Epilepsy
Lindsay Hoyle Excerpts(10 years, 11 months ago)
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Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. I am bringing in an eight-minute limit. I call Kate Hoey.
GP Services
Lindsay Hoyle Excerpts(11 years ago)
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Mr Prisk
On the development of local plans, in east Hertfordshire and elsewhere, the problem is that our rather nice, but historical and inadequate, premises restrain the ability of practices to provide modern facilities. Is that my hon. Friend’s experience of the local planning process in his constituency?
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. May I make a suggestion? The Speaker suggested a time limit of about 10 minutes, and the hon. Gentleman has now had 13 minutes. I hope there will not be too many more interventions, and that the hon. Gentleman is coming to the end of his speech.
John Howell
Thank you, Mr Deputy Speaker. I am coming to the end, but let me respond to my hon. Friend’s intervention. It depends on where the practice is and what its buildings are like. Some are quite modern, and one would not want to change their facilities. Even those practices may need to add an extra surgery, if the village is going to grow by several thousand people, so they need to plan for where it will go and for the doctor that will use it.
The trend in the population has been towards more elderly patients and more patients with long-term, chronic or multiple conditions. That leads to an increase in the number of patients per year. There is no doubt that the age profile is having an impact. The Government’s allocation of a named doctor to a patient is useful for the co-ordination of services, even though in an emergency the patient may not be able to see that doctor on the day when they require them.
Yes, there is a need for money to be provided for GP services, but this is possible only if we have a strong economy. The Government have evened out the payments between practices so that they do similar things in similar parts of the country and there are not wide variations between them. That has to be the right way to go. It also has to be right to increase the strength of the economy in order to provide these services.
Douglas Carswell (Clacton) (UKIP)
I am very interested in what the hon. Lady is saying, because it sounds ominously like the situation in Clacton. Indeed, in one Frinton surgery in my constituency, one doctor was trying to serve 8,000 patients. She is absolutely right to avoid the temptation to blame the patients or to suggest that they are the problem. Does she agree that part of the answer is to ensure there are far more attractive terms for would-be GPs? That does not necessarily mean higher salaries—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Mr Carswell, interventions are meant to be short, not speeches. I am sure you have got to the point.
Stella Creasy
It is unusual for me to agree with the hon. Gentleman, but I agree that we need to look at how we can attract and retain doctors. We also need to look at what these problems do to the rest of the NHS.
Let me tell the hon. Gentleman about a constituent of mine who had a problem with his eyesight that was caused by high blood pressure. Because he could not get a doctor’s appointment, he left the condition alone. He has now gone blind in one eye and his other eye is at risk. His elderly wife came to me because she did not want to bother the doctor. We have to change that culture and to consider the consequences of not using our resources to deal with those early problems. When we leave somebody like that and they end up going blind, the cost to all of us to help them is much greater than if they had been able to access a GP. We must look at the terms of the job, but also at where the resources are not going. I have been raising those questions with local health care providers.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. May I just stress that if we stick to 10 minutes, I can give everybody 10 minutes? If we run over, people will end up having their speeches cut and I do not want to do that to anybody.
NHS (Government Spending)
Lindsay Hoyle Excerpts(11 years ago)
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Mr Deputy Speaker (Mr Lindsay Hoyle)
I remind Members that there is a seven-minute speaking limit. We should get everybody in, unless there are interventions, in which case we may have to change it.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. I must now introduce a six-minute time limit on speeches.
Charlie Elphicke (Dover) (Con)
When I was first campaigning in Dover and Deal, I found that the previous Government’s legacy was that they had run down the much-loved Buckland hospital in Dover. Wards had been axed one by one; services had been withdrawn one by one; and the hospital had been decimated for more than a decade. There had been talk of plans to build a new hospital, but they had gone nowhere for the better part of a decade. It was a total disgrace; we did not get a fair share of health care in Dover and Deal.
In addition, an agreement appeared to have been made by the hospital trust in 2006 to take away the out-patient services at Deal’s hospital. There were claims of a consultation with the then MP and the then elected representatives to withdraw those out-patient services. So when I was elected I faced a situation where the hospital trust wanted to axe out-patient services and people were very concerned that Deal’s hospital was so undermined that it would be lost altogether. That was unacceptable.
What did the Conservatives do about it? Thanks to our funding of the NHS—the amount of money we have put in and the increase in spending in real terms—we managed to get a new hospital built and it opens in March. That is a real achievement, ensuring that we will have a fairer share of health care back in Dover. After the years of going backwards, we will go forwards, and people in our community will be able to be seen and cared for in our community. Rather than have Deal’s hospital being run down and closed, as people feared, because Labour left it teetering on the edge, we campaigned hard.
I undertook a large survey across the whole of Deal and I listened to people’s views. Thousands responded and we had hundreds in a meeting in a church to listen to the doctors and put the case for keeping the hospital, and now the clinical commissioning group, using its new funding powers, is ensuring that that hospital is safeguarded for the future. In that way, under the Conservatives, we have safeguarded Deal’s hospital and we are getting a new Dover hospital.
We also had difficult times in our local hospital trust—the East Kent Hospitals University NHS Foundation Trust had the CQC come in and investigate. In the past there would have been a cover-up and things would all have been swept under the carpet, just as they were in Staffordshire. That was the disgrace under the previous Government; the shadow Health Secretary oversaw that shameful episode. This Government have been open, honest and frank about the situation, and have ensured that special measures are taken and that we will have more nurses, more investment and better health care as a result. That is an important milestone. It shows not only that we have a new Dover hospital and that we have safeguarded Deal’s hospital, but that we have a better trust thanks to the reforms the Government have put in place.
But I think we should go further. I want to see five-star health care in Dover and Deal, so that rather than the cold wards of old, we should have new individual care and recovery suites, which can enable flexibility. People could be there for short-time observation; for step-down care for a week or two, rather than blocking up the acute hospital; for re-ambulation over a two to three-month period; or for much longer-term palliative care or perhaps end-of-life care. I am working with Kent county council, the local CCG and other health stakeholders to examine how we can bring forward that sort of innovative proposal. It will help with NHS funding because it will save money lost through bed-blocking; it will save money because its beds will be less expensive than elsewhere in the NHS; and it will provide a better experience for patients because they will be able to get better and recover within the community.
We need to rethink A and E more generally, by having more local emergency centres. My plan is that at the new Dover Buckland hospital, which opens in March, we should see a local emergency centre being used as an out-of-hours base for the doctors and CCG. It should be beefed up so that it has a much more emergency flavour to it, rather than a minor injuries one, so that more people use it, more people have trust and confidence in it and fewer people will inappropriately admit themselves to A and E down the road in Ashford. In that way, we will be able to get the right kind of cascading, the right level of treatment and the right places, given how our health system works. Such an approach would allow simpler stuff to be carried out more locally in our communities, whereas the more complicated accident and emergency problems would be dealt with in a more centralised A and E unit. That kind of modernisation in how we deal with out-of-hours care and A and E-type care is something I hope we will think about and see more of in future. I do not see this as a left/right issue, just as I do not see community hospitals, which I believe in, as a left/right issue. I see it as being about people who are concerned about localism, and the localisation of health care and bringing it closer to the patient and to the community. That is the way we should be building the future of our NHS. It is a great shame we have seen so much politicisation and weaponisation of this—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. I call Grahame M. Morris. You have five minutes.
