Pennine Acute Hospitals NHS Trust

Debbie Abrahams Excerpts

Tuesday 17th January 2017 Westminster Hall

[Graham Stringer]

As I just said to my hon. Friend, I will not go into the details, but I probably know more than she does about the situation from the patients’ side, because a relative was affected. I have no doubt that those patients were treated appallingly. I cannot comment on the details of personnel issues, but I can comment on the fact that patients have been badly treated. Given the technicalities of the situation and having watched the programme, I find it worrying that although one or two cases were found after six months, the nurses were re-employed.

After “Dispatches”, the CQC report found scandalous failings within the trust. It found that the safety and wellbeing of patients were inadequate, and that the trust’s responsiveness and effectiveness needed improving, but that the care of patients was good. That report was very worrying; the trust would have been put in special measures, if a new team had not already been put in place to deal with the situation.

As I say, the CQC report found that the care of patients was good, but within a very short time—and after excellent investigative work by Jennifer Williams of the Manchester Evening News and other journalists—an internal report on maternity care was made public, showing that the care provided by some individuals was very poor indeed.

It is worth reading out for the record an extract from that internal report, because we have now had a 13-year period of failure. It is also worth remarking that both that internal report and the CQC report relied on nothing but internal statements by the trust’s staff. A paragraph from the internal report really contradicts the CQC report, as it states:

“Staff attitude has been a feature of a significant number of incidents, from the most basic reports of staff relationship breakdowns, resulting in women and their families exposed to unacceptable situations, to an embedded culture of not responding to the needs of vulnerable women”.

The report went on to say of one woman that

“in one incident it is clear that the failure of the team to identify her increasing deterioration and hypoxia attributed her behaviour to mental health issues. Failure to respond to deterioration over a period of days resulted in her death from catastrophic haemorrhage.”

That means that, according to internal sources, the situation was actually worse than had been thought.

The report continued:

“A further example of staff attitude and culture has been experienced recently when a woman gave birth to her baby just before the legal age of viability (22 weeks and 6 days)…whilst no resuscitation would be offered to an infant of this gestation, compassionate care is essential. However, when the baby was born alive and went on to live for almost two hours, the staff members involved in the care did not find a quiet place to sit with her to nurse her as she died but instead placed her in a Moses basket and left her in the sluice room to die alone.”

That is inhuman treatment.

These failings are the failings of individuals, of management, who failed to sort things out, and of the structure of the Pennine trust itself. I could list a whole series of other cases. In fact, late last night I was contacted by constituents I know about another case. I do not know the details of that case, but my constituents wanted me to take it up, as they strongly believed that a misdiagnosis meant that proper therapeutic care had not been provided. So problems in the Pennine trust continue.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

My hon. Friend is making a very powerful speech and I share his absolute horror at some of the reports of the standard of care that some patients have received. Like me, he was at a meeting with staff last month, who also expressed their concerns about the quality of care being provided.

I am trying to understand something. Is my hon. Friend saying that this poor care, as set out in the CQC report and other reports, is endemic and is found right across the Pennine Acute Hospitals NHS Trust? Also, does he recognise that the new leadership is playing an important role and that the site leadership teams will have an important role in turning this situation around?

[Graham Stringer]

What I am saying is that there have been failures from the very beginning of this trust, in that it has four hospitals that were jealous of each other. That caused administrative problems, which means the trust has never worked well, and there is also a structural problem. Secondly, there have been failures of management to deal with those issues of individual failure to care.

I have enormous confidence in Sir David Dalton and the team who are taking over the Pennine trust. Sir David’s record of developing Salford Royal hospital is exemplary, and I hope that he can do the same with North Manchester general hospital and the other hospitals within Pennine.

As my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) said, along with my hon. Friend the Member for Heywood and Middleton (Liz McInnes) we met the trade unions in Pennine just before Christmas and, like the vast majority of the staff, they were committed to improving healthcare in the trust. Like my hon. Friend the Member for Oldham East and Saddleworth, I made the point that one has to acknowledge failures to ensure that there is improvement. One cannot just say that, just because so many staff are committed, that is good enough for the future. One also has to recognise the failure of the local clinical commissioning groups to deal with the problems, the fact that the board of the trust seems to have been paralysed and the fact that NHS Improvement has not dealt with the trust’s problems.

I have listed some of the cases that have caused public concern. One cannot put a financial cost on those cases, but if one reads the internal report on maternity care, one sees that the amount of money spent on compensation in the year 2014-15 was £58 million. I repeat— £58 million. Nearly £20 million went on three cases, which means that just over £6 million was spent on each one. In those cases, the people involved took legal action and at the end of the process were awarded that sum to look after severely handicapped patients.

There is no question but that, as I just said to my hon. Friend the Member for Oldham East and Saddleworth, Sir David Dalton has put in place a team who are committed to taking North Manchester general hospital out of Pennine and putting right what was a structural mistake.

It is worth reflecting on another point that was made in the Westminster Hall debate about 10 years ago, which is about why the Pennine trust was created. It was not created for good medical reasons. There was a public reason, which was given at the time by Billy Egerton, the then chair of the North Manchester health trust—I think that was what it was called. He said that he thought that if North Manchester general hospital had remained separate from the trust, it would have been prey to the predatory instincts of Manchester Royal infirmary and the major central hospitals in Manchester. First, I do not think that was a good idea—there could have been co-operation—and secondly, there were a number of chief executives in the trust who were retiring, which meant that three chief executives could be paid off and one chief executive found. Those three chief executives who were paid off came back and did consultancy work for the NHS. Unfortunately, that is the way that the NHS has dealt with problems. It has spent money, and wasted money.

