Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 29th October 2019 Commons Chamber

[Ms Dorries]

That is a big question because it covers two areas. This Government have invested £2.3 billion in mental health services, a huge amount of which is to go into salaries, to deliver community health services where they are needed: close to patients and to their relatives and families. It is also to provide community health teams and support teams in schools for young people. Clinical commissioning groups are under an obligation to provide those mental health services with the set funding. If the hon. Lady would like to meet to hear more about that, I will be happy to discuss it with her.

[Mr Jeremy Hunt (South West Surrey) (Con)]

As this is your last Health questions, Mr Speaker, may I thank you for your many years of campaigning for speech and language therapy for children? It has given great hope to many families in a situation similar to your own.

On the issue of early intervention, given that half of all mental health conditions are established before the age of 14, does the Minister, who is passionate about this, agree that mental health provision in schools is essential? Will she update the House on progress towards the 2023 objective of a quarter of schools having a mental health lead?

[Ms Dorries]

I thank my right hon. Friend for his question and for his work as Secretary of State. He was the longest-serving Secretary of State for Health ever, and he is passionately interested in this subject, too. Yes, we are on track—in fact, we are more than on track—to meet our objective of 25% of schools being covered by a school mental health support team by 2023-24.

The school mental health support teams have been launched in trailblazer areas, and I visited one a few weeks ago at Springwest Academy in Hounslow to see the amazing work the teams are doing with young children. The teams are teaching coping strategies and identifying mental health problems as they arise very early in life, which helps children to deal with those mental health problems now and into adulthood. We are on track and we hope to meet that objective.

--- Later in debate ---

[Matt Hancock]

I want to pay tribute to the hon. Lady for the work that she, her Health Committee and all its members have done on this legislation. I think that the legislation proposed by the NHS—with the support of the Select Committee, which will of course scrutinise it further—is an important step forward. I am delighted that Her Majesty committed in the Queen’s Speech to legislation on the NHS, of which these proposals will be the basis.

[Mr Jeremy Hunt (South West Surrey) (Con)]

Haslemere in my constituency has a busy minor injuries unit, used by 8,000 people a year, which is currently threatened with closure. Given that that would be catastrophic for the town of Haslemere and for the Royal Surrey A&E in Guildford, will the Secretary of State listen to the residents of Haslemere and agree not to close this vital facility?

[Matt Hancock]

My predecessor, my right hon. Friend, is an assiduous campaigner for South West Surrey. There is no better spokesman for South West Surrey than my right hon. Friend. He has raised this issue with me in private over recent weeks since these concerns were raised. I have in turn raised it with the chief executive of the NHS, and I can confirm that the walk-in centre will stay open.

Baby Loss Awareness Week

Jeremy Hunt Excerpts

Tuesday 8th October 2019 Commons Chamber

[Mr Jeremy Hunt (South West Surrey) (Con)]

It is a great privilege to speak from the Back Benches for the first time in over a decade following two extremely powerful speeches from both Front Benches. I thank the Minister of State and the shadow Minister for two extremely compassionate and understanding speeches in which they spoke about the sheer pain felt by so many families up and down the country.

I also thank the many hon. Members on all sides—my hon. Friends the Members for Eddisbury (Antoinette Sandbach), for Colchester (Will Quince) and for Banbury (Victoria Prentis), the hon. Member for Washington and Sunderland West (Mrs Hodgson) and many others—who have spoken so powerfully on this matter. I cannot possibly compete with the power of their words because there is nothing that anyone can suffer more than the loss of a child. I just want to make one observation from my many years—some would say too many—as Health Secretary with respect to this issue, and that observation is about the impact on professionals.

When you go around hospitals up and down the country, and ask the doctors, nurses and midwives, “What is the most traumatic thing that has ever happened to you in your professional career?”, almost invariably they will say that it is when they lose a baby. We often talk about the trauma for the families, who of course are the primary victims in this situation, but we must never forget the people who are sometimes called the second victims: the doctors, nurses, midwives and other professionals who have to go home, worrying that if they had done something differently that baby might still be alive, and who have to come back to work the next day and struggle on, dealing with that incredible trauma.

In that situation, those professionals want nothing more than to be completely open, transparent and honest with the families and with their colleagues about what happened to ensure that lessons are learned and that that tragedy is never repeated again. But in the NHS today, we make that practically impossible. People are terrified of the Nursing and Midwifery Council, the General Medical Council, the Care Quality Commission and their trust. They are worried about being fired and they are worried about all sorts of consequences, so the one thing that should happen—the one thing that everyone in that situation wants to happen more than anything else, which is that lessons are learned from that tragedy—is often the one thing that never happens at all.

Let us remember that there are 1,400 neonatal deaths every year, as the shadow Minister said. That is about four every single day across the NHS. The great tragedy—not just in the NHS but in hospitals all over the world—is the fact that a tragedy can happen in Blackpool one day, and a month later exactly the same tragedy can happen in Cornwall. There has not been enough effort to try to share the learnings from such tragedies. I commend the efforts of the Government and my successor Ministers for doing everything they possibly can to put this right and to ensure that we really do become a learning organisation. In truth, though, this is a big job that will take a long time, because it is about changing culture.

The NHS needs to look at other industries that have successfully changed from having a blame culture to having a learning culture. The airline industry is the most famous example, but there are also the nuclear and oil industries. That job of changing culture will be our central responsibility if we are to reduce the agony for parents and the professionals involved in the care of babies. The most powerful way to change culture is to shout out loud and clear those human stories of the terrible loss involved, because that is what promotes change.

I finish by commending everyone involved in Baby Loss Awareness Week—the brave Members of this House who have spoken out, and given many others hope that they are not alone; the many brave members of the public who have relived their own tragedies over and over again to try to promote change in this area; and the Ministers concerned, who have a heavy responsibility when it comes to this agenda, and who I know take that responsibility with the utmost seriousness.

--- Later in debate ---

[Victoria Prentis (Banbury) (Con)]

As ever, I am grateful to be called to speak, Madam Deputy Speaker, although I was not anticipating it because I was not here at the beginning of the debate. I can only apologise for that, but I was elsewhere on unavoidable duties.

This is a debate in which we love to hate participating. It is not a pleasurable experience for anyone who has lost a child, and I know that some Members across the House feel exactly as I do when speaking in this debate. Nevertheless, I am grateful for the opportunity to lay my annual asks on the table.

First, I must give an enormous amount of thanks to the previous Secretary of State for Health and Social Care, my right hon. Friend the Member for South West Surrey (Mr Hunt), whose speech I am really looking forward to watching on catch-up tonight. I am immensely grateful, as are all of us who have been involved in this area for many years, for all that he did. It must be counted as one of his major achievements as Secretary of State that there has been a 19% reduction in stillbirths and an 8% reduction in maternal mortality since 2010. Those are really good figures, and I hope that he will look back on his career in many years when he retires—

[Mr Hunt]

I can retire now. [Laughter.]

[Victoria Prentis]

I hope that my right hon. Friend will count that among his most important achievements. I expect that he said, as did the hon. Member for Ellesmere Port and Neston (Justin Madders), that blame is probably not the way to go, and that we need a cultural shift in the NHS, so my ask this year is that we should make maternal death a never event. Luckily, maternal deaths are rare—I was almost one of them myself—but making them a never event, with the definition and the muscle that that provides, would be very helpful.

With my prison service background, I should add that a child or, indeed, a mother dying in custody should also probably be a never event, with all the chain of investigations that should flow from that. I know that the recent death in custody is being very well investigated, and there is no need to comment further on that case now. The never event definition is helpful, because it sets in train a course of investigations that need not be blamed-filled but which are helpful for learning.

Sadly, the situation elsewhere is not as helpful as in this country. A baby dies every 11 seconds worldwide, and many maternal deaths are completely preventable. I am pleased that the Secretary of State for International Development has chosen to make maternity a priority for the Department for International Trade. He wrote an excellent article about it in The Times last week, and I encourage hon. Members to read that article.

The Secretary of State for International Development is helping members of the Royal College of Midwives to provide training in rural Bangladesh, and he is resourcing organisations that work with women who have had female genital mutilation performed on them and who have dreadful maternal complications as a result. He is working to provide vaccinations, which are so helpful in preventing the death of newborn babies. Across the board, the fact that maternity is now a priority for DFID is really helpful.

I close by thanking you, Madam Deputy Speaker, for your support in this area and for allowing me to say a few brief words this afternoon, and by advertising the baby loss service at St Mary’s, Banbury at 6 o’clock this Sunday. It is an extraordinary event, and we have been doing it for only a few years. People came to that church in the first year who had never talked about their loss, and it is overwhelming.

Such services are taking place all over the country, as the hon. Member for Ellesmere Port and Neston said. Unfortunately we have not organised one in Parliament this year, as we normally do, because we are not sitting, but I am sure we will organise one in future years. I thank everybody who has taken part in this debate, which I think is now annual. I am thrilled that we have Government time, and I hope we have it again in future.

NHS Pay Review Body and Agenda for Change Pay Deal

Jeremy Hunt Excerpts

Wednesday 27th June 2018 Written Statements

[The Secretary of State for Health and Social Care (Mr Jeremy Hunt)]

I am responding on behalf of my right hon. Friend the Prime Minister to the 31st report of the NHS Pay Review Body (NHSPRB). The report has been laid before Parliament today (Cm 9641). I am grateful to the chair and members of the NHSPRB for their report.

The Government welcome the 31st report of the NHS Pay Review Body, which endorses the “Agenda For Change” multi-year pay and contract reform deal (2018-19 to 2020-21).

NHS staff do a fantastic job in delivering world-class care. Even with increasing pressures on the NHS due to, among other things, an ageing population and changing public expectations, they work incredibly hard, always putting patients first and keeping them safe while providing the high-quality care we all expect.

We have already announced that, to secure the future of the health service as it approaches its 70th birthday, we have increased NHS funding by an average 3.4% per year, which will see the NHS receive £20.5 billion a year in real terms by 2023.

The Government accept the NHSRPB’s observations and are very pleased to confirm their acceptance of the “Agenda For Change” multi-year pay and contract reform deal.

The new deal will see nearly 1 million NHS workers benefit over three years and help deliver better value for money from the £36 billion “Agenda For Change” pay bill, with some of the most important changes to working practices in a decade.

The deal includes a range of pay and non-pay proposals that will benefit staff and patients. Most NHS staff below the top of their pay band will benefit from pay increases through the restructuring of the pay bands—higher starting pay, removal of overlapping pay points and shorter pay scales.

From this year the lowest NHS starting salary will increase year on year from £15,404 to £18,005 in 2020-21.

The starting salary of a nurse will rise to £24,907 in 2020-21 which will have a significant impact on retention and recruitment issues.

The deal also guarantees fair basic pay awards for the next three years to staff who are at the top of pay bands—a cumulative 6.5% over three years.

The agreement will put learning and development right at the heart of local annual appraisals, helping to improve the experience for staff, ensuring they demonstrate the required standards for their role before moving to the next pay point. We know that getting appraisals right helps improve staff engagement and through that better outcomes for patients. The deal also commits NHS employers to support staff to improve their physical and mental health, helping to reduce sickness absence, increasing capacity for patient care.

This is a major step forward. The agreement reflects the Government’s public sector pay policy that pay flexibility should be in return for reforms that improve recruitment and retention and boost productivity.

During the NHS trades unions consultation on the AfC framework agreement, the Department of Health and Social Care received a number of representations from non-statutory non-NHS organisations that provide NHS services seeking additional funding on the same basis as NHS bodies.

It is important to stress that the AfC reforms were those, based on the AfC employment contract (and all the terms and conditions) the NHS Staff Council agreed could help the NHS recruit, retain, motivate and boost the productivity/capacity of its workforce.

We know that there a small number of non-statutory non-NHS organisations that provide NHS services, employ existing and new staff on the AfC contract and will be required to implement the reforms.

I believe it is right that these organisations should receive a share of the additional funding made available for AfC staff employed by NHS bodies listed at annex 1 of the NHS terms and conditions of service handbook; each employ existing and new staff on the AfC contract, are required to implement the deal and will need to meet the costs of doing so.

From 2018-19, the AfC pay deal will apply to existing and new staff on the AfC employment contract employed in both NHS bodies and non-statutory non-NHS organisations that provide NHS services, the terms and conditions of which are set out in the NHS terms and conditions of service handbook.

I have asked my officials to write directly to all NHS commissioners and provide them with further detail of the eligibility criteria for additional funding during the three years of the pay deal, that will apply to those non-statutory non-NHS providers of NHS services.

In line with the Chancellor’s commitment at Budget 2017, the Government will release the £800 million already set aside to support the pay deal for 2018-19 in England. Barnett consequential will flow to the devolved Administrations in the usual way. Following the recent announcement on the NHS long-term funding settlement, for the remaining two years of the deal (2019-20 to 2020-21) funding will be met from the settlement. The long-term settlement will provide the NHS with increased funding of £20.5 billion per year in real terms by the end of five years.

[HCWS803]

Gosport Investigation Report

Jeremy Hunt Excerpts

Wednesday 20th June 2018 Written Statements

[The Secretary of State for Health and Social Care (Mr Jeremy Hunt)]

Today the report of the Gosport independent panel on events at Gosport War Memorial Hospital from the late 1980s to 2001 has been published.

This report follows four years of work by Bishop James Jones and his panel. The Bishop has adopted a strong commitment to a “families first” approach to public disclosure, which means that the process of public disclosure began earlier today with the families themselves.

The report provides a comprehensive account of events at Gosport War Memorial Hospital from the late 1980s to 2001. It has drawn on previous reviews but also on important new material unearthed by the panel.

Given the gravity of issues and the content and scale of the report, we will need to consider its findings with great care and thoroughness across Government in the coming weeks.

All relevant agencies and Departments both nationally and locally, including the Home Office and Ministry of Justice are also giving the report urgent and thorough attention. Once that work is done, the relevant agencies will decide what steps to take next.

Copies of the report have been laid before the House and are available from the Vote Office and at: https://www.gosportpanel.independent.gov.uk/panel-report/

An oral statement will be delivered to both Houses later today.

[HCWS577]

Gosport Independent Panel: Publication of Report

Jeremy Hunt Excerpts

Wednesday 20th June 2018 Commons Chamber

[The Secretary of State for Health and Social Care (Mr Jeremy Hunt)]

This morning, the Gosport Independent Panel published its report on what happened at Gosport Memorial Hospital between 1987 and 2001. Its findings can only be described as truly shocking. The panel found that, over the period, the lives of more than 450 patients were shortened by clinically inappropriate use of opioid analgesics, with an additional 200 lives also likely to have been shortened if missing medical records are taken into account.

The first concerns were raised by brave nurse whistleblowers in 1991, but then systematically ignored. Families first raised concerns in 1998 and they, too, were ignored. In short, there was a catalogue of failings by the local NHS, Hampshire constabulary, the General Medical Council, the Nursing and Midwifery Council, the coroners and, as steward of the system, the Department of Health.

Nothing I say today will lessen the anguish and pain of families who have campaigned for 20 years for justice after the loss of a loved one. But I can at least, on behalf of the Government and the NHS, apologise for what happened and what they have been through. Had the establishment listened when junior NHS staff spoke out, and had the establishment listened when ordinary families raised concerns instead of treating them as “troublemakers”, many of those deaths would not have happened.

I pay tribute to those families for their courage and determination to find the truth. As Bishop James Jones, who led the panel, says in his introduction:

“what has to be recognised by those who head up our public institutions is how difficult it is for ordinary people to challenge the closing of ranks of those who hold power...it is a lonely place seeking answers that others wish you were not asking.”

I also thank Bishop Jones and his panel for their extremely thorough and often harrowing work. I particularly want to thank the right hon. Member for North Norfolk (Norman Lamb), who, as my Minister of State in 2013, came to me and asked me to overturn the official advice he had received that there should not be an independent panel. I accepted his advice and can say today that, without his campaigning in and out of office, justice would have been denied to hundreds of families.

In order to maintain trust with the families, the panel followed a “families first” approach in its work, which meant that the families were shown the report before it was presented to Parliament. I, too, saw it for the first time only this morning, so today is an initial response and the Government will bring forward a more considered response in the autumn.

That response will need to consider the answers to some very important questions. Why was the Baker report, completed in 2003, only able to be published 10 years later? The clear advice was given that it could not be published during police investigations and while inquests were being concluded, but can it be right for our system to have to wait 10 years before learning critically important lessons that could save the lives of other patients? Likewise, why did the GMC and NMC, the regulators with responsibility for keeping the public safe from rogue practice, take so long? The doctor principally involved was found guilty of serious professional misconduct in 2010, but why was there a 10-year delay before her actions were considered by a fitness to practise panel? While the incidents seemed to involve one doctor in particular, why was the practice not stopped by supervising consultants or nurses who would have known from their professional training that these doses were wrong?

Why did Hampshire constabulary conduct investigations that the report says were

“limited in their depth and range of offences pursued”,

and why did the Crown Prosecution Service not consider corporate liability and health and safety offences? Why did the coroner and assistant deputy coroner take nearly two years to proceed with inquests after the CPS had decided not to prosecute? Finally and more broadly, was there an institutional desire to blame the issues on one rogue doctor rather than to examine systemic failings that prevented issues from being picked up and dealt with quickly, driven, as the report suggests it may have been, by a desire to protect organisational reputations?

I want to reassure the public that important changes have taken place since these events that would make the catalogue of failures listed in the report less likely. These include the work of the Care Quality Commission as an independent inspectorate with a strong focus on patient safety, the introduction of the duty of candour and the learning from deaths programme, and the establishment of medical examiners across NHS hospitals from next April. But today’s report shows that we still need to ask ourselves searching questions as to whether we have got everything right. We will do that as thoroughly and quickly as possible when we come back to the House with our full response.