Grahame M. Morris
I would rather weaponise it than privatise it, which is what I accuse the Government of doing. That would not have been possible without the active support of the Liberal Democrat party—talking of which, the hon. Member for Redcar (Ian Swales) has just taken his place in the Chamber. I feel bitter about what has happened. The hon. Gentleman and I both served on the Health and Social Care Bill, which has now been enacted. The lead advocates were the right hon. Members for Chelmsford (Mr Burns) and for Sutton and Cheam (Paul Burstow). That Act was a really dangerous move, because part 3 opened up our national health service to the full force of competition. Conservatives may say that the difference is only marginal, but the truth is that that Act allows hospital trusts to have up to 49% of their income come from private patients.
I know that we are desperately short of time, but I want to set out some political dividing lines. Labour and the Conservatives are making very different offerings for the NHS. Labour’s offering is that it will provide more nurses and GPs, and I think it will find favour. In the next general election—
National Health Service
Lindsay Hoyle Excerpts(11 years ago)
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Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Speeches of up to eight minutes would be helpful if we are to try to get everybody in—do not worry, you did very well, Paul.
Andy Burnham
On a point of order, Mr Deputy Speaker. I have always to correct the record when these statements are made. I apologise for delaying the House, but I am going to carry on doing it. I did not put it out to tender; it was a process I inherited, and in the middle of that process I changed the policy from “any willing provider” to “NHS preferred provider”. Contrary to what the Secretary of State said at the Dispatch Box, NHS Peterborough and Stamford was still in the race.
Mr Deputy Speaker (Mr Lindsay Hoyle)
You have certainly corrected that. It is a point of correction, rather than a point of order. It is all on the record now and everyone can continue. Let us see whether we can turn the heat down a bit.
Sir Oliver Heald
Further to that point of order, Mr Deputy Speaker. I just do not accept the point of order that the shadow Secretary of State has made. May I just—
Mr Deputy Speaker
Order. No—I said straight away that it was not a point of order, but a point of correction. The point is that it is all on the record for people to read tomorrow, to continue a debate on who is right and who is wrong. Both parties, quite rightly, have stated what their belief is. Mr David T.C. Davies has not much time to go and I am very worried that he will not get to the end of his speech. He has only eight minutes in total.
David T. C. Davies
Thank you, Mr Deputy Speaker. I am grateful, because I want to talk about quite a few other things. We did not hear very much about waiting time comparisons, but of course the waiting times in England and Wales are very different. In Wales, people wait at least 26 weeks, with 14,745 having been waiting for more than nine months for treatment; in England, people wait about 18 weeks. One hundred and fifty people have died in Wales waiting for cardiac surgery.
Rehman Chishti
I pay tribute to the work my hon. Friend does in his constituency. I often see it on Facebook and read about it on the internet. He is a tireless campaigner for the health service in his constituency. He mentioned the A and E in his constituency. A linked issue is that of resources. In my constituency, £13.4 million has just been invested in resources for the A and E department—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. I do not want such long interventions. If the hon. Gentleman wishes to speak, we can always put him on the list. If he wants, he can save something for later.
Stephen McPartland
My hon. Friend makes a fantastic point, and he is a fantastic campaigner, too. I am sure that that money would not have arrived without a huge effort on his part.
The Leader of the Opposition was in my constituency last week, and we were grateful to him for his visit. He came and celebrated the £150 million investment that I had secured for my hospital. He can come as much as he likes, because I got more donations, supporters and volunteers from his visit. Perhaps he could come on a weekly basis. Incidentally, let me talk about the Lister treatment centre, which the right hon. Gentleman visited. It was privatised under the previous Government. I ran an 18-month campaign to have this private facility returned to the NHS, and I succeeded. I am probably the only Tory MP in history who has managed to renationalise a part of the NHS that had been privatised under a Labour Government. I worked very hard on that campaign, but it was lonely work. The local Labour council did not back me; the local Labour candidate did not back me; the Labour shadow Secretary of State did not back me; the Leader of the Opposition did not back me; but the GMB union did and for that I am very grateful.
Three people died in that facility and 8,500 patients’ records were lost. It was a complete and utter shambles. Clinicenta Carillion, the organisation that was responsible for running that facility, destroyed the lives of thousands of people in Hertfordshire; that must never be repeated. That is what we talk about when we talk about the NHS. Who did I stand up for? I stood up for the patients, for the staff and for their families. Where did I get my information from? From members of staff who were working in that facility daily, under huge pressure, suffering and working as hard as they could to provide the best service they could. They could not do it, because their hands were tied behind their back—the contract was so bad. The local hospital was not even allowed sight of the contract until it was signed, sealed and delivered by the previous Government. They did not even know what they were being signed up to, which is a disgrace. I am proud of my hospital and the staff who work in it, but we must always remember that, at the end of the day, these are human beings, who are working incredibly hard to deliver real improvements in services.
Fortunately, that facility is being handed back to my local hospital. The Secretary of State for Health worked with me. He allowed me to come and see him, and we had a variety of meetings. I argued with the Care Quality Commission. I was very lonely throughout that campaign, but at the end of the day the Secretary of State worked with me and he nationalised that private facility, which the previous Government—disgracefully—privatised. I am proud of the Secretary of State, and I am only sorry that he is not in his place, because I wanted him to come and open one of our wonderful new facilities in February. The Prime Minister can come in March.
The facility that I was discussing got so bad that GPs lost confidence and wrote to each other saying, “Do not refer patients to this facility or you will put them at risk.” The CQC started proceedings to revoke the licence. That facility was falling apart—a facility that was privatised by the previous Government. It was nationalised by the Conservatives.
So I am proud of the NHS and proud of the staff who work in it. I am proud of the £150 million development in my constituency, which is making my hospital one of the most modern facilities in the UK. I am disgusted that the Leader of the Opposition wants to weaponise our local NHS and never once backed my campaign to bring that shameful private contract back to the NHS. The Labour party should apologise to my local community for playing Russian roulette with our local health service and politics with my constituents and patient safety.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
I am in no turmoil whatever. I will be walking through the Lobby with pride behind my hon. Friends. We cannot know exactly how much a mansion tax, if levied, would raise towards the national health service. What we do know is that the British people who want to save the national health service from the depredations of Government Members have to vote Labour. We have to vote for my right hon. Friend the Member for Leigh (Andy Burnham) to become Secretary of State for Health—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. We do not need a statement; we have got the message.
Mr Burns
In conclusion, it is sad that the hon. Lady has completely undermined the case and the costings of the right hon. Member for Leigh (Andy Burnham). I have no doubt that when she has swallowed her pride and gone through the Lobby today, she will battle as hard as she is renowned for battling and will hit the leader of her party over the head to try to get him to see common sense and abandon this ridiculous policy that she also thinks is ridiculous.
Mr Deputy Speaker
Order. I have tried to work within the spirit of the previous announcement, but I think the time has come to introduce the eight-minute limit.
Angela Smith
I thank my hon. Friend for that intervention and I am really sorry to hear of the cases she raises. The situation really does need to be sorted out, because the Yorkshire ambulance trust goes on to say that
“the service was experiencing a high level of demand in the South Yorkshire area around the time of Mr Bailey’s incident. Overall, demand was 12% above predicted levels and the level of ‘Red’ call demand was 55% above predicted levels…Rising demand on all health care resources continues which requires changes to deliver improvements in urgent and emergency care.”
I shall say no more about Mr Bailey’s case because it will be referred elsewhere and it may well go to law—I have simply set out the facts of the case as they have been put to me—but the point is this: why are we experiencing these problems with response times in the ambulance service? Why are we hearing, week after week in Prime Minister’s questions and on the Floor of the House in other debates, that the ambulance service is letting people down—even in the most serious cases, when people are going into cardiac arrest or having a major stroke?
