping the results. I welcome the seven-day-a-week initiative and the move to change the culture and the system, so that ultimately patients see improvement in patient care.
Will Quince (Colchester) (Con)
Thank you, Ms Vaz; I missed the first few minutes of the debate owing to a delegated legislation Committee, so I appreciate your calling me to speak. I speak not as a healthcare professional, but as a husband, father and proud supporter of our NHS. I am passionate about our NHS, because it has always been there for me and my family when we needed it. My daughter was born in Colchester general hospital and my son sadly passed away there in October last year. I cannot fault the care and compassion that the NHS gave me and my family, and I will never forget that. Yet, I am bombarded with criticism that, as I am a Conservative, I must somehow care less about the NHS than the Labour party does. The scaremongering and empty rhetoric is patronising and insulting. It has to stop.
I spent several months, as we all did, speaking with constituents in the run-up to the general election. The message I received was loud and clear: they care deeply about our NHS and want us to work together to address the underlying causes and challenges facing it—challenges like an ageing population and the rise in long-term health conditions like diabetes and dementia. They do not want cheap party political point scoring.
I am fortunate to represent a constituency with a large general hospital. The pressures on my own hospital are well known, as it is currently in special measures. Last year, we saw a major incident declared in relation to accident and emergency. I desperately want Colchester hospital to come out of special measures as soon as possible. However, I want it to happen only when the healthcare regulators feel that it has improved significantly enough to warrant it. Although I and many others were saddened to see Colchester receive an inadequate rating from the CQC, that close scrutiny is absolutely necessary. High standards at the trust are needed to address some of the deep-rooted issues facing the hospital. That is why I welcome the steps taken by the Secretary of State to introduce such a rigorous inspection regime, which puts patient safety at its heart.
I do not recognise the assertions of the petition we are debating today. The changes to contracts and conditions for workers in the NHS are absolutely vital to help us deliver the seven-day NHS that we all need. Diseases and illnesses do not strike only in the working week. Patients should get the same high-quality, safe care on a Saturday and Sunday as they do on a weekday. To take the case of my grandmother, who also sadly passed away last year, why can someone diagnosed with cancer at the beginning of the week have radiotherapy within two to three days, but someone diagnosed at the end of the week have to wait until Monday? That is not acceptable, which is why we need better flexibility in NHS staff contracts, going hand in hand with recruiting more doctors, consultants and nurses to staff those enhanced services.
Colchester general hospital emergency department has undergone a major reform programme over the past six months, which has contributed significantly to a sustained improvement in performance. The trust invested in three rapid assessment and diagnostic units, which have increased the department’s ability to assess and treat patients rapidly, resulting in shorter stays. In addition, there is now an action plan in place to address low staffing levels, which have improved significantly on every shift. The trust is welcoming a cohort of new substantive nurses, who are joining following a successful recruitment campaign. I sat on the recruitment panel for the new chief executive of the trust, Frank Sims, and I am very confident that he will be able to help turn the trust around. He has a strong record on staff engagement and working with partner organisations—two areas in which our trust desperately needs to improve.
I want to put on record the help and support that the Secretary of State has given Colchester general hospital. He has visited twice during the past year and has taken a genuine interest in our local healthcare. I also very much welcome the recent announcement about the success regime, which shows the determination of the Secretary of State to address the underlying issues facing the NHS in Essex and tackle them head on. Identifying problems, bringing in better leadership and helping our health and care systems to work better together is, in my view, the right approach.
NHS professionals tell us what is needed to address the underlying issues in the system: better self and family care; early diagnosis of illness and response; more focus on preventive healthcare; faster access to medication; community-based care where appropriate; and quicker discharge into community services. We can argue and debate about the process and the different ways of implementing the change our NHS needs. We can debate the funding. We could and should debate the future challenges. Make no mistake, our NHS will need to adapt over the next five years to keep pace with our changing demography and society, but let us make it a grown-up debate based on evidence and professional opinion, not conjecture and scaremongering.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I declare an interest: I am a doctor and member of the British Medical Association, and I still work in the hospital.
We are talking about data showing that people admitted at the weekend are more likely to die within 30 days than those admitted on weekdays. It is important to listen to what Bruce Keogh said, which is that it would be misleading to assume that all of those deaths could be prevented. We use terms as if the deaths were avoidable or talk about people “dying unnecessarily”, but we do not know. We must understand what the data show. There is nothing wrong with the data and nothing that can ever be bigger, because the NHS is the biggest single health service in the world. Professor Freemantle has done the work twice and the pattern is there, but it is not people dying at the weekend; it is important to realise that his data show the reverse. They show fewer people dying on a Saturday or Sunday then dying on a Wednesday. What is higher is the number of people who are admitted, and we need to understand that. As the hon. Member for Totnes (Dr Wollaston) said, they are sicker people. On a Saturday, there are 25% more people in the most ill category and on a Sunday there are 35% more people in that category.
