Urgent and Emergency Care Review
Jeremy Hunt Excerpts(12 years, 11 months ago)
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Andy Burnham (Leigh) (Lab)
(Urgent Question): To ask the Secretary of State for Health if he will update the House on Professor Sir Bruce Keogh’s urgent and emergency care review following this morning’s briefing to the media.
The Secretary of State for Health (Mr Jeremy Hunt)
In January this year, the board of NHS England launched a review of urgent and emergency care in England. Urgent and emergency care covers a range of areas, including accident and emergency departments, NHS 111 centres and other emergency telephone services, ambulances, minor injury units, and urgent care centres. The review is being led by Professor Sir Bruce Keogh, NHS England’s medical director. A report on phase 1 of the review is being published tomorrow, and it is embargoed until then. [Interruption.] This is an NHS England report, and NHS England is an independent body, accountable to me through the mandate. The report that will be published tomorrow is a preliminary one, setting out initial thinking. [Interruption.]
Mr Speaker
Order. There are highly charged feelings on this matter, but the Secretary of State has been asked a question, and his reply must be heard.
Mr Hunt
I should underline the fact that this morning’s briefing was under embargo, an embargo which, to my knowledge, has been respected. The final version will be published in the new year.
Sir Bruce has said that he will outline initial proposals and recommendations for the future of urgent and emergency care services in England, which have been informed by an engagement exercise that took place between June and August this year. There will be further consultation on the proposals through a number of channels, including commissioning guidance and demonstrator sites. Another progress report will be produced in the spring of 2014.
Decisions on changing services are made at a local level by commissioners and providers, in consultation with all interested parties. That is exactly as it should be, as only then can the system be responsive to local needs. It is vital to ensure that both urgent and emergency care and the wider health and care system remain sustainable and readily understandable to patients. A and E performance levels have largely been maintained, thanks to the expertise and dedication of NHS staff. A and E departments see 95% of patients within four hours, and the figure has not dropped below the 95% target since the end of April. However, urgent and emergency care is falling behind the public’s needs and expectations.
The number of people going to A and E departments has risen historically, not least because of an ageing population. A million more people are coming through the doors than in 2010. Winter inevitably challenges the system further, which is why we are supporting the most under-pressure A and Es with an additional £250 million. Planning has started earlier than ever this year, and the NHS has been extremely focused on preparing for additional pressure.
We will look at Sir Bruce’s report extremely carefully. Reform of the urgent and emergency care system may take years to complete, but that does not mean that it is not achievable. We are exceptionally fortunate in this country to have in the NHS one of the world’s great institutions. NHS staff are working tirelessly to ensure that the care that people need will continue to be available to them, wherever and whenever they need it.
Andy Burnham
Rarely has this House been treated to a more disrespectful and complacent reply. There are new reports today of 12,000 patients spending 12 hours or more on trolleys in A and E. A and E is in crisis according to the College of Emergency Medicine, and this is before the winter has even started. People are increasingly asking, “Where are the Government and what are they doing about it?” So far all they have heard is, “Crisis? What crisis?” But behind the scenes it is a different story. Such is the panic in Whitehall, the Prime Minister has apparently taken personal charge and this morning the media were given a private briefing on a major review of emergency care. What is going on and why is the Secretary of State running scared, blaming NHS England and trying to keep this House in the dark? It should not be for us to drag the Secretary of State here to give Members information already passed to journalists.
Let me remind the House what the Secretary of State said at Health questions in July. He said that Bruce Keogh’s review
“will report this autumn, precisely so that we can make sure we learn any lessons we need to learn for this winter”.—[Official Report, 13 July 2013; Vol. 566, c. 902.]
To hear him now, it was all about the long term. Let me ask him: what are those lessons, and what immediate action is he now taking ahead of winter?
Weekend briefings suggested Sir Bruce emphasises alternatives to A and E, such as walk-in centres and 111, but Monitor reported yesterday that one in four walk-in centres have been closed and others are today under threat of closure. We need a clear answer. Will the Secretary of State stop further closures of walk-in centres? Does he now accept that his 111 helpline is flawed, and will he put nurses back on the end of the phone, rather than call handlers? And what of the recruitment crisis in A and E? There is a shortage of senior A and E doctors and, according to the Royal College of Nursing, 20,000 too few nurses. Will the Secretary of State give a clear commitment to bring all A and Es back up to safe staffing levels?
Last week, a complacent Prime Minister stood there, told us everything was fine, and even claimed that the average waiting time in A and E had gone down to 50 minutes, but that is not true. I have here a written reply from the public health Minister telling us it has gone up to over two and half hours. When are the Government going to show this House and the country some respect, cut the spin, and give us the real picture about a crisis that is happening right now?
Mr Hunt
Mr Speaker, I will tell the right hon. Gentleman what complacency is: it is refusing to have a public inquiry into Mid Staffs, where staff in A and E departments were bullied and harassed when they tried to speak out. He did not think it was worth having a public inquiry into the poor care that his Government swept under the carpet and which we are doing something about. There is one figure that he refused to mention: the A and E performance figures published last week of 96.4%—hitting the target, higher than the previous week, higher than this time last year. That sums it up: in a good week he wants to run down the performance of hard-working staff whereas this Government are backing them.
Why are we having an A and E review? It is to clear up the mess and confusion caused by 13 years of Labour mismanagement of our emergency services. The right hon. Gentleman talks about walk-in centres. Why were they introduced? Because of the disastrous mistake over the GP contract. The brave thing for his Government to have done would have been to admit they got that wrong and reverse it, but they did not. They introduced a whole new raft of services, which confused the public: A and E, walk-in centres, GP surgeries, telephone helplines. Tomorrow we will sort out those problems. Yes there are difficult decisions, but they are decisions his Government ducked and left the public exposed as a result.
Before the right hon. Gentleman runs down our A and E services, let me just gently remind him that he talked about a recruitment crisis, but we have 300 more A and E consultants than when he was Health Secretary, we have nearly 2,000 more people—[Interruption.] I am sorry that this is difficult for those on the Opposition Front Bench to listen to. We have nearly 2,000 more people being seen within four hours every single day than when the right hon. Gentleman was Health Secretary —that is some 700,000 more people every year. We have more hospital doctors, more hospital nurses, more treatments and fewer long waits than when he was Health Secretary, and he should celebrate that improvement in our NHS’s performance, instead of trying to run down the people on the front line.
I will tell the right hon. Gentleman something else we are doing. We are tackling the long-term causes of pressure in A and E that his Government absolutely failed to do: not just the GP contract but also the integration of the health and social care system, the lack of which means that hospitals are not able to discharge people from their beds on time, causing huge pressure. Today, the shadow Health Secretary has shown his true colours. The man whose Government made so many wrong decisions about A and E is exposed as trying to make political capital while this Government sort out his mess.
David Tredinnick (Bosworth) (Con)
How many extra lives does my right hon. Friend expect to save through consolidating the A and E facilities in London, by having a smaller number of hospitals with more doctors? Does he expect to replicate that across England?
Mr Hunt
My hon. Friend is absolutely right. The changes we announced in north-west London will save hundreds of lives, by using principles that we will hear more of from Sir Bruce tomorrow. In particular, we are putting 800 extra people into out-of-hospital care, which will help the frail elderly, many of whom should never go to A and E—it is the most confusing place that someone with advanced dementia can go. If we can treat them at home, it is better for them and for our hard-working A and E departments.
Mr Ben Bradshaw (Exeter) (Lab)
May I assure the Secretary of State that the people of Exeter are not confused about their walk-in centres, but appreciate them and have been using them in ever-increasing numbers? These centres are now under threat, so will he at least admit that closing NHS walk-in centres and scrapping Labour’s GP access targets has been a dreadful mistake?
Mr Hunt
Perhaps the right hon. Gentleman might like to hear what the British Medical Association said yesterday about walk-in centres. The BMA is not known for its support of Government policies, but it said that urgent care centres
“were often opened in places with little patient demand…The result has been a lot of money being spent on these facilities with some now closing because commissioners have found there is not sufficient demand”.
That is the problem we are sorting out.
Paul Burstow (Sutton and Cheam) (LD)
One long-term cause of pressures in our A and E departments is the lack of parity of esteem between physical and mental health. Does the Secretary of State agree that it is unacceptable that two thirds of people experiencing a mental health crisis do not get access within four hours to a psychiatric assessment? Was it not a failure of the previous Government not to set access standards for people with mental health problems? Is it not time, as the mandate does today, to deliver just that?
Mr Hunt
My right hon. Friend is absolutely right about that. We do need parity of esteem between mental and physical health. The situation puts particular pressure on A and E departments, including the one closest to this House, at St Thomas’s hospital, where people said that the biggest single worry they have and the biggest single thing that makes it difficult for them to meet their targets is the lack of quick access to psychiatric services. We are looking at this matter and he is right to highlight it.
Mr Kevin Barron (Rother Valley) (Lab)
The Minister said that changes taking place in urgent and emergency care are done locally for local need. What does he think of the following statement made by Sir David Nicholson last week before the Select Committee on Health? He said:
“We are bogged down in a morass of competition law…we have competition lawyers all over the place telling us what to do, which is causing enormous difficulty.”
Does the Secretary of State not agree that the Government were warned about that when they brought in the Health and Social Care Act 2012? They were told that competition law was going to create chaos in the NHS, and it is doing exactly that.
Mr Henry Bellingham (North West Norfolk) (Con)
Is the Secretary of State aware that hospitals in Norfolk have recently made it clear to MPs that one of the key drivers of a big increase in people going to A and E is the fact that many people are not going to their doctor? Does he agree that it is essential that the GP contract of 2004 is rewritten so that doctors provide that 24/7 cover? When will he be able to sit down with the BMA and make real progress to right a serious mistake that the Opposition made?
Mr Hunt
My hon. Friend speaks wisely. The most senior A and E doctor in the country, Professor Keith Willett, said that he thought that between 15% and 30% of the people attending A and E could be looked after in the community. This is a root cause of pressure. I am afraid that the Labour party needs to show some humility before it starts whipping up public concern about problems that it had a very big part in making. I am in the process of discussions with the BMA, and I hope my hon. Friend will not have to wait too long for some good news.
Glenda Jackson (Hampstead and Kilburn) (Lab)
Will the Keogh review genuinely examine the lack of parity in respect of those who are physically ill and those who are mentally ill? We are already suffering from a crisis in emergency mental health beds in London and we are seeing an increasing use of A and E departments for those who are mentally ill. Surely we should be looking at an increase in walk-in centres for the mentally ill, which have proven to be remarkably effective in helping those on the brink of a serious fall.
Mr Hunt
The hon. Lady is absolutely right that the urgent emergency care we offer to people with mental health problems is not up to scratch and needs to be a great deal better. Different solutions will be appropriate in different parts of the country, but often going to a normal A and E is not the right approach. We need to consider whether, when people have such conditions, there can be better access to people who know them, their medical history and their condition and who are in a position to advise them in a way that means they do not end up doing what I have seen happening time and again in A and Es, where people end up as frequent fliers, going again and again to an A and E just because there is nowhere else to go. That is one thing that we are trying to sort out tomorrow.
David Rutley (Macclesfield) (Con)
We have heard a lot today about NHS A and E services in England. Will my right hon. Friend tell the House whether there are any lessons to be learned from A and E services in Labour-run Wales?
Mr Dennis Skinner (Bolsover) (Lab)
This Government have been in power for three and a half years. They could have chosen to remedy some of the continuing problems in the health service, but what did they do? They decided to reorganise it from top to bottom. Is there any wonder there is a crisis this winter? Instead of closing A and Es and walk-in centres, why does the Secretary of State not walk away? It would give him more time to count his money.
Mr Hunt
Let me tell the hon. Gentleman that thanks to the reorganisation that he is so bitterly against, we have 5,500 more doctors on the front line and 8,000 fewer managers. We would not be managing to hit our A and E target today if we had not taken the difficult decisions that the Leader of the House took when he was doing my job.
Glyn Davies (Montgomeryshire) (Con)
Geography dictates that my Montgomeryshire constituents depend on A and E services in hospitals in England. Will my right hon. Friend reassure us that devolution will not be allowed to create a health care iron curtain between England and Wales, and will he ensure that decisions on A and E services in Shropshire take account of the interests of my constituents?
Heidi Alexander (Lewisham East) (Lab)
On repeated occasions in this place, the Health Secretary has claimed to be saving A and Es when his proposals would remove intensive care units in many hospitals and allow blue-light ambulances to go sailing past their doors. Will the Health Secretary tell me what his definition of an A and E is?
Mr Speaker
Order. I can scarcely hear the Secretary of State’s answers, and I want to hear them. Let us hear the response.
Mr Hunt
Thank you, Mr Speaker.
The hon. Member for Lewisham East (Heidi Alexander) will know that her constituents have some of the best stroke survival rates in England because we reduced the number of hospitals in London offering stroke services from 32 to eight. I am not going to stand in the way of those changes if they save lives.
Jeremy Lefroy (Stafford) (Con)
I very much look forward to the review, which is urgent. Given that accident and emergency departments do not operate in isolation, will the Secretary of State assure me that the review will consider the whole system, including support services, critical care units and the availability of specialist consultants—particularly those in paediatrics—who need to be available for an A and E to function effectively?
Mr Hunt
No one has campaigned more assiduously than my hon. Friend for his local hospital, despite the incredible tragedies and difficulties that it has been through and the pressures that has created for the people of Stafford. He is absolutely right: if we are going to solve the problem, we must consider the system holistically and consider how different A and E departments can specialise services. We need much more of a hub-and-spoke system, rather than one where every A and E has to offer exactly the same menu of services. If we do that, we will save more lives and that has to be the right thing to do.
Mr Pat McFadden (Wolverhampton South East) (Lab)
Following Monitor’s report yesterday on the closure of walk-in centres, is it not the case that at the heart of the Government’s NHS reforms is a massive shift in power from the consumers—the patients—to the producers of services? When the Government’s slogan is, in effect, “All power to the producers”, it is not surprising that services have been reorganised in a way that does not benefit patients. May I suggest that instead of sticking up for the BMA, the Secretary of State starts to stick up for patients?
Mr Hunt
After what happened at Mid Staffs, we will not take any lessons on sticking up for patients—none whatsoever. We are taking the power out of the hands of the managers in PCTs and SHAs and putting it into the hands of doctors on the front line who are seeing patients every day. That is the best thing we can possibly do.
Bob Stewart (Beckenham) (Con)
My constituents tell me that they much prefer to go to their doctor than to any other centre. Will the Secretary of State try to get more doctors involved in out-of-hours care?
Mr Hunt
That is the tragedy of what happened in 2004, when the personal link between doctor and patient was broken because the previous Government abolished named GPs for every patient. My hon. Friend speaks very wisely, as that is exactly what most members of the public want—they want to be able to get in and see their own GP quickly and easily. That is at the heart of the problem that tomorrow’s review of A and E will seek to address.
Caroline Lucas (Brighton, Pavilion) (Green)
Notwithstanding the brilliant local work of nurses and doctors, hospitals like those in the Brighton and Sussex University Hospitals NHS Trust face real challenges, including bed shortages and people having to wait for many hours for tests such as X-rays and so on. Sometimes, people wait in A and E for 12 hours for a bed. Does that not demonstrate how reckless and dangerous it is for the Secretary of State’s Department to impose cuts of £30 million on that hospital trust this year and next year, and will he reconsider?
Mr Hunt
Let me gently remind the hon. Lady that we have protected the NHS budget—we took a very difficult decision—but how the NHS budget is spent in local areas is a matter for local discretion. It is challenging for all hospitals, because if we are to address the long-term stability of the NHS we need to spend more money out of hospitals, which means finding efficiency savings in hospitals. We do not want to duck those challenges, which is why we are having the review that will be published tomorrow.
Angie Bray (Ealing Central and Acton) (Con)
My right hon. Friend will be aware that there are concerns about whether blue-light ambulance services will continue to define what an A and E is. Does he agree that for some years now victims of stroke, trauma and other serious problems have not necessarily gone to their local A and E but to specialist hospitals, and that that has been the reason behind the excellent improvement in outcomes?
Mr Hunt
My hon. Friend speaks extremely wisely. We have talked about stroke, so let me give another example, which is trauma. We have cut mortality rates by 20% as the result of a strategy to specialise trauma care. Those are the difficult decisions that the Government believe that we should not duck and that we need to face up to. If I may say so, when the Opposition were in power, they took a slightly wiser approach to the issue than the party political posturing we are getting today.
Graham Jones (Hyndburn) (Lab)
The Secretary of State earlier quoted the suggestion that GP walk-in centres were in the wrong places, where there was little demand. Last year, 33,000 people used the under-threat Accrington Victoria hospital walk-in centre, and now there is deep anger with the Conservative party. Will he explain how 36,000 people going to overstretched Royal Blackburn hospital A and E will help the situation there?
Mr Hunt
The hon. Gentleman makes my point for me extremely eloquently. Under the previous Government, we had a top-down, ham-fisted policy of opening walk-in centres everywhere as a sticking plaster solution to the disasters with their GP contract. Sometimes they were valuable services, sometimes they were not. We are clearing up the mess, but sometimes, when those centres are useful and important for the public, we will keep them.
Martin Horwood (Cheltenham) (LD)
The origins of the recruitment crisis in A and E obviously predate this Government. Will Sir Bruce Keogh’s review highlight the local trusts, like that in Gloucestershire, which appear to have significantly worse recruitment and retention records than neighbouring trusts and have used it as a rationale for downgrading services—such as, in this case, those at Cheltenham general hospital?
Mr Hunt
I hope that it will. I hope that it will give clarity about the long-term future for A and E departments, which has been a difficult issue for this Government and for the previous Government. What people want is stability, and they want to know that there is a Government who are prepared to face up to difficult decisions. They want to know that they have a future, and I hope that tomorrow’s review is the first step towards providing that security.
