NHS Trusts: Accountability
Steve Barclay Excerpts(5 years, 10 months ago)
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The Minister for Health (Stephen Barclay)
I commend my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) for bringing the important matter of NHS accountability before the House. No one who heard his remarks can doubt for one minute his passion both for the NHS and for ensuring that the services it provides meet the needs of his constituents. He is right in this month, when we mark the 70th anniversary of the NHS, to emphasise that the NHS belongs to the people—not to any specific party or group, but to the constituents it serves.
My right hon. Friend made a number of specific allegations. Having been a Minister, he will appreciate that, having brought those issues before the House in the way he has, it is difficult for me to comment on some of the specific points, but I commit to follow up with him after the debate on some of those issues. In particular, he raised a very concerning allegation regarding a constituent who had collapsed before 10 pm outside the urgent treatment centre. He is right that that centre should be open until 10 pm, so clearly that is a specific issue that I will be keen to explore with him.
My right hon. Friend raised concerns as to whether his constituents who have whistleblown have in practice been gagged. As you are probably aware, Madam Deputy Speaker, as a member of the Public Accounts Committee, I spent a considerable amount of time and effort on that issue. In response to concerns raised by the PAC during that time, in 2013, the Government introduced guidance that banned gagging orders and a legal duty of candour. As this is the first time I have been at the Dispatch Box since the ministerial reshuffle, I am sure my right hon. Friend will join me in paying tribute to the outgoing Secretary of State, who is now Foreign Secretary, who made patient safety a central tenet of his time in the Department and, as part of that, spoke up for whistleblowers and for the value they offer to the NHS.
Sir Mike Penning
I must apologise to my colleague, the now Foreign Secretary, who was so generous with his time in seeing me. I hope that the new Health Secretary will not get so upset when I am banging on his door—perhaps as much as I was on the previous Health Secretary’s door.
Stephen Barclay
I am grateful to my right hon. Friend for recognising that in the House. I think that is widely shared across the NHS.
It is right that the Government are bringing forward the draft Bill to place the Healthcare Safety Investigation Branch on a legal footing. Indeed, trusts should disclose any pay settlements to NHS Improvement. Therefore, on the concern to which my right hon. Friend brought the House’s attention—whether whistleblowers have been gagged and, if so, whether that has been induced through financial payment—both those breach the Government’s guidelines and they would need to be reported to NHS Improvement. If he is able to share any specific allegations after this debate, I will be keen to explore them.
My right hon. Friend expressed concern that service changes are “all in the hands of bureaucrats” and I must take slight issue with that.
Stephen Barclay
Well, I must take issue with that point. First, my right hon. Friend is well aware that the Government have four tests that apply to service change that ensure the voice of patients is heard and in particular that service reconfigurations are clinically led and done at a local level. I draw attention to the work that Professor Tim Briggs and Professor Tim Evans are doing through the “Get it right first time” initiative, which is all about driving through change to service provision through the leadership of national clinicians working with local clinicians in order to get that service buy-in.
Sir Mike Penning
I do not want to take up too much more of the Minister’s time, but I am afraid that, in parts of the country, certainly in mine, the requirement to consult is simply being ignored. I have given the House a classic example in which an urgent care centre was closed at night with no consultation at all. It took 18 months for a bogus consultation to take place on whether it should close at night. The changes are there to be seen by everyone. I know that the Minister is telling me all this in good faith but, as he has heard from colleagues on both sides of the House, on the frontline, in the real world, people are ignoring the guidelines, which is surely illegal.
Stephen Barclay
I shall just unbundle two separate points from my right hon. Friend’s remarks. First, his point that these changes are all in the hands of the bureaucrats collides with the Government’s own position, which is that there are four tests. What he is drawing out is not whether the guidance is there as a protection but whether it is being implemented operationally, and that obviously needs to be looked at on a case-by-case basis. Secondly, he and I debated this issue in some detail in an Adjournment debate in March, when this specific point was explored more fully. The urgent care centre in question saw an average of seven patients between midnight and 8 am, and an average of four between 10 pm and midnight. So in the period between 10 pm and the centre reopening at 8 am, an average of 11 patients were being seen. I suspect that that is why, at local level, the change was made. I appreciate that it was initially done on patient safety grounds, with the consultation following, as we explored previously.
Sir Mike Penning
This is a hugely emotive issue. Yes, the excuse was that the centre was closing at night on grounds of patient safety because it could not get a GP there, but it does not take 18 months to turn round and say, “Oh, by the way, the numbers weren’t there in the first place and that’s why we had to close the centre.” That was the excuse 18 months after it had been closed at night times. Whether the numbers are right or not—they are hugely contested by my constituents—it cannot be acceptable that no consultation took place for 18 months.
Stephen Barclay
As I have said, we did explore these issues in some detail in March, and I absolutely respect the conviction with which my right hon. Friend is championing the interests of his constituents.
In the spirit of balance, I draw my right hon. Friend’s attention to the fact that a number of enhancements have also been made, including the introduction of a number of bookable appointments through NHS 111, which includes a clinical assessment service to ensure that patients’ needs are medically assessed; the addition of near patient testing for some conditions, reducing waiting times and reducing the need for patients to attend Watford Hospital; and an improved IT system meaning that medical staff will be able to access patient records if they give their consent. The clinical commissioning group also expects the service to expand to include a greater skill mix of other professionals such as pharmacists, emergency care practitioners and community nursing staff, and to provide access to mental health services. This is not a static situation. Some improvements have been made, but I absolutely take on board the concerns that my right hon. Friend has raised.
My right hon. Friend has raised concerns about the hiring of leadership positions, particularly two chief executive roles. He will be aware that this point was also raised by the hon. Member for Blackpool South (Gordon Marsden) in respect of the chair of Blackpool Victoria Hospital in an Adjournment debate only last week. I also note that the right hon. Member for Warley (John Spellar) and the hon. Member for Coventry South (Mr Cunningham) have raised similar issues. It is right that the views of constituency Members should be taken on board as part of any consultation, because Members of Parliament interact with a wide spectrum of their electorate and they are obviously well placed to feed into such consultations. As a Minister, that is something I take very seriously, and working on the cross-party basis, I am always keen to hear from colleagues when concerns arise.
That goes back to my right hon. Friend’s point about trust. Issues in terms of pay need to be balanced. On the one hand, we need to recognise the complexity of senior leadership roles. We are dealing with hospital trusts that often have budgets running into the hundreds of millions of pounds. These are senior, complex, challenging roles that need to attract talented individuals. At the same time, those salaries and that remuneration need to be balanced with the wider values of the NHS. There is a live discussion about what the right level of remuneration is to attract talent while not being out of step with the NHS values that both sides of the House recognise.
I turn now to my right hon. Friend’s point about the new hospital site and capital investment in the STP area. He will be aware that the same STP currently has a significant new build proposal at Harlow. My right hon. Friend the Member for Harlow (Robert Halfon) is assiduous in championing that proposal, and I met with the chief executive of that trust—
Sir Mike Penning
My constituents will not know what STPs are. At the end of the day, the new site is in Essex, on the east Hertfordshire border, which is nowhere near my constituency. There is no tangible benefit when the debate is about a new hospital in west Hertfordshire.
Stephen Barclay
I beg to differ from my right hon. Friend on that, because this gets to the crux of the issue. The NHS must evolve. It has to move with technology and with the skills mix. Alongside the significant funding injection that the Prime Minister announced at the Royal Free Hospital, the NHS must also deliver productivity. At the specialist level, such as oncology or neuroscience, we often have populations of 3 million that need to be treated. Look at the footprint of the Christie NHS Foundation Trust, for example.
If we look at the other end, we need to deliver more care in the home and not have acute trusts soaking up so much investment. We need dynamic reconfigurations without acute trusts being the sole focus of our attention. We need service changes but—this goes to the core of my right hon. Friend’s remarks—they must be taken forward with clinical leadership and in a way that delivers trust.
I am happy to continue to engage with my right hon. Friend’s specific allegations on a case-by-case basis.
Dr Caroline Johnson
The Minister talks about dealing with things on a case-by-case basis, so I wonder whether he will consider Grantham’s A&E, which has had to close overnight for nearly two years, to see what can be done to facilitate its reopening as soon as possible.
Stephen Barclay
Again, I am happy to consider that issue. I have been up to visit the United Lincolnshire Hospitals NHS Trust and have met the chief executive and the leadership team, so I am aware of the issues, which are partly due to geography. However, we are straying slightly away from Hemel Hempstead.