The proposals for devolution will help to deal with the problem. The national structures have not worked. Having the combined authority, encompassing the 10 local authorities, taking decisions and examining these issues, with North Manchester general hospital being within the Manchester hospital schemes, is not a guarantee of success, but I generally believe that when decisions are taken closer to what is happening on the ground, they are more likely to be correct decisions than if they are left to a national body, which has clearly failed in this situation.

--- Later in debate ---

[Mr Nuttall]

I am grateful to the hon. Gentleman for raising walk-in centres. I was going to mention them later, but I will deal with the issue now. I met with representatives from the Bury CCG some months ago, before all this was announced, and they took me through what they were planning. They convinced me that it was in the best interests of my constituents. It would be easy for me to say the popular thing, which is, “I think we should oppose it.” I entirely appreciate why the good folk of Prestwich do not want their walk-in centre to be closed. I can see that there is a likelihood that it would increase pressure on the A&E. That highlights the point I was making, which is that there are good arguments to be made on both sides of the debate as to whether to have walk-in centres or a more community-based approach to delivering services. That is where Bury CCG was coming from.

Following the devolution of healthcare in Greater Manchester, since last April, we have been in an entirely new situation. We have an opportunity to make a reality of the joining up of health and social care, which has long been argued for.

I want to make three points this morning. First, I do not accept that the problems that have been identified at Pennine acute are all down to a lack of funding. To be fair, I think the hon. Member for Blackley and Broughton accepted that the questions went much wider than funding. It is an easy get-out to simply blame a lack of funding.

[Debbie Abrahams]

Does the hon. Gentleman accept that the NHS estimates a shortfall of £1 billion for the Greater Manchester health economy by 2020 under the devolution deal? Does he also accept the differences between the consolidation of different sites into specialist units and the huge shortfall that has meant that Pennine acute has not been able to recruit staff?

[Mr Nuttall]

There are two separate points there. On the first, I have been involved in politics for getting on for the best part of 40 years, and I have never come across a time when it has been claimed that the NHS is not short of money. I cannot remember a time when the parties have all agreed that the NHS was getting all the money it needed. In every general election that I have ever been involved in, there has always been this claim that the Conservative party is about to privatise the NHS and the NHS is short of money. We are not very good at it—if we had been, we would have privatised it years ago, were that the Conservative party’s intention. The fact of the matter is that Pennine acute alone is a huge organisation, with a budget of more than half a billion pounds. Even with our small part of the NHS, such sums of money are difficult to comprehend, never mind the totality of it.

We can all argue that our particular part of the NHS should be given more funding, but in reality the NHS will always be competing with all the other calls on the public purse. If we are to stick with the current funding model, we will only ever be able to increase spending on the NHS significantly if we have a strong and growing economy. I do not want to get bogged down in the broader questions about our NHS, however, because the specific issue this morning is the future of Pennine Acute Hospitals NHS Trust.

The CQC report identified major problems with the leadership of the organisation. Like the hon. Member for Blackley and Broughton, I have every confidence that Sir David Dalton and his new team will bring a fresh approach and outlook to the trust. The one worry I have is that we are perhaps expecting too much of that gentleman. He is clearly a very talented man, but we are all limited by the fact, no matter what our particular talents may be, that there are only 24 hours in the day. I have heard anecdotal stories that he is pulled from pillar to post because he has so many demands on his time. That is understandable; it is not in any way a criticism. It is just a fact of life that he is being asked to do an awful lot. I wish him every success in the world. I hope he can deliver, and I am confident that he will but, if I have one concern, it is that he is perhaps being asked to do too much. I understand that he is focusing on trying to have a more decentralised approach to management to bring management closer to those the trust seeks to manage, and I hope that that will improve matters.

My second point is the issue of maternity services. The removal of children’s services and the closure of the maternity department and the special care baby unit at Fairfield occupied much of my time for years when I first moved to the Bury North constituency. Almost everyone thought that the services at Fairfield were excellent. At the time, my constituents and I were told that things would be even better—even safer—if services were closed at Fairfield and moved to North Manchester and Bolton hospitals. I made it clear that I had doubts about that, as did my constituents. I do not want to quote again from the CQC report, but I want to put on the record this particular quote from it:

“We found poor leadership and oversight in a number of services, notably maternity services, urgent care (particularly at North Manchester Hospital) the HDU at Royal Oldham hospital and in services for children and young people.

In all of these services leaders had not led and managed required service improvements robustly or effectively.”

My constituents could be forgiven for saying, “We told you so.” They can understandably feel vindicated on the stance they took. Incidentally, I understand from a councillor who serves on the Pennine acute scrutiny committee that it was told that the trust was liaising with Newcastle hospitals to learn best practice for maternity services. However, some little time later, when the scrutiny committee asked how that was going and followed up on that idea, it was told, “Sorry, it never went ahead. We are not proceeding with that now.” That little anecdote perhaps gives some idea as to why the CQC discovered problems.