We need to establish the reasons, and I suggest that there are three obvious ones. There may be more—there may be problems with the management of ambulance services, and in many cases there clearly is a problem in the case of YAS—but I would suggest that there are three obvious problems. One problem is the increasing difficulty that people have in getting access to GPs’ surgeries. The evidence was laid before the people present for this debate earlier, by the shadow Secretary of State, so I will not go through it again.
Secondly, there has been the closure of NHS Direct and the establishment of NHS 111. There is no way that NHS 111 can be compared with NHS Direct; it is like comparing apples and pears. I have used NHS Direct in the past. It was a superb service that enabled me to decide which was the appropriate place to go to for my treatment and to get the right treatment at the right time. I can assure hon. Members that the one place I did not end up, having used NHS Direct, was A and E—that would have been the last place I had to go to.
Thirdly, social care cuts represent one of the most fundamental problems of our time. As my right hon. Friend the Member for Wentworth and Dearne (John Healey) said, £1 in every £10 has already been cut from social care budgets. It is obvious, even to the most disinterested observers of the debate on health, that cutting social care budgets at local authority level will ultimately impact on the health service. I was in local government for 10 years, and I saw for myself the importance of the local authority and the local NHS working together to enable elderly people to stay in their own homes and to keep them out of the health system—the acute health system, in particular—as much as possible.
The shadow Secretary of State, my right hon. Friend the Member for Leigh (Andy Burnham), outlined what needs to be done in the very long term, strategically, to get the NHS in the right shape. He also outlined the more immediate actions that a Labour Government would have to take if they gained power in May: providing more clinically trained staff to handle NHS 111 calls; restoring the GP guarantee of an appointment within 48 hours; and ensuring that councils, the NHS and the local voluntary sector work together to identify older people at the highest risk of hospital admission and link them up with the right support. I cannot wait for 8 May to see that strategy for the short term being put in place.
Ambulance services are crucial to the trust that people have, and need to have, in their local health services. One can broadly measure the trust that people have in their local health service by how much they can rely on their ambulances. Everybody likes to think that if they need an ambulance they will get one, and get it quickly. I was disappointed this afternoon that the Prime Minister used my question to indulge in petty political point-scoring. These issues are too serious for that. He did not even express sympathy for the family affected and instead made a cheap point about NHS staff. That was disgraceful. It is not good enough, and it is not good enough—
National Health Service (Amended Duties and Powers) Bill
Lindsay Hoyle Excerpts(11 years, 2 months ago)
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Dr Whiteford
The points the Minister is making about competition take us back to the transatlantic trade and investment partnership. He must be aware that the NHS across these islands is developing in very different directions, and competition has not been at the heart of what has happened in other parts of the UK. I want him to give us cast-iron guarantees today that there will be no obligation on the NHS in Scotland to open up because of that trade agreement, even if the UK decides in its favour. What opportunities are there, if the treaty exposes the Scottish Government to—
Dr Poulter
I will come to TTIP shortly, and I think that I will be able to reassure the hon. Lady and the hon. Member for Angus (Mr Weir).
The Health and Social Care Act put in place an alternative route to the courts, through Monitor, to address abuses of the rules around procurement. The Bill would remove that alternative route, meaning that future complaints under the law would result in hugely costly legal processes for health care commissioners, and complaints would be considered by the courts, rather than by Monitor, a health expert regulator. That cannot be good for patients. The Bill would result in more money for the lawyers, and much less money for our NHS and the patients that it looks after.
Another important point is that by favouring NHS over non-NHS providers, the Bill would be a move against the voluntary and charity sector providers, such as Macmillan and Marie Curie, who have done so much to help care for patients for many years.
Dr Poulter
I am going to make some progress—I hope the hon. Lady will forgive me—because Mr Deputy Speaker is looking at me.
Dr Poulter
Points were made about the voluntary and charitable sector supporting innovative new models of care. Through the Newquay pathfinder project Age UK has provided volunteer support to vulnerable older people considered at risk. Under the home scheme the British Red Cross provides volunteer support to patients in their homes, which is aimed at preventing admission to, or facilitating discharge from, hospital. The charity has care in the home contracts with more than 30 NHS trusts and social services departments, and the scheme enables reduced admissions, increased convenience to patients, and many other associated benefits.
My hon. Friend the Member for Stafford (Jeremy Lefroy) mentioned Macmillan. I like to talk about Macmillan, which has long provided vital support to patients right across the UK. It is collaborating with doctors in Staffordshire to transform cancer care and end-of-life care, and together they aim to commission care right across the patient journey. In cancer, that means commissioning prevention and health promotion, ensuring early diagnosis and prompt treatment through survivorship and improving end-of-life care.
In reality, the only route proposed in the Bill for recourse against unfair treatment by commissioners is to take us back to the previous Labour Government’s competition laws in 2006 and open up legal challenge through the courts. Only private providers with enough resource behind them are likely to be able to afford to exist in that court-based system, to pay high legal fees, and to invest in providing NHS care to patients, and smaller providers, especially charities, will lose out. Surely we do not want to see that in our NHS—an NHS in which, I hope we all agree, charitable and small local health care organisations have something important to contribute for the benefit of patients.
Before I conclude, I must briefly address some of the misleading commentary that has surrounded TTIP, which is serving only to distract from the real debate about our NHS. First, may I state that there is absolutely no agenda whatsoever to privatise our NHS through the back door? TTIP cannot force the privatisation of public services by EU member states. This position has been made explicitly clear by us and by the relevant negotiating parties. To suggest otherwise would be disingenuous and, frankly, wrong. I encourage Members to look at the recent negotiating mandate published by the European Commission, where this position is made absolutely clear. I note the comments of Ignacio Garcia Bercero, EU chief negotiator, on the record at the end of round 7 negotiations—
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
On a point of order, Mr Deputy Speaker. I do not know what is going on with this speech. I know that the Minister is a distinguished medical person, but he is presenting the speech with so much jargon and such technical terms that very few people out there will understand the main thrust of it. The only thing many people have understood in the last few minutes is the back-door privatisation.
Mr Deputy Speaker (Mr Lindsay Hoyle)
That is absolutely not a point of order, but we will hear from some other speakers if we can get to the end of this speech. We might then hear some other parts of the debate.
Dr Poulter
Thank you, Mr Deputy Speaker.
I have mentioned the benefit to patients many times in my speech, because that is, after all, what I care about as a doctor and what I care about as a Health Minister, and what I hope all hon. Members care about; I know that the hon. Member for Huddersfield (Mr Sheerman) does so.
Additionally, and contrary to claims made by some, TTIP will not prevent any future Government from changing the legal framework for the provision of NHS services. Neither will it prevent the termination of the private provision of such a service in accordance with the law or contracts entered into, as is already the case today. The reassurances that we and the European Commission offered were sufficient for the right hon. Member for Wentworth and Dearne (John Healey), a previous shadow Health Secretary, when he stated:
“On the NHS....my direct discussions with the EU’s chief negotiator have helped produce an EU promise to fully protect our health service including, as the chief negotiator says in a letter to me, so that: ‘any ISDS provisions in TTIP could have no impact on the UK’s sovereign right to make changes to the NHS.”
If it was good enough for the right hon. Gentleman—
Barbara Keeley (Worsley and Eccles South) (Lab)
I congratulate my hon. Friend the Member for Eltham (Clive Efford) on his excellent opening speech—I think it was one of the best speeches I have heard in the House—and on introducing his Bill so that we can review and reform some of the more pernicious effects of the Health and Social Care Act 2012. One of the worst was to force market tendering of services, meaning that millions of pounds are wasted on the process, money that should be spent on improving front-line patient care.
