Junior Doctors Contract

Alex Cunningham Excerpts

Friday 20th November 2015 Commons Chamber

[Alistair Burt]

As we all know, the pay of a junior doctor varies. As the Secretary of State has made clear, there will be an 11% increase in basic pay; antisocial hours will still be covered; junior doctors will work fewer hours to ensure greater safety; and there will be more cover at the weekends to ensure that the burden junior doctors bear is more equally shared.

[Alex Cunningham (Stockton North) (Lab)]

As my hon. Friends have said, the absent Secretary of State has lost the confidence of almost everybody in the NHS, to the point that consultants, nurses and others support junior doctors in their fight against him. Morale is at an all-time low and the deficit runs into billions. How will Ministers get the NHS out of this very dark hole?

[Alistair Burt]

First, we will avoid the language of “fight” and the sense that this has become an industrial dispute, although there are elements of one, given how the BMA has behaved over the negotiations. As far as the public are concerned, however, this is not an industrial dispute: it concerns them very deeply. They appreciate and value their doctors, they want to have their treatment and they want to be safe. People must talk. The BMA, which withdrew arbitrarily from the negotiations, needs to take up the Secretary of State’s offer and start talking. We all know that ultimately this will be ended by talking. Whether that happens today or after 1 December is entirely up to the BMA. I repeat that the Secretary of State is right to be spending this morning dealing with the potential consequences of the action suggested, and I still wait to hear from any Opposition Member that they reject strike action by doctors.

National Health Service

Alex Cunningham Excerpts

Wednesday 21st January 2015 Commons Chamber

[Andy Burnham]

I want to make some more progress; I will give way later.

We need to know the reasons for the increase in A and E attendance. Safely meeting that demand would require an extra eight accident and emergency departments in England, but the Government have been closing, not opening, A and E’s. That is why there is so much pressure in the system.

There has been an even more dramatic increase in the last year. NHS England figures show that there were an extra 446 extra visits to A and E in the 2014 calendar year. That is a dramatic change on the Secretary of State’s watch and the time has come for some honesty from him about the real reasons for it. Until he faces up to those reasons, however uncomfortable they may be for him, he will not be able to develop a proper solution and the situation will get worse. We cannot let that happen.

Let me list what I believe are the decisions of this Government that led to the increase. I will identify four and take each in turn. The first, as Opposition colleagues mentioned, is the decision to scrap NHS Direct and replace it with the flawed NHS 111 service. NHS 111 was originally intended to be a call-handling service, and indeed was conceived by the previous Government. It was intended to simplify access; it was intended to patch people through to the relevant agency, be it the GP out-of-hours service or NHS Direct.

However, when the present Government came into office, they made a major change: they decided that NHS 111 would not signpost NHS Direct but replace it. That was a major mistake. The established and trusted NHS Direct model, a single national contract in the public sector, was replaced with 46 patchwork contracts in the public and private sectors across the country. They replaced the model of nurses on the end of the phone, to provide reassurance for families, with call handlers and computer screens. As a result, where 60% of calls to NHS Direct were handled by nurses, with NHS 111 it is only 20%.

But the present system of call handlers and computer screens is not a case of “computer says no”. The problem is that too often it is a case of “computer says, ‘Go to A and E.’” NHS England figures show that there has been a dramatic increase, in the last year, in the number of people calling NHS 111 who are referred to A and E, or to whom an ambulance was dispatched. In November 2014, there were 67,000 referrals to A and E—a 26% increase on the same month in 2013—and 108,000 ambulances dispatched—a 20% increase on November 2013.

[Alex Cunningham (Stockton North) (Lab)]

All these problems have led to an increase in the number of days that people are taking off as a result of stress—nurses especially. Thousands of days are being lost to the system, adding to the crisis. Should we not be appreciating the staff in our NHS hospitals, and maybe starting by awarding them the 1% pay rise that the pay review body recommended for all of them?

[Andy Burnham]

The Secretary of State’s decision to reject the independent advice of the pay review body about what was fair and affordable, and to single out NHS staff for exclusion from the promise that the Chancellor had made that the public sector, as part of his restraint policy, would get 1%—to say that NHS staff would get less than that—was a kick in the teeth, and was to risk staff morale just at the moment that the NHS needed to be recognising and rewarding those staff, who are working so hard to keep things going. To make inflammatory comments such as those that the Secretary of State has made in the newspapers today is the wrong response. He should be getting back round the negotiating table with those staff. He should be working with them to find solutions. They are keeping the NHS going right now, and they deserve a bit better than they have had off this Secretary of State.

Oral Answers to Questions

Alex Cunningham Excerpts

Tuesday 25th November 2014 Commons Chamber

[Mr Hunt]

I recognise those issues, and I am very happy to take that suggestion away. I particularly want to put on the record that the scare stories put out by Labour in Lancaster about the potential closure of Royal Lancashire Infirmary are false. It is totally irresponsible to scare people in Lancaster in that way.

