NHS Trusts: Finances

Ben Gummer Excerpts

Monday 1st February 2016 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on what steps are being taken to improve the financial position of NHS trusts.

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

The House will know that in 2014, the NHS itself set out its plans for the next five years, which included a front-loaded funding requirement of £8 billion. As our economy is strong, this Government have been able to honour that request and will be funding it in full, including a down payment of £2 billion in this financial year ahead of the spending review period.

Next year, there will be an increase of £3.8 billion and taken together, we shall, therefore, be providing £10 billion towards the NHS “Five Year Forward View”. Within that context, there are a number of hospital trusts that are running a financial deficit, in large part because of the need to staff wards safely after what was learned in the aftermath of the scandal of Mid Staffs.

It is also the case that the best hospitals have begun to transform along the lines required by the NHS “Five Year Forward View”, but some have not. This has made the management of their finances all the more difficult. NHS Improvement expects that NHS hospital trusts will report an overall deficit for the current financial year, 2015-16. Savings achieved in the rest of the NHS have ensured that this overall deficit will be offset, so that the system as a whole will achieve financial balance.

For the next financial year, NHS Improvement will continue to work with trusts to ensure that they improve their financial position. To help them in this endeavour, the Department has introduced tough controls on the costs of staff agencies, a cap on consultancy contracts, and central procurement rules as proposed by Lord Carter in his review on improving hospital efficiency.

The House should know that the savings identified by Lord Carter come, in total, to £5 billion a year by 2020. The chief executive of NHS Improvement, Jim Mackey, is confident that taken together, these measures will enable hospital trusts to recover a sustainable financial position next year.

[Heidi Alexander]

I am afraid the Minister seems to be in a state of denial. He claims that the settlement secured by the Department of Health in the spending review will sort the financial pressures that hospitals are under, but either he does not understand the scale of the problem or he simply has his head in the sand.

In the past few weeks it has become abundantly clear that hospitals across the country are buckling under the strain of providing healthcare with an inadequate budget. Four out of five hospitals are now predicting a deficit. Monitor is reportedly assembling teams of management consultants to dispatch to up to 25 trusts in need of turnaround, and now we learn that, along with the Trust Development Authority, it has written to every hospital asking it to take urgent steps to regain control of its budget, including

“headcount reduction, additional to the current plan”.

Was the Minister or the Secretary of State aware that this letter had been sent? Did it receive ministerial approval? How many hospitals have subsequently had meetings to discuss headcount reductions? How many job cuts have been agreed as a result of these meetings? On the one hand the Care Quality Commission is telling hospitals they are unsafe, and on the other, Monitor is telling them to cut staff. So which one is it, Minister? What proportion of these so-called headcount reductions will involve clinically trained staff?

On Saturday the King’s Fund said:

“Three years on from Robert Francis’s report into Mid Staffs, which emphasises that safe staffing was the key to maintaining quality of care, the financial meltdown in the NHS now means that the policy is being abandoned for hospitals that have run out of money.”

Will the Minister now accept that his Government’s financial mismanagement of the NHS has made it impossible for some hospitals to provide safe patient care? Is it not the case that this Government have fundamentally lost control of NHS finances? Is it not clear that the only way Ministers are going make their planned £22 billion worth of efficiency savings will be to cut staff, cut pay and close services? I say to the Minister that it is time to stop the NHS doublespeak and just come clean.

[Ben Gummer]

The hon. Lady started by claiming that the Secretary of State and I were in a state of denial. Were she to look at the outcomes of the NHS this year compared with the last year that her party was in power, she might consider that the performance of the NHS has improved beyond measure. We have 1.9 million more accident and emergency attendances, 1.3 million more operations, 7.8 million more outpatient appointments and 4.7 million more diagnostic tests. This is an NHS that is performing more procedures, helping more patients and doing more for the people of this country than at any time since its foundation. I would therefore gently suggest that those in denial are her party and her. The service is working hard to try to deliver better patient care in a challenging environment.

The hon. Lady asked a number of subsequent questions about staffing levels and letters sent out by NHS Improvement, and I will endeavour to answer each in turn. She asked about the settlement the Treasury has reached with the NHS, and I would point out that that is precisely the settlement that the NHS itself asked for and that the Labour party refused to endorse at the last election.

The hon. Lady’s second question—or statement—related to the fact that there are teams of management consultants. That allows me to remind her that the numbers of management consultants have been cut considerably—by the previous Government and by this one—in contrast to what happened under the Labour Government, who increased the numbers of managers in the 13 years they were in power. We will make no apology for the fact that NHS Improvement and its constituent bodies are working hard with some of the most challenged providers to help to turn them round and to try to address the issues of efficiency and quality they all have. Is the hon. Lady somehow suggesting that they should not be doing that? Should they not be going round hospitals trying to help those that are not able to control their own finances? Should they not be doing what is needed to try to improve the quality of the care those hospitals provide? If that is her suggestion, it is a quite remarkable one, and one that should be more widely shared with the people she seeks to represent.

The hon. Lady talked about the letter sent out by NHS Improvement. Yes, the Department was aware of it, as it was aware of the letter sent out the same day by Professor Sir Mike Richards, of the Care Quality Commission, addressing the issues of quality that need to be tackled across the service. I know that this is news to Opposition Members, but there are not separate parts of the NHS issuing separate diktats. The letters issued on staffing and other issues in the last few months have been co-signed by Professor Sir Mike Richards, the chief inspector of hospitals, by Dr Mike Durkin, the director of safety at NHS England, by Jim Mackey, the chief executive of NHS Improvement, and by Simon Stevens, the chief executive of NHS England. This is one system addressing the particular problems that are evident in some challenged providers and making sure that those providers level up to the best. If the hon. Lady is not convinced of that, she should look at the co-signatories of those letters to see how they correspond one with the other.

The hon. Lady asked about the line in one of the letters about reductions in headcount. I point her to the reductions in the headcount of administrators that the Government have achieved over the past five years. We have managed to reduce the number of administrators in the NHS by 24,000, while increasing the number of clinicians by 16,000. Would the hon. Lady, while not promising the money to the NHS that it has asked for, ask it to maintain the same level of administrators in the years ahead, or would she back NHS Improvement’s plan to find efficiencies across the NHS, precisely so that the money that is spent on administrators can be spent better—on clinicians, on increasing the number of clinicians and on directing resources to the frontline? I know the hon. Lady is earnest in what she says about the NHS, but I cannot believe that she is really riding out in defence of increasing spend on back office at the expense of the frontline.

The hon. Lady asked about safe staffing ratios. She made a number of statements that, in retrospect, she might feel were somewhat irresponsible. The reason for that is that the letter issued about safe staffing in October last year, which built on advice given by the National Institute for Health and Care Excellence, was co-signed by Professor Sir Mike Richards, the chief inspector of hospitals, and by NHS Improvement and its two constituent bodies. It was a co-signed letter because quality and efficiency are two sides of the same coin. Those hospitals that are providing the highest quality of care in this country tend to be those that are also in control of their finances. Likewise, those that are struggling with quality tend to be those that cannot control their finances. If the hon. Lady were to suggest that, somehow, there is a binary distinction between the two—that there is a choice to be made between quality and efficiency—I would gently say to her that she is about a decade behind all current thinking on how a successful health service is run. It is about making sure that quality and efficiency go hand in hand, and the very best hospitals can achieve both.

In all this, the hon. Lady should avoid falling into the trap that her predecessor so often did of assuming that that there is some kind of trade-off between quality and efficiency, and also attempting a pretty low-level politicising of the NHS—an approach that was roundly rejected at the last election. I ask her to consider the counterfactual—that were she standing at this Dispatch Box now, having won the last election, she would not have had the £8 billion to invest in the NHS that we have managed to have, and she would not therefore be able to assure the public of continued improvements in the number of patients treated, an increased number of operations, GP numbers in excess of 5,000, which we have promised to deliver by 2020, record numbers of A&E admittances, and record numbers of out-patient appointments. She would have been able to promise none of that. That is why Conservative Members are proud to reaffirm that we are the true party of the NHS.

[Dr Sarah Wollaston (Totnes) (Con)]

We all welcome the front-loading of the NHS settlement, and want to congratulate NHS staff on the extraordinary efforts they are putting in to improve quality, alongside coping with rising demand. If NHS Improvement is tasking management consultants to come in and advise trusts on turning around financial problems, will the Minister also task it with looking specifically at issues of social care and how the interrelation between underfunding of social care impacts on the health economies of local trusts, and with looking at improvement and prevention, because prevention was also noted by Simon Stevens to be unfinished business from the spending review?

[Ben Gummer]

My hon. Friend will be aware of the increase in the better care fund that this Government have introduced and the 2% precept on council tax bills that will deliver increases for social care. She will also be aware that “Five Year Forward View” is a holistic understanding of the healthcare system that includes transformation of the NHS and social care towards that point. That is why we are proud to fund “Five Year Forward View” in the manner that Simon Stevens requested —front-loaded, with £3.8 billion in the next year. The manner of that bottom-up integration over the next few years will ensure that the challenge around social care that my hon. Friend identifies will be addressed in years to come.

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

With almost 80% of trusts running a deficit, I am not sure that we can say that it is just failing hospitals that are having problems. The Government talk about giving £10 billion upfront, but £2.2 billion of that is already written off in the deficit, and usually budgets are ascribed across the Department of Health, whereas Public Health England and Health Education England are losing money. With the £3 billion that is being clawed back from the areas that are not specifically under NHS England, it is actually £4.5 billion, not £8 billion, that is being put in. “Five Year Forward View” identified public health and prevention as crucial. The Government have a plan to recruit 5,000 extra GPs, but I am not sure how that can be done without Health Education England. The one thing that has so far been shown in evidence to impact on unnecessary deaths is a good, strong ratio of registered nurses to patients, so it is important that we look at how that will be funded. If trusts are not allowed agency or immigrant nurses, how are they going to do this? Why do we not get the National Institute for Health and Care Excellence to finish the piece of work on safe nursing levels throughout hospitals?

[Ben Gummer]

I thank the hon. Lady, who asked some salient questions that I will address. She asked about the deficits across the system. It is true that there are some particularly challenged providers where the heaviest deficits fall, and they account for the larger part of the accumulated deficit, but it has been a very challenging time across the system, not only because of the demographic challenges facing the NHS that have got worse in every year of this and the previous Parliaments, but because of the effect of the excessive charges of agencies levied after the increase in staffing levels in the wake of Mid Staffs. To seek to address that area, which makes up the majority of the cost of the deficit, we have brought in the controls not only on agency spend—on locums—but on very high salaries and on consultancy spend. Taken together, that will make a significant difference to hospital trust finances.

The hon. Lady talked about public health. We accept that that is a very important part of achieving “Five Year Forward View”. That is why, over the course of this Parliament, we will invest £16 billion in public health across England, to ensure that we can achieve the kind of transformation that she wishes to see.

On GP recruitment, we intend to have 5,000 additional GPs by the end of this Parliament. I am glad to say that Health Education England is so far meeting its targets in filling those training places. I congratulate its chief executive, Professor Ian Cumming, on the work he has done in that regard.

The hon. Lady mentioned safe staffing and the NICE guidelines. During the process of NICE looking at safe staffing levels, it became clear, as the chief nurse identified, that we need to look more broadly at team staffing levels, not just at individual positions on wards. I think that the hon. Lady in particular will understand that. That is why the chief nurse and Dr Mike Durkin were commissioned together to look at and build on the advice of NICE. The safe staffing guidance, which will be released in the next few months, will show a broader and more complex understanding of staffing levels, which I know the hon. Lady will appreciate from her time on the wards.

I want to be clear that that staffing guidance will be signed off only once it has the approval of NICE, Professor Sir Mike Richards, the Care Quality Commission and Dr Mike Durkin, the head of safety and quality at NHS England. It will require their imprimatur.

[Jeremy Lefroy (Stafford) (Con)]

Our experience in Staffordshire is that it takes a medium to long-term plan to put things right. I pay tribute to the work of the staff at the Stafford County hospital and the Royal Stoke University hospital. Will the Minister assure me that any measures put in place, both in Staffordshire and across the country, will take a long-term view and not be driven by the need to cut costs within a financial year? A five-year plan, at the very least, is vital.

[Ben Gummer]

I could not agree more with my hon. Friend. It is important to take a long-term view. That is something that has bedevilled the NHS under all kinds of Administrations since its creation. For the first time, it has a five-year forward view, which means that it can begin to transform properly. The very best trusts in the country, such as that in Northumbria, previously run by Jim Mackey, have been able to do that. We want to bring that kind of excellence to hospitals across England, to ensure that they provide the sustainable staffing and quality levels that my hon. Friend is beginning to see at Mid Staffs after the long-term view taken by that hospital.

[Mr Ben Bradshaw (Exeter) (Lab)]

Devon NHS had no deficit in 2010 when we had a Labour Government. It now has the worst deficit in England. What assurances can the Minister give my constituents in Exeter and those elsewhere in Devon that services and waiting times will not deteriorate even further?

[Ben Gummer]

I thank the right hon. Gentleman for his co-operation and help in trying to form the future of the NHS in Devon. This will work only if there is a cross-party effort, and the same is true of the national level. We have particular, urgent problems in Devon, and that means that the deficit will increase unless we take significant local action. That action needs to be led by local clinicians, and I am very glad that they are talking constructively. My job and that of the right hon. Gentleman is to provide support in the coming months so that we can have one plan that we can then implement.

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

Let me give the Minister an example from my constituency of how some of the challenges are affecting patients. My local hospital of Whipps Cross ended up downgrading the nursing bands in an attempt to save money. As a result, it now has a big crisis in staff morale, the CQC has intervened because of the quality of care, and it has a massive agency bill. Moreover, Whipps Cross University hospital is part of Barts Health NHS Trust, which has the largest private finance initiative deal in the country. It is due to pay back £7 billion on a £1 billion loan, and last year alone it paid out £148 million—half of which was interest—on its PFI deal. What is the Minister doing to help trusts renegotiate such costs and tackle these legal loan sharks of the public sector?

[Ben Gummer]

To ask about PFIs signed by the previous Government is a brave line of attack. I have held a number of meetings about Barts with the hon. Lady’s colleagues, and I completely understand the difficulty that she and they—and, indeed, the trust—find themselves in. I had a meeting about Barts this morning. I also had two last week, and I shall be having a further two this week and next week, precisely because I want to see the transformation she needs in her area. I am very happy to discuss that in greater detail with her. In fact, I will convene a meeting of local MPs in the near future.

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

The Government rightly front-loaded the extra money that the NHS called for in the “Five Year Forward View”, but it is vital that that money is used to drive transformation, such as the productivity improvement that is needed and the shift of care out of hospitals. Will my hon. Friend assure me that the money will go not just to plug deficits, but to change the way in which services are delivered?

[Ben Gummer]

My hon. Friend is entirely right and speaks from experience. That is why, as part of the spending review settlement, £1.8 billion was set aside as a transformation fund. The principle behind the transformation fund is that the money will go to those trusts that are beginning to show transformation in the way they are running not only their finances, but their whole operations. That is for the betterment of patients as a whole. We have to see transformation; otherwise money will be wasted, as it has been in years previously.

[Keith Vaz (Leicester East) (Lab)]

What help and assistance can the Minister give to the ambulance service in Leicester? On Sunday 24 January, 10 of the 25 ambulances that serve the whole of Leicestershire were parked outside A&E at the Royal Infirmary, trying to hand over patients to the staff. On 856 occasions in the last year, ambulances had to wait between two and four hours to hand over those patients. In Leicester we need not more consultants, but a better system of management.

[Ben Gummer]

The right hon. Gentleman raises an issue that has been severe in Leicester, and I am aware of it. I am happy to have a separate meeting with him to discuss the matter and what is being done about it. Across the country, however, we are seeing a rather better performance this winter than last. That is because of the extraordinary amount of planning done by the NHS, and because we are getting better at dealing with the extraordinary pressures that are placed on the NHS in winter. In Leicester, there has been a particular issue. I am aware of it, and I reassure him that it will be fixed in time for next year.

