Junior Doctors Contracts

Lord Clarke of Nottingham Excerpts

Thursday 11th February 2016 Commons Chamber

[Mr Hunt]

The hon. Member for Lewisham East (Heidi Alexander) has made a number of incorrect statements with which I shall deal with later, but what the country will notice about her response is more straightforward. When we have a seven-day NHS, in a few years’ time, people will say that it was obviously necessary and the right thing to do. They will remember that it was not easy to get there, and they will also remember—sadly—the big call that she made today for short-term political advantage to be placed ahead of the long-term interests of patients.

Previous reforming Labour Governments might have done what we are doing today. Let me say to the hon. Lady that she has vulnerable constituents—we all have vulnerable constituents—who need a true seven-day NHS, and those are precisely the people that the NHS should be there for. Sorting this out should not be a party issue; it should be something that unites the whole House, and she will come to regret the line that she has taken today.

Let me address some of the hon. Lady’s particular points. She has said today and on other occasions that this has been badly handled. If she wants to know who has handled contract negotiations badly, it was the party that gave consultants the right to opt out from weekend work in 2003 and that gave GPs the right to opt out of out-of-hours care in 2004. Is it difficult to sort out those problems? Yes. Are we going to be lectured by the people who caused them? No, we are not.

The hon. Lady also questioned whether there was support for imposition. Let me just read her exactly what the letter that I got from Sir David Dalton says. He states that, on the basis of the stalemate,

“I therefore advise the government to do whatever it deems necessary to end uncertainty for the service and to make sure that a new contract is in place which is as close as possible to the final position put forward to the BMA yesterday.”

And what does Simon Stevens, chief executive of NHS England, say?

“Under these highly regrettable and entirely avoidable circumstances, hospitals are rightly calling for an end to the uncertainty, and the implementation of the compromise package the Dalton team are recommending.”

The hon. Lady talked about the impact on morale. Perhaps she would like to look at the hospitals that have implemented seven-day care, including Salford Royal, Northumbria and one or two others. They have some of the highest morale in the NHS, because morale for doctors is higher when they are giving better care for patients. She also says that we should not impose the contract, but what she is actually saying is that if the BMA refuses point blank to negotiate on seven-day care, we should give up looking after and doing the right thing for vulnerable patients. What an extraordinary thing for a Labour shadow Health Secretary to say. She also said that we were conflating the junior doctors contract with seven-day working. Well, let us look at what the Academy of Medical Royal Colleges said in 2012. It said:

“The weekend effect is very likely attributable to deficiencies in care processes linked to the absence of skilled and empowered senior staff”.

Most medical royal colleges say that junior doctors with experience qualify as senior staff.

The NHS has made great strides in improving the quality of care. Since I have been Health Secretary, avoidable harm in hospitals has nearly halved, nearly 20% of acute hospitals have been put into a new special measures regime—and we are turning them round—and record numbers of members of the public say that their care is safe and that they are treated with dignity and respect. The seven-day NHS is not just a manifesto commitment; we are doing this because we are willing to fight to make the NHS the safest, highest quality healthcare system in the world. Today we have seen that the Labour party is not prepared to have that fight. Does not this prove to the country that it is the Conservatives who are now the true party of the NHS?

[Mr Kenneth Clarke (Rushcliffe) (Con)]

I congratulate my right hon. Friend on taking this clear and correct decision, because it is quite obvious that after three years, the BMA was prepared to let the whole thing drag on with talks and days of action until he either abandoned the seven-day service or gave the junior doctors an enormous pay settlement in order to buy their agreement to do it. In future discussions, will he keep concentrating, as he has, on the essential public interest, which is to meet the rising and remorseless demand on the service resulting from an ageing population and clinical advance? Will he also use the extra resources that the NHS is getting at the moment to deliver a better service to patients and not allow it to be taken away, as so often happened in the past—including a little more than 10 years ago in 2003—by very large pay claims by the various staff unions, as that would lessen his ability to give us the modern NHS that he is talking about?

