Sir Jeremy Hunt
MP for Godalming and Ash · Conservative · United Kingdom
“It is a pleasure to speak under your chairmanship, Mr Twigg. I speak today as chairman of the all-party parliamentary group for financial markets and services. I refer hon. Members to my entry in the Register of Members’ Financial Interests, which states that I accept speaking engagements from financial services companies.”
“Chief executives of banks made very ill-judged decisions to continue paying themselves large bonuses at a time when the rest of the country was suffering, and the country suffered a longer and deeper recession at that time as a result of our exposure to the financial services sector, which was much greater than that of our peers.”
“We are in a much, much better state than we were in 2008.” But I do think that it has gone slightly too far in the other direction. Sometimes we can over-correct.”
“What further action will the Government take to improve access to finance for small and medium-sized enterprises and scale-ups, which has been a particular issue in the period since the financial crisis?”
“I thank the hon. Lady for her role in helping to salvage Barings. I did not know that before. She is absolutely right to raise that issue. I do not say this in a party political way, because my party pretty much supported it at the time, but there is no doubt that, in the run-up to the financial crisis, regulation was not as tight as it n…”
“To their credit, this Government have built on those reforms with the Leeds reforms, the Pension Schemes Act 2026 and the forthcoming Financial Services and Markets Bill, all of which are extremely welcome. But, as the hon. Member for Buckingham and Bletchley said, our competitors are not standing still.”
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“No one fights harder and more eloquently than my hon. Friend for the needs of the people of Stafford. I always look with concern at proposals to change emergency services given the huge pressures that exist, so I shall happily look at the plan as he suggests.”
“All I would do is urge the hon. Gentleman to listen to what the Prime Minister said at this Dispatch Box last week. She said that we recognise the short-term pressures—indeed, the Communities Secretary came up with a package of £900 million extra over the next couple of years—but that we also need a long-term sustainable solution, on which the Government are working hard.”
“My right hon. Friend understands these matters extremely well from his time as a very distinguished Health Minister. He is absolutely right; the truth is that we want widespread availability of A&Es but we do not serve patients best by offering identical services everywhere. That is why in the past three or four years one of the things we are most proud of is the setting up of a national network of 26 trauma centres, which has had a dramatic impact on mortality rates for the most serious cases.”
“Let me wish the shadow Health Secretary a merry Christmas and say that despite his rhetoric I see that Santa has been quite generous to him. His local trust in Leicester has 254 more nurses and 306 more doctors than in 2010. Next year, we will have a new £43 million emergency floor at the Leicester royal infirmary. We need to ensure that there is sufficient bed capacity in our hospitals over winter—that is a very important part of winter planning—but we are also doing 5,000 more elective operations every day than when Labour was in office.”
“May I gently urge the hon. Gentleman to be careful with his rhetoric? We are not closing operating theatres for a month over Christmas. We need to be very careful what we say in this place, because people outside are listening. The answer is to ensure that we increase capacity in the NHS, and that is why we have 11,000 more doctors and 11,000 more hospital nurses than we had six years ago. We are training 15,000 more doctors every year from 2018-19 to ensure that we can avoid these problems in the future.”
“As we enter the challenging winter period, I want, on behalf of the whole country, to thank the 2.7 million people working in the health and care system—particularly those giving up all or part of their own Christmas day to look after patients. We are in their debt, and we wish them a merry Christmas, whenever they get the chance to celebrate it with their families.”
“That is an excellent question. We are doing a number of things. First, we have the Stay Well this Winter campaign, which has a lot of advice to go out to his constituents and all our constituents about how to avoid things that can lead to their having to go to A&E. However, we also urge the public to remember that accident and emergency departments are for precisely that.”
“I do listen carefully to what the hon. Lady says, because she has campaigned long and hard for social care. However, with respect, I would say to her that she is ignoring one simple fact: there is more money going into social care now than would have been the case if we had followed her advice at the last election. What the Communities Secretary announced was £900 million of additional help over the next two years.”
“The hon. Lady talks about council tax, but she does not call out Labour councils like Hillingdon, Hounslow, Merton and Stoke which complain about pressures in the social care system and then refuse to introduce the social care precept that could make a difference to their residents. We are taking the situation seriously. More was done this week and more will be done in future.”
“First, I absolutely commend the hon. Gentleman for standing with his constituents and championing individual cases. I will happily look into the proposed changes and how they will affect people like Zac. I assure the hon. Gentleman that when we make these changes it is to improve the services of people and his constituents; that is why we are making them.”