As I said, I am happy to engage with my right hon. Friend the Member for Hemel Hempstead on his specific allegations. It is important that service changes are done at the local level with clinical leadership in a way that builds trust, and I will continue to engage with him in the weeks and months ahead.
Question put and agreed to.
Management of NHS Property
Steve Barclay Excerpts(5 years, 10 months ago)
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The Minister for Health (Stephen Barclay)
It is a pleasure to serve under your chairmanship once again, Ms Dorries. I pay tribute to the hon. Member for Bristol South (Karin Smyth) for bringing such an important issue before the House.
The hon. Lady opened by saying that property may not be the most exciting of topics but, as her speech set out, it is integral to the healthcare service offered in local settings. The substance of her remarks was whether we can better align the property estate with a place-based approach to healthcare. As we move to a more integrated and place-based approach to health, I think there is cross-party consensus that property has an important role to play as an enabler of that. The hon. Member for York Central (Rachael Maskell) kindly recognised that that is very much the approach that I have taken in my post, and my hon. Friend the Member for York Outer (Julian Sturdy) recognised it in expressing his frustration with one or two meetings and asking whether decisions on property are aligned with the place-based approach.
The first point I will make to the hon. Member for Bristol South is that the long-term plan and the future discussions about the NHS give us the opportunity to look at wider system changes around integration and place-based healthcare, and how property aligns with that—for example in York, which has been discussed—as an enabler of change in a more holistic approach. As such, her remarks are timely as part of that wider debate.
The hon. Lady mentioned Knowle West health park, which, if I am honest, I looked at for the first time when preparing for the debate; I was not as sighted on that as I might have been. The issue is that, if NHS England provided that service, the additional market rent costs would have been reimbursed, but because it is provided by the county council they are not. However, as she recognised, there has been progress in recent weeks, thanks in part to her work. I am happy to take forward a discussion on that offline if that would be helpful, because I recognise that it is an important service and that we need to ensure that, where market rents are applied, it is not counterproductive to those services.
However, that should not get in the way of the wider point. The hon. Lady suggested that the new approach is a backwards step. I simply point out that there has actually been significant progress by NHS Property Services. The previous model had the inherent conflict that the primary care trusts were both the landlord and commissioner of the property, and therefore the use of the estate was quite opaque. As a result, we did not get transparency on the true cost of the estate, meaning that inefficiencies were not being flushed out and estates were not being utilised in the most effective way.
One driver of NHS Property Services applying market rents has been the need to encourage better utilisation of the estate by being more transparent on the actual costs. I point out to the hon. Lady that there has been significant progress as a consequence. Some £200 million in capital receipts has been unlocked, 500 capital investment construction projects are being launched each year and running costs have been reduced by £120 million. On balance, as we look forward to the long-term plan and pick up on some issues that the hon. Lady quite rightly highlighted, it is also important to recognise that the old system often allowed estates to be utilised inefficiently. Having truer market rents has actually enabled more transparency and driven efficiencies, with savings then able to be reinvested into the service.
The hon. Lady also mentioned salaries and bonuses, which again are part of a wider question. On the one hand, these are big businesses and their leaderships compete in a competitive market. There is a wider debate within Parliament on the right value to assign to senior salaries in the public sector in order to attract talent. These are big budgets, so we need to attract people of the right ability; it is a false economy to save a relatively small sum on lower salaries for people who then make incorrect decisions that waste much larger sums. At the same time, salaries should reflect the values of the NHS and should not be out of step with others in the NHS. There is a cross-party debate on that, and I am interested in the hon. Lady’s points about it.
The hon. Lady also raised NHS Property Services’ new offices. My understanding is that the previous model was highly inefficient. It had five different properties, so the move to Gresham Street was a consolidation of those five properties into one. That drives productivity, which is a key issue that we need to unlock within the workforce. Two thirds of NHS costs are in the workforce, so driving workforce productivity is a key objective. I am sure the hon. Lady will agree that the workforce being consolidated in one office enables a degree of productivity and efficiency that would be harder to achieve if they were disparate across five areas.
The hon. Lady mentioned the impact of the rent adjustment on Bristol. Some 15 GP practices in and around the city of Bristol occupy NHS Property Services sites. NHS England has been working with the Avon local medical committee, practices, NHS Property Services and the Bristol, North Somerset and South Gloucestershire clinical commissioning group and has facilitated negotiations between GP practices and NHS Property Services on reviewing the levels of rent and service charges invoiced to GP practices, to ensure that there is transparency on them.
However, as the hon. Lady will be aware, rent and business costs incurred by practices are reimbursed to GPs under the premises cost directions, and GPs should be compensated for any rent changes through that route. The Department has provided an additional £127 million to the NHS England mandate, with effect from the 2016-17 financial year, to fund the increased costs in the NHS of this policy change.
Karin Smyth
I am grateful for the Minister’s comments about, and work on, Bristol. I agree that the estate was not always particularly well managed in the local health system previously, and that the correct incentives are needed. However, does he agree that he has outlined a merry-go-round of money keeping the entire system afloat? NHS Property Services exists on a large and continuing Department of Health loan, so it is not, in any sense—as the Minister described—a successfully run property business.
Stephen Barclay
I was trying to make the point that greater transparency on the true cost of the estate drives behaviour to use the estate more effectively. Part of the difficulty has been that, because the estate was not adequately charged market rents in some areas, moving to a fairer and more transparent assessment of market rents—these things are independently assessed, I hasten to add—is a difficult adjustment. However, a consequence of correctly assessing the value of the estate is the unlocking of efficiencies where the estate is not being utilised, and that money can then be reinvested into the system.
I absolutely agree with the hon. Lady’s wider point, which I took as the substance of her remarks, that property is the enabler of system change. That also came out in the points raised by my hon. Friend the Member for York Outer, and has been inherent in points made by the hon. Member for York Central in our previous discussions. Property does not sit in a silo but is inherent in the wider service offering, and it also plays into reconfigurations. A key part of clinically led reconfigurations of estates to drive productivity will be what property there is to enable that and how to utilise it.
The point on which there is a degree of cross-party consensus, as my hon. Friend the Member for Henley (John Howell) recognised, is that decisions need to be accountable. Likewise, I am happy to pick up on the point he raised on behalf of his constituents about there being no accountability. That is an absolutely fair challenge to the Department and one that I am very happy to look at. However, I am mindful, as I know he will appreciate, that these are often independent bodies making independent decisions, and we need to look at how they fit into the system.
A further point raised by the hon. Member for Bristol South, although it is slightly outside of the scope of the debate, was about wholly owned subsidiaries, which she also raised in more detail in the estimates debate. I make two points. First, as she knows, subsidiary companies actually give greater flexibility to trusts that want to compete in a local market and perhaps offer higher salaries offset by changes to pensions. That is one way in which trusts are empowered and enabled to hire in a competitive market, for instance in the case of maintenance staff. It is an enabler, and it often results in people getting paid more for a role, although there may be other, less favourable terms and conditions to offset that. I merely point out that those were exactly the arrangements reached for Members, and I do not remember too many press headlines suggesting that Members were being exploited by that change.
Secondly, I remind the hon. Lady that, as I am sure she is well aware, legislation introduced by the last Labour Government enabled wholly owned subsidiaries. Again, I do not recall Labour Ministers, when taking that legislation through the House, suggesting that it would provide a way of exploiting NHS workers or privatising the NHS.
I commend the hon. Lady for the points she raised. This is a timely debate given our discussions with the NHS leadership on the long-term plan. She is absolutely right—Government Members and other Opposition Members also recognised this—about the centrality of property to the place-based approach that we seek to take. I am happy to have a separate discussion with her on Knowle Park to check whether that is now in the right place or whether further work is needed. I look forward to further discussions with her on how we should utilise the property estate in the most effective way.
Question put and agreed to.
Healthcare on English Islands
Steve Barclay Excerpts(5 years, 10 months ago)
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The Minister for Health (Stephen Barclay)
It is a pleasure to serve under your chairmanship, Mr Hanson. I pay tribute to my hon. Friend the Member for Isle of Wight (Mr Seely) for raising the issue in the way that he has. He has used Westminster Hall exactly as it should be used—to bring the concerns of his constituents front and centre before the House. He set out not only the challenges faced, but the ways forward and a number of solutions for different issues. In short, he raised issues of funding that relate to population and geography, travel, the potential for further integration, and also a way forward involving digital and data. I will address each of those in turn.
