House of Commons
Tuesday 2 June 2015
The House met at half-past Eleven o’clock
[Mr Speaker in the Chair]
It is with deep sadness that I must report to the House the death of the former Member for Ross, Skye and Lochaber, Charles Kennedy.
Charles represented his constituency, in its various forms, for nearly 32 years. It is, moreover, a matter of record that he led his party, the Liberal Democrats, from 1999 until 2006, achieving the best parliamentary representation of his party in the House of Commons in living memory.
On a personal note, let me say that I was always grateful to Charles for his support, encouragement and co-operation. I think that I carry the House with me in saying that Charles Kennedy was a principled, progressive and passionate politician, and, very importantly, a proud parliamentarian. In an age of pervasive cynicism about politics and politicians, Charles had that rare and uncanny capacity to cut through to large numbers of voters of all political persuasions and of none, right across the country. He was doubtless assisted in that by his obvious sincerity, his relaxed style, and his geniality. I know that he was widely liked and respected in all parts of the House, and he will be sadly missed. I am sure that the House will want to join me in offering heartfelt condolences to his family and friends.
It will be appropriate today for there to be very brief references to Charles, but I hope that the House will more widely take my lead when I say that tomorrow, after Prime Minister’s Question Time, there will be a dedicated session of tributes, when people will be able to say what they think, feel and remember about our departed colleague, Charles Kennedy.
Oral Answers to Questions
The Secretary of State was asked—
Ambulance Waiting Times
As you said, Mr Speaker, we shall have those tributes tomorrow, but I should like very briefly to echo your comments, because I know that the whole House is shocked and deeply saddened by the umtimely passing of Charles Kennedy. He was a giant of his generation, loved and respected in all parts of the House. Our thoughts are particularly with Liberal Democrat Members who knew him well, and to whom he was a very good friend over many years. We shall all miss him as a brave and principled man who had the common touch, and who proved that it is possible to be passionate and committed without ever being bitter or bearing grudges. Our thoughts are with his whole family.
I can tell the hon. Member for South Shields (Mrs Lewell-Buck) that the ambulance service is performing well under a great deal of pressure. Although a number of national targets are not being met, the service is responding to a record number of calls, and is making a record number of journeys involving all categories of patients.
I echo the comments made about the late Member for Ross, Skye and Lochaber. He was one of the kindest Members of the House, and he will be greatly missed by many of us.
As for the Secretary of State’s response to my question, I think that his assessment was a bit off. When my constituent Malcolm Hodgson’s son-in-law broke his leg in a local park, he waited in agony for 50 minutes for an ambulance, and then waited a further five days for an operation. Can the Secretary of State explain how our ambulance and health services were allowed to fall into such a dire state over the past five years, and will he apologise to that young man for the delay and the pain that he suffered on the right hon. Gentleman’s watch?
I take responsibility for everything that happens on my watch. [Interruption.] I think it is a little early to ask the Secretary of State to resign—but maybe not. The ambulance service is under great pressure, but across the country we have 2,000 more paramedics than five years ago, we are recruiting an additional 1,700 over the next few years, and from March this year, compared with March the previous year, the most urgent calls—the category A red 1 calls—went up by 24% and the ambulance service answered nearly 2,000 more calls within the eight-minute period. There is a lot of pressure, we have a plan to deal with it, but we need to give credit to the ambulance service for its hard work.
I stood against Charles Kennedy in 1992 in Ross, Cromarty and Skye and will take the opportunity tomorrow of remembering what a very happy occasion it was and how very glad I was to lose to Charles at that election.
I strongly opposed the creation of the South Western Ambulance Service because I believed the Wiltshire Ambulance Service did a better job on its own. I know the Secretary of State has been monitoring the calls received by the South Western Ambulance Service—one of the two trial areas. Will he tell the House whether response times in the south-west have improved or got worse in recent years?
NHS England will be updating the House on the results of that trial. It was a very important trial because it was designed to stop the dispatch of ambulances to people who did not need one within eight minutes, in order to make sure ambulances were available for people who did need one. South Western was very helpful in taking part in that trial and we will update the House shortly on the results of it.
Yesterday 400 people in my region expected to begin a paramedics course put on by the East of England Ambulance Service only to discover that there is no course and they are now £4,000 out of pocket. That is because the University of East Anglia and Anglia Ruskin University could not get accreditation for the courses. Does the Secretary of State think this event is going to help the ambulance service in the east of England where staff are already overwhelmed? It is a critical service—a vital service. Does he think this will contribute to hitting those targets, which at the moment are being inadequately met?
I welcome the hon. Gentleman to his place. It is important that we train more paramedics. It is one of the most challenging jobs in the NHS and I will take up the issue he raises with the Secretary of State for Business, Innovation and Skills to understand precisely what the problem was and to try to resolve it as quickly as possible.
Will the Secretary of State consider reviewing the protocol, which is unique to the ambulance service in terms of our emergency services, that breaks cannot be broken into even if there is a category A incident in the area? We had the loss of a young man in Berwick recently; the ambulance which was in post in the ambulance station a mere four minutes down the road was not called and the boy died. That is the cause of enormous distress across the rural areas of Northumberland.
I welcome my hon. Friend to her place as someone who campaigned a great deal on health issues while she was a parliamentary candidate; it is wonderful to see her here. That is a tragic case and we need to look at those rules. I will take that up and see what we can do.
Translarna (Duchenne Muscular Dystrophy)
2. When he expects NHS England to reach a decision on access to Translarna for the treatment of Duchenne muscular dystrophy; and if he will make a statement. (900001)
NHS England is considering the interim commissioning position for Translarna as part of its wider prioritisation process for funding in 2015-16 and expects to come to a decision by the end of this month. Translarna has also been referred for evaluation by the National Institute for Health and Care Excellence’s highly specialised technologies programme. Draft NICE guidance will be available later this year, with final guidance expected in February 2016.
I thank the Minister for that response and welcome him to his place. Yesterday my constituent Jules Geary came to see me regarding her son Jagger, who suffers from Duchenne muscular dystrophy. Jagger had been approved for Translarna treatment but then suddenly found that it had been withdrawn at the last moment. Like many other boys, he is now waiting, not knowing when a treatment that will prolong his mobility will be forthcoming. Will my hon. Friend meet me, Jules and Muscular Dystrophy UK to discuss how this process can be streamlined so that other children do not have to wait this long?
Muscular dystrophy is a terrible, debilitating illness and my sympathies go out to Jagger and his family. My hon. Friend will be aware that families and their representatives will be going to Downing Street on 10 June to make their representations on this matter. The Minister for Life Sciences has introduced an accelerated access review precisely because of the concerns that my hon. Friend has raised, and I know that he will welcome representations once it has been completed.
Is the Minister aware of the case of my constituent, little George Pegg? At one time he could not walk, but this drug has made his life 100% better and he can now walk. Why are we dithering? This has been going on for at least a year, so why don’t you get off that backside of yours and get it approved?
I thank the hon. Gentleman for his question. In relation to posteriors, it is good to see his in its rightful place. I have heard of his constituent’s case, which is as distressing as that of Jagger and of all those suffering from Duchenne muscular dystrophy. It is a terrible disease that causes lasting pain to the sufferers and their families. That is precisely why we are pushing hard for a decision from NHS England by the end of this month—it could not have come as quick as he had hoped—and for interim NICE guidance by the end of this year. I am pushing officials to move as quickly as they can on this.
The reality is that NHS England has failed to respond to letters or to turn up for meetings, and it has behaved in an utterly unaccountable manner in regard not only to Translarna but to Vimizim, which is used to treat Morquio syndrome. We have still not had confirmation that an interim decision will be made on 25 June, but we are now being told that there will be a decision from NICE on 5 June. Will Ministers finally get a grip on this and give the families affected by these various conditions some sense of when they might get the treatment that could improve their quality of life?
I am sorry to hear that the hon. Gentleman has had that experience with NHS England. My hon. Friend the Minister for Life Sciences will want to speak to him about that; if it is the case, it is clearly unacceptable. As the hon. Gentleman will have heard from my previous answer, we are hoping to get quick decisions from NHS England on the interim commissioning guidance this month, and I am pushing hard for a decision from NICE as soon as possible this year, so that we can get interim guidance from it.
Mid Staffordshire NHS Foundation Trust
We are putting the terrible tragedy of the old Mid Staffs behind us, and I congratulate my hon. Friend and the staff at the hospital on their superb efforts under a great deal of pressure. We are also investing over £300 million in the Staffordshire health economy, and the local trust and commissioners are making good progress on implementing the recommendations made by the trust special administrators.
I thank my right hon. Friend for his reply. He will have seen the reports over the weekend on the severe pressure on accident and emergency services at the Royal Stoke University hospital, while Stafford’s County hospital A&E often meets the 95% four-hour target. The trust special administrators assured us that the Royal Stoke would have the capacity to cope with additional patients from Stoke and Stafford. Given that that is not the case, will the Secretary of State ensure that A&E in Stafford is reopened to operate 24/7 as soon as is clinically possible?
I share my hon. Friend’s concern about what is happening at the Royal Stoke. Some of the care there was totally unacceptable; there should be no 12-hour trolley waits anywhere in the NHS. I have said that I support a full 24/7 A&E service at County hospital as soon as we can find a way of doing it that is clinically safe, and I will certainly work hard to do everything I can to make that happen.
Administrative Burdens (GPs)
4. What steps he is taking to reduce the burden of administration on GPs. (900004)
Before I respond, I should like to thank my two predecessors, who have covered most of this portfolio: my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) and the right hon. Member for North Norfolk (Norman Lamb). They have given me a firm foundation on which to build, and I am grateful to them for their work in the Department. Reducing the burden of administration on GPs is important to all of us in the Government. We have already cut the quality and outcomes framework by more than a third to help reduce administration, but we are looking for ways to do more because we recognise that this is a significant problem.
Let me take this opportunity to welcome my right hon. Friend back to the Front Bench. I know that he will want to spend a lot of time in GP surgeries, and we look forward to welcoming him to Lincolnshire in due course.
I want to ask him about the use of information technology and computers during consultations with GPs. I am told by a GP in my constituency that so much time is spent collecting data and inputting them into the computer that there is a loss of focus on the patient, with a possible detriment to patient care. Will my right hon. Friend undertake to look into that and to come to the House in due course to say what can be done to ensure that, during every GP consultation, the focus is always on the patient and not on the computer?
Notwithstanding the importance of recording information collected during a consultation, my hon. and learned Friend’s constituent is absolutely right that it should not get in the way of the relationship between doctor and patient. We have already removed some of the administrative burdens by cutting a third of the quality and outcomes framework indicators that need to be recorded, but plainly more needs to be done. He is right to say that I am looking forward to seeing quite a lot of GP surgeries in the forthcoming months.
I welcome the Minister to the Dispatch Box. Does he think that the community pharmacy could help in great ways with the proper integrated care of patients so that the burden on GP surgeries is shared with other health professionals?
