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NHS Reform

Volume 598: debated on Thursday 16 July 2015

With permission, Mr Speaker, I would like to make a statement on measures to improve the safety culture in the NHS and further strengthen its transition to a modern, patient-centric healthcare system. The failings at Mid Staffs, detailed in the Francis report, were not isolated local failures. Facing up to widespread problems with the safety and quality of NHS care and learning the appropriate lessons has been a mission that the Government and the NHS have shared, with a common belief that the best way to deal with problems is to face up to them rather than wish that they did not exist.

Measures taken in the last Parliament include: introducing the toughest independent inspection regime in the world; more transparency on performance and outcomes than any other major healthcare system; new fundamental standards; a duty of candour; and the excellent recommendations by Sir Robert Francis QC. But because the change we need is essentially cultural, a long journey remains ahead. The Department of Health was described during the Mid Staffs era as a “denial machine”. We therefore have much work to do if we are to complete the transformation of the NHS from a closed system to an open one, from one where staff are bullied to one where they are supported, and from one where patients are not ignored but listened to.

Today I am announcing some important new steps, including: our official response to Sir Robert Francis’s second report, “Freedom to Speak Up”; our response to the Public Administration Select Committee report “Investigating clinical incidents in the NHS”; and our response to the Morecambe Bay investigation. I am also publishing Lord Rose’s report into leadership in the NHS—a key part of the way in which we will prevent tragedies such as these from happening again. I would like to thank everyone involved in writing those reports for their excellent work.

In his report “Freedom to Speak Up”, Sir Robert Francis QC made a number of recommendations to support this cultural change. All NHS trusts will appoint someone whose job is to be there when front-line doctors and nurses need someone to turn to with concerns about patient care that they do not feel able to raise with their immediate line manager. We will also appoint an independent national officer, located at the Care Quality Commission, to make sure that all trusts have proper processes in place to listen to the concerns of staff before they feel the need to become whistleblowers. Other changes will include providing information about raising concerns as part of the training for healthcare professionals and part of the curriculum for medical students, and placing a greater focus on learning from reflective practice in staff development.

Dr Bill Kirkup’s report into Morecambe Bay brought home to the House that there can be no greater pain than when a parent loses a child and then finds that pain compounded when medical mistakes are covered up. We will accept all the recommendations in this report, including removing the Nursing and Midwifery Council’s current responsibility and accountability for statutory supervision of midwives in the United Kingdom, and bringing the regulation of midwives into line with the arrangements for other regulated professions.

Likewise, we agree with the vast majority of the recommendations of the excellent PASC report into clinical incident investigations. In particular, we will set up a new independent patient safety investigation service by April 2016, based on the success of the “no blame” approach used by the air accidents investigation branch in the airline industry. It will be housed at Monitor/Trust Development Authority, which have the important responsibility of promulgating a learning culture throughout the NHS. Monitor/TDA will operate under the name “NHS Improvement”, and Ed Smith, currently a non-executive board member of NHS England, will become the new chair, with a brief to appoint a new chief executive by the end of September.

For NHS managers, Lord Rose’s report, “Better leadership for tomorrow”, makes vital recommendations to join up the support offered to NHS managers, to improve training and performance management, and reduce bureaucracy. He extended his remit to cover the work of clinical commissioning groups, which play a key role in the NHS, and today I am accepting all 19 of his recommendations in principle, including moving responsibility for the NHS leadership academy from NHS England to Health Education England.

These are important recommendations, which, in the end, all share one common thread: that the most powerful people in our NHS should not be politicians, managers or even doctors and nurses, but the patients who use it. Using the power of intelligent transparency and new technology, we now have the opportunity to put behind us a service where you get what you are given and move to a modern NHS where what is right for the service is always what is right for the patient.

A litmus test of that is our approach to weekend services. About 6,000 people lose their lives every year because we do not have a proper seven-day service in hospitals. Someone is 15% more likely to die if they are admitted on a Sunday than if they are admitted on a Wednesday. That is unacceptable to doctors as well as patients. In 2003-04, the then Government gave GPs and consultants the right to opt out of out-of-hours and weekend work, at the same time as offering significant pay increases. The result was a Monday-to-Friday culture in many parts of the NHS, with catastrophic consequences for patient safety.

In our manifesto this year, the Conservative party pledged to put that right as a clinical and moral priority. I am today publishing the observations on seven-day contract reform for directly employed NHS staff in England by the Review Body on Doctors and Dentists Remuneration—the DDRB—and the NHS Pay Review Body. They observe that some trusts are already delivering services across seven days, but this is far from universal. According to the DDRB, a major barrier to wider implementation is the contractual right of consultants to opt out of non-emergency work in the evenings and at weekends, which reduces weekend cover by senior clinical decision makers and puts the sickest patients at unacceptable risk. The DDRB recommends the early removal of the consultant weekend opt-out, so today I am announcing that we intend to negotiate the removal of the consultant opt-out and early implementation of revised terms for new consultants from April 2016. There will now be six weeks to work with British Medical Association union negotiators before a September decision point. We hope to find a negotiated solution but are prepared to impose a new contract if necessary. To further ensure a patient-focused pay system, we will also introduce a new performance pay scheme, replacing the outdated local clinical excellence awards, to reward those doctors making the greatest contribution to patient care.

I am also announcing other measures today to make the NHS more responsive to patients. Those include making sure patients are told about Care Quality Commission quality ratings as well as waiting times before they are referred to hospitals, so that they can make an informed decision about the best place to receive their care. NHS England will also develop plans to expand control to patients over decisions made in maternity, end-of-life care and long-term condition management, which I will report in more detail subsequently to the House. Finally, because the role of technology is so important in strengthening patient power, we must ensure that no NHS patient is left behind in the digital health revolution. I have therefore asked Martha Lane Fox, the former Government digital champion, to develop practical proposals for the NHS National Information Board on how we can ensure increased take-up of new digital innovations in health by those who will benefit from them the most.