Mr Khalid Mahmood (Birmingham, Perry Barr) (Lab)
Is the Secretary of State aware that the A and E crisis is creating a huge backlog in specialist procedures, and will Sir Bruce Keogh’s review take that into account?
Mr Hunt
The number of people waiting more than a year for an operation has gone down from 18,000, when the hon. Gentleman’s Government were in power, to fewer than 1,000 now. We have reduced long waits at a time of great pressure on the NHS, so I do not recognise the hon. Gentleman’s figures at all, I am afraid.
Mr Lee Scott (Ilford North) (Con)
My right hon. Friend will have seen the disastrous reports that have come in about Barking, Havering and Redbridge University Hospitals NHS Trust, with some of the most alarming things including a report of a baby being put in a stationery cupboard. I am sure that, as he said in a recent debate, he will conduct a full review of King George hospital. Can that be done urgently, as we are now in a very serious situation?
Mr Hunt
I pay tribute to my hon. Friend for raising both publicly and privately his concerns about the hospital provision that his constituents face. We shall of course make sure that there is a proper review before any service changes are made. I hope that he will be reassured by the big change that happened this year with the introduction of an independent chief inspector of hospitals, who is going round the country rooting out poor care, not sweeping it under the carpet, as happened so often under the Labour Government.
Derek Twigg (Halton) (Lab)
Does the Secretary of State regret the loss of 6,000 nursing jobs since the last election?
Mr Philip Hollobone (Kettering) (Con)
The three Members for north Northamptonshire— the hon. Member for Corby (Andy Sawford), my hon. Friend the Member for Wellingborough (Mr Bone) and I—have come together on a cross-party basis, and are working with local clinical commissioning groups and Kettering general hospital to try to attract more investment to our local A and E because of the increase in the local population. May I share with the Secretary of State the fact that all agree that up to a third of attendees at A and E could be better treated closer to home, particularly in excellent urgent care centres such as that in Corby?
Mr Hunt
My hon. Friend speaks extremely wisely. He invited me to visit Kettering hospital, and I saw for myself that it was a very, very busy hospital. In the end, if we just stick with the current model we will reach bursting point, which is why we need to look at new models. That is why tomorrow’s review is important, and part of that—in fact, the bulk of the work in tomorrow’s review—is about how we transform out-of-hospital care, which is the big strategic change that we need to make in our NHS, and on which I am afraid the previous Government made so little progress.
Nic Dakin (Scunthorpe) (Lab)
Tomorrow’s review is supposed to deal with issues to do with this winter. Will the Secretary of State give the House an assurance that there will be no crisis of A and E on his watch this winter?
Mr Hunt
A and E departments are under huge pressure. We are seeing about 1 million more people every year than three years ago, and we have done more this year than has ever been done in NHS history to help to prepare the NHS for winter, including giving £250 million to 53 local health economies where the pressures are greatest. We continue to monitor the situation very, very closely to give more support where we can.
Alex Cunningham (Stockton North) (Lab)
The crisis in nurse vacancies and recruitment highlighted today by the Royal College of Nursing affects the North Tees and Hartlepool NHS Foundation Trust, which tells me that it has been forced to recruit trained nurses from the Philippines, as there are insufficient UK nurses available. What is the Secretary of State doing to address that particular part of his failure?
Mr Hunt
I have to gently say to the hon. Gentleman that recruiting nurses from the Philippines did not happen for the first time under this Government. One reason why those nurse vacancies have gone up is that the Government decided to conduct a public inquiry into what happened at Mid Staffs. The system reacts to that by wanting to hire more nurses, and I think that he should welcome that, not criticise it.
Barbara Keeley (Worsley and Eccles South) (Lab)
The report by the Health Select Committee on the A and E crisis found that only 16% of hospitals had the right level of consultant cover in A and E. Yesterday, we learned that half the vacancies for senior A and E doctors are unfilled, as doctors move to work overseas. The issue of staffing in A and E has been understood for the past three and half years, and there have been repeated warnings and reports. What has the Secretary of State done to address it and make sure that A and E wards have sufficient staff cover?
Jenny Chapman (Darlington) (Lab)
What has the Secretary of State got to say about the fact that in my area, compared with four years ago, it is harder to get a GP appointment. We no longer have NHS Direct, and cuts in adult social care mean that patients are not making room for other patients to go to A and E. The person raising that with me is the chief superintendant of Darlington police, who is fed up with his officers being held up by taking patients to A and E, as those patients would otherwise wait more than an hour for an ambulance?
Mr Hunt
The hon. Lady makes some important points, and I congratulate her on being the first Opposition Member to raise the fact that it has become harder and harder to get an appointment with a GP. [Interruption.] I know that it is hard to accept, but it is a fundamental problem, and a challenge facing our A and E departments that the Government are determined to sort out.
Jim Shannon (Strangford) (DUP)
Before tomorrow’s report on the urgent and emergency care review, may I tell the House that in Northern Ireland, we treat urgent referrals by direction to the doctor on call and linking up with the chemist. Emergency referrals are done through hospitals, showing good practice and delivery. Is the Secretary of State prepared to contact the Northern Ireland Assembly and the Minister responsible to see how best practice works?
Mr Hunt
I am in regular contact with the Northern Ireland Minister for Health, Social Services and Public Safety about good practice in Northern Ireland, and I am delighted to hear that they are doing some good things in urgent and emergency care. We should be open to all good practice, not just in our country but all over the world.
Mr Andy Slaughter (Hammersmith) (Lab)
The Secretary of State may have seen the report in The Sunday Times at the weekend about the dispute between the medical director for London, who said that 20% to 30% of blue-light A and Es should close, and Sir Bruce Keogh, who said that less than that should close. Disgracefully, the Secretary of State has not told us what is in Sir Bruce Keogh’s report, but we know that it is below that figure, so why did he announce to the House two weeks ago that four out of nine—45%—of blue-light A and Es in west London would close, pre-empting the Keogh review?
Mr Hunt
Because it is going to save the lives of the hon. Gentleman’s constituents; it will mean that 800 more people are employed in out-of-hospital care; it will mean three brand-new hospitals for the benefit of his constituents; it will mean seven-day working; and it will mean seven-day opening of GP surgeries. That is why.
Kevin Brennan (Cardiff West) (Lab)
On reflection, does the Secretary of State regret the fact that he described people who felt ill enough to have to go to A and E on a number of occasions as “frequent flyers”? And would he like to apologise?
Mr Hunt
I am sorry, that is a completely ridiculous thing to say. I was using the phrase to talk about people who have to go back to the NHS time and again. The whole purpose of the reforms is to make sure that we give a better service to people who regularly use the NHS, and he should understand perfectly well what I was talking about.
Paul Goggins (Wythenshawe and Sale East) (Lab)
What discussions has the Secretary of State had with his colleagues across government about the need for urgent additional investment in social care? Surely he appreciates that the savage cuts to local authority social care budgets have only added to the pressure on accident and emergency units.
Mr Hunt
I find it a little difficult to take a lesson from the right hon. Gentleman, as his Government cut social care funding per head when they were in power and when the economy was in much better shape than it has been since the financial collapse that they caused. If he looks at what we announced this summer, he will know that the Chancellor announced an extra £2 billion of support for the NHS budget going into social care to deal with precisely the problems that he raised.
Mr Virendra Sharma (Ealing, Southall) (Lab)
Last week, the Secretary of State assured—[Interruption.]
Mr Sharma
Last week the Secretary of State assured me that A and E at Ealing hospital is safe, but since then we have heard very confusing and contradictory statements in the local area. First, will the Secretary of State reassure us today that the A and E department at Ealing hospital is safe in the future? Secondly, will he meet me and my colleagues from the west London area—I have written to him—to discuss our concerns and so that we can express our feelings?
Mr Hunt
I am always happy to meet colleagues if they have concerns about what is happening in their constituency, but I absolutely stand by what I said. There will remain an A and E at Ealing. That was the decision that I made because I wanted to give clarity, but I also said that the shape and size of that A and E may change in accordance with the announcement that is being made tomorrow by Sir Bruce Keogh. I hope that will give the hon. Gentleman further clarity and further certainty to reassure his constituents.
Bill Esterson (Sefton Central) (Lab)
The Secretary of State has already acknowledged that keeping people in their own home is one important way to relieve the pressure on A and E. I do not understand why, if he wants to make a real difference, he will not reinvest the NHS underspend to make up for the cuts in local government and put it into social care.
Mr Hunt
We have put in an additional £2 billion—that makes a total of £3.8 billion being invested to support the social care budget. That is significant because it is recurring expenditure. We have shown our commitment by continuing to support the social care system through this Parliament. The trouble with underspends is that they depend on how many resources we have in any particular year. It is therefore much harder to invest off the back of them.
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
The Secretary of State has spoken about the importance of continuing care from one’s own GP to limit admissions to A and E, yet in Hackney, when GPs tried to take over and run the out-of-hours service, the commissioners were paralysed by the fear of legal challenge and, rather than putting patients’ interests first, put the rich lawyers’ interests first.
Steve Rotheram (Liverpool, Walton) (Lab)
This Secretary of State has been forced to answer more urgent questions in the House than even the Prime Minister about Mrs Bone. When will he stop blaming others about the mess he has made of our NHS, take some responsibility for the top-down reorganisation and get on with the job that he has been over-promoted to do?
Mr Hunt
Let me tell the hon. Gentleman how well the NHS is doing. If one listens to the rhetoric from the Opposition Benches, one could completely underestimate the hard work of people on the front line. There are 800,000 more operations being carried out every year in the NHS than ever happened under Labour. At the same time, long waits for operations have gone down. I think that is something to be proud of.
John Woodcock (Barrow and Furness) (Lab/Co-op)
The response that the public health Minister gave to my written question showed that ambulance response times have increased over the past two years in 11 out of 12 trusts in England. Why is this happening?
Mr Hunt
Just as there is more pressure on A and E departments, there is also more pressure on ambulance services. We are treating that as very much part of how we support accident and emergency services over the coming period. There are particular pressures in the London area, the east of England and the east midlands, and we are doing everything we can to put those problems right.
Helen Jones (Warrington North) (Lab)
The Secretary of State referred to the Chancellor’s recent announcement about money for social care, yet this is only a tiny fraction of what the Government have already taken out of the social care budget through their 30% cuts to councils. Did he not realise the impact that that would have on A and E, or did he just not care about it?
Mr Hunt
I am very conscious of the pressure that having to sort out Labour’s deficit is creating on all Government Departments, but the Opposition cannot have it both ways. They cannot say that they are in favour of fiscal responsibility and then complain about every single cut. The difficult decision that this Government took was to protect the NHS budget. That is something that the Opposition did not agree with. They wanted to cut the budget from its current levels.
NHS England (Mandate)
Jeremy Hunt Excerpts(12 years, 11 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Today the Government have laid before Parliament the refreshed mandate to NHS England for 2014-15. The refreshed mandate will come into effect from 1 April 2014 and was developed following public consultation which ran from 5 July to 27 September.
The mandate sets an ambitious agenda to transform patient care and we expect NHS England to demonstrate significant progress against all the objectives by March 2015. To provide stability and enable the NHS to plan ahead, we have carried forward all existing 24 objectives. The Government have kept changes to an essential minimum to ensure the refreshed mandate remains strategic, outcomes-focused and affordable within NHS England’s budget, which is also set out in the mandate for 2014-15.
Where the Government have introduced changes, these focus on the priorities that will support the successful transformation of health and care services to meet the needs of an ageing population and the increasing prevalence of long-term physical and mental health conditions:
the vulnerable older people’s plan as a means for improving the health of the whole population and to provide excellent care for older people;
the addition of one new objective in relation to the system wide response to the Francis inquiry recommendations; and
taking forward actions to deliver a service that values mental and physical health equally.
The Government have included further ambitions on a limited number of areas to deliver the quality of care and treatment people need and expect. These areas are: reducing avoidable premature mortality; supporting people with dementia; improving patient experience—friends and family test; and making better use of resources.
The mandate also reflects the work being taken forward by NHS England to improve integrated care; addressing the failings witnessed at Winterbourne View private hospital; supporting a fair playing field for providers; improving outcomes for children and young people; and supporting innovation to improve patient care.
While the mandate sets out our vision over the long term, we also need to tackle immediate pressures. The Government previously announced their plans to handle pressures on A and E this winter and the allocation of £250 million funding to NHS England for distribution to the areas that need it most. The additional allocation requires an increase to the revenue budget for NHS England for 2013-14, and a revision to the current mandate will be laid before Parliament shortly reflecting this uplift in the budget only.
Alongside the mandate for 2014-15, we have published the Government’s response to the consultation and a refreshed version of the NHS outcomes framework 2014-15. Similar to the approach taken with the mandate, we have kept changes to the NHS outcomes framework to an essential minimum.
Copies of all these documents have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
Changes to Health Services in London
Jeremy Hunt Excerpts(12 years, 11 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
With permission, Mr Speaker, I would like to make a statement on the “Shaping a healthier future” programme, a locally led review of NHS services across north-west London.
The NHS is one of the greatest institutions in the world. Ensuring that it is sustainable and that it serves the best interests of patients sometimes means taking tough decisions. The population of north-west London is growing and will reach approximately 2.15 million by 2018. About 300,000 people have a long-term condition. However, there is great variation in the quality of acute care. In 2011, there was a 10% higher mortality rate at weekends for emergency admissions, and the number of hospital re-admissions differs considerably across the area. The Independent Reconfiguration Panel expressed concerns that the status quo in north-west London was neither sustainable nor desirable, and might not even be stable.
In order to address these challenges, the NHS in London started the “Shaping a healthier future” programme in 2009. It proposed significant changes to services, including centralising accident and emergency services at five rather than nine hospitals; 24/7 urgent care centres at all nine hospitals; 24/7 consultant cover in all obstetric wards; a brand new trauma hospital at St Mary’s hospital, Paddington; brand new custom-built local hospitals at Ealing and Charing Cross; seven-day access to GP surgeries throughout north-west London; the creation of over 800 additional posts to improve out-of-hospital care, including a named, accountable clinician for all vulnerable and elderly patients with fully integrated provision by the health and social care systems; and increased investment in mental health and psychiatric liaison services.
These changes represent the most ambitious plans to transform care put forward by any NHS local area to date. They are forward-thinking and address many of the most pressing issues facing the NHS, including seven-day working, improved hospital safety and proactive out-of-hospital and GP services. The improvements in emergency care alone should save about 130 lives per annum and the transformation in out-of-hospital care many more, giving north-west London probably the best out-of-hospital care anywhere in the country.
The plans are supported by all eight clinical commissioning groups, the medical directors of all nine local NHS trusts, and all local councils except Ealing. It was as a result of a referral to me by Ealing council on 19 March 2013 that I asked the Independent Reconfiguration Panel to conduct a full review.
The panel submitted its comprehensive report to me on 13 September 2013 and I have considered it in detail alongside the referral from Ealing. I am today placing a copy of the panel’s report in the Library, alongside the strong letters of support for the changes that I received from all local CCGs and medical directors. The panel says that “Shaping a healthier future” provides
“the way forward for the future and that the proposals for change will enable the provision of safe, sustainable and accessible services.”
Today I have accepted the panel’s advice in full and it will be published on the panel’s website.
The panel also says that while the changes to A and E at Central Middlesex and Hammersmith hospitals should be implemented as soon as practicable, further work is required before a final decision can be made about the range of services to be provided from the Ealing and Charing Cross hospital sites.
Because the process to date has already taken four years, causing considerable and understandable local concern, I have today decided it is time to end the uncertainty. Therefore, while I accept the need for further work, as the IRP suggests, I have decided that the outcome should be that Ealing and Charing Cross hospitals should continue to offer an A and E service, even if it is a different shape or size from that currently offered.
Any changes implemented as part of “Shaping a healthier future” should be implemented by local commissioners following proper public engagement and in line with the emerging principles of the Keogh review of accident and emergency services.
I have today written to the chair and vice-chair of the health and adult social services standing scrutiny panel of the London borough of Ealing council, the chair of the IRP Lord Bernie Ribeiro, the chief executive of NHS England and local MPs, informing them of my decision.
These much-needed changes will put patients at the centre of their local NHS, with more accessible, 24/7 front-line care at home, in GP surgeries, in hospitals and in the community. More money will be spent on front-line care, which focuses on the patient. Less will be wasted on duplication and under-performing services.
Let me be clear that, in the joint words of the medical directors at hospitals affected, there is a
“very high level of clinical support for this programme across NW London”.
Local services will be designed by clinicians and local residents and will be based on the specific needs of the population.
None of these changes will take place until NHS England is convinced that the necessary increases in capacity in north-west London’s hospitals and primary and community services have taken place.
I want to put on the record my thanks to the IRP for its thorough advice. As the medical directors of all the local hospitals concerned said in their letter to me, these changes will
“save many lives each year and significantly improve patients care and experience of the NHS.”
When local doctors tell me that that is the prize, I will not duck a difficult decision.
I commend this statement to the House.
Andy Burnham (Leigh) (Lab)
People at home will have listened carefully to what the Secretary of State has just said, and they will have one simple question in their mind: why is this man trying to close so many A and Es when we are in the middle of an A and E crisis? At least seven A and Es across the capital are under threat, at a time when all London A and Es are working flat out and are full to capacity. As we stand here, thousands of people are waiting to be seen, stuck on trolleys or held in the back of ambulances that are queuing outside A and E. When the A and Es we have are struggling to cope, how on earth can it be safe to close or downgrade so many?
That brings me to what I see as the major flaw in what the Secretary of State has announced. These plans have been in development for four years, as he said. Four years ago, A and E was not in the crisis that it faces today. The reality on the ground in London has changed. In 2013, A and Es in London have been getting worse and worse and worse. Across London, 200,000 people have waited in A and E for longer than four hours in the past 12 months. Here is the statistic that should make people stop and think: taking all its major A and E units together, London has missed the Government’s A and E target in 48 of the last 52 weeks.
