Accident and Emergency Departments

Meg Hillier Excerpts

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. I am astonished that the Labour party seeks to defend those changes to the GP contract, which got rid of named GPs, removed responsibility for out-of-hours services from them and broke the personal responsibility that the best GPs always wanted to feel for the people on their list. In fact, many brave practices refused to go along with those contract changes and continue to have named GPs. There is clear evidence that people who have named GPs use hospital services less. If we are going to give older people the right care, we need to undo those damaging changes.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

The Secretary of State has spoken confidently about how his changes will make a difference in the short term, but over the weekend the BBC revealed that A and E departments are, on average, 10% understaffed and that one trust in London is 75 nurses down. Despite what he has announced today, how can he be sure that those vacancies can be filled?

[Mr Hunt]

The hon. Lady is right that there are staff shortages, and it is not because trusts do not want to employ people; it is because it is difficult to find people to fill all those vacancies. Those are some of the longer-term problems that we will have to address when looking at how to make working in A and E more attractive. There are a number of things we can do in the short term to alleviate the pressure, such as putting GPs on the front desks at A and E departments so that people can get help, ensuring that the social care system is open seven days a week so that people can be discharged on Saturdays and Sundays, and extending consultant cover late into the evenings and at weekends, when A and E departments are busiest. I think that it is right that we do those things straight away while trying to address the longer-term problems.

Oral Answers to Questions

Meg Hillier Excerpts

Tuesday 16th July 2013 Commons Chamber

[Anna Soubry]

I am more than happy to meet the hon. Lady and the family but, as she knows, this is a treatment that we have talked about endlessly, and we have had many meetings, which I am more than happy to continue to have with her.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

Since 2010, thousands of NHS staff have left the NHS with big, fat redundancy cheques, only to go through the revolving door and get new jobs in the NHS, often months later. Will the Secretary of State tell us how much has been spent on redundancy payments and whether he regrets that waste of NHS money?

[Mr Jeremy Hunt]

The hon. Lady asks that question as if that kind of thing never happened under Labour. The answer is that it is not acceptable, which is why we are changing the rules to ensure that people cannot get payoffs and then walk straight into another NHS job. The other answer is that the reorganisation that she criticises means that we have put more money on the front line, including for 6,000 more doctors, which I think was the right thing to do.

Oral Answers to Questions

Meg Hillier Excerpts

Tuesday 11th June 2013 Commons Chamber

[Norman Lamb]

I applaud the CCG for the priorities it has set. Reducing waiting times for access to psychological therapies is a really good move, and the virtual ward has the potential to keep people out of hospital, maintaining their health better and reducing cost to the NHS.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

Hackney CCG was one of the first to be up and running in shadow form. It is now operational but it is still persisting with a tendering approach to out-of-hours services. Will the Secretary of State write to the CCG to explain what has been said in this House—that tendering is not a requirement—and make it absolutely clear where the law lies?

[Norman Lamb]

The point I have tried to make all along is that this is about the judgment of the clinical commissioning groups, and nothing is imposed by the Government in what is required of them. European procurement rules existed under the Labour Government and this Government, but it is up to CCGs, working within the health and wellbeing board arrangements, to commission as they see fit for the benefits of their population.

Accident and Emergency Waiting Times

Meg Hillier Excerpts

Wednesday 5th June 2013 Commons Chamber

[Andy Burnham]

That shows the human cost of the failure that we have seen in recent weeks; my hon. Friend has identified yet another aspect of it.

There has been a huge reduction in nurse-led call back, so inexpert advice is being to people who should probably have other options put to them. An internal graph produced by NHS Direct shows that under the old 0845 NHS Direct service, about 60% of calls received a nurse call back; under 111, that has now dropped to between 17% and 19%. What is happening to these people? They are getting poor advice, so they are frightened and are going to A and E. What is this Secretary of State doing about it? Absolutely nothing.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

The Public Accounts Committee recently heard evidence about out-of-hours services in Cornwall. The bad experiences there showed that a lot of cost shunting was going on. If there was even a risk of taking somebody on through the GPs on call, it was cheaper and easier for that service to shunt the costs to the NHS through for ambulance services. Does my right hon. Friend agree that that is a complete waste of money and that it underlines the shambles that he has just described?