[Jason McCartney (Colne Valley) (Con)]

I welcome this urgent question, because clinical and patient decision making in Calderdale and Huddersfield NHS Foundation Trust is being dictated by a catastrophic PFI deal signed in 1998, under which Halifax hospital, which cost £64 million, will eventually cost the taxpayer £773 million. That has led to a proposal to close A&E at Huddersfield royal infirmary. Will the Minister please launch an urgent review into these catastrophic PFI deals? I look forward to exploring the matter further with him in my Westminster Hall debate tomorrow afternoon.

[Ben Gummer]

My hon. Friend should know that that review is already taking place in the Department of Health. We are looking again at the PFI deals that were signed by a previous Administration, who went around the country claiming to be building new hospitals without telling people that they had all been put on the credit card and that the bill would be paid by future generations and, in part, by the NHS itself. That is a great shame, and it has created a great deal of uncertainty for many trusts. I know that my hon. Friend has specific issues in Huddersfield, and we will answer them tomorrow in Westminster Hall.

[Norman Lamb (North Norfolk) (LD)]

Will the Minister make it very clear whether he accepts the view of Simon Stevens that if there is a funding gap in social care, which is projected to be the case in 2020 and before, it will simply increase the deficit in the NHS; and that the funding of social care remains “unfinished business”? Does he accept that case?

[Ben Gummer]

I accept the case for the “Five Year Forward View”. Simon Stevens was very clear that the relationship between social care and the NHS needs to be transformed. That called for an additional £8 billion into the NHS, which we have provided, and it required additional money for social care. We have provided that in the better care fund and the council tax precept.

[Mrs Anne Main (St Albans) (Con)]

West Hertfordshire Hospitals NHS Trust has been struggling for a very long time. For five of the 12 years from 1998 to 2010, it registered a deficit, which peaked at £27 million in 2005-06. It is struggling because of a backlog of repairs and maintenance to its elderly estate, through a lack of investment from the previous Labour Government. What more can be done to help hospital trusts that are struggling with a massive backlog of ongoing maintenance?

[Ben Gummer]

My hon. Friend is entirely right. I went to Watford a few weeks ago, and the buildings are in a poor state of repair. They do not enable clinicians to provide the high standards of care that they all aspire to; in many cases, it is difficult to do so. West Herts trust requires additional capital expenditure. I have talked with the trust about how it might realise that, and I am discussing that in the Department at the moment.

[Mr Iain Wright (Hartlepool) (Lab)]

I was contacted earlier today by a constituent. She had a scan last Tuesday, and the following day she was told that she required an urgent referral to a gynaecologist within two weeks and that she would be provided with an appointment within 48 hours. That did not happen. This morning, I was told by the NHS that no appointments were available anywhere, and that it had no idea when one would be available. My constituent is frantic.

In an earlier response, the Minister mentioned outcomes and increased numbers of appointments, but the reality of the NHS in 2016, for my constituent and millions like her, is that no funding or staffing is available not just for routine appointments, but for urgent appointments related to cancer. What will the Minister do for my constituent, and how quickly will he get a grip to ensure that appropriate funding is provided for the NHS?

[Ben Gummer]

During the course of the last Parliament and the beginning of this one, we have moved from being one of the worst performers on cancer outcomes in Europe to a position roughly midway in the table. We have done that through making rapid improvements in the work we do with people suffering from cancer. There is a lot more to do, but the money is flowing in and improvements to outcomes are being made. However, if there are individual cases, I will of course look at them, as I know will the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), who has responsibility for cancer services. I am happy to take this on as a personal case.

[Henry Smith (Crawley) (Con)]

During the past decade, under the previous Labour Government, the healthcare trusts that serve Crawley constituency had chronic deficits, and services such as A&E and maternity were closed at Crawley hospital. Services are now returning to that location. Will the Minister confirm that this Government will invest £10 billion in our NHS over the course of this Parliament, and will he say by how much the NHS is being cut in Wales, where Labour is in control?

[Ben Gummer]

I can confirm that the amount of money available to the NHS will increase by £10 billion over the course of this Parliament. However, this is not just about an infusion of money; it is about concentrating on quality and efficiency across the service. In Wales, not only has money been cut, but there has not been such a concentration on quality and efficiency, which is why outcomes are so much worse in Wales than they are in England.

[Daniel Zeichner (Cambridge) (Lab)]

The hospital in Cambridge that serves my constituency, Addenbrooke’s, is one of the trusts with the most challenging deficits. Today, it is urging people not to attend accident and emergency, which it explains by saying that it is seeing more and more frail, elderly patients. At the same time, the Conservatives in Cambridgeshire are refusing to levy the 2% that the Chancellor has offered them. We have a crisis in social care and health funding in Cambridgeshire. How can it possibly help hard-pressed staff at Addenbrooke’s to hear the instruction that numbers should be cut? Will the Minister assure me, patients and staff in Cambridgeshire that that diktat will be withdrawn?

[Ben Gummer]

No. I cannot assure the hon. Gentleman that we will stop trying to find efficiencies across the NHS. The important thing is to make sure that we channel money right to the frontline, which means doing so in his hospital, as in others. It will sometimes mean finding efficiencies in individual trusts and commissioning groups, and making sure that the money is rediverted. I should say to the hon. Gentleman that the problems at Addenbrooke’s go much further than A&E. The hospital is in special measures and there is much to put right. I am confident that that will be managed, under the stewardship of the new chief executive, who has proven himself to be excellent.

[Andrew Stephenson (Pendle) (Con)]

Will my hon. Friend the Minister thank the Secretary of State for supporting calls for extra investment in Burnley general hospital? The additional £15.6 million committed last year for a phase 8 development at Burnley general will create a state-of-the-art ophthalmology unit and allow the hospital to centralise all out-patients in one location. Following the new £9 million urgent care centre, this is the latest boost for our local hospital, which lost its accident and emergency department and other key services under the previous Labour Government.

[Ben Gummer]

The reality, as my hon. Friend recounts in relation to his own constituency, is that satisfaction in the NHS is at near-record levels, and that dissatisfaction in the NHS is at record lows. We rank No. 1 in the Commonwealth Fund rankings of hospital and health systems across the world. Far from the picture painted by Opposition Members, the fact is that people feel the NHS is getting better. There is increasing proof that the NHS is safe in the hands of the Conservative party, and it will continue to be so for the next five years.

[Nic Dakin (Scunthorpe) (Lab)]

The health economy in north Lincolnshire has been severely challenged for a number of years. When I meet the chief executive and others from the North Lincolnshire and Goole NHS Hospitals Foundation Trust, I get the impression that they are trying run up a finance escalator that is flying down towards them. What can the Government do to help in these circumstances?

[Ben Gummer]

I recognise the problems that the hon. Gentleman has identified at Northern Lincolnshire and Goole Hospitals NHS Foundation Trust and in north Lincolnshire. NHS Improvement is looking at them in detail at the moment. I hope that by working with the trust’s existing management, we will see an improvement over the next year. That is the point of what NHS Improvement is trying to do. I reassure the hon. Gentleman that if Jim Mackey produces the kind of results that he produced in his own hospital trust, his constituents will see NHS outcomes of a quality that has so far eluded them.

[Ben Howlett (Bath) (Con)]

I had the great displeasure of seeing at first hand the catastrophe that was NHS Connecting for Health under the last Labour Administration. It was therefore a bit rich of Labour Front Benchers to table this urgent question. Does my hon. Friend agree that this Government have introduced a strong regulatory regime and that joint investigations by NHS Improvement, the Care Quality Commission and Monitor will prevent future contractual failures?

[Ben Gummer]

I can give my hon. Friend that reassurance. Every Monday when I meet leading officials in the NHS, the people in the room are from the Care Quality Commission, NHS Improvement and NHS England. We make joint decisions. That is important because the system has to work as one. If the different parts pull in different places, we will not provide the solutions that we need. That is what has happened throughout the history of the NHS. For the first time, we have a system-wide response to the challenges facing the health service.

[Rachael Maskell (York Central) (Lab/Co-op)]

The CQC is downgrading trusts such as York Teaching Hospital NHS Foundation Trust owing to the national NHS staffing crisis. In addition, the trust will have an £11 million deficit for the first time at the end of this year. What risk assessment did the Minister make in respect of patient safety before the Government agreed to endorse NHS Improvement’s letter that advises trusts to cut headcount?

[Ben Gummer]

The hon. Lady is wrong. The CQC is not downgrading any trusts. It provides a very important function in the NHS that did not exist before, which is to give open and transparent accounts of how good the quality is in individual trusts. For the first time, patients can see whether their trust is safe, well led and effective. That means that there can be a proper and solid response where there are failings. In too many parts of the NHS, there is not the level of quality that other parts deliver. The CQC shines a light on where we need to improve. Our job, as part of the system with NHS Improvement, is to make those areas measure up.

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

My trust in Hull is predicting a deficit of £21.9 million by the end of the financial year. Following a CQC report a few years ago that criticised the staffing levels in Hull, a huge amount of effort has gone into increasing the staffing levels, but that has come at a cost, especially given the premium that is paid for medical staff. Will the Minister reassure my constituents that we will not return to the staffing levels that the CQC criticised in the past when dealing with the deficit of nearly £21.9 million?

[Ben Gummer]

I can give the hon. Lady that reassurance. When I was in Hull a few months ago, I had a fantastic series of conversations with clinicians—not just those who are leading the hospital, but those on the frontline in the wards—about how to address the staffing challenges in Hull and east Yorkshire. It is tailored responses to the problems in individual localities that will provide the quality of service in Hull that she wants for her constituents. I am committed, as are the staff in Hull, to ensuring that she sees it.

[Marie Rimmer (St Helens South and Whiston) (Lab)]

Will the Minister join me in visiting my local clinical commissioning group, trust and social services? The reason I ask is that St Helens and Knowsley Teaching Hospitals NHS Trust has just been rated “good” in four of the five areas and “outstanding” in care. The chief executive is managing Southport hospital to help there in the interim. She previously helped Warrington out of its problems. We have no problem with our chief executive and our staff are outstanding and work hard. However, we are having to recruit nurses from Spain. There is a wonderful working relationship between the CCG, the hospitals and adult social care, with lots of pooling going on. Nevertheless, Whiston faces a £7 million deficit and that is not down to the PFI tariff. [Interruption.] Sorry, Mr Speaker, I will come to the question. Will the Minister please join me for a constructive discussion with those people to see what is happening on the frontline?

[Ben Gummer]

I know that the Under-Secretary of State for Public Health was in Whiston last year. I was in Manchester a few weeks ago, and I plan to go back there and to the north-west in the next few weeks. I will be doing a regional tour, and I would very much like to meet the hon. Lady and talk to her trust’s chief executive. She raises an interesting point, which is that chief executives in many trusts across the NHS are of exceptional quality. It is often easy to knock managers in the NHS, but there are some fantastic managers, and I am sure that her constituency has one.

[Mr Speaker]

I say to the Minister in all friendliness that I hope the region is aware of his upcoming tour. It sounds a most exciting prospect.

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

Will the Minister think carefully about what has happened up and down the country? Health trusts such as mine in Calderdale and Huddersfield have run successfully for many years, but recently—I think this is something to do with the destabilisation of clinical commissioning groups—many problems have entered into the general life of those trusts. In Huddersfield we do not want the closure of A&E in our hospital, or the closure of the main hospital and its replacement by a much smaller one. Will the Minister look carefully and forensically at what has happened in the Huddersfield and Calderdale area? It is not just the whipping boy of the unfortunate independent financial arrangement that was negotiated under John Major but signed under Tony Blair.

[Ben Gummer]

The hon. Gentleman is an experienced Member of Parliament and, as he will know, there was a time when reorganisations and changes in the structure of the NHS, and the way that hospitals were disposed, was very much decided in Whitehall. That changed as a result of the Health and Social Care Act 2012, and such changes are now led by clinicians. The changes to which he alludes—which we will discuss tomorrow in Westminster Hall—are led by local clinicians, and ultimately the Secretary of State must defer to their opinion. An independent reconfiguration panel judges those changes, and so far the Secretary of State has always concluded that the panel and local clinicians have been correct. That is the right thing to do. In this case I hope and expect that we will do the same, but I will look carefully at the hon. Gentleman’s concerns, and ensure that I take them on board and relay them back to the CCG.

[Liz McInnes (Heywood and Middleton) (Lab)]

At Pennine Acute Hospitals NHS Trust, which serves my constituency, A& E attendances are at a record high, and this weekend the local paper carried the headline “Stay away from A&E unless it’s life or death.” The trust is predicting a deficit of £29 million by the end of the financial year, and although staff work hard in difficult circumstances, does the Minister truly believe that that is an example of a successfully run NHS?

[Ben Gummer]

There are many examples of success in the NHS, and hospitals, CCGs and community health organisations are delivering exceptional care within existing budgets. We must ensure that we spread that practice and approach to care across the NHS. Some parts of the NHS are not doing that, but with our ability to level up and “universalise the best”, as Bevan coined it, we will ensure that everyone gets the level of care that those in the best areas of the NHS already receive.

[Andy Slaughter (Hammersmith) (Lab)]

Last week Imperial College Healthcare NHS Trust reported a £25 million deficit, and announced a non-clinical vacancy freeze on top of 10% vacancy rates, and above-target use of agency staff. Its solution was to pay its chief executive £350,000 last year to oversee the downsizing of the major local hospital, Charing Cross. What is that other than a short-sighted and dangerous attempt to undermine the NHS?

[Ben Gummer]

Given the hon. Gentleman’s record of statements given to his constituents, whether on housing or hospitals, I would prefer very much comments from the clinicians running Imperial College NHS Healthcare Trust, than I do his own comments about this.

[Christian Matheson (City of Chester) (Lab)]

On the one hand, the Secretary of State is suggesting that he wants a seven-day-a-week NHS, which I presume is not an empty slogan, and on the other hand Ministers are calling for headcount reductions. That suggests that we are asking fewer people in the NHS to work longer hours. Does the Minister share my concern that that is a recipe for staff overstretch and increased pressure on staff, and therefore potentially for greater failings for patients?

[Ben Gummer]

If the hon. Gentleman had not mischaracterised the situation, he might have been able to ask a more coherent question. The fact is that NHS Improvement was looking for what savings could be made in back-office functions in hospitals so that that money could be recycled into the frontline. All I can say to him is that under this party the number of clinicians has increased by 16,000 since 2010. That is a record of which we are proud and on which we will continue to build over the next few years.

Draft General Dental Council (Fitness to Practise etc.) Order 2015

Ben Gummer Excerpts

Tuesday 19th January 2016 General Committees

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

I beg to move,

That the Committee has considered the draft General Dental Council (Fitness to Practise etc.) Order 2015.

It is a pleasure to be in the Committee with you in the Chair, Mrs Gillan. It is good to see hon. Members here and it is especially good to see the hon. Lady—I have forgotten her constituency, but it is good to see her back from maternity leave.

[Rachel Reeves (Leeds West) (Lab)]

Leeds West.

[Ben Gummer]

Leeds West. I will go through this as quickly as possible. If Members have questions, they may raise them and I will try to respond quickly as well.

The Dentists Act 1984 established the General Dental Council and set out the GDC’s functions and processes. The GDC is responsible for regulating the dental workforce in all parts of the UK. It has powers and duties that include setting the standards of conduct, performance and behaviour that dentists and dental care professionals are expected to adhere to. In addition, it is responsible for investigating any complaints or concerns that suggest that a dental professional may have failed to meet those standards.

The Government are keen to ensure that the GDC has an appropriate framework in place to allow it to carry out its statutory responsibilities effectively. The current legislation that governs the early stages of an investigation into a dental professional’s fitness to practise does not provide sufficient flexibility to enable the GDC to carry out that function in the most effective and efficient way. Legislative change is needed to address that.

The order, made under section 60 of the Health Act 1999, amends the Dentists Act 1984 to reform the investigational stages of the GDC’s fitness to practise procedures. The Department of Health publicly consulted on the proposals in the order and the vast majority of respondents agreed that the measure should be introduced and would have a positive effect on the GDC’s fitness to practise procedures.

Through this section 60 order, I propose to provide the GDC with the powers to make five key amendments to its processes. First, the GDC will be provided with a rule-making power to allow it to delegate the decision-making functions currently exercised by its investigating committee to case examiners. The GDC’s current framework requires that, following the triage of a fitness to practise complaint about a dental professional, if that complaint falls in the GDC’s remit, it must be considered by an investigating committee. That means that a panel must be convened for every case that reaches that stage. It is anticipated that the introduction of case examiners will mean a swifter resolution of fitness to practise cases as a full investigating committee will not need to be convened for every case. Instead, allegations will be considered by two case examiners.