[Mrs Cheryl Gillan in the Chair]
It was said that there was an increased number of deaths among elective patients admitted on a Sunday, and people wondered why that was. As a surgeon with a Monday list, I can say that the norm now is that patients come in on the morning of surgery. So, for me to get permission for someone to come in on a Sunday, let alone a Saturday, means that that person has complex co-morbidity. If we are simply looking at additional populations, we cannot simply use a broad sweep and assume that all of this can be changed, because it cannot be; these people are inherently more ill, whether they are elective patients or emergency patients. Those data are absolutely there and they remain when we re-analyse them or try to balance them, so this issue needs to be tackled.
There are a few myths going around, including the idea that the opt-out clause is a major barrier. The opt-out clause that was cited was for routine work. Consultants do not get to opt out of emergency work at night or at weekends if they work in an acute service. If a consultant works in a service where acute provision is at all relevant, that acute provision is part of what they do and they do not get to opt out of it. Nine out of 10 consultants work out of hours and the other 10% are engaged in specialties for which there is not an acute service.
There has been talk about getting people to work for only 40 hours. My colleagues who are still up the road holding it together work for 48 hours and they simply cannot work more than that because it is illegal under the European working time directive to do so. Most consultants within the acute system work 48 hours a week, and I am sure that those of us who are married to them or simply aware of them will be well aware of that fact; indeed, we will have been told that in no uncertain terms in the last few months.
It is important that we focus what we do on trying to save the lives of those among those 11,000 people who can be saved. When I was a junior doctor, I was aware that getting scans out of hours or at weekends was very difficult, and so patients hit “pause” for a few days. I do not think there is that much difference in services; I find it hard to believe that there is. In Scotland, the situation has been changing for five or 10 years, not by threatening or cajoling people but simply by evolving. Our consultant radiologists cover the entire weekend; our stroke patients get CTs; and our heart attack patients go straight to get angiography, will get an angioplasty there and then, and will go home after breakfast the next morning. So this idea that we have big tracts of those in medicine sitting home watching “Coronation Street” is not true.
The NHS will be cash-strapped; it has to save £22 billion per year in the next five years, which is a big challenge. So now is not the time to say, “We can provide GP services eight to eight, seven days a week.” The pilots have not been successful. The uptake was 50% for Saturday and 12% for Sunday, and some of those pilots reported that there was great difficulty in covering the out-of-hours GP service, which people who feel unwell should be going to, because what was being talked about was totally routine.
Both in hospital and in primary care, we need to focus our attention on improving the access for people who feel unwell, which includes people being able to access a GP and not having to go to A&E with something that means they do not need to be there. That is recognised within the profession, but it is important for people to work together towards that aim rather than pulling out the pin and throwing a grenade at somebody, which is obviously how the profession regards what has happened during the summer. Like many people in Westminster Hall today, I was inundated by messages from colleagues, including from doctors south of the border who I do not know at all. They were very angry at the statement on 16 July that senior doctors do not work outside 9 to 5, which is patently not true.
We need to look at what we should do about these figures. One of the groups that shows the effect of this situation very strikingly is stroke patients. However, research by Bray looked at 103 stroke units, including units where there was seven-day consultant review through the day, and compared them. There was absolutely no difference between that seven-day service and units where there was a routine ward round and no ward rounds at the weekend. What made a significant difference was the ratio of fully trained registered nurses to patients. When that ratio was halved, so that there were twice as many nurses, the mortality was reduced by a third. So, before we go rushing into policy, even if we are working cross-party it is important to understand the data sufficiently to answer the question, “Do we need more doctors or do we actually need more nurses?” That is a pretty important question to answer before any moves are made.
It is also important to focus on the emergency side. People say, “Well, Tesco is open 24/7”. Actually, it is not open 24/7 totally. People will not find the fishmonger 24/7; the baker will not be making fresh bread; and there will not a butcher producing fresh cuts of meat. It will be the basic system that is open 24/7, so let us not confuse matters. And frankly, we can generate a person to work in Tesco, stacking shelves or operating the till, an awful lot quicker than we can create a GP, which will take 10 years because there are five years of medical school and then five years of training, or a consultant, which requires five years of medical school and—in my time—about 15 or 16 years of training.
There is no quick fix for this situation and we cannot afford to take on extra staff, but actually the money would be the easiest bit because we do not have the extra staff. The Government talk about 5,000 extra GPs and yet the British Medical Association shows that we will lose 10,000 GPs in the next five years. That means that we would need 15,000 GPs, and we simply cannot produce that number. So we need to ensure that we hang on to all the doctors we have, including the junior doctors, because that partly comes down to what those junior doctors see, including how they see their seniors working and what they think of that as a career. I say that because junior doctors have always gone to places such as Australia but they used to come back; now they are not coming back.
This whole matter could have been handled better, but the issue is working with people. The Scottish Government are also working towards seven-day cover, but they have been very clear that what they are talking about—the priority within that system—is seven-day cover for people who are ill. That means expanding the out-of-hours service for GPs and expanding what is available to us as senior doctors inside hospitals. That is the route that must be followed, and not the use of a grenade.
