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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“The hon. Gentleman should give a slightly more complete picture of what is happening in his hospitals. There are nearly 2,000 more operations every year, 7,000 more MRI scans, and 7,000 more CT scans than there were five years ago. When it comes to the issue of deficits, we are tackling the agency staff issue. That happened because trusts were responding to the Francis report into what happened in Mid Staffs. Rightly, they wanted to staff up quickly, but it needs to be done on a sustainable basis. I simply say to him that if we were putting £5.5 billion less into the NHS every year, as he stood for at the previous election, the problems would be a whole lot worse.”
“My hon. Friend knows about these things from his own clinical background, and he is absolutely right. We are now doing something—it is probably the most ambitious programme anywhere in the world—to identify the costs that hospitals are paying. From April, we will be collecting the costs for the 100 most used products in the NHS for every hospital. That information will be shared. We are the biggest purchaser of healthcare equipment in the world, so we should be paying the lowest prices.”
“It is stretching things a bit to call that an austerity-driven problem when, next year, we are putting in the sixth biggest increase in funding for the NHS in its entire 70-year history. There are some severe problems at Barts, but we will tackle the deficit. We also need to ensure that we improve patient safety and patient care.”
“As ever, my hon. Friend speaks very wisely. When we are reducing these deficits and costs, the trick is to take a strategic approach and not to make short-term sacrifices that harm patients. That is why, at the weekend, we announced a £4.2 billion IT investment programme, which will mean that doctors and nurses spend less time filling out forms and more time with their patients.”
“By 2020, everyone will be able to get GP appointments at evenings and weekends. By March this year, a third of the country—18 million people—will have benefited from improved access to GP services.”
“I know that West Hampshire CCG is providing extra space and capacity to take on more trainees, and across the country we plan to have 5,000 more doctors working in general practice by the end of this Parliament. This will be the biggest increase in GPs in the history of the NHS. It builds on the extra 1,700 GPs we have working in the NHS since 2010. It does take too long to get to see a GP. We are committed to sorting that out, and the record investment in the NHS five year forward view will make that possible.”
“I am happy to do that. The hon. Lady is right to make those points. It is to care for the vulnerable people with long-term conditions that we need to see the biggest support given to GPs, because strengthening their ability to look after people proactively will mean that those people are kept out of hospital and kept healthier, and costs are kept down for the NHS.”
“I am absolutely prepared to do that and I have met a number of GPs in my hon. Friend’s area. We are reversing the historic underfunding for general practice, with an increase of more than 4% a year in funding for primary care and general practice for the rest of this Parliament. That will give hope to the profession, whose members are vital to the NHS.”
“We have plans, as I mentioned, to have 5,000 more doctors working in general practice, and there is a big interviewing process. We need to increase the number of GPs going into general practice by 3,250 every year and I am happy to liaise with the Province to see how we can work together on these plans.”
“Significant progress has been made in our negotiations with the British Medical Association on a new contract for junior doctors, but agreement has not been reached on the issue of Saturday pay, despite previous assurances from the BMA that it would negotiate on that point. So, regrettably, 2,884 operations have been cancelled ahead of tomorrow’s industrial action, which will affect all non-emergency services. I urge the BMA to put the interests of patients first and to reconsider its refusal to negotiate.”
“I will happily look into that matter. The Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), has held a round table on bullying and harassment. I thank the hon. Lady for raising the issue, because over the past decade—none of us should be proud of this—the number of NHS staff who say they are suffering from bullying and harassment has gone up from 14% to 22%. If we are going to deliver safer care, we have to make it easier for doctors and nurses on the frontline to speak out without worrying about being bullied or harassed.”
“The only reason we do not have a solution on the junior doctors is the BMA saying in December that it would negotiate on the one outstanding issue—pay on Saturdays—but last month refusing to negotiate. If the BMA is prepared to negotiate and be flexible on that, so are we. It is noticeable that despite 3,000 cancelled operations, no one in the Labour party is condemning the strikes.”
“As a result of the changes the Government have made on welfare reform, we have 2 million more people in work and nearly 500,000 fewer children growing up in households where nobody works. Part of that is making important reforms, including having independent medical assessments of people who are in the benefit system. I think everyone should welcome that.”
