Oral Answers to Questions

Debate between Jim Shannon and Ben Gummer

Tuesday 10th May 2016 Commons Chamber

[Ben Gummer]

It is true that the skills mix and the way in which specialist nurses have changed over the past six years may well account for the variation that the hon. Lady has noticed—I am willing to write to her with the detail—but the total number of nurses has increased, and we are giving better and more varied training to nurses across the board so that they can deal with the specialist problems that are increasingly the core part of their work.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his response. Specialist nurses are vital for the care and support that they provide for patients and families, not just for the elderly but for the disabled. What is his Department doing to ensure that funding for specialist nurses is maintained and that we do not end up in the situation that we have in Northern Ireland with Four Seasons, which is responsible for 62 homes in Northern Ireland and 450 across the whole of the United Kingdom of Great Britain and Northern Ireland?

[Ben Gummer]

Funding for nurses has increased over the past six years. It is because of the sixth largest increase in the NHS budget that we can guarantee that nursing numbers will remain in that strong position for the remainder of this Parliament. That will include specialist nurses. My role is to make sure that as many nurses as possible get additional training so that we have a wider and richer skills mix, specifically so that nurses can develop their careers—something that I am afraid was often made more difficult rather than easier under the previous career structure.

Upper Gastrointestinal Haemorrhage

Debate between Jim Shannon and Ben Gummer

Monday 11th April 2016 Commons Chamber

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

I thank my hon. Friend the Member for South West Wiltshire (Dr Murrison) for his wide-ranging introduction to this important matter, and for his ability to make this difficult medical subject relevant using the important context of “Downton Abbey”. Lord Grantham’s ulcer is, indeed, a filmic representation of a dangerous clinical event that can happen to people. Mercifully, its incidence in this country is relatively low when compared with that of our European partners and colleagues, although the mortality rates associated with GI bleeding are higher than we would wish. The data are not as robust as I would like them to be, and comparisons can therefore not be nice ones, but none the less mortality rates are not as low as they should be when compared with European comparators.

My hon. Friend points out a number of reasons why that should not be the case. He speaks wisely about the need for on-site site endoscopy, on-site radiology, on-site surgery and on-site critical care, all of which were recommended by the NCEPOD report. That tallies closely with the most recent National Institute for Health and Care Excellence guidelines. The guidelines specify that endoscopy should be offered to unstable patients with severe acute upper gastrointestinal bleeding immediately after resuscitation and offered within 24 hours of admission to all other patients with upper GI bleeding.

Reports from NHS Improving Quality and the National Confidential Enquiry into Patient Outcome and Death, to which my hon. Friend referred, go further and state that that will require the appropriate structures to be in place at all hours of the day and on all days of the week. As he reflected, that tallies well with the aims of the Government in producing a seven-day NHS, although I will, if I may, take issue with certain aspects of his comments in a few moments.

The audit of endoscopy services for acute upper gastrointestinal bleeding in 2007 found that only half of all acute trusts in England were compliant with NICE guidelines in this area. The most recent survey has shown some improvement. In 2013, 62% of services are able to provide a formal 24/7 rota for endoscopy specialists, and 56% of services can offer acute admissions for endoscopy within 24 hours of admission. While this is an improvement, there is clearly a long way to go if only 62% and 56% of services respectively provide the kind of provision we expect. Our aim, therefore, is to ensure that every patient has 24/7 access to safe, high-quality GI endoscopy services with facilities to perform an interventional procedure linked to other essential interventions, such as interventional radiology and surgery. High-quality care will not only reduce mortality and complications but increase early discharge, through the use of formal risk assessment scores, and reduce lengths of stays.

It is therefore important that those services are available to those patients at all hours of the day, and on all days of the week. That is why we have made clear our commitment that, by the end of this Parliament, patients with urgent and emergency hospital care needs will have access to the same level of consultant review, diagnostic tests and treatment seven days a week; patients with upper GI bleeds will be one of many cohorts of patients to benefit from that.