After the Francis report and the increase in the number of nurses being taken on to try to get the figures that are sought, what we had at the beginning of the summer was trusts that are struggling being told, “Cut back. Don’t use agencies. Don’t replace people unless they’re absolutely crucial.” We need to give serious thought about whether it is actually more nurses that we need before we rush in to bring in a whole lot—
Maria Caulfield
I welcome the hon. Lady’s thoughts and agree with a lot of what she has said. On the issue of nurses, does she agree that it is not just the number of nurses that matters but the skills mix? Because of budget constraints, what has happened over the past two decades is that the skill of senior nurses has been cut back, and those senior nurses are now often not on duty at nights and weekends, which has made a crucial difference.
Dr Whitford
I made the point that Bray’s paper talked about registered nurses—so, degree nurses—and that reflects the skill mix.
We need to know what the actual problem is rather than just running in and throwing ideas and policies around. Attacking staff who work very hard and for really long hours is not very fruitful. We need NHS staff to believe in the political decisions, the guidance and the direction being taken in the future, so I simply suggest that everyone in this House look at the way forward.
Mrs Cheryl Gillan (in the Chair)
When time permits, it is our practice in Westminster Hall that when a Member has been here for the opening speeches and then had to step out temporarily, we give them the opportunity to speak. So I call Andrea Jenkyns to speak.
Andrea Jenkyns (Morley and Outwood) (Con)
Thank you, Mrs Gillan. I will be brief, but I wanted to make a few points that I feel are important. I am speaking in this debate because I truly support the NHS. I have worked in it for the past four years, through the charity sector, and my sister also works in it. The NHS is a vital national institution, and we must protect it and make sure that it is secure for the next generation. However, that does not mean that it is constituted in a way that is perfect. There are many flaws, which must be addressed to ensure that the service is in step with people’s lives in this rapidly changing world.
With more medical innovation comes more advanced treatment. Diseases that 20 years ago might have been a death sentence can now be easily treated, but only if we provide people with the care that they need, when they need it. Patients should not be worried about going into hospital on a weekend, thinking they might not be able to see a consultant to diagnose their complaint. That is why I fully support the Government’s plans for a truly seven-day NHS.
Let us not forget that the recommendations come from independent bodies that have reviewed the pay and conditions of senior managers in the NHS. The recommendations would bring about real change and ensure that people could access the treatment they needed, when they needed it. It is about ensuring that key decision-making staff are there to support people when they most need it. That will ensure that we start to treat people as soon as possible after their diagnosis. There should be no situation where consultants can demand extremely high fees to provide a service to patients out of hours. Other key public sector workers cannot do that.
The change is only possible through the Government’s investment of £10 billion in the NHS, and through the determination to ensure that the NHS provides the best possible services to patients and reassurance to families whose loved ones are unwell, and ensures better outcomes for all. The hon. Member for Warrington North (Helen Jones) mentioned the demoralisation of NHS staff. Trials of seven-day services have already taken place in such hospitals as Salford and Northumbria, and according to the Government’s statistics, those hospitals have increased patient care and staff morale.
I briefly turn to the substance of the petition that led to the debate. For the past four years, I have worked on health issues. Since I have been elected, I have become a member of the Health Committee and have set up an all-party group on patient safety. The Health Secretary has been attacked, with calls for a vote of no confidence, but since I have been elected, he has been absolutely fantastic. Throughout the work I have done, not only on the Health Committee, but in setting up the all-party group, he has been there to support me with help and guidance. I am planning a major national campaign on hand washing, and he has met charity representatives. He is a person to lead our NHS. Every time I speak with him, I am hugely impressed by his compassion, knowledge and drive to make real improvements to the service and the lives of those who work in it. I have no doubt that he is the right man to drive through improvements to the health service, and I have every faith that he, as much as anyone else, wants to improve the NHS, to work closely with the staff and to ensure that the changes to how they work are well received and appropriate to their needs.
I return to the opening remarks of the hon. Member for Warrington North. She accused the Secretary of State of attacking NHS staff. She has said that the NHS is under threat from this Government. During the election campaign, Labour tried to weaponise the NHS, and she has continued that agenda today. The debate should, however, include a view of the NHS under Labour’s tenure. If we are looking at staff costs, we should look at the massive increase in agency costs that began under the last Labour Government. From 2007 to 2009, spending on agency staff increased by 60% and continued to rise in the five years of the previous Government because of the shackles placed on contracts by Labour. That situation is being addressed by the Secretary of State, with caps on costs for agency staff bringing down costs for trusts. While Labour is busy weaponising the NHS, the Secretary of State is trying to undo the damage done to the service under Labour.
My experience of the NHS has not always been good. Sometimes it has been fantastic; other times it has been not so great, such as when I lost my father to a hospital-acquired infection. I am encouraged by the work that is being done on improvements.