The faster resolution of cases will enhance public protection. It will also remove some of the stress from the procedure for all parties involved. In addition, greater consistency in decision making should be achieved because case examiners will deal with a higher volume of allegations than an investigating committee, because the committee is convened from a large pool.

I realise that the fact that case examiners will be employees of the GDC may be a cause of anxiety for some. It is important to remember that they will not be making findings of fact in respect of whether a registrant’s fitness to practise is impaired. They will make the decision as to whether a case needs to proceed to the adjudication stage and be considered by a practice committee.

Additionally, the GDC, in its rules and guidance, will provide that the case examiners must make decisions based on documentary evidence, which will be supplied to them in the same manner as is currently the case for the investigating committee. The case examiners will not be involved in evidence gathering. One lay case examiner and one registrant case examiner from the same part of the register as the individual whose case is being considered will consider an allegation, which will provide another safeguard to ensure fairness in the process.

Interested parties will be keen that case examiners are recruited, trained and supported in the right way. I have been assured by the GDC that case examiners will receive comprehensive and robust training. The GDC is developing a robust system of review and appraisal that will monitor and support performance and ensure appropriate decision making. The quality of the case examiners’ decisions will be underpinned by ongoing training and detailed guidance. The GDC will also introduce mechanisms for auditing decisions on a routine basis and apply lessons learnt from the audits to the guidance material.

Secondly, provision will be made to allow both the case examiners and the investigating committee, in certain cases, to address concerns about a registrant’s practice by agreeing appropriate undertakings with that registrant. This will be instead of referring them to a practice committee. Undertakings will be applied, where appropriate, at the end of the investigation stage of the fitness to practise process. The introduction of this change will mean that some cases that are currently referred to a practice committee may not need to be. This will be in instances where it is determined that the agreement of undertakings could lead to a resolution of the case in a way that is sufficient to protect patients and the public. For example, if the case involved an allegation that a registrant’s health was affecting their fitness to practise, it may be possible to agree undertakings that would address any risks posed to the public and to the registrant as a result of this health condition. This would also avoid the anxiety, time and cost incurred by referring the case for a full hearing. Rules will provide that a registrant must not be invited to comply with undertakings if there is a realistic prospect that, if the allegation were referred to a practice committee, the registrant’s name would be erased from the register.

Thirdly, the GDC will be provided with the power to make rules to provide for a review of a decision that an allegation should not be referred to the case examiners or to the investigating committee, and a review of a decision that an allegation should not be referred to a practice committee. This will not be an unfettered power. Through rules, the GDC will provide that a review can be undertaken by the registrar if it is considered that the original decision was materially flawed, or if new information has come to light which may have altered that decision and a review is in the public interest. Such a review can occur only within two years of the original decision to close the case. Allowing a review in these circumstances adds a further safeguard to the system. Providing the GDC with the power to take suitable action will improve public protection and maintain public confidence in dental regulation.

The order will also introduce a power to enable the investigating committee and the case examiners to review their determination to issue a warning. A registrant will be able to request such a review within two years of the original decision to issue the warning. At present, there is no mechanism via which a registrant who is issued with a warning can appeal this decision within the GDC. Instead, the only route of appeal open to them is to apply for judicial review. This can be costly for the registrant and the GDC and stressful for the registrant. Warnings can remain on an individual’s record for a number of years—for as long as the warning has been issued—and be accessed by patients and employers. Providing individuals with a route of appeal that does not require application for a judicial review is a fairer and more proportionate approach.

Finally, provision will be made to ensure that registrants can be referred to an interim orders committee at any time during the fitness to practise process. Currently, the legislation around when a case can be referred to an interim orders committee, at certain points in the process, is ambiguous. This amendment will remove any ambiguity and maintain public protection and confidence throughout the entire fitness to practise process. It will provide a higher level of patient protection, ensuring that those who are potentially unsafe to practise can have their registration suitably restricted while inquiries and investigations are made. In addition to enhancing patient safety and improving the fitness to practise processes for a registrant and all parties concerned, it has been identified that making these amendments will create approximately £2.5 million per annum of efficiency savings for the GDC over the next 10 years.

In summary, these proposals to reform and modernise the GDC’s fitness to practise processes will make the system more efficient and effective, benefiting patients, practitioners and the health service. They will result in improved public protection and an increase in public confidence in the General Dental Council. I commend the order to the Committee.

--- Later in debate ---

[Ben Gummer]

I am surprised to be on my feet now, because I thought a huge number of Members would wish to contribute to the debate, but I am forced to reply only to the two speeches that have been made. I can give brief but, I hope, reassuring answers to them.

The shadow Minister, the hon. Member for Ellesmere Port and Neston, has been as assiduous as ever in looking at the detail of the order, and he was entirely correct to raise challenges. On the independence of case examiners, which my hon. Friend the Member for Lichfield also raised, it is important to say that the Government and regulators have sought to use experience and mechanisms already in place in other regulatory bodies to improve the system in the GDC. This is not a system dreamed up ab initio but one used by other regulators as a complaint passes through the regulatory system. We therefore hope that it has good antecedents, especially in the GMC, whose good-quality case handling over the years has been mentioned.

I understand that the system is new to the dental profession, so it is important that I point out two things. First, there will be two case examiners. One will be lay and the other will come from the same part of the register as the person being referred. To answer one of the points that the hon. Member for Ellesmere Port and Neston made, there will be continuity. If the two case examiners cannot reach a decision, the case will still go to a practice committee with three members, as happens currently. In a sense we hope to use an additional layer, whether or not there is a clear route to an investigating committee. If that layer fails, a case will default back to the original structure as outlined in the 1984 Act.

[Justin Madders]

I am grateful to the Minister for his explanation, and I agree that the processes are similar to those of other regulatory bodies. We certainly hope that efficiencies will result from the order. The point that the hon. Member for Lichfield and I were making is that it is about the perception of the investigators’ independence. That is critical, particularly given the history of this particular body.

[Ben Gummer]

On the hon. Gentleman’s wider point about the reform of healthcare regulation and why it is happening through section 60 orders at this stage, I understand his frustration. I hope I can reassure him by referring to my written ministerial statement just before Christmas, in which I outlined that we are hoping to take forward the Law Commission’s report and look at the work that the Professional Standards Authority for Health and Social Care has put together on the reform of professional regulation, to see whether there is an ideal combination of the two pieces of work.

I have discussed the order at length with the regulators. They are content with the way we are going, and we will enter a period of extensive consultation, which I hope will lead to substantial reforms. However, that can be done only on a consensual basis. I very much hope to involve the Opposition in that work, because it is clearly important that healthcare regulation remains a non-partisan issue.

That takes me to another point that the hon. Gentleman raised: how we will guarantee the independence of the case examiners. I understand, especially given the recent history of the GDC, that he wants to ensure that independence in the first years. The Professional Standards Authority for Health and Social Care has proved itself a worthy guardian of healthcare regulation in the past few years. Its reports, one of which he quoted in his speech, give an accurate picture of the state of healthcare regulation. It will audit the new system with assiduity and report back in its annual review about whether it is working.

My hon. Friend the Member for Lichfield referred to the fees gathered by the General Dental Council, which have increased in several of the past few years. I understand from the PSA’s last report that the GDC’s performance has improved somewhat over the past year, but it certainly has a great distance to make up. It is not for me to determine fee levels for healthcare regulators. However, with a number of fees having gone up recently, I made clear to all the regulators when we met last that I expected them to do everything within their powers to either freeze fees or, where they find can efficiencies, pass them back to their members if possible.

[Michael Fabricant]

Can my hon. Friend reassure me that the specific measures in the order will not lead directly, because of excess or extra costs, to increased fees?

[Ben Gummer]

I can assure my hon. Friend that the order will be cost-saving for the General Dental Council—the estimated savings are £2.5 million. It depends slightly on whether the increase in referrals to the GDC continues. If it does, that saving will be eaten up in the increased resources required to process claims. However, if the number of incidents stays the same or reduces, I agree: the logic would be that the GDC might find space to reduce the fees it charges to its members. That is exactly what I have encouraged all the regulators to look at—how can they make justice quicker, which is good for everyone? If they save money in the process, which should only be a secondary consideration, it should be passed on to their members. In some regulated professions, many people, such as nurses or associated healthcare professionals, are not on high wages, and the fee levels make a difference. The regulators are aware of my views, and I put them as strongly as I can without infringing on their independence.

I hope I have answered every one of the shadow Minister’s points.

[Justin Madders]

indicated assent.

[Ben Gummer]

I think that is a yes. If there are no more questions, I will sit down. I hope that the Committee will endorse this section 60 order.

Question put and agreed to.

Hand Hygiene: NHS

Ben Gummer Excerpts

Wednesday 13th January 2016 Westminster Hall

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

I thank my hon. Friend the Member for Amber Valley (Nigel Mills) for bringing this important matter to the notice of the House, and I thank hon. Members on both sides of the Chamber for their speeches and contributions.

Hand-washing is an interesting thing, is it not? For the majority of human history, from Pontius Pilate to Lady Macbeth, it was associated with a bad act. Hand-washing was what someone did after they had done something wrong. It was only through the transformation in clinical knowledge in the 19th century that the understanding of hand-washing and its criticality in reducing infection rates became commonplace, but it was a long fight. It is worth remembering that Ignaz Semmelweis, the man who made people understand that washing their hands in obstetric and maternity settings reduced the risk of infection, was so criticised by his colleagues that it drove him to insanity, and eventually to death in an asylum. This was a hard-won victory, and I utterly endorse the wise comments made by the hon. Member for Central Ayrshire (Dr Whitford): perhaps it is because it has become such a commonplace part of our modern understanding of hygiene that we have forgotten its central importance in reducing infection.

My hon. Friend the Member for Morley and Outwood (Andrea Jenkyns) came to the Department of Health a few months ago and sat in on one of the Secretary of State’s Monday morning care meetings to discuss her Handz campaign and the fact that she wanted to set up an all-party parliamentary group on hand hygiene. I know that her personal testimony brought acuity to our understanding of why this is important. It is all too easy to see MRSA, E. coli and C. diff rates plotted on a chart and to forget that, actually, the result of those infections can lead to the tragic and completely unnecessary loss of life. However, even if it does not lead to that, it can often mean a very extended stay in hospital, with serious injury sometimes incurred as a result of infection.

The overall story of infection caused by poor hand-washing has been good over the last decade. Rates of MRSA, MSSA, C. diff and E. coli have all come down— very considerably in some circumstances—but, as the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), rightly noted, we have plateaued in almost all of those, and worryingly so. In fact, in the case of MRSA, there has been a worrying, albeit slight, increase in rates in hospitals. That has now been consistent enough to constitute a trend.

We have to be clear that, from the Government’s perspective, we are still not entirely sure in each case why the reductions have not continued. To some extent, it is clear that an increasing role is played by community infection and community onset, or expression, of infection. We do not yet have a full understanding of the relationship between community settings and hospitals, and the chief medical officer is working very hard to try and understand it. Therefore, this is a pressing moment, not least because of the problems of antimicrobial resistance, which the hon. Member for Central Ayrshire mentioned, and which is why we have to be particularly vigilant.

Overall, the one thing that will guarantee that we do not make more progress is if I make a central directive from Richmond House and then ensure compliance through a massive, bureaucratic reporting mechanism. The only point on which I differed from anyone in their observations was when the shadow Minister, in his generally very wise comments, talked about the relationship to staff retention. That was because, although general infection control should be part of how teams work, it should be part of the personal, professional responsibility of a clinician, no matter where they work—whether in the community or between hospitals as a bank nurse or clinician—to take infection control very seriously.

How do we improve matters? How do we make sure that, as in so much of the NHS—to copy Bevan’s words, which I do not tire of using—we are “universalising the best” and lifting poor performers, of which there are several, up to the best standards in the country, some of which can be found with our neighbours in Scotland?

[Dr Philippa Whitford]

I have not worked in a hospital in England, but the poster campaign that the hon. Member for Morley and Outwood (Andrea Jenkyns) referred to involved massive posters that were in the lifts and targeted at visitors, porters, nurses and doctors. The five points of contact were above every sink and in every room. If we are trying to change a culture, I wonder whether the first thing is actually just to try to get the campaign out there among staff and visitors.

[Ben Gummer]

I take the hon. Lady’s point, and I agree that we have to re-educate the public that we have not won the battle and that we have to re-engage. I will take her comments to the chief medical officer and talk to her about what more we can do to re-engage the public in the debate on hospital-acquired infections.

[Douglas Chapman]

My hon. Friend the Member for Central Ayrshire (Dr Whitford) has outlined some of the initiatives taken by the Scottish Government and the NHS in Scotland. Despite those measures, hospital-acquired infections in Scotland still cost the NHS £183 million a year. If we managed to reduce those infections by 20%, that would give us a saving of £36 million. A 40% reduction would give us £73 million. Does the Minister agree that there is a huge financial incentive to reducing the infection figures as much as we can, especially in these times of public spending restraint?

[Ben Gummer]

The finances follow the far bigger win, which is the benefit to patients and the saving of lives.

One further thing that I will attack quickly is compliance monitoring. It is a very interesting area, and I would encourage local trusts to look at it in detail. The CQC has it as one of its main targets and, in the new inspection round, which will come very soon, it will want to look at the area as a central part of its monitoring.

NHS Bursary

Ben Gummer Excerpts

Monday 11th January 2016 Westminster Hall

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

I add my voice to those of other Members who have spoken today to say how much I appreciate the decision of the Petitions Committee to bring the matter to the notice of the House. I thank my hon. Friend the Member for Sutton and Cheam (Paul Scully) for outlining the case as many of the petitioners see it. As both shadow Ministers—the hon. Members for Lewisham East (Heidi Alexander) and for Central Ayrshire (Dr Whitford)—said, we had a high-quality debate, and Members raised a huge range of points in a calm and collected but passionate way. I hope Members will forgive me if I address as many points as I can. I hope to finish before the end of our allotted time, so that people can get away, but I am aware of the number of different points that were raised. I am also aware of the intense public interest in this important issue, which is why I want to make sure that I address every point that was raised—including detailed points.

Many Members, including the hon. Member for Lewisham East, were here for the debate on tuition fees in 2011. It was a searing experience. It is the only time I can think of—the hon. Lady and other Opposition Members will remember this—when protests could be heard by those in the Chamber. We all remember, too, having to leave by secret exits because of the riot outside. It was understandable that, at the time, people were so passionate about the change being made. The hon. Member for Ilford North (Wes Streeting) was a central player in the great debate, and he acquitted himself with honour. He explained in great detail his side of the argument—and that of the National Union of Students—at the time of probably the most controversial change made under the coalition Government. Yet every single one of the claims made at the time—the central claims against the changes—has been proven untrue.

I want to address the core point made in the considered speech of the hon. Member for Sheffield Central (Paul Blomfield)—that the Government should make changes on the back of evidence. My contention is that that is exactly what we are doing. Since the changes made in 2011, there has been an increase in the number of students in every part of the higher education universe. Most importantly, to my mind, there has been a considerable increase in the number coming from disadvantaged backgrounds. That is precisely why, even if it were not for the reasons that I want to come on to about why what we are doing is important for the NHS and for nursing in particular, it is an important change. Nursing students are the only significant group of students not to have been included in the reforms that have so significantly benefited the rest of the university sector.

[Paul Blomfield]

Clearly we could have a lengthy debate—I am sure you would counsel us not to, Mr Evans—on the merits of the student loan system. I was surprised by the Minister’s unequivocal statement a moment ago. Will he agree that one section of the demographic that has been negatively impacted by the introduction of the new student funding regime in 2012 is mature students?

[Ben Gummer]

I will not agree with the hon. Gentleman’s contention. UCAS figures for mature students in 2011, the year of the change, show that there were 42,170 acceptances. That figure dropped in the following year, as did the figures for all students across the university sector. It then went up to roughly the same figure in 2013, and up again in 2014. In 2015 the figure was 48,690, so the number of mature students has increased, and in percentage terms the increase is, I believe, more than that for university students of the normal age. When we consider the core reasons for the change—expanding the opportunity to go to university, through the number of places; increasing quality, which has improved according to a number of metrics; improving student experience, which has also happened in the past few years; and, most importantly for a university system, creating a ladder of opportunity for those born with least—we see that the reforms have delivered by every one of those measures. It is precisely for that reason that, even were it not for the wider issues that the NHS confronts, I would believe what we are doing to be entirely right. It enables us to spread to nurses the same benefits that have been realised in the rest of the student population.