At this point I should be very clear in my response to my hon. Friend. He restated the position, often quoted by Opposition Members, that somehow there is a lack of definition about our intentions for 24/7 services. I say to him gently that we have been very clear indeed about how we believe the seven-day NHS will be delivered. In secondary and tertiary care, it will be based entirely on the needs of urgent and emergency care pathways. Those pathways have been outlined in 10 clinical standards brought together by the Academy of Royal Medical Colleges, under the chairmanship of Sir Bruce Keogh. Those 10 clinical standards have informed the policy we have developed on urgent emergency care, which will be announced and rolled out in the weeks and months to come.

We could not have been more clear, both in this place—I believe we have been clear to my hon. Friend—and to the public at large, that our intentions for a seven-day NHS are rooted in the provision of a consistent urgent and emergency care pathway for patients. We have never intended to mandate from the centre non-acute dermatological services, as he suggested, or any other service like that.

Clearly, to support good 24/7 services in hospitals we have to be able to provide exceptional diagnostic services. Whatever the lacunae in the current evidence base around particular specialties in the NHS—we are never going to have a full picture in the way we might wish—we can draw general conclusions. One, which my hon. Friend rightly drew, is that the quality of diagnostics needs to be consistent, people need to have access to those diagnostic services on a regular, rigorous, robust and consistent basis, and those services need to be available on a Saturday night much as they would be on a Monday morning. That is why the Government’s intentions on 24/7 services involve consistent diagnostic services, as we have made clear since the beginning of the policy.

It is important to explain how those services will become priorities for trusts. In the roll-out of a consistent 24/7 service in diagnostics, we want to be clear to trusts about exactly what is expected of them. Patients admitted as an emergency should be seen as soon as possible by a consultant for review, but at least within 14 hours of arrival at hospital. In-patients must have scheduled seven-day access to the full range of diagnostic services, including endoscopy, with reporting of results within one hour for critical patients and 12 hours for urgent patients. In-patients must also have timely 24-hour in-patient access to consultant-directed interventions such as critical care, interventional radiology, interventional endoscopy and emergency general surgery, either on-site or through formally agreed network arrangements. Finally, all acutely ill patients in high dependency hospital areas, such as the acute medical unit and the intensive care unit, must be seen and reviewed by a consultant twice daily.

I hope my hon. Friend will see that we are already encapsulating his principal demands about upper gastrointestinal bleeding in the general outline of the clinical standards that we plan to roll out to ensure consistent quality of care for urgent and emergency care pathways.

We will monitor the implementation of those clinical standards through transparent metrics, and I hope that in a year, if my hon. Friend is successful in securing a further Adjournment debate—I would happy to brief him privately on this issue both then and in the interim—he will see that through the transparent metrics that we will publish on mortality, length of stay, emergency readmissions and whole series of other measures, there will be trust compliance across clinical standards.

[Jim Shannon]

I understand that mortality rates for hospitalised conditions can be as much as 35%. That worries me, and I am not sure whether the Minister has addressed that issue. He referred to 10% mortality, but some hospitalised conditions have a 35% mortality rate. We must address that.

[Ben Gummer]

There is variation in mortality, and I hope we will make progress in that area over the next period. We must understand comparisons of mortality across the country, and as the hon. Gentleman knows, the Secretary of State is interested in discovering and understanding that issue. We must also understand variations across the European Union, and in the United Kingdom where there are apparent variations between practice in England and that in Scotland, Wales and Northern Ireland. Some of that comes down to data collection, but we must understand where it comes down to practice and consider how we can improve in accordance with our most neighbourly health systems.

Junior Doctors: Industrial Action

Debate between Jim Shannon and Ben Gummer

Thursday 24th March 2016 Commons Chamber

[Ben Gummer]

The new trade union legislation does not apply to doctors in the way my hon. Friend suggests, but I appeal to them and their consciences not to withdraw emergency cover and put patients at an increased risk of harm.

[Jim Shannon (Strangford) (DUP)]

In Northern Ireland, we have become experts in compromise and reaching agreement. We have had to come to terms with difficult issues and compromise on many things. The Northern Ireland Assembly Health Minister is in talks with the BMA and junior doctors to find a tailored solution for Northern Ireland that is affordable and has patient safety at its heart. Does the Minister not agree that it is time to get round the table, meet the BMA and junior doctors and realise that compromise between all parties can and often does reach a fair solution for all?