Andrew Gwynne (Denton and Reddish) (Lab)
It is a pleasure to see you in the Chair, Mrs Gillan. We have had a good debate, and it is a pleasure to speak in it, for a number of reasons. This opportunity comes with a number of pressures. I note that this is the first debate relating to an e-petition under the new system. As the shadow teams are still being put together, I am not sure whether this will be my last outing as a shadow Health Minister or as a shadow Minister altogether, but patience is a virtue and time will tell.
It is a particular pleasure to respond to my good friend the Member for Warrington North (Helen Jones), who opened the debate. From my slightly partisan perspective as the shadow Health Minister, I thought she made a devastating critique of the Government’s record on the NHS. She will be an outstanding Chair of the Petitions Committee, which is, again, a parliamentary first. I declare an interest: in my first Parliament, from 2005 to 2010, I was a member of the Procedure Committee, and we looked at the practicalities of having a proper petitions facility and a petitions Committee to back that up in the House of Commons. The wheels of democracy take a long time to turn, but here we are 10 years later with the Petitions Committee, debating the first of the probably great number of petitions already lodged with the House of Commons. I welcome my hon. Friend to her post.
While I am making welcoming remarks, I welcome the promotion of my hon. Friend the Member for Lewisham East (Heidi Alexander) to the role of shadow Health Secretary today. She will be a doughty campaigner for the NHS in that role, as she has been for her constituency, not least because she cut her teeth on the Lewisham hospital issue.
I also pay tribute to my right hon. Friend the Member for Leigh (Andy Burnham), who has served diligently and excellently as the shadow Health Secretary for the past four years. I have been privileged to work under him. He has been committed to the national health service in his time as a Health Minister and as the Health Secretary, and in his time in opposition.
There was a need to adjust the terms of the debate to ensure that we addressed the issues and not the personalities, but we have all alluded to why we are here, what triggered the petition and the reasoning behind it. Government Members might want no challenge to their record and policies, but the fact is that while we agree on a large area of health policy—where we do, it is right that there is consensus—we will not avoid political debate just because it is uncomfortable for some Members. It is right that where the Opposition—whichever parties they may be—have differences of opinion with the Government of the day, we are able to raise them.
When it comes to the seven-day NHS, the Health Secretary has a habit of spinning the data to suit his purpose and to divert attention away from some of the Government’s failures on the NHS. Of all his public pronouncements since the election, the most controversial —indeed, it inspired many people to sign the petition—was his suggestion that NHS staff are avoiding working at the weekend. As we heard from the hon. Member for Central Ayrshire (Dr Whitford), that is just not the case, and she speaks with a vast amount of experience. Let me reiterate: it is not true, and we know it is not true.
I want to place on record my appreciation and thanks to all who work in our NHS: the consultants, the doctors, the nurses, the support staff and the ancillary staff. They do a tremendous, often thankless job under difficult circumstances. The deluge of social media users sharing photos of themselves working at the weekend on wards and in surgeries demonstrated just how absurd the Health Secretary’s claim was. Indeed, according to a series of freedom of information requests, only 1% of consultants in our health service actually opt out of weekend working.
The Health Secretary told consultants they needed to “get real”, but it is the Health Secretary who needs to get real. Rather than picking fights with hard-working NHS staff, he should be consulting them on the best way to deliver seven-day services. If the Government are serious about delivering further weekend care, they have to stop coming out with speculation and conjecture, and must urgently define what they want to deliver and how they plan to pay for it. Demonising doctors who are already working evenings and weekends will get us nowhere.
A seven-day NHS is the aim of all those who want the best health service in the world—I include myself among them—but to achieve one, we have to listen to those on the frontline and address their concerns. Staff are rightly worried about losing their antisocial hours pay, the effect of which could be devastating for huge numbers of assistants and nurses. Working at night is as expensive as shifts get, with transport and childcare being more expensive or totally unavailable, and all the evidence shows that night shifts have a detrimental effect on people’s health. It is only right that such shifts are appropriately compensated. I sincerely hope that the Minister, for whom I have a great deal of respect, will address that point in his reply.
We must not forget that the seven-day NHS pledge has been made many times before. It was in the 2010 Conservative manifesto. The Prime Minister repeated it in October 2013, and in September 2014, and of course it was also in the Conservatives’ 2015 election manifesto. The question I am pondering is: if they promised it before and failed to deliver it, why on earth should anyone believe them this time? We would all welcome a seven-day service, but that must be matched by the funding necessary to recruit, support and, importantly, retain hard-working NHS staff. We have already heard that there is a shortage of nurses; there are fewer nurses per head of the population than in 2009-10. The head of Health Education England, Ian Cumming, said earlier this year that
“GP recruitment is what keeps me awake at night.”
The scale of the recruitment crisis is startling even to those of us who have been following the fortunes of the two Health Secretaries since 2010. The coalition Government were wrong to cut training places as one of their first acts, and immigration policy is not joined up with the need for recruitment from abroad. If adequate numbers of staff are not being trained at home, the two polices do not make any sense together. As we have heard, retention is a big challenge; it is about not only the new staff coming through the system but the staff leaving at the other end.