“The Government have made a huge and significant assessment of the cost of overseas people using the NHS, and we think that there are £500 million of recoverable costs that we do not currently recover. When it comes to the EU, the biggest problem that we have is that we are able to reclaim the costs of people temporarily visiting the UK, but we do not do so as much as we should because the systems in hospitals are not as efficient as they need to be. We are sorting that out.”
“I think my hon. Friend got a bit of a reaction with those comments. The Labour party is saying that if a negotiated settlement cannot be reached, we should not impose a new contract—in other words, we should give up on seven-day care for the most vulnerable patients. There was a time when the Labour party spoke up for vulnerable patients. Now it is clear that unions matter more than patients.”
“Most of all, we must recognise that our understanding of sepsis across the NHS is totally inadequate. This condition claims around 35,000 lives every year, including those of around 1,000 children. I would like to acknowledge and thank my hon. Friend the Member for Truro and Falmouth (Sarah Newton), who—as well as being the constituency MP of the Mead family—has worked tirelessly to raise awareness of sepsis and worked closely with UK Sepsis Trust to reduce the number of avoidable deaths from sepsis. In January last year I announced a package of measures to help to improve the diagnosis of sepsis in hospitals and GP surgeries, and significant efforts are being made to improve awareness of the condition among doctors and the public, but the tragic death of William Mead reminds us there is much more to be done.”
“Call advisers are trained not to deviate from their script, but the report says that they need to be trained to appreciate when there is a need to probe further, how to recognise a complex call and when to call in clinical advice earlier. It also cites limited sensitivity in the algorithms used by call-handlers to red-flag signs relating to sepsis. The Government and NHS England accept these recommendations, which will be implemented as soon as possible. New commissioning standards issued in October 2015 require commissioners to create more functionally integrated 111 and GP out-of-hours services, and Sir Bruce Keogh’s ongoing urgent and emergency care review will simplify the way in which the public interacts with the NHS for urgent care needs.”
“Across those different parts of the NHS, a major failing was that in the last six to eight weeks of William’s life, the underlying pathology, including pneumonia and chest infection, was not properly recognised and treated. The report cites potential factors such as a lack of understanding of sepsis, particularly in children; pressure on GPs to reduce antibiotic prescribing and acute hospital referrals; and, although this was not raised by the GPs involved, the report also refers to the potential pressure of workload. There were specific recommendations in relation to NHS 111 which should be treated as a national, not a local, issue.”
“Today NHS England published the results of that investigation—a root cause analysis of what had happened. The recommendations are far-reaching, with national implications. The report concludes that there were four areas of missed opportunity on the part of the local health services, where a different course of action should have been taken. They include primary care and general practice appointments made by William's family, out-of-hours telephone conversations with their GP, and the NHS 111 service. Although the report concluded that they did not constitute direct serious failings on the part of the individuals involved, if different action had been taken at those points, William would probably have survived.”
“This tragic case concerns the death of a one-year-old boy, William Mead, on 14 December 2014 in Cornwall. While any health organisation will inevitably suffer some tragedies, the issues raised in this case have significant implications for the rest of the NHS, from which I am determined that we should learn. First, however, I want to offer my sincere condolences to the family of William Mead. I have met William’s mother, Melissa, who spoke incredibly movingly about the loss of her son. Quite simply, we let her, her family and William down in the worst possible way through serious failings in the NHS care that was offered, and I want to apologise to them, on behalf of the Government and the NHS, for what happened. I also want to thank them for their support for, and co-operation with, the investigation that has now been completed.”
“We must simplify the options so that people know what to do, and that is happening as part of the urgent emergency care review. It is a big priority, and this tragic case will make us accelerate that process even faster.”
“Fundamentally, when we look at the totality of what the Mead family suffered, we will see that there is a confusion in the public’s mind about what exactly we do when we have an urgent care need, and the NHS needs to address that. For example, if we have a child with a high temperature, we might not know whether they need Calpol or serious clinical attention. The issue is that there are too many choices, and that we cannot always get through quickly to the help that we need. We must improve the simplicity of the system, so that when a person gets through to 111, they are not asked a barrage of questions, some of which seem quite meaningless, and they get to the point more quickly and are referred to clinical care more quickly.”
