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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“I must confess that I have not yet read that report, but my hon. Friend has reminded me of how important it is that I should do so. I will read it carefully while thinking about whether it could help us to get through the winter pressures this year.”
“Once again, I thank my hon. Friend for his persistent campaigning on behalf of Kettering general hospital. It is a very busy hospital under a great deal of pressure, and I know that people work very hard there. The Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), who has responsibility for hospitals, met campaigners from Kettering recently to discuss this issue, and I will bring the matter up with Monitor as well.”
“I do not. That Act meant that we reduced the number of managers and administrators in the NHS in England by 19,000, saving the NHS £1.5 billion a year. The reason for the deficits that the hon. Lady talks about is that, around the same time, we had the Francis report on Mid Staffs, and hospitals in England were absolutely determined to end the scandal of short-staffing. However, agency staffing is not a sustainable way of doing that, which is why we are taking measures today to change that.”
“If the hon. Lady looks at what has happened with permanent full-time nursing staff, she will see that the numbers have gone up in our hospitals by 8,000 over the past two years, so there are alternatives. We need to do more to help the NHS in this respect, and I will be announcing something about that shortly.”
“Last year I launched My NHS, where patients can see how safe their local hospital is and many other things. From next May, there will be overall information on the quality of mental health and cancer care.”
“I agree, and I congratulate the doctors and nurses working in the Cossham maternity unit. Southmead hospital in Bristol has some of the best maternity survival rates in Europe, so there is a lot of very good practice. The way to get the word out is through transparency of outcomes, not endless new targets, so my hon. Friend is absolutely right.”
“I would like to make a statement on measures the Government are taking to help NHS organisations tackle the deficits by reducing the cost of agency staff. Building on previously announced controls, from the end of November we will introduce maximum shift rates for all clinical staff employed through agencies, which will gradually decrease over time as the measures take effect and demand for agency staff reduces. In addition, we will work with each trust to limit or reduce the overall agency spend. Exceptional breaches of the limits will require advance agreement. Taken together, these measures are expected to improve patient care and reduce NHS agency staff spend by £1 billion over three years. The chief inspector of hospitals has confirmed that he believes this is the right thing to do.”
“Yes, I do. Let us be clear: this is about patient safety, about which every single doctor and nurse in the NHS is passionate. The problem is that the doctors whom the hon. Lady has met have been misled by their own union. This is not about cutting the pay bill for junior doctors, as the BMA has suggested. This is about safer care at weekends, reducing unsafe hours and doing the right thing for patients, and that is the right thing for doctors as well.”
“I will take no lessons on transparency from the Opposition. Professor Sir Brian Jarman said that the Department of Health under Labour was a “denial machine” when it came to the problems of Mid Staffs. We have made the NHS more transparent than ever before, and we will continue to practise transparency.”
“We are making good progress and we expect to make a substantive announcement on that before the end of the year. That will be about improving the standard and the quality of care in A and E departments, which I know my hon. Friend has a great interest in, and removing the confusion that people feel about what precisely the NHS offer is in their area. It is looking good and I hope to have something to announce to the House before too long.”
“This is a very serious issue and I will happily look into it personally to make sure that a full investigation is taking place into the incident the hon. Lady mentions, which clearly should not have happened. The 111 service has been an improvement on what we had before. It has taken nearly three times as many calls as the service it replaced, and around a quarter of those are referred to a clinician, but it is clearly not perfect, given the hon. Lady’s story, so I will look into the case that she raised.”
“I thank my hon. Friend for her great interest in this issue and for the campaigning she did before entering Parliament, which I know stemmed from personal tragedy. This is an incredibly important issue. We face a crisis in global healthcare as a result of anti-microbial resistance, which means the current generation of antibiotics is no longer as effective as it needs to be. Proper hygiene in hospitals is therefore vital, and we have a lot of plans that I will be happy to share with her.”
“I agree with my hon. Friend about the importance of transparency and publishing in a timely manner. I will look again at the planned publication date for the report she wants to see, which will be published so that Parliament can debate it properly. The normal practice is for advice to Ministers to be published at the same time as policy decisions are made, as happened with the Chantler review and the Francis report.”
“There certainly is. We spend £1.3 billion every year on litigation claims—money that could be used to look after patients on the front line. The way to avoid spending that money is to have safer care, and that is why it is so important that we have a seven-day service.”
“The hon. Lady is absolutely right; we need more midwives. We recruited more midwives in the previous Parliament, and we do need to expand maternity provision as we have a growing birth rate. I am happy to look at the problems in her area. However, we also have a maternity review coming up early next year, led by Baroness Cumberlege, that will help us to address this problem sustainably.”
“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.”
“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.”
“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”.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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 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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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 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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”