My message to the Minister and the Health Secretary is this: if they want to deliver a seven-day NHS, we will work with them, but they will not achieve it by picking a fight with staff and, importantly, they will not achieve it unless it is properly funded. The Conservatives made many promises on the NHS before the election, many of which the Government have already dropped, and many more of which have not been funded. If the seven-day NHS promise is to be realised, I implore the Minister to work closely with the health service unions and actually go out and speak to the health professionals that keep our system going.
More broadly, we need a serious debate about how services are organised across the whole week, so that people can stay healthy in their own homes. The Minister and I have debated the concept of whole-person care on numerous occasions—in fact, we debated it at length both before and during the general election. There was a degree of consensus around the plans of my right hon. Friend the Member for Leigh. We desperately need to make sure that all parts of our health and care service work together to ensure that care focuses on the individual.
It is no good Government Back Benchers lauding the ring fence for the NHS budget when, as we heard from my hon. Friend the Member for Warrington North, social care budgets have been ransacked. I should not need to remind Government Members, but the fact is that social care cuts are NHS cuts because of the pressure that they cause throughout the health system. Let us look carefully at the workforce issues that triggered the petition and this debate. Let us work with staff, because without them the NHS will not be transformed into that single health and social care service. For all of us who care about the NHS, ultimately that must be our goal.
The Parliamentary Under-Secretary of State for Health (Ben Gummer)
It is a great pleasure to serve under your chairmanship for the first time, Mrs Gillan, as it was to serve under the previous Chair, Ms Vaz.
This is an important and exciting day because we are responding to the first e-petition under the new system. The hon. Member for Denton and Reddish (Andrew Gwynne) is quite right that it should have happened some time earlier. I hope that through what are pretty modest forays into social media we can make more popular the debates that take place in Westminster Hall, because they are often far more thoughtful and certainly more nuanced than some of the debates that one hears just a few hundred yards away.
I am grateful to the Chairman of the Petitions Committee, the hon. Member for Warrington North (Helen Jones), for her introduction. Hers was a vigorous opening argument and certainly did what it should have done, which was to spur a good and, at many points, enlightening debate. There is much to which I would like to respond, but at times the debate turned into a general critique of the NHS, so if I tried to answer every point, Mrs Gillan, I think we would be here beyond the 7.30 pm cut-off that you and, I imagine, other Members would not like me to reach.
The debate encompassed many of the issues and problems that confront the NHS, as do all discussions of seven-day services because they touch on contract reform and how we manage the NHS workforce. At the core of the debate was what we are trying to do: deliver exceptional, world-class care to every patient coming to an NHS institution, hospital, GP or community service in England and, by extension, the other nations of this country.
I, too, pay tribute to some shadow Front Benchers. I am grateful for the words of the hon. Member for Denton and Reddish. I almost wish he had not said what he did, because I wanted to say that I hope he keeps his Front-Bench position. He has always been a very reasonable defender of the Labour party’s point of view and a strong interrogator of the Government’s policies. That is exactly what opposition should provide. I should take the opportunity to say how much I will miss his colleague, the hon. Member for Copeland (Mr Reed), with whom I sat in this Chamber a couple of days ago for his last debate as a shadow Minister. I did not have the opportunity then—the moment escaped me, and I did not have knowledge or foresight about where he would be on Saturday—to wish him well and say how much I had, in my short time as a Minister, enjoyed debating important issues in the Chamber with him.
It is also entirely right to say that the right hon. Member for Leigh (Andy Burnham) has been Secretary of State for Health, a Health Minister before that, and a shadow Secretary of State for a long time. His contribution to debates about the NHS has been very important. It is clear from how he speaks that he cares passionately about the health service, and I very much hope that he delivers the same kind of force of argument in his new position as shadow Home Secretary.
It will be good to see what the new shadow Minister, the hon. Member for Lewisham East (Heidi Alexander), brings to her role. I hope that she will enter into arguments and debates on NHS reform with the spirit of openness and decency shown by the hon. Member for Central Ayrshire (Dr Whitford), who often attends these debates, bringing a great deal of personal experience from both this country and abroad, and who makes sure—no doubt because we often feel chastised if it goes any other way—that the debate is continued with a sense of decorum and a remembrance that our discussions are held in public. We must be aware of the fact that what turns people off political discourse more than anything is a silly repetition of party political positions with no meeting in the middle or discussion of the issues at hand.
It is in that spirit that I hope to address the central point of the presentation of the petition by the hon. Member for Warrington North. I am glad that we have these petitions, although perhaps a little less glad that this particular petition contains such stridency of language. Nevertheless, at the core, what concerns me is the point made very well by the hon. Lady: words matter. That was echoed by my hon. Friend the Member for Faversham and Mid Kent (Helen Whately). We must be very careful about the words we use—not only the manner in which we say them but how they might or might not be construed.