Any further changes to this fragile and overburdened system must proceed with the utmost caution. Will the Secretary of State give me a categorical assurance that he personally gave in-depth consideration to the latest evidence of the pressure on London A and Es and to the changed reality that 2013 has brought before making his decision? I understand how tough such decisions are. Sometimes, difficult changes need to be made, as I found when I reorganised stroke services in London before the last election. When he does the right thing, based on a clear clinical case that lives will be saved, we will support him, as we did on children’s heart surgery. The problem with the closure programme, as managers admitted to Members of the House at the outset, is that it is primarily about saving money, not saving lives.
Even though the Secretary of State has made some minor concessions today, he is still performing pretty brutal surgery on west London’s NHS. It is the single biggest hospital closure programme the NHS has ever seen. Has he considered the impact of the changes on people in those communities who are on low incomes? They will face much greater costs and journey times in getting to hospital.
Will the Secretary of State be straight with us on the much-loved Charing Cross and Ealing hospitals? I listened carefully to what he said. What is the “further work” that he referred to? He spoke of their A and Es being of a different size and shape. Is that not spin for saying that the units will be downgraded and become urgent care centres? Alternatively, is he giving those units a permanent reprieve today? If he cannot answer those questions directly, local people in those areas will take what he has said as weasel words.
The Secretary of State said that there will be investment in communities before the changes go ahead. He said that to the hon. Member for Enfield North (Nick de Bois) in respect of Chase Farm hospital, but he is closing that unit next month. What guarantee do people have that he will follow through on this promise, when he broke the promise that he made to his hon. Friend?
The Secretary of State has made a statement on London health services. People will not have missed the fact that he has failed to mention Lewisham hospital and what happened at the Court of Appeal yesterday. Is that not a staggering omission? The victory that was won by the people of Lewisham will give hope to people who are disappointed by today’s announcement.
The humiliation of the Secretary of State in court again raises major questions about his judgment and his ability to manage such important decisions. In the summer, we explicitly warned him to accept the first court ruling. Instead, he ploughed on, throwing around taxpayers’ money in a cavalier fashion, to protect his pride and defend the indefensible. I have a simple question: how much has he spent on appealing that decision? When he decided to appeal, did the official legal advice from the Government recommend an appeal or did he overrule it? Will he confirm today to this House and to the people of Lewisham that there will be no further appeal against the court’s ruling? Will he give the people of Lewisham and the staff who work at Lewisham hospital a commitment that their A and E and maternity services will be protected? Finally, will he apologise to the people of Lewisham for the unnecessary distress and worry he has put them through?
It will not have escaped people’s notice that the Secretary of State is trying to put powers through the House quite soon to grab further powers for himself and drive through financial closures of A and Es without proper consultation, so that in effect he can do what he tried to do to Lewisham to every community in England. That will send a chill wind through those communities that fear to lose their A and Es, and that is why we will oppose those powers when they are considered by the House.
In conclusion, the Government have come a long way since the Prime Minister stood outside Chase Farm hospital days after the last general election and promised a moratorium on all hospital changes. Local people in west London will not have forgotten the Prime Minister standing outside Ealing and Central Middlesex hospitals and promising the same. People are seeing through a Prime Minister whose broken promises on the NHS are catching up with him. Has it ever been clearer than it is today that people simply cannot trust the Tories with the NHS?
Mr Hunt
I am afraid the right hon. Gentleman is sounding more and more desperate. Today the Government have taken a difficult decision that will improve services for patients. It was a moment for him to show that he understood the challenges facing the NHS, but that was not to be. He said that we should not proceed with the changes given winter pressures on A and Es, but he should read the document. The proposals are for more emergency care doctors, more critical care doctors, and more psychiatric liaison support that helps A and E departments, and they are supported by the medical directors of all nine trusts affected. He said that if evidence can be produced to show that the proposals will save lives, Labour will support them. What more evidence does he want? He should be shouting from the rooftops to support the proposals, but instead he is putting politics before patients.
The right hon. Gentleman mentioned A and E performance, and I am happy to tell him about that. On average a person now waits 50 minutes in A and E before they are seen; when he was Health Secretary it was 71 minutes. The number of patients seen in less than four hours every day is 57,000—nearly 2,000 more than when the right hon. Gentleman was Health Secretary. Our hospitals are performing extremely well under a great deal of pressure because we are taking difficult decisions of the kind that we are talking about today.
The right hon. Gentleman also talked about hospital closures. Again, he should read the proposals: a brand new trauma centre at St Mary’s hospital in Paddington; two brand new elective care centres at Ealing and Charing Cross; seven-day NHS care that will save lives; 24/7 obstetric care; 16 paediatric care centres. Those are big improvements in hospital care—[Interruption.] I will come on to Lewisham. I am acting to end uncertainty because I made the decision today that whatever the outcome of further discussions that the Independent Reconfiguration Panel recommends, there will remain an A and E at Ealing and Charing Cross. That is the best thing I can do for those residents.
The right hon. Gentleman mentioned Lewisham, but let us remember that the problem started because his Government saddled South London Healthcare NHS Trust with £150 million in private finance initiative costs. I judged that the right thing for patients was to sort out a problem that was diverting £1 million every week from the front line. Yes it is difficult, but I would rather lose a battle with the courts trying to do the right thing for patients than not try at all.
Finally, these are difficult decisions, but the party that really has NHS interests at heart is the one that is prepared to grip those decisions. We are gripping the problems in A and E, and in terms of hospital reconfigurations. That is why the NHS is safe in our hands and not safe in those of the Labour party.
Mr Stephen Dorrell (Charnwood) (Con)
Does my right hon. Friend agree that we tackle health inequalities, and improve health outcomes and access to accident and emergency departments, by facing up to the need to make difficult decisions to change the way care is delivered to keep it up to date? Does he further agree that today we have seen a Government who are prepared to face those challenges, and an Opposition spokesman who has demonstrated a determination to duck them? Who cares about the NHS?
Mr Hunt
I thank my right hon. Friend for that comment. He is right that this is about facing up to difficult decisions. One aspect of the proposals that is so exciting for people who want a transformation in services is that they involve employing 800 additional people for out-of-hospital care. The real way we will reduce pressure on A and E units is by ensuring that people, particularly the frail and elderly, are looked after better at home. That is what we must do. We must recognise that, fundamentally, the problems will not be solved by trying to pour in money in the way that it has always been poured in. We must rethink the model. This is a positive and ambitious programme. If the shadow Secretary of State were in my shoes, he would speak differently of the proposals, because they represent the way forward for the kind of integrated care he normally champions.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
Let me remind the Secretary of State that the High Court ruled that his actions in trying to remove services from Lewisham hospital to save a separate failing trust were illegal. He then lost the appeal. Will he now stop throwing good public money after bad, leave Lewisham hospital alone, and learn to respect the views of the people who work in our hospital and those who use its services?
Mr Hunt
I respect those views and the right hon. Lady for her campaigning. I understand why the people of Lewisham were unhappy about those changes but, as Health Secretary, I had to take a decision in the interests of all patients in south London. That was the first time the powers—the trust special administrator powers—were used. My interpretation was different from the courts, but I respect them as the final arbiter of what the law means. However, when we have to make difficult decisions about turning round failing hospitals—south London has some of the most serious problems in the country—it is important that the local NHS can take a wider health economy view of what changes are necessary. As I have said, I will respect what the Court has decided, but it is important that I continue to battle for the right thing for patients.
Nick de Bois (Enfield North) (Con)
The Secretary of State, his predecessor and the Prime Minister are well aware of my continued opposition to the decision to downgrade Chase Farm. However, today, will he join me in condemning the shadow Secretary of State, who has said that Chase Farm is closing? It is not closing. Against my wishes, there is a proposal to downgrade the A and E unit. The hypocrisy and politicking is worse because the previous Labour Government initiated the process and authorised the downgrade in the first place.
Mr Hunt
My hon. Friend speaks wisely. It is disappointing that we are not having a more intelligent debate. When Labour was in power, it closed or downgraded 12 A and E units in 13 years. The then Government realised that there were problems. He is right that they started the problem in Chase Farm. That is why, when we are facing such difficult decisions, it is important to have a responsible debate. I accept that MPs have views on their constituencies, but we have to start looking above the parapet to the wider interests of patients. That is a difficult thing to do, but I would have hoped for more leadership from the shadow Secretary of State, who used to be Health Secretary.
Mr Andy Slaughter (Hammersmith) (Lab)
The Secretary of State is destroying services in four great London hospitals, two of which are in my constituency, in the biggest closure programme in the history of the NHS. Why is he closing A and Es in two of the most deprived communities in London—Brent and White City—and why, rather than certainty, is he installing chaos into Ealing and Charing Cross hospitals? What is happening to the 500 beds at Charing Cross? What is happening to the best stroke unit in the country? What does he mean by A and Es that are different in size and shape? When will he answer those questions? This is a cheap political fix. How can anyone have confidence in the Secretary of State—
Mr Speaker
Order. We understand the general drift of the observations—[Interruption.] Order. I understand how strongly the hon. Gentleman feels, but he should really ask one question. The Secretary of State is a man of dexterity and no doubt will meet the hon. Gentleman’s needs as he sees fit.
Mr Hunt
Thank you, Mr Speaker. I will. The hon. Gentleman does no credit to himself or his party with such hyperbole. Let me remind him that the leaders of the clinical commissioning groups, including the ones in his area, which are there to look after his constituents, have said that
“delivering the Shaping a Healthier Future recommendations in full will save many lives each year and significantly improve patients’ care and experience of the NHS.”
That is what the doctors are saying, which is what I want to follow.
Bob Blackman (Harrow East) (Con)
At the Central Middlesex hospital, we have well qualified doctors and nurses waiting for patients to arrive but, at the same time, we have long queues at Northwick Park hospital. That makes no sense. Will my right hon. Friend assure me that any reduced resources at Central Middlesex hospital will be transferred in full to Northwick Park so that patients can be seen far more quickly and in a far better manner?
Mr Hunt
I assure my hon. Friend that the resources taken out of some acute services will be used to give better, safer and more high-quality services to his constituents. Northwick Park is one of the best examples of that. Stroke services in the north-west London area were centralised in Charing Cross and Northwick Park. As a result of those changes, which were introduced by the right hon. Member for Leigh (Andy Burnham), stroke mortality rates in London have halved. That is a very good example of why it makes sense to centralise certain more specialist and complex services if we are to get the best results for patients.
Mr Andrew Love (Edmonton) (Lab/Co-op)
The Secretary of State talked about putting politics before patients, but I remind him that the Prime Minister, when he was Leader of the Opposition, went to Chase Farm to say that the Conservatives would stop all configurations. That simply has not happened, but yet the Secretary of State continues to have a role. Patients and local residents are firmly opposed to the reconfiguration at that hospital and he will end up in court very soon over the matter. There is still time for him to reconsider that decision.
Mr Hunt
We did not agree with how the previous Government went about reconfigurations. I have announced a better way of achieving them, with better public and clinical support. My predecessor as Health Secretary paused on reconfigurations because he wanted to introduce a better structure, including the four tests, one of which was the need for local clinical support, and another of which was the need for effective public engagement. That is why we are in a better place today than we were with the previous Government’s reconfigurations.
Sarah Teather (Brent Central) (LD)
My constituents in Brent will be very disappointed with the Secretary of State’s announcement of the A and E closure at Central Middlesex hospital. However, given that the hospital trust began moving acute services out to Northwick Park hospital many years before the process began, they will probably not be surprised. Does he agree that there is an urgent need for health managers to work closely with Transport for London to ensure good transport links for my constituents in Harlesden to get to Northwick Park? It is currently extremely difficult to do so. Will he write to health managers to express that view?
Mr Hunt
The hon. Lady makes an important point. I accept that there will be changes in transport arrangements. I am happy to work with her and to talk to TfL about how improvements can be made in respect of the changes I have announced today.
I hope that the hon. Lady talks to her constituents about the positive aspects of the proposals. Hers will be the first part of the country in which all GP surgeries are open seven days a week—at least, there will be seven-day access to GP surgeries throughout her constituency and north-west London. North-west London will be the first part of the country where we have full seven-day working and we eliminate the fact that mortality rates are 10% higher if people are admitted in an emergency at the weekend. The positive aspects of the proposals will mean that her constituents find that they get better, safer care and live for longer.
John McDonnell (Hayes and Harlington) (Lab)
I represent wards with some of the highest morbidity and lowest life expectancy in north-west London. Clinical support for reform and restructuring was based on adequate funding during the period. Hillingdon clinical commissioning group has written to the Secretary of State to express its concern about the current funding formula, which could undermine service delivery unless there are additional resources. Will he meet representatives from the CCG and Hillingdon hospital, which he has denied additional winter money this year, to talk about the long-term future of our health economy?
Mr Hunt
Hillingdon CCG supports the changes because it recognises the profound impact they could have in addressing health inequalities. I know that that is precisely what concerns the hon. Gentleman. His constituents will be big beneficiaries of the changes we are announcing today. The funding formula is an extremely difficult issue. We have decided to depoliticise it by making it a matter for NHS England—it is decided at arm’s length from politicians because we believe it is very important that things are decided on the basis of an independent formula.
Sir John Randall (Uxbridge and South Ruislip) (Con)
I thank my right hon. Friend for his statement. We in Hillingdon are very pleased for our near neighbours in Ealing and in Charing Cross for this reprieve—rather than stay of execution—and it will take pressure off our residents. I echo the words of the hon. Member for Hayes and Harlington (John McDonnell), however, about the pressures we are facing in Hillingdon. Perhaps we could have a meeting with my right hon. Friend to discuss some of these issues, including the funding formula and the winter pressures.
Mr Hunt
It is the first time I have responded to a question from my right hon. Friend, so I shall take the opportunity to congratulate him on his knighthood. I am more than happy to meet him and his neighbour as long as they understand that the funding formula is not in my gift—it is decided by an independent body. As for the winter pressures money, the allocation was not decided by Ministers: it was decided by the people who are responsible for making sure that we head off winter pressures. They decided to concentrate resources in the third of the country where the problems were most severe, and that is how that selection was made.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
The whole House knows that all the medical directors in the hospitals involved in north-west London support the reconfiguration. Does the Secretary of State really understand the importance of bringing ordinary people with him? Londoners are especially cautious about these reconfigurations because of the historic problems with access to GPs and the many excluded communities for whom A and E is their primary care, and because these institutions are often major employers in their area and people identify with them. Does he realise that unless he brings ordinary people and patients with him on these reconfigurations, Londoners will continue to fight them and, as in the case of Lewisham, they will continue to win?
Mr Hunt
Apart from the very last sentence, I actually agree with what the hon. Lady says. It is important to carry the public with us in these reconfigurations. Governments of both parties have struggled to do that in these difficult reconfigurations, which is why the new structures that we have introduced will put doctors in the front line to argue for changes. It is not just the medical directors of trusts supporting them, but the CCG leaders, who are all local GPs, making that case. That is why there is much stronger support for these changes. All the elected representatives on the local councils, apart from Ealing, supported these changes, and that is a very big change from what we have seen previously. I agree with the hon. Lady: we need to do more work and it is very important to carry people with us.
Angie Bray (Ealing Central and Acton) (Con)
It is fair to say that today’s announcement leaves my constituents in a much better place than they were over a year ago when we set out to save our four local A and Es. Obviously, there is disappointment about the loss of the A and Es at Hammersmith and Central Middlesex, but huge relief that the bigger A and Es at Ealing and Charing Cross will be saved. My right hon. Friend says, rightly, that it will be for the local CCGs to take responsibility for the future of these A and Es. Can he give us a little more detail on how he sees the services being delivered and improved by the CCGs, and can he reconfirm that the A and Es at Ealing and Charing Cross will be saved as A and Es?
Mr Hunt
I can absolutely confirm that A and Es will remain at Charing Cross and Ealing hospitals, thanks in no small part to the remarkable campaigning that my hon. Friend has done for her constituents, both in public and in private. I commend her for that. The process that has to happen is clearly set out in what the IRP says and in my reply. There must be full consultation. There will be changes to the way in which services are provided, but they will be changes made in the interests of patients. Whatever those changes are, A and Es will remain at those two hospitals.
Heidi Alexander (Lewisham East) (Lab)
It is a bit rich for the Secretary of State to accuse the Opposition of being desperate when he has been told by the court not once, but twice that he acted unlawfully in relation to Lewisham. The Secretary of State’s amendment to the Care Bill would enable him to do to other hospitals what the courts said yesterday he could not do in south London. Will he admit that under those changes no hospital would be safe, and that in fact he wants to inflict the blatant injustice that he tried to inflict on Lewisham on hospitals not only across London, but up and down the country?
Mr Hunt
I understand why the hon. Lady is rightly representing the concerns of her constituents, but she must also understand that I have to look at their interests as patients, as well as at the interests of the broader south London population. It is important to make that amendment to the Care Bill because hospitals are not islands on their own. We have a very interconnected health economy, and what happens in Lewisham has a direct impact on what happens in Woolwich and vice versa. If we are to turn around failing hospitals quickly—something that the last Government sadly did not do—we need to have the ability to look at the whole health economy, not at problems in isolation.
Mr Lee Scott (Ilford North) (Con)
Will my right hon. Friend look again at Barking, Havering and Redbridge trust? As he knows, the difficulties that Queen’s hospital has had simply meant that, in its own admission, it would not be able to cope without an A and E at King George hospital for many years to come.
Mr Hunt
I commend my hon. Friend for raising this issue with me consistently. I know his very real concern is to make sure that when those changes are made they do not have an adverse impact on his constituents. I will go back and make absolutely certain that no changes will be made until it is certain that they are clinically safe.
Jim Dowd (Lewisham West and Penge) (Lab)
Why does the Secretary of State find it so difficult to realise that he is not above the law? Both the Court of Appeal and the High Court have made it plain that his flagrant disregard for the law in trying to destroy Lewisham hospital cannot stand. Why does he not have the decency to abandon his proposals; apologise to the people of Lewisham and the staff and users of Lewisham hospital; and share his humiliation with the Leader of the House, the previous Secretary of State, who launched this illegal programme in the first place?