As a member of the Health Committee, I am very concerned about the increasing role that private companies are paying in providing NHS services. We recently looked at what is happening in Stoke and Staffordshire. There have been a few references to that in this debate and I will talk some more about it, but we looked at it under the label of the integrated care pioneers pilot. I want to talk more about that development as an example of just what can happen under this Government’s market framework—[Interruption.]
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. There are a lot of conversations and I am struggling to hear the hon. Lady. If we need to have the conversations, can we turn them down a little?
Barbara Keeley
Thank you, Mr Deputy Speaker.
The clinical commissioning groups involved plan to tender by summer 2015 a £1.2 billion contract to deliver cancer services and end-of-life care for 876,000 people across the area. The witnesses we heard from made it clear that commissioning on a disease-specific basis like this is risky. There are only a few small-scale examples of that being done anywhere, and nothing on the scale of this project. Despite the risk, we heard some worrying things about local people or local MPs not being listened to and about a lack of consultation with or involvement of hospital-based clinicians. The Minister has just referred a number of times to letting doctors get on with running the NHS, but the CCGs involved in driving this pilot are not even involving or listening to local clinicians. I and other colleagues on the Committee found that bodies such as Healthwatch England and Macmillan Cancer Support were cheerleaders for—and in Macmillan’s case, a funder of—development work on a project that could end up privatising cancer and end-of-life care for almost a million people. I for one found that disturbing. I felt, and I know that some of my colleagues did too, that there was a conflict of interest. Healthwatch England was meant to be the consumer champion of health and care.
By contrast with what Government Members have said, there was also a fair amount of concern among Committee members about the role of Macmillan Cancer Support in funding the development work when many believe that the money they give to Macmillan goes directly to cancer care. Indeed, the example I saw on the Macmillan website yesterday was that a donation would pay for a Macmillan nurse for a period to help people living with cancer and their families receive essential medical, practical and emotional support. It does not appear to be a selling point for that charity that funds would be used on a project to privatise end-of-life and cancer care in Staffordshire and Stoke.
Clive Efford
claimed to move the closure (Standing Order No. 36).
Question put forthwith, That the Question be now put.
The House proceeded to a Division.
Mr Deputy Speaker (Mr Lindsay Hoyle)
I ask the Serjeant at Arms to investigate the delay in the No Lobby.
Mr Deputy Speaker (Mr Lindsay Hoyle)
I ask the Serjeant at Arms to investigate the delay in the No Lobby.
Clive Efford
On a point of order, Mr Deputy Speaker. I understand that, in order to go into Committee, this Bill requires a resolution from the Government. Given the overwhelming number of people who turned up on a Friday to support it, would it not be churlish of the Government not to pass that resolution and make sure that this Bill goes into Committee forthwith?
Mr Deputy Speaker (Mr Lindsay Hoyle)
As you pointed out, it is something for the Government, but not me, to take on board.
Mitochondrial Replacement (Public Safety)
Lindsay Hoyle Excerpts(11 years, 5 months ago)
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Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Nineteen Members wish to speak and other Members are trying to catch my eye to intervene. It is an important debate and we need to allow the allotted speakers in, so Members should think very hard before trying to intervene.
Fiona Bruce
Thank you, Mr Deputy Speaker.
Parliament should be allowed to deliberate on and debate this issue at length, but that might not happen. I understand that the Government propose to lay regulations permitting PNT and MST before the end of this year. Sir John Tooke, president of the Academy of Medical Sciences has said:
“Introducing regulations now will ensure that there is no avoidable delay in these treatments reaching affected families once there is sufficient evidence of safety and efficacy.”
In other words, Parliament should vote blind and sign off legislation permitting these procedures before the recommended experiments—some of them critical, regarding safety—have been completed.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. I will bring a four-minute limit in to give us a chance to maximise the number of speakers. If Members can cut the length of their speech, all the better.
Cervical Cancer Screening
Lindsay Hoyle Excerpts(11 years, 9 months ago)
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The Parliamentary Under-Secretary of State for Health (Jane Ellison)
I congratulate the hon. Members for Wirral South (Alison McGovern) and for Liverpool, Walton (Steve Rotheram) on securing and leading this debate. We all wish that we were not debating this issue, important though it is, against such a tragic backdrop. I share the view of the hon. Member for Wirral South that it is a great innovation that, through e-petitions and the Backbench Business Committee—she knows that I used to serve on that Committee—we can now bring issues of such huge public concern swiftly to the House for debate.
This has been an excellent debate, and I thank all Members for their contributions. Depending on how tolerant Mr Deputy Speaker is feeling, I may not get the chance to address all the points that have been raised, but I hope Members know that I will, as I always commit to, respond to them after the debate.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. The Deputy Speaker is always generous in the time that he gives but, recognising that there are constraints, I welcome those comments.
Sadiq Khan (Tooting) (Lab)
On a point of order, Mr Deputy Speaker. You will be aware that we on the Labour Benches have on a number of occasions expressed concern about the Government’s policy on legal aid and its consequences. This morning His Honour Judge Leonard QC sitting at Southwark Crown Court stayed proceedings in the Crown v. Crawley and others, a £4.5 million fraud trial, after he heard representations from one of the country’s leading and most respected QCs that the case should not proceed, as a fair trial was not possible because of the consequences of the legal aid changes introduced by the Lord Chancellor.
This case alone has cost the taxpayer tens of thousand of pounds and justice has not been done, but it is extremely serious for the criminal justice system in this country, which has not just been brought into disrepute, but is now rendered ineffective by a Lord Chancellor who is out of his depth. [Interruption.] I understand that there are at least eight other complex criminal cases, including—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Mr Swire, I will make the decision. We do not need any help from the Front Bench.
Sadiq Khan
That demonstrates the respect that the Government have for the justice system.
I understand that there are at least eight other complex cases, including those relating to the LIBOR fixing scandal, where barristers of sufficient expertise have not been found. Mr Deputy Speaker, have you received any indication from the Lord Chancellor that he intends to make a statement today to the House about the consequences of the judgment for the criminal courts, and his proposals to remedy the crisis he has caused in the court system?
Mr Deputy Speaker
I can assure the right hon. Gentleman that I have had no indication that anybody from the Ministry of Justice team is coming to make a statement. It is not a matter for the Chair, but it is certainly on the record and people are now aware of it.
Care Bill [Lords]
Lindsay Hoyle Excerpts(11 years, 11 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Jeremy Lefroy (Stafford) (Con)
I beg to move, That the clause be read a Second time.
Mr Deputy Speaker (Mr Lindsay Hoyle)
With this it will be convenient to discuss the following:
New clause 16—Powers of local commissioners in relation to TSA recommendations—
‘(1) In section 65DA(1) of the National Health Service Act 2006 (Chapter 5A of Part 2: Objective of trust special administration) omit “objective” and insert “objectives” and omit “is” and insert “are”.
(2) After subsection (1)(a) insert—
“(b) the continued provision of such of the services provided for the purposes of the NHS by any affected trust at such level, as the commissioners of those services determine.”.
(3) After subsection 1(b) omit “(b)” and insert “(c)”.
(4) In subsection (2) of that section after “The commissioners” insert “of the trust in special administration and any affected trust”.
(5) In subsection (4) of that section after “the commissioners” add “of the trust in special administration and any affected trust”.
(6) In subsection (9) of that section after ““commissioners” means the persons to which the trust provides services under this Act” add “and the commissioners of services at any affected trust”.
(7) In section 65F insert—
“(2E) Where the administrator is considering recommending taking action in relation to another NHS foundation trust or an NHS trust which may become an affected trust, the administrator shall engage with the commissioners of services at any such NHS foundation trust or NHS trust in order to enable those commissioners to make decisions pursuant to the matters set out in section 65DA.”.