Yes, the whole concept of out-of-hospital care involves an expansion of what is considered to be direct primary care, and it also involves other support services. I am aware of projects in which pharmacies are already connected directly to GP surgeries. We will be expanding some of the pilot work that has already been done. If my Twitter account is anything to go by, pharmacies are very keen to promote themselves and say what they can do for patients, and we will certainly be responding.
Will the Minister pass on my thanks to the Secretary of State for visiting a GP surgery in my constituency in April? Will the Minister assure the House that during his tenure he will continue to visit GPs and to spread examples of good practice to other GPs who may have room for improvement?
I thank my hon. Friend for his question, and the Secretary of State will have picked up his thanks for the visit. Seeing GPs is really important. I will let the House into something that I am likely to say again, which is that my dad is a GP. I pay tribute to him, as he has just passed his 93rd birthday. I thank him and all other GPs for their devotion to practice and to looking after people so well. They are a vital part of the service. I will be keen and rather soft on GPs. I want to see them enjoy their profession as much as my father has enjoyed his.
I welcome the hon. Lady to her place. Briefly, there is a £1 billion fund to improve, over the next five years, GP surgeries and premises and access to GP practices. It is an important part of the process of improving access to GPs, which is good not only for patients but for GPs, who can feel fully engaged in their work without being overburdened. This support should certainly help.
Dementia Diagnosis and Care
Following a sustained effort to improve dementia diagnosis rates in the last Parliament I am pleased to report that in England we now diagnose 61.6% of those with dementia, which we believe is the highest diagnosis rate in the world. But there is much work to be done to make sure that the quality of dementia care post diagnosis is as consistent as it should be.
I thank my right hon. Friend for his answer. A long-standing Weaver Vale constituent, Mrs Gladys Archer, successfully looked after her husband for many, many years at home until he was admitted to hospital for a routine operation. Following a misdiagnosis, he has had to go into a care home with all the personal cost and trials and tribulations that that involves. Will my right hon. Friend look into that case, and highlight what measures are in place and how we can improve matters so that we can stop patients with Alzheimer’s or dementia suffering when they are admitted to hospital?
I thank my hon. Friend for raising that case and I will happily look into it. That is a perfect example of why we need to change the way we look after people with long-term conditions, such as dementia, out of hospital. If we can improve the care that we give them at home and give better support to people such as that man’s wife, we can ensure that the kind of tragedy my hon. Friend talks about does not happen.
Unpaid family carers play a key role in the care of people with dementia, many with heavy caring workloads of 60 hours a week or more. Can the Health Secretary understand how fearful carers now are of talk of cutting their eligibility for carer’s allowance and will he fight any moves within his Government to do that?
I absolutely recognise the vital role that carers play and will continue to play, because we will have 1 million more over-70s by the end of this Parliament, and we need to support them. I hope that she will recognise that we made good progress in the previous Parliament with the Care Act 2014, which gave carers new rights that they did not have before.
18. Two weeks ago, it was dementia friendly care week and I had the pleasure of spending a part of that at a picnic in the village of Corfe Mullen in Mid Dorset and North Poole. Does my right hon. Friend agree that although much progress has been made in diagnosis, there is still a long way to go in terms of care, especially for those individuals in Mid Dorset and North Poole? (900020)
I welcome my hon. Friend warmly to his place; he hits the nail on the head. We had a big problem with diagnosis—less than half of the people who had dementia were getting a diagnosis—and we have made progress on that. It is still the case that in some parts of the country, although I hope not in Mid Dorset, when someone gets a diagnosis not a great deal happens. We need to change that, because getting that support is how we will avoid tragedies such as that in Weaver Vale, which we heard about earlier.
The Secretary of State knows that the availability of social care for vulnerable older people has a big impact on the NHS, especially for people with dementia, yet 300,000 fewer older people are getting help compared with 2010. Given that the Secretary of State has said that he wants to make improving out-of-hospital care his personal priority, can he confirm that there will be no further cuts to adult social care during this Parliament, which would only put the NHS under even more pressure?
I can confirm that we agree with the hon. Gentleman and the Opposition that we must consider adult social care provision alongside NHS provision. The two are very closely linked and have a big impact on each other. I obviously cannot give him the details of the spending settlement now, but we will take full account of that interrelationship and recognise the importance of the integration of health and social care that needs to happen at pace in this Parliament.
Emergency Medicine (Doctor Recruitment)
The Secretary of State meets the Royal College of Emergency Medicine on a regular basis. The number of middle-grade emergency medicine doctors has increased by 24% since May 2010. Health Education England is working with the RCEM further to strengthen the workforce to ensure that patients receive high quality care.
I thank the Minister for his response, but I disagree with him. There is a shortage of middle-grade accident and emergency doctors. When will the next recruitment of such doctors take place in the Indian subcontinent and elsewhere and have all the Home Office regulations and impediments been resolved to allow the recruitment to take place?
I should make it clear first that, for the hon. Lady’s constituents, we have no say over the control of the health service in Northern Ireland. We have seen an increase of 24% in middle-grade doctors in the English health service and, as I have said, we have seen an increase in all doctors in emergency medicine of 25%. That is a considerable increase in an area that has been difficult to recruit to for a very long time. The Government made a difference in our previous incarnation and we will continue to do so.
I welcome my hon. Friend to his place and wish him well. Is he aware that when the Select Committee on Health considered emergency care and took evidence from the Royal College of Emergency Medicine in the last Parliament it was clear that there was a perception among doctors that this was not as attractive as other specialties and that that is a serious problem? What is he going to do about it?
I thank my hon. Friend for bringing that to my attention. I was not aware of it and it is certainly something I shall consider. There are several specialties in the NHS where this is a problem and I shall be addressing that as I review the workforce in the years to come.
The Government have committed to make sure GPs can be accessed when needed seven days a week, ensuring that people are able to access primary medical care when they need to.
This is already being rolled out through the GP access fund, which will enable 18 million patients to benefit from improved access to their local GP, including extended hours, telephone or Skype consultations.
Does the Secretary of State agree that the news he brings will be of great comfort to elderly people in particular, but in addition the signposting of people towards GPs rather than acute hospitals will be very important and a very useful addition to our policy?
My hon. Friend makes an important point. It is partly the availability of services seven days a week, which we need to provide because illnesses do not happen on only five days a week and we need to respond to changing consumer expectations; but it is also about the signposting. That is absolutely critical, so that people know where to go and do not overburden A&E departments, which should be there for real emergencies.
The right hon. Gentleman talks about access to GPs. Will he wait a moment and think about Islington South, where this month we have three GP surgeries closing because our GPs have all resigned? Given the changes in the funding formula that this Government have overseen, will he meet a group of inner-London MPs to talk about our grave concerns about the change to funding and the lack of resources available to GPs?
I am happy to ensure that inner-London MPs have a meeting with the Minister to discuss those issues. The underfunding of general practice has been an historical problem, because we have had very strong hospital targets, which have tended to suck resources into the acute sector and away from out-of-hospital care. We want to put that right.
The problem in Northamptonshire is that because of rapid population growth, the gap between the appointments required of GP surgeries and the slots available is one of the biggest in the country. There are 333 Northamptonshire GPs at the moment; Healthwatch Northamptonshire estimates that another 183 will be required within the next five years. How are we going to fill that gap?
My hon. Friend is absolutely right to draw attention to that issue. We have plans to train another 5,000 GPs across the country. In the last Parliament, we increased GPs by about 5%. We need to go much further, as part of a real transformation of out-of-hospital care.
How does the Minister intend to find the 5,000 extra GPs when many surgeries throughout the United Kingdom cannot fill the spaces that they have, and how does he plan to fund it? The proposals appear to only fund the setting up of seven-day-a-week, 8 till 8 GP services and not running costs—and these are big running costs.
I welcome the hon. Lady to her place. We do need to find these extra GPs and we will do that by looking at GPs’ terms and conditions. We need to deal with the issue of burnout because many GPs are working very hard. We also need to raise standards in general practice. In the previous Parliament, an Ofsted-style regime was introduced, which is designed to ensure that we encourage the highest standards in general practice. That is good for patients but also, in the long run, good for GPs as well.
Just so that the Secretary of State is aware, it takes 10 years to produce a GP, so that will not be an immediate response. The £8 billion that the Conservatives have suggested they will add by 2020 was just to stand still, not to fund a huge expansion, and as change, which the NHS requires, costs money, can the Secretary of State perhaps give us an indication of what extra we may expect in the next two years?
Well, I can, but may I gently say that under this Government and under the coalition we increased the proportion of money going into the health budget, whereas the Scottish National party decreased the proportion of money going into the NHS in Scotland? The £8 billion is what the NHS asked for to transform services, and that will have an impact, meaning that more money is available for the NHS in Scotland. I hope the SNP will actually spend it on the NHS and not elsewhere.
I thank the Secretary of State for personally intervening to enable the Ilex View medical centre in Rawtenstall to open for longer hours, despite that being precluded under its private finance initiative lease of that building. Will he update the House on what steps can be taken to ensure that where GPs are in a building that is subject to a PFI lease, he will be able to intervene to ensure that they can truly open seven days a week and for extended hours?
This is one of the main reasons why the Chancellor allocated £1 billion to modernise primary care facilities in the autumn statement. We recognise that many GP premises are simply not fit for purpose. If we are going to transform out-of-hospital care, we need to find ways to help GPs move to better premises, to link up with other GP practices, and that will be a major priority for this Parliament.
The 2010 Conservative manifesto promised every patient seven-day GP access from 8 am to 8 pm, but access has got worse and almost half of all patients now say they cannot see a GP in the evenings or at weekends. Five years on, the Conservatives made the exact same promise. Can the Secretary of State tell us why he has failed?
I welcome the hon. Lady back to her place, although I know she hopes it will be for only a brief time, and say to her that we have not failed. We made very good progress delivering seven-day access to GP surgeries for nearly 10 million people during the last Parliament, and we have committed to extending that to everyone during this Parliament. I think the hon. Lady said that what is right is what works, and what works is having a strong economy so we can put funding into the NHS that will mean more GPs.
The Keogh review is all about responding to the long-term challenges facing the NHS, many of which we have already discussed in this Question Time. The implementation of the recommendations of the Keogh review will improve urgent and emergency care services and ensure patients get the right care in the right place.
The “Shaping a healthier future” programme in north-west London, which is seen as a prototype for Keogh in closing or downgrading A&Es, is causing great concern, from the tragic death of Guy Bessant reported yesterday to the more than £20 million spent on external consultants last year. Eleven west London MPs would like to meet the Secretary of State and, I hope, the Under-Secretary, to discuss those concerns. Will they agree to meet us?
I read of the tragic death of that gentleman, who was a Wandsworth resident. Our hearts go out to his family.
As the hon. Gentleman knows, “Shaping a healthier future” is a clinically led programme supported by all eight clinical commissioning groups in the area and all nine medical directors of the trusts involved. There are no plans to make changes to A&E services at Ealing hospital, contrary to what was put about during the election, but I recognise that this is the subject of ongoing concern. All the recommendations of the Keogh review are entirely driven by one thing, which is putting patients and patient safety first, but I am happy to meet him and his colleagues to discuss it.