Mr Hunt
There is no humiliation in doing the right thing for patients, and I will always do that. Sometimes it is difficult and we have battles with the courts, but no one is above the law. I have said that I respect the judgment made by the court yesterday, and that is what I shall do.
Mr David Burrowes (Enfield, Southgate) (Con)
Are there not three lessons to learn from the Secretary of State’s statement and the response from the shadow Secretary of State? First, we should listen to the opinions of local doctors. Secondly, delay puts at risk patient safety. Thirdly, we should not play politics. For Enfield, is it not the case that we should recognise that local doctors have united to say that we need to get on and implement changes, because delay would put at risk patient safety this winter, not least at our new, expanded North Middlesex hospital in Enfield? The future of Chase Farm is secure, but it could also be put at risk if we do not allow the implementation of good changes. We should not play politics, but Enfield council is doing so by trying to challenge the changes.
Mr Hunt
As so often, my hon. Friend speaks wisely. It is very important that in all this we do the right thing for patients. My view on all these big changes is that once we have decided what to do, it should be done as quickly as possible, but within the bounds of what is clinically safe. It is very important that safeguards are in place and I would always follow the advice of local doctors as to the right moment to proceed with an important change in safety.
Stephen Timms (East Ham) (Lab)
Will the Secretary of State commit to doing better against the four-hour A and E waiting target in London in the future? Will he put on the record today his acknowledgement of the value of the contribution being made by those A and E units—too few at the moment—that are doing well against that target at the moment?
Mr Hunt
There are a number of hospitals that are doing extremely well, and we are doing everything we can to support those that are in difficulty. I absolutely recognise how hard front-line NHS staff are working: we are working with them in an incredibly detailed way on a hospital-by-hospital basis, not just in London but across the country, to see what additional support we can give to people as we go through a difficult winter. We have already announced £250 million of support for the third of trusts in the greatest difficulty, and we are looking at what other, non-financial means we can use to support other trusts. The search continues, because we recognise how challenging winters are for the NHS under this Government as under previous ones.
Simon Hughes (Bermondsey and Old Southwark) (LD)
Given the difficult legacy of the financial arrangements in London and south-east London in particular, and the Court of Appeal judgment yesterday, will the Secretary of State give an assurance that in future decisions will have the support of GPs in the areas affected; will not put at risk other viable and successful parts of the London health family; and will not suddenly impose new management structures and create huge disruption—for example, at King’s College hospital, Guy’s hospital and St Thomas’s hospital—as London health partners appear to be suggesting?
Mr Hunt
I certainly agree with two of the three points. I do not think it is credible to say that we will not make any changes to the NHS, even if they are in the interests of patients, unless there is unanimous support from local GPs. The reality is that that would always be difficult to achieve. We would end up with paralysis, which would be against the interests of patients. However, I do think that GPs should be in the driving seat and be the advocates of these changes, and we should listen to them above all people on whether to proceed with the changes. The whole purpose of the Government’s reforms to the NHS is to create less bureaucracy not more, so I would be concerned if there was any suggestion that more was being created.
We must always ensure that changes do not have an adverse impact on successful neighbouring areas. However, we need to encourage all areas to work together, because we have an interconnected health economy, particularly in London.
Mr Speaker
Order. The hon. Gentleman has had his say and we are grateful to him.
Mr Hunt
I am disappointed that the hon. Gentleman is disappointed. I am interested to know what his definition of “totally ignored” means, because we have decided that we will not close Ealing A and E, and that is a big decision. With respect to how his constituents feel, I completely understand that many people will be nervous about any changes. I hope he will become a big advocate of these changes, because his constituents will be among the first in the country to have seven-day access to GPs and a seven-day NHS, which means there will not be a higher mortality rate for admission to hospitals at the weekends and that there will be 24/7 consultant obstetric cover for people who need it when giving birth. They are big and important changes that will benefit his constituents.
Mr Speaker
Order. I should just say to the House, almost as a courtesy, that I am prioritising London Members. However, non-London Members should take heart. If they exercise their knee muscles they may have an opportunity in due course.
Paul Burstow (Sutton and Cheam) (LD)
The hon. Member for Hackney North and Stoke Newington (Ms Abbott) was absolutely spot on in her question to the Secretary of State, not least with regard to variability and accessibility of GP services. A few months ago, I asked him whether he would make it a requirement for plans to expand out-of-hospital care to be in place before hospital changes occur. Can I take it from his statement that it is his intention that, when recommendations from the Independent Reconfiguration Panel are before him, he will require plans to build capability for community health services and primary care services to be in place before they go ahead?
Mr Hunt
The right hon. Gentleman campaigns assiduously for his constituents. I recognise that there are worries about potential changes in his constituency, an issue he often raises. Yes, we must ensure, if there are transitions or changes, that proper plans are in place to ensure they can be made safely. If he reads the report, he will derive a great deal of comfort from the stress the IRP puts on the necessity of having proper alternative provision in place before any changes are made.
Ms Karen Buck (Westminster North) (Lab)
The Secretary of State’s statement has left us even less clear than we were on the implications for hospital services for Westminster residents. Frankly, that is quite an achievement. Planned non-emergency hospital services have already moved away from St Mary’s Paddington to pre-empt the closure programmes that he is now telling us will not happen. That was done on the basis that St Mary’s would become the premier emergency hospital for west London, so where does that leave the provision of additional emergency services? Will that leave my constituents having to travel to Hammersmith, Ealing and Central Middlesex hospitals for their treatment, something the local authority was not even consulted on? Many GPs did not even know where their patients were being treated.
Mr Hunt
I hope that I have provided clarity by saying that there will remain an A and E at Ealing and Charing Cross, and that I support what the report says, which is that there should be five major A and E centres, of which St Mary’s Paddington will probably become the most pre-eminent trauma centre in the country. This is a big step for the hon. Lady’s constituents who use St Mary’s, and I think that they will be pleased with what I have said today.
Mary Macleod (Brentford and Isleworth) (Con)
I congratulate the Health Secretary on his important announcement regarding the A and Es at Charing Cross and Ealing. My constituents in Chiswick will feel reassured about the ongoing service at Charing Cross, and I thank him for that. Does he agree it is important that at the centre of any decision he makes about health care are improved patient care and saving lives across London?
Mr Hunt
My hon. Friend is absolutely right. When the dust settles on these decisions—there is rightly so much local passion, concern and uncertainty relating to hospitals, such as Charing Cross, which has a great tradition—what people will notice is whether their local NHS services are getting better. I am afraid that one of the legacies from the previous Government was the abolition of named GPs in 2004 and a sense that it has become more difficult to access one’s local GP. The proposals mean that her constituents will be some of the first in the country to have seven-day GP services, a big step forward that her constituents will welcome.
Jeremy Corbyn (Islington North) (Lab)
Will the Secretary of State give me an assurance, following the huge debate that took place over the future of the A and E department of the Whittington hospital—and, by extension, the neighbouring Royal Free hospital—that its future is secure and that he will not try to reconfigure services once again in north London? Does he recognise that during that debate, my right hon. Friend the Member for Leigh (Andy Burnham), who was then Secretary of State, intervened to assure the future of the Whittington A and E department? I would like the same assurance from the Secretary of State, if that is possible.
Mr Hunt
I think the best reassurance I can give the hon. Gentleman is that, unlike when the Labour party was in power, the Secretary of State does not sit behind his desk planning reconfigurations in every part of the country. This is a locally driven process. We have put in place safeguards to ensure that, where there is a reconfiguration proposal from a local NHS, it meets certain criteria. It has to be supported by local GPs and there has to be proper engagement with the public. If his constituents are worried, I hope they will take heart from the thoroughness of the process that has happened today. It is the right process and a good process, and it will lead to better outcomes for the people involved.
Mr Brian Binley (Northampton South) (Con)
My own general hospital, in keeping with many throughout the country, has come in for unfair criticism owing to the increasing pressures exerted on its A and E department. What does the Secretary of State think has caused those pressures, and will he reassure my constituents by telling us what he is doing to help relieve A and E departments?
Mr Hunt
My hon. Friend is right to draw attention to the pressures. I am sure that most A and E departments, including his own one in Northampton, would say that the biggest single cause has been the increase in the frail elderly population and the inadequacy of the care those people receive outside hospital. We are trying to put that right by having named, accountable GPs responsible for out-of-hospital care, reversing the historic mistake made in 2004, when that personal link between GP and patient was abolished.
Barry Gardiner (Brent North) (Lab)
This decision is devastating for my constituents. The Secretary of State will know that in the last winter period, Northwick Park hospital and Central Middlesex hospital, which comprise the North West London Hospitals Trust, were the worst-performing hospitals when it came to meeting A and E targets not only in London, but in the country. The trust scored 81.03%. That is an appalling record. What he has done today, by announcing the almost immediate closure of Central Middlesex, can only make that much worse. The College of Emergency Medicine has said that his reconfigured hospitals should have at least 16 consultants in their emergency departments, but his decision will give them 10—and that is not for major trauma centres. Will he elaborate on what he will do to bring the number of consultants up to the level required by the college?
Mr Hunt
Has the hon. Gentleman, who is so against these proposals, not noticed the proposals for more emergency care doctors, more critical care doctors and more psychiatric liaison support for A and E departments, which will reduce pressure on A and Es and mean that people admitted through A and Es for emergency care will not have a 10% higher chance of mortality if they are admitted at weekends? His constituents will be among the first to benefit from that. I would caution him, therefore, against saying that this is devastating for his constituents. We were reminded in Prime Minister’s questions earlier of how Labour suffered from predicting massive job losses, when in fact there was an increase in jobs. This announcement is good news for the hon. Gentleman’s constituents, and he should welcome it.
Sir Tony Baldry (Banbury) (Con)
Does my right hon. Friend agree that, difficult though it may be, all NHS trusts will have to live within their budgets, because, with both Front Benches effectively having agreed public spending limits for several years to come, the amount of money that can be spent on the NHS will be finite whoever is in government?
Mr Hunt
My hon. Friend speaks wisely. Let us bear in mind the challenges facing north-west London, which are similar to those across the country, including in Oxfordshire. In the next two decades, its population is predicted to increase by 7%, and life expectancy has risen by three years in the last decade alone. Furthermore, the uncertainty over public finances means that the trust cannot bank on substantial increases in the NHS budget, so it has to do the responsible thing and look for better, smarter, more efficient ways to use that money to help more people. It has been brave and bold in doing this, and I think that many other parts of the country will take heart from what has happened today and come forward with equally bold plans.
Stephen Pound (Ealing North) (Lab)
Your House, Mr Speaker, is being made dizzy this afternoon by the surfeit of spin we are suffering. We are being asked to believe that this benevolent Government are partly motivated by a desire to end uncertainty. The death sentence ends the uncertainty of life, but it is not necessarily something I would recommend. Will the Secretary of State please provide a little information about what exactly a different shape and size A and E department looks like? The people of Ealing deserve to be told precisely what it means, otherwise they will think the worst.
Mr Hunt
I hope the hon. Gentleman will be pleased that today the death sentence on A and E at Ealing has been not just reprieved, but cancelled; it will keep its A and E. The definition of A and E is not something that politicians decide. We said in the statement that what the A and Es at Ealing and Charing Cross contain must be consistent with Professor Sir Bruce Keogh’s review of A and E services across the country, which they will be, and that any changes made in service provision must have full consultation with his constituents, which will happen. On the basis of an IRP report that simply says, “More work needs to be done,” I cannot answer all his questions, but I hope I can give him greater certainty than he had this morning that there will be an A and E for his constituents in Ealing.
Dr Sarah Wollaston (Totnes) (Con)
Clinically led, evidence-based changes to services save lives. That is straightforward and clear. It is also clear that we have to make these changes happen if we are to live within our means and the health service budget. How are we going to make reconfigurations such as this one more straightforward, because the cost and time are unacceptable? Likewise with mergers, how are we going to streamline this process?
Mr Hunt
My hon. Friend speaks wisely. It concerns me, as it does her, that these processes take so long. When it comes to changes in A and E and maternity services, exhaustive public consultation is necessary, because they cause such great public concern, but we also need to deal with these issues in a much more timely way, particularly when it involves sorting out the problems of failing hospitals. I agree with her, therefore, and I am looking at what can be done to speed up all these processes, while retaining the appropriate consultation with the public.
Lisa Nandy (Wigan) (Lab)
Does the Secretary of State have any idea of the concern he is causing up and down the country? In Wigan, we value our 24-hour A and E service; we do not want it downgraded, and we do not want it closed. Will he clarify his proposal for the future of Ealing A and E? Is he proposing a type 1 service? Also, will he give me a cast-iron guarantee that any future decision about our local hospital will be made on the basis of people’s lives, not cost?
Mr Hunt
I can assure the hon. Lady that decisions about the future of A and Es will be based on what is best for patients and on what will save lives and get the best outcomes—that will apply in her constituency, as it will in mine and every other constituency—but that will sometimes mean a difficult decision if we have a change that doctors strongly support, but about which members of the public are anxious. I have said that services at Ealing will change, but that there will be proper public consultation and that at the end of the process there will still be an A and E. The recommendation from the process was that the A and E should close, but I said, “No, I think there should be an A and E at the end of the process.” I am injecting that much certainty, therefore, but I am not going to micro-manage the local NHS by saying precisely what those services should be.
Oliver Colvile (Plymouth, Sutton and Devonport) (Con)
It is not only A and E units in London that are under pressure; Derriford hospital’s A and E unit is also under pressure, because of our night-time economy. Is my right hon. Friend willing to meet me and potentially representatives from the English Pharmacy Board and my own Devon pharmacists to discuss how they can help to relieve some of the pressure on A and E units, especially down in Devon?
Mr Hunt
I would be more than happy to meet my hon. Friend and his local pharmacists. There is a lot that pharmacists can do. One change we are making that could make a big difference, where proper protections are in place for patients, is allowing pharmacists to access GP records so that they can give people the correct medicines, know about people’s allergies and things like that. There are lots of other things as well, though, and I look forward to the discussion.
Grahame M. Morris (Easington) (Lab)
The statement has broader implications beyond London, although I accept that colleagues from Islington and Ealing want to ensure they have their A and E facilities. On smaller A and E facilities outside London, however, the Secretary of State said there would be no political fixes, yet when he announced additional moneys to deal with winter pressures on 53 NHS trusts, there were none in the north-east of England. What assurance can he give my constituents that hospitals in the north-east will have sufficient resources to meet the demands placed on them in winter?
Mr Hunt
The decision on where to allocate the extra help was based on where the need was greatest, and it was taken not by Ministers, but on the basis of recommendations from people working in the NHS and dealing with these problems. They chose the 53 local health economies where they thought the pressures were greatest. The fact that nowhere in the north-east was selected indicates that A and E performance is better in the north-east of England than in other parts of the country.
Steve Rotheram (Liverpool, Walton) (Lab)
When the Secretary of State is not leading the smear campaign against my right hon. Friend the Member for Leigh (Andy Burnham), he is continually being dragged into the Chamber to react to events that he should be in control of. When will he finally get a grip on the problems in our A and Es across the country?
Mr Hunt
I completely reject what the hon. Gentleman says. There are 1.2 million more people using A and E every year than there were under the last Government, yet people are waiting for a shorter time, with more people being seen within the four-hour target. But we are doing something else. We are addressing the long-term problems of A and E, including the patent failures of the last Government over the GP contract, social care integration and the working time directive. All those things have made the pressures worse, but we are sorting them out.
Oral Answers to Questions
Jeremy Hunt Excerpts(13 years ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Stephen Metcalfe (South Basildon and East Thurrock) (Con)
12. What recent progress he has made on improving the performance of hospital trusts placed in special measures.
The Secretary of State for Health (Mr Jeremy Hunt)
Significant progress has been made at all 11 trusts placed in special measures in July, including changing the chair or chief executive officer and recruiting more nurses in every single one them and partnering each of them with a high-performing hospital so that they can make rapid progress in turning things around.
Martin Vickers
I thank the Secretary of State for his reply. He will be aware of my constituents’ concerns about services at Diana, Princess of Wales hospital in Grimsby. There are doubts about the future of the stroke unit and high mortality rates, and there are also problems with the East Midlands ambulance service. Will the Secretary of State give an assurance that he is satisfied that progress is being made at the hospital?
Mr Hunt
I think good progress is being made and I commend my hon. Friend for his campaigning on the issue. The trust concerned has introduced better privacy for patients, hired 154 nurses since the Keogh report and introduced electronic vital signs reporting at the bedside—all because we are being transparent and open about problems in the NHS and not sweeping them under the carpet.
Andrew Bridgen
Burton hospital, which serves part of my constituency, was one of the 11 hospitals placed in special measures following the Keogh report. Will my right hon. Friend assure my constituents that the improvements needed in those hospitals will be carried out in a culture of openness and transparency rather than one of opaqueness and cover-up, which so unfortunately typified the way in which the previous Government ran the NHS?
Mr Hunt
I know that my hon. Friend takes a very close interest in what happens at his hospital and I think that progress is being made in turning it around. What will be of concern to my hon. Friend is that, as far back as 2005-6, Burton’s mortality rate was 30% higher than the national average—it was even higher than that at Mid Staffs—and yet the problem was not sorted out. We are sorting it out.
John Stevenson
As the Secretary of State is aware, North Cumbria trust is in special measures. We have on our doorstep a potential solution to our problems, namely Northumbria trust. Will the Secretary of State give me an assurance that everything possible will be done to get North Cumbria out of special measures at the earliest opportunity and, much more importantly, that every support will be given to Northumbria in is acquisition of North Cumbria?
Mr Hunt
I can give my hon. Friend both assurances because Northumbria has been doing a huge amount to help North Cumbria turn itself around, including installing its patient experience systems to ensure that patients are treated with the dignity and respect that they deserve. The problems have been around since 2007 and he can tell his constituents that we are finally turning them around.