[Alex Cunningham (Stockton North) (Lab)]

T3. My constituent Corron Sparrow was left lying in the road for two hours with a compound fracture of his leg despite a call from a policeman to the North East Ambulance Service pleading for help. Eventually the service responded by sending an ill-equipped St John Ambulance team who then had to call for professional assistance. There are many more failures. It is now three weeks since I wrote to the chief executive, Yvonne Ormston, asking for an inquiry into this, but she has not even acknowledged my letter. Will the Minister intervene and tell the North East Ambulance Service that it cannot just ignore these matters?

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I am very sorry to hear about the difficulties experienced by the hon. Gentleman’s constituents, and of course I am happy to look into those and do what I can to help him with that. However, I would also like to make it clear on the record that because this Government have put £15 billion more into the NHS during this Parliament, we are making sure that we are keeping services running efficiently through the winter for the benefit of patients.

Five Year Forward View

Alex Cunningham Excerpts

Thursday 23rd October 2014 Commons Chamber

[Mr Hunt]

They are not forced against their will to outsource. They make the decisions as to where they want to purchase services from, and they do so on the basis of what is best for patients. Just like the primary care trusts that they succeeded, they have to follow European law in the way that they do that.

[Alex Cunningham (Stockton North) (Lab)]

The growing funding gap over the next five years is a real cause for concern. Can the Secretary of State tell me whether, after five years of changing plans, scrutiny and prevarication, we will finally get approval from his Department and the Treasury for the new North Tees and Hartlepool hospital, or will I have to wait for my right hon. Friend the Member for Leigh (Andy Burnham) to approve it after the election?

[Mr Hunt]

I have met the chief executive involved and heard their case for that, and we are processing it as fast as we can.

Mitochondrial Replacement (Public Safety)

Alex Cunningham Excerpts

Monday 1st September 2014 Commons Chamber

[Alex Cunningham (Stockton North) (Lab)]

I want to tell the story of a Stockton family with a vested interest in what happens in this Chamber today.

Baby Jessica Newall was carried into my advice surgery by my constituent and her uncle, Martin Holliday. He put her pram seat on the table and we were introduced. Jessica looked like any other young baby: pretty in pink and seemingly content. If it had not been for the feeding tube disappearing into her nose, I would never have known that there was anything amiss. She brought her mum, Victoria, and her grandparents. They were there to win my support for mitochondrial replacement technique, which would help ensure that everything possible was done to minimise the possibility of a baby being born with faulty mitochondria and having to suffer as I am sure Jessica does.

I listened carefully to Jessica’s mum who very calmly and with great personal strength told me Jessica’s story. Jessica will not live much longer—perhaps only a year or two. She cannot be fed naturally and relies on a feeding tube. Her body will not develop, which means that she will not grow and her internal organs will deteriorate. She cannot communicate like other babies. Perhaps worst of all, Jessica often wakes up screaming in terror and there is nothing her parents can do but hug her and comfort her.

Victoria told me that there is no cure or treatment. She went on to tell me about what she saw as the answer for giving women like her a chance to have a baby without the substantial risk of that baby suffering from the disease. I know that we cannot make decisions on the basis of emotion, and yes, Jessica’s story is heartbreaking and charged with emotion that would affect any caring person, but it is also an accurate factual story demonstrating the devastation that mitochondrial DNA diseases can cause. That demands action from Ministers and this House of Commons.

We also need that positive action for many other reasons too. Even in less severe cases, mitochondrial disease can have an overwhelming impact on families, and the Government’s consultation recognises the

“painful, debilitating and disabling suffering, long-term ill-health and low quality of life”

that all too often result.

The north-east England Stem Cell Institute described these disorders as

“a cruel class of inherited disease, because serious, even life threatening conditions are coupled with great unpredictability about how future children will be affected.”

There is no cure, but there has been lots of research and we have seen some progress in this area. It is an inescapable fact that medical advances such as these will trigger ethical conundrums and challenge us actively to consider how we perceive the sanctity of life. I agree that there are safety issues. This is not without risk, but if we are to avoid this horrific suffering in the future, we need the regulations now to make the necessary progress and help ensure that we do not have more babies like Jessica.

Oral Answers to Questions

Alex Cunningham Excerpts

Tuesday 10th June 2014 Commons Chamber

[Mr Jeremy Hunt]

I agree with my hon. Friend that it has to be done on the basis of evidence. Part of that is an important change that the Government have made, which the Labour party criticised a great deal. We have depoliticised the process by giving it to NHS England, where it is decided at arm’s length from Ministers on the basis of need. It is challenging to do it fairly. There are some historical imbalances, and we have to do what we can to address them, but we have to do it in a way that is fair and is not tarnished by party politics.