In implementing the Keogh review, will the Minister also consider the impact on our community hospital minor injuries units, given the difficulties they are facing in staff recruitment? Will she meet me to discuss the difficulties facing Dartmouth community hospital? There are wider implications for the rest of the country.
I think I have some sense of the difficulties my hon. Friend describes from previous meetings, but I am of course happy to talk to her about that. All these things are important, but as I say, the driving principles behind the Keogh review are patient safety and making sure that people get the best and most appropriate urgent and emergency care.
Adult voluntary sector hospices in England receive, on average, about a third of their running costs from the NHS. Although this amount varies for individual hospices and it is a locally commissioned service, the level of funding has remained broadly stable.
I delighted that my right hon. Friend is back on the Front Bench. He will know that hospices up and down the country, such as Willen hospice in Milton Keynes, do a marvellous job in caring for terminally ill patients and their families, yet they have an annual struggle to raise money from local communities to support their work. Will he assure me that he will do all he can to maximise the direct funding that hospices receive from the NHS?
I thank my hon. Friend for raising this subject. He is absolutely right: Willen hospice in his constituency, next door to mine, has an excellent reputation, as does St John’s hospice in Moggerhanger in my constituency. We are all indebted to hospices for the invaluable work they do. I am sure that he and the House will be interested to hear that, from April, there will be pilot projects working on a new funding formula for palliative care, with the aim of providing a fair and transparent process and improvements. I expect that there will be a report to the House in due course.
Does the Minister agree that there is a deeper ongoing problem in the financing of hospices? Kirkwood hospice in my constituency faces it all the time. Is it not about time we tackled long term the roots of the problem of funding hospices?
That is probably tied into the whole issue of end-of-life care. A review of that is going on, as the hon. Gentleman may be aware. End-of-life care is important. Choices for people about where they wish to end their days is very important, and the Choice review which reported recently, whose recommendations the Government are considering, will make further progress. Hospice funding is part of that, but we expect local commissioners to take notice of what hospices can provide for those in their area.
I welcome my hon. Friend to her place. Building on the national diabetes prevention programme, we are developing a comprehensive action plan to improve the outcomes of people with and at risk of diabetes.
I thank my hon. Friend for her excellent response. As she will know, diabetes can often lead to the amputation of a limb. Fareham, my constituency, has one of the highest rates of limb amputations in the country. Can my hon. Friend please explain how the NHS diabetes prevention programme will address this issue?
My hon. Friend raises an extremely important issue. I welcome the fact that she has so quickly got to grips with some of the key local health facts in her area. Hon. Members across the House can look at how their clinical commissioning group is performing in the national context. My hon. Friend is right to say that her CCG performs poorly when it comes to amputations. There is a huge opportunity for improving the outcomes for people if we can get the worst-performing CCGs in that context up to the standard of the best. The national diabetes prevention programme is very much about preventing people getting to the stage where those complications can cause such terrible problems.
13. May I join the Minister in congratulating the hon. Member for Fareham (Suella Fernandes) on her place in this House? She was a worthy opponent of mine in 2005 and I am glad she managed to get elected. On the national diabetes prevention programme, for those of us who have diabetes the issue is what is corporate Britain doing to work with the Government in order to reduce the amount of sugar and fat in food and drink? Unless we do that, we cannot tackle the diabetes crisis that we will face. (900015)
The right hon. Gentleman is quite right. Tackling obesity is one the great public health challenges of our age. Right across the developed world we are looking at all the things that are going on around the world—the new science and the new research. The right hon. Gentleman is right to say that industry has a role to play, as has every part of Government—national Government and local government—as well as families, GPs and the NHS. This will be a whole-nation approach to tackling obesity. We are working on our plans, which I look forward to discussing with him in due course.
Type 2 diabetes is costing our NHS £9 billion a year, and obesity, as we have heard, is the major risk factor. Does the Minister agree with the previous Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), who said the other week that
“Just taking a passive approach to”—
“is not going to work…we have to go further than we’ve gone up to now in the responsibility deal”?
Does the Minister agree and what more is she going to do about it?
I welcome the hon. Lady back to her place. It is good to see her back in that job and not on the Government Benches. It is far from the case that we took a passive approach—far from it. Some important things were learned from the way we have worked with industry and we are looking to build on those, but as I have said, there is no silver bullet. There is not a single academic study in the world that says that the way to respond to obesity in the developed world is through a single mechanism. We have to look at a whole-system approach, and that is what we are doing.
Hospital Trusts (Deficits)
The NHS faces significant financial challenges this year and beyond. That is why we have now committed £10 billion extra for the NHS—£2 billion for this year and at least £8 billion more by 2020. Individual trust plans for 2015-16 are still being worked up but, with concerted financial control from providers, we expect to deliver financial balance in 2015-16.
But does the Secretary of State accept that in trusts such as mine, which anticipates a £15 million deficit this year, that cannot be done without cuts to staff, beds and services? What happened to the Prime Minister’s pledge on a bare-knuckle fight to protect district general hospitals, when trusts such as mine are facing such circumstances?
I will tell the hon. Lady what has happened to the Prime Minister’s pledge to protect hospitals: an extra £10 billion that we have promised for the NHS, which her party refused to promise. Her local hospital has 88 more doctors since 2010, and it is doing an extra 2,000 operations for her constituents year in, year out. I will tell her what makes the deficit problem a lot worse: the heritage of the private finance initiative, which means £73 billion of debt that her party bequeathed to the NHS.
In 2004 the then Huntingdonshire primary care trust said that it would give Hinchingbrooke hospital a grant of £8 million towards the cost of a new PFI treatment centre. Shortly before the PCT’s demise, it changed without discussion the terms of the grant and made it a loan, which has since been treated in its accounts as a deficit. If I write to my right hon. Friend, will he look into that patently unfair treatment?
On behalf of everyone on the Opposition Benches, I echo the Secretary of State’s warm tribute to Charles Kennedy. I cannot have been the only person this morning wondering why politics always seems to lose the people it needs most. Charles was warm, generous, genuine and principled. We will miss him greatly. We send our love and deepest sympathy to his family.
I congratulate the Secretary of State on his reappointment, but I commiserate with him on the financial position in the NHS that he inherits from himself. He told The Daily Telegraph today that the NHS has enough money, but that is not true. The deficit in the NHS last year was nearly £1 billion. Can he tell the House what the projected deficit is for the whole of the NHS for this year?
I welcome the right hon. Gentleman to his place. We have seen many feisty disagreements on health policy, and that is just in the shadow Health team. Perhaps he no longer believes his mantra about collaboration, not competition—we know that the shadow care Minister has disagreed with that for some time. To answer his question directly, there is a lot of financial pressure in the NHS, and that is because NHS hospitals took the right decision to respond to the Francis report into Mid Staffs by recruiting more staff to ensure that we ended the scandal of short-staffed wards. As a temporary measure it recruited a lot of agency staff, which has led to deficits, and that is what we are tackling with today’s announcement about banning the use of off-framework agreements for recruiting agency staff.
It is a new Parliament, but there are the same non-answers from the Secretary of State. He did not answer; he never does. I will give him the answer: NHS providers are predicting the deficit to double this year to more than £2 billion. Why has financial discipline been lost on his watch? It is because early in the previous Parliament the Government cut 6,000 nursing posts. They cut nurse training places and, when the Francis report came out, they left hospitals with nowhere to turn other than private staffing agencies. The Bill for agency nurses has gone up by 150% on his watch. He even admitted on the radio this morning that it was a mess of their making. Will he now apologise for this monumental waste of NHS resources and get our hospitals out of the grip of private staffing agencies by recruiting the 20,000 nurses that the NHS needs?
I have here the figures on nurse training placements, which started to go down in 2009-10, by nearly 1,000. Who was Secretary of State at the time? I think it was the right hon. Gentleman. [Interruption.] I have the figures here, and they show that planned nurse training places went down from 21,337 to 20,327. He talks about apologies, but where is the apology for what happened at Mid Staffs, which led to hospitals having to recruit so many staff so quickly? That is the real tragedy, and that is what this Government are sorting out.
May I give my hon. Friend a particularly warm welcome to her place? NHS England routinely commissions eculizumab for the treatment of paroxysmal nocturnal haemoglobinuria, or PNH, and atypical haemolytic uraemic syndrome, or aHUS, as the drug is proven to be safe and effective in treating these conditions.
I very much welcome the statement last week from the Prime Minister in which he requests NHS England to look into the case of my constituent, 12-year-old Abi Longfellow. I am sure that gives great hope to Abi’s family. Abi has a rarer form of DDD—dense deposit disease—involving the alternative complement pathway, and there is evidence that eculizumab helps. Will my hon. Friend ensure that NHS England looks at this rare form and gathers evidence not just from the UK but from countries such as the US, China and Canada which have research and trials in this area?
This is a particularly difficult and tragic case. My hon. Friend is right to champion the case of her young constituent. My right hon. Friend the Prime Minister asked NHS England to make further contact with the Longfellow family to fully explain the decision, and I can confirm that the clinical director for specialised services at NHS England North has spoken to the family twice in the past few days. The National Institute for Health and Care Excellence is reviewing, as a priority, the evidence on the use of eculizumab in treating this condition.
During the previous Parliament I made it my priority to ensure that NHS hospitals learned from the tragedy of Mid Staffs to transform themselves into the safest hospitals anywhere in the world. That work will continue. Today NHS England has announced measures to ensure that even more funding is available to improve the quality of care. These include restrictions on the use of agency staff and management consultancies, and on senior pay. It is right that the NHS takes every possible measure to direct resources towards improving patient care.
I thank the Secretary of State for supporting the bid by East Lancashire Hospitals NHS Trust for £15.6 million to improve the surgical centre, opthalmology and out-patient services at Burnley General hospital, on which I lobbied him extensively. Thanks to the hard work of the trust’s staff, it has exited special measures. What progress has been made on improving safety in hospitals via the special measures regime?
Order. I remind the House at the start of the Parliament—this might be of particular benefit to new Members—that topical questions are supposed to be significantly shorter than substantive questions: the shorter the better, and the more we will get through.
The Secretary of State has said that safe care and good finances go together, but clinical negligence claims are up by 80% since 2010, while trusts are posting huge deficits. Does he think that finances have deteriorated because care quality has deteriorated or that care quality has deteriorated because finances have deteriorated?
The evidence is very clear that safer hospitals end up having lower costs, because one of the most expensive things that can be done in healthcare is to botch an operation, which takes up huge management time as well as being an absolute tragedy for the individual involved. My message to the NHS is this: the best way to reduce your costs and deliver these challenging efficiencies is to improve care for patients. Our best hospitals, like Salford Royal and those run by University Hospitals Birmingham NHS Foundation Trust, do exactly that.