In conclusion, I will make a quick third point. I believe that what Pennine acute would benefit from most in the months and years ahead is a period of stability. It seems to me that part of the problem at Pennine is the constant chopping and changing of leadership. No sooner does one team settle in than they move on and someone else takes over. The difficulty is the resultant lack of accountability. When things go wrong, it can always be blamed on someone else, whether that is to do with a lack of funding or decisions made by a previous management. My constituents and I need to see an end to the changes; we need to see some continuity. My constituents want Pennine acute to be a success. Other NHS trusts are successful, so there is no reason why, with the right leadership in place, Pennine acute cannot be as successful.

--- Later in debate ---

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

It is a pleasure, Mr Streeter, to serve under your chairmanship in such a well-attended debate. I congratulate the hon. Member for Blackley and Broughton (Graham Stringer) on securing the debate and on encouraging so many of his neighbours, who clearly have an interest in healthcare in the area served by the Pennine trust, to attend and to make such powerful contributions. Everyone has spoken from the heart and with true sensitivity.

As the hon. Gentleman said at the start of the debate, it is difficult to strike the right balance between drawing attention to trusts’ obvious failings, which need to be brought into the public domain and dealt with, and not seeking to lay blame on individuals. We all recognise that the individuals who work in the trust, as we heard so powerfully from the hon. Member for Heywood and Middleton (Liz McInnes), who worked at the trust for many years, give of their best and wish to provide the best possible care for their patients. Often the systems and structures around the individuals can inhibit that good intent.

I applaud the hon. Member for Blackley and Broughton for highlighting some dreadful examples of very poor care in the trust over many years, but especially those that came to light last year. As he well knows, the problems at Pennine go back many years. The trust is 16 years old, as other Members have said. Within three years of its creation, consultants at the trust had passed a vote of no confidence in its then management, as the hon. Member for Heywood and Middleton reminded us.

The hon. Member for Ellesmere Port and Neston (Justin Madders) pointed out that, in the days before the CQC, Sir George Alberti was asked to report on what was happening. Much of last year’s CQC report, however, echoes the findings of the 2005 Alberti report, as the hon. Gentleman said in his constructive contribution. We must try therefore not only to learn the lessons, but to implement them; they clearly have not been in the past few years. I will touch on some key findings of the CQC report before I develop my remarks on what we are doing to respond to the findings and shortcomings.

The CQC report was based on an inspection in February and March last year, which rated the Pennine Acute Hospitals NHS Trust overall as inadequate. In particular, the trust was rated inadequate for safety and leadership. As the hon. Gentleman pointed out, however, it was rated good for care, which is a visible tribute to the quality of care provided by the dedicated staff in the main.

The report found other problems: shortages in nursing, midwifery and medical staff, which have been touched on by other hon. Members; a lack of understanding of key risks at departmental, divisional or board level; problems in services, including in A&E, maternity, and children’s and critical care; key risks were not recognised, escalated or mitigated effectively; and there was inconsistent performance reporting and concern about the quality of data to support performance reporting.

In addition, the CQC identified low morale in a number of services, in particular maternity, and described a poor culture with deeply entrenched attitudes. Regrettably, some staff accepted suboptimal care as the norm, and patients’ individual and specific needs were neither appropriately considered nor met.

Those were the CQC findings. In contrast to what has happened following previous problems and subsequent actions, the new CQC regime is introducing beneficial change—which I hope is recognised by the hon. Member for Heywood and Middleton—and improvement. An inadequate rating by the CQC would normally result in the trust being put into special measures, but in this case a different remedy is being used to turn the trust around and, in particular, to address the obvious challenge of leadership, which almost every contributor to the debate has identified as an historical failing at the trust.

In April last year, the management team of the neighbouring Salford Royal, led by Sir David Dalton and Jim Potter, took over the chief executive and chair roles at Pennine acute on an interim basis. That team is in the process of guiding a management contract for the long term to continue providing the strong leadership needed to drive the improvements that we all recognise. The new management team at the Pennine trust got to work immediately. In July last year, the Salford team completed a diagnostic assessment of the issues facing Pennine and developed a short and long-term improvement programme based on patient safety, governance, workforce, leadership and operational performance.

[Debbie Abrahams]

Given the Pennine trust’s current position and the staff shortfalls that the Minister has also mentioned, what additional funding support can he offer Pennine acute?

[Mr Dunne]

I will not be drawn too far down that route at this point, because I would like to develop my overall response. This is not all about funding, as many hon. Members have said. Staff shortages are not necessarily driven by funding either; they are often driven by a trust’s difficulties making it an unattractive place to work. I do not have in my head the number of applicants for vacancies, or the number of vacancies, but I will tell the hon. Lady in a moment how many staff have joined the trust—what increase there has been—under its new leadership.

[Debbie Abrahams]

rose—

[Mr Dunne]

I am afraid, unless the hon. Lady can give me some figures on vacancies that will help my understanding—

[Debbie Abrahams]

Maintained vacancies have caused significant pressure on, for example, middle-grade clinicians in the A&E department. Vacancies have been maintained to try to save money, and that has been a real issue.

[Mr Dunne]

I am grateful to the hon. Lady for her intervention. I will come on to staff issues in a few moments.