Stephen Metcalfe
As my right hon. Friend will be aware, Basildon university hospital in my constituency is one of the 11 hospitals that were placed in special measures following the failure of the previous Government to act on the information that they had. Will he tell the House what support the new management team, in whom I have great confidence, are receiving and when my constituents can expect to see sustained, long-term improvements?
Mr Hunt
I reassure my hon. Friend that the trust has hired 257 more nurses since the problems emerged this year, has better A and E processes, and has been partnered with the Royal Free in London to help it make even more progress. He will be as shocked as I am that when the Care Quality Commission identified problems at that hospital the last Government sat on the report for six months. That cannot be acceptable.
John Healey (Wentworth and Dearne) (Lab)
How can NHS patients and staff have any confidence in decisions about their local services when they are taken by the Competition Commission on the overriding grounds of what is best for a competitive market and not what is best for patients? Will he learn from the failure of the merger between the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and the Poole Hospital NHS Foundation Trust, and take merger off the table as an option for Rotherham hospital?
Mr Hunt
May I reassure the right hon. Gentleman that the competition authorities make their decisions based on what is in the best interests of patients and do not hold competition as an overriding ideology? He is right that we need to work closely with those authorities to ensure that they have the expertise to take decisions in the right way and with trusts to ensure that they have the expertise to ensure that they do not stumble when they go through those processes.
Jenny Chapman (Darlington) (Lab)
How can the public have confidence in their health service when police officers are taking patients who are sick and injured to A and E because ambulances are backed up outside A and E and take longer than an hour to arrive?
Mr Hunt
I will tell the hon. Lady why the public can have confidence in their health service: compared with three years ago, on broadly the same budget, the NHS is doing 800,000 more operations year in, year out; MRSA rates have halved; and the number of people who wait for a year or longer for operations has gone down from 18,000 to fewer than 400.
Clive Efford (Eltham) (Lab)
Will the Secretary of State explain why we have had a summer crisis in A and E? We are all used to the emergency services being overwhelmed in winter. Given the crisis that we have had, what will he do to assist the NHS in averting a winter crisis this year, rather than just blaming everybody else?
Andrew Gwynne (Denton and Reddish) (Lab)
The Secretary of State for Health is clearly not adequately monitoring performance. If he was, he would be aware that serious problems remain across the accident and emergency departments of the trusts that were placed in special measures by Professor Sir Bruce Keogh. On his watch, the A and E performance at eight of the 11 trusts has got worse since Keogh reported, including at my hospital in Tameside. The A and E performance has got substantially worse at East Lancashire Hospitals NHS Trust, where the number of patients waiting for more than four hours has doubled since Keogh reported, and at Medway NHS Trust, where the figure has quadrupled. When will he stop all the grandstanding, cut the spin and get a grip on his A and E crisis?
Mr Hunt
I hope that the hon. Gentleman will be pleased that something is happening under this Government that did not happen under the Labour Government: we are putting those hospitals into special measures and sorting out the problems, including the long-term problems with A and E such as the GP contract—a disaster that was imposed on this country by the Labour Government.
Andrew George (St Ives) (LD)
6. What the current (a) highest, (b) lowest and (c) mean average registered nurse-to-patient ratio is on acute hospital wards.
Alun Cairns (Vale of Glamorgan) (Con)
10. What steps his Department is taking to promote a culture of openness and transparency across the NHS.
The Secretary of State for Health (Mr Jeremy Hunt)
We need to change the culture of the NHS so that where there are problems with care or safety, people feel able to speak out. The Government have banned gagging clauses, they are introducing a statutory duty of candour, and they have for the first time published surgery outcomes for 10 specialties by consultant.
Alun Cairns
I commend the Secretary of State for his transparency agenda, which has uncovered previously untold horrors. What more can he do to ensure that in future no Minister can ever cover up failure in the NHS?
Mr Speaker
Order. I told the Secretary of State privately before, and I say it publicly now, that if he intends to devote part of his answer to talking about what happened under the previous Government, he can abandon that plan now and resume his seat. I suggest he resumes his seat.
Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab)
As part of this openness and transparency, will the Government improve their relations with the police and prison services, so that we can have a clearer idea of why people with mental illnesses are spending time in police cells or being sent to prison?
Mr Hunt
I am pleased to tell the right hon. Gentleman that we are working closely with the police to try to ensure that some of the people held in police cells are given much faster access to mental health services. That includes a street triage pilot, which has had early and promising results.
Charlotte Leslie (Bristol North West) (Con)
I was informed this morning that the chair of the NHS property board has resigned. That follows the revelation last week, through parliamentary questions I asked, that the board has been raiding its capital allocation to subsidise its own revenue funding. In the interests of transparency, will the Secretary of State undertake to review and publish the recruitment and employment procedure of executive and non-executive members of the board—including civil servant Peter Coates who created the board, which oversees £3 billion-worth of assets—and conduct careful audit and scrutiny of the board’s accounts and minutes?
Mr Jamie Reed (Copeland) (Lab)
With regard to openness and transparency, the Secretary of State’s failure to extend the Freedom of Information Act to private providers delivering NHS services is fostering a culture of secrecy. As he forces clinical commissioning groups to tender more services to the private sector, and if he truly believes in openness and the independence of health regulators, will he follow the clear advice from Monitor and extend FOI legislation to private providers, or is he content to allow them to continue to withhold information from patients?
Mr Hunt
When it comes to transparency about care, there should be an absolute level playing field between private providers and NHS providers. To answer the hon. Gentleman’s question on regulators, what this Government are going to do, Mr Speaker, is ensure that the Care Quality Commission has statutory independence so that no Government can ever try to interfere with the processes of reporting poor care.
Mrs Linda Riordan (Halifax) (Lab/Co-op)
11. Whether he plans to close all or part of Calderdale Royal hospital’s accident and emergency ward.
The Secretary of State for Health (Mr Jeremy Hunt)
While always paying regard to the superb job done by most doctors, we should allow no hiding place for doctors who endanger patients’ lives by irresponsible or careless behaviour, which is why we have asked the Law Commission to come up with proposals to speed up General Medical Council investigations. We are also considering a new criminal offence of wilful neglect, as recommended by Professor Don Berwick.
Priti Patel
The cancer diagnosis of my constituent, Mrs Julia Wild, was delayed by nine months because of a mistake by the initial doctor at her first assessment. For four years, she has been fighting for an apology, for transparency and for the doctor to acknowledge what went wrong with her case. What can Mrs Wild, and other patients in the NHS who have had similar experiences, do to ensure that their complaints are taken seriously, that these life-changing mistakes are acknowledged and that the individuals responsible are held to account?
Mr Hunt
My hon. Friend speaks extremely well and I fully understand her concern about Mrs Julia Wild and the care she received. I cannot second-guess the clinical judgment of the GMC, but I agree that Mrs Wild is owed an apology. If the local NHS will not give it, I will give it now. We should have spotted the advanced lobular cancer and I apologise to her that we did not.
Chi Onwurah (Newcastle upon Tyne Central) (Lab)
On Friday I visited Cruddas Park surgery in my constituency to see the fantastic work that doctors and staff are doing in the face of huge levels of unmet need, health inequalities and rising mental health issues. If we hold doctors to account for their mistakes, is it not right that they should be able to hold Ministers to account for taking millions of pounds out of their funding and then telling my right hon. Friend the Member for Newcastle upon Tyne East (Mr Brown) that it was nothing to do with him?
Mr Crispin Blunt (Reigate) (Con)
While we are always of course keen to hold doctors to account for their mistakes, I trust that we will be equally keen to reward them for examples of really good practice, such as those my right hon. Friend will see on Thursday when he makes his very welcome visit to the East Surrey hospital. I commend to him the work of Dr Ben Mearns and his emergency and acute team, who demonstrate good practice and also make it transparent to the rest of the national health service.
Mr Hunt
I am greatly looking forward to visiting my hon. Friend’s hospital on Thursday and going out on the front line. I agree that we need to celebrate success. This has been a difficult year for the NHS as we have learned to be much more transparent about problems when they exist, but one of the advantages of having a chief inspector is that his team will be able to identify and recognise outstanding practice, so that everyone will understand that, as well as some of the problems that get more attention, brilliant things are happening throughout our NHS.
Steve McCabe (Birmingham, Selly Oak) (Lab)
Is the Secretary of State comfortable with a surgeon such as Ian Paterson flitting between the NHS and the private sector, making the same blunders in both but being subject to different levels of accountability and his victims having access to different levels of redress?
Mr Hunt
As I said in response to an earlier question, the responsibility to be transparent about care should apply equally in the public and the private sector. Obviously, in the public sector we have more levers, because we are purchasing care and we can impose more conditions than it is possible to do in the private sector. The most important thing is to have a culture in which such problems come to light quickly when they happen, so that they are dealt with and not repeated.
Mr John Baron (Basildon and Billericay) (Con)
15. For what reasons the publication of data on one-year and five-year survival rates for all cancers within the Clinical Commissioning Group Outcomes Indicator Set has been deferred until March 2014.
Steve Baker (Wycombe) (Con)
16. What steps he is taking to ensure that the NHS becomes a more patient-led organisation.
The Secretary of State for Health (Mr Jeremy Hunt)
The big shift we need to make is to turn the NHS into a patient-led organisation. Two measures that will help that are: independent inspections by a new chief inspector that put the patient experience at their heart; and asking every NHS in-patient if they would recommend their treatment to a friend or member of their family.
Steve Baker
I am encouraged by that answer. Long ago, the medical establishment was held to account by what were essentially patient-led co-operatives, and today more and more voices are asking for more patient engagement. Will the Secretary of State consider a paper brought forward by Civitas and Anton Howes calling for the incremental implementation of patient-led commissioning to close this gap?
Mr Hunt
No one campaigns harder than my hon. Friend on the issue of putting patients first in his constituency and throughout the NHS. CCGs have a legal obligation to involve patients in decisions about services and about them personally. The ideas in the paper he mentions are interesting, and I respect them, but given that we have brand-new commissioners and inspectors going out this year, I think we should see how the current reforms work first.
Annette Brooke (Mid Dorset and North Poole) (LD)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Jeremy Hunt)
Today we published a report demonstrating that the NHS could recover as much as £500 million from better systems to monitor and track those who should be paying for the NHS treatment and introducing new charges to certain categories of people currently exempt. This is a significant sum of money that could fund 4,000 doctors, and far from being xenophobic, as some in the Opposition have alleged, the Government believe it is right that overseas visitors who do not pay for the NHS through the tax system should make a fair contribution through charges.
Annette Brooke
Poole hospital, which is much loved locally and has excellent care ratings, has a financial problem relating to tariffs that must be addressed. The £5 million spent on putting a failed case for a merger between Bournemouth and Poole hospitals to the Competition Commission raises questions about processes and openness with the public. I hope the Secretary of State can make some comments today, but will he meet me and other local MPs to discuss all these issues in greater detail?
Mr Hunt
I am happy to do so. I want to make it clear to my hon. Friend that I am keen to ensure we have a structure inside the NHS that makes it easy for high-performing hospitals that want to work more closely together and share services to do so, if it is in the interests of patients. We need to do more work in this area.
Andy Burnham (Leigh) (Lab)
The Secretary of State has been in post for a year, and in that time we have got used to his style: everything is always someone else’s fault, be it lazy GPs, uncaring nurses or the last Government. And today we see more diversion tactics—now immigration is to blame. But there is an inconvenient truth that gets clearer day by day and which he cannot spin away: A and E is getting worse and worse and worse on his watch. We have had ambulance queues, a treatment tent in a car park and now police cars doubling as ambulances, with a patient dying on the backseat. The NHS stands on the brink of a dangerous winter. Will he today set out in detail what he personally is doing to avert a crisis?
Mr Hunt
I welcome the right hon. Gentleman back to his place. It is a great pleasure to see him there, even if it is not entirely what the Labour leader wanted.
If the right hon. Gentleman is shocked that I breached the A and E target for one quarter last year, he will want to make a full apology for the fact that he breached it for two quarters when he was Health Secretary.
Andy Burnham
This complacent spin is no good to the NHS. If he wants to compare records, let us do that. Under me, 98 per cent. of people were seen within four hours; under him, over 1 million people in the last year waited more than four hours in A and E—not only a winter crisis, but the first summer A and E crisis in living memory. Today it gets worse. New figures this morning show a further 450 nursing jobs have been cut, taking the total close to 6,000 under this Government. But what were they doing last night? They were voting in the Lords against safe staffing levels. Will he now listen to the experts, stop the job cuts and take immediate action to ensure that all A and Es have enough staff to provide safe care this winter?
Mr Hunt
We will listen to no one on the Opposition Benches when it comes to safe care for patients in the NHS. They presided over a system where whistleblowers were bullied, patients were ignored and regulators felt leaned on if they tried to speak out about poor care. That is a record to be ashamed of.
Mark Pawsey (Rugby) (Con)
T5. There is evidence that a nutritional meal can be a real aid to the recovery of patients, yet the Campaign for Better Hospital Food found that 82,000 hospital meals are thrown in the bin every single day. Will the Minister update the House on the steps being taken to ensure that patients receive a hot balanced meal, served at an appropriate time?
Toby Perkins (Chesterfield) (Lab)
T4. My constituent Jemma Hill is 25 and suffers from chronic hip pain, for which a specialist has recommended hip arthroscopy surgery. However, she has now been told that her local clinical commissioning group does not fund such treatment. Does it not make a mockery of GP-led commissioning when a CCG will not fund the treatment recommended by a specialist to whom the GP referred my constituent in the first place?
Jason McCartney (Colne Valley) (Con)
T8. Does the Secretary of State agree that we need to learn from the mistakes of the Safe and Sustainable review of children’s heart surgery services and improve the forthcoming review in two ways? First, we should make the process a lot more transparent. Secondly, areas such as neo-natal, paediatric and adult intensive care unit services and transport and retrieval services should fall within the scope of the new review.
John Glen (Salisbury) (Con)
T10. Dr Elizabeth Stanger, a highly respected Salisbury GP, recently questioned me about the sustainability of providing multiple treatments for complex medical problems for several generations of the same family of foreign nationals. I welcome today’s announcement, and ask the Minister to reassure me that the mechanism to recover the funds will ensure that the money goes back to the clinical commissioning group so that it can provide a benefit locally.
Mr Hunt
I absolutely can reassure my hon. Friend about that. The point about the new, improved system for recovering charges is that we want the money to go back to the people providing the services so that they will be able to resource them better. This is not the diversionary tactic that some have accused us this morning of introducing; £500 million could have a huge impact on the NHS front line and allow his GPs to do a much better job.
Kate Green (Stretford and Urmston) (Lab)
This evening, the joint health overview and scrutiny committee for Trafford and Manchester will meet to consider whether the preconditions for the reconfiguration of services in Trafford, including those set down by the Secretary of State, have been met. I understand that the NHS area team has already confirmed that it believes the conditions have been fulfilled, but will the Secretary of State tell me what would happen if, as seems possible, the scrutiny committee were to take a different view tonight and decide that not all the conditions had been met?
Duncan Hames (Chippenham) (LD)
A written answer from the former Minister, my hon. Friend the Member for Broxtowe (Anna Soubry), to my recent parliamentary question has on this subject revealed that people living in the south-west of England are three times as likely to contract Lyme disease as those in the rest of the country, yet I have a constituent doing what he calls drug runs to the rest of Europe to access the medicines necessary to tackle his symptoms. Will the Minister meet me to discuss how we can ensure the continuing availability of treatments for Lyme disease on the NHS?
Miss Anne McIntosh (Thirsk and Malton) (Con)
When the Secretary of State meets the chairman of NHS England to discuss future priorities for NHS spending, will he ensure a fair deal for rural areas by ensuring that they reflect rurality, sparsity and the number of elderly patients and that we keep the minimum income guarantee for rural GP practices?
Mr Hunt
I can reassure my hon. Friend, as I am meeting some Yorkshire GPs later this week who have concerns about that very issue. The most important thing about the difficult issue of the funding formula is that it should be fair. That is why under the new legislation we have given the decision to an independent body so that it is taken at arm’s length from Ministers and so that it strikes the right balance between the issues of rurality, age and social deprivation.
Hazel Blears (Salford and Eccles) (Lab)
The NHS, with its massive purchasing power, can make a real difference to local areas through jobs and through supply chains. Some hospital trusts are enthusiastically implementing the Public Services (Social Value) Act 2012, including Barts and King’s. Will the Minister ensure that his new procurement strategy recognises the importance of social value?
Tim Loughton (East Worthing and Shoreham) (Con)
The Secretary of State knows Worthing hospital well; he has rolled his sleeves up there. When I went there a few weeks ago, I was told that the average age of patients in the hospital, stripping out maternity, is 85, yet we have qualified for no winter pressures money and we have a diminishing number of community hospital beds. Will he look into this anomaly, as he well knows the specific pressures we have on the south coast?
Mr Hunt
I understand my hon. Friend’s concerns and I know that there is a large elderly population in Worthing. I thought it was an excellent hospital with a fantastic atmosphere when I went and did part of a shift there. The winter pressures money went to the third of A and E departments that are struggling the most, so it is probably a compliment to his hospital that it did not receive it. We felt that with limited funds we had to concentrate resources where they were going to have the most impact. I hope that he understands why we had to make that difficult decision.
Joan Walley (Stoke-on-Trent North) (Lab)
This week, the report of the trust special administrator in respect of Stafford hospital is being presented to Monitor. Given that the preferred option is that the University Hospital of North Staffordshire should in some way take over, will the Secretary of State urgently meet all Members of Parliament for the north Staffordshire area to ensure that health care in north Staffordshire, where we already have a deficit of £31 million with an extra £18 million set to come over, will not be destabilised?
Mr Hunt
We are acutely aware of those concerns. In any reconfiguration, and particularly in this one, we want to ensure that there is no instability in the local health economy. We have given the trust special administrator a little longer to come up with a plan for Stafford hospital to try to secure local agreement, so I have not had a recommendation yet and I am going to wait and see what he says.