T2. Bringing health and social care together in meaningful integration is a priority for me and my constituents in St Ives. What can the Secretary of State do to help achieve this for the good people of west Cornwall and the Isles of Scilly? Will he accept an invitation to come to west Cornwall to discuss this challenge and see some of the good work that is already being done? (900026)
May I welcome my hon. Friend to his place? Among the many good reasons to go to Cornwall over the next few months will be to visit the Cornwall better care fund, which is part of the Government’s £5.3 billion better care fund, and get the opportunity to see the work of the Cornwall pioneer. Integration of social care and healthcare is extremely important, and it will be great to see it in Cornwall.
T3. For the first time in recent history, many of London’s more prestigious teaching hospitals—King’s College, University College London, Guys and St Thomas’s, and the Royal Free—are all forecasting deficit budgets. Apart from crossing his fingers and hoping the economy picks up to fund investment, what exactly is the Secretary of State going to do to tackle this problem? (900027)
I would not expect the hon. Lady to want to listen to me on the “Today” programme, but I have been talking a lot today about the measures, including in my topical statement. I will tell her exactly what we are doing: this week we are announcing measures to restrict the use of agency staff, which was an important, necessary short-term measure in response to what happened at Mid Staffs. We need to move beyond that. Later in the week we will be helping trusts reduce their procurement costs and taking a number of measures, so a lot is happening. There are a lot of challenges, but I know that NHS trusts can deliver.
T5. Burton hospital trust and the Heart of England foundation trust are discussing how they can make better use of the facilities at the Sir Robert Peel hospital. Will colleagues on the Treasury Bench encourage both trusts to make better use of the facilities, provide new facilities and services at the hospital, and make sure that local people are properly consulted? (900029)
It is a particular pleasure to see my hon. Friend returned to the House. He will be aware that local commissioning decisions are the responsibility of local commissioners, which is something that this Government will continue, as per our reforms in the last Government. I am making it expressly clear to NHS England that I expect consultations to be full and proper and to engage everyone in the local community.
T4. The Secretary of State has admitted this morning that under his watch the NHS and the taxpayer have been ripped off to the tune of somewhere in the region of £1.8 billion for temporary workers and £3.3 billion for agency workers. How many fully qualified NHS nurses could have been employed with that type of finance? (900028)
I will tell the hon. Gentleman what we have done: on my watch, there are 8,000 more nurses in our hospitals to deal with the tragedy of the legacy of poor care left behind by his party. That is what we have done. As part of that, trusts also recruited temporary staff. They have become over-dependent on them, which is why we have taken the measures we announced this morning.
T8. I am very grateful to the right hon. Gentleman for agreeing to meet me and some inner- London MPs to discuss the crisis of GPs in Islington and the surrounding area. In preparation for that meeting, will he look very carefully at the funding formula? It has changed, which means that resources have moved out of inner London to areas such as Bournemouth, where there are more older people. We need to look very carefully at that. Three surgeries have closed in Islington. (900032)
T7. The rate of hospital-acquired infections improved dramatically and halved in the last Parliament. Having lost my own father to a hospital-acquired infection, I am fully aware of the challenges we face. Will the Secretary of State look into ensuring that surgical site infections are included in all future statistics? In doing so, we can work on eradicating them, as they are a common way to catch an infection. (900031)
May I, too, welcome my hon. Friend to her seat. I was aware of the tragic death of her father, so she will be pleased to know that we are already collating information on SSIs resulting from orthopaedic surgery. That is done by Public Health England and the information is available from NHS England as a set of statistics. We are looking at what else we can do to include indicators on SSIs for other procedures.
T10. May I invite Ministers to comment on the recent statement by the Academy of Medical Royal Colleges that the Government’s anti-obesity strategy is“failing to have a significant impact”and that there is a“huge crisis waiting to happen”? (900034)
The Government is quite clear, as was the coalition Government, that tackling obesity is one of the great challenges of our time for the whole of the developed world, not just this country. We are looking at a comprehensive strategy right across all aspects of Government, including local government and so on. We will address that and rise to the challenge. Everyone has a part to play, including, as has been said during this Question Time, industry and, of course, families themselves.
T9. My constituent Daniela Tassa has lost her hair while being treated for secondary breast cancer. Sadly, Miss Tassa has been turned down by Solihull clinical commissioning group for a hair replacement treatment called intralace. Is there any guidance that Ministers can offer CCGs when it comes to the sanctioning of such hair replacement treatments? (900033)
I welcome my hon. Friend to his place. I am very sorry to hear of his constituent’s diagnosis of secondary breast cancer. It is of course vital that the NHS supports all patients in the best way possible, but clinical commissioning groups need to make decisions on whether to commission a particular hair-replacement service for patients based on their clinical benefit and cost-effectiveness. I very much hope his CCG will be looking carefully at that.
The planned closure of a GP surgery in my constituency means that more than 1,000 patients will have to go elsewhere to seek basic primary care needs. Local doctors are particularly concerned about the impact this will have on the A&E department at the Royal Free hospital. Will the Minister agree to meet me and local doctors to address those concerns and to ensure that the future of GP surgeries in my constituency is protected?
I welcome the hon. Lady to her place. As has already been covered, the closure of GP surgeries is an issue. They happen from time to time. As my right hon. Friend the Secretary of State said, there will be an opportunity to meet inner-London MPs to discuss this matter.
The all-party group on cancer has long campaigned on the importance of holding clinical commissioning groups accountable for their one-year cancer survival rates as a means of promoting earlier diagnosis. That will be part of the delivery dashboard from April onwards. What steps will the Government take to ensure that underperforming CCGs take corrective action?
My hon. Friend has long championed this issue and I look forward to debating it with him further. He is right to say that the CCG scorecard is currently being developed. Academic experts are looking at a range of indicators, including the one-year cancer survival data which he has brought to the House so often, for inclusion in the scorecard. It is likely to be published this summer. I will of course look carefully at the points he makes ahead of that.
With your permission, Mr Speaker, may I join others in marking the tragic death of Charles Kennedy? He was one of the most able politicians of his generation, and was loved and admired across the political spectrum. He was a brave and principled man, and he will be missed enormously.
May I raise with the Secretary of State my passion for mental health? He will be very much aware of my absolute determination to achieve equality for those who suffer from mental ill health. Will he guarantee that he will do everything to ensure that people with mental ill health get the same timely access to evidence-based treatment as everyone else?
May I start by saying that it was an incredible privilege to work with the right hon. Gentleman on the Government Benches on mental health issues over many years? He was a great inspiration to many people in the mental health world for his championing of that cause. It is my absolute intention to ensure that his legacy is secure and that we continue to make real, tangible progress towards the parity of esteem that we both championed in government.
I welcome the expansion of GP services to seven days a week. Will the Secretary of State remember rural areas such as Ribble Valley when GP services are expanded? Funnily enough, people who live in rural areas also get ill at the weekends.
We will absolutely remember them. That is why it is so important to embrace new technology. Sometimes people who have to travel long distances are able to use such things as Skype or to make a phone call to receive important advice. This is a big priority for us.
With almost 82,000 people living with diabetes in Northern Ireland over the age of 17, does the Minister agree that this ticking time bomb needs more research into better treatments? One way of doing that would be to ensure that there is sufficient funding for Queen’s University in Belfast, in the hope of providing a superior treatment for the many who are affected and living with that disease.
The hon. Gentleman is right to draw attention to the important role of research. We will leave no stone unturned in looking at all aspects of the treatment or prevention of diabetes. The issue of research is something I recently discussed with the chief medical officer. I will draw to her attention the point he makes. As he knows, although health is a devolved matter we always make a point of sharing all research right across our United Kingdom.
May I invite the new Minister with responsibility for GPs to meet me and a couple of excellent GP surgeries that want to expand their services for the local community but are being prevented by the local clinical commissioning group?
Of course I welcome my hon. Friend’s invitation. The innovative work being done by a number of GP practices around the country to expand services is welcomed by all; there is an opportunity to take good practice from one GP practice to another. In addition to my visit to Cornwall, I am clearly on the way to Derbyshire.
With the accident and emergency crisis, over which the Secretary of State has presided, more and more police officers are queuing outside fewer A&E departments in ever-lengthening queues. Last year, there were 1,000 incidents in the Metropolitan police alone. In Liverpool, Patrick McIntosh died after waiting for an ambulance for an hour. Does the Secretary of State accept that after 17,000 police officers have been cut by his Government, this is the worst possible time to ask the police service to do the job of the ambulance service, and that he is guilty of wasting police time?
I think that is harsh. Let me tell the hon. Gentleman some of the progress that was made under the last Government, and that this Government will continue, to reduce the pressure on police, particularly with regard to the holding of people with mental health conditions in police cells. We are in the process of eliminating that; it has seen dramatic falls. We recognise that the NHS needs to work more closely with the police, particularly in such circumstances, and he should recognise the progress that has been made compared with what happened before.
Order. I am genuinely sorry that some colleagues were disappointed today; I ran things on a bit, but we need to move on. In one respect, Health questions is analogous to the national health service, under whichever Government, in that demand always exceeds supply, but I have noticed colleagues who were trying to take part today and I will seek to accommodate them on a subsequent occasion.
Debate on the Address
Debate resumed (Order, 1 June).
Question again proposed,
That an Humble Address be presented to Her Majesty, as follows:
Most Gracious Sovereign,
We, Your Majesty's most dutiful and loyal subjects, the Commons of the United Kingdom of Great Britain and Northern Ireland in Parliament assembled, beg leave to offer our humble thanks to Your Majesty for the Gracious Speech which Your Majesty has addressed to both Houses of Parliament.
Health and Social Care
It is an honour to speak about health and social care in our debates on the Gracious Speech, because nothing matters more to this Government than providing security for all of us at every stage of our life, and nothing is more critical to achieving that than our NHS.
I start by welcoming the right hon. Member for Leigh (Andy Burnham) and his colleagues back to their positions. I will not take it personally that two of them want to break from debating with me to go elsewhere. However, it is a topsy-turvy world when the shadow Health Secretary who was the scourge of private sector involvement in the NHS now wants to be the entrepreneurs’ champion. As one entrepreneur to another, may I put our differences to one side and on behalf of the whole Conservative party wish him every success in his left-wing leadership bid? This is perhaps the only occasion in history when my party’s interests and those of Len McCluskey are totally aligned.
That is not to mention the hon. Member for Leicester West (Liz Kendall), who is, in her own way, a kind of insurgent entrepreneur, taking on the might of the Labour establishment, in the mould of Richard Branson or Anita Roddick. Sadly, I fear that she will demonstrate that pro-business, reform-minded, centre-ground policies are as crushed inside today’s Labour party as they would have been in the country if Labour had won the election.
The shadow Health Secretary said countless times during the election campaign that the NHS would be on the ballot paper. He was right—the NHS was indeed the top issue on voters’ minds—but not with the result he had intended. So, just as he has now done significant U-turns on Labour’s EU referendum policy, economic policy and welfare policies, I gently encourage him to do one on Labour’s health policies too.
