Oral Answers to Questions

Debate between Ben Gummer and Helen Whately

Wednesday 14th December 2016 Commons Chamber

[Ben Gummer]

I am gratified by the fact that the Electoral Commission says that our register is one of the most accurate and secure in the world, but we clearly need to protect the entire integrity of the democratic process. That is why all security agencies will be making sure that our systems are as secure as possible. I am grateful to the people working in the National Cyber Security Centre for the work they do—a lot of it is very difficult and technical—which is why we are better protected than most countries around the world. I intend to make sure that that capability and capacity improve and increase.

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

2. What steps he is taking to use single departmental plans to ensure joined-up and efficient Government.

[The Minister for the Cabinet Office and Paymaster General (Ben Gummer)]

Single departmental plans represent the Government’s planning and performance management framework. SDPs help the Cabinet Office to ensure that Departments deliver the Government’s key priorities, track progress against manifesto commitments and encourage greater efficiencies in Government.

[Helen Whately]

The five-year forward view for mental health encourages the Cabinet Office to oversee cross-Government implementation of proposals. What steps is my right hon. Friend taking to make sure that mental health is a priority for each Department?

[Ben Gummer]

I am grateful to my hon. Friend for raising this matter, which I know is very close to her heart and is one in which she has expertise. It is very important that we co-ordinate this matter across Government because it is not just a matter for the Department of Health, although I should say that my right hon. Friend the Secretary of State for Health is taking this as a personal issue, as is the Prime Minister. Our purpose in the Cabinet Office is to make sure that the decisions and recommendations that the Prime Minister will make in due course are implemented across Government, so that there is a response from across the Government by the whole of the Government to something that affects everyone in this country.

Junior Doctors: Industrial Action

Debate between Ben Gummer and Helen Whately

Thursday 24th March 2016 Commons Chamber

[Ben Gummer]

The right hon. Gentleman should know that we have negotiated with the BMA for more than three years. We have a choice either to cave in, which would produce a bad contract—much like the 2000 and 2003 contracts, which we are trying to correct, because everyone agrees they are wrong—or to move forward, accepting the fact that 90% of this contract has been agreed. We believe that it is in the interests of patients and doctors to do the latter.

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

Does my hon. Friend agree that this time the BMA has gone too far, and will he join me in calling on junior doctors to reach beyond the BMA and put their patients first and the BMA leadership second? Junior doctors are the future of the NHS, and they must play their role in constructively solving this problem.

[Ben Gummer]

I agree entirely with my hon. Friend, and we need this new contract to help junior doctors to achieve a better work-life balance, so that they can maintain their studies, training and experience in a better way than is currently allowed. We must also ensure that they are not exhausted by the contract, which is what happens under the current failed contract. It is in their interest for the new contract to be introduced, and I hope that in the coming weeks they will revise their view of whether this industrial action is truly necessary.

Junior Doctors’ Contract Negotiations

Debate between Ben Gummer and Helen Whately

Monday 8th February 2016 Commons Chamber

[Ben Gummer]

The hon. Lady speaks from experience, and rightly points to the fact that avoidable mortality that is attributable to weekends is different from mortality at weekends—the Secretary of State has been clear about that in his public statements. However that gap does exist, as the hon. Lady knows, and Professor Sir Bruce Keogh was clear in his statements that there is an avoidable rate of mortality. He stated:

“There is an avoidable ‘weekend effect’ which if addressed could save lives. This is something that we as clinicians should collectively seek to solve. It also strengthens the moral and professional case for concerted action.”

The way in which the hon. Lady characterised the discussions in September, October and November is not quite right. We implored the BMA to come and talk; I personally had those discussions with leaders of the BMA, and they refused to do so. It was only when they came and talked to us that we made substantive progress.

The hon. Lady is right to raise these issues, and we wanted to discuss such matters with the BMA. One issue was protection against excess hours, but we had no counterparty with whom to negotiate. Since we have had that counterparty, we have made good moments of progress, and the result is the guardian position, which she welcomed in another place. The guardian will be able to levy fines, and those fines will be remitted to the guardian. I hope—and indeed expect—that process to reduce the excess hours that we still see in a small minority of positions. We must get away from the perverse incentives for trusts and a small minority of doctors that mean that unsafe working hours are perpetuated.

Of course we all regret the course that this dispute has taken, but it would not have done so had the BMA taken a responsible position from the beginning. If people lie to their members and say that they will have their pay cut and their hours raised, of course doctors will be angry—all of us would be. The fact is that that was never true, but it has inflamed the situation. We could have had the kind of productive talks that we have had over the past three or four weeks back in August, September and October had we not had all the mess beforehand because of untruthful statements issued by the BMA.