This is also a timely debate, as the shadow Minister mentioned, following the Prime Minister’s announcement at the Royal Free Hospital last week of a significant funding boost to the NHS. Alongside that, NHS leaders are drafting a long-term, 10-year plan on services, which will look at many of the issues he cited in his speech. As we start that journey with NHS leaders, bringing the issues of the Isle of Wight front and centre is timely and helpful.
I would segment the funding formula issue into two: the challenges that the Island has in common with other parts of the country, such as those posed by the over-80s and by the significant number of constituents with dementia, and those that are unique to it. Indeed, few hon. Members feel that their constituents’ circumstances do not merit being higher up the funding formula than they currently sit. It is valid to raise those issues, and NHS England will look at them on the advice of the Advisory Committee on Resource Allocation, which advises on the funding formula. Those decisions are common to other areas, but they need to be made in respect of the Island. If my hon. Friend wishes, I am happy to facilitate a meeting with NHS England so the funding pressures pertaining to the demography of the Island can be raised. He will recognise that the setting of the funding formula is an independent process.
There are specific issues about the geography that my hon. Friend raised very well, not least about maternity services and paediatrics. The Island needs to supply those services and that will have an impact on its funding. I am happy to look at those issues. Integration is one way that headroom will be facilitated to meet those challenges. As he said, the Island was a vanguard site that has received £8.4 million of extra funding since 2015 to facilitate the transformation of services. That funding recognised some of the Island’s specific geographical challenges.
Although geography can be, and is in certain areas, a disadvantage and a driver of cost, it is also a driver of opportunity, as my hon. Friend set out. The Island has a strong sense of place and identity, and there are strong personal links between key decision makers and stakeholders. As the shadow Minister rightly said, the move towards greater integration between health and social care—as is reflected in the name of the Department—is also an opportunity to drive integration between the council and health services. My hon. Friend alluded to the bureaucratic obstacles to that, and I am happy to work with him to overcome them. As patients present with multiple conditions and as we move away from silos of care to a more holistic approach to patients and their wellbeing, the Island offers a huge opportunity for greater integration.
On my hon. Friend’s point about data, I had an interesting meeting yesterday with the chief executive of the Christie in Manchester, which is one of our outstanding trusts. I was struck by the fact that 19% of its patients take part in medical research programmes. The chief executive set out how that is hugely beneficial to the trust and to the patients, who get access to cutting-edge drugs and the latest thinking. He has also been able to attract some of the world-leading figures in research because he has a population that researchers can work for, which is very attractive to them. That is a real win-win, and the demographics of the Island offer an opportunity in that regard.
Mr Seely
One point that I did not make was that when it comes to looking at dementia, the Island would be very open to becoming a national leader or a place where academics and researchers could investigate how we can live better with dementia in this country. We have double the national average of people with dementia, so it would be a natural fit for us.
Stephen Barclay
I am keen to work with my hon. Friend on that, because the Government have prioritised their research and development budget, as I know from my time at the Treasury. A significant investment has also been made in health R&D. The NHS has an opportunity to combine its patient data with our world-leading universities and R&D to attract researchers, drive forward the most innovative approach on healthcare and translate that cutting-edge research into day-to-day care. That can be a frustration for our constituents; it is fine to have the research, but we need to roll it out to scale in a way that is meaningful for patients. The challenge of the Island’s geography is also a huge advantage to it. I do not know what percentage of its patients are taking part in research, but that may be an area for him to explore and for the Department to work with him on.
My hon. Friend also raised the potential of digital. He will be aware that the Secretary of State has asked Dr Eric Topol, one of the world leaders on the use of digital in healthcare, to undertake a report for the Department. My hon. Friend is right that rather than a patient having to be physically present in all instances, as was traditionally the case, there is scope to use digital much more for them to see a consultant online and for information to be sent digitally. I recognise that if the clinical commissioning group is in deficit, finding the headroom to invest in that technology becomes a trade-off and a challenge, but that is one of the opportunities that will be opened up by the Prime Minister’s investment in the NHS and it is an area that the 10-year forward view will specifically examine.
In terms of timing, the Island has a chance to look at how it can become a leader, what has been done with digital enablers and early adopters in the NHS, and in which areas it can lead on in technology. I will come on to the challenges of travel, but reducing the need for journeys is a more sustainable solution than seeking to subsidise them. Our starting point should be how we can use technology to reduce the need for as many journeys, rather than how we can subsidise more journeys. That offers significant scope.
On travel, I heard my hon. Friend’s remarks about the cost and its wider impact on families. There is a correlation with a separate debate we have had about car parking charges. Clearly, there are specific challenges related to travel, but as he also set out, it is quite complex, because there are already arrangements with the ferry companies and national schemes for subsidies and assistance that can be given to people who are financially challenged. It is a question of looking at how we can fit in with the existing schemes and what agreements can be reached with the companies concerned. I am happy to meet him to pick up on that specific point to better understand our current approach and what can be done, given the challenges. Again, the challenge of distance is not unique to the Island, but as he mentioned, there are certain features of travel to the Isle of Wight and the Scilly Isles that pose challenges.
As my hon. Friend will be aware, the NHS healthcare travel cost scheme provides financial help for travel costs for patients on low incomes who are referred. The scheme is part of the NHS’s low-income scheme, under which people are also entitled to free prescriptions and glasses. Under the scheme, the full cost of transport can be reimbursed by the NHS to eligible patients. Schemes are in place, but I hear the wider points that he has raised and I am happy to discuss them with him.
In short, my hon. Friend has set out that the Isle of Wight is ideally placed to be at the vanguard of the NHS’s approach as we move forward with the 10-year forward view, in embracing digital and integration and in looking at how to deliver place-based commissioning most effectively. There are some specific challenges with regard to its population and its geography in terms of travel. The interplay of those two things is another challenge in terms of efficiencies of scale and the services that are considered essential on the Island, which may be dealt with at a larger-population level elsewhere.
In the NHS more widely, as we move to a hub-and-spoke model and to more flexible population sizes, and as we look at place-based commissioning, the Isle of Wight has huge potential to be at the forefront, as my hon. Friend has set out. I am very happy to follow up this debate by meeting my hon. Friend, and to facilitate a discussion between him and NHS England, to ensure that we deliver what he has campaigned passionately for—the best healthcare for residents of the Island—and that the significant investment set out by the Prime Minister is maximised for his constituents.
The shadow Minister quite reasonably asked whether we were open to changes to the legislation. As he will be aware, the Prime Minister said to the NHS leadership in her remarks at the Royal Free Hospital that we are open to such suggestions if NHS leaders feel that changes are necessary. As part of the workings of the long-term plan, those leaders will need to look at what they need, and whether much of the integration—I know that the Mayor of Manchester supports the integration that is taking place in Manchester—can be done under existing legislation, or whether changes are needed, and if so, what those are. That will be part of the discussions with Simon Stevens and others in the weeks and months ahead.
David Hanson (in the Chair)
The hon. Member for Isle of Wight has the opportunity to make any concluding comments, should he so wish.
Blackpool Teaching Hospitals NHS Foundation Trust: Governance
Steve Barclay Excerpts(5 years, 10 months ago)
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The Minister for Health (Stephen Barclay)
May I begin by thanking the hon. Member for Blackpool South (Gordon Marsden) for securing the debate? I am pleased to see my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) in his place, and I know that both my hon. Friend the Member for Fylde (Mark Menzies) and the hon. Member for Lancaster and Fleetwood (Cat Smith) have expressed an interest in the issue.
The issues raised by the hon. Member for Blackpool South are clearly a cause for concern. While the CQC has not identified any governance issues in the trust, it is clear that the recruitment process for the new chair had a number of irregularities. One of the defining features of our approach to the NHS since the Francis report has been a willingness to face up to difficult issues. I therefore welcome the opportunity to focus on these irregularities and will address each in turn.
The previous chair of the trust resigned in January 2018 to take up the role of chair in another, nearby foundation trust, University Hospitals of Morecambe Bay. That caused a recruitment process for the chair of Blackpool Teaching Hospitals NHS Foundation Trust to commence in February this year. Autonomy in appointing executives is an important NHS foundation trust freedom. As a foundation trust, Blackpool Teaching Hospitals NHS Foundation Trust has the freedom to determine many of its own policies and procedures, including those relating to the appointment of a new chair.