[Alex Cunningham (Stockton North) (Lab)]

T4. Health inequality on Teesside is a major issue, but the Government axed plans for our new hospital four years ago. I am told that Ministers now accept that a new hospital to replace the two hospitals at North Tees and Hartlepool is the right way forward. When will they remove the barriers to the project and give the support that is needed?

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

That is certainly something that we will look into.

Health

Alex Cunningham Excerpts

Monday 9th June 2014 Commons Chamber

[Mr Hunt]

I am going to make some progress, and then I will give way.

The NHS is about more than just getting through difficult winters. Looking to the future, this Government will continue to take the bold steps necessary to prepare our NHS for the long-term challenges it faces. There are two key areas for action if we are to rise to this enormous challenge. First, we must never turn the clock back on Francis. The NHS will never live up to its founding ideals if it tolerates poor or unsafe care. The last Government presided over an NHS in which doctors or nurses who spoke out were bullied, in which problems at failing hospitals were brushed under the carpet and in which vulnerable older people were ignored and, tragically, on occasions, treated with contempt and cruelty. This Government have stood up for the patient, championing high standards with a new culture of compassionate care which is now transforming our health and care system.

[Alex Cunningham (Stockton North) (Lab)]

The Secretary of State has already admitted some of his own failures this afternoon. Does he not think that some of the money he invested in his £3 billion reorganisation of the national health service could have been used to ensure that the NHS was hitting its targets today?

[Mr Hunt]

Perhaps the hon. Gentleman would like to look at the facts relating to the actual cost of the reorganisation. The net saving as a result of it has been more than £1 billion a year, and we are now employing 7,000 more doctors and 3,000 more nurses than when his party was in office. Last year, as a result of this programme—

--- Later in debate ---

[Andy Burnham]

I will give way to the hon. Gentleman before the end of my speech, but not now; I will do so when I am ready, because I want to develop my point, which is this: a successful NHS was thrown into chaos by reorganisation. Four years after Lansley’s big bang, the dust has still not settled. People out there are struggling to make sense of the 440 NHS organisations that have replaced the 163 that the Government inherited. They cannot make it all fit together and so are still sweeping up the mess. It was always nonsense to commission local GP services from a national level. To correct that, NHS England is now suggesting a new round of structural changes. This is the reorganisation that never ends. It is now rumbling into the fifth year of this Parliament. In fixing one problem, I fear the Government are going to create another—a local conflict of interest with GPs commissioning GPs. The truth that they do not like to face is that the former Health Secretary presented a defective and confused plan, and they now know, in their heart of hearts, that instead of pausing it, as they did, they should have stopped it altogether. They did not, and however much they tinker it will never make sense.

That is why the only Bill in the Gracious Speech with any link to health is the one that tries to clear up the mess of reorganisation. The small business, enterprise and employment Bill restricts redundancy payments to public officials. If ever there were a Bill that locked the stable door after the horse had bolted, this is surely it. When the Health and Social Care Act 2012 went through the House, there were repeated warnings from Labour Members, including my hon. Friend the Member for Leicester West (Liz Kendall), that the reorganisation would result in primary care trust staff being made redundant and then rehired, with, as a result, a huge waste of NHS resources. In June 2011, the Leader of the Opposition challenged the Prime Minister in this House on precisely that point. The Prime Minister failed to act on the warning. As a result—these are shocking figures; Government Members should listen to them—over 4,000 people have subsequently been made redundant and then rehired within the NHS. In the first three years of the reorganisation, there have been over 32,000 exit packages, averaging £43,500, and 2,300 six-figure pay-offs, 330 of which were worth more than £200,000. The total bill is £1.4 billion and counting. What a scandalous waste of NHS resources when people are waiting longer for cancer care.

We always know when this Government are on the ropes: it is when they furiously try to blame the previous Government. This time, they cite employment contracts, but that excuse will not wash. Given that they were explicitly warned about this when their health Bill was going through the House before the reorganisation took place, people will ask why on earth they did not bring forward the measures on redundancy in this Queen’s Speech before the NHS reorganisation, not after it. It all adds up to mismanagement of the country’s most cherished asset on a spectacular scale.

[Alex Cunningham]

I would like my right hon. Friend to know about Port Clarence, a very isolated community in my area which lost the nurse it had for four hours a week. People are having to go through a tremendous tangle within the NHS to find out who is responsible. The local doctors cannot commission the service because they provide the nurse, so they have to go to NHS England, yet we cannot get any progress. It is a terrible state of affairs.

[Andy Burnham]

This is the point. The NHS is still struggling to make sense of the mess that the Government inflicted on it. Just when it needed clarity and leadership, what did it get? It got drift and chaos. That is the problem it is struggling to deal with.