When we first introduced transparency into the system to strengthen the voice of patients, some called it “running down the NHS”. Since then, public confidence in the NHS in England has risen 5 percentage points. By contrast, in Wales, which resisted this transparency, a survey has seen public satisfaction fall by 3 percentage points. Over the previous Parliament, the proportion of people who think that the NHS in England is among the best healthcare systems in the world increased by 7 percentage points, the proportion of those who think NHS care is safe increased by 7 percentage points and the proportion of those who think that they are treated with dignity and respect increased by 13 percentage points. That demonstrates beyond doubt the benefits of an open and confident NHS, which is truly focused on learning and continuous improvement.

As we make progress in this journey, we must never forget the people and the families who have suffered when things have gone wrong. In particular, there are the families and patients at Morecambe Bay and Mid Staffs, the whistleblowers who contributed to Sir Robert Francis’s work, and everyone who has had the courage to come forward in recent years to help reshape the culture of the NHS. Without their bravery and determination, we would not have faced up to the failures of the past or been able to construct a shared vision for the future. We are all massively in their debt. This statement remains their legacy, and I commend it to the House.

I thank the Secretary of State for his statement and for advance sight of it. Let me say at the beginning that I support much of what he said. I will focus my remarks on his plan for seven-day working, and then touch on some of the other issues he raised.

Ensuring that our health services are there for everyone whenever they are needed—be that a weekday or a weekend—should be our shared goal across this House for a 21st-century national health service. Illnesses do not stop at the weekend and nor should our NHS. Although we support the principle of what the Secretary of State is trying to achieve with seven-day working, and will work with him where possible, I urge some caution in the manner in which he is attempting to drive through these changes. His remarks contain no acknowledgment that the NHS right now is in a very fragile condition. It has gone backwards, not forwards, in recent times. A&E is in crisis, and primary care services are overwhelmed. There is a shortage of staff and an over-reliance on agency workers. Staff are demoralised and worn out. If he does this in the wrong way, many may walk away and that would make matters even worse. Given all that, it is not immediately clear how seven-day services can be delivered in the timeframe he has set out without significantly impacting on the rest of the NHS.

The Secretary of State said that around 6,000 people lose their lives every year because we do not have a proper seven-day service. Of course that is an appalling statistic, but is there not a risk of implementing seven-day services by simply spreading existing resources more thinly? A recent study published in “Health Economics” concluded:

“There is as yet no clear evidence that 7-day services will reduce weekend deaths or can be achieved without increasing weekday deaths.”

Will the Secretary of State tell us on what evidence he has based his announcement and, crucially, what steps he is taking to guard against what the study warns could be an increase in weekday deaths?

If the Secretary of State wants to make changes on this scale, it is vital that he works in partnership with NHS staff. I gently say to him that briefing headlines such as “Declaring war on doctors” have not got us off on the right foot, as doctors are already feeling worn out and put upon. The British Medical Association said:

“Today’s announcement is nothing more than a wholesale attack on doctors to mask the fact that for two years the Government has failed to outline any concrete proposals for introducing more seven-day hospital services.”

Will the Secretary of State take care to avoid provocative statements such as “Declaring war” and will he rethink the manner in which he is pursuing these negotiations? Talk of imposing deals at this stage is not helpful; it is premature and it would be better to proceed in a more constructive manner.

Staff across the entire hospital system—not just doctors —will be needed to run these services, but the Government confirmed only last week that many of them will face another five years of pay cuts. In total, that will amount to a decade of pay cuts. Has the Secretary of State looked at the detail of the Chancellor’s announcement on pay for NHS staff? Will he tell the House what effect he believes this deal could have on staff numbers and retention?

The Secretary of State said very little about how he will fund seven-day services, but given that the NHS is struggling to fund weekday services, it is likely to need significant investment over the next five years, over and above funding attached to the five-year forward view. Can he confirm that the money allocated to fund the five-year forward view does not include seven-day working? That is not specifically mentioned in the “Five Year Forward View”. If so, what extra funding will be made available specifically to deliver seven-day working, and when will this funding be available? The announcement today appears to be unfunded and it will not escape the House’s attention that the 2010 Conservative manifesto also promised to deliver seven-day services. The Secretary of State has a lot of convincing to do if he expects people to believe him this time.

In a statement last week in another place, Lord Prior, the Under-Secretary of State with responsibility for NHS productivity, said he was establishing an independent inquiry into extending charges in the NHS. This has sounded alarm bells among many patient groups. Will the Secretary of State say more about the terms of reference for this independent inquiry and when it will proceed with its work?

The Francis “Freedom to speak up” report contained a number of important recommendations to foster a more open culture and we support his work to implement them. The right hon. Gentleman will know that there have been a number of appalling examples of poor care in recent times at Orchid View, Oban Court and Winterbourne View, and these scandals were exposed only when undercover reporters infiltrated the care home. Will he look seriously at the idea of an independent body to receive complaints from NHS staff and social care staff so that they are not faced with the problem of always going to their employer if they are to blow the whistle?

I welcome what the Secretary of State had to say about the Kirkup report and his acceptance in full of its recommendations. We, too, think of the families affected by the failures at Morecambe Bay. I supported steps to improve the regulation of midwives, but the big question mark over the right hon. Gentleman’s commitment is the failure to bring in a Bill on professional regulation. This was an important recommendation of the Francis report and the continued delay in implementing this proposal is putting patients at risk and preventing regulators from doing their job. Will the Secretary of State now commit to legislating at the earliest opportunity for the Law Commission’s reforms?

These are extremely serious matters and I do not believe that some of the Secretary of State’s more political comments today were appropriate, nor do I believe they will build the consensus that will be needed across this House to deliver these important changes. Labour introduced more transparency into the NHS with the establishment of independent regulation and the inspection of hospitals. I appointed Robert Francis to begin the work of looking at what went wrong at Mid Staffs. Where the Secretary of State seeks to build on these constructive changes, we will support him, but he will not achieve his goals by provoking confrontation with doctors or playing politics with patient safety.