[Andy Burnham]

I agree that there is a false economy here. The picture is repeated. The Government go for these privatised contracts, such as with 111, at the lowest cost, resulting in a drop in standards and less clinical support. What happens? People then turn up at A and E. What happens when social care is cut? People turn up at A and E. What happens when NHS walk-in centres are closed? People end up at A and E. This has serious implications. Across England, 22 serious incidents, including three deaths, are being investigated in connection with NHS 111, and we know that one in five calls is abandoned. This service is failing; it needs urgent action to tackle these problems.

A and E Departments

Meg Hillier Excerpts

Tuesday 21st May 2013 Commons Chamber

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

The Secretary of State seems to have decided that changing GP out-of-hours services is part of the solution to the A and E crisis. In the Public Accounts Committee a few weeks ago, we heard from clinical commissioning groups that they fear a single tender just to GPs because of the threat of legal action. We have seen that played out in Hackney, where GPs have been knocked back by the clinical commissioning group. When will the right hon. Gentleman get a grip on his Department and let the CCGs have the freedom to commission local GPs rather than fear the legal action that prevents them from doing so?

[Mr Hunt]

I want them to have that freedom, but they are operating under the same constraints as primary care trusts, which means having to abide by European procurement law. It is the Labour party that is against any changes in our relationship with the European Union.

Oral Answers to Questions

Meg Hillier Excerpts

Tuesday 16th April 2013 Commons Chamber

[Mr Jeremy Hunt]

I would be absolutely delighted to do that. I had an excellent visit to Kettering hospital that was hosted by my hon. Friend, and I saw at first hand just how hard people are working in tough circumstances, with big increases in A and E admissions causing a great deal of pressure throughout the hospital. One had a sense at the hospital that there was a mission to turn things around and make things better, and a management team who were totally committed to doing that. I congratulate them and all the front-line staff who are doing such an important job for the people of Kettering.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

A year ago, GPs in Hackney bid to run the out-of-hours services. Earlier this year, they were told that it had to be tendered because the board was fearful of legal challenge from private health companies. Who is running the NHS—the Secretary of State or the private health company lawyers?

Oral Answers to Questions

Meg Hillier Excerpts

Tuesday 15th January 2013 Commons Chamber

[Mr Hunt]

NHS funds are independently decided by the NHS Commissioning Board, and I know that is a key concern of the board. I visited Kettering hospital, so I know that it is a very busy hospital coping well in difficult circumstances.

[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?

[Dr Poulter]

The hon. Lady is right to raise concerns about specific groups. The direction of travel in reducing readmission rates has to be the right thing; far too many patients were bouncing back to hospital when they would have been better looked after in the community. The longer term answer for some conditions, such as heart disease and possibly sickle cell and thalassaemia, may be year-of-care tariffs, which we are looking at very closely, as is the NHS Commissioning Board.

Liverpool Care Pathway

Meg Hillier Excerpts

Tuesday 8th January 2013 Westminster Hall

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

I am pleased to serve under your chairmanship, Mr Weir. I congratulate the hon. Member for Montgomeryshire (Glyn Davies) on securing this debate on such an important issue.

I represent St Joseph’s hospice on Mare street in Hackney, which is a beacon of good practice in end-of-life care. Under the expert leadership of its chief executive, Michael Kerin, its medical director, Dr Anjali Mullick, and the Sisters of Charity, who founded it more than 100 years ago, the hospice ensures that people in their last stages of life receive care and die with the respect and dignity that they deserve, and that is what we are talking about today.

It is worth reiterating here what end-of-life care should offer. It is about treating someone who is dying as a person, and not as a number or a patient, and about looking at that individual’s needs in the round. It is not about giving a mechanistic response. As my hon. Friend the Member for West Lancashire (Rosie Cooper) said, surely once a clinical decision has been made about someone’s life chances, we, as a compassionate society, should try to ease suffering and support them to die well. The Liverpool care pathway, which is used only when someone is in the last hours or, in some circumstances, the last days of their life, aims to provide the tools to enable rest and care rather than making active interventions that would cause a person to die less well.

