Oral Answers to Questions

Sarah Wollaston Excerpts

Tuesday 14th November 2017 Commons Chamber

[Mr Hunt]

The hon. Lady is absolutely right; that is totally unacceptable. Anyone who is a parent would say that it is far too long. That is why we decided to have a Green Paper on children’s and adolescents’ mental health, which we are hoping to publish very soon.

[Dr Sarah Wollaston (Totnes) (Con)]

In its annual “State of Care” report, the Care Quality Commission has highlighted that there are 4,000 fewer nursing home beds in England than there were in April 2015. What plans does the Secretary of State have to address the workforce and funding issues that lie behind this? Will he meet me to discuss the situation in my constituency and nationally?

[Mr Hunt]

I congratulate my hon. Friend on becoming Chair of the Liaison Committee. Of course, I am always happy to meet her, and the issue that she has raised is very important. Our figures show that the number of nursing home beds, as distinct from the number of nursing homes, is broadly stable. There is real pressure in the market, however, and there are real issues about market failure in some parts of the country, so I am more than happy to talk to her about that.

Social Care

Sarah Wollaston Excerpts

Wednesday 25th October 2017 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

It is a pleasure to follow the hon. Member for Central Ayrshire (Dr Whitford) and I particularly commend her comments on the importance of prevention, which we must not forget. I join the Minister in paying tribute to the wider care and health workforce, and of course the many unpaid family carers for all that they do. I would like to touch on the forthcoming consultation and some of the current and future challenges. If hon. Members will forgive me, I will take very few interventions because I know that many are waiting to speak.

On the consultation, the Health Committee yesterday had the pleasure of hearing from members of the House of Lords Committee on the Long-term Sustainability of the NHS on the subject of the long-term sustainability of the NHS and social care. They started out with the remit of talking about the NHS, but rapidly realised that the two systems are completely inseparable and that we have to stop considering health and social care in separate silos. The Minister will hear overwhelmingly from the people who contribute to the consultation that we cannot keep thinking of these systems in isolation, so right from the outset will she make it a consultation on the sustainable future funding of both health and social care?

One thing that we heard loud and clear from members of the Lords Committee yesterday was that we need to do more about future planning and that the system for this has been dismal for decades. Their recommendation was that we should set up an office for health and care sustainability that gives us all good-quality, reliable data about not only the demographic challenges but the future needs of both systems so that we can plan ahead for the costs we face in a realistic manner.

Too often in this House we have very divisive debates on this issue, and the challenges in funding future health and care costs are so enormous that I fear the only way we will meet them is by those on both Front Benches and all Members across the House agreeing that we need to work jointly to reach solutions, because no political party has a monopoly on good ideas. Particularly in a hung Parliament, where it is very difficult for us to pass primary legislation, the only way we will move forward on behalf of the people we all represent—we all want the best for them—is if the solutions are worked towards jointly across the House. I hope all Members will move forward in this debate in a spirit of co-operation, because we have to fund this properly. I am afraid that there is a funding gap, although I absolutely welcome the £2 billion that has been pledged. There is consensus that by the time we reach 2019-20, we will face an estimated funding gap, despite the uplift, of more than £2 billion. That will have a real impact on all those we represent.

We must fund this properly not just now, in the short term, but in the long term, and we must come forward with solutions, but it is not just about funding. It is about staffing, and planning properly for a wider workforce across health and social care, so I very much hope that that will also be included in the consultation. Unless we plan ahead for our future workforce, we will always be playing catch-up, as we do at the moment. Of course, we have seen many important changes. In the future, for example, healthcare assistants will be able to train to move forward through the apprenticeship route to become nursing associates and on into degree nursing. We know from Camilla Cavendish’s review that it is not just about pay in the sector but the lack of continuing professional development and training opportunities and, in particular, the inability to rotate through the NHS and social care community settings. That gives an example of how the Government are making some positive moves, which I welcome.

I hope that from the start the consultation will cover both health and social care and that the Minister will go further in covering not just the sleep-in crisis but some of the many other issues that affect my constituents. For example, some are having their assessments re-examined, and disabled young adults facing a change in the support that will be available to them. I hope that the Minister will meet me to discuss some of the issues raised by my constituents in Kingsbridge who face significant changes to their care.

Surgical Mesh Implants

Sarah Wollaston Excerpts

Wednesday 18th October 2017 Westminster Hall

[Dr Sarah Wollaston (Totnes) (Con)]

I congratulate the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing this important debate. In the brief time available, I would like to touch on the issues of how we allowed this situation to continue to for so long, consent, clinical quality and governance, including in the private sector, and what we should be doing going forward.