The redundancy payments did not only cost £1.4 billion; they have also cost the NHS dearly in lost morale. I ask the Secretary of State to imagine how these redundancy payments and six-figure pay-offs look to the staff to whom he has just denied a 1% pay increase—an increase that would have cost a fraction of that £1.4 billion. The truth is that he does not know how they feel because he refused to meet front-line staff protesting about his decision at the NHS Confederation conference. Well, I did meet them, and I can tell him how they feel. They find it truly galling and feel that they have been singled out by the Secretary of State, whose decision seems like a calculated snub. May I suggest that he urgently reconsider this approach and find the time to sit down with staff representatives? Right now, a fragile NHS simply cannot afford a further drop in staff morale. The Chancellor promised this increase and the pay review body judged it affordable; the Secretary of State should honour it.

The truth is that a whole lot more is needed if the NHS is to be put back on track. It finds itself today in a dangerous place. It is facing escalating problems but has a Government who will not talk about them.

--- Later in debate ---

[Jackie Doyle-Price]

I cannot agree with the hon. Lady. The important thing is that Government Members make it clear to the NHS that we expect it to put the interests of patients at its heart. I want again to draw attention to what has happened in Basildon and Thurrock university hospitals trust because it is perhaps the best example of the profound change we have had in NHS culture over the last five years. We now have a Government, and leaders within the NHS, who are finally prepared to face up to what is going wrong and to deal with it, rather than to cover up, be complacent and say, “We’re no worse than anyone else.”

I have to say that it has been a turbulent journey for those of us involved in Basildon hospital over those five years. The shadow Health Secretary, who is not in his place, will recall coming to this House in 2009, at the same time as he spoke about Mid Staffordshire, to highlight exactly what was going wrong at Basildon. Since then I have had a number of conversations with senior managers in which I was told, “Well, we’re no worse than anyone else. You’ll find this everywhere.” That was not good enough, but after two and a half years of not making any progress at all, Members of this House had very robust discussions with Monitor and said, “This needs proper intervention.” That led to a complete change in the leadership. A new board was appointed that was more inclined to give challenge where it was due. We had a leadership team that put stronger emphasis on good clinical leadership, and a chief executive was appointed who was determined to make sure that Basildon hospital delivered the standards of care that all patients deserve. What we have had is cultural change, and cultural change comes from leadership; it does not come from legislation. As I have said in many contexts, any organisation is a creature of the person at its top, so when we get good leadership in individual hospitals we get a step change in performance.

I also wish to pay tribute to the Secretary of State for the continued emphasis he places on patients, because when the head of the NHS—the person operationally responsible here in Parliament for performance—is articulating that, it will spread the cultural change which will deliver the real change in performance. I pay tribute to Clare Panniker, Basildon hospital’s current chief executive, who has delivered this significant change in the 18 months she has been in post. She has taken Basildon from being one of the worst performing hospitals to a position where it is coming out of special measures. She has been ably supported by the chairman of the trust, who has also been prepared to give a robust challenge and to stand behind her when she was doing so. Most of all, I wish to pay tribute to all the staff at Basildon. It has not been easy for them—it has not been good for their morale to see in the newspapers regular reports of the latest horror story of poor care within the trust—but they have reacted to the cultural change that Clare Panniker has brought. They have bought into it and given good, honest feedback, and I no longer get whistleblowing letters from staff about the latest incident. They have procedures to act on things and the management then implement that change. It says a lot about the commitment of the staff in that hospital that they have bought into that process and delivered us to where we are now. We all need to learn that sunlight is indeed the best disinfectant. It is not good enough to pretend that there is not a problem when there so clearly is, and it is important that we continue to put patients at the heart of the NHS. Only by doing that will we be able to ensure that the incidents witnessed at Mid Staffs and Basildon will become a thing of the past.

I wish to turn my attention to another issue that was not mentioned in the Queen’s Speech but which is on the Government’s legislative timetable for the coming year: the plan to introduce standardised packaging for tobacco products. I have to say to the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb) that it is a very bad idea. I fully support the policy objectives of tackling tobacco consumption and, in particular, of dissuading and preventing children from ever taking up smoking, but I have worries that this tool is not effective and that its unintended consequences may bring about worse health outcomes than doing nothing at all. Sir Cyril Chantler is said to have examined that as part of his review, but I am not persuaded of the evidence. In particular, I believe that introducing standardised packaging will worsen the public health outcomes if unregulated illicit tobacco products replace the regulated ones. We all know how toxic regulated cigarettes are, but when unregulated products enter the market the health outcomes will be very much worse.

Sir Cyril Chantler has concluded that Her Majesty’s Revenue and Customs has been very effective in tackling contraband and illicit tobacco, and he has cited figures going back to 2001. Although they show an improvement, the nature of the problem has changed over that period. European Union enlargement took place during that time and there was an immediate rise in the amount of illicit tobacco, but that has been tackled, mainly through co-operation with tobacco manufacturers. That illicit tobacco was also a legal product, whereas the illicit tobacco coming into this country today is not from Europe and it is not from regulated markets; it tends to be made in places such as China and Indonesia. Some of these products are extremely nasty, with tobacco rolled with whatever is available and containing high levels of tar. I commend The Sun for the exposé it ran last week in which an illicit producer from Indonesia explained just how toxic some of his products are and how standardised packaging will help him make money by reducing the costs of production.