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

The level of support among junior doctors for this pay dispute is at least in part because of longstanding dissatisfaction with the experience of being a junior doctor. Sir David Dalton recommended a review of those longstanding concerns in his recent letter. Do the Government intend to commission such a review?

[Ben Gummer]

The Government will be looking at Sir David Dalton’s recommendation and acting on it. He is right to point to the fact that the 1999 contract is imperfect—it was agreed back in 2008 that it had many failings, and that something needed to be done to fix it. That contract in its generality has helped to contribute to the lowering of morale in the junior doctor workforce, which Sir David Dalton has recognised, as has the Secretary of State. It is not just the way in which training placements are made and a whole series of other problems with the contract; it is also the fact that people have to work for long periods of consecutive nights and days, all of which is reduced in the latest proposed contract.

NHS Trusts: Finances

Debate between Ben Gummer and Helen Whately

Monday 1st February 2016 Commons Chamber

[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.

Oral Answers to Questions

Debate between Ben Gummer and Helen Whately

Tuesday 5th January 2016 Commons Chamber

[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?

Oral Answers to Questions

Debate between Ben Gummer and Helen Whately

Tuesday 17th November 2015 Commons Chamber

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

6. What steps his Department is taking to improve clinical outcomes for people treated by the NHS.

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

On a number of fronts, the Department is looking at how it can improve clinical outcomes. Indeed, that is the entire focus of the Department. With reference to hospitals, we can improve clinical outcomes across the service through introducing a seven-day NHS, by increasing transparency and by looking at the cover provided by consultants and doctors.

[Helen Whately]

I welcome the Government’s commitments to improving outcomes for patients admitted at weekends, but seven-day services are needed not just in hospitals but in primary care, community care, social care and mental health services. What steps are the Government taking to make sure that seven-day services are available in all settings where patients need care urgently?

[Ben Gummer]

My hon. Friend makes her point extremely well. A seven-day NHS will operate only if it works across all areas of care. That is why the local integration of care and health services is part of our wider vision for the NHS. I urge her to look, when it is published, at Professor Sir Bruce Keogh’s report on urgent and emergency care, which envisages precisely the sort of joined-up care that will ensure people receive the correct attention at the correct level and do not therefore go to hospital when they can be dealt with in primary care settings.

NHS: Financial Performance

Debate between Ben Gummer and Helen Whately

Monday 12th October 2015 Commons Chamber

[Ben Gummer]

I thank my hon. Friend for bringing the attention of the House to innovation at a local level. This kind of innovation, which will allow us to transform the service into an even better NHS in the years to come, is being repeated in many trusts across the country. If I may, I will reply to him by letter on the specific issue of scientists after I have investigated the points he has made.

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

In addition to needing extra funding, which the Government have rightly committed to provide, the NHS could and should make better use of its resources through better procurement, the use of technology and the employment of permanent rather than temporary staff. The challenge is how to do this at the necessary pace and scale. Will my hon. Friend advise what steps the Government are taking to drive the pace and scale of the changes that are important not only to improve productivity but for better outcomes and patient experience?

[Ben Gummer]

My hon. Friend identifies precisely the action we in the Department need to take. It would be a dereliction of duty to pour money into an unreformed system, as it would mean money being spent on administration, bureaucracy and waste, and not on the changes we need to improve patient care. We need to move at pace to bring in the changes necessary to transform the system if we are to get the NHS we all want to see.

NHS (Contracts and Conditions)

Debate between Ben Gummer and Helen Whately

Monday 14th September 2015 Westminster Hall

[Ben Gummer]

The hon. Lady points out that contractual differences already exist between NHS Scotland and NHS England. Officials have looked with interest at the experience of NHS Scotland—one of the pleasures of the devolved NHS system is that we can all learn things from one another. I hope that the new replacement of the clinical excellence award will be perceived as far fairer by clinicians and will reward those surgeons who are giving their utmost in academic research and the professional development of others. That is a tangible improvement to consultants’ terms.

It is important to point out, as several of my hon. Friends have done, that we are talking about ensuring that, at most, consultants work no more than one weekend in every four. That is the basis on which they will be contracted to work in a seven-day NHS. We are not talking about seven days at a time, but about shift rotas and patterns, as many people in professional life already recognise, not least some of those who have spoken in this Chamber. We need to get to a situation in which NHS professionals at the top, as well as those at the bottom, are trusted to organise their life and work patterns according to the professionalism they hold so dear. Many consultants in the NHS want to move to contract reform so that they may express their professionalism in that way, and we need to ensure that it happens so as to bring them with us, rather than its being forced on them.