First, I pay tribute to the many women who have been courageous in coming forward and discussing intensely painful and personal experiences, not only with myself but with other Members. I would like to quote one, who said:

“I am in so much pain at times that I just give up on the day…The pain never goes, it just varies in intensity.”

We have heard numerous examples of how these devices are deeply impacting on people’s lives with life-changing symptoms. In many cases, those symptoms were not life-changing before the procedure. Many women have delayed symptoms or were unaware that they had these devices inserted in the first place. Women have told me that they did not consent to these devices being inserted and were not informed of the risks. A fundamental principle of consent is that unless the consent is informed, it is not consent at all.

It is very difficult for women to be properly advised of the complications when we have such poor data, and that goes to the heart of the scandal. The clinical trials of these products were inadequate. We know now that variations in the type of mesh lead to a greater or lesser risk of complications in the first place, yet these products were varied and introduced and marketed aggressively without adequate clinical trials, and that is why there has been such a long delay before action has finally been taken. I hope the Minister will address that in her remarks, because if clinical trials are not a fundamental condition for the introduction of new devices, we will see this situation with other devices.

Another concern is the way that such procedures are used. We saw variation in the techniques with which these devices were introduced. We must have an absolute guarantee that there will be proper clinical trials, just as we would expect for the introduction of medicines.

[Chris Ruane (Vale of Clwyd) (Lab)]

Does the hon. Lady agree that if the companies failed to introduce proper clinical trials at the outset, they should now be queueing up to ask these women to come forward so that they can look at the specific cases where the devices have failed? They should be begging these women to come forward.

--- Later in debate ---

[Dr Wollaston]

The hon. Gentleman raises an important point, but many women were not even informed that they had the devices in the first place. Other Members have touched on the fact that because the complications can be late in arising and because of the inadequacy of recording, it is very difficult for women to come forward.

In the brief time available, I would like to mention the yellow card scheme—I will add links on my social media later—which enables women to self-report complications. However, if someone does not know they have had the device fitted they will not report those complications. There is work to raise awareness among GPs of the possibility that symptoms that women present with are related to mesh, to ensure that those women are referred. I welcome the specialist centres that have been set up to treat women who have been so adversely affected by mesh, but if mesh is inserted in the first place, it should absolutely be done in specialist centres.

I do not agree that we should ban mesh, because for some women the symptoms of stress urinary incontinence or prolapse can be life-altering. We should retain it as an option where alternative procedures may create worse outcomes or worse complications, but there must be adequate consultation with women about the risks so that they can weigh them up. I agree with Members who have said they hope that NICE can prioritise the development of more detailed guidance, so that we may have it as soon as possible.

A fundamental absence of data is at the heart of the issue. There has been cavalier practice, and we cannot allow that to continue. The women who have been affected deserve an apology and recognition of the extent of the problem and the delays in recognising and dealing with it. I welcome the findings of the mesh oversight group report, which describes pragmatic and practical recommendations, but clear failings have been allowed to continue for so long. At the heart of those failings is the inadequacy of clinical trials, recording and consent. Finally, we know that the devices are regulated by the European Union. I hope the Minister will comment on how the Government propose to take this issue forward after we leave the European Union. At the heart of it is the need to ensure that the safety of women is prioritised at all times.

[Albert Owen (in the Chair)]

I thank the Chair of the Health Committee.

--- Later in debate ---

[Jackie Doyle-Price]

I hesitate to give a full answer, but the advice I have received is that over the years these products have been reviewed and there are clinical standards for the size of the mesh. I will write to my hon. Friend in more detail, because I am not an expert in that.

The hon. Member for Kingston upon Hull West and Hessle calls for a public inquiry. I think it is more important that we get the treatment that is needed, but I encourage everybody to report their cases through the yellow card scheme.

I am horrified to hear from my hon. Friend the Member for Totnes that many women did not know they were having the device fitted in the first place. That general issue indicates some arrogance of the medical profession towards women. The stories I have heard from colleagues, about how their constituents have been treated by their GPs when they have gone for treatment, are indicative of that. Women tend to suffer in silence. Quite often that means they are not the best at championing themselves. That is clearly unacceptable. This issue has been considered by the mesh oversight group, and it has been clear that improvements are needed to ensure informed consent.

