Ebola

Jeremy Hunt Excerpts

Monday 13th October 2014 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

With permission, Mr Speaker, I would like to update the House on the Government’s response to the Ebola epidemic in west Africa.

I shall start with the chief medical officer’s assessment of the current situation in the affected countries. As of today, there have been 4,033 confirmed deaths and 8,399 confirmed, probable and suspected cases of Ebola recorded in seven countries, although widespread transmission is confined to Liberia, Sierra Leone and Guinea. The number is doubling every three to four weeks. The United Nations has declared the outbreak an international public health emergency.

The Government’s first priority is the safety of the British people. Playing our part in halting the rise of the disease in west Africa is the single most important way of preventing Ebola from infecting people in the UK, so I would like to start by paying tribute to the courage of all those involved in this effort, including military, public health, development and diplomatic staff. I would particularly like to commend the 659 NHS front-line staff and the 130 Public Health England staff who have volunteered to go out to Sierra Leone to help our efforts on the ground. You are the best of our country and we are deeply proud of your service.

Among the three most affected countries, the UK has taken particular responsibility for Sierra Leone, with the US leading on Liberia and France focusing on Guinea. British military medics and engineers began work in August on a 92-bed Ebola treatment facility in Kerry Town, including 12 beds for international health workers. In total we will support more than 700 beds across the country, more than tripling Sierra Leone’s capability. With the World Health Organisation, we are training more than 120 health workers a week and piloting a new community approach to Ebola care to reduce and, hopefully, stop the transmission rate. We are also building and providing laboratory services and supporting an information campaign in-country.

We are now deploying the Royal Navy’s RFA Argus and its Merlin helicopters along with highly skilled military personnel, bringing our military deployment to 750. They will support the construction of the Kerry Town Ebola treatment centre and other facilities, provide logistics and planning support, and help establish and staff a World Health Organisation-led Ebola training facility to increase training for health workers.

Taken together, the UK contribution stands at £125 million, plus invaluable human expertise: that is the second highest bilateral contribution after the US’s. However, we do need other countries to do more to complement our efforts and those of the US and France. On 2 October, the Foreign Secretary held an international conference on defeating Ebola in Sierra Leone during which more than £100 million and hundreds of additional health care workers were pledged.

I now move on to the risks to the general public in the UK. The chief medical officer, who takes advice from Public Health England and the Scientific Advisory Group for Emergencies, has this morning confirmed that it is likely that we will see a case of Ebola in the UK. This could be a handful of cases over the next three months. She confirms that the public health risk in the UK remains low and that measures currently in place, including exit screening in all three affected countries, offer the correct level of protection. However, while the response to global health emergencies should always be proportionate, she also advises the Government to make preparations for a possible increase in the risk level. I can today announce that the following additional measures will take place.

On screening and monitoring, rapid access to health care services for anyone who may be infected with Ebola is important not only for their own health, but to reduce the risk of transmission to others. Although there are no direct flights from the affected region, there are indirect routes into the UK, so next week Public Health England will start screening and monitoring UK-bound air passengers identified by the Border Force as coming in on the main routes from Liberia, Sierra Leone and Guinea. This will allow potential Ebola virus carriers arriving in the UK to be identified, tracked and given rapid access to expert health advice should they develop symptoms. These measures will start tomorrow at Heathrow terminal 1, which receives about 85% of all such arrivals across the whole airport. By the end of next week, they will be expanded to other terminals at Heathrow and Gatwick, and to the Eurostar, which connects to Paris and Brussels-bound arrivals from west Africa.

Passengers will have their temperature taken and will complete a questionnaire about their current health, their recent travel history and whether they might be at potential risk through contact with Ebola patients. They will also be required to provide contact details. If neither the questionnaire nor the temperature reading raises any concerns, passengers will be told how to make contact with the NHS should they develop Ebola symptoms within the 21-day incubation period, and allowed to continue on their journey. It is important to stress that a person with Ebola is infectious only if they are displaying symptoms. Any passenger who reports recent exposure to people who may have Ebola or symptoms, and any passenger who has a raised temperature will undergo a clinical assessment and, if necessary, be transferred to hospital. Passengers identified as having any level of increased risk of Ebola but without any symptoms, will be given a Public Health England contact number to call should they develop any symptoms consistent with Ebola within the 21-day incubation period. Higher risk individuals will be contacted daily by PHE. Should they develop symptoms, they will have the reassurance of knowing that this system will get them first-class medical care—as the NHS demonstrated with nurse William Pooley—and the best possible chance of survival.

We expect these measures to reach 89% of the travellers we know have come to the UK from the affected region on tickets booked directly through to the UK, but it is important to note that no screening and monitoring procedure can identify 100% of people arriving from Ebola-affected countries, not least because some passengers leaving those countries will not be ticketed directly through to the UK. Today, I can therefore announce that the Government, working with the devolved Administrations, will ensure that highly visible information is displayed at all entry points to the UK, asking passengers, in their own best interests, to identify themselves if they have travelled to the affected region in the past 21 days. This information for travellers will be available by the end of this week.

We are taking other important measures. We tested operational resilience with the comprehensive exercise that took place on Saturday, which modelled cases in London and the north-east of England. Local emergency services across England will hold their own exercises this week and share lessons learned. It is vital that the right decisions on Ebola are made following any first contact with the NHS, so we have put in place a process for all call handlers on NHS 111 to ask people who report respiratory symptoms about their recent travel history so that appropriate help can be given to higher risk patients as quickly as possible. During recent months, the chief medical officer has issued a series of alerts to doctors, nurses and pharmacists setting out what to do when someone presents with relevant symptoms. We will also send out guidance to hospital and GP receptionists.

The international profile of the UK as a favoured destination inevitably increases the risk that someone with Ebola will arrive here so, working closely with the devolved Administrations, a great deal of planning has gone into procedures for dealing with potential Ebola patients in the UK. All ambulances are equipped with personal protective equipment. If a patient is suspected of having Ebola, they will be transported to the nearest hospital and put in an isolation room. A blood sample will be sent to Public Health England’s specialist laboratory for rapid testing. If they test positive for Ebola, they will be transferred to the Royal Free hospital in north London, which is the UK’s specialist centre for treating the most dangerous infectious diseases. We also have plans to surge Ebola bed capacity in Newcastle, Liverpool and Sheffield, making a total of 26 beds available in the UK.

I will always follow medical advice on whether any measures that we adopt are likely to be effective and are a proportionate response to the risk. However, I believe that we are among the best and most prepared countries in the world.

Lastly, we are harnessing the UK’s expertise in life sciences to counter the threat from Ebola. The UK Government, alongside the Wellcome Trust and the Medical Research Council, have co-funded clinical trials of a potential vaccine, which might be pivotal in the prevention effort. We are working actively with international partners to explore how we might appropriately make further vaccine available.

We should remember that the international community has shown that if we act decisively, we can defeat serious new infectious disease threats such as SARS and pandemic flu. The situation will get worse before it gets better, but we should not flinch in our resolve to defeat Ebola both for the safety of the British population and as part of our responsibility to some of the poorest countries on the planet. Our response will continue to develop in the weeks and months to come, guided by advice from the chief medical officer, Public Health England and the Scientific Advisory Group for Emergencies.

I commend the statement to the House.

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for the advance copy of his statement and commend him for making it at the first opportunity.

We have all been horrified by the devastating scenes from west Africa and our hearts go out to the communities that are confronting this threat on a daily basis. Public concern about Ebola is rising here and it is important that people have reliable facts and regular updates.

There are parallels between the current situation and the 2009 swine flu pandemic with which I dealt. I was grateful for the helpful approach of the then Opposition, particularly the right hon. Member for South Cambridgeshire (Mr Lansley), and I aim to provide the Secretary of State with the same approach. However, we do have a role in scrutinising the Government’s approach and I will do that today in a constructive spirit.

I echo the Secretary of State’s tribute to the many NHS staff, Public Health England staff and members of the armed forces who have helped on the ground in west Africa. We have a duty to protect them in any way we can. I want to start with the advice that is given to those who are treating people with the disease. People will be worried by the reports of a second case of Ebola in a health worker, this time in Dallas. We have seen protests in Spain by clinical staff who feel that a colleague has been unfairly exposed to infection. In the light of that, will the Secretary of State say whether he has confidence in the official advice that is being given to those who are treating the disease, and whether it needs to be reviewed?

Let me turn to the risk to the public here. The Secretary of State says that it remains low and the chief medical officer predicts a handful of cases. A handful is not a very scientific term. Will he be more precise and give the House the full range of figures that the advisory group has considered, including the worst case scenario? I recall agonising over whether to publish the official predictions for swine flu and about the risk of worrying the public unnecessarily. However, I think that the public interest lies in openness. Will the Secretary of State confirm that he is planning for the worst case scenario, so that there is no sense of complacency?

Let me turn to our preparedness to deal with an outbreak. There has been confusion about screening at point of entry. Last Thursday, the Department of Health said:

“Entry screening in the UK is not recommended by the World Health Organization, and there are no plans to introduce entry screening for Ebola in the UK.”

Screening was also ruled out by the Secretary of State for Defence. However, just 24 hours later, we were told that screening was to be introduced. Will the right hon. Gentleman say what prompted that about-turn? What official advice has he received from the chief medical officer and Public Health England on entry screening? Based on the science, do they think that it is necessary? Do the arrangements he has announced for temperature checks fully comply with that advice?

As there are currently no direct flights from the affected countries, will the Secretary of State say exactly who will be screened? Will it be all arrivals from those countries? How many people a day or week do we expect that to be, and how will they be identified? Have front-line Border Force staff been properly briefed about what is expected of them, and are they being trained in what to look for and in screening procedures? Why is there only partial coverage of ports of entry? What about sea ports and other UK airports? Will he say where the checks will take place on Eurostar, given that it stops at a number of places en route to London?

On the exercise this weekend, as the Secretary of State will know, a patient was transferred from Newcastle where there are beds in negative pressure isolation units to the Royal Free hospital, which has Trexler isolators. Do the Government believe that Ebola is better handled in Trexler beds, and is the Secretary of State satisfied that the two NHS beds—both at the Royal Free—are sufficient? Given that in addition to the two Trexler beds there are already 24 negative pressure isolation beds, which make up the 26 beds he referred to, will he say what he means by “surge Ebola bed capacity”? If it becomes necessary to treat Ebola cases more widely in isolation beds, is he satisfied that there is adequate provision across England? Is he satisfied that all relevant NHS staff, including GPs, ambulance and 111 staff, know how to identify Ebola, the precautions to take in any potential presentation, and the protocols for handling it? He mentioned symptoms a few times in his statement. For the public watching this statement, will he tell the House simply what those symptoms are?

On treatment, the British nurse who was successfully treated here was offered and took an experimental medication called ZMapp. Will it be standard practice to offer all affected patients ZMapp, and if so, are there sufficient supplies in the NHS to do that? The Secretary of State rightly focused on a vaccine, which would of course be the best reassurance we could give the public. During the swine flu pandemic, huge effort went into compressing the timetable for the development of a vaccine. Is he confident that everything that can be done is being done to speed that up?

Finally, as the Secretary of State said, the best way to protect people here is to stop Ebola at source. The UK has rightly pledged £125 million to assist Sierra Leone, but with cases doubling every three to four weeks there is wide agreement that the response of the wider international community has been slow and inadequate. The window to halt Ebola before it runs out of control altogether is closing fast. What assessment has been made of the resilience of neighbouring countries such as Guinea and Liberia, and what help is being offered to them? The International Development Committee report was clear that the lack of proper health coverage allowed the outbreak to grow unchecked for so long. Does the right hon. Gentleman accept that improving global health systems is the best way to prevent these outbreaks, or at least ensure that they are caught before they get out of control? Many countries support placing universal health coverage at the centre of global development, yet the UK is currently opposing such plans at the UN. Will he say a little more about the Government’s position on that, and whether they are prepared to reconsider it in the light of recent events? Knowing from my experience how difficult these situations are, I assure the Secretary of State that the offer of help is genuine, but on behalf of the House I ask him for regular updates and maximum openness in the weeks and months to come.

[Mr Hunt]

I thank the shadow Health Secretary for the constructive tone of his comments. That is totally appropriate and I am grateful. I will start with the point on which he finished, because the most crucial thing we can do to protect the UK population is deal with the disease at source and contain it in west Africa. That is why I am working extremely closely with the International Development Secretary, and she is working closely with me because the role of NHS volunteers is important. The right hon. Gentleman is absolutely right: the initial international response has focused on taking the three worst affected countries and giving them a partner country in the developed world to help them—we are helping Sierra Leone, America is helping Liberia, and France is helping Guinea.

That has worked up to a point, but we need more help from the rest of the international community. I had a conversation earlier today with US Health Secretary Burwell. We talked about a co-ordinated international response for the whole of west Africa, because we will not defeat this disease if we operate in silos. We need to recognise that this disease does not recognise international boundaries; the right hon. Gentleman was absolutely right to make that point.

Let me try to give the right hon. Gentleman some of the information he requested. First, he is absolutely right to raise the issue of the protection of health workers. That has to be our No. 1 priority both here in the UK and abroad. That is why we are building a dedicated 12-bed facility in Sierra Leone that will give the highest standards of care, equivalent to NHS standards of care, for health care workers taking part in the international effort to contain the disease there. That is also very relevant to health care workers here: events in both Spain and the US will have caused great concern.

I am satisfied that the official advice to health care workers is correct. The Centers for Disease Control and Prevention in the US, the US equivalent of Public Health England, believes that breaches in protocol led to the infection of the US nurse—the case we have seen in the media recently—but it is investigating that. The advice is always kept under review and if that advice changes we would, of course, respect that. It is important that we follow the scientific advice we have, but that the scientists themselves keep an open mind on the basis of new evidence as it emerges. I know that they are doing that.

The right hon. Gentleman talked about the full range of figures. He is absolutely right to say that we will maintain public confidence in the handling of this by being totally open about what we know. The reason we have stuck carefully to the formula of “a handful of cases” is because it is genuinely very difficult to predict an accurate exact number. Let me say this: we would not have used the formula of “a handful of cases” if we thought that the number of cases over the next three months would reach double figures. However, it is also important to say that that was a current assessment. That assessment may change on the basis of the evidence. I will, of course, keep the House informed if it does change.

The right hon. Gentleman talked about screening. It is important to deal with a misunderstanding. Why did the policy change on Thursday? The answer is that it changed because the clinical advice from the chief medical officer changed on Thursday. Her advice changed not on the basis that the risk level in the UK had changed—she still considers it to be low—but because she said that we should prepare for the risk level going up. That is why we started to put in place measures, but they are not measures primarily intended to pick up people arriving in the UK who are displaying symptoms of Ebola. We think that most of those people should be prevented from flying in the first place. The measures are designed to identify people who may be at risk within the incubation period of developing the disease, so that we can track them and make sure they get access to the right medical care quickly.

As I mentioned, we think we will reach 89% of people arriving in the UK from the affected countries. We will continue to review that. If the numbers increase and the risk level justifies it, we have contingency plans to expand the screening, for example to Birmingham and Manchester. The reason we have included Eurostar at this early stage is because there are direct flights from those three countries to Paris and Brussels, from where it is easy to connect to Eurostar. We will use the tracking system for people who are ticketed directly through to the UK in order to identify, where we can, people who then independently get a Eurostar ticket. It is important to say that because they are changing the mode of transport in Paris and Brussels, tracking is not as robust as it would be for people taking a direct flight to the UK. We will not be able to identify everyone, which is why we need to win the support of people arriving in the UK from those countries, so that they self-present, in their own interest, to give us the best possible chance of helping them if they start contracting symptoms.

I am satisfied that the Trexler beds and the negative isolation rooms are safe both for health care workers and in preventing onward transmission. They use different systems—one of them is a tented system and the other is based on people wearing personal protective equipment —but I am satisfied that both of them are safe. I will continue to take advice on that. It is very important that ambulance staff know that someone is a potential Ebola case, so that they wear the PP equipment.

As we will not be able to identify everyone who comes from the affected countries, it is important that the 111 service knows to ask people exhibiting the symptoms of Ebola whether they have travelled to those affected areas. The right hon. Gentleman asked what those symptoms are. They are essentially flu-like symptoms, but they are not dissimilar to the symptoms someone might exhibit if they had, for example, malaria. That is why it is important to ask for people’s travel history and whether they have had or may have had contact with people who have had Ebola, in order to identify the risk level.

We would like to continue using ZMapp for people in the UK who contract the disease, but that is subject to international availability. It might not be possible to get it for everyone, because there is such high international demand, but we will certainly try.

In terms of the development of a vaccine, we are doing everything we can to work with GSK to bring forward the date when a vaccine is available. Indeed, we are considering potentially giving indemnities if the full clinical trials have not been conducted.

[Dr Sarah Wollaston (Totnes) (Con)]

May I welcome the Secretary of State’s statement and pay tribute to all the staff who are giving him professional detailed scientific advice? I join him in paying tribute to all the NHS personnel, our forces personnel and diplomatic staff putting their own lives at risk in west Africa.

I am particularly pleased to hear that those individuals returning to the UK or coming to the UK from west Africa will be able to access support in a timely manner and in a manner that does not put other individuals at risk in crowded health care settings. Will the Secretary of State say more about the testing arrangements, which I hear are going to be at Porton Down? Does he have any plans to make further testing centres available so that testing can happen more rapidly?

[Mr Hunt]

I thank my hon. Friend for her comments and her support for the statement. I want to pay particular tribute to the chief medical officer and Dr Paul Cosford at Public Health England, who have done an enormous amount to make sure we develop the right policies, which are both proportionate and enable us to prepare for the future. The Government are hugely grateful for their contribution.

We are satisfied that the testing arrangements at the PHE facility at Porton Down are adequate to the level of risk, but one of the reasons why I wanted to announce to the House the current estimate of the number of Ebola cases we are dealing with in the UK was to make the point that we will continually keep those arrangements under review should the situation change. We need to recognise in a fast-moving situation such as this that it might well change, and I will keep the House updated, but in such situations the resilience of all those very important parts of the process will be checked.

[John McDonnell (Hayes and Harlington) (Lab)]

In May the Government announced the closure of the health control unit at Heathrow airport in my constituency. It contained the staff who undertook the monitoring, screening and treatment of passengers who were sick. I believe many of those staff have now been made redundant, so can the Secretary of State tell me what the staffing arrangements will now be at Heathrow airport? Also, will a training programme be developed for airport staff themselves, including cabin crew and others?

[Mr Hunt]

The hon. Gentleman makes a very important point. In terms of the staffing arrangements, a total of about 200 people will be employed in the screening process, working at both Heathrow and Gatwick airports in the hours when they are open, and potentially at other airports if we expand the screening. It is a comprehensive facility.

The hon. Gentleman’s most important point is that we must make sure that those who might come into contact with people who might have Ebola—airport staff and people working on aeroplanes, and people working at receptions at GPs’ surgeries, at A and E departments and at hospitals—have basic information about how the virus spreads, so that we can avoid any situations of panic. The virus is transmitted through exchange of bodily fluids. It is not an airborne virus, so it is not transmitted as easily as something like swine flu. The advice is that those doing physical examinations of patients need to wear the protective equipment, but that that is not necessary when having a conversation with a patient, for example. That advice will always be kept under review, but the hon. Gentleman is absolutely right to say that we need to make sure everyone knows that advice.

[Sir Malcolm Bruce (Gordon) (LD)]

The work that the British Government have done in Sierra Leone and Liberia to build health systems has been extremely important, but those systems were clearly inadequately developed to cope with this kind of problem. I welcome the joined-up thinking across government, but will the Secretary of State give me an assurance that the legacy of this situation will be not only that we have contained Ebola but that we have built health systems in those countries that are capable of dealing with future outbreaks? The long-term legacy must be stronger health systems, as well as the protection of British citizens, which is of course important.

[Mr Hunt]

I remember working with the right hon. Gentleman on the International Development Select Committee many years ago, when we had many conversations about strengthening the resilience of local health care systems. He is absolutely right to say that that must be our long-term goal, and I will ask the Secretary of State for International Development to write to him to explain how our efforts in Sierra Leone will help to strengthen its local health care system in the long run. The simple point I would make is that this illustrates the dual purpose of our aid budget more powerfully than any example I can remember. First, our aid budget gives humanitarian assistance to some of the poorest countries in the world and, secondly, it protects the population at home in the UK. Those two aims go hand in hand.

[Ian Paisley (North Antrim) (DUP)]

I welcome the Secretary of State’s statement and I appreciate having been given an advance copy of it. He mentioned the devolved regions. First, will he tell us which Minister in Northern Ireland will take personal responsibility for this matter? Secondly, he will know that the main point of entry for potential victims of this terrible disease is the Republic of Ireland. What special measures are being put in place to stop people using those points of entry to travel from the Republic to Northern Ireland when there are no apparent protective measures in place?

[Mr Hunt]

The Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), has been in touch with Jim Wells in the Northern Ireland Assembly and she will take up that issue. The broader point that the hon. Member for North Antrim (Ian Paisley) makes is that there are many points of entry into the UK, and it is important for us to recognise that our screening and monitoring process will not catch absolutely everyone who comes from the affected regions. That is why we need to have other plans in place, such as the 111 service, and to have encouragement at every border entry point for people to self-present so that we can protect them better, should they develop symptoms.

[Mr Andrew Lansley (South Cambridgeshire) (Con)]

I welcome the Secretary of State’s statement to the House, and I am also grateful to the shadow Secretary of State for what he said. All Members share the Secretary of State’s admiration for the staff of the NHS and Public Health England who are assisting in the front-line treatment and care of those in west Africa. In that context, he is right to try to tackle the virus in west Africa, but this is not just about the availability of much better treatment facilities; it is also about working in the community in short order to try to stem the continuing transmission of the disease. Work has clearly been done on that; will he tell us how we might scale it up?

[Mr Hunt]

My right hon. Friend makes an important point. I discussed this with United States Secretary Burwell today. The US is piloting a programme in Liberia, and we are doing the same thing in Sierra Leone. We are both providing the same response, which is to tackle the disease at source. We know that, if we can get 70% of the people who develop Ebola symptoms into treatment and care, we will contain the disease. At the moment, the disease is replicating at a rate of 1.7, which means that every 10 people infected are going on to infect another 17 people. That is why the virus is spreading so fast, and we can halt it only if we get people into treatment very rapidly. Community treatment centres are therefore an important part of the Department for International Development’s strategy to help to contain the virus, and that is why we are supporting the development of 700 beds in Sierra Leone.

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

May I beg the Secretary of State to work across Europe and all the countries that can help? I have a daughter who has just returned from west Africa and she has reported to me and the family that the situation is critical—it is desperate. There is a lack of any kind of facility to control this disease. Parents are dying, leaving children with nobody to care for them. The situation is very grave, so will he redouble his efforts to persuade Europe, the World Health Organisation, the UN—all of us—to do something more significant and to do it now?

[Mr Hunt]

The hon. Gentleman speaks movingly and well about the incredible gravity of the situation, and he rightly says that we need full international support on it. In such a situation there are a number of things we are much better tackling as part of an international effort; we are very proud of our 659 NHS volunteers, but volunteers from the whole of Europe could go out and play a part. They need reassurance that they will be safe if they end up contracting the virus, because the truth is that there is no 100% guarantee of safety, even for people who follow the correct procedures—that is why these people are so brave. The hon. Gentleman is absolutely right in what he says, and I reassure him that that is exactly the conversation I have been having with international colleagues: we do need a co-ordinated effort.

[Bob Stewart (Beckenham) (Con)]

The military have superb experience of dealing with contaminated areas. Are contingency plans in place to bring the military services into line to help, should that be required?

[Mr Hunt]

We are doing that already: we have made a commitment of 750 military personnel, who will be going to the affected region to help; we have military engineers helping to build the 92-bed facility in Kerry Town; and Royal Fleet Auxiliary Argus is on the way to Sierra Leone. We are tapping into that expertise, and it has a vital role to play.

[Michael Connarty (Linlithgow and East Falkirk) (Lab)]

Following on from the question put by my colleague from Northern Ireland, the hon. Member for North Antrim (Ian Paisley), clearly the nearest hospital to Scotland with provision is in Newcastle. Who is the responsible person with whom the Secretary of State has been working in Scotland? What arrangements are taking priority in Scottish towns, because someone who has 21 days to travel in the UK might not wish to stay in England alone?

[Mr Hunt]

The hon. Gentleman is right in what he says. This morning, my hon. Friend the Under-Secretary spoke to Alex Neil, the Scottish health Minister, and on Wednesday we will have a Cobra meeting with the devolved Administrations to test how resilient the structures are between the constituent parts of the UK. That is a very important part of our effort.

[Martin Horwood (Cheltenham) (LD)]

Perhaps I should declare a non-pecuniary interest, Mr Speaker, as my wife works for Public Health England. I join the Secretary of State in applauding all of her colleagues and the others who are putting themselves in harm’s way in the front-line battle against Ebola. Given his predecessor’s reorganisation of the NHS and of public health, does the Secretary of State need to check whether there are now sufficient local directors of public health in post and whether they have sufficient resources, qualified staff and seniority within local authorities to take a local lead, should that be necessary, in the fight against Ebola?

[Mr Hunt]

We are absolutely checking that, and it is all in hand.

[Fiona O'Donnell (East Lothian) (Lab)]

I do not know whether the Secretary of State has any plans to speak to the hon. Member for Clacton (Douglas Carswell), but if he does will he ask him why he now supports a party that would decimate the UK’s aid budget? Does the Secretary of State, like me, feel a great sense of pride in being part of a family of nations whose aid budget is saving lives in Liberia and Sierra Leone, and, in turn, keeping people in the UK safe?

[Mr Hunt]

The hon. Lady speaks extremely wisely and there is cross-party agreement on that matter. That shows why it is so wrong to make an artificial division between helping people abroad and helping people at home. I think we have a moral responsibility to help people in the poorest countries abroad in any case, but in my time in this House there has been no better example than this one of how doing so is in the interests of people in the UK, too. It helps to make us more secure, and we can be incredibly proud of the work we are doing as a result.