[Paul Blomfield]

I thank the Minister for giving way again. I want to challenge him on those figures, which I guess—I do not have them before me—relate purely to full-time students. If we consider full-time and part-time students, we see unambiguous evidence that the number of mature students has fallen dramatically.

[Ben Gummer]

The numbers do relate to full-time students. I concede that, in the case of part-time students, there have been, for a longer period than the time since 2011, problems in maintaining a rise consistent with that across the population. The Chancellor has accepted that fact, which is why he devoted specific attention and funds in the spending review to supporting part-time mature students. However, in this case we are talking about a nursing degree that is, for the vast majority, a full-time one. For the majority of nurses—I believe the figures are not quite those given by the hon. Member for Central Ayrshire, although I do not have them to hand—their degree is a normal undergraduate degree, taken before maturity. For all those people, I want the same benefits that have been provided across the rest of the university sector. The hon. Member for Sheffield Central was a Member in the previous Parliament, as was the hon. Member for Lewisham East, and they made exactly the same claims then as they do now about a reduction in opportunity, a reduction in number of applicants and a reduction in all the areas where we want universities to perform. I am afraid they have been proved wrong and the Government have been proved right, and that is why it is important that we extend those benefits to nursing.

I will address in terms the process by which we have come to this decision, about which the hon. Member for Ilford North raised some detailed questions, and our intention for the wider reform of training routes into nursing. It is important that hon. Members should see the changes that we are making to university training as part of a wider reform enabling us to increase both numbers and the quality of courses, as well as improving the student experience for nurses entering nurse registration by whatever route. The policy has been worked through in considerable detail in the Department of Health. There has been consultation with leading nursing professionals. The Department of Health is advised by a number of chief nurses. All were consulted and involved in working up policy in this area, which is entirely how it should be.

We have been very open about the fact that we want a full and detailed consultation about how the proposals should be implemented. We want that to be thorough and to involve everyone, whether they oppose or are in favour of the changes, so that we get the detail right. While I will maintain that the overall policy direction is correct for the reasons I have given, it is important to make sure we implement the detail correctly. If we do not get it right, it could have a perverse impact. If we do, this could be an important moment for the nursing profession, because we will be able to do something that previous Governments have not been able to do. Even in the wildest spending realms of the imaginations of some colleagues of the hon. Member for Lewisham East, it would not be possible to commit the resources to expand the training places that the route we have decided on will make possible.

The Opposition must answer a central point when they set out their opposition to the proposal. The fact is that we want to give more training places to people who want to become nurses. Last year, there were 57,000 applicants for 20,000 places. We want to expand the number of places so that people get the chance to become a nurse, but within the current spending envelope—even if we were to increase it more significantly than we propose to over the next five years, and certainly far more significantly than the Opposition propose—it is not possible to do that.

[Dr Whitford]

Does the Minister not accept, on the basis of invest to save, that if agency nurses are costing the NHS £2 billion, such an investment in future nursing would, in actual fact, save money in the long term?

[Ben Gummer]

I agree with the hon. Lady that one key thing we have to do is ensure we have a permanent workforce and do not depend across the service on agency and locum nurses and doctors. However, part of that is ensuring we have the workforce numbers trained to be able to fill places. In the past, we have failed to predict workforce numbers with any accuracy, which is something all Governments are guilty of.

No matter what happened to training places, the changes required across the service because of the impact of Mid Staffs on our understanding of safe staffing ratios has meant an increase in the requirement for nurses. At the moment, in the very short term, that requirement has to be plugged by agency and locum nurses, but we want to replace them with a full-time permanent staff that is sustainable. I hope the Opposition are able to bring an alternative view—I would be interested to hear it—but if we are to increase the number of training places, we have, simply put, to be able to afford to do so. The surest way of expanding places is to repeat exactly what we did for all other university degrees back in 2011, which has seen a massive expansion in training places.

The other point that the hon. Member for Lewisham East and her colleagues must address if they wish to oppose this reform is how they would afford not only the expansion in training places, but the maintenance support for nurses going through training. I completely agree with the hon. Member for Central Ayrshire and my hon. Friend the Member for Lewes (Maria Caulfield): the current bursary funding is not generous. It is certainly not sufficient for many, especially those with caring duties, to maintain themselves, but how can we find the increase while ensuring we expand places at the same time?

Through reforming bursaries, we are ensuring that we can increase the cash amount by 25%—something that, again, could not be funded out of the existing envelope, even though we are increasing NHS spending more than any other major party promised at the last election. We are therefore able to provide the support that people going through nurse training are rightly asking for.

[Paul Blomfield]

The Minister makes great play of the comparison between the reforms introduced in 2012 for other undergraduates and this reform. I admire the way he talks—I say that without any irony—about sharing the benefits of the current scheme with student nurses, midwives and allied professions. I am not quite sure they would describe a £56,000 debt as a benefit. Putting that to one side, does he not recognise the sharp difference between other undergraduates and those studying nursing, midwifery and allied professions in terms of the commitment to clinical placements, the shift patterns and everything else that will prevent them from being able to take employment in order to offset the cost of their education?

[Ben Gummer]

That is the case at the moment. The hon. Gentleman must answer the question of precisely how we increase support for people who are working in clinical learning placements. Converting the bursary regime means that we can increase that support by 25%.

It is easy for the hon. Gentleman to make a play to the gallery about how the reforms might work, but I ask him again to look carefully at the experience of other students and at the 47,000 applicants who are unable to secure a place because of the constriction in places. He is not able to give those people an answer about how we expand places without resources that I imagine he is not willing to commit from his position. The best way of giving those people the opportunity is reforming the education system. I am afraid that it is simply not credible for the Opposition to decry the proposals, which is their right, without providing an alternative of how we might fund the additional places and the maintenance of those who are in position.

[Heidi Alexander]

The Minister talks about the ratio of applicants to nursing students. Will he say what proportion of the applicants who failed to secure a place met the entry criteria to the course? What guarantee can he give that removing the bursary will increase the number of successful applicants?

--- Later in debate ---

[Ben Gummer]

I will write to the hon. Lady with year-by-year figures, where available—pass rates change every year. The nursing training course is one of the most over-subscribed of all undergraduate courses. Compared with other undergraduate courses, whatever metric we use, it is a significantly over-subscribed course. We know that a significant number will not receive a place on a course, even though they have met the criteria.

[Dr Whitford]

If the cap is completely removed, the Government will lose any ability to plan a workforce for the future. If all 47,000 applicants are given a place, what will happen when they come out at the other end? There will not be the placements to train them, and there will certainly not be the jobs. Is this just a way of having a flood of cannon fodder nurses, so that their pay can be frozen?

[Ben Gummer]

The hon. Lady mentioned in her speech, as did the hon. Member for Ilford North, the need by some trusts to recruit from abroad and to use locum and agency nurses. I hope she will understand therefore the internal logic of our argument: even at the moment, we are not able to fill places from the domestic supply of nursing graduates. It is precisely our wish to expand that supply. Planning the workforce will, in large part, be controlled through the placements that Health Education England buys from universities on behalf of the taxpayer and the NHS.

Several hon. Members raised the issue of clinical placements, on which we are now in deep discussions with Universities UK. The hon. Member for Ilford North raised that issue, as did my hon. Friend the Member for Lewes. I urge them both to look at the example of the University of Central Lancashire, and its relationship with Central Manchester University Hospitals NHS Foundation Trust and Bolton NHS Foundation Trust. They are delivering innovative and exciting ways of providing new placements outside the scope of the existing placement scheme, even without any Government support or change in the rules.

There is an appetite for delivering additional clinical placements, and we will see how that progresses in our discussions with Universities UK. All the while, it is important to point out that the Nursing and Midwifery Council has to register nurses at the end and ensure that the degrees are satisfactory. All of this will have to abide by the NMC’s recommendation that the placements are up to scratch, so we are constrained, quite rightly, in anything we might want to do by what it decides in that regard.

[Heidi Alexander]

The Minister gave the example of the University of Central Lancashire. Does he accept that one reason that pilot is successful is that individuals are guaranteed a job at the end of it, which would not be the case for the students to whom he proposes applying these more general changes?

[Ben Gummer]

In the course of taking interventions, I am skipping around the points that hon. Members have raised, which I want to address. The hon. Lady is right that the University of Central Lancashire has worked up a really good course, which is partly about job security at the end of it. It is exactly the kind of scheme we are looking at to improve attrition rates, which were another point that my hon. Friend the Member for Lewes raised. We have to do better to help nurses complete their courses, and again, that metric has improved across the rest of the university sector since 2012. I hope that in freeing up nurse training a little through our reforms, we will be able to provide better incentives for foundation trusts and NHS trusts to have an end-to-end training offer for student nurses—if not modelling the one that the University of Central Lancashire has brought in, then a variant on it.

There is a lot of exciting thinking out there in universities, foundation trusts and NHS trusts about how we can implement the reforms to make nurse training better, expand the number of places and solve their workforce problems. My job is to release that thinking. I cannot do it within the straitjacket of the existing system, but I can through the reforms I am able to make.

[Dr Whitford]

Is the pilot in Lancashire that has been described not an argument for better manpower and workforce planning, rather than for simply throwing things open to the winds, which is what is proposed?

[Ben Gummer]

I was merely making the point that there is a lot of exciting thinking out there, outside the workforce planning that we are doing. Through our reforms, I hope to be able to encourage more of that. I know that there is some very innovative thinking in my part of the country. People want to get on with it in the NHS and university sectors, but at the moment they cannot, because of the constraints on how nurses are trained and recruited.

I turn to the issues raised by my hon. Friend the Member for Sutton and Cheam, who introduced the debate on the petition. He asked four specific questions. One was on specialist courses, and the shadow Minister repeated that point. Some specialist courses have suffered shortages for many years. For several years, the Higher Education Funding Council for England has been dealing with the wider attribution of training funds and university tuition funds across the sector, and it will take on responsibility for making sure that very small and specialist courses are properly funded and promoted. In liberating the universities sector a little, I hope that we will be able to excite interest in some of the more specialist courses, which have been suffering for several years, and better match foundation trusts’ workforce requirements with universities’ ability to deliver.

My hon. Friend asked whether foundation trusts will be able to pay back loans as an inducement. I do not know whether that will be possible for foundation trusts specifically, but they are free to offer pay premiums to aid their recruitment—they have been able to do so for many years. I imagine that will continue.

My hon. Friend asked about the number of placements and the financing of them. That will be determined by the consultation and in discussions with Universities UK. He also asked about the arrangement for placement expenses, and I have heard his point. I know it is a unique problem that is specific to student nurses—although to some extent, it also applies to student teachers—and again, we want to look at that in detail in the consultation to ensure that we get the implementation right. That is why it is not just a matter of pure detail; it is about how the policy works as implemented.

The hon. Member for Ilford North raised a number of points in addition to the ones he raised in his Adjournment debate. I apologise for not having answered all of them previously; I had a short time and he raised a huge number, with his usual eloquence. However, I hope I can answer some of his specific points on this occasion.

The hon. Gentleman asked about the problems of recruiting into community-based settings. There is a shortage in that specialty, which has traditionally suffered from problems in recruiting. I am well aware, just as he is, of the need to improve recruitment into community settings and primary care settings if we are to get the proper integration of primary and secondary care, and more importantly, of social care and the NHS. That is one of the key challenges facing us in the years ahead. Health Education England has a scheme under way called “Transforming nursing for community and primary care”, which it launched just over a year ago, precisely to incentivise nursing applicants into that specialty. Again, I hope that universities will respond positively, as they have in the case of other courses, so that they step up to the workforce demands placed on them as a result of the reforms that we are making.

The hon. Gentleman asked what the amount of debt to be written off was. The long-term loan subsidy—he will understand the phraseology—remains at 30%. That is the figure that the Treasury has set. As a consequence of that and because of, as he put it, reliable reports from newspapers, which he imputed to be fact, he asked whether there would be an increase in student fees above inflation. I can say to him that there are no plans at all to increase student tuition fees above inflation.

The hon. Gentleman asked whether I would be willing to meet those who disagree with my point of view and that of the Government on this matter. I would, of course, and I have done already. I would be delighted to meet anyone whom he wishes to bring to me, including the demonstrators he mentioned.

The hon. Gentleman began his speech, however, by talking about a burden of debt. It is important for all of us here to remember that the loan is an attachment against earnings, which is time-limited and limited according to the ability to earn, so it is not like debt such as a mortgage. We made the same argument back in 2011 and 2012, and it is important that we use language correctly in this place. We saw an uptake in university courses after the 2012 reforms. Once prospective students understood how the financing worked, how they would pay back the tuition fees and that it was not a debt that would saddle them in the same way that a mortgage or hire purchase agreement might, as was suggested at the time, university applications increased significantly. We all have an interest in this place in making sure that the number of people going into nursing increases. It is important, therefore, that even if we disagree with the policy, we do not misrepresent it.

[Wes Streeting]

After leaving the National Union of Students in 2010 when my term in office expired, I worked with Martin Lewis from MoneySavingExpert.com and the coalition Government to try to communicate the facts behind the tuition fees system, so I endorse what the Minister says about getting the facts across. Martin Lewis and I are concerned that the Government are seeking to apply retrospective changes to the terms and conditions of student loans without a parliamentary debate and vote. We would have a much better airing of all the issues, and this issue specifically, if we had that debate and vote in the House of Commons. Will the Minister commit to that process now?

[Ben Gummer]

The hon. Gentleman knows that I cannot commit other Ministers to debates, but I will certainly represent his concerns to the Minister for Universities and Science, my hon. Friend the hon. Member for Orpington (Joseph Johnson). He makes a strong point. It seems that I am the only person in this Chamber not to have a close acquaintance with Martin Lewis, but I will ensure that the hon. Gentleman’s points, including the one about the Delegated Legislation Committee—I sat on such Committees for a few years and never received anything nearly as exciting as student grants—are represented to the Universities Minister, so that he can answer him directly.

I wish also to address the points raised by the hon. Member for Heywood and Middleton (Liz McInnes), who talked about equality impact assessments. We have worked up an assessment of the impact that the changes will have on recruitment into nursing—of course we have—as part of our policy generation. That will culminate in a full equality impact assessment and a business case, which will be published at the time of the consultation, not long from now. I hope that that will inform the discussions that take place, so that we can have a robust and evidence-based debate.

The hon. Lady talked about housing costs, which was reflected in an intervention by the right hon. Member for Oxford East (Mr Smith). Housing costs are a considerable pressure for many students—not only those applying for nursing courses, but those in high-cost parts of the country. That is partly why we want to increase the amount of maintenance we can provide. To return to my central point, within the current spending envelope we can do that by such a considerable amount—25%—only through a reformed system. To do it in other ways would be prohibitively expensive, and I do not believe the Opposition have proposed that.

The hon. Lady asked about NMC registration fees. At the moment, they are incurred at the point of registration when the university course has finished and are tax-deductible. They have risen in the last year, which I know has caused disquiet among nurses. I have spoken to the regulators, including the NMC, and implored them to keep their fees at a sensible level and to avoid rises whenever possible. The NMC has had to deal with a considerable increase in fitness-to-practise cases, but I hope that with internal cost savings it will be able to mitigate further rises. I have certainly asked it to do that, although it is an independent body.

The hon. Lady cited someone she had spoken to who was, if I understood her correctly, halfway through a degree. It is important to state that the change is for new students only, so those on existing courses will not be affected.

[Liz McInnes]

The Minister has said that the equality impact assessment will be published at the time of the consultation, but what assessment has been made to ascertain the effect of the proposed changes?

[Ben Gummer]

The hon. Lady probes like an expert, but she should know that there has been a detailed assessment of the impact of the changes as part of the policy development, which is still taking place. When we launch the consultation, the full details of the assessment will be made public as part of the process, so she will be able to see very soon what the changes will mean.