[Dr Wollaston]

Will the Minister assure the House that she will investigate clinical governance in the private sector as well as in the NHS, because many women tell me that this issue has affected them in the private sector?

[Jackie Doyle-Price]

I give my hon. Friend that assurance. To be frank, the same standards of consent and regulation apply in the private sector as in the public sector. A number of colleagues mentioned issues in the private sector, but there is no excuse; it is equally regulated by the Care Quality Commission and the General Medical Council, so the same standards apply.

Oral Answers to Questions

Sarah Wollaston Excerpts

Tuesday 10th October 2017 Commons Chamber

[Mr Hunt]

I would like to thank the hon. Gentleman for speaking out about mental health, like so many colleagues in this House, which makes a massive difference to the Time2Change campaign. It is unacceptable for someone to be waiting that long, and I do not want to stand here and defend it. I will certainly look into the individual case that the hon. Gentleman raises, but the fact is that many Members will know of similar cases. The money is starting to get through to the frontline. It is not just money, though; it is also capacity, and having trained mental health therapists—nurses; psychiatrists—and that is why we are boosting their training, too.

[Dr Sarah Wollaston (Totnes) (Con)]

As someone who is married to an NHS psychiatrist, may I start by paying tribute to all those volunteers, carers and professionals working in mental health on World Mental Health Day? Has the Secretary of State seen today’s briefing by the Children’s Commissioner, highlighting the vital importance of prevention and early intervention? Will he set out what steps he is taking to support a growing workforce—volunteers and professionals—working in prevention and early intervention?

[Mr Hunt]

My hon. Friend is absolutely right. I am aware of the report that she talks about. We know that half of mental health conditions become established before the age of 14, which is why early intervention is so important. In July, I announced an expansion in the mental health workforce—another 21,000 posts. A number of those will be in children’s mental health, to address the issues she raises.

NHS Pay

Sarah Wollaston Excerpts

Wednesday 13th September 2017 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

It is a pleasure to follow the hon. Member for Central Ayrshire (Dr Whitford). I pay tribute to her for her work on the Select Committee on Health in the previous Parliament. That work was inevitably full of expertise and always constructive; I thank her for that. I agree with her that the NHS is a team, but that team should also include the wider social care staff because we cannot continue to look at the two systems in isolation. I echo her point, thanking all our NHS and care staff for the contribution they make not just to our wider economy, but—most importantly—to patients. Those are the people we should keep at the heart of this debate.

I welcome this debate. I also welcome the relaxation of the cap because we need to give the NHS Pay Review Body greater flexibility to make recommendations about what we need to put in place for our NHS staff. I agree with the hon. Member for Central Ayrshire that we should look at the impact of pay on morale, recruitment and retention—this is an international workforce, as well as a national one—but we also need to look at pay across regions and within specialties because there is great variation. We should focus our efforts on ensuring that we are looking at the situation from the patients’ perspective by, for example, looking at the greatest areas of deprivation, which very often have the lowest ratios of NHS and care staff and who are under the greater pressure.

Seven years of sustained pressure on NHS pay is taking a toll. Nobody anticipated that it would go on for this long, so it is time to relax the cap. We should look not just at the issue of pay, but at the wider pressures within the NHS. I am delighted to announce that the Health Committee, which held its first meeting just before Prime Minister’s Question Time, has agreed that its first inquiry of the Parliament will be on the nursing workforce. We will look not just at pay, but at the wider workforce pressures, including the increased workload that comes from increasing demand across the system, morale and all the other non-pay issues that contribute to the pressures on nurses. We will also look at bursaries and the new routes into nursing, and at their impact on people entering the nursing workforce. We have heard about that already today. For example, we know that those who drop out of nursing courses are more likely to be in the younger age groups, whereas those who go into nursing as mature students are much more likely to stay. We need to look at all those wider impacts.

[Maria Caulfield]

I really welcome the news that the Select Committee is going to do a review of nursing. Will the Committee look into pay structure? The current Agenda for Change structure is being used by some trusts, in hospitals and communities, as a way of downgrading nursing roles. For example, a senior sister in one place may be paid a band 7 salary, whereas someone in the same role somewhere not too far down the road may be paid a band 5 salary. There is inequity in the current system.

[Dr Wollaston]

That is an important point. I very much hope that my hon. Friend will contribute to the Committee’s inquiry. As well as looking at the new routes into nursing, we will look at the skills mix, roles within health and social care more widely, the impact of Brexit and language testing, workload and morale. We will be seeking contributions from hon. Members across the House and from people outside.