[Mr Nigel Evans (Ribble Valley) (Con)]

The Secretary of State has spoken about multiple points of entry, and major connection points are via Schiphol, Charles de Gaulle, Madrid and Frankfurt. Has he spoken to his opposite numbers in those countries to see whether they are following the best practice that is being rolled out in the United Kingdom? Will he ensure that those who are manning the points of entry in the UK have the ability to deal with children, because if a parent is detected with symptoms, their children will have to be properly looked after?

--- Later in debate ---

[Mr Hunt]

My hon. Friend makes an important point. I am sure that those arrangements are already in place, but I will ensure that they are. Yes, we are in touch with colleagues in other countries. It is important to say that there are only a very few direct flights to Europe from the affected region, and indeed there are none to the UK. At the moment, it is possible to be fairly confident that we will reach the vast majority of people who come from those affected areas. But part of what I am trying to convey in this afternoon’s statement is that the risk level could change—for example, there could be a breakdown in public order in the affected countries—which is why we need to be prepared for a much more porous situation, with people coming from many different points of entry.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

Is the Secretary of State talking to our universities, as a number of them must have overseas students from west Africa returning for their studies in October? Is he focusing on them in particular, and what provisions are we making to cater for them?

[Mr Hunt]

The hon. Lady makes a very important point. Clearly, it is important that anyone who comes from those countries, whether a student or a visitor, is treated with the same screening and monitoring process. Screening and monitoring people simply on the basis of their passport would not work. There will be people who have indefinite leave to remain in the UK but who have a Sierra Leonean passport, and it would not be appropriate to put them through that process. It is most important that we have a system in place in which we can check and find out who has been to the Ebola-affected areas in the past three weeks, so that we can give them help if they need it.

[Jason McCartney (Colne Valley) (Con)]

My right hon. Friend has given details of plans for extra Ebola bed capacity in regional centres such as Sheffield. Will he confirm that those regional centres will be used alongside the Royal Free hospital in London, or will they be used only when capacity there has been reached?

[Mr Hunt]

Essentially, the plan is to start with the Royal Free, which has capacity to go from two beds to four. Then we have six beds available in Newcastle and Liverpool and two beds available in Sheffield. Following that we can further expand capacity at the Royal Free.

[Fiona Mactaggart (Slough) (Lab)]

Will the Secretary of State ensure that British citizens fleeing Ebola-affected countries are not left destitute and homeless? My constituents Mr and Mrs Mahmood have been working in Sierra Leone for the past four years. When they returned, they were told that they were not eligible for income-based jobseeker’s allowance or housing benefit. Will the Secretary of State speak to his counterparts at the Department for Work and Pensions to ensure that no British citizen is left in such a state when they have to flee a country that is affected by Ebola?

[Mr Hunt]

If the hon. Lady lets me know the details of the individuals concerned, I will happily take up the case.

[John Hemming (Birmingham, Yardley) (LD)]

A systemic lacuna in the Government’s proposals relates to the lack of monitoring of lower-risk travellers. Will the Secretary of State consider having daily contacts with such travellers on the basis that identifying erroneous risk assessments at the first stage is the key to bringing things under control in the interests of the travellers as well?

[Mr Hunt]

The judgment on how effective we are at identifying higher-risk passengers must be made by the scientists and the doctors involved. Their view is that we are currently going further than we need to given the current risk level, but that it is prudent to do what we are doing because that risk level might increase. I will always listen to their advice.

[Ms Margaret Ritchie (South Down) (SDLP)]

I thank the Secretary of State for his statement on Ebola. Given that one of the busiest air routes within these islands is that between London and Dublin—the hon. Member for North Antrim (Ian Paisley) has already referred to the role of the Republic of Ireland—will he outline what discussions have taken place between him and his officials and the Minister for Health and his officials in the Republic of Ireland?

[Mr Hunt]

The hon. Lady makes an important point. The Under-Secretary of State for Health, my hon. Friend the Member for Battersea, has been in contact with the Northern Ireland Health Minister, and we will pursue discussions with the Republic of Ireland. Although the hon. Lady’s concern is legitimate and it is right that she has asked the question, it is important to say that the current assessment is that the risk level to the UK is low. I would imagine that the risk level in Ireland is similarly low, but that is ultimately a matter for the Irish authorities. At the moment, we are following a precautionary process just in case the risk level increases. We will of course involve colleagues in the Irish Republic in our assessment of those risks.

[David Rutley (Macclesfield) (Con)]

I am pleased that my right hon. Friend is focusing on the protection of health care workers in the vital work he is taking forward. Given that lessons are still being learned from cases in Texas and Madrid, what mechanisms are in place to update procedures when any new findings are brought into the public domain?

[Mr Hunt]

My hon. Friend is absolutely right that what happened in Dallas is of great concern. We need to listen to our colleagues in the Centre for Disease Control in the US as they try to understand exactly what happened. If they decide that we need to change the protocols for protecting health care workers, we will of course take that advice extremely seriously. At the moment, their scientific assessment is that there was a breach in protocol, not that the protocols were wrong. Until we identify what those breaches were, we cannot be 100% sure. We are working very closely with them and we have a good and close working relationship. We will update our advice to UK health care workers accordingly.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I thank the Secretary of State for the answers he has given so far, but my right hon. Friend the Member for Leigh (Andy Burnham) asked whether he was satisfied that all relevant NHS staff, including all GPs, know how to identify Ebola, know the precautions to take with patients presenting, and know the protocols for handling Ebola. I did not get a sense from the Secretary of State’s reply of how complete that knowledge is. He has talked a lot about receptionists, and that is important as they are in the front line of risk, but hospital cleaning staff and cleaning staff in GP practices are also at risk if such patients present.

[Mr Hunt]

The hon. Lady makes an important point, but I reiterate the point I made earlier to another hon. Member. The risk level to the UK general population remains low, so the measures we are taking are precautionary because of a possible increase in that risk level. As part of that, we are sending advice to everyone we think might be in contact with anyone who says that they have recently travelled to the Ebola-affected areas and who displays those symptoms. That is why alerts have gone out to hospitals, GP surgeries and ambulance services to ensure that they know the signs to look for and are equipped with that important advice.

[Mr Philip Hollobone (Kettering) (Con)]

To cross a typical western international border illegally, one needs a passport and passports are meant to have stamps in them. What steps are we taking with the seven most affected west African countries to ensure that they stamp the passports of people who go into and leave those countries so that we can readily identify the stamps in their passports should they come to the UK? What extra resources is Border Force putting into checking the stamps in people’s passports when they come to the United Kingdom?

[Mr Hunt]

I will get back to my hon. Friend with the exact details of what is happening with passport stamps, but I reassure him that we are working very closely with Border Force officials and we have a high degree of confidence that we will be able to identify the vast majority of people who travel from the most directly affected countries within the recent incubation period of the virus. It is important to remember that that incubation period is 21 days, so we are looking at the previous three weeks. We have a high degree of confidence, but I will get my hon. Friend information on whether passport stamps could be an additional source of security.

[Keith Vaz (Leicester East) (Lab)]

I join others in congratulating the Secretary of State on initiating screening, as he did on Thursday. That is the right approach, as is targeting it at certain ports. As he knows, viruses do not wait for direct flights and it is extremely important that there is a synergy between our screening processes and those of Sierra Leone and other west African countries. Did we supply the screening equipment, and if we did not, is he satisfied that it is fit for purpose? The same goes for the screening in other hubs throughout Europe.

[Mr Hunt]

We have absolutely checked the screening equipment that is being used in those three countries, and in Sierra Leone, which is our more direct responsibility, that is being done by Public Health England officials. The reports that we are getting back say that people are checked not just once, but several times. It is really important to say that the main purpose of the screening that we are introducing—I call it screening and monitoring, rather than screening—is to identify passengers who may be at higher risk. We are not particularly expecting to identify people showing symptoms because they should have been prevented from leaving the country in the first place, but we want to keep tabs on them while they are in the UK, in their own interests, and that is the purpose of the process.

[Mr David Nuttall (Bury North) (Con)]

I thank the Secretary of State for his statement. Given the large number of languages in use in that part of west Africa and the consequent practical difficulties in producing notices and posters that travellers can actually read for the purposes of self-presenting, may I ask my right hon. Friend in what circumstances he would reconsider the decision not to introduce the screening and monitoring of passengers arriving at Manchester airport?

[Mr Hunt]

We have not yet made a decision on Birmingham and Manchester, and we will continue to review the risk advice from the chief medical officer and PHE on whether such action would be appropriate. It is important to say that the measures we take must be proportionate, but they must also look forward to potential changes in the risk, so that we can react very quickly were that risk to increase dramatically, and that is exactly what we are doing at other UK airports.

[Jeremy Corbyn (Islington North) (Lab)]

I thank the Secretary of State for his statement and for the support given to health services in west Africa, but does he not agree that this terrible time shows the massive health inequalities that exist all around the world and that, although there will be a big international effort to deal with Ebola, it calls into question the effectiveness of the millennium goals on preventive health measures, not just in west Africa, but in a much wider sense? Do we not need to redouble our efforts to reduce health inequalities around the world for the protection of everyone?

[Mr Hunt]

The hon. Gentleman is right, although the millennium development goals have been successful in making a start on the process of reducing health inequalities. We can see that in other areas, such as the provision of antiretroviral drugs to HIV-positive patients in Africa, and that has been completely transformed in the past decade. But he is right: while some countries have very underdeveloped health care systems, the risk of such public health emergencies is much higher and therefore the risk to the UK is higher.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

I should like to echo the tributes paid to our NHS volunteers and to all health workers. Today of all days, it is important to recognise the sacrifices that they make. The Secretary of State has indicated that Newcastle’s Royal Victoria infirmary in my constituency is next in line after the Royal Free to receive Ebola victims. Will he say a little more about what measures are or will be in place for public awareness, training, equipment, staffing and basic hygiene procedures to enable that to happen?

[Mr Hunt]

I am happy to let the hon. Lady have full details of what is being planned at the RVI, which is an excellent hospital. It was one of the hospitals that was part of the exercise that we did on Saturday to test preparedness. In that exercise, we modelled what would happen if someone became sick and vomited in the Metro centre and was then transferred to the RVI. We modelled the decisions about whether they would be kept there or transferred to the Royal Free, and so on. I am very satisfied with the measures in place at that hospital, but I will happily send her the details.

[Roberta Blackman-Woods (City of Durham) (Lab)]

I am one of a group of parliamentarians who returned from a visit to west Africa on Friday. We were quite surprised to be asked no questions about where we had travelled, and to be offered no screening at either the EU or UK border; I came back to Newcastle from Brussels. Will the Secretary of State reassure us that all regional airports will offer screening and advice to people who might be affected? Will he redouble his efforts, in partnership with other agencies, to stop the spread of this disease, which is devastating parts of west Africa?

[Mr Hunt]

We are absolutely redoubling our efforts, and we are looking at what screening procedures are needed at regional airports. The screening and monitoring procedures that I outlined are starting at Heathrow terminal 1 tomorrow; they will be rolled out progressively across Heathrow, Gatwick and Eurostar terminals over the next two weeks. We are satisfied that that will reach the vast majority of people travelling from the affected countries. Any decision to expand those arrangements to other regional airports will be taken on the basis of the scientific advice that we receive about risk.

[Mrs Louise Ellman (Liverpool, Riverside) (Lab/Co-op)]

Liverpool university’s Institute of Infection and Global Health, and the Liverpool School of Tropical Medicine, have done a great deal of work to address the problem of the transmission of Ebola. Does the Secretary of State’s work involve their recommendations, and do his proposals for combating Ebola, particularly as regards international travel, address the issues that those institutions raise?

[Mr Hunt]

The hon. Lady is absolutely right to say that we have fantastic research on the spread of infectious diseases at a number of institutions in this country, including in Liverpool, and we are not only using that research in the battle that we are leading in Sierra Leone, but making it available to partner countries leading the battle in other parts of west Africa. The advice that I get from my experts, from Public Health England and from the chief medical officer takes full account of the research done in places such as Liverpool.

[Kevin Brennan (Cardiff West) (Lab)]

In his statement, the Secretary of State said that the screening measures would reach 89% of passengers from the three affected countries; it is therefore hoped that one in 10 will self-identify. Will he tell the House the numbers that the estimate is based on, not just the percentage, so that we have an idea of how many people will be involved in these screening measures?

[Mr Hunt]

For the month that we looked at, September, we are talking about around 1,000 people arriving from the directly affected countries, which is about 0.03% of all Heathrow travellers for that month. It is important to say that the vast majority of those will be low-risk passengers, but those are the people with whom, initially, we would want to have a conversation, so that we could understand whether they had been in contact with Ebola patients or had been in the areas particularly affected by Ebola, and so that we could decide whether we needed to put in place tracking procedures to allow us to contact them quickly, should they develop symptoms.

[Heidi Alexander (Lewisham East) (Lab)]

The Secretary of State may be aware that this weekend Lewisham hospital dealt with a suspected Ebola case. Thankfully, tests have shown that the individual is free from the virus, but may I press the Secretary of State further on the advice given to staff on the NHS front line? When was the guidance to NHS hospital and general practitioner receptionists sent out, and what steps have been taken to ensure that the guidance has been read and understood, and will be acted on?

[Mr Hunt]

First, on what happened in Lewisham hospital, the moment the individual was identified as a potential Ebola case, he was put into isolation. We learned, from what happened there, the importance of making sure that the guidance is widely understood. Making sure that everyone on the NHS front line knows what happens is an ongoing process. It is important to say, as I did in my statement, that the chief medical officer is satisfied that the arrangements in place right now are correct for the level of risk. The additional processes that I talked about are to make sure that we are ready for an increase in that risk.

[Mr Iain McKenzie (Inverclyde) (Lab)]

Did I hear correctly that the Secretary of State said that 21 days is quite a lengthy time for the incubation of this particular disease? Will he commit to putting a further screening in place towards the end of that 21 days so that he can be assured that those entering the country are free of Ebola?

[Mr Hunt]

I am not sure that I entirely understood the hon. Gentleman’s question, but the incubation period is 21 days, so if we identify through the screening and monitoring process someone who is higher risk, we will want to stay in touch with them for that period of 21 days on a daily basis to make sure that we are monitoring their temperature and that we get help to them as quickly as possible if they need it.

[Mr Stephen Hepburn (Jarrow) (Lab)]

I welcome the introduction of screening at various London locations, but what about Newcastle, which runs numerous flights every day to the airports that act as hubs for these west African countries, and obviously there is passage that way?

[Mr Hunt]

The hon. Gentleman is absolutely right. We have numerous ports of entry to the UK. We are one of the most international countries in the world, and London is one of the most international cities in the world, so the actions that we take must be proportionate to the risk. The risk is currently low, so the advice is that having no screening procedures at those airports is proportionate to the risk now, but we are taking this precautionary approach, starting with the Heathrow, Gatwick and Eurostar terminals, because we want to prepare for a possible increase in that level. Were that to happen we would of course look at whether that screening process should be expanded to regional airports.

[Andy Sawford (Corby) (Lab/Co-op)]

In a recent film of medical workers treating people in west Africa with Ebola, a young doctor said that the one benefit of her protective mask was that people could not see her cry. Even as the media focus inevitably moves on, we know that this will go on for months and months, so will the Secretary of State give us all an absolute assurance that we will continue, even though we cannot see her cry, to hear her voice and do whatever we can to help people in west Africa?

[Mr Hunt]

If that is the last question today, it is a fitting one on which to end. The hon. Gentleman is absolutely right: this is an appalling human tragedy. There have been more than 4,000 deaths so far, in countries that are already, in many ways, the unluckiest in the world in terms of the levels of poverty that they already have to cope with daily. We can be incredibly proud of the 659 NHS volunteers, and the military, diplomatic and development staff who are stepping up to the plate, and we should always remember our humanitarian responsibility never to forget those countries’ plight.

NHS England and the NHS Outcomes Framework

Jeremy Hunt Excerpts

Tuesday 22nd July 2014 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

Today, I laid before Parliament my first “Annual Assessment of the NHS Commissioning Board (known as NHS England) 2013-14”. The “National Health Service Commissioning Board Annual Report & Accounts 2013-14” was also laid (HC408). Together they describe an organisation that has established itself and made progress in delivering the Government’s mandate, but has more to do to deliver all of its objectives. Copies of both documents are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

The mandate to NHS England sets the Government’s ambitions for the NHS as well as the funding available to achieve and deliver the care people need and expect. The Health and Social Care Act 2012 requires the mandate to be reviewed on an annual basis to ensure that it remains up to date.

It has never been more important to provide the NHS with stability and continuity of purpose than now. And that is why the Government proposes to uphold all of the existing objectives in the current mandate, and maintain a stable mandate for 2015-16, to enable the NHS to build on its achievements and make further progress on the ambitious agenda already set.

Meanwhile, the challenges facing the NHS and wider health and care system for 2015-16 remain, with an ageing population and an increase in the numbers of people with long-term conditions. We want to see the NHS make further progress in transforming primary care to improve services for older people and those with the most complex needs, and on delivering a system-wide response to the Francis inquiry recommendations, while from 2015-16 joining up health and social care through the better care fund will be key to transforming care.

Within the stable mandate, as part of its existing objective to make progress towards parity of esteem for mental health, NHS England is working with the Department to fulfil its commitment to develop a range of costed options for new access and/or waiting time standards for mental health services, in order to implement these standards starting from April 2015, with a phased approach depending on affordability.

The NHS has generally been performing well and meeting demand despite increasing pressure on services. A stable mandate will allow the NHS to focus on maintaining its performance in providing high-quality, compassionate, and joined-up care now and in the future.

In addition, this summer we will be reviewing the NHS outcomes framework. The review has two aims: to update the framework for 2015-16 by improving, adding and removing existing indicators, and to indicate a direction of travel for future indicator development. Reviewing the NHS outcomes framework this year is also an opportunity to increase alignment between the framework and the objectives in the mandate given the commitment to stability for the mandate for 2015-16.

We have been working closely with NHS England on the approach to the mandate and the review of the outcomes framework, and will be engaging with stakeholders over the summer, ahead of publication in the autumn.

NHS Modernisation (Costs and Benefits)

Jeremy Hunt Excerpts

Tuesday 22nd July 2014 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

I announced in July 2013 that the costs of implementing policies in the Health and Social Care Act were likely to be closer to the estimate in the business case for the programme—£1.5 billion in today’s prices—rather than the £1.6 billion to £1.7 billion estimate reported in October 2012.

I can today confirm today that I am expecting the costs of NHS modernisation to be no higher than £1.5 billion.

Up to 31 March 2013, costs of £1,096 million had been incurred across the health and care system on developing and establishing the new arrangements. During 2013-14 organisations in the new system reported that they had incurred a further £220 million to continue this work. Some of these costs will relate to the continuous improvements that all organisations are expected to make. So, at most, the costs to 31 March 2014 were £1,316 million, comprising:

£456 million on staff redundancies;

£75 million on IT for the new organisations;

£88 million on estates costs of closing bodies and setting up new organisations;

£26 million on internal departmental costs—for example, programme management;

£323 million on setting up clinical commissioning groups—excluding items above; and

£348 million on other costs of closing bodies—for example, PCTs—and setting up new organisations.

In the impact assessment, long-term annual savings arising from the changes were estimated at £1.5 billion per year from 2014-15 onwards. Gross savings over the transition period—2010-11 to 2014-15—were estimated at £4.5 billion.

As I announced last year, annual savings are still expected to be £1.5 billion from 2014-15.

The reductions in administration costs up to 31 March 2014 are set out below. These are calculated on a basis consistent with the impact assessment for the Health and Social Care Bill—with the figures set aside any administrative spending on implementing the reforms.

Special Measures Regime

Jeremy Hunt Excerpts

Wednesday 16th July 2014 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

With permission, Mr Speaker, I would like to make a statement about hospitals in special measures, and the next steps for rolling out a new inspection regime in the social care sector.

One year ago in the wake of the Francis inquiry, Professor Sir Bruce Keogh delivered his report into NHS hospitals with the highest mortality rates. Shockingly, he found that the poor care swept under the carpet for four years at Mid Staffs was not an isolated incident or “local failure” as some have claimed, and he recommended that 11 trusts should be placed into special measures. As a result of the new independent hospital inspection regime introduced by this Government, a further five trusts have been placed into special measures, taking the total to 16 trusts—more than 10% of all acute trusts in the NHS in England. Today I am reporting back to the House on the progress of the first trusts to be put into special measures, and on how the lessons we have learned can be applied to adult social care.

I would like to start by thanking all the front-line staff who have been involved in the special measures process, which can often be traumatic and stressful, with difficult media coverage in local and national newspapers. Thanks to their superb efforts, I am pleased to report today that progress is being made in nearly every trust and that the chief inspector of hospitals has recommended that five should now come out of special measures. Together with Monitor and the TDA—the NHS Trust Development Authority—he will shortly be publishing a report of his findings.

Across all the initial special measures trusts, leadership capability was carefully reviewed, leading to 53 changes at board level. A hundred more doctors and 1,300 more nurses and nursing support staff have been recruited. Every hospital has put in place a comprehensive improvement plan and was partnered with at least one other high-performing hospital, giving access to best practice and hands-on guidance and assistance.

The chief inspector and Monitor have confirmed that Basildon and Thurrock NHS Foundation Trust can leave special measures with no further support. Under Clare Panniker’s inspired leadership, the trust has appointed 241 additional nurses and has been given a “good” rating overall, with its maternity unit the first in the country to be rated “outstanding”. The chief inspector has recommended that George Eliot NHS Trust should also exit special measures, with a new acute medical unit, 31 more doctors and a strong partnership with University Hospital Birmingham NHS Foundation Trust.

The chief inspector and the TDA have confirmed that Buckinghamshire Healthcare NHS Trust, where there has been good progress on staffing, nutrition and hydration, should also leave special measures, with some continued support in place. The chief inspector has recommended that East Lancashire Hospitals NHS Trust, with some 238 more nurses and nursing assistants in place, should also exit special measures with some continued support. He has recommended that Northern Lincolnshire and Goole Hospitals NHS Foundation Trust should also leave special measures, with some continued support in place, having improved stroke care and employed 166 extra nurses and nursing assistants.

While United Lincolnshire Hospitals NHS Trust has made progress, including the employment of 140 additional nursing staff, work remains to be done, and the chief inspector has recommended that it should remain in special measures for a further six months. Turning around a hospital which had significantly high death rates going back to 2006 is a big task, but I know, having visited the trust myself, how much enthusiasm there is to exit special measures.

At North Cumbria University Hospitals NHS Trust, a further 90 nursing staff have been employed, and mortality is now within normal limits. However, the chief inspector has recommended that further progress is still needed, although we are hopeful that this will be completed within six months. At Tameside Hospital NHS Foundation Trust, while staff are reporting a better leadership culture and there have been improvements on some key safety indicators, he recommends a further six months in special measures to ensure that sustainable improvements really are in place.

The chief inspector continues to have strong concerns about Medway NHS Foundation Trust—an organisation with long-standing difficulties, care failures and high mortality rates going back to 2005. He recognises some progress, including the recruitment of 113 nurses, but has concerns about the sustainability of those improvements. He will make his recommendations about Burton Hospitals NHS Foundation Trust and Sherwood Forest Hospitals NHS Foundation Trust in the next few days, following their local quality summits.

All the Care Quality Commission’s recommendations will need to be fully considered by Monitor or the TDA before they are confirmed. I pay particular tribute to the work done by the chief inspector and his team from the CQC, and to Monitor and to the TDA, for the extraordinary effort they have put into making the improvements outlined above.

However, the responsibility for safe and compassionate care goes far beyond hospitals. Hundreds of thousands of people—some of the most elderly and vulnerable in our society—receive care in their own homes or in residential and nursing homes. Yet in recent years a member of the public, Jane Worroll, discovered from a secret camera that her mother was being systematically abused in Ash Court care home in London. Another secret camera filmed a resident being slapped and mocked at the Old Deanery home in Essex earlier this year. Perhaps most shocking of all was, in the words of the West Sussex coroner, the “institutionalised abuse” handed out to the residents of the Orchid View care home in Copthorne, where five people were found to have died as a result of poor care. The long list of failings included residents being left in soiled sheets, call bells ignored or left out of reach, and medications mismanaged.

Every older person has a right to be treated with dignity and respect in the way we would all wish for our own parents and grandparents. This Government are determined to see demanding standards and tough enforcement apply as much outside hospitals as inside.

Inexplicably, the previous Government scrapped expert-led inspections of adult social care organisations—as they did for hospitals. The same individuals, therefore, might have been inspecting a large teaching hospital and a small care home in the same week without any opportunity to develop the detailed expertise necessary to make important judgments.

Today I can confirm that we are bringing back expert-led inspections for adult social care, and I am encouraged that the new chief inspector of social care, Andrea Sutcliffe, has announced the toughest ever enforcement regime, to ensure that ongoing abuse and neglect in residential care homes and domiciliary care services is stamped out once and for all.

Alongside the new programme of rigorous and independent inspections, the CQC is being given the power to produce ratings of care providers that will provide a fuller picture of the quality of care than mere compliance with minimum standards. The first ratings will be published in October.

New fundamental standards of care will also be introduced, which will allow the CQC to prosecute those responsible for unacceptable care. In addition, we are introducing safeguards that will allow the CQC to remove and bar individual directors.

I can announce today that once in special measures, care services will be given six months to shape up or action will be taken that will lead to them closing down. This regime will start next April. From then, any care service rated as “inadequate” under the new ratings system will be required to improve within a time-limited period. The CQC will then take action to close down any services that do not meet the standards that people have a right to expect.