(8) In section 651(1)—
(a) after “action which the administrator recommends that the Secretary of State” insert “or the commissioners of any affected trust“; and
(b) after “should take in relation to the trust” insert “or any affected trust”.
(9) In section 65K add—
“(3) Where the final report contains recommendations for changes to be made to services provided by an affected trust, the commissioners of services at that affected trust shall make a decision within 20 working days whether they wish to undertake public and patient involvement regarding all or any of the recommendations and, if they are so minded, shall comply with any arrangements for patient and public involvement agreed by those commissioners under this Act before making any final decision concerning the said recommendations.”.
(10) In section 65KA add—
“(7) Where the final report contains recommendations for changes to be made to services provided by an affected trust, the commissioners of those services shall make a decision within 20 working days whether they wish to undertake public and patient involvement regarding all or any of the recommendations and, if they are so minded, shall comply with any arrangements for patient and public involvement agreed by those commissioners under this Act before making any final decision concerning the said recommendations.”.
(11) In section 65KB(1)(d) after “that” insert “to the extent that the report recommends action in relation to the trust in administration”.
(12) In section 65KB(2)(a) after “decision” insert “in relation to any recommendations made the in relation to the trust in administration”.
(13) In section 65O add—
“(4) In this chapter “affected trust” means—
(a) where the trust in question is an NHS trust, another NHS trust, or an NHS foundation trust, which provides goods or services under this Act that would be affected by the action recommended in the draft report; and
(b) where the trust in question is an NHS foundation trust, another NHS foundation trust, or an NHS trust, which provides services under this Act that would be affected by the action recommended in the draft report.
(14) In section 13Q(4) at the end insert “save to the extent required by section 65K(3) or 65KA(7)”.
(15) In section 14Z2(7) at the end insert “save to the extent required by section 65K(3) or 65KA(7)”.
(16) In section 242(6)(b) at the end insert “save to the extent required by section 65K(3) or 65KA(7)”.’.
This Clause ensures that all commissioners of services affected by a trust special administrator’s report have the right to define local specified services; clarifies that, save for the trust in administration, local commissioners remain the decision makers for services they commission; and restores public engagement for changes other than for a trust in administration.
Amendment 30, page 102, line 31, leave out clause 119.
Government amendments 35, 36 and 11 to13.
Jeremy Lefroy
I wish to speak to new clause 6, which stands in my name and those of hon. and right hon. Members from across the House.
The new clause would give the Secretary of State some discretion to amend details of the final recommendations from Monitor regarding the outcome of the administration of an NHS foundation trust. As the law stands—so I am advised—the Secretary of State must either accept or reject Monitor’s recommendations in full. If they are rejected, there is another lengthy period of reconsideration. The result is that even if the Secretary of State broadly welcomes Monitor’s recommendations but has concerns about some matters of detail, it appears that he has to reject everything.
I have tabled this new clause as a direct result of my experience representing a constituency that has undergone the very first trust special administration of a foundation trust. I hope it will also be the last—at least in its current format. It has been a hugely time-consuming and costly process, and I would not wish it on any other community, constituency or Member of this House. The new clause would slightly improve the process, but what I would much rather see is a total rethink of the way in which the basic tasks of a trust special administration are carried out, both for NHS trusts and for NHS foundations trusts.
In my view, the relevant legislation—introduced by the previous Government and continued under this one—is not fit for purpose, but that is a debate for another day. In the meantime, I simply urge Monitor and the NHS Trust Development Authority not to put any other trusts—whether they be NHS trusts or foundation trusts—into the current form of administration. I urge everybody to work together on developing a system that enables trusts that are too small, such as the Mid Staffordshire trust, to be dissolved without having to go into a rapid, short-term and wholesale redesign of services. It can be done and I am certainly willing to work with anyone who wishes to design a better system.
I will not go into the full details of the administration of the Mid Staffs NHS Foundation Trust—that is a subject for a full debate on another day—but I will simply point out that it was made a foundation trust in 2008 on the recommendation of Monitor after a lengthy process, and that it is now being dissolved in 2014 on the recommendation of Monitor after a lengthy process. In paragraph 4.269 of his inquiry report, Robert Francis says:
“There can be no doubt that the Trust should never have been authorised as an FT”,
which happened in 2008. There must be a better way of doing things.
My new clause 6 would give the Secretary of State the power to accept the broad thrust of Monitor’s recommendations in the unhappy event of any future administration, giving her or him discretion to alter their detail without having to reject them in their entirety. The new clause therefore offers the Secretary of State flexibility and discretion in what is too rigid a process. I think that any Secretary of State would welcome that. A constant theme of the Ministers whom I have heard in my short time in Parliament has been that such and such an amendment would introduce too much inflexibility into the law. I am therefore doing exactly what Ministers long for, which is to offer them such flexibility.
Joan Walley (Stoke-on-Trent North) (Lab)
The hon. Gentleman is making well-informed comments about the whole issue we face. He says that the arrangements need to be looked at on another day, but surely our experience in Staffordshire and the complete confusion over a set of recommendations that have been accepted but cannot be implemented means that we ought to find some way to resolve the whole issue in this evening’s debate, not give the Secretary of State powers to close down general hospitals at random all over the country.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Ms Walley, in fairness, interventions must be very short.
Jeremy Lefroy
I am grateful to the hon. Member for Stoke-on-Trent North (Joan Walley) for playing an extremely important and constructive role in this whole matter. She has been very supportive, and she makes some extremely important points. We need to look at the whole issue of administration, to which I will come in a few moments.
The Secretary of State’s decision to introduce the addition has given me considerable comfort about new clause 6, which I tabled before his decision, not being necessary. He does not seem to consider himself entirely constrained by the law into only accepting or rejecting Monitor’s recommendations in full; there is clearly room for proposing changes to details while still accepting the main thrust about the dissolution of a trust.
We shall of course need to see the results of the NHS review of consultant-led maternity services. If, as I hope, they are retained as a vital part of the regional health service—together with the level 1 special care baby unit, which serves a much wider area—it is important that finances are put in place to ensure that they are sustainable. I would therefore welcome clarification from the Minister about how the Department of Health now interprets the law.
If the Secretary of State’s decision on Mid Staffordshire demonstrates that the law allows for positive changes to the details of recommendations without Monitor having to go through another lengthy and legalistic process at a time when, as in the case of Stafford, a hospital is in a very fragile state, I welcome that fact, and new clause 6 will be unnecessary. However, if the Minister wants confirmation of the flexibility set out in the new clause, I would be happy for the Government to accept it or something similar.
Finally, to return to the question of trust special administrations, I believe that they are the right way to dissolve the legal entity of a foundation trust, but they are most certainly not the right way to redesign clinical services. That is not to criticise Monitor generally or the trust special administrators in the case of Mid Staffordshire—I believe that they acted within the remit given to them by this House—but we as a House did not get it right either in 2006 or in 2012. I urge a complete rethink, starting today.
Mr Jim Cunningham (Coventry South) (Lab)
My hon. Friend is right when she says that the Secretary of State wants the power to privatise—I will be brutal about it—NHS services. We must recall—this is why we cannot believe the Minister or the Secretary of State—that before and during the general election, the Prime Minister said that there would be no top-down reorganisation of the national health service—[Interruption.]
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. With the hon. Gentleman facing that way I could not hear a word he had to say. I am sure it was a very short intervention that I would love to hear. Will he repeat the question?
Mr Cunningham
I am sure my hon. Friend will agree that the changes the Government want to make are in order to privatise the national health service through the back door. That is why the Secretary of State wants that power. Equally, we cannot believe the Secretary of State because, during the general election, the Prime Minister said that there would be no major changes to the national health service, and no top-down reorganisation. Why should we believe this lot now?