I thank the right hon. Gentleman for his support on many of the measures that we are announcing today. Where we can work together, we should. I thank him for his support for the principle of seven-day working, although I gently point out that this was in our manifesto in May and it was not in his. I shall deal in turn with the points that he raised.

On funding for seven-day services, the right hon. Gentleman has just fought an election on plans that would have meant that the NHS would get £5 billion less than this Government are prepared to commit. We are committing £10 billion to the NHS to implement the five-year forward view, which we can do on the back of a strong economy. That includes plans for a seven-day service.

The right hon. Gentleman talked about comments by Lord Prior in another place. There is no independent review on charging for NHS services. After the election, he should be very careful of such scaremongering. That is what he was doing for the whole election. When he makes such comments, he frightens NHS staff. He should think about the effect on morale when he does that.

The right hon. Gentleman said that the NHS has gone backwards, not forwards, but I have just presented figures showing that public confidence in the NHS is going up; the number of people who think that the NHS is one of the best systems in the world has increased. I gently point out that the reports we are publishing today are a response to problems that happened on his watch and that we are facing up to, so he should have a little modesty in this situation.

The right hon. Gentleman asked an important question about spreading services currently offered on five days over seven days. A lot of work has been done on this. The truth is that having services only on five days is not only dangerous for patients but incredibly inefficient for hospitals. For example, someone admitted to hospital on a Friday in need of a diagnostic test might not get the result until the following Monday or Tuesday so will have to stay in hospital for the weekend even though they could possibly have been discharged. That is bad for the patient and expensive for the NHS, so these measures will result in huge cost savings.

Most importantly, the right hon. Gentleman talked about carrying staff with us. Doctors go into work every weekend throughout the NHS and do a fantastic job, but often it is not recognised and they are not thanked. We want a more professional contract that recognises that contribution. That is why these measures are supported by the Royal College of Surgeons, the Royal College of Physicians and the Royal College of Emergency Medicine.

When the previous Labour Government changed the consultants’ contract in 2003, senior doctors did not like it. They said that it led to

“a loss of a sense of vocation and what it means to be professional”.

That quote is from a King’s Fund report. It undermined the basic relationship between doctor and patient. We are not blaming doctors, and actually we are not blaming unions, because unions will always ask to see what they can get—the right hon. Gentleman spends more time with unions than I do, so he knows that better than I do. The people responsible for that decision in 2003 were the Ministers who signed off changes to the consultants’ contract and the GPs’ contract. It was Labour politicians who were responsible for those changes, and they must take responsibility for the fact that it was the wrong thing to do.

Finally, this is the most important question of all, and we have not heard an answer today: does the right hon. Gentleman support the measures that the Government are putting forward to make our hospitals safer with seven-day working or not? Leadership is about making choices, and today’s choice is this: is he on the side of the patient or on the side of the union? We know whose side we are on. For Labour, once again, the politics matters more than the patients.

I welcome the Secretary of State’s vision of an NHS that is empowered to focus more fully on the people and communities it serves and that is more transparent, less bureaucratic and as safe on a Sunday as it is on a Wednesday, and I welcome his comments about culture change. Does he agree that meeting that challenge will also depend on financing? As welcome as the extra £8 billion announced in the Budget is, will he join me in urging colleagues to ensure that as much of that as possible is front-loaded, because it is so necessary for the transformational changes he has talked about? In encouraging leadership across the NHS, will he ensure that the changes that are needed at a local level, and the systems we can integrate for the benefit of patients, can be introduced more quickly and effectively?

I thank my hon. Friend for her important comments, and for sitting through a very long speech I gave this morning. We are trying to achieve many things. At their heart, as she rightly says, is a recognition that culture change does not happen overnight. She is right that the profiling of the extra money that the Government are investing in the NHS is important, because we need to spend money soon on some things, such as additional capacity in primary care, as in two to three years’ time that will significantly reduce the need for expensive hospital care. We are going through those numbers carefully. She is also right that local leadership really matters. I know that she will agree, especially as she comes from Devon, that leadership needs to be good at a CCG level as well as a trust level, because CCGs have a really important role in commissioning healthcare in local communities. That is an area where we need to make a lot of improvements.

I have to declare an interest: like most doctors, I am a member of the British Medical Association.

I commend the Secretary of State for his announcement about a national officer for whistleblowers. Shona Robertson, Scotland’s Cabinet Secretary for Health, announced this in June, and we are taking action on the Francis report in the same direction. It is vital that members of staff feel they have someone to speak to if things are not going well, and that if they are not being responded to locally there is an independent voice that they can go to.

With regard to seven-day services, the excess deaths of people who are admitted at weekends is recognised and abhorred by the vast majority of doctors. I do not know anybody who gets up and works the hours we do and does not care that someone did not do well. However, I think we are blurring the lines between the elective and emergency systems. The sickest people the Secretary of State mentions—those who run the risk of dying if admitted on a Friday or a Sunday—are not part of the elective system but of the out-of-hours emergency system. It is suggested that hospitals are like the Mary Celeste and there are no doctors. In fact, any service with an emergency component runs 24/7, but there is a multi-disciplinary team. Sometimes patients will be stuck on a ward because they cannot get access to a scan or there is no physiotherapist to help them recover from their stroke.

We are already working towards solving this in Scotland. We are doing so in a more collaborative way, and that is important. There is no resistance to that, because it is recognised that we need all parts of the service. This is different from people coming in for a routine check-up on a Sunday when that does not result in a detriment to them if it is not available. The biggest shortage we have is in human resources—doctors, nurses, physios, occupational therapists and radiographers. I recommend that the Secretary of State separate these two aspects. The first is that hospital consultants did not get the option to opt out of 24/7 care for emergency patients in the contract, whereas GPs did. It is a matter of providing, funding and setting up a full service with all that is behind it to deal with ill patients seven days a week, no matter when they come in.