My Department and the CQC will work with the sector on the details of that framework, including what support can be given to failing providers and the timing of any closures. In particular, the CQC will work with people using services, their carers and their families to ensure that no one suffers as a result of any service closing down.

We are taking these steps because we have a moral duty to our most vulnerable people to ensure that they receive the best possible care and that they are treated with compassion, dignity and respect. We also owe it to those many excellent providers who deliver good care every day and need proper recognition.

When this Government took the tough decision to confront the reality of poor care within the NHS, people said we were running down the NHS and its dedicated staff. But we refused to accept a status quo that tolerated poor standards, betrayed NHS values and, most of all, betrayed hard-working staff who have given their lives to the care of others.

As a result, we are finally turning around performance in failing hospitals—something we are today extending to social care. Much remains to be done, but after a traumatic moment in its history, both the NHS and the social care systems have faced the truth, confronted the past, and can now face the future with confidence.

I commend this statement to the House.

[Andy Burnham (Leigh) (Lab)]

Anyone who supports the NHS must always be prepared to shine a light on its failings so that it can face up to them and improve. Therefore, I welcome much of what the Secretary of State has said today, and I join him in thanking Sir Mike Richards and Sir Bruce Keogh. Their work builds on foundations laid by the previous Government, and I do not think the Secretary of State helps his case today by continuing to make assertions not supported by the facts. Let me once again gently remind him of the broader context.

It was following care failures in the 1980s and 1990s that independent regulation of the NHS was introduced for the first time by the previous Government. It was that independent regulator that, as Sir Bruce Keogh said, helped reduce mortality in all NHS hospitals over the past decade and then uncovered problems at Mid Staffs.

The Secretary of State was right to say that Mid Staffs needed to be a moment of change for the NHS. The central lesson of the first Francis report, which I commissioned, was that staffing levels were critical to safe care. The big question that arises is for this Government to answer: why, following that report, did they fail to learn the lesson and allow staffing to fall across the NHS in the first three years of this Parliament? Nurse numbers were cut by almost 6,000 in the three years between July 2010 and July 2013, but the cuts fell particularly hard on some of the 11 trusts that we are considering today. North Cumbria cut 148 nursing posts, United Lincolnshire cut 179 and Basildon cut 345. When the Health Secretary was forced to put those trusts into special measures, it was because they were getting worse on his watch.

The Health Secretary mentioned Basildon—like him, I congratulate the trust and its staff on its improvement—but I left a clear warning in place about Basildon in 2010, following a statement I made to the House. Why on earth was it allowed to cut so many staff in the following three years when Francis had already warned of the dangers of doing so? I have an answer to a parliamentary question that shows that Ministers did not hold a single meeting about Basildon up to its being placed in special measures, presumably because they were distracted with their reorganisation. Will the Health Secretary now admit that it was an error to cut so many nursing staff, and will he today accept the National Institute for Health and Care Excellence recommendations on safe staffing levels?

Let me turn to the special measures regime. We welcome the improvements at some of the 11 hospitals and pay tribute to the staff, but it is a concern that four are showing only limited signs of improvement. One trust, Medway, has barely shown any, but how can that be after a year in special measures? Does it not raise questions about whether the regime is providing enough support to improve? A CQC inspection published last week found a catalogue of concerns at Medway—patients on trolleys overnight without appropriate nursing assessment, medication given without appropriate identification of patients, and insufficient nursing levels with an over-reliance on agency staff. The Secretary of State claims that all the problems are long-standing ones, but the CQC found that happening right now. The trust has been in special measures for one year. How can there have been no improvement, what is he doing to help Medway to improve, and given its worrying lack of progress, will he report back to the House at the first opportunity?

There are also questions about the inspection regime. Last week, it was revealed that in 2012 the CQC employed as inspectors 134 applicants who had failed competency tests, of whom 121 are still in place. Again, how was that allowed to happen? Is the Health Secretary confident in the ability of those inspectors, and if not, what is he doing about it?

Three of Cumbria’s four largest hospitals are in special measures. General practitioners are under severe pressure, and my hon. Friend the Member for Copeland (Mr Reed) relayed their warnings to the House yesterday. Is there not a much wider failure in the health economy, as he warned, and with an overly hospital-focused inspection programme, is there not a risk that wider problems in the heath economy are being missed? Is it not the case that hospitals are often dealing with pressures and problems not of their own making—but due to cuts to primary care, social care or mental health—and to be truly effective, should not the Health Secretary’s inspection regime take a much wider view of the whole health economy?

That brings me to social care, about which the Health Secretary is right to say that we have seen appalling failures in recent years at Winterbourne View, Orchid View and Oban Court. We welcome the extension of the special measures regime to care homes, but I must say that it sounds like a U-turn. Only recently, he legislated to remove the CQC’s role in assessing whether councils commission care effectively. Is he conceding that that was a mistake, and does he accept that it must be reversed if we are to have truly effective care inspection?

Local authority commissioning can be the root cause of care failures, but so can the impossible budget cuts that many providers now have to absorb. Is that not the real reason why we have such problems in our malnourished social care system today? New House of Commons Library analysis—we are publishing it today—shows that £3.7 billion has been cut from adult social care since 2009-10. That is not sustainable. How does the Health Secretary think that older and disabled people will ever get the standards of care to which he aspires with cuts on this scale?

The truth is that the collapse of social care is in danger of dragging down hospitals, which are becoming dangerously full of older people and struggling to function. The Health Secretary will not like to admit it, but in the year to the day since he stood at the Dispatch Box and made his first statement on the Keogh report, hospital accident and emergency departments have missed his own lowered A and E target in every single one of those 52 weeks. Does that not tell us more clearly than anything that it is not just a small number of trusts that have got worse on his watch, but the whole NHS? The cancer treatment target has been missed for the first time ever, it is harder to see a GP, and waiting lists have hit a six-year high. He does not just need a plan for some trusts; he urgently needs a credible plan to get the whole NHS back on track.

[Mr Hunt]

I had hoped for a little more consensus on the issue of dealing with poor care. I am afraid that what we had from the right hon. Gentleman was a set-piece speech. However, let me go through the points that he raised.

First, the right hon. Gentleman spoke about nursing numbers. Let us look at the number of nurses since the Government took office. We have 6,200 more nurses on our wards than when he was Secretary of State for Health. Why is that? It is because we took the difficult decision, which he opposed every step of the way, to get rid of the bureaucracy, the primary care trusts and the strategic health authorities—19,000 administrators—so that we could afford more nurses, more doctors, more paramedics and more front-line staff. It is time that he admitted that he was wrong to oppose those important reforms.

The right hon. Gentleman then talked about trusts missing A and E targets. Despite the fact that we are doing better on A and E than he did as Health Secretary, he has missed the point about targets. It was an obsession with targets under Labour that led to the problems in Mid Staffs and many of the trusts that are in special measures today. Let us just take one example. [Interruption.] The Opposition should listen to this example because it provides an important lesson about targets that the Labour party has still not learned. Buckinghamshire had a terrible tragedy in 2004 and 2005, when more than 30 pensioners died in a clostridium difficile outbreak. Why did that happen? The independent report said that the trust was too focused on Government targets.

That is the dividing line. The Opposition want an NHS that is obsessed with targets. The Government recognise that targets matter, but that treating people with dignity, respect and compassionate care matters. Is it not extraordinary that the party that founded the NHS has got itself into a position where it does not care how people are treated in the NHS?

The right hon. Gentleman talked about social care. If he wants more funding for social care, why has he called for the better care fund to be halted, when it will put an extra £1.9 billion at the disposal of the people who commission adult social care?

Let us look at some of the examples that the right hon. Gentleman raised. He talked about Basildon. When he was Health Secretary, the CQC sat on a report about that trust for six months that talked about bloodstains on the carpets, blood on the floors and vital safety measures being ignored. When the reason why the report was not published for so long was looked into, people at the CQC said that they were afraid to publish something that could embarrass the Government of the day. Is it not time that he admitted that the way the Labour Government ran the CQC was wrong? We now have an independent inspections regime, which is a big step forward.

The right hon. Gentleman talked about Cumbria. There are real issues in some of the hospitals in Cumbria. However, when Labour was in office, somebody in one of those hospitals—North Cumbria—was paid £3.6 million because they were disabled for life. Should that not have been a warning sign? There were also issues at Morecambe Bay involving children.

[Mr Jamie Reed (Copeland) (Lab)]

What are you doing?

[Mr Hunt]

What are we doing? We are doing what I set out in the statement. We are putting more nurses and doctors into hospitals that are in special measures. We are turning around the failing hospitals that Labour swept under the carpet.

Even if Labour has not understood the lessons of Mid Staffs, the NHS has. We have 6,000 more nurses; five hospitals are out of special measures; there is record public confidence in safe and compassionate care; and, from today, we have new plans to stamp out poor care in adult social care. When everyone in the NHS is so keen for those plans to work, is it not time that Labour ended its denial about the past and backed them as well?

[Margot James (Stourbridge) (Con)]

I congratulate my right hon. Friend on bringing back an expert-led inspection regime for adult social care. I ask him to learn from the experience with schools in Birmingham five, six or seven years ago, which managed to bamboozle Ofsted by planning for the inspections. I ask him to ensure that a good proportion of the inspections under the new regime have no notice whatsoever.

[Mr Hunt]

My hon. Friend, as ever on health issues, makes an extremely important contribution. She is right that we drew a lot of inspiration from the Ofsted regime, which is clear, transparent and easy for the public to understand. She is right that snap inspections are importation. I reassure her that the CQC has the power to perform snap inspections. It has already used that power and will continue to do so.

[Mr Jack Straw (Blackburn) (Lab)]

Does the Secretary of State agree that it is a tribute to the new leadership of Professor Eileen Fairhurst, the chair of the East Lancashire Hospitals NHS Trust, the other senior clinicians and managers, and the vast majority of staff at the trust, who are of a high quality, that the trust has been able to turn around and get out of special measures? Does he also accept that, as Professor Sir Bruce Keogh makes clear—these are my words, not his—it is essential that the trust does not take its foot off the gas, but continues the process of change and, above all, cultural change in the way that patients are treated? Lastly, although the additional nurses are welcome, will he say something about the implications for the future funding of the trust?

[Mr Hunt]

The right hon. Gentleman makes some important points. I will start with the point that provides a broader lesson for the NHS. Not taking our foot off the gas is really important. This is the start of a very long journey. I said last year that it would take about three years to turn around a hospital where the wrong culture has become entrenched.

I pay tribute to the leadership at East Lancashire Hospitals NHS Trust. The CQC report said that the staff on the front line now feel more supported, more empowered to take decisions and more able to raise concerns. If there is one thing that we have learned, it is that successful hospitals make it easy for their staff to speak out and support them in speaking out. The hospitals with problems are the ones where people feel bullied and intimidated when they speak out. I am delighted with the progress that has been made.

In respect of finances, this is a challenging time for finances across the NHS. I simply say that, as I am sure the leadership of the right hon. Gentleman’s trust recognise, the most expensive thing of all is delivering poor care. The most important way of saving money is ensuring that the care that is delivered is safe.

[Paul Burstow (Sutton and Cheam) (LD)]

I very much welcome the changes the Secretary of State has announced on social care inspections. However, standards and enforcement alone are not sufficient. Does he agree that we need to look at the support that is provided to organisations so that they can change before they get to a point of crisis? If so, will he look at the work of My Home Life, which runs programmes to transform the lives of people in care homes and improve their quality of life by working with staff in a different way? I commend that work and hope that he looks at it.

[Mr Hunt]

I am happy to do that. I agree with the right hon. Gentleman. I would like to see a lot more innovation. Even in the best care homes, which deliver good care by today’s standards, there is room for much more innovation and imagination in seeing how we can make people’s last years ones that they really enjoy. I have seen some amazing dementia care homes that break the mould. I am very happy to look at the work of that organisation. I am sure that there is a lot we can all learn.

[Mike Gapes (Ilford South) (Lab/Co-op)]

The Secretary of State said that 16 trusts are in special measures, but he mentioned only 11 of them. As he knows, Barking, Havering and Redbridge University Hospitals NHS Trust includes King George hospital in my constituency. Will he take this opportunity to explain why he has not said anything about that trust? Is it because the plans to close the A and E this year or next year are in total disarray, but he does not want to admit it publicly? Will he take this opportunity to clarify—yes or no—whether it is still his intention that King George hospital’s accident and emergency will close?

[Mr Hunt]

First, let me reassure the hon. Gentleman on the last point. The trust has made it absolutely clear that the change in A and E will not happen until it is safe. It is very unlikely that it will happen in the near or medium term. The reason I did not mention his trust is that the statement was about the 11 trusts that were put into special measures exactly a year ago and his trust was not put into special measures until just before Christmas. It, too, is making progress. It has employed 31 additional nurses, it has an excellent chief nurse, whom I have met on a number of occasions, it has had a new chief executive since April and there is an increase in patient satisfaction. However, there is still a long way to go because it is a very challenged trust with some deep-seated problems. We need to support it at every step of the way.

[Jeremy Lefroy (Stafford) (Con)]

Today’s statement and the appointment of the chief inspector of hospitals arise from the Francis report on Mid Staffs in my constituency. I am sure my right hon. Friend acknowledges the great improvements that have been made at Mid Staffs thanks to the hard work of staff and others, but he will also acknowledge that the situation remains fragile. Will he ensure that both Stafford and the University Hospital of North Staffordshire are given the full support they need to come together and implement the recommendations of the trust special administrators in full, as a minimum?

[Mr Hunt]

I pay tribute to the staff in Stafford hospital. I also make the point that, even through the four years when those terrible examples of care happened in the hospital, much excellent care was happening, too, and the hospital had dedicated and hard-working staff. This has probably been tougher for them than for anyone else in the whole NHS. I thank my hon. Friend for the way in which he has campaigned for his local hospital. No one could have done more for their local services. I agree with him that we must implement the very detailed recommendations of the TSAs quickly and in full, and ensure that we give every bit of support necessary to both Stafford and UHNS to ensure that that merger works.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The Health Secretary talked about denial of the past, but that was a bit rich given that Conservative Ministers gave Jimmy Savile a managerial post at Broadmoor. He wants to think about that a bit more.

In view of the disgraceful care failures the Health Secretary detailed, I find it surprising that he relies on inspection to raise standards and ignores the obvious impact of cuts of £3.7 billion in social care budgets. Does he not see that inspection will not fix the parlous state of social care?

[Mr Hunt]

I am afraid that that is the difference between Government and Opposition Members. The hon. Lady says that there was denial over Jimmy Savile, but I stood at this Dispatch Box and apologised to relatives and members of the public for the mistakes relating to Jimmy Savile. I do not call that denial; I call it facing up to the past.

Of course, inspection is not the only answer, but the reason it was so wrong to abolish the expert-led inspections we used to have in social care is that the first step, if we are trying to improve standards, is at least to know where the problems are. Until we have those expert-led inspections, we will not know that. The next step is to work out how to solve the problems. We will be doing both.

[Mr Henry Bellingham (North West Norfolk) (Con)]

The Queen Elizabeth hospital in King’s Lynn serves my constituency and that of the Secretary of State’s deputy, the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb). Will the Secretary of State pay tribute to the superb acting chief executive, Manjit Obhrai, and the former acting chairman, David Dean, who have done a sterling job, along with the hard-working staff, on the hospital’s comprehensive improvement plan? When will that hospital come out of special measures, and will he pay tribute to the excellent work that has been done in the past few months?

[Mr Hunt]

I am happy to do so. The hospital has recruited 95 more nurses and nursing support staff since last July. It has appointed a director of nursing and a medical director and lead for patient safety, which strengthens clinical leadership. Some very important changes have been made, and I pay tribute to the hospital’s leadership for making that possible. I hope my hon. Friend understands that, under the new system we have set up, it is not for the Secretary of State or any Minister to say when a trust is ready to come out of special measures. We have deliberately given that judgment to an independent chief inspector, so that no one who has a vested interest or a hope that a hospital will come out of special measures, and no one who is involved in turning around a trust, is responsible for that important independent judgment. However, that means that, when hospitals come out of special measures, people can have confidence that the judgment has been correctly made.

[Grahame M. Morris (Easington) (Lab)]

This is an important statement, but it is regrettable that the Health Secretary is implying that the care failures were all the fault of the previous Government. Will he confirm that Sir Bruce Keogh, who gave evidence to the Select Committee on Health yesterday, and not the Secretary of State, decided which hospitals would be placed in special measures? I understand that Sir Bruce’s decision was based on those hospitals being outliers for two consecutive years. According to my maths, that means that the failures described by the Secretary of State occurred on this Government’s watch. If he is apologising and feeling contrite, would he like to own up to that failure?

[Mr Hunt]

The examples of poor care I gave happened under this Government. I am therefore being absolutely clear that failures in care happened under both the previous Government and this one. The difference is that this Government are doing something about it. We are taking action and taking the difficult steps to get those trusts out of special measures. The public are beginning to have confidence that, when there are problems, they are not being swept under the carpet but being dealt with.

[Charlotte Leslie (Bristol North West) (Con)]

Bad care is unacceptable, but what turns bad care toxic is covering it up and denying that it is happening. I am pleased that we are beginning to get a consensus across the House that transparency and unearthing problems is the beginning of solving them. On that note, will my right hon. Friend the Secretary of State work on a cross-party basis with the right hon. Member for Leigh (Andy Burnham) and the Labour party on Wales, which was also targeted by Bruce Keogh’s expertise? He has suggested that it would be sensible to have a Keogh-style investigation in Wales, not only because of mortality statistics and diagnostic waiting times, but because tales coming to me and the right hon. Member for Cynon Valley (Ann Clwyd) are raising the alarm. I urge hon. Members on both sides of the House who are worried about patients in Wales to urge such an investigation there, because the investigation here unearthed problems.

[Mr Hunt]

I totally agree with my hon. Friend. It is an absolute tragedy for people who use the NHS in Wales and Welsh NHS workers that they are not getting the support that people in England get to deal with poor care. For some reason, the Labour Administration in Wales believe that it would be incredibly embarrassing to find problems, but that is what hospitals and hospital staff are crying out for. The staff did not go into those jobs to deliver poor care. They want the support to deliver the best care. It is time that Labour in Wales understood that and got the support of Labour in England to do so.

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

The Secretary of State will know that the local MPs covering Tameside hospital have never pulled their punches in calling for the need to improve our local hospital. He may recall that we publicly called for the previous leadership of our hospital to be removed even before the Keogh review process began. Speaking on behalf of my hon. Friend the Members for Denton and Reddish (Andrew Gwynne), who sits on the Opposition Front Bench, and my hon. Friend the Member for Ashton-under-Lyne (David Heyes), we are disappointed that Tameside remains in special measures, but we believe that progress has been made, particularly in A and E and with regard to mortality rates. We believe that the new management team, who have brought about those changes, deserve our support. We will never accept anything but the very best care in Tameside, and we agree that there is more to do, but we believe we are on a journey of improvement and that our hospital is in a different place from where it was 12 months ago.

[Mr Hunt]

I thank the hon. Gentleman for the tone of his comments and totally agree with his sentiments. Tameside has recruited 70 new nurses and nursing staff. To take one important indicator—it is only one—the number of falls has decreased by 18%. The staff definitely feel more supported by the management. However, he is right that this is a long process—the trust has been troubled for many years—and we are absolutely determined to back the staff and get them over the line.

[Mark Reckless (Rochester and Strood) (Con)]

Mortality rates at Medway are not as elevated as they were in 2005, but does the Secretary of State believe that the astonishingly well paid interim managers have made any sustainable improvements, and will he expand on how University Hospitals Birmingham will help us to drive improvements at Medway?

[Mr Hunt]

To be frank with my hon. Friend, the situation at Medway is still troubling. It has made some improvements to maternity services and has about 100 more nurses, and the dementia unit has made progress, but we have not had the stability of management and leadership that will be necessary to sustain improvement. It always takes a very long time to make such improvements. We will therefore work hard to do that. I hope that the partnership with UHB will be a part of that change, because Julie Moore is one of the best chief executives we have in the NHS. I will work closely with my hon. Friend, because I know he takes a great interest, to ensure that we get the lasting changes we need at Medway.

[Graham Jones (Hyndburn) (Lab)]

Sir Bruce Keogh focused on the A and E at Royal Blackburn, which I have had the privilege of visiting. However, Hyndburn faces significant NHS cuts, such as cuts to the walk-in centre, which 36,000 people have been through; cuts to the NHS GP practice in Accrington Victoria; and cuts to personal medical services GP contracts, which GPs are deeply concerned about, and which will lead to a reduction in hours. GPs tell me that that will impact on A and E. Is the shadow Secretary of State right to say that we should look not only at hospitals, but at the broader picture, if we are not to neglect patients and let them down?

[Mr Hunt]

If the hon. Gentleman is worried about cuts, perhaps he might talk to the shadow Secretary of State and ask him why he said it was irresponsible for us to increase the NHS budget as we did.

On the particular issue the hon. Gentleman raises, I actually agree with the shadow Secretary of State. It is not always possible to solve these problems simply by reference to the institution. Sometimes we have to look at the broader health economy. That is particularly true of A and E, but it is true for many other parts of the NHS too. Where there is a broader health economy issue we must look at that as well, but this process means that Ministers are held to account for finding a solution, whatever that solution is.

[Martin Vickers (Cleethorpes) (Con)]

I join my right hon. Friend in his tribute to the front-line and managerial staff at North Lincolnshire and Goole NHS Foundation Trust. My constituents will particularly welcome the increase in staffing levels and the improvements in the stroke unit, which has been a particular concern. He will be aware of recent public criticism of the hospital trust by North Lincolnshire clinical commissioning group. Can he assure my constituents that the continuing help and support will focus on the aspects of its criticism?

[Mr Hunt]

That certainly needs to happen. I visited my hon. Friend’s trust and saw a knee operation. I talked to the staff about the special measures regime, and they said that they thought important changes were happening, so I was delighted too when they came out of special measures. We will certainly give all the support they need, and I thank him for the support he is giving his local hospital.

[David Heyes (Ashton-under-Lyne) (Lab)]

Does the Secretary of State agree that possibly the single most important factor in turning these hospitals around is the quality of the leadership? He has referred already to Tameside hospital, where the report talks of the staff reporting a better leadership culture. This hospital has suffered for far too long from inadequate leadership. I am confident that good leadership is in place now. The change in the hospital is palpable. I am confident that, given a fair wind, it can be out of special measures within the six months referred to, despite the severe underfunding with which the hospital management is grappling daily.

[Mr Hunt]

Funding pressures are everywhere in the NHS, but I agree with the hon. Gentleman’s sentiments that this is largely about leadership. As well as this work, we are working with Sir Stuart Rose to try to understand what we can better do to sustain and support the highest quality leadership. We have some great leaders in the NHS, but we probably do not have enough of them. I think there has been an improvement at Tameside. I strongly welcome that and we will certainly be supporting the leadership and the staff in that hospital every step of the way.

[Stephen Metcalfe (South Basildon and East Thurrock) (Con)]

I congratulate my right hon. Friend on his statement. I, too, congratulate Clare Panniker on her inspirational leadership at Basildon hospital. She informs me that rather than cutting 345 nurses between 2010 and 2013, there were 1,908 in 2010, 2,000 in 2013 and that that number is now up by 241. Does he agree that to tackle problems in the NHS we need honesty and accuracy when discussing these issues?

[Mr Hunt]

We do. I think it is time that those on the Opposition Front Bench, in particular, recognised that they were wrong to oppose so bitterly the move to get rid of 19,000 administrators in the NHS, so that we can afford 7,000 more doctors and 4,000 more nurses across the whole NHS. That has made a huge difference to the statement we are making today.

[Helen Jones (Warrington North) (Lab)]

The Secretary of State is right to say that abuse should never be tolerated, but does he not also accept that many of the problems in residential care for the elderly stem from a system that is trying to make profits out of the running of homes that are grossly underfunded because of the cuts his Government have imposed, and which, despite having some excellent staff who do their best, rely largely on untrained and underpaid staff? When is he going to tackle the real problems at the heart of the system, as well as announcing inspection regimes?

[Mr Hunt]

I do not accept that all profit-making organisations are going to deliver poor care. There are some excellent ones and some bad ones. Poor care is poor care wherever it exists. The hon. Lady is right to say that we need to value more the staff who work in residential care homes and domiciliary care services. They do a fantastic job that is often not well paid. The best thing we can do for them is to make sure that, where they are in an organisation that delivers poor care, we shout about it and talk about it, so that people find out about it and something gets done.

[Mr Robin Walker (Worcester) (Con)]

More nursing staff and a rigorous focus on care for the person, as well as an improved inspections regime, are very welcome, but does the Secretary of State agree that we also need to focus on sharing best practice and innovative approaches to care, such as those being pioneered at the Association for Dementia Studies at the university of Worcester?

[Mr Hunt]

We absolutely do need to do that. Dementia care is an area where there needs to be lots more work and innovation. There is huge variation and even some very caring places could try new ideas. There are some very interesting ideas about dementia care in Holland, too. I absolutely welcome that work.

[Derek Twigg (Halton) (Lab)]

Does the Secretary of State think that standards could be improved further by having minimum levels of staffing in care homes, and does he think that more can and should be done to improve pay and rewards for care workers?

[Mr Hunt]

We have recommended levels of staffing, but in the NHS we have decided not to have minimum levels of staffing. We were worried that that would be seen as a hurdle where, once achieved, nothing more would need to be done about staffing levels. The real issue about staffing levels and mandating numbers from the centre is that care needs change on a daily basis depending on how complex the needs are of the patients in a particular ward or home. That is why it is difficult to do it from the centre. We want to make sure that everywhere has the right numbers of staff. That is why I hope the hon. Gentleman welcomes the fact that we have so many more nurses.

[Dame Angela Watkinson (Hornchurch and Upminster) (Con)]

Barking, Havering and Redbridge University Hospitals Trust is working really hard to get out of special measures. We have a new chief executive and a new chairman who are paying particular attention to the recruitment of nurses and improving the efficiency of the appointment system. Will my right hon. Friend join me in congratulating Barking, Havering and Redbridge Trust on improving the level of patient satisfaction by four points?