As I said, we will miss something if we just look at the issue as one of pay. Pay restraint is estimated to contribute between £3.3 billion and £3.5 billion of the five year forward view efficiency savings up to 2019-20. If that goes, what will fill the gap? We have to be careful that there is no loss of services or losses in the workforce, because workforce pressures—probably more than any other issue—contribute to nursing staff leaving the profession. We have to look at the bigger picture.

[Eleanor Smith (Wolverhampton South West) (Lab)]

I have been a nurse for 40 years, but this is not just about nursing. There are other groups as well, including occupational therapists and physiotherapists, who are also registered professionals. Along with everybody else, they are just as important as nurses.

[Dr Wollaston]

The hon. Lady is absolutely right. Look, for example, at the applications for nursing courses. Even though the number of applicants has gone down, it may not ultimately result in a loss of numbers entering nursing. Some of the applicants from that overall drop in numbers might have gone on to other courses, so we need to look at the bigger picture. In opting to look at the nursing workforce, the Health Committee is not saying in any way that other parts of the workforce are not important. The NHS is a team, but it would be difficult for us to report within a certain timeframe if we looked at the entire workforce. I have no doubt that we will look at other aspects of the workforce over the course of this Parliament. I assure the hon. Lady that we will not lose sight of the bigger picture and I hope that she will contribute to the inquiry.

We need to look at the big picture regarding the total budget for health and social care. The right hon. Member for North Norfolk (Norman Lamb) has long made this point, and we have both made it clear that it is time for us to take a cross-party approach to sustainable funding for health and social care in the long term. I look forward to working with him on that over the course of this Parliament.

[Norman Lamb]

I totally agree with the hon. Lady and I am keen to continue working with her. Did she see the Independent Age survey that showed that well over 80% of Members of Parliament on both sides of the House agree that there needs to be a cross-party settlement for the future of the NHS and the care system?

[Dr Wollaston]

I welcome that and I look forward to working with the right hon. Gentleman over the coming months to try to encourage colleagues on both sides of the House, including the Front Benches, to agree to the idea. Next year is the 70th anniversary of the NHS, and I cannot think of anything more constructive we could do than to work across political parties in order to deliver sustainable long-term funding for health and social care.

I will bring my remarks to a close because I know that many hon. Members wish to speak. I look forward to hearing suggestions from colleagues in the House and outside this place about the points they would like the Health Committee’s inquiry into the nursing workforce to cover.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

It will be obvious to the House that a great many people wish to speak this afternoon. We have a limited time for this debate, which will probably finish at around 4.30 pm. Therefore, after the next speaker, I will impose an initial time limit of five minutes, which might be reduced further depending on how many people still wish to speak. There will, however, be no time limit on the next speaker as I call Mr Stephen Morgan to make his maiden speech.

Ambulance Services (Devon)

Sarah Wollaston Excerpts

Wednesday 12th July 2017 Westminster Hall

[Dr Sarah Wollaston (Totnes) (Con)]

I beg to move,

That this House has considered ambulance services in Devon.

It is a pleasure to serve under your chairmanship, Mr Davies. Let me say at the outset that we all pay tribute to our blue light services and that this debate is not in any way intended to criticise them. The intention is to set out the challenges that they confront and to celebrate their professionalism and the work that they do, but also to ask my hon. Friend the Minister to address some key issues that they face in Devon and, in particular, in my constituency.

The debate has been triggered by a number of incidents. People have contacted me either directly or indirectly to raise concerns about long waiting times faced by my constituents; an incident that typifies the situation happened last month. An elderly lady was left for two hours at the roadside, on a baking hot day, waiting for a paramedic crew to arrive. She had serious neck injuries and was in some distress. Were it not for the kindness of passing strangers, things might have been even worse, but a consultant anaesthetist happened to be passing and was able to provide critical assistance at the scene, and the lady also had assistance from the police and from staff from South Hams Community Hospital. As a result, the outcome has been good, but it could have been very different. That has caused a great deal of concern, because it is not an isolated incident. Although much of the focus of my speech will understandably be on the critical, type 1 cases, which require a response within eight minutes—everyone understands that—I would like the Minister also to think about those other cases that we are all coming across in our constituencies which are not immediately life threatening but are nevertheless very serious and where the outcome can be very different unless we see a timely response from our ambulance services.