[Mr Hunt]

My right hon. and learned Friend speaks with great wisdom and also great experience. Many Members will remember how, when he was Health Secretary, the BMA put posters of him up all over the country saying “What do you call a man who ignores medical advice?”, and there he was, smoking his cigar. I am sure that there have been Labour Health Secretaries who have had similar treatment. He makes an important point, however. Under the new Labour Administration of Tony Blair, huge amounts of extra resources were put into the NHS but, unfortunately, because of the impact of contract changes in 1999, 2003 and 2004, weekend care actually became less effective, not more effective. Now, thanks to the tough decisions we have taken on public spending and turning the economy around, we have been able to give the NHS a funding settlement next year that is the sixth biggest in its entire nearly 70-year history. We are absolutely determined that, if we are putting that extra money into the NHS, it should come with reform that leads to better care for patients. That is the Conservative way, and we will not be deflected from it.

Junior Doctors Contract

Lord Clarke of Nottingham Excerpts

Monday 30th November 2015 Commons Chamber

[Mr Kenneth Clarke (Rushcliffe) (Con)]

I congratulate my right hon. Friend on his steady and patient pursuit of a seven-day service for patients in the face of the extraordinarily militant tactics of the BMA. As one of his predecessors, I can reassure him that the tendency to personalise any dispute against the Secretary of State is a long-standing tradition of this trade union that goes back to Lloyd George, when it resisted panel doctors. It was ferocious in its opposition to Nye Bevan and the establishment of the NHS and every Secretary of State of every party since that time has had exactly the same experience in a dispute. If my right hon. Friend succeeds in getting the negotiations under way on a time-limited basis, as he rightly said, will he approach the BMA—of course, in a reasonable way—and insist that it make it clear that it supports a seven-day service, which would be of benefit to the country, and will not turn this into a demand for large amounts of extra pay? I think the British medical profession is among the best paid in Europe, if not the best paid. Everyone should concentrate on how to raise standards of service to ordinary patients up and down the country and how to get rid of higher mortality rates at weekends?

[Mr Hunt]

I thank my right hon. and learned Friend for his robust support. I seem to remember that when he was Health Secretary posters were put up all over the country saying, “What do you call a man who ignores doctors’ advice”, with a picture of my right hon. and learned Friend. He knows exactly what this is all about. It is not just Conservative Health Secretaries: Nye Bevan and Alan Milburn went through this.

My right hon. and learned Friend is absolutely right: we will all be delighted if the strike is postponed. Incidentally, it begins at 8 o’clock tomorrow morning, not midnight—I must correct that. He is right: the Government’s focus is unremittingly on improving patient care. We have made it clear that any settlement has to be within the current pay envelope. The great sadness is that the vast majority of doctors are passionate about doing something about seven-day services. If only we had had the chance to negotiate from June, we could have avoided the situation we are in.

NHS: Financial Performance

Lord Clarke of Nottingham Excerpts

Monday 12th October 2015 Commons Chamber

[Ben Gummer]

I will address the hon. Lady’s final point first, if I may. The previous coalition Government’s 2012 Act has saved considerable numbers—billions of pounds—which we would now have to make up if we had not made difficult decisions.

That allows me to address the hon. Lady’s first point. We have a choice: we can take the traditional view of politicians, which is to try to paper over the cracks and pour money into an unreformed system, or we can take the difficult decisions that will mean that we deliver patient care in the long term. That is what the Conservative party is willing to do: we are not only providing the commitment to funding, but taking the necessary, difficult decisions.

On the specific issue of agency nurses—one such example of difficult decisions—it is not so much the number of nurses available as the scandalous rates at which they were hired out to NHS trusts. We have taken action on that to ensure that NHS providers can procure agency staff when and how they need them at a reasonable rate.

[Mr Kenneth Clarke (Rushcliffe) (Con)]

Will my hon. Friend confirm that there have been no cuts in expenditure on the health service and that there have been no cuts in the total level of service? The problems at the moment are caused by the extraordinary pressures of an ageing population, clinical advances and rising public expectations. Will he continue to get the right balance between the needs of greater efficiency and responsible public financing, putting patient interests first and resisting short-term lobbying from trouble spots, which is a permanent feature of the politics of the NHS? In particular, will he resist any attempts by organisations such as the British Medical Association to turn controversy into yet another pay claim?