“My hon. Friend speaks wisely. Christmas can be a very lonely time for a number of people, so we all commend the work of voluntary organisations that do so well. I would be delighted to meet her.”
“The best thing we can do to narrow the gap is make sure that we continue to invest properly in the NHS and social care system, and make good progress on public health, which often has the biggest effect on health inequalities. That is why it is good news that we have record low smoking rates.”
“The hon. Lady is right to highlight this issue and I agree with her. I am not happy with the service that we provide through CAMHS at the moment. It is a big area of focus for the Government. We are putting a lot of investment in, but there is lots more to be done.”
“We are taking action and I agree with the right hon. Gentleman that what has happened in that case is completely unacceptable. We are currently commissioning a record number of in-patient mental health beds, and it is a very big priority for us to eliminate the problem entirely by the end of the Parliament.”
“I add my congratulations to those of the Speaker on the hon. Gentleman’s long service, which has included campaigning for Bolsover hospital. I simply say to him that we will look very carefully at all proposals to change the services offered. I think community hospitals have an important role in the future of the NHS, but the services they provide will change as more people want to be treated at home.”
“Only by implementing the report’s recommendations in full will we honour the memory of Connor Sparrowhawk, and I commend the statement to the House.”
“There is a new healthcare safety investigations branch to perform speedy, no-blame inquiries into avoidable harm and death, modelled on the successful system that has operated in the airline industry for many years. There is also a consultation concluding this week on legislation to create a safe space for NHS staff to talk openly about how to improve the safety of care for patients, without having to worry about litigation or professional consequences. The culture of the NHS is changing following a number of tragedies, but this report shows that there is much progress to be made in the collection of information about unexpected deaths, analysis of what was preventable and learning from the results.”
“This is more likely to be because hospitals get better at spotting and reporting them than because care is deteriorating. We should also remember that when there is a tragedy in the NHS, there is always a second victim—namely, the doctor or nurse involved, who invariably suffers huge anguish. So let us today also give credit to all NHS front-line staff for the changes that are already taking place to improve patient safety. For example, the number of people experiencing the four main hospital harms is down by a third since November 2012; MRSA and clostridium difficile rates have halved since 2010; and we have 10,000 more hospital nurses in our wards since the Francis report, and they are now at record numbers.”
“From next year we will become the first country in the world to publish data on avoidable deaths at a hospital-by-hospital level. I want to address the issue of how we ensure that data published about avoidable deaths are accurate, fair and meaningful, and that the process of publication rewards openness and honesty. Of course we will be working closely with the CQC, NHS Improvement and senior NHS doctors and nurses to get this right, but I want to make it clear to the House that I will not be setting any target for reducing reported avoidable deaths, and nor do I believe it will be valid to compare numbers between hospitals because the data depend on clinical views that may change or vary. I expect—this might surprise some in the House—to see an increase in the number of reported avoidable deaths.”
“We will also ensure that the NHS reviews and learns from all deaths of people with learning disabilities, in all settings. The learning disabilities mortality review—LeDeR—programme will provide support to families and local NHS areas to enable reporting and an independent, standardised review of all learning disability deaths of people between the ages of four and 74. We will ensure that there is coverage in all regions by the end of next year and full national roll-out by 2019. As the programme develops, all learnings will be transferred to the national avoidable mortality programme. I have today asked the LeDeR programme to provide annual reports to the Department of Health on its findings and how best to take forward the learnings across the NHS.”
“As the report highlights issues around support to families, Health Education England will be asked to review the training for all doctors and nurses with respect to engaging with patients and families after a tragedy and, equally importantly, maintaining their own mental health and resilience in extremely challenging situations. As the report identified particular concerns about the treatment of people with learning disabilities, we will take two further actions. In acute trusts we will ask for particular priority to be given to identifying patients with a mental health problem or a learning disability to make sure that their care responds to their particular needs, and that particular trouble is taken over any mortality investigations to ensure that wrong assumptions are not made about the inevitability of death.”
“I have asked the NHS National Quality Board, which includes senior clinicians from all national NHS organisations, to draw up guidance on reviewing and learning from the care provided to people who die, in consultation with Keith Conradi, the new chief investigator of healthcare safety. These guidelines will be published before the end of March next year, for implementation by all trusts in the year starting next April. We will also be working with the National Quality Board to ensure that much more support is offered to bereaved families.”