Families will want to know what happens next. I hope that they and hon. Members will understand the need to avoid making any statement that could prejudice the pursuit of justice. The police, working with the Crown Prosecution Service and clinicians as necessary, will now carefully examine the new material in the report before determining their next steps, in particular whether criminal charges should now be brought. In my own mind, I am clear that any further action by the relevant criminal justice and health authorities must be thorough, transparent and independent of any organisation that may have an institutional vested interest in the outcome. For that reason, Hampshire constabulary will want to consider carefully whether further police investigations should be undertaken by another police force.

My Department will provide support for families from today, as the panel’s work has now concluded, and I intend to meet as many of the families as I can before we give our detailed response in the autumn. I am also delighted that Bishop James Jones has agreed to continue to provide a link to the families, and to lead a meeting with them in October to allow them to understand progress on the agenda and any further processes that follow the report. I commend the role played by the current MP for the area, my hon. Friend the Member for Gosport (Caroline Dinenage), who campaigned tirelessly for an independent inquiry and is unable to be here today because she is with the affected families in Portsmouth.

For others who are reading about what happened and have concerns that it may also have affected their loved ones, we have put in place a helpline. The number is available on the Gosport Independent Panel website and the Department of Health and Social Care website. We are putting in place counselling provision for those affected by the tragic events and who would find it helpful.

Let me finish by quoting again from Bishop Jones’s foreword to the report. He talks powerfully about the sense of betrayal felt by families:

“Handing over a loved one to a hospital, to doctors and nurses, is an act of trust and you take for granted that they will always do that which is best for the one you love.”

Today’s report will shake that trust, but we should not allow it to cast a shadow over the remarkable dedication of the vast majority of people working incredibly hard on the NHS frontline. Working with those professionals, the Government will leave no stone unturned to restore that trust. I commend this statement to the House.

[Mr Speaker]

Just before I call the shadow Secretary of State—the Secretary of State made reference to this point in passing—I think that it is only fair to mention to the House that a number of colleagues whose constituencies have been affected by the events at Gosport Hospital are unable to speak in these exchanges because they serve either as Ministers or, in one case, as Parliamentary Private Secretary to the Prime Minister. It should be acknowledged and respected that a number of those affected individuals are present on the Front Bench. I am of course referring to the Minister for Care, the hon. Member for Gosport (Caroline Dinenage); the Secretary of State for International Development, the right hon. Member for Portsmouth North (Penny Mordaunt); the Under-Secretary of State for Exiting the European Union, the hon. Member for Fareham (Suella Braverman); and the hon. Member for Meon Valley (George Hollingbery).

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I thank the Secretary of State for the advance copy of his statement. I welcome the tone of his remarks and the apology that he has offered on behalf of the Government and the national health service.

This is a devastating, shocking and heartbreaking report. Our thoughts must be with the families of the 456 patients whose lives were shortened. I, like the Secretary of State, pay tribute to the right hon. Member for North Norfolk (Norman Lamb), whose persistence in establishing this inquiry in the face of a bureaucracy that, in his own words, attempted to close ranks, must be applauded. I know that other Members have also played an important part, including the hon. Member for Eastbourne (Stephen Lloyd), who is in his place, and the Minister for Care, who is understandably and properly in her Gosport constituency this afternoon. I also thank all those who served on the inquiry panel, and offer particular thanks for the extraordinary dedication, calm, compassionate, relentless and determined leadership—yet again—of the former Bishop of Liverpool, James Jones, in uncovering an injustice and revealing a truth about a shameful episode in our nation’s recent history.

As the Secretary of State quoted, the Right Rev. James Jones said:

“Handing over a loved one to a hospital, to doctors and nurses, is an act of trust and you take for granted that they will always do that which is best for the one you love.”

That trust was betrayed. He continued:

“whereas a large number of patients and their relatives understood that their admission to the hospital was for either rehabilitation or respite care, they were, in effect, put on a terminal care pathway.”

Others will come to their own judgment, but for me that is unforgivable.

This is a substantial, 400-page report that was only published in the last hour or so, and it will take some time for the House to fully absorb each and every detail, but let me offer a few reflections and ask a few questions of the Secretary of State. Like the Secretary of State, the question that lingers in my mind is, how could this have been allowed to go on for so long? How could so many warnings go unheeded?

The report is clear that concerns were first raised by a nurse in 1991. The hospital chose not to rectify the practice of prescribing the drugs involved. Concerns were raised at a national level, and the report runs through a complicated set of back and forths between different versions of health trusts and successor health trusts, management bodies and national bodies about what to do and what sort of inquiry would be appropriate. An inquiry was eventually conducted and it found an

“almost routine use of opiates”

that

“almost certainly shortened the lives of some patients”.

It seems that that report was left on a shelf, gathering dust.

I am sure that many of the officials and players acted in good faith but, taken as a whole, there was a systemic failure properly to investigate what went wrong and to rectify the situation. In the words of the report, serious allegations were handled

“in a way that limits the impact on the organisation and its perceived reputation.”

The consequence of that failure was devastating.

To this day, the NHS landscape understandably remains complex and is often fragmented. How confident is the Secretary of State that similar failures—if, God forbid, they were to happen again somewhere—would be more easily rectified in the future? Equally, as the Secretary of State recognises, there are questions about Hampshire constabulary. As the report says,

“the quality of the police investigations was consistently poor.”

Why is it that the police investigated the deaths of 92 patients, yet no prosecutions were brought? The report has only just been published, but what early discussions will the Secretary of State be having with the Home Secretary to ensure that police constabularies are equipped to carry out investigations of this nature, if anything so devastating were to happen anywhere else?

What about the voice of the families? Why did families who had lost loved ones have to take on such a burden and a toll to demand answers? It is clear that the concerns of families were often too readily dismissed and treated as irritants. It is shameful. No family should be put through that. I recognise that the Secretary of State has done work on this in the past and I genuinely pay tribute to him, but how can he ensure that the family voice is heard fully in future? He is right that we must be cautious in our remarks today, but can he give me the reassurance that all the relevant authorities will properly investigate and take this further? If there is a police investigation, can he guarantee that a different force will carry it out?

I also want the Secretary of State to give us some more general reassurances. Is he satisfied that the oversight of medicines in the NHS is now tight enough that incidents such as this could never be allowed to happen again? What wider lessons are there for patient safety in the NHS? Is additional legislation now required? Does he see a need for any tightening of the draft Health Service Safety Investigations Bill to reflect the learnings from this case?

The Right Rev. James Jones has provided a serious, devastating, far-reaching service in a far-reaching report. Aggrieved families have had to suffer the most terrible injustice. In the next few weeks, we will rightly acknowledge 70 years of our national health service. The Secretary of State is right to say that this must not cast a shadow over the extraordinary work done every day by health professionals in our NHS. But on this occasion, the system has let so many down. We must ask ourselves why that was allowed to happen and dedicate ourselves to ensuring that it never happens again.

[Mr Hunt]

I thank the shadow Health Secretary for the considered tone of his comments. I agree with everything he says. Members across the House will understand that we are all constrained in what we can say about the individual doctor concerned—because that is now a matter for the police and the CPS to take forward—but we are not constrained in debating what system lessons can be learned, and we should debate them fully, not just today but in the future. The big question for us is not so much, “How could this have happened once?”—because in a huge healthcare system we are, unfortunately, always occasionally going to get things that go wrong, however horrific that sometimes is—but, “How could it have been allowed to go on for so long without being stopped?”

Reflecting the hon. Gentleman’s comments, the poor treatment of whistleblowers, the ignoring of families and the closing of ranks is wrong, and we must stop it. We must go further than we have gone to date. In a way, though, it is straightforward, because we know exactly what the problem is and we just have to make sure that the culture changes. The more difficult bit is where there were process issues that happened in good faith but had a terrible outcome.

In particular, this report is a salutary lesson about the importance of transparency. Obviously I had only a couple of hours to read it—so not very long—but it looks as though the Baker report was left to gather dust for 10 years, for the perfectly straightforward and understandable reason that people said that it could not be published in the course of a police investigation or while an inquest was going on. I am speculating here, but I am pretty certain that had it been published, transparency would have prompted much more rapid action, and some of the things that we may now decide to do we would have done much, much earlier. That is an incredibly powerful argument for the transparency that has sadly been lacking.

How confident can I be that this would not happen again? I do think that the culture is changing in the NHS, that the NHS is more transparent and more open, and that interactions with families are much better than they were. However, I do not, by any means, think that we are there yet. I think that we will uncover from this a number of things that we are still not getting right.

As the hon. Gentleman will understand, it is not a decision for the Government as to which police force conducts these investigations. We have separation of powers and that has to be a matter for the police. One of the things that we have to ask about police investigations is whether forces have access to the expertise they need to decide whether they should prioritise an investigation. When the medical establishment closes ranks, it can be difficult for the police to know whether they should challenge that, and it does appear that that happened in this case.

In terms of wider lessons on the oversight of medicines and the Health Service Safety Investigations Bill, we will certainly take on board whether any changes need to be made there.

[Gillian Keegan (Chichester) (Con)]

The culture of closing ranks and ignoring whistleblowers in the NHS is gravely worrying. Even as a new MP, I have had constituency cases where people have alerted me to this, and I feel that it could still happen today. What implications will the report have for the wider health service, particularly for elderly care and people who have family members in these situations?

[Mr Hunt]

There is one very important point that the shadow Health Secretary mentioned that it is important to understand from this report. We very often have a problem where people in an end of life situation are not treated in the way that we would want for our own relatives or parents. To put it very bluntly, the worry is that someone’s end may be hastened more quickly than it should be. We have made a number of changes, including scrapping the Liverpool care pathway, which happened under the coalition Government. But in this case, these patients were not in an end of life situation. They were actually going to the hospital for rehabilitation and expecting to recover—but they were old. One of the things that we will have to try to understand—all of us—is how this could have been allowed to happen and how this culture developed. I am afraid that the report is very clear that, inasmuch as the doctor was responsible—I have to be careful with my words here—lots of other people knew what was going on.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

I am very grateful to the Secretary of State for an advance copy of his statement. There is much in it that I agree with, both in tone and content.

These are truly horrific events, and our first thoughts must always be with the families of those who have been affected by this scandal. It is deeply distressing to lose a loved one in any circumstances, and the circumstances in this case, with all the press coverage, will only have amplified that distress for everyone concerned.

When the inquiry was originally announced, it was expected to take two years, and it is extremely disappointing that it has stretched out until now. There has no doubt been a catastrophic failure of monitoring and accountability, not only with regard to the doctor concerned but those who failed to investigate these actions. The Government are also included in this failure. However, I am grateful to the Secretary of State for issuing the apology that he has today, and welcome the fact that the Government will bring forward more considered responses in the autumn.

I sincerely hope that this will be the beginning of justice, and ultimately closure, for the families affected. I hope that the Secretary of State will support the opening of criminal investigations into the events following the report’s findings. The public find it very difficult to have faith in health regulators who act both as investigators and prosecutors—and even the judge—in complaints. I hope that he will look at this aspect to ensure public confidence and faith in the healthcare regulation system in the future.

[Mr Hunt]

I thank the hon. Gentleman for his comments and agree with what he says. Of course, if the police decide to bring forward criminal prosecutions, that would have the support of the Government, but the police must make that decision independently. If a family feel that an injustice has been done, who can they go to if they feel that ranks are being closed? I think we have made progress on that question, but we need to reflect very carefully on whether it is enough progress.

[Alan Mak (Havant) (Con)]

The events at the hospital and the panel’s report are of significant interest to me and my constituents, and those of my hon. Friend the Member for Meon Valley (George Hollingbery), on whose behalf I am also speaking. His constituents and mine have asked whether the families can be confident that the report’s findings will be acted on and that people will be held accountable for what happened.

[Mr Hunt]

My hon. Friend is right to ask that question. The best parallel is the Hillsborough process, which was also led by Bishop Jones. A similar report was published that put documents into the public arena, essentially enabling people to understand truthfully what happened. On the basis of that, inquests were reopened, criminal prosecutions happened and so on. We are at that stage of the process. I hope that the transparency and thoroughness of the report will give families hope that they are at last being listened to.

[Norman Lamb (North Norfolk) (LD)]

May I first thank the Secretary of State for backing and trusting my judgment in 2013, without hesitation, and proceeding with this panel inquiry? I join him in paying tribute to the work of Bishop James Jones and the whole panel. Bishop James Jones is a remarkable man who has shown extraordinary clarity of thought that has, in a very impressive way, built the trust of families who have been involved in this process.

I am not sure that I share the Secretary of State’s confidence that an earlier publication of the Baker report would have resulted in the transparency he called for, bearing in mind that I had to intervene in 2013 to stop a statement being made that there would be no public inquiry even after the publication of that report. Does he agree that we have to find a way of overcoming the problem of having different inquiries through inquests, through the police and through regulators, because, together, those stopped the vital information getting out into the public domain and stopped proper investigation into these issues? Does he also agree that we need a mechanism to ensure that in future families are never ignored again, and that when legitimate allegations of wrongdoing are made, they are investigated properly and families are involved in that process?

[Mr Hunt]

First, I again pay tribute to the role that the right hon. Gentleman played. One of the most difficult things for any Minister is knowing when to accept advice, which is what we do most of the time, and when to overrule it. His instincts have been proved absolutely right. It is not an easy thing to do, and it causes all sorts of feathers to be ruffled, but he stuck to his guns, and rightly so. Bishop James Jones, who is a truly remarkable public servant, talked in the Hillsborough panel report about the

“patronising disposition of unaccountable power”.

That is what we have to be incredibly on guard against.

The right hon. Gentleman is right: at the heart is the problem that we did not listen to families early enough and we did not listen to whistleblowers inside the NHS early enough. My reason for saying that all these things need to see the sunlight of transparency much sooner is frankly that if they had come to light sooner and if proper attention had been given to this in 2001—we all know that Mid Staffs started in 2005—how many other lessons and tragedies throughout the health service could have been avoided? That is why I think it would be the wrong reaction today to say that we are getting there on patient safety and that transparency problems are solved: there is a lot further to go.

[Dr Julian Lewis (New Forest East) (Con)]

Within the last few hours, I have learned that I have a constituent whose grandmother had recovered from successful hip surgery without the need for any drug interventions and was sent to Gosport War Memorial Hospital for rehabilitation, only to be given a lethal cocktail of drugs that killed her. The matter was reported to Gosport police when it happened in 1998. Does the Secretary of State agree that if people are found wilfully to have administered lethal drug doses unnecessarily, they deserve to lose their liberty, and that if people are found wilfully to have covered up such crimes—for that is what they are—they deserve to lose their jobs?

[Mr Hunt]

I think everyone in the House would share my right hon. Friend’s sentiments, but we have to let the law take its course, and we have to make sure that justice is done, because it has been denied for too long.

[Stephen Morgan (Portsmouth South) (Lab)]

On behalf of my constituents, I thank the Secretary of State for the apology and the statement today. Can he confirm that all families affected have been contacted and say a bit more about the support that will be available to those who have lost loved ones?

[Mr Hunt]

I am happy to do that. All the families who think they had a relative affected have been part of the panel process, and they were all invited for a briefing by Bishop Jones this morning in Portsmouth. We will provide ongoing support and counselling if necessary through the Department of Health and Social Care, which was a specific request of Bishop Jones. We are also conscious that when people read the news, they may suddenly decide that they or a loved one were affected by this. We have set up a helpline so that people can contact us and we can help them to trace whether they too have been affected.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

Does not every instance of people being scared to speak out and relatives finding it too difficult to complain underline the importance of the Healthcare Safety Investigation Branch, which the Secretary of State has established? I remind him that I am chairing the Joint Committee of both Houses that is carrying out prelegislative scrutiny of the draft Health Service Safety Investigations Bill. When we report on 24 July, will my right hon. Friend undertake to bring that into law as quickly as possible? That will afford the safe space that people need to report such matters without fear or favour.

[Mr Hunt]

Absolutely. I commend my hon. Friend for his work and for being one of the colleagues in this place who have thought and talked about the importance of getting the right safety culture in the NHS. The Healthcare Safety Investigation Branch matters because in situations such as this, it could have been called in, done a totally independent investigation, got to the truth of what was happening quickly and prevented a recurrence of the problem. That is one of a number of things that we need to think about.

[Stephen Lloyd (Eastbourne) (LD)]

Ten years ago, a constituent came to see me called Mrs Gillian McKenzie. She told me a story that sounded so far-fetched that I struggled to believe it. In her opinion, her mother and many other elderly people had effectively been killed before their time at a hospital in Gosport. I found it staggering. I then read the hundreds of pages of documents that this amazing woman, Mrs McKenzie, had put together over the weekend, and I came to the harrowing conclusion that there could be a chance of a significant number of early deaths at the Gosport War Memorial Hospital.

I was a candidate then, not the MP. I contacted my good friend, my right hon. Friend the Member for North Norfolk (Norman Lamb), and I took Mrs McKenzie and relatives up to London to meet him. He agreed that this could be something wicked beyond compare. Over the next few years, there was continual campaigning and lobbying, and continual pushback. Finally—I pay tribute to my right hon. Friend—we got this commission off the ground. By the way, Mr Speaker, Mrs McKenzie is now 84. I saw her on Saturday evening, wished her luck and gave her a hug. Twenty years later, we are talking about the deaths of more than 450 and possibly 600 elderly people. The relatives today got the truth.

[Stephen Lloyd]

I am, Mr Speaker. I appreciate the latitude.