[Ben Gummer]

I thank my right hon. and learned Friend for his assurances on what needs to be done: he, more than anyone in the House, knows how to do it. Had the Government taken the Opposition’s advice and cut the money going into the NHS, we would not have achieved record numbers of doctors and nurses; we would not have halved MRSA and clostridium difficile rates; we would not have eliminated mixed-sex wards; and we would not have achieved record high cancer survival rates. All that has been made possible because of the funding commitments that the Government have made, to which the Opposition failed to commit at the election.

NHS Success Regime

Lord Clarke of Nottingham Excerpts

Thursday 4th June 2015 Commons Chamber

[Mr Speaker]

Order. I must say that it is a pleasure to welcome back to the House the right hon. and learned Member for Rushcliffe (Mr Clarke), who when he celebrates 45 years in the House this month will I think be approaching the mid-point of his parliamentary career.

[Mr Kenneth Clarke (Rushcliffe) (Con)]

At this crucial mid-point, thank you very much, Mr Speaker, for that unusual way of calling me.

Does my hon. Friend the Minister recall that the whole purpose of introducing the purchaser-provider divide many years ago, which was developed by the Labour party and is now known as local commissioning, was to concentrate on patient care, patient outcomes and local priorities? Will he therefore, with this welcome announcement, continue to stick by NHS England, allow it to do that, and resist the blandishments of the shadow Health Secretary, who seems to pine for the days of centralised bureaucracy and is still feebly trying to weaponise the NHS for party political purposes?

[Ben Gummer]

It gives me particular pleasure to respond to my right hon. and learned Friend. He was an exceptional Secretary of State for Health because he understood the centrality of local decisions by patients and their doctors and commissioners. I confirm that we will continue to allow local commissioners to make the decisions, rather than try to wrest power back from them to Whitehall, which is precisely what the shadow Secretary of State did when he was Secretary of State.

National Health Service

Lord Clarke of Nottingham Excerpts

Wednesday 21st January 2015 Commons Chamber

[Alan Johnson]

I do not understand the hon. Gentleman’s point about my role in trebling tuition fees. I certainly was the higher education Minister who introduced tuition fees, against fierce opposition. I supported them and made the arguments—all the arguments we now hear from Liberal Democrats—against the opposition of the Conservative party.

In terms of privatisation, we did introduce independent treatment centres. At every stage, we asked the local NHS, “Have you got the capacity to get these waiting lists down? Have you got the capacity to carry out the elective surgery without denuding emergency services?” which happened all the time. Hon. Members will be surprised how many found that capacity when we said, “Okay, we’ll introduce an independent treatment centre.” Suddenly, consultants stopped going to the golf course and taking Saturdays off. They got the waiting times down. In places that did not have capacity, we introduced independent treatment centres. The role of the NHS is to treat patients, and I am very proud of the record that we and my successor, my right hon. Friend the Member for Leigh (Andy Burnham), stood on in 2010.

[Mr Kenneth Clarke (Rushcliffe) (Con)]

Does the right hon. Gentleman agree that, since the late 1980s, every Secretary of State from both political parties, with the exception of the right hon. Member for Holborn and St Pancras (Frank Dobson), accepted that one could raise the quality of patient care by introducing competition and choice of provider in the system? The right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) quite sensibly pursued that policy, as did Alan Milburn, with particular vigour, and the shadow Secretary of State when he was in office. Will the right hon. Gentleman try to encourage his successor not to go back on that, because the health service is now much better at coping with the problems of changing demand than it was 20 or 30 years ago?

[Alan Johnson]

The right hon. and learned Gentleman knows, because we have debated this before—I will come on to some of the history—that the big difference between what he and other Governments did during the 1980s and what we did is the single tariff. They competed on price. We had a single tariff that meant that, wherever that operation took place, it was paid for at the same rate.

With that top-down reorganisation that we could see from space, all the Conservative party’s efforts to convince the public that they could be trusted with the stewardship of the NHS were thrown into disarray at a stroke. The fact that the NHS tops the list of public concerns as we approach a general election can be traced to that self-inflicted wound.