The Queen’s Speech committed the Government to the NHS’s Five Year Forward View and the £8 billion that the NHS says it needs to fund it. The shadow Health Secretary refused to put such a commitment in Labour’s manifesto, and I hope today he will change that policy so that we can have cross-party consensus on this important blueprint for the NHS.
Does the Secretary of State agree that one of the biggest challenges we face is to achieve parity of esteem between mental health and physical health in the NHS, and that the way to achieve that parity is by ensuring that mental health services are properly funded and that we have a culture change in the NHS that means that physical health and mental health are treated as the same?
My hon. Friend is absolutely right, and I want to thank him for his tireless campaigning on parity of esteem for mental health in the last Parliament. One in 10 children aged five to 16 has a mental health problem, and it is a false economy if we do not tackle those problems early, before they end up becoming much more expensive to the NHS as well as being extremely challenging for the individual involved. We are absolutely determined to make progress in that area.
The Secretary of State has quite rightly said that the NHS needs to become more efficient. May I encourage him to visit Advanced Digital Institute Health, based in Saltaire in my constituency, so that he can see at first hand the wonderful work it is doing using modern technology to improve the quality of healthcare in our communities and to make it much more efficient, helping NHS resources go as far as we need them to go?
I would be delighted to visit my hon. Friend as soon as I can find the time, but I have already seen some great technology at Airedale hospital, which I think is in or near his constituency. It had some incredibly innovative connections with old people’s care homes, where people could talk to nurses directly, so there is some fantastic technology there, and I congratulate his local NHS on delivering it.
In the election campaign, the right hon. Member for Leigh talked constantly about NHS privatisation that is not actually happening. Now that he is the entrepreneurs’ champion, will he speak up for the dynamism that thousands of entrepreneurs bring to the NHS and social care system, whether they be setting up new dementia care homes, researching cancer immunotherapy, developing software to integrate health and social care or providing clinical services in the way he used to approve of when, as Health Secretary, he privatised the services offered at Hinchingbrooke hospital?
I am glad that the right hon. Gentleman is getting to the meat of the debate. My constituents and people around the country want to know whether the big issues will be tackled, and the big issues are difficult ones, such as tackling the royal colleges about the training of medical people, from nurses, doctors and other A&E professionals right the way through the system. Is it not time we had a radical approach to how we train our medical staff in this country?
We do need to make important changes to the training of medical staff, and I shall give the hon. Gentleman one example of where that matters: creating the right culture in the NHS so that doctors and nurses feel able to speak out if they see poor care. In a lot of hospitals they find that very difficult, because they are working for someone directly responsible for their own career progress, and they worry that if they speak out, that will inhibit their own careers. We do not have that culture of openness. The royal colleges have been very supportive in helping us make that change, but yes, medical training is extremely important.
To build on the point made by the hon. Member for Huddersfield (Mr Sheerman), is not a critical aspect—something that the Health Committee has looked at—what doctors are learning now? More needs to be done about prevention. Has my right hon. Friend seen early-day motion 1 about reducing levels of obesity, and is not reducing the amount of sugar in fizzy drinks a key challenge for him?
My hon. Friend is absolutely right. The big change we need to see in the NHS over this Parliament is a move from a focus on cure to a focus on prevention. In this Parliament, we will probably see the biggest single public health challenge change from smoking to obesity. It is still a national scandal that one in five 11-year-olds are clinically obese, and I think we need to do something significant to tackle that in this Parliament.
There is a big difference between the Secretary of State’s view of the health service and mine—he believes in a market; I do not. It is as simple as that. But I want to correct him on something. He just said that privatisation was not happening, but I will not let him stand at that Dispatch Box and claim that black is white any more. Figures show that as many contracts are going to private sector organisations as to NHS organisations. Will he confirm that that is the case and stop giving wrong information to the people of this country?
I gently say to the right hon. Gentleman that I believe in exactly the same use of the independent sector in the NHS as he did when he was Health Secretary; there is no difference at all. What has happened is that for whatever reason—I dare not think what—since he became shadow Health Secretary, he has changed his tune. The facts on privatisation are that it increased from 4.9% at the start of the last Parliament to 6.2% towards the end of the Parliament. That is hardly a massive change. Our approach is to be neutral about who provides services but to do the right thing for patients.
I worked on the front line of the NHS, in a service providing exemplary care, for more than 11 years. Just over two years ago that same service was privatised, and it has proved to be very damaging for patients, staff and the taxpayer alike. Will the Secretary of State continue to allow companies such as Virgin Care, which exists purely to make profits out of ill people, to continue to bid for NHS services?
May I welcome the hon. Lady to her place and say that I welcome to this place as many people with experience of working in the NHS as possible, because every Parliament has important debates on the NHS? Let me gently say to her that the biggest change made in the last Parliament was to take the decision about whether services should be provided by the public sector or the private sector out of the hands of politicians who might have an ideological agenda, and give it to local GPs so that the decision can be taken in the best interest of patients.
I happen to agree with the shadow Health Minister—the hon. Member for Leicester West (Liz Kendall)—but not the shadow Health Secretary that what is best is what works. Where it is best for patients to use charities or the independent sector, I support that, but I do not think it should be decided for ideological reasons by politicians.
Let me make some more progress, and I shall give way later.
The Queen’s Speech also talked about a seven-day NHS as part of our determination to make the NHS the safest healthcare in the world. When the right hon. Member for Leigh was Health Secretary, things were different, and he knows that we had a culture of targets at any cost and a blind pursuit of foundation trust status, which led to many tragedies. I hope he will today accept that if we are to make the NHS the safest and most caring system in the world, we must support staff who speak out about poor care, and stop the bullying and intimidation of whistleblowers that happened all too often before.
Finally, I hope we can agree on something else today—namely, that with the election behind us, we all use more temperate language in our health debates. There are many pressures on the NHS from an ageing population, tight public finances and rising consumer expectations, but the one pressure people in the service can do without is constantly being told by politicians that their organisation will not exist in 24 hours, 48 hours, one week, one month or whatever. It is a toxic mix of scaremongering and weaponising that is totally demoralising for front-line staff.
The Secretary of State has said that privatisation is not happening, but in Staffordshire the £1 billion end-of-life cancer care contract is up for tender, threatening the hospital finances at Royal Stoke even further. Before the election, my right hon. Friend the Member for Leigh (Andy Burnham) gave a commitment to the Royal Stoke University Hospital that it would be the preferred provider for this contract. Will the Secretary of State give that commitment today?
As I said earlier, I do not think these decisions should be made by politicians; I think they should be made by GPs on the ground, on the basis of what is best for the hon. Gentleman’s constituents. That is a dividing line between me and the shadow Health Secretary, if not the shadow Health Minister, because I think there is a role for the independent sector when it can provide better or more cost-effective services to patients. It appears that the Labour party, under the leadership of the right hon. Member for Leigh, would rule that out in all circumstances.
The right hon. Gentleman said right there that there is a role for the independent sector and that he is neutral about it but wants to see it increase. Then he says that privatisation is not happening. Is he trying to take everybody for mugs? He needs to come to this Dispatch Box and be quite clear about what is happening. Section 75 of his Health and Social Care Act 2012 does not give discretion to doctors; it forces NHS services out on to the open market. That is why we are seeing privatisation proceeding at a pace and scale never seen before in the NHS.
I am afraid that this is exactly the sort of distortion and scaremongering that got the right hon. Gentleman nowhere in the election campaign. He knows perfectly well that the 2012 Act does nothing different from what the EU procurement rules required under the primary care trusts when he was Health Secretary. Yes, I do believe that there is a role for the independent sector in the NHS, but I think the decision whether things should be done by the traditional NHS or the independent sector should be decided locally by GPs doing the right thing for their patients. That is the difference between us.
The Secretary of State is spot on with regard to the use of language. In the last Parliament the Health Select Committee saw an attempt to paint a picture of privatisation as equalling the provision of private health care. Will my right hon. Friend confirm that under the previous Government private sector activity in foundation trusts fell and the rate of privatisation was slower than in the preceding five years—something that the Committee noted in a report that was blocked by Labour members of the Committee?
Yes, I will. The figures that my hon. Friend cites are right. I will tell him something else. Half a million fewer people took out private health insurance in the previous Parliament because the quality of care that they could get on the NHS was rising. The Government are committed to the NHS. If the right hon. Member for Leigh does not want to believe what I am saying about privatisation, perhaps he will believe the respected think-tank the King’s Fund, which is clear that his claims of mass privatisation were and are exaggerated.
My right hon. Friend spoke eloquently about the importance of supporting mental health care, of parity of esteem and of technology. Does he share my view that the NHS has a strong embedded interest in the spread of fast broadband in rural areas, which would allow people better access to telemedicine and online psychotherapy?
Absolutely. I had a good visit to my hon. Friend’s county hospital, but I also remember seeing at Airedale hospital how reassuring it was for a vulnerable old lady to be able to press a red button on her armchair, be connected straight through to the local hospital and talk to a nurse within seconds. With that kind of service, that person is less likely to need full-time residential care. That is much better for her and more cost-effective for the NHS.
Much has been made of finances during this debate. I do not know whether my right hon. Friend is aware of this, but Darent Valley hospital in my constituency underspent by some £250,000 last year while providing the best services in Kent. The challenge that it is still dealing with today is the legacy of the private finance initiative that created the hospital in the first place.
My hon. Friend has an excellent hospital, which I hope to visit at some stage. A third of the hospitals that are in deficit have PFI debts that make it much harder to get back into surplus. That is a persistent problem, and we are doing everything we can to help them deal with it.
The reality is that hard-working NHS staff have made terrific progress in incredibly tough circumstances in recent years. More than a million more operations were performed last year compared with five years ago, yet fewer people are waiting more than 18 weeks for their operation. Seven hundred thousand more people were treated for cancer in the last Parliament than the one before. Despite winter pressures, we have the fastest A&E turnaround times of any country in the world that measures them. There is more focus on safety than anywhere in the world post Mid Staffs, with 21 hospitals in special measures, seven that have exited special measures, and improvements in quality and safety at all of them.
There are more doctors and nurses than ever before in the history of the NHS. Public satisfaction with the NHS was up 5% last year; dissatisfaction is at its lowest ever level. The independent Commonwealth Fund found that under the coalition the NHS became the top performing health system of any major country—better than the US, Australia, France and Germany. That is not to say that there are not huge challenges, including the fact that by the end of this Parliament we will have a million more over-70s, so we need important changes, especially a focus on prevention, not cure. That means much better community care for vulnerable people so that we get help to them before they need expensive hospital treatment. Part of that is the integration of health and social care, which the right hon. Member for Leigh deserves credit for championing. It also means transformed services through GPs, including the recruitment of more GPs to expand primary care capacity, and a new deal that puts GPs back in the driving seat for all NHS care received by their patients.
The Secretary of State is right to emphasise the need for greater resourcing and support for GPs. What steps is he taking to help GPs with earlier diagnosis of complex cancers? Early diagnosis leads to more effective treatment and less need for hospitalisation.
