Mental Health (Registered Practitioners and Approved Clinicians)
Jeremy Hunt Excerpts(11 years, 3 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
In my oral statement on 29 October 2012, Official Report, column 32, I said that I had asked Dr Geoffrey Harris to conduct an independent review into the technical irregularities that had occurred within four strategic health authorities (SHAs)—North East, Yorkshire and the Humber, West Midlands and East Midlands—with regard to the functions of approving registered medical practitioners and approved clinicians under the Mental Health Act 1983. In addition, I asked Dr Harris to consider this matter in the context of the new NHS structures that come in to force from April this year in order to identify whether any lessons need to be learned.
Dr Harris has now submitted his report to me. “Independent review of the arrangements made by SHAs for the approval of registered medical practitioners and approved clinicians under the mental Health Act 1983” 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.
In summary, Dr Harris found that the SHAs involved did not overtly or wittingly delegate the functions concerned. However, he identified two key principles as to how the technically irregular delegation happened. First, the SHAs concerned should have been aware that, where a function has been conferred by statute on a public authority, the public authority may not further delegate the performance of the function to another body unless expressly permitted to do so.
Secondly, the SHAs considered that, because they remained accountable for the functions, the delegation of the operation of the approval arrangements to mental health trusts through contracts was not something that risked legal irregularity. The report sets out the factors that led to this situation in more detail.
In the second part of his review report, Dr Harris recommends that every organisation in the post-April 2013 NHS, including the Department of Health, should undertake a process of due diligence. To guide this process he sets out four key principles:
that there is a clear and secure location of responsibilities across the system and that all organisations taking on transferred functions, and receiving new ones, should have a full understanding of them;
that each organisation is assured that it has the authority to exercise its powers and duties. All of the bodies must be cognisant of the duties and powers conferred upon them by Parliament, or delegated to them by the Secretary of State, and recognise that this provides the essential authorisation for all decision making and action;
that each organisation ensures it has the appropriate capability and capacity to carry out its functions; and
that there should be a process of continuing audit, that is once the functions of the organisations are settled, understood and resourced, that there is periodic audit of their discharge;
Finally, Dr Harris recommends that all bodies should include material in their governance statements for 2012-13 and for all subsequent years, which confirms that any arrangements in place for the discharge of their current statutory functions have been checked for any irregularities, and that they are legally compliant.
I have accepted all of Dr Harris’ recommendations, and will ensure that the Department and the NHS now take these forward.
South London Healthcare NHS Trust
Jeremy Hunt Excerpts(11 years, 3 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 future of South London Healthcare NHS Trust.
The NHS exists to provide patients with the highest levels of care and compassion, and it does so in a way that is more equitable than the system in any other country in the world—it provides comprehensive care, free at the point of need. But to be true to those values, different parts of the NHS need to be financially sustainable. Financial problems left unaddressed become clinical problems, not least because money used to fund deficits cannot be used for patient care. The South London Healthcare NHS Trust is the most financially challenged in the country, with a deficit of £65 million per annum.
It currently spends some £60 million a year, or 16% of its annual income, to service two private finance initiative contracts signed in 1998. For this and other reasons, repeated local attempts to resolve the financial crisis at the trust have failed. As a result, the trust is losing more than £1 million every week. In the three years since it was formed in 2009, it has generated a deficit of £153 million. That figure will rise to more than £200 million by the end of this financial year, a huge amount of money that has to be diverted away from front-line patient care.
After consulting with the trust, its commissioners and the London strategic health authority, my predecessor as Health Secretary, my right hon. Friend the Leader of the House, instituted the special administration process, which includes a period of intense local engagement. Matthew Kershaw, former chief executive of Salisbury NHS Foundation Trust, was appointed as the trust special administrator in July 2012. I would like to put on record my thanks to him and his team for his exceptionally detailed and thorough work.
Mr Kershaw had the extremely difficult task of finding a clinically and financially sustainable way forward for the South London Healthcare NHS Trust. Reluctantly, he concluded that only by looking beyond the boundaries of the trust to the wider health community could he put forward a viable solution. I support that analysis.
I received his recommendations on 7 January. Six of his seven recommendations were as follows: first, that over the next three years, all three hospitals within the trust, Queen Elizabeth hospital in Woolwich, Queen Mary’s in Sidcup and the Princess Royal in Bromley, should make the full £74.9 million of efficiencies he has identified; secondly, that Queen Mary’s in Sidcup be transferred to Oxleas NHS Foundation Trust and developed into a hub for the provision of health and social care in Bexley; thirdly, that all vacant or poorly utilised premises be vacated, and sold where possible; fourthly, that the Department of Health pay the additional annual funds to cover the excess costs of the PFI buildings at the Queen Elizabeth and Princess Royal hospitals; fifthly, that the South London Healthcare NHS Trust be dissolved, with each of its hospitals taken over by neighbouring NHS and foundation trusts; and sixthly, to aid implementation, that the Department of Health write off the accumulated debt of the trust so as not to set the new trusts up to fail, that the Department of Health provide additional funds to cover the implementation of his recommendations and that a programme board be appointed under an independent chair, reporting to Sir David Nicholson as chief executive of the NHS Commissioning Board, to ensure the changes are effectively delivered. I have accepted each of these recommendations in full.
As a consequence of what he found, Mr Kershaw also recommended that services be reconfigured beyond the confines of South London Healthcare NHS Trust across all of south-east London. This part of his recommendation included reducing the number of accident and emergency departments across the area from five to four, replacing the A and E department at University Hospital Lewisham with a non-admitting urgent care centre, reducing the number of obstetrician-led maternity units from five to four and downgrading the current obstetrician-led maternity unit at University Hospital Lewisham to a stand alone midwife-led birthing centre. Each obstetrician-led maternity units would also have a midwife-led birthing centre. The recommendation also included co-locating paediatric emergency and in-patient services with the four A and E units, with paediatric urgent care provided at Lewisham, Guy’s and Queen Mary’s hospitals. Finally, he recommended that University Hospital Lewisham should become a centre for non-complex elective procedures, such as hip and knee replacements, to serve the entire population of south-east London.
The public campaign surrounding services at Lewisham hospital has highlighted just how important it is to the local community. I respect and recognise the sense of unfairness that people feel because their hospital has been caught up in the financial problems of its neighbour. However, solving the financial crisis next door is also in the interests of the people of Lewisham because they too depend on the services that are currently part of the South London Healthcare NHS Trust. None the less, I understand their real concerns about how any changes could affect their access to vital health services. Those concerns are echoed by Lewisham clinical commissioning group and many clinicians at Lewisham hospital. I have had in-depth discussions with the hon. Members representing those affected who have reflected those concerns to me.
As a result of those concerns, I asked the NHS medical director, Professor Sir Bruce Keogh, to review the recommendations and to consider three things: whether there was sufficient clinical input into the development of the recommendations; whether there is a strong case that the recommendations will lead to improved patient care in the local area; and whether they are underpinned by a clear clinical evidence base, as set out in the third of the four tests for reconfigurations.
On the matter of clinical input, a highly experienced clinical advisory group, led by local GP, Dr Jane Fryer, and including eight trust medical directors, six clinically qualified clinical commissioning group chairs, the London ambulance service medical director, the local director for trauma and three directors of nursing, supported the trust special administrator. Further scrutiny and challenge was provided by an external clinical panel, which included representatives from the Royal Colleges of Midwives and of Obstetricians and Gynaecologists. The panel was chaired by Professor Chris Welsh, the strategic health authority medical director for the midlands and the east of England. Both groups included respected national and local clinicians. They built on years of previous work in this area and held a series of clinical workshops in August and September last year. Sir Bruce was satisfied that there had indeed been sufficient clinical input.
On the issue of better care and clinical evidence, the recommendations provide for the adoption, for the first time in south-east London, of the 2012 pan-London standards for acute care, which are the standards that all six local CCGs have said that they want to commission for emergency and maternity care. They define the best available clinical practice and set the bar higher than that provided by most other acute providers in England.
Sir Bruce agreed that the adoption of these standards could not be achieved without a reduction in the number of sites delivering acute in-patient care. Such a reduction will enable the necessary concentration of resources and senior clinical staff. A similar approach has already led to significant improvements in stroke, major trauma and cardiovascular disease services throughout London, saving hundreds of lives.
For both emergency and maternity care, Sir Bruce found no evidence that patients would be put at risk through increased journey times. The whole population of south-east London will continue to be within 30 minutes of a blue light transfer to an A and E department, with the typical journey time being on average only one minute longer. Accessing consultant-led maternity services will involve an increase in journey times on average of two to three minutes by private or public transport. Sir Bruce therefore concluded that there should be no impact on the quality of care due to the small increase in travel time.
On the issue of maternity services, the expert clinical panel advising the TSA was not willing to support the increased risk to patients of having an obstetrician-led unit at Lewisham without intensive care services. As achieving the London-wide clinical standards will be possible only with the consolidation of the number of sites with these facilities, Sir Bruce supports the proposal for this unit to be replaced with a free-standing, midwife-led unit at Lewisham hospital. This will continue to deal with at least 10% of existing activity and potentially up to 60%, and £36 million of additional investment has been earmarked to ensure that there is sufficient capacity at other sites.
Turning to the emergency care proposals, Sir Bruce was concerned that the recommendation for a non-admitting urgent care centre at Lewisham may not lead, in all cases, to improved patient care. While those with serious injury or illness would be better served by a concentration of specialist A and E services, this would not be the case for those patients requiring short, relatively uncomplicated treatments, or a temporary period of supervision. To better serve those patients, who will often be frail and elderly, and would arrive by non-blue light ambulances, Sir Bruce recommends that Lewisham hospital should retain a smaller A and E service with 24/7 senior emergency medical cover. With these additional clinical safeguards and the impact that this is likely to have on patient and clinician behaviour, Sir Bruce estimates that the new service could continue to see up to three quarters of those currently attending Lewisham A and E.
Allowing Lewisham to retain its A and E would help to reduce the level of increased demand at hospitals with larger A and E services, while an additional £37 million of investment will further expand services at these hospitals for more serious conditions. Sir Bruce advised that patients with those more serious conditions should now be taken to King’s, QE, Bromley or St Thomas’s—not for financial reasons, but to increase their chances of survival.
On the issue of paediatric care, Sir Bruce recognised the high-quality paediatric services at Lewisham and that any replacement would have to offer even better clinical outcomes and patient experience. His opinion is that this is possible, but dependent on very clear protocols for primary ambulance conveyance, a walk-in paediatric urgent care service at Lewisham, and rapid transfer protocols for any sick children who would be better treated elsewhere. He is clear that this will require careful pathway planning and will need to be a key focus of implementation.
With these caveats, Sir Bruce was content to assert that there is a strong case that the recommendations are likely to lead to improved care for the residents of south-east London and that they are underpinned by clear clinical evidence. He believes that overall these proposals, as amended, could save up to 100 lives every year through higher clinical standards.
Yesterday, 30 January, as no viable alternative plan had been put forward, and in light of Sir Bruce’s opinion, I decided to accept the recommendations of the trust special administrator, subject to the amendments suggested by Sir Bruce. It is important to be clear that my acceptance of these recommendations is conditional on Monitor approving the proposals relating to foundation trusts, and on my Department negotiating an appropriate level of transitional funding with organisations such as King’s Partners.
Owing to the size of the task, there is a significant level of risk associated with achieving the identified savings. I recognise that the additional clinical safeguards that I have put in place will marginally increase these financial risks, but on balance I have made the judgment that this is worth it if it means that local patients are reassured that they will gain from an additional better service, rather than losing their A and E.
I believe the amended proposals meet the four tests required for local reconfigurations and I am therefore content for the process now to proceed to implementation. I expect the South London Healthcare NHS Trust to be dissolved by no later than 1 October 2013. The implementation of these proposals will be challenging and complex. It needs to be planned for carefully and will not happen overnight. I call on all organisations, hospitals and commissioners to offer their full support during the coming years to achieve the ambition of these proposals for the benefit of the people of south-east London, and I commend this statement to the House.
Andy Burnham (Leigh) (Lab)
Just when we thought this Government’s mismanagement of the national health service could not get any worse, it just has. Let us be clear about what the Secretary of State has announced today. He has at last accepted recommendations that were agreed by the previous Government but then delayed by his predecessor’s moratorium, thereby deepening the financial problems of South London Healthcare NHS Trust. And he has rejected an outrageous proposal that Lewisham hospital should lose its accident and emergency department—a proposal that never should have been made in the first place, but which has cost more than £5 million of precious NHS cash on accountants in the process, enough to give some of the 5,000 nurses who were sacked their jobs back.
But the Secretary of State has accepted the principle that a successful local hospital can have its services downgraded to pay for the failures of another trust. That takes the NHS into new territory. The Secretary of State has just crossed a line and set dangerous precedents—namely, that in his new market-driven NHS, finance takes precedence and any hospital, no matter how successful, is vulnerable to changes through backdoor reconfiguration, that success can be punished and failure rewarded, and that a community can see its A and E and maternity services downgraded without proper consultation and without clinical justification.