The other aspect is trying to get value for money. If we have invested in expensive machines and theatres, we want them to work as many days a week as possible so that we get value for money, but that must be secondary to the first priority, which is looking after sick people. I suggest that the Secretary of State starts talking about the two aspects on separate tracks and not crossing backwards and forwards, and that this should be collaborative. I echo the hon. Member for Totnes (Dr Wollaston) in saying that we require the money to be front-loaded so that we get it to start changing the service now.

Order. May I gently say that from now on we are going to have to enforce the time limits on Opposition responses to ministerial statements much more strictly? Otherwise they eat into the time available for other colleagues. The shadow Secretary of State has five minutes in response to a 10-minute statement and the third party spokesperson has two minutes. That really does have to be adhered to as a matter of course from now on.

The hon. Lady speaks with the authority of someone who works in hospitals, and I always listen to her very carefully. I do not think it is easy to make a rigid distinction between elective and emergency care. The opt-out in emergency care does apply, for example, to accident and emergency doctors. Sometimes when people are admitted to hospital because they are ill—they would not be admitted if they were not—their condition may not appear to be life-threatening on a Friday afternoon but then, over the course of the weekend, they deteriorate, and by the time they are seen by a senior consultant on a Monday or a Tuesday, it is too late. The trouble is that we have a culture in which a lot of major services are available only from Monday to Friday, and that is what is causing these avoidable deaths. The hon. Lady is right to say that this is not just about senior consultant cover; it is also about diagnostic care, handovers and many other things, and we are working at those. The Royal Edinburgh Infirmary has done a very good job of eliminating the difference between weekday and weekend mortality rates, as have Salford Royal and Northumbria hospitals in England. We need other hospitals to follow those examples.

Senior clinicians in my constituency are warning of a major threat to patient safety as a result of a proposed downgrade of one of Britain’s best hospitals, Wythenshawe. The regional transplant unit is a world-class centre for heart and lung and there is a major trauma centre adjacent to Manchester airport, where it should be. That must all be protected. The Secretary of State knows my view that the consultation has been opaque, and that the decision-making process has been flawed. Will he review the decision as urgently as possible, and meet me and other Members for local constituencies as a matter of urgency before the summer recess to discuss what can be done?

I am more than happy to meet my hon. Friend to discuss those matters. Wythenshawe is an excellent hospital—I have been there—and it has provided a number of staff who have helped to turn round the standard of care at Tameside hospital, which has seen dramatic improvements. I recognise that Wythenshawe is an excellent hospital, and I am very happy to meet him to listen to his concerns.

How will the Secretary of State pay for his very laudable objective of seven-day working when he has lost control of NHS finances? Contrary to what he claimed about the situation in Devon, as things now stand our patient care is suffering, waiting times are rocketing and we are facing a £434 million deficit.

Let me tell the right hon. Gentleman why so many places are going into deficit. They have looked at the lessons of Mid Staffs and said, “We don’t want that to happen here.” That is why, in the past two and a half years, hospitals have employed 8,000 more nurses on hospital wards to deal with the scandal of short staffing that they faced and wanted to do something about. In the end, if it is not sustainable, it is not quality care, so we have to find smart ways to control deficits—not by reducing the staff and making care unsafe, but by making changes to process and through efficiencies, such as making sure that nurses do not spend too long filling out forms and can spend more time with patients. In terms of funding, I would just say that the only way to fund a strong NHS is to have a strong economy, and that is why the country voted in a Conservative Government in May.

I declare an interest as a member of the BMA.

I absolutely agree with all the points made by my hon. Friend the Member for Totnes (Dr Wollaston). I like the reforms of leadership, but will the Secretary of State recognise the existing great leadership in the NHS? A safe NHS is one in which staff morale is at its best. If every leader in the NHS was at the level of Professor Sir Peter Morris, we would already have the best and safest health service in the world.

My hon. Friend obviously speaks with huge knowledge—I am wondering whether she is the first Conservative MP who is also a member of the BMA —and is extremely welcome for the insights she brings to the House.

Leadership and morale are absolutely crucial. One of the ways in which we can improve morale is by giving patients and doctors alike the sense that we are honest about the problems and have good plans in place to tackle them. Nothing eats away more at morale than people going in day in, day out and not giving patients the care that they want to give and feeling that nothing is being done about it. That is why the move towards transparency, which I know my hon. Friend supports, is so important.

I echo the comments of the hon. Member for Altrincham and Sale West (Mr Brady). Despite a public consultation wanting five major trauma receiving sites in Greater Manchester and Wythenshawe hospital being the public choice, it did not receive specialist status at the end of the Healthier Together process yesterday. What assurances can the Secretary of State give the people of Trafford and south Manchester, particularly in relation to the 18 specialisms that are underpinned by Wythenshawe being a major trauma receiving site?

As I said to my hon. Friend the Member for Altrincham and Sale West (Mr Brady), I will look into the decision made by Healthier Together. The assurance that I can give to the constituents of the hon. Member for Wythenshawe and Sale East (Mike Kane), and indeed to all people in the Greater Manchester area, is that with some of the most exciting changes, such as the integration of health and social care and the transformation of out-of-hospital care—it has just been announced that there will be seven-day GP services across Greater Manchester—they are blazing a trail. It will be exciting for his constituents; none the less, I understand their concerns about their local hospital and I am happy to look into that.

We in Staffordshire know better than most what the denial machine that the Secretary of State referred to meant to local people, so I congratulate him on his commitment to transparency and consistency. Will he encourage the Heart of England NHS Foundation Trust and the Burton Hospitals NHS Foundation Trust to work much more collaboratively, so that that commitment to transparency and better service is delivered to my constituents in Tamworth and Fazeley?