[Ben Gummer]

The contract is a compromise. We have compromised in a series of areas to try and reach a settlement, and 90% of it has been agreed with the BMA, but in the absence of talks—one party refuses to discuss the remaining items on a point of principle—we have to move ahead with implementation. That train has now left the station, and we will be bringing in the new contract later this year.

Cosmetic Surgery

Debate between Jim Shannon and Ben Gummer

Tuesday 20th October 2015 Commons Chamber

[Ben Gummer]

I will certainly look into that case, as it does not sound right. I cannot trespass on the realms of the GMC, but I will inquire into the specific case outlined by the hon. Gentleman.

The hon. Gentleman makes a valid point about the cost to the NHS and this is not the only area in which we have considered and continue to consider cost recovery for the NHS. It can be difficult as sometimes the cost of legal action outweighs the cost of recovery and it is not something that the service is used to doing. I am keen to explore it further, but in the context of the action we are taking, which I shall come on to, I hope that the hon. Gentleman will understand the need to take this bit by bit so that we get the process right. In principle, I certainly agree that if organisations cause a cost to fall on the NHS, as in this case, there is a good argument for seeing whether that cost can be recovered.

That takes me on to another part of the hon. Gentleman’s speech that was particularly striking, about the celebrity endorsements in this case. It is not for me to make policy announcements in an Adjournment debate, nor would I want to in the case of celebrity endorsements, but I agree with the hon. Gentleman that people should think carefully about how they endorse cosmetic surgery. It is a serious intervention and if anyone seeks to glamorise something to which careful thought should be given, people and the organisations using those endorsements should treat them with extreme care.

I would point the organisation that the hon. Gentleman is dealing with and everyone else towards the code of conduct in advertising, the Committee of Advertising Practice and the Broadcast Committee of Advertising Practice, which drew up guidance in October 2013, especially on protecting children and young people. I think it would be appropriate to make sure the organisation of which he speaks is complying with the spirit as well as the letter of that guidance, and if not I will certainly help him to ask whether anything more can be done on that.

The hon. Gentleman raises the issue of counselling. Any reputable organisation should seek to ensure that people undertake procedures only when they need to do so and have been properly counselled on the consequences of their actions so that they can make an informed decision. The Government believe that that should happen in every case for cosmetic surgery. There should be an informed decision, taken with serious thought.

Finally, on the issues to do with The Hospital Group the hon. Gentleman raised, I cannot speak without further advice, but there clearly seem to be questions about trading standards, which he raised. I hope that I and my officials will be able to meet him to look carefully at this case, to make sure if The Hospital Group is misrepresenting its position apropos its surgeons and those it seeks to represent, it is not besmirching an industry which more widely does take its duties and the way it represents itself seriously.

[Jim Shannon]

The hon. Member for North Durham (Mr Jones) has raised a topical issue of which we are all aware. Many people have had botched operations. Has the Minister’s Department been able to quantify how many? Optimax was one of the groups involved with a lot of the operations for laser surgery. People thought that was safe, but it was obviously not safe for all. Has the Department been able to quantify the numbers and therefore take action?

[Ben Gummer]

I am afraid I do not have an answer to the hon. Gentleman’s question, but I will make sure we write to him if such figures exist, although I suspect they may not. Let me inquire, and then I shall reply to his question.

Let me turn to the broader policy issues to which the hon. Member for North Durham referred. He referred to Sir Bruce Keogh’s review. It began in January 2012 after the PIP breast implant scandal. It covered the rapidly growing non-surgical cosmetic market. He published that review in 2013 and it highlighted the rapid growth of cosmetic interventions, and suggested safeguards among 40 recommendations to protect patients. The aim of those was to improve how surgical and non-surgical interventions were done, to set standards for training practitioners and surgeons and for how supervision from regulated healthcare professionals can support self-regulation of the industry, and to improve the quality of the information clients have to ensure they are able to make informed decisions about their treatment. The Government published their response in 2014.