[Mr Hunt]

I am very happy to do that, and I pay tribute to the leadership of the trust. There is a new chief executive and, as I have said, I have met the chief nurse. It is a very large trust with two big hospital sites. There are some very big challenges to tackle, but they are making important progress, and, like my hon. Friend, I am keen to get them out of special measures as soon as we can.

[Joan Walley (Stoke-on-Trent North) (Lab)]

Having read the Care Quality Commission annual report and met the CQC, and seen in the report that in Stoke-on-Trent more than 20% of care homes have not been fit for purpose for a period of more than three and four quarters, may I welcome the inspection regime of care homes? Training and enforcement will be important.

May I refer back to the comments made by the hon. Member for Stafford (Jeremy Lefroy) in respect of Mid Staffordshire Trust and Stafford hospital, and to previous meetings we have had with the Secretary of State, his colleague in the House of Lords and the Prime Minister and say that, between now and September, we need to know categorically from the Treasury whether the Government are going to fund in full what the University Hospital of North Staffordshire trust says it will cost to run the new configured hospital services across the whole of north Staffordshire? Only when that happens can the Government say that they have solved the issues relating to Mid Staffordshire.

[Mr Hunt]

I thank the hon. Lady for her support for the new special measures inspection regime for care homes. With respect to the merger of UHNS and Mid Staffs, we will make sure that the funding is available that is necessary for that merger to happen. Money is not the issue. The issue is doing what the TSA asked to be done quickly and in full, and making sure that we have the right leadership across both hospitals on a long-term sustainable basis. I do not think it is about money; it is about taking rapid action to make sure there are stable services and that there is continuity of care.

[Mr Marcus Jones (Nuneaton) (Con)]

Will my right hon. Friend join me in congratulating the staff at George Eliot hospital on their hard work in the past year and on the excellent result they achieved in the CQC review? Does he acknowledge that we need to do more at George Eliot to keep that improvement going and agree that we have now built a very strong platform on which to build the future of George Eliot as an important district general hospital in my constituency?

[Mr Hunt]

I agree with my hon. Friend on both points. We have seen 31 more doctors there since special measures, 52 more nurses, a new acute medical admissions unit and better flow throughout the hospital, reducing the number of moves that patients make between wards during their stay, so lots has been done. When I did a stint in the A and E department at George Eliot, I was very well looked after by the nurses there, but they told me how bad the IT systems were—I think they said there were 16 different IT systems in the hospital—and how they were constantly filling out new forms. I therefore hope that the partnership with University Hospitals Birmingham, which has one of the best hospital IT systems in the country—a fantastic system, developed by the trust itself—will mean that George Eliot can move to having really good IT, so that nurses have more time with patients, which is what they want.

[Bill Esterson (Sefton Central) (Lab)]

The Secretary of State spoke earlier about the need to value staff who work in residential homes. I presume he meant by that people who care for vulnerable, elderly and disabled people in their own homes as well. I completely agree with that, and he knows that we have discussed many times in the House issues such as the 15-minute time slots and the lack of reimbursement for the travel costs that people who care for elderly or disabled people have to bear. Does he agree, therefore, that unless we address issues such as the pay and conditions of staff, whether in residential homes or in people’s own homes, we will struggle to recruit and retain the very best staff, whom we desperately need to look after our vulnerable people?

[Mr Hunt]

I agree with the hon. Gentleman that we need to value staff who work in the social care sector much, much better. I think they do a fantastic and very difficult job for what is not high pay at all, so I recognise that issue. I also agree with his concern about 15-minute slots. I find it hard to believe that anyone can really do everything they need to when visiting someone who is frail or vulnerable in their own home in just a 15-minute slot. The new inspection regime will look at that and if it is unsatisfactory, it will say so.

[Several hon. Members]

rose—

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[Mr Hunt]

Such reports will be used. Members of the public will be involved in the inspection regime and the way that care homes respond to complaints and concerns raised by families will be an important part of what the new chief inspector looks at.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

We all hope that the special measures regime speeds up the improvements that are needed in Morecambe Bay hospitals, but does the Secretary of State accept that the turmoil that those hospitals have been in for years now will never properly end until the Government recognise that the trust simply cannot deliver services with the same level of funding, given the almost unique challenges of rural isolation, severe deprivation and health need in the area?

[Mr Hunt]

I thank the hon. Gentleman for the work he has done with James Titcombe on the tragedy that happened at Morecambe Bay. I think there are particular issues in that trust owing to the fact that it is on two sites that take a long time to travel between geographically. The point of the new regime is to ensure that those issues get surfaced and that Ministers and the system have to address them. I hope that that is what will happen.

[Robert Jenrick (Newark) (Con)]

We await the report from Sherwood Forest Hospitals Trust with interest. Improvements have been made there, certainly in staffing levels, with the number of nursing staff rising significantly since the hospital trust went into special measures. However, one of the impediments to change at the trust is the terrible legacy of the private finance initiative, which is taking up 15% to 20% of the trust’s annual budget—something like £45 million. Is there anything more we can do to assist trusts in special measures that have a crippling legacy of PFI?

[Mr Hunt]

That is certainly something we keep under constant review, because it is a particular issue in some trusts. I would like to pay tribute to the progress made in Sherwood Forest trust—and in Newark hospital, which I know my hon. Friend has campaigned for—and to mention that it has an excellent chief executive, who has done a very good job in challenging circumstances.

[Nic Dakin (Scunthorpe) (Lab)]

I would like to pay tribute to the staff team at Northern Lincolnshire and Goole Hospitals Trust for the progress they have made, which has resulted in the trust moving out of special measures, but there is still much more to do. How will the Secretary of State ensure that the funding challenges faced by the local health service do not get in the way of making the further progress that is necessary?

[Mr Hunt]

Good progress has indeed been there, including centralising stroke services in Scunthorpe. There are funding pressures everywhere. What I would say about funding is that I do not want to run away from the fact that money is tight throughout the NHS, but lots of places are delivering safe, compassionate care even with those funding constraints. In fact, when we look in detail, we see that less safe care is the most expensive, so what we are doing should help trusts such as the hon. Gentleman’s to deliver safer care.

[John Stevenson (Carlisle) (Con)]

May I reiterate my support for my right hon. Friend’s policy of putting patients at the centre of the NHS? Clearly I am disappointed that North Cumbria Trust continues to remain in special measures, particularly given the hard work of the staff and management there. However, will the Secretary of State assure me that if the trust, with the support of Northumbria, produces a robust action plan to address the issues that have been raised, a re-inspection by the CQC can happen sooner rather than later?

[Mr Hunt]

No one is keener than my hon. Friend and I to get the trust out of special measures as quickly as possible, and I thank him for the many representations he has made with respect to North Cumbria. I know that the trust is disappointed not to come out of special measures, but it is now rated good in terms of being caring, and the CQC said in July that the staff were supportive to patients and those close to them, so some encouraging things are happening at the trust, and we will do everything we can to help it to go the final furlong.

[Andrew Stephenson (Pendle) (Con)]

I very much welcome the progress that has been made at East Lancashire hospitals. Following action by the Secretary of State last year, the trust has now recruited more than 200 new nurses, nurse support staff and consultants. In March, a new state-of-the-art £9 million urgent care centre at Burnley was officially opened to the public, replacing the old A and E department, which was downgraded under Labour in 2007. Given that poor performance at the trust was established back in 2005 and that the last Government failed to act on it, how can we ensure that future problems are addressed speedily, rather than being hushed up?

[Mr Hunt]

I thank my hon. Friend for his interest in his local hospital and I agree with him that the trust has made good progress. There is a simple way to ensure that these things get acted on quickly and that is to make sure they are public. When things are public—when they are transparent and everyone knows about them—the NHS and Ministers have to act, and that is the purpose of this system.

[Bob Stewart (Beckenham) (Con)]

Will my right hon. Friend confirm that if someone dies or is hurt in a residential care home, the directors of that home will also be held culpable under law?

--- Later in debate ---

[Mr Hunt]

Absolutely, and I think we have legislated to make that the case.

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

With reference to University Hospitals of Morecambe Bay NHS Foundation Trust, which has just gone into special measures, may I reassure the Secretary of State that the CQC has seen some improvements there delivered by front-line staff, particularly at Royal Lancaster infirmary? However, I want to underline what the hon. Member for Barrow and Furness (John Woodcock) said about the unique geographical problems facing a trust with four hospitals separated by hundreds of miles of sea, mountains and valleys.

[Mr Hunt]

I absolutely recognise that issue, which is something we will have to think about in terms of the long-term sustainability of the trust. Let me reassure my hon. Friend and the hon. Member for Barrow and Furness that the CQC chief inspector will not say that a trust can come out of special measures unless he can see a long-term sustainable future for that trust, so part of the purpose of the regime is to force everyone in the system to confront those issues so that we bite the bullet quickly.

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

The positive progress of the Northern Lincolnshire and Goole NHS Foundation Trust is to be welcomed and is a direct result of the work of health care assistants, nurses and doctors. On the issue of social care, may I commend North Lincolnshire to the Secretary of State and ask him perhaps to visit again? The local council has not only refused the request by the Labour opposition on the council to cut social care in the budget, but has actually increased funding for elderly and disabled people by £1 million in this year’s budget and is opening up a network of well-being centres to support older people in their own homes, as well as constructing a £3.2 million intermediate care facility, so that a lot of our residents do not have to go into hospital in the first place.

[Mr Hunt]

I thank my hon. Friend for the warm welcome he gave me when I visited the trust—including the visit to a not particularly healthy, but delicious bakery as part of the trip. I welcome what is happening in social care, and I think it is something on which we can agree at the national level across the House—that cuts in social care can be very counter-productive, leading to more pressure on the social care system and more pressure on the NHS.

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 15th July 2014 Commons Chamber

[Mr Adam Holloway (Gravesham) (Con)]

1. What progress his Department has made on improving primary care for frail older people.

[The Secretary of State for Health (Mr Jeremy Hunt)]

It is a particular pleasure to be here this morning, although I appreciate that that feeling may not be reciprocated on all sides of the House.

Our NHS will not be sustainable unless we totally transform out-of-hospital care. That is why we have introduced the £3.9 billion merger of the health and social care systems, and reforms to the GP contract. We are encouraging clinical commissioners to be responsible for all out-of-hospital commissioning.

[Mr Holloway]

I am delighted that my right hon. Friend is answering questions today. Will he confirm that the changes announced will mean that frail elderly patients in Gravesham will have a single person to co-ordinate their care?

[Mr Hunt]

There is agreement across the House that we need a focus on frail elderly patients and a system in which everybody knows, for their mum, dad or grandparents, that there is someone in the NHS where the buck stops in relation to complex, long-term conditions. That is a condition of the better care fund, so I hope that that will make a big difference in my hon. Friend’s constituency.

[Alison McGovern (Wirral South) (Lab)]

The Secretary of State mentioned integration. Good care and support for older people in their own homes are vital, yet a constituent visited me recently to say that she simply could not find a decent trustworthy care company to look after her relative. Will the Secretary of State join me in calling for all local authorities to sign up to the ethical care charter?

[Mr Hunt]

I do not know what the charter says, but I am happy to have a look at it. I agree with the hon. Lady’s sentiments. The important change we need to make is to understand that it is a false economy not to look after people who are vulnerable—those who need help washing, getting out of bed and feeding every day. Scrimping on such care is incredibly dangerous: it costs the NHS more, but most of all it means that those people are not treated with the dignity and respect that they should be.

[Greg Mulholland (Leeds North West) (LD)]

A recent Age UK report shows that older people are many times more likely to be moved multiple times in hospital, and that there is an attitude that they should not be using up hospital beds. What does my right hon. Friend suggest to tackle the problem, for example through improved guidance?

[Mr Hunt]

The attitude to which my hon. Friend refers is totally unacceptable. It is not specifically an NHS problem; we need to change the way of thinking across our society. In particular, I worry about people with dementia who are sometimes in hospital wards where they are not able to speak up for themselves. That is why we have introduced probably the toughest inspection regime of any hospital system anywhere in the world, and I hope it will make a real difference.

[Ms Margaret Ritchie (South Down) (SDLP)]

In view of the fact that there are currently 10 million people in the UK over 65, and the latest projections are for a further 5.5 million elderly people in 20 years’ time, what plans have the Government made to allocate and prioritise resources for the future care of older people with complex needs?

[Mr Hunt]

The hon. Lady is absolutely right. The figure always in my mind is that by the end of the next Parliament we will have more than 1 million additional over-70s. We need to totally change the way we look after those people, through the single point of contact and a different attitude to continuity of care. One of the things that matters most to those people is the feeling that there is someone in the NHS who knows about their particular needs, their family and their carers. That is the big challenge for the NHS in the next few years.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The Health Secretary does not seem to realise that continuity of care is actually getting worse under him. The GP patient survey shows that the proportion of people who cannot regularly see their preferred GP has risen from 34% in 2012 to 39% in 2014, an increase equivalent to 1.2 million people. Experts say that that is one of the reasons why A and E is under so much pressure. Will he confirm that on Friday it will be precisely one year since hospital A and E departments last met his Government’s own A and E target?

[Mr Hunt]

What I will confirm is that the worst possible thing for continuity of care was Labour’s scrapping of named GPs in 2004. The single thing that makes the biggest difference is to have, for every frail and elderly person in our NHS, someone who is responsible. That is what we are bringing back.

--- Later in debate ---

[Sir Edward Leigh (Gainsborough) (Con)]

5. What steps he plans to take to improve standards in general practice.

[The Secretary of State for Health (Mr Jeremy Hunt)]

We are working hard to improve standards of care in general practice. We have brought back named GPs for those aged 75 and over, introduced a new inspection regime and are doing everything we can to recruit more GPs to improve capacity.

[Sir Edward Leigh]

When will both political parties be honest about the massive looming black hole in health funding, with an ageing population demanding ever better care? We cannot afford to pay for it out of general taxation, so are we going to be honest and have an open debate about moving to the French system of social insurance in which people are charged and repaid if they do not have the means, giving them an infinitely better health service?

[Mr Hunt]

I do not agree with my hon. Friend; let me explain why. The first and important point is that independent studies, such as that which was done last month by the Commonwealth Fund, have ranked the NHS top out of 11 major health economies, including the French example. Money is, of course, tight throughout the NHS, but we have been able to find efficiency savings of £20 billion over the last five years, and we will continue to find them. What I would not support, however, is any system of charging that would make it harder to access NHS services, particularly for older people whom we need to access more services more quickly if the NHS is to be sustainable.

[Lucy Powell (Manchester Central) (Lab/Co-op)]

Let me reassure the Secretary of State that Opposition Members are pleased to see him still in his post today, but if I were him, I would not take that as a compliment. On GP access, what is he actually doing? Survey after survey shows that patient satisfaction with access to their GP is getting worse and worse. That has been borne out in my constituency surgery in a significant number of cases. One constituent recently came to see me who had been discharged from hospital with significant care needs and he was told that he would have to wait three and a half weeks to see his GP. What is the Secretary of State actually doing about it?

[Mr Hunt]

I am delighted that the hon. Lady is delighted that I am in my position here today—we can all be delighted about that wonderful piece of news. Let me tell her that we are doing a lot to improve access to GPs. We have recruited 1,000 more GPs over the course of this Parliament. Let me gently say to her that we can afford those 1,000 GPs only because we pushed on with difficult reforms, getting rid of the PCT bureaucracy and removing 19,000 managers. We would not have been able to afford them if we had listened to her party and continued to spend money on bureaucracy and management.

[Mr Philip Hollobone (Kettering) (Con)]

In every area, there are some very good GPs and some less good ones. How does my right hon. Friend think that clinical commissioning groups should celebrate those GPs who go the extra mile and provide an example for others to follow?

[Mr Hunt]

My hon. Friend has made a very good point. We have learnt from the big efforts to improve standards of care in hospitals—of which I think everyone in the House should be proud—that the best way in which to improve those standards is to be transparent about how well people are doing. What the new chief inspector of hospitals has done is identify not just the failing hospitals that have been put into special measures, but the good and outstanding hospitals, so that they know what they should and can aspire to. I think that we shall hear shortly how the chief inspector of general practice intends to implement the same regime in general practice.

[Mr Speaker]

Order. If the right hon. Gentleman would face the House, it would greatly avail us. I understand the natural temptation to look backwards—[Laughter.]—as in, behind him! But he must face the House.

[Mr Jamie Reed (Copeland) (Lab)]

On 20 June, I wrote to the Secretary of State informing him of the claims of doctors in Cumbria that unless drastic action were taken to reduce the pressures on GPs’ work loads, patients could die. I have not even received a response. Why, having being given such a stark warning, is the Secretary of State sitting on his hands? There are fewer GPs today than there were during Labour’s last year in office. How can standards in general practice be improved when surgeries are dealing with a recruitment crisis?

[Mr Hunt]

Let me give the hon. Gentleman his answer now. According to the Royal College of General Practitioners, 40 million more appointments with GPs are being made in every single year than were made when Labour was in office, and we have 1,000 more GPs than we had when his party was in power.

Let me say very clearly that the way in which we will deal with this problem is by increasing the capacity of general practice and the capacity of primary care. The hon. Gentleman should be supporting that—and he might just think about the 48-hour target that Labour has been talking about. If a new target for GPs is introduced, they will simply cut the amount of time that is available for them to deal with the most frail and vulnerable patients, and that would be wrong.

[Sir Tony Baldry (Banbury) (Con)]

6. What steps his Department is taking to support carers.

--- Later in debate ---

[Gordon Henderson (Sittingbourne and Sheppey) (Con)]

11. What progress his Department is making on improving the performance of failing hospitals.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The new special measures regime for failing hospitals is designed to introduce honesty and transparency for hospitals in difficulty. The new chief inspector of hospitals will report later this week on progress in the first year. I am sure that the whole House will welcome the fact that the new regime has made really encouraging progress.

[Gordon Henderson]

Medway NHS Foundation Trust is not in my constituency, but is used by many of my constituents. It was announced last week that Medway is to remain in special measures because of the inadequacies of its A and E department. What steps can my right hon. Friend take to ensure that Medway receives the help needed to improve the service it provides to my constituents?

[Mr Hunt]

I thank my hon. Friend for his question. He is right that the chief inspector raised concerns about some issues that persist at Medway. It is important to praise the staff for the progress that they have made in the past year. We have put in place 113 more nurses, the Bernard dementia unit, which has made some really good progress, and a twinning arrangement with University Hospitals Birmingham, which is one of the best in the country. There are some encouraging signs. I wish to reassure him and his constituents that we will stop at nothing to ensure that we turn that hospital around

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

The former chief executive of Hull and East Yorkshire Hospitals NHS Trust, Phil Morley, left his post suddenly just before the publication of a very poor Care Quality Commission report, leaving behind a culture of bullying in the trust. Is the Secretary of State as surprised as I am that he has now been appointed chief executive of a hospital in Essex?

[Mr Hunt]

I do not know the details of the individual case, and it would not be right for me to comment. However, what I will say is that we have changed the rules to prevent people who are responsible for poor care from popping up in another part of the system. From now on, when trusts appoint people to boards, they can check their prior records on a central database administered by the CQC. Let me tell the hon. Lady that we are absolutely determined to change the culture in the NHS so that we stamp out the bullying and intimidation that were such a factor for so many doctors and nurses for many years.

[Stephen Metcalfe (South Basildon and East Thurrock) (Con)]

23. Will the Secretary of State join me in congratulating the management and staff of Basildon hospital who have worked hard to turn the hospital around so that it is now rated as good? Will he confirm that his Department will continue to support it so that the hospital can carry on making progress?

[Mr Hunt]

I am delighted with the progress that has been made under Clare Panniker’s leadership. The hospital now has 241 more nurses, and the first maternity unit in the country to be rated as outstanding. My hon. Friend will want to know why it is that when there was a CQC report under the previous Government, it was sat on for six months and nothing was done.

[Mr Nick Gibb (Bognor Regis and Littlehampton) (Con)]

19. In 2005, Littlehampton’s community hospital was demolished to make way for a new community hospital. Weeks later, the plans were put on hold because community hospitals went out of vogue. Sussex Community NHS Trust now wants to increase the number of in-patient beds at community hospitals. Will the Secretary of State ensure that NHS Property Services rebuilds Littlehampton community hospital to deliver those beds where they are needed?

[Mr Hunt]

That is not actually a matter for NHS Property Services Ltd; it has to be locally driven. However, my hon. Friend is absolutely right that we need to enhance community care services, whether in community hospitals or through services delivered at home. My hon. Friend has a high proportion of older people in his constituency and the transformation will be incredibly important for all his constituents.

[Andrew George (St Ives) (LD)]

Will my right hon. Friend join me in welcoming the National Institute for Health and Care Excellence’s statement today on the establishment of safe staffing levels on hospital wards? He will be aware that I have been campaigning on the matter for many years. The 1:8 ratio is certainly not a target but a baseline against which safe staffing and patient care can now be measured.

[Mr Hunt]

I welcome what NICE has done today, because it is incredibly important that we end the scandal of short-staffed wards in our NHS, which was a feature for many years under Governments of both parties. The lesson of Mid Staffs is that the oldest and most vulnerable patients, such as people with dementia, can be forgotten when a hospital is under pressure, so NICE’s guidance will be welcomed and useful. It is important to say that it can save money, because nothing is more expensive than unsafe care.

--- Later in debate ---

[Paul Burstow (Sutton and Cheam) (LD)]

14. What the timetable is for publication of a successor to the current national dementia strategy.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Dementia is one of the most important issues we face at the moment and we are having detailed discussions with stakeholders about the best way to ensure that the very successful Prime Minister’s challenge on dementia continues into the next Parliament.

[Paul Burstow]

I am grateful for that answer and have no doubt that the continuation of the challenge is very important, but both the Prime Minister and the Secretary of State have told the House from the Dispatch Box that there will be a successor to the national dementia strategy. My question was very straightforward. Is there a timetable for delivering that strategy, given that the current strategy ends this year?

[Mr Hunt]

I should clarify for my right hon. Friend that the Prime Minister’s challenge was a successor to the national dementia strategy. The Prime Minister’s challenge finishes at the end of this Parliament and that is why we are having discussions about what should succeed it, because we all have an interest in ensuring that we maintain the tremendous momentum of the past few years.

[Mr Speaker]

I call Michael Connarty—he is not here.

--- Later in debate ---

[James Duddridge (Rochford and Southend East) (Con)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Jeremy Hunt)]

I am pleased to tell the House that on 19 June the Prime Minister hosted a very successful global dementia summit as a follow-up to the G8 dementia summit. We are currently diagnosing and treating 70,000 more people every year with dementia, but the big challenge is, as he set out at the G8 summit, finding a cure or disease-modifying therapy by 2025. We had useful discussions on what barriers need to be eliminated to ensure that the research happens to find such a cure.

[James Duddridge]

What assessment has the Secretary of State made of the need for a single hyper-acute stroke unit in south Essex?

[Mr Hunt]

I know that discussions are going on on that very topic and the CCGs are very interested in putting a hyper-acute stroke service at Southend hospital, which I know has excellent stroke services. We still need further improvements in the ambulance services for the east of England if we are going to do that and that is what we are currently discussing.

[Andy Burnham (Leigh) (Lab)]

I shall begin by congratulating the Health Secretary on surviving the massacre of the moderates. This was no real surprise for those of us on the Opposition Benches, however, because we know that his real views on the NHS are anything but moderate. On his watch, there has been more privatisation and now there is an accelerating postcode lottery. Today, the Royal College of Surgeons has revealed that some people waiting for hip replacements are being denied treatment that is available elsewhere because of arbitrary pain thresholds that are so harsh in places that people must be in severe debilitating pain before they can be treated. This is in direct contravention of National Institute for Health and Care Excellence guidance. Will the Secretary of State today condemn the fact that people are being denied treatment in that way, and act immediately to end the practice?

[Mr Hunt]

Of course it is absolutely right that people should follow NICE guidance, including all clinical commissioning groups, but if the right hon. Gentleman looks at what has happened over the past four years, he will see that we are treating more people, not fewer, with 6,000 more people getting their knees replaced and 9,000 more getting their hips replaced every year. That is possible only because we have 7,000 more doctors in the NHS because we took the difficult decision to get rid of the primary care trusts. Will he now accept that he was wrong to oppose those reforms and wrong to put politics before patients?

[Andy Burnham]

The Secretary of State says that CCGs should be following NICE guidance, but they are not. Seven out of 10 are not following that guidance, and people who are waiting for operations today will be left in pain because he is not acting. The truth is that the reorganisation has resulted in a postcode lottery writ large, and it is worse than we thought, because there is now a proposal in one area to end the provision of hearing aids on the national health service. That is totally unacceptable. Action on Hearing Loss warns that that would set a dangerous national precedent, leaving millions unable to live their lives. So, no ifs, no buts—will he condemn that proposal now and guarantee that patients will not be forced to pay for hearing aids on his watch?

[Mr Hunt]

I make it absolutely clear that everyone should follow NICE guidance. As the right hon. Gentleman has talked about the reorganisation, will he please accept that we are now doing 850,000 more operations on the NHS every single year? That means that more people are getting help with their hearing, their hips and their knees, and with all the other things that they need. He bitterly opposed that reorganisation, but he must now realise that he was wrong to oppose it then and he is wrong to oppose it now.

[Stuart Andrew (Pudsey) (Con)]

T2. I recently had the pleasure of meeting my constituents Susan Childs and Doreen Smulders, who raised the issue of the inequalities that exist for men with prostate cancer. Will my right hon. Friend tell me what steps are being taken to address the shortfalls in care and support that such men are receiving across the country?

