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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“As my hon. Friend knows, I have met the parents of Sam Morrish—Scott and Sue Morrish—on a number of occasions. They described how when their son died, all the shutters came down. I met them only a few months after I became Health Secretary, and that engraved itself on my memory because it was so awful to hear about what they were doing. My hon. Friend raises a rather sensitive issue, which I tried to talk about in my statement. I expect, as a result of the changes, the number of reported avoidable deaths to increase. If that happens, I do not think that it will necessarily mean that patient care is suffering. We have to be very careful, in this House and with our local newspapers, to say that if trusts start to report an increased number of avoidable deaths, it might mean that they have a more transparent culture and are being more open.”
“NICE has published its staffing levels for wards. I recognise the problem, and it is exactly what we were dealing with in the Francis report. We now have 10,000 more full-time nurses on our hospital wards than we had three years ago. We are making significant progress, but there is still huge pressure on hospital wards. We have developed a new methodology that more accurately makes sure that patients get the care that they need, whether it is from a nurse, a healthcare assistant or whoever else in the hospital. I am happy to write to the hon. Lady and tell her what that guidance is.”
“I absolutely do so. I know that the family of David Hinks have campaigned very strongly on this matter. The key point about families is that they are often the people who know best what happened to individuals when something went wrong, because they saw the care at every single stage. Whether the care took place in a care home, hospital or a GP surgery, families are likely to have seen the whole thing, and can really help us to understand what might have gone wrong. They are therefore a positive force in this process.”
“There is no country in the world that is even considering what we have announced today, which is to ask hospitals to publish the number of their avoidable deaths on a quarterly basis. It is a very big step that can happen in a system built around public service.”
“When we understand it in that way, we start to realise that the first thing to ask is what could be changed in the system, but if we uncover bad behaviour by individuals—there are 1.3 million people in the NHS, so it is obviously going to happen at some stage—then there of course needs to be full accountability. On the tone of these exchanges, let me say something optimistic: I really do believe that the NHS can become the safest, highest-quality healthcare system in the world. That would be welcomed by the Labour party, as the party that was in power when the NHS was set up, and we would welcome it as part of our absolute commitment to higher standards in public services.”
“In fairness to the hon. Gentleman, he makes two important points. I know that he worked very closely with James Titcombe, who is one of his constituents. We are now learning the right way to deal with the tension between accountability and having a learning culture. Essentially, this boils down to an understanding that 98% of the time a mistake is made because of a systems problem—a structure or a framework that did not enable a doctor or a nurse to operate to the best of their ability—while 2%, 1% or perhaps even less of the time it is a case of genuine negligence by an individual that deserves full accountability.”
“My hon. Friend makes a really important point. I will have discussions with the Minister responsible for social care, the Under-Secretary of State for Health, my hon. Friend the Member for Warrington South (David Mowat), about what we can do in the social care field. I am optimistic that we can do something, because if we make this part of the framework of the new CQC inspection regime—obviously, that has to happen with the consent of the CQC—we can create a very strong incentive for adult social care providers to do what we want and to follow what is happening in the NHS.”
“There should be no hiding place for managers who neglect their legal responsibility, which is the duty of candour that we in this place passed into law in 2014. That is my first point. It is also important to be realistic about the ability to impose a culture on organisations by ministerial diktat, but we can achieve that because this is something that NHS staff want. In some ways, what is most worrying about Pennine is that Salford Royal, one of the best hospitals in the NHS, is virtually next door to it, but the transmission of learning at Salford Royal did not seem to penetrate even into a neighbouring hospital. That is why we must get much better at sharing learning between hospitals.”
“I am happy to do so. We will lay down in regulations in the House that the information must be published for all trusts on a quarterly basis. I draw my hon. Friend’s attention to what I said in the statement, which is that it is not legitimate to compare the numbers in different trusts, because trusts will have different levels of reporting. In fact, our better trusts may actually have higher levels of reported avoidable deaths because they are better at picking up these things.”
“This is a very complex issue, but it is a very important one, particularly for people with learning disabilities who are users of the services of multiple organisations. The National Quality Board will put together guidance before the end of March, so that we can roll this out across the whole NHS during next year.”