There will be no cheers for the statement in Lewisham and it will send a chill wind through any community worried about its hospital services. There is now utter confusion about the Government’s policy on hospital reconfiguration. In three years, they have gone from moratorium to pandemonium. Across the country, half-baked cost-driven proposals to close A and Es and maternity units are being foisted on local communities without evidence of how that can be done safely and without putting lives at risk, yet at the same time, A and Es everywhere are under severe pressure. Thousands more patients are waiting for more than four hours to be seen and there are queues of ambulances lined up outside.
In that context, it is simply not tenable to downgrade any A and E department without first establishing a clear clinical case for how it can be done without compromising patient safety, but that is what the Government are doing here. They have set up a financially driven process and thrown together a clinical justification that is not independent but drawn up in his own Department, leaving the Secretary of State’s so-called four tests in tatters. Let me remind him that the fourth test is that any proposal for change must have “demonstrable support from commissioners”. Let me quote to him the chair of the Lewisham clinical commissioning group, Dr Helen Tattersfield, who has said:
“If the TSA proceeds as currently planned it is my belief that not only will this result in a reduction of quality and provision of health services for Lewisham residents with huge risks to health outcomes but also the effective end of clinical commissioning in Lewisham.”
It is clearly the case that the proposals that the Secretary of State has announced today will lead, in Dr Tattersfield’s words, to a reduction of quality and provision in Lewisham. These changes are opposed by the doctors he promised to put in charge of the NHS, and therefore clearly fail the fourth test that he has set out.
Furthermore, is the Secretary of State confident that what he has announced today is legal? We warned him that he was going beyond the powers in the Health Act 2009. He said that he would commission fresh legal advice. Will he publish it today so that there can be a proper debate on the legal position? He mentioned PFI, but is it not the case that the schemes he mentioned were initiated and negotiated under the Major Government? He said that he had consulted South London Healthcare NHS Trust, but is it not a fact that it found out about this process from the media?
This decision will damage fragile trust in the way that the NHS manages changes to hospitals. The Government need to get back to first principles. Will the Secretary of State confirm, learning from this debacle, that in future no proposal to downgrade or close A and E and maternity services will ever get out of the starting blocks if it does not have a proper clinical case to support it?
Will the Secretary of State today issue an apology to the people of Lewisham? How on earth are they expected to have confidence in the figures he has announced from a clinical review thrown together—cobbled together —in his Department in a matter of days? He has caused huge distress to them but he has also failed to listen to them. Thousands of people have put their lives on hold to fundraise, to lobby, to campaign: 52,000 names on a petition; 25,000 people on a march. This community have rallied together to defend their local hospital, led by the fantastic efforts of the local MPs, but more than that, they have fought valiantly for every community worried about this Government’s cavalier approach to our country’s most valued institution. This community have stood up to an out-of-touch Government who think they can treat some of more deprived parts of our country with utter disdain. This community have achieved something today, but I am certain that they will continue the fight—and let me say that they will have our support. Will the Secretary of State confirm that what he has just announced takes away their right of appeal to the Independent Reconfiguration Panel? If that is the case, are they not justified in continuing the fight to stop this Government riding roughshod over the people of Lewisham and south London?
What we have seen here today is the first glimpse of the new market-driven NHS that the Government have created, where the moneymen and not the medics are calling the shots. We have seen another chapter in the unfolding omnishambles that is this Government—this one, sadly, could be entitled the Lewishambles. We have seen a scandalous waste of money on a solution that will not be acceptable to people in Lewisham—and it is not acceptable to people anywhere. The Secretary of State is asking this House to accept the unacceptable. We will not do that for Lewisham and we will not do it for anywhere else.
Mr Hunt
I am afraid that the shadow Health Secretary clearly wrote his response before he read my statement. Listening to him this morning, he has never sounded further away from being part of the Government-in-waiting that he aspires to be.
Let me say this to the right hon. Gentleman: the apology over what is happening in South London Healthcare NHS Trust needs to come from Labour Members, because they were the people who failed to resolve this problem over very many years. It was their party that set up two PFI deals, signed in 1998, which have been incredibly dangerous. It was their party that created a financial situation that means that £1 million every week is being bled from front-line patient care in order to fund a deficit, and that 100 lives every year are not being saved that could be saved in Lewisham and the whole of south-east London.
What I did not hear from the right hon. Gentleman was any contrition about the fact that this incredibly difficult problem was something that his Government and, indeed, he as Health Secretary totally failed to resolve. Let me remind him that the legislation that I followed actually came from the Labour party, which passed it when it was in government. He asked me to confirm that the people of Lewisham have no right of appeal to the IRP against this decision, but who was it who stripped them of that right to appeal? It was him when his Government passed the legislation. Nothing that he has said has contained a single alternative proposal to deal with this problem. If he was being responsible as shadow Health Secretary, he would have come up with just one proposal, but he did not come up with a single one or tell the House about any of his ideas.
The right hon. Gentleman talked about the pressure on A and E, but we will take no lessons from him. We met our A and E targets last year, whereas in Wales, where the Labour party is cutting the NHS budget by 8%, the A and E targets have not been met since 2009.
I am afraid that what we have heard—I hope that other contributors will strike a different tone—is a very disappointing response from the Labour party. The shadow Health Minister, the hon. Member for Leicester West (Liz Kendall), who is not on the Opposition Front Bench today—perhaps this will explain why—has said that Labour would not do what she called the “easy politics” of opposing every single reconfiguration, but what we have heard this morning is easy politics from a party that closed at least 12 A and Es and at least nine maternity units while it was in office. The right hon. Gentleman needs to recognise that the responsible thing for a Health Secretary to do is that which will save the most lives, and that is what I have announced this morning.
Robert Neill (Bromley and Chislehurst) (Con)
My hon. Friends the Members for Old Bexley and Sidcup (James Brokenshire) and for Bexleyheath and Crayford (Mr Evennett) are on duty on a Public Bill Committee, but they wish to associate their views with my question. We thank the Health Secretary and congratulate him on taking a tough but necessary decision to deal with a mess that was not of his making and that was inherited from the Labour party. Does he accept that, thanks to the intervention of Sir Bruce Keogh’s review, more care has been taken, with both an evidence base and a consultation, than under the previous Government with regard to the reduction of A and E services at Queen Mary’s, Sidcup? Will he also help me by explaining the likely time frame for the conclusion of discussions with King’s Partners on transitional funding, which is particularly important for those of us whose constituents are predominantly served by the Princess Royal university hospital in Farnborough?
Mr Hunt
I thank my hon. Friend for his constructive involvement in all the discussions we have been having to resolve this difficult issue, particularly with respect to his own constituents. He is absolutely right, because in the end the things that matter most are the clinical considerations. I thought it was extremely important to take advice from the NHS medical director, Sir Bruce Keogh, and I have taken that advice. He is absolutely clear that this will save lives, which is my biggest responsibility.
My hon. Friend is also right to say that the success of these proposals depends on negotiations with King’s Partners about the potential merger that it is involved in, and we want to conclude those as quickly as possible. They are a very important part of this issue. It is our ambition to proceed as quickly as possible for the sake of the people of south London, who need certainty about the future provision of their health services, but we have some difficult negotiations to conclude in order to make that happen.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
The only reason the proposals to close the A and E at Lewisham and downgrade the maternity services have not gone ahead in full is, of course, because of the enormous protests of over 50,000 local people and the almost total opposition of all consultants and GPs, including the GP commissioning group. Today’s proposals are an absolute sham and a shambles and utterly unacceptable to all of us who represent people in Lewisham.
Does the Health Secretary agree that, instead of allowing this rushed TSA process, which is completely unsuitable for the reconfiguration that he now proposes, he should allow the GP commissioning group to do the job for which he set it up, namely to lead a consultation process, properly, in order to understand the clinical needs of local people, whether the merger between Lewisham and Woolwich hospitals should go ahead, and to meet the real clinical needs of the local people? Will he also acknowledge that no due diligence was done in respect of the proposals, and that Lewisham hospital will need the strongest guarantees that it will not be led into a new, unsustainable trust by his proposals?
Mr Hunt
May I say to the right hon. Lady that a “sham and a shambles” are what I inherited and what I am dealing with, not what I am bequeathing through my announcement this morning. With respect to the GP-led clinical commissioning group in Lewisham, of course I understand its opposition to the proposals put forward by the trust special administrator, but it supports the principle that complex procedures should be done from fewer sites. That is an important point. Inevitably, when we are reducing the number of sites for complex medical procedures, the people in the areas where those procedures will no longer happen will often be opposed to the changes. That is what has happened here, but the group supports the principles behind what the trust special administrator has said.
The right hon. Lady’s concern that we are setting up a new trust that will not be sustainable is precisely why I am taking this extremely difficult decision today. Lewisham hospital has proposed that it and Queen Elizabeth hospital in Woolwich should be allowed to work out their own way of dealing with the deficit, but that was precisely the problem that happened when the South London Healthcare Trust was set up. Trusts with deficits were put together in a marriage that, in the end, failed to address those difficult decisions. My responsibility to her constituents is to address those issues and to give them certainty about the provision of their health services. Already, her constituents who have a stroke or a heart attack do not go to Lewisham hospital. They go to Tommy’s or Guy’s or other places where those specialist services can be delivered, and they get better treatment. We are expanding that principle through what I am announcing today, and it will save around 100 lives a year. That is something that she should welcome.
Bob Stewart (Beckenham) (Con)
I find it rather strange that a successful hospital is being slashed when others are being saved. I am particularly concerned about some of the figures on which these decisions have been made, and I really require my right hon. Friend to justify the financial figures that support this case. I am personally very worried about where babies will be born in Lewisham, and about the loss of the full A and E services there. I am not very happy about this, and I clearly do not support the closure.
Mr Hunt
There is not a closure. Let us talk about maternity deaths. London has a higher rate of maternity deaths than most other parts of the country, and that is something that any responsible Health Secretary should try to tackle. The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives agree that the way to reduce the number of maternal deaths, in which London does not score well, is to centralise the facilities that deal with the more complex births in fewer sites, where surgeons can get more experience and deliver better clinical outcomes. That is what this proposal is doing. It will lead to fewer maternal deaths in Lewisham and south-east London. It will also mean that, for the first time, south-east London will do something that it does not do at the moment, which is to meet the London-wide clinical quality standards. That must be the most important thing for the people of south-east London.
Heidi Alexander (Lewisham East) (Lab)
The Secretary of State’s announcement today might appear to offer something of a lifeline to Lewisham’s A and E, but it is far from the emergency and maternity services that my constituents and the people of south-east London deserve. I remain concerned about maternity services in south-east London. Between April 2011 and November 2012, maternity services were suspended 37 times in south-east London. There are 4,000 babies a year born at Lewisham. Can the Secretary of State give me an assurance that the money spent on increasing capacity for maternity services at other hospitals will be spent in the hospitals where Lewisham mums will actually go?
Mr Hunt
The hon. Lady is absolutely right that any change such as this has to be done extremely carefully, and we are investing an extra £36 million to expand the capacity of neighbouring consultant-led maternity services to make sure that they can cope with the extra demand, but may I urge the hon. Lady to understand the clinical rationale behind what is happening? London has halved its stroke mortality rate, because it reduced the number of hospitals treating people with strokes from 32 to eight. As a result, her constituents in Lewisham now go for their stroke treatment to the Princess Royal and King’s. That has led to fewer deaths in Lewisham and many other places. We need to do the same for high-risk pregnancies, and the Royal College of Obstetricians and Gynaecologists has established that women with high-risk pregnancies would prefer to travel a little further if that means they will get better clinical outcomes, which is what this is all about.
Simon Hughes (Bermondsey and Old Southwark) (LD)
I appreciate the thoughtful way in which the Secretary of State has tried to deal with a problem that is absolutely not of his making, and I appreciate the fact that he has changed key recommendations and that there will be a continuing A and E service at Lewisham, dealing with up to 75% of the work. However, like other colleagues, I do not therefore understand why there cannot be continuing maternity care there as well, because the key point is that there should be intensive care provision on the site and maternity care services should be provided. I also say to him honestly that I have not heard of any evidence that the key fourth test—support from GP commissioners—has been passed, and I ask him to give me an assurance that no plans will go ahead until and unless the GP commissioning body in Lewisham agrees.
Mr Hunt
Let me take those two points in reverse order. First, on GP commissioners, all six local commissioning groups support the principles upon which these proposals were developed. To meet the London-wide clinical quality standards, which are not being met in south-east London at present, it is necessary to centralise the provision of more complex services in the same way that we have already successfully done for heart attacks and strokes. That principle applies as much to complex births and complex pregnancies as it does to strokes and heart attacks, and it will now apply for the people of Lewisham to conditions including pneumonia, meningitis and if someone breaks a hip. People will get better clinical care as a result of these changes. That is the most difficult project in all the work of the trust special administrator. The project has been to try to resolve an unsustainable financial situation while improving clinical care for the people of south-east London, and I think that, in the end, we have got a set of proposals that does that.