I will absolutely encourage that. The Heart of England NHS Foundation Trust is one of the biggest in the country and has had significant challenges. The Burton foundation trust has been through the special measures process, and patient care has improved as a result. Collaborative working will be the way forward. We need to break down the silos that have cursed so much of the NHS, and I will happily pass on that message.

I advised food manufacturers in the ’90s about bringing in seven-day working to keep supermarket shelves stacked. Twenty years on we are still talking about seven-day working in the NHS, and it seems to me that good care and saving lives are rather more important. Will the Secretary of State ensure that exactly the same principle applies to mental health? Does he recognise that it is just as important to ensure that people can leave hospital and go home on a timely basis, seven days a week, but that with cuts to local government funding there will be more pressure and it will be more difficult to achieve that? Together with the extraordinary pressure that the system is under, does that not make the case even more strongly for a new settlement for the NHS and social care?

I thank the right hon. Gentleman for finding time to come to the Chamber on what I know is an important day. I am not sure whether I am allowed to wish him luck, but I greatly value the time that I spent working with him as a ministerial colleague, and I know he will make an important contribution to the House. He is right, as ever, to speak about mental health. The programme towards seven-day working is as important for mental health as it is for other services, and we must also ensure that the revolution happens for things such as suicide rates and crisis care. He is right about the importance of the social care system; and in my mind when I speak about seven-day care I am thinking about social care and health as one entity.

Our doctors no doubt work incredibly hard in our hospitals. The people of Brigg and Goole and the Isle of Axholme work at weekends, whether in factories, at the docks or in the fields, and they want an NHS that does the same. The Secretary of State will know about my passion for ambulance services, which at weekends are often the last line of support for patients. What will his plans mean for ambulance services and the incredible job that paramedics do across the country?

I thank my hon. Friend because he leads by example as a first responder and does a fantastic job in his constituency—indeed, that role takes place at weekends. Paramedics and ambulance services operate a seven-day service. Nurses, paramedics and others who work in hospitals currently do not have an opt-out; consultants are the only ones who do. These measures will give ambulance services confidence that if they take someone to hospital at the weekend, there will be a proper senior consultant present and their patient will get in front of the right person. That will make their job all the more rewarding.

The Secretary of State has not outlined what steps should be taken to recruit, train and retain front-line staff who are key to patient safety.

We have big plans to recruit and retain staff, and those are being worked up by Health Education England. We think that we will need extra doctors to deliver seven-day care, just as we will need more GPs. We think we can afford that within the extra £10 billion that we are putting into the NHS, and we are ensuring that all the numbers add up. I am sure that I will inform the House once we have come to a conclusion.

I declare an interest as an NHS nurse. Does the Secretary of State agree that the UK has one of the worst one-year cancer survival rates compared with the rest of Europe, with one in five cases being diagnosed as an emergency admission? Having a prompt diagnosis is very important. A seven-day-a-week service would be a major step forward, because patients should be seen when clinically indicated, not when indicated by the calendar. With a seven-day service they will be seen more quickly and be less poorly. Not only will that save money but—more importantly—it will save lives.

Absolutely. May I say how pleased I am to welcome my hon. Friend’s experience to the Conservative Benches? It makes a big difference. She is absolutely right. NHS England will be saying more about how we intend to deal with the problem of late diagnosis of cancer, which is critical if we are to improve our cancer survival rates. One point that links to the announcements I have made today is better collaboration between senior cancer consultants and GPs. If GPs are to be able to spot cancers earlier, they will need to link into the learning they can receive through closer contact with consultants and hospitals. That is something we need to think about.

As someone who has spent quite a bit of time going to hospitals over the past 16 years, I have learned a little about it. I suspect that some people, like the doctors who the Secretary of State wants to collaborate with, just might have reflected on why this Tory Government are more concerned with getting in agency nurses and doctors than giving nurses a decent pay increase. Has it not crossed his mind that by telling nurses they are worth only 1% more, he will finish up with more agency nurses? The truth is that doctors see this happening every day. The main reason is that the Government have tried to reform and privatise the NHS for the past five years. The doctors and the nurses do not trust him—it is time he got out.

Let me tell the hon. Gentleman what the doctors and nurses working in our NHS hospitals see. They see 8,000 more hospital nurses on full-time contracts than when his party was in power, because we are doing something about the scandal of short-staffed wards that was left behind by his Government.

Will my right hon. Friend ensure that neither the revalidation regime nor the NHS’s status as a near monopsony employer is allowed to promote anxiety among NHS staff who would otherwise wish to speak up? It is essential that they know they have that freedom and security.

As ever, my hon. Friend is spot on. At the heart of what I am saying today is creating a new learning culture inside the NHS where people are able to be open. In the airline industry, it is much easier for a junior pilot to talk to a senior pilot about a mistake they think the senior pilot has made without feeling it will impact on their career. We need to break down the barriers, so that when people talk about their concerns—even about what their boss has done, which is never easy—they are listened to and treated seriously, and there are no consequences as a result. We absolutely have to make that change.

Are the Government considering the introduction of charging in the NHS, as a member of the Secretary of State’s ministerial team, Lord Prior, suggested in the other place in response to Lord Patel?

Given the political priority which my right hon. Friend attaches to 24/7 consultant cover for accident and emergency hospitals, why was his Department unable to answer the question I put about which hospitals in England currently provide such cover? Will he collect that data and make sure that it is published?

The truth is that all hospitals have been moving in this direction in the past five years in different ways. My hon. Friend is absolutely right to say that, to make sure we deliver on our manifesto commitment, we will be doing a full and comprehensive audit of which people are delivering which types of services. It is partly about senior consultant cover, which we are talking about today, partly about seven-day diagnostic services, partly about handover, and partly about mental health and many other standards, but, yes, that work is being done.