By the time of the publication the Government had already started work on a number of the recommendations. To address the issue of proper training for cosmetic practitioners, the Royal College of Surgeons set up an inter- specialty committee with representation from the relevant specialty associations and professional organisations including plastic surgery, ear nose and throat, oral and maxillofacial surgery, breast surgery, urology, the Royal College of Obstetricians and Gynaecologists, the Royal College of Ophthalmologists, the General Medical Council and the Care Quality Commission. The committee also includes patient and provider representation, and representatives from the devolved Administrations are invited as observers.

The committee established three sub-groups which are taking forward the work to implement the recommendations. They cover standards for training and certification, clinical quality and outcomes, and patient information. The committee is also in the process of developing an overarching framework for certification to improve the safety and delivery of cosmetic surgery. Individuals performing cosmetic surgery will be expected to practise within their field of specialty training. The framework for certification takes into account equivalence for non-UK-based surgeons.

NHS: Financial Performance

Debate between Jim Shannon and Ben Gummer

Monday 12th October 2015 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for his statement. This is a question for Members across the whole of the United Kingdom of Great Britain and Northern Ireland, where there are pressures on the NHS, because while we all have passion and love for the NHS, we must ensure that there is enough money for it. Will the Minister confirm the amount of money that will be there for accident and emergency departments and say what will be done on waiting lists?

[Ben Gummer]

The hon. Gentleman will know that funding for the NHS in Northern Ireland is not within my bailiwick. I therefore point him in the direction of the Northern Ireland Office and his Assembly. As far as England is concerned, I confirm that we will deliver not the £8 billion that the NHS has asked for, but £10 billion over the course of this Parliament.

Operational Productivity in NHS Providers

Debate between Jim Shannon and Ben Gummer

Wednesday 1st July 2015 Westminster Hall

[Ben Gummer]

I do not want to ruin the hon. Lady’s nascent reputation by agreeing with her again—happily, there are very few Opposition Members present to notice, although that is not an implied criticism—but she is absolutely right. We are lucky that nursing places are quite significantly over-subscribed. The position is popular, but she is absolutely right that we need to not only make far greater use of apprenticeships but widen the skills base in nursing full stop. We are actively working on that in the Department—I have spent much of the day on it, and I am sure there will be more to come.

To help chief executives in this interim period, we have forced all agencies that want to offer their services to ensure that they are doing so through framework contracts, and we are ensuring that there is an hourly cap on the rate that can be charged. We have also taken additional measures on managerial salaries, along with a few other measures, to ensure that managers have the opportunity to be able to manage costs as they wish. We understand, however, that this is the first stage of a much deeper programme of reform that is needed. Lord Carter’s report points in that direction by suggesting that we use our existing workforce far better, so that people are doing the job that they are suited to and qualified for and that their time is not wasted. That is the great win, not only for efficiency and patient care, but for staff enjoyment of their jobs.

The hon. Member for Coventry South (Mr Cunningham) made some helpful interventions about NHS workers’ quality of life. It has been a sad but persistent truth of the NHS for many years—decades, in fact—that staff-reported incidents of harassment and bullying have been higher than the national average and that workforce stress and illness is higher than average. Some of that is to be expected—parts of the NHS are extremely stressful working environments—but we can do much more. Part of that is about ensuring, when people turn up to work, that they are doing the job they wanted to do, with a suitable but not excessive degree of pressure, and that the system is not wasting their time. If we make them happier in their jobs, their patient care will improve and their commitment to the service will be even greater. I am therefore aware of the prize, not just in pounds, shillings and pence, but in an improvement to staff morale and therefore patient care.

[Jim Shannon]

One of the things that concerns me from a Northern Ireland perspective—this has also been raised in discussions with other Members in the Chamber today and outside—is that the NHS greatly relies on, in our case, Filipino workers, which is an immigration issue. Has the Minister had any discussions with the Minister for Immigration, the right hon. Member for Old Bexley and Sidcup (James Brokenshire), to ensure that there will be no shortfall when the gaps left by those who are here on work visas need to be filled and that the quality service in the NHS will not be lost? The hon. Member for Bristol South (Karin Smyth) referred to training people to ensure that keen, interested and able replacements are available. Has the Minister given any thought to that?