The process followed by Blackpool is explained in the trust’s own constitution, which sets out the make-up of the nominations committee responsible for senior appointments. That committee is made up of six individuals, including the chair, or another senior role if the chair is the position being recruited for, as well as three governors and the chief executive. The sixth member is an independent assessor—in this case, the chair from another foundation trust, Salford Royal.
This is where the first irregularity arises. NHS Improvement guidance states that a foundation trust’s chief executive should not be permitted to vote on the appointment of the chair to whom he or she will be accountable. However, in this case, the chief executive was on the nominations committee for this role. While she did not breach the guidance, it is clear to me that if a chief executive should not vote on the appointment of the chair, it follows that a chief executive should also not be involved earlier in the appointments process, given the relationship of accountability that exists between chief executives and chairs of NHS trusts and foundation trusts.
However, I recognise that that instruction was deep within guidance dating from 2012, and there have been other pieces of NHSI guidance for foundation trusts regarding their governance arrangements that did not contain similar advice. There is an expectation that advice and guidance given to NHS trusts is clear and understandable. I have been informed that guidance on this topic is being refreshed by NHSI as part of the review of NHSI’s role in board appointments following Dr Kirkup’s findings in relation to Liverpool Community Health NHS Trust, to which the hon. Member for Blackpool South referred, and I have asked for the lessons learned to be fed into that refresh.
The chief executive did voluntarily stand back from the process after concerns were raised by the hon. Gentleman regarding her involvement. That was before the final interview was held for any of the candidates. Though it might be fair to ask whether involving the chief executive in the recruitment of the chair was the wisest course of action, it was within the trust’s constitution.
The second irregularity is the response from NHSI to the hon. Gentleman’s letter of 3 May, which fails to refer to its own guidance regarding the need to ensure that the chief executive is not permitted to vote on the appointment of a chair to whom he or she will be accountable. That is regrettable, and I understand that NHSI will write again to him to apologise for that error.
The third irregularity highlighted is the speed of the process. The nominations committee engaged recruitment consultants GatenbySanderson to provide professional services during the recruitment process. Part of that process involved emailing local MPs to inform them that the recruitment process was taking place. However, as the hon. Gentleman has highlighted, there was little time between that email being sent and the closing date for applications—10 working days over the Easter holiday period. The email did not include the closing date for applications, further hampering MPs’ ability to contribute effectively to the process.
I understand that the recruitment process began in February and concluded in May, with the new chair in post from 1 June. The recruitment company has confirmed that this process was run to a standard timeframe. That raises the question of why the local engagement, an important part of the overall appointments process, appears to have been rushed in this instance. There are clearly lessons to be learned, and I will be working with NHSI to ensure that its guidance is refreshed, and that it is clear in its advice to foundation trusts and trusts about the importance of local engagement.
The hon. Gentleman’s letter to the trust of 17 May referenced the trust’s council manual, pointing out that it did not include any reference to the chief executive sitting on the nominations panel. This document sits under the constitution of the trust, and I am satisfied that the explicit rules addressing this matter in the constitution have been followed. I have today received a personal assurance from the trust chief executive, Wendy Swift, that the trust will review its constitution to remove any ambiguity in respect of the appointment of the chair and non-executive directors.
Just to reassure the hon. Gentleman, I will read directly from that letter to me:
“I would like to reassure you that we had already taken a decision to review our Constitution to remove any ambiguity in respect of the appointment of the Chair and Non-Executive Directors.”
I will happily share that letter with the hon. Gentleman.
The independent assessor on the panel was the chair of Salford Royal NHS Foundation Trust. He agreed as to the candidate recommended by the nominations committee’s interview panel to the council of governors, and has not raised objections about how the process to recruit the new chair was run. I have had a personal assurance from the chief executive that there has been no contact between her and the chair of Salford Royal NHS Foundation Trust, and that she has not in any way tried to influence the decision-making process leading to the chair’s appointment.
The chief executive’s letter to me, dated 27 June—it might be helpful to the House if I quote it—goes on:
“I did know the new Chair on a professional basis prior to his appointment. We have worked within the same Health Economy for a number of years and attended the same strategic meetings and events. For clarity, the Chair was the Chief Executive of the Strategic Health Authority (2002-2006) whilst I was the Chief Executive of Blackpool PCT. After 2006, there were no personal or professional links until the Chair was appointed as the Chair of the University Hospitals of Morecambe Bay NHS FT (2014-2018).”
It is clearly difficult to reconcile the involvement of chief executives in the process of selecting chairs with principles of good governance. This appointment took place under the system of foundation trust autonomy put in place under successive Governments, and is a matter for the foundation trusts themselves. However, NHSI recognises that the role it plays in board appointments, both executive and non-executive, is not sufficiently clear and that there would be benefit in reviewing and codifying its oversight and support arrangements.
While any such changes should pay due regard to the fact that autonomy in appointing executives is an important NHS foundation trust freedom, I assure the House that I will be working with NHSI to ensure that the irregularities regarding this appointment do not occur in the future.
The hon. Gentleman has done the House a service in highlighting the clear irregularities in respect of this appointment. I hope that my response goes some way to reassuring him that NHSI will work with the Department to ensure that further irregularities do not occur.
Question put and agreed to.
Draft Nursing and Midwifery (Amendment) Order 2018
Steve Barclay Excerpts(5 years, 10 months ago)
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The Minister for Health (Stephen Barclay)
I beg to move,
That the Committee has considered the draft Nursing and Midwifery (Amendment) Order 2018.
It is always a pleasure to serve under your chairmanship, Mr Evans. Health Education England’s “Shape of Caring” review made a series of recommendations to strengthen the capacity and skills of the nursing and caring workforce. A key recommendation was to explore the need for a defined carer role to act as a bridge between the unregulated healthcare assistant workforce and the registered nursing workforce. The amendments that we are proposing to the Nursing and Midwifery Order 2001 put in place provisions to regulate a nursing associate role that satisfies that recommendation.
In short, the proposed amendments to the 2001 order give the Nursing and Midwifery Council statutory responsibility for regulating the nursing associate profession in England and extend its powers and duties under the order to nursing associates in respect of the key functions of registering nursing associates in England and setting the standards of proficiency, education and training, and continuing professional development and the conduct of nursing associates in England.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
During my time as Chair of the Select Committee on Education there was great controversy about teaching assistants and whether they diluted the profession. I can see that nursing associates need to be registered, to have that recognition of being regulated, but will nursing associates mean a watering down of the profession? Will we have a large number of them as substitutes for highly qualified nurses?
Stephen Barclay
I am grateful to the hon. Gentleman for raising that point. I think we can all see the value for children in school that teaching assistants offer alongside teachers. They are a good example of how, in education, the need for a diverse workforce has developed, and that is exactly what today’s order addresses. It is a response to what employers have said they want, which is more flexibility in their workforce, to ensure progression for staff who want to progress into nursing, but who in the past might have felt trapped in a healthcare assistant role by having young children or otherwise been constrained from going to university. Our proposal gives them a ladder between the two roles, as part of a flexible workforce that responds to employers in the way that happens in education, as the hon. Gentleman correctly said.
Mr Sheerman
Is the plan to expand the nursing profession by enabling people to join as nursing associates before becoming better qualified and ending up as fully qualified nurses?
Stephen Barclay
The hon. Gentleman is right to probe on this, because that is the essence of the Government’s proposal. The nursing associate role is a stepping stone. Some people will progress to nursing associate and stay in that role, but some, having done the foundation year of their degree, might want to do the following two years and become a nurse. We want to respond constructively to that aspiration, which his constituents will have, as do mine. Some will start as healthcare assistants, gaining valuable experience in that role, but some will want to progress to nursing associate and some will want to become a registered nurse. The draft order is about ensuring flexibility in the workforce to enable that.
Mr Sheerman
I have checked, and the starting qualification for a nursing associate is GCSEs grades 4 to 9 in English and maths. The lower end of that range is very low indeed, is it not? Indeed, it is the same starting qualification for teaching assistants. Is the Minister happy with that?
Stephen Barclay
Yes, I am, and it is helpful of the hon. Gentleman to raise this issue. The qualifications that nursing associates will undertake are to be set by the NMC, so people will need to go on courses that satisfy the NMC. However, they will also gain valuable hands-on experience alongside their foundation training. Our proposals are about creating a ladder from the nursing associate role. Some will stay at that level, because they feel that, educationally, that is the level they have attained, and they want to continue as a nursing associate—
Stephen Barclay
I will just finish my point and will then happily take one further intervention, after which I will make some progress.