As several hon. Members have said, local political leaders have broadly welcomed Sir David Dalton’s appointment as the chief executive of the Salford Royal trust, which is one of the finest trusts in the country and was one of the first to be rated outstanding by the CQC. He is listening to staff and, where appropriate, deploying Salford’s systems and experience to help to support staff in Bury, Rochdale, Oldham and North Manchester to deliver the high standards of service that we all want. I welcome the support that has been expressed for Sir David’s efforts by everyone who has spoken in this debate, in particular the hon. Member for Blackley and Broughton.

Sir David believes that all the evidence shows that staff are best placed to know what needs to be improved in their ward or department. He has introduced a system—tried and tested in Salford—that involves staff and supports them to test their ideas for improvement. Ideas that are shown to work will be replicated across the whole hospital. That approach turns on its head the idea that people in senior management positions always know what is best for patients on a ward, and instead recognises that frontline staff have expertise in spades and supports them. It will help to develop the culture change that was called for in particular by the hon. Member for Oldham West and Royton (Jim McMahon), who rightly identified that as a fundamental problem in the Pennine acute trust.

As my hon. Friend the Member for Bury North (Mr Nuttall) called for, Sir David Dalton at the beginning of this month introduced new site-based leadership teams in each of the four hospitals. For the first time since the creation of the trust 15 years ago, each hospital site and place-based team will consist of a medical director, a nursing director and a managing director, each dedicated to the daily oversight of that hospital. Together, they will manage the services of a care organisation. That site-based arrangement will give leadership teams a clearer focus and enable them to offer staff better support and engagement and take operational decisions for each site. Those leaders will also have the benefit of being in post on site to strengthen local relationships and promote joint working with other partners in the health economy, including local authorities and commissioners.

The hon. Member for Blackley and Broughton and my hon. Friend the Member for Bury North highlighted poor maternity care. The newly appointed director for women’s and children’s services led an internal review of maternity services under the new management arrangements. That review dug deeper and revealed even more than the CQC was able to. Some of the instances of poor care that were revealed are truly shocking, and I express my sincere regret to everyone affected by those tragic incidents, some of which the hon. Member for Blackley and Broughton highlighted. As an immediate result of those reviews, an improvement plan and a new management team for maternity services have been put in place at North Manchester general hospital. Central Manchester University Hospitals NHS Foundation Trust maternity staff are working alongside Pennine staff to develop a clinical leadership and staffing support programme.

The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) asked about staffing. I am advised that between March 2016, when the new management team came into place, and December 2016, the number of people employed on a full-time or part-time basis by the trust increased by more than 300. I think that is 300 more full-time equivalents. That includes seven doctors, 133 registered nurses and 58 midwives and is a net addition to the trust.

The A&E departments remain under pressure, not least given the winter pressures that have been common across the NHS in the past couple of weeks. That is particularly true at North Manchester, but that department has been stabilised and measures have been put in place to support staff, including direct GP and primary care input into the A&E department from Manchester GPs. Those GPs are supporting the department seven days a week and seeing around 30 patients a day, taking pressure off the service and ensuring that patients see the right professionals and receive the right care. Similarly, the local NHS in Oldham is piloting embedding enhanced primary care support in the A&E and urgent care system. Two GPs a day work between 11 am and 11 pm to support that system.

Measures have also been taken to stabilise children’s services; there has been a temporary reduction in beds at the Royal Oldham and North Manchester hospitals to reflect the workload that staff, given their current numbers, can deal with safely. Those measures are having an impact on turning around the performance of the hospitals in the trust. Additionally—the hon. Member for Ellesmere Port and Neston asked about funding—extra financial support of £9.2 million was secured in year to enable the trust to put in place immediate and short-term measures to stabilise services.

The hon. Members for Blackley and Broughton and for Oldham West and Royton asked about avoidable deaths and the culture of silence when problems arose. The new management have been determined to change that culture. Since April 2016, the trust has investigated and closed down 489 serious incident cases, and the average investigation time has been reduced from 156 days to 90 days. Considerable progress has been made on changing the culture of how problems and complaints are dealt with.

Hon. Members talked about the future and expressed concern, particularly from a staff perspective, about yet another change happening. As all Members are aware, NHS England is in the midst of implementing sustainability and transformation proposals and turning those into plans for 44 areas across the country. Greater Manchester’s five-year plan, “Taking charge of our Health and Social Care”, predates the request for STPs, but NHS England has agreed that that plan meets the STP requirements and they are now effectively one and the same thing. There is, therefore, a real opportunity for healthcare in Manchester, with devolution of control to the council and opportunities for the local authority to work with the NHS to improve services for all the people of Manchester, to become a model for the rest of the country.

The NHS in Manchester has been looking at how acute services can best be organised to deliver benefits, including operational financial efficiency, for quality of care, patient experience and the workforce. As has been said, the proposal is to create a single acute provider for Manchester, with the Wythenshawe hospital and the North Manchester general hospital joining the Central Manchester foundation trust. That is an ambitious proposal, and the organisational change it requires is complex, but we believe that the potential benefits are considerable and offer a real chance for care to be standardised across the city. I know that hon. Members will be concerned about what that means for the Pennine trust. If that proposal proceeds, services at North Manchester general hospital will be combined with those at the other hospitals in Manchester, but the intention is for the remaining hospitals in the Pennine acute trust to continue to work with Salford Royal in a new relationship, which is under active consideration.