This has been a 10-year battle. Today, the relatives got the truth. The relatives and I demand justice. I urge the House, the Government and the police to do everything necessary to ensure that the individuals named in the report are brought to justice.

[Mr Hunt]

There can be no justice unless the truth is put on the table. That is the crucial first step, and now justice must proceed. I thank the hon. Gentleman for his campaign for Mrs McKenzie. Perhaps the best words I can use are these of the panel in the report:

“Yes, we have listened and yes, you, the families, were right. Your concerns are shown to be valid.”

[Mr Philip Dunne (Ludlow) (Con)]

I echo the tributes to the work of Bishop James Jones and the integrity and diligence that he and the panel have shown in conducting this inquiry. The Secretary of State has rightly focused on the impact on families, and I was pleased to hear in his statement that there will be a helpline for families who suspect that they have been affected—not least because the immediate catchment area around Gosport includes a lot of retirement homes, and many families whose elderly relatives went to the area to retire may live some distance away. Given the publicity that the report has given rise to, a considerable number of people may need to get in touch. Will he ensure that the helpline is adequately resourced?

[Mr Hunt]

Yes, I will absolutely do that. I ought to say that I know my hon. Friend met many families and relatives during his time as a Minister in my Department, and he always dealt with those cases with a huge amount of compassion. The facts of the matter are, according to the report, that 650-plus people had their lives shortened, but we are in touch with only about 100 families, so we are expecting more people to come forward.

[Diana Johnson (Kingston upon Hull North) (Lab)]

I, too, join in the comments that have made about the remarkable work of Bishop James Jones—not only in this important report, but on Hillsborough and on mediating with the Government last summer about moving the contaminated blood inquiry away from the Department of Health. I seek an assurance from the Secretary of State about the approach that Bishop Jones has put forward, which is the “families first” approach. Is there now a commitment from the Government to making that approach—families first—the hallmark of any inquiry that is ever held in the future?

[Mr Hunt]

I think actions speak louder than words. Such an approach is what Bishop Jones requested on this occasion, and we have done that. We obviously need to think through some process issues, because when a Minister wants to report to the House, they need to be a little bit informed as to what they are talking about. However, I think we have found a way to do that with this report and with the Francis report, so I think it is a good template.

[Andrew Bridgen (North West Leicestershire) (Con)]

May I commend the diligence and determination of the right hon. Member for North Norfolk (Norman Lamb), without whose efforts we would not be hearing the truth today, as grim and disturbing as that truth might be? Does my right hon. Friend agree that this raises further questions about the way in which doctors’ performance and patient safety are monitored? With the GMC, doctors are in effect policing themselves. Is it not time to say that this system has to change?

[Mr Hunt]

We do have to ask those questions, and we have to be able to respond to the concerns of my hon. Friend and his constituents about how we can be absolutely certain there will not be a closing of ranks. My experience, however, is that doctors are very quick to want to remove those of their number who are letting the profession down because this damages everyone’s reputation. There are some very difficult questions for the GMC and for the NMC. Because their processes took so long, I do not think they can put their hand on their heart and say that they have kept patients safe during that period.

[Mr Kevan Jones (North Durham) (Lab)]

The legislation regulating both doctors and healthcare professionals is now 35 years old. It is inefficient, outdated and—as I know from a constituency case in which the individual concerned is into the fifth year of her complaint to the GMC—not user-friendly for the complainant. The GMC and other healthcare professionals want change and the Secretary of State’s Department has already consulted on change, so will he give a guarantee that he will bring forward legislation to ensure that the system is not only effective, but effective for patients who make complaints?

[Mr Hunt]

The right hon. Gentleman is absolutely right: we have a regulatory landscape that is very complex, does not achieve the results we want, and forces regulators to spend time doing things they do not want to do and does not give them enough time for things they do want to do. Obviously, because of the parliamentary arithmetic, if we are able to get parliamentary consensus on such a change, that would speed forward the legislation.

[Helen Whately (Faversham and Mid Kent) (Con)]

There are many “if onlys”, but one of them is: if only the junior doctors and others who spoke up had been listened to. I know my right hon. Friend is committed to making sure that people and whistleblowers are listened to and that he is committed to transparency. Will he say a bit more about what he is doing to make sure that everyone involved in patient care—from consultants to healthcare assistants, porters, patients and families—are listened to and that their concerns are acted on?

[Mr Hunt]

I think we have made progress when it comes to whistleblowing because every trust now has a “freedom to speak up” guardian—an independent person inside the trust whom clinicians can contact if they have patient safety concerns. That is a big step forward, which was recommended by Robert Francis. Where I am less clear that we have solved the problem is in relation to having someone for families to go to if they think that everyone is closing ranks, and we now need to reflect on that.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I refer the House to my entry in the Register of Members’ Financial Interests and my history of working in the NHS.

A brave nurse came forward all those many years ago to highlight a concern, but the concern was not taken forward adequately at that time. Often in these circumstances, the NHS closes ranks, management remove the individual who raises the concern—the clinician in this instance—and allows the system to continue. Is there some way of monitoring the types of concerns raised by clinicians, ensuring that the staff who raise these concerns are not themselves penalised and that the system then takes accountability forward?

[Mr Hunt]

The hon. Lady is absolutely right to raise that matter. The nurse concerned, Anita Tubbritt, talks in the report about her concerns and the pressure that she was put under, and it was a brave thing to do. When the hon. Lady reads the report, she will see that nurse auxiliaries and others who were not professionally trained clinicians also came forward with concerns and were also worried about the impact that doing so would have on their own career. That is what we have got to stop because, in whatever part of the UK, getting a culture in which people can speak openly about patient safety issues is absolutely essential.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I was a junior doctor at the Royal Hospital Haslar in Gosport, which is just around the corner from the Gosport War Memorial Hospital, so I know that hospital fairly well, and I also know that the people of Gosport will be disappointed and distressed by this, since they very much value their community hospital.

Does the Secretary of State agree with me that there is an issue about the governance of smaller institutions, as we have seen in the past? I in no way wish to disparage the excellent work done by community hospitals, of which I have been a champion for many years, but will he look specifically at the pages in the report that touch on this? There is an issue about governing and ensuring safety in small institutions—whether in general practice or in hospitals?

[Mr Hunt]

I think that that is actually an excellent point, and we should definitely look at it. Big hospitals have clear lines of accountability—boards, chief executives—but those often do not exist in community hospitals and there is no one who can say they are the boss of that trust, so we should look at that.

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

The grandmother of one of my constituents died in Gosport War Memorial Hospital in January 1999—in other words, after concerns were being raised by families and by staff at the hospital. The family believe that her morphine dose was well above that needed for her reported pain. I thank the Health Secretary for the tone of his statement, and I also thank Bishop Jones for the work he did on this inquiry. Does the Secretary of State believe that this report shows a need for tightening the draft Health Service Safety Investigations Bill?

[Mr Hunt]

I thank the hon. Lady for her comments. I do not want to jump to a conclusion about any changes to the draft Bill. However, we should definitely reflect on any legislative changes that might be needed as a result of this report, and that Bill could be a very powerful vehicle for doing so.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

My right hon. Friend has mentioned trust, and as a doctor myself, I am very aware of and humbled by the fact that people come to me with their children and put their trust in me to look after them. When events such as this occur, trusts can be shaken, and it is therefore important that these things are dealt with quickly. In this case, the investigation, since complaints were first received, has been going on for far too long. What will my right hon. Friend do to reassure people that any such complaints will be dealt with much more quickly in future, and that opportunities to save lives will not be lost in the meantime?

[Mr Hunt]

That is the big question we have to answer for both the House and the British people. However, I would say to the hon. Lady that I am confident that, where there is unsafe practice, it is surfaced much more quickly now in the NHS than it has been in the past. I am less confident about whether we have removed the bureaucratic obstacles that mean the processes of doing such investigations are not delayed inordinately so that the broader lessons that need to be learned can be learned.

[Andrew Selous (South West Bedfordshire) (Con)]

One of the reasons for the growing success of the “Getting it right first time” programme is the creation of clinician-agreed datasets. Will the Secretary of State give the House an assurance that there will in future be proper analysis of the data on the excess number of deaths and the use of this particular type of drug in excessive amounts? Such analysis would have shown this hospital as an outlier, so questions could have been asked, as is now happening successfully with the GIRFT programme.

[Mr Hunt]

I thank my hon. Friend for his championing of the GIRFT programme, which is incredibly powerful and successful. He will have noticed that we announced last week that we are expanding it into a national clinical information programme, which will cover more than 70% of consultants. What is disturbing in this case, though, if I may say so, is that the data was really around mortality, and we have actually had that data for this whole period. There is really nothing to stop anyone looking at data, and we can see a spike in the mortality rates in this hospital between 1997 and 2001. They go down dramatically in 2001, when the practices around opiates were changed. That is why we have to ask ourselves the very difficult question about why no one looked at that data or, if they did, why no one did anything about it.

[Robert Courts (Witney) (Con)]

Will the Secretary of State commit to look at the wider structural issues that affect patient safety, and particularly at things such as staffing levels and pressures on doctors and nurses?

[Mr Hunt]

Absolutely. One of the big lessons from this report is that we have to look at systemic issues as much as at the practice of an individual doctor or nurse.

[Alex Burghart (Brentwood and Ongar) (Con)]

I congratulate the Secretary of State and the right hon. Member for North Norfolk (Norman Lamb) for getting us to this point. I was deeply concerned to hear in the Secretary of State’s statement that Ministers had been given advice not to proceed with this independent panel. Is the Secretary of State convinced that Ministers are now receiving better advice?

--- Later in debate ---

[Mr Hunt]

Of course that is an issue that we will look into. I would just say, in the interests of transparency, that the Department of Health has been on the same journey as the whole of the rest of the NHS with respect to patient safety issues.

[Eddie Hughes (Walsall North) (Con)]

Does the Secretary of State agree that this report highlights the importance of the CQC to the NHS and patient safety? Will he consider giving that body greater regulatory powers?

[Mr Hunt]

The legal independence of the CQC, and its ability to act as the nation’s whistleblower-in-chief, is one of the big, important reforms of recent years, and I think that will give the public confidence. However, I do not think that that is the entire answer, and I still think there is an issue about who families go to when they think they are being ignored by the establishment.

[Andrew Jones (Harrogate and Knaresborough) (Con)]

We have had Mid Staffs, Morecambe Bay and now the Gosport War Memorial Hospital. That tells us that significant patient failures are not one-offs; indeed, the Francis report of 2013 was one of the most challenging public documents I have ever read. My right hon. Friend has made patient safety a personal priority, with his customary judgment and compassion. Can he confirm that this developing culture within the NHS remains a priority for him and that the NHS will do all that it can to protect the most frail and vulnerable that it looks after?

[Mr Hunt]

That is absolutely my priority, and my hon. Friend worked very closely with me on that when he was my Parliamentary Private Secretary. Changing culture is a long, long process, but I think we can start through some of the things we do in this House. Reacting afresh to this report, and not just saying, “We’ve done what we need to do, because we had Mid Staffs and Morecambe Bay,” is a very important next step.

[Mr Philip Hollobone (Kettering) (Con)]

For me, the two most shocking things are the number of deaths and the length of time it has taken for this scandal to be exposed. Further to the earlier question, until the Secretary of State overruled it, the official advice from the Department of Health was that this public inquiry should not take place. Is there going to be an official investigation into why that official advice was given and which civil servant should be held accountable for it?

[Mr Hunt]

We will, of course, look at that. That was why I said in my statement that there were failures by the Department of Health—the specific incident needs to be looked at—and also as the steward of the system in which so many other things went wrong.

[Nigel Huddleston (Mid Worcestershire) (Con)]

Can the Secretary of State confirm that all deaths in the NHS will be properly assessed by a coroner or a medical examiner so that lessons can be learned and avoidable deaths minimised?

[Mr Hunt]

I can confirm that, from next April, all hospital deaths will be examined by an independent doctor—this is the medical examiner process. We are expanding the learning from deaths programme to primary care. That is exactly where we want to go.

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 19th June 2018 Commons Chamber

[Layla Moran (Oxford West and Abingdon) (LD)]

3. What discussions he has had with the Home Secretary on the effect of the tier 2 visa cap on recruitment in the NHS and social care sector.

[The Secretary of State for Health and Social Care (Mr Jeremy Hunt)]

Last week the Home Secretary removed doctors and nurses from the tier 2 visa cap.

[Layla Moran]

In Oxfordshire, the situation with social care workers is at least as bad a problem. Of course we all very much welcome the removal of doctors and nurses from the cap, but what about social care workers? Why are we focusing on only half the problem?

[Mr Hunt]

Perhaps I can help the hon. Lady by pointing out that tier 2 visa cap is specifically for higher-paid workers. We do need to think about social care workers, but a lot of them are lower paid. That is why we are putting together a 10-year workforce plan for the health and social care sectors, both of which are very important. We will make sure that that goes hand in glove with the NHS plan that we announced yesterday.

[Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)]

The real effect of the cap is that there are not enough staff in the health service, as is shown by “NHS SOS”, a campaign run a few weeks ago in Stoke by The Sentinel that highlighted the lack of doctors and nurses. Realistically, what will the Secretary of State do to remedy that situation in Stoke-on-Trent? Will he meet people from The Sentinel so that they can present the evidence?

[Mr Hunt]

Let me tell the hon. Gentleman what we have been doing in the past five years: we have 14,300 more nurses, 10,100 more doctors, and over 40,000 more clinicians across different specialties. He will be very relieved to know that, on top of that, we are promising 50% more than his party did at the last election.

[Kate Hollern (Blackburn) (Lab)]

4. What assessment he has made of the (a) quality and (b) availability of health and social care services for people with learning disabilities.

--- Later in debate ---

[Alan Mak (Havant) (Con)]

22. What steps his Department is taking to support UK life sciences and medical research.

[The Secretary of State for Health and Social Care (Mr Jeremy Hunt)]

The life sciences sector is critical to the UK economy, which is why we support it with a £1 billion annual grant through the National Institute for Health Research.

[Luke Graham]

What steps is my right hon. Friend taking to further life sciences in Scotland? Will he meet me to see what the UK Government can do to support the forthcoming International Environment Centre in Clackmannanshire in my constituency?

[Mr Hunt]

I am happy to do that. The life sciences industry is critical to Scotland, and Scotland’s role is critical to the UK. We all remember Dolly the sheep being pioneered in Edinburgh University, and last week’s announcement of a new centre in Renfrewshire is another good example of the great things happening in Scotland.

[Alan Mak]

The use of big data and artificial intelligence in medical research has the potential to save hundreds of thousands of lives. Will my right hon. Friend consider setting up data hubs and support the full digitisation of patient records?

[Mr Hunt]

My hon. Friend is very knowledgeable about that area. We have announced the creation of a set of digital innovation hubs, and perhaps we can broaden those to turn them into the hubs that he thinks would be a good idea.

[Ian Austin (Dudley North) (Lab)]

Getting new drugs approved more quickly would not just be a big boost for the life sciences and medical research sectors, but would help my constituents and others across the country with cystic fibrosis who desperately need access to Orkambi. They have been waiting for years; it is not good enough. Why can the Secretary of State not sort this out, get a grip, get his officials and Vertex in a room, and force them to come to an agreement? People have waited too long for this.

[Mr Hunt]

That is exactly what we have been doing, but we need Vertex to be reasonable regarding the price that it offers the NHS. We need to pay fair prices. We have heard that it will be coming back with a new offer next week—we hope it is a reasonable one—but we urge Vertex to waive commercial confidentiality so that we can all see, in the interests of transparency, the kind of prices it is trying to charge the NHS.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Will the Secretary of State consider West Yorkshire in particular? We have the universities, the science, the technology and the life sciences; all we need is a new teaching hospital in Huddersfield.

[Mr Hunt]

We have great teaching hospitals in Yorkshire and we have introduced five new medical schools. When we do the new workforce plan later this year, who knows? We may need more.

[Dr Sarah Wollaston (Totnes) (Con)]

Further to the point made by the hon. Member for Dudley North (Ian Austin), we know that the UK is a world leader in research into rare conditions, but that does not always translate into timely access to those treatments. The Secretary of State will know that there are many CFTR—cystic fibrosis transmembrane conductance regulator—treatments in the pipeline that could benefit people who are living with cystic fibrosis. Will he meet me to see how we can ensure that those are available in a timely manner for the people who desperately need them?

[Mr Hunt]

Of course I am happy to meet my hon. Friend. I recognise that this is one of the things that we are not good at at the moment. We have fantastic research, with amazing new drugs developed in this country, but our uptake can be painfully slow, and that is of course something that we want to put right.

[Carol Monaghan (Glasgow North West) (SNP)]

ME affects approximately a quarter of a million people across the UK, and while there has been substantial psychological research into the condition, there has been very little biomedical research. What funding will the Secretary of State make available specifically for biomedical research into the treatment and diagnosis of ME?

[Mr Hunt]

I am grateful to the hon. Lady for raising that issue. She is introducing a debate on it in Westminster Hall on Thursday. I have met a number of families who have suffered very badly as a result of ME, and we would all like better research, so I hope that her campaign is successful.

[Craig Tracey (North Warwickshire) (Con)]

6. What recent assessment he has made of the public health benefits of participation in sport.

--- Later in debate ---

[Andrew Lewer (Northampton South) (Con)]

18. What steps he is taking to encourage the adoption of personal health and care budgets.

[The Secretary of State for Health and Social Care (Mr Jeremy Hunt)]

I know that the thoughts of the whole House are with the families affected by the terrible atrocity a year ago.

Personal health budgets have a transformative effect on people with very complex health needs, and we plan for 50,000 to 100,000 more people to benefit from them by 2021.