Jimmy Savile (Investigations Update)
Jeremy Hunt Excerpts(13 years ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I wish to provide an update on progress with the Jimmy Savile investigations relating to national health service institutions.
There are currently three main investigations under way—Broadmoor, Stoke Mandeville and Leeds General Infirmary. Kate Lampard is providing independent scrutiny of the quality and rigour of these three investigations on behalf of the Department of Health. There are also investigations taking place at a further 10 trusts.
The Metropolitan Police Service, working with Kate Lampard, has established there was further relevant information regarding Jimmy Savile. The Department of Health asked the Metropolitan Police Service, through an agreed information-sharing process, to review information it held to ascertain if it included material related to health and care settings.
This review is still ongoing. We understand the material includes information about hospitals where investigations are already under way, and reference to other hospitals. Once this review is complete, the information will be passed on to the relevant trusts or investigations as quickly as possible. I will then issue another written statement, including the names of any other hospitals involved.
Although all 13 investigations are currently on track, this additional material means that the timetable will be affected. It is vital that the final NHS investigation reports are thorough and complete, and reflect all the evidence about Jimmy Savile’s pattern of offending. The final reports of all the investigations will now aim to be completed by June 2014, with publication sooner if that is possible.
Information Sharing (Caldicott Review)
Jeremy Hunt Excerpts(13 years, 1 month ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Today I am publishing the Government’s response to Dame Fiona Caldicott’s review of information sharing. This review was recommended by the Future Forum on information which reported in January 2012.
I am grateful to Dame Fiona and her panel and to the many people who provided valuable input into her review. Building on the wealth of experience, viewpoints and insights gained through the review and the preceding NHS Future Forum’s work, this document sets out the overall ambition and actions to transform how our health and our care services use and share information to the benefit of patients and service users.
For citizens, patients and users of care services, this response sets out how a new approach to information sharing across health and care can support more joined up, safer, better care for us. Dame Fiona’s review and our response look at actions for clinicians and other care professionals, managers, commissioners, councillors, researchers, and many others.
There are four key themes in the response:
patient and citizen rights—they should have confidence in how their information is handled through knowing how it is used and shared and how to object and through having access to their electronic care records;
improving sharing for direct care—appropriate and legal data sharing to drive integrated, joined-up, person-centred and safer care for people (where information governance rules have, in the past, been seen as a barrier);
improving sharing for other purposes—the importance of information for research, commissioning and public health and improving practice in this area, recognising this can only be done effectively if people are given a say in how information about them is used; and
better protection for information boards and other leadership groups will take responsibility for good information practices in their organisations, professionals will be consistent in the rules they apply and front-line staff will have improved training and education on information sharing and confidential information.
In summary, this response sets out the overall ambition and the early actions that will enable better information sharing to support our health and our care services to meet our needs and expectations, for now and the future.
“Information: To share or not to share? The Information Governance Review” and “Information: To Share or not to share, Government Response to the Caldicott Review” have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
University Hospitals of Morecambe Bay Trust
Jeremy Hunt Excerpts(13 years, 1 month ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
University Hospitals of Morecambe Bay Trust (UHMBT) has been the subject of scrutiny for a number of years, following the high number of serious untoward incidents in its maternity and neonatal services. The families of those who were harmed or died under the care of the trust have persistently and courageously sought a full and independent investigation into the circumstances surrounding these deaths. I am today announcing to the House the terms of reference for the independent investigation into the management, delivery and outcomes of care provided by the maternity and neonatal services of UHMBT from January 2004 to June 2013, under the chairmanship of Dr Bill Kirkup CBE. Dr Kirkup is a former associate medical director at the Department of Health, and served on the Hillsborough independent panel.
The investigation will primarily focus on the service provided by the trust, and the response of the trust to shortcomings previously identified. It will look at evidence relating to organisations external to the trust where this will help shed light on the tragic events that occurred, and assist in producing recommendations for preventing such incidences in the future. The principle concern of this investigation is getting the answers the families have requested. Answers are required about what went so desperately wrong with the care they received, and the steps the trust must take to ensure no other families suffer in the future.
This is not an investigation into the regulatory and supervisory systems of the NHS, as these issues have only recently been examined by the second Mid Staffordshire inquiry, and the Department of Health will publish its full response in due course. Nor is it a public inquiry as the requirements for public evidence sessions are not considered suitable for the privacy and tact with which this investigation must be undertaken. To ensure that the investigation will meet the requirements of openness and transparency, all of its sessions will be open to family members.
The investigation is expected to report to me by next summer and a copy of the full terms of reference has been placed in the Library of the House. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
Dr Kirkup plans to issue a method statement for the investigation in October 2013. I am grateful to him and the families for their significant contribution to the design of this investigation process. I sincerely hope that it will provide them with the answers that they seek.
Accident and Emergency Departments
Jeremy Hunt Excerpts(13 years, 1 month ago)
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Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
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Andy Burnham (Leigh) (Lab)
(Urgent Question): To ask the Secretary of State for Health if he will make a statement on his plans to alleviate pressure on accident and emergency departments.
The Secretary of State for Health (Mr Jeremy Hunt)
This morning I made a written ministerial statement outlining the Government’s plans for the winter and detailing how we are allocating £250 million of funding for NHS England. Working with Monitor and the NHS Trust Development Authority, NHS England will distribute this money in 2013-14 to the areas where it is needed most. This follows the announcement in August by my right hon. Friend the Prime Minister that A and E departments will be given an additional £500 million over the next two years to deal with seasonal pressures. Patients need to be able to rely on the NHS all year round, and especially when demand is at its greatest. Ensuring the NHS’s sustainability means identifying each of the challenges it faces and, where possible, alleviating the burden.
Flu is an avoidable pressure on the NHS. Every year, around 750,000 patients see their GP with flu symptoms and nearly 5,000 people die. While flu levels have been comparatively low in the last two years, it would be complacent to assume that they will not rise. Should this happen, it will increase pressure on A and Es, which have already seen a rise in admissions of 32% in the last decade.
The best way to protect oneself and other people from flu is to get the flu vaccine, so, for the first time, children aged two and three will be offered the innovative nasal spray vaccine. Young children’s close contact with others makes them more likely to transmit flu to vulnerable groups including infants and the elderly.
Around 27,000 people spend time in hospital with flu every year, so it is very important that NHS staff should do all they can to avoid getting, and passing on, flu. Less than half of front-line NHS staff get vaccinated against flu. In some hospitals, that drops to fewer than one in five. The Government want to boost significantly the number of health care workers getting the flu vaccine. Trusts will not be eligible to receive a portion of the money in future years if they do not achieve a staff vaccination rate of 75%, except in exceptional circumstances.
This funding will be targeted in the following way: £15 million will go towards securing a reliable NHS 111 service throughout the winter period; subject to completion of current scrutiny of plans, a total provisional amount of £221 million will go to the 53 highest-risk systems; and a small contingency of £14 million will be used for final settlements, for trusts to use in the winter. My written ministerial statement outlines the indicative amounts that have been allocated to specific trusts. The additional allocation will require an increase to the revenue budget for NHS England for 2013-14, as had been specified in the mandate, and the revision to the mandate will be laid before Parliament in due course.
I recognise, however, that we need more radical change to reduce pressures on A and E departments over the longer term. I am currently consulting on my plans to provide improved care for vulnerable older people, to keep them out of hospital through better, more proactive care in their community. This will include better joint-working between the health and care systems; personalised, proactive care overseen by a named, accountable GP; and the sharing of GP records across different organisations, including out-of-hours GP services and the ambulance service.
NHS staff are working harder than ever before, and the British public rely on the NHS just as much as they have always done, and on a year-round basis. The plans outlined in this announcement will improve patient safety levels and help to reduce avoidable pressure on the NHS in the winter months ahead.
Andy Burnham
This Secretary of State has been in office for one year—the worst year in A and E in a decade: close to 1 million people waiting more than four hours, and on his watch, the first summer A and E crisis in living memory. But with this Government it is always someone else’s fault: GPs, nurses, patients, the weather, immigration, bank holidays—nothing to do with him, Mr Speaker, he is just a member of the public, as he is fond of saying. Well, I have got news for him: he is the Secretary of State, and it is time he started acting like it. All year we have warned him about the growing A and E crisis. First, he ignored those warnings, leaving A and E ill-prepared on the brink of a dangerous winter, as the NHS Confederation has warned. Now, in panic, he briefs out half-baked plans, without coming to this House. This is too little, too late. It is not good enough that we have had to drag him here on an issue of huge importance to our constituents. With his spin about the GP contract, he neglects the real causes.
First, on staffing, we learn today of the shocking shortage of doctors covering A and Es overnight, and we heard at the weekend reports of A and Es up and down the land without enough staff. More than 5,000 nursing jobs have been lost on the Government’s watch—and counting. Enough is enough. When will the Secretary of State stop the job cuts and ensure that all A and Es have enough staff to provide safe care?
Secondly, on GP opening hours, the Secretary of State tries to blame the 2004 contract but conveniently ignores the fact that A and E performance improved between 2004 and 2010. The truth is that it is the Government who have let GP practices stop evening and weekend surgeries, and it is the Government who ended the guarantee of appointments within 48 hours. What is he doing to restore patient access to GPs?
Thirdly, on social care, in the first two years of this Government there was an appalling 66% increase in the number of people aged over 90 coming into A and E via a blue-light ambulance—that is more than 100,000 very frail and frightened people in the backs of ambulances speeding through our cities and towns. That is a scandal, and it is more to do with social care cuts than anything else. I do not know how many more times I am going to have to ask the Secretary of State this: when will he do something to stop the collapse of social care in England?
All the while the Secretary of State blames a contract signed 10 years ago for today’s pressure he neglects the real causes of his A and E crisis. That is dangerous and it cannot carry on. Patients and staff cannot go through another year in A and E like the one we have just had. He should cut the spin, get a grip or go.
Mr Hunt
In the right hon. Gentleman’s endless quest to turn the NHS into a political football, he, disappointingly, paints a picture that is a long way from reality. He talks about A and E performance. Yes, since I have been Health Secretary we have missed our target in one quarter, but when he was Health Secretary he missed it in two of the three quarters, including 14 weeks over the crucial winter period. What he does not tell the House is that this Government actually hit their A and E target for the year as a whole, whereas in Labour-controlled Wales the NHS budget has been cut and the A and E target has not been hit since 2009—he repeatedly refuses to confront that.
The right hon. Gentleman talks about the number of nurses being down. He might want to check the figures and correct the record for the House when he uses the 5,000 figure, because the fact is that the number of hospital nurses—hospitals are where A and E departments are—has gone up under this Government, as has the number of doctors, health visitors and midwives. None of that would be possible if we had cut the NHS budget by £600 million from its current levels, which is his policy.
The right hon. Gentleman then talks about the social care budget. Under his Government the number of over-80s went up by more than a quarter, yet the Labour Government cut social care funding per head. We have introduced the innovative £3.8 billion merged health and social care fund, which will transform the joined-up nature of the services that people receive.
Finally, I am afraid that Labour Members are burying their heads in the sand about the enormous damage they did when they removed named GPs for members of the public under the GP contract. Professor Keith Willett, one of the most senior doctors in the NHS and responsible for all A and E services in NHS England, has said that between 15% and 30% of the people using A and E could be using primary care instead. That is why we are announcing really important changes to the way in which the GP contract operates, in order to address this problem. When the Government come before the House with a sensible package of short-term and long-term measures, any responsible Opposition would welcome it—instead, we have had political posturing and no attempt to address the real challenges facing the NHS.
Mr Stephen Dorrell (Charnwood) (Con)
May I welcome the £250 million that my right hon. Friend has announced as short-term relief of the pressures in A and E departments this winter, and in particular the £10 million he has announced for Leicester’s hospitals trust? Does he agree that the way to relieve pressure in A and E departments is by recognising that the health and care system is a single system that needs to be joined up and that the announcement by the Chancellor of £3.8 billion made available from health service spending to promote better integration of health and social care is the most effective single thing we can do to relieve pressure on A and E departments?
Mr Hunt
As so often on these matters, my right hon. Friend speaks extremely wisely. Since April, we have been working hard to deal with the underlying pressures on A and E departments while ensuring that we have cash available for short-term measures while those longer-term measures are put in place. He is absolutely right that joined-up integrated services are critical for A and E departments, because one of the biggest problems that they mention is the difficulty in discharging people from hospital, which makes it hard for them to admit patients who need to be admitted, often in very distressed circumstances. We also need to address the longer-term IT problems that mean that A and E departments cannot access people’s medical records and the question of alternatives to A and E, particularly in the community and through enhanced GP services.
Mr Ben Bradshaw (Exeter) (Lab)
If the Secretary of State is serious about people not attending A and E unnecessarily, why did he cut Labour’s extended GP opening hours and why is he allowing NHS walk-in centres to close up and down the country?
Mr Hunt
The fact is that one thing we need to do is to address why people go to A and E instead of the alternatives, such as walk-in centres. Communication about the alternatives to A and E is not as good as it needs to be. We are addressing those issues, but I must say to the right hon. Gentleman that the previous Government failed to address this problem when he was Health Minister and the difficult issue of the reconfiguration of services was never fully grasped. We are grasping it and that is why Professor Sir Bruce Keogh is undertaking his review right now.
Dr Sarah Wollaston (Totnes) (Con)
I congratulate the Secretary of State on his welcome stand on continuity of care and the role that that plays in reducing A and E admissions. Could he go further in stating how he will ensure that we have more doctors trained from medical school in both A and E and general practice?
Mr Hunt
My hon. Friend is right and staff recruitment is critical. We have already said that we want another 2,000 GPs and are considering whether that is enough. We recognise the fact that general practice is very stretched, that we need GPs to offer more services and that we need more people to do that. Professor Keogh’s review is considering A and E departments, and one thing we are asking is why we are one of the only countries in Europe to have an emergency medicine specialty. Other countries do not do that and ask all doctors to spend time in A and E. We are also considering what we need to do to make A and E a more attractive profession for people to go into, given the antisocial hours that come with the territory. That is not an easy problem to solve, but we recognise that it is incredibly important that we crack it.
Grahame M. Morris (Easington) (Lab)
Has the Health Secretary had a chance to pause and reflect on the Government’s decision not to publish the risk register? If so, did the register warn that the reorganisation might have had an adverse effect on A and E performance?
Mr Hunt
As I recall, the risk register for that period found its way into the public domain. As for our publishing the risk register, we are following exactly the same policies as the hon. Gentleman’s Government followed in office. They refused to publish that register for the simple reason that officials need to be able to give Ministers frank advice in private if Ministers are to do their job properly. That is why we have not changed the policy.
Mr Christopher Chope (Christchurch) (Con)
The Royal Bournemouth hospital accident and emergency department treats 70,000 patients a year. Will my right hon. Friend explain how it can possibly be in the interests of those patients for that department to be downgraded to a minor injuries unit?
Mr Hunt
The changes that my hon. Friend alludes to are locally driven and have not crossed my desk. I want to reassure him that if they do cross my desk, I would not approve them unless there was convincing evidence that that was in the interests of patients and there had been proper consultation.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
Having been defeated in the High Court by the Save Lewisham Hospital campaign, the Secretary of State has decided to appeal that decision. Given the crisis in A and E in London, has he any new ideas as to how A and E services should be provided in Lewisham, and if so, will he share them with the local MPs?
Mr Hunt
We are determined to do what is right for the people of Lewisham and of south London. Let me be clear: the problems of South London Healthcare NHS Trust were not addressed by the right hon. Lady’s Government when they were in office. We are addressing them, and sometimes those decisions are difficult, and sometimes they are not popular with local people. I took the decision that I did because it will save about 100 lives a year. I think it was the right decision, and I want to ensure that I do the right thing by her constituents.
Sir Tony Baldry (Banbury) (Con)
The extra £10 million for the Oxford University Hospitals NHS Trust to deal with winter pressures is very welcome. Sir Jonathan Michael and his team have already made it very clear that they will open a significant number of new beds this winter and take on a significant number of new members of staff. The Oxfordshire clinical commissioning group is already working hard on enhancing primary triage, so that fewer people have to go to A and E. Would it not be better if we just let NHS managers—the NHS—get on with this, rather than the Opposition continuously shroud-waving every winter, in the hope there might be some failing that could shore up their flagging opinion polls?
Mr Hunt
We have not heard any kind of policy from the Opposition today, or any suggestion as to what they would do differently. We have presented to the House a package of short-term and long-term measures, designed to address the immediate and the underlying challenges. It is a very comprehensive package, but it is going to be a very tough winter and I would urge all responsible politicians from all parties to row in behind the package, which I think will make a very big difference on the front line.
Mr Kevin Barron (Rother Valley) (Lab)
If the 2004 GP contract was to blame for the current crisis in A and E, could the Secretary of State explain why, in 2009-10, over 98% of patients were seen within four hours?
Mr Hunt
That contract set in train a process whereby it became easier and easier to access an A and E department, and harder and harder to access a local GP. Since that period we have had, I think, 3 million more people going to A and E every year than was the case at the time of that contract change. That is one of the underlying problems. It will take time, but we shall put that problem right.
Sir Bob Russell (Colchester) (LD)
I recently spent the whole evening on the night shift of the A and E at Colchester general hospital, and I do not recognise what we have heard from the Labour Front Bench today. As the Secretary of State is keen on alternatives to A and E, may I urge him to work with the Secretary of State for Education and implement first aid training as part of the school curriculum? Within a generation, we would have 1 million qualified first-aiders. That is one way of reducing unnecessary visits to A and E.
Mr Hunt
My hon. Friend has campaigned regularly on this subject and there is a lot of merit in what he says. We do need more young people to know the basics of first aid, and that can be extremely important—even life-saving. But we also need to ensure that the NHS is there when we need it, 24/7, and that is why we need to make some important changes to the way in which A and E departments operate, in both the short term and the long term.