David T. C. Davies
I listened with great interest to my hon. Friend the Member for Enfield North (Nick de Bois) but I will be supporting the Government 100% tonight because I have great confidence in what the Government have achieved with the NHS. I say that because I have seen the alternative; I have seen what has happened to the NHS when it is run by Labour, because that is the problem that I and many of my constituents face at the moment in Wales.
My right hon. Friend the Member for Sutton and Cheam (Paul Burstow) came forward earlier with a petition from the left-wing pressure group 38 Degrees. Health campaigners have been talking today about the amount of salt that we take but one has to take dangerously large pinches of salt with anything that comes out of that organisation. These people purport to be happy-go-lucky students. They are always on first name terms; Ben and Fred and Rebecca and Sarah and the rest of it. The reality is that it is a hard-nosed left-wing Labour-supporting organisation with links to some very wealthy upper middle-class socialists, despite the pretence that it likes to give out.
It is 38 Degrees who were coming out with all sorts of hysterical scare stories a few years ago about how the Government were going to privatise the NHS. It took out adverts in newspapers, scaring people witless that that was going to happen. Of course the organisation has forgotten all about it now because there was never any intention to do that. We will never privatise the NHS because we believe in public services in this party. A couple of months ago, 38 Degrees came out with more scare stories about how it was going to be gagged because of another piece of legislation that the Government were putting through to bring about fairness in elections. It said that we would never hear from it again, and yet here we are a few months later with yet another host of terrible stories, scaring members of the public quite unnecessarily. I do not think that we have to take any lessons from 38 Degrees, nor hear any more about their petition.
I am backing the Government tonight because I know that the Secretary of State has done an enormous amount to drive up standards in the NHS even as they fall in Wales. It is this Secretary of State who has presided over falls in waiting lists to 18 weeks in England. People are lucky in Wales if they can get to the target of 36 weeks. There has been an increase in funding when it has been cut in Wales and there is much better access to cancer drugs in England than we have in Wales.
New clause 16 refers to the need to confer with members of neighbouring boards. We have health boards, not trusts, in Wales. I hope the Secretary of State will confer with the boards in Wales about these changes. The only criticism that I have of the Government is that they have been so successful in improving the NHS in England that large numbers of people now contact me every single day, in Wales and in my constituency, asking for the right to be treated by the NHS run by the coalition Government and not by the NHS run by the socialists in Wales.
I ask the Minister and Opposition members to look at an article in the Western Mail today by a woman called Marianna Robinson who has spoken about the difficulty she has had in trying to get treatment and how desperately she wants to be treated in Bristol. There is a place for her in Bristol but she is not allowed to have it. I ask Ministers, and perhaps Opposition Members, to think about what we are doing here. I would like to see patients in Wales who wish to be treated in England being allowed to go to England and get treatment, with the money then being taken off the block grant to the Welsh Assembly. If Opposition Members—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. I think I need to help the hon. Gentleman. As he knows, we are dealing with the new clause. I do not want the history of the Welsh health service, which is certainly not what Members are here to listen to. I know he wants to get back to the new clause, which is where we will carry on. He should also look to the Chair now when he speaks.
David T. C. Davies
I shall simply say this, Mr Deputy Speaker. I will vote in the Lobbies with the Government tonight. Many people in Wales would like the opportunity to vote with their feet and be treated by the national health service which is run by this coalition Government, and I hope that we shall get around to addressing that at a later stage.
Care Bill [Lords]
Lindsay Hoyle Excerpts(11 years, 11 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Deputy Speaker (Mr Lindsay Hoyle)
With this it will be convenient to discuss the following:
New clause 10—Exercise of functions—
‘When exercising functions under section 31 (Urgent procedure for suspension, variation etc.) of the Health and Social Care Act 2008, the Care Quality Commission may not take account of its functions under section 83 (Trust special administration: appointment of administrator) of this Act.’.
New clause 12—CQC duty to support integration of social and health care—
‘In exercising the functions and duties set out in section 90 (Performance ratings), the Commission must act always to require, enable and encourage the provision of health services in ways that support and facilitate the functions and duties of—
(a) local authorities set out in section 3 (Promoting integration of care and support with health services etc.) of this Act,
(b) the NHS Commissioning Board set out in section 23(1) 13N (The NHS Commissioning Board: further provision) of the Health and Social Care Act 2012, and
(c) clinical commissioning groups set out in section 26 (14Z1) (Clinical commissioning groups: general duties etc.) of the Health and Social Care Act 2012
where it considers that this—
(i) improve the quality of those services (including the outcomes that are achieved from their provision),
(ii) reduce inequalities between persons with respect to their ability to access those services, or
(iii) reduce inequalities between persons with respect to the outcomes achieved for them by the provision of those services.’.
New clause 27—Corporate responsibility for neglect—
‘(1) This section applies where a person registered under Chapter 2 of Part 1 of the Health and Social Care Act 2008 (a “registered care provider”) in respect of the carrying on of a regulated activity (within the meaning of that Part) has reasonable cause to suspect that an adult in their care is experiencing, or at risk of, abuse and neglect.
(2) The registered care provider must make (or cause to be made) whatever enquiries it thinks necessary to enable it to decide whether any action should be taken in the adult’s case and, if so, what and by whom.
(3) Where abuse or neglect is suspected, the registered care provider is responsible for informing the Safeguarding Adults Board in its area and commits an offence if (without reasonable cause) it fails to do so.
(4) A registered care provider is guilty of an offence if the way in which its activities are managed or organised by its board or senior management neglects, or is a substantial element in, the existence and or possibility of abuse or neglect occurring.
(5) A person guilty of an offence under this section is liable on conviction to imprisonment for a term not exceeding two years, or to a fine, the range of which will be specified by regulations, or to both.’.
New clause 28—Review of protections for persons in the health and social care sector making disclosures in the public interest—
‘(1) Within six months of this Act receiving Royal Assent, the Secretary of State must make arrangements for an independent review of—
(a) the adequacy and effectiveness of provisions for the protection of persons employed within the health and social care sector who make disclosures in the public interest (whistleblowers) about matters of concern to their employer, a prescribed person or body or another person or body;
(b) the treatment and experience of past whistleblowers; and
(c) the need and opportunities to improve existing protections.
(2) The review shall take account of—
(a) the efficacy of existing legal provisions, policies, procedures and practices for the protection of whistleblowing and whistleblowers and access to redress for whistleblowers who suffer adversely consequent upon their disclosures;
(b) the available evidence on—
(i) the impact of whistleblowing on changes in health and social care standards; and
(ii) the treatment of whistleblowers over the last 20 years; and
(c) other matters as required by the Secretary of State.
(3) The Secretary of State shall arrange for a report with recommendations (or an interim report as may be required) from this review to be prepared and laid before each House of Parliament within 12 months of the review commencing.’.
New clause 29—Duty to minimise harm—
‘In section 20 of the Health and Social Care Act 2008 (regulation of regulated activities), after subsection (2)(b) insert—
(c) ensuring that the likelihood of harm befalling persons in respect of whom a regulated activity is taking place is reduced as far as possible.”.’.
New clause 30—Mandatory incident reporting and patient safety management systems—
‘In section 20 of the Health and Social Care Act 2008 (regulation of regulated activities), after subsection (3)(k) insert—
(l) impose requirements as to the reporting by all providers of regulated activities to the affected persons or their representative and family of incidents occurring in the carrying out of such activities which lead to the—
(i) death;
(ii) unexpected deterioration of condition; and
(iii) introduction of a new adverse condition in respect of the person, regardless of the severity of the new condition and the short and long term impact on the person;
(m) impose a requirement for the preparation and publication by all providers of regulated services of a safety management system plan.”.’.