The Secretary of State was unclear before. May I say that, as far as I am concerned, Labour Members are absolutely in favour of measures that will increase safety at the weekend, and that my party will never prosper as a mouthpiece for the British Medical Association? Is he not concerned that the porters and nurses, who are being asked to swallow a decade-long real-terms pay cut, will not be able to deliver such change given the level at which they are being demoralised?

If you will permit me, Mr Speaker, may I also say that I very much welcome the full acceptance of the recommendations of the Morecambe Bay inquiry? Will the Secretary of State ensure that the families will remain fully involved in ensuring that these measures are implemented, as well as accepted, by Government?

Of course. The hon. Gentleman has liaised very closely with the Morecambe Bay families over the period of the inquiry. I am happy to give him the assurance that they will remain closely involved.

I am very pleased that the hon. Gentleman says he does not want his party to be the mouthpiece of the BMA, but if that is the case, it needs to get behind the proposals that the Government are making today and say it supports them. We have not heard that from his party and that is what the public want to hear.

The trust or place that has probably learned the most from Mid Staffordshire is Mid Staffordshire, or, as it now is, County Hospital, Stafford. Quality of care and performance has increased dramatically, with 98% and more patients seen within four hours at A&E. That is why we need a 24/7 A&E. May I urge the Secretary of State to ensure that the new independent patient safety investigation service is truly independent, despite being housed in the Monitor-Trust Development Authority building?

I thank my hon. Friend for the amazing work he has done in supporting County Hospital through the most unimaginably difficult circumstances. I put on record my thanks to the doctors and nurses working in that hospital who are doing a fantastic job. They have improved care. Many of them were working at the old Mid Staffs hospital and, even during the period of those problems, they were working incredibly hard and doing a very good job for patients. They did not want to be associated with any of the bad things that happened. They are a shining example to all of us. Yes, the independent patient safety investigation service needs to be independent, but I think trusts will welcome this measure. It will mean that a trust has a body, which is completely independent of anyone working in the trust, that it can call in. In a no-blame way, it can find out exactly what happened—a bit like a French juge d’instruction; that kind of principle. I think that will be really welcomed in the NHS, but independence is vital.

I declare my interest as a former NHS manager, latterly for a clinical commissioning group. I very much welcome the focus on patients, transparency and the use of digital, which will be very helpful for the challenges we will face. As a former NHS manager, I would make the plea that management needs support in facing the challenges ahead. I am afraid that confrontation with local doctors as the first step over the summer period is not helpful. Will the Secretary of State please support NHS managers in this difficult task ahead, across clinical and non-clinical standards? I very much welcome the Rose review, but can we please give managers the support they need?

I am really grateful to the hon. Lady for making that point. NHS managers have one of the most difficult challenges in the country. Not only do they have to balance revenue and expenditure; they have patients’ lives at risk and public accountability. It is really difficult to run a hospital or a clinical commissioning group. These are some of the most difficult jobs one can imagine. We need to support them. I hope they will agree and welcome a move away from targets as the main way of driving change in the NHS to intelligent transparency and peer review. This is not a confrontation with doctors. Doctors overwhelmingly support a seven-day service. It is, I am afraid, a battle with the BMA, with which we have been trying to negotiate on the matter for nearly three years. It has refused to move. It needs to get in touch with what its members want and what the public want, and then I hope we can make much faster progress.

A characteristic of the health system in our country is that we have something like 20% to 25% fewer doctors per head of population than comparable countries such as France, Germany and Spain. Is it part of the Secretary of State’s vision to correct this over time, and will that make reforms such as these easier to push through?

We do need more doctors and more nurses. We saw an increase of about 8,000 nurses and 10,000 doctors in the previous Parliament. We will need more for the simple reason that we will have 1 million more over-70s by the end of this Parliament. That said, the NHS is admired in the other countries my hon. Friend talks about for our models of care, which are sometimes less hospital-centric and therefore inherently more efficient than what happens in some other systems. The learning should go both ways.

My question is about whistleblowers. I want to know whether the Secretary of State is really satisfied that the fit and proper person test for managers is working, when it allows a chief executive who bullies and mismanaged, as happened in Hull, as the Secretary of State knows, to move with the help of the Trust Development Authority to another job as a chief executive, paying £170,000, and yet the whistleblower has to fight for her rights. When the fit and proper person test was invoked, the TDA investigated and the new trust, unsurprisingly, said that that chief executive was okay. I do not think that that is independent, transparent or in the spirit of Francis.

I recognise that the hon. Lady has legitimate concerns about the way that the whistleblower, who I think is one of her constituents or is near to her constituency, was treated. I have, as she requested, looked into that very carefully. She will understand that it would not be right or proper for me to comment on an individual case. She knows that, as a result of requests by her and fellow MPs, I looked into whether due process was followed in the case that she mentioned. All I will say is that bullying behaviour should not happen anywhere in the NHS. That is a very important part of the culture change that I want to see.

In Torbay, there are a number of concerns about access to primary care, due to issues of recruitment and retention of GPs. Recognising the comment that the Secretary of State made earlier in response to my hon. Friend the Member for Totnes (Dr Wollaston), how does the Secretary of State see his statement today helping to improve this situation?

We have some fantastic primary care in Torbay. I remember visiting my hon. Friend during the election campaign and going to a hospice run by an absolutely inspirational lady. We need to build on those traditions, and modern technology offers us an opportunity to go even further. In the end, this is about having a less hospital-centric system and prevention rather than cure, and our great tradition of general practice will be our strongest asset in that change.

The idea of seven-day working sounds absolutely fantastic for supplying services, but in west Cumbria, where we struggle to deliver services five days a week, it sounds like nothing more than a fantastic pipe dream. I am aware that the Secretary of State understands the specific problems we have in west Cumbria, but I want to ask him about a letter that I recently wrote to him to do with Cockermouth hospital—a beautiful new hospital which sits half empty. Will he meet me and clinicians from that hospital to see how we can deliver and solve the problems in Cockermouth?