The Conservative party leader’s efforts to detoxify the Tory brand vis-à-vis the NHS could be described as an attempt to return to the consensus that existed prior to the 1980s. The great historian of the NHS, Rudolf Klein, says that following its contentious birth there followed 35 years when the NHS was “cocooned in consensus”. That changed in 1982, when the Thatcher Government’s internal think-tank, the Central Policy Review Staff, produced a paper with the option of replacing the NHS, a tax-financed health service, with a system of private insurance. This option—the right hon. and learned Member for Rushcliffe (Mr Clarke) will probably remember this—was, incidentally, presented to Ministers not by the Secretary of State for Health but by the Chancellor of the Exchequer. It was defeated thanks to the efforts of Norman—now Lord—Fowler, but it expressed for the first time the idea that a tax-funded NHS was wrong and broke that 35-year consensus.

From that moment, through weird and wonderful ideas, right up to 2005 when Conservatives Members stood on the platform of the ridiculous patient passport, their policy has been about taking money out of the NHS and changing the very principles of the service. I could not describe it better—I think there would be agreement on this—than the great American clinician and health care expert, Donald Berwick, who I believe the Secretary of State has used during his time in office as an adviser. He describes the NHS as

“one of the truly astounding endeavours of modern times”

and, in a wonderful phrase, as

“a towering bridge - between the rhetoric of justice and the fact of justice.”

This ideological battle is not over. Indeed, it has just been joined by the ultra-Thatcherite leader of UKIP. The hon. Member for St Ives (Andrew George) is no longer in his place, but he was perhaps right in thinking that we should get back to a consensus on the NHS.

We could raise relevant arguments about many aspects of the NHS. Indeed, my colleagues in Hull and I are talking to the Secretary of State about some issues central to Hull. However, in this speech I do not want to talk about clinical health or the successes of the NHS. I want to talk about one of its failures. At the tenth anniversary of the NHS in 1958, there was a debate in this Chamber. Nye Bevan, the great architect of the NHS who was mentioned earlier, stood up and said what a great success it had been, but that the failure had been mental health. He spoke, using the language of the time, of the disgraceful conditions in our mental hospitals. Of course, there has been a huge improvement since 1958, but it remains a fact that mental health is a poor relation of the NHS, and children and adolescent mental health is a poor relation of that poor relation.

I would like to cite three awful statistics published by the Office for National Statistics. First, 10% of children between the ages of five and 16—or to put it another way, three in every class—experience mental health problems. The second disgraceful statistic is that that figure rises to 60% when applied to children in care. The final disgraceful statistic is that 95% of imprisoned young offenders have a mental health disorder. Many of those young offenders should not be in prison at all. I have raised the case on the Floor of the House of my constituent, Vince Morgan, a young man with a severe psychotic illness who committed suicide in a prison cell having been failed by every single organisation and authority that was meant to help him. Section 136 of the Mental Health Act 1983 is still being used to incarcerate children, mainly as a result of the failure to provide sufficient in-patient tier 4 child and adolescent mental health services facilities.

Forgive me for being parochial, but this is a crucial issue in our area. In Hull and East Riding, we were served well by an in-patient unit called West End for 20 years. When NHS England assumed responsibility for tier 4 services as a result of the changes from the reorganisation—all other tiers being the responsibility of the local clinical commissioning groups—it changed the specifications for tier 4 units, saying that they had to be open seven days a week, 24 hours a day. There was no consultation with anyone. This was done in March 2013. As West End was open only from Monday to Friday, with children spending the weekends at home—a regular feature of CAMHS treatment—the unit was closed. The option of extending the provision, so that it was a seven-day service, was never offered. Parents of children who had benefited from this important part of the NHS had no input whatever in a decision made by a huge quango that had no local accountability and no local presence. So much for the glib slogan, “No decision about me without me”.

I raised this issue in the Chamber on 23 October. The Minister of State, Department of Health, the right hon. Member for North Norfolk (Norman Lamb), who is in his place, gave me a sympathetic response. I am convinced that he cares deeply about the problems of mental health, but he appears to be entirely powerless to do anything about them. Since then, there has been a review of tier 4 services by NHS England, which, as the Health Committee has said:

“does not provide a conclusive answer on the reasons for the current problems, nor on whether there are sufficient beds”.