For that reason, I am delighted that the consultants committee of the BMA has agreed to rejoin negotiations. It has seen that there is a basis for reaching an agreement, which suggests—contrary to some of what has been said by Opposition Members—that things are being done with a sense of collaboration. We have wanted to enter the negotiations for some time. The BMA, for reasons no doubt connected with the election—probably understandably—decided to withdraw from negotiations, but it has now come back. We and the consultants committee can reach a good position on the proposed contract.

The junior doctors’ contract is a proposal of great strength, not least because we include a significant increase in basic pay rates, which should be welcomed across the board. The contract addresses one of the points made by the hon. Member for Warrington North and does something important for the way in which junior doctors are perceived by their management. Instead of offering, in effect, danger money for excess hours, which is surely not the way to manage a workforce, it gives junior doctors a right to a review of their hours, so that they may properly manage their work rotas and patterns. For the first time, that will be enshrined in their contract. They will have far more predictable work patterns; providers—employers—will be forced to think seriously about work-life balance when constructing the roster; and, on pay and on the offer to juniors for their working life, the proposed contract will produce a far happier outcome.

I had hoped that the juniors committee would already have agreed to come back to the table, and I remain hopeful. The committee is meeting imminently—in six minutes’ time, in fact—and I hope that it is listening to the words in this Chamber, because hon. Members and others listening have heard nothing from both Government and Opposition Members but unalloyed praise for NHS staff and a real desire to work cross-party to secure the kinds of advances in quality that everyone wishes to see. With the juniors at the table, we could reach a constructive and reasonable resolution to the need to change their contract. That need was impressed on Ministers not only by the DDRB—the review body on doctors and dentists remuneration, but by the NHS’s own independent pay review body. Many in the service, perhaps more quietly than those who have been most exercised on Twitter, know that it is necessary.

[Helen Whately]

Is the Minister aware that if we compare the number of staff in a particular NHS service with the demand for that service over time, we can see that demand is sometimes highest when staff numbers are at their lowest? Demand and staff numbers do not match well. Is there not an opportunity to look at changing staff shifts and rotas to ensure that there is the greatest number of staff when demand is greatest?

[Ben Gummer]

My hon. Friend is entirely right. The whole purpose of what we are doing through contract reform is to match the professionalism of doctors, consultants and those working on agenda for change contracts—nurses and so forth—with the demands of any particular hospital. That cannot be decided by me or NHS England, but has to be decided in each setting, because of the differences—sometimes subtle and sometimes wild—between hospitals. In a study of some 15 hospitals released a couple of years ago, it was noticeable that there was 3.6 times more consultant cover for acutely ill people on a Wednesday than on a Saturday, even though 3.6 times more people were not acutely ill on a Saturday. The comparison is roughly drawn, but it points to a mismatch between rostered staff and peak patient flows. Most hospital managers would not only accept that point, but offer it to you.

All that suggests that somehow no seven-day NHS working is going on at the moment. As the shadow Minister and other hon. Members have said, however, some hospitals are already delivering an exceptional seven-day service—sometimes at no extra cost at all, and sometimes with only a minimal cost increase. What is most noticeable is that care quality has improved. In some cases that is now measurable, which is very exciting, and we can see reductions in mortality attributed to changes to staff working patterns. The staff, when asked, “What difference has this made to your lives?” point, as the key difference, to the fact that this was led by enthusiastic members of the staff themselves. There we have a pointer as to where we need to go: we need to get staff buy-in at the beginning. When the change is done well, it gives staff far greater control over their working life, which has led in a couple of hospitals to appreciable improvements in staff satisfaction.

Those settings have achieved the trick that we want to see throughout the NHS, which is for contract reform to empower and help staff to deliver care with the professionalism that I and everyone in this Chamber know that they wish to, while delivering better, higher quality care and decreased mortality—all within tight spending constraints, despite the increases to the cash budget that the Government have pledged to the NHS. If we can achieve that, we will have done something very special: we will have dealt with the lack of a link that has existed for too long between patient quality and care, and restrictive contracts that do not reflect how many staff want to work, and certainly do not reflect how patients admit themselves to hospital.