[Alex Cunningham]

The Government’s own inquiry showed that there would not be an increase in the amount of illicit tobacco traded in this country. Does the hon. Lady not trust her own Ministers and the report they commissioned?

[Jackie Doyle-Price]

I was quoting that report and challenging its conclusions, which are based on a flawed analysis of the market—that is what I have been trying to explain. No, I do not trust that report. It is superficial and it has been put together with a particular agenda. As I say, it will lead to unintended consequences which will be very bad for public health.

My constituency contains Tilbury docks and the Purfleet ferry terminal. Despite the best efforts of Border Force, Essex police and the port of Tilbury, these products are getting through. Despite large seizures every week, Border Force does not believe that it is getting even 10% of the illicit product that is coming into the marketplace. It is estimated that one in three cigarettes smoked in London are illicit, and a good proportion of them will come through the ports in my constituency. Standardised packs will inevitably reduce costs for illicit manufacturers, who will be able to produce the product without differentiation in brand. I believe this proposal is a charter for a lot of very nasty people to make a lot of money, and if they do, the health outcomes we wish to see will not be achieved.

Let us be frank: we are talking about packets of cigarettes sold from holdalls behind pubs for a couple of pounds. Children do not start smoking by walking into their newsagents and picking a branded product; they are introduced to smoking via that holdall, at the back of the bike sheds or at the back of pubs. When cigarettes become that cheap, because of the proliferation of illicit products in the market, these children will be smoking some very nasty things. I ask Ministers to think again, because this is not the best tool for achieving a reduction in smoking and there will be unintended consequences for public health. I ask this Minister to sit down with Border Force and understand just how difficult the fight is that it is waging against serious organised crime and smuggling.

Francis Report

Alex Cunningham Excerpts

Wednesday 5th March 2014 Commons Chamber

[Andy Burnham]

I hope that the Secretary of State was listening to my hon. Friend. The point I was making—he did not like it—was that there is plentiful evidence that the NHS has gone downhill in the 12 months since the publication of the Francis report. The chaos in A and E has increased, and pressure on mental health services has reached almost intolerable levels.

Trusts face great difficulties in recruiting sufficient A and E doctors—a central issue in the Francis report, as it addresses safe staffing numbers.

[Alex Cunningham (Stockton North) (Lab)]

I agree that this is a debate about the whole NHS, and the 111 service is failing people. On Saturday night, I had direct experience of that with my six-month-old grandchild. I phoned the 111 service, but nobody could tell me when I could speak to a doctor. What did I do? I went to A and E.

[Andy Burnham]

That is the problem. The Government’s focus is on hospitals. All the while, alternatives to A and E are being degraded and taken away. It is an undeniable fact that it has become much harder to get a GP appointment under this Government. The Patients Association warns that it may soon be the norm to have to wait for up to a week. [Interruption.] The Secretary of State says, “Nonsense.” He should get out and speak to people. The people I speak to tell me they are getting up in the morning and ringing the surgery at 8 am or 9 am, only to be told there is nothing available for weeks. As my hon. Friend the Member for Stockton North (Alex Cunningham) said, they ring 111 and the advice given is to go to A and E.

The Government have created the situation that the Secretary of State will not address. He wants to put it all in his own terms, but this is the reality in the NHS right now and this is what has happened since the publication of the Francis report. He has put more pressure on hospitals, because he has made it harder for people to get a GP appointment, and hospitals today face greater difficulty in meeting their targets. Indeed, as I just said, in the 12 months since the Francis report, hospital A and Es have missed the target 32 times running. These issues go to the heart of what we are debating today.

--- Later in debate ---

[Alex Cunningham (Stockton North) (Lab)]

Thank you, Mr Deputy Speaker. It is an especial pleasure to follow my near neighbour in the north-east of England, my hon. Friend the Member for Easington (Grahame M. Morris), and I agree with everything he said. I was particularly interested in his reference to the reduction in tariff costs, which made me think about the new hospital we were planning to replace the Hartlepool and North Tees hospitals. That is yet to be delivered, despite its being crucial to health care in the area we both represent. I am hoping that we may soon hear from the Government that they are going to approve the assistance we need to deliver it, which will help us cope in that part of the world with the reduction in the actual tariffs.

Our national health service is for millions one of the world’s success stories of the second half of the 20th century, with teams of dedicated people—from porters and reception staff to nurses and consultants—who have risen to the challenge of change and innovated to do the best for our people. As a result, the NHS has survived and largely prospered despite the often unnecessary burden and restrictions placed on it by Government.