Hon. Members mentioned resources for estates. Like any trust, the Pennine acute trust needs better-quality, flexible and fit-for-purpose buildings. I have little time in which to outline what is happening but, as some hon. Members will be aware, construction has begun of a brand new, purpose-built 24-bed community intermediate care unit on the grounds of North Manchester hospital. That unit will cost £5 billion and will take 12 months to build. The Royal Oldham hospital, which includes the old workhouse, is being developed into a high acuity centre to serve the population of north-east Manchester.

Motion lapsed (Standing Order No. 10(6)).

NHS Commissioning (Pre-Exposure Prophylaxis)

Debbie Abrahams Excerpts

Tuesday 7th June 2016 Commons Chamber

[Mr Speaker]

I think his Whips are pleased to see the arrival of the right hon. Member for South Holland and The Deepings (Mr Hayes). He has never knowingly been keen to be hurried on anything.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

Will the Minister clarify the timescale for the decisions? Evidence reviews and trials can take months and years, but clearly, as other Members have said, people do not have months and years. Will she tell us what the process and the timescales will be, so that we can be reassured—or not?

[Jane Ellison]

We would expect to get the evidence review that we have called for in the autumn. NHS England is already working on plans for the pilot programme, which will happen over a two-year period. We hope to get that under way towards the end of this year. Both those pieces of work are under way. We expect the pilots to be informed by the review, hence we want to get it back in a relatively short time.

Defending Public Services

Debbie Abrahams Excerpts

Monday 23rd May 2016 Commons Chamber

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

In that vein, I will try to be constructive, but I need to point out the current situation. I want to challenge the Government on their assertion that they will “deliver opportunity for all”, as the Prime Minister put it last Wednesday, or extend life chances for all. All the evidence indicates the contrary.

We are one of the most unequal countries in the world and under this Government that is set to get worse. In the UK 40 years ago, 5% of income went to the highest 1% of earners. Today that income figure is 15%. The Institute for Fiscal Studies forecasts indicate that between 2015 and 2020 the 90:10 ratio—that is, the ratio of income at the 90th percentile of the household income distribution to income at the 10th percentile—will increase from 3.8 to 4.2, largely as a result of tax and social security changes. In other words, the richer people are, the more quickly they will accumulate even more income, and the poorer they are, the less income they will accumulate.

We know that that is bad for society. If we are looking for constructive criticism, there is so much evidence to show that as the gap between rich and poor widens, everybody suffers in terms of social mobility, life expectancy, mental health and crime. Everything gets worse when we become more unequal, and that is what is happening. It is not just a matter of income; it is also about wealth, as we know from the Panama papers, which revealed that the richest are keeping their assets in offshore tax havens where tax is avoided and evaded.

According to the Equality Trust, in the past year alone the wealth of the richest 1,000 households in the UK increased by more than £28.5 billion. Their combined wealth is now more than that of 40% of the population—that is 10.3 million families. While the wealth of the richest 1% has increased by 21%, the poorest half of households saw their wealth increase by less than a third of that figure. I could go on. This is constructive criticism. This is the effect of the Government’s policies.

The Government, like the coalition, have a regressive approach to their budgets, and it looks as though this will continue. Regressive economic policies where the total tax burden falls predominantly on the poorest, combined with lower levels of public spending, are key to establishing and perpetuating inequalities, with all the damage that I have just described. As has been pointed out, when Labour was in government NHS spending increased by 3.2% in real terms, whereas between 2010 and the present, we have seen a decrease from 6.2% to 5.9%. That has caused a financial crisis for many trusts. In my own area in Greater Manchester, where we have had the opportunity of devo Manc, we are expecting a deficit of £2.2 billion by 2020. That is the projected outcome of the unfavourable devolution of that budget.

The same is happening in education and, in my area, in social security and support for disabled people. We have seen a general decline in support for disabled people since the 1960s. I am looking critically at Labour’s record too. In 2012 1.3% of GDP was spent on support for disabled people. Now that figure is 1.1% and it will decline to 1% by 2020. It is particularly the people on low income, including the working poor, and the sick and the disabled who have been hammered and continue to be hammered by this Government. As a result of the Welfare Reform Act 2012, 3.7 million people will have had £28 billion of cuts in support.

We have just passed the Welfare Reform and Work Act 2016, which will compound the cuts. We are all aware of one of those—the cut of £1,500 a year to approximately 500,000 people who have been found not fit for work in the employment and support allowance work-related activity group. That is anathema, particularly as the evidence shows that on average disabled people have extra costs of £500 a month.

That and further cuts will plunge disabled people into poverty and affect their condition. Ultimately it will affect the demand on the NHS and social care. The Government’s own data released last August show that people on ESA and incapacity benefit in 2013 were 4.3 times more likely to die, compared to the general population, which shows just how vulnerable they are. These figures were released during the August bank holiday after the Government were compelled by the Information Commissioner to release them.

Research published last November in a peer review journal estimated that the work capability assessment alone was associated with 590 additional suicides, 280,000 additional cases of self-reported mental ill health and 725,000 additional anti-depressant prescriptions. Just a week ago, when Parliament was not sitting, the Government published the peer review reports on 49 social security claimants who had died between 2012 and 2014. At the time the former Secretary of State denied that the Government held any records on people whose deaths may have been linked to the social security system. We now know from those reports that 10 of the 49 claimants had died following a sanction, and 40 of the 49 deaths were the result of a suicide or suspected suicide. That has occurred throughout the country. The heavily redacted reports highlight widespread flaws in the handling by Department for Work and Pensions officials of claims by vulnerable claimants.