Jim Shannon (Strangford) (DUP)
Twenty-four thousand elderly people died last winter due to cold-related illnesses, and many of them had been referred to A and E departments. What specific assurances will the Minister make to vulnerable elderly people, who really dread the onset of winter?
Mr Hunt
That is what today’s announcement is all about. We are trying to reassure them that we are leaving no stone unturned, and where there are things that we can do in the short term, we are doing those things because we want every older person to feel confident that their NHS will be there for them—that their local A and E department will be able to cope with the additional pressures that develop every winter. But I would also say to them that where there are alternatives to A and E departments, people should consider those as well. That is why some of the measures that we are investing in are good alternatives to A and E, which can often give more appropriate treatment.
Mark Reckless (Rochester and Strood) (Con)
Hospital staff have acted with extraordinary enthusiasm to, as they put it, reboot Medway following the Keogh review. Can the Secretary of State confirm that the £6 million or so extra that he may provide to help our A and E should be in addition to anything that the clinical commissioning group might otherwise have agreed to provide?
Mr Hunt
Yes, I am happy to confirm that it is additional money. I thank my hon. Friend for the interest that he shows in his local hospital, which is going through a very challenging time. We are absolutely determined that where hospitals are failing or delivering inadequate care, we will not sit on those problems; we will expose them and deal with them. That is the best thing we can do for my hon. Friend’s constituents and people all over the country where there are, unfortunately, problems with local hospitals.
Mr John Denham (Southampton, Itchen) (Lab)
In the last year, the A and E target was missed at Southampton hospital in 38 of 52 weeks. Since I last raised that in the House, Monitor has gone in to investigate the governance of the hospital, yet no money has been made available by the Secretary of State in today’s announcement. Is that not a sign that the crisis is so big that he has only been able to give a limited amount of help to those places that have an even worse crisis than we have in Southampton?
Mr Hunt
The pressure exists throughout the NHS. The right hon. Gentleman is absolutely right: there is real pressure in all hospitals. I commend all A and E departments for their hard work. The ones that got additional resources today were the 53 local health economies where we thought the risks were highest, and I think it was right to target that money to help those areas, but that is not to say that there is not a lot of pressure in other areas. That is why the long-term changes that we are talking about—the transformation in IT systems, the increased availability of GPs to look after frail and vulnerable older people, the integration of health and social care services—will benefit the right hon. Gentleman’s constituents and his hospital profoundly, and I am sure he will notice the difference.
Angie Bray (Ealing Central and Acton) (Con)
I welcome the extra money for Ealing Hospital NHS Trust and North West London Hospitals NHS Trust. It will come in very useful indeed. However, my right hon. Friend will be aware that four hospitals in North West London are still under threat of losing their A and Es. The independent review into that decision is due to report to his Department very shortly. When are we likely to get a final decision from him?
Mr Hunt
Let me reassure my hon. Friend. First, I thank her for her assiduous campaigning for her local hospital, which is recognised on both sides of the House. I am expecting that report on Friday, and as the House knows, when it comes to issues of hospital reconfigurations, I want to make decisions as quickly as I can. I will want to consider it very carefully, but I think everyone would like the certainty of knowing what will happen, so I will report to the House as soon as I am able to make a decision.
Bridget Phillipson (Houghton and Sunderland South) (Lab)
Hospitals across the north-east, as in many parts of the country, are facing considerable pressure on their A and E departments. Will the Secretary of State set out in more detail the rationale used to allocate the funding? I notice that not a single NHS trust in the north-east appears on his list.
Mr Hunt
The decision on which 53 areas to concentrate the resources was not made by me; it was made by NHS England, talking to Monitor and the NHS Trust Development Authority, on the basis of where, in their professional assessment, the highest-risk areas are. That is a sign that hospitals in the north-east are performing extremely well. In the past few months I have visited Newcastle, and I thought the hospital was absolutely fantastic; I did a stint on the front line there. There are some outstanding hospitals across the country, and there is very good NHS provision in the north-east. That is probably the reason.
Andrew George (St Ives) (LD)
I wish my right hon. Friend well in his quest to reintegrate a fragmented service —a trend which was largely started under the previous Government—but given the fact that the ambulance service provides a very good bolster, and indeed support, and helps to remove pressure from many A and E departments, how much of the £500 million will be made available to support ambulance services in their support of A and E departments?
Mr Hunt
Quite a lot of the money will help ambulance services indirectly because it will be intended to reduce the number of blue light calls by, for example, providing primary care alternatives to A and E by better integrating health and social care economies, but the long-term change that we announced last week, which I think will make a real difference to ambulance trusts, involves IT. In this day and age it is crazy that an ambulance can answer a 999 call and go to someone’s home not knowing that they are a diabetic who has mild dementia and who had some falls last year. That information could be incredibly helpful to paramedics and we want to make sure that, with patients’ consent, they have it at their fingertips.
Mr Pat McFadden (Wolverhampton South East) (Lab)
The A and E at the Wolverhampton New Cross hospital is already under great pressure and earlier this year had its busiest day in history, but what really concerns local people are the possible implications of the closure of the A and E at Mid Staffs and the transfer of the work to New Cross. Can the Secretary of State confirm that if that goes ahead, New Cross hospital will have the resources in terms of capital and staff to make it work, because the alternative will be a second-class service for patients in both Wolverhampton and Staffordshire?
Mr Hunt
I thank the right hon. Gentleman for the interest and support that he shows for his local hospital. Of course, Mid Staffs has an extremely troubled history and it would be a derogation of my duties if I did not try to sort out the problems there once and for all, but we will not make any changes that have knock-on effects on neighbouring trusts without proper assessment and making sure that provisions are in place so that they can cope with any additional pressures. The final decision about what is going to be done has not been made, but I reassure the right hon. Gentleman on that point.
Steve Baker (Wycombe) (Con)
The A and E crisis in Wycombe results from the closure of the department under the previous Government. Although I would love to lay the blame squarely on Labour, is not the truth that, over the life of the NHS, clinical practice and management have changed substantially? Will my right hon. Friend consider producing a White Paper that takes a holistic view of emergency and out-of-hours care so that we can have an A and E service that is fit for the 21st century?
Mr Hunt
My hon. Friend has campaigned as hard as anyone in the House for more personalised and humane care for his constituents, and he is right. We need a radical rethink about the way that A and E departments work. My only hesitation in leaping to accept his suggestion of a White Paper is that that process takes a very long time. Professor Sir Bruce Keogh is in the middle of a review and I want him to be able to report back. I hope that we can get support across the House for what he says so that we can implement his solutions much sooner than that White Paper process would allow.
Heidi Alexander (Lewisham East) (Lab)
The Secretary of State may be holding on to some sort of misplaced belief that he did the right thing with regard to Lewisham. However, the High Court judgment in the summer ruled and found him to have acted unlawfully in taking the decision to slash services at Lewisham in order to solve financial problems elsewhere. Rather than wasting more taxpayers’ money in appealing against this judgment further, why will he not allow local health care professionals to determine the future shape of acute services in south-east London to meet the needs of the community and not just the needs of NHS accountants?
Mr Hunt
I know that the hon. Lady has campaigned assiduously and determinedly for her constituents. Even though we have different views, I hope she will understand that at every stage I have taken the decisions, often difficult decisions politically, that I think will best serve her constituents and the people of Lewisham. I accepted the advice of the medical director of the NHS that that decision on Lewisham would save a significant number of lives. That is why I took that decision. As to what we do going forward, I will continue to do what I think is the right thing for her constituents. If she does not agree with the decisions I make, I hope she will at least show greater respect for the motives behind them.
Gavin Barwell (Croydon Central) (Con)
I have discussed with my right hon. Friend on many occasions the issues facing Croydon University hospital. I am very grateful for the £4.5 million that has been announced today. May I ask him both to look kindly on the bid for capital investment for the A and E department there, and to pay tribute to the doctors and nurses in my A and E department and others across the country who are working so hard under such pressure?
Mr Hunt
I thank my hon. Friend for making that point. It cannot be said enough how hard A and E staff in particular work—antisocial hours in very challenging conditions. Many hon. Members will have seen that in their local hospitals. With respect to the capital allocations, I hope that the House has a sense from today that we are looking to solve the long-term problems facing A and E departments, as well as giving immediate help for this winter and next winter, so of course we will look carefully at the business case put forward by his local hospital for capital.
Valerie Vaz (Walsall South) (Lab)
The Royal College of Physicians, the College of Emergency Medicine and others have already come up with a 10-point plan for what to do about emergency care. That is the professional view. When will the Secretary of State act on it?
Mr Hunt
The royal colleges have come up with a number of important and good ideas. I hope that the hon. Lady has seen from my announcement today that we are making some profound changes to address the underlying problems in A and E which incorporate much of their thinking, but there are other ideas. We will continue to engage closely with the royal colleges because they can give us a lot of help in ensuring that we get the right answer.
Mr Peter Bone (Wellingborough) (Con)
Wellingborough’s nearest A and E is Kettering general hospital, which is 30 minutes or more for most of my constituents to get to. However, the proposal for an urgent care centre at the Isebrook hospital in Wellingborough will allow 40% of those constituents to go locally and relieve pressure on Kettering. Is this the sort of thing that the Secretary of State wants to encourage?
Mr Hunt
I always try to support the ideas that come up from different parts of the NHS because people on the ground usually have the best ideas about what needs to be done, but when decisions cross my desk it is important that I consider the knock-on effect on other areas, and I get independent advice on that as well. I shall follow closely the proposal that my hon. Friend mentions.
Nic Dakin (Scunthorpe) (Lab)
Does the Secretary of State believe that he has done enough to avoid a crisis in A and E this winter?
Mr Hunt
I think we have done everything we can, and we have tried to listen hard to the suggestions for what can help in the short term and what can address the underlying problems. I believe it is possible for the NHS to meet its targets this winter, but I do not want to say that it is going to be easy. It will be a very tough winter and we need to get behind the doctors and nurses on the front line who are doing their very best to deliver a great service to the public.
Nigel Mills (Amber Valley) (Con)
I welcome the extra £4.5 million for the Derby hospitals trust. On a separate matter, can the Secretary of State reassure my constituents that if they ring 111 they will now get a quality service that gives them the advice they need?
Mr Hunt
I thank my hon. Friend for mentioning the support that we are giving to Derby, which I hope will be a great help over this winter and next winter. Improving 111 is an important part of the long-term solution for A and E. If there is one thing that could persuade people not to go to their local A and E, it is to pick up the phone and get a good service. We have 92% satisfaction rates with 111 now, after the teething problems earlier in the year, but I think it can be even better. One of the things that would make the biggest difference is if we did something that has never happened before, which is to make it possible for doctors at the end of the 111 lines to access people’s medical records, with their consent. Then people would be talking to someone who knew about them, their allergies and their medical history. That is a big change. It never happened under the previous Government. Their attempts—[Interruption.] NHS Direct had no access to people’s medical records, which is what we are talking about. That would be a profound change and could make a big difference.
Barbara Keeley (Worsley and Eccles South) (Lab)
It appears that the Secretary of State is not listening to the Health Committee, which has looked into the issue. The Chair, the right hon. Member for Charnwood (Mr Dorrell), has made it clear that he does not think the 2004 GP contract is to blame for these issues, but we found out that only 16% of hospital trusts have the recommended level of emergency consultants, and we noted that nearly £2 billion has been taken out of adult social care. When will the Secretary of State deal with the staffing cuts and budget issues that are actually causing the A and E crisis?
Mr Hunt
My right hon. Friend said to the House that he largely agreed with the changes that I wanted to make to the GP contract. I always listen very carefully to what the Select Committee says, but I point out to the hon. Lady what Professor Keith Willett, who is the person at NHS England who is in charge of all A and E departments, said. He said that between 15% and 30% of the people attending A and E departments could be looked after by primary care. If we ignore that—I am afraid that what Labour did in 2004 has made the problem a great deal worse—we will not solve the underlying problems with A and E.
Iain Stewart (Milton Keynes South) (Con)
I warmly welcome the additional £2.7 million for Milton Keynes hospital, which will help address short-term pressures this winter, but, looking at the longer term, I urge my right hon. Friend to look again at the case that I and my hon. Friend the Member for Milton Keynes North (Mark Lancaster) and the Milton Keynes Citizen have been making for an expanded A and E centre in Milton Keynes to meet the needs of a vastly increasing population.
Mr Hunt
I congratulate my hon. Friend and his Milton Keynes colleague on their assiduous and regular conversations with me on the pressures on their A and E. I recognise that it is operating way above its original planned capacity and hope that today’s announcement will make some difference, but we will continue to look at long-term solutions because we recognise that there are long-term pressures.
Mr Andy Slaughter (Hammersmith) (Lab)
In view of the continuing and worsening crisis in A and E, will the Secretary of State concede that closing four out of nine A and E departments and 500 beds at Charing Cross hospital is now unsustainable? Will he abandon those plans, or at least suspend them until the crisis is over?
Mr Hunt
I take issue with the hon. Gentleman’s suggestion that this is a worsening crisis in A and E. We have hit our A and E target for the last 22 weeks. We recognise that there are real pressures and are seeking to address them. On the proposals for north-west London, he knows that I cannot comment until I have received the Independent Reconfiguration Panel’s advice. I will look at it very carefully, but obviously, considering the pressures on A and E departments across the country, I will want to ensure that any proposed solution makes sure that his constituents get the service they need when it comes to urgent and emergency care.
Julian Smith (Skipton and Ripon) (Con)
I welcome the £1.5 million for Airedale hospital in Yorkshire and urge the Secretary of State to keep a watchful eye on those hospitals serving some of the most rural parts of our country, such as the Yorkshire dales, which I represent.
Mr Hunt
Absolutely. I have visited Airedale hospital, which I think is excellent. It is one of the few hospitals in the country where the A and E department has access to GP records, which means it can give patients a much better service. It also has fantastically innovative ways of looking after the frail elderly in the community. I think that some of the smaller rural hospitals are blazing a trail when it comes to the changes we need to make elsewhere.
Andy Sawford (Corby) (Lab/Co-op)
Kettering general hospital’s A and E department was built for 20,000 people a year but is now trying to meet the needs of 80,000 people. The money announced today is of course welcome, but I ask the Secretary of State to look seriously at our bid—a joint bid from neighbouring MPs too—for capital investment in Kettering’s A and E.
Andrew Bridgen (North West Leicestershire) (Con)
Will my right hon. Friend pledge to do everything in his power to undo the mess created by Labour’s 2004 GP contract give-away in order to help restore the essential link between patients and family doctors, which will lead to better patient outcomes and reduce pressure on our A and E departments?
Mr Hunt
My hon. Friend is absolutely right. I am astonished that the Labour party seeks to defend those changes to the GP contract, which got rid of named GPs, removed responsibility for out-of-hours services from them and broke the personal responsibility that the best GPs always wanted to feel for the people on their list. In fact, many brave practices refused to go along with those contract changes and continue to have named GPs. There is clear evidence that people who have named GPs use hospital services less. If we are going to give older people the right care, we need to undo those damaging changes.
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
The Secretary of State has spoken confidently about how his changes will make a difference in the short term, but over the weekend the BBC revealed that A and E departments are, on average, 10% understaffed and that one trust in London is 75 nurses down. Despite what he has announced today, how can he be sure that those vacancies can be filled?
Mr Hunt
The hon. Lady is right that there are staff shortages, and it is not because trusts do not want to employ people; it is because it is difficult to find people to fill all those vacancies. Those are some of the longer-term problems that we will have to address when looking at how to make working in A and E more attractive. There are a number of things we can do in the short term to alleviate the pressure, such as putting GPs on the front desks at A and E departments so that people can get help, ensuring that the social care system is open seven days a week so that people can be discharged on Saturdays and Sundays, and extending consultant cover late into the evenings and at weekends, when A and E departments are busiest. I think that it is right that we do those things straight away while trying to address the longer-term problems.
Glyn Davies (Montgomeryshire) (Con)
My constituents depend on A and E services in Shropshire, which in many cases are already a long way distant. Does my right hon. Friend agree that when reorganisation takes place, which will happen in Shropshire, proper account should be taken of the distances that people living in rural areas will have to travel for emergency and urgent services?
Mr Hunt
I absolutely agree. It is really important that we recognise those challenges in rural areas, and indeed semi-rural areas such as my constituency, where we have had similar issues. I can assure my hon. Friend that when we make structural changes, we take those issues closely into account.
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)
How many walk-in centres have been closed since May 2010?
Andrew Selous (South West Bedfordshire) (Con)
I would like to praise very highly the A and E staff at Luton and Dunstable hospital, whose work I have seen at close quarters on a number of recent occasions. If A and E staff had access to GP records, would there not be better diagnosis and would not time be saved? If some of our smaller hospitals are doing that, it raises the question why all of them are not.
Mr Hunt
My hon. Friend is absolutely right. The truth is that many in the NHS had their fingers burnt when the previous Government, with the best of intentions, tried to address the problem, unfortunately with abysmal results and billions of pounds wasted. I do not think that we should let that failure stop us doing what we know can transform services. When we look at the changes that have been made in the banking, airline and retail industries, we see that we need to use the benefits of modern technology in the NHS. It will save thousands of lives.
Steve McCabe (Birmingham, Selly Oak) (Lab)
How could any Secretary of State imagine that it is okay to preside over a situation in which there are only five consultants working overnight in A and Es across the entire country?
Mr Hunt
I agree with the hon. Gentleman that consultant cover is not as good as it needs to be, and not just in A and E departments, but across NHS hospitals, so I hope that he will support me in moving forward with a seven-day NHS, which is a very big change and might be opposed by people working in the NHS. I am delighted that I can be assured of his support.
Neil Carmichael (Stroud) (Con)
Does the Secretary of State agree that putting patients first is at the heart of this and that that means, in part, ensuring that they can navigate the system and go to places such as the excellent Vale community hospital in Dursley where appropriate?