[Rushanara Ali (Bethnal Green and Bow) (Lab)]

T3. Since 2010, the percentage of patients who say that they can see their GP within 48 hours has halved from 80% to 40%. Given the pressure on the NHS, and especially on accident and emergency services, will the Secretary of State explain why the Government’s reforms are threatening to close 98 surgeries around the country, including five in Tower Hamlets? Will he publish the full list today?

[Mr Jeremy Hunt]

Let me gently explain to the hon. Lady that she has excellent GP provision in Tower Hamlets, led by Dr Sam Everington. It is a model of what can happen under the Government’s reforms. The way in which we are going to make it easier for people to see their GP is with additional capacity. We have 1,000 more GPs during this Parliament, and we have achieved that only because we took the difficult decision to get rid of 19,000 managers, which was bitterly opposed by the hon. Lady and the Labour party.

[Margot James (Stourbridge) (Con)]

T4. Now that the Medicines and Healthcare Products Regulatory Agency has concluded its consultation on the use of generic asthma inhalers by schools in cases of emergency when a child does not have his or her own inhaler, will my hon. Friend update the House on the next steps? In particular, does she expect schools to be allowed to keep these inhalers in the new school year?

[Barbara Keeley (Worsley and Eccles South) (Lab)]

T6. On nurse-patient staffing ratios, it has been reported in the Health Service Journal that out of 139 trusts surveyed, 119 failed to fill their registered day nurse hours, 112 failed to fill their registered night nurse hours and 105 failed to fill their registered nurse hours across day and night. Is it not time for Ministers and NICE to state straightforwardly that a ratio of one nurse to eight patients or better is the only way for patient safety?

[Mr Jeremy Hunt]

NICE has taken the sensible decision to issue its guidance. It does so independently, but we are not making it mandatory on the advice of the chief nursing officer and many other chief nurses across the country for the simple reason that if we have a mandatory minimum, that can become the maximum that trusts invest in and many wards need more than 1:8. That is why NICE’s guidance was so important today.

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

T5. The Chavasse report on improving care for members of the armed services and veterans builds on the improvements that we have already made and has been welcomed by the Department of Health and indeed the Ministry of Defence. We owe it to our armed services to carry on making improvements to their care, so will the Minister encourage NHS England to look favourably on its recommendations?

--- Later in debate ---

[Mr Jim Cunningham (Coventry South) (Lab)]

May I remind the Secretary of State that it takes seven years to train a doctor and most of the doctors he boasts about were trained under a Labour Government? What is he doing about the disparity between GPs surgeries and the service that they offer? Some months ago I made some visits in Coventry and I was amazed by the difference in the levels of service.

[Mr Jeremy Hunt]

It does take seven years to train a GP, but we also have to have an NHS that is able to pay for GPs when they are trained. That is why it was so important to take the difficult decision to reduce the amount of money that we spend on back-office and management costs. The hon. Gentleman is right to say that there is too much disparity in the services offered by different GPs. That is something that the chief inspector of general practice is thinking about, and he will publish his plans shortly.

[Mr Robert Buckland (South Swindon) (Con)]

T8. From my regular discussions with local GPs in Swindon, I know that the reasons behind recruitment issues are often complex and localised. Will my right hon. Friend assure me that those responsible for commissioning GP services will place daily access to general practitioners at the heart of their considerations?

[Mr Hunt]

I know that they do that, and I know that people recognise that access is a critical issue. That is why the Prime Minister introduced a £50 million fund last year that has been taken up by 1,100 of the 8,000 surgeries across the country to improve access in evenings, at weekends and by e-mail and Skype. I hope that those will benefit his constituents.

[Bill Esterson (Sefton Central) (Lab)]

SSP Health runs a number of GP practices in my constituency and across Merseyside. When it took over, it promised full-time GPs and an improvement in services, yet after well over a year several of the practices are still run by locums. We have seen vulnerable, elderly people unable to get appointments for many days, if not weeks, and those who can have gone to other practices. Will the Secretary of State look at what is going on with SSP Health in and around Merseyside and give me and other hon. Members an answer?

[Mr Hunt]

I am happy to do so, because the service that he describes—I have not seen the details—sounds totally unacceptable.

[Paul Burstow (Sutton and Cheam) (LD)]

T9. Given that last year, more than 7,500 people with a mental health crisis found themselves in police cells rather than anywhere appropriate such as a hospital, given that 263 of those people were children and young people, and given that they stayed for 10 and a half hours in a police cell, is it not time that we took the evidence of street triage, which we know works, and rolled it out across the country?

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

I welcome the Secretary of State’s commitment to getting rid of as much bureaucracy as possible, so will he look into what is happening with NHS England in south Yorkshire that is delaying approval for a much-needed GP surgery in my constituency? Given that it is in partnership with the local authority, the delay risks us losing the surgery altogether.

[Mr Jeremy Hunt]

I am happy to look into the details of that case and be as much of a bureaucracy buster as I can.

[Robert Halfon (Harlow) (Con)]

T10. Is my hon. Friend aware that nurses are paying an extra £200 a month and patients an extra £40 a week for ever-increasing hospital car parking charges? Will he look into the problem, meet me and do everything he can to end the great hospital car parking rip-off?

[Mr Hunt]

I share my hon. Friend’s concerns that the car park charges in some hospitals are just too high. I understand that hospitals have financial pressures, as do many parts of the system, but I am happy to talk to him on another occasion about what specifically can be done on this issue.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

Annually 30,000 applications for funeral payments are rejected, leaving families committed to expensive funerals that they cannot afford. People who are approaching end of life are not advised, as part of their palliative care, about planning for funeral costs or their eligibility for support. What is the Secretary of State going to do to remedy this?

[Iain Stewart (Milton Keynes South) (Con)]

The Secretary of State will be aware of the campaign run by the Milton Keynes Citizen, my hon. Friend the Member for Milton Keynes North (Mark Lancaster) and myself for an expanded A and E department at Milton Keynes hospital. What assurances can he give me that A and E services at the hospital will be able to meet the needs of an expanding population?

[Mr Jeremy Hunt]

No one could have campaigned harder than my hon. Friend and his hon. Friend the Member for Milton Keynes North (Mark Lancaster) for improving the services at their local A and E department. A consultation is currently taking place. There is no question of closing both A and Es in that area, and I understand that a very good capital bid for £2 million for his local A and E has been put in which, subject to the usual value-for-money requirements, looks like it is very strong.

[Julie Hilling (Bolton West) (Lab)]

My constituent, 81-year-old Rita, was taken seriously ill on holiday and had to spend two weeks in hospital. She was discharged with a letter saying that she needed very urgent surgery, but has had to wait five weeks before she even sees a consultant, let alone getting any treatment. What can the Secretary of State do for Rita and others like her?

[Mr Hunt]

We are working extremely hard to make sure that people do not have those long waits. We are doing about 3.5 million more diagnostic tests, for example, every year in the NHS than four years ago. I am happy to look into the individual case and see what lessons can be learned and to see whether we can help the hon. Lady’s constituent.

[Duncan Hames (Chippenham) (LD)]

Is it ever acceptable, as reported to me in my constituency surgery last week, for a GP to tell their patient, “There is nothing I can do, so I don’t want to hear any more about your mental health”?

Visitor and Migrant NHS Cost Recovery Programme

Jeremy Hunt Excerpts

Monday 14th July 2014 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

The Government have today published the “Visitor and Migrant NHS Cost Recovery Programme—Implementation Plan 2014-16”. This document acts as a statement of purpose and includes commitments for programme delivery as well as announcing policy for increasing cost recovery rates.

The Department of Health is working to create a fairer NHS by improving the systems for charging overseas visitors and migrants to make sure they contribute towards their NHS health care. It is clear that more can be done to increase cost recovery; our independent research estimated that in the financial year 2012-13 we recovered an estimated £73 million, which represented less than 20% of the estimated total possible recovery. To deliver this the Department has been working with the NHS, its arm’s length bodies, and key stakeholders to design and test measures to encourage providers to identify and charge non-EEA visitors and identify and report EEA visitors’ usage of NHS services.

The implementation plan provides a guide to the NHS of how this will be achieved. A key aspect of this is a new financial incentive which will increase the level of cost recovery from chargeable patients from outside the European economic area (non-EEA). This process will enable NHS providers to bill chargeable non-EEA patients at a rate of 150% of standard NHS tariff for the cost of the care provided. The Department intends to lay secondary legislation before Parliament by the end of the 2014-15 financial year to enable this. The Department will keep the rates of the incentives under review to ensure that it is effective and is driving change.

The plan also includes increased scrutiny of the cost recovery from non-EEA patients by NHS providers. This will ensure that their statutory obligation to support NHS sustainability through appropriate identification and charging of visitors and migrants is being met.

These measures will help to underpin and maintain the principles that the NHS will always treat those in urgent need of care and that NHS care is free at the point of delivery for residents. This programme aims to reinforce the fairness of our health service by ensuring that everyone who is not entitled to free health care contributes to the cost of running the NHS.

“Visitor and Migrant NHS Cost Recovery Programme—Implementation Plan 2014-16” has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

NHS Investigations (Jimmy Savile)

Jeremy Hunt Excerpts

Thursday 26th June 2014 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

With your permission, Mr Speaker, I would like to make a statement on the Jimmy Savile investigations.

This morning, 28 investigations into Savile were published, including two larger reports on Leeds infirmary and Broadmoor hospital and 26 smaller reports on other institutions. I know that this House and, indeed, the whole country will share a deep sense of revulsion at what they reveal: a litany of disturbing accounts of rape and sexual abuse committed by Savile on vulnerable children and adults over a period of decades.

At the time, the victims who spoke up were not believed, and it is important today that we all publicly recognise the truth of what they have said, but it is a profoundly uncomfortable truth. As a nation at that time, we held Savile in our affection as a somewhat eccentric national treasure with a strong commitment to charitable causes. Today’s reports show that, in reality, he was a sickening and prolific sexual abuser who repeatedly exploited the trust of a nation for his own vile purposes.

The report published by Leeds infirmary today reveals that Savile was a predatory porter who abused and raped patients without scruple. Sixty people reported abuse to the investigation. One of his teenage victims believed that she was pregnant as a result of his abuse. Two witnesses told the investigation Savile claimed to have had jewellery made from glass eyes taken from bodies in the mortuary. Other reported behaviour is too horrific to recount in detail to this House, but is set out in full in the reports published today.

Savile was also an opportunistic sexual predator at Broadmoor. The investigation concludes that at least five individuals, and possibly more, were sexually abused by Savile. Inexplicably, Savile was allowed to watch female patients as they stripped naked for bathing.

There were fewer incidents reported in the other 26 investigations, but there are strong indications that they were consistent with a wider pattern of offending. I have placed the reports of all the investigations in the House of Commons Library. Five investigations are ongoing and will report later this year.

Today’s reports will shake this House and our country to the core. Savile was a callous, opportunistic, wicked predator who abused and raped individuals, many of them patients and young people, who expected and had a right to expect to be safe. His actions span five decades, from the 1960s to 2010. The family favourite loved by millions courted popularity and used it to perpetrate and cover up his own evil acts.

I and, I am sure, the whole House will want to pay tribute to all the victims who came forward to talk about their experiences. It took great courage for them to relive their often extremely distressing and disturbing experiences.

The reports paint a terrible picture, as time and again victims were ignored or, if they were not, little or no action was taken. The systems in place to protect people were either too weak or were ignored. People and institutions turned a blind eye.

Today, I want to apologise on behalf of the Government and the NHS to all the victims who were abused by Savile in NHS-run institutions. We let them down badly and however long ago it may have been, many of them are still reliving the pain they went through. If we cannot undo the past, I hope that honesty and transparency about what happened can at least alleviate some of the suffering. It is the least we owe them.

Today, changes to the way that we guard against abuse would make it much harder for someone such as Savile to perpetrate these crimes for so long. The safeguarding system, as the Leeds report makes clear, has been much improved over the past 30 years. The landmark Children Act 1989 enshrined a child’s right to protection from abuse. The first child sex offenders register was established in 1997, and 1999 saw legislation to prevent sex offenders from working with children. Criminal Records Bureau checks and the Disclosure and Barring Service have provided further protection. The Children Act 2004 requires NHS bodies to safeguard and promote the welfare of children, and to sit on the local safeguarding children board. NHS England published its safeguarding framework in 2013.

Savile was, however, never convicted of any offence, so this safeguarding system depends on much better awareness by professionals and the public and a much heightened vigilance against such abuse than there was in the past. Although that is reassuring to an extent, we cannot be complacent. Today, I am writing to all the system leaders in the NHS—NHS England, the NHS Trust Development Authority, Monitor and the Care Quality Commission—to ask them to ensure that they and all trusts review safeguarding arrangements in the light of the reports, and to ensure that they are confident about patient safety.  For its part, the Department of Health has accepted all the specific recommendations assigned to it in the Broadmoor report.

There are some painfully obvious lessons for the system as a whole. First, we must never give people the kind of access that Savile enjoyed to wards and patients without proper checks, whoever that person may be. Secondly, if people are abusive, staff should feel supported to challenge them, whoever that person may be, and take swift action. Thirdly, where patients report abuse, they need to be listened to, whatever their age, whatever their condition, and there needs to be proper investigation of what they report. It is deeply shocking that so few people felt that they could speak up and even more shocking that no one listened to those who did speak up. That is now changing in the NHS, but we have a long way to go.

In ensuring appropriate measures, we must not hinder the extraordinary contribution of thousands of volunteers and fundraisers working in the NHS every day. They are the opposite of Savile and we need to ensure that their remarkable contribution is sustained.

In parallel with this NHS work, the Department for Education is overseeing investigations into Savile’s activity in care settings, based on the same tranche of information that led to the smaller NHS investigations. There are other ongoing investigations by the police into allegations of historic child sexual exploitation. I hope this reassures the House of the seriousness of this issue and our response to it. The Department will also work with the National Society for the Prevention of Cruelty to Children and the National Association for People Abused in Childhood to ensure that information is swiftly passed on.

I conclude by paying tribute to Kate Lampard and her team. When patient safety is the issue, speed is vital. These investigations have swiftly and effectively brought to light vital issues that must be addressed. She will be publishing her conclusions and recommendations on this scandal later this year, as will the national group on sexual violence against children and vulnerable people. This report will bring together the Government’s wider work to eradicate violence against children and vulnerable people.

But today, above all, we should remember the victims of Savile. They were brave. They have been vindicated. He was a coward. He has been disgraced. The system failed to prevent him from abusing. It failed to act when people spoke up. We must not allow history to repeat itself. I commend this statement to the House.

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for notice and sight of his statement. I commend him for the way he introduced it to the House and welcome everything he said. The reports published today are truly disturbing, and as sickening as any ever presented to the House. How a celebrity DJ and predatory sex offender came to have unfettered access to vulnerable patients across the NHS, and gold-plated keys to its highest security hospital, surely ranks as one of the worst failures of patient and public protection our country has ever seen. It raises questions of the most profound kind about how victims of abuse are treated, how systems for protecting vulnerable children and adults work and the nature of celebrity and society’s relationship with it.

The Secretary of State was right to begin with an apology—I support him in making it—to the hundreds of people who were appallingly failed and whose lives have been haunted ever since. Our first thought must be with them today. They had a right to look to the NHS as a place of safety and sanctuary, but they were cruelly let down by the very institutions that were meant to offer protection. As one of Savile’s victims put it:

“It was like another insult. I’m in a top security hospital and someone has got to me again. When does it stop?”

Today’s statement will have evoked memories of the most painful kind for them, so will the Secretary of State ensure that all Savile’s victims have full and direct access to all the counselling and other support they will need?

One of the main purposes of this process of inquiry should have been to give all the victims the opportunity to be heard, but the Secretary of State might know that there are reports today in the Yorkshire Post that one person who tried to come forward was at first ignored in October 2012. Will he assure us that all reasonable steps have been taken by those preparing these reports to help victims come forward and tell their story, including those who might have been ignored when they first tried?

Many of Savile’s victims have suffered severe financial loss as a result of the challenges they have faced. I understand that claims for compensation will in the first instance draw on Jimmy Savile’s estate. Has there been an assessment of whether the estate’s funds will be sufficient to meet all claims? Given what has been revealed today and the abject failures of public bodies, should not the Government now consider allocating public funds to ensure that all the people damaged by Savile are properly compensated and supported?

Reading the report, it is not at all clear to me that a proper process has yet been put in place to hold people who failed in their public duties to account. If evidence is revealed in any of these reports that shows that any person still working in the NHS or the Department of Health knowingly facilitated these crimes, will the Secretary of State assure us that they will now face the full weight of the law and that those who were negligent in respect of their public duties will also be held fully to account?

It is incomprehensible how this could have been allowed to happen over 55 years. Although it relates to a different era, there are serious lessons that we can learn, given that abuse continues in our health and care system today. Let me turn to those. The first area of concern relates to how victims of abuse are treated, particularly young people or people in the mental health care system. Sadly, there are still far too many instances of abuse in our care system and in mental health settings, and the real figure is likely to be higher because of under-reporting. Will the Secretary of State consider what more needs to be done to give people the confidence to come forward and the reassurance that they will be listened to? Is there a case for more training for staff in dealing with allegations of abuse?

The second area of concern relates to how public bodies carry out vetting and barring arrangements, make public appointments and manage their relationship with celebrity. Hospitals across the country have increasingly sophisticated fundraising operations and links with celebrity endorsers. Will the Secretary of State accept the Broadmoor report’s recommendation that no celebrity should be appointed to an executive position or given privileged access to a hospital or its patients and that they should be fully vetted if appointed to a non-executive position? More broadly, is there now a case for a code of conduct setting out the appropriate relationship that the NHS should have with celebrity or business backers?

On vetting and barring, figures obtained by my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) show that the number of people barred from working with children as a result of committing a sexual offence against a child has dropped by 10,000, or 75%, in the past three years. These extremely worrying figures have come about as a result of changes to the vetting and barring arrangements. This raises the concern that there are people working in our health and care system now who may pose a risk to children. Will the Secretary of State look again at this issue, consult the Home Secretary, and urgently report back to the House on why these figures have dropped by so much in such a short space of time, and on whether they believe that the current child protection regime is strong enough?

The question arises of whether this process of inquiry is a sufficient response to the scale of these atrocious crimes. It is hard to draw a clear picture and consistent recommendations from 28 separate reports and all the other inquiries that are still ongoing in schools, care homes, the BBC and the police. I, too, pay tribute to the work of Kate Lampard in assuring the quality of the reports published today, and we wait for her second phase of work, but questions remain about their independence given that each hospital has, in effect, investigated itself. There is also a question of whether this needs to be more independent of Government.

The Broadmoor report raises serious questions about the conduct of civil servants and Ministers in the Department of Health in how Savile came to be appointed to the Broadmoor taskforce. In evidence to the inquiry, the then Minister describes the main objective of Savile’s appointment as follows:

“The principal question was can Government break this hold that the Prison Officers Association has on the hospital.”

She went on to say:

“This task force was dreamed up and seemed like a very good idea and step forward Jimmy Savile who knew the place backwards and was more than happy to volunteer his time to do this. And we were happy to do it.”

That paints a picture of chaos in the Department and a complete absence of due process for such a serious appointment. This is an extraordinary revelation. Although there is no suggestion that any Minister knew of any sexual misconduct, it points to the need for a further process of independent inquiry so that we all, as Ministers and former Ministers, can learn the lessons of what happened, but also draw together the threads of the multiple ongoing inquiries. It simply cannot be left for Savile’s victims to try to pull together the details of these investigations.

As the shadow Home Secretary, my right hon. Friend the Member for Normanton, Pontefract and Castleford (Yvette Cooper), has said, there is now a clear case for a proper, overarching, independent review led by child protection experts into why there was such large-scale institutional failure to stop these abhorrent crimes. I would be grateful if the Secretary of State gave this proposal careful consideration. I finish by assuring him of our full support in helping him to establish the full truth of why abuse on this scale was allowed to happen for so long.

[Mr Hunt]

I thank the shadow Health Secretary for the constructive tone of his comments. Many of the suggestions he has made are very sensible. We will take them away and look at them, but I will go through a number of them now. First, we will indeed make sure that all Savile’s victims get the counselling they need. I think that it has been made available to them, but it is absolutely right to double-check that they are getting every bit of help they need and that we are taking all reasonable steps.

I hope that what has happened today will be, in its own way, another landmark for all victims of sexual abuse in giving them the confidence that we are changing, not just as an NHS but as a society, into being much better at listening when people come forward with these very serious allegations. It hits you time and again when reading these reports how many people did not speak up at the time because they thought that no one would believe them. We are not going to change that culture overnight, but we have to be a society that listens to the small person—the person who might get forgotten and does not feel they are important in the system.

On the claims for compensation, the right hon. Gentleman is absolutely right to say that the first draw for those claims will come from the Savile estate. I hope I can reassure him, however, that, as we have said, the Government will underwrite this so that if there are any claims that are not able to be met by the estate we finance them from the public purse. We think it is important that we should do that, although Savile’s estate is the first place to start, for obvious reasons.

The right hon. Gentleman is right to say that if there is evidence that people have criminally neglected claims that were made at the time or behaved inappropriately—even if it is not a matter for the law and they behaved in a way that could make them subject to disciplinary procedures in NHS organisations—that should be addressed. We will urge all NHS organisations to look carefully at anyone who is mentioned in the reports. Of course, the police will, naturally, look at the evidence against any individuals, who of course have the right to due process, which everyone in the House would accept.

On the specific point about the behaviour of one Minister and what it suggested about the motivation for Savile’s approval for his job at Broadmoor, my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke), who was Secretary of State at the time, has said that that behaviour would be indefensible now and that it would have been indefensible at the time. I agree with him. Everyone must be held accountable for the actions they took.

We are doing a great deal to make sure that all NHS staff are trained to feel more confident about speaking out. The Mid Staffs whistleblower Helene Donnelly is now working with Health Education England to see what needs to change in the training of NHS staff in order to change that culture.

On the new disclosure and barring scheme, we are already doing work to examine the reason for the drop in the number of people who are being barred from working with children. The Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb) is looking into that. I have given this a lot of thought and it is important to say that in the current environment, were we to have another Savile, it is likely that the disclosure and barring scheme would bar him from working with children and in trusts, but that is not certain because he was never convicted of a crime. The Criminal Records Bureau checks would not have stopped that, but it is possible for the disclosure and barring scheme to prevent people from working with children and vulnerable adults even if they have not committed a crime. For example, their employment track record may show that they were dismissed for doing things that raised suspicions. It is also important to make the point—I think everyone in the House will understand this—that it is not possible to legislate to stop all criminal vile activity. What we depend on for the disclosure and barring scheme to work is a culture in which the public and patients feel able to speak out and staff listen when they do so, in order that these things surface much more quickly.

Finally, the question of whether any further inquiries are necessary will, of course, be considered. The first step is to let Kate Lampard do her full report. At this stage, she has not drawn together all the different inquiries and tried to draw lessons from the system as a whole. I asked her to do two things. The first was to verify independently that the reports of NHS organisations were of the necessary quality, and I think she has done that superbly. The second stage of her work is to see what lessons can be drawn from the system as a whole. We need to hear what she has to say about that and, indeed, what the Department for Education and the BBC learn from their reports, and then we will come to a conclusion about whether any further investigations are needed.

[Dr Sarah Wollaston (Totnes) (Con)]

May I join the Secretary of State in paying tribute to the victims? They were not silent. What today’s reports show is that very many people witnessed—even directly condoned—some deeply inappropriate behaviour. How could it ever be acceptable for a celebrity to be able to watch female patients showering? Will the Secretary of State join me in sending a message to NHS staff that they should always raise concerns if they witness such behaviour and that they will be protected if they do so?

[Mr Hunt]

I am absolutely happy to do that. I wholeheartedly agree with my hon. Friend’s comments. The NHS needs to move to a system where it is the norm rather than the exception to report, and where NHS staff feel comfortable that reporting any concerns is an absolutely normal part of their job. She is right to say that one of the most disturbing things in the reports is the clear evidence that some people helped Savile in what he did—for example, that people were escorted to his private room in Broadmoor—which is very shocking. That is why it is very important that everyone is vigilant. I totally agree with what she said.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

The only people who emerge with any credit are the victims, and we need to support them. However, I was slightly stung by the Secretary of State’s comment about the right hon. and learned Member for Rushcliffe (Mr Clarke). If the right hon. and learned Gentleman thought that the actions of the Minister—it was Edwina Currie, if I remember rightly—were inappropriate then, as they would be now, will he apologise for his stewardship of the Department at the time, or will the Secretary of State look at the Minister’s conduct and come back to the House to explain how it was possible?

[Mr Hunt]

I hope that I have gone some way to meet the hon. Lady’s concerns because, on behalf of the Government and the NHS, I have offered a full apology to all the victims for what happened, and I have accepted that there were failures at many levels. It is very important to say that the reports show that there was no evidence that Ministers or officials were aware of any sexual abuse by Savile. I pointed to the comments by my right hon. and learned Friend the Member for Rushcliffe because I wanted to make it clear that this Government are not defending actions which, as he has said, were indefensible then and would be indefensible now.

[Tim Loughton (East Worthing and Shoreham) (Con)]

I commend my right hon. Friend for his measured statement. Indeed, I welcome the shadow Secretary of State’s comments about joining our call for an overarching inquiry, because this is the tip of the iceberg. There are still ongoing inquiries to do with Savile in the NHS, 11 local authorities, care homes and others.

Specifically on the subject of victims, there is something that the Secretary of State can do to help immediately. So many victims have very bravely come forward after suffering trauma over many decades and many are still calling the ChildLine and NAPAC—the National Association for People Abused in Childhood—helplines. However, for too many, the therapeutic support that they need to help them through such a particularly difficult time is absolutely not there. Police and health professionals have come to me to say that they know such people, but cannot do anything for them. With the resources in the NHS, the Secretary of State can help now.