First, I would like to address demand, which is rising at an extraordinary rate. During the five years to 2016-17, over the area of the South Western Ambulance Service NHS Foundation Trust we have seen a considerable rise in demand, but there has been a 19.2% increase in the Totnes constituency alone, a 29% increase in Plymouth and a 23.7% increase in Torbay. The challenge is far greater in a rural setting, for obvious reasons. The SWASFT area is the most rural area in England; and if we look at the activity for Devon, we see that 23.5% of SWASFT’s activity is in that county, but that is matched by only 22.2% of its funding.

[Neil Parish (Tiverton and Honiton) (Con)]

I very much appreciate the debate that my hon. Friend has introduced in the Chamber today. She is making a very good point about the rurality of Devon, which is one of the largest counties in the country. Of course, the issue is not just its size. If one starts going north-south, there are no really fast roads—we need much more done to the north Devon link road. Apart from the scale of the county, however, the issue is about getting an ambulance to an incident in time and our very scattered population. My hon. Friend makes a very good point. I am sure that Ministers are aware of the size of Devon, but there is also the question of the time it takes to get from A to B if one is not going on major roads.

[Dr Wollaston]

I thank my hon. Friend for his intervention. Of course, as we know, demand can escalate considerably during the peak summer times, but many of our roads are single-track ones with passing spaces, and it can be very difficult to get an ambulance resource to the scene in a timely manner.

My first point to the Minister is that there are no concessions for rurality; there is no funding premium to allow SWASFT to meet the extra demands that it faces. In fact, overall, its funding has fallen by 2.46% per incident in 2017-18, compared with 2014-15. It has to meet the huge increase in demand with shrinking resource, in what is one of the most challenged areas in England because of rurality. I would like the Minister to acknowledge that key point and the impact of rurality on response times.

My second point to the Minister is that although overall SWASFT is doing a good job in meeting the performance target of 75% of category 1 calls receiving a response within eight minutes, that does rather mask the picture in the most rural parts of the area. Let us take the South Devon and Torbay clinical commissioning group area as a whole, for which we have some data that show that it just meets the target, with the figure of 75.65% of calls. If we look at the breakdown for the Totnes constituency, we see that during the past three months the figure has been 61%, so my point to my hon. Friend is that, when considering a county such as Devon, he should look not just at the overall, top-line figure, but at the impact in the most rural parts of the constituencies. I hope that he will ask for that as an ongoing measure, as a response to this debate.

[Peter Heaton-Jones (North Devon) (Con)]

There is a specific example of exactly what is being described by my hon. Friend in my constituency of North Devon—the situation in Lynton and Lynmouth, the twin villages right on the north coast. At the beginning of last week, the South Western ambulance trust withdrew what was in effect a rapid-response paramedic vehicle that was traditionally stationed in Lynton and Lynmouth, specifically because of the rurality and the distance from anywhere else of those two villages. There is a lot of concern in the community because that service has been withdrawn. I pay tribute to the CCG, which is looking for an alternative arrangement, but the fear is that there is still a gap, and the response time, because of the distance of Lynton and Lynmouth from everywhere else, is key. May I ask my hon. Friend the Minister, through my hon. Friend the Member for Totnes (Dr Wollaston), to consider that particular example?

[Dr Wollaston]

I thank my hon. Friend for that intervention. Likewise, very considerable concerns have been raised in my constituency about the withdrawal this month of rapid-response vehicles from Dartmouth and Kingsbridge and in Totnes. I understand the reasoning that double-crewed ambulances can provide the conveyance that people need to hospital and that utilisation of the single vehicles is less—about 24%. I understand the rationale behind it, but equally I ask the Minister to respond to precisely the concerns that my hon. Friend the Member for North Devon (Peter Heaton-Jones) has raised, because the worry in communities such as mine is that once the double-crewed ambulances are conveying a casualty to an urban centre, they tend not to come back again, whereas the rapid-response vehicles did. There is a genuine concern about how we will ensure that the double-crewed ambulances come back.

As I have said, I welcome the increase in the double-crewed ambulance resource as the rapid-response vehicles come away, and I am aware of the data whereby efforts are being made to provide a reassuring response that actually the number of hours in total will increase. However, that change is just coming in this month, and I would like the Minister to assure the House today that he will look very closely at the data as they emerge over the next few months, to ensure that those vehicles are returning to the rural areas, because I fear that otherwise we will again see that SWASFT is meeting the overall, top-line target for the entire patch, but that will be at the expense of rural constituencies such as my own, where there will simply be a worsening of the response. We need to look at that very closely, and I would like the Minister to assure me that, following this debate, he will specifically ask SWASFT to ensure that there is a response available and it does not worsen in the rural parts of Devon.