Quite rightly, some people will want to continue as a nursing associate, playing a valuable role on a ward and freeing up those who have done three years at university level to focus more on skilled roles. That is part of the flexibility that employers have asked for. Others, having had a taste in the foundation year, will want to do a further two years. The system allows that progression, which I am sure the hon. Gentleman’s constituents will want.
Mr Sheerman
The Minister said that he would allow me one last intervention, and this will be my last. The great criticism of nursing has been that it became an academic and university qualification. Everybody said that something had gone wrong. If we tie this change to graduate apprenticeships, which nursing is moving towards, it could mark the beginning of a return to a much more hands-on, experience-driven qualification. That is most interesting, so I thank the Minister for his responses.
Stephen Barclay
I am grateful to the hon. Gentleman. I see exactly what he is driving at, and I have a great deal of sympathy with that point. It is slightly beyond the scope of this legislation, which covers those who satisfy the foundation-course level after their first year. If they want to become a registered nurse, they will need to satisfy, as now, the three-year-degree level. The legislation does not say that people do not have to reach the educational attainment of a registered nurse. Rather, it allows them to continue to earn, to gain hands-on experience and to do that in stages, which may provide flexibility to, for example, those with young children or other caring responsibilities. It allows that stepping stone.
The hon. Gentleman touches on a point slightly beyond the scope of today’s order, which is whether someone could gain a nursing qualification without a degree—I think that was within his question. That is not what this legislation does. It requires—
Mr Sheerman
On a tiny point of information, it is fascinating to think that we could get back to the days when people had much more hands-on training and went right through to a degree, but with no debt.
Stephen Barclay
The hon. Gentleman absolutely sees my enthusiasm for this order, and that is why I hope that colleagues on both sides of the Committee will support it. Alongside the apprenticeship levy, it offers an alternative to a student loan and what we might see as a more conventional degree. That is not to say that we will not continue with that route, because obviously it will remain a main pathway into nursing, but it is good to give flexibility to employers and to school leavers and others who see the opportunity to go into nursing. We are conscious that, currently, many people who want to do nursing are rejected when they apply, so having different pathways is a key part of the system.
Stephen Barclay
I did say that I would make some progress, but I am conscious that I have not taken an intervention from the hon. Gentleman, so I will take one more and then, with the leave of the Committee, I will make some progress.
Grahame Morris
It is interesting that the Minister is setting out arguments for a kind of continuing professional development. We are talking about an additional grade of people who could go on to become registered nurses, but I wonder how that might be possible, given that Health Education England’s budget for workforce development, which is largely used for continuing professional development for nurses, has been cut by more than 60% in the last two years, from £205 million down to £83.45 million in the current year. How does that square with that ambition?
Stephen Barclay
The hon. Gentleman raises an important point, because continuing professional development is key. When two thirds of what we spend on the NHS goes on staff, how we effectively train them is key. That is in part why my right hon. Friend the Prime Minister made the commitment she did on Monday on the funding settlement—again, that is slightly beyond the scope of today’s deliberations. It is also why the Government have committed to, for example, 1,500 new doctors being trained, opening five new medical schools and other initiatives, including, as I said a moment ago, the apprenticeship levy, as other vehicles.
One piece of feedback that I get from nurses when I go out to visit hospitals is the importance of CPD, which I am looking at very closely, because of the need for a wider skills mix. To take GPs, for example, it is important to look at whether all the activity that they are currently doing is necessary or whether some of those tasks could better be performed by others, if there were a wider skills mix. However, that is slightly beyond the scope of today’s deliberations, so I will make some progress.
The draft order amends the offence provisions in the Nursing and Midwifery Order 2001. The amendments provide that a person commits an offence in connection with the nursing associate part of the register, nursing associate qualifications or the use of the nursing associate title when not entitled to. The offences were drafted to reflect the fact that nursing associates will be regulated in England only.
The draft order makes provision to allow admission to the register to those who complete or commence their training by 26 July 2019 through the pilot courses run by Health Education England or through an apprenticeship route. It excludes nursing associates from being given temporary prescribing rights in a time of national emergency, such as a pandemic flu outbreak. It also removes the screener provisions from the 2001 order, as they are now redundant.
The draft order makes consequential amendments to the Nursing and Midwifery Council’s rules and to other legislation, and closes sub-part 2 of the nurses part of the register by amending the Nurses and Midwives (Parts of and Entries in the Register) Order of Council 2004, which determines the parts of the NMC’s register and the titles that may be used by those included in that register. The Department carried out a full public consultation across the United Kingdom on the proposed amendments and received 373 responses. There was broad agreement on the proposed legislation to regulate nursing associates in England.
Health Education England has established two pilot groups of 1,000 nursing associate trainees, who are due to complete their training in early 2019, and the Health Secretary has announced plans for up to 5,000 additional nursing associates to commence training via the apprenticeship route in 2018, and up to 7,500 a year thereafter. The draft order will insert a new provision in the Nursing and Midwifery Order 2001 to allow applicants who have started or completed a nursing associate qualification through either the HEE pilot or the apprenticeship route by 26 July 2019 to have their qualifications recognised.
In summary, these are important changes to the governing legislation of the Nursing and Midwifery Council that will see the nursing associate role regulated. Nursing associates will support nurses so that they can focus on the more clinical aspects of patient care, and will support the increase in nurse numbers by providing a clear pathway into the nursing profession, which the hon. Member for Huddersfield alluded to.
Grahame Morris
I am grateful to the Minister for giving way; he is being generous. What is his estimate of the current number of vacancies for registered nurses in the system?
Stephen Barclay
The Health Committee’s estimate of 11% is at odds with the actual working vacancy rate of 1%—obviously, if one factors in places filled by agency and bank staff, one gets a different number. However, that is an interesting point, because the whole draft order is about how we get additional staff into the workforce to support nurses—it is about how we provide more resource to work alongside nurses. If the hon. Gentleman’s point is that we need more nurses in our workforce, that will be achieved both by increasing the clinical profession, which the Government have done—we can run through how many more people there are in the profession compared with 2010—and by creating new pathways into nursing. That is what the draft order does, and that is why I commend it to the Committee.
Stephen Barclay
I am grateful to the hon. Gentleman for his support for the role of nursing associates. He raised several important issues, which I will address.
Let me first respond to the point that the hon. Member for Huddersfield raised about the Royal College of Nursing. Under the heading “Our position”, the RCN has said in a briefing note:
“We support the introduction of the nursing associate…role and the plans to regulate it.”
It goes on to raise several points, some of which the hon. Gentleman gave good visibility to. I hope that gives the general tenor of the RCN’s support for the role, although that support is not unqualified and it has some questions—I do not want to mischaracterise its support. I hope that addresses that issue.
The hon. Member for Ellesmere Port and Neston raised the replacing of nurses, and he is absolutely right that it would be a concern if that were the intent behind the draft order. He will be aware that the CQC has oversight of staffing models, and that it will therefore be for trusts to discuss with the CQC how they will satisfy the necessary models.
Members referred to the harrowing report that Bishop Jones published today. I recently went up to Liverpool Community Health NHS Trust, on which the Kirkup report contained some shocking revelations, highlighted, as the hon. Gentleman knows, through the tenacious campaign of the hon. Member for West Lancashire (Rosie Cooper). We have also seen what happened at Morecambe, after the tireless work of James Titcombe following the death of his baby, Joshua, and at Mid Staffordshire. Too many such cases sadly come before the House, and I know there is consensus on both sides of the House that we must ensure that the right staffing and the right regulatory system are in place.
Grahame Morris
The Minister is absolutely right about ensuring that standards are maintained. I served for five years on the Health Committee, which oversees, and has an annual hearing with, the Nursing and Midwifery Council. A point of contention was always the level of fees that its members must pay, because it is linked to professional standards and professional development. Will the Minister clarify what level of fees will apply to nursing associates? Is that set out in the draft order?
Stephen Barclay
From memory, the fee is the same as for a nurse in the NMC, which is £120, although I am sure that my colleagues will correct me if my memory is misplaced on that. That is a flat rate applied by the NMC across the board.