[Sir Henry Bellingham]

I thank the Secretary of State for that reply. Does he agree that a key part of integrating health and social care is giving individuals more say and flexibility in how they use their entitlements? Will he consider extending his pilots to my constituency of North West Norfolk?

[Mr Hunt]

Absolutely, and not just to North West Norfolk, but to the whole country. We are currently consulting on giving a right to personal health budgets to people with the most complex health needs. That would be about 350,000 people and would include anyone with a continuing NHS need combined with a mental health need, a learning disability, autism or PTSD. Obviously, it would be hugely significant if we were able to proceed with that.

[Andrew Lewer]

Will the Minister ensure that the long-term NHS plan puts a major emphasis on empowering patients through the wider availability of personal budgets? May I also join my hon. Friend the Member for North West Norfolk (Sir Henry Bellingham) and make a pitch for my local area of Northampton for one of the next wave of pilots?

[Mr Hunt]

Absolutely, and technology will have a big role, because this year we intend all NHS patients to be able to access their health records through an app. That will be extremely empowering, but my hon. Friend is right that giving people with long-term conditions control over their health and care destiny is a potentially huge leap forward.

[Ms Angela Eagle (Wallasey) (Lab)]

While I agree with the philosophy and approach behind health and personal care budgets, will the Secretary of State acknowledge that the 21% fall in social care funding between 2010 and 2015-16 has caused a catastrophe in this area? Will he acknowledge that if this approach is to work in future, the funding has to be there?

[Mr Hunt]

I congratulate the last Labour Government on introducing direct payments, which were the first step in this process. The hon. Lady talks about cuts in social care, which I acknowledge, but, with respect to her, she never talks about the reason, which was that in 2008 we had the worst financial crisis in our peacetime history, and we had to take measures. It is as a result of creating 3.2 million jobs since then that funding for social care is now going up.

[Jim Shannon (Strangford) (DUP)]

Bearing in mind that the number of bed days lost increased in the second quarter of 2017-18, with most of the patients subject to delays being elderly people, will the Minister outline a dedicated strategy for getting people out of hospital and back home with appropriate care as a matter of urgency, for the good of the patient as well as the public purse?

[Mr Hunt]

This is a huge challenge in all parts of the United Kingdom. In England, about 22% of bed days are occupied by people who have been in hospital for more than three weeks, and probably less than 20% of those people should be in hospital. We are taking urgent steps to rectify that, because it is very, very bad for the patients involved.

[Mr Marcus Jones (Nuneaton) (Con)]

9. What steps he is taking to increase the size of the mental health workforce.

--- Later in debate ---

[Kevin Foster (Torbay) (Con)]

23. What funding his Department has recently allocated to capital investment projects in the NHS.

[The Secretary of State for Health and Social Care (Mr Jeremy Hunt)]

In the Budget we announced £3.9 billion of additional capital funding, and 77 projects have conditional approval.

[Sir Roger Gale]

Could my right hon. Friend indicate what implications that welcome statement might have for the much needed rebuilding and refurbishment of the A&E unit at the Queen Elizabeth the Queen Mother Hospital in Margate?

[Mr Hunt]

I hope it will have a positive impact. We are asking NHS trusts to get their proposals in during July. We are also delighted that there is a new medical school in Canterbury and we hope that this will be the start of a transformation of NHS services.

[Kevin Foster]

Earlier this year, Torbay and South Devon NHS Foundation Trust was allocated £13.3 million of capital funding for improved urgent care and a new emergency department at Torbay Hospital. Will my right hon. Friend confirm what progress is being made to get those major construction projects under way?

[Mr Hunt]

I think it will be brilliant not just for patients at Torbay Hospital but for patients living in Newton Abbot and Torquay. My understanding is that this project is on track, and my hon. Friend should be very proud, because he campaigned hard.

[Helen Jones (Warrington North) (Lab)]

Warrington desperately needs a new hospital to replace its old, out-of-date buildings, so in allocating future capital funding will the Secretary of State bear in mind the levels of health deprivation that exist in the area, and will he ensure that any new hospital is accessible to those in my constituency, which has areas that are among the most health deprived in the borough?

[Mr Hunt]

I visited the hospital not too long ago and was able to see for myself some of the estate issues the hon. Lady talks about. I can assure her that need is a fundamental criterion when we look at allocating capital funding.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

The Secretary of State knows that he has presided over a crisis in capital funding, with a £5.5 billion estimated maintenance backlog, £1 billion of which is classified as urgent. Yesterday’s statement hopefully goes some way to addressing that, although it was far from clear whether capital funding was included in that announcement. Can the Secretary of State confirm today whether any cash generated by the sale of NHS property under the Naylor review is in addition to the money announced yesterday?

[Mr Hunt]

Yes, I can.

[Mary Glindon (North Tyneside) (Lab)]

11. What recent discussions his Department has had with representatives of NICE on increasing the capacity of the highly specialised technologies evaluation process.

--- Later in debate ---

[Rosie Cooper (West Lancashire) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health and Social Care (Mr Jeremy Hunt)]

When something goes tragically wrong in healthcare, the best apology to grieving families is to guarantee that no one will experience the same heartache again. Last week I accepted the recommendations of the Williams review of gross negligence manslaughter, and we announced a new national clinical improvement programme to provide NHS consultants with confidential data on their clinical outcomes. From next April independent medical examiners will examine every hospital death, and the learning from deaths programme will be extended to primary care.

[Rosie Cooper]

Will the Secretary of State encourage NHS England to respond to my freedom of information request of 13 March this year regarding Greater Manchester Shared Services and the likely failure of the NHS to correctly enforce guidance on recruiting agency staff in the reappointment of Deborah Hancox after her criminal conviction and two-year prison sentence for defrauding the NHS? How can we employ these people?

[Mr Hunt]

The hon. Lady has highlighted what is potentially an extremely serious issue. Obviously the FOI is a matter for NHS England, but let me reassure her that the Minister for Health, my hon. Friend the Member for North East Cambridgeshire (Stephen Barclay)—the hospitals Minister—met the chief executive of the NHS Counter Fraud Authority this morning.

[Richard Graham (Gloucester) (Con)]

T6. A recent report by the King’s Fund highlighted the potential for a hypothecated source of funding for health and care, with national insurance as a possible starting point. Does my right hon. Friend agree with the report that hypothecation would increase transparency in regard to what our constituents pay for health and care, and will he encourage the Chancellor to look at the report’s implications?

[Mr Hunt]

I thought that the report made powerful reading, and I know that my hon. Friend was associated with it. Yesterday the Prime Minister was straightforward about the fact that, if we are to preserve our NHS and make it one of the best systems in the world, the burden of taxation will need to increase, and she was willing to listen to the views of colleagues about the most appropriate way in which that should be done.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The Association of Directors of Adult Social Services has reported a £7 billion reduction in adult social care funding since 2010, and Age UK has reported there are now “care deserts” in some parts of the country. There are 1.2 million older people living with unmet care needs, and one in five care services has the poorest quality ratings from the Care Quality Commission.

As well as a long-term funding solution for social care, we need the extra £1 billion this year and £8 billion in the current Parliament that Labour pledged before last year’s general election. However, all that the Government offer is a delayed Green Paper. When will the Secretary of State deal with the current crisis in social care?

[Mr Hunt]

No, that is not correct. Yesterday we made very clear our support for the social care system and our recognition that reform of the NHS must go hand in glove with the social care system, and we said there would be a new financial settlement for the social care system. It is also time that the Labour party took some responsibility for the financial crisis that made all these cuts necessary.

[Andrew Jones (Harrogate and Knaresborough) (Con)]

T7. Prostate cancer survival rates may be at a record high, but it is still among the biggest cancer killers in our country today. What can the Government do to save more lives in this area?

--- Later in debate ---

[Hannah Bardell (Livingston) (SNP)]

T2. Given the challenges the Secretary of State and his Government face in recruiting and retaining health and social care staff, will he follow the example of the Scottish Government, who pay their social care assistants and care assistants the real living wage, meaning they earn £1,100 a year more than their counterparts in England?

[Mr Hunt]

May I gently remind the hon. Lady that it was this Conservative Government who introduced the national living wage, and we did that on the basis of transforming the economy, championing policies that were by and large opposed every step of the way by the Scottish National party?

[Martin Vickers (Cleethorpes) (Con)]

The Minister of State visited my hospital trust last month. Is he in a position to support its requests, and will he say whether he is satisfied with the progress it is making to remove itself from special measures?

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[Stephen Morgan (Portsmouth South) (Lab)]

T5. The Institute for Fiscal Studies says that there is no such thing as a Brexit dividend, so the Secretary of State will need to put up taxes to fund our NHS. Will he be transparent and promise NHS workers in Portsmouth, to whom he has only just given a pay rise, that the burden will not fall on hard-working families like them—or is he robbing Peter to pay Boris?

[Mr Hunt]

Will the hon. Gentleman be transparent, if he disagrees with the Brexit dividend, and challenge his own party leader, who supports it?

[Michelle Donelan (Chippenham) (Con)]

I am delighted that our NHS will be getting an extra £20 billion. This has long been at the top of my agenda, and the agenda of my constituents. Does my right hon. Friend agree that, to ensure that that money is always spent on the NHS, we need to consider a hypothecated tax as part of the funding plan?

[Mr Hunt]

As I say, there are compelling arguments in favour of hypothecated taxes, but there are also strong reasons why we have to be cautious—namely, the fact that tax revenues go up and down, year on year, while the NHS needs stable funding. Important arguments and discussions need to happen between now and the Budget, when the Chancellor will make that decision.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

T8. In the light of the additional funding announced by the Secretary of State yesterday, will he tell me how much additional funding will be provided for palliative care, which I highlighted in my Terminal Illness (Provision of Palliative Care and Support for Carers) Bill?

[Mr Hunt]

I thank the hon. Gentleman for his private Member’s Bill. Palliative care is something that we do well in the UK—thanks, a lot, to the brilliant hospice movement—but we can do a lot better. I know that this will be an important part of the NHS plan.

[Vicky Ford (Chelmsford) (Con)]

Stroke is the fourth largest single cause of death in Britain. What action are the Government taking to prevent stroke and to raise awareness? And will the Minister meet me to discuss my GP surgery at Sutherland Lodge?

--- Later in debate ---

[Mr Hunt]

I sincerely hope so, because Scottish NHS patients are currently 30% more likely to wait too long for their elective care.

[Wera Hobhouse (Bath) (LD)]

What comparison has the Minister made of the cost of preventing children and young people’s mental health issues by tackling adverse childhood experience in the first few years of life, rather than letting them develop into much costlier issues for school-age children?

--- Later in debate ---

[Jeff Smith (Manchester, Withington) (Lab)]

Last November, the Health Secretary committed to ending out-of-area mental health placements by 2020, but the number of people placed more than 100 km from their home rose by 65% over the past year. The earlier response from the Under-Secretary of State for Health and Social Care, the hon. Member for Thurrock (Jackie Doyle-Price), was no answer, so what are the Government actually going to do to turn the situation around?

[Mr Hunt]

There are record numbers of tier 4 beds, and we are putting record amounts of money into mental health.

[Sir Roger Gale (North Thanet) (Con)]

Mr Speaker, you will recall recently granting me a Westminster Hall debate on the HPV vaccine for boys. Will the Department update me on progress?

--- Later in debate ---

[Mr Speaker]

I dare say that it will be, but the Secretary of State has heard the hon. Gentleman and is nodding enthusiastically from his sedentary position, and I take the nod as an indication of good intent.

[Mr Hunt]

I am happy to confirm that we will do that forthwith.

[Mr Speaker]

Forthwith. Splendid. The hon. Gentleman looks satisfied—at least for now.

We have an urgent question in a moment from Alison Thewliss. I advise the House that it is on an extremely important matter that warrants urgent treatment on the Floor of the House, but it does not warrant treatment at length. I do not intend to run it for any longer than 20 minutes, because there is other business to protect.

NHS Long-Term Plan

Jeremy Hunt Excerpts

Monday 18th June 2018 Commons Chamber

[The Secretary of State for Health and Social Care (Mr Jeremy Hunt)]

With permission Mr Speaker, I will make a statement about the Prime Minister’s announcement yesterday of a new long-term funding plan for the NHS. The NHS was built on the principle that good healthcare should be available for everyone, whatever their background and whatever their needs. Seventy years on, it remains this country’s most valued public service: an institution that is there for every family, everywhere, at the best of times and at the worst, so no one in this House underestimates the importance of putting the NHS on a steady financial footing, not just for the sake of their constituents but also for their own families and loved ones. That is why I am proud today that this Government have announced their commitment to a long-term funding settlement for the NHS.

From vaccinations to IVF, to radiotherapy and to next-generation immunotherapies, the NHS has always been at the forefront of excellence in medicine, but as only the sixth universal healthcare system in the world, it has also come to symbolise equity both at home and abroad. Despite pressures in recent years, the Commonwealth Fund rates the NHS as the best healthcare system in the world, cancer survival rates are at a record high, stroke mortality is improving faster than almost anywhere else in the OECD and heart disease mortality rates continue to fall. All this is thanks to NHS staff who continue to work tirelessly, day in, day out to make it the world-class service it truly is.

But alongside advances in medicine, demographic pressures pose a potentially existential threat to the NHS as we know it. With the number of over-75s expected to increase by 1.5 million in the next 10 years, these pressures, far from reducing, will intensify. So in March the Prime Minister made the bold decision to commit to a 10-year plan for the NHS backed up by a multi-year funding settlement. Since then I have been working closely with the Prime Minister and the Chancellor, and I can today announce that the NHS will receive an increase of £20.5 billion a year in real terms by 2023-24—an average of 3.4% per year growth over the next five years. The funding will be front-loaded with increases of 3.6% in the first two years, which means £4 billion extra next year in real terms, with an additional £1.25 billion cash to cope with specific pension pressures. Others talk about their commitment to the NHS, but this settlement makes it clear that it is this Government that delivers, and the details will shortly be placed in the Library of the House.

This intervention is only possible due to difficult decisions taken by the Government—opposed by many—to get our nation’s finances back in order and our national debt falling. Some of the new investment in the NHS will be paid for by our no longer having to send annual membership subscriptions to the EU after we have left, but the commitment that the Government are making goes further, and we will all need to make a greater contribution through the tax system in a way that is fair and balanced. My right hon. Friend the Prime Minister said that we will listen to views about how we do that and, my right hon. Friend the Chancellor will set out the detail in due course. I want to pay particular tribute to the Chancellor, whose careful stewardship of the economy—alongside that of George Osborne before him—is what makes today’s announcement possible.

The British public also, rightly, want to know that every pound in the NHS budget is spent wisely. It is therefore critical to the success of the plan that the whole NHS improves productivity and efficiency, eliminates provider deficits, reduces unwarranted variation in the system so that people get the consistently high standards of care wherever they live, gets better at managing demand effectively, and makes more effective use of capital investment. We have set the NHS five key financial tests to show how it will play its part in putting the service onto a more sustainable footing, and I will expect the NHS to give this work the utmost priority. The tests will be a key part of the long-term plan.

However, this is more than just a plan to get finances back on track. In its 70th year, we also want our NHS to make strides towards being the safest, highest-quality healthcare system in the world. That means making a number of improvements to the treatment and care currently offered, including getting back on track to delivering agreed performance standards, locking in and further building on the recent progress made in the safety and quality of care, and transforming the care offered to our most frail and vulnerable patients, so that we prioritise prevention as much as cure. It also means transforming our cancer care, where we still lag behind France and Germany despite record survival rates. There is no family in this country that has not been touched by cancer, so the whole House will want to know how the NHS intends to make our cancer treatment and care among the best in Europe.

Many of our constituents worry about the mental health of their loved ones, families and friends. Again, I am proud of this Government’s record here: investing more in mental health than ever before and legislating for true parity as part of one of the biggest expansions in mental health provision in Europe. A critical part of the plan will be to decide what next steps will enable us to claim not just that we aspire to parity of provision with mental health, but that we are actually delivering it.

For our most vulnerable citizens with both health and care needs, we also recognise that NHS and social care provision are two sides of the same coin. It is not possible to have a plan for one sector without having a plan for the other. Indeed, we have been clear with the NHS that a key plank of its plan must be the full integration of the two services. As part of the NHS plan, we will review the current functioning and structure of the Better Care Fund to make sure that it supports that. While the long-term funding profile of the social care system will not be settled until the spending review, we will publish the social care Green Paper ahead of that. However, because we want to integrate plans for social care with the new NHS plan, it does not make sense to publish it before the NHS plan has even been drafted, so we now intend to publish the social care Green Paper in the autumn around the same time as the NHS plan.

Finally, there are two further elements crucial to putting the NHS on a sustainable footing. Alongside the 10-year plan, we will also publish a long-term workforce plan recognising that there can be no transformation without the right number of staff, in the right settings and with the right skills. This applies to both new and existing staff. As part of this, we will consider a multi-year funding plan for clinical training to support this aim. Similarly, we know that capital funding is critical for building the NHS services of the future and, again, we will consider proposals from the NHS for a multi-year capital plan to support the transformation plans outlined in the long-term plan.

Given the national economic situation, yesterday’s announcement is bold and ambitious. For the first time, national leaders of the NHS will develop a plan for the next decade that is clinically led, that listens to the views of patients and the public and that is backed by five years of core funding. We want to give the NHS the space, the certainty and the funds to deliver a comprehensive long-term plan to transform health and care and to ensure that our children and grandchildren benefit from the same groundbreaking health service in the next 70 years as we all have done in the first 70.

That is the Government’s commitment to our NHS, and I commend this statement to the House.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I thank the Secretary of State for an advance copy of his statement.