I would also like to address the matter of the workforce, which is an issue across the NHS as the Minister knows. Within our paramedic resource there is actually an 11% turnover of paramedic staff, in part because they are such a skilled and valued workforce, which means in many cases they are being attracted into other parts of the NHS, for example to work in casualty departments and minor injuries units. Everyone can understand that, but we need to make sure that we are recruiting and retaining within our blue light response services as well. For example, there are currently about 100 vacancies over the whole of the SWASFT area, and 16 whole time equivalent vacancies in Devon alone. What is the Minister doing to work alongside Health Education England to address the workforce issues? I will again make the point I have done in previous debates about the impact of the pay cap on the recruitment, retention and morale of the workforce. Again, I call on Ministers to consider giving the pay review bodies greater flexibility to be able to increase the rates of pay.

We know that there are pressures on our ambulance services, but we cannot view them in isolation. I would like the Minister to consider the impact that this is having on our other blue light services, particularly the police. They have raised some worrying concerns with me about not only the amount of time that they are having to spend on scene—as they did the other day in the incident that I described—while they wait for an ambulance resource to arrive, but the fact that on occasion they themselves have to take people to hospital who should really be conveyed by an ambulance resource. To clarify, in May this year there were 226 incidents where an ambulance was requested but no ambulances were available to be assigned in the Devon and Cornwall police area, and in June there were 158. These long waits are having a knock-on on the police’s ability to carry out their other duties, and that should concern us all.

[Kevin Foster (Torbay) (Con)]

I thank my hon. Friend and neighbour for giving way and congratulate her on securing this much needed debate. As she will be aware, it is not only the police who are experiencing long waits. One of my constituents, Susannah Tandy, has got in touch about an incident a week ago when her 12-year-old son fell 11 foot from a tree. An ambulance was called at 1 pm but did not arrive until about quarter to 4. These sorts of waits not only build up anxiety but could see situations get much worse. Thankfully Murphy appears to be making a recovery, but it could have been a lot worse.

[Dr Wollaston]

I think we are all glad to hear that Murphy is making a good recovery. As my hon. Friend says, we must focus not just on the immediately life-threatening incidents but on the kinds of incidents that he described, where an ambulance is very important and somebody’s condition could deteriorate because of a long wait. For SWASFT we must keep an eye on not just the category 1 incidents, but the others as well, and I hope the Minister will do so.

In this debate we should also celebrate the successes, because there are undoubtedly those as well. We have seen examples of very good co-working between our blue light services. For example, in the “collapsed behind closed doors” scheme fire services co-operate with the ambulance service where there are concerns that somebody might be collapsed in a residence. In the past the police may have responded, but now the fire service can also provide that assistance, and I pay tribute to those co-responders in the fire service. From my time as a rural GP in Chagford, I remember the number of occasions when people phoned me in surprise because the fire service had arrived instead of the ambulance service, but it is actually providing a fantastic resource. On occasions when it is absolutely critical that somebody has a defibrillator on site as soon as possible, the fire service can and does perform an amazing job. We have got further to go, particularly in remote rural communities where a fire resource might be closer to hand. I hope the Minister will look at how we can go further to make sure that we develop a multi-skilled workforce who are properly rewarded for the expertise and skills that they develop across the fire service.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

The ambulance crews across Devon do a fantastic job. I represent an urban seat in Plymouth, but the demand that is placed on both urban and rural ambulance services has a knock-on effect, because there is no wall that divides Plymouth from the rest of Devon. Demand needs to be understood between both urban and rural areas. Will the hon. Lady comment on what happens in the summer months when the south-west becomes an even more popular tourist destination and additional demand is placed on not only the ambulance services but our wider emergency services? That moves the ambulance resources out of their normal patterns. Ambulances are increasingly moved to further away places with longer response times than their normal patterns might take them.

[Dr Wollaston]

The hon. Gentleman makes an extremely important point. He will know that for both our ambulance services and our police services those kinds of influxes from outside are not adequately reflected in the funding formula. That is in addition to the rurality that he referred to. In fact, the key point remains that the greater danger is to people living in rural areas where, for example, a resource might take somebody to Derriford Hospital but not return, and then when the ambulance service dispatches the nearest ambulance it will be in Derriford. That is why ambulance services tend to get tied up.