New clause 33—Candour Commissioner—
‘(1) The Secretary of State shall establish an Office of the Care Commissioner for Candour and Disclosures in the Public Interest (the “Candour Commissioner’s Office”).
(2) The Candour Commissioner shall have duties to—
(a) protect and promote a culture of candour and disclosure in the public interest in the health and care services sector,
(b) provide or arrange confidential advice and support for persons working in the health and social care sector considering making a disclosure in the public interest,
(c) provide or arrange advice and support for persons in the sector who have made such a disclosure, and
(d) monitor the treatment, employment and re-employment of persons mentioned in paragraph (c) within the sector.
(3) The Commissioner shall report to the Secretary of State, with recommendations—
(a) on any issue within the Commissioner’s remit as she/he sees fit,
(b) making an assessment of the extent to which persons and bodies within the sector are protecting and promoting a culture of candour, with particular reference to the treatment, employment and re-employment within the sector of persons who have previously made a disclosure in the public interest.
(4) The Secretary of State shall lay a copy of the Commissioner’s annual report before each House of Parliament accompanied by an explanatory statement setting out the steps that the Government plan to take to remediate any shortcomings identified by the Commissioner.’.
Amendment 19, in clause 90, page 81, line 27, at end insert—
‘(2A) The Commission must, in respect of such English local authorities as may be prescribed—
(a) conduct reviews of the provision of such adult social services provided or commissioned by the authorities as may be prescribed;
(b) assess the performance of the authorities following each such review; and
(c) publish a report of its assessment.
(2B) Regulations under subsection (2A) may prescribe—
(a) all adult social services of a particular description; and
(b) all local authorities or particular local authorities.’.
Paul Burstow
This part of the Bill and this group of new clauses and amendments are all about ensuring that the system delivers the best possible quality of care and that, when things go wrong, it is clear how the situation is to be corrected and what penalties will be faced by those who have let people down and, in some cases, treated them in an appalling way. There is much in this part of the Bill that is to be applauded, although the nature of the Report stage of a Bill means that we often do not applaud a Bill much, because we are focusing on the things that we want to amend further.
New clause 8 deals with a subject that was also a feature of our discussions in Committee—namely, the concern that the commissioning role of too many local authorities, and the discharge of their responsibilities for planning for the care and support needs in their communities, had degenerated into little more than crude procurements and, worse still, in some cases just spot purchasing of care services. In some local authorities, there was no sense of strategy or of engagement with the local population, and there were no pragmatic conversations with provider organisations ahead of a procurement process. There was no real sense of how to shape the market to deliver the best possible outcome from the point of view of the wider public interest.
Those concerns were expressed a number of times in Committee, and they have been echoed throughout all the stages of the Bill. They were certainly strongly expressed by a number of the representative bodies of provider organisations when they gave evidence to the Joint Committee scrutinising the Bill. Of all the evidence sessions in that Joint Committee, the one that sticks with me is the one at which the provider organisations gave evidence. There was a palpable sense of the deterioration, and even the collapse, of relationships between local authorities and providers as a consequence of the commissioning not being done well in some organisations.
My new clause is designed to address a concern expressed by a number of organisations about a change that the Government made to the Bill in the other place. In that change, they removed from the legislation that established the Care Quality Commission the provision for periodic reviews of the performance of local authorities in regard to their statutory duties on care and support. I am prepared to accept the arguments that the Minister made before removing that provision, but only if we can have much greater certainty that the Care Quality Commission will undertake regular thematic reviews of care and support services.
New clause 8 sets out a number of the things that I think such a thematic review should include. For example, we have established a regime for sector-led improvement whereby local authorities can seek peer review of their delivery of quality commissioning of care and support services. It is working well in some places, but there is certainly evidence that it is not in others. There is a concern that arrangements will be made that allow an inadequate level of peer review and, frankly, people to get away with not doing the right thing. That is why a back-stop provision allowing thematic reviews is absolutely essential, and why ideally I would like the CQC to be independent in its judgment on that, rather than beholden to Ministers to authorise it. That is not the situation we are in, but the new clause would have us look at those issues.
I was told by a provider that I met at an event which the United Kingdom Homecare Association organised with me that CQC inspectors positively discourage comments about local authority commissioning. If a provider has a concern about how they are being constricted, arguably inappropriately, by a commissioner’s decision or practice and tries to raise that with an inspector, they are told, “That is not a matter for us.” It is absolutely a matter for the CQC. I hope the Minister can say something about what he will say to the CQC on that issue. It seems to me that understanding the intervention of commissioners is a really important part of gathering intelligence about the robustness of a local care economy, and the best way to gather that intelligence, at least in part, is by inspectors being open to being told about that.
Andrew George
My right hon. Friend is making an excellent case. There is another reason why it is essential that inspection in that area becomes paramount, and that is because of the drivers in the system itself that discourage avoidable hospital and community hospital admissions and seek the earliest possible discharge into the community. What we have is a scenario in which people are being cared for in their homes, in an “out of sight, out of mind” environment, so inspections become all the more important because of the need to ensure that they are safe—
Paul Burstow
I defer to you on that point, Mr Deputy Speaker.
New clause 8 would ensure first, that there is an examination of how sector-led improvement is working; secondly, that the concern about rates for care, which we touched on when we debated new clause 15, is looked at, particularly time and task commissioning and procurement; and thirdly, that the way in which resource allocation formula are drafted and how they operate—an issue that came up in my Committee’s inquiry into the Bill—and the fact that they are often very opaque to the public, with regard to what is and is not in them when it comes to determining the level of a personal budget, are absolutely crucial to the quality of the care someone might be able to receive.
Francis Report
Lindsay Hoyle Excerpts(11 years, 11 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. The hon. Member for Beckenham has only just come in. He perhaps ought to hear a little bit more of the debate to get the flavour of it before he intervenes. That would help his good self.
Grahame M. Morris
We should remember that most hospitals provide very high standards of care, and have dedicated and compassionate staff. I am not just talking about doctors and nurses, but ancillary workers, cleaners and support staff. I worked in a pathology department as a medical scientific officer for a number of years. We should remember that the NHS is an integrated service that relies on all of its elements to perform at a high level and deliver a high-quality service.
Clearly, what happened in Mid Staffs was alarming. There were unacceptable practices, including, as other Members have said, professional failings. The hon. Member for Stafford (Jeremy Lefroy), in a terrific speech that was considered, thoughtful and non-partisan, alluded to those professional failings. My right hon. Friend the Member for Rother Valley (Kevin Barron), a former Chair of the Health Committee, made the point strongly that many Labour Members feel there should be a duty of candour on individuals. That is one of the recommendations of the Francis report that was rejected by the Government but could well make a difference. There were clear signs that changes needed to be made and we need to ensure that failures are never repeated elsewhere.
When care failures are uncovered, the priority above all else is to make a candid assessment of what went wrong and what needs to be done to fix it. Francis was clear on the need for cultural change. That is exactly what happened in the wake of the Mid Staffs scandal. Despite attempts by some Government Members to undermine Labour’s commitment to the NHS, for the record we should be aware that it was the then Secretary of State, my right hon. Friend the Member for Leigh (Andy Burnham), who is now in his place, who called in Robert Francis to lead the initial review into what had happened so that we could find out what went wrong and learn lessons for the future.