I am pleased to have learnt this afternoon that the future of the health service is in good hands: during this debate, I heard from my great niece, Meghan Quarne, who has just managed to secure a place at the Edinburgh medical school, so I am one very proud great-uncle this afternoon.

Yes, the NHS has been a success story, but there have been many failings that have devastated families, health professionals and politicians. We must never minimise the impact of failures that have occurred under different Governments at, for example, Bristol, Alder Hey and Mid Staffs. We must take action to ensure that we improve what we do in the NHS.

I also recognise that a number of trusts have been placed in so-called special measures. That is good not because of the things that are going wrong, but something is being done about the problems so I look forward to seeing the improvements that we all desire.

Of course it does no one any credit to play the political blame game. Members from current and previous Governments must recognise that things do go wrong, sometimes badly, and that everyone should work co-operatively to drive the improvements that we all want. That said, we must also recognise that the NHS is still a success story. It is treating more people with more complex conditions as well as the routine ones. However, the Francis report exposed an organisational subculture within parts of the NHS that was guilty of persistently compromising patient safety, jeopardising the quality of care and tarnishing the experience of the NHS as a first-class health care system.

In the most extreme examples, the failings identified in the Francis report have resulted in patients dying needlessly owing to dehydration and exposure—yes, severe neglect. It is unquestionable that such deficiencies resulted in suffering being needlessly caused to large numbers of patients. The report highlighted a wide-ranging and complex mix of failings, which included a board that was more focused on finance than on the quality of care received by patients; chronic understaffing that impacted on the ability to provide the care required; and a culture of poor practice and neglect that many staff felt powerless to challenge.

There can be no doubt that the situation was utterly abhorrent and should never have been allowed to arise, let alone be repeated. The NHS Confederation was candid, but accurate, in describing the failings at Mid Staffordshire as

“a nadir for the health service.”

In short, there are lessons to be learned from the ordeal—lessons that need to be learned quickly and thoroughly. The recommendations made by the Francis report some 13 months ago were therefore squarely aimed at addressing and improving that frame of mind within trusts through increased levels of transparency and by placing greater focus on the quality of care being delivered.

Although it is important that we recognise that genuine culture change is a slow and evolutionary process that could take time, particularly when some of the changes in question are centred on sensitive issues such as the ability to raise concerns, it cannot be an excuse for risking further neglecting patients by failing fully to address each of the core concerns that were identified.

It is therefore disappointing that the Government have taken an inconsistent, scattergun approach to the report’s findings, ploughing ahead with a damaging top-down reorganisation of the NHS, cutting thousands of nurses and delivering a crisis in A and E. That course of action is destined to weaken and destabilise the NHS, not remedy the problems that have already been diagnosed. It must be a matter of concern that the recommendations that Francis made appear to be some considerable way off becoming a reality.

With the health service’s resources being limited in the face of rising demand for health care, coupled with an increasingly complex system of commissioning services that can involve many layers of bureaucracy and administration, it is more important than ever that the Government acknowledge the limitations that exist to transforming the culture of the NHS through legislation alone.

Although the Government accepted the report’s recommendation to introduce a duty of candour to organisations, they rejected the recommendation to extend that duty to individuals. My hon. Friend the Member for Easington mentioned that earlier. However, those individuals—the leaders and professionals in the NHS—are central to transforming care.

All parts of the NHS—from the ward to the board—have a role to play in creating a more open and honest health service. Every member of staff, regardless of role or seniority, should therefore see providing dignified, compassionate care to all patients as central to their duty. The vast majority of them do so, but I am still apprehensive because an organisational duty alone will not help individuals challenge an organisation with a dysfunctional culture. A simple duty on an employer will not encourage employees to come forward if they are not already motivated to do so by a professional code of conduct.

It is worth noting that an inherent tension remains between prioritising the quality of care delivered to patients and pushing the importance of financial performance. This is particularly true if increasing front-line staff numbers is viewed as the main route to improving safety and quality at the expense of an unnecessary and complicated reconfiguration of care pathways and services.

The Francis report identified one of the root causes of the terrible failures at Mid Staffordshire as a fundamental lack of staff, and many people have talked about that. Although some of the failings were the result of unprofessional behaviour on the part of individuals, the factor overwhelmingly responsible for many of the failings was a lack of staff. Yet, despite this finding, there are now thousands fewer nurses and front-line staff in the NHS than in 2010, with 7,000 front-line staff being made redundant between 2010 and 2013.

Achieving the excellent results and care that patients demand and deserve is dependent on a number of factors, and adequate staffing is certainly central to achieving that goal. However, excellent care requires not only the appropriate number of staff but, importantly, staff with the correct mix of skills. Those skills include a range of factors, including leadership, staff engagement and appraisal.