The hon. Member for Huddersfield and the Opposition Front Bencher also raised the issue of overseas staff. This will be a new role, and the Prime Minister’s announcement on tier 2 visas applies to existing roles, such as doctors and nurses, whereas this role is not currently in place. However, the opening of the nursing associate part of the register will provide a new registration route for overseas nursing staff whose competence and qualifications fall short of those of a registered nurse, providing that they can demonstrate that they meet the same high standards expected of a nursing associate trained in England. Again, just as it is a ladder for his constituents, it is a pathway through which European staff could potentially enter the NHS. [Interruption.] My memory was correct: the NMC has consulted on applying a fee of £120.
The hon. Member for Ellesmere Port and Neston mentioned the guidance. The Department is working with arm’s length bodies, NHS Employers, healthcare environment inspectorates and the regulators—the NMC and the CQC—to develop guidance. That will obviously need to be in place before the first tranche of nursing associates come out of their training in January ’19. I also note his point on panels. It is a perfectly fair observation, and I take it on board.
Justin Madders
The figure is proposed to be set at the same rate as for a nurse. I understand that, once the NMC sets up this process, the costs will be broadly similar to those for a nurse, but the fact is that this role is designated to be on “Agenda for Change” band 4, whereas nurses are in band 5. Does the Minister agree that there is possibly an argument that the proposed fee should be slightly lower to reflect that?
Stephen Barclay
I see exactly the point that the hon. Gentleman raises. The NMC is consulting on that, and I think that consultation should be allowed to run its course, but I am sure that his points will have been heard by those undertaking it.
Agency spend was raised. Again, that is an area of considerable focus within the Department. It is part of the transformation that the Prime Minister signalled with the investment announced on Monday, and there is a lot of work on, for example, e-rostering and how to give staff greater predictability and flexibility, and how we can use technology to facilitate that, because that also has an impact on retention rates.
I hope I have addressed the hon. Gentleman’s points. I am grateful for his and the Opposition’s support for the new role. It is important that we increase the number of people able to access roles in the NHS, and this is a valuable pathway to enable that. I commend the draft order to the Committee.
Question put and agreed to.
Resolved,
That the Committee has considered the draft Nursing and Midwifery (Amendment) Order 2018.
Oral Answers to Questions
Steve Barclay Excerpts(5 years, 10 months ago)
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Martyn Day (Linlithgow and East Falkirk) (SNP)
The Minister for Health (Stephen Barclay)
NHS England, NHS Improvement and Health Education England are working with trusts on a range of recruitment, retention and return-to-practice programmes to ensure that the required workforce are in place to deliver safe and effective services.
Martyn Day
The nursing vacancy rate in England is more than double that in Scotland, with one in 10 positions unfilled. The Royal College of Nursing has welcomed the Scottish Government’s Health And Care (Staffing) (Scotland) Bill, which will enshrine safe staffing levels in law. Will the Minister now follow the Scottish Government’s example and bring such a provision into law for NHS England?
Stephen Barclay
I fear that the hon. Gentleman wrote his question before yesterday’s announcement. I thought that he might have started by welcoming the additional £2 billion of investment that Scotland’s NHS will be receiving. We are making historic investment in recruitment, which is why we are opening five new medical schools in England, training 1,500 new medical doctors, taking initiatives such as on apprenticeships and opening new pathways into clinical roles.
Mr Philip Dunne (Ludlow) (Con)
While I welcome yesterday’s announcement and the workforce strategy that is coming out in the autumn, will the Minister comment on the Home Office’s new proposals to allow greater flexibility for professional clinicians coming to work in the UK, and on what impact that might have on filling vacancies?
Stephen Barclay
My hon. Friend is right to draw attention both to the Home Office’s welcome announcement on tier 2 visas and to the work on the workforce strategy, in which he played a key role. It will ensure that we have the right workforce for the NHS for the next 10 years.
Mr Ben Bradshaw (Exeter) (Lab)
But the Royal College of Nursing and the Nursing and Midwifery Council are both now so worried about Brexit’s impact on the staffing crisis that they have called for a people’s vote on a deal. Given their on-the-ground experience and the demolition of the myth of a Brexit dividend for the NHS, is it not becoming ever more clear that the dogmatic hard Brexit being pursued by the Government is already doing untold damage to our NHS?
Stephen Barclay
The right hon. Gentleman, as a former Minister of State, will not want to choose selectively from the data on European economic area recruitment into the NHS. He will know full well that there are 3,200 more NHS staff from the EU since the referendum, which shows that people are still coming. If he has an issue with the Brexit dividend, perhaps, as my right hon. Friend the Secretary of State pointed out yesterday, he will raise that with his party leader, who sees that there is a Brexit dividend.
Mr Philip Hollobone (Kettering) (Con)
Kettering General is a wonderful hospital with amazing staff, but one of its big financial problems is caused by its over-reliance on agency staff. What can be done to reduce the reliance of so many hospitals, including Kettering, on agency staff to populate their wards?
Stephen Barclay
My hon. Friend rightly points to the key issue of how we bring down the £2.5 billion of agency spend. That goes to the heart of the Prime Minister’s announcement yesterday. Up-front investment in our workforce will allow us to reduce that agency cost.
Mike Hill (Hartlepool) (Lab)
Mr Speaker
Order. The question should relate to the workforce, which is the matter we are dealing with now, but never mind. I am sure that the hon. Gentleman is interested in hearing about the workforce situation.
Stephen Barclay
The two do go together because the mental health workforce is a key component of the NHS workforce. I am sure that the hon. Gentleman will welcome the extra £1 billion by 2020 that the Prime Minister announced yesterday, as well as the Government’s prioritisation of mental health, which for too long has been seen as a Cinderella service within the NHS.
Dr Philippa Whitford (Central Ayrshire) (SNP)
In 2015, the Secretary of State suggested that junior doctor rotas contributed to avoidable hospital deaths, but research shows that the most important factor is the number of patients under the care of each registered nurse. A 7% increase in mortality for every patient means that 36,000 nursing vacancies in England pose a real threat to patient safety. So with no announcement, and a 33% drop in applications since the removal of the nursing bursary, will the Government follow the Scottish Government’s policy and reintroduce the bursary?
Stephen Barclay
The hon. Lady will be well aware that there are 14,000 more nurses in the NHS than five years ago, but she is right to point to the wider issue of long-term workforce planning. That is why she will be aware that Audit Scotland criticised NHS Scotland for its lack of long-term workforce planning.
Dr Whitford
As the Minister heard, the Scottish Government have just passed a law on staffing. With an ageing population, social care is critical to the function of the NHS, but the charity Independent Age says that we will be short of 700,000 care workers by 2037. With no extra funding for social care announced yesterday, how will the Secretary of State make caring a real profession? Would not it be good to start with a decent wage?
Stephen Barclay
The hon. Lady’s supplementary question really reinforces the answer that I gave a moment ago: the essence of why we need a long-term plan is so that we anticipate these issues. We are addressing that through the Green Paper on social care, and that is part of the investment that the Prime Minister announced yesterday.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
Yesterday the Prime Minister said that
“current workloads are not sustainable”—
is that any wonder after eight years of Tory cuts and austerity? The Minister knows that the number of health visitors in the workforce is falling, and that health visitors are vital to improving child health and wellbeing outcomes. No new public health money was announced yesterday; new money will come in 2020. Can the Minister guarantee that health visitor numbers will not continue to fall and that the public health budget will be ring-fenced?
Stephen Barclay
I am grateful that the shadow Secretary of State has drawn attention to public health because the Government have been making significant progress in that area. We have the lowest ever number of teenagers smoking and the lowest ever teenage pregnancy rate. Binge drinking is down and we are addressing child obesity with the sugar tax, which is among a number of measures that the Government have been bringing forward. We are making progress on public health and the hon. Gentleman is right to draw that to the attention of the House.
Jonathan Ashworth
This Government are breaking the Tory manifesto promise and raising taxes, yet they cannot even answer basic questions about health visitor numbers. The NHS workforce deliver the constitutional performance targets, including the 18-week referral-to-treatment target, and targets for accident and emergency and cancer treatment. Will the Minister reassure patients and the taxpayers whose taxes are going up that he will rule out dropping those essential targets?
Stephen Barclay
Once again—as we heard yesterday—there is no welcome for the announcement of additional funding for the NHS. Opposition Front Benchers are playing politics and talking down our NHS. The Prime Minister has set out a long-term vision to improve standards and raise mental health, which Labour Back Benchers highlighted. The hon. Gentleman should come to the House and welcome that investment in our NHS.