I accept the point made by the hon. Member for Stafford that we should not hark back to previous Administrations, but my recollection, as a relatively new Member from 2010, is that that was not something we engaged in. It was a huge issue for Labour, and for me personally, that people were dying due not to lack of care in a hospital setting, but to the length of waiting lists—people were dying on waiting lists. After 1997, the NHS was transformed. Spending had tripled to £104 billion when Labour left office. Under Labour, 100 new hospitals were constructed, and the Labour Government employed 89,000 more nurses and 44,000 more doctors than had been employed in 1997. The transformation of the NHS under the last Government was reflected in public satisfaction with the service, which rose from record lows before 1997 to record highs.
There was a bit of contention during Prime Minister’s Question Time, and subsequently during the opening speeches in the debate. The Secretary of State suggested that the number of nurses had risen, but my information from the Royal College of Nursing and FactCheck indicates that that is not the case. I hope that the record can be corrected, because staff numbers are a key issue. A number of Members have referred to it today, and Robert Francis cited staffing as a causative factor.
It would, I think, be irresponsible to assume that a combination of implementing the Francis recommendations—even all of them—and talking down the last Government will be sufficient to ensure the provision of high-quality care throughout the NHS. The truth is that the combination of cuts in alternative services—I am not just talking about the replacement of NHS Direct with the 111 service, the reduction in the number of walk-in treatment centres, the difficulties in gaining access to GP services and, indeed, the cost and disruption caused by the top-down reorganisation—is more likely to contribute to failures in care. It will certainly increase the pressure on accident and emergency departments.
The Francis report made it clear that the “overwhelmingly prevalent factors” in the failures at Mid Staffordshire
“were a lack of staff, both in terms of absolute numbers and appropriate skills”.
It was made clear that ensuring that our hospitals are adequately staffed is key to ensuring that standards of care are high. That point was made by the hon. Member for St Ives (Andrew George), who I know has been campaigning on the issue for some time. A year on from the Francis report, a survey found that 39% of nurses believed that the staffing position had become worse rather than better, and 57% said that their wards remained dangerously understaffed. I hope that the Minister has noted that, because it must be cause for concern.
The hon. Member for Stafford told us that when he was first elected the NHS trust was running a deficit of £10 million, and the focus of the hospital management was on reducing the deficit in order to secure foundation trust status. What went through my mind then were figures given to the Select Committee, according to which nearly a third of NHS trusts are predicting deficits towards the end of the current financial year, and the possibility that similar pressures will be applied as a result. We are now seeing the spectre of clause 119 of the Care Bill, which we are to debate next week on Report and Third Reading. If it paves the way for rapid hospital closures—Labour Members fear that predatory private health care interests may seize the opportunity—that will be very dangerous. We must examine that issue very seriously.
According to evidence from the survey conducted, I think, by the RCN, not only are hospital wards increasingly understaffed, but nurses are being burdened with work that is preventing them from doing their jobs. I am sorry to fire statistics at the House, but, according to that evidence, 86% agreed that the amount of non-essential paperwork had increased in the last two years. There has thus been an historic recent increase in administrative duties. That has been keeping nurses in their offices or at their nurse stations, standing in front of computers or photocopying machines, instead of being available on the wards providing the TLC—that direct health care—that patients require.
Just this week the president of the Royal College of Psychiatrists warned the Government that the mental health sector is heading towards its own Mid Staffs-type scandal. I am very concerned about that. The figures for that field were given earlier, but the fact that the budget for mental health services is reducing in real terms should be a cause for concern. This Government gave a commitment to parity of esteem as between physical and mental health. That was promised and loudly trumpeted as a significant step forward, but in truth it has failed to materialise. There is a clear funding imbalance between acute providers and non-acute trusts, which will disproportionately impact on mental health services in the wake of the Francis report.
I also want to touch on the tariff reduction. In 2014-15 there will be an overall reduction in the tariff price—essentially, the price that hospitals are paid for procedures and operations they perform—of 1.5% for acute providers and 1.8% for non-acute trusts. A third of NHS trusts are predicting they will be in deficit at the end of the financial year, and this tariff reduction will only compound that problem. This means the efficiency target for mental health and community trusts is in practice a fifth higher than for acute trusts, so perhaps it is no wonder that we have a chronic bed shortage, highlighted by various newspapers and the BBC, with children and adolescents travelling long distances to access appropriate care and sometimes temporarily being put in police cells. This is not acceptable, and there are real concerns that programmes introduced by the last Labour Government to make talking therapies available to people with mental health conditions are not getting the priority they deserve. Last year half of all patients referred for counselling did not see a specialist, with a third giving up entirely because the waits were so long.
As I mentioned in an earlier intervention, 1,700 mental health beds have been lost over the last two years, and services are under such pressure that people with mental illnesses are ending up either in police cells or presenting at accident and emergency departments, as the right hon. Member for Sutton and Cheam (Paul Burstow) said. Those are completely inappropriate locations.
I want to mention the cuts to social care since 2009 and the impact they are having on the ability of the service to deliver quality care in the light of our review of the Francis recommendations. We should not forget that since 2009-10 some £1.8 billion has been cut from local authority budgets for adult social care. The cumulative spending power of my own local authority, Durham county council, is being reduced by 17.3% under this Government.
Areas such as mine with a legacy of coal mining or industry have higher care needs. These are the areas that are being hardest hit by cuts to local government. It is simply not possible to make cuts of this significance to local government without it having an impact on standards of care. Some 76% of community nurses agree that social care cuts have resulted in increased work pressures, with just 15% thinking that patients are receiving adequate support from social care services. Cuts mean that an increasing number of those with care needs are going without any support—the figure I have seen is about 800,000—and those receiving support are not even having basic needs met. We know about the 15-minute visits, and councils are now having to introduce or increase charges for services that may well have been free before or might be free in other parts of the country.
Care in the home and in the community is declining, and people are turning to their local hospitals—this is the point I am trying to make—as the default option. That means that those who should be taken care of at home are staying unnecessarily in hospital beds. Accident and emergency is the coal face—the pressure point—and any failures in the system show up there, putting even more pressure on an already burdened system. In “The Francis Report: one year on”, Robert Francis said that there needs to be
“a frank discussion about what needs to be provided within the available resources…It is unacceptable to pretend that all can be provided to an acceptable standard when that is not true.”
I agree with him. It is no good telling people that care standards will be improved or maintained while removing the support that is required to provide high standards of care, particularly social care. In conclusion, I agree with the Health Committee that legislation and regulatory bodies can only do so much to ensure that care standards are met if the necessary staff and resources are not available.
Mr Deputy Speaker (Mr Lindsay Hoyle)
I now have to announce the result of Divisions deferred from a previous day.
On the motion relating to the draft Marriage (Same Sex Couples) (Jurisdiction and Recognition of Judgments) Regulations 2014, the Ayes were 360 and the Noes were 104, so the Question was agreed to.
On the motion relating to the draft Marriage of Same Sex Couples (Registration of Shared Buildings) Regulations 2014, the Ayes were 363 and the Noes were 100, so the Question was agreed to.
On the motion relating to the draft Marriage of Same Sex Couples (Use of Armed Forces’ Chapels) Regulations 2014, the Ayes were 366 and the Noes were 103, so the Question was agreed to.
On the motion relating to the draft Consular Marriages and Marriages under Foreign Law Order 2014, the Ayes were 367 and the Noes were 100, so the Question was agreed to.
On the motion relating to the draft Marriage (Same Sex Couples) Act 2013 (Consequential and Contrary Provisions and Scotland) Order 2014, the Ayes were 365 and the Noes were 103, so the Question was agreed to.
On the motion relating to the draft Overseas Marriage (Armed Forces) Order 2014, the Ayes were 368 and the Noes were 98, so the Question was agreed to.
I now call Alex Cunningham.