Dame Tessa Jowell (Dulwich and West Norwood) (Lab)
The Secretary of State will be aware of the dismay with which this statement will be heard across south London. Whatever eloquent argument he advances, the people of south London will take from what he said that the maternity and A and E services at Lewisham have been downgraded.
I have had the opportunity to look briefly at the wording of his statement, and I am alarmed by the degree of risk that Sir Bruce Keogh identifies, particularly in relation to the relocation of the paediatric service. The clinical outcomes to which he refers are dependent on extremely difficult interconnections among ambulance services, receiving staff and inpatient beds, and rely on them all working effectively. He rightly recognises the knock-on effect for other hospitals, and my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman), my hon. Friend the Member for Streatham (Mr Umunna) and I, together with all south London MPs, also recognise those knock-on effects. Given that King’s college hospital has seen a fourfold increase in cancelled operations since 2009-10, we are therefore very concerned about the consequences for the care of the constituents whom we represent. We are also concerned that the responsibility for the PRU, which King’s is prepared to welcome, will be properly and adequately financed.
Mr Hunt
The right hon. Lady talks about the risks that Sir Bruce alludes to in his analysis of the trust special administrator’s proposals. Those risks are precisely why I have not accepted the proposals in their entirety and have put in place a series of additional safeguards.
Not resolving this issue, which is effectively what the Labour party is calling for because it has put forward no alternative proposals, would carry a high degree of risk. It would mean that south London would not meet the London-wide clinical quality standards. It would mean that £1 million a week would continue to be diverted from front-line patient care into funding an unsustainable deficit. That would be bad for her constituents and those in neighbouring constituencies.
We must look at the south-east London health care economy as a whole, but the objective must be to improve the services that people receive. That is a difficult balance to get right, but I think that we have the right balance in the proposals that I have outlined this morning.
Mr Stephen Dorrell (Charnwood) (Con)
Does my right hon. Friend agree that the very difficult decisions that he has announced to the House reflect the application in south London of something that is needed across the health service—a willingness to address difficult issues, but led always by clinical evidence on how to deliver the best possible outcomes for the patients who rely on the service?
Mr Hunt
I entirely agree with my right hon. Friend. It would be totally irresponsible for me as Health Secretary to fail to take a decision that could save as many lives as I believe this decision will save. If we are to save more lives in A and E and reduce the number of maternity deaths in London, it involves taking difficult decisions. The disappointment for me is that the Labour party has chosen to jump on an Opposition bandwagon, rather than putting forward its own solution to deal with the clinical issues in south-east London. Unfortunately, the Opposition are playing to the gallery. That is not what a Government-in-waiting should be doing.
Jim Dowd (Lewisham West and Penge) (Lab)
I start by congratulating the Secretary of State on admitting in his statement something that has been denied from the outset: that this is a reconfiguration. Indeed, it is a back-door reconfiguration.
I do not think that my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock), my hon. Friend the Member for Lewisham East (Heidi Alexander) and I can adequately represent the outrage and anger of the people of Lewisham at the sheer unfairness of this proposal. The Secretary of State is wrong to say that Matthew Kershaw concluded that his review needed to go wider than South London Healthcare NHS Trust; he started from that premise and said so openly at the meeting in July at the office of the Secretary of State’s predecessor.
Is the Secretary of State aware that even the maternity proposal will mean that a double rota is necessary at King’s College hospital and Queen Elizabeth hospital Woolwich, because it will increase the expected annual number of births at both units to more than 8,000? That will lead to worse services and less choice for patients. The fact that it does not have the support of local commissioners does not seem to register with the Secretary of State.
Will the Secretary of State say whether it was really necessary to spend £5.5 million of taxpayers’ money to demonstrate that his four tests are meaningless and that the guarantees and undertakings of this Tory-Liberal Government are worthless?
Mr Hunt
First, let me say to the hon. Gentleman that this is a reconfiguration. However, the normal processes for reconfigurations have been suspended because of legislation that was passed by the Government who were in power until 2010 and whom he supported.
The trust special administrator, Matthew Kershaw, looked extensively at whether there was an option within South London Healthcare NHS Trust to solve the problem. He invited expressions of interest from other people who might run the hospitals in the group, but nobody was able to come forward with a proposal that would solve the problem within the geographical confines of the trust. Indeed, nobody—not the Labour party, nor any of the people who oppose these changes—has come forward with a proposal that would not impact on neighbouring health care economies.
The hon. Gentleman spoke about choice. Choice is not just about the number of hospitals that one could go to, but about the number of good hospitals that one could go to. Nowhere in south London currently meets the London-wide clinical quality standards. As a result of my decision today, the whole of south-east London will meet those standards and it will have some of the highest quality care in London for people who use A and E and maternity services.
On the cost of the process, £5.5 million is the cost of failure—the total failure of the last Government to address this issue when they could have done, rather than bequeath the highest deficit anywhere in the NHS.
Nick de Bois (Enfield North) (Con)
The Secretary of State recognises that Lewisham is the victim of an unfair decision as a result of failed PFI and failed finance, which were not of his making. He will recognise the striking similarities with Chase Farm hospital, which has also been downgraded because of the appalling PFI arrangements at neighbouring hospitals. He knows that I utterly oppose that decision. Given the present concerns, particularly with regard to implementation, will he meet me and a cross-party delegation to look closely at these matters?
Mr Hunt
I recognise how hard my hon. Friend has campaigned on behalf of his constituents and how deeply they feel about these issues. He knows that the decision has been made. We want to get the safe implementation of that decision absolutely right and I would be more than happy to meet him to discuss how we can best ensure that that happens.
Clive Efford (Eltham) (Lab)
The Secretary of State inherited a mess that was created by his Conservative predecessor, who abandoned the “A picture of health” process. That led to the betrayal of my constituents in respect of what they expected to come out of that process, particularly at Queen Mary’s hospital Sidcup. When he opposed “A picture of health”, the former Secretary of State said that he would decide on that closure based on what local clinicians said. In this process, it is clear that local clinicians are opposed to the closure of the A and E. Will the Secretary of State therefore say what value he places on the views of the local commissioners, who are completely opposed to what he proposes?
Mr Hunt
Of the six local clinical commissioning groups, five support these proposals. One group is against the proposals, but it accepts the principles behind them, including the idea that to deliver higher quality care, we must perform complex surgery at fewer sites. That will mean that more of the hon. Gentleman’s constituents have better care outcomes. I remind him that if his Government had resolved this problem when they were in office before 2010, none of us would be having this discussion today.
Mr Nick Raynsford (Greenwich and Woolwich) (Lab)
The Secretary of State has accepted all Matthew Kershaw’s recommendations. He will know that the trust special administrator recommended a substantial investment package to support the changes that he recommended, including £161 million of capital funding and £55 million of transitional funding over three years. In his statement, the Secretary of State referred to just £36 million of capital spending for maternity and £37 million for A and E. That is £73 million lower than Mr Kershaw’s recommendation. There was no reference in the statement to the transitional funding of £55 million. Will the Secretary of State confirm whether Mr Kershaw’s funding recommendations have been accepted?
Mr Hunt
We accept that very detailed analysis was used by Matthew Kershaw to come up with those numbers. We will look at them very carefully. However, we need to have sensitive negotiations with the new partners who will be part of making this solution happen before the final numbers are agreed on.
Teresa Pearce (Erith and Thamesmead) (Lab)
When modelling future need, what account did the administrator or the Secretary of State take of the fact that there will be increased health needs due to the increases in child poverty and homelessness in my constituency, as is predicted by every expert on these matters? The efficiency proposals rely to a large extent on keeping vulnerable elderly people out of hospital and caring for them in the community. Given the local authority budget cuts and the fact that some private companies that deliver those services in Bexley in my area are slashing the wages and conditions of staff, how does the Secretary of State think those services will be improved? Will he urgently review the services for elderly people to ensure that they stack up with the proposals that he has outlined today? This morning, the Secretary of State has said a number of times that these plans will save lives. I sincerely hope that he is right. If time shows that he is not right, will he resign?
Mr Hunt
In such matters, what a Minister does is take very seriously the medical advice they are given—I am sure the hon. Lady’s party was exactly the same when it was in power. Medical advice suggests that the way forward I am deciding on and announcing this morning will save 100 lives, and I am taking the decision on that basis. The hon. Lady would do no differently in my shoes.
For child poverty, changes in demography are taken into account in the modelling used, but the overriding priority has been to improve clinical services. That will make the biggest difference to the most socially disadvantaged people, including the frail elderly who—I agree with the hon. Lady—are often the least well served by our current NHS structures and the silos between what is done by local authorities and the NHS. I and my ministerial colleagues in government are currently doing a lot of work to break down those barriers and offer a more integrated service to the frail elderly, so as to avoid some of the problems mentioned by the hon. Lady.
Kate Hoey (Vauxhall) (Lab)
Surely the Secretary of State understands—even if Sir Bruce Keogh does not seem to do so—the huge effect that downgrading the maternity unit at Lewisham will have on King’s college and St Thomas’ hospitals. They are full to the seams and will not be able to cater easily for increased numbers of women. What exactly is the Secretary of State offering hospitals such as mine in terms of finance? Will he lay out clearly that this kind of merger of King’s college hospital, Guy’s and St Thomas’ and the mental health trust is not the way forward when it has been brought in from the top by those same experts who get it wrong so often, and when local people have had absolutely no involvement? In view of the disruption taking place, will he say that it is absolute nonsense for millions of pounds to be spent on consultants and business plans to bring together a huge organisation that will not be in the interests of local people?
Mr Hunt
On the merger, may I gently point out that I want to follow the hon. Lady’s advice if she is against people deciding things from the top down. It is for local trusts to negotiate such things, and they must do so on the basis of what is in the clinical interest of the population they serve. I will not be a Secretary of State who steps in and stops those things happening, unless they amount to a reconfiguration, in which case procedures are in place that require proper democratic support for any changes.
On the changes to maternity provision in Lewisham, we have allocated £36 million to expanding the capacity at those other hospitals that will take on more complex and high-risk births as a result of the proposals, and we will work closely with those trusts to ensure that that capacity is in place. I agree with the hon. Lady that it is extremely important for such work to be done in a meticulous way so that we get the better clinical outcomes we want as a result of what I am announcing today.
Mr Kevin Barron (Rother Valley) (Lab)
I sat on the Health and Social Care Bill Committee. The principle in that Bill, which became an Act last year, was that clinicians will be in charge. The lead clinical commissioner has said that this downgrading would pose a huge risk to health outcomes in Lewisham. How does that square with the provisions of that Act passed in this House last year?
Mr Hunt
Clinicians and commissioners have been closely involved in these proposals which, as the right hon. Gentleman will know from reading my statement, affect the broader south-east London area covering six clinical commissioning groups. Five of those groups support the proposals. One does not, but it supports the principles behind them, which is that more complex procedures must be carried out on fewer sites. We have had the benefit of the clinical input of senior people such as Sir Bruce Keogh, and many of the royal colleges have been involved in the external clinical advisory group, which had significant input on the proposals. One question I asked Sir Bruce was whether there had been sufficient clinical input, and his conclusion was that yes, there had been.
Oral Answers to Questions
Jeremy Hunt Excerpts(11 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health (Mr Jeremy Hunt)
Despite the huge improvements that have been made over the last decade in the outcomes for people with cardiovascular disease, it is still one of the biggest killers in England and the largest cause of disability. That is why we are developing a CVD outcomes strategy, which will set out where there is scope to make further improvements in patient outcomes in this area.
Neil Carmichael
I am chairman of the all-party parliamentary group on vascular disease, which recently produced a report highlighting the need for early diagnosis and intervention, and the additional risks associated with obesity and diabetes. Is the Secretary of State willing to meet me and some of my colleagues to consider how we can improve outcomes for sufferers of vascular disease?
Mr Hunt
I thank my hon. Friend for his excellent work with the all-party group and for the group’s constructive response to our consultation on the outcomes strategy. I am more than happy to meet him and other representatives of the all-party group. With an ageing population and rising levels of obesity, we cannot be complacent about cardiovascular disease and have much to do.
Helen Jones (Warrington North) (Lab)
The Prime Minister promised before the election that there would be no reconfigurations or closures unless there was clinical and local support. Why then has the Secretary of State decided to break up the existing vascular network centred on Warrington hospital, meaning that emergency patients face a trip to Chester by ambulance, when this has neither clinical support nor support in the local community? When did that policy change, or was it just an election promise that the Conservatives never intended to keep?
Mr Hunt
We believe in the clinical networks, including the network for cardiovascular disease. We have increased the funding for those networks by 27%. However, we want them to include mental health and maternity services. We think that it would be wrong to do what the Labour party wants, which is to concentrate that funding on cardiovascular disease and cancer, and deprive of the clear benefits of such networks the 700,000 women who give birth on the NHS every year and the nearly 1 million people who will be diagnosed with dementia.
Tim Farron (Westmorland and Lonsdale) (LD)
Given that the majority of vascular interventions are acute in nature, following trauma or cardiac episodes, is it not reckless for NHS Lancashire and NHS Cumbria to be talking about moving vascular services away from the Morecambe bay area, meaning that people from the south lakes and north Cumbria will have to travel as far as Preston, Blackburn or Carlisle to receive treatment? Will the Secretary of State meet me, other local MPs and local consultants to discuss how we can put the matter right for local people?