Today’s announcement is the clearest admission that eight years of cuts, of the tightest financial squeeze in its history and of privatisation have pushed the NHS to the brink. Is not the announcement of new potential legislation the clearest admission that the Health and Social Care Act 2012 has been a wasteful mess and should never have been introduced in the first place?

With waiting lists at 4 million, with winters in our NHS so severe that they were branded a “humanitarian crisis” and with 26,000 cancer patients waiting more than 60 days for treatment, Tory MPs should not be boasting today but should be apologising for what they have done to the NHS.

We have long called for a sustainable funding plan for the NHS, and I note that the Secretary of State did not use the words “Brexit dividend.” Is that because he knows—I say this for the benefit of his own Back Benchers—there is no such thing as a Brexit dividend? That is why the Institute for Fiscal Studies said with respect to the Brexit dividend that

“over the period, there is literally zero available”.

If the Secretary of State disagrees with the IFS, will he confirm the Government’s own Office for Budget Responsibility forecasts that there is no Brexit dividend initially for the public finances? Is it not the truth that this package will be paid for by extra borrowing and higher taxation? The Prime Minister should level with the British public and not take them for fools.

The Secretary of State is graceful enough to concede that higher taxation is on the way, but do the British public not deserve to know how much extra tax they will be paying? Will VAT go up under the Tories? Will the basic rate of income tax go up under the Tories? It is not good enough for him to say that these are matters for the Chancellor, because they are matters for the Cabinet of which he is a member.

Given that the Secretary of State is putting up tax and borrowing, and of course every £1 should be spent wisely, can he guarantee that not a further penny piece will be siphoned off into poor-quality, poor-value privatisation? Three years ago, he told us that the NHS would find £22 billion-worth of efficiency savings. How much of those efficiency savings came to fruition?

How much will the NHS be spending on agency workers and locums in the coming years? The NHS already spends £3 billion a year. Staffing gaps have led to clinical negligence claims of £1.7 billion a year, twice the rate of 2010. How much of this new money will go to further claims? The NHS spends £389 million a year on consultancy costs. Will consultancy costs increase, or will the Secretary of State cap them? With hospital trusts in deficit by £1 billion, can he guarantee that trusts will break even next year?

Is it not the truth, as expert after expert has said, that this settlement is not good enough to deliver the needed improvements in care? Indeed that is why the Prime Minister could not even confirm, when asked a basic question today, whether this funding will deliver the NHS’s constitutional standards on treatment waits, A&E waits and cancer waits.

Can the Secretary of State tell us whether, this time next year, the waiting list for NHS treatment will be higher or lower than the 4 million it is today? This time next year, will there be more or fewer patients waiting more than 60 days for cancer treatment? This time next year, will there be more than 2.5 million people waiting beyond four hours in accident and emergency or fewer? If he cannot give us basic answers to these fundamental performance target questions, that exposes the inadequacy of this settlement.

Why does the Secretary of State not tell us what was left out of this settlement? We have a childhood obesity crisis; we have seen cuts to sexual health services and to addiction services; and health visitor numbers are falling. Yet there is no new money for public health in this announcement—instead we are told to wait until next year. We have a £5 billion repair bill facing the NHS and outdated equipment, yet there is no new money for capital in this settlement—instead we are told to wait until next year.

On social care, we have had £7 billion in cuts and we have had 400,000 people losing care support. The social care Green Paper is delayed again. Is it not a total abdication of responsibility to have left social care out of this settlement? This is not a credible long-term funding plan for our NHS; it is a standstill settlement for the NHS. The reality is that under this plan the NHS will remain understaffed, under-equipped and underfunded—it needs to be under new management.

[Mr Hunt]

It was a valiant effort, but the hon. Gentleman could not get away from the truth in British politics: when it comes to the NHS, Labour writes the speeches, Conservatives write the cheques. He gamely managed to avoid smiling when he said that this settlement was not enough. He said the same thing on “Sunday Politics” yesterday. Let me remind him that at the last election his party was promising not the 3.4% annual increases that we are offering today, but 2.2%. What today he says was not enough he said in the election was enough to

“'restore the NHS to be the envy of the world”.

His leader said that it would

“give our NHS the resources it needs”.

What we are offering today is not 10% or 20% more than that, but 50% more. In five years’ time this Conservative Government will be giving the NHS £7 billion more every year than Labour was prepared to give. [Interruption.] It is funny, isn’t it, that Labour Members talk about funding the NHS but when we talk about it they try to talk it down? They do not want to hear the fact that under a Conservative Government there will be £7 billion more funding every year—that is 225,000 more nurses’ salaries under a Conservative Government. [Interruption.]

[Mr Speaker]

Order. There is far too much noise in this Chamber. As is my usual practice, I was addressing Education Centre students via Skype this morning. They were from a primary school from Wythenshawe and Sale East. One of the youngsters said to me, “Is it not the case, Mr Speaker, that often Members speak very rudely to and at each other?” I could not dissent from that proposition. I think it would be helpful if Members calmed themselves. The Secretary of State is accustomed to delivering statements and responding to urgent questions in this place, and he knows, and will expect, that there will be plenty of opportunity for people to question him. As he gives his answers, it is only right that he be heard, as I want then to hear every Member.

[Mr Hunt]

Thank you, Mr Speaker. The hon. Gentleman said just now that there is

“no such thing as a Brexit dividend”.

I have heard lots of other people say that from a sedentary position. But what did their leader say on 26 February? These were his exact words:

“and we will use the funds returned from Brussels after Brexit to invest in our public services and the jobs of the future”.

So who is right: is it the hon. Gentleman or his leader?

After paying the Brexit divorce bill this Conservative Government will use the contributions that would have gone to Brussels to fund our NHS—that is what the British people voted for. But the main reason we are able to announce today’s rise, one of the biggest ever single rises in the history of the NHS, is not the Brexit dividend but the deficit reduction dividend, the jobs dividend, the “putting the economy back on its feet” dividend, after the wreck left behind by the Labour party. Every measure we have taken to put the economy back on its feet has been opposed by the Labour party, but without those measures there would be no NHS dividend today; with the Conservatives you don’t just get a strong NHS, you get the strong economy to pay for it.

In the next few weeks, as Labour scrabbles around to raise its offer on the NHS, we will no doubt hear that it is offering more for the NHS, but when the Labour party comes forward with that offer, the British people will know that the only reason it has done so is that a Conservative Government shamed it into doing so with an offer far more generous than anything Labour was prepared to contemplate.

Another thing I have heard said about NHS funding is, “Whatever the Conservatives offer, we’ll match and do more,” but the trouble is that the opposite is true, because under this Government NHS spending in England is up 20% in the past five-year period, but in Wales it is up just 14%. That is to say that for every extra pound per head invested in England, in Wales it is just 84p, which is why people are 70% more likely to wait too long in A&Es in Wales. The right response to this statement would be for Labour to say that every additional penny though the Barnett formula will go into the NHS in Wales, but we did not hear that pledge.

The hon. Gentleman also talked about social care, and this matters. I fully agree with him that we need to have a strong plan for social care and that it needs to go side by side with the NHS plan, and we have made some important commitments to the social care sector today. But if he is going to criticise social care cuts, he might at least ask why austerity happened. It was not, as he continually suggests, because of an ideological mission to shrink the state, but to save our economy and create jobs so that we could reinvest in public services. The evidence for that is shown today, with the first ever five-year NHS funding plan, to go alongside a 10-year plan. This is a Conservative Government putting the NHS first and shooting to pieces his phoney arguments about Conservative values.

[Dr Sarah Wollaston (Totnes) (Con)]

I recognise and thank the Secretary of State for his tireless efforts in making the case for this funding uplift and for a long-term plan. Will he now go further and set out whether, as a result of the extra funding, we will see an end to capital-to-revenue transfers? Will he also set out the role of transformation funding, because we all know that that is essential to get the best from the resources that we are going to add?

[Mr Hunt]

My hon. Friend asks two important questions. As she knows, we have committed to phase out capital-to-revenue funding, because if we are to make the NHS sustainable in the long run, we urgently need to make capital investment in estates, technology and a whole range of new machinery, including cancer-diagnostic machinery and so on, and we will not be able to do that if we continually have to raid capital funds for day-to-day running costs. That was one of the main reasons why we decided that we had to put revenue funding on a more sustainable footing. My hon. Friend is absolutely right about that.

Transformation funding is also important, because when the five year forward view was published, pressures in secondary care and the acute sector meant that a lot of transformation funding was sucked into the hospital sector and we were not able to focus on the really important prevention work that can transform services in the long run. I am very sympathetic to the idea that we need, if not a formal ring fence, a pretty strong ring fence for transformation funding, so that the really exciting progress that we see in some parts of the country can start to spread everywhere.

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

I echo the comments made about the approach of the NHS’s 70-year anniversary across the four countries of the UK, having myself spent a fair chunk of those 70 years—perhaps slightly longer than I care to admit—working in the NHS.

Like most people present, I imagine, I absolutely welcome the additional funding, which has been described as bringing the UK to the same level of spending as France by 2023. In that description is, though, the admission that we do not spend the equivalent of what France spends right now. Indeed, we saw a deficit of almost £1 billion in 2017-18, despite transformation funding being sucked in to try to clear that deficit.

I echo what the hon. Member for Totnes (Dr Wollaston) said: is transformation funding on top of this funding? If it is just revenue funding, will there be a separate announcement about transformation funding? The Secretary of State also mentioned the need for prevention, yet we do not see any mention of money for public health. That is where we need to be doing prevention.

It is said that we need a 3.9% increase in social care spending, but that is not identified in the statement. If the Green Paper is to come only in the autumn, social care may not get real funding until next year. With the demographic challenge that the Secretary of State mentioned, that is just too far away. The NHS has faced, on average, an uplift of 1.2% over the past eight years, according to the King’s Fund. Taking it up to 3.4% brings it more in line with the traditional uplifts that we have seen, and yet, in actual fact, with an ageing population, the pressure is even higher. Hopefully, this will stop the slide of the NHS, but the NHS Confederation says that it is not possible to transform on this kind of money. It is, therefore, important that these other projects are looked at separately and are funded separately.

As for where that money is to come from, I do not know how the Prime Minister kept a straight face when she talked about the Brexit dividend. The Institute for Fiscal Studies says that there will not be a dividend. The Office for Budget Responsibility talks about a £15 billion drop in public service and finances. I want to know how the rise will be funded. Will it all be just borrowing and tax rises? The Government should be honest about how they will fund this rise.

[Mr Hunt]

First, may I thank the hon. Lady for doing something that the shadow Health Secretary did not do, which is to welcome this £20 billion annual rise in the NHS budget? I completely agree with her about the importance of prevention, the importance of social care and the importance of making sure that we sustainably invest in transformation funding. The think tanks do disagree on what level of rise is necessary. Lord Darzi and the Institute for Public Policy Research said 3.5%; we are on 3.4%, which is not far off that. The IPPR went a little higher, but, like the hon. Lady, Paul Johnson said that this will stop the NHS going backwards.

With respect to overall funding levels for the NHS, the United Kingdom currently funds the NHS at the western European average as a percentage of GDP. That is not as high as France or Germany and it is true that, by the end of this five-year period, our funding will end up at broadly similar levels to those of France today, although of course it may change them over the five-year period.

I gently say to the hon. Lady that if that is a worry for her, she needs to explain to NHS users in Scotland why, when NHS spending has increased by 20% in England over the past five years, it has increased by only 14% in Scotland because of choices made by the Scottish National party. For every additional pound per head invested in the NHS in England only 85p has been invested in the NHS in Scotland. I hope that she makes a pledge, as I hope Labour does with its responsibility for Wales, that every extra penny that she gets through the Barnett formula will go to the NHS, because that is what the voters in Scotland want.

[John Redwood (Wokingham) (Con)]

As soon as we are fully out of the EU, there will indeed be a very big Brexit dividend, which a lot of us want to get on and enjoy here at home. Will the Secretary of State confirm that some of that money will be spent on training and educating and recruiting people already settled here into full-time NHS jobs to cut down on very expensive agency staff and to stop denuding the health services often of poorer countries around the world?

[Mr Hunt]

My right hon. Friend is absolutely right. One thing that we have historically got wrong in the NHS is not having a long-term workforce plan. Whatever Members’ views on the Brexit debate, it was always a false economy to say that we could get away with not training enough people because we could import them from other EU countries. The truth is that we are not the only country with an ageing population: France, Spain and Portugal need their doctors and nurses as well, as indeed, as he rightly says, do poorer countries.

[Mr Dennis Skinner (Bolsover) (Lab)]

For the sake of the record, is the Minister aware that, when John Major’s Government fell and Labour came into office, £33 billion was being spent on the national health service? By the time the Labour Government left office, they had trebled the amount of money in real terms to an average of 5.9%. People like me are proud of that achievement. The reason why the people will not listen to him and his 10-year plan is that he is the same man who, only two years ago, was calling on the junior hospital doctors to work seven days a week. He caused chaos in the national health service and he is not fit to run it.

[Mr Hunt]

May I gently say to the hon. Gentleman—

[Mr Skinner]

There’s no need to be gentle with me.

[Mr Hunt]

Okay, may I decisively say to the hon. Gentleman, if he was so proud of what the last Labour Government did, why did he say nothing when, at the last election, his party was only offering a 2.2% increase? If he thinks it is important to be generous, he should be welcoming what we are saying today.

[Theresa Villiers (Chipping Barnet) (Con)]

I warmly welcome this new money for the NHS in its 70th anniversary year. Does the Secretary of State agree that it should devote some of these new resources to more staff dealing with early diagnosis of cancer, to help more people beat this condition in accordance with the “Shoulder to Shoulder” campaign being run by Cancer Research UK?

[Mr Hunt]

I absolutely agree. In fact, the critical thing that we need to improve in our cancer care is diagnosing more people at stages 1 and 2, rather than at stages 3 and 4. That means more staff and more diagnostic machinery. One of the most encouraging points about Simon Stevens’s response to the new settlement was that he said that it will allow us to accelerate the improvements that we are making in cancer care.

[Norman Lamb (North Norfolk) (LD)]

I welcome this as a step in the right direction, but there is a complete absence of any clarity about how this will be funded. Given that, given—as he knows—the lack of any Brexit dividend and given that there has been nothing of detail at all on social care despite the Secretary of State recognising the need to bring health and social care together, can I tempt him again to engage in genuine cross-party discussions to reach a proper, long-term settlement, including consideration of a dedicated NHS and care tax?

--- Later in debate ---

[Mr Hunt]

With respect, this is a huge increase in NHS funding, the like of which I am not aware that the Liberal Democrats were proposing at the last election. Although I am grateful to the right hon. Gentleman for welcoming the settlement, for him to stand up and say that it is not enough is not a satisfactory response. As he knows, we have actually put our money where our mouth is and demonstrated that we are committed to the NHS, with one of the biggest single injections of cash in the history of the NHS.

[Sir Peter Bottomley (Worthing West) (Con)]

I am glad that both my right hon. Friend and the Prime Minister have welcomed the fact that all parties have supported the health service: the Liberals first with Christopher Addison, for whom my father once worked, in 1919; Henry Willink, a Conservative member of the coalition Government, in 1944; and Aneurin Bevan, who made some changes and nationalised the hospitals, rather than the family doctors. Both the resources and the reform are needed, and future generations will be grateful to this Government—hopefully with the support of other parties—for taking this forward.

[Mr Hunt]

I thank my hon. Friend for that comment. If there is ever a memorial built to Sir Henry Willink for his role in the White Paper that critically announced to this House that we were going to have a national health service, my hon. Friend should certainly be the person to unveil it because he has done a huge amount to make the point that, although Nye Bevan’s role was absolutely critical, other people in other parties also played a vital role.

[Frank Field (Birkenhead) (Lab)]

Well done. But is it well done enough? For 20 years some of us have been calling for a reform of NHS and social care financing by showing that the public’s wish is for a reform of the national insurance base. When is the Secretary of State going to win that battle for us, please?

[Mr Hunt]

Given that I thought the response from the right hon. Gentleman’s Front Bench was a bit churlish, I am going to be very grateful for the fact that he said well done. I think that “well done enough” is what we say when we deliver the plan that is now being developed because, as he knows incredibly well, having a plan is not the same as delivering it. With respect to imaginative proposals as to how we fund the NHS, the right hon. Gentleman always speaks incredibly interestingly and powerfully on the subject. The Prime Minister has said that she will listen to all views on that ahead of the Budget.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

I congratulate my right hon. Friend not only on being the longest-serving Health Secretary, but on the tenacious way in which he has campaigned for the money that we are hearing about today. In talking about improving cancer outcomes, does he agree that the patient experience is very important, and that the campaign of Hertfordshire MPs for a radiotherapy centre in our county is something that may possibly benefit from this new largesse?

[Mr Hunt]

I have listened carefully to what my right hon. and learned Friend says. With regard to cancer care for people who have had a cancer diagnosis, I commend the work of Dimbleby Cancer Care—a really fantastic charity. The shadow Health Secretary, the Lib Dem health spokesman—the right hon. Member for North Norfolk (Norman Lamb)—and I attended the start of its annual 50 km walk on Friday night.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

The Secretary of State closed by saying that he wants to transform health and social care, but every economic expert, from the Institute for Fiscal Studies to the Health Foundation, tells us that with a growing ageing population increasingly living with long-term conditions, this announcement will do nothing more than see the NHS stand still. Will he now admit that it is not enough to repair the damage of the past eight years of cuts to public health, GPs, and social care? How will he ensure that we have a service with new models of care fit for the 21st century?