My hon. Friend the Member for Lewes spoke with great eloquence about her own nursing experience. Other hon. Members may not know that she has a master’s degree connected with her nursing work. She certainly knows about the full gamut of the academic discipline of nursing, and I take her views with considerable seriousness. She was right to point out that the change is part of a wider package of reform.

Several hon. Members spoke clearly and, in one case, movingly, about people who want to become nurses but cannot, either because they did not achieve the necessary grades earlier in life to go to university—that was a failing of their education rather than because of an innate inability to be a nurse or to pass the exams—or because they have caring responsibilities. We want both sorts of people to be in nursing, because they care and because of their vocational call to be nurses. At the moment, a significant number of them are working as healthcare assistants and cannot progress to being nurses. They are prevented from doing so unless they leave the workforce, go to university and then come back into the system. Even under the existing arrangements, that makes it impossible for many of them, which is profoundly wrong.

That is why it is a priority for me, as I announced a few weeks ago, to open up an apprenticeship route to enable healthcare assistants to move from a band 3 position in the NHS to an intermediate new position—nursing associate—that is part of a vocational route to full nursing registration. The exciting thing about that is that it will provide a dual training route into nursing. There is the traditional nursing undergraduate route, which will still take three years, and there will be the new route—an apprenticeship—which will open up nursing to a whole new group of applicants who are currently precluded from achieving their dream of going into nursing and who do not even count in the statistics of those refused a place.

In the round, we are doing what I hope many Opposition Members want. I share their wish to see the diversity of the workforce, which is already one of the most diverse in the country, improve still further, and to see opportunity expanded, the quality of training improved and support given to people at university. Conservative Members also want all those things.

I appreciate the sensitive way in which hon. Members on both sides of the Chamber have spoken. I also appreciate that they may disagree with how the Government want to proceed to try to improve nurse training. In the absence of alternative ideas, I believe that our proposals really are the way to expand places, improve diversity, increase opportunity, especially for those from disadvantaged backgrounds, improve quality and provide support for those at university.

[Mark Durkan]

The Minister has criticised colleagues several times during the debate and said that the Government are not hearing alternatives. Will he reframe the consultation so that they can hear alternatives? It is clear that people want to work on a different premise and to a different agenda, with much better outcomes, including achieving the important goal of better equipment that he referred to. Widening the consultation would allow those alternatives to be heard, but the way the consultation is framed at the moment means they will not be heard.

[Ben Gummer]

I would be delighted to hear alternatives, and not just via the medium of the consultation. I would very much like them to be offered within the current spending envelope, but if people wish to offer alternatives outside that envelope, they must explain how much they will cost and how they will be funded. Within that spending envelope, the reforms will allow us to expand the number of places and improve quality, support and opportunity.

[Liz McInnes]

The Minister mentioned introducing apprenticeships to enable healthcare assistants to move on and train as nurses. Before I left the NHS, a similar scheme was being implemented. It was called “Modernising Scientific Careers” and applied to healthcare scientists. There was a long and arduous consultation process, which to my knowledge has still not been completed. How long does the Minister envisage it will take to implement the process for nurses and healthcare assistants?

[Ben Gummer]

We have a commitment to have 100,000 apprenticeships across the NHS in this Parliament, a significant proportion of which will be for nurses. I am approaching this at the utmost speed, and I and the Government will be judged on whether we deliver in five years’ time. I know that the hon. Lady will hold us to account. I will happily pick up on where the consultation to which she contributed has gone—I hope there is not still someone in the basement of the Department of Health working on it—and give her an answer as to what happened as a result of it.

I want to address one final result of the reforms that we are bringing in. It was raised by my hon. Friend the Member for Isle of Wight (Mr Turner) and by the hon. Member for Scunthorpe (Nic Dakin), both of whom talked about the rurality of their areas and the impact that isolation has on recruitment. I hope that, especially through the introduction of nursing associates—an apprenticeship route through to nursing—we can help address problems of recruitment and retention in specific parts of the country. I recently floated that not far from the hon. Gentleman’s constituency, in Hull, where people were receptive of the idea of a different route into nursing that complemented the university route.

This is potentially an exciting moment for nursing. We will be able to expand the number of places and improve support, diversity, opportunity and quality—all things that have been achieved in the rest of the university sector. We will do so quickly, and we will do it even better if we have a good and robust consultation on the details. I will of course write to hon. Members who feel that their points have not been answered, and I once again thank the Petitions Committee for bringing the matter to the notice of the House.

Oral Answers to Questions

Ben Gummer Excerpts

Tuesday 5th January 2016 Commons Chamber

[Anna Turley (Redcar) (Lab/Co-op)]

3. What proportion of hospital trusts are in deficit.

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

Three-quarters of trusts are reporting a deficit for the conclusion of the first half of this financial year.

[Anna Turley]

John Appleby, the chief economist at the independent think tank the King’s Fund, said recently that although the Government claim they will get an increase in funding in the NHS, they have

“in effect, already spent the money”

because of the scale of the hospital deficits. In my South Tees area, the deficit for 2014-15 is nearly £17 million. Will the Minister accept that the Government have totally lost control of NHS finances?

[Ben Gummer]

The first point to make is that this Government have provided the money for the NHS that it has asked for—this is money the Opposition refused to say they would pledge at the last election. The second point to make is that Jim Mackey, the new chief executive of NHS Improvement and one of the best chief executives in the NHS, has said that he will help to get hospital trusts in control next year, and that, with the transformation fund announced by my right hon. Friend the Secretary of State, we are confident we will be able to get hospital trusts into balance next year.

[Andrew Stephenson (Pendle) (Con)]

Does the Minister agree that clamping down on expensive temporary agency staff is an important step in helping to sort out the NHS and allowing it to balance the books?

[Ben Gummer]

My hon. Friend is entirely right, and we are already having an impact. We had to bring in the requirement for safer staffing rotas because of the catastrophe at Mid Staffs and the need to try to staff hospitals better, and that had an immediate consequence which called for agency workers. Unfortunately, some companies have taken advantage of that situation, but we have introduced measures to stop that and are already having an impact across the service.

[Paul Farrelly (Newcastle-under-Lyme) (Lab)]

The University Hospitals of North Midlands NHS Trust faces a deficit of £19 million for 2015-16, but until the NHS’s Staffordshire review is completed it faces uncertain prospects further out, not least as it has taken over Stafford county hospital recently. The hospital wrote to the Minister before Christmas, so will he meet hospital management and local MPs as soon as possible this new year to discuss this uncertain situation and the progress on the whole Staffordshire review?

[Ben Gummer]

I would be happy to meet them, I will meet them and I congratulate them on eliminating 12-hour trolley waits for the first time this year. They are doing a great job in difficult circumstances, as are many hospitals across the country. I am confident that they, too, will be able to get their deficit under control next year, with the help of the transformation fund, which is available for high-performing trusts.

[Mr David Hanson (Delyn) (Lab)]

4. How many people have diseases classified by his Department as rare.

--- Later in debate ---

[Anne Marie Morris (Newton Abbot) (Con)]

10. What plans he has to publish a rural healthcare strategy.

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

The “Five Year Forward View” published by NHS England sets out the healthcare strategy for the whole of England, including rural areas. Rural areas have their own health needs, which should be taken into account in planning and developing healthcare systems.

[Anne Marie Morris]

What specific research has the Minister undertaken in order to understand, and what steps has he taken to address, the very different needs and costs of rural communities in the south-west, which has disproportionately high numbers of over 85-year-olds and population distributions that make inflexible multi-speciality community providers and primary and acute care configurations unattainable?

[Ben Gummer]

The “Five Year Forward View”, written by Simon Stevens, takes particular account of rural areas, but of course not all rural areas are the same. It is down to clinical commissioning groups to judge the needs of their local areas and make sure that they are reflecting the specific circumstances in which they find themselves.

[Tulip Siddiq (Hampstead and Kilburn) (Lab)]

11. What progress his Department has made on expanding access to non-invasive pre-natal treatments in hospitals.

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

Non-invasive pre-natal testing is not currently offered routinely for screening women in pregnancy for Down’s syndrome and other trisomy conditions within the NHS. However, it is available to detect genetic changes leading to specific skeletal abnormalities and certain forms of cystic fibrosis. The UK national screening committee has reviewed the case for implementing NIPT as part of the existing foetal anomaly screening programme and will provide its advice shortly.

NIPT is not currently offered for Down’s syndrome routinely within the NHS. Some NHS trusts have piloted the test for screening and a number of maternity units offer NIPT privately. NIPT is available through the NHS to detect genetic changes leading to specific skeletal abnormalities and also to detect certain forms of cystic fibrosis.

The UK national screening committee—UK NSC—which advises Ministers and the NHS in the UK about all aspects of screening policy, has reviewed the case for implementing NIPT as part of the existing NHS foetal anomaly screening programme and will provide its advice in the new year.

[Tulip Siddiq]

At my 12-week scan, I was told that I faced a risk of Down’s syndrome in my child. I was given two options. One was an invasive test available on the NHS—the amniocentesis test, which carried a risk of miscarriage. The second was a non-invasive test, which was not available on the NHS and cost £400. Does the Minister agree that the non-invasive test should be rolled out across the country so that mothers, regardless of wealth, can have equal access to screening and do not have to face the unnecessary risk of miscarriage?

[Ben Gummer]

I thank the hon. Lady for bringing her personal experience to the House, and I hope that all is well. She will understand that screening has to be a non-political matter. That is why we have a specific, clinically led committee to look at whether a screening programme should be implemented. It has been looking at NIPTs over the past year and will be making its decision very shortly. On the principle, though, I completely agree with her; it lies at the foundation of the NHS and we support it.

[Philip Davies (Shipley) (Con)]

12. What assessment he has made of the adequacy of clinical commissioning group transformation plans in addressing the needs of (a) all vulnerable children, (b) children in the care system, and (c) children who have been abused.

--- Later in debate ---

[Maria Caulfield (Lewes) (Con)]

13. What steps he plans to take to increase the availability of nurse training in the NHS.

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

I thank my hon. Friend for asking this question. I can tell her that we have made significant steps. In the past two years, there has been an 11% increase in nurse training places, and I anticipate that that increase will continue this year. We are providing over 23,000 full-time-equivalent additional nurses by 2019. We expect there to be an additional 10,000 nurse training places as a result of the announcements made by my right hon. Friend the Chancellor last year.

[Maria Caulfield]

Speaking as a nurse, I would struggle to undertake my nurse training given the proposed changes to the bursary scheme. I know that the Minister is working very hard on this, but will he outline what additional routes into nursing are planned to help mature students and those on a low income to gain access to nurse training?

[Ben Gummer]

My hon. Friend is right to point out that there are different ways into nursing. Just a few weeks ago, we announced a massive expansion in apprenticeships across the NHS, and I anticipate that a significant number will be for those going into nursing. The new post of nursing associate is a vocational route into nursing via an apprenticeship. In addition, our reforms to bursaries will ensure that there is a 25% increase in funding to recipients, bringing it into line with the rest of the student cohort. That cohort has seen a considerable expansion in the number of students coming from disadvantaged backgrounds as a result of the reforms that we undertook in 2011 and 2012.

[Helen Jones (Warrington North) (Lab)]

Does the Minister accept that his Government’s decision to cut nurse training places by 3,000 a year since 2010 has led to the huge shortage of nursing staff in the NHS and an increased reliance on nurses recruited from abroad and expensive agency staff, and that that will get worse with the abolition of bursaries? Is not this a textbook example of a false economy from the Government?

[Ben Gummer]

The hon. Lady should look at the facts. March 2015 saw a record number of nurses in the NHS—319,595. We are increasing the number of nurse training places. We are able to increase them by considerably more than we could have done otherwise, as a result of the reforms to student finance that bring nurses into line with teachers and other public sector professionals.

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

It would be good to hear the Minister concede that it was a bad idea back in 2010 to cut the number of nurse training places. Even today we are still training fewer nurses than we were in 2009. Not only have this Government failed to recruit enough nurses, they have failed to retain them too: last year there was a 12% increase in the number of nurses leaving hospitals. With staff morale already at an all-time low, why does the Minister think it is right that nurses should be burdened with a lifetime of debt to pay for his Government’s mistakes?

[Ben Gummer]

The hon. Gentleman raises a reasonable point about attrition rates: they have remained too high for too long. One of the things we are undertaking at the moment is to talk intensively with universities to see how we can reduce attrition rates. We have had some success in some areas, but I want to see far more. It is important that students stay on their courses as much as possible. Of course, many go into community nursing. I would be prepared to write to the hon. Gentleman about further actions we are taking on attrition rates.

[Amanda Solloway (Derby North) (Con)]

14. What steps his Department is taking to involve young people in plans for improving children and young people’s mental health.

--- Later in debate ---

[Michael Tomlinson (Mid Dorset and North Poole) (Con)]

T4. Following the assisted dying debate, will the Department set out what steps it is taking to improve end-of-life care, and will Ministers join me in praising local hospices such as Forest Holme hospice in Poole, which serves my constituents?

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

I will certainly join my hon. Friend in praising the work of hospices. It is a unique contribution in the world of healthcare and we should be proud of their efforts. He will know that I have a commitment to end-of-life care and to improving it. I hope shortly to make announcements in response to last year’s NHS Choices review. I have been talking intensively to people from the sector about what might or might not be possible.

[Heidi Alexander (Lewisham East) (Lab)]

It is a sad state of affairs when a new year starts with the prospect of industrial action in the NHS. Nobody wants strikes, not least the junior doctors, but they feel badly let down by a Health Secretary who seems to think that contract negotiations are a game of brinkmanship. When will he admit that changing the definition of unsocial hours and the associated rates of pay for junior doctors is a forerunner to changing a whole load of other NHS staffing contracts to save on the NHS pay bill? That is what all this is really about, isn’t it?

--- Later in debate ---

[Pat Glass (North West Durham) (Lab)]

T2. The Health Secretary just tried to tell us why we have 8,500 more nurses in the NHS. Let me tell him why it is. It is because we have record recruitment from abroad. Since the Chancellor announced the scrapping of bursaries for trainee nurses and midwives, there has been a worrying reduction in the number of applications for next year’s training, compared with what we would expect to see at this time of year. That can only have a negative impact on the number of trained nurses from this country and on net migration. Was there any discussion between the Department of Health, the Home Office and the Chancellor before this idiocy was introduced?

[Ben Gummer]

We have record levels of nurses in training and a record number of nurses in practice because of the decision by my right hon. Friend the Health Secretary to increase nurse training by 11% over the past two years. We can expand that significantly due to our reforms to the funding of nurse training. As regards nurses from abroad, part of the reason we are undertaking this change is so that every putative nurse in this country can have the opportunity of having a nursing position. At the moment, we have to limit those positions because of the funding regime that is in place.

[Jake Berry (Rossendale and Darwen) (Con)]

T8. Will my right hon. Friend join me in paying tribute to the first responders in Rossendale, who support the ambulance service by attending 999 calls to very serious cases, including one involving a friend of mine over Christmas? Will he in particular pay tribute to Brian Pickup, who is stepping down as team leader of the first responders after 11 years of unpaid public service?

--- Later in debate ---

[Mark Garnier (Wyre Forest) (Con)]

T10. The Worcestershire Acute Hospitals NHS Trust now finds itself in special measures, and today its chairman has resigned, largely as a result of an over-extensive and highly complex review of clinical services in the county that has so far failed to reach an agreed conclusion. Given the complexity of the review process, and the apparent impossibility of it reaching an agreed conclusion, what steps can the Government take to untie the Gordian knot that created that situation and help the trust to get back on a stable footing?

[Ben Gummer]

My hon. Friend is right and there is a particularly complex series of circumstances in Worcestershire. I am determined to do something about that, and I want to meet him and his colleagues in the next few days to discuss possible options. I will then discuss those issues in turn with NHS England.

[Andy McDonald (Middlesbrough) (Lab)]

T5. The management at James Cook university hospital in Middlesbrough is seeking to increase nurses’ current 30-minute meal break, which they struggle to take, to a compulsory unpaid 60-minute break that will result in nurses effectively working one shift a month unpaid. In their judgment that will do nothing to address the real issues of staff shortages and patient safety, but will merely disadvantage patients and nurses alike. Will the Secretary of State investigate the matter and write to me?

[Ben Gummer]

I thank the hon. Gentleman for bringing that issue to the attention of the House. All contracts should be governed by the “Agenda for Change” contract, and I would be concerned if there were deviations from that. I would welcome further detail on that so that I can respond to him.