“All trusts will be asked to identify a board-level leader as patient safety director to take responsibility for this agenda and ensure that it is prioritised and resourced within their organisation. This person is likely to be the medical director. They will be asked to appoint a non-executive director to take oversight of progress. We will ensure that investigations of any deaths that may be the result of problems in care are more thorough and that they genuinely involve families and carers. More broadly, instead of the patchwork approach that we currently have, all trusts will be asked to follow a standardised national framework for identifying potentially avoidable deaths, reviewing the care provided and learning from mistakes.”
“This will include estimates of how many deaths could have been prevented in their own organisation and an assessment of why this might vary positively or negatively from the national average, based on methodology adapted by the Royal College of Physicians from work done by Professor Nick Black and Dr Helen Hogan. We will require trusts to publish that information quarterly, in accordance with regulations that I will lay before the House, so that patients and the public can see whether and where progress is being made. Alongside those data, trusts will publish evidence of learning and action that is happening as a consequence of that information. They will feed the information back to NHS Improvement at a national level so that the whole NHS can learn more rapidly from individual incidents.”
“As a result, there is inconsistency. Some NHS trusts get elements of mortality reporting right, but not one gets all the elements right. In particular, the leaders of NHS organisations and their doctors, nurses and other staff simply do not have access to the full picture of how many patients die in their care, which deaths were preventable, and what needs to be learned. I thank Professor Sir Mike Richards and his CQC colleagues for an extremely thoughtful and thorough report. I am accepting all their recommendations. From 31 March next year, the boards of all NHS trusts and foundation trusts will be required to collect a range of specified information on potentially avoidable deaths and serious incidents, and to consider what lessons need to be learned, on a regular basis.”
“I asked the CQC to look at what happened at Southern Health NHS Foundation Trust and to assess more broadly what lessons there are for the NHS as a whole. Its findings make sobering reading. Among other findings, the report says that families and carers often have a poor experience of mortality investigations; that they are sometimes not treated with kindness, respect and sensitivity; that they can feel that their involvement is tokenistic; and that they often question the independence of the reports. The report also says that the NHS does not prioritise learning from deaths and misses countless opportunities to learn and improve as a result, and that there is no single framework that sets out how local NHS organisations should identify, analyse and learn from deaths of patients in their care or those who have recently been in their care.”
“With permission, Mr Speaker, I will make a statement. On 12 April, I asked the Care Quality Commission to conduct an investigation into lessons that needed to be learned following the tragic death of Connor Sparrowhawk in 2013 at Southern Health NHS Foundation Trust. I pay tribute to his family, and particularly to his mother, Sara Ryan, for persistently and determinedly campaigning for a proper investigation into what happened. The lesson of Mid Staffs, Morecambe Bay and indeed other injustices such as Hillsborough is that when families speak out, we must listen. In this case, thanks to Dr Ryan’s efforts, many improvements will be made to the care of people with learning disabilities and many lives will be saved.”
“It is not about money; it is about making sure that lessons are learned openly and transparently so that history does not repeat itself. That is really what this is about, and that is why we will continue our mission to make NHS care the safest and highest quality in the world.”
“The point I would make, because we have had a good exchange and I do not want to get into the specific politics of NHS funding, is that this is a win-win, because avoidable harm and death is incredibly expensive for the NHS. The time it takes to carry out investigations when things go wrong is utterly exhausting for the doctors, nurses and managers involved, who would much rather be doing front-line care. Preventing these things from happening in future is the best possible way of freeing up time for people on the frontline. I will take away what the hon. Gentleman said about the Elizabeth Dixon case and find out what is happening with that review. The real lesson of today is that every family, every doctor and every nurse has a simple aim when a tragedy happens.”
“I am sure that it was a great surprise to many people in the NHS how excluded many families felt. We clearly have to do better in that respect. The hon. Gentleman talked about the National Patient Safety Agency, and I pay credit to Sir Liam Donaldson, who was chief medical officer under the previous Labour Government and a great champion of patient safety, but we now have different structures in place. The new CQC inspection regime and the healthcare safety investigation branch are giving equal, if not greater, priority to patient safety. We discuss on many occasions the funding issues that the hon. Gentleman raised, as I think he is acknowledging with his facial expressions.”
“Through the national framework, we are trying to move away from a blame culture. Of course people have to be held accountable. If there is gross negligence and people do totally irresponsible things, then there must be no hiding place and proper accountability: that is what families rightly insist on. For the vast majority of the time, however, people are just trying to do their jobs as best they can. As he rightly says, it is often a systemic problem that can be solved with systemic changes. We are now trying to implement the culture of investigation that has worked so successfully in the airline industry and other industries. I absolutely assure the hon. Gentleman that families and carers will be equal partners as we develop the new national guidance. This area was one of the most shocking things about the CQC report.”