Those fine principles are great, although they may not always be adhered to fully. Good leadership and training of staff are vital, and that is one of the issues I want to address in the short time I have to speak.

We face an important challenge as a society as we consider the end-of-life care we aspire to. Most of us want a choice of where we die. If we had a free choice, most of us would choose to die at home, supported by organisations such as Marie Curie or hospices such as St Joseph’s, whose nurses go out and care for people in the community. Where individual practitioners are out and about and are not being overseen, that will create greater challenges in the future for regimes such as the Liverpool care pathway, but that is no reason to dismiss it or not to see it as an important way of helping and supporting people as they die.

That raises an important issue for us as a society. If we agree that dying well is important, we need to recognise that practical and policy issues need to be addressed. Patient and family choice about where to die works only if proper 24/7 care is provided, whether in the home, the hospice, the hospital or another setting, and we need to make sure that proper resources and support are available. Often, that is about training practitioners in general so that they know what best practice is. If we look to our inner humanity, we all know what we would want, leaving aside all the medical trappings, if we were dying: we would not want to be poked and prodded in the last hours of our lives; we would want to have a good, well-supported death.

Training and development are vital, and I welcome the work done by trainee doctors in Liverpool, which my hon. Friend mentioned. When the hospice movement started, it was rare for doctors to get proper training; indeed, I think they spent about a day on the bedside manner for dealing with a dying patient and speaking to their family. Things have moved on a lot since then, and it is vital that, in the debate about the Liverpool care pathway, we do not throw out the baby with the bathwater. The LCP has done good things, although improvements could probably be made at any point to any such approach. None the less, it is vital that we maintain the approach that dying well is important and should be available to all in every setting.

Oral Answers to Questions

Meg Hillier Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Mr Hunt]

My right hon. Friend is absolutely right. By 2018, nearly 3 million people will have not one but three long-term conditions. All too often, the system treats them on a disease or condition basis, and not as a human being who needs an integrated care plan. That is the route to lower costs, but it is also the route to transformed care.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

The Public Accounts Committee has heard that, of 20 trusts that needed to improve their diabetes care, only three took the accepted help. How will the Secretary of State ensure that care through health providers meets the grand targets he has set for himself?

[Mr Hunt]

The hon. Lady is absolutely right to point out that the consistency of provision is not good, but we will be publishing a diabetes action plan that will try to ensure more consistent provision throughout the NHS. We also need to raise our sights as to what is possible, because as I have mentioned, a third of the population have long-term conditions, and we can do much better at helping people to live with those conditions in a way that promotes their independence.

Oral Answers to Questions

Meg Hillier Excerpts

Tuesday 17th July 2012 Commons Chamber

[Anne Milton]

I thank my hon. and learned Friend for his supplementary question. I cannot comment on the individual details of the case, but I appreciate his concern that NHS staff could be prevented from speaking out by confidentiality agreements. Confidentiality and compromise agreements are allowed in contracts, but the Public Interest Disclosure Act 1998 provides that any clause in that contract or compromise agreement between employer and employee is void in so far as it acts to stop the employee making a protected disclosure.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

Given the proliferation of new bodies being created to deliver NHS services, including a number of private sector organisations, can the Minister be confident that the NHS constitution protects whistleblowers working for private companies but delivering NHS public services?

[Anne Milton]

I assure the hon. Lady that all must have regard to the NHS constitution. In fact, we issued guidance to NHS organisations that all contracts of employment should cover whistleblowing rights. In September 2010, we amended terms and conditions of service and guidance to the NHS on supporting and taking action on concerns raised by staff. The changes made to the NHS constitution make very clear the rights and responsibilities of NHS staff and their employers in respect of whistleblowing. As I have pointed out, all those providing services on behalf of the NHS must have due regard to the NHS constitution.