“I absolutely endorse what the hon. Gentleman says. The point is that families and carers are part of the answer because they can help us to understand what went wrong. It is therefore in the interests of all of us to treat them with kindness, respect and dignity.”
“This autumn, I met a mental health nurse who told me how she had had to cope with the pressure of one of her patients throwing himself off a bridge the day after a consultation. I am sure that all Members have stories of the incredible dedication of NHS staff—not just people doing their jobs, but people putting their heart and soul into their work, staying late, going the extra mile, and sacrificing home time and holidays to be there for patients. As I did last week, I also recognise the 50,000 NHS staff from EU countries, including 26,000 low-paid staff, who do a brilliant job. Today we have heard concerns about funding, A&E—”
“I beg to move an amendment, to leave out from “House” to the end of the Question and add “welcomes the Government’s investment, on the back of a strong economy, of significant additional funding and resources each year for the NHS during the 2015 Parliament; notes that this settlement was frontloaded at the specific request of the NHS in NHS England’s own plan to deliver an improved and more sustainable service, the Five Year Forward View; and further notes that the NHS will receive a real terms increase in funding in each year of the Spending Review period, while the Labour Party’s Manifesto at the last election committed to only an extra £2.5 billion a year by 2020, far less than the NHS requested.”. As I did in last week’s debate on social care, I start by recognising the fantastic work done by NHS staff up and down the country.”
“I will give way in a moment, but I just want to finish this sentence, if I may. We have heard concerns about funding, A&E performance, waiting times and morale, and I want to answer them all. There are many pressures in the NHS, but I also want to recognise some successes, because one of the things that is most damaging to morale is not giving credit where it is due.”
“As the hon. Gentleman knows, those things would certainly be unsustainable if we had followed the Labour party’s investment plans at the time of the previous general election. If he wants to know what is happening to staff, let me tell him that in the period I have been Health Secretary, we have got 5,000 more doctors and 10,000 more nurses. That is what happens when we have a Government who are prepared to invest in the NHS. The shadow Health Secretary talked about A&E—he is right to say that we are not hitting the target, and we are doing something about that—but he did not tell the House that, since Labour left office, we have recruited 1,200 more doctors for A&E departments, which is a 25% increase, including a more than 50% increase for consultants. Every day, we are seeing 2,500 more people within four hours.”
“With respect, the hon. Lady might be on the wrong side of the House, because I started my speech by recognising the brilliant work done by doctors and nurses, something that the shadow Health Secretary conspicuously failed to do. Let us look at her own hospital: since 2010, St George’s has— [ Interruption. ] I do not know whether she is interested in hearing my response to her intervention. Since 2010, her hospital has had 884 more nurses and 240 more doctors, and her CCG had a £10 million funding increase this year.”
“The shadow Health Secretary also did not talk about cancer. In 2010, we had the lowest cancer survival rates in western Europe. Since then, we have referred for cancer tests 2,200 more people every day, and 100 more people are starting cancer treatment every day. The cancer charities say that this is saving 12,000 lives a year. On mental health, he did not mention the fact that we are treating 1,400 more people every day, with record dementia diagnosis rates.”
“I want to tell the House about one hospital that was put into special measures. Care was unsafe at Wexham Park in Slough—so much so that fewer than half the hospital staff were prepared to recommend the care provided there to their own friends and family—but it has gone from having six of its eight clinical areas rated as requiring improvement or inadequate, to having all eight of them rated as good or outstanding. It has come out of special measures, as have 15 hospitals in total, and we should all commend the staff who have worked incredibly hard to turn around those hospitals.”
“My hon. Friend is absolutely right to raise that point. People will be astonished to hear Labour Members wasting their time talking about a privatisation of the NHS that is not happening when they were responsible for PFI, the worst possible privatisation that has done such enormous damage. Another point that the shadow Health Secretary did not mention was the quality and safety of care in our NHS that Labour left behind. The Francis report revealed massive problems—short staffing, a culture of denial and cover-ups—and they were not just at Mid Staffs but, as we now know, at Basildon, Morecambe Bay and many other trusts. Since we have been in office we have changed that. We have put 31 hospitals into special measures, which is more than 10% of hospitals across the entire NHS, and we have recruited record numbers of doctors and nurses.”