Mr Hunt
We are very keen to ensure that all reconfigurations of services have strong local, clinical support. We are making good progress in this area. There is always a trade-off between access, which I recognise is extremely important in a rural constituency such as the hon. Gentleman’s, and the centralisation of services, which sometimes leads to better clinical outcomes. I am happy to arrange for him to meet me or one of my colleagues to discuss his concerns in more detail.
Keith Vaz (Leicester East) (Lab)
Those with diabetes, such as myself, are five times more likely to get cardiovascular diseases. Last year’s National Audit Office report indicated that 1 million diabetics did not get their nine checks. What steps will the Secretary of State take to ensure that those checks are made available to all diabetic patients?
Mr Hunt
I congratulate the right hon. Gentleman on his campaigning work for people with diabetes, and I am aware that there are 24,000 premature deaths every year because we are not as good as we need to be at tackling the disease. It is shocking that only half those with diabetes are getting the full set of nine checks that everyone with diabetes should be getting every year, and when we publish the cardiovascular disease outcomes strategy—which I hope will be in spring—I hope we will address some of his concerns about how we can do a better job for diabetes sufferers.
Jim Shannon (Strangford) (DUP)
Deep vein thrombosis is the leading direct cause of maternal deaths across the United Kingdom. Will the Minister consider interaction with the regional assemblies, including the Northern Ireland Assembly, to agree a UK strategy to address that issue?
David T. C. Davies (Monmouth) (Con)
2. What recent steps he has taken to reduce hospital waiting times in England.
Andrew Percy (Brigg and Goole) (Con)
3. What representations he has received from clinicians in Yorkshire and the Humber on the decision to close the children’s heart surgery unit at Leeds children’s hospital.
The Secretary of State for Health (Mr Jeremy Hunt)
I know that some are disappointed at the decision by the Joint Committee of Primary Care Trusts and want to see children’s congenital heart surgery continue at their local hospitals. However, the Safe and Sustainable review was an NHS review, independent of Government. Under the circumstances, and given that legal proceedings and a review by the independent reconfiguration panel are under way, my hon. Friend will understand that it is not appropriate for me to comment further.
Andrew Percy
One hundred and seventy clinicians from across Yorkshire and northern Lincolnshire have written to express their dismay at the decision, stating that for time-critical transfers it
“exposes a number of children to the risk of death,”
largely because it will require transfers to Newcastle, where services are not co-located. Does that not prove that the decision does not enjoy clinical support in Yorkshire and north Lincolnshire and that it is simply not true that this has been a clinically led review?
Mr Hunt
I have seen the letter to which my hon. Friend refers and I understand that these are extremely complex issues. Let me reassure him that when I take my final decision, it will be on a clinically led basis. I will do that when I have received the IRP’s report, which I am due to receive by 28 March.
Mr Kevin Barron (Rother Valley) (Lab)
The independent reconfiguration panel has already visited Leeds and I understand that it will visit again before that date. If it decided that both Leeds and Newcastle ought to stay open, would that be agreed?
Mr Hunt
I will make my decision when I have the IRP’s final recommendation. Obviously I cannot speculate on what the final decision will be, but let me reassure the right hon. Gentleman, as I did with my hon. Friend the Member for Brigg and Goole (Andrew Percy), that my decision will be taken on the basis of clinical need—in other words, what will save the most lives.
Martin Vickers (Cleethorpes) (Con)
I note my right hon. Friend’s comments about his final decision being based on clinical advice, but will he also give consideration to patients and families in areas that are more remote from the centre, such as my constituency? This decision causes extra strain and cost to families and will also mean that they will not go to Newcastle, and therefore Newcastle will not achieve its target number of operations.
Meg Munn (Sheffield, Heeley) (Lab/Co-op)
I understand the Secretary of State’s reluctance—quite rightly—to comment on the processes he is going through, but will he confirm that he expects full transparency in the review process? That means all the minutes of the JCPCT being given to the review process and none of them being redacted.
Mr Speaker
I must say to the House that if we are to get through the questions we need shorter questions and shorter answers from now on.
Priti Patel (Witham) (Con)
6. What steps he is taking to ensure that patient experience is a priority for the NHS.
The Secretary of State for Health (Mr Jeremy Hunt)
Improving the quality of care throughout the NHS is a key priority for the Government, and one of the things we are doing to make that happen is, for the first time, asking all NHS in-patients whether they would recommend the care they received to a friend or member of their family.
Priti Patel
My constituents have consistently been let down by the failure of the last Government and a debt-ridden PCT to invest in local community health services. Will my right hon. Friend join me in encouraging the new clinical commissioning groups to respond to Witham’s growing population and health needs by investing in localised community health care?
Mr Hunt
I am happy to do so, and I commend my hon. Friend for her campaigning, because if we invest properly in community health services, we can allow the frail elderly, who are among the biggest users of the NHS, to stay at home happily, healthily and for much longer. That must be a key priority for us all.
Barbara Keeley (Worsley and Eccles South) (Lab)
At the last Health questions, the Secretary of State told me:
“Every NHS bed is getting an extra two hours of care per week compared with the situation two years ago.”—[Official Report, 27 November 2012; Vol. 554, c. 122.]
Quoting national average nurse-patient ratios does not help to improve the patient experience, but cutting 7,000 nurses sure does affect it. We have unsafe levels of care in 17 hospitals. Will he treat this issue a bit more seriously and do something about those unsafe levels?
Mr Hunt
With respect to the hon. Lady, she cannot talk about alleged cuts in the NHS while her Front-Bench team support a policy of real cuts in the NHS budget. In the last Opposition day debate, the right hon. Member for Leigh (Andy Burnham) said that he thought it was irresponsible of the Government to increase the NHS budget in real terms. That means he wants a real cut in the NHS budget, which would make the staffing issues to which she referred much, much worse.
Mr Stephen Dorrell (Charnwood) (Con)
Does my right hon. Friend agree that one of the most effective things we can do to improve the patient experience of health and care is to improve the co-ordination, not just between the hospital service and community-based health services, but between the NHS and social care, and to put in place the infrastructure, including the IT infrastructure, to make that real?
Mr Hunt
My right hon. Friend makes an extremely important point—in fact, I will be giving a speech on this tomorrow—because, in the end, if it is not possible to see a full medical record of some of these frail elderly or heaviest users of the NHS going in and out of the system throughout the year, it is not possible to give them the integrated, joined-up care that they desperately need. This will be a very big priority for us.
Andrew Gwynne (Denton and Reddish) (Lab)
One of the biggest drivers of patient experience on hospital wards is the dedication and care of the nursing staff, but, as my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) said, the Care Quality Commission has identified 17 NHS hospitals that are operating with unsafe staffing levels, putting vulnerable patients and especially older people at risk. Frankly, it is the Secretary of State’s job to ensure that every NHS hospital operates with safe staffing levels, so does he now think it was a mistake to strip out almost 7,000 nursing posts from our NHS?
Mr Hunt
It is my job, and that is why the Government have protected the NHS budget. The hon. Gentleman’s Front-Bench team, on the other hand, want to cut it in real terms. He has to think carefully before he starts talking about all these so-called cuts, given that his shadow Health spokesman wants to cut the NHS budget in real terms. [Interruption.] That is what he said last December. I agree with the Care Quality Commission that it is totally unacceptable for hospitals to have unsafe staffing levels. The commission also said, however, that budgets and financial issues were not an excuse, because those budget pressures existed throughout the NHS and many hospitals were able to deliver excellent care despite them.
David Morris (Morecambe and Lunesdale) (Con)
7. What steps he is taking to improve the survival rates of cancer, stroke and heart disease patients.
The Secretary of State for Health (Mr Jeremy Hunt)
Our cancer strategy set out the ambition to save 5,000 lives by 2014-15 through earlier diagnosis, cancer screening and improved access to treatment. We are working on an outcomes strategy for cardiovascular disease.
David Morris
Will my right hon. Friend tell the House how many patients have benefited from the cancer drugs fund to date?
Mr Hunt
I am happy to inform my hon. Friend that 25,000 people have benefited to date from the cancer drugs fund, which the previous Government failed to introduce. On top of that, 53,000 more people every year are being admitted for chemotherapy and 219,000 more cancer treatments are happening every year than happened in any year under the last Labour Government.
Grahame M. Morris (Easington) (Lab)
21. I have previously raised with the Secretary of State the opportunity cost—in terms of cost and effectiveness —of the proton beam therapy system. Given that expert opinion—in the form of the national radiotherapy advisory group—is divided, and given that the cost of the proton beam therapy system is 100 times more than other advanced radiotherapy systems that my region and others lack, why is he proposing to spend £125 million on it?
Mr Hunt
I recognise that the hon. Gentleman has a long-standing view on this matter. I am guided by clinical advice. Over the next two years, we will publish the cancer survival rates by multidisciplinary team across the country in all the major cancers for the very first time. That will give us a much better objective base from which we can work out what the most effective treatments are.
Mr Nick Gibb (Bognor Regis and Littlehampton) (Con)
20. Despite the fact that the incidence of breast cancer peaks in the 85-plus age group, the peak age for breast surgery is for women in their mid-50s and 60s. Does that not confirm the findings of the Royal College of Surgeons-Age UK report that, despite trends towards older people leading healthier lives, many older women are missing out on curative surgery, from which they are perfectly fit enough to benefit?
Mr Hunt
My hon. Friend will know that last October we outlawed age discrimination, and if that is the reason for this happening, it is totally unacceptable. We have to recognise that cancer is one of our biggest killers and that the over-85s are a key group if we are going to tackle it. He will welcome today’s news about making available drugs to tackle breast cancer, which may mean that surgery will no longer be necessary.
Mr Jim Cunningham (Coventry South) (Lab)
19. Will the Minister tell us what the reduction in size of the Department’s cancer policy team will be after April 2013, and whether any of the team’s functions will be removed to other bodies or scrapped?
Nick Smith (Blaenau Gwent) (Lab)
8. When his Department plans to publish its proposed new sexual health policy document.
Ian Swales (Redcar) (LD)
9. What recent assessment he has made of the number of health care appointments and operations which are postponed.
The Secretary of State for Health (Mr Jeremy Hunt)
My Department collects data on the number of cancelled elective and urgent operations, which show that these remain very low compared to total activity. We do not collect information on postponed appointments or operations. The NHS must make arrangements locally to minimise postponements and cancellations to avoid the inconvenience to patients.
Ian Swales
I thank the Secretary of State for that answer. This is an issue in my area, with the chief executive of South Tees hospital saying that one factor is excessive use of A and E for non-urgent cases, resulting in pressure on hospital resources. What can the Secretary of State do to make sure that A and E units are used only for genuine accidents and emergencies?
Mr Hunt
My hon. Friend makes a very important point. I am concerned that 114 non-urgent operations were cancelled in the South Tees area between November and January, which is significantly higher than this time last year. He is right that we need to think about the model for an A and E service. Nearly 1 million more people go through A and E every year than they did two years ago. We have to recognise that for A and E services to be sustainable, we need to think about people who would better off seeing their GP or going to an urgent care centre.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
Is the Minister aware that health care appointments are still bedevilled by the number of people who do not show up, even for appointments with consultants and senior hospital staff? Is it not about time that we looked at a simple system, in which people could pay up front a small amount of money that they get back when they turn up? I am sure that my constituents, as good Yorkshire people, would take their appointments much more seriously if they got their money back when they turned up?
Mr Hunt
I am interested to hear that suggestion from the Labour Benches, which is not necessarily where I would have expected it to come from. The hon. Gentleman might be surprised at my response, which is that I would be very concerned about such a system. I understand the issue and I think we need to modernise the process of GP and hospital appointments. Technology can play a good role in that, for example by giving people text reminders of appointments that they have booked. My concern is that the system suggested by the hon. Gentleman would put people off going to see their doctor if they needed to. I would not want to do anything that deterred people from using the NHS who most need to do so.
Kate Green (Stretford and Urmston) (Lab)
10. What estimate he has made of the number of patients who waited longer than four hours for treatment in accident and emergency departments in 2012; and if he will make a statement.
The Secretary of State for Health (Mr Jeremy Hunt)
We want to make 2013 the year we break down the stigma associated with dementia and transform the care and treatment received by the one in three over-65s who will get the condition at some stage. Today, the Alzheimer’s Society published a map showing the totally unacceptable variations in dementia diagnosis across the country, with some areas diagnosing fewer than a third of people who have the condition, thereby denying them the medicine and support that would help them live happily at home for much longer. We are determined to put this right.
Annette Brooke
Given that next week is designated as cervical cancer prevention week and we know that many women ignore, or do not recognise, the early symptoms of cervical cancer, what action will the Secretary of State take to raise awareness of cervical cancer symptoms?
Mr Hunt
That is a very important point. Every year we screen about 3.5 million women for cervical cancer and we think we save about 4,500 lives, but we could save many more. Our “Be Clear on Cancer” campaign is highlighting the four clear symptoms people need to watch out for: unexplained bleeding, weight loss, pain, and lumps.