The hon. Lady is right. This week we saw the results of the international cancer benchmarks study, which showed that our GPs take longer than GPs in Norway, Sweden, Canada and Australia to diagnose cancers, and we still have a survival rate that lags. This needs urgent attention. The chief executive of Cancer Research UK is putting together a cancer strategy for the Government that I hope will address this issue. We will bring the results of that to the House.
Does the Secretary of State accept that the Better Care Together report on future services in Morecambe Bay put precisely that innovative focus on primary care and prevention, but that recognition of Morecambe Bay’s unique geography and extra funding are needed to implement it? The right hon. Gentleman said that he was sympathetic to that before the election. Has he now concluded that it is the way forward?
I understand that geographical isolation is a particular issue and may have led to some of the problems at the trust that the hon. Gentleman and I have discussed on many occasions. We need to be sensitive to that in helping the standard of services to improve going forward.
I will just make some progress.
Prevention also means transforming mental health services. I paid tribute earlier to my former colleague the right hon. Member for North Norfolk (Norman Lamb), who did a terrific job. I welcome in his place my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), the Minister for Community and Social Care, who I know will build on his legacy. It also means a big focus on public health, especially tackling obesity and diabetes. It remains a scandal that so many children are obese. I know that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), is working hard on a plan to tackle those issues.
We must continue to make progress on cancer. We have discussed some of the measures that we need to take, but independent cancer charities say that we are saving about 1,000 more lives every month as a result of the measures that have already been taken. We want to build on that.
We have also talked about technology a number of times today. It will remain a vital priority to achieving the ends that I have described. In the last Parliament, I said that I wanted the NHS to be paperless by 2018. In this Parliament, I would like us to go further and be the first major health economy to have a single electronic health record shared across primary, secondary and social care for every patient. Alongside that, our plans to be the first country to decode 100,000 genomes will keep us at the forefront of scientific endeavour, ably championed by the Minister for Life Sciences, my hon. Friend the Member for Mid Norfolk (George Freeman).
I welcome what my right hon. Friend is saying about transforming services. He has mentioned Airedale hospital twice. I thank him for visiting Pendle a few weeks ago, and visiting Marsden Grange, one of my local care homes, where he saw the telemedicine service from the care home perspective. Will he say more about how telemedicine and improved technology in the NHS can help improve patient care?
Yes, I absolutely can. Let me give him one specific example. A couple of years ago, I noted a statistic that showed that 43 people died because they were given the wrong medicine by an NHS doctor or nurse. That problem could be avoided if doctors and nurses had access to people’s medical records so that they could see whether patients had allergies and give them the right medicine. The previous Labour Government had a crack at electronic health records. It was not successful, but they were right to try. We have to get it right if we are to have the best health service in the world. I am committed to that.
The Secretary of State will know that prevention is better than cure. He spoke about parity of esteem for mental health services. I wrote to him last year about a teenager who was threatening to commit suicide. He had been given a counselling appointment through his GP four weeks ahead, even though the kid was saying that he was going to kill himself that day. What will the Secretary of State do about improving counselling services to stop young people wanting to take their life because their appointment is many months away?
The hon. Gentleman is right to raise that issue. The previous Minister with responsibility for mental health set up the crisis care concordat, which he got all parts of the country to sign up to, to provide better care. There is a big issue with the quality of child and adolescent mental heath services provision. We want to cut waiting times for people in urgent need of an appointment, so I recognise the problem and I hope that the hon. Gentleman will give us some time to bring solutions to the House.
The Secretary of State has spoken of the importance of people’s ability to secure hospital appointments. The same applies to GP services, but when I wrote to him about my constituents’ difficulties in securing appointments with their GPs, he told me that that was the responsibility of NHS England, not his Department. Will he now recognise that he must take responsibility for dealing with the problems of GP surgeries, so that my constituents, and those of every other Member, can make appointments with their family doctors when they need them?
I absolutely do recognise that. One of my key priorities is to deal with the issues of GP recruitment and the GP contract, and to make general practice an attractive profession again. If we are to deal with prevention rather than cure, vulnerable older people in particular will need more continuity of care from their GPs, and we must help GPs to provide it.
None of those big ambitions will be achieved, however, if we do not get the culture right for the people who work in the NHS. One of the reasons that Mid Staffs—and, indeed, so many other hospitals—was in special measures was the legacy which, for too long, put targets ahead of patients. We should never forget that Mid Staffs was hitting its A&E targets for most of the time during which patients in the hospital were experiencing appalling care. In that context, Sir David Nicholson used the phrase “hitting the target and missing the point”.
Through the toughest inspection regime in the world, we are slowly changing the culture to one in which staff are listened to and patients are always put first. However, although we identify hospitals that are in need of improvement much more quickly, we are still too slow in turning them around. I know that the new hospitals Minister, my hon. Friend the Member for Ipswich (Ben Gummer), will be looking closely at that, and I warmly welcome him to my team. Like me, he believes it is wrong that we have up to 1,000 avoidable deaths every month in the NHS, that twice a week we operate on the wrong part of someone’s body, that twice a week we leave foreign objects in people’s bodies, that almost once a week we put on the wrong prosthesis, and that people die because they are admitted on a Friday rather than a Wednesday.
We will leave no stone unturned in our quest to make a seven-day NHS the safest healthcare system in the world. Nye Bevan’s vision was not simply universal access or healthcare for all. The words that he used at this Dispatch Box nearly 70 years ago, in 1946, were “universalising the best”, which meant ensuring that the high standards of care that were available for some people in some hospitals were available to every patient in every hospital. Our NHS can be proud of going further and faster than anywhere in the world to universalise access, but we need to do much more if we are to complete Bevan’s vision and universalise quality as well. The safest, highest-quality care in the world, available seven days a week to each and every one of our citizens: that must be the defining mission of our NHS, and this Conservative Government will do what it takes to deliver it.
During Health questions, I congratulated the Secretary of State on his reappointment, and I do so again now, but I hope he will not be too offended if I point out gently that it was not universally welcomed in the NHS. In fact, as far as reappointments go, his makes the recent one at FIFA look positively popular. We wish him well, of course, but he has a lot of work to do to regain the trust of staff throughout the NHS, and he should not underestimate the scale of the task.
I welcome all the new Health Ministers, but I particularly welcome the new Minister for Community and Social Care, the right hon. Member for North East Bedfordshire (Alistair Burt). He did outstanding work during the last Parliament in seeking justice for the victims of contaminated blood, alongside other Members in all parts of the House. I am sure that the victims and their families will see his appointment as a hugely encouraging sign. Let me also say to him that if he wishes to continue to pursue that issue with the same zeal during the current Parliament, he will have my full support.
Our thoughts are with our Liberal Democrat colleagues today, and I want to pay tribute to the right hon. Member for North Norfolk (Norman Lamb), although he has now left the Chamber. He had an obvious commitment to mental health, even if his words were not always matched by Government action. That said, one of the great achievements of the last Parliament was the profound change that we all witnessed in the public and parliamentary debate about mental health. For the first time, Members of the House spoke openly and honestly about their own mental health problems.
It was my honour last week to visit Priestley mental health unit at Dewsbury and District hospital. It does amazing work for local people. The welfare changes implemented over the past five years have put an incredible strain on vulnerable people who need mental health care, and, according to the projection for the next five years, the number of people in that terrible situation will increase and our mental health care services will have to meet an increased demand. Does my right hon. Friend share my concern about that?
As my hon. Friend the Member for Liverpool, Walton (Steve Rotheram) pointed out a moment ago, NHS services are often not there for young people in particular when they need them, but we must also ask ourselves why people end up in that position in the first place. We have seen, in some of the public policy decisions that have been made in recent times, a failure to understand how changes can affect people’s mental health. The work capability assessment, for instance, did not pay sufficient regard to mental health, and that needs to change if we are to give people proper support in this Parliament.
Let me, at the start of the new Parliament, urge all new and all re-elected Members to bear in mind the momentum on mental health that was built in the last Parliament, and to do everything they can to build on it. Given the nature of modern living and the stress and insecurity that we all have to absorb, mental health will remain the issue of our times, and we shall need public policy to match. The last Parliament made huge progress in raising mental health issues, but this Parliament needs to translate those words into action.
Progress was also made on patient safety, and the Secretary of State deserves credit for that, but, again, it is important for the momentum not to be lost in this Parliament. In that context, there appears to be a significant omission from the Gracious Speech. Improving the regulation of health professionals was a central recommendation that emerged from the Francis report, and a Bill to modernise professional regulation has long been anticipated. It would have had cross-party support, and would have enabled the regulators to get on with the job of protecting and safeguarding the public from poor care. The failure to introduce such a Bill means that there is now no prospect of reducing the time it takes to deal with complaints, which, at present, is typically 15 months from start to finish. Jackie Smith, chief executive of the Nursing and Midwifery Council, has said that she is “deeply disappointed” by the omission, and that it is a “major setback” to the response to the Francis report. Can the Secretary of State explain why no such Bill was mentioned in the Queen’s Speech, and tell us when it can be expected? We need a professional regulatory regime that is modern, up to date and fit for purpose.
The issue on which I now intend to focus is finance. For the last five years, we have been treated to repeated lectures from Ministers about the importance of sound management of the public finances. That is the signature of this Government, or so they like to claim. Today I want to put that claim to the test in respect of the NHS, and to look in detail at the Government’s stewardship of NHS finances.
The Government like to talk about the deficit, but they do not often mention the very large deficit they have created at the heart of the NHS. We will put that right today, and consider the promises they made in the run-up to the election: local promises to reopen A&E departments, and national promises to deliver GP opening hours of 8 am to 8 pm and seven-day NHS working. We will ask how all that can be delivered, given that the NHS finances are deteriorating fast.
The Conservatives are fond of saying that we did not fix the roof when the sun was shining, but I can tell the hon. Gentleman that we did fix the leaking roofs of hospitals and GP surgeries that they left behind, and we had to invest a significant amount to do so. When we came to office in 1997, more than half the NHS estate predated the NHS itself, and people remember those days. We had to put that right: we had to rebuild substantial portions of the NHS simultaneously by means of the PFI, which, I might add, was inherited from the Major Government.
The right hon. Gentleman has clearly forgotten the patient records IT project—at £12 billion, it is officially the most disastrous white elephant IT project in British political and Government history—and the £250 million spent on independent sector treatment centres and on higher tariffs to private providers for operations not done, and the £63 billion on the private finance initiative. That is the record of the Government of which he was a part. Has he forgotten that voters made their decision on that record on 7 May?
I will tell the hon. Gentleman what I remember: I remember NHS waiting lists in 2010 being at their lowest ever level; I remember public satisfaction with the NHS being at its highest ever level; and I also remember leaving behind a financially solvent national health service. Let us look at it today: NHS waiting lists at a six-year high; cancer patients waiting longer for their treatment to start; A&E in crisis; and, as I said, a £1 billion deficit, and rising, at the heart of the NHS. That is the Secretary of State’s record, and a little more humility might not go amiss.