Last week I called for a statement to be made on those reports, but the Leader of the House refused, so I am putting on record the questions to which I want answers. What action has been taken to address the recommendations from those reports? Will the Government review the recommendation from the Select Committee’s sanctions report last year to establish an independent body to review the deaths of social security claimants? Will they agree to an independent review of sanctions and stop the rollout of the current pilot on in-work sanctions? Finally, given the links of those deaths to the work capability assessment, will the Minister recognise that that process has lost credibility, and will he make the fresh start that we want to see?

In 2009 we became signatories to the UN convention on the rights of persons with disabilities. The Government promised a White Paper on employment to set out how they intend to halve the disability employment gap by 2020. Where is that dealt with in this Queen’s Speech? The Prime Minister said last week that the Government were reducing the disability employment gap. No, they are not. The evidence shows the contrary—that it is up from the previous year to 33%. Only 124 employers have signed up to the Disability Confident campaign. Last year 37,000 disabled people benefited from Access to Work, out of 1.3 million. That clearly will not cut it.

On education and training, why is there is such a delay in children being assessed for education, health and care plans? Why are we not increasing the number of apprenticeships available to disabled people? What will the shifting of the disabled students allowance on to higher education mean for disabled people? What about the 42% reduction in access to transport funding, which is making disabled people prisoners in their own home, and the cuts in home adaptations for disabled people? I have not even mentioned the £4.6 billion of cuts to social care, also impacting on disabled people. The cuts to local government funding will also have a direct impact on them.

This Government must look at the cumulative effect of all these cuts on disabled people, and they must value claimants in our social security system. Like our NHS, it is based on principles of inclusion, support and security for all, and it is there for any one of us, should we become sick or disabled.

Oral Answers to Questions

Debbie Abrahams Excerpts

Tuesday 10th May 2016 Commons Chamber

[Ben Gummer]

I, too, as I know will all my ministerial colleagues, congratulate my right hon. Friend the Secretary of State on a remarkable tenure in his post.

It is clear that mature student numbers dropped immediately after the higher education reforms, but they then started rising and have now exceeded the rate before the reforms. I am happy to give the hon. Gentleman the details of that. We are also clear that we need to nurture mature students, which is why the consultation asked the specific question that it did. We want to invite answers from the service about how best we can do that because we are clear that the current system is not working as well as it should.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

2. What recent assessment he has made of the effectiveness of specialist nurses in supporting disabled people.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

Specialist nurses make a valuable contribution to the care of disabled people. They have specialist post-registration qualifications, which are attained through additional training. There are now 3,000 more nurses working in the NHS than in May 2010, ensuring that disabled people continue to receive the highest possible quality care.

[Debbie Abrahams]

In May 2010 there were 5,360 learning disability nurses. In January 2016 there were 3,619. The Government promised to protect the NHS frontline. Why does this protection not extend to people with learning disabilities?

[Ben Gummer]

It is true that the skills mix and the way in which specialist nurses have changed over the past six years may well account for the variation that the hon. Lady has noticed—I am willing to write to her with the detail—but the total number of nurses has increased, and we are giving better and more varied training to nurses across the board so that they can deal with the specialist problems that are increasingly the core part of their work.

NHS Bursaries

Debbie Abrahams Excerpts

Wednesday 4th May 2016 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

And where has the hon. Member for City of Chester (Christian Matheson) been during the debate? [Interruption.] Oh, I beg your pardon, but that is not as good as being here in on the Floor of the Chamber in real life.

Thank you very much, Mr Deputy Speaker, for this opportunity to respond to the debate. I thank the hon. Member for Lewisham East (Heidi Alexander) for raising the important question of the development and expansion of nurse training in England. I thank colleagues for a good debate, with discussions informed by those with close connections with the NHS, either personally or through family.

I pay tribute to all those who work and train in hospitals, who fill the posts that we have been speaking about, and who are the subject of our debate. They are not only nurses and midwives; several colleagues made specific references to allied health professionals, such as those in dietetics, occupational therapy, orthotics and prosthetics, physiotherapy, podiatry and chiropody, radiography, speech and language therapy, operating department practice, dental hygiene and dental therapy—all important components of the NHS. We recognise the importance of the work done in our hospitals, and we thank them for their effort.

This has been a not unusual debate in which the Government propose changing something and the Opposition react with horror. Whether the Government’s arguments are good or bad, that is how it goes. There have been a variety of Opposition arguments—some good, some less good—but whenever change is proposed, there is a set of reactions. As for the poorest reaction, I say this to the hon. Member for Lewisham East with great sincerity: please do not go down the class route. It was absolutely unnecessary to try to pick out what people might have heard in various places as they were growing up and graduating. I am the son of a doctor and a teacher, so there were public health workers in my household. The sense that I got of public service and commitment was possibly shaped then. I do not think that the experience was any different from that of the hon. Lady, or of the hon. Member for Liverpool, Wavertree (Luciana Berger), who had a private education at Haberdashers’ Aske’s School for Girls. I see no evidence in the hon. Lady’s obvious commitment to mental health and everything else that her conversations shaped her poorly in any way. To suggest that the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), may not have picked up the same sort of information, and that that may have impacted on his care and work as a Health Minister, was pretty low. The hon. Member for Lewisham East should not go down that road again.