In addition, that Health Committee report, published in November, pointed out that NHS England had

“presided over a system which has resulted in children being sent hundreds of miles to access care.”

There has been no resolution on this issue in Hull and East Riding, or in other parts of the country, such as Devon and Cornwall. We have a foundation trust provider that recognises the problem and has identified a site for a new seven-day in-patient service, but the commissioner at NHS England has yet to commission. The CCGs are powerless. The acute trust often has to open its adult wards to children.

Let me tell the House what this means to the victims of such failure—to the children who were once so well served by the West End unit. Maisie Shaw is a 13-year-old who has had serious mental health problems since her father died two years ago. Her mother, Sally, is a teacher. Clearly, children need to be close to their family when they are undergoing treatment. Family involvement is a crucial aspect of their recovery. In December, Maisie took an overdose after breaking into a locked medication box at her home in Hessle. As it was a Saturday, there were no CAMHS staff on duty and, of course, no in-patient facility. She was taken to Hull royal infirmary on Saturday and cared for in a locked ward at the maternity hospital, with a 24-hour guard until Monday morning. She was sent to Stafford, which is almost 200 miles away, and then to Sheffield, which involves a round-trip of 120 miles by her family to visit her. As part of her treatment, she will be home at weekends, but when her mother asked what help would be available for this very disturbed child if there was an emergency, she was told to ring 999.

The subject of my debate in October 2013 was Beth Hopper, who is now 15. Beth’s mother, Kathy, is a staff nurse for the NHS. Beth is an extremely intelligent girl who has, according to her school, huge academic potential. She suffered a severe mental breakdown at the age of 11 and spent nine months at the West End unit, which opened at weekends specifically to tend to her needs. Kathy believes that the unit saved her daughter’s life. Since West End closed, Beth has been sent away 19 times. She has been to Cheadle, 103 miles away. She has been to Liverpool. She has been to Warrington. She has been Nottingham. She has been Widnes. Of course, while there is no argument that to travel further for more expert care is a factor in physical health, it is rarely the case with mental health, particularly when the patient is a child. Indeed, Maisie and Beth’s clinicians in Hull often have to travel to care for her in these distant locations, thus adding to the cost of that care. It is no exaggeration to say that the condition of Beth and Maisie is actually being made worse by this treatment. It is truly scandalous.

So that Beth’s voice is heard in this debate, I will read out a letter that she sent to her mother the other week. She wrote this:

“I really just don’t know what to do or what I want, or what is best for me anymore.”

Forgive her grammar.

“I aren’t happy here. I am happy at home, but I am scared that things might go like they were before. I just want normality. I want to have the chance to be a kid for once, before it is too late. I feel as though nobody is listening to me. I am so isolated here I am scared to join the groups and don’t want to make new friends anyway. I want my old friends, who I miss.”

We need to hear these children’s voices.

A and E (Major Incidents)

Lord Clarke of Nottingham Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Kenneth Clarke (Rushcliffe) (Con)]

Does the Secretary of State share my recollection that five years ago no political pundit of any kind predicted that the welcome ageing of the population and the ending of the 24 hours a day, seven days a week commitment of general practice would produce the quite extraordinary surge in demand that we now have to cope with? Does he therefore agree that instead of wild criticisms of local crises he needs to persist in the short term by providing resources and improving co-operation between social services and health care, and in the long term by implementing the changes necessary in response to demand, as set out by Simon Stevens in his report, which our reforms have enabled NHS England to produce?

[Mr Hunt]

My right hon. and learned Friend speaks with a great deal of wisdom as someone who has occupied this post and he is absolutely right. All Health Secretaries face pressures of the kind we are going through now and face difficult winters. Winter is always a difficult time for the NHS and, as the Prime Minister said, we need a short-term plan to help—that is what our plan of creating about 5,000 extra front-line clinicians this winter alone is doing—but we must also consider the long-term plan. That involves finding a better way of looking after vulnerable older people other than through A and E departments—that means better care in the community, better support from GPs and better community services—and that is exactly what we are doing.