[Ben Gummer]

I was going to come on to that, so I shall do so now that the hon. Gentleman has prompted me. There have been long and deep discussions about this. Our estimate is that no more than 700 nurses will be affected by the time the new rules are in place, which is a different number from that given by the Royal College of Nursing, whose number we do not recognise. It is small challenge given the scale of the workforce and one that we will surmount at the time, but we must see it within the broader policy of reducing immigration to this country from the hundreds of thousands to the tens of thousands—a policy that has broad support across the House and certainly in the country at large. It would be wrong for the largest employer in the country—one of the largest employers in the world—to exempt itself from that overall ambition.

In the end, we will achieve a sustainable workforce in this country only if we do all we can to ensure that those who are British and have grown up here and want to work in the NHS have the opportunity to do so. That is why it is important that we widen and open the avenues into working in the NHS, as the hon. Member for Bristol South suggested, over the next few years, in order to meet the challenge to which the hon. Member for Strangford alluded.

I want to quickly run through the other issues raised by my hon. Friend the Member for Hendon. On master vendors, he has a specific issue regarding some constituents with whom he has been dealing, but I understand that master vendors are managed under a series of arrangements with the Crown Commercial Service. Officials will meet with that organisation soon to discuss the overall issues around master vendors. It is for individual trusts to make such purchasing decisions, but I understand the issue he has raised and the terms in which he put it, and I will ensure that it is investigated properly.

My hon. Friend identified two areas involving agencies and fraud. Fraud is of course unacceptable, and the NHS has quite good systems for identifying it. Given the scale of the NHS, I find it surprising—it is entirely to the credit of those who work in the NHS—that fraud makes up such a tiny proportion of the excessive costs in the NHS.

On the revalidation of locum doctors, for which the General Medical Council is responsible, some doctors find it difficult to gather all the required supporting information needed for revalidation due to the peripatetic nature of the work. To help with that, specific guidance is available for both the doctors and their employers via NHS England and NHS Employers. Locum doctors are part of a larger issue about agency spend and foreign workers working in the NHS. I imagine that the three organisations will come together in the next few years to produce a more stable situation.

[Mr James Gray in the Chair]

Let me turn to the remaining points of the hon. Member for Bristol South. On the stability of the system, I hope and anticipate that one product of the general election is that the system will be broadly stable over the next five years. We intend to continue with the current structure of the NHS. There will be some small changes, such as that identified by my right hon. Friend the Secretary of State last week concerning the NHS Trust Development Authority and Monitor, but we are broadly content with how the system is set up. We must now proceed to ensure that it works.

The shadow Minister made a point about structures and fragmentation. There will always be a genuine dilemma here, because one can approach any system and say that change can be achieved by altering structures, but changing structures can lead to the same outcome. That has been the story of the NHS since its inception. It would be a mistake to think—the hon. Member for Bristol South and the shadow Minister were not suggesting this—that a structural change would somehow produce the outcomes that we all want. The priority is to ensure that the system’s wiring works correctly—that everyone’s interests are aligned and that the incentives are correct—so that people want to sit around the table and come to a considered decision, which can too often not be the case when there is an adversarial relationship between providers, producers and purchasers. That is why I hope that the system’s stability over the next five years will allow us to focus on the significant challenges mentioned by the shadow Minister.

European Convention on Human Rights

Debate between Jim Shannon and Ben Gummer

Tuesday 19th June 2012 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I congratulate the Home Secretary and Immigration Minister on bringing this matter before the House. I fully understand the reason for the debate, but I hope that the clarification given in the letter that hon. Members have seen will ensure that there is no Division.

Everyone has a right to respect for his private and family life, home and correspondence, as many other hon. Members have said. This has been used by many people, however, to claim that anyone has a right to live and settle, with their family, where they choose and so can come to the UK, with or without a visa, to have a private family life. It must never be forgotten, however, that the right is a qualified not an absolute right, and that qualifications are essential in respect of immigration. We must therefore retain the right of the Home Secretary to control immigration through the rules already implemented and what is proposed today.