[Mr Hunt]

It is funny, isn’t it: the hon. Lady says that this is not enough, but she did not say that when her own party was offering almost half the amount at the last election. She also says that every economic expert says that it is not enough. Let me tell her about one economic expert that does not say that—the Institute for Public Policy Research, left-leaning, in a piece of work done by Lord Ara Darzi, a former Labour Health Minister, who says that 3.5% is enough.

[Mr Philip Dunne (Ludlow) (Con)]

May I wholeheartedly congratulate my right hon. Friend on this historic achievement in securing a long-term funding increase for the NHS? I suspect that it is because he is now the longest-serving Health Secretary that he has the credibility within Cabinet to secure this achievement. I also congratulate him on proposing to get the NHS to develop a 10-year plan alongside a long-term workforce plan—which is such a critical element of this—and a long-term capital funding plan, because this needs to be seen coherently alongside the social care Green Paper. Bringing them all together at the right time must be the right thing to do. Will he, as part of the deployment of this new-found funding, look to use the data revolution to innovate to ensure that we have world-class data driving better patient outcomes?

[Mr Hunt]

As usual, my hon. Friend speaks very perceptively. When he was a Minister in my Department, he did a fantastic job in getting our capital funding and our workforce planning into a much, much better place. He is right. Although this is a big opportunity for the NHS, we must not make the mistake of solving yesterday’s problems tomorrow. A huge data and tech revolution is about to happen in healthcare all over the world, and we must make sure that we are at the forefront of it.

[Dr Paul Williams (Stockton South) (Lab)]

How does the Secretary of State plan to lead the transformation from reactive hospital care to preventive community care? He has presided over a fall in community nurses, a fall in GP numbers, cuts to public health and social care, and widening health inequalities. How are the next five years going to be any different from the past five years?

[Mr Hunt]

Let me tell the hon. Gentleman what I presided over: 10,100 more doctors; 14,300 more nurses; the Commonwealth Fund saying that our healthcare system is the best in the world; the biggest expansion in mental health provision; and improved outcomes for cancer, heart attacks, strokes and nearly every other disease category. I can do that because this Conservative Government have put the economy back on its feet. Everyone in the NHS knows that, in the end, that is how we get more resources into it.

[Sir Desmond Swayne (New Forest West) (Con)]

Clinicians tell me that half of interventions have no value to the patient whatsoever, and yet the Medicines and Healthcare Products Regulatory Agency wages war on new entrants with inexpensive and effective remedies. There is plenty of scope for reform, isn’t there?

[Mr Hunt]

There certainly is. The pattern to date had been very different in tone between the two sides. My right hon. Friend is right to challenge the NHS on this, because the truth is that we do not adopt new treatments and new medicines nearly quickly enough. I hope that this new settlement will mean that we can change that.

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

The Government have promised parity of esteem for mental health. Can the Secretary of State clarify whether there is a ring-fenced element of this funding for mental health?

[Mr Hunt]

I can clarify that NHS England has a mandatory—[Interruption.] I can confirm, if the Opposition would be kind enough to listen to what I am about to say, that NHS England has a mandatory mental health standard, which means that every CCG is required to increase its mental health funding by more than its total funding. That is an effective ring fence.

[David Tredinnick (Bosworth) (Con)]

To follow on from the question asked by my right hon. Friend the Member for New Forest West (Sir Desmond Swayne), will the Secretary of State look at making greater use of the Professional Standards Authority’s accredited register of 85,000 practitioners? If he made it possible for them to refer to doctors, he would reduce the burden on doctors. That is a recommendation of that statutory body.

[Mr Hunt]

I am happy to look again at that issue, which I have looked at in the past for my hon. Friend.

[Mr Kevan Jones (North Durham) (Lab)]

I welcome any new money for the NHS, but does the Secretary of State agree that prevention is better than cure? Durham County Council has had its public health budget cut every single year for the last eight years. Can he tell me how much of this new money will be going to public health, or is he now going to have another fight with the Treasury to get it to release more money for public health?

[Mr Hunt]

Today’s announcement is for NHS England’s core frontline services, but the right hon. Gentleman is right about the critical role of public health. Many of those services are delivered by the NHS, and we are very clear in what we are saying today and in a further announcement we will make in due course that there cannot be a transformation of the NHS without a proper emphasis on public health.

[Neil O'Brien (Harborough) (Con)]

The Secretary of State recently visited my constituency, so he will be aware of the important capital investments in my area, such as the new St Luke’s Hospital in Market Harborough, the decision to keep Glenfield Hospital’s children’s heart unit and the brand new state-of-the-art A&E at Leicester Royal Infirmary. Does the Minister agree that capital investments that improve productivity have an important part to play in the long-term plan for the NHS? Does he also agree that Leicestershire would be a very good place to make those investments?

[Mr Hunt]

Leicestershire would, I am sure, be a very good place to make them. Indeed, my hon. Friend will know that there has been considerable capital investment in Leicestershire. He makes an important point: one of the real benefits of a long-term plan is that we can create a stable environment for capital investment. One of the problems we have had is that when the budget is set hand to mouth, year in, year out, people do not make long-term investments in things such as IT systems. We have to put that right.

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

It is important to be honest about where public spending is coming from. Can the Secretary of State confirm that the Government’s own estimates, released in part by the Brexit Select Committee, show that far from there being a Brexit dividend, the plan that they are set to follow is scheduled to increase public borrowing by £55 billion a year by the end of the forecast period, meaning that this spending will have to be funded in spite of Brexit, not because of it?

[Mr Hunt]

It is a matter of fact that when we leave the EU we will not have to pay membership subscriptions. There will be a divorce bill, and when that is settled, those subscriptions will be available for the NHS, which was exactly what the British people voted for. The right hon. Gentleman is talking about the projections for the economy in the meantime. All I will say is that there is a lot of debate about those projections. They have not always been right in the past, and the British economy has been much more resilient than many people predicted.

[Richard Graham (Gloucester) (Con)]

An announcement of the largest ever new injection of funds into the NHS is a triumph for our longest ever serving Health Secretary and the Prime Minister, because it shows the outstanding priority of this Government. Every Member of the House should welcome that. When my right hon. Friend looks at productivity gains in the NHS, will he focus on the implementation of IT projects? Although Gloucestershire Hospitals NHS Foundation Trust does a remarkable job in many ways and its staff work unbelievably hard, the expensive and underperforming Smartcare project could have been better done.

[Mr Hunt]

I thank my hon. Friend for hosting me at his local hospital, which was very informative. He is absolutely right: it is an enormous cause of frustration to staff throughout the NHS that so many of our hospital systems are, frankly, antediluvian. We must put that right, because so many nurses could spend so much more time with patients if they were not having to fill out forms, and the same is true for doctors.

[Liz Kendall (Leicester West) (Lab)]

We cannot put the NHS on a steady financial footing without a proper funding settlement for social care, yet the Secretary of State now says that that will not happen until the spending review, which in reality means no substantial extra money for social care until 2020 at the earliest. We cannot transform care for older people or reduce pressure on the NHS until we look at the two together. Why are the Government still ducking this vital issue?

[Mr Hunt]

I always listen to the hon. Lady very carefully when she talks about the social care sector. I would say to her that while we are not announcing a new long-term plan for social care today, we are making some very important commitments to the NHS and the social care system, including the commitment that we will not allow the pressure from the social care system on the NHS to increase further. That means that, even before the date she mentioned, we are going to have to look very carefully at the settlement for social care.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I congratulate my right hon. Friend, whose commitment to our NHS is very clear. Does he agree with me, however, that the Commonwealth Fund indicator that really matters concerns clinical outcomes, some of which he referred to in his statement, and on that the news is not good? Will he do everything he can to make sure that the increased funding he has announced today is absolutely dedicated to improving outcomes for stroke, cancer and heart attack, on all of which we still lag well behind countries with which we can reasonably be compared?

[Mr Hunt]

I absolutely agree 100% with my hon. Friend, and we really must look at outcomes. The Commonwealth Fund was kind enough to say that that was actually one of the areas in which we are one of the fastest improving Commonwealth Fund countries. However, it has to be said that that was from a very low base, and we need to sort that out.

[Stephen Doughty (Cardiff South and Penarth) (Lab/Co-op)]

Can we get the facts straight? The Welsh NHS is spending 8% more per head on NHS and social care combined than in England—per head—so let us not have any more stories about the Welsh NHS.

It is absolutely clear that there is no Brexit dividend. The Institute for Fiscal Studies says it, the Financial Times says it and the Government’s own analysis from the Treasury shows it. What is more, Brexit is already having a cost. The Home Office has had to have an extra almost £500 million in the past two years to pay for Brexit preparations, such as registering EU nationals, which would pay the salaries of 20,000 nurses. Will the Secretary of State admit that that is what is really going on—a Brexit deficit, not a dividend?

[Mr Hunt]

We do need to get the facts straight about what is happening in Wales. A&E performance is over 8% lower in Wales, according to the latest figures, which means that Welsh NHS patients are 70% more likely to wait too long in their A&Es than patients in England. The Welsh Government have taken a series of decisions not to invest every penny available in the Welsh NHS, which is why spending has risen at a slower rate. Had they not done so, hundreds of millions more could have gone into the Welsh NHS.

[Victoria Prentis (Banbury) (Con)]

On Friday, I was lucky enough to visit the award-winning neck of femur service at the great Horton General Hospital. The length of time that patients stay is very dependent on great links between the hospital and social care. Does my right hon. Friend agree that spending to save is possible, so that even more of this great funding can be spent on patient returns?

[Mr Hunt]

Absolutely. The most important way of spending to save is to invest in prevention, and a lot of that work comes from strong local hospitals. Before my hon. Friend finally leaves this place, I have no doubt at all that her local hospital will be called not the Horton General Hospital, but the Great Horton General Hospital.

[Karen Lee (Lincoln) (Lab)]

Does the Secretary of State agree with me that without the reinstatement of the nursing bursary, we cannot even hope to train enough nurses. The figures show that the numbers training have fallen—this is a serious inquiry—and until we can train enough nurses, we can talk about extra nurses, but we will always need agency nurses. Does he agree that we need to reinstate the nursing bursary so that people can afford to train?

[Mr Hunt]

The reason why we took what I fully accept was a very difficult decision was that we wanted to fund the training of an additional 5,000 nurses every year. When there is a reform of higher education funding, there is always an initial dip in applications. In this case, record numbers of 18 to 19-year-olds applied, but there was a dip among mature students. That is why we have introduced the apprenticeship route. We need to make sure that that works if that dip is to be reversed.

[Richard Drax (South Dorset) (Con)]

I welcome my right hon. Friend’s statement. Like all colleagues in the House, I am a great supporter of community hospitals. Under the latest Dorset clinical commissioning group review, Portland Community Hospital is to be replaced with a medical hub on the island. Will the extra money allow the CCG to review the review, and perhaps save hospitals such as Portland Community Hospital?

[Mr Hunt]

Obviously, that would be for the CCG to look at; it will focus on anything that allows it to focus on prevention and not cure. I do not know the specifics of that case, but in general there is a strong and important role for community hospitals, although not always doing exactly the same things they have done in the past. Often, they can become local NHS hubs, offering a wide range of services. That tends to be the best way to preserve their future.

[Wes Streeting (Ilford North) (Lab)]

Standing at that Dispatch Box, the Secretary of State made the astonishing claim that when it comes to NHS funding, the Conservatives write the cheques and Labour writes the speeches. Let me tell him about increases in health spending under every Government in my lifetime: a measly 1.4% increase under David Cameron; 2.7% under Mrs Thatcher; even John Major managed a better 4.7%. It was only under the Labour Governments of Gordon Brown and Tony Blair that we saw increases in NHS spending of 5.4%, under Gordon Brown, and 6.1%, under Tony Blair. Does that not demonstrate that we cannot trust the Conservatives on the Brexit dividend and we cannot trust their claims on NHS spending? Until the Conservatives sort out social care and public health spending, the Labour Governments will have a record that this Government cannot even begin to touch.

[Mr Hunt]

The hon. Gentleman has just proved my point about Labour making speeches about the NHS. He talked about a “measly” increase under David Cameron; what he forgot to tell the House was that his own party’s plans that year were to cut the NHS budget because of the train crash of an economy that they left the country with.

[Mr Marcus Jones (Nuneaton) (Con)]

This is a massive and welcome boost for our NHS, and I very much welcome it. Will my right hon. Friend say more about the importance of public health and social care in the context of his announcement today and what his plans are? The issue is not just about getting people to live longer, but getting them to live well for longer.

[Mr Hunt]

My hon. Friend asks a very smart question. The truth is that no healthcare system anywhere in the world, faced with our demographic challenge, would ever feel it had enough money unless it transformed its model of care to one based on prevention rather than cure. That is why public health and the social care system are absolutely critical. One of the big lessons that we need to learn with this new funding is to spend it in a way that brings down the long-term rate of growth in demand for hospital services. That is the only way in which we can make it work.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

World-leading childhood cancer research and treatment take place in Newcastle, but those leading that research are clear that there is no sight of a Brexit dividend, given the loss of EU staff and the uncertainty hanging over intra-EU collaboration and EU funding. Rather than peddling Brexit mythology, will the Secretary of State take on board those very genuine and very serious concerns?

[Mr Hunt]

We have taken on the concerns of everyone in the NHS. Whether someone agrees with Brexit or the Brexit dividend, the Government are making a commitment for a £20 billion annual increase in the NHS budget in five years’ time. I hope that will help people in Newcastle and everywhere else in the country.

[Chris Davies (Brecon and Radnorshire) (Con)]

As the Labour Welsh Government are the only Government in recent times to reduce funding for the NHS, will my right hon. Friend do all he can to ensure that the very welcome £1.2 billion that will come to Wales under the Barnett formula will not be spent on another Welsh Labour Government pet project, but will be spent on the health of the people of Wales?

[Mr Hunt]

My hon. Friend speaks on behalf of not just his constituents but all NHS users in the whole of Wales who are asking themselves why it is that their Government have chosen not to invest in the NHS in the way that has happened in England, as a result of which they have much longer waits in their A&Es.

[Jim Shannon (Strangford) (DUP)]

I very much welcome the Secretary of State’s statement. I congratulate him on staying the course, and on his perseverance and dedication. I say very well done. It has been indicated that the Northern Ireland Department of Health will also benefit over the next few years. What discussions have taken place with the Northern Ireland Department of Health to ascertain the monies to be allocated, and the focus and priorities?

[Mr Hunt]

This is, as the hon. Gentleman knows, a devolved matter, but I would say that England, Scotland, Wales and Northern Ireland are all on the same journey when it comes to the NHS. We are all moving to integrated out-of-hospital care built around the person and focused on prevention. In one respect, Northern Ireland has gone further faster than anywhere in the UK: I refer to the integration of the health and social care systems. There is plenty we can learn from them and they from us.

[Jeremy Lefroy (Stafford) (Con)]

I congratulate the Secretary of State on this very welcome announcement and reiterate what others have said about the importance of prevention and public health. Since this is a long-term settlement, may I ask him to ensure that the disparities between various parts of England are narrowed over the coming years? They are too great, with some getting £300 or £400 a year per person less than other areas. That is just too much of a difference.

[Mr Hunt]

I totally take on board what my hon. Friend says. I am happy to engage with him and with NHS England. As he knows, we have taken the politics out of that particular process by giving it to NHS England, which I think is the right thing to do. I know NHS England would be happy to engage with him on that.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I welcome long-term planning in funding for the NHS, which is needed. However, as chair of the all-party group for disability, I know there are concerns that the learning disability workforce has fallen by a third, learning disability training is not yet compulsory and there are 1,200 avoidable deaths in the learning disability population annually. In Learning Disability Week, people are asking to be treated well. Will the Secretary of State prioritise this area and make sure our most vulnerable people with learning disabilities are no longer left behind?

[Mr Hunt]

I thank the hon. Lady for asking that important question. We have introduced a £10,000 golden hello for postgraduates who go into the learning disability field. She is right that we have had particular pressure on the learning disability workforce. In the aftermath of Mid Staffs, there has been a whole range of measures to improve hospital ward staffing ratios for nurses and that has had an impact on learning disability nurses. That is absolutely something we hope to address with this new funding.

[Simon Hoare (North Dorset) (Con)]

I echo the thoughts of my hon. Friend the Member for South Dorset (Richard Drax) on the role of community hospitals as the segue between the acute sector and patients going home. Will my right hon. Friend confirm that, with this very welcome new money coming into the health service, the drive for efficiencies and increases in productivity will continue and indeed be increased to ensure that the biggest bung—the biggest bang is felt for those bucks?

[Mr Hunt]

My hon. Friend is absolutely right not to use the word “bung” in his question and to correct that very quickly indeed. He is also right to talk about productivity. The last Labour Government made important progress in bringing down waiting times. That required significant extra resources. When Alan Milburn had a 10-year plan, there was not a big productivity element to it. This time, when resources are much tighter, we have to make sure that productivity and efficiency gains are at the heart of the progress we make.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

The Secretary of State is right that more funding is urgently needed, because he knows better than anyone that the percentage of NHS trusts in deficit rose from 5% in 2010 to 44% last year. Today, he has talked repeatedly about prevention, but he has failed to say directly what will happen to public health. Will he therefore clarify whether any of the settlement he has announced today will go towards public health services, vital for prevention and tackling health inequalities, which are being cut by £800 million over five years?

[Mr Hunt]

Today’s settlement covers NHS frontline services. As I explained in the statement, it does not cover public health, but we fully recognise its importance. The hon. Lady talks about the increase in trust deficits. It is true that the number of hospitals in deficit has gone up, but that is because we deliberately decided to be very careful in the way that we performance-managed trusts with deficits. In Mid Staffs, getting rid of the deficit was one of the reasons why the number of nurses in wards was stripped down to totally inappropriate levels. We have to make sure that we handle this in an appropriate way.