Hon. Members may not be surprised to hear that I have read—several times, as it happens—the Secretary of State’s speech on this matter. I have also seen the coverage on it, and there is dissonance between the two. At no point did he attack NHS staff or suggest that they are not working in conditions that are often heroic, and at no point did he suggest that we have ended up at this impasse because of a wilful wish on the part of NHS staff not to work at weekends. What was construed from that speech has unfortunately meant that our debate has been about a number of words and phrases that were not used, intended or even suggested.
Turning to the core of the speech, the Secretary of State began by saying that talking about seven-day services is not news to a large number of NHS staff, because nurses, porters, cleaners and many of those working under the “Agenda for Change” contract have, for the entirety of their professional lives, been working in seven-day services. His main contention was that, given the weight of evidence on excess mortality that can be attributed to differential working patterns at weekends and on weekdays, it is at least reasonable to ask what we are doing to ensure that if someone is admitted on a Saturday or a Sunday they can expect the same quality treatment and intensity of consultant and diagnostic support as they would receive on a Wednesday. That suggestion was not plucked out of the blue.
I have two points to make. Given that the petition is an ad hominem attack on the Secretary of State, it is right to say that I have never encountered anyone in a ministerial post who has acquitted himself with as much passion about a point on which he wishes to concentrate—patient safety—as the Secretary of State. The right hon. Member for Leigh recognised that when he was shadow Secretary of State, and it is recognised even by those who often oppose the Secretary of State in the BMA and other professional representation bodies. The fact is that the Secretary of State is passionate about patient safety. He cares deeply about it, which is why he takes an intense interest in gathering evidence about differential mortality rates.
I want to run through in detail where NHS England’s thinking comes from and why the Government have decided to act as they have. As the hon. Member for Central Ayrshire knows, there have been various academic papers from the United States and some from the United Kingdom on differential mortality, and they contain many of the questions and answers that have been alluded to today. It is certainly true that people are admitted sicker at weekends, which points in part to the need to do something about community and GP services at weekends. That is part of the reason why people are being admitted sicker. If somebody with a serious acute illness is seen on a Wednesday, they will receive a level of service—both diagnostic and consultant support—that they are unlikely to receive in many hospitals on a Saturday or Sunday.
Helen Jones
The Minister is making a sensible point, but could he enlighten us about exactly which services the Government foresee working seven days a week? Has the Department for Health assessed how many extra staff will be required to ensure that happens? NHS staff have got to have days off sometimes, so if they are working at the weekend they will have to have a day off in the middle of the week. How many more staff will we need?
Ben Gummer
Those are very reasonable questions. If the hon. Lady will allow me to continue with what I was setting out, I will certainly answer them.
That assortment of academic research, together with the wide anecdotal evidence from people who have experienced poor care in good hospitals, either for themselves or for their relatives, led NHS England to conduct the Seven Days a Week forum in 2013, which gathered together clinicians to look at the challenge. It produced a clear strategy for dealing with differences in care quality at weekends, compared with the week, and set out 10 clinical standards that it believes hospitals must meet to eradicate the difference between weekday and weekend working. Many hospitals are implementing the 10 clinical standards on a variable basis during weekdays, so the work done for weekends was helpful in determining a standard clinical approach for maximising the ability to reduce avoidable deaths for weekend and weekday admittances. The product of that forum was taken forward by NHS England and incorporated into its five-year forward view, in which the NHS, separately from the Government, made a commitment to seven-day services. It did so not because of the benefits to patients—as my hon. Friend the Member for Sutton and Cheam (Paul Scully) said, that is a secondary reason for pursuing the agenda—but purely because of the need to reduce excess mortality where possible.
This is a challenge on the scale of infections in hospitals. It is our duty not only to find out precisely why excess deaths are happening—as the hon. Member for Central Ayrshire correctly said, further work is needed and the data must be understood—but to do what we can as quickly as possible to reduce them where we think they are preventable. That is why NHS England incorporated the seven-day service into its five-year forward view. NHS England asked for an additional £30 billion of spending between 2015 and 2020, of which it said £22 billion can be achieved through efficiencies within the service. It is important to point out to the hon. Member for Warrington North, who made that point, that they are not cuts but genuine efficiencies within the organisation. On top of the £22 billion of internal efficiencies though a better use of IT, to which she alluded, and better job rostering—I will turn to that in a minute—there will need to be an injection of £8 billion to make up the rest of the £30 billion. That package will implement the five-year forward view, which includes seven-day services and many other things of great importance and about which all parties agree, such as shifting resources from providers to primary care, social care and the community sector.
This programme was not invented by the Secretary of State in a speech given to annoy doctors and consultants, much as that might be the impression given by some people on Twitter. It is the policy response of a Government taking seriously the clinical evidence and advice of NHS England, led by Professor Sir Bruce Keogh. We are responding to give NHS England and the providers tools with which they can deliver a seven-day NHS service in hospitals and GP practices.