Although I appreciate the attraction of nationally set minimum ratios of nurses to patients, it is important that we recognise that this is an over-simplification that does not necessarily represent the safest way forward. Not only would a minimum staffing level remove the flexibility required to meet the changing needs of patients, but a nationally set minimum would run the risk of being seen to constitute a ceiling rather than a floor. Instead, appropriate staffing and the best mix of skills are perhaps best determined locally, based on robust evidence and local circumstances.

I well remember that, when I was a non-executive director of the North Tees and Hartlepool NHS Foundation Trust, we had a fantastic chief nurse—her name was Smith—who led a tremendous team. She inspected the wards. She took a team of people on to the wards. They talked to the patients. They looked under the beds. They dragged their hands across the top of the wardrobe units to test their cleanliness. They did a full and thorough check. They talked to the staff. They put nurses at the centre of patient care—something that is absolutely critical today.

Although there has been a small increase in the number of hospital-based nurses in the past year, a paper from the NHS regulator, Monitor, analysing foundation trusts’ plans for 2013 to 2016, shows how temporary increases in nurse numbers this year, 2013-14, will be outweighed by larger cuts to nurse numbers over the next two years. Indeed, the paper suggests that hospitals are planning to “significantly reduce nurses” from next April and that the temporary rise this year is just

“a short term fix for operational pressures”.

Specifically, the analysis shows that, although trusts are planning to increase nurse numbers by 2% this year—around 3,400—that will be followed by 4% cuts in 2014-15 and around 6,900 will go the year after.

There has never been any excuse for neglect by nursing staff. There has never been any excuse for what happened at Mid Staffs. But if, as Francis said, a lack of staff was fundamental to the Mid Staffs failure, that is surely the central lesson for us all, including the Government, to learn.

Children and Families Bill

Alex Cunningham Excerpts

Monday 10th February 2014 Commons Chamber

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

I rise to support Lords amendment 125 for the very simple reason that children have no choice about getting into a car. Every day, up and down this country, children are told to get into a car by their parents or guardians; they have no choice. I think that we should operate on the basis of the “Do no harm” principle. The facts are clear: 165,000 incidents of childhood disease are caused every year by passive smoking. Not all car journeys are short: a close family member of mine was made to get into a car and to travel many hours to go on holiday while a pipe was smoked in the car. Despite protests, that pipe continued to be smoked.

On enforcement, many laws are not properly enforced—like all hon. Members, I want full enforcement—but is anyone saying that we should abandon the law against driving while holding a mobile to one’s ear because it is not always properly enforced? I have written to my police force to ask how many convictions they have had for people holding a phone to their ear.

Yes, in a perfect world we would change this situation through education, and of course we should refrain from banning things unless we have to, but the fact is that too many children—an estimated 185,000 every day—have to put up with it. Against their will—they have no choice—they are told to get into a small metal unit. We are here to speak up for those who have no voice, which is why I am proud to support the measure tonight.

[Alex Cunningham (Stockton North) (Lab)]

I quote:

“I would ban smoking in cars where children are present. I would do that for the protection of children. I believe in protecting children. I would see it as a child welfare issue.”

Those were precisely my feelings when I introduced the Smoking in Private Vehicles Bill under the ten-minute rule exactly 964 days ago. I did so after a briefing from the British Lung Foundation, with which I have been proud to work ever since. My thoughts have not changed in the two and a half years since, and I am delighted that the day has come when hon. Members have the opportunity for a decisive vote to make life healthier for half a million children. Although I share the sentiment and could hardly have put it better myself, the words I started with are not mine; they date from February this year and are those of the then public health Minister, the hon. Member for Broxtowe (Anna Soubry).

In Committee in the other place, an amendment was tabled and supported by all political parties, with eight peers speaking in favour of the ban. Such is the cross-party nature of the measure. This will be the fourth time that Members of this House have asked for a definitive vote on the issue. After my ten-minute rule Bill failed to get a Second Reading, the noble Lord Ribeiro’s private Member’s Bill won support in the other place but failed to make progress in the Commons. In this Chamber, we tried to amend this Bill, but we failed again. Now, after sustained pressure from a cross-party group of Back Benchers and Lords, four measures are proposed in the Bill—including powers to bring in standardised packaging of cigarettes and to prevent smoking in cars with children present—and I welcome them all.

It is not just parliamentarians who support such a ban—quite the opposite. The changes are backed by many professional bodies and research groups. I have been delighted to work closely with other organisations, as well as the British Lung Foundation. The list is too long to name every person and organisation, but it includes Cancer Research UK, Action on Smoking and Health, the British Medical Association, the British Heart Foundation and Fresh, our own campaigning organisation that has done so much in north-east England. We must not forget the royal colleges and the 700 health professionals, who have already been mentioned.

Facts, figures and statistics in abundance have highlighted the appalling dangers of passive smoking, particularly to children and young people, and specifically in relation to smoking in vehicles. A plethora of studies have returned the same results: smoking in a vehicle significantly increases children’s exposure to harmful toxins and particulates. Numerous surveys and opinion polls have consistently shown that the public support such recommendations. I have no doubt that my fellow Members will draw attention to them as the debate progresses.