Is it not true that the NHS’s greatest resource, and indeed greatest cost, is its staff? Imperial College Healthcare NHS Trust overspent on staff by £24 million last year, and at the end of the financial year 12% of all its spending was going on agency and “bank” staff. While it is completely right to clamp down on the ludicrous overspend on agency staffing, does this not reflect the reality of cuts in training and of an attitude to staff pay by the Government? Does my right hon. Friend agree that we will not deal with agency staff without having a better deal for the recruitment and retention of permanent staff in the NHS?
My hon. Friend anticipates me, because this is precisely the issue I am coming on to. Under the Lansley reorganisation, workforce planning went out of the window, and that led to today’s huge workforce crisis and hospitals being in the grip of private staffing agencies. That is the single biggest driver of the NHS deficit that I mentioned a moment ago, and I will talk about that shortly.
The Secretary of State gave us a pious warning about temperate language, yet this is the Secretary of State who today on the front page of The Daily Telegraph is saying that the NHS has enough cash and now must deliver:
“the time for debating whether or not”
it has enough money is over, it
“now needs to deliver its side of the bargain”.
Not for the first time, that is a statement by the Secretary of State that will have caused jaws to drop across the NHS. People will not forget the time he accused hospitals of coasting when they were in the middle of an A&E crisis, but even by his standards this was a staggering piece of spin.
The simple fact is that the NHS does not have enough money. In fact it is seriously short of money. It is facing a £1 billion deficit this year, with two thirds of hospitals in the red, which marks a major deterioration from what the Conservatives inherited in 2010, when there was a surplus of over £500 million.
Are not some rather stupid decisions about to be made? Wythenshawe hospital has a £3 million deficit and is talking about cutting 28 district nursing posts. The Secretary of State said earlier that community resources are important. Of course they are, but if we are going to cut district nurses every time there is a trust deficit like the one at Wythenshawe, we are not going to get through another winter without a much more serious A&E crisis.
That is exactly the point. When we are in a crisis like this, short-term, knee-jerk cuts are made, which make the situation wrong in the long term.
When I raised these deficits in the election campaign, the Secretary of State said I was scaremongering, but just two weeks after the election the truth emerged. [Interruption.] He says I was, but we now know the truth. There was an £822 million deficit in the NHS last year, a sevenfold increase on the previous year. [Interruption.] The Secretary of State says he is dealing with it. That is not good enough. That is appalling mismanagement of the NHS. Financial grip in the NHS has been surrendered on this Secretary of State’s watch, and things are looking even worse this year. Far from scaremongering, these issues are real and should have been debated at the last election. The NHS is now facing a £2 billion deficit this year. As my hon. Friend the Member for Warrington North (Helen Jones) said earlier, that will mean cuts to beds, to staff and to services.
The right hon. Gentleman talks about appalling mismanagement. Why did we have that growth in deficits? We had it because those hospitals were, in the wake of the Francis report and the appalling tragedy at Mid Staffs, desperately trying to make sure they did not have a crisis of short-staffed wards. If there was any appalling mismanagement, it was when the right hon. Gentleman was Health Secretary; he left behind an NHS where there were too many wards and too many hospitals that did not have enough staff. We are doing something about that. That is not mismanagement; that is doing the right thing for patients.
I am grateful that the Secretary of State has intervened because yet again he has got his facts wrong. Am I not correct in saying that in the first two years of the last Parliament the Government cut staffing further from the levels I left by 6,000? [Interruption.] No, he and his predecessor cut nurse places by 6,000 in the first two years of the last Parliament. Separately, they cut nurse training places, leading to a shortfall in nurse recruitment of around 8,000 in the last Parliament. When the Francis report was published, the NHS had fewer staff than it had in 2010 and fewer nurses coming through training.
The Secretary of State likes to blame everybody else, but how about taking a bit of blame himself for once? He left the NHS in the grip of private staffing agencies, and since the Francis report a small fortune has had to be spent on private staffing agencies. The figures have gone through the roof on his watch and he has failed to do anything about it. That is why people will not believe that the NHS is safe in his hands.
Would my right hon. Friend care to remind the Secretary of State of a privatisation that has increased the NHS deficit and not improved efficiency? After the proposed transfer of a scanning contract from the Royal Stoke university hospital there was rightly a public outcry. The scanner remains there, but none the less the private company, Alliance Medical, is staying in there, taking its cut and the cost to the taxpayer has increased.
I remember visiting with my hon. Friend. Let us put the facts on the record. The Secretary of State said a moment ago that privatisation was not happening, but it is happening. It is affecting my hon. Friend’s constituents, where cancer scanning has now been privatised. What happened? The contract was, I believe, given to Alliance at £87 million, whereas the NHS had bid £80 million. It was given to the private sector, however, which has now subcontracted the NHS at the same price of £80 million, creaming off £7 million. That is a scandalous waste of NHS resources when the NHS is facing a £2 billion deficit this year.
Does my right hon. Friend think it is a matter of concern that a significant report by Lord Stuart Rose, a Conservative peer, was suppressed by the Secretary of State? It would have given an indication of failings in NHS management and allowed us to correct some of the problems identified.
My hon. Friend raises an important point. Again, the Secretary of State is quick to lecture about openness and transparency, but a report compiled at huge cost to the public purse by Lord Rose, former chief executive of Marks & Spencer, was not published in the last Parliament even though it was submitted to the Department months before. What possible justification can there be for that? The Secretary of State is avoiding my gaze right now. I would be very interested to hear his answer on why that report was not published, and if he wants to take to his feet now—[Interruption.] He says from a sedentary position that it was not finished. Well, if you believe that, Mr Speaker, you will believe anything. Even though Lord Rose says it was finished, the Secretary of State sent Lord Rose’s homework back and said it was not good enough. People will draw their own conclusions from what we have just heard.
We have seen a staggering deterioration in the NHS finances on the Secretary of State’s watch and a loss of financial grip across the whole system. If we are to see the finances brought under control, it means we will see more of the cuts mentioned a few moments ago.
The warning lurking behind the front page of The Daily Telegraph will not be lost on NHS staff today. The Secretary of State knows the NHS is facing very difficult times and this is an early attempt to shift the blame on to NHS staff. Basically, he is saying, “If things go wrong it’s not my fault, it’s yours because I gave you enough money.” It is the classic style of this Government and this Secretary of State in particular: “Get your blame in on somebody else first.”
I have been listening with a great deal of interest to the right hon. Gentleman, but I have to tell him that the country rejected Labour’s plan for the NHS. Will he now pledge to support the NHS’s own five-year plan, so that we can make some progress in the debate instead of hurling abuse across the Dispatch Box?
I must point out to the hon. Lady that Labour had a 20-point lead on the NHS going into the general election, which suggests that the public believed what we were saying about the NHS rather than what the Conservatives were saying. We do support the five-year forward view, and I have said as much, but it needs money now. If that plan is to be made real, it needs investment now. The NHS will not be able to deliver it while it has a £2 billion deficit this year; instead, it will go backwards. It will be unable to make the progress it needs to make.
Let us look at why the grip has been lost. This all goes back to the disastrous decision during the last Parliament to ignore the pleas of patients and staff and to force through the biggest-ever reorganisation in the history of the NHS, which nobody wanted and nobody voted for. Back then, a financially solvent NHS was turned upside down and, just when the service should have been focusing on making savings, it was instead firing and rehiring staff, abolishing and recreating organisations and making front-line nursing staff redundant. That destabilised the NHS, and it has never recovered since.
I welcome the right hon. Gentleman’s support for the five-year forward view, but how can he make all these criticisms of the NHS and give that support in the light of Labour’s not supporting our election commitment to give the NHS the £8 billion of funding it needs?
I shall come to the £8 billion, which was the centrepiece of what the Conservatives were proposing during the election campaign. The simple question was: where is it coming from? They never answered that question. The other question they need to answer is: what are they going to do for the NHS now? The £8 billion was promised for five years’ time, but, as I have been saying, the NHS is facing a crisis this year and next year. An IOU for five years’ time is not much use to the NHS when it faces laying off staff and closing services.
Forgive me; I am new here and very confused. This seems very simple to me. At the election, I promised every person who voted for me in South Cambridgeshire that I would not join in with this negative campaigning, and as Andrew Lansley’s successor I feel that now is the time I should stand up. Is it not time to put the past behind us? The NHS has a fabulous leader in Simon Stevens. That man is standing up for the NHS and saying, “Let’s do this together.” Okay, let us have a debate about where the £8 billion is coming from—that is a financial debate and I am happy to have it—but let us believe in the man who is standing up and saying we can do this together. Let us work as a team and let us listen to the man with the plan. It is him we should be talking about.
The hon. Lady makes a very good point, and I hope she does a lot more for the NHS than her predecessor did. He caused a huge amount of damage. She is right to say that the NHS is looking for the consensus she describes. NHS staff would hugely value more consensus on the five-year forward view.
The problem, as I have said to the Secretary of State before, lies in the privatisation. The Health and Social Care Act 2012, which the hon. Lady’s predecessor took through Parliament, is forcing NHS services out on to the market. As I have said, 40% of those services are now going to private sector organisations, with 40% going to the NHS. The Secretary of State claims that privatisation is not happening, but I am afraid that that is just not correct in any way. If there is to be consensus, the Government should repeal that Act. They never had a democratic mandate from the people of this country. They never gave their permission for the NHS to be put up for sale in this way. If the hon. Lady’s party were to repeal section 75 of the Act, she could help to create the basis for consensus on the NHS.
The day after the general election, I was approached by someone outside my constituency office. He congratulated me on winning, but said that he was terrified. He had been told by the local Labour party that if the Conservatives won the election, he would personally have to find £80,000 to pay for his son’s operation because the NHS would be privatised. Will it ever be possible to build consensus when one political party in this House is seeking to weaponise the NHS?
I do not know which election the hon. Gentleman was fighting, but I went round the country and heard stories from patients who were having their treatment rationed. Older people were not being given cataract operations, for example, and were having to consider going private. Varicose vein operations were being rationed. If he never heard those stories, he could not have been listening to his constituents on the doorstep.
The NHS is in the grip of private staffing agencies because of the cuts to front-line posts and to nurse training, and because of low morale. This is the Secretary of State who denied NHS staff a 1% pay increase after years of pay freezes. What a kick in the teeth for staff who are working flat out to try to keep the NHS going! Good will in the NHS is at an all-time low, and it is no wonder that so many disillusioned staff are going to work for agencies to supplement their income. The Secretary of State has woken up to the problem today, and he has promised to take tough action on the agency bill, but will not put a cap on the agency spend in financially troubled trusts that results in those trusts being understaffed, because he will not permit them to recruit the staff they need? He needs to clarify that point. Will he also consider the rates paid on internal banks, and correct the ridiculous situation in which staff have a greater incentive to work for external agencies than for their own employer?