The two main arguments presented today against what we are trying to do have been about deterrents, or the idea that the occupations are somehow unpalatable and that people will not go into them. On deterrents, I am old enough to have been here for the original debates on the introduction of student fees. Everyone protesting against them at the time said that no one would ever go to university again, and that people from poor backgrounds would never go to university. The same arguments come up every time the subject is raised, and the same arguments have been proved false time and again. What is not false is the damage done at the time of the debates when it is suggested to those who want to aspire to higher education, and to take themselves in a different direction, that it will somehow be made impossible, and that they should not want to do it. Those arguments have been used time and again, and they have been used again today. They were wrong then; they are wrong now.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

What is unique about this situation, as has been mentioned several times, is that a disproportionate number of the nurses using the bursary scheme enter as mature students, including three of my nieces. If bursaries were not available to them, they would not have gone on to train as excellent nurses.

[Alistair Burt]

If the hon. Lady had been here for the entire debate, she would have heard people speak about the problems of hardship following bursaries; that was referred to by the hon. Member for Ilford North (Wes Streeting) and by Government Members. People want access to more funds, which might help those whom the hon. Lady just mentioned, but the assumption is that, because it will be a student loan and because it is a change, people just will not want to do the courses. There is no evidence to suggest that that is correct. Using it as a scare story is unhelpful for the recruitment that we want.

Southern Health NHS Foundation Trust

Debbie Abrahams Excerpts

Tuesday 3rd May 2016 Commons Chamber

[Alistair Burt]

I know that my hon. Friend has followed these matters closely for her constituents. Since last year there have been nine changes to the board, and the chair of the board left last weekend. NHS Improvement has the powers to alter governance, and I know from speaking to NHS Improvement that it takes that power and responsibility extremely seriously. The balance is between ensuring continuity and stability so that what the trust has promised is delivered, and wholesale change, which would provide an opportunity for further delay and prevent the work going on, but I know that NHS Improvement is very aware of its responsibilities in relation to governance, as I hope is the trust itself.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

It is right that this House legislated for parity of esteem for mental health care; I am proud that we did that. I recognise the Minister’s commitment to quick resolution so that we can implement recommendations to address the failings of the trust. Will he consider an independent inquiry similar to the first independent inquiry into Mid Staffs that my right hon. Friend the Member for Leigh (Andy Burnham) initiated in 2010?

[Alistair Burt]

I can do nothing more than repeat what I said earlier. I am aware that there might be circumstances in which an inquiry would bring out more and would demonstrate the degree of concern that colleagues in the House might find appropriate and that the families and others would understand. My first duty is to make sure that everyone is safe in the trust and to ensure the completion of the work that needs to be done to deliver what the CQC has found. Even after this very thorough work by CQC, which is transparent—that is why we are talking about it today—if anything further is needed, I will give it genuine and serious consideration.

Junior Doctors Contracts

Debbie Abrahams Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

My hon. Friend makes an important point. The deal on the table is fair for junior doctors; there is higher premium pay for people who work regular Saturdays than there is for nurses, paramedics, healthcare assistants in their own operating theatres, fire officers, police officers and pretty much anyone else in the public or private sector. Under the new contract we are bringing down premium rates for Saturday pay, but we are making sure we compensate that with a 13.5% increase in the basic pay—to my knowledge, that is not being offered anywhere else in the public sector. That will mean take-home pay goes up for 75% of junior doctors. It is a very fair deal. It is designed to make sure that they are not out of pocket as we make changes that are safer for patients, which is why we should be talking about these changes and not having these strikes.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

A phased implementation is not the same as having a pilot with an independent evaluation to assess the effects of this contract on the workforce, and on safety and quality of care. Why will the Health Secretary not accede to the wholly reasonable proposal to pilot the new contract, which will break the current deadlock?

[Mr Hunt]

We have had eight studies in the past six years—those were independent studies, not commissioned by the Government, and they covered areas such as paediatric and cancer care, emergency surgery and a whole range of other areas. Six of those eight studies mentioned staffing levels at weekends as something that seriously needs to be investigated. Today there are higher mortality rates for weekend admissions, and the Government have a responsibility to do something, not to commission further studies. That is why we are determined to press ahead.

Brain Tumours

Debbie Abrahams Excerpts

Monday 18th April 2016 Westminster Hall

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Edward. I pay tribute to my hon. Friend the Member for Warrington North (Helen Jones) for her exceptional speech and to the chair of the all-party group on brain tumours, the hon. Member for Castle Point (Rebecca Harris), for making such a moving speech.

As we have heard, brain tumours account for 40% of all cancers in children. They are the leading cause of male deaths for 20 to 29-year-olds and they are the biggest cancer killer for those under 40. We do not have a good survival rate for brain tumours; four out of five people will die within five years of being diagnosed. Brain tumours are on the increase. Twenty-nine people a day are diagnosed, reducing life expectancy by 20 years on average, which is the highest for any cancer.

Brain tumours are the largest cause of preventable or treatable blindness in children, and childhood brain tumour survivors are 10 times more likely to suffer long-term disability than well children. This accounts for 20,000 additional disabled life years for all children who are diagnosed each year. We have heard about the low base of research funding for brain tumours. The Minister has already been asked about that and I look forward to a favourable response.