Mr Hunt
I am delighted to hear about the excellent Vale community hospital in Dursley. On my hon. Friend’s general point, we have not been good at persuading the public that there is anything between GP surgeries and A and E departments. The NHS has tried repeatedly to come up with walk-in centres and urgent care centres. Some have been successful, and some have not. At the heart of the challenge is the fact that the public want a 24/7 service for accidents and emergencies and urgent care. We have to ensure that they have it and that they understand where it is.
Kate Green (Stretford and Urmston) (Lab)
Last year, Central Manchester University Hospitals NHS Foundation Trust and University Hospital of South Manchester NHS Foundation Trust both missed their A and E waiting targets on 30 out of 35 weeks. This year, of course, they will be coping with the additional challenge of absorbing the fallout of the downgrading of the A and E at Trafford general hospital. I note that neither trust has been awarded additional funding today. Can the Secretary of State assure me that the risk model that NHS England applied has properly taken account of the consequences of having to absorb major organisational change and, if it turns out that there are more pressures on those A and E departments this winter, that provisional funding will be looked at again?
Mr Hunt
I can absolutely reassure the hon. Lady on that point. We are extremely careful—I have had good discussions with her about this—before making any structural changes, to ensure that the impact on neighbouring A and E departments is properly thought through. Since the statement to the House about Trafford hospital, we have approved a capital funding programme for one of the neighbouring hospitals that will be affected. That is extremely important and we will continue to monitor it closely.
Henry Smith (Crawley) (Con)
The A and E unit that my constituents have to access is at East Surrey hospital, and I welcome last year’s investment of £4 million to refurbish it, but does my right hon. Friend agree that Labour’s closure of Crawley A and E in 2005 certainly did not help with the pressure on local A and E departments?
Mr Hunt
A number of things have contributed to these changes, one of which is that we have not succeeded, as an NHS or as a Parliament, in getting the way in which we do reconfigurations right: they do not command the confidence of the public and people are not satisfied that there are alternatives that they can trust or that good alternatives will be put in place when a change is proposed. We need to learn the lessons from what happened in my hon. Friend’s constituency.
Derek Twigg (Halton) (Lab)
Since 2010 the new Whiston hospital has seen an increase of 25% in emergency demand, but it has not been funded for it. I met the chief executive and vice-chair of the governing board last Friday and asked them whether they would be able to guarantee a safe service if that level of activity continues with the winter pressures, and they said that they might not. Will the Secretary of State urgently look at the situation at Whiston and come up with some solutions?
Mr Hunt
I hope that when the hon. Gentleman looks at today’s announcement it will reassure him that we are addressing not just the immediate pressures in the most difficult areas, but the underlying pressures. That 25% increase at Whiston—I pay tribute to the staff in its A and E department, who will no doubt be working extremely hard to cope with it—has come about because we have not had better alternatives to A and E and because departments have often found it difficult to discharge people from hospital into the community, which has further increased the pressure on them. What we have announced in the past few months and today will make a real difference to alleviating those pressures.
Robert Halfon (Harlow) (Con)
My right hon. Friend will be aware that Princess Alexandra hospital in Harlow is an outstanding hospital with outstanding staff. My constituents will be incredibly grateful for the £5.7 million announced today, which comes on top of a £470,000 grant provided to St Clare hospice by the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb), who has responsibility for care. Does my right hon. Friend agree that that shows that this Government invest in the NHS in Harlow, and will he come to Princess Alexandra hospital to see the excellent work that is being done?
Mr Hunt
I would be delighted to go to Princess Alexandra hospital, where I am sure the work is indeed excellent. I agree with my hon. Friend’s fundamental point, which is that this Government took the very difficult decision not just to protect the NHS budget, but to increase it. That was described as irresponsible by the right hon. Member for Leigh (Andy Burnham). We are spending £600 million more in real terms this year than we would have spent if we had followed his advice. That makes a very big difference to hospitals such as that in my hon. Friend’s constituency.
Diana Johnson (Kingston upon Hull North) (Lab)
Will the Secretary of State be clear: did the risk register warn the Government that their reorganisation would hit the A and E performance targets?
Mr Hunt
There has been exhaustive analysis of the problems in A and E departments and whenever I have visited such departments I have not heard a single person say that the reorganisation was the cause of them. What they talk about is the underlying problems, which we are addressing today.
Mr Philip Hollobone (Kettering) (Con)
Despite the best efforts of its hard-working staff, the A and E department at Kettering general hospital has been under huge pressure for some time. It has failed to meet its targets and the chief executive resigned recently as a result. Would my right hon. Friend be kind enough to confirm the amount of additional funding to the A and E department at Kettering, and what is his assessment of the analysis that up to a third of those who present themselves to A and E departments could receive better, quicker and more appropriate treatment elsewhere?
Mr Hunt
My hon. Friend has campaigned assiduously for Kettering hospital, including by inviting me there to see it for myself. I think that its staff are working extremely hard. I am pleased to confirm that today’s announcement means that an extra £3.9 million will be given to the hospital to help it meet those pressures over this winter. I think that the people working in A and E would be the first to say that where there are alternatives in the community, they should be used. The long-term change we need to make is to reverse what has happened over the past decade, which is that it has become easier and easier to go to an A and E department and harder and harder to get an appointment with a GP. That was the profoundly wrong change made by the previous Government and that is what we have to put right.
Mr Andrew Love (Edmonton) (Lab/Co-op)
The Secretary of State will be aware that the major reason given for the reconfiguration of services at Chase Farm hospital was the need to increase the number of consultants and specialist staff in accident and emergency, but we discovered over the weekend, as colleagues have indicated, that there is a massive shortage of specialist staff and consultants, particularly in outer London, where there are special pressures. The Secretary of State has indicated some of the short-term measures, but my constituents want reassurance that steps will be taken to bolster the number of A and E consultants and specialist staff to look after them.
Mr Hunt
The hon. Gentleman is right to say that that is one of the key issues in the underlying pressures on A and E departments. About a quarter of the money announced today will be used to increase the capacity of A and E departments, including increasing consultant cover. In the end, however, we need more trained consultants; we need more doctors who want to work in A and E departments. That is a longer-term challenge, but one of the ways in which we will make A and E more attractive is by convincing doctors that we have a long-term, sustainable strategy to make sure that it does not become an impossible job. That is what the measures on improving GP access, IT systems and the social care system aim to achieve.
Dr Thérèse Coffey (Suffolk Coastal) (Con)
The Secretary of State may be interested to know that in a parliamentary seminar earlier this year the College of Emergency Medicine said that walk-in centres provided temporary help with A and E attendances but that their closure has had no impact at all. More importantly, does my right hon. Friend agree that we should praise those hospital trusts that have not needed extra money and that that is a ringing endorsement of their leadership?
Mr Hunt
My hon. Friend speaks extremely wisely, as ever. She is right. The reason why the 100 or so hospitals that have not benefited today did not get money is that our assessment is that they have outstanding leadership and will be able to cope. That is not, however, to minimise the pressure they will be under or the fact that it will be extremely hard work. I pay tribute to them because, as good hospitals, they often have to deal with more people wanting to go through their doors than through those of other hospitals with less good reputations. We need to support everyone and my hon. Friend is right to say so.
Chris Bryant (Rhondda) (Lab)
One pressure that applies equally in Wales and in England is that on the recruitment of consultants for A and E. Last year, Welsh health boards advertised for 14 A and E consultants but managed to appoint only one, and that was after a nine-month interregnum. May I urge the Secretary of State—this has been impressed on me many times by those who work in the NHS—to speak to the Minister for Immigration, because many trusts and hospitals are saying that the new operation of the immigration rules makes it impossible to recruit from overseas, even from countries that deliberately train for the international market?
Mr Hunt
We have designed the immigration rules so that they are flexible enough to make sure that NHS hospitals can recruit trained staff where they are needed and where we cannot find people with those skills in the UK. I say to the hon. Gentleman that although some challenges may be the same in England and Wales, one challenge is very different in Wales, because Labour there decided to cut the budget by 8%, which has made life a great deal harder for NHS trusts.
Mr Marcus Jones (Nuneaton) (Con)
Since May 2010 an extra 300 clinical staff are working at the George Eliot Hospital NHS Trust, which is now recruiting more nurses and more A and E consultants in response to the Keogh review. Does that not show that under this Government more resources are being directed towards front-line patient care?
Mr Hunt
It absolutely does. There are nearly 4,000 more front-line staff under this Government than there were under the previous Government at the time of the last election. More importantly, where there are problems in hospitals—my hon. Friend’s hospital has had a number of problems—this Government are not sitting on them or seeking to cover them up. We are addressing them and I hope that by the time of the next election we will be able to demonstrate that we have turned around my hon. Friend’s hospital and a number of others and that finally these serious problems are being addressed.
Mr Robert Buckland (South Swindon) (Con)
Will my right hon. Friend join me in thanking A and E staff at the Great Western hospital for their hard and successful work? Will he assure me that, if hospitals such as the GWH and the Royal Berkshire just down the M4 corridor incur any additional needs this winter, there is contingency in the budget?
Mr Hunt
We do have a contingency built into these plans, but it is also important for trusts to plan in advance. One of the reasons why we announced this funding in August and why we have today announced where it will go is in order to enable people to make long-term plans. The lesson we have learned from previous years is that if we come up with these packages in the middle of winter it is too late for anything to happen. I totally join my hon. Friend in commending the hard work at Great Western hospital.
NHS Winter Planning
Jeremy Hunt Excerpts(13 years, 1 month ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
Today the Government can announce their plans for winter and the allocation of £250 million funding to NHS England. This money will be distributed by NHS England to the areas that need it most in 2013-14, working with Monitor and the NHS Trust Development Authority (TDA). This follows the Prime Minister’s announcement in August that A&E departments will benefit from an additional £500 million over the next two years to address seasonal pressures.
It is important to provide the NHS with greater support during the winter period, particularly at a time when the scale of the challenge facing the NHS and wider health and care system is becoming increasingly clear. It is essential that even when demand is at its highest, patients get the excellent support they need and rightly expect. Emergency admissions have risen by 32% over the last decade and our main priority is to make sure the NHS can cope with this increasing pressure, not only this winter but also for the future.
As in previous years, a robust monitoring process will be in place from the beginning of November until the end of February and data will be available online to local organisations to support their management and co-ordination.
NHS England, Monitor and the NHS Trust Development Authority have been working jointly to determine where this funding will make the greatest impact and make a demonstrable difference to patients. The funding will be targeted in the following way:
£15 million towards securing a reliable NHS 111 service throughout the winter period;
subject to completion of current scrutiny of plans, a total provisional amount of £221 million for the 53 high-risk systems; and
a small contingency of £14 million for use for final settlements for trusts to use in the winter.
Indicative amounts have been allocated, subject to change, to the following trusts outlined as follows:
Region | System as Identified by NHSTrust/NHS Foundation Trust | Provisional Amounts(£000s) |
|---|---|---|
London | Barking, Havering & Redbridge University Hospitals NHS Trust | £7,000 |
London | Barnet & Chase Farm Hospitals NHS Trust | £5,120 |
London | Barts Health NHS Trust | £12,800 |
London | Croydon Health Services NHS Trust | £4,500 |
London | Ealing Hospital NHS Trust | £2,900 |
London | North Middlesex University Hospital Trust | £3,800 |
London | North West London Hospitals NHS Trust | £6,400 |
London | South London Healthcare NHS Trust | £7,700 |
London | Whittington Health NHS Trust | £2,960 |
London | West Middlesex University Hospital NHS Trust | £2,300 |
Midlands and East | Basildon and Thurrock NHS FT | £2,490 |
Midlands and East | Bedford Hospital NHS Trust | £3,734 |
Midlands and East | Derby Hospitals NHS FT | £4,487 |
Midlands and East | Heart Of England NHS FT | £9,289 |
Midlands and East | Kettering General Hospital NHS FT | £3,919 |
Midlands and East | Mid Essex Hospital Services NHS Trust | £2,869 |
Midlands and East | Mid Staffordshire NHS FT | £3,747 |
Midlands and East | Milton Keynes Hospital NHS FT | £2,763 |
Midlands and East | Northampton General Hospital NHS Trust | £4,000 |
Midlands and East | Peterborough and Stamford NHS FT | £5,050 |
Midlands and East | Sandwell and West Birmingham Hospitals NHS Trust | £4,218 |
Midlands and East | Shrewsbury and Telford Hospital NHS Trust | £4,000 |
Midlands and East | The Queen Elizabeth Hospital, King's Lynn. NHS FT | £3,990 |
Midlands and East | The Princess Alexandra Hospital NHS Trust | £5,700 |
Midlands and East | United Lincolnshire Hospitals NHS Trust | £8,000 |
Midlands and East | University Hospital Coventry and Warwickshire NHS Trust | £4,000 |
Midlands and East | University Hospital Of North Staffordshire NHS Trust | £3,460 |
Midlands and East | University Hospitals Of Leicester NHS Trust | £10,000 |
Midlands and East | Worcester Acute Hospitals Trust | £1,000 |
North | Aintree University Hospital NHS FT | £1,520 |
North | Airdale NHS FT | £1,450 |
North | East Lancashire Hospitals NHS Trust | £1,403 |
North | Lancashire Teaching Hospitals NHS FT | £914 |
North | Leeds Teaching Hospitals NHS Trust | £1,890 |
North | Northern Lincolnshire and Goole Hospitals NHS FT | £1,044 |
North | North Cumbria University Hospitals NHS Trust | £2,292 |
North | Southport & Ormskirk Hospital NHS Trust | £4,042 |
North | Stockport NHS FT | £1,530 |
North | Tameside Hospital NHS FT | £2,475 |
North | University Hospitals Of Morecambe Bay NHS FT | £1,257 |
North | York Teaching Hospital NHS FT | £2,061 |
South | Brighton and Sussex University Hospitals NHS Trust | £2,326 |
South | Dartford and Gravesham NHS Trust | £4,080 |
South | East Sussex Healthcare NHS Trust | £2,300 |
South | Hampshire Hospitals NHS FT | £3,302 |
South | Heatherwood and Wexham Park Hospitals NHS FT | £6,644 |
South | Medway NHS FT | £6,120 |
South | North Bristol NHS Trust | £5,900 |
South | Oxford University Hospitals NHS Trust | £10,207 |
South | Plymouth Hospitals NHS Trust | £5,500 |
South | Portsmouth Hospitals NHS Trust | £1,427 |
The additional allocation will require an increase to the revenue budget for NHS England for 2013-14, as specified in the mandate. This revision to the mandate will be laid before Parliament in due course1.
One of the avoidable pressures on the NHS is flu. On average around 750,000 patients see their GP with flu symptoms and nearly 5,000 people die each year. Flu levels have been relatively low over the past two years but this does not mean they will not go up this year. And if cases of flu do increase, the pressure on A&Es will also increase. The best way for people at risk from flu to protect themselves, their families and—in the case of NHS staff—their patient is to get the flu vaccine.
For the first time, young children aged two and three will be offered the innovative nasal spray vaccine to protect them against flu. Young children’s close contact with each other means they are likely to transmit the virus to other more vulnerable groups—including infants and the elderly.
Front-line health care workers, by the very nature of their jobs, deal with people who are unwell every day and on average, around 27,000 people spend time in hospital with flu every year. NHS staff can play an important role in not picking up the flu virus and passing it on to other patients who are often people who are already poorly and vulnerable to infection by simply having the flu vaccine. Less than half of front-line NHS staff get vaccinated against flu, and in some hospitals this figure drops to fewer than one in five. This is why we want to significantly boost the number of health care workers getting the flu vaccine to 75%. Trusts will not be eligible to receive a portion of the money in future years if they do not vaccinate 75% of their staff this year, except in exceptional circumstances where they can prove to the TDA, Monitor and NHS England that they have robust plans in place to ensure they meet this ambitious target the following year.
1The mandate is the document published annually by the Secretary of State under section 13A of the National Health Service Act 2006, specifying for NHS England its objectives and revenue and capital budgets.
NHS Modernisation (Costs and Benefits)
Jeremy Hunt Excerpts(13 years, 3 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
The Government’s estimates of the costs and benefits of implementing policies in the Health and Social Care Act were contained in the “Coordinating document for the Impact Assessments and Equality Analysis” published in September 2011. These estimates reflected the changes that the Government made to their proposals following the listening exercise and the report of the NHS Future Forum.
Officials have continued to track closely the actual costs and benefits of the changes. Last September I reported to the House that the current estimate of costs was in the range £1.5 billion to £1.6 billion, which is equivalent to £1.6 billion to £1.7 billion in today’s prices. I can confirm today that I expect the costs—including spending on redundancy—to be no higher than announced last year. Indeed, the costs are likely to be nearer the estimate in the business case for the programme (£1.5 billion in today’s prices).
I can also announce that, 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, comprising:
£435 million on staff redundancies;
£54 million on IT for the new organisations;
£42 million on estates costs of closing bodies and setting up new organisations;
£22 million on internal departmental costs (e.g. programme management);
£299 million on setting up clinical commissioning groups (excluding items above); and
£244 million on other costs of closing bodies (e.g. primary care trusts (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.
Annual savings are still expected to be £1.5 billion from 2014-15. Over the period 2010-11 to 2014-15, on a comparable basis with the impact assessment, the cumulative savings in administration costs arising from the reforms are still expected to be at least £5.5 billion. This sets aside administration costs of around £1.5 billion that are expected to be incurred on implementing the changes across this period.
I am today publishing “Business Case for the Health and Care Modernisation Transition Programme” which was prepared for the major programme established to take forward implementation of the reforms. A copy 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. This publication meets a commitment made in “Health and Social Care Reforms: Transition Programme Scheme for Publication” (published in May 2012). The business case reflects the landscape that existed in December 2011, after the Government had responded to the listening exercise. Although the financial estimates in the business case are largely consistent with the impact assessment they took account of some costs (estimated at £127 million in total) that were excluded from the impact assessment either because they were out of scope (for example, because they related to measures not requiring legislation) or because they were redacted (for example, because they were commercially sensitive). The business case estimated the costs of implementing the changes at £1.5 billion at today’s prices