I would be very happy to meet the hon. Lady and clinicians. I am aware of the problems in that health economy and I am aware that they are long-standing. They are a concern to me and I would be delighted to do anything I can to support her in helping to solve them.

I was shocked to hear the right hon. Member for Leigh (Andy Burnham) running down the NHS yet again. He obviously has not been watching the series on television about the Royal Derby hospital, or looked at its website, where most of the comments are incredibly positive. Also in Mid Derbyshire we have surgeries that wish to take some of the burden away from hospitals. Does the Secretary of State agree that we should be encouraging that, where they can offer services to save people from going to hospital?

I absolutely agree. I commend the Royal Derby, which is an excellent hospital, and thank my hon. Friend for mentioning it. It is really interesting: around the country the number of people per thousand who use A&E varies from 166 to 355—a dramatic variation—and a lot of that relates to the availability of good primary care services, which is why our plans for seven-day GP appointments are also a very important part of the programme.

I welcome the partnership on patient safety that is being announced today between Queen’s hospital in Romford and King George hospital in Ilford and the Virginia Mason Institute, and echo some of the comments made by my hon. Friends about the Government taking staff with them and looking at issues around pay and workforce. May I gently point out to the Secretary of State that it is now two months since I wrote to him about pressures in our local health economy and the future of our A&E department. Can he offset my disappointment by agreeing to meet me and my hon. Friend the Member for Ilford South (Mike Gapes) and other local MPs to discuss those issues?

I know that the hon. Member for Ilford South (Mike Gapes) secured a Westminster Hall debate on this yesterday, during which I hope the hon. Member for Ilford North (Wes Streeting) covered most of the issues he wants to address, but I am happy to arrange to meet him or to get the Under-Secretary of State for Health with responsibility for hospitals, my hon. Friend the Member for Ipswich (Ben Gummer), to meet him to discuss those issues in more detail. The hospital trust that the hon. Gentleman talks about—Queen’s and King George are covered by the same trust—has been through a very challenging period. It is a big trust; it is going through special measures, but I think it has good new management. I think they have really turned things around, and that staff are to be absolutely commended. The link with Virginia Mason in Seattle will be as inspirational for them as it has been for me to see what is possible.

I welcome today’s statement about transformation of our NHS. Will the Secretary of State join me in welcoming the progress made by East Lancashire Hospitals NHS Trust, which came out of special measures about 12 months ago, and particularly the fact that a Health Service Journal and Nursing Times survey recently ranked the trust among the top 100 places to work, with improved staff engagement and morale, which is a huge transformation from where we were when the trust was put into special measures?

I thank my hon. Friend for his passionate support for that trust through a very difficult period. I also thank him for giving us perhaps the single biggest insight into how to transform a hospital in difficulty: according to all the measures, the most important single thing is to engage with staff. If staff feel supported and listened to, the result is safer care for patients and better outcomes. That is something they have done in East Lancashire, and it is something that many other hospitals could learn from.

Many current failures in care are caused by poor integration of services, not the failure of a specific service. What, in the proposals announced, addresses that problem?

The integration of the health and social care systems, as talked about by the right hon. Member for Leigh (Andy Burnham), is a very big priority. It is a vision shared by all parties. That is part of delivering safe seven-day care. The consequences for the health and social care system if we do not have safe hospital care are people with much greater medical needs, creating much more pressure in the system, so it is part of the same picture.

I thank the Secretary of State for coming to the House and also, I think, for making two written statements. There are only 32 other written statements from Ministers. I remember that when I first got here, there would be 87 written statements on the last day of term, with no chance to scrutinise the Minister. Following what my hon. Friend the Member for Lewes (Maria Caulfield) said, has the Minister had a chance to look at my Ovarian Cancer (Information) Bill, which would help reduce the number of ovarian cancer deaths through earlier detection?

I thank my hon. Friend for his support for that Bill. I hope that plans that NHS England will announce shortly about how we can improve early cancer detection will give him much encouragement. He will see that some of the things that he is campaigning for are actually going to happen.

Everyone supports seven-day-a-week, 24-hour NHS care—who would not? But the bottom line is that there are insufficient resources and insufficient people at the moment for it to be possible to deliver those services. For the Secretary of State to try to blame the health unions for that is not fair, and there are people behind that. The tone of the statement that the Secretary of State made this morning at the King’s Fund has already caused alarm among GPs, and Maureen Baker, chair of the Royal College of General Practitioners, said that this announcement

“will sound…alarm bells for hardworking GPs who fear we will be next in line—even though we are already being pushed to our limits in trying to provide a safe five-day”

a week

“service for our patients.”

I do not blame doctors; I do not blame the unions. I blame Ministers from the hon. Lady’s Government who gave consultants an opt-out at weekends that has had a catastrophic impact on patient care. I am delighted that she supports seven-day care, but it was not in the Labour manifesto; it was in the Conservative manifesto, and we are putting in extra money—£5.5 billion more than Labour was promising—to ensure that we can pay for it.

I welcome the changes that my right hon. Friend has announced today in turning the NHS into a learning organisation rather than a denial machine. Does he agree that there should be a best practice industry standard for healthcare in this country, which learns and compares itself with other countries’ healthcare systems, such as Germany, France and Canada?

That is a very interesting idea, and I am happy to take it away. I am a strong believer in learning from best practice all over the world. Sometimes it is difficult to gather the data, but it is an interesting idea.

The Secretary of State might be in aware that in Huddersfield we are having great difficulty in attracting and recruiting A&E specialists, nurses and GPs. He will know that I am more an education specialist than a health specialist, but given that this is an NHS reform statement, is it not time that we had a serious, fundamental look at how we educate and train everyone in our health service—doctors, nurses, technicians, the whole lot? At the moment it seems more appropriate to sometime in the 20th century than to looking forward in the 21st.