[Rebecca Pow (Taunton Deane) (Con)]

This announcement is really welcome and the Secretary of State’s commitment shines forth. The financial commitment is much needed, but, as two GPs said to me on the platform as I left Taunton this morning, waste in the NHS must be tackled, as well as funding. On top of that, best practice systems must be introduced, particularly in the cancer pathway.

[Mr Hunt]

My hon. Friend knows about that from her own family experience and I thank her for telling me about some of the challenges she has had in the interests of improving them for all NHS patients. She is right that one of the biggest opportunities the NHS has is to standardise best practice across the whole health economy. We collect, share and publish more data than any other healthcare system anywhere in the world, so we have the chance to get this right in a way that is not possible in other countries. I know we are absolutely determined to do so.

[Judith Cummins (Bradford South) (Lab)]

Given the crisis in access to NHS dentistry, in particular for our children, will the Secretary of State confirm that dentistry will get its fair share of this funding in line with demand?

--- Later in debate ---

[Mr Hunt]

The hon. Lady campaigns hard on this issue and I believe she is meeting the Minister with responsibility for dentistry tomorrow to talk about it further.

[Alex Chalk (Cheltenham) (Con)]

I warmly welcome this enormous funding boost, which is far in excess of that proposed by any Opposition party. Does my right hon. Friend agree that local trusts should consider using these further resources to help to attract and retain additional doctors in tough-to-recruit fields such as emergency medicine, to support and extend A&E in hospitals such as Cheltenham General Hospital?

[Mr Hunt]

Of course I agree with that. My hon. Friend campaigns extremely vigorously on behalf of his own hospital in Cheltenham. Recruitment will be one of our top priorities. One way we want to tackle that is very simply by giving hope to people in the NHS and to people thinking of going into medicine that there is a long-term plan that has the support of the NHS, and which is at one remove from the party politics that we always get around the NHS. I think that is something doctors and nurses overwhelmingly want.

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

How much of this welcome additional money will be used simply to pay off accumulated debt and current deficits, and how much will be a real increase?

[Mr Hunt]

The think-tanks who pore over the numbers disagree on that. Some say that it is about enough to stabilise the current situation—that is what Paul Johnson of the IFS says—and others say there is enough room to transform. Who is proved right will depend on how much we do on productivity and efficiency to create the headroom for the real changes we all want to see. That is why we have to get that bit of the equation right.

[Mr Philip Hollobone (Kettering) (Con)]

An extra £20 billion a year in real terms in five years’ time is a massive financial boost for the NHS. The Secretary of State knows Kettering General Hospital well because he has been there twice. Would he ensure that just £20 million to £30 million of that goes on funding the new urgent care hub at Kettering General Hospital, which everyone says is what the hospital desperately needs?

[Mr Hunt]

I am feeling extremely generous this afternoon, and it is incredibly tempting just to say yes, but I think I had better not and say that my hon. Friend should follow the right processes. However, Kettering could not have a stronger advocate than him.

[Ben Lake (Ceredigion) (PC)]

Given that the Secretary of State has confirmed this afternoon that increased NHS funding will not be wholly accounted for by any fantastical Brexit dividend, could he clarify whether the Welsh Government will be expected to increase the Welsh rates of income tax if the UK Government’s promise of an additional £1.2 billion for Wales is to be realised?

[Mr Hunt]

Any funding commitment made by the UK Government will be appropriated to Wales in accordance with the Barnett formula. That is the procedure that we have followed. The choice for the Welsh Government is whether they put all that money into the NHS or, as they have done in the past, choose to prioritise it elsewhere.

[Henry Smith (Crawley) (Con)]

I very much welcome my right hon. Friend’s announcement that some of the subscriptions that we will no longer be paying to the European Union will be redeployed for the national health service. Under the last Labour Government, Crawley Hospital lost its A&E department and its maternity department. Over the last eight years, services have been returning. Can I have an assurance that this additional spending on the NHS will follow through with the return of further local services?

[Mr Hunt]

It absolutely needs to boost local services. If there is one lesson that we have learnt from the last few years, it is that we will not, in the long run, crack the funding pressures in our health system unless we find a way of properly investing in local services, which I know my hon. Friend has campaigned for so hard.

[Mr Adrian Bailey (West Bromwich West) (Lab/Co-op)]

An omission from this otherwise welcome statement was any mention of capital spending. It is vital for future health outcomes in the Black country and west Birmingham that the midland metro hospital, currently half built and suspended following Carillion’s collapse, is completed. Will the Secretary of State tell me where in this package the funding will be found for that, and when?

[Mr Hunt]

The hon. Gentleman is right to raise that issue, which is of great concern to us, as I know it is to him. The Minister of State responsible for hospitals, my hon. Friend the Member for North East Cambridgeshire (Stephen Barclay), visited the trust last Thursday and I know is working incredibly hard to try to resolve that situation as soon as possible.

[Alberto Costa (South Leicestershire) (Con)]

I congratulate the Secretary of State on his very welcome intervention in ensuring the longevity of our NHS with these wonderful proposals. Will he give some consideration to the way in which doctors are trained? At present, it is a costly and time-consuming affair. Only around 10 UK medical schools have a graduate entry system. In his long-term plan, looking at recruitment, will he consider how the skillset that we see among our population—for example, medical scientists and other related professionals—can best be harvested in training future medics?

[Mr Hunt]

My hon. Friend asks a profoundly important question. The medical school students who are going to medical school this year will become consultants in 2031 at the earliest, so we have to make sure that we update the way people are trained for the totally different world that they will be facing in terms of technology, medical innovation and the demarcations and roles inside hospitals and community care. This is very much part of the long-term workforce plan that will be announced alongside the NHS long-term plan later this year—it is what that will be about.

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

I can understand why some in Government think that there is a Brexit dividend. After all, we know that the Health Secretary’s colleagues in the Home Office have been given enough money from Brexit to cover the cost of 20,000 nurses. His colleagues in the Department for Environment, Food and Rural Affairs have been given 14,000 nurses’ worth of money and even his colleagues in the taxman’s office have been given 11,000 nurses’ worth of money. I am sure that the Secretary of State would not want to betray the good will of a single doctor, nurse, cancer patient or future patient by making promises that he cannot keep, so can he tell us, once and for all, whether he personally believes that there is a Brexit dividend—yes or no?

[Mr Hunt]

I have answered this many times, and I am very happy to answer it again. Yes, we will be able to access extra funding by not paying subscriptions to Brussels once the divorce bill has been settled, and that will mean many thousands of extra nurses.

[Nigel Huddleston (Mid Worcestershire) (Con)]

I and my constituents warmly welcome this extra money for the NHS. Does the Secretary of State agree that the British public are not stupid? They, unlike some of the Opposition, are well aware that any and all Government expenditure always comes from taxation, either now or in future. We have listened. We have had a conversation. They have told us that they want more spending on the NHS. We have said, “But that may mean you paying more taxes,” and they have said, “Fine, it’s that important.” Is that not a good and honest agreement between the public and the Government?

[Mr Hunt]

My hon. Friend could not have put it better. The only surprise here is that having spent years and years saying that we should invest more in the NHS through the tax system, when the Government actually stand here and say that is what they are doing, the Opposition tell us that they are against it.

[Peter Kyle (Hove) (Lab)]

Whether it is mentioned by the Prime Minister, the Leader of the Opposition or anyone else, there is only one fact about the Brexit dividend, and that is that it does not exist. Will the Secretary of State tell all the staff in the NHS how much of the money announced today is contingent on the Brexit dividend, so that they can bank for the future based on how much will actually materialise come autumn?

[Mr Hunt]

I am very happy to tell the hon. Gentleman that all this money will materialise, because this is a Government that keep their promises. If he is so worried about the Brexit dividend, he should be speaking not to me but to his own leader, who said that he wants to

“use funds returned from Brussels after Brexit to invest in our public services”.

Have a word with him!

[Stephen Kerr (Stirling) (Con)]

I also welcome the statement from the Secretary of State, but I note that it relates to health spending in England only. Will my right hon. Friend spell out what this means for Scotland in particular, thanks to the Barnett consequentials, and how can we ensure that the additional funds provided to the Scottish Government are spent on the NHS in Scotland, which has not always happened in the past?

[Mr Hunt]

My hon. Friend is right to raise that question, because under the Barnett consequentials, for every £1 per head additional for the NHS in England, there will be £1 per head available for the NHS in Scotland. The Scottish National party has chosen to invest only 84p of every £1, which is why people in Scotland are 30% more likely to wait too long for their elective care in Scotland. That is a choice made by the SNP in Scotland and I hope that it will do it differently this time.

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

I welcome any additional funding because, let us face it, it is not just the NHS that is in deep crisis, but social care, too. However, as others have said, it is still not enough—3.5% was the minimum that was needed to see actual improvements. What assessment has the Secretary of State done to gauge what the improvements will be in the next 12 months? What financial scenarios is the Chancellor considering, and will the Secretary of State commit to stop tendering health services to the private sector, which is a waste of money for the public?

[Mr Hunt]

It is really extraordinary that on a day that we have announced a £20 billion annual rise in the NHS budget—you could not get a bigger commitment from a Government to state-funded healthcare—Labour is still running off down the rabbit hole of privatisation. If it is any reassurance to the hon. Lady, last year the proportion of NHS services contracted to the private sector went up by the enormous amount of zero.

[Derek Thomas (St Ives) (Con)]

This statement is very welcome, but I have raised in this place before how the money is distributed around the UK; it is well known that the south-west gets about 2% less a year of increased NHS funding. When the Secretary of State has a moment, will he look again at how funding is distributed, and ensure that as it increases, it is increased fairly?

[Mr Hunt]

I am happy to do that. My hon. Friend asks the same question as my hon. Friend the Member for Stafford (Jeremy Lefroy). These matters are now decided at arm’s length by NHS England because we think that the fairest way is to take the politics out of it, but I am happy to work with him to engage with NHS England on the Cornish questions.

[Diana Johnson (Kingston upon Hull North) (Lab)]

I listened to what the Secretary of State said earlier about how there can be no transformation of the NHS without a proper emphasis on public health. How will the planned £800 million of cuts to public health help with that transformation, particularly when it comes to tackling the child obesity crisis, the growing sexual health services crisis and the cuts to addiction services, which are causing enormous problems for individuals and the communities now having to deal with them?

[Mr Hunt]

I fully recognise the pressures the hon. Lady is talking about. I said what I said about public health because I do not believe there is a sustainable long-term solution to NHS funding pressures unless we have an equally sustainable solution for public health, and indeed for social care, which she also talks about. She will have to wait for us to negotiate our next spending review settlement to understand how we intend to address those.

[Martin Vickers (Cleethorpes) (Con)]

I welcome the Secretary of State’s statement and congratulate him on securing cross-Government support for his proposals. He rightly said that every pound must be spent wisely, and he will know that there is great variation in procurement across the NHS. What will he do to ensure better procurement?

[Mr Hunt]

We will set up a single, central procurement system so that every hospital in the NHS can benefit from the efficiencies gained from bulk buying, but we have to do that in a way that does not shut out smaller companies from bidding for NHS contracts.

[Marsha De Cordova (Battersea) (Lab)]

The Government’s new NHS funding includes no additional funding for social care. The Secretary of State has said that the Government will publish a social care Green Paper in the autumn. Will he confirm—yes or no—whether the Green Paper will include social care funding for working-age disabled adults?

[Mr Hunt]

We will consider the provision for working-age disabled adults as part of our review of the whole social care system, because that is extremely important.

[Marsha De Cordova]

Will it be in the Green Paper?

[Mr Hunt]

We are doing that work in parallel to the Green Paper, but the hon. Lady is absolutely right to highlight it.

[Matt Warman (Boston and Skegness) (Con)]

rose—

--- Later in debate ---

[Afzal Khan]

Will the Secretary of State clarify how this money will be divided between the regions? Children growing up in the north, in constituencies such as mine, have vastly different life chances from their counterparts in the south. We do not want this funding to reinforce the north-south divide.

[Mr Hunt]

As the hon. Gentleman knows, we take deprivation into account very seriously when we allocate NHS funding, because it has a direct impact on people’s demand for NHS services, but other things also have an impact on people’s health, such as housing and employment prospects. The bigger lesson is that we need to integrate all our services for our most disadvantaged citizens.

[Matt Warman]

rose—

--- Later in debate ---

[Mr Hunt]

My hon. Friend is absolutely right, and that is a big priority for us, which is why this year we will publish a final 10-year NHS workforce plan, at the same time as the NHS plan that Simon Stevens is putting together. Together they are designed precisely to avoid shortages in particular and very important specialties.

[Nic Dakin (Scunthorpe) (Lab)]

Community pharmacies feel stretched at the moment, yet they are well placed, at the heart of the community, to have a real impact by taking pressure off GPs. Will the Secretary of State give a commitment that some of this money will go to reinforce the strength of community pharmacies so that they can play their part in prevention as well as cure?

[Mr Hunt]

The hon. Gentleman is right that community pharmacies have a vital role to play. I do not think we use them enough. We need to find better ways for them to help us in the prevention agenda, and one way we are doing that is by integrating medical records so that they can be accessed by pharmacies, which will help them to give good advice to patients.

[Karin Smyth (Bristol South) (Lab)]

May I press the Secretary of State on the issue of transformation and his hint—I think—at ring-fencing? If the people of Bristol South are to be asked to spend more money on the NHS, how will they know that it is being used to improve health outcomes and not simply to bail out local hospital deficits?

[Mr Hunt]

The hon. Lady is right to ask that question, and I encourage her to hold her local NHS to account on that. There are some simple metrics, which we can share with her, that can tell us whether the NHS is using the money wisely, and one of them is whether her local hospitals are managing to reduce their emergency admissions by providing better care in the community. She is right that it is the litmus test of whether the money is being spent wisely.

[Kate Green (Stretford and Urmston) (Lab)]

May I press the Secretary of State on his answer to my hon. Friend the Member for Battersea (Marsha De Cordova), particularly in relation to profoundly disabled adults, who need not just excellent healthcare, not even just excellent physical and social care, but access to services that maximise their social participation? Will he say a little more about the work being done in parallel with the social care Green Paper?

[Mr Hunt]

I want to reassure the hon. Lady that, in all our discussions about core social care funding and the funding accessed by local councils, we discuss working-age disabled adults every bit as much as the frail elderly. They are central. Many councils actually spend more on that group than on older people. We will not crack the social care problem unless we take that group of people extremely seriously.

[Paul Blomfield (Sheffield Central) (Lab)]

The Secretary of State talked about mental health funding without mentioning the crisis facing our young people. He knows that across the country there are appalling waiting times to access child and adolescent mental health services. How significant is today’s announcement to tackling that issue?

[Mr Hunt]

It is very significant, first, because we have been clear that a transformation in mental health is central to our ambition for the new 10-year plan, and secondly, because, as the hon. Gentleman knows, the Green Paper will over that period see the number of people employed in looking after young people with mental health problems increase from 9,000 by an additional 8,000—a near doubling in the size of the workforce. This financial plan gives us the confidence to say we can deliver that.

Gross Negligence Manslaughter in Healthcare: Review

Jeremy Hunt Excerpts

Monday 11th June 2018 Written Statements

[The Secretary of State for Health and Social Care (Mr Jeremy Hunt)]

On 6 February 2018 I informed the House that I had asked Professor Sir Norman Williams to carry out a rapid policy review of gross negligence manslaughter in healthcare settings. This review was prompted by concerns among healthcare professionals that errors could result in prosecution for gross negligence manslaughter, even in the face of broader organisation and system failings. In particular, there was concern that this fear had had a negative impact on reflection and learning by healthcare professionals, which is vital to improving patient care.

My Department is today publishing the report of Sir Norman’s rapid policy review.

Any investigation of a healthcare professional for suspected gross negligence manslaughter begins with the death of a patient a—life needlessly cut short and a family grieving. Sir Norman and his Panel have heard from such families. Their experiences were vital in informing this review and I would particularly like to thank them for their courage in providing evidence to the review.

The report finds that prosecutions and convictions of healthcare professionals for gross negligence manslaughter are rare. It also finds that the legal test for the offence is set at an appropriately high level. This should reassure healthcare professionals that only where conduct is “truly, exceptionally bad” and in consideration of “all the circumstances” will the bar for gross negligence manslaughter be met.

However in order to provide greater consistency the report makes recommendations to improve the investigation of allegations of gross negligence manslaughter involving healthcare professionals. These include:

developing an agreed understanding of gross negligence manslaughter that reflects the most recent case law;

improvements to the way that healthcare professionals provide expert advice and evidence; and

improvements to local investigations into unexpected deaths in healthcare to provide a full understanding of the cause of death, ensuring improvements are made to reduce the likelihood of similar incidents.

The report also considers the impact of criminal and regulatory investigations on the willingness of healthcare professionals to reflect on their practice. It finds that reflective material is rarely sought in such investigations. Nonetheless, in order to provide clear assurance to professionals, the report recommends that those regulators that have a power to require information from registrants when investigating their fitness to practise should have this power removed in respect of reflective material.

Finally the report looks at the regulation of healthcare professionals. It makes a number of recommendations for further work to understand inconsistencies in the way that different regulators carry out their fitness to practise functions. It also finds that the General Medical Council’s right to appeal decisions of the Medical Practitioners Tribunal Service has resulted in a lack of confidence in their regulator as well as having an unanticipated impact on the willingness of doctors, especially trainees, to reflect fully on their practice. Since the PSA has a near identical right of appeal to Medical Practitioners Tribunal Service decisions, it is clear that there would be no gap in the law where regulatory action is being taken as a result of a serious criminal conviction, and the report recommends that the GMC’s right of appeal should be removed.