[Dr Sarah Wollaston (Totnes) (Con)]

Nobody wants to return to the days of exhausted junior doctors being forced to work excessive hours, and the Secretary of State will know that that is why junior doctors have expressed concern about the potential impact of removing financial penalties from trusts. Will the Secretary of State set out what has happened during the negotiations to reassure the public and doctors about patient safety?

--- Later in debate ---

[Mr Robin Walker (Worcester) (Con)]

May I thank the Minister for his helpful answer to my hon. Friend the Member for Wyre Forest (Mark Garnier)? Further to that question, having recently met the clinical leadership at Worcester Royal hospital, they are adamant that they want permanent management in place at the hospital. The Care Quality Commission report said that the number of interim directors was one reason why it was put into special measures. Can the Minister reassure me that he will be doing everything he can to put in place permanent long-term management at the Worcestershire Acute Hospitals NHS Trust as quickly as possible?

[Ben Gummer]

I can assure my hon. Friend of precisely that.

[Paula Sherriff (Dewsbury) (Lab)]

Mid Yorkshire Hospitals NHS Trust is planning to implement a significant reconfiguration plan 12 months earlier than was agreed by the Secretary of State. Dewsbury hospital will be significantly downgraded before infrastructure is in place to ensure that patients still receive vital care safely. Will the Secretary of State meet me to discuss this premature move, which appears to be purely financially driven and not in the best interests of my constituents?

[Ben Gummer]

I thank the hon. Lady for bringing that issue to the notice of the House. The reconfiguration she mentions is the responsibility of local commissioners, but I am very happy to meet her, and anyone she wishes to bring with her, to discuss the planned changes.

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

My local mental health trust recently reduced its psychiatric liaison cover in A&E and is now considering the level for the coming year. Will my right hon. Friend provide an update on what the Government plan to do to ensure specialist mental health care in A&E?

Access to Health Services: West Cumbria

Ben Gummer Excerpts

Thursday 17th December 2015 Commons Chamber

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

It seems appropriate that the final debate before Christmas is about maternity. It is appropriate in another way because it is about an area of the country that has too often been forgotten in the planning of services and where the people feel left out from the way in which the NHS has been formed in the past. The Government and I wish to address that. I am grateful to the hon. Member for Copeland (Mr Reed) for bringing his points to the House. He is a forthright campaigner for his constituents and cares passionately about his constituency, and he understands the needs and concerns of his patch. I listen with care, because I know he chooses his words with care. He would not have used the strong language he used in his speech were it not for the fact that he judged it necessary to do so.

I will begin where the hon. Gentleman ended—on the floods. I was glad that, despite the extraordinary amount of rainfall in Cumberland and Westmorland, the effect on NHS services was not as severe as it was in 2009 and 2005. That shows we are at least getting a bit better at resilience and planning. I would like to pay tribute to some of the people who stood out during the difficult period of the past few weeks. The NHS workers from across north Cumbria, many of them in his constituency, worked all hours to make sure people could access medication and receive treatment. It is a credit to them. The amount of work, commitment and vocational passion they bring to their jobs was reflected in the hon. Gentleman’s speech.

I will come on immediately to the problems in north Cumbria. They are well documented, although there is no agreement yet on how we address them. The fact is that north Cumbria is one of those rare things in England: a very remote area. We do not have them in our country in the way that others do. Our neighbouring country of Scotland has more remote areas and is able to understand the pressures that they put on health systems in a way that we do not. The Whip, my hon. Friend the Member for Hexham (Guy Opperman), also represents a remote and rural area. Rural areas pose particular challenges to a service that has grown out of an urban design for healthcare provision over many decades. We are seeing the pressures and difficulties posed by that structural conflict in north Cumbria.

To be blunt—the hon. Gentleman is cognisant of this—the care of patients in north Cumbria has fallen well short of where it should have been because of the structural failures in the way the NHS is set up in that area. That is why the hospitals were placed in special measures and why they have been there for so long. It is why they have not exited from special measures and why NHS England, together with Monitor and the trust development authority, has felt it necessary to place the whole of the health economy of north Cumbria into its so-called success regime. That is not a title I love very much, but I hope it points to the place we need to get to.

I will say from the outset that the success regime will be successful only if it comes up with a plan that is deliverable and has the support of local people and clinicians. The problem in the past has been that ideas have been proposed, normally from the centre, and placed on to local people. Completely understandably, they have said, “I am not having this. This doesn’t suit what we believe we need in terms of healthcare for our area and that’s not good enough.” Because the NHS is owned by local people, we will only win this if they feel any redesign will improve quality and services. We also have to be clear that it will pose difficult challenges to us as politicians, both as local representatives and Ministers. It is important we get behind the success regime when it concludes and are prepared to take difficult decisions. The one thing that will ensure that the poor state of patient care quality persists in north Cumbria for years and decades to come is if we do not take a decision. We have to take a decision. We have to make sure it is the right decision. We have to get behind it and make sure it happens.

Turning to some of the specific issues the hon. Gentleman raised, the issue of staffing really underlies all the problems in the various NHS bodies in north Cumbria. It is difficult to recruit to certain specialties in north Cumbria. That means the trusts and other NHS bodies depend on locums and agency staff. That is not the way to run the health economy either in north Cumbria or across the NHS. That is why we have taken wider action on staff agency costs and why we need specific help for north Cumbria. The success regime is looking specifically at this.

The hon. Gentleman mentioned the new medical school, led by the University of Central Lancashire, on the West Cumberland campus. I welcome its sense of innovation. It already provides very good non-medical healthcare courses, and I am glad it is reaching into new areas. I will be excited to see how it progresses and would like to see what it is doing for myself in the near future. I certainly endorse his plan for a rural health policy laboratory—it is the right way to go—which I hope will feed into the success regime and our understanding of how to learn from other areas of greater rurality and sparsity, such as Canada and Australia, and how they deal with, and provide exceptional care to, people in dispersed communities.

The hon. Gentleman mentioned nursing bursaries. I will not get into that debate now, but I hope he will be reassured by my announcement a few hours ago of a nursing apprenticeship route all the way to degree level to ensure that healthcare assistants can progress to registered nurses via an intermediate nursing associate position. In north Cumbria, it is much easier to recruit to healthcare assistant posts than to nursing posts. I hope he will understand where I am going with this. As in Hull and other parts of the country where it has been difficult to get nurses into post, it will allow us to give to our excellent, committed healthcare assistants, who have the values of the NHS right at the core of their being, a career progression route that they have not had so far. I hope he will take comfort from that initiative.

I understand that staff often work excessive hours just to keep things going in stressed areas such as north Cumbria. The NHS depends on their good will at such moments, but it is not something we should bank on, which is why we need to get it right for his constituents and the whole of north Cumbria.

The hon. Gentleman made two final points about the building programme at the West Cumberland and the transformation fund. I will certainly consider his request in respect of the West Cumberland, although it is probably best that Monitor comes to a final decision once the success regime diagnostic is at least concluded, which should be imminently, because it would be a mistake to embark on something that would be moderated by a joint decision within the success regime deliberations. I will ensure, however, that there is pace to that. It is important, if it is committed to, that it is delivered, but I assure him that I will look into the matter first thing in the new year.

The transformation fund is designed to stimulate the innovation we know there is in the NHS around clinical management and to bring efficiencies to bear across the hospital estate. It is not, I stress, a bail-out fund; it is designed to do what it says on the tin: to transform how we run our hospitals. Efficient care is good-quality care, as the hon. Gentleman understands better than most, which is why the hospitals delivering the best care in the country are also the best at looking after their finances. There is considerable talent within the management and clinical management core in the NHS, and we want to realise their ideas for making the NHS more efficient across the services it provides. That is the purpose of the fund. It is to help realise that innovation and to match their efforts. If we simply pour it into bailing out hospitals that are not doing their bit to transform and bring in efficiencies, it will be doing the wrong thing and we will be wasting money. However, I will certainly make his request clear to the leadership of NHS Improvement, which is concerned with this matter. He will be pleased to know that Jim Mackey, the exceptional new chief executive of NHS Improvement, is well acquainted with his part of the country and has its interests at heart.

It remains to me, as the last person to speak from the Floor this year, to thank the hon. Gentleman for bringing this important matter to the House. On this occasion, last is certainly not least, and I hope that Cumbria will be first in the new year in terms of the announcements we will make. I wish everyone still remaining in the Chamber—the Clerk, the Serjeant, the Whip, the Doorkeeper, the officials in the Box, the one or two determined visitors and you, Madam Deputy Speaker—a very happy Christmas.

Question put and agreed to.

Regulation of Health and Social Care Professionals

Ben Gummer Excerpts

Thursday 17th December 2015 Written Statements

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

The Government remain committed to reform of the regulation of health and—in England—social care professionals. The Government are grateful for the work of the Law Commissions of England and Wales, Scotland and Northern Ireland in making recommendations and has been considering how best to take these forward.

Our priorities for reform in this area are better regulation, autonomy and cost-effectiveness while maintaining and improving our focus on public protection. We intend to consult on how these priorities can be taken forward, taking account of the Law Commissions’ work on simplification and consistency and building on the Professional Standards Authority for Health and Social Care’s paper “Rethinking regulation” published in August 2015. We will present proposals that give the regulators the flexibility they need to respond to new challenges in the future without the need for further primary legislation.

We recognise the need for some immediate reform in this area. Subject to parliamentary time we plan to take forward reforms to regulators’ rule-making process and the way that the larger regulators deal with concerns about their registrants. This will improve accountability and make the system more efficient and effective.

This Government remain committed to the principle of proportionate regulation of healthcare professionals. Having considered the arrangements already in place to ensure that public health specialists from backgrounds other than dentistry or medicine are appropriately registered and qualified, the Government do not consider that extending statutory regulation to this professional group is necessary. To this end, they will not be taking forward secondary legislation in this regard.

[HCWS417]

Student Nursing (Finance)

Ben Gummer Excerpts

Monday 14th December 2015 Commons Chamber

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

It is a privilege to respond to this debate, and the hon. Member for Ilford North (Wes Streeting) made a powerful speech. I know that he has experience and expertise in student finance. He was on the front line when we had discussions in this place some years ago, albeit outside the Chamber, and he brings passion and knowledge to this debate. He may feel that I am rehearsing points that he has heard previously, but before I address some of the specific and detailed questions that he rightly raised, I hope he will not mind if I run through some of the issues and reasons why the Government feel that this measure is the right thing to do at this time.

The hon. Gentleman will be aware that nursing remains one of the few subjects not within the purview of the current student finance system. To our mind, the current system is not delivering as it should for either students or patients. Simply put, nursing is one of the most oversubscribed subjects in the whole academic range, and the fifth most popular subject that UCAS offers. Last year, there were 57,000 applicants for the 20,000 nursing places available.

I do not wish to go down the route of discussing NHS finance, because it will lead us to a place that is not easy for the hon. Gentleman’s argument and not particularly realistic. There is no way that any Government of any stripe would be able to offer a place to every single person with the necessary qualifications who wished under the current funding system to apply for a nursing place. The question for us is this: how do we change the system to give more people the opportunity to study nursing, and do so in a way that we are able better to supply the nurses and the nursing positions required in the NHS?

The hon. Gentleman asked a very important and pertinent question, which is why in his hospital, which I know from having gone there and from discussing this with him in other debates in this place, he should be seeing a shortage of filled nursing places. It is a function of parts of London that there are problems in recruiting—I was in Hull last week where they have a similar problem, albeit for different reasons—and yet there is an oversubscription for places. He could have added that we almost have a record number of nurses in training at the moment. So how does that add up?

Under the Government, we have seen a significant expansion in the number of nurses in the workplace. The response to the tragic events at Mid Staffs, the subsequent Francis report and the results of the Morecambe Bay inquiry led us to the conclusion that had eluded previous Governments: we needed safe staffing levels on wards that were not, in some parts of the country and in some hospitals, safely staffed. That required a significant increase in nursing numbers, which could be provided in the short term only by agency nurses. That is why we have not only increased the number of nurses in training—clearly, they take a while to come through—but have been required to take action on the cost of agencies taking advantage of the situation. That does not change the fact that it is simply not possible, within the current funding set-up, to satisfy either the demand for or the supply of nursing places.

There are other reasons. Even if we did not need to do something to get a better match between the number of nursing places and what the NHS requires and students want, I would want to push this reform. It is for that reason that I directly disagree with the hon. Gentleman’s assessment of student finance reform. I disagreed with him when we had this discussion in 2011, albeit not in this Chamber. If I may gently put it, I think those on the Conservative side of the House were proved right by those reforms. The simple fact is that we now have more applications from disadvantaged students to higher education than ever before in the history of higher education. We have seen a significant expansion in the number of students full stop going into higher education. Eighteen-year-olds from the most disadvantaged areas were 72% more likely to apply to higher education in 2015 than they were in 2006. It has happened in precisely the opposite way to what he and his friends on the Labour Benches, when they were making the argument in 2011, expected to happen.

[Wes Streeting]

The Minister should look more carefully at what happened to mature student applications following the reforms—they plummeted—and think about the profile of the people applying to be nurses and midwives. Does he accept that the majority of loan debt will never be paid back, including by graduates who will earn far more than nurses?

[Ben Gummer]

I will turn to mature students, but I hope the hon. Gentleman will concede my central point. The significant majority of students going into nursing are doing so at an undergraduate point at 18 or 19 years of age. For that cohort across the rest of the higher education sector, we have seen the most spectacular expansion in opportunity than at any time since higher education was opened up more broadly to people after the second world war. That is something that Members on both sides of the House should celebrate. I know that those on the sensible wing of the Labour party also embrace the reforms and see why they were a good thing.

I disagree with many in the Opposition, but to be direct with the hon. Gentleman, I want to bring those advantages to student nursing. I want to expand the number of places available to people from all backgrounds to give them the opportunity to enter nursing, and I want to secure the advantages that come from bringing people from non-traditional and disadvantaged backgrounds into nursing, in the same way as we achieved in the rest of the higher education sector. I believe passionately in that. Even if the NHS and the students themselves—the 37,000 who applied but did not get a place last year—did not require this change, I would still be making it, because it is the right thing to do for those who otherwise would not have an opportunity. Under the new student financing arrangements, they will have that opportunity.

[Peter Kyle (Hove) (Lab)]

I wish to press the Minister on my hon. Friend’s point about mature students. In higher education, the number of mature students attending has now fallen by half. This is directly related to the current funding regime. The social mobility commissioner has cited education as the key vehicle by which mature people can achieve social mobility. How will the Minister prevent the number of mature nursing students falling as it has done in higher education?

[Ben Gummer]

I will turn to that point with pleasure, if the hon. Gentleman will give me a few minutes, because I have several things to say about mature students. I accept that this area of the proposals requires close attention, which is why I want to ensure that they are as robust as possible and that the consultation, to which the hon. Member for Ilford North referred, is as good as possible.

I want to answer the questions from the hon. Member for Ilford North about the consultation. We will consult on the full gamut of the reforms, but we will not consult on the principle, because that has been decided, as was outlined by my right hon. Friend the Chancellor. It is unfair to say he sneaked it out, given that it was made evident in his speech and was reacted to by the Opposition, as I know because I heard them. As for the timetable, the consultation will begin in January. We have not determined precisely when it will conclude, but it will be a full consultation. In significant part, it will look at how to ensure that mature students are supported, and I can confirm one element of it: we will allow mature students to apply for a second loan. Of course, that will account for only a small number of the cohort, but we will look at the impact of the changes on mature students, because they make up about a third of the cohort going into nursing.

[Mr George Howarth (Knowsley) (Lab)]

I am a little confused by the Minister’s argument, which appears to be that by removing an existing advantage, he will create an advantage for more people to enter the nursing profession. Most people listening will find that slightly illogical, but he is not normally an illogical person. Would it not be sensible to do as my hon. Friend the Member for Ilford North (Wes Streeting) suggested and have a proper impact assessment followed by a vote in Parliament, so that we can decide the right way forward, on the basis of that impact assessment?

[Ben Gummer]

The right hon. Gentleman makes a fair point, and I can tell him that an economic impact assessment and an equality impact assessment will be published with the consultation. I hope that that will begin to inform the debate. He might imagine that my proposition does not align with what he thinks the effect will be. I just ask him to look at what happened in 2011 when we did the same for the vast majority of other students, when Opposition Members put exactly the same arguments and warnings, and since when the precise opposite has happened.