Paul Blomfield (Sheffield Central) (Lab)
T3. The Minister of State earlier failed to answer the key question on midwife numbers, so I wonder whether the Secretary of State could take it on. Before the last election, the Prime Minister made a firm pledge to increase the number of midwives by 3,000. Will the Secretary of State tell the House whether that pledge will be honoured or discarded along with all the other promises on the NHS?
Mr Hunt
The number is up by 800 already, but as the Labour Front-Bench team knows, it takes some time to train midwives. I say to the hon. Gentleman that none of the investment in additional midwives would be possible if we had a real-terms cut in the NHS budget, which is what his Front-Bench team wants.
Mr Douglas Carswell (Clacton) (Con)
T2. Many of my constituents in Jaywick have complained about local GP services, saying that there are too many locums and inadequate provision. In order to attract and retain good GPs in an area with a challenging work load, the local commissioning body needs to be able to offer them more favourable terms. Will the Minister ensure that there is sufficient local flexibility so that the commissioning body can do that?
Mr Hunt
My hon. Friend makes a very important point, putting his finger on a key issue: the 24-hour availability of GP services. That is going to be crucial as the NHS goes forward. The NHS medical director, Bruce Keogh, is looking at the whole issue of seven-day working in the NHS and will certainly be examining what flexibility needs to be given to local areas to make that possible.
Mike Gapes (Ilford South) (Lab/Co-op)
T4. On 30 December, ambulances in north-east London were diverted from the Whipps Cross, Queen’s and Homerton hospitals, with only the accident and emergency units at the Royal London hospital and the King George hospital in Ilford being open. Last week, on 8 January, Queen’s hospital in Romford was again diverting ambulances. Will the new Secretary of State look at the decision of his predecessor, whom I see on the Bench near him, and cancel the insane decision to close the accident and emergency unit at King George hospital?
Mr Hunt
The decision has been taken, but we have made it absolutely clear that we will not proceed with implementing it until there is sufficient capacity in the area, particularly at Queen’s hospital in Romford, to cope with any additional pressures caused by it, and that undertaking remains.
Miss Anne McIntosh (Thirsk and Malton) (Con)
T5. The NHS has confirmed that North Yorkshire is the only part of the country that will inherit a £19 million debt, which has to be carried by the new clinical commissioning groups. That was the situation we were promised we would never be in. What is the Secretary of State going to do to urgently address the chronic underfunding of rural areas for the NHS in North Yorkshire?
Mrs Mary Glindon (North Tyneside) (Lab)
T6. As one in three women who get cancer are over the age of 70, can the Minister say when the newly launched Be Clear on Cancer campaign will be rolled out nationally?
Iain Stewart (Milton Keynes South) (Con)
T9. Many of my constituents are concerned by the Care Quality Commission’s recent findings at Milton Keynes hospital, which came despite an increase in nursing staff since 2010. What reassurances can my right hon. Friend give my constituents that the problems are being rectified and that they will be able to enjoy high-quality care?
Heidi Alexander (Lewisham East) (Lab)
T8. Last week, the Secretary of State refused my request to meet a small group of local GPs, hospital doctors and residents who are opposed to the closure of accident and emergency and maternity at Lewisham hospital, yet in his former role he seemed very happy to trade hundreds of texts with Rupert Murdoch’s lobbyists about the purchase of BSkyB by News Corp. Why is it one rule for Rupert Murdoch’s lobbyists and another for doctors in Lewisham?
Mr Hunt
I think that the hon. Lady might perhaps read Lord Leveson’s conclusions before she starts hurling about allegations, many of which came from her side of the House, that were later shown to be totally false. With respect to the decision on Lewisham hospital, I thought that we had a very useful meeting last night with the south London MPs who are directly affected. She understands that the process put into law by her party and her Government means that I cannot reopen the entire consultation and start seeing some groups without seeing all groups that are affected. That is why I am limiting the discussions I have with colleagues, but I think that that is the right thing to do.
Paul Burstow (Sutton and Cheam) (LD)
The evidence is compelling that improved access to talking therapies for children and adults makes a huge difference to their mental health. Will the Minister therefore assure me and the House that the NHS Commissioning Board will have the necessary dedicated teams to ensure that the adult improving access to psychological therapies—IAPT—programme is delivered and that the new children’s programme is, too?
Mrs Madeleine Moon (Bridgend) (Lab)
Today’s edition of The Daily Telegraph carries an article on dementia, including a quote from a GP who says that it is not useful to give an early diagnosis when there are no drug or care needs. Does the Minister agree that that GP, like many others, fails to realise that for pre-senile dementias in particular, early diagnosis allows planning and allows families to understand the confusion created by altered personalities, behaviour, emotional responses and language skills?
Mr Hunt
I know that the hon. Lady spoke very movingly in the debate on dementia last week and I wholeheartedly agree with her. The medicines available for people with dementia do not help everyone, but we do not know that until we try them. By diagnosing only 42% of people with dementia, as is currently the case, we are denying nearly two thirds of dementia sufferers the chance to see whether they could benefit from those medicines and, as she rightly says, the chance to plan their care, which could mean that they could live at home for much longer.
Mr John Baron (Basildon and Billericay) (Con)
The all-party group on cancer is delighted that the one and five-year cancer survival indicators have been included in the CCG outcome indicator set. We have campaigned for that in the belief that it will drive forward earlier diagnosis, as the Secretary of State knows. Can he clarify how CCGs will be held to account through that indicator set? For example, what action will be taken on underperforming CCGs?
Mr Hunt
I congratulate my hon. Friend on his campaigning on cancer issues through the all-party group. The NHS Commissioning Board is held to account through the mandate, which clearly states that we must make tangible progress towards having the lowest mortality rates in Europe for cancer and a number of other major diseases. I will expect the board to clamp down hard on CCGs who fail to deliver on what needs to happen for them to deliver on that promise.
Dan Jarvis (Barnsley Central) (Lab)
Cancer Research UK has expressed deep concern about the fragmentation of cancer services and the climate of uncertainty that makes it harder to improve them due to the Government’s NHS reorganisation. I appreciate that that is not the fault of the Secretary of State, but he has the power to do something about it. Will he listen to Cancer Research UK and stop the fragmentation of cancer services?
Mr Hunt
Of course, I understand the concerns of Cancer Research, and I know that the hon. Gentleman understands the personal tragedy that cancer can cause. The change in the clinical networks is happening because we want them to cover dementia, which we were talking about earlier, mental health services and maternity and paediatric services. It is right that they should do so, but I want to make absolutely sure that as we go through the restructuring the benefits of the cancer clinical networks remain as strong as ever.
Pauline Latham (Mid Derbyshire) (Con)
Will my right hon. Friend look at the east midlands cancer drugs fund? While I welcome the cancer drugs fund enormously, the east midlands will yet again underspend, leaving some of my constituents paying for their own treatment because they have been refused funding. Will my right hon. Friend please get his Department to investigate why?
Valerie Vaz (Walsall South) (Lab)
How will the Secretary of State assess the effect of the cancer drugs fund on cancer survival rates?
Mr Philip Hollobone (Kettering) (Con)
Kettering has the sixth fastest household growth rate in England, and accident and emergency admissions to Kettering general hospital are now at 12% year on year. Will the Secretary of State ensure that the NHS funding formula reflects the very latest population estimates?
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
Penalties on readmission rates were introduced to improve clinical practice, but patients suffering from sickle cell and thalassaemia in my constituency and elsewhere cause hospitals to be fined for readmission, even though it is often in the patient’s best clinical interest. Will the Minister once again reconsider exempting sickle cell and thalassaemia from the penalty?
Mr Hunt
The biggest safeguard is the fact that the Government have made it one of our key priorities to improve mortality rates for cancer to the best in Europe. That means we are putting in a huge amount; for example, we are investing £450 million in early diagnosis. There are many other measures, which shows how seriously we take it.
Natascha Engel (North East Derbyshire) (Lab)
My 92-year-old constituent, Ron Lewin, was referred for minor oral surgery. He was eventually written to by the specialist, who said that waiting lists were very long and that assessment appointments were available in 18 weeks, but that they did offer an independent service if he wished to be seen earlier. Independent obviously means paying to jump the queue. Is that how the Government propose to cut waiting lists?
Zac Goldsmith (Richmond Park) (Con)
Will my right hon. Friend’s Department make an assessment of the effects on local air quality and public health of a potential third runway at Heathrow, and will he submit those findings to the Davies commission on airport capacity?
Alex Cunningham (Stockton North) (Lab)
My constituent, Elaine Catterick, has had a serious operation at the James Cook hospital on Teesside cancelled twice in three months—once with just a few hours’ notice. She has also learned that there are twice-daily meetings at the hospital to decide whose operation should be cancelled next, as staff struggle to cope with spending cuts. I hope that is not what the Secretary of State wanted from his reforms, so what is he going to do about it?
Public Health Grants to Local Authorities (2013-14) and (2014-15)
Jeremy Hunt Excerpts(11 years, 4 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Today I am announcing ring-fenced public health grants to local authorities for 2013-14 and 2014-15.
This Government have an ambitious vision to help people live longer, healthier and more fulfilling lives, and to improve the health of the most vulnerable fastest. From April 2013, upper tier and unitary local authorities will take on a new duty to improve their population’s health, funded by this ring-fenced budget. Local authorities are best placed to understand the needs of their communities, and to tackle the wider determinants of health at a local level, putting people’s health and well-being at the heart of everything they do—from adult social care to transport, housing, planning and environment. The public health grants will allow local authorities to transform the lives of the local people through commissioning a wide range of innovative services.
Despite difficult financial circumstances, I am pleased to announce that we have been able to provide an above inflation growth representing a major investment in health and the prevention of illness. We are investing £2.7 billion in 2013-14 and £2.8 billion in 2014-15. In each year every local authority will see real-terms growth. This is on top of an updated 2012-13 baseline that is now just over £2.5 billion, significantly above the estimate of £2.2 billion that we published in February last year.
Announcing allocations for the next two years will provide local authorities the certainty they need to extend and develop their planning, including for initiatives that may be better delivered across more than one year.
The allocation is built on the advice of the independent Advisory Committee on Resource Allocation (ACRA). ACRA’s interim recommendations went through an intensive engagement during the summer, generating some important changes that we believe will be welcomed by the public health and local government communities.
Full details of the public health grants to local authorities 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.
South London Healthcare NHS Trust
Jeremy Hunt Excerpts(11 years, 4 months 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.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the trust special administrator’s report on South London Healthcare NHS Trust and the NHS in south-east London.
The Secretary of State for Health (Mr Jeremy Hunt)
I have today published the final report of the trust special administrator to South London Healthcare NHS Trust and laid it before Parliament. I received the report yesterday and must now consider it carefully. I am under a statutory duty to make a decision by 1 February on how best to secure a sustainable future for services provided by the trust.
The trust special administrator began his appointment on 16 July. He published his draft report on 29 October and undertook a consultation on his draft recommendations between 2 November and 13 December. More than 27,000 full consultation documents and 104,000 summary documents were distributed during the consultation and sent to 2,000 locations across south-east London, including hospital sites, GP surgeries, libraries and town halls. A dedicated website was established to support the consultation, the TSA team arranged or attended more than 100 events or meetings and the consultation generated more than 8,200 responses.
I understand the concerns of hon. Members and, indeed, the people living in areas affected by the proposals, especially in Lewisham. They have a right to expect the highest quality NHS care, and I have a duty to ensure that they receive it. However, they will understand that it would not be appropriate for me to give a view on the report’s recommendations only one day after receiving it. To do so would be pre-emptive and would prejudice my duty to consider the recommendations with care and reach a decision that is in the best interests of the people of south-east London.
However, I have made it clear that any solution would need to satisfy the four tests outlined by the Prime Minister and my predecessor, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), with respect to any major reconfigurations: the changes must have support from GP commissioners; the public, patients and local authorities must have been genuinely engaged in the process; the recommendations must be underpinned by a clear clinical evidence base; and the changes must give patients a choice of good-quality providers.
The challenges facing South London Healthcare NHS Trust are complex and long standing, but to fail to address them is to penalise other parts of the NHS from which resources must be taken to finance the biggest deficit anywhere in the NHS. To date, it has not proved possible to ensure that South London Healthcare NHS Trust can secure a sustainable future for its services within its existing configuration and organisational form. In appointing a special administrator to the trust, the Government’s priority was to ensure that patients continue to receive high-quality, sustainable NHS services, and I will consider the special administrator’s report with that objective in mind.
Dame Joan Ruddock
I thank the Secretary of State for his reply. Neither I nor my hon. Friends the Members for Lewisham East (Heidi Alexander) and for Lewisham West and Penge (Jim Dowd) are opposed to change or to greater efficiencies, but we are opposed to the destruction of Lewisham hospital, which is a solvent, well-regarded trust that meets all its performance and financial standards.