Liam Byrne (Birmingham, Hodge Hill) (Lab)
Paul Masterton (East Renfrewshire) (Con)
The Minister for Health (Stephen Barclay)
Community first responders play a valuable role in helping ambulance services. Support includes ongoing training, necessary medical equipment and occupational health support.
Paul Masterton (East Renfrewshire) (Con)
In just five years, the Neilston and Uplawmoor first responders have responded to over 1,300 calls, saving many lives, and earlier this month they received the Queen’s award for voluntary service. Will the Minister join me in congratulating all the volunteers and paying tribute to community first responder units right across the United Kingdom?
Stephen Barclay
I am very happy to join my hon. Friend in congratulating Stuart McLellan, Ross Nelson and the volunteers that play such a key role. I know that my hon. Friend the Member for Brigg and Goole (Andrew Percy) also performs this service in his constituency. I have spoken to him about it and I know that it plays a very valuable role.
Mr Speaker
Ah yes, in the frame, we now have a dame—I call Dame Cheryl Gillan.
Heidi Allen (South Cambridgeshire) (Con)
The Minister for Health (Stephen Barclay)
The workforce strategy we are bringing forward will include investment and an expansion in the number of medical schools— five new medical schools—alongside those 1,500 new doctor places.
Heidi Allen
I had wanted to ask the Secretary of State to get behind exempting nurses and doctors from the tier 2 visa process, but I do not need to do that; I just have to thank him for his support in doing that. Instead, for his next challenge, will he commit to looking again at the pensions cap, which I fear might be one reason some senior NHS professionals and doctors are retiring sooner than they might otherwise do?
Stephen Barclay
I am grateful for my hon. Friend’s support on tier 2 visas. She will be aware that clinicians who reach the £1 million lifetime allowance limit can expect a pension of about £44,000, payable at age 60, increasing with inflation, plus a tax-free lump sum of about £132,000. Although these are ultimately issues for the Treasury, it is important that we ensure that tax allowances, two thirds of which go to higher-rate taxpayers, are fair to other taxpayers.
Nigel Mills (Amber Valley) (Con)
Martin Vickers (Cleethorpes) (Con)
The Minister of State visited my hospital trust last month. Is he in a position to support its requests, and will he say whether he is satisfied with the progress it is making to remove itself from special measures?
The Minister for Health (Stephen Barclay)
I very much enjoyed visiting the trust with my hon. Friend. As he will be aware from our discussion during that visit a process for capital bids is under way. As my right hon. Friend the Secretary of State set out, the date for that is mid-July and I look forward to seeing the bid from my hon. Friend’s trust.
Nic Dakin (Scunthorpe) (Lab)
Stephen Barclay
My right hon. Friend is right to champion this, as he did through the recent Adjournment debate, when he set out the case in more detail. We recognise, as we did at the last Health questions and in the Adjournment debate, that there are significant issues with the local hospital, and that is why it is working very actively on its bid for capital funding.
Lisa Nandy (Wigan) (Lab)
Peter Heaton-Jones (North Devon) (Con)
Northern Devon Healthcare Trust recently announced that it is to share the chairman and chief executive of the Royal Devon and Exeter NHS Foundation Trust. Will the Minister meet me to ensure that the new arrangements will help to secure services in North Devon?
Jeff Smith (Manchester, Withington) (Lab)
Last November, the Health Secretary committed to ending out-of-area mental health placements by 2020, but the number of people placed more than 100 km from their home rose by 65% over the past year. The earlier response from the Under-Secretary of State for Health and Social Care, the hon. Member for Thurrock (Jackie Doyle-Price), was no answer, so what are the Government actually going to do to turn the situation around?
Rachael Maskell (York Central) (Lab/Co-op)
Thank you, Mr Speaker. NHS Property Services intends to sell the Bootham Park Hospital site, but reinvesting in that site would make such a difference to the health needs of our city. Will the Minister ensure that that happens?
Stephen Barclay
I have met the hon. Lady, and she made her case in a characteristically powerful fashion. The matter is being looked at actively.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
On a point of order, Mr Speaker.
Health and Social Care
Steve Barclay Excerpts(5 years, 11 months ago)
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Stephen Barclay
As my right hon. Friend the Secretary of State pointed out, the NHS has £80 billion of PFI contracts and a £200 billion a year spend on PFI.
[Official Report, 23 May 2018, Vol. 641, c. 951.]
Letter of correction from Stephen Barclay.
An error has been identified in my winding-up speech during the Opposition day debate on NHS Outsourcing and Privatisation.
The correct response should have been:
Stephen Barclay
As my right hon. Friend the Secretary of State pointed out, the NHS has £80 billion of PFI contracts and a £2 billion a year spend on PFI.
Princess Alexandra Hospital, Harlow
Steve Barclay Excerpts(5 years, 11 months ago)
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The Minister for Health (Stephen Barclay)
I pay tribute to my right hon. Friend the Member for Harlow (Robert Halfon). He raises the important issue of the future of the Princess Alexandra Hospital in Harlow, and is quite right to draw the attention of the House to it once again. As he said, he has raised this in a previous Adjournment debate, through multiple questions and in meetings with Ministers, including me, and he has secured visits from my right hon. Friend the Secretary of State and from my predecessor, my hon. Friend the Member for Ludlow (Mr Dunne).
The strength of my right hon. Friend’s campaign is further reinforced by the number of colleagues here this evening. Dare I say, Madam Deputy Speaker, that I am sure the constituents of Epping Forest take a great interest in Harlow’s future hospital; this issue concerns you as well as my hon. Friends the Members for Saffron Walden (Mrs Badenoch), for Broxbourne (Mr Walker) and for Hertford and Stortford (Mr Prisk), who are all here signalling their support for this important capital programme.
I join my right hon. Friend in paying tribute to Nancy Fontaine, the chief nurse and deputy chief executive. She has played an important, transformative role at the Princess Alexandra over the past few years and may now, I understand, be moving to a new post. She has played a key role in taking the Princess Alexandra out of special measures—a distinction achieved in March this year. The trust improved its overall CQC rating, having been rated good in the effective and caring domains. That is a tribute to Nancy Fontaine, the senior leadership team and the entire staff of the hospital, who have worked so hard.
I also recognise that, as my right hon. Friend said, Princess Alexandra Hospital does face problems with the condition of its estate and buildings; he and I have discussed the issue during oral questions, and the Secretary of State has also recognised the point. NHS Improvement has advised that the condition of the hospital is not currently fit for purpose. It is right that plans are made to improve the estate and that those plans should be locally driven.
As my right hon. Friend will be aware, the Government fully support the upgrading of the NHS estate to bring the NHS further into the 21st century. That is why we have committed £3.5 billion of additional capital funding in the 2017 autumn Budget to support the most ambitious programme of investment in buildings and technology that the NHS has seen to date.
My right hon. Friend referred to the application from the Princess Alexandra, and he will be well aware that the strategic outline case was put forward in July 2017 with the support of the local authority, outlining the various options that had been considered. The strategic outline case concluded that the best option was to build a new hospital, potentially as part of a broader health campus on a new site. The trust secured local support from the clinical commissioning groups and the sustainability and transformation partners for that strategic outline case, which has been through the necessary local healthcare governance procedures. I am pleased that plans for the new hospital and health campus are supported so strongly by local NHS stakeholders.
The trust submitted a bid in autumn 2017 for STP capital for its integrated healthcare campus scheme, which was intended to replace the existing Princess Alexandra Hospital estate. The trust’s capital bid at that time asked for between £500 million and £600 million. That was not considered sustainable; the bidding process feedback asked the trust to revise its capital plans to a more realistic level.
It is also worth reminding the House, and this is partly a tribute to the success of my right hon. Friend’s campaigning for Harlow, that that sits alongside the many millions of pounds secured for the public health campus, which is due to open in phases from 2021. He is correct to identify the opportunities that both schemes bring for a wider NHS career as part of the investment the Government are making—not just in Harlow but in the healthcare of the region, reflected by the support of colleagues in the House.
Alongside those two schemes, the same STP, Hertfordshire and West Essex, also put in a bid for more than £600 million of capital funding in the same bidding round of autumn 2017 for the redevelopment of the West Hertfordshire Hospitals NHS Trust Watford site. That is a signal of the amount of capital the Government are putting in and the need for the local plans to reflect the competing bids around the country as part of that appraisal. There have been other capital schemes, such as the £2 million to which my right hon. Friend referred, given to improve emergency capacity for the winter.