[Mr Hunt]

I commend my hon. Friend for his campaigning for vulnerable children over many years. The letter I sent to NHS England this morning asks it to make sure that all the lessons are learned from the reports, and it includes the very clear suggestion—I want the NHS to interpret my letter in this way—that it should ensure that it commissions the support needed for children in these circumstances so that they get the very support that is necessary. This is not just about encouraging people to speak out; it is about making sure that when they do, they feel listened to and supported.

[Grahame M. Morris (Easington) (Lab)]

I thank the Secretary of State for his statement and my right hon. Friend the shadow Secretary of State for his considered response. In relation to the scale of the abuse—with ages ranging from five to 75, and involving 28 hospitals—lessons need to be learned about the systematic failure not just within the NHS, but within other institutions. Will the Health Secretary have discussions with the Cabinet Office and others to make sure that appropriate lessons are learned?

[Mr Hunt]

Absolutely. I want to reassure the hon. Gentleman that we are taking a cross-Government approach—across a range of Departments, but particularly the Department for Education and the Home Office—and that the Government as a whole will draw the lessons from this whole horrific series of episodes to make sure that we have a joined-up approach.

[John Hemming (Birmingham, Yardley) (LD)]

I agree with the Secretary of State that our first thought has to be for the victims, and that in future we must listen to the powerless and not block inquiries. If we go back to 2011—before Savile died—an American journalist, Leah McGrath Goodman, was banned from coming to the UK to investigate child abuse, including by Jimmy Savile. Even more recently, she was arrested at the airport on 5 June, while coming to an inquiry. Will the Secretary of State speak to his colleague the Minister for Security and Immigration to ask why somebody in the UK Border Agency seems to be aiming to inhibit one of the inquiries?

[Mr Hunt]

I am afraid that I do not know the details of that particular case, but I will look into it and write to the hon. Gentleman.

[Ann Coffey (Stockport) (Lab)]

Is not one of the wider problems our perceptions of how a sexual predator looks and acts? When men like Savile are arrested, the usual reaction is shock that such a nice man could abuse children, but sex predators are not men in dirty raincoats; they come from all walks of life and all professions. That perception means that children are not being heard. Will the Secretary of State make preventing as well as detecting child sexual abuse a public health priority? It is only through a better informed public, more aware of how predators such as Savile behave, that we will be able to protect children from abuse.

[Mr Hunt]

I completely agree, and that is one of the big lessons. The shadow Home Secretary was absolutely right to say that this issue raises serious questions about the nature of celebrity in our society. One of the reasons that totally inexcusable things happened—such as being given the keys to Broadmoor—was that somehow on the basis of Savile’s image people made wrong assumptions about him. The hon. Lady is absolutely right. One of the things that will change as a result of this investigation is that people will be more willing to challenge those who previously were not challenged. But there is a long way to go.

[Mr Simon Burns (Chelmsford) (Con)]

I totally agree with the Secretary of State’s belief that there should be more openness, and an increased sense of need to report concerns, but is he satisfied that, particularly with regard to NHS staff who may report concerns or whistleblowers, there is enough protection within the system to encourage more people to be more open?

[Mr Hunt]

No, I am not. That is why earlier this week we asked Sir Robert Francis to do a follow-up review to his public inquiry to determine what else needs to be done to create a culture of openness and transparency in the NHS. We have come a very long way as a society in terms of our understanding, but there is more work to be done. It is also very important, as I said in my statement—I know everyone would agree with this—that we do not undermine the brilliant work done by volunteers in hospitals and that we do not create a kind of bureaucratic morass that makes it impossible for that really important work to be done. However, I know we can do better than we are at the moment and important lessons need to be learned.

[Valerie Vaz (Walsall South) (Lab)]

The Secretary of State has been very gracious in his apology given that he was not Secretary of State at the time. Might I make one further practical suggestion? Will he speak to the Prime Minister about perhaps appointing a Minister to co-ordinate all these reports across the public institutions?

[Mr Hunt]

I reassure the hon. Lady that that responsibility lies with the Home Secretary, and the Home Office has a cross-governmental committee that will bring together all the lessons from all the reports. My first priority is to ensure that we are doing everything we can to make NHS patients safe, but there are much broader lessons to be learned. That is being led by the Home Office.

[David Morris (Morecambe and Lunesdale) (Con)]

Does my right hon. Friend agree that what has happened is absolutely abhorrent and that it sends out a strong message to everyone in society that even a celebrity is not above the law of the land? May I also praise the work of Kate Lampard and her team in bringing this forward?

--- Later in debate ---

[Mr Hunt]

That is absolutely right. Celebrities have never been above the law of the land, but what is clear from the report is that even though that is the case legally, in practical terms they were above the law because they were able to get away with things for a very long time that ordinary people would not have been able to get away with. That is why this is such a big moment of reflection for us. I know that everyone in the House will want to think hard about what we need to do to change that culture.

[Simon Danczuk (Rochdale) (Lab)]

We know that Savile was well regarded by many politicians; by way of example, he was friends with Cyril Smith and appeared in a Liberal party political broadcast in the 1970s, and had friends in high places. Surely an overarching inquiry into child sex abuse would help us to understand the political networks to which Savile belonged.

[Mr Hunt]

I know that the hon. Gentleman has campaigned a lot on these issues. We have not ruled out anything, but we want first to draw together the lessons for the NHS and across Government as quickly as possible. One of the important benefits of the way in which we have proceeded so far is that, because it is an investigation and not a public inquiry, we can get to the truth relatively quickly. However, we will certainly look at the cross-governmental lessons.

[Dr Phillip Lee (Bracknell) (Con)]

As a former member of the medical staff at Stoke Mandeville hospital and now as the Member representing Broadmoor hospital, I have many questions, but let me concentrate on one. In appendix 2A part V, there is a letter about Broadmoor from Jimmy Savile to the Department of Health. It is headed “National Spinal Injuries Centre at Stoke Mandeville”, and it is signed “Dr Jimmy Savile”. Indeed, the content of the letter is deeply unprofessional and remarkable, and it was copied on to a series of people, including the then Secretary of State. Will my right hon. Friend assure me that each of these individuals has been investigated in respect of their response to this correspondence, as I cannot believe that people could have received it without being deeply concerned about this vile man’s involvement in a high-security hospital?

[Mr Hunt]

My hon. Friend raises a very important point. We received the reports only this week, but I will certainly take this away with me and look into exactly the point he makes.

[Mr Frank Field (Birkenhead) (Lab)]

I thank the Secretary of State for allowing me early advance notice of the report relating to St Catherine’s hospital in Birkenhead. Much more importantly, may I associate myself with the apology that the right hon. Gentleman gave to my constituent and others? He will know that that hospital has been bulldozed and that we now have a fine community hospital. To bulldoze these practices within the NHS, will the Secretary of State consider and come back to me later on these two issues? First, it took my constituent 48 years before she was believed and 50 years before she received an apology. What steps are we going to take to ensure that justice is provided much more quickly? Secondly, Jimmy Savile was escorted around St Cath’s Birkenhead by officials, who witnessed him jumping into bed with a young patient and who thought it funny. All the rules in the world provide some defence, but how do we get people to exercise judgment—whatever the rules say, whatever the circumstances and whoever does it—and say that this behaviour is not acceptable?

[Mr Hunt]

I would like to associate myself with the right hon. Gentleman’s comments; I share his disbelief and shock that it has taken so long. In some ways justice will never be done, because Savile died before it could be served on him, which is one of the biggest tragedies of all. I agree: there was a major lack of judgment, some of it because of the different attitudes prevailing at those times. One of the big differences today is that we make links between what is disgusting but not illegal behaviour and potential abuse in a way that did not happen in those days. I want to share with the right hon. Gentleman what most shocked me personally in the reports, and it was the way in which Savile interfered and abused people who had just come out of operations and were recovering from them. The fact that Savile was able to do that, without being supervised, is shocking and when those people spoke up about what had happened, they were not believed. That is one of so many lessons that need to be learned; I know that everyone wants to learn them.

[Penny Mordaunt (Portsmouth North) (Con)]

It is clear from the Portsmouth report that there were incidents with no corroborative evidence of the abuse. In one local case, the complainant was unconscious at the time of the alleged incident and learned of it from a hospital cleaner who witnessed it. Does my right hon. Friend agree that “no proof” is not the same as “it did not happen”, that his welcome words of apology should apply to all those who think they may have been abused and that we need a clear process for how such unprovable complaints can be dealt with?

[Mr Hunt]

Absolutely right. The case that my hon. Friend mentions was a real tragedy because that person suffered very real psychological harm in subsequent years as a result of what they were told by the cleaner. There are two points. First, we cannot necessarily corroborate, but we can see a pattern. What is impressive about these investigations is the fact that the investigators say time after time that although it is not possible to prove that these things happened, they believe that they did happen because the evidence was credible. On one or two occasions, they say that they are not sure, but in the vast majority of cases, they thought that the evidence was credible. Secondly, there will continue to be times when offences are alleged, but it is not possible to prove them in a court of law. The big lesson to be learnt is that that does not mean no action should be taken. We must do what it takes to protect patients.

[Ian Paisley (North Antrim) (DUP)]

I appreciated the right hon. Gentleman’s statement. Does he agree that the fear of litigation by NHS practitioners appears to be one of the reasons why the system does not lend itself to the provision of a good listening ear, and, indeed, one of the reasons why a compassionate response to that listening is not always forthcoming? What practical steps can be taken to ensure that, at an early stage, practitioners actually listen to complaints?

--- Later in debate ---

[Mr Hunt]

I agree with the hon. Gentleman. I think that we need to change the balance in the NHS, so that the safest thing for people to do if they want to avoid litigation is to report concerns rather than sitting on them. That is an interesting lesson that has been learnt in other industries, such as the airline industry, and I hope that the follow-up review by Sir Robert Francis will help us to understand it better.

[Sir Paul Beresford (Mole Valley) (Con)]

I thank the Secretary of State for what he has said about the reports. In his statement, he referred to the importance of the changes that have come about over the past few years, both under this Government—and there are more to come—and under the last Government. Many of those changes have derived from advice given by specialist police forces or by teams within police forces.

The Association of Chief Police Officers runs courses, and collects expertise for the purpose of those courses. Its aim is to catch the individuals concerned, to help those who have been attacked by them and to monitor those individuals after they have been put on the sex offenders list. Does the Secretary of State think that it would be useful to ask ACPO whether it could provide any more advice for the Government to consider? I know that the Metropolitan police’s Jigsaw team is currently considering changes that would help it to monitor and control sex offenders once they have been detected and put on the list.

[Mr Hunt]

My hon. Friend has made an important point. Of course we need to co-operate very closely with the police service, and the Home Secretary is doing a huge amount of work to establish what needs to be done to increase conviction rates for sexual offences. The point for the NHS to consider, however, is that the disclosure and barring scheme will only work properly if NHS organisers comply with it—as they are obliged to do—and report incidents, because that enables other NHS organisations to find out about them. I am not satisfied that the levels of compliance are as high as they should be.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I feel that our concern for victims must lead us to ask whether the actions of Ministers, or managers in the NHS, caused the pain that they suffered. That is one of the things that we can still do. Beyond compensation, there is accountability, and there must be accountability.

I must tell the Secretary of State that I do not think it was enough for him to say that behaviour was indefensible. Colleagues of his were Ministers at the time of that behaviour, and they must be brought to book for their actions. I agree with my right hon. Friend the Member for Leigh (Andy Burnham): we should focus on the fact that that appointment of a disc jockey to a hospital position was not appropriate. In some respects, that individual would have carried more credibility because of his appointment, and that is why I think that accountability is important.

I also think that, in future, children and vulnerable patients must be protected from certain people who have access to wards. It is not good enough to talk about bureaucracy. Volunteers, celebrity fundraisers and business backers must be subject to checks before being given access to hospitals and to wards, and they must expect to be subject to those checks. The present arrangements must change.

[Mr Hunt]

We do need more robust checks. However, I can tell the hon. Lady that I have apologised to all the victims and have said that if some of the reasons given in the reports for Jimmy Savile’s appointment to one position were as the reports claim, that was indefensible. Moreover, the Secretary of State who was in office at the time has said that it was indefensible. I think that that is accountability.

[Mr Philip Hollobone (Kettering) (Con)]

The Secretary of State has been good enough to apologise on behalf of Her Majesty’s Government and the NHS. Given that Jimmy Savile’s celebrity status was largely due to his employment by the BBC, are we not owed a big apology by the BBC, now that the report has been published?

[Mr Hunt]

My hon. Friend makes an important point. Today’s report is about the NHS and the BBC report is ongoing, as is the report being done by the Department for Education and the work being done by other Departments. We have to wait for the BBC to make its own statement on the matter, but my priority now is NHS patients, and the reason that I wanted to go at speed on this was to make sure that any changes we need to make now, we do so.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

The Secretary of State says, quite understandably, that we cannot undo the past, but there are several people culpable in this affair who are still drawing substantial NHS pensions. Why does he not consider docking their pensions, as a consequence for their behaviour and as a clear warning to others?

[Mr Hunt]

I do not rule that out at all. If someone has behaved in a way that is in breach of either the law or the regulations that were in place at the hospital in which they worked, and there is a way to have legal redress such that things like pensions can be docked, I think that they should face the full consequences of that.

[Tessa Munt (Wells) (LD)]

Child sexual abuse is always abhorrent. The victims are always innocent and nobody should be above the law. At the beginning of this month, six Members and I wrote to the Home Secretary—now we are supported by a further 104 MPs—requesting an investigation by an independent panel into at least eight cases of child sexual abuse going back over 30 years, where the evidence has been lost or destroyed by the police, by Her Majesty’s Customs and Excise and by other agencies, and where the cases have therefore been stalled or abandoned altogether. To date, we have had no reply, so can I ask the Secretary of State to encourage the Home Secretary and the Education Secretary, and anyone who else who might be moved to take the matter on, to do so, and accept that such an independent investigation is essential to search out the truth and to make sure that action is taken after that?

[Mr Hunt]

I would like to reassure the hon. Lady that we have a Home Office committee, chaired by the Home Office Minister from her own party—the Minister for Crime Prevention, the hon. Member for Lewes (Norman Baker)—that is drawing together all the lessons from Savile across all Departments. It is then going to take that view as to what needs to happen next to prevent child sexual abuse, and I would like to reassure her that the Home Office and the Government as a whole have no higher priority than that.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

Jimmy Savile visited the Royal Victoria infirmary in Newcastle on a number of occasions—generally, it appears, around the time of the great north run. The Newcastle hospital trust’s investigation concludes that nothing untoward happened and there was constant supervision, but it refers to an NSPCC investigation that had access to other witnesses, which suggests that unsupervised access did occur. That is obviously a matter of huge concern for everyone who put their trust in the RVI, whether as a patient or as a child. Is not my right hon. Friend the Member for Leigh (Andy Burnham) right? It is not up to them to try to draw what could be horrendous conclusions from these somewhat conflicting reports. Do we not need an overarching independent inquiry?

[Mr Hunt]

We are having an overarching independent inquiry—that is what Kate Lampard is doing—but on whether we need to have further inquiries, we need to wait until we get the response, which we are hoping for this autumn, because at the moment, we have published individual reports, but we have not drawn any wider lessons for the NHS system-wide. One of the things that I hope will be a consequence of today is that if there are any victims who were abused at the RVI, they will use today as some encouragement to come forward. I have given instructions and I am absolutely clear as Health Secretary that I want every single one of the concerns of anyone who comes forward to be investigated thoroughly—as thoroughly as all the ones that are tragically coming to light today.

[Bob Blackman (Harrow East) (Con)]

It is astonishing that this catalogue of abuse was allowed to happen and that no action was taken at the time. I commend my right hon. Friend for his statement, both for the way he has delivered it and for the content, but can he elucidate for the House what specific changes he foresees in legislation, although legislation has moved forward, and any specific changes to procedures that now need to be taken as a result of the publication today?

[Mr Hunt]

I hope my hon. Friend will forgive me if I do not try to predict Kate Lampard’s recommendations before she makes them, but I think the obvious question to ask is whether we have the procedures in place that ensure that someone like Savile would not be given the keys to an institution in the way that he was. I do not believe that would happen today. My understanding of the way that NHS organisations work is that it would be impossible for someone to be given the freedom of a trust in the way that he was at Broadmoor, but I do not want to take that as a fact. I want Kate Lampard to look at that, so that we can be absolutely sure that it would not happen. I think the other obvious area for her to consider is the functioning of the disclosure and barring scheme, and to make sure that it really is set up in a way that would make it more likely for us to catch someone like Savile. Again, I think it is likely that he would be caught by the DBS, but I would like Kate Lampard to look at that and give me her views.

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

I am not sure that I share the Secretary of State’s view about Jimmy Savile being caught by the procedures now in place through the DBS, but I want to ask him this: under changes introduced by this coalition, a regular volunteer at a children’s hospital—acting, for example, as a reading volunteer on the ward—will not require a Criminal Records Bureau check, and given the harm done by the revelations about Jimmy Savile, I am sure that will cause concern to millions of parents around this country, so does the Secretary of State share that concern, especially in the light of the NSPCC’s comments this week that the pendulum has swung too far towards the abuser by the changes that his Government have introduced?

[Mr Hunt]

I do not agree with that. The CRB checks that were introduced by the last Labour Government were a very important step forward when they started in 2002, but what is also important, as I am sure Labour recognises, is that they have limitations, because they identify whether someone has a criminal record. Jimmy Savile was never convicted of a criminal offence, so CRB checks alone would not have stopped this abuse. That is why we need a broader system, which is what the disclosure and barring scheme is intended to be. It is deliberately set up as something that is risk-profiled, so the higher the risk, the higher the standard of investigation, but that is one of the things that Kate Lampard will look at and we need to listen to what she says when she gives us her final report.

[John Glen (Salisbury) (Con)]

I was grateful for the opportunity early this morning to look at the thorough report of Jimmy Savile’s visits to Odstock hospital. At Odstock, although it seemed that Mr Savile visited, the report concluded that there was no evidence of any wrongdoing. However, one recommendation was that the Department of Health issue national guidance on VIP policy and VIP visits. Can the Secretary of State confirm that he will look at that, so that all hospitals, including the successor to Odstock, Salisbury district hospital, can have a reliable policy in place?

[Mr Hunt]

I think that is a very sensible suggestion. I want to wait until Kate Lampard gives her final report in September, so I do not want to pre-empt what she says, but certainly, one of the blindingly obvious things that jumps out at us from these reports is that too generous treatment was given to someone on the basis of that celebrity status, and we definitely need to learn lessons. As I am sure my hon. Friend would appreciate from his own constituents’ point of view, the fact that there is no evidence of abuse sadly does not mean that there was no abuse, and that is why it is really important for us to remember that there may well be many people who are not mentioned today who have been quietly suffering for many years. I hope today will give them encouragement to come forward.

[Mike Kane (Wythenshawe and Sale East) (Lab)]

I thank the Secretary of State for advance sight of the report from Wythenshawe hospital this morning. For me, the shocking revelation that I noted was that it was an open secret among patients, as early as 1962, that this man was doing what he was doing—and I quote:

“a dirty old man up to no good”.

If there is one good thing that can come from this for the nation, it is that we implore all institutions, both governmental and in civil society, to keep their child protection, safeguarding and recruitment selection procedures up to date and under review.

[Mr Hunt]

The hon. Gentleman is absolutely right and touches on a matter that we have not touched on so far this morning. Recruitment is a very important area that we must get right in this process, and I wholeheartedly agree with what he said.

[Kate Green (Stretford and Urmston) (Lab)]

Today will be an emotional day for victims and their families as the report is published. Will the Secretary of State tell the House how victims have been supported and informed about the publication, particularly today and in the run-up to today, and how they will be kept informed as subsequent actions are carried forward? In particular, what efforts have been made to inform and support those who are most vulnerable, such as those with learning difficulties or who are severely mentally unwell, perhaps as a result of the abuse they suffered many years ago?

[Mr Hunt]

The hon. Lady is right to raise that issue, and the guidance that I have issued to NHS organisations today makes it clear that I want to give maximum protection not just to the victims identified in these reports, but to people going forward. That is the least we owe them.

[Mr Tom Watson (West Bromwich East) (Lab)]

Has the Secretary of State received intelligence, or does he have a suspicion, that victims of Savile were frightened to come forward because he enjoyed powerful political protection?

[Mr Hunt]

I do not believe there is any evidence of that in the reports, but there is a lot of evidence that people felt that they would not be believed because of Savile’s celebrity status. Part of that celebrity status was his connections in high places, and that is part of the myth that we need to puncture as a result of today’s report.

bill presented

Pension schemes

Presentation and First Reading (Standing Order No. 57)

Secretary Iain Duncan Smith, supported by the Prime Minister, the Deputy Prime Minister, Mr Chancellor of the Exchequer, Danny Alexander, Secretary Vince Cable and Steve Webb, presented a Bill to make provision about pension schemes, including provision designed to encourage arrangements that offer people different levels of certainty in retirement or that involve different ways of sharing or pooling risk.

Bill read the First time; to be read a Second time on Monday 30 June, and to be printed (Bill 12) with explanatory notes (Bill 12-EN ).

Patient Safety

Jeremy Hunt Excerpts

Tuesday 24th June 2014 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on his announcement on patient safety.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Mr Speaker, I would like to make a statement to the House about a package of measures that I have announced today to boost safety, transparency and openness in our NHS. It follows my earlier written ministerial statement.

Just last week, the independent Commonwealth Fund said that under this Government the NHS has risen to be the top-rated health care system in the world. Despite many challenges in our NHS, it is therefore clear that we have much to be proud of. However, it is also clear that there is more to do. It is estimated that for 12,000 deaths a year in hospitals there was a 50% or greater chance of their being prevented. Figures released by NHS England today tell us that there were 32 never events in the past two months, including cases of a throat pack and a hypodermic needle being left inside patients post-surgery. These are shocking statistics.

In the Government’s response to Sir Robert Francis’s landmark public inquiry on the poor standards of care at Mid Staffordshire NHS Foundation Trust, I made clear our determination to make the NHS the safest and most open health care system in the world. Today, all hospital trusts around the country will therefore receive an invitation to the Sign up to Safety campaign, which is led by Sir David Dalton, the inspirational chief executive of Salford Royal. The campaign will help us to achieve our ambition of halving avoidable harm, thereby potentially saving 6,000 lives. Trusts will be asked to devise and deliver a safety plan, and may receive a financial incentive from the NHS Litigation Authority to support implementation.

We are fulfilling the pledge that we made in our response to Francis to create a hospital safety website for patients. As of today, the NHS Choices website will tell us how all hospital trusts are performing across a range of seven key safety indicators, including one for open and honest reporting. For the first time, the website will let patients and the public see whether a hospital has achieved its planned levels for nursing hours. Indeed, I am pleased to inform the House that the latest work force statistics, published today, show us that we have 5,900 more nurses in our hospital wards since our response to Francis just over a year ago.

Finally, I am pleased to announce today that Sir Robert Francis QC will chair an independent review on creating an open and honest reporting culture in the NHS. The review will provide advice and recommendations to ensure that NHS workers can speak up without fear of retribution. It will also look at how we can ensure that where NHS whistleblowers have been mistreated, there are appropriate remedies for staff and there is accountability for those who have mistreated them.

I am confident that the package of measures announced today will shine a light on poor care so that lessons can be learned, action can be taken and harm to patients can be prevented. In the process, we will support front-line staff to help the best health care system in the world blaze a trail on issues of safety, transparency and compassionate care.

[Andy Burnham]

The Health Secretary rightly calls for openness, transparency and accountability. It is a pity that that does not extend to his dealings with this House. He spent the morning touring TV studios, but could not find the time to come to the Chamber. Is that because he has signed away day-to-day control of the NHS, as his public health Minister—the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison)—let slip, or is it because he did not want to face questions on the damning criticism of him from the outgoing president of the Royal College of Psychiatrists, who says that he is ignoring the “car crash” in mental health? Either way, it should not be left to us to drag the Secretary of State to the House.

An open, learning culture in all parts of the NHS is an ambition shared across this House and it builds on the work of the last Government following care scandals in the 1990s. More information is welcome, but how will the Secretary of State guard against the risk, as expressed this morning by Martin Bromiley, of creating a “naming, shaming and blaming” culture? He has just told the House that a fifth of hospitals are failing to report properly. Why is that and how will he correct it?

The Secretary of State mentions the Commonwealth Fund and I join him in celebrating the standing of the NHS. He implies that it has all been achieved in the past four years. That is pure spin. I remind him that the NHS first came top in 2007 and that this year’s report specifically traces the NHS’s recent success to reforms implemented by the last Labour Government and to the Darzi report, which it says led to

“an increased emphasis on improving the quality of care provided by the NHS.”

Perhaps the Secretary of State will reflect that analysis in any future statement on the previous Government’s record.

The Secretary of State promises new data on infection—one area where the Commonwealth Fund found cause for concern compared with 2010, with the NHS now ranked worst in the world for patients reporting infection in hospital or shortly after. What is he doing to turn that worrying trend around? On staffing, will he commit to publishing figures on how many of the nurses he mentioned are agency nurses? Is the NHS not now spending a fortune on agency staff—£1.4 billion, 162% higher than planned—because, in the first four years of this Parliament, the Government and the then Secretary of State, who is now the Leader of the House and sitting on the Front Bench, cut nurse training places by 10,000?

The Secretary of State talks about his new target to save 6,000 lives over three years. Can he explain how that will be achieved when people are now waiting longer to start treatment for cancer, when NHS waiting lists have hit a six-year high and when ambulance response times are getting longer? Is not that the real reason he was afraid to come here today? The NHS is getting worse on his watch and the Government have surrendered their power to do anything about it.

[Mr Hunt]

We talk about many things and there will always be political differences between Opposition and Government Members, but I would have thought that on patient safety, on saving patients’ lives, on dealing with the issue that once a week in the NHS we operate on the wrong part of someone’s body and on other terrible issues, there might be a degree of consensus. It is incredibly disappointing that, again, the right hon. Gentleman has chosen to make a political football out of something that should be above party politics.