There is a fundamental question at stake. My right hon. Friend the Member for Leigh (Andy Burnham) has made it clear that the powers associated with the failure regime under which the TSA acts were not intended to be used to encompass the services of other hospitals. Yet in order to tackle the huge financial deficit sustained by South London Healthcare Trust, the TSA proposes to close Lewisham hospital’s accident and emergency services, including the acclaimed children’s A and E, to end all medical and surgical emergency care and to demolish maternity services. He then proposes to sell off half the hospital’s land. That cannot be justified. Each year around 120,000 people use Lewisham A and E, more than 30,000 children use the children’s A and E and more than 4,000 babies are born in the hospital. There is no current capacity at any of the other hospitals in the area to provide for those patients.
These proposals amount to a major reconfiguration by the back door, and they are opposed by virtually all the health professionals in the area and by the people of Lewisham. Does the Secretary of State believe that a reconfiguration of services in south-east London is necessary? If he does, he needs to propose one with the relevant consideration for patient safety and health care standards and that meets his four tests. These proposals do none of that and must be rejected.
Mr Hunt
First, I want to recognise the right hon. Lady’s real concerns about the proposals that have been made. I also recognise that they reflect the concerns of many of her constituents and, indeed, many people in Lewisham. Her point about scope is one I replied to in my letter to the right hon. Member for Leigh (Andy Burnham) before Christmas. I have taken legal advice on that and been told that under the unsustainable provider regime, which the previous Government put into law, an administrator must initially look at a trust’s defined area, but if they conclude that the defined area is not in itself financially sustainable—they have a duty to come back with a financially sustainable solution—and if it is necessary and consequential, they need to look at a broader area. Of course there is interrelation between different parts of the south-east London health care economy. However, I will be getting fresh legal advice on that point, because I recognise that it is extremely important.
I welcome the fact that the right hon. Lady recognises that changes need to be made. I also hope that she understands that I have a duty to address this issue, which has affected hospitals in the South London Healthcare Trust area for many years. The deficit of the trust amounts to £207 million in the period since it was set up, and that is money that must be taken away from other parts of the NHS. I have a clear duty to address that issue. I will not comment on specific proposals today, but I will be very happy to meet her and her colleagues from Lewisham in order to hear from them directly about their concerns. Indeed, I will be meeting the trust special administrator on 10 January so that I can ask him any questions about his proposals before I make my decision, which must be within 20 working days.
Bob Stewart (Beckenham) (Con)
I remind my right hon. Friend that the Beckenham Beacon is not only modern, but extremely central. I stress the incredible value it could have in south London. I very much hope that the services currently provided there will increase, rather than decrease, at the end of this consultation.
Mr Hunt
I thank my hon. Friend for again speaking up for his constituents, as indeed I have done as a constituency MP on many occasions. I want to reassure him that the four tests we have outlined for any major changes to health care services would indeed apply to the Beckenham Beacon and that, were there to be any changes, we would need to be satisfied that they would have strong, local, clinical support, that his constituents had been properly consulted and that there was clear evidence that change would be beneficial.
Andy Burnham (Leigh) (Lab)
I apologise for missing the start of proceedings on this urgent question.
It has long been accepted that difficult decisions are needed to secure the sustainability of health services in south-east London. That is why recommendations from the review, “A Picture of Health”, were agreed under the previous Government. The trust special administrator has adopted many of those proposals, which we welcome.
However, the review presented today goes way beyond that and takes the NHS into new territory. It uses powers passed by the previous Government in a way that was never intended and, in so doing, sets a worrying precedent whereby normal processes of public consultation are short-circuited and back-door reconfigurations of hospital services are pushed through. The Health Act 2009, which I took through this House, states that
“the administrator must provide to the Secretary of State and publish a draft report stating the action which the administrator recommends the Secretary of State should take in relation to the trust.”
In making recommendations that have a major impact on another trust, is the Secretary of State not going beyond the powers this House has given to him? He has acknowledged that he needs to commission fresh legal advice, which suggests to me that the legality of the process is in doubt. Will he publish all the legal advice he has been given so far and give a commitment that any new legal advice he commissions will be made available?
As this is a financially driven process, the people of Lewisham have justifiable concerns about whether it is safe to close their A and E and downgrade the maternity services. Is the Secretary of State satisfied that a clinical case has been established behind these major changes? Given that all A and E departments in south London are currently overstretched and operating at full capacity, people will need to be convinced that these changes will not put lives at risk.
Finally, will the Secretary of State give a guarantee today to the people of Lewisham that, if he accepts the TSA’s recommendations, they will have the full consultation rights that come with any hospital reconfiguration, including the ability to challenge the clinical case and, if necessary, to refer it to the Independent Reconfiguration Panel? This process is attempting to rewrite the rules on making changes to hospital services, bypassing the intention of the House. It will send a shiver through any communities without a foundation trust, as it raises the prospect that their hospital will be able to be used as a pawn to solve problems in another.
People in Lewisham feel a huge sense of unfairness and I am sure that that will be shared by people across the House. The onus is on the Secretary of State to justify the changes and ensure that rules governing hospital changes are fair and respect the essential rights of all communities to be fully consulted and involved in any decision affecting their services.
Mr Hunt
We have followed to the letter the processes laid down in the law that the right hon. Gentleman’s Government passed. We followed the procedure extremely carefully. This is the first time that the procedure has been invoked, so we have taken extra legal advice to make sure that the processes followed strictly adhere to the letter of the law. I will continue to take legal advice, because I want to make sure that we absolutely follow the wishes of the House in how we carry out the procedure.
Unlike the right hon. Gentleman’s Government, we have introduced new safeguards for any major changes made to NHS services. Those safeguards did not exist when the right hon. Gentleman was Health Secretary. We have said that we will not accept any changes unless there is proper consultation of the local population, clear evidence and clear local clinical support. We made that commitment in the four tests, which did not exist under his Government.
I will not accept any of the changes that the special administrator proposes unless I am satisfied that all four tests have been met. They include proper local consultation, because I consider that to be extremely important.
Gareth Johnson (Dartford) (Con)
The report mentions an increase in elective surgery in Darent Valley hospital—my local hospital, which is just over the Kent border with south London. Although the hospital has enjoyed extra funding from the Government, it still has capacity issues. Will the Secretary of State ensure that the knock-on issues are taken into account before he makes any decision?
Mr Hunt
My hon. Friend makes a very important point. One of the most important things that I have to consider in the next 20 days is what he describes as the knock-on impact of all the proposed changes. I have a duty to find a solution that is financially and clinically sustainable for the South London Healthcare NHS Trust area. However, I need to consider the knock-on effects everywhere else, including in Lewisham and my hon. Friend’s constituency.
As well as legal advice, I will be seeking clinical advice and want to make sure that my officials agree with the financial considerations made in the report. I will consider all that advice in enormous detail before I come to any decisions.
Heidi Alexander (Lewisham East) (Lab)
I am grateful to the Secretary of State for agreeing to meet Members with Lewisham constituencies about this matter. Representatives of the Save Lewisham Hospital campaign, which is made up of local GPs, local hospital doctors and the public, are also very keen to meet the Secretary of State to put our case directly to him about why it is important to retain a full, admitting A and E and full maternity service at Lewisham. Will he agree to meet them?
Mr Hunt
I want to meet colleagues from the House but, as I am sure the hon. Lady will understand, I want to be careful not to restart the whole consultation process that has been happening in what I believe is a very thorough way in the past few months. However, one of the things that I will be considering very carefully—and I will listen to any points that the hon. Lady makes when I meet her—is whether the consultation has been done properly, as it needs to be done and as was intended by the legislation. I will not accept any changes unless I am satisfied on that point.
Dame Tessa Jowell (Dulwich and West Norwood) (Lab)
I welcome the Secretary of State’s apparently open-minded approach to the proposals, which have caused enormous clinical alarm in our hospitals as well as local concern.
Two particular issues affect my constituents and those of my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman) in relation to King’s College hospital. I ask the Secretary of State to take them seriously. First, should the proposed closures at Lewisham hospital go ahead, that will impact on the King’s College hospital paediatric A and E, which is already overstretched; the staff have enormous concern about their ability to meet any additional demand.
Secondly, will the Secretary of State agree that discussions currently under way to merge the managements of King’s College hospital with those of Guy’s and St Thomas’s should be suspended while the extensive reorganisation threatens the stability of a number of hospitals? If they were to go ahead in parallel, that would risk engulfing our hospitals with preoccupations about reorganisation rather than there being a focus from our world-class hospital staff in south London on treating the patients that we represent.
Mr Hunt
The right hon. Lady makes two important points. As she knows, I visited King’s College hospital just before Christmas and was incredibly impressed by what I saw. I visited the geriatric ward and was really impressed, and I am sure that the paediatric service is outstanding as well. It came across to me as an extremely well run hospital. I will, of course, make sure that I consider the impact of the changes proposed by the trust special administrator on King’s, just as I will consider the impact on all surrounding hospitals.
With respect to the merger proposals, because the legislation requires me to come to a decision within 20 working days, the right hon. Lady will find that I have to make and publish my decision quickly enough to ensure that any impact from the changes is properly considered by the people pursuing the possibility of a merger between King’s, Guy’s and Tommy’s.
Mr Nick Raynsford (Greenwich and Woolwich) (Lab)
The Secretary of State will understand that I have not been able to read the entire trust special administrator’s report in the hour or so I have had access to it. However, while I was reading the report, it became clear that a great deal of concern was expressed during the consultation about the implementation of the proposals. Indeed, the report highlights the fact that following previous reorganisations, costs have increased rather than reduced as a result of the very process of reorganisation.
Given those worries, will the Secretary of State agree to meet representatives from other boroughs, who are equally concerned? I remind him that he declined my request for a meeting on the trust special administrator’s draft report; I hope he will not decline to meet now that we have the full report. In particular, will he consider the implications for patient care and services of a major reorganisation, which can be disruptive and fail to deliver the savings envisaged?
Mr Hunt
I heed absolutely the right hon. Gentleman’s warning that reorganisations are not always the panacea that they are made out to be. We need to be absolutely clear that, if we accept the proposals, they will deliver a sustainable, robust and clinically sound outcome for the right hon. Gentleman’s and neighbouring constituents, as the trust special administrator believes they will. I shall be delighted if the right hon. Gentleman attends the meeting with other MPs affected by the proposal. I shall hear what he has to say further at that meeting.
Clive Efford (Eltham) (Lab)
The Secretary of State has to recognise the serious contradictions between the proposals in the trust special administrator’s report and the Conservative manifesto before the last general election. If he were to accept the proposals, particularly in relation to A and E, that would be a serious betrayal of promises made to the electorate. There are also the changes expected from the “A Picture of Health” proposals for Queen Mary’s hospital in Sidcup in relation to overnight elective surgery. How much is the Secretary of State bound by the specific promises made in the Conservative manifesto before the election when it comes to making a decision on the report?
Mr Hunt
We were concerned in the run-up to the last election at the pace and scale of many of the reconfigurations pursued by the last Government. That is why when we came into office we paused the reconfigurations and introduced the four tests—an additional safeguard to make sure that reconfigurations were not done without local clinical support.
We wanted to avoid what had happened so often, including in my own constituency—an alliance of Health Ministers and NHS managers riding roughshod over what local people wanted. We wanted to stop that, so we put in place new systems. I hope that the hon. Gentleman will be comforted by the robustness and thoroughness of the processes that we are now going through.
South London Healthcare Trust
Jeremy Hunt Excerpts(11 years, 4 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I wish to inform the House that the trust special administrator appointed to South London Healthcare NHS Trust provided me with his final report on 7 January 2013. It makes recommendations to me in relation to securing a sustainable future for services provided by that organisation.
Details about the appointment of the administrator, Matthew Kershaw, were given in a written ministerial statement issued on 12 July 2012, Official Report, columns 47- 48WS.
The report was provided to me in accordance with chapter 5A of the National Health Service Act 2006, as introduced by the Health Act 2009, and has today been laid before Parliament and made publicly available at:
www.dh.gov.uk/health/2013/01/south-london-healthcare/
Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
I would like to thank Matthew Kershaw for the work he has carried out in producing his report. This is the first time the trust special administrator’s regime has been used since the last Government introduced the provisions which were enacted in the Health Act 2009. In accordance with the legislation, in addition to producing his recommendations on the future of the trust, Mr Kershaw has also been responsible for managing South London Healthcare NHS Trust and maintaining services for patients while the board is suspended pending the outcome of the regime. I do not underestimate the demands this has placed on him.
In triggering this regime, the Government’s priority was to ensure that patients continue to receive high-quality, sustainable NHS services. At the time Mr Kershaw was appointed last July, South London Healthcare NHS Trust was overspending by £1 million a week. In the last financial year, the trust had a deficit at over £65 million, the largest in the country. Left to itself, the trust’s very severe financial position would have continued in a downward spiral of continuing deficits and ultimately threaten the quality of care for patients across south-east London.