I would briefly like to mention the impact of the 111 service. SWASFT is doing extremely well—it is, in fact, the best-performing in the country—at treating patients at home rather than conveying them to hospital. That is the so-called “see and treat” model, and they are also doing well with “hear and treat”. However, there is a concern about the increase in calls, because there has been an overall increase in calls of 24% for the whole of the SWASFT area over five years, with 470 more calls per day, although only an additional 81 people per day are having to go to hospital. While that may reflect the great success of paramedics’ expertise in seeing and treating at home, will the Minister consider whether it also reflects unnecessary calls and the impact of 111, which has been raised many times in this House? Are too many people still having an ambulance called on their behalf when it could have been avoided?

Finally, I would like to end on a positive note in thanking all our volunteers who do so much to save lives across Devon, working alongside our blue light services. I would like to praise all those who support our Devon air ambulance service, all the volunteer community first responders and those who support, fund and supply defibrillators in our communities. On behalf of all in this House, we thank them and our wonderful paramedics and ambulance service crews.

Adult Social Care Funding

Sarah Wollaston Excerpts

Thursday 6th July 2017 Commons Chamber

[Steve Brine]

I thank the hon. Lady for that response. This subject was much discussed during the general election, and I think it will be greatly discussed during this Parliament.

Nobody is making any threats. The Government are very supportive of the best-performing systems, where local government and the NHS work together to tackle the challenge of delayed transfers of care. We have said that, depending on performance, we will consider a review in November of the 2018-19 allocations of social care funding provided in the spring Budget for areas that are poorly performing. As I have said, that funding will all remain with local government, to be used for social care.

Obviously, we recognise that there are real pressures in the system. That was why we responded—I think the hon. Lady’s party was pleased with this at the time—with an additional £2 billion for social care in this year’s Budget. We have also given councils the chance to raise the council tax precept. My authority, Hampshire, has done that, and I think that has been well received.

Turning to the actual report, it would be easy to duck all of this. Dare I say that I hope we can conduct this debate in a sensible spirit? People out there working in the system who want to pass the mum test, as was said this morning, want us to do that and are watching things closely. Of course, it would be easy to bury our heads in the sand, but let us remember that had we had the rigorous inspection regime that the Secretary of State put in place earlier, a lot of problems, including those in the hospital sector when the hon. Lady’s party was in government, would not have been heard of. We know about the current situation only because of the inspection regime that has been put in place.

The CQC report found a number of things, and obviously we will digest it over the days and weeks ahead. It found that the adult social care sector performed best in how caring its services are: 92% of services were rated good and 3% outstanding. We can kick this issue around all we like, but today’s report shows exactly why we introduced the inspection regime. It is uncovering the care that is good—the vast majority of it—and it is also uncovering the care that is not, which is where we want to help and support local authorities to make sure that improvements are made for the people we represent.

[Dr Sarah Wollaston (Totnes) (Con)]

It is concerning to note from the CQC’s state of adult care report that staff turnover rates have risen from 22.7% to 27.3% in the three years to 2015-16. Will the Minister meet me to discuss the important role that supporting skills and opportunities for career progression can play in reducing turnover, improving morale and, most importantly, improving the quality of care that people receive? Will he visit my constituency to see the excellent joint working that has been done by the trust and South Devon College towards just that?

[Steve Brine]

I thank my hon. Friend for that. I think she knows that I will be in the vicinity of her constituency at some point over the next few months, and I would like to take her up on her offer. I wish her well in her current campaign.

The workforce is critical. Adult social care is a rapidly growing sector, and there are about 165,000 more adult social care jobs than there were in 2010. It is imperative that we get the right people into the right jobs, to deliver the improved quality of care and services that we all want to see. We are working closely with our delivery partner Skills for Care to improve the level of skills in the adult social care workforce, and we are making the profession more attractive with the introduction of the national living wage, from which up to 1.5 million people in the social care sector are expected to benefit. I might point out that that policy has come in only as a result of this Prime Minister and this Government.

Oral Answers to Questions

Sarah Wollaston Excerpts

Tuesday 4th July 2017 Commons Chamber

[Mr Hunt]

If I may say so, that was a brilliant recovery. The hon. Lady is absolutely right to focus her attention on the performance of ambulance services. They are under pressure. They are hitting around 71% for their category A calls, and the target is to hit 75%. However, there are some bigger issues with the way those targets work, which we are looking at. Her ambulance service has just had a Care Quality Commission inspection.