“I thank the chief inspector of hospitals, Professor Sir Mike Richards, for his outstanding work in raising quality.”
“I have often from this Dispatch Box been prepared to praise some of the achievements of the last Labour Government. They did bring down waiting times, but they did not focus on the quality and safety of care. What we now know from the CQC’s new regime, which has just finished its first round of inspections, is that 56% of our hospitals are good or outstanding. One could say that it is disappointing to know that 44% of hospitals are not, but to those who would use that as a political weapon I say this: we are the only country in the world brave enough to set up an independent inspection regime, and if we want to have the safest, highest quality care, the first thing we need to know is where it is good and where we need to improve it.”
“He is right that there has never been greater financial pressure—we have had the financial crisis in 2008, the deficits and the growth in demand from the ageing population—but he must accept that that makes it all the more extraordinary that Labour wanted to cut the NHS budget in 2010 and to cut it from the current levels in 2015. I simply say that we could, as a Government, have chosen to cut NHS funding from this year’s level by £1.3 billion, as under Labour’s plans, but we would have had to lay off 11,000 doctors or 40,000 nurses.”
“The right hon. Lady is right that the Care Quality Commission was set up by the last Labour Government, but it did not have independence from the Government in its inspection reports. When we legislated for that, Labour tried to vote it down. We got it through and changed the inspection system, and it is working extremely well. I want to move on to the substance of the debate, which is about the funding of the NHS. I congratulate the hon. Member for Leicester South (Jonathan Ashworth) on his courage—indeed, his chutzpah—in confronting the issue of funding, despite inheriting a Labour policy to cut NHS funding by £5.5 billion a year by the end of the Parliament.”
“Simon Stevens, whom he quoted, said “our case for the NHS has been heard and actively supported.” NHS Providers, which he quoted, said it was “a good settlement for the NHS.” The King’s Fund, which he quoted, said it was “a good settlement for the NHS”. In fact, because of the Government’s commitment to the NHS, we are spending 10% more on it as a proportion of GDP than the OECD average—that is more than Norway, Finland, Korea, Australia and New Zealand.”
“That is not the problem with our script; it is the problem with the right hon. Gentleman’s script, because as shadow Health Secretary he sanctioned a policy that would have given the NHS £1.3 billion less this year, and at the last election the then shadow Chancellor said he would give not a penny more to local authorities, whereas we are seeing social care funding go up by £600 million this year. More money is going into the NHS and the social care system under a Government who are committed to funding them both. What is especially wrong with the argument made by the shadow Health Secretary, whom I welcome to his place for his first Opposition day debate, is his suggestion that the Government have not honoured their promises to the NHS. What did the independent commentators say at the time of last year’s spending review?”
“My right hon. Friend is right. I congratulate him, because he was part of the shadow Health team that persuaded the then shadow Chancellor and Leader of the Opposition that we needed to make that investment, thanks to which the NHS is doing 5,000 more operations every single day.”
“The money we raise from international visitors is up three times, from £84 million to £289 million.”
“They show that 40 fewer trusts are in deficit. Yes, a year ago, half of trusts were missing their financial plans, but now 86% are hitting those plans. The latest figures, from Friday, show that the deficit will fall 73% from last year, and even lower than the year before. Why is that? It is because of a sustained effort by the NHS to tackle the problem. [ Interruption. ] The Opposition do not want to hear this, but the truth is that the NHS is gripping the very problem the shadow Health Secretary called a debate on. Agency spend, one of the biggest challenges, is on track to go down from £3.7 billion to less than £3 billion. The rates paid for agency nurses are down 18% on a year ago, and for locum doctors they are down 13%. Our procurement changes are on track to save half a billion pounds.”