[Mr Howarth]

The Minister is being generous in giving way twice, but we are not talking about what happened then; we are talking about a particular group that at the time was excluded from the provisions. He has not yet explained why he has now decided to include them in those provisions, other than by saying he is taking away an advantage that already exists.

[Ben Gummer]

It is simply because I wish to see the same advantages that accrue to those already on the new finance system accruing to those who are not. I want to see an expansion in the number of places and I want to see the effects of the changes made by the Office for Fair Access to university admissions in the rest of the sector applied to nursing, so that we see not only an expansion in the numbers of nurses being trained, but a broadening of the backgrounds of those going into nursing, exactly as has happened in all other areas of higher education.

I want to explain, I hope quickly, how this change forms part of a wider reform we are making in student access to nursing. The hon. Member for Ilford North framed his entire speech, understandably so, around the university route into nursing, but he omitted to reflect on the fact that the Government have stated that we will introduce an apprenticeship route into nursing to degree level—level 6. That will provide an alternative route into nursing, whereby nurses will be able to earn while they learn from healthcare assistant level all the way to a full nursing qualification at degree level. It will be possible for them to do so as mature students, which means it might take a bit longer, but they will be able to earn all the way from an existing job to gaining a nursing qualification—an innovation that should be welcomed on both sides of the House and which will mark a real expansion of opportunity for the current NHS.

[Jess Phillips]

rose—

[Ben Gummer]

Before I give way to the hon. Lady, I should also explain that there are many people working as healthcare assistants at the moment who do not have the opportunity to progress to a nursing position unless they leave the workforce to do so. That puts many of them in an impossible position, because they have families to support and other duties and responsibilities. For the first time, we have been able to give that group of people an opportunity to progress, through the apprenticeship route, to a full nursing position. That will expand the whole area of career progression to include one of the larger cohorts in the NHS workforce, in a way that no Government have previously been able to do.

[Jess Phillips]

I wonder whether the Minister can clarify whether people will be paid for doing that apprenticeship and, if so, at what rates they would be paid. He rightly referred to getting mature students with families into work, so will he also say whether that cohort will fall foul of the rule that people must be doing 16 hours of work, and not be in training, to receive the Government’s 30 hours of free childcare? It was made clear in the Childcare Public Bill Committee that those nurses currently studying would not be able to access the 30 hours’ free childcare because that would not be considered work. When they saved my life, it looked like work.

[Ben Gummer]

The hon. Lady speaks with authority from her own personal experience—I have noticed that recently she has spoken her mind without holding back. We are in detailed discussions with the Nursing and Midwifery Council about precisely how the apprenticeship route will work. The council is the independent regulator and has to certify that the qualification matches the existing degree/university route. The qualification has to have complete equality of both esteem and rigour. Of course we envisage the apprentices earning a salary. We envisage opening the route to existing healthcare assistants to give them the opportunity to progress to a nursing grade while continuing at a similar salary point as an apprentice. However, because the hon. Lady’s question about maternity care pertains to student nurses rather than apprentices, I will ensure that I write to her in detail.

The hon. Lady clearly sees why this is an idea with strength, so I hope that in asking her question she realises that there will be two routes into nursing: the university route and the apprenticeship route. I think this is potentially one of the most exciting innovations in the workforce of the NHS for several decades, because it opens up nursing to a whole range of existing workers who have not had an opportunity before, and provides a wholly different route into nursing, but with the same rigour and robustness that the existing university degree route provides.

[Peter Kyle]

rose—

[Ben Gummer]

I shall give way once more, but I do not want to detain the House much longer.

[Peter Kyle]

I thank the Minister for giving way a second time. It is clear that he really cares about getting mature students into these nursing training programmes. If the numbers fall as we go forward, will he come back to us and report on it, and will he pause any further reforms until that decline is halted?

[Ben Gummer]

I expect to be held account for this significant reform right the way through the changes that are envisaged. I hope to be able to return to provide good news about progress, as has happened in other student areas. That is why we want to be very deliberative about the way in which we form this consultation, because it is important to get it right.

I have taken note of the careful questioning of the hon. Member for Ilford North, who clearly understands the full gamut of the issues that need to be addressed in this consultation. Let me answer some of the questions he raised, and I shall write to him about any that I do not answer.

The hon. Gentleman asked about the funding of clinical placements. We have already started discussions with Universities UK about that, and it will form part of the wider consultations. The Barnett consequentials will be a matter for Her Majesty’s Treasury, as is the case for everything else connected to Barnett consequentials. I know that BIS officials are discussing the issue in the normal way.

The hon. Gentleman asked about research into financial hardship, and I know that that will form part of the consultation. The Government will be open to any further research beyond the economic impact assessment.

I was asked whether I would be happy to meet students. Of course I would. I have already met Unison and the Royal College of Nursing to discuss the changes I wish to make. I should not pretend to answer for them, but I have had productive discussions with both, especially about the apprenticeship route. I know that we will disagree with both Unison and the RCN about bursaries, but I think there is an understanding, particularly on the part of Unison, of how we are trying to open up different routes to nursing for different parts of the workforce. If we get it right, the apprenticeship model will be a strong one.

The hon. Member for Ashton-under-Lyne (Angela Rayner) made an important point in her intervention about agency nurses, so let me answer that as I am passing. As I alluded to earlier, part of the reason we are looking at that issue is to ensure that we provide a more sustainable workforce throughput, so that we do not need to rely on agencies and bank staff for the peaks in NHS demand. That is why we need to do something about numbers, and I hope that, as a result of the Chancellor’s announcement, we will increase the number by 10,000 over the course of this Parliament—a very significant increase in the establishment of student nurses. In fact, it will be the largest increase in student nurses under any Government since 1948.

I hope I have answered the majority of the questions put by the hon. Member for Ilford North—

[Wes Streeting]

rose—

[Ben Gummer]

Clearly I have not. I will allow him an opportunity to intervene once more, but I do not want to detain the House much longer.

[Wes Streeting]

I particularly welcome what the Minister said about treading carefully and thoughtfully around the consultation. The one issue he has not addressed, however, is whether extending the tuition fees regime to nursing, midwifery and other allied health subject students will be subject to a full and thoughtful debate followed by a vote in this House and the other place.

[Ben Gummer]

I cannot give the hon. Gentleman a definitive answer to that question yet. Let us wait and see the outcome of the consultation, so that the House can be best informed. I imagine that there will be ample opportunities in Backbench Business Committee debates and indeed Opposition day debates, and I know that the hon. Gentleman and his colleagues will want to bring these issues up for further debate. I will reflect the hon. Gentleman’s concerns to the Secretary of State and to the Leader of the House, and I am sure they will receive them with interest.

I genuinely thank the hon. Gentleman for bringing forward this debate, which has provided an opportunity for the Government to explain our plans and the rationale behind them. There will be points on which we will disagree, but I hope the hon. Gentleman will see the force of our arguments about wanting to expand the nursing workforce, to provide different routes into nursing and to provide the sort of opportunities to 18 and 19-year-old undergraduate nurses that have been extended to other parts of the higher education sphere. These are big proposals. They could mean a remarkable and rapid transformation of the NHS workforce, and a significant expansion in the number of nursing students. We need to get it right, and I hope that, through a constructive discussion across the House, drawing on the kind of expertise we have heard from Members in this short Adjournment debate, we will indeed get it right.

Question put and agreed to.

Draft National Health Service (Licensing and Pricing) (Amendment) Regulations 2015

Ben Gummer Excerpts

Monday 30th November 2015 General Committees

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

I beg to move,

That the Committee has considered the draft National Health Service (Licensing and Pricing) (Amendment) Regulations 2015.

I will outline the Government’s case to the Committee. Despite the significant pressure on the public finances as a consequence of the deficit, the Government have protected the national health service in real terms. As the Chancellor announced in the spending review last week, we will ensure that the NHS receives an additional £10 billion a year above inflation by 2020-21, with £6 billion front-loaded in the first two years of the six-year period. The settlement is a good one for the front-line NHS given the wider pressures on public spending, and it has been welcomed by NHS England and NHS providers.

The settlement is also a key part of our wider commitments for the system: to realise the NHS’s ambitions, as set out in the five-year forward view and by Simon Stevens, the chief executive of NHS England; to ensure that the NHS has a sustainable, long-term future; and for patients to continue to have access to high-quality care free at the point of delivery. Such a plan should have buy-in throughout the House.

As hon. Members are aware and will, I am sure, collectively agree, the NHS faces multiple and unprecedented challenges, which illustrate the urgency of delivering on the five-year forward view. That is the NHS’s own vision for its future, which we supported in the spending review. The vision includes understanding that an ageing population, many of whom have complex conditions, requires changes to how services are configured and delivered; that despite the Government’s additional investment, resources are ultimately finite; and that the rapid pace of innovation in medicines, medical technologies and technologies more generally challenges how we deliver healthcare, whether to individuals or to communities.

The pressure of the changes can be seen in the number of patients being seen and treated in our hospitals and in the position of the finances in the acute sector. That is why we have made and will continue to make the necessary investment in the NHS. More broadly, such factors make it imperative that our health service does all it can to move to better, more sustainable ways of working as soon as possible. Changes to the way in which services are configured and delivered mean that in future much greater collaboration and integration will be required.

I will provide some background to the draft regulations. The Health and Social Care Act 2012 introduced a new, independent, transparent and fair pricing system, which requires Monitor and NHS England to collaborate to set prices and to develop further new payment models across different services. The intention was to create a more stable and predictable environment, allowing providers and commissioners to invest in technology and innovative service models to improve patient care.

Monitor has a specific duty to promote healthcare services that are efficient and effective and to maintain and improve quality. It achieves that by working with NHS England to regulate prices and to establish rules for local pricing and flexibilities. NHS England defines the units of service for which prices or rules will be specified. At all stages Monitor and NHS England have to agree elements of the tariff with each other.

The Act also includes a statutory basis for providers and commissioners to express formal objections to the methodology that Monitor proposes for calculating national prices, rather than to the price itself. Following comprehensive engagement with commissioners and providers, Monitor is required to publish a final draft of the national tariff and to allow 28 days for commissioners and providers to consider the proposals. Commissioners and providers may object formally to the proposed methodology for calculating national tariff prices for specified services.

Following the consultation, under existing rules Monitor calculates the percentage of commissioners objecting, the percentage of providers objecting and the percentage share of supply held by the objecting providers, which allows the objections of providers to be weighted proportionately to the nationally priced services. I hope that is clear. Each threshold is set at 51%. If any of those thresholds is met, Monitor cannot publish the national tariff and has either to put forward alternative proposals and publish them for consultation or refer the method and the objections received to the Competition and Markets Authority.

Let me explain how that process has worked in practice to date. Two tariff processes have taken place under the new arrangements, in 2014-15 and this year, 2015-16. No objection threshold was met when the first proposed national tariff was consulted on in 2014-15, and the tariff was published on time. For 2015-16, the objection tariff mechanism was triggered—the share of supply objection threshold was met, as 73.7% of providers by share of supply objected. As a result, the unexpired 2014-15 tariff remained in place, at a considerable cost to the health service and, ultimately, the taxpayer.

NHS England estimated that the system, and ultimately taxpayers, would face a significant cost pressure by continuing to pay 2014-15 tariff prices in future. The NHS cannot afford a repeat process of 2015-16 unless exceptional circumstances arise, because having the process subject to ongoing delays to resolve the pricing mechanisms for anything less would cause a significant level of instability, at a time when the NHS is trying to focus its energy on developing new, sustainable methods and models of care.

A criticism of the current payment mechanism has been that it acts as a barrier to delivering new care models—this is essentially the point of this debate—and especially out-of-hospital care models. Continuing to pay 2014-15 tariff prices would reinforce those barriers, so there would be less to invest in community services, in improving access to mental health services, in primary care or in supporting seven-day services across the entire NHS.

The reality of the tariff-setting process is that a finite amount of money is available, which has to be allocated fairly across the system, even with the very considerable increase in funding that we proposed for next year of some £6 billion. It has to be allocated in a way that is most likely to benefit patients and to support the change to new models of care, which the NHS five-year forward view envisages. Monitor and NHS England need to be able to agree and publish a tariff in a timely manner to give the NHS the stability it needs to implement the five-year forward view.

The objection mechanism is intended to be triggered in exceptional circumstances. When the thresholds were prescribed in 2013, it was made clear publicly in the explanatory memorandum to the original regulations that the thresholds would be kept under review, given that there was no precedent from other sectors for what an appropriate threshold should be. Allowing providers to have their objection weighted according to their share of supply has allowed larger providers to use the objection threshold as a veto to protest if and when they disagree with a particular aspect of the method, or to changes to the pricing system outside the method. Therefore, in order to avoid future potential for disruption and consequential costs to the taxpayer and the system, and to ensure that as much resource reaches the front line as possible, the objection thresholds and share of supply have been revisited to provide a process that is as fair and stable as possible for all NHS providers and commissioners.

We consulted on a range of proposals to change the objection thresholds, including the option of removing the share of supply threshold and increasing the objection percentages for clinical commissioning groups and relevant providers of NHS care services, either to 66% or to 75%. The Department received a total of 221 responses to the consultation from a range of stakeholders. That is a positive response rate, and we thank all those who took the time to contribute to that complicated consultation. We are not deaf to the concerns raised by stakeholders, which is why the package of measures set out in the spending review seeks to address some of the issues that have been raised.

Some 46% of respondents to our consultation, including many commissioners and mental health providers, agreed with our proposal that the objection mechanism should be revised to provide greater clarity to the system ahead of the coming financial year. However, 52% of respondents opposed the proposal. The majority of those were providers, who gave 123 responses. They felt that the process worked as intended and that it was too early to make any changes. Respondents believed that the current system had not existed long enough to enable proper evaluation and assessment. There were also calls for deeper and more timely engagement and transparency on tariff proposals.

The tariff development process is still evolving. Monitor and NHS England continually evaluate how to improve their processes, including engagement, and will include this process in that evaluation going forward. We also welcome the recent proposals from NHS providers on improving the process and look forward to continuing the dialogue.

We considered in detail all responses to the consultation. However, as I outlined, our main concern must be to address the financial health and future sustainability of the overall system and to ensure that the collective system focus is on delivering the vision and the new models of care set out in the five-year forward view. That will require the NHS to shift its perspective from managing organisation-based issues to an approach based on system management—for example, through implementing new models of care that provide properly integrated services for patients.

This is about funding patient care rather than building systems and institutions. As such, our focus must be on securing a tariff settlement for 2016-17 that is fair, that supports the development of new, sustainable models of care, and that is achieved in enough time to be effectual for the coming year. NHS England has indicated that a repeat of the 2015-16 process could have a negative impact on planned investment in areas such as mental health and community services, which would have serious implications for the health service as a whole. That is not acceptable to the Government, and we will not allow it for either patients or the taxpayer, who is funding these considerably increased resources for the NHS. We will keep under review the need for any further changes to ensure that the system operates optimally in patients’ interests.

The regulations will remove the share of supply threshold and increase the objection thresholds for providers and commissioners from 51% to 66%. We believe that removing the share of supply threshold creates a fair balance in the system as a whole, while still allowing for objections to be heard. All providers of NHS services will continue to play a crucial role in the tariff development process. Furthermore, the changes made through the regulations will create the stability that is necessary for the tariff-setting process, while retaining a comprehensive development mechanism that will allow for prices to be set in a fair, transparent and consistent way, taking into account the views of all providers.

In summary, the intention behind the objection mechanism was that the threshold should be high enough to prevent any unnecessary delay to the tariff caused by objections that were not sufficiently representative, but low enough to highlight systematic issues with the method, rather than issues with the prices themselves. We now consider that the objection percentage for providers and commissioners should be higher but remain consistent for commissioners and providers in the interest of fairness. The regulations will retain the ability of commissioners and providers to object to the proposed method during the statutory consultation, while requiring levels of objection to be more significant to prevent Monitor from publishing the national tariff. That means that the national tariff can be published early enough to give all stakeholders the certainty needed to make the necessary planning changes locally.