I turn to the changes in the contracts, which are at the heart of the petition and the speech of the hon. Member for Warrington North. The contract terms are based on a review by the doctors and dentists pay review body, which identified a number of areas where contract reform is needed, including the systems of opt-out and on call. It asked a completely reasonable question: why should it be that some members of the workforce, who are expected to work at weekends as part of their normal shift patterns, do not have the option of an opt-out from their contract, while others—who tend, as it happens, to be far more highly paid than those who do not have the option of an opt-out—do? It proposed a series of changes, which in our view make up a far better contract for both junior doctors and consultants. On balance, we feel that it presents a real opportunity for consultants and doctors to improve not only their working conditions but, in some cases, their pay.
To take some salient examples from the consultants’ contract, we want a far more equitable and reasonable distribution of clinical excellence awards—many consultants are privately critical of how they are awarded—within not a cut to the total consultant budget, but exactly the same existing pay framework.
Dr Philippa Whitford
To point out a slight difference, we do not have those awards in Scotland. We have local discretionary points, but the national clinical awards have been done away with for quite some time. Much as we also struggle with staff, we have not been haemorrhaging them south on that basis.
Ben Gummer
The hon. Lady points out that contractual differences already exist between NHS Scotland and NHS England. Officials have looked with interest at the experience of NHS Scotland—one of the pleasures of the devolved NHS system is that we can all learn things from one another. I hope that the new replacement of the clinical excellence award will be perceived as far fairer by clinicians and will reward those surgeons who are giving their utmost in academic research and the professional development of others. That is a tangible improvement to consultants’ terms.
It is important to point out, as several of my hon. Friends have done, that we are talking about ensuring that, at most, consultants work no more than one weekend in every four. That is the basis on which they will be contracted to work in a seven-day NHS. We are not talking about seven days at a time, but about shift rotas and patterns, as many people in professional life already recognise, not least some of those who have spoken in this Chamber. We need to get to a situation in which NHS professionals at the top, as well as those at the bottom, are trusted to organise their life and work patterns according to the professionalism they hold so dear. Many consultants in the NHS want to move to contract reform so that they may express their professionalism in that way, and we need to ensure that it happens so as to bring them with us, rather than its being forced on them.
For that reason, I am delighted that the consultants committee of the BMA has agreed to rejoin negotiations. It has seen that there is a basis for reaching an agreement, which suggests—contrary to some of what has been said by Opposition Members—that things are being done with a sense of collaboration. We have wanted to enter the negotiations for some time. The BMA, for reasons no doubt connected with the election—probably understandably—decided to withdraw from negotiations, but it has now come back. We and the consultants committee can reach a good position on the proposed contract.
The junior doctors’ contract is a proposal of great strength, not least because we include a significant increase in basic pay rates, which should be welcomed across the board. The contract addresses one of the points made by the hon. Member for Warrington North and does something important for the way in which junior doctors are perceived by their management. Instead of offering, in effect, danger money for excess hours, which is surely not the way to manage a workforce, it gives junior doctors a right to a review of their hours, so that they may properly manage their work rotas and patterns. For the first time, that will be enshrined in their contract. They will have far more predictable work patterns; providers—employers—will be forced to think seriously about work-life balance when constructing the roster; and, on pay and on the offer to juniors for their working life, the proposed contract will produce a far happier outcome.
I had hoped that the juniors committee would already have agreed to come back to the table, and I remain hopeful. The committee is meeting imminently—in six minutes’ time, in fact—and I hope that it is listening to the words in this Chamber, because hon. Members and others listening have heard nothing from both Government and Opposition Members but unalloyed praise for NHS staff and a real desire to work cross-party to secure the kinds of advances in quality that everyone wishes to see. With the juniors at the table, we could reach a constructive and reasonable resolution to the need to change their contract. That need was impressed on Ministers not only by the DDRB—the review body on doctors and dentists remuneration, but by the NHS’s own independent pay review body. Many in the service, perhaps more quietly than those who have been most exercised on Twitter, know that it is necessary.
Helen Whately
Is the Minister aware that if we compare the number of staff in a particular NHS service with the demand for that service over time, we can see that demand is sometimes highest when staff numbers are at their lowest? Demand and staff numbers do not match well. Is there not an opportunity to look at changing staff shifts and rotas to ensure that there is the greatest number of staff when demand is greatest?
Ben Gummer
My hon. Friend is entirely right. The whole purpose of what we are doing through contract reform is to match the professionalism of doctors, consultants and those working on agenda for change contracts—nurses and so forth—with the demands of any particular hospital. That cannot be decided by me or NHS England, but has to be decided in each setting, because of the differences—sometimes subtle and sometimes wild—between hospitals. In a study of some 15 hospitals released a couple of years ago, it was noticeable that there was 3.6 times more consultant cover for acutely ill people on a Wednesday than on a Saturday, even though 3.6 times more people were not acutely ill on a Saturday. The comparison is roughly drawn, but it points to a mismatch between rostered staff and peak patient flows. Most hospital managers would not only accept that point, but offer it to you.