The challenges facing South London Healthcare NHS Trust are complex and long standing. To date, it has not proved possible to ensure that South London Healthcare NHS Trust is able to secure a sustainable future for its services within its existing configuration and organisational form. The Government’s priority is to ensure the delivery of a long-term, viable solution for services provided by the trust if it cannot be made sustainable. All responses to my predecessor’s statutory consultation on whether to trigger the regime, including from South London Healthcare NHS Trust itself, stated that a solution for the trust cannot be viewed in isolation from broader service provision within south-east London.
In accordance with my statutory duty, I will consider the trust special administrator’s recommendations carefully and make a final decision by 1 February that can secure sustainable services for the people of south-east London. In considering the recommendations, I will examine particularly:
whether the recommendations are likely to provide a sustainable long-term financial position which will secure high-quality services in the local area for the future; and
whether the recommendations have regard to the Government’s four key tests for local service reconfiguration. These are support from GP commissioners, strengthened public and patient engagement, clarity on the clinical evidence base and support for patient choice.
Ultimately, my priority is to ensure that all NHS hospitals live within their budgets and achieve the best quality care, best patient outcomes and best patient experience for all their NHS patients.
I will inform the House of my decision as soon as reasonably possible afterwards.
Health Allocations 2013-14
Jeremy Hunt Excerpts(11 years, 4 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Today I am informing the House that the NHS Commissioning Board has announced the allocations to clinical commissioning groups (CCGs) for 2013-14 of £63.4 billion.
The board’s overriding objective is to improve outcomes for patients and to reduce health inequalities. Together with ensuring stability during transition, this has driven the decisions the board has taken in the approach to allocations for next year.
All CCGs will receive an identical increase of 2.3%, which will ensure that funding is stable in the first year of the new commissioning arrangements and supports a smooth transition. The board is also initiating a review of the approach to allocations, not just confined to CCG allocations, to give the best opportunity to improve outcomes for patients and tackle health inequalities.
Full details of the allocations have been placed in the Library and can be seen at: www.commissioning board. nhs.uk/files/2012/12/ccg-allocations-13-141.pdf. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
NHS Consultants and Junior Doctors' Contracts
Jeremy Hunt Excerpts(11 years, 5 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I am responding on behalf of my right hon. Friend the Prime Minister to the report by the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) “Review of compensation levels, incentives and Clinical Excellence and Distinction Awards schemes for NHS Consultants”. The report has been laid before Parliament today (Cm 8518). The report was to all four UK Health Departments. I am grateful to the chair and members of the DDRB for their report.
The recommendations in the report are wide ranging. As well as making recommendations on a new approach to national and local awards, it suggests the contract needs to recognise different stages in a consultant career by introducing a break point in the pay scale and a new principal consultant grade, that would cover up to 10% of the consultant work force at any one time.
The report sets out the case for change and the Government accept the key principles underlying the report. In particular, we agree that clinical excellence awards should recognise current not past excellence and that there is a compelling case for changes in the consultant contract. Local NHS organisations need to have a consultant contract that meets their needs and is fit for purpose for the future.
I recognise that there may be some concerns within the medical profession over the report. The Government are therefore committed to work with the profession on these recommendations with a view to reaching agreement with doctors’ representatives on how they should be implemented.
I am particularly mindful of the position of doctors who hold current pensionable and consolidated awards and on the impact of the DDRB’s proposals for national awards on the most senior doctors including clinical academics. It will be important to ensure that their reward packages remain competitive so that we continue to recruit and retain the most able consultants in the UK and provide appropriate incentives to encourage clinical excellence and innovation; not only in patient care but also in medical research and teaching.
The Government do not necessarily accept that consultants should be prohibited from holding awards simultaneously in the old and new schemes. This will depend on the final scheme design and should be considered as part of transition planning to ensure that all consultants retain appropriate incentives for continued excellence while avoiding paying twice for the same activities.
I am also prepared to consider the issue of pensionability of future awards as there is nothing inherent in a career average pension scheme that prohibits this. I therefore believe that longer-term national awards can remain pensionable. I would also be prepared to consider affordable proposals on pensionability of future local awards.
In advance of these discussions, we intend shortly to launch a specific consultation about discontinuing two anomalies in the current schemes.
We wish to work with the profession and employers to ensure that pay arrangements for doctors are affordable and sustainable in the long term. We will therefore also be seeking to agree changes to doctors’ contracts to better support seven-day working in the NHS. A move to seven-day working must be approached alongside better availability of community services and primary care. An NHS fit for the future needs to be delivering the same quality of service at the weekend as it does during the week and pay arrangements need to reflect this.
We are also today publishing a report commissioned from the NHS employers organisation by the four UK Health Departments on the junior doctors’ contract. The incentives in the current contract operate in a way that militates against the best quality training and restrict the service contribution made by doctors in training. We therefore wish to agree changes to ensure pay arrangements for juniors are also fit for purpose.
I am ambitious to see early progress on implementing these changes. I would wish to see a heads of agreement reached by the spring of 2013 on changes across both contracts with the intention of implementation beginning from April 2014. With the agreement of the devolved Administrations, this will be taken forward on a UK-wide basis, while respecting any differences arising from devolved responsibilities.
Copies of both reports are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. The report on the junior doctors’ contract has been placed in the Library.
“Liberating the NHS: No decision about me, without me”
Jeremy Hunt Excerpts(11 years, 5 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
Today I am publishing “Liberating the NHS: No decision about me, without me”, Government response and the Department’s NHS choice frameworks for 2012-13 and 2013-14. The response document and the choice frameworks 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.
The consultation document, “No decision about me, without me—Further consultation on proposals to secure shared decision-making”, published on 23 May 2012, set out proposals to provide patients with more opportunities to be involved in decisions about their care and to make choices. A small number of focused consultation questions were asked which sought views on whether the proposals were realistic and achievable and whether there were any issues that had not been recognised sufficiently. The consultation ran for 14 weeks from 23 May to 31 August 2012.
The majority of the 172 responses received to the consultation were broadly supportive of the proposals as a means for patients to become more involved in their care, in partnership with professionals.
Some respondents outlined concerns that greater choice did not equate to the wider adoption of shared decision-making. We agree with this principle and set out in the response document the clear importance of both proposals to increase patient involvement and patient choice.
Other themes were raised regarding the practical implementation of the proposals relating both to patient involvement and patient choice. The response document addresses the comments made by respondents and sets out how we are implementing the proposals to increase patient involvement and patient choice.
The Department’s NHS choice framework for NHS funded care and treatment in England will set out, for the first time, the choices that people can expect to be offered. This will raise awareness of these choices, including where people have legal rights to make choices, as well as setting out where they can find information to support these choices and what they can do if they are not given the choices they are entitled to.
NHS Funding
Jeremy Hunt Excerpts(11 years, 5 months ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
We have heard a lot of bluster and nonsense today. At its heart is an extremely uncomfortable truth for the Opposition: this Government are spending more on the NHS than Labour would have spent. That spend has moved away from consultancy and the back office to the front line, so the NHS is now performing better—I know that it is uncomfortable, but it is true—than it ever did under Labour. That means more treatment—[Interruption.] This might not be what Opposition Members want to hear, but they might as well listen. That means more treatment, more care and more lives saved. The previous Government talked the talk on the NHS, but it is this Government who have delivered an NHS of which we can be immensely proud.
Mr Hunt
I said that I would make a little progress, if that is all right.
I must confess to being both surprised and delighted at this afternoon’s motion, because I would have thought that the last thing the right hon. Member for Leigh (Andy Burnham) would want to do was remind the nation of his opposition to our increasing the NHS budget. The motion is about spending, but we can spend only what is in our budget. What did he say about budget and spend during his failed bid for the leadership of his own party? [Interruption.] I think that right hon. and hon. Members on the Opposition Benches should listen to what those on their Front Bench are saying. He said:
“It is irresponsible to increase NHS spending in real terms”.
So let me ask him to clarify this to the House: does he stand by his comment that it is irresponsible to increase NHS spending?
Andy Burnham
Yes, I do. I said in my speech that the NHS should be protected in real terms at the front line. That is what the Secretary of State has not done. I cannot believe that he is contradicting the contents of the letter from Andrew Dilnot. He really needs to tread very carefully before he goes any further.
Mr Hunt
Let me say very gently to the right hon. Gentleman that he can hardly come to this House criticising us for an alleged cut in NHS spending if his own plans would have led not to higher but to lower NHS spending. We are increasing spending by £12.5 billion, and he thinks that that is irresponsible.
Grahame M. Morris
Will the Secretary of State at least acknowledge that the previous Labour Government increased resources in the NHS from £30 billion when we took office to over £100 billion when we left office in 2010?
Mr Hunt
I will confirm for the hon. Lady that the nurse-to-bed ratio has gone up so that nurses are spending—[Interruption.] Perhaps the Opposition will want to hear about issues of care. The average bed is getting two hours of nursing care per week more than under Labour.
Let me give the right hon. Member for Leigh another chance to clarify Labour policy on health spending. In Wales, Labour has announced plans to cut the NHS budget by 8% in real terms despite an overall settlement protected by Barnett. Given that the motion condemns an alleged cut in NHS spending, will he, once and for all, condemn the choice that Labour made in Wales? If he does not want to do that, let me tell him what the British Medical Association says is happening in Wales. It talks of a “slash and burn” situation and “panic” on the wards. Would he want that to be repeated in England? If not, he should not sit idly by but have the courage to condemn the choice that Labour has made in Wales.
While we are on the subject of Wales, the right hon. Gentleman will know that NHS patients there are five times less likely to get certain cancer drugs than English NHS patients, but the Labour Welsh Health Minister has said it would be “irresponsible”—the same word that the right hon. Gentleman used—to introduce a cancer drugs fund in Wales. Does the right hon. Member for Leigh support what Labour is doing with regard to cancer drugs in Wales—yes or no?
Susan Elan Jones (Clwyd South) (Lab)
Can the Secretary of State tell us whether that has anything to do with the cuts in capital spend from Westminster central Government? Does he have any comment to make on National Audit Office figures showing that spending on health in Wales is higher than that in England, or does that not fit with his fictitious version of events?
Mr Hunt
I gently remind the hon. Lady that this is about the choice made by the Labour Government in Wales. They had a choice. They could have protected the NHS budget—they had the money under Barnett to do that—but they chose not to do so, and that is supported by the right hon. Gentleman.
Julian Smith
Does it surprise my right hon. Friend that we heard nothing from Labour Members about productivity, innovation or the Derek Wanless report, which demonstrated that Labour’s health spending led to lower productivity rather than higher productivity?
Heidi Alexander (Lewisham East) (Lab)
Will the Secretary of State give way?
Mr Hunt
I am going to make a little progress, if I may.
The right hon. Member for Leigh rather helpfully spelled out the difference between his position and our position when he admitted in the New Statesman that we are spending more than he wanted to spend on the NHS. He said of the NHS budget:
“They’re not ring-fencing it. They’re increasing it.”
In respect of NHS spending, he said:
“Cameron’s been saying it every week in the Commons: ‘Oh, the shadow health secretary wants to spend less on health than us’…it is true, but that’s my point.”
It was a good point, because we are spending more and he would have spent less. So why on earth call an Alice in Wonderland Opposition day debate condemning levels of spending in the NHS when he has so clearly put it on the record that he wanted that spending to be less?
Mr Graham Stuart (Beverley and Holderness) (Con)
Does my right hon. Friend agree that it is disingenuous, should it be allowed by the Deputy Speaker to say that, of the shadow Secretary of State and Labour Members—
Mr Deputy Speaker
Order. I do not think we can have “hypocrisy” either, so we will have the Secretary of State instead.
Heidi Alexander
The Secretary of State seems to be very keen to ask questions of our Front Benchers. Why will he not answer the question put to him by my hon. Friend the Member for West Ham (Lyn Brown)? How many nurses have lost their jobs on his watch? I do not want to be told about the nurses-to-beds ratio—answer the question.
Mr Hunt
It is because we have protected the NHS budget that the number of clinical staff in the NHS has gone up and not down. [Interruption.] Okay, let me explain this, because there is a very important point here. Unlike Labour Front Benchers, I do not want to micro-manage every hospital in the country and tell them exactly how many doctors and how many nurses they should have. I want them to put money on the front line, and the result is that the number of clinical staff—doctors, nurses, midwives and health visitors—has gone up and not down.
Mr Deputy Speaker
Order. I am sure that the hon. Member for Broxbourne (Mr Walker) is not going to walk out after his intervention and will stay a little longer.
Mr Walker
The meeting is in thirteen minutes.
My right hon. Friend knows that it is not just about funding but about good management. He cannot be responsible for management across the NHS, but in the East of England ambulance service there are question marks over the quality of its senior management. Will he find time to cast his eye over those senior managers?
Mr Hunt
I assure my hon. Friend that I am aware of the concerns that he raises, which are frequently raised with me by the Minister of State, my hon. Friend the Member for North Norfolk (Norman Lamb), who has a constituency in the east of England. I follow that situation carefully.
Let me now deal with the substance of the motion. I have always talked about spending going up from the first year of the comprehensive spending review—the first year when this Government had full control of the budget and were responsible for setting the spending plans. In 2011-12—[Interruption.] The shadow Secretary of State should listen to the facts. He tabled the motion, so he probably should hear the answer, although I know it is not what he wants. In 2011-12, spending went up by £2.5 billion in cash terms—0.1% in real terms—on 2010-11. This year, 2012-13, it will go up again, as it will in every year of the Parliament.