There is one final thing that I would like to add—in fact, it is the penultimate thing, because I must answer the point made by the hon. Member for Warrington North about staff. She is right to say that, of course, seven-day services will, in some disciplines, have an effect on the staff numbers that might or might not be required. That is part of the plan being developed by NHS England, in close association with Health Education England. We are recruiting close to record numbers of nurses, doctors and consultants, and we are doing so in many of the diagnostic specialties as well.

However, this is a question of not just staff numbers, as the hon. Lady recognises, but much smarter rostering and rota-ing, so that we use staff and their time as effectively as they would like us to. It is also a question of the productive use of staff time. She rightly pointed to the bureaucracy that ties people down. In some hospitals—some quite near her constituency—that bureaucracy has been reduced to a very minimum, as a result of which staff have patient contact time of an order of magnitude different from that in hospitals just 50 or 60 miles away. If we can bring all levels of staff exposure to patients—the patients they want to care for, for the maximum period of time—up to the best level in the NHS, we will already have the productivity gains in the workforce that will make possible not just seven-day working but a whole series of other improvements in care quality.

My final point about the opportunity that contract reform gives us was touched on by the hon. Member for Ealing Central and Acton (Dr Huq), who spoke about whistleblowing. It is an important point. When people attack the Secretary of State they should remember that he brought in freedom to speak up and the duty of candour, is bringing whistleblowing champions into the NHS, and has acted on some of the most difficult recommendations of the Francis report. It is this Secretary of State who said for the first time, “If you are employed by the NHS and feel that care is not being delivered in a way that is good for patients, we will prize your voice and listen to you above those who might stop you being heard.”

That kind of message to the system is new. It is so radical that I think many still do not quite believe it could be true, but I hope that the instigation, at some considerable cost, of whistleblowing champions, along with the framework for whistleblowing and the independent national officer, demonstrates to Members and the outside workforce that we are deadly serious about listening to staff, no matter where they work or who manages them, to make sure that we improve patient care wherever possible. We know that improving staff’s experience in their working lives is a crucial part of that.

Although this was not mentioned in the debate, I am conscious that far too many staff in the NHS suffer bullying and harassment. The numbers are almost unheard of in any other walk of life, including the Army and the police. NHS workers unfortunately can expect abuse from members of the public and bullying within management chains to a degree that is unique in the public sector and close to being so across the entire workforce. That is an historical problem that has led to the very high levels of staff sickness that the NHS has carried for decades. It will not be an easy problem to crack, but I have to tell Members that I and the Secretary of State are absolutely committed to doing something about it. NHS staff go to their place of work because they care about patients and about their vocation, but too often can get pushed back by poor management, abusive patients and poor performance management processes, and often feel belittled in what they are doing. If we can do something about their working conditions and improve their working lives, that will be very important, not just for staff but for patients. If we can improve the working practices and the working lives of the 1.3 million people devoted to our nation’s healthcare, we will do so much to help them produce even better care for the patients they serve.

I hope that Members on both sides of the House have come to a broad understanding that the changes anticipated by the contract reform are necessary. It is certainly true that we must take account of the data and listen carefully to the arguments of everyone involved in the provision of NHS services seven days a week, to make sure that changes are made as collaboratively as possible, so long as collaboration is made possible by all parties. We must also bind ourselves to the promise that we should all reflect correctly the words of politicians on both sides of the House, lest their misconstruction cause worry and fear in the outside world. In all that, we must ensure that the changes we make improve the quality of patient care and reduce the excess rate of mortality, which I know everyone, including all Members, would like to come down when and if possible.

Question put and agreed to.

Resolved,

That this House has considered the e-petition relating to contracts and conditions in the NHS.

NHS Success Regime

Debate between Ben Gummer and Helen Whately

Thursday 4th June 2015 Commons Chamber

[Ben Gummer]

I welcome the hon. Lady to her place. I only hope that she does not have the same contempt for her constituents that her predecessor seems to have expressed. It is interesting how it all comes out afterwards. I repeat to the hon. Lady that the decisions will be made locally by local people and local commissioners in response to local problems, and where they arise we will seek to address them.

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

I have heard that trusts in my constituency were potential candidates for this regime. Will the Minister please make it clear that, unlike some previous oversight regimes, this regime will enable local health care organisations to work together to solve their problems and will involve not just scrutiny but more support?

[Ben Gummer]

I thank my hon. Friend for her question. I am delighted to see her in her place. She has experience and expertise in this area. She will know that elsewhere in the country, before 2010, local commissioners, doctors and providers often came up with good solutions, but then strategic health authorities would come in with a completely different answer and override all of them. That is what we are seeking to avoid.