Why has there been no mention of staff training? Surely increasing the number of nurses coming through training is the only proper long-term answer to cutting agency spend. If the Secretary of State wants a fresh start, why does he not make an immediate pledge to increase nurse training commissions this year, as I would have done if Labour had won the election? Will he do that? If not, why not? Until he corrects this situation, the NHS will continue to be saddled with long-term agency costs. The truth is that the chickens are coming home to roost. The Secretary of State has left the NHS in the grip of private staffing agencies, and the measures he has announced today will not help.
The Secretary of State has also tried to paper over the cracks with a headline promise of £8 billion. There are three problems with that. As I said to the hon. Member for Faversham and Mid Kent (Helen Whately), it represents an IOU for five years’ time, but it will not deliver real money now, which is what the NHS needs. Secondly, the £8 billion makes sense only if the NHS manages to make £22 billion of efficiency savings by 2020. That is the five-year plan, as I am sure Members agree. To date, the Secretary of State has not provided any real details of where that £22 billion of savings is going to come from. Many of the people I speak to in the service say that the NHS has already had five years of hard efficiency savings, and that savings on that scale cannot be achieved without causing real harm to services. Does the £22 billion involve cuts to staff? Does it involve service closures? Does it involve more rationing of drugs and treatments? Will he now set out a plan for those £22 billion-worth of efficiencies? People have a right to know how he plans to achieve them.
Thirdly, can the Secretary of State tell us where this £8 billion is coming from? During the election, Ministers repeatedly failed to answer this question. The Chancellor was asked about it 18 times on “The Andrew Marr Show”, and his evasion was excruciating. So can the Secretary of State now give us an answer? If he cannot, people will conclude that the Conservatives either knew they were going to break this promise or did not want people to know where the money was going to come from. But people need to know, because the Government could be about to repeat the big spending mistake that they made in the last Parliament.
Five years ago, I warned the Government that it would be irresponsible to pay for the NHS by raiding social care, but that is exactly what they did. Around a third of a million vulnerable older people lost social care support at home and, unsurprisingly, many of them ended up in hospital. Those cuts to social care had terrible human costs, but they also created huge operational and efficiency problems for the NHS, with record numbers of frail people occupying hospital beds. I say this again to the Secretary of State: if you let social care collapse, it will drag the rest of the NHS down with it. It is a false economy on a grand scale to cut social care to pay for the NHS. Will he be clear today: will he confirm that, if the Government have no plans for new taxes, the money for the NHS will come from cuts to other unprotected Departments? If that is the case, are we not looking at even deeper cuts to local government and social care in this Parliament than we saw in the last?
The Secretary of State cannot keep dodging those questions. The Gracious Speech promised plans to integrate the NHS and social care, but there will be nothing left for the NHS to integrate with if he carries on in this way. The care cuts in the previous Parliament were the root cause of the A&E crisis. Hospital accident and emergency departments have now missed the Government’s lower target for 97 weeks in a row. If they cut social care again, we will have to deal with a full-blown NHS crisis.
Attendances at A&E departments increased 10 times faster in the four years after 2010 than in the four years before 2010. That was caused not just by the ageing society, as the Secretary of State likes to claim, but by his failure to look after that ageing society.
Where was the action in the Queen’s Speech on the scandal of 15-minute care visits? The truth is that there is no solution for the NHS without a solution for social care, but the only plan on offer from this Government is more cuts, and those cuts will pile pressure on an already overstretched NHS. This is where the NHS finds itself at the start of this Parliament.
The Secretary of State has promised us a seven-day NHS, which we all support. He has promised us 8 am to 8 pm GP opening. How on earth will he deliver those promises when he cannot say where the money is coming from, and when the NHS is facing a huge financial deficit? He will make a grave mistake if he tries to introduce seven-day working in the NHS on the backs of NHS staff. Staff who work the most unsocial shift patterns often face the greatest cost. For instance, they have no choice but to use their car if public transport is not running. It would be utterly wrong to pay in part for seven-day working by removing the unsocial hours payment, and we will oppose any attempt by him to do that. Good will is evaporating in the NHS and we cannot afford to lose any more.
In conclusion, to listen to the Secretary of State today, we might be forgiven for thinking that everything is fine in the NHS, but it is not. People are waiting longer and longer for cancer treatment to start, and the cancer standard has been missed for the past five consecutive quarters. NHS waiting lists are at a seven-year high. People cannot get GP appointments when they need them; they are left ringing the surgery for hour after hour in the morning to be told that nothing is available for days. Ambulances are taking longer to arrive, as we heard at Health questions earlier, A&E remains in permanent crisis mode, mental health services are in crisis, social care is being cut, NHS services are being privatised, and the bill for agency staff has left the NHS in the grip of private agencies.
The uncomfortable truth for the Secretary of State is that he is running out of people to blame. This is the NHS that he inherits from himself, and it is heading downhill fast. The onus is now on him to produce a plan to turn round NHS finances, turn round A&E and deliver on the promises he has put before the country. The NHS enters this Parliament facing one of the most dangerous moments in its history. We will not let him shift the blame on to NHS staff. The party that created the NHS will hold him to account for the damage that he is doing to it right now.
As this is the first time that I have spoken in this Parliament, may I state for the record that I am married to a full-time NHS consultant forensic psychiatrist who also chairs the Westminster liaison committee for the Royal College of Psychiatrists and will shortly be taking up a role as the registrar of the Royal College of Psychiatrists? I also have a daughter who is a foundation junior doctor and another daughter who is a medical student. The House will be pleased to hear that my son has managed to escape; perhaps his handwriting was not quite bad enough.
I was honoured to have worked as a front-line clinician in the NHS for 24 years, and I wish to start by extending my thanks and paying tribute to all those colleagues who work across the NHS with such professionalism and compassion. In replying to the Gracious Speech, I wish to touch on four areas: the workforce challenge; the financial challenge; volunteering; and issues around prevention.
I was so pleased to see the Five Year Forward View right at the centre of our commitments in the Gracious Speech. I am talking about the commitment not just to back the Five Year Forward View but to the £8 billion that we will need by 2020. I ask the Government to front-load as much as possible of that £8 billion, because what we see alongside that £8 billion is the need to make £22 billion of efficiency savings. Ministers will know that in the previous Parliament those efficiency savings were largely achieved by pay restraint in the NHS, but in the long term pay restraint will start to have implications for recruitment and retention, which are already major challenges for the NHS.
I welcome today’s announcement because it was unsustainable to continue spending £3.3 billion a year on agency costs. Using agency staff not only leaches money from the NHS that could be better spent elsewhere, but has an undermining effect on permanent staff in the NHS. In fact, it starts to have a domino effect on the ability to retain staff, so it is simply unsustainable. When the Minister responds, I hope she will set out how the caps on those rates, which I welcome, will play in relation to the rates that are paid to NHS bank staff and give us more detail about the arrangements. Where there are crises in staffing, we need to know that safety will be paramount and how those caps will be overruled in emergencies. It is important that that clarity is delivered across the NHS.
Recruitment and retention are about not just pay rates but staff morale and the way that staff feel valued. They are also about the ability of staff to work in teams. We need to consider the effect of increased shift working across the NHS. I am talking about the effect of the structure of the service. There is also the burden of paperwork and administration on NHS staff. All those things are important when we consider how to retain permanent staff in the NHS and to move away from our reliance on agencies.
Will my hon. Friend join me in welcoming the work of the Royal College of Emergency Medicine, which is trying to change the way that emergency medicine consultants work in order to retain more of them in their particular specialty? At the moment, far too many of them leave that specialty, creating some of the problems that we see across the country.
Absolutely, and I recognise and value the work that has been done. We also need to look at the skill mix across the NHS. It is unsustainable to deliver the commitments to primary care and to improve access to primary care unless we look further at the skill mix across the wider NHS. For example, we talked in Health questions about the use of pharmacists. The one area of the NHS where there is not any kind of workforce shortfall is in pharmacy, and that industry has much to offer to primary care. We also need to consider the role of physician associates and nursing assistants, and look at how we can diversify and provide better continuing professional development across the NHS. All those things will be important as we move forward.
My hon. Friend will know that in the previous Parliament the Public Accounts Committee expressed concerns about the use of clinical excellence awards for senior clinicians and the very high levels of senior management pay. It felt that they were incongruous when compared with the restraint shown towards lower- paid and more junior staff. Does she think that Select Committees such as her own—if she is re-elected to it—and Ministers need to look at that in the future?
I thank my hon. Friend for his points. There is an important piece of work that can be done by the next Health Committee in looking at all the wider workforce issues across the NHS, including those to which he refers.
I shall now touch on seven-day access for the NHS. Such a service is vital, but we must focus on safety. The primary focus of seven-day access must be eliminating the unacceptable variation in mortality rates across the NHS on different days of the week. It is important that we address the issue of reducing avoidable and unnecessary hospital admissions. Perhaps the Minister could look at the frailty service in Newton Abbot which considers how GPs can work together to prevent unnecessary hospital admissions. If we broadened access to general practitioners at the weekends, we might be able to reduce unnecessary admissions to hospital, for example of children with asthma. There is much that can be done, but if we are prioritising providing 8 till 8 access in very rural areas there might be unintended consequences in general practice. If we are diverting funding into areas where we are providing a service in which several practices over a large geographical area have to federate, we could inadvertently end up with patients having to travel further than they would to visit a local out-of-hours service.
Will the Minister carefully consider the unintended consequences when we implement seven-day access to ensure that we do not divert essential funds that could be used for safety and avoiding unnecessary admissions into something that is worth while in theory but that might not give the best outcomes for patients? I hope that the Minister will be able to reassure me that the Government will allow local CCGs to look carefully at what is best, while consulting local communities, and to be as flexible as possible.
I also ask the Minister to consider the importance of volunteering across the NHS. In all our constituencies there will be extraordinary organisations that work as partners with the NHS, but I have some concerns, one of which I would like to share with the Minister. In my area, a wonderful charity called Cool Recovery worked with users of mental health services and their families to provide an extraordinary level of support. Sadly, particularly given that I was a patron of this charity, I have to report that it is having to fold for the want of a relatively small amount of stable long-term funding. The voluntary sector—those partner organisations across the NHS—is calling out for access to stable long-term funds. Newly set-up charities gain access to very valuable funding sources, but when they apply for funds once they are established, the response is that it should be provided by commissioners. I ask the Minister to consider carefully how we can sustain some of the extraordinary charities working across the country by giving them access to stable long-term funding so that they can carry on with their work. This issue was raised with the Select Committee by the voluntary sector during our inquiry into children and adolescent mental health services, so it is an issue across the NHS that is causing real problems.
Order. I am listening intently to the hon. Lady, as always, and as I know the House will be. It is by accident that the clock is not operating as I had intended it to. In short, I had intended the seven-minute limit to apply to the hon. Lady. It would be unfair suddenly to apply it, but she ought to operate according to its spirit, and I know she is approaching what will be a very impressive peroration.