I look forward to hearing about the trust’s updated plans for how it intends to transform the way care is provided to patients through integration with community and primary care, rather than just re-provide capital assets. Schemes are required to demonstrate affordable revenue assumptions and value for money, and to fully consider disposing of surplus assets to part-fund their developments.
My right hon. Friend asked about timing. Given the challenges that the trust faces, I appreciate that it is a key issue for his constituents. An announcement will be made in the autumn on the next round of STP capital allocations, and I will continue our regular dialogue with him as that progresses. Bids are due by mid-July; I know the trust is fully aware of that timescale and I expect it is working closely to it.
I want to pick up on a comment my right hon. Friend made about the workforce. While capital is key to the redevelopment of the Harlow estate, it has to sit alongside wider workforce planning. The long-term nature of workforce planning has sometimes meant that there has perhaps been insufficient focus on this area. That is why the Government are bringing forward, through Health Education England, a workforce strategy this summer to look specifically at how we better plan for our workforce. I know that, particularly through his chairmanship of the Education Committee, my right hon. Friend champions a cause that is close to both our hearts: apprenticeships and how we better use them within the workforce. I am keen that he continues to work with the trust to expand the number of apprenticeships on offer. Based on quarter 1 to quarter 3 data, it has so far offered 10 apprenticeships, against a public sector target for the trust of 72, with a half a million pound apprenticeship levy to be allocated. There is therefore scope for the trust to continue its efforts on apprenticeships as part of that wider agenda. I know my right hon. Friend will continue to champion that agenda.
In conclusion, what is recognisable from the presence of my hon. Friends the Members for Saffron Walden, for Broxbourne and for Hertford and Stortford, as well as the constituency interests of other Members in the Chamber, is that this scheme is not just about Harlow but about the wider health care needs of the region. It is one that the Secretary of State has taken a close personal interest in, visiting on more than one occasion. It is one that my right hon. Friend has assiduously raised in the House and has done so, rightly, again today. I reaffirm, as I said to him when we last debated this matter on 8 May, that we recognise that the Princess Alexandra hospital estate is in a poor condition. That is why the bid that I expect in mid-July is timely. I look forward to the bid addressing the transformation challenge. It is part of the Government’s wider £3.5 billion commitment to the NHS estates until 2022-23. I know my right hon. Friend will support his local STP in the transformation the system needs. I look forward to continuing to work with him as part of the plans to ensure the NHS is fit for the future in Harlow and in the surrounding region.
Question put and agreed to.
NHS Outsourcing and Privatisation
Steve Barclay Excerpts(5 years, 11 months ago)
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The Minister for Health (Stephen Barclay)
The Government oppose the motion. There is no complaint from the Chair of the Health and Social Care Committee, my hon. Friend the Member for Totnes (Dr Wollaston), about papers sought and not provided. Indeed, there are no papers, according to the evidence that the Secretary of State read out at the start of the debate, which was provided to him by officials. There is no logic to the motion when, as several Members pointed out, there has been no increase in the share of NHS spending on the private sector over the past year. As my hon. Friend the Member for Corby (Tom Pursglove) in particular highlighted, the rate of increase has been slower under this Government than it was under previous Governments.
As my hon. Friend the Member for Torbay (Kevin Foster) pointed out, that is perhaps why so few Labour Members wanted to address the motion. As my hon. Friend the Member for Cheltenham (Alex Chalk) said, the motion contradicts both legislation passed by the Labour Government in the form of the Freedom of Information Act, and numerous statements made by senior Labour politicians such as the former Foreign Secretary and Member for Blackburn in his evidence to the Chilcot inquiry.
Instead, there was a mix of confusion and division among Opposition Members. The hon. Member for Lincoln (Karen Lee), who is not in her place and did not stay for the speech of the hon. Member for Bristol South (Karin Smyth), said that there is no logic to the use of the private sector, but in a well-informed and measured speech the hon. Member for Stockton South (Dr Williams) said that sometimes it should be enabled. That point was conceded in the Chamber today by Labour Front Benchers, and in numerous media interviews, including on the “Victoria Derbyshire” show. They seem confused about whether they welcome the use of the private sector.
The confusion extended to the remarks of the hon. Member for Blaydon (Liz Twist). She said that Gateshead trust is very good, yet she seems to ignore the fact that the legislation on subsidiaries was passed under a Labour Government. The staff survey for that trust shows that the subsidiary has a satisfaction rate that is 15% higher than it was in the NHS as a whole. Because of her ideology, she seemed to suggest that her constituents working within that trust, which is 100% owned by the NHS, are wrong.
As my hon. Friends the Members for Lewes (Maria Caulfield) and for Faversham and Mid Kent (Helen Whately) pointed out, there was a rewriting of history. The Labour Government before 2010 embraced the private sector. As illustrated in Wrexham, contracts in Wales are given to the private sector when Labour is in office. Labour Members say one thing in opposition and do something else in office. We have seen the contradiction today. Labour Members say that they dislike accountable care organisations and that they are a form of privatisation. It might surprise colleagues to learn that the Mayor of Greater Manchester, the former Labour Secretary of State for Health, is seeking to pilot an ACO because he recognises the benefits of integration.
The House heard misleading statements today. We were told by the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) that there has been a slow and steady erosion of the NHS as a provider, even though the facts show a zero increase in the private sector share of NHS spending. My hon. Friend the Member for Bexhill and Battle (Huw Merriman) highlighted the fact that private sector involvement was embraced, sought and progressed by the Blair Government.
That rewriting of history was further underlined by the Labour Members’ PFI amnesia. As my right hon. Friend the Secretary of State pointed out, the NHS has £80 billion of PFI contracts and a £200 billion a year spend on PFI. Labour Members mentioned Carillion—12 of the 13 Carillion contracts for service management were entered into under the Labour Government.[Official Report, 11 June 2018, Vol. 642, c. 4MC.]
The reality is that this Government are investing more in our NHS and delivering more outcomes for patients. Some 2,500 more patients a day are seen within the four-hour A&E target. We are training more dentists. The hon. Members for Lincoln and for Canterbury (Rosie Duffield) failed to mention the extra medical training places offered in their constituencies as part of the Government’s investment.
The Conservatives have run the NHS for the majority of its 70 years. This Government are investing in our NHS and treating more people in it. This Government will ensure that the NHS remains fit for the future.
Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)
claimed to move the closure (Standing Order No. 36).
Question put forthwith, That the Question be now put.
Question agreed to.
Main Question put accordingly.
Fit and Proper Persons Requirement
Steve Barclay Excerpts(5 years, 11 months ago)
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The Minister for Health (Stephen Barclay)
On 8 February 2018, the Government accepted the recommendations made by Dr Bill Kirkup in his report into Liverpool Community Health NHS Trust. This included a recommendation to the Department of Health and Social Care to undertake a review of the fit and proper persons requirement (FPPR). The current scope of the FPPR is to ensure that people who have senior level responsibility for the quality and safety of care are fit and proper to carry out their role. The FPPR was introduced in response to concerns raised following investigations into Mid Staffordshire NHS Foundation Trust and Winterbourne View Hospital.
Today, I can announce the arrangements for the review, which will be led by Tom Kark QC. The review will commence shortly, with a document review to begin in June and July 2018 and principal evidence gathering to be undertaken in August and September 2018. Tom Kark QC led the team of counsel to the public inquiry into the serious failings in care at the Mid Staffordshire NHS Foundation Trust from 2010 to 2013.
The review will consider the scope, operation and purpose of the fit and proper person test as a means of specifically preventing the re-deployment or re-employment of senior NHS managers where their conduct has fallen short of the values of the NHS. It will engage and discuss these issues with a range of interested parties, including, but not limited to, the Care Quality Commission, NHS Improvement, NHS England, relevant parliamentarians, and patients and relatives. I have discussed the terms of the review with the hon. Member for West Lancashire (Rosie Cooper).
NHS Improvement (NHSI) has led on the health and care system’s wider response to the recommendations made in the Kirkup review. The NHSI board paper published on 22 March sets out NHSI’s response to the recommendations in the Kirkup review, and a further update on progress against these agreed actions will be discussed at NHSI’s next board meeting on 24 May.
The Kark review will aim to report its conclusions and recommendations by autumn this year. The report will be published and I will make arrangements for its presentation to Parliament. A copy of the draft terms of reference, which will be finalised with input from Tom Kark QC, is available as an online attachment.
Attachments can be found online at:
https://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2018-05-23/HCWS713/
[HCWS713]