“With respect to 111, there are some things that we can, and must, do quickly in response to this report, but there is a more fundamental change that we need in 111 as well. One thing we can do quickly is look at the algorithms used by the call-handlers to make sure they are sensitive to the red-flag signs of sepsis. That is a very important thing that needs to happen. NHS 111 has in some ways been a victim of its own success: it is taking three times more calls than were being taken by NHS Direct just three years ago—12 million calls a year as opposed to 4 million—and nearly nine of out 10 of those calls are being answered within 60 seconds. When it comes to the identification of diseases such sepsis, we need to do better and to look urgently at the algorithm followed by the call-handlers.”
“We are also talking to Public Health England about a public awareness campaign, because it is not just clinicians in the NHS, but it is also members of the public and particularly parents of young children, who need to be aware of some of those tell-tale signs. So a lot is happening, but the root cause of the issue is understanding by clinicians on the frontline of this horrible disease, and it does take some time to develop that greater understanding that everyone accepts we need. I can reassure the hon. Lady, however, that there is a total focus in the NHS now on reducing the number of avoidable deaths from sepsis and other causes, and that is something the NHS and everyone who works in it are totally committed to.”
“On top of that—I will come to the issues around 111, and I agree that there are some important things that need to be addressed—a year ago I announced an important package to raise awareness of sepsis. It covers the different parts of the NHS. For example, in hospitals a big package on spotting it quickly has been followed from December 2015, with NHS England publishing the cross-system sepsis programme board report, which is looking at how to improve identification of sepsis across the care pathway. The hon. Lady is right to raise the issue of faster identification by GPs. That is why, in January 2015, I announced that we will be developing an audit tool for GPs, because it is difficult to identify sepsis even for trained clinicians, and we need to give GPs the help and support to do that.”
“I hope I can reassure the shadow Health Secretary on all the points she raised. First, there has been a sustained effort across the NHS since September 2013 to improve the standard of safety in the care we offer in our hospitals. An entirely new inspection system was set up that year. It has now nearly completed inspections of every hospital, and it has caused a sea change in the attitudes towards patient safety. Sepsis is one of the areas that is looked at. In particular it is incredibly important that when signs of sepsis are identified in A&E departments the right antibiotic treatment is started within 60 minutes. That is not happening everywhere, but we need to raise awareness urgently to make that happen, and that inspection regime is helping to focus minds on that.”
“My hon. Friend is absolutely right. There is so much in this report, but we must not let some very important recommendation slip under the carpet, and that is one of them. We have a commitment to a paperless NHS, which involves the proper sharing of electronic medical records across the system. We have also instructed clinical commissioning groups to integrate the commissioning of out-of-hours care with the commissioning of their 111 services to ensure that those are joined up. It is a big IT project, and we are making progress. Two thirds of A&E departments can now access GP medical records, but she is absolutely right to say that it is a priority.”
“Other doctors would say that that is a mistake that could easily have been made by anyone, which is why the report is right to say that it is about not individual blame, but a better understanding of the risks of sepsis. She is right in what she says. As we are trying to join up the services that we offer to the public, it is a good principle to have one number that we dial when we need advice on a condition that is not life-threatening or a matter for a routine appointment with a GP, and 111 is an easy number to remember. However, we need to ensure that there is faster access to clinicians when that would count, and that those clinicians can see people’s medical records so that they can properly assess the situation.”
“I agree with the broad thrust of the hon. Lady’s remarks. Of course she speaks with the authority of an experienced clinician herself. In this case, the tragedy was that there was actually a doctor who spoke to the Mead family on the night before William died, and he did not spot the symptoms. It is not simply a question of access to a doctor, but ensuring that doctors have the training necessary. However, as she says, dealing with cases such as this can be very difficult. The doctor’s view on that occasion was that, because the child was sleeping peacefully, it was fine to leave him until morning when, tragically, it was too late.”
“We should be inspired by the successes that we have had to make sure that we are much, much better at tackling sepsis.”