“I thank the shadow Health Secretary for the constructive nature of his comments. He is absolutely right in that, because this issue can unite people in all parts of the House. In fairness, these tragedies happen when those on either side of the House are responsible for the NHS, and we all have a responsibility to work to do better than we are doing at the moment. I particularly agree with the hon. Gentleman that front-line doctors and nurses work incredibly hard, and we need to get away from a blame culture when these tragedies happen. That blame culture is the root cause of why we are not learning as we should from the problems that arise, because people are worried about what will happen to them personally if they speak out. We have seen this with a number of tragedies.”
“I thank my hon. Friend, who does a huge amount of work on patient safety, not least because of sadness in her own family’s experiences that gives her particular passion in this respect. This is absolutely about creating a just culture. Inspiring people like James Titcombe, who lost his own son at Morecambe Bay, talk far more eloquently than I can about the need to get this right. Part of that just culture is about justice for people who use the NHS in future, to whom we have a responsibility to learn the lessons and make sure that mistakes are not repeated. One of the really important things we need to get right is to make sure that when something goes wrong in one place, there is a national way in which the lessons can be conveyed right across the NHS as quickly as possible.”
“Lady is absolutely right about near misses, and we will include that issue in the “learning from mistakes” ambition. The hon. Lady is most right of all about people with learning disabilities. The heart of the problem is deciding when a death was expected and when it was unexpected. About half of us die in hospitals. As she rightly says, the vast majority of those deaths are expected, but when a person has a learning difficulty it is very easy for a wrong assumption to be made that they would have died anyway. That is a prejudice that we have to tackle, and one that Connor Sparrowhawk’s mother talks about extremely powerfully. We have to make sure that this is not just about lessons for the whole NHS, but particularly about ensuring that we do better for people who have learning disabilities.”
“I thank the hon. Lady for her contribution. I recognise the progress made in the Scottish patient programme, and particularly the inspirational leadership of Jason Leitch, who has done a fantastic job in Scotland and some very pioneering work. The hon. Lady made some good points that I will take in reverse order. On whistleblowers, I asked Sir Robert Francis to look at this in his second report. He concluded that it would be very difficult, if not impossible, to go back over historical cases, because the courts have pronounced and it is very difficult to create a fair process where legal judgments have already been made. However, I take on board what she says, and I do not think that that means that we cannot learn from what has happened in previous cases; they are very powerful voices. The hon.”
“I am happy to put on the record the fact that those words have the Government’s wholehearted support. I credit my right hon. Friend for his work leading the APPG. I commissioned the CQC report because a year ago we had a report by Mazars on what happened at Southern Health, which said that only 19% of unexpected deaths were investigated and that that fell to 1% for people with learning disabilities. That cannot be acceptable, and it is why it is so important that we act on today’s report.”
“That is not possible if the majority of staff are employed on a temporary basis. He makes a very important point.”
“First, I am sure the whole House will join me in offering my condolences to the hon. Gentleman for what happened to his father. The incredible grief that he and others feel when they lose a family member is compounded if it is subsequently discovered that the death was avoidable. The hon. Gentleman raises a very important point. The CQC was not specifically looking at the issue of locums in this report, but in many other reports, on many occasions, it has talked about the dangers of locum and agency staff for precisely the reason he mentions. It is partly because people are not necessarily around at the time of an investigation, as they have moved on and work somewhere else, but it is also partly because, as I am sure we all believe, staff can give better care if they are in a team of people who know and trust each other.”
“My hon. Friend has spoken very eloquently about that issue many times in this House. If a baby is born with a serious brain injury there will typically be a court case that lasts 11 years, and a settlement of around £6 million. That family are having to cope with the shock of having a disabled child—some families say that that is a kind of mourning process because the baby is not the one they were expecting, although they then go on to give the most extraordinary love to that child—and we compound it by making them go through a legal process that lasts more than a decade. It is absolutely shocking and despicable if that happens. We need to find a way to get those families the financial support that they need earlier, and make sure that we learn the lessons more quickly. That is absolutely what this agenda is all about.”