Let me go through the right hon. Gentleman’s points. This morning in the radio studios, I talked about fulfilling a pledge that I made to the House in my response to Francis—that we would publish staffing data, something that he never did when he was in power. We have done that for 6,700 wards throughout the country, because we want to end the scandal of short staffing that happened on his watch and directly led to Mid Staffs.

I am delighted to come to the House. I have made a written ministerial statement. I often come to the House and I am delighted that the right hon. Gentleman has raised this issue. As he has raised some specific points, I need to address them. He quoted what the outgoing president of the Royal College of Psychiatrists said, but he failed to mention what the incoming president said this morning, which was to praise the remarkable work done by this Secretary of State and his Ministers to raise the issue of mental health.

The right hon. Gentleman talked about the Commonwealth Fund. Let us look at that. When he was Secretary of State, we fell from being top-rated in the world to being second. We are now back on top. He has spent the past four years saying that under the coalition Government the NHS is going to rack and ruin. Someone who is independent has now looked at it and said that we are the best in the world. The right hon. Gentleman should reflect on that before he starts to criticise and run down the NHS.

Let us talk about agency nurses. I am very proud of the fact that, in just over a year, we have 5,900 more nurses on our wards. That is an increase of 4,000 nurses across the system compared with when Labour was in power. Why is that? It is because we are doing something about the issue of safety and compassionate care—issues that the right hon. Gentleman repeatedly swept under the carpet when he was Health Secretary.

Finally, let me make this point. We are doing something that is a world first today: we are publishing staffing data on a hospital-by-hospital, ward-by-ward basis. Yes, we are also publishing which hospitals do not have an open and transparent reporting culture. Creating transparency about failures has, I am afraid, become one of the biggest dividing lines in this House. I think it is a very great shame that every time I raise the issue of poor care in the NHS, the right hon. Gentleman accuses me of running down the NHS and softening it up for privatisation, when what I am actually doing is standing up for patients, which is what he should have done when he was Health Secretary.

[Dr Sarah Wollaston (Totnes) (Con)]

I welcome today’s announcements. Unsafe care in the NHS carries not only a terrible personal cost, but a terrible financial cost—£1.3 billion a year in litigation alone—and I welcome the announcement of Sir Robert Francis’s review. Will the Secretary of State use this opportunity to reassure NHS staff that they do not need to wait for the outcome of that review, and that if they raise concerns about unsafe practice, not only will they be protected, but they would be failing their patients if they failed to do so?

--- Later in debate ---

[Mr Hunt]

I start by welcoming my hon. Friend to her new position as Chair of the Health Select Committee, which I think she will do brilliantly well. I also thank her for the fact that she had been talking about this issue long before she took up that post, and as someone who has worked in the NHS, she has always recognised its importance.

My hon. Friend is absolutely right to say that NHS staff should not wait until the outcome of the new Francis review before speaking out. My view is that the atmosphere is beginning to change inside the NHS. We are getting trust boards that are now spending much more time talking with safety, but the reason I wanted to have this review is that there are problems and issues across the world with people in health care speaking out, and nowhere has really embraced the culture of safety that we have in the airline, nuclear and oil industries, where concerns about safety are on a completely different level. I know that I have the wholehearted support of NHS staff in this mission; I think it is a shame that we do not have the support of the Labour party.

[Kevin Barron (Rother Valley) (Lab)]

In response to the Francis report in relation to the duty of candour, the Government said that it should be on institutions and not on individuals. Given that the Government appear not to want to bring in new regulatory bodies in relation to individual action inside the national health service, does the Secretary of State have any faith in the regulatory bodies currently looking after health professionals, given the state that Mid Staffs hospital ended up in?

[Mr Hunt]

We looked carefully at whether the duty of candour should apply to individuals, and we decided against that because we were worried about creating a legalistic culture in trusts. However, we are working with the regulatory bodies. The right hon. Gentleman is absolutely right to raise concerns, as they were indeed raised in the Francis report. Following on from my earlier response, one of the lessons that we learned from the airline industry is that pilots are professionally protected if they speak out, so on balance it is to their advantage to speak out rather than to shut up. As a result of that reporting of safety incidents, near misses and so on, the industry has achieved a remarkable reduction in accidents. I would like to see whether we can do the same thing in the NHS.

[Angie Bray (Ealing Central and Acton) (Con)]

One of my constituents spoke out against malpractice at the hospital where she worked and was subsequently vindicated at a tribunal, but she lost her job and has been unable to find work in the national health service ever since. Is it not time that we put an end to some kind of blacklist that stops people being re-employed when they have done the right thing?

[Mr Hunt]

I would like to thank my hon. Friend for the support that she has given to her constituent, whom I think I have also met. My hon. Friend is absolutely right: we have to stop this system of consequences for people who do the right thing and speak out. It is not right for me to comment on an individual case, because legal proceedings are often involved, but one hears of situations where people have spoken out and then been victimised by a trust, and that is wrong. We need to be better at looking after whistleblowers, but we need to go further and eliminate the need for whistleblowing by creating a culture where trusts are hungry to hear from their own staff about safety concerns because they want to put them right.

[Mr Ben Bradshaw (Exeter) (Lab)]

An Exeter psychiatric nurse of more than 20 years’ standing wrote to me in despair this week saying that

“mental health services are in collapse”,

and that patients are regularly placed in “life threatening” situations or sent as far away as Bradford because there are no beds locally. Vulnerable people are waiting a shocking three months for the co-ordination of their care. How dare the Secretary of State come to the House today and claim that our mental health services are not in crisis?

[Mr Hunt]

There are real pressures in our mental health services, but the right hon. Gentleman should recognise the progress that the Government have made. That includes doubling the money going into talking therapies, having global summits on dementia and putting a massive amount of money towards raising the profile of dementia in this country and across the globe, and legislating for parity of esteem as between mental and physical health—something that never happened under the previous Government. There is a lot of work to do, but I think he should give credit where it is due.

[David Morris (Morecambe and Lunesdale) (Con)]

On transparency of staffing levels, does my right hon. Friend know that the University Hospitals of Morecambe Bay NHS Health Trust vacancy level for nurses is now 4%, against a regional average of 10%? That is obviously an increase in nurses in my area, and I thank him for that.

[Mr Hunt]

I welcome the increase in nursing across the country, and I am surprised that Labour Members do not welcome it. When I started in this job they spoke constantly about nursing numbers, but I notice they have now stopped doing that. Although those numbers are an important first step, it is not possible to compare trust with trust at this stage because they are all self-reported numbers. Over the next months—certainly by next spring—we will go through all the figures ensuring that NICE-approved tools are used to fulfil them. We will then see how trusts are doing compared with each other, which will be useful to them.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

As a member of the Health Committee, I am disappointed that the Secretary of State does not understand that being dragged to the House to answer an urgent question is not the same as coming here to make a statement. I would prefer to hear first in this House what the Government are doing.

The Secretary of State mentions the leadership of David Dalton and Salford Royal NHS Foundation Trust, but that leadership led to safe staffing levels, which he has not supported. A recent Nursing Times survey found that the majority of nurses said that their wards were dangerously understaffed. I hear from nurses who are working with ratios of 2:22, 2:24 or 2:28—that is the reality. Does he think it is time he apologised for cutting the number of nurses?

--- Later in debate ---

[Mr Hunt]

Again, I am surprised that we do not have more agreement. If the hon. Lady looks at the figures, she will see that in the past year there have been 5,900 more nurses on our wards. Why does she not welcome that? We are using Salford Royal—a brilliant hospital that she knows well—to lead a safety campaign across the whole country to learn from the brilliant things that it is doing. I put a written statement before Parliament, and nothing I said this morning is not in the public domain. I would be delighted to come to the House any time to make an oral statement, and I notice that far more coalition MPs want to ask questions about safety and compassionate care than do Labour MPs.

[Steve Baker (Wycombe) (Con)]

My right hon. Friend will remember some of the issues that I raised in the House about patient safety, and the Francis report, the Keogh review, and the new Care Quality Commission regime have made a material improvement. On Friday last week, Buckingham Healthcare NHS Trust was the second trust to emerge—at last—from special measures. Will the Secretary of State join me in congratulating that trust, and express the hope that that marks a new beginning about which we can be optimistic?

[Mr Hunt]

I would be delighted to do that. Incredible hard work by doctors, nurses and health care assistants on the front line of my hon. Friend’s local hospital has meant that the trust has come out of special measures, which the whole House should celebrate. Indeed, it was helped in that by Salford Royal, and one of the most encouraging things about the new special measures regime is that we are pairing up hospitals in difficulty with other hospitals that have a better record, and we are getting tremendous results.

[Derek Twigg (Halton) (Lab)]

Clinical commissioning groups commission services in hospitals. What discussions has the Secretary of State had with CCGs to ensure that when they commission services they particularly look to ensure transparency and that patient safety is the highest priority in their discussions?

[Mr Hunt]

We have a lot of discussions, and the hon. Gentleman is right: the commissioning of care is vital and we need CCGs to play their part. We have many discussions with NHS England about how to do that, and we will be considering how we can make CCGs more publicly accountable for their record in those areas.

[Sir Tony Baldry (Banbury) (Con)]

Oxford University Hospitals NHS Trust has managed to make multi-million pound recurring savings over the past couple of years and is now in the black. At the same time it has managed to create 400 new jobs in the trust, almost all of which are new doctors and nurses. Does that not demonstrate that it is possible for the NHS both to meet the Nicholson challenge, and to recruit more doctors and nurses to improve and enhance patient safety?

[Mr Hunt]

It certainly does, and that is another area where it would be refreshing to have a bit more openness from the Labour party. We can afford 8,000 more doctors and 4,000 more nurses in our NHS than when Labour was in power because we got rid of primary care trusts and strategic health authorities, and 20,000 administrative jobs that were not on the front line—a change that Labour opposed bitterly every step of the way. Labour Members must say what would happen to those doctors and nurses if we repealed the Health and Social Care Act 2012, as they have publicly committed to do.

[Jenny Chapman (Darlington) (Lab)]

If the Secretary of States wants some kind of TripAdvisor-style scheme for the NHS that is fine; it may improve safety and it may help patient choice. However, a woman who has fallen to the bottom of her stairs and is waiting hours for an ambulance does not have a choice. That is happening now and it was not happening five or six years ago. What is he going to do about that?

[Mr Hunt]

First, I will ensure that throughout the system when we have failures in care we are completely transparent about them and do not seek to brush them under the carpet. That is a very important change. Secondly, yes there is pressure on ambulance services, just as there is pressure in most parts of the NHS now, but under this Government our ambulance service is taking 1,000 more people every day on emergency journeys. We should credit it with doing a very good job in difficult circumstances.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

I commend my right hon. Friend for being determined to create a different and more effective safety culture in the NHS, just as in the airline or oil and gas industries. Does he accept that publishing more data is only part of the equation and will not necessarily change attitudes and behaviours, particularly if those data are then gamed at another target? We must tackle attitudes and behaviours at source—in the operating theatre, the GP’s surgery and throughout the whole service—to get that better safety culture.

[Mr Hunt]

As ever, my hon. Friend speaks wisely. The first step is to be open and transparent about where the problems are, and I hope today will be a step in that direction. In the end, however, if we are to change things we must create a learning culture in all our hospitals so that the word goes out from the top down that the management is interested in hearing from staff if they have concerns about safety, because it wants to learn from those concerns and put them right. One of the messages I have been trying to get across is that that does not cost money; it saves money. We spend £1.3 billion a year on litigation and £800 million on adverse events. If we are feeling, as everyone is, a tough climate financially, this is a positive thing to do for that reason as well.

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

The House will be aware that the Health Secretary has refused to comply with the Information Commissioner’s ruling to publish the risk register for NHS reorganisation. Will he at least say whether that risk register warned the Government specifically that such reorganisation would hit A and E services?

[Mr Hunt]

That risk register is in the public domain, but I defend the right of my officials to give confidential advice to Ministers as that is an important part of government. I want my officials to be open and transparent with me if they think I am about to do the wrong thing, and all Ministers need a protected area where they can get frank advice. The hon. Gentleman is one of my constituents, so he will be pleased to know that the Royal Surrey county hospital in Guilford is embracing the safety campaign with vigour and completely renewing the way its wards are organised to improve patient care and safety.

[Mr David Ruffley (Bury St Edmunds) (Con)]

I commend the Secretary of State for these practical and sensible reforms on patient safety, and I look forward to discussing them with staff at West Suffolk hospital—the biggest district general hospital in my area. Does he agree that the sensible and deliverable transparency reforms will ensure that the conspiracy of silence that we saw tragically in Mid Staffs is not repeated on his watch?

[Mr Hunt]

I am absolutely determined to make that the case. The biggest example—a number of them have been raised today—is the issue of hospitals put in special measures. Over the last year, we have put more than 10% of NHS acute trusts into special measures. That was a very difficult decision and was not welcomed at the time. The result, I am pleased to say, is that we are seeing real and significant change in all those hospitals. I hope as many of them as possible will get out of special measures quickly, but we can achieve that change only if we are honest about the problem in the first place.

[Julie Hilling (Bolton West) (Lab)]

Bolton hospital is having to go abroad to recruit qualified nurses this summer because there are no British-trained nurses available. Will the Secretary of State now take responsibility for cutting nurse training places by 10,000 since the last election and accept that the lack of qualified nurses is just making the problem of safety worse?

[Mr Hunt]

What I will take responsibility for is agreeing to a public inquiry into what happened at Mid Staffs—something rejected by the Labour party—that has woken up the whole NHS to the need for safe staffing in all our wards. We are implementing the report and that will indeed be reflected in the nurse training numbers going forward.

[Jackie Doyle-Price (Thurrock) (Con)]

Basildon and Thurrock hospital was the first to exit the special measures regime after a number of years of failure. It did so because the leadership embraced what happened, was willing to learn the lessons from what went wrong and went out of its way to fix them. Far from being a naming, shaming and blaming culture, is it not the truth that my right hon. Friend is strengthening the culture of accountability in the NHS, which is as it should be?

[Mr Hunt]

Yes, and I would like to thank my hon. Friend for her superb work in supporting Basildon and Thurrock hospital through a very difficult period. I think that the chief executive there, Clare Panniker, is an exemplary one. She wrote an article in The Guardian pointing out that it is incredibly painful for trusts when they go into special measures, that it causes a lot of pressure in the local media, but that it also means that change can be made much more quickly when an urgency to solve these problems, many of which have been around for years and years, is created. I commend the staff of that hospital not just for coming out of special measures but for being rated “good” by the chief inspector of hospitals—a fantastic achievement.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

Never mind the fact that this Government will not publish the risk register for a £3 billion top-down reorganisation; the Secretary of State and his Ministers will not meet me. If he wants to talk about accountability, why will he and his Ministers not meet me to talk about a minor injury unit in Guisborough being closed, a minor injuries unit in Brotton hospital being closed, a GP centre in Park End being closed and a walk-in and GP centre in Skelton being closed? All those units are in my constituency and they are all being closed, yet the Secretary of State and his Ministers will not meet me, which would represent genuine accountability.

[Mr Hunt]

Let me say to the hon. Gentleman that the accountability he talks about is precisely demonstrated by his ability to ask me questions right now as he has just done. He needs to be accountable and come clean with the House by saying that he has actually met my Ministers on a number of occasions on precisely the issues that he raised.

[Several hon. Members]

rose—

[George Freeman (Mid Norfolk) (Con)]

After the shocking events at Mid Staffs under the last Government, I would like to congratulate the Secretary of State on his crusade for accountability and transparency as the best disinfectant, as shown by his support for whistleblowers and for 4,000 additional nurses. Does he agree that the collection, monitoring and day-to-day use of data on health outcomes is absolutely key? I welcome his Minister’s support for measures in my ten-minute rule Bill, now adopted and sponsored by me and my hon. Friend the Member for Stafford (Jeremy Lefroy).

[Mr Hunt]

I am happy to do that, and I would particularly like to congratulate my hon. Friend on the insight he has brought with regard to the power of data. In one example of why this is so important, the latest figures showed 43 or 44 people dying in the NHS because of medication errors, but if the person giving the medication had been able to see the patient’s entire prescription history, those horrific tragedies might have been avoided. That is why proper sharing of data is so important.

[Mr Andy Slaughter (Hammersmith) (Lab)]

I want to ask about the safety of the 22,000 patients who use Hammersmith hospital A and E every year. There is no increased capacity in the acute primary or community care services locally, which the Secretary of State set as a prerequisite for any A and E closures in west London. Will he ask Imperial Healthcare Trust to review plans to close the A and E at Hammersmith on 10 September? Will he answer that question, as my constituents in Shepherd’s Bush and White City deserve an answer to it, not the spin and the game playing that I always get from the Secretary of State?

[Mr Hunt]

I am afraid I will take no lessons in spin and game playing after what the hon. Gentleman wrote in local election leaflets in Hammersmith and Fulham, failing to tell his own constituents about the brand new hospitals, the opening of a seven-day GP surgery and the 800 out-of-hospital professionals. I think he behaved absolutely disgracefully.

[Charlotte Leslie (Bristol North West) (Con)]

I very much welcome the Francis review into whistleblowing, which does indeed focus on transparency, and I am bemused and depressed that we cannot get universal welcome for it across the House. In addressing the name, shame and blame argument, does my right hon. Friend recognise that many front-line staff will be relieved at what he has announced because it will force management priorities to be the same as their priorities, which are overwhelmingly about patient safety?

[Mr Hunt]

My hon. Friend speaks wisely, and I commend her for her work in championing whistleblowers. In her relatively brief time here, she has made a big difference on that issue. Personally, I do not like to use the term “naming and shaming” because I think identifying problems should always be the first step to sorting them out. What we are doing today by identifying trusts that do not have a proper open and honest reporting culture is also helping them to change that reporting culture while at the same time identifying trusts that have a good culture. It is all about changing the culture, so this is a positive move, and I think that NHS staff will really welcome it.

[Nic Dakin (Scunthorpe) (Lab)]

Does the Secretary of State agree that the best way to deal with concerns about patient safety, such as those raised last week about Scunthorpe general hospital, is to have a proper independent investigation that respects patient confidentiality and reports objectively, clearly and transparently so that appropriate action can be taken when all the facts are known?

[Mr Hunt]

There are definitely times when an independent investigation is needed, and a number of them are going on in the NHS at the moment. The first thing, however, is to talk to the trust and get it to deal with the particular issues being raised and to create a culture in which trusts are willing, enthusiastic and keen to do that. Today is an attempt to deal not only with what happens when things go wrong with whistleblowers, but with how to create the right culture in the first place.

[John Stevenson (Carlisle) (Con)]

I commend the Secretary of State for his desire to put patients at the centre of the NHS. Does he agree that patient safety in places such as North Cumbria can be ensured not just by quality medical care, but by good-quality leadership and management? Would he therefore agree that we need quality management throughout the NHS that is confident about being open and transparent?

[Mr Hunt]

I would agree with that, and I am grateful to my hon. Friend for talking to me on many occasions about the issues at North Cumbria hospital and for sharing his determination to turn things around— [Interruption.] I find it extraordinary that Labour Members are making all this noise. My hon. Friend will know that that hospital had to give £3.6 million in compensation to just one person because of an appalling mistake when Labour was in power. They should be welcoming these changes, not criticising them.

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

On 1 May I asked the care Minister why there had been a 60% drop in the number of people barred from working with vulnerable adults in the health and social care sector, and an even bigger drop of 75% in those barred from working with children. The Minister said that he was going to investigate, but I have heard nothing since. Does the Secretary of State share my concern that fewer unsuitable people are being barred from working in the social and health care sectors on his watch?

[Mr Hunt]

I do not know the answer to that question, so I will look further into the matter and get back to the hon. Lady.

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

As the hon. Member for Scunthorpe (Nic Dakin) mentioned, local GPs raised concerns last week about a cluster of cases at Scunthorpe and Grimsby hospitals—not at Goole hospital, which was also revealed last week never to have breached its four-hour waiting target. There is still a lot more to be done, so does the Secretary of State share my concern at the evidence received by the Health Select Committee last week from the Care Quality Commission, which stated that all too often, members of staff who raise concerns are dealt with by the human resources department rather than in a proper way that allows their complaints to be properly aired?

[Mr Hunt]

That is a very good point, and I thank my hon. Friend for welcoming me to Goole hospital; I had a very good visit. That hospital is in special measures but it is making real progress. It was interesting to talk to staff at the front line. I do not know when the hospital will be ready to leave special measures, but the staff on the front line felt that things were changing, and they welcomed that. My hon. Friend is absolutely right that if someone raises a safety concern, it should not be viewed as an HR issue; it is a patient safety issue, and trusts need to treat it as such.

[Jim Shannon (Strangford) (DUP)]

In his reply to the right hon. Member for Leigh (Andy Burnham), the Secretary of State referred to avoiding avoidable harm. Given that Combat Stress has reported the referral of some 358 additional troops for urgent treatment—a rise of some 57%—will he give us some idea of the discussions in which he has engaged with service charities to ensure that that harm can be avoided?

[Mr Hunt]

We have ongoing discussions with the Ministry of Defence about the care and support that we offer to our combat troops, but I can assure the hon. Gentleman that we give them the highest priority.

[Henry Smith (Crawley) (Con)]

I welcome the action taken by my right hon. Friend to extend transparency for the purpose of safety in the NHS, but could it be extended to the social care sector, especially in the light of the January 2010 Care Quality Commission report on Orchid View care home in Copthorne, near my constituency? The report rated the home as good, but 19 patients subsequently died.

[Mr Hunt]

I thank my hon. Friend for raising that very harrowing issue. I hope I can reassure him by saying that we are progressively extending the changes we introduced to hospital inspections to inspections of general practice and adult social care settings. The new inspection regime is designed to be much tougher when it comes to identifying problems. It is never possible to identify all abuse in an inspection, which is why what I have announced today is so important: it is about the creation of a culture that tries to prevent such problems from arising in the first place.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I welcome the statement and the work that the Secretary of State is doing. Mr Mufti, who was the medical director of Medway hospital under the last Government, raised serious concerns about the bullying of staff, which he feared was affecting the quality of care and patient safety. Will the new provisions address that problem?

[Mr Hunt]

That is exactly the intention. Following my conversation last week with Nigel Beverley, the chief executive of Medway, I think that the hospital is making good progress after going into special measures. However, it is important to recognise that while it is possible to change things externally, real culture change must come from inside. This is not a day on which we are announcing new targets or top-down initiatives. The Sign up to Safety campaign to be led by Sir David Dalton will be voluntary: hospitals must choose whether to sign up to it. I think that that will enable us to make more progress than we would make if we tried to do things in the old way.

[Several hon. Members]

rose—

[Mr Rob Wilson (Reading East) (Con)]

I was saving my energy, Mr Speaker.

I welcome my right hon. Friend the Secretary of State’s changes, which have made improving patient care and raising standards such a central part of the NHS mission. It is important to shine a light on poor performance, which is why I also welcome today’s CQC report on Royal Berkshire hospital, which highlights a number of important challenges that confront my local hospital. Does he agree that only by being open and transparent about problems can we tackle them and fix them for the long term?

[Mr Hunt]

I absolutely agree with my hon. Friend. I have had many discussions with him as he has campaigned in the House for his local hospital. The creation of a culture of openness and transparency should have support in all parts of the House, but that will not happen if every time we are honest about a problem, we are told that we are somehow running down the NHS. I urge Labour Members to think carefully about the way in which they approach this issue.

[Margot James (Stourbridge) (Con)]

I applaud the cultural change that my right hon. Friend is leading in the NHS and the social care sector. As he may know, three former members of staff at Granary care home, owned by Shaw Healthcare, were last week found guilty of appalling violence and abuse of frail elderly patients. The sentences handed down to those three individuals were utterly derisory, the longest being four months in prison. Will my right hon. Friend meet the Secretary of State for Justice to review sentencing in this crucial area?

[Mr Hunt]

I shall be happy to raise that issue with the Justice Secretary, and I thank my hon. Friend for raising it. I think it reminds us that whatever changes we may make in the House, it will take time for them to filter through. I am afraid that, even now, some terrible things are happening. One of the things that worries me most is that abuse of this kind often involves people who have dementia and cannot speak up for themselves. That is why it is so important for us to raise the profile of dementia, and to improve the training of those who care for people with the condition.

[Martin Vickers (Cleethorpes) (Con)]

May I take up what was said by my hon. Friend the Member for Brigg and Goole (Andrew Percy)? My right hon. Friend the Secretary of State will appreciate the concern felt by my constituents at a time when the local media are full of a dispute between the clinical commissioning group and the hospital trust about an ongoing investigation of patient safety. Can he assure patients that every support will be given to the CCG and the trust when the recommendations following the inquiry become known?

[Mr Hunt]

Yes, I can. My hon. Friend’s local trust is in special measures, and the decision on whether a trust should come out of special measures is no longer one for the Secretary of State; it is made independently by the chief inspector of hospitals. I hope that we have created incentives for system leaders to solve these problems, because if they do not, the chief inspector will simply not decide that the trust can be taken out of special measures.

[John Howell (Henley) (Con)]

I join my hon. Friend the Member for Wycombe (Steve Baker) in praising the improvements that have taken place in Buckinghamshire Healthcare NHS Trust, which has come out of special measures, and which affects part of my constituency. Are not those improvements a very good example of the way in which we are summoning up the political courage to tackle such trusts, particularly when they have experienced high death rates in the past?

[Mr Hunt]

I hope that they are. I think that in the end we shall be judged on how successful we are in turning around hospitals in special measures. Last week I met Anne Eden, the chief executive of Buckinghamshire Healthcare. I think she has done an excellent job in extremely difficult circumstances, but I know she would agree that there is still much work to be done. Taking hospitals out of special measures is the first step, but ultimately we must reassure the public that when there are problems, we shall be on their side and try to sort those problems out.