“My right hon. Friend is right that just occasionally we should listen to experts—but only very occasionally. In the spirit of listening to experts, and as the Leader of the Opposition is here, I will tell my right hon. Friend something else the King’s Fund has said that he will agree with, which is that “claims of mass privatisation were and are exaggerated.” Let us not go chasing down rabbit holes. The result of this Government’s commitment to the NHS is that real-terms spending per head has gone up by 4.6%, which is double the rate in Scotland and three times the rate in Wales. The hon. Member for Leicester South also mentioned the National Audit Office. He did not mention that the numbers quoted in the NAO report are last year’s figures. He chose not to mention this year’s numbers, which were published last week.”
“That is absolutely right. In all frankness, that argument could have been made from the Opposition Front Bench this afternoon, and we would be having a much better debate.”
“I thank my hon. Friend, who himself personifies calm and dignity. Community hospitals are indeed extremely important. Their role may change, but they will none the less continue to be a vital part of provision in most of our constituencies.”
“As for waiting lists, of 1,000 people who are waiting more than a year for their treatment, which is unacceptable, there is just one person from an outstanding trust who has been waiting that long. Some 93% are from trusts that require improvement or are inadequate. This is why we have a huge programme to support and improve those trusts and deal with the challenges they face.”
“There is another danger in the shadow Health Secretary’s argument, a trap that is very easy not just for him but for many commentators to fall into: the suggestion that this is a uniform problem across the NHS that it is powerless to grip without further Government intervention. The reality is that there is huge variation across the system. The deficits at good or outstanding trusts are five times less than the deficits at other trusts. If all trusts had the same financial performance as the good or outstanding ones, we would have a surplus of nearly half a billion pounds. Half the deficits are from just 22 trusts. We see this variation on a very specific level. For example, the amount paid for a pair of surgical gloves, which are very important to all hospitals, is £1.27 in some hospitals and just 50p in others.”
“I will make some progress, but I will find time to give way to hon. Friends who I know want to come in. I want to pick up on a particularly extraordinary comment made yesterday by the shadow Health Secretary. He said: “aggressive efficiency targets have contributed to deficits”. That is a curious thing to say, first because his own spending plans would have meant £5.5 billion more efficiencies. If he thinks our plans are aggressive, I just wonder how he would describe Labour’s approach. Secondly, I know we are all Corbynistas now, but basic economics suggests that efficiency plans do not increase deficits, but reduce deficits. That is what we need to do in the NHS, because we want the money to go to patient care.”
“I do recognise that. It has been going up in Scotland as well. It is short-sighted of both Administrations not to work with us to tackle the problem; otherwise, staff living in border areas play off one system against the other.”
“I am not blaming hospitals. We are supporting hospitals to deal with the problem. The root cause of the problem, set out in the Francis report, was hospitals covering up bad problems. We said no to that and said that we were going to sort it out by having more nurses on our wards. That is why, in the four years that I have been Health Secretary, we have had 10,000 more nurses on our wards.”
“That is a big prize and we should support it, not try to make political capital out of it.”
“If we are going to be the safest and the best quality system in the world, that has to be everyone’s job, everyone’s focus and everyone’s commitment—politicians, yes, but managers, doctors, nurses, porters, healthcare assistants and every single person working in NHS. On the way forward, we first need to move to accountable care organisation models and the “Five Year Forward View”, including the STP process. The shadow Health Secretary called STPs “secret plans”, but in fact 28 of the 44 have been published and the rest will be published before Christmas. Many in the House, on both sides, objected to the Health and Social Care Act 2012 because they felt it did not do enough to support integrated care. Well, now we have a process that is bringing together the NHS and the social care system, acute trusts and primary care, at a local level.”
“It is noticeable that the two potential solutions we have heard have been from Opposition Back Benchers—the right hon. Member for Leicester East (Keith Vaz) and the former shadow Chief Whip, the right hon. Member for Doncaster Central (Dame Rosie Winterton)—and not from the Opposition Front Bench. My hon. Friend makes an important point. The shadow Health Secretary is right to hold the Government to account for the funding of the NHS and the social care system, but it is a big mistake to distil all issues around the NHS into the simple issue of money. That subcontracts the responsibility for safe, high-quality care to politicians.”