I want to focus on the arguments about enforcement and intrusion. It is important to remember that the police already have a number of duties with regard to private vehicles, and to recognise that the additional enforcement costs of a measure to outlaw smoking when children are present are minimal.

[Andrew Percy (Brigg and Goole) (Con)]

Will the hon. Gentleman give way?

[Alex Cunningham]

I will not.

Other hon. Members have mentioned the non-wearing of seatbelts, which is a tricky misdemeanour to spot if ever there was one. It needs an eagle eye, but the police routinely monitor drivers and passengers alike to ensure compliance with the law. The introduction of legislation in 2006 to make the use of appropriate child restraints mandatory for children under the age of 12 were also considered very complex, and similar concerns were raised at the time. However, implementation went ahead and has been successfully enforced.

To argue that it would be too difficult and burdensome for officers to spot the act of smoking in a car, or to identify whether a child is being carried at the same time, is therefore no excuse. Indeed, I argue that such actions are markedly easier to recognise than gauging the height of a seated child to ascertain whether correct restraints are used. To suggest that officers would be unable to identify such instances is to underestimate their competence. I take much comfort from knowing that when educational campaigns on seatbelts accompanied the legislation, seatbelt use shot up from 25% to 91%, and from knowing that Department of Health figures indicate that there was 98% compliance from the moment the smoke-free legislation was introduced. I hope that the instances of such rules being flouted would be few and far between as a result of Britons’ law-abiding nature. I remain confident that, as with compliance on seatbelts, such regulations would become largely self-enforcing. Let us not forget that it is the role of the police to enforce the law.

Unlike most adults, children lack the freedom to decide when and how they travel, and do not know how harmful second-hand smoke is. Other hon. Members have already covered that point, so I will not repeat it.

There are international precedents for action: South Africa, Mauritius and Bahrain have all outlawed smoking in cars with a child present, as have seven of the eight states or territories of Australia, nine—I understand it is soon to become 10—of the 13 states in Canada and six of the 50 states in the United States. One published study from Canada has documented a positive impact on reducing second-hand smoke exposure in the relatively short term after implementation. Positively, it did not find any displacement effects of smoking being shifted to the home. It is time that we followed suit, heeded public and medical opinion, and got out of the slow lane.

I am only too aware that a positive decision for a ban still requires the Government to introduce the necessary regulations. I hope that the Minister will indicate when that is likely. The evidence strongly supports the Lords amendment, and I urge that Members on both sides of the House do likewise and stand up today for the protection of children.

[Several hon. Members]

rose—

Accident and Emergency

Alex Cunningham Excerpts

Wednesday 18th December 2013 Commons Chamber

[Andrew Percy (Brigg and Goole) (Con)]

There is doubtless concern on both sides of the House about A and E and the health service in general, but there is also more than an ounce of political opportunism, some of which we have heard today. Not once did we hear any reference made to the Nicholson savings, which have put local acute hospital trusts under huge pressure, with £160 million taken out of the budget for the Humber area alone.

If we talk to the chief executives of the hospitals, we find that they say that it is not top-down reconfigurations or policy changes since the general election that have placed them under such pressure, but the Nicholson savings. I know that there is cross-party support for those savings, but we should all be as honest as possible in this place and ensure that we all accept a degree of responsibility for that challenge and the funding that it has taken out of our acute trusts, resulting in pressure on A and E departments—not just this year, but last year and in future years.

As I say, there is a huge degree of political opportunism going on about the NHS. It is clear that the Labour party has decided that this is going to be an issue at the general election. In my own constituency, the very people who stood silent when our hospital was losing its beds, when we were losing our hospital wards, when all our mental health beds were being taken away from us—these were the people who represented the town for the Labour party—now suddenly find themselves standing up and pretending to be NHS campaigners. The public see through it—and I am sure they will at the next election, too.

Similarly, we have heard not a single apology from any Labour Member about the 50,000 beds cut under their Government. We have heard a lot about how people turning up at hospital often find that there are not enough beds, but not once did a Labour Member defend the 50,000 hospital beds lost when their party was in government. That tells us all we need to know about the reason for this debate and for the general comments we have heard about the NHS recently. It is all about political opportunism; it is about the next election. I am sorry that our hard-working staff in the NHS—I work with them every weekend when I volunteer as a community first responder—are being placed in the middle of a dirty political game.

In my remaining minute and a half, I would like to talk about a couple of examples from my constituency that are helping to address the problem.

[Alex Cunningham (Stockton North) (Lab)]

Does the hon. Gentleman have the same problem in his area as we have in Stockton-on-Tees, where GPs tell me that people are being denied registration because their lists are unofficially being closed? If that is happening across the country, surely it is no wonder that there is unprecedented pressure on A and E departments.