“I am happy to undertake that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), will look urgently into whether such a campaign would be right. I can reassure my right hon. Friend that the package that we put together and announced last January did contain what most people felt was necessary, but we can always look at whether more needs to be done. I commend her for her campaigning on the issue of sepsis. On a more positive note, when the NHS has decided to tackle conditions such as MRSA and clostridium difficile, it has been very successful. In the past three years, the number of avoidable deaths from hospital-acquired harms—the four major ones—has nearly halved, so we can do this.”
“On the whole, that has been a positive experience, but I know that there have been problems in the south-west, and I am happy to look further at them.”
“I gently say to the right hon. Gentleman that when 111 was set up it had the support of the Opposition. The shadow Health Secretary at the time looked at the risk register. The number of calls has increased dramatically partly because demand for NHS services has increased dramatically. That does not mean to say that there are not important things that need to be improved. We need to look honestly at what went wrong. The 111 service was one of the four areas where we should have done better. I am happy to look carefully at what is happening with 111 in the south-west. One improvement is that, in many areas, we are integrating the commissioning of 111 with the Ambulance Service, and that is something that happens in the south-west.”
“All 111 services have clinicians present at call centres, so it is about not the availability of clinicians, but the speed with which they are involved in cases where they can make a difference. It is also about the training of those clinicians so that they can recognise horrible infections such as sepsis quickly. It is a combination of things. The important thing here is that if we are to give the public confidence in a simpler system where they have a single point of contact—albeit a phone line or a website—they need to be confident that if they are not immediately speaking to someone who is clinically trained they will be put through to such a person if it is necessary. We have not earned that confidence yet, which is why it is so important that we learn lessons from what happened in this tragic case.”
“I understand what the right hon. Lady is saying, and of course I would listen to her because of her experience, but I reassure her that that is not the only thing that we are doing; we are doing lots of other things. The report makes many recommendations, one of which is to look at the algorithms that the call-handlers use to make sure that they are more sensitive to some of the red-flag signs of sepsis, meningitis and other conditions. There are lots of other recommendations. They include earlier access to clinicians where appropriate, and recommendations on the training of clinicians in the out-of-hours service, the training of GPs and the training of people in hospitals. So we will be undertaking a much bigger body of work as a result of this review.”
“If we are to improve standards of care, we need to standardise safety standards across the NHS, including for spotting potential sepsis cases, and that means a much simpler system.”
“I have said before at this Dispatch Box that successive Governments of both parties have under-invested in general practice, and that is part of the reason why it takes too long for many people to get a GP appointment. It is why we have said that we want to have about 5,000 more doctors working in general practice by the end of this Parliament. That is an important part of what we want to do. The other side is improving our offer to the public. When you have a child with a fever, and you are not sure, and it is the weekend, very often you have a choice between an out-of-hours GP appointment, a weekend appointment at your GP surgery, calling 111 or showing up at an A&E department. It is just confusing to know the right thing to do.”
“We believe from the independent case note analysis that has been done across the NHS, not just for sepsis but for hospital deaths, that there are around 200 avoidable deaths every week. That is something we share with other health systems; it is not just an NHS phenomenon. It is why we are asking hospitals to publish their estimated avoidable death rates, and we are having an international summit on that next month. We think there are about 12,000 avoidable deaths from sepsis every year, and that is as a result of a combination of different parts of the NHS—GP, hospital or the 111 system—not spotting the signs earlier. That is what we are determined to put right.”
“My hon. Friend is right to say that we are doing that for hospitals. When I talk about 200 avoidable deaths every week, that is hospital deaths, not deaths as a result of problems in the 111 service. It is much harder to quantify avoidable deaths outside hospital, but we are determined to do that, and we are going further and faster than any other country that I am aware of as part of our commitment to make the NHS the safest system anywhere in the world.”
“No one could have done more than this Government to tackle the issue of avoidable deaths across the NHS. It is much harder to identify when a death was avoidable when it happens outside hospital. As part of our work on reducing the number of avoidable deaths in the wake of what happened at Mid Staffs, we are looking at how we could improve primary care generally. Our first priority is to reduce the number of avoidable deaths in hospital and to learn from reports such as this one when they point to improvements that need to be made in the 111 service.”