Andy Burnham
Would the Secretary of State care to remind the House of the commitment in the coalition agreement? Could he read that out for us?
Mr Hunt
I have just said that spending will go up in every year of the Parliament. Let me point out to the right hon. Gentleman that these are small real-terms increases, albeit ones that he bitterly opposed. That is why, given the uncertainties around GDP deflators, Andrew Dilnot’s letter says, in the sentence that the right hon. Gentleman did not want to read out, that
“it might also be fair to say real terms expenditure has changed little over this period.”
There it is, exposed for all to see: a bogus Labour motion trying to paint a picture of cuts to the NHS budget when even the head of the UK Statistics Authority says that the broad picture of NHS spending is that it has been protected in real terms—something that almost certainly would not have happened had Labour been in power.
Andy Burnham
I am struggling to believe what I am hearing. The Secretary of State is saying that Andrew Dilnot agreed with him that there had been real-terms increases in every year of this Parliament—[Interruption.] That is what he just said at the Dispatch Box. Let me quote Andrew Dilnot again, for the sake of accuracy. He said that
“we would conclude that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10”.
How can the Secretary of State square what he has just told the House of Commons with what is in Andrew Dilnot’s letter? Is he saying that Andrew Dilnot is wrong?
Mr Hunt
Some politicians walk into the same trap not once but twice. Let me give the right hon. Gentleman the sentence that comes straight after that, which he did not want to quote. It says that
“it might also be fair to say that real-terms expenditure had changed little over this period.”
That is what Andrew Dilnot is saying, which is why the motion is so completely bogus.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
I am no statistician, but my understanding of that English is that things have not changed much. However, the Secretary of State has consistently said that he and the Government have pledged to implement an increase. There is nothing in that letter to suggest that any increase has occurred.
Mr Hunt
The right hon. Lady’s party has been saying that spending has been cut, and it had the foolishness to call an Opposition day debate on the basis of a letter from Andrew Dilnot that states that, broadly speaking, spending has remained unchanged. That is why, at its heart, the motion is bogus.
The sad fact is that this is not the debate that the Opposition planned to have, two years into this Parliament. The right hon. Gentleman dreamed of coming to the House to remonstrate about an NHS that was on its knees and that was not delivering for the public. He wanted to argue about waiting times, but they have gone down, with fewer people waiting a long time for an operation than at any time under Labour. He wanted to argue about treatments, but there are more people getting new hips and knees and many other treatments than under Labour. [Interruption.] Opposition Members should listen to this. He wanted to argue about cancer, but 23,000 people are now getting drugs under the cancer drugs fund that Labour refused to set up.
Today, the right hon. Gentleman has tabled a motion criticising the decisions taken by the coalition and my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) on NHS spending in our first two years in office. This is also about how we spend the money, as many of my hon. Friends have said. What are the decisions that the right hon. Gentleman is criticising? They are precisely the decisions that mean that the NHS is now performing at record levels, and vastly better than at any time under Labour.
Let us look at those decisions. There was the decision to reduce the number of managers by 7,000 and transfer resources to the front line. There was also the decision to cancel Labour’s disastrous attempt to embrace the technology revolution that cost billions and set the NHS back by years. Then there was the decision to end the wasteful consultancy spend, which has now been cut by 39%. [Interruption.] The right hon. Gentleman needs to listen to this. There was the decision to stop the scandal of unsustainable private finance initiative projects that left the NHS with a £73 billion debt and £1.6 billion-worth of repayments every year. [Interruption.]
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Christmas is coming. Let us show a little bit more Christmas spirit towards each other. Members on both sides of the House want to hear the Secretary of State.
Mr Hunt
I could not agree with you more, Mr Deputy Speaker. I am trying to give the House some good news, but it is difficult for the Opposition to take it in.
There was also the decision, championed by both coalition parties, to transfer that money to the front line, so we now have more clinical staff, including 5,000 more doctors; better access to drugs, including £600 million invested in the cancer drugs fund; 500,000 more elective admissions every year than under Labour; over 3 million more out-patient appointments every year than under Labour; nearly 1 million more going through accident and emergency every year than under Labour; and 1.5 million more diagnostic tests every year than under Labour. On top of all that, we have 60,000 fewer people waiting longer than 18 weeks than under Labour; 90% fewer people waiting more than a year than under Labour; clostridium difficile down more than a third compared with under Labour; MRSA halved compared with under Labour; and the number of people facing the indignity of mixed-sex wards down by 98% compared with under Labour.
Of course the NHS faces huge challenges with an ageing population and increasing demand, but we are now facing up to those challenges with ambitious plans to tackle dementia, to reduce mortality rates for the big killer diseases to the lowest in Europe, to embrace the technology revolution—but getting it right this time—and to improve the quality of care which, in parts of the system, has been allowed to become shockingly poor for far too long. All those priorities were ignored by Labour in office and, even worse, they have been rejected by Labour today as a “meaningless list”. Those were Labour’s words. Well, tell that to the 157,000 people who die from cancer every year, or the 800,000 people who have dementia, or the people whose families suffer from the poor care that we read about every week in the newspapers.
None of the improvements to the NHS, and none of the ambitions for our NHS, would be possible without the extraordinary dedication of our doctors, nurses and front-line professionals, to whom I pay tribute today. But none of them would have been possible either if we had not increased the NHS budget and NHS front-line spend, contrary to what Labour intended and wanted. Labour’s plans would have meant less spending in real terms on the NHS, and vastly less spending on the NHS front line. No clever fiddling with baselines can obscure the harsh reality that Labour’s policy towards the NHS is a mass of contradictions that fools nobody—certainly not the brilliant doctors, nurses and professionals who have given their lives to saving and improving the lives of others. I urge the House to reject this ridiculous motion.
Liz Kendall (Leicester West) (Lab)
During this debate, Ministers and the few Government Members who have spoken have either denied that the Government have broken their promise to increase NHS spending or have claimed that it does not matter, as if the Prime Minister’s clear, direct and personal pledge to voters can easily be swept to one side. They—perhaps with the exception of the hon. Member for Southport (John Pugh)—have also skated over or ignored the waste, confusion and utter distraction of their back-room NHS upheaval.
In contrast, Opposition Members have talked about the harsh reality of the double whammy of cuts and reorganisation on their constituencies. My hon. Friend the Member for Lewisham East (Heidi Alexander), my right hon. Friends the Members for Lewisham, Deptford (Dame Joan Ruddock) and for Rother Valley (Mr Barron), my hon. Friends the Members for Corby (Andy Sawford), for Bolton West (Julie Hilling) and for Easington (Grahame M. Morris), and the hon. Member for Strangford (Jim Shannon) spoke powerfully about their concern that changes to local services are being driven by money alone, not by improving patient care. I also pay tribute to my right hon. Friend the Member for Cynon Valley (Ann Clwyd), who spoke with bravery and compassion about the unacceptable standards of care in parts of the country, which must be tackled.
Perhaps the most worrying example of the combination of cuts and reorganisation that the Government are forcing through involves what is happening to cancer networks. Those groups of local specialists were set up more than a decade ago under Labour’s 2000 cancer plan to help tackle one of Britain’s biggest killers. It is widely acknowledged that cancer networks have played a central role in improving mortality rates, cancer survival rates and equality of cancer care, and they have done that on small budgets with few staff, offering good value for taxpayers’ money. Crucially, the specialist local skills of cancer networks are vital to making even greater improvements that cancer patients need and deserve in the future.
Ministers have repeatedly promised to protect budgets for cancer networks. On 31 January last year, the then Health Secretary told the House that
“cancer networks funding is guaranteed during the course of 2011-12.”—[Official Report, 31 January 2011; Vol. 522, c. 612.]
On 27 November this year in a debate on the NHS mandate, the new Health Secretary told the House:
“Cancer networks are here to stay and their budget has been protected.”—[Official Report, 27 November 2012; Vol. 554, c. 127.]
Those promises have been broken.
In response to a freedom of information survey from Labour, cancer networks report budget cuts of 13% in 2011-12 alone—[Interruption.] The Secretary of State shakes his head but he can look through all the figures, including individual examples, if he wants to see those cuts. In total, budgets have been slashed by 26%—by a quarter—since the Government came to power.
The Government’s national cancer director, Professor Mike Richards, at least has the honesty to say that
“cancer networks will have a smaller proportion of the budget in future.”
I understand that the Health Minister in the House of Lords, Earl Howe, has also been forced by an urgent question to admit that less money will be available to cancer networks.
Mr Hunt
First, these networks are brilliant. They are a good thing and they have done a huge amount. The Government support them and we are expanding them. That is why instead of just having cancer, cardiac and stroke networks, we will also have networks for dementia and maternity. The budget for those networks is going up by 27%.
Liz Kendall
The budget for cancer networks has been cut by a quarter. The Secretary of State is not expanding those networks but merging them and diluting their specialist expertise, as I will show. The cuts and the Government’s NHS upheaval mean that cancer networks have lost one fifth of their staff, withdrawn or scaled back current work, and put future projects on hold—[Interruption.] The Secretary of State is still denying that so let me tell him what the networks actually say.
The Arden cancer network in Coventry and Warwickshire says that it has lost its vital chemotherapy nurse. The Peninsula cancer network in Devon and Cornwall says it has had to turn down £150,000 from Macmillan Cancer Support to fund a programme for cancer survivors because its future is so uncertain. Essex cancer network says that posts have been removed, its staff are in a redeployment pool, and that it will have
“no presence in Essex from April 1st next year.”
Instead of supporting those vital local experts, as well as specialists in heart and stroke networks, the Government are merging them into 12 generic clinical networks that cover bigger geographical regions and far more health conditions. No one is against sharing the skills and experience of cancer and cardiac networks. However, as Maggie Wilcox, a former palliative care nurse, breast cancer patient, president of Independent Cancer Patients’ Voice and the layperson on the recent review by the Department of Health into breast screening said,
“subsuming cancer networks into generic clinical networks could be disastrous for cancer patients…you cannot be both a specialist and a generalist.”
That is especially important in an area as complex and fast-developing as cancer. Staff will not be able to make the same depth or scale of improvements if they are forced to cover a large area and more conditions with fewer members of staff.
The Secretary of State ploughs on regardless, denying that there is a problem and telling BBC Radio 5 Live that it is too early to know what will happen. How utterly complacent and out of touch. Networks are already disappearing. Their staff have left or are looking for jobs because their future is in such disarray. With their reckless NHS reorganisation, the Government have wasted not just taxpayers’ money but the knowledge and expertise of specialist staff, and patients are paying the price.
Liz Kendall
I do not think the Secretary of State understands that in a really complex and fast-developing area such as cancer, we need to know about individual, specific issues and concerns. If there are fewer staff covering bigger areas and more health conditions, we will not get specialist expertise.
If the Secretary of State does not believe me, perhaps he would like to comment on what Dr Mick Peake, the clinical lead for NHS cancer improvement and the national cancer intelligence network, has said. He has stated:
“With the shift towards GPs commissioning, the need for this expert…clinical advice will become ever more crucial…I am worried that in the process of reorganisation of the networks…we will lose many expert and very committed individuals, and that this could impact on the quality of commissioning and cancer services in the future.”
What will be the impact on patients, who are what the network is supposed to be about? Let us take prevention. Who has championed prevention by increasing the uptake of screening programmes? Cancer networks. Who trains GPs to spot the signs of cancer so that patients get earlier diagnosis? Cancer networks. Who has helped patients get their tests and scans done in days, not months, and slashed waits for cancer specialists to two weeks? Who has helped hospitals compare their performance, use the best drugs and treatments and transform patient information and support, and who has been central to setting up the new national cancer outcomes database, which the Government rightly say will help reduce cancer variations and drive improvements in future? Cancer networks. So why is the Secretary of State diluting—[Interruption.] Oh, now he switches to talk about the cancer drugs fund, because he knows that by stripping away vital local expertise, he is putting care at risk.
When the Secretary of State tells Radio 5 Live that he does not know why Labour is flogging this issue, calls cancer networks a mere pilot and says that his upheaval will be in patients’ best interests, cancer specialists, patients and Opposition Members know that he is wrong. We know that he cannot sustain the progress on cancer and make even more improvements in future when he is ripping away the foundations of better cancer care. As Earl Howe has just told Members of the Lords, it is “perfectly correct” that the share of the pot that cancer networks will be able to get will be smaller next year than it is this year. I rest my case.
The Prime Minister said that he would increase spending on the NHS, but NHS spending is lower in real terms today than it was when Labour left office—broken promise No. 1. Health Ministers repeatedly claim that they have protected cancer network budgets—broken promise No. 2. No top-down NHS reorganisation, mental health a priority and social care budgets protected—broken promises three, four and five. The list goes on. The Prime Minister claims that his priority can be summed up in three letters—NHS. That very same organisation is responding with its own three letters—SOS. I commend the motion to the House.