All that suggests that somehow no seven-day NHS working is going on at the moment. As the shadow Minister and other hon. Members have said, however, some hospitals are already delivering an exceptional seven-day service—sometimes at no extra cost at all, and sometimes with only a minimal cost increase. What is most noticeable is that care quality has improved. In some cases that is now measurable, which is very exciting, and we can see reductions in mortality attributed to changes to staff working patterns. The staff, when asked, “What difference has this made to your lives?” point, as the key difference, to the fact that this was led by enthusiastic members of the staff themselves. There we have a pointer as to where we need to go: we need to get staff buy-in at the beginning. When the change is done well, it gives staff far greater control over their working life, which has led in a couple of hospitals to appreciable improvements in staff satisfaction.
Those settings have achieved the trick that we want to see throughout the NHS, which is for contract reform to empower and help staff to deliver care with the professionalism that I and everyone in this Chamber know that they wish to, while delivering better, higher quality care and decreased mortality—all within tight spending constraints, despite the increases to the cash budget that the Government have pledged to the NHS. If we can achieve that, we will have done something very special: we will have dealt with the lack of a link that has existed for too long between patient quality and care, and restrictive contracts that do not reflect how many staff want to work, and certainly do not reflect how patients admit themselves to hospital.
There is one final thing that I would like to add—in fact, it is the penultimate thing, because I must answer the point made by the hon. Member for Warrington North about staff. She is right to say that, of course, seven-day services will, in some disciplines, have an effect on the staff numbers that might or might not be required. That is part of the plan being developed by NHS England, in close association with Health Education England. We are recruiting close to record numbers of nurses, doctors and consultants, and we are doing so in many of the diagnostic specialties as well.
However, this is a question of not just staff numbers, as the hon. Lady recognises, but much smarter rostering and rota-ing, so that we use staff and their time as effectively as they would like us to. It is also a question of the productive use of staff time. She rightly pointed to the bureaucracy that ties people down. In some hospitals—some quite near her constituency—that bureaucracy has been reduced to a very minimum, as a result of which staff have patient contact time of an order of magnitude different from that in hospitals just 50 or 60 miles away. If we can bring all levels of staff exposure to patients—the patients they want to care for, for the maximum period of time—up to the best level in the NHS, we will already have the productivity gains in the workforce that will make possible not just seven-day working but a whole series of other improvements in care quality.
My final point about the opportunity that contract reform gives us was touched on by the hon. Member for Ealing Central and Acton (Dr Huq), who spoke about whistleblowing. It is an important point. When people attack the Secretary of State they should remember that he brought in freedom to speak up and the duty of candour, is bringing whistleblowing champions into the NHS, and has acted on some of the most difficult recommendations of the Francis report. It is this Secretary of State who said for the first time, “If you are employed by the NHS and feel that care is not being delivered in a way that is good for patients, we will prize your voice and listen to you above those who might stop you being heard.”
That kind of message to the system is new. It is so radical that I think many still do not quite believe it could be true, but I hope that the instigation, at some considerable cost, of whistleblowing champions, along with the framework for whistleblowing and the independent national officer, demonstrates to Members and the outside workforce that we are deadly serious about listening to staff, no matter where they work or who manages them, to make sure that we improve patient care wherever possible. We know that improving staff’s experience in their working lives is a crucial part of that.
Although this was not mentioned in the debate, I am conscious that far too many staff in the NHS suffer bullying and harassment. The numbers are almost unheard of in any other walk of life, including the Army and the police. NHS workers unfortunately can expect abuse from members of the public and bullying within management chains to a degree that is unique in the public sector and close to being so across the entire workforce. That is an historical problem that has led to the very high levels of staff sickness that the NHS has carried for decades. It will not be an easy problem to crack, but I have to tell Members that I and the Secretary of State are absolutely committed to doing something about it. NHS staff go to their place of work because they care about patients and about their vocation, but too often can get pushed back by poor management, abusive patients and poor performance management processes, and often feel belittled in what they are doing. If we can do something about their working conditions and improve their working lives, that will be very important, not just for staff but for patients. If we can improve the working practices and the working lives of the 1.3 million people devoted to our nation’s healthcare, we will do so much to help them produce even better care for the patients they serve.
I hope that Members on both sides of the House have come to a broad understanding that the changes anticipated by the contract reform are necessary. It is certainly true that we must take account of the data and listen carefully to the arguments of everyone involved in the provision of NHS services seven days a week, to make sure that changes are made as collaboratively as possible, so long as collaboration is made possible by all parties. We must also bind ourselves to the promise that we should all reflect correctly the words of politicians on both sides of the House, lest their misconstruction cause worry and fear in the outside world. In all that, we must ensure that the changes we make improve the quality of patient care and reduce the excess rate of mortality, which I know everyone, including all Members, would like to come down when and if possible.
Question put and agreed to.
Resolved,
That this House has considered the e-petition relating to contracts and conditions in the NHS.