Behind all the facts and figures are the personal stories. I was particularly moved by one of my constituents who wants to remain anonymous. He has a young family and he has had a difficult time. He told me he has gone from being a fit, healthy individual to one who struggles to do many of the everyday things that a dad wants to be able to do with his children. He was diagnosed last year at the age of 40 with a grade 2 oligodendroglioma. After an 11-hour craniotomy, during which he was awake, he has spent much of the past nine months fighting infection and undergoing extensive physiotherapy to help him to learn to walk again and to enable him to live a relatively normal life. He started radiotherapy at the Christie last month to try to control the regrowth of the tumour. Unfortunately, the nature of these things means that it is almost certainly regrowing, yet he says he is one of the lucky ones with, hopefully,

“a decent number of years ahead”

of him. However, he is taking nothing for granted. He has been lucky in terms of being awarded an Access to Work grant, which has been invaluable in helping him to stay in work.

I also want to mention a young man, Christopher Clarke, who was 18 when he died of his brain tumour. He was a lovely lad. He was so cheerful in spite of the diagnosis and prognosis. He had a profound effect on his circle of friends. Even 10 years after his death, they are still fundraising for the trust that was set up in his name.

Satvinder Uppal was 54 when she died of a brain tumour five years ago last week. The real issue for Satvinder’s family was the delay in diagnosis of the brain tumour, which we have heard is common. In spite of prolonged jaw pain, severe headaches and memory issues, the tumour was not picked up when she went on various occasions to visit her GP. It was not until she collapsed at home that she was finally diagnosed at A&E. As her family said,

“The specialist cancer centre was brilliant, but getting the diagnosis in the first place was the issue.”

What does the Government plan to do to extend brain tumour research from the current low level? What will the Minister do to ensure that clinical guidelines reflect the poor diagnosis rates?

Dementia and Alzheimer’s Disease

Debbie Abrahams Excerpts

Tuesday 12th April 2016 Westminster Hall

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I add my congratulations to the hon. Member for Strangford (Jim Shannon) on his exceptional speech and on securing the debate. It is a pleasure to speak, however briefly, in the debate as a co-chair of the all-party parliamentary group on dementia, as the only MP—I think that is still the case—who is a dementia friends champion, and as a former carer for my mum, who had Alzheimer’s disease. As we have heard today, if anyone’s life has not already been touched by someone who has dementia, it soon will be.

I commend the Government for their commitment and, in particular, the Prime Minister’s challenge and the investment in research funding that was announced last year at the World Health Organisation’s first ministerial conference on global action against dementia. It needs global action; we cannot act in isolation. It is estimated that by 2018 the global cost of dementia will be $1 trillion. I therefore ask the Minister to update us on the longer-term plans for building on that research investment and, specifically, what funding has been set aside to meet the challenges that make up the Prime Minister’s challenge on dementia and whether we are on track.

In addition to research, we need to ensure that hospital services take into account the specific needs of people with dementia. We know from the recent Alzheimer’s Society campaign, “Fix Dementia Care”—my hon. Friend the Member for South Shields (Mrs Lewell-Buck) mentioned some of the results—that 57% of carers, families and friends of people with dementia felt that the person they cared for was not treated with understanding or dignity in hospital; only 2% of hospital staff understood the specific needs of someone with dementia. We obviously need to address that. Could I put in a plug for the APPG report? Seven out of 10 of the people in hospital are not actually there for their dementia, but for something else. We have a report coming out next Wednesday on dementia and comorbidities, and I hope that people will be able to join us for that.

I am sure that my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) will mention this in her winding-up speech, but we cannot divorce the issues in relation to social care from dementia care. I called on someone, just in a regular door-knock, and she obviously had dementia. She was on her own. She greeted me with an empty medication bubble pack and just said, “I don’t know what to do.” Too many people are isolated in that way. So many demands are placed on family carers. I hope that the Minister can address some of those issues.

[Graham Stringer (in the Chair)]

We have gone slightly over time because of the unusual circumstances, so could the Front-Bench spokespeople bear that in mind? You have marginally over seven minutes, and that will leave just over a minute for Jim Shannon.

Oral Answers to Questions

Debbie Abrahams Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Alistair Burt]

Overall access to NHS dentistry is good, but it does vary from area to area, and West Yorkshire, as the hon. Member for Dewsbury (Paula Sherriff) well knows, is one of the areas that worries us and that we are trying to do something about. Work is being undertaken in the West Yorkshire area to look at issues around NHS dentistry. I have met a number of hon. Members to discuss this matter. It has my attention, so I will be monitoring it closely, and my hon. Friend was right to raise it.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

The King’s Fund analysis revealed that there will be not a £10 billion, but a £4.5 billion real-terms increase to the NHS. Will the Health Secretary apologise for misleading not just this House but the public as a whole?

[Mr Speaker]

Order. The hon. Lady must not accuse a Member of misleading the House. If she wishes to insert the word “inadvertently” she would spring back into order, which is where I am sure that she wishes to be. Do I take it that the word “inadvertently” has been inserted?

[Debbie Abrahams]

I am happy to insert “inadvertently”.

[Mr Jeremy Hunt]

The hon. Lady may inadvertently have not been listening to my previous answers. Let us look at what Simon Stevens, the chief executive of the NHS, actually said about that spending settlement. He said that the Government had listened to and “actively supported” the NHS case for public spending.