The hon. Gentleman makes an important point. As part of what I said in my statement, we are looking at how we train doctors. My hon. Friend the Member for Weaver Vale (Graham Evans) talked about creating a learning culture, and the big change that we need to make is creating a culture in which people feel supported to speak out about any concerns or anything on which they think they can see a way of doing something better. They must not feel that that could threaten their career prospects. We do not have that culture in the NHS at the moment, but we need it if the NHS is to be the world’s largest learning organisation, as I argued in a speech this morning. I think staff are up for it, but it is a big change.

I thank my right hon. Friend very much for his extraordinarily embracing response to the Public Administration Select Committee report on clinical incident investigation. We started less than a year ago with the germ of an idea, and it has turned into what amounts to a radical reform of safety investigation in the health service. That is a tribute to him and to the Committee’s witnesses, but it is a tribute to the health service itself that it has embraced the idea, which is a big change that I believe will be transformative.

May I pick up on the Secretary of State’s reluctance to provide special legislation for the immunity of those giving evidence to the new patient investigation body? Will he keep an open mind on the subject? If he wants that body to be truly independent and to have a special status, he should remember that the marine accident investigation branch and the air accidents investigation branch have specific legislation to provide for such immunity. Public interest disclosure protection must not be challenged by freedom of information requests, given that freedom of information has been extended into areas where we never imagined it would go. We have to be specific in legislation that that cannot happen in this instance.

It will, Mr Speaker.

My hon. Friend’s idea is really interesting, and I am happy to take it up and explore whether we need to replicate that immunity so that we can get to the truth more quickly in a no-blame context.

I thank my hon. Friend for the work of the Public Administration Select Committee. I think it is true to say that we would not have the new patient safety investigation service, modelled on the air accidents investigation branch, which has worked so well in the airline industry, if it had not been for the work of PASC. It brought the idea to my attention and it was a good idea, and I know that he will help me make sure that it is a success in practice as well.

I support the comments of my neighbours, the hon. Member for Altrincham and Sale West (Mr Brady) and my hon. Friend the Member for Wythenshawe and Sale East (Mike Kane). Three years ago the new health deal for Trafford resulted in the reduction of overnight and weekend services at Trafford General hospital on the basis that patients would receive better specialist care at Wythenshawe hospital. Does the Secretary of State understand that local people feel that the process has been chaotic, opaque and unresponsive to their concerns, and will he undertake to review the decision as a matter of urgency?

I thank the hon. Lady for the responsible approach that she took to the changes at Trafford general. Of course, I will listen to her concerns carefully, alongside those of her colleagues, and take them up with the NHS. Perhaps if she comes to the meeting that I am organising for her colleagues, that will provide an opportunity for me to do that.

I welcome a huge amount of the statement, particularly about the balance between transparency and more autonomy and the combination of scrutiny and support. Does the Secretary of State agree that not only hospitals and GPs but community and social care services need to be 24/7?

My hon. Friend speaks with great knowledge about health matters, because of her previous job. [Hon. Members: “McKinsey.”] Yes, McKinsey, which does some important work for the NHS. She is absolutely right that we need to be able to discharge into the community on all seven days, and it is important that the primary care and social care systems are part of that change.

When does the Secretary of State intend to implement the recommendation of the Royal College of Pathologists and introduce the role of medical examiner, to provide independent scrutiny of deaths? That has been repeatedly delayed, despite the success of five pilot schemes and the fact that it was recommended in the Francis report.

That is an important recommendation, and the Government support it. We intend to implement it, but there are costs involved, which we are going through as part of the spending review process.

Local people in Corby and east Northamptonshire want to see a truly seven-day NHS. One way of achieving that in our area is to get moving on the new urgent care centre at Kettering, which has attracted cross-party support. Some Members could learn valuable lessons from that project and from what has been going on in Northamptonshire. I thank Ministers for all that they have done in the past to help get that project moving. Will the Secretary of State do everything he can to help it come to fruition in the months ahead?

It sounds a promising project, and I will keep myself closely informed of its progress. We need to better integrate urgent care centres into the work of GPs and hospitals so that, for example, somebody’s GP medical record can be accessed in those centres and any advice that people get there can be seen by their hospital consultant or GP at a later date.

I must first declare an interest as a state-registered health clinician who worked in acute medicine until the election.

I have witnessed pilots of seven-day working, on the ground and across the country, that have just taken five-days-a-week services and stretched the same complement of staff to seven days a week, therefore not making the service any more efficient or safe. With £22 billion of efficiency savings, or cuts, how will we fund seven-day working?

A lot of the efficiency will come from seven-day working, and I do not agree with the hon. Lady that there will be a simple cost increase. The cost to a hospital of cranking down all its services on a Friday afternoon and then having to crank them up on a Monday morning is huge, and it is not efficient. Part of the savings will come from having more streamlined services that operate to a consistently high standard across the week.

Many of my constituents complain about the lack of availability of GP appointments at weekends and outside normal hours. The consequence of that is that people who are ill turn up at A&E, causing pressure on it. I know that my right hon. Friend is taking action on that, but what is he doing to ensure that we have proper seven-days-a-week working across the NHS in primary care as well as in hospitals?

My hon. Friend is absolutely right to draw attention to the fact that our manifesto commitment was to a true seven-day service across hospitals and general practice. That is why, a few weeks ago, we announced in our new deal for general practice plans to recruit 5,000 GPs so that we can increase capacity and make sure that people can get routine appointments in the evenings and at weekends.

I welcome the NHS Pay Review Body’s report on seven-day services. There is a compelling case for such services, but contractual barriers to reform need to be addressed. Today’s statement refers to England and Wales, and the Northern Ireland Assembly has devolved responsibility for health. Will the Secretary of State consider having contact with the other UK regions, to assist them in engaging with national bodies based here on the mainland on how this important matter can be taken forward?

I am very happy to do that. We can learn a lot from each other across the UK about how things are implemented. I thank the hon. Gentleman for his interest in English health matters, because there is always a good read-across.