[John Glen (Salisbury) (Con)]

I welcome today’s announcement, and I assure the Secretary of State that Salisbury district hospital, which is in Odstock in my constituency, will be keen to sign up to the campaign. However, will he acknowledge that it and several other hospitals have been alive to issues of patient safety for a long time, and have recently been involved in a new patient safety initiative launched by Wessex academic health science network? Is it not important for existing arrangements to be acknowledged, so that there is no duplication of effort?

[Mr Hunt]

That is absolutely true. A number of initiatives are taking place, and I welcome them. The involvement of universities can help us to understand some of these very difficult issues. This is uncharted territory for the NHS, because nowhere else in the world are we seeing the rigour with which we are going about our task. I think that we should be open about anyone who can contribute to the debate.

[James Morris (Halesowen and Rowley Regis) (Con)]

I welcome the Secretary of State’s focus on transparency and accountability. He is right to draw attention to the positive steps that the Government have taken in regard to mental health services in the last four years, but given our aspiration to secure parity of esteem between mental and physical health in the NHS, and our need to drive up mental health care standards throughout the country, should we not extend the transparency and accountability measures that he has announced to those services?

[Mr Hunt]

I pay tribute to my hon. Friend’s campaigning on mental health issues, which has done a huge amount to raise the profile of the subject. Let me reassure him that the information that we are publishing on the website today includes staffing data for all the mental health trusts. We completely recognise the parity issue, at least in what we are doing today.

[Guy Opperman (Hexham) (Con)]

In my previous job, before I entered the House, I conducted dozens of clinical negligence cases. Almost every defending trust was obstructive, defensive and reluctant to admit blame, even when patently culpable. I strongly welcome the changes that are being brought about. Does my right hon. Friend agree that greater transparency and whistleblowing will bring about the safety changes that we all want to see?

[Mr Hunt]

I very much agree with my hon. Friend, and he will know that one of the things we have introduced this year is the duty of candour, which makes it a legal requirement for trusts to be honest with patients and their families when harm or avoidable death has occurred. He is absolutely right that we have to tackle this, and he will also know that when trusts are open and transparent, relatives are less likely to sue, because they recognise the good will and spirit involved.

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

Will the Secretary of State join me in commending the initiative of Bedfordshire clinical commissioning group, under the excellent leadership of Dunstable GP Dr Paul Hassan, which has instituted unannounced checks on the wards of local hospitals by local GPs?

[Mr Hunt]

I do commend that, and it is excellent to see CCGs taking responsibility, because they control the NHS budgets. I think that is an excellent initiative, and I hope that other CCGs follow suit.

[Jeremy Lefroy (Stafford) (Con)]

May I commend my right hon. Friend on the work he has done on patient safety, while gently suggesting that perhaps the long-term, or even medium-term, aim should be to eliminate avoidable harm, rather than just halve it? In my case, in Stafford, we have seen huge improvements in patient safety since the very difficult times a few years ago, but I ask my right hon. Friend to bear in mind the hospital’s current situation, which is fragile, and to ensure that it is not left to its own devices, but that all the support necessary to maintain patient services during this difficult transition is given.

[Mr Hunt]

No Member of this House has done more for their local hospital than my hon. Friend, and I commend him on what he has done. We certainly will not leave that hospital to its own devices; we are following very closely what is happening. I want to pay tribute to him, too, on the issue of safety, because when the Francis report came out, he was one of the earliest voices saying, “Yes, this is about compassionate care, but it is also about safety.” I do not at all rule out the aspiration of zero harm and zero avoidable deaths, but that is a point we will have to get to step by step, and I am very proud that we are taking the steps that we are today.

[Mr Philip Hollobone (Kettering) (Con)]

A few years ago, Kettering general hospital had some of the very worst hospital infection rates in the whole country; now it has some of the very best. Last year, it had some of the very worst rates for attendance at A and E within the four-hour target; now it has some of the very best. Does this not demonstrate that determined local hospital leadership, plus dedicated and committed nursing staff, can transform the patient experience in our hospitals?

[Mr Hunt]

It absolutely does, and I think that is very important. There are huge pressures on NHS hospitals. I have been to Kettering hospital at my hon. Friend’s invitation, and it is a very busy hospital. There is a lot of pressure in the system, but with the right leadership it is absolutely possible to deal with these challenges, and I know that my hon. Friend has had a huge impact in Kettering, supporting the hospital through a difficult period.

Safety, Transparency and Openness in the NHS

Jeremy Hunt Excerpts

Tuesday 24th June 2014 Written Statements

[The Secretary of State for Health (Mr Jeremy Hunt)]

Today I am announcing a package of measures to boost safety, transparency and openness in the NHS.

In March, I announced a new ambition to reduce avoidable harm in health care by half, thereby saving 6,000 lives. A new campaign—“Sign Up to Safety”—will be launched today to help achieve this ambition. The campaign will call for everyone working in the NHS to listen to patients, carers and staff, learn from what they say when things go wrong and take action to improve patient safety. Every health care organisation will be formally invited to sign up to the campaign and commit to delivering a safety plan that will contribute to the new ambition. The safety plans will be reviewed by the NHS Litigation Authority, and if the plans are robust and will reduce claims, trusts will receive a financial incentive from the NHS Litigation Authority to support implementation of their plans. This is just one way that we can tackle some of the financial costs of poor care.

In the Government’s response to Sir Robert Francis QC’s “Public Inquiry into Mid Staffordshire NHS Foundation Trust”, we pledged to create a hospital safety website for the public. As of today, NHS Choices will provide key hospital-level patient safety data in one place which means the public can see how hospitals compare in terms of safety across seven key indicators—including reporting culture, hospital infections and cleanliness, response to patient safety alerts and health care staff recommendations to their friends and families about the organisation they work in. In our response, the Government also said that hospitals needed to be more transparent about staffing levels, and for the first time the new hospital safety website will tell the public whether a hospital has achieved its planned levels for nursing hours.

Finally, I am announcing an independent review into creating an open and honest reporting culture in the NHS chaired by Sir Robert Francis QC, who chaired the landmark inquiry into the poor standards of care in Mid Staffordshire NHS Foundation Trust. The review is being established to provide independent advice and recommendations on measures to ensure that NHS workers can raise concerns with confidence that they will be acted upon, that they will not suffer detriment as a result and to ensure that where NHS whistleblowers are mistreated there are appropriate remedies for staff and accountability for those mistreating them. The review will consider the merits and practicalities of independent mediation and appeal mechanisms to resolve disputes on whistleblowing fairly. It will do this by listening to and learning the lessons from historic cases where NHS whistleblowers say they have been mistreated after raising their concerns and by seeking out best practice.

The safety campaign that we are launching today, together with what is now an unprecedented and world-leading level of transparency and openness, will help to create the right conditions needed to harness the commitment of everyone in the NHS to deliver the best and safest possible care.

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 10th June 2014 Commons Chamber

[Mr Robin Walker (Worcester) (Con)]

1. What recent assessment he has made of the role of the Prime Minister’s challenge fund in improving access to GP services.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Mr Speaker, it is a pleasure to see you again so soon.

The Prime Minister’s challenge fund will be rolled out over 1,100 of the 8,300 GP surgeries in the country. It will improve access out of hours, at weekends and electronically, and it will benefit up to 7.5 million people.

[Mr Walker]

I am glad that this Government, unlike the previous one, whose disastrous contract negotiations led to a decline in GP access, is making sure that out-of-hours care is as widely available as possible. Will the Secretary of State assure me that he will do whatever he can to ensure that places, such as Worcester, that have not yet been reached by the challenge fund will also see the benefits of this approach?

[Mr Hunt]

My hon. Friend is right to say that some bad changes were made. What will most benefit his constituents, whether or not they are part of the initial tranche of the Prime Minister’s challenge fund, is the reintroduction of named GPs for the over-75s. For people with complex long-term conditions, continuity of care is extremely important, and every single one of his constituents aged 75 or over will now get a named GP.

[Kate Green (Stretford and Urmston) (Lab)]

We are very pleased in Old Trafford to have secured funding for 80 extra care beds for one of the most deprived parts of my community. We also hope to be able to bring health care services, including GP surgeries, on to the same sites, but we are experiencing difficulty in unblocking funding via the NHS area team. Will the Secretary of State meet me to discuss this issue and how we might be able to move forward?

[Mr Hunt]

Yes, I would be more than happy to meet the hon. Lady and see what I can do to help her to improve health care in her area.

[Jessica Lee (Erewash) (Con)]

I thank my right hon. Friend the Secretary of State for his recent visit to Erewash. He has kindly offered to come back another time. We welcome the Prime Minister’s challenge fund being allocated to Erewash. May I reassure my right hon. Friend that our excellent GPs are working very hard to make sure that services and support are appropriately allocated in our community?

[Mr Hunt]

I thank my hon. Friend for her work to promote good health care in her area. I very much enjoyed meeting her local GPs. I was disappointed that it was only for about five minutes. I very much hope to go back and have a proper discussion. They were very enthusiastic about the Prime Minister’s challenge fund, and are making some very innovative changes.

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

May I push the Secretary of State on this matter? What my constituents want is to be able to get to see a GP when they really need one; they do not want to turn up in A and E just because they cannot get an appointment for a week. Is not poor management of GP surgeries—poor management from top to bottom—at the heart of this problem?

[Mr Hunt]

Actually, I agree with the hon. Gentleman. I think that we do have a problem. We have some fantastically good GP surgeries and some brilliant GPs, but we have not in the past had structures in place to make sure that we deal quickly with underperforming GP surgeries and, indeed, underperforming GPs. We need to have much more transparency of data so that we can see where the problems are. We have introduced a rigorous new inspection regime, with a new chief inspector of general practice, and I hope that that will go some way to addressing the issues he raises.

[Andy Burnham (Leigh) (Lab)]

People ringing their surgery this morning only to be told that no appointments are available for days will be listening to the Secretary of State’s answers today and thinking that he is living in a different world. People’s real experience is that it is getting harder and harder to get a GP appointment under this Government, but for some it could get much worse. I recently visited a practice in east London that faces closure in October because of this Health Secretary’s changes to GP funding. NHS England says that 97 other practices are in the same position, affecting thousands of patients. Will he today give a guarantee that no practice will have to close?

[Mr Hunt]

Let us address this issue head on. The right hon. Gentleman knows perfectly well that it is totally wrong to have a system in which two neighbouring GP practices can be paid different sums of money for doing the same amount of work. We must have an equitable funding formula for GP practices, which is why we are phasing out the minimum practice income guarantee. That is a sensible decision. We are also taking measures to ensure that we do not affect patient care in the process. Of course we are looking at the individual cases carefully, but I am sure that he would agree that we have to fund GP practices equitably.

[Graeme Morrice (Livingston) (Lab)]

2. If he will commission a review of the safety of polypropylene transvaginal mesh implants.

--- Later in debate ---

[Ms Margaret Ritchie (South Down) (SDLP)]

5. If he will meet the chair of the College of Emergency Medicine to discuss A and E units.

[The Secretary of State for Health (Mr Jeremy Hunt)]

I met the chair of the College of Emergency Medicine four times in the last six months and I will meet him again next week.

[Ms Ritchie]

I thank the Secretary of State for his answer. Will he tell the House what progress has been made by Health Education England, along with the College of Emergency Medicine, to recruit trainee doctors from India in an attempt to address the serious staffing shortages in emergency medicines departments? Will he work with Ministers from other devolved regions to address the serious shortage in A and E doctors, which is having an impact on waiting lists in hospitals the length and breadth of the UK?

[Mr Hunt]

The hon. Lady is right that operational pressures on A and E are happening throughout the United Kingdom. We have made good progress in recruiting 50 A and E doctors to help relieve pressure this year in A and E departments, but that is a short-term measure. The long-term issue is to get more doctors going into A and E from training, and we are looking at contract structures and at what we can do with training schedules to make that more attractive. We will certainly work with colleagues in devolved Administrations and tell them what we have learned.

[Chloe Smith (Norwich North) (Con)]

I welcome the fact that waiting times have halved under this Government, but the Norwich walk-in centre should stay in its city centre location to continue to move people away from A and E when they do not need to go there. Will the Secretary of State meet me to discuss urgent and primary care provision in Norwich?

[Mr Hunt]

I would be delighted to meet my hon. Friend, and she is right to say that the long-term solution to pressures in A and E is to find alternatives in out-of-hospital care that are easy for people to find. That means improving GP access and any other alternatives, and I am sure we can find a good solution in Norwich.

[Mrs Linda Riordan (Halifax) (Lab/Co-op)]

There is not one person in my constituency who does not want to see the accident and emergency unit stay open. If this is made clear in any consultation, will the Secretary of State commit today to scrapping the callous closure proposals?

[Mr Hunt]

As the hon. Lady knows, local service changes are the responsibility of the local NHS, but when they get referred to me, through local authorities, I will never take a decision that is against the interests of patients, including her constituents. Were such a proposal to come to me, I would indeed listen to any representations that she makes.

[David Tredinnick (Bosworth) (Con)]

Does my right hon. Friend agree that a critical problem that A and E units will face in the future is antibiotic resistance? Is he aware that the Science and Technology Committee, of which I am a member, has been looking at this issue, and it also interests the Health Committee, of which I am also a member? Can he assure me that he is talking to the Prime Minister about how to stimulate new antibiotic research, and will he also remember that nature has its own remedies, such as tea tree oil?

[Mr Hunt]

My hon. Friend is right about the seriousness of the issue of antimicrobial resistance. Some 25,000 people die in Europe every year as a result of the failure of antibiotics—more than die in road traffic accidents. I raised the issue at the World Health Assembly and I have discussed it closely with the Prime Minister.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

The Health Secretary will be aware that the chair of Morecambe Bay trust has stood down today, ahead of what is expected to be another critical report from the Care Quality Commission about services. What guarantees can the Health Secretary give the worried people who are served by the Furness general hospital that its A and E department will be protected and the vital national industries that depend on its services will continue to be able to rely on them?

[Mr Hunt]

First, I thank the hon. Gentleman for the work that he does locally, in particular with people such as James Titcombe, who has campaigned extensively to improve the quality of care at Morecambe Bay. I assure the hon. Gentleman that whatever the problems are at Morecambe Bay, we will be transparent and open, and we will make sure that we deal with them promptly. That is why we have had these independent inquiries. We will look closely at what the report says and make sure that we act quickly.

[Liz Kendall (Leicester West) (Lab)]

The College of Emergency Medicine says that the use of agency doctors has become endemic in the NHS, and that hospitals are increasingly relying on more expensive agency nurses, just as Labour warned when jobs and training places were cut. It is clear that NHS finances are going backwards under this Government. Will the Minister now confirm Monitor’s latest figures, which show that annual spending on agency staff in foundation trusts has soared to £1.4 billion, a staggering 150% higher than trusts planned at the beginning of the year, and will he explain how that makes any financial sense?

[Mr Hunt]

Let us look at why the number of agency nurses has increased. It is because trusts have responded to the Francis report, published just over a year ago, and are seeking to end the shocking under-staffing of wards that was endemic under the last Labour Government. Of course we want people to recruit full-time nurses on proper contracts, and that is happening. That is why we have 3,000 more nurses—not agency nurses, but proper full-time nurses on proper NHS contracts—than when the hon. Lady’s Government were in power, and we will continue to make progress.

[Mr Philip Hollobone (Kettering) (Con)]

6. What recent assessment he has made of the performance of the A and E department at Kettering general hospital.

--- Later in debate ---

[The Secretary of State for Health (Mr Jeremy Hunt)]

rose—

[Mr Speaker]

Go ahead.

[Mr Hunt]

Thank you, Mr Speaker. I like to wait until you give me the word.

[Mr Speaker]

If the Secretary of State needs encouragement I am happy to give it to him.

[Mr Hunt]

I am most grateful for any encouragement I can get.

The NHS needs to change its culture to be much more open to whistleblowers. That is why we have banned gagging orders in contracts and funded a whistleblowing helpline and website, and why we are working with brave whistleblowers, such as Helene Donnelly from Mid Staffs, to reform the training of NHS clinicians to make it easier.

[Michael Fabricant]

I am grateful for that answer. About 10 years ago, two people, a nurse and a consultant surgeon from the same hospital, came to my surgery and showed me evidence of filth—mouse droppings—in even consulting rooms and the operating theatre. They were frightened to leave the documentation with me, because they thought they would be sacked if it was found that they were the whistleblowers. Will they now have the assurance that they could give me or others evidence without fear of retribution?

[Mr Hunt]

I hope so, but I want to be honest with the House. It takes time to change a culture, and that is the big change we have to make. Whistleblowers are now coming forward from Coventry, Cambridge, Ealing and all over the country. That is why I am afraid that I profoundly disagree with the shadow Health Secretary, who said that the lessons of the Francis report were about a local failure. This is about a systemic problem and we have to change it across the NHS.

[Charlotte Leslie (Bristol North West) (Con)]

Given there are so many emerging cases of whistleblowers—both current and historic—being treated with injustice, a precedent will not be set for accountability until these injustices are actually faced. Will the Secretary of State set up a truth and reconciliation committee to look at historic and current cases so that accountability becomes a reality?

[Mr Hunt]

First, I commend my hon. Friend for her campaigning on this issue in the House and on the Health Committee. We have not done everything we need to do to change the culture within the NHS, and we are looking at what more needs to be done to get a culture change profound enough to make it easier for people to speak out. This is not just about whistleblowing. If it is whistleblowing, we have failed because it means that someone has had to go to the press or outside their organisation when they were worried. We need an NHS where people within their own organisation are listened to when they have concerns, and we are looking at what we need to do to take that forward.

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[Mr John Baron (Basildon and Billericay) (Con)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Almost a year ago, following the Keogh report, we put 11 NHS trusts into special measures, the first time such a large number of trusts have been put into special measures. Yesterday I was pleased to report to the House that the first trust, Basildon, has come out of special measures. I am pleased to tell the House today that across all the trusts in special measures, an additional 1,202 nurses and an additional 118 doctors have been recruited. The programme is making good progress, and the whole House will want to commend the efforts of all the staff in those hospitals on the tremendous efforts they are making.

[Mr Baron]

I join the Secretary of State in commending the management and all the staff of Basildon hospital for their excellent work and a great team effort. The hospital is now no doubt on an upward trajectory. I should like to raise with him the matter of the human papilloma virus vaccination programme for young women. It has been a success, and there is mounting evidence that is should be extended to young men. Will the Government now look into the feasibility of doing that?

[Mr Hunt]

My hon. Friend is right, and I am grateful to him for mentioning how proud we are of the HPV vaccination programme for girls and women. It is one of the best in the world, and we are getting an 86% take-up rate among eligible 12 to 13-year-old girls. He is also right to say that we now need to look at whether the programme should be extended to men and boys. A decision was taken at the time that it did not need to be, but we are now reviewing that decision. We will shortly be getting advice from the Joint Committee on Vaccination and Immunisation—which, as he will know, gives us independent advice on these matters—and we will take its advice seriously.

[Andy Burnham (Leigh) (Lab)]

I am sure that, like me, the Secretary of State will have been shocked to the core by the serious case review into the Orchid View care home. It spoke of institutionalised abuse and of residents dying of sheer neglect. This is just the latest case of appalling abuse in care homes, following that of Winterbourne View and the recent “Panorama” programme on Oban House. People are asking how many more times we must see abuse of this kind in our care homes before we take decisive action to stop it. Will the Secretary of State give serious consideration to the central finding of yesterday’s review, which was that the same principles of patient safety that apply in the NHS should now be applied to the care home sector?

[Mr Hunt]

I thank the right hon. Gentleman for that question. He is absolutely right to suggest that the lessons of Francis need to be applied to the care home sector, to general practice and to all out-of-hospital care every bit as much as they are applied to NHS hospitals. That is why we have legislated in the Care Act 2014 not only for a chief inspector of general practice but for a chief inspector of adult social care, Andrea Sutcliffe, who has made an excellent start. She is going around all the care homes, and she is bringing back the rigorous Ofsted-style analysis that was unfortunately taken away by the last Government. That will mean that we have proper transparency in standards. Going back to an earlier question from my hon. Friend the Member for Lichfield (Michael Fabricant), we also need to do more to help whistleblowers working in care homes. Because there are so many care homes, we cannot depend solely on the inspectors to get this right. We have also introduced the ability to prosecute offenders, which did not exist before.

[Mr Nigel Evans (Ribble Valley) (Con)]

T3. The fears of the people of the Ribble valley that the old Clitheroe hospital would be closed and not replaced were allayed when the new hospital was built. It recently opened with 32 in-patient beds, radiology, diagnostics and other facilities. Will the Secretary of State come to Clitheroe to have a look at this brand-spanking-new hospital, which is being welcomed by the local community, and to say thank you to the staff there for all they do? If he does so, I promise to take him for a pint of healthy real ale afterwards in the Campaign for Real Ale pub of the year in Pendleton in the Ribble valley, to celebrate the opening of the new hospital.

[Mr Speaker]

What a generous fellow the hon. Gentleman is!

[Mr Hunt]

Well, I must say that that sounds like a pretty irresistible offer, and I will give it careful consideration. Local community hospitals have an important role to play in our NHS because of the high standard of compassionate care that they deliver, and because they are easy for relatives to get to. I am delighted to see my hon. Friend campaigning for his local hospital, and delighted that it is doing so well.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

T2. A Birmingham trust has recently announced that it will be possible to cut 1,000 beds across the city by setting a maximum stay of seven days for most patients. Not surprisingly, this has caused some alarm. Are Ministers aware of that proposal? What guidance, if any, can they offer in regard to such proposals?

[Jesse Norman (Hereford and South Herefordshire) (Con)]

T5. Like other rural communities, Herefordshire has long suffered from chronic underfunding in health care. Does the Secretary of State share my view that setting clinical commissioning group allocations should be an evidence-based process that takes into account factors including sparsity and old age? Also, will he ignore the calls from the shadow Health Secretary, who was seeking to cut the previous NHS allocations in areas such as Herefordshire?

[Mr Jeremy Hunt]

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

[Alex Cunningham (Stockton North) (Lab)]

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

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[Mr Andy Slaughter (Hammersmith) (Lab)]

T10. Last October the Secretary of State said that Hammersmith accident and emergency would be closed when it was safe to do so. Imperial proposes to close it on 10 September, when on its own admission there is insufficient capacity at St Mary’s and it is not safe to do so. Will he keep his promise and ensure that Hammersmith A and E does not close, especially when there is not sufficient capacity in the system?

[Mr Jeremy Hunt]

I keep my promises, but may I point out to the hon. Gentleman that the way in which he has campaigned on those issues has been totally irresponsible? He put out leaflets in the local election campaign saying that Charing Cross hospital would be demolished. He failed to mention that it was going to be rebuilt as a brand-new hospital with an A and E department. I hope that he will not be invited to it when it is reopened unless he apologises to his constituents for the way he has presented this issue.

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[David Rutley (Macclesfield) (Con)]

T8. Following the recent speech by the new NHS England chief executive Simon Stevens about the important role of local hospitals, can my right hon. Friend confirm that district general hospitals such as Macclesfield will continue to play a vital role in delivering local health services in the years to come?

[Mr Jeremy Hunt]

I can confirm that. What my hon. Friend said was profoundly important. There is not an automatic link between size and quality. We know that for certain types of treatment, there is huge benefit in centralising services, as has happened for stroke services in London, but other services can be delivered extremely well at smaller units, and we will continue to support those.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The Minister has just talked rather piously about spending NHS money on front-line services, but the NHS is spending £300,000 on a university secondment for a staff member who has left. How does he justify that sort of abuse?

[Mr Hunt]

I just point out to the hon. Lady that in the Queen’s Speech we made it clear that we are cracking down on inappropriate payments to people who leave the NHS, many of which are the result of contracts set up by her Government.

[Ian Swales (Redcar) (LD)]

T9. My constituent, Beth Charlton, recently lost her father to pancreatic cancer and notes that patients have only a 3% chance of surviving five years. That is much lower than the survival rates for other cancers and has not improved in 40 years. Will the Minister invest more in early detection and diagnosis of this silent killer?

[Mr Dennis Skinner (Bolsover) (Lab)]

In the last hour I have heard the Secretary of State and his Ministers complain about the problems with A and Es; I have heard them talk about the problems with GPs; now we hear that they have lost control of care of the elderly. Instead of continuing to blame the last Labour Government of four years ago, why does the right hon. Gentleman not admit that the NHS is not safe in his hands? Let us have an election and get a Labour Government.

[Mr Jeremy Hunt]

Because we are making the NHS safe. We are taking action to deal with the issues that the hon. Gentleman’s Government swept under the carpet. The NHS is getting safer and more compassionate. It is delivering more care to more people than ever happened under the Labour Government. We are proud of our record on the NHS, and we will not make the NHS better by pretending that problems do not exist when they do.

[Sir Andrew Stunell (Hazel Grove) (LD)]

Stockport Mind reports that it takes on average 12 months to receive the first appointment for cognitive behavioural therapy after diagnosis. What action can be taken to improve that standard in Greater Manchester?

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[Charlotte Leslie (Bristol North West) (Con)]

As he heralds an era of transparency, can the Secretary of State update us on what steps he has taken to ensure that private providers in the NHS are every bit as transparent and accountable as public ones?

[Mr Jeremy Hunt]

I think they absolutely should be, and the changes that we introduced in the Care Act 2014 relating to the transparency of the inspection regimes apply to private providers supplying services to the NHS just as they do to NHS providers. Let us be absolutely clear: poor care is poor, whether it happens in the public sector or the private sector, and we must clamp down on it wherever it happens.

[Bill Esterson (Sefton Central) (Lab)]

The Minister said that he was dealing with the chronic shortage of staff who help vulnerable children and young people, who cannot get access to mental health services. Will he tell us when there will be enough staff delivering those services to that important group?