The Home Secretary’s clarification of the rules for the courts has assured me and, I hope, the House. The Human Rights Act was a good thing in principle, but once lawyers became involved, it changed, as is so often the case. I am reminded of that great and famous Shakespearean quote, “First kill all the lawyers.” That is a bit drastic, I know—I am not saying we should do it—but it is how many people feel when they hear some European judgments. The status of our judiciary has been perpetually challenged by the European Court in cases presided over by people with questionable experience making questionable rulings. As is often the case with Europe, we sign up to something in theory that turns out to be completely different in practice. That is our frustration with Europe and many of its rulings.

The ruling on the Abu Qatada case revealed that seven of the 11 top judges at the European Court of Human Rights had little or no judicial experience; one was 33 when appointed and had no senior judging experience. British judges go through years of training in the law before their application will ever be considered. To have such under-qualified people overruling our own judges is a slight, but worse still, it is dangerous and leaves us with our hands tied on too many occasions. That is the reason for this debate, I believe.

In the past, and even this very day, article 8 issues are being raised in asylum applications or as a basis for standalone applications for leave to remain in the UK. They have also been raised in appeals against deportation or removal. This was not the reason the article was created; it was not meant to be a free pass into the UK and the benefits of living in such a great nation. According to the Courts Service, in 2010, 233 people won their appeal against deportation, and of those 102 were successful on article 8 grounds. According to figures from the independent chief inspector of UKBA, however, in 2010, 425 foreign national prisoners won their appeals against deportation, and these were won primarily on article 8 grounds.

Whichever figures are right, the matter must be addressed, which is what I think the Home Secretary is trying to do through the motion. While our immigration rules should always take note of human rights issues, they must be based on the needs of the country, which must have the right to caretake those very rights. Article 8 is increasingly difficult to impose legally; it is time to get this right, which is what the motion does.

I have received correspondence from groups stating that the removal of paragraph 395C of the immigration rules is tantamount to sacrilege. That paragraph stated that no one could be removed from the UK if it would contravene the UK’s obligations under the Geneva convention on refugees or the European convention on human rights. It set out a range of factors that UKBA had to consider before deciding to remove a person from the UK and reflected the considerations necessary for assessing compatibility with article 8. Those considerations included the person’s length of residence in the UK, the strength of their connections with the UK, their personal history, their character and conduct, their domestic circumstances and, importantly, any previous criminal record.

Other briefings, however, point out that deleting the paragraph has not altered the UK’s obligations under the convention. We are still bound by the rules, but that does not mean that we cannot implement our own rules. In my view, we have not yet given our sovereignty to Europe. The Home Secretary has confirmed that there will be safeguards for those who have been subjected to torture in their homeland—an assurance that many Members have sought and received. I agree with the Home Secretary in asserting her right, and the right of every UK citizen, to have control over immigration in this country.

I am not by nature someone who scaremongers. If I were, I would be reciting the figures, which are screaming out for an immigration policy change. What I will say is that if we deny ourselves the right to allow or disallow people into the country, will there even be a United Kingdom in the future, or will we be like other countries that have put their trust in the European Union only to find themselves on the brink of demise?

[Ben Gummer (Ipswich) (Con)]

Several times in his speech the hon. Gentleman has referred interchangeably to the European Union and Europe when discussing the European convention on human rights. It is very important that we make the distinction in this House and in public, because the public are making the same association between the European Union and the European Court, and it is very damaging when trying to understand both institutions and separate them in the public mind.

[Jim Shannon]

I thank the hon. Gentleman for his intervention. Clearly we want to focus on where the responsibility for this issue lies.

I want to make a quick comment about what the hon. Member for Perth and North Perthshire (Pete Wishart) said. We agree on many things. I am a descendant from an Ulster Scot from the lowlands of Scotland, so I have an affinity with the Scottish nation. It is very obvious which papers he does not read in his house, but it is also obvious what his concerns are, and they are rightful concerns. I disagree with him on independence for Scotland, and I also disagree with him on the issue we are discussing, but I am sure that there are many other issues on which we will agree in future.

We have the right to make immigration control rules. As a nation, it is not in our nature to abuse human rights—that is not what this debate is about—and we will certainly not start doing that with these rules, especially when there is an underlying onus to consider the human rights implications in every decision our judiciary makes. I therefore support these rules and the guidance, as well as the clarification that the Home Secretary and the Minister for Immigration have provided. I believe they are necessary and important, and the people I represent want to see them in place.