[Dr Sarah Wollaston (Totnes) (Con)]

As a result of the capped expenditure process, the wider Devon sustainability and transformation plan is being asked to make £78 million of savings at short notice—within the next nine months. Does the Secretary of State share my concern about the impact on patients, the short timeframe and the undermining of savings already agreed by the STP? Will he meet me to discuss this matter and the wider CEP?

[Mr Hunt]

I am more than happy to meet my hon. Friend. The principle behind the capped expenditure process is that we should have fairness between patients in different parts of the country. We should not see patients in one part of the country disadvantaged because the NHS has overspent in their neighbouring area, but the way in which we implement the process must be sensitive and fair. We must ensure that we get it right.

NHS Shared Business Services

Sarah Wollaston Excerpts

Tuesday 27th June 2017 Commons Chamber

[Mr Hunt]

Let me respond to those points. First, what happened at SBS was totally unacceptable. It was incompetent and it should never have allowed that backlog to develop, but before the hon. Gentleman gets on his high horse, may I remind him that SBS and the governance arrangements surrounding it were set up in 2008, at a time when a Labour Government were rather keen on contracting with the private sector? I know that things have changed, but the fact of the matter is that throughout this process our priority has been to keep patients safe. Transparency is nearly always the right thing; I am the Secretary of State who introduced transparency over standards of care in hospitals—[Laughter.] It is interesting that Opposition Members are laughing, as Labour was the party responsible for sitting on what happened at Mid Staffs for more than four years, when nothing was done.

Transparency is incredibly important but it is not an absolute virtue, and in this case there was a specific reason for that. If we had informed the public and the House immediately, GP surgeries would have been overwhelmed—we are talking about 709,000 pieces of patient data—and they would not have been able to get on as quickly as we needed them to with identifying risk. That was the priority and that is what today’s report confirms: patient safety was the priority of the Department and NHS England. I put it to the hon. Member for Leicester South (Jonathan Ashworth) that if he were in my shoes, and faced with advice that said that it was wrong to go public straight away as that would compromise the very important work GPs had to do to keep patients safe, he would have followed exactly the same advice. That is why, while I completely recognise that there is a potential conflict of interest with the Government arrangements, I do not accept that there was an actual conflict of interest, because patient safety concerns always overrode any interests we had as a shareholder in SBS.

The NHS is a large organisation. It has a huge number of contracts with both the public and private sectors, and no Government of any party can ever guarantee that there will be absolutely no breach of contract. However, what we can do is ensure that we react quickly when there is such a breach, which happened on this occasion, and that we have better assurance than we had on this occasion. I assure the House that the appropriate lessons will be learned.

[Dr Sarah Wollaston (Totnes) (Con)]

While Members from across the House will be relieved that so far no patients are identified as having been harmed by this appalling incident, will the Secretary of State set out what steps he is taking to ensure that this can never happen again?

[Mr Hunt]

Absolutely. There is a short-term and long-term lesson. The short-term point is that it is unlikely this would happen again because it was paper correspondence, and we are increasingly moving all the transfer of correspondence to electronic systems. The longer-term point is exactly that—[Interruption.] An Opposition Member mentions cyber-attacks; they are absolutely right to do so, because of course we have different risks. This clearly indicates that we need better checks in place, so that when we trust an independent contractor with very important work, we know that the job is actually being done, and that did not happen in this case.

Oral Answers to Questions

Sarah Wollaston Excerpts

Tuesday 21st March 2017 Commons Chamber

[David Mowat]

The figures for child extractions are clearly disappointing and two key actions need to take place: less sugar, which we expect the soft drinks levy to help with; and getting more fluoride on to teeth, particularly through fluoride varnishing. That has increased across the NHS over the last year, and by 12% in Birmingham. We hope that that will make a difference.

[Dr Sarah Wollaston (Totnes) (Con)]

The NHS mandate was published yesterday, just days before coming into force. Can the Secretary of State set out the reason for the delay, because it allows very little time for scrutiny of this important document by this House? Will he also set out how he is going to prevent money being leached from mental health services and primary care to prop up provider deficits, so that we can meet objective 6 on improving community services?

[Mr Hunt]

My hon. Friend makes very important points. The reason for the delay was because about a month ago we had wind that we might be successful in securing extra money for social care in the Budget, and we needed to wait until the Budget was completed before we concluded discussions on the mandate. Our confidence as a result of what is in the Budget has enabled us to make the commitments we have made in the mandate, including making sure that we continue to invest in the transformation of out-of-hospital care.