I acknowledge and appreciate the strong opposition to these changes from some providers. However, we believe that changes are necessary to avoid further significant disruption to financial planning in the NHS. The regulations, along with the generous spending review settlement, will create stability for the system as a whole, so that the NHS can channel its energy into delivering the five-year forward view. Money spent on resolving disagreements on the tariff is money taken away from patient care. That cannot be right, and I hope all hon. Members will support us in making what we feel are necessary changes. I commend the regulations to the Committee.

--- Later in debate ---

[Ben Gummer]

I thank the shadow Minister for taking the care—I mean this in all sincerity—to look at a complicated area of health economics and for providing me with so many questions and challenges; he is right to do so. It is good for the House that we are considering the regulations in such detail, because the mechanism by which the tariff operates lies at the heart of how the NHS has worked not only since the 2012 Act but for several decades, under different Administrations.

I will provide a quick gloss for why the tariff is a difficult mechanism to get a perfect line on at any one time. It is, by its nature, a complicated beast, encompassing a huge number of procedures. Having to set a price is a function of the NHS, which is effectively a monopoly purchaser. The tariff is not the product of a whim of Monitor. Monitor does not sit down one day and say, “I believe the tariff for a cardiac procedure should be x, and for a knee joint procedure it should be y,” although I know the shadow Minister is not suggesting that to be the case. The tariff goes through a rigorous costing process to try to understand what advances in efficiency and medical technology can be brought to bear and how the costs of different procedures have gone down, remained the same or increased. At the termination of that process, which involves clinicians all the way through and a whole gamut of health economists, the tariff is put to providers across the country.

There is a balance that we have to strike as a Government. It was acknowledged in the passage of the 2012 Act—which I remember, though mercifully I was not on the Public Bill Committee that scrutinised it—that the changes would need to be finessed over time. That was the nature of the reforms to the health economy that were proposed and then passed by Parliament. The initial thresholds of 51% were not drawn scientifically, but on the basis of probing Ministers and Parliament and on the understanding that they would have to be reviewed in future. It is important that we get the balance between the tariff setting and the tariff challenge absolutely correct.

The situation that we have found ourselves in, as the hon. Gentleman said, is that a proportion of providers that do not represent in totality a significant number—a proportionate majority—can challenge the tariff successfully if it is not in their interest. It is our judgment that at the moment we are not correctly balancing the ability to challenge and the threshold at which we find that ability to challenge, and the interests of commissioners who are acting on behalf of patients and of taxpayers.

We consulted on three different thresholds, including a continuation of 51% and a higher threshold of 75%. We took a slightly different view from the hon. Gentleman of the outcome of the consultation. He mentioned some figures, but I merely repeat that 46% of respondents to the consultation, many of whom were commissioners and mental health providers, agreed that the tariff needed to be changed. Those who opposed a change to the tariff were, not surprisingly, providers. That is their right and it is not surprising in many instances that they chose to do so. One should question, however, whether it is right that 37% of providers by number—even if they make up a larger proportion by revenue—have the ability to challenge the tariff set by Monitor in its extensive process and consultation. That tariff also has to be used by commissioners on behalf of patients.

There are two effects. The first is to delay the implementation of the tariff at all, which creates massive financial uncertainty in the system. I am conscious that, with time, with the 51% threshold and given the number of providers able to reach the bar, that that would become a constant. Financial planning in the NHS would therefore become less about planning and more about responding to challenge after challenge. Secondly, and perhaps more importantly for why we need to look at things again, we have to balance the interests not only of providers by number and revenue throughout the entire sector, but of commissioners, the people buying care on behalf of local people. In order to buy that care, the commissioners are using a significant part of the revenue raised in taxes.

Members of all parties understand that achieving the move that we all want to a care system based on primary care, strong community services, full integration with social care and increasing resource committed to mental health services is about addressing the balance between providers and others modes of care rather more subtly that has been done in the past. I think we agree on that.

The question is how we go about that. That process will bring some challenges to some providers, who will have to do things more efficiently and differently. That is in the nature of creating a more productive NHS. It is precisely the kind of productivity challenge that Simon Stevens indicated in his five-year forward view.

Our contention is that we have to create a realistic objection threshold that can be met if there is overwhelming response to a tariff in one particular area that is unfair, but that, on the other hand, does not create a continued roadblock because a proportion, even a smaller proportion within the NHS as a whole, continues to hold up tariff changes—the tariffs discovered scientifically by Monitor.

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

The Minister is being generous and patient in the way in which he is trying to explain this to the rest of the Committee, because we are not all quite as well briefed as my hon. Friend the Member for Ellesmere Port and Neston. However, the Minister seems to be saying—he will forgive me if I have got this wrong—that we have moved to 66% because there was an agreement, or an understanding, that 51% was basically a finger in the air, and we would have to adjust it at some point in the future. The Minister wants to remove what he sees as a veto by providers, whereas my hon. Friend says that if all the providers got together, they would never reach the 66%. So what is the gap between the two?

[Ben Gummer]

That is not entirely the gloss I would give to my comments.

There is no veto to all providers, because we are talking about 66% of providers in total meeting the objection threshold. This means that one particular bloc in the healthcare system as a whole that uses the tariff—it is not just used by NHS providers—will not be able to block the proposed tariff. Currently a smaller proportion of NHS providers—it is not even the full number—can block the tariff. It is not a scientific process, but in trying to balance the interests of commissioners and a healthy provider sector, which incidentally we will fund considerably more in years to come, we feel it is not right to give an objection threshold of 51%, and that we need to show a more significant number. That is why 66% of all providers would have to meet the objection threshold.

I would not like to speak for Earl Howe, who I know spent many hours explaining this matter and going through it in detail during the passage of the 2012 Act, but I think it was understood at the time—this was why the Bill developed as it did during its gestation—that, as with any health economy, the regulations would need to be finessed as issues emerged. To be blunt, we are at a time when NHS spending has gone up over the past few years, although it has been under significant pressure, as the hon. Member for Ellesmere Port and Neston said, because of changing demographics, and the way in which the tariff system and the changes made in the 2012 Act have enabled the tariff and the whole health economy to operate has allowed us to manage funds in an efficient manner.

I am conscious that others may want to speak, so I want to cover some of the other issues that the hon. Gentleman raised. He mentioned patient safety. I hope that I can place the issue in the larger context of all our reforms around the Care Quality Commission, introducing a simple grading system that gives complete transparency, and our additional funding to the commission over the past five years. By everyone’s estimation, the commission has improved its performance significantly, although we all want to it to improve still further.

We believe that patient safety is ensured by a raft of measures, not just by increasing NHS funding, but by increasing transparency on outcomes, by better regulation and inspection, and by giving a voice to NHS workers—giving them freedom to speak out through the whistleblowing champions that we have introduced and the efforts we are making to bring in a learning culture in the NHS. We are making those efforts in order to develop an NHS that learns from mistakes, can point out and shout about failures in patient safety, and can improve patient care in an iterative process.

That cannot, and can never be, about just pumping money in at one end and expecting to get improved care out at the other. We know that increased resources are one component, but to characterise tariff as a patient safety alarm is itself a little alarmist. It is one part of a health economy. As I explained, it is set by clinicians and economists, and the whole architecture that the Government have tried to reinforce and in parts introduce is there to underpin patient safety in the round. This is merely one component of that.

The hon. Gentleman raised specialised services. He could also have raised the issue of emergency admittances. Both those things are being looked at in the current tariff proposals. I understand the concerns that he raised, and I know that officials and Monitor will have heard them.

I must finally address the consultation process itself. I am not sure that the hon. Gentleman’s characterisation is fair on this. The consultation lasted a month. I do not think we can count a Spanish summer as happening in the NHS in the way he might suggest, as if everyone had vanished and was unable to respond. We received a significant number of responses. Given the fact that there are roughly 147 NHS acute trusts and a significantly larger number of commissioners—we are not talking about thousands, however—receiving 221 responses is good. They were full responses and I was completely open about their nature and the fact that, frankly, they were split, if not 50:50, about as close to 50:50 as a public consultation gets, on the quality of the Government’s proposals. The Lords sits in the summer months in a way that the House of Commons does not when we are back in our constituencies, but the 20-day scrutiny period is significant, and their lordships will have looked over it with due care and attention.

I understand the hon. Gentleman’s concerns about the nature of the changes, and it is understandable that he wishes to raise them. In part, they are the objections of some providers, and I am glad that he has brought them to the Committee’s attention, but I hope that, after this discussion, he understands that the regulations are part of a larger balance between different parts of the NHS to ensure that the additional money that we are putting into the NHS—the NHS budget will exceed half a trillion pounds over the course of this Parliament—goes towards reforming the system, new models of care and the primary, social, community and mental healthcare that all our constituents want improved on the ground. This tariff reform will help the process by ensuring that a bloc of providers cannot obstruct that change without significant enough numbers.

[Justin Madders]

I am grateful to the Minister for his gracious comments at the start of his speech. Does he accept that, under the regulations, if all NHS providers objected, they still would not reach the objection threshold? Can he explain why NHS providers are being put on an equal footing with non-NHS providers?

[Ben Gummer]

I hope the hon. Gentleman understands that the tariff, because it is a set price across the entire sector, has to treat every provider with equality. We cannot have a tariff of one price that accounts for one provider differently from another. All providers operate under the same tariff system, which means that no single bloc in the NHS or the healthcare system can obstruct tariff reform.

In summary, I hope that the Committee understands why these changes are necessary. They have been consulted upon in full, which is why I continue to commend these regulations to the House.

Question put,

World Prematurity Day

Ben Gummer Excerpts

Tuesday 24th November 2015 Westminster Hall

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

It is a great pleasure to answer another debate on neonatal care. It demonstrates that there is a real head of steam behind this important issue. I cannot comment with any experience on the number of debates on this issue that there were in the previous Parliament, but it is clear that there is now a critical mass of Members in this House, and interest in all parties, to try to do something to improve neonatal care, whether that is for babies who are born prematurely or at term.

First, I add my tribute and thanks to those given by the shadow Ministers and spokesmen, the hon. Members for Ellesmere Port and Neston (Justin Madders) and for Airdrie and Shotts (Neil Gray), for the personal stories told by Members, and I will state on the record that I think the whole House is grateful to them for their personal bravery in explaining what has happened to them, and to other Members who have told the stories of their constituents.

It was with such a story that my hon. Friend the Member for Daventry (Chris Heaton-Harris) began his speech, discussing the account of Catherine and Nigel Allcott, and their son and daughter. He reminded us, as did many hon. Members later, that we can speak about statistics and percentages but what we are actually dealing with are newborn people, little ones and “the smallest things”, who deserve the greatest protection and care that we can possibly give, because they could not be more vulnerable.

In a 2014 study, The Lancet estimated that there were 5.5 million newborn deaths in the world every year and it is that stupefyingly large number that we are addressing today in discussing World Prematurity Day. I know that many speeches were addressed to the domestic situation, but I am very grateful to the shadow Minister, the hon. Member for Ellesmere Port and Neston, for pointing out that we have an international obligation in this regard, and I will certainly talk to my counterpart in the Department for International Development about the areas that our aid spending are being focused on in terms of healthcare and neonatal support, to see if we are doing all we can to try to spread the best practice in this country and Europe to those parts of the world that are beginning their journey in creating a universal healthcare system for their populations.

With that in mind, I turn to the current situation in the United Kingdom. In this country we have some of the finest neonatal care in the world, but what has been apparent in the speeches given today—accurately reflecting the facts—is that we have far too much variability. That is the principal reason why we are at the bottom of the pack in terms of developed countries when measuring rates of stillbirth, which is by means of proxy for the way that we look after premature babies. So I will outline what the Government plan to do about that situation, because it significantly touches—indeed, it does not just touch but covers—the ground that those campaigning to improve care for premature babies have so rightly highlighted, and the Bliss report is an important contribution to that work.

My hon. Friend the Member for Daventry and many other hon. Members have pointed to the announcement a couple of weeks ago by the Secretary of State that we wish to see the rates of stillbirth, neonatal death and maternal death reduce by 20% by 2020, and by 50%, or by half, by 2030. Within that target, we include a reduction in brain injury for babies.

It is worth pointing out that many of the contributory factors to stillbirth and to brain injury are the same for prematurity, which, in the round, are public health measures. They have not been covered much in this debate but I would like to raise them, because it is very important that we also understand the obligations of parents, to ensure that we can bring down the rates of prematurity and stillbirth.

We still have too many mothers in this country smoking. We know that smoking is a significant contribution to prematurity. If we were to improve the variability of smoking rates across the country, which is actually quite shocking, we would do much to reduce rates of stillbirth. In looking at the smoking rates across the country, it is quite interesting that there is not just a simple binary division between areas of affluence and areas of deprivation. There are some areas of significant deprivation where local public health partners have made considerable strides in reducing smoking rates compared with areas that are quite close by. Likewise, obese pregnant women are much more likely to experience miscarriage or pre-term birth than those women who are in the normal body mass index range.

Therefore, we have significant public health challenges ahead of us in reducing obesity, smoking, drinking and substance abuse, and if we are able to achieve those reductions in partnership with parents across the country we will have made the biggest stride that we can towards reducing rates of prematurity, ensuring that those babies that are born premature are as healthy as they can be and reducing rates of stillbirth, whether premature or term.

I wish to turn to the University of Leicester study and the “Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries in the UK”—or MBRRACE-UK—report that was published last week, which was touched on by the hon. Member for Ellesmere Port and Neston. The study highlights the challenge ahead regarding the care of neonates across the country. The figures are arresting. In half of all the cases highlighted, at least one aspect of antenatal care that could have had an impact on whether the baby was born alive could have been improved. In a third of cases, there were significant problems with bereavement care and in a quarter there were major issues with one or more aspects of intrapartum care.

For me, perhaps the most troubling statistic in the report is that in only a quarter of all the stillbirths it looked at was there an internal case review. We are not improving our position as quickly as we could because we are not reviewing cases in enough instances—we should be reviewing 100% of them—and we are not spreading the knowledge of the reviews across the system. That is one reason why the Secretary of State is so keen to turn the NHS into a learning organisation. Until we get the NHS to do well something that it currently does badly—spreading learning from places that have had a problem, a tragedy, and from those that have made significant strides—we will not make improvements. I refer hon. Members to the experience of St George’s hospital in Tooting, where they have undergone that journey in the past few years, just through dogged clinical persistence, and have been able to change the outcomes for children attending the maternity unit.

I was interested in the remarks made by the hon. Member for Croydon North (Mr Reed) on support for parents, and I shall certainly take his valid point about maternity leave—to which my hon. Friend the Member for Colchester (Will Quince) added comments about paternity leave—to my colleagues in the Department for Work and Pensions. I would hope that all employers—not that they will know about or watch this debate—would have the consideration to behave properly with parents of a premature child. The hon. Gentleman’s point about the need to reflect the development of a baby who has been born prematurely in maternity pay arrangements is interesting and important. I shall certainly take his comments back to colleagues but I can make no promises about what we can do.

The hon. Gentleman also talked about mothers’ mental health, which is something that the Government put a lot of emphasis on in the previous Parliament. We know about the importance of investing in perinatal mental health and that it pays significant dividends if done successfully. That is why we announced in March that we will invest an additional £75 million in it over this Parliament. The services, as provided, are not sufficiently good and we need to do much to improve them.

I hope that many of the instances that hon. Members have mentioned of the lack of support for parents with a premature child who is either living or has died and the lack of counselling for both mother and father—along with the important points made by my hon. Friend the Member for Daventry about marriage counselling and the powerful ones made by my hon. Friend the Member for Banbury (Victoria Prentis) about the difficulty of maintaining a marriage through a premature or stillbirth—can be addressed through the additional money. My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who is now in his place, was critical in securing that funding in March.

Various hon. Members also made important points about parking charges and travelling. I hope that NHS England’s 2014 neonatal critical care services review and service specifications will lead, in the next few years, to ensuring that we have more comprehensive neonatal cover. There will be instances when that is not possible—we cannot predict every occasion on which there will be stress on a maternity service—but I hope that the services specifications will come to correct that in the next few years. Hospitals should follow the Department of Health guidance on parking, which contains specific recommendations to ensure that people who have to park for long periods are catered for.

I know that hon. Members raised additional issues that I have not been able to cover in this fascinating debate but I shall ensure that they are responded to afterwards. I thank all hon. Members for their interesting and personal accounts regarding this important subject.