“I want to put on the record that the right hon. Gentleman was a big champion for people with learning disabilities when he was in my ministerial team, in particular over issues such as Winterbourne View, which he brought to my attention and did a huge amount of positive work on. I have met Sara Ryan. I spoke to her again yesterday. I repeat what I said in my statement: that without her campaigning we would not now be making the huge changes on a national level that we are. I wholeheartedly agree with the right hon. Gentleman’s other comments.”
“That is why the report is very clear that all acute trusts are required to know when patients have learning disabilities or mental health problems and to pay particular attention in any mortality investigations that happen regarding those patients.”
“My hon. Friend makes a very good point. We are making sure that all A&Es have liaison psychiatry services by the end of this Parliament. The critical issue is that someone with a severe mental health problem or learning disability who turns up in an A&E has special needs, and has bigger needs than the other patients there, but unless that is recognised early in the process, they are unlikely to get the care they need. If a tragedy then happens and they go on to die—as sadly happens sometimes—but the illness or disability is not known about, people do not realise that there are other potential issues.”
“When the new guidelines are published, we need to investigate, as far as we possibly can, deaths that have already happened. I totally recognise the hon. Gentleman’s picture of Pennine and share his real worry about the standard of care in that trust. The positive thing is that under the leadership of Sir David Dalton—the chief executive of Salford Royal, which is one of the safest trusts in the NHS and a CQC outstanding trust—things are beginning to turn around. I have spoken to him about the situation at Pennine on many occasions. The hon. Gentleman is right to say that there is a lot of work to do there.”
“My hon. Friend is absolutely right. Boards now have a legal duty of candour, and are obliged to tell patients the truth about what has happened when something goes wrong, but how can they possibly do so if they do not properly record deaths or avoidable deaths? That is why this is a very significant moment. From next year, on a quarterly basis, all trusts will be publishing how many avoidable deaths there are in the trust. Those figures will be compared with national benchmarks. That is how we will start to make boards feel that they have a critical responsibility on this.”
“The right hon. Lady is absolutely right. I will take away with me the question of what the legal responsibilities will be for people in adult social care settings. One thing the report highlights, which I had not particularly anticipated, was the problem that a number of people with learning disabilities are cared for in multiple settings, so if there is a tragedy, the place where the tragedy happens may not be the place responsible for what went wrong. Often, the person’s previous care provider never even finds out that that person has died. One thing that Sir Mike Richards talks about is making sure that all care providers are informed promptly when something happens, so that there can be a multi-institution examination of what went wrong.”
“I am happy to look personally at the case that my hon. Friend talks about. I think he speaks for all patients and families who have suffered tragedies when he says that the only thing people want is for lessons to be learned. A more challenging issue is that staff sometimes do not feel empowered to speak out in such situations, and they worry about the consequences. A number of trusts have an outstanding learning culture that is really supportive of staff, but that is not the case everywhere. One of the big lessons from today is that we must work out how to spread that positive culture across the NHS.”
“It is a difficult one, because access to lawyers is a matter for the Ministry of Justice. I am not trying to duck the issue, but my responsibility, in what we are trying to do today, is to try to make sure that families do not feel as though they need to go to lawyers, because the NHS is open and transparent enough. With the values of people in the NHS, I think that ought to be achievable. I am happy to look at the case that she raises, and to bring it up with my colleague the Lord Chancellor.”
“I am happy to do that. The best way to understand what we are trying to achieve—this relates to what the right hon. Member for North Norfolk (Norman Lamb) said earlier about the speed of investigation—is to think about the tragedy of the recent Croydon tram crash. Within one week of the accident, the rail accident investigation branch produced and published a full investigation into exactly what happened, which made it possible to transmit that learning around the whole tram industry. That is what we are looking for. We have modelled the healthcare safety investigation branch on what happens in the transport industry. It has already been set up, and we are lucky that the person heading it up is Keith Conradi, who headed up the air accident investigation branch and knows exactly how these things should happen.”
“There are a number of barriers, one of which is time. Staff feel very pressured for time. I strongly argue that it is a false economy not to allow time for lessons to be learned, because tragedies, when they happen, take up a huge amount of time. From a management and leadership point of view, we have to make sure that doctors and nurses are given the time for reflective learning as part of what they do. Another thing is the management culture. If people feel that the management of their trust are open and listening, they are more likely to be open and listening themselves. If they feel that there is a hire-and-fire culture, they are less likely to take that approach. There are a number of lessons.”
“Their standards about what is expected and what is unexpected may start to change as they realise that things could have been done to prevent a death that they might previously have described as expected. We have a duty, as Members, to encourage responsible reporting of this new openness, and that, in turn, will help staff.”