These recommendations aim to support a just and learning culture in healthcare, where professionals are able to raise concerns and reflect openly on their mistakes but where those who are responsible for providing unacceptable standards of care are held to account. This will support improvements in patient safety.

I thank Sir Norman and his panel for their work in delivering this important report. I accept the recommendations in full.

Attachments can be viewed online at: http://www. parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2018-06-11/HCWS751.

[HCWS751]

Breast Cancer Screening

Jeremy Hunt Excerpts

Monday 4th June 2018 Written Statements

[The Secretary of State for Health and Social Care (Mr Jeremy Hunt)]

On 2 May 2018 I informed the House of a serious failing in the national breast screening programme in England, which resulted in thousands of women aged between 68 and 71 not being invited to their final breast screening between 2009 and May 2018. This statement provides an update on the specific commitments I made in my oral statement and the actions we are now taking to support those affected and prevent similar incidents from happening in the future.

First, in my original statement, I committed that the NHS would offer an appointment for screening to all women who missed their scheduled appointment as a result of this error, and that we would provide clear information and advice for anyone with concerns. I asked Public Health England to work with the NHS to contact women who missed their screening by the end of May. I can now confirm that Public Health England met this deadline by 18 May, contacting 195,565 women registered with a GP in England. In addition, all the affected women known to have moved to Scotland, Wales or Northern Ireland were also written to by 1 June 2018.

The result of this is that as of 1 June 2018, 26,774 women have now received an appointment for screening, with hundreds already screened. I am providing detailed information on how many women have been contacted in each English constituency, alongside the confirmation that we have written to all those women now registered with a GP in one of the devolved administrations— 503 women in Scotland, 94 women in Wales and 72 women in Northern Ireland. In addition, a dedicated helpline was established on 2 May 2018 to support women who may have concerns. This helpline operates from 8am to 8pm, 7 days a week, and has received over 46,000 calls.

Secondly, I made clear that no one would face delays to their routine screening as a result of the NHS catching up on these additional appointments. I can confirm that, over the last four weeks, the NHS has put in place an additional 68,000 screening appointments nationally and is on track to ensure that all women affected who want a screen will be seen by the end of October, without impacting on other patients. I want to put on record my enormous gratitude to clinical staff who have worked tirelessly to offer additional appointments and to management teams who have co-ordinated and pooled their resources across different centres, or looked to other private providers, to expand capacity to manage the extra demand.

Thirdly, I explained to the House that we were still attempting to understand how many women had been affected and how many had experienced harm as a result. I made it clear that some of the figures I provided were provisional estimates and undertook to provide a further update. I can now confirm, based on analysis by Public Health England, using data provided by NHS Digital that up to 174,000 women were affected by this issue, of which we know that up to 130,000 are still alive. As a result, the numbers who may have had their lives shortened as a result of missing their screening is now estimated to be fewer than 75. While this figure is lower than the original estimates given in my statement, this does not lessen the devastating impact that this has had on some people’s lives.

Finally, the most important thing we can do in cases of serious error is to ensure there is a robust and thorough process to investigate, understand and learn from what went wrong. In my original statement, I also announced an independent review, chaired by Lynda Thomas, chief executive of Macmillan Cancer Support, and Professor Martin Gore, consultant medical oncologist and professor of cancer medicine at the Royal Marsden with Peter Wyman from the CQC as the Vice Chair. I can now confirm that we have agreed the terms of reference for this review, details of which are attached to this statement. The Chairs are considering how best to involve affected women, their families and wider stakeholders and will release information on this when it is available.

Our cancer screening programme is widely recognised as world-leading, but on this occasion a number of women have been let down. It is now clear that this may have resulted in significant harm for a small number of women, while thousands more have faced unnecessary distress and anxiety as they waited to hear if they have been affected. I would like to repeat my wholehearted and unreserved apology to the women affected and their families—and above all reassure them that we are working hard to understand what went wrong and what we need to do to stop similar incidents from happening in the future.

[HCWS731]

NHS Outsourcing and Privatisation

Jeremy Hunt Excerpts

Wednesday 23rd May 2018 Commons Chamber

[The Secretary of State for Health and Social Care (Mr Jeremy Hunt)]

I welcome the opportunity of this debate to dispel some particularly pernicious myths.

May I say how much I enjoyed the shadow Health Secretary’s speech? If they had listened to his denunciation of privatisation and outsourcing, I think my children would have said that Alice in Wonderland has nothing on the Labour party when it comes to taking totally contradictory positions on an identical issue. My favourite thing was the stirring way in which he said, “What concerns me most is contracts handed out that are poor value for taxpayers,” after his Government left £80 billion-worth of PFI contracts for the NHS to pick up the pieces. That costs the NHS £2 billion every year—money that cannot be used for good patient care. He had lots of other gems and we will return to them during the course of this speech.

I want to start with the motion. I am afraid that it is a transparent attempt to set hares running about NHS privatisation that is not happening. He used the phrase “creeping toxic privatisation”, but the truth is that we know it is not happening and the Opposition know it is not happening. With all the pressures facing the NHS today, to scare staff and the public with fake news is breathtakingly irresponsible.

In the motion, the Opposition use the Humble Address mechanism to ask for the release of documents, knowing full well that it will fuel wild conspiracy theories if we refuse to release those documents, as we must for reasons that are nothing to do with the NHS, but to do with good governance. However, there is a flaw in their Machiavellian logic. When I asked officials for advice on what submissions we as Ministers hold on privatisation—this great swathe of secret plans that the Opposition constantly allege—this is the written advice that I got back: “Officials have, since the Humble Address was received, sought to find submissions about the privatisation of clinical or patient services within the period specified, but to this point none have been identified. Her Majesty’s Government has no plans to privatise the NHS.” That was the official advice, but don’t take it from me. The respected King’s Fund said in 2015 that

“claims of widespread privatisation are exaggerated.”

Another way in which the Labour party loves to try to scare the public is to deliberately muddle up privatisation and outsourcing, which of course are quite separate. I think the shadow Health Secretary knows that, going by some of his comments. What are the facts on outsourcing? The Prime Minister did indeed wax lyrical about the possibility of 40% of acute operations in the private sector being done under the NHS banner—not this Prime Minister, but Tony Blair in 2006. Had we followed Tony Blair’s advice, we would be spending nearly £2 billion more on outsourcing than we currently spend. The Secretary of State from that period also said quite openly, “We intend to use the private sector when it can bring expertise or resources to help improve services.” That is not me, but Alan Milburn in 2002.

And boy, did team Labour set about that outsourcing with enthusiasm: not just increasing the PFIs we have talked about and not just giving the first contract for an NHS acute hospital to the private sector in 2009—that was Andy Burnham—but increasing the amount spent on outsourcing by 50% in the last four years of that Government. [Interruption.] Fifty per cent. These are the facts. I know the hon. Member for Dewsbury (Paula Sherriff) wants to do the fake news and the scare stories, but let us just listen to the facts. Let us talk about what has been happening under this Government. In my first year as Health Secretary, the proportion going to the independent sector went up by 0.6%. In the second year it was 1.2%, in the third year it was 0.4% and last year it was 0%.

I need to correct the record. During Prime Minister’s questions, I hurriedly passed the Prime Minister a note about the increase in Wales in the use of the independent sector. She said at the Dispatch Box that in Wales it had gone up last year by 0.8%. I need to correct that, because in fact it went up by 1.2%—50% more than I thought. Wales, where Labour is in government, is racing ahead. In fact, in pounds spent, the use of the independent sector last year in Wales went up by a third. What that shows is not just that these allegations are nonsense, but that Labour knows they are nonsense. If there was any truth to them they would not be increasing outsourcing in Wales by one third at the same time as branding it as verging on the criminal in England. With the huge pressures facing the NHS and immense efforts by frontline staff to cope with flu, winter and an ageing population, can the Labour party really be trusted with the NHS when it spends its time putting out fake news?

Unlike Labour, we do not believe that the NHS should close its ears to innovation in other sectors or other countries. We want the NHS to be the best in the world and there are things to learn from others that will help patients and help the NHS. Sometimes those innovations will even come—dare I say it?—from America. But to copy global best practice from one small part of what is happening in America does not mean that we want to copy its system itself, which I think, and I think most people in this House think, is an affront to that great country, with poor outcomes, lack of coverage and high cost.

To stop ideology trumping the needs of patients, the Conservative-led Government in 2012 legislated to stop politicians choosing whether to boost the private or the public sector, formally and legally giving that decision to clinicians who run clinical commissioning groups. I will tell the House why we did that. What would happen if we followed what the shadow Chancellor advocated last year, when he said

“we will reverse Tory privatisation by renationalising the NHS”

is that 120,000 people would have to wait longer for operations on their hips, knees and for other elective surgery. The price of Labour ideology, putting ideology before patients, would be nearly 200 people waiting longer in every constituency in this House.

[Julian Knight (Solihull) (Con)]

The Secretary of State touches on a point that is very pertinent in my constituency. I met a former police officer who had an NHS operation on his hip. The operation went wrong, so the local NHS trust paid privately for the officer to have the operation done correctly. Does that not show that at times it can be a very good thing to involve the private sector? The key is that the NHS is free at the point of need.

[Mr Hunt]

That is exactly the point. Sometimes the quality is high in the private sector and sometimes it is low. When it is low, we will clamp down hard just as we do with the NHS.

[Karin Smyth (Bristol South) (Lab)]

I am listening carefully to the Secretary of State’s comments on ideology and the Health and Social Care Act 2012. He will remember that I, in a CCG, was implementing the 2012 Act. Is he saying that he is proud of the Act and that it has worked out as intended?

[Mr Hunt]

As Chinese Premier Zhou Enlai said about the French revolution, it is too early to tell.

As my hon. Friend the Member for Solihull (Julian Knight) alluded to, there is one ideology that we will not compromise on: our belief that the NHS should be free at the point of use and available to all. And why will we not compromise on this? It is because, contrary to Labour’s creation myth about the NHS, it was a Conservative Health Minister, Sir Henry Willink, who first proposed it in 1944. Here are his words from 1944 announcing the setting up of the NHS:

“Whatever your income, if you want to use the service…there’ll be no charge for treatment. The National Health Service will include”—

[Interruption.] I know this is difficult for Labour Members, but let me tell them what the Conservatives said when we were setting up the NHS:

“The National Health Service will include family doctors”

and will

“cover any medicines you may need, specialist advice, and of course hospital treatment whatever the illness”.

Nye Bevan deserves great credit for delivering that Conservative dream, but let us be clear today that no party has a monopoly on compassion, and no party has a monopoly on our NHS. There are some other myths—

[Jonathan Ashworth]

Will the Secretary of State give way?

[Mr Hunt]

I will give way, with great pleasure.

[Jonathan Ashworth]

I really do think the Secretary of State has some brass neck. The Tory party voted against the creation of the NHS 20-odd times. That is the reality of what happened in 1948, including on Third Reading in this House. It is a Labour creation.

[Mr Hunt]

As the shadow Health Secretary knows perfectly well, the way that this House works is that Oppositions often vote against the Government when they disagree with elements of a Bill, but that does not mean that they disagree with the principles of the Bill. I remember the hon. Gentleman’s party voting against the Care Act 2014. That does not mean that they disagreed with the principles behind it.

[Mrs Louise Ellman (Liverpool, Riverside) (Lab/Co-op)]

The circumstances around the recent collapse of Carillion have left Liverpool with an unfinished hospital. Negotiations with a potential new contractor are under way but may require ministerial involvement because of the involvement of other Departments. Will the Secretary of State give me an absolute assurance that he will do whatever he can within his power to ensure that that new hospital is completed as soon as possible?

[Mr Hunt]

I can give the hon. Lady that assurance. I am most grateful to her for raising that issue and reassure her that my hon. Friend the Minister of State responsible for hospitals was at the hospital on Friday, going into detail about how we make sure that there are no delays on that issue.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

rose—

[Mr Hunt]

I will give way one last time and then I will make some progress.

[Jamie Stone]

I thank the Secretary of State for giving way. On the issue of freedom of access and equality of access, would he at least concede that where there are issues of distance, rurality and remoteness of location, that is a challenge—although health is devolved to the Scottish Parliament—which means that it is not quite as free for some of my constituents as it is for people who live in Glasgow, Edinburgh or London?

[Mr Hunt]

The hon. Gentleman makes a fair point, which would be echoed by many Government Members who represent rural constituencies. There is a balance to be struck between the benefits of specialist surgery, where greater volumes of a particular procedure are done, leading to better outcomes for patients, and the trade-off that we make with travel times. I know that that is something that the local NHS, in all parts of the UK, thinks through very carefully.

There is another myth we always get from the Labour party that I think it is very important to dispel: the narrative about the NHS being in total decline. Let us be clear about the pressures facing the NHS. We had to deal with the financial crisis of 2008, which left this country’s coffers empty. We have had to deal with the fact that over the last seven years, we have had half a million more over-75s. We had to deal with a crisis of care at Mid Staffs, which turned out to be a problem affecting many other parts of the NHS.

Yes, it is true that we are missing some important targets at the moment, but let us not forget the extraordinary things that have been achieved despite that pressure, such as for cancer. We inherited some of the lowest cancer survival rates in western Europe. In 2010, only 10% of patients got intensity-modulated radiotherapy; that figure is now 44%. We have two new proton beam therapy machines—at the Christie and University College London Hospitals—and there are 7,000 people alive today who would not be had we stayed with the cancer survival rates of 2010. Every day, 168 more people start cancer treatment than did in 2010. This is a huge step forward.

On mental health, previously we had no national talking therapy service for people with anxiety and depression; today, 1,500 more people are starting or benefiting from talking therapy services every single day, and we have huge plans to extend mental health provision to 1 million more people.

[Karen Lee]

Does the Secretary of State think it acceptable that ambulances were waiting outside Lincoln A&E for up to seven hours over the winter? Is that a mark of progress?

[Mr Hunt]

No, I do not think it acceptable at all, but I would ask the hon. Lady to bear it in mind that we have 2,000 more paramedics than we did in 2010 and that we have invested in a huge amount of capital equipment for the ambulance services. Of course we need to do more, but, when she talks about A&E, she should recognise the achievements of many hospitals, including her own. Every day across the NHS—even over this difficult winter—2,500 more people are seen within four hours than were in 2010.

Labour seems to think that quality problems in the NHS started in 2010. I should point out that because of what we have done to deal with the problems of Mid Staffs, which happened on Labour’s watch, including through the new Care Quality Commission regime, 2.1 million more patients every year benefit from good or outstanding hospitals than did five years ago. A couple of weeks ago for the first time the majority of hospitals in the NHS were good or outstanding, which is a huge step forward and a huge tribute to NHS staff. That might be just one reason the Commonwealth Fund last year said that the NHS was the best healthcare system in the world. When Labour was in office, it was not even the best in Europe.

There is another reason to oppose the motion. It has nothing to do with health policy, but is a much bigger point of principle. After more than five years in this role, the one thing I have learned is that good policy can be made only through frank and open discussion between Ministers and officials. It will not surprise the House to know that Ministers are human, we make multiple mistakes—not me of course—and it is critical that the Secretary of State in charge of the largest health system in the world can get honest, high-quality advice, but the motion would fundamentally undermine that.

This is not a party political point. Many Labour Members have benefitted from such advice, and all of us would want Ministers of any party in power to benefit from such advice, regardless of whether we support the Government, yet the motion asks us to release not just that written advice from officials, which would have an enormous chilling effect, but notes of confidential discussions between Ministers and officials. In short, as my right hon. Friend the Member for Aylesbury (Mr Lidington) said only last week, it would undermine the safe space within which Ministers and civil servants consider all the options and weigh up the best approach. Officials must be able to give advice to Ministers in confidence. The candour of all involved would be seriously affected if there were any fear of those discussions being disclosed.

No Government of any party have ever operated in an environment where advice is sought one week and made public the next. Let us look back to what Andy Burnham said in 2007 when he as a Minister was asked to release information. His words were:

“Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents. This would inhibit the free and frank exchange of views about significant risks and their management, and inhibit the provision of advice to Ministers.”—[Official Report, 23 March 2007; Vol. 458, c. 1191.]

Far from increasing the accountability of the Executive to the legislature, releasing such information would risk weakening it, as more and more discussions would end up taking place informally with no minutes taken at all.

[Alex Chalk (Cheltenham) (Con)]

Does my right hon. Friend agree that it would be completely inconsistent with the Freedom of Information Act—passed, by the way, by a Labour Government—which deliberately carved out an exemption for precisely these sorts of communications? It would be very odd—in fact, completely counterproductive—to turn that on its head.

[Mr Hunt]

My hon. Friend speaks extremely wisely. He is right: it would fundamentally weaken the ability of the Executive—which the Freedom of Information Act tried to protect—to make considered, thoughtful and wise decisions. Ultimately, that would put at risk the credibility of our democracy itself.

I think it fair to say that, despite my many faults as Health Secretary, I have pursued transparency in the NHS with greater vigour than has been the case previously. I passionately believe that in this House we must be accountable for the outcomes of all the decisions that we make, but all of us are mortal—all of us make mistakes—so if accountability is the watchword after a decision is made, thoughtfulness must be the watchword before it is made. Any measures that affect the honesty and frankness of the advice that Ministers receive would fundamentally reduce that thoughtfulness and reduce the effectiveness of our Government for the people whom they serve.

For those reasons—as well as because of all the ridiculous myths about the millions and privatisation—I have absolutely no hesitation in asking my right hon. and hon. Friends to vigorously and thoroughly oppose the motion.

[Several hon. Members rose—]