“That is what this Conservative Government will deliver, and I urge the House to support the amendment.”
“That is exactly what we need to sort out. We have the STP process to stop people doing their own thing, instead of having a co-ordinated, well-planned strategy. If we stick with this process, embrace innovation and technology and retain a relentless focus on safety and quality of care, in this Parliament we will see a million more people accessing mental health treatment every year; 5,000 more doctors working in general practice and a transformation of services through GPs; a new four-week cancer waiting time standard that will save 30,000 lives a year; more failing hospitals turned around; the weekend effect tackled; more doctors and nurses; and an NHS staying true to the promise made to patients in 1948 that safe, high-quality care would be there for everyone, regardless of income.”
“They work with some of the oldest and most vulnerable people in our society, many of whom have dementia. That is a growing population, with the number of over 90-year-olds having increased by more than a quarter. Life expectancy is up by a whole year since Labour left office. While I would like to claim credit for every Government achievement, that is a demographic change and no thanks to this Government. It also places huge pressure on the system. Every older person is a dad, a mum, a grandparent or a neighbour, and Members on both sides of the House, whatever our disagreements, want them to be treated with the utmost standards of dignity and respect.”
“I beg to move an amendment, to leave out from “House” to the end of the Question and add: “welcomes the Government’s Spending Review settlement for health and social care, which ensures that the amount of money available to local authorities for adult social care services will rise significantly across the Parliament, and ensures that up to £3.5 billion more will be available by 2020; commends the work and dedication of those in the social care sector; and further welcomes the introduction by the Government of the social care precept which allows local authorities greater autonomy in making decisions about how they best meet their local communities’ needs for social care.”. I too want to start by paying tribute all those working in the social care system; there are few jobs that are more important to our society.”
“I absolutely agree with the hon. Gentleman. It is the hallmark of a civilised society that we treat all older citizens with dignity and respect. I totally disapprove of 15-minute visits. I find it impossible to understand how anyone could really look after someone’s needs in a 15-minute visit. I hope that, like us, he is proud of the introduction of the national living wage, which is helping the people who do this very important work. It will help 900,000 people working in the social care system by paying all over-25s a minimum hourly rate of £7.20 from this April.”
“We are absolutely determined to clamp down on employers who do not pay the national living wage. If the hon. Gentleman or any other hon. Member has any evidence at all of that happening, they should let HMRC know. HMRC has a policy of naming and shaming employers who do not do the right thing and rightly so.”
“The hon. Gentleman is absolutely right to make that point. I want to talk about Winterbourne View a little later, because this is not just about older people.”
“I asked the lady how she motivated her staff every day, and she said, “If I can get a resident to smile, they won’t remember it the next day, but I do, and I go home with a smile on my face.” The care that was being provided was, to be frank, completely remarkable. This is a moment for all of us to reaffirm what the Prime Minister said today at Prime Minister’s questions: we want these people to remain and we are confident and optimistic that we will be able to get them to remain.”
“I will give way shortly, but I want to finish my point about the critical role played by care staff. In total, 1.5 million people work in the social care sector, and I want to mention one group in particular: the 90,000 who come from the EU. They do a brilliant job and we value their contribution to the sector. If the House will forgive me, I want to share one story from early in my time as Health Secretary about an absolutely brilliant manager, who is Polish, of a dementia care home in Swiss Cottage. The people at the home had advanced dementia and many were unable to talk or move, so the atmosphere in the home was challenging to say the least.”
“I absolutely want to be someone in this role who confronts poor care and does everything possible to fight for the highest standards. That is exactly why I am doing this job. Poor care comes in different forms and, yes, funding is an issue. As the health and social care system goes through perhaps its most financially challenging period since the founding of the NHS, I particularly want to ensure that we protect the high standards that the right hon. Gentleman cares about.”
“With respect to the right hon. Gentleman, with whom I have enjoyed many debates in this House, neither he nor I wanted the Brexit vote to happen, but now that it has, we have to cope with a very changed world. The Prime Minister said that she is confident of getting an early agreement. I hope that what we are saying in this House this afternoon will resonate with people and make them understand just how valued they are.”