“I thank my hon. Friend for that important intervention. If we are going to deal with the 1,000 tragic sepsis deaths among children every year, it needs a sustained effort from all of us, not just the NHS. I will take away the action of looking at what Public Health England is doing to raise public awareness. The Minister for Public Health, my hon. Friend the Member for Battersea (Jane Ellison), will look at what health visitors can do to boost awareness of sepsis, but in the end we all have a responsibility to understand the symptoms better.”
“Not at all. I gently urge Opposition Members not to fall into the trap of trying to make political capital when tragedies such as this happen. In the wake of the Francis report on Mid Staffs, this Department has done more than any Government have ever done to improve the safety of care in the NHS. If you take the four most common harms—urinary tract infections, venous thromboembolisms, pressure ulcers and falls—the number of deaths in hospitals has fallen by 45% in the past three years. We are making sustained progress in improving the level of safety and care in the NHS, but we are never complacent, which is why are taking so seriously the report issued today.”
“I am grateful to my hon. Friend for raising that issue, which has not been raised so far this afternoon. He is right. We have a pressing global need—not just a UK need—to reduce the inappropriate prescribing of antibiotics. That is why training of clinicians is so important. In the case of sepsis, not only is the prescribing of antibiotics appropriate but it is essential and it is essential to do it quickly. We need to make sure that, as we train GPs to reduce their prescribing of antibiotics so that we do not develop the resistance to antibiotics that could be so disastrous for global health, they do not avoid prescribing them when they are absolutely essential.”
“I do agree that we need more clinicians in primary care. We also need to invest in secondary care, which is why the hon. Lady has a new A&E centre opening in Hull, which I am sure she welcomes. We need more clinicians in primary care so that we can deal with these issues more quickly, before people need hospital care and to spot conditions such as sepsis. This Government are investing £10 billion in the NHS annually in real terms in order to step up the improvement in the services that we offer.”
“We will certainly look at whether we need to have more clinicians in 111. We do have clinicians available in 111. My own view is that it is the separation of the out-of-hours services and the 111 service that is at the heart of the problem that we are looking to deal with, but as part of the review we will look at the availability of clinicians in 111.”
“I can reassure the hon. Gentleman that we are looking at all these things. As with the issue of the prescribing of antibiotics raised by my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake), of course we want GPs to avoid inappropriate referrals to secondary care, but it is vital that where a referral is needed, it happens. We see this not just in cases of sepsis, but in cases of cancer. It is vital that we get better at catching cancers earlier if there is to be a successful outcome to the treatment, so the hon. Gentleman is absolutely right. That will be looked at.”
“The hon. Lady is right about the importance of involving patients when such tragedies occur, and I said in my response to the urgent question how grateful I was to the Mead family for their co-operation. One of the things the report identifies as important is earlier involvement and more listening to parents and families in such situations. I caution the hon. Lady against a blanket dismissal of the service offered by 111. There are many clinicians and call-handlers who work extremely hard and who deal with about a million calls a month, and the vast majority of those cases have satisfactory outcomes. But does that mean that there are not significant improvements that we need to make to that service? No, it does not. Of course there are things that need to be done better and we must learn the lessons from this terrible report.”
“I think that is a misrepresentation of what happens with 111. There are clinicians in every 111 call centre. There are not physically enough doctors and nurses to have doctors and nurses answering every single call, and indeed the advice from the clinicians in the NHS responsible for the 111 service is that that would not be appropriate. If we are to do the triage that the hon. Lady talks about, what matters is that where a clinician needs to be involved, they are involved more quickly than happened in the current case. That is the lesson that this Government are determined to learn.”
“Welcome back, Mr Speaker. As part of our commitment to a seven-day NHS, we want all patients to be able to make routine appointments at their GP surgeries in the evenings and at weekends, and 2,500 out of 8,000 surgeries are currently running schemes to make that possible.”
“My hon. Friend is absolutely right. That system does not work for people who have to go to work, and we want to make it easier for people to book appointments online or using an app on their phone. We also want to make it easier for people living in rural areas such as his constituency of North Cornwall to have telehealth appointments where appropriate, so that they can see someone without actually having to go to the surgery.”