Afternoon summary

• Robert Francis QC, who led the inquiry into the Mid Staffs hospital scandal, has welcomed the government's response to his report. Jeremy Hunt' proposals would "contribute to the development of the openness, transparency and candour that will maintain the public's confidence and promote a true partnership with patients", he said. (See 3.57pm.) But Andy Burnham, the shadow health secretary, said 86 of the 290 recommendations in the Francis report were not being fully implemented.

• Philip Hammond, the defence secretary, has written to Tory MPs telling them that, if they rebel in a vote tomorrow on armed forces reorganisation, this could "risk serious damage to our future armed forces".

• Nick Boles, the planning minister, has suggested that the Conservatives should set up a liberal party that could fight elections alongside the Conservatives. (See 3.10pm.)

• Chris Grayling, the justice secretary, has insisted that the EU charter of fundamental rights is not enforceable in Britain. In the Commons Bill Cash, the Eurosceptic Conservative, tabled an urgent question about a court judgement last week suggesting Britain's opt-out from the charter did not apply. Cash said: 

Do you appreciate the import of Mr Justice Mostyn's ruling opens the flood gates now to a tidal wave of charter-based legal action at enormous cost to the British taxpayer and businesses, and raises a fundamental clash between Westminster supremacy and the claims of the EU and the European court of justice which goes beyond mere renegotiation? 

Will you agree to support my proposal for urgent legislation as follows: notwithstanding any provision of the European Communities Act 1972, nothing in the charter of fundamental rights of the European Union shall be binding in any legal proceedings of the United Kingdom, and shall not form part of the law applicable in any part of the United Kingdom. This act reaffirms the supremacy of the United Kingdom parliament? 

Grayling said the government did not agree with Mr Justice Mostyn and that it hoped to clarify the matter soon.

The case [last week] was dismissed on its facts but the judge, in passing, made some comments on the charter and on the case law of the court of justice of the European Union in Luxembourg. The judge's view was the Luxembourg court in a case called NS held the charter could create new rights that apply in the UK. 

It is important to be very clear to the House we do not agree with that analysis of the NS case. We intend to find another case - and the reason we can't do it on this one is because the Home Office was successful and you can't appeal on a case you have won. We do, though, intend to find another case at the earliest opportunity to clarify beyond doubt the legal effects of the charter and to put the record straight.

• Tristram Hunt, the shadow education secretary, has told MPs that banks can afford to pay a higher levy to the government to fund an extension in free childcare. He made the claim in a debate on Labour 's plans to extend free childcare from three and four-year-olds from 15 to 25 hours per week.

In the last financial year, the banks paid a staggering £2.7 billion less in overall tax than they did in 2010. The government has given the banks an extraordinary tax break and we would reintroduce some fairness into the system to support our child care plans.

Can I quote from this Saturday's Financial Times? 'Good times return as City gets in Christmas spirit', reported the paper. 'After years of yuletide austerity following the financial crisis party organisers and venue owners are seeing a resurgence in the market for festive frivolity', according to the FT.

Good luck to them. We on the Labour benches like to see a return to some animal spirit but all we are saying is some of that festive frivolity can be spent on securing affordable child care. It's called progressive politics and the party opposite should try it.

That's all from me for today.

Thanks for the comments.

Reaction to Jeremy Hunt's statement

Here is a round-up of reaction to Jeremy Hunt's statement. The medical profession seem to like it. But others are less positive.

From Robert Francis QC, who led the inquiry into Mid Staffs

Since the publication of the report I have been very encouraged by meeting many dedicated healthcare professionals from all parts of the service - doctors, nurses, managers, and trainees - who want to play their part in making the NHS a uniformly safe and caring place for all their patients. 

Reassuringly many in the NHS have not waited until today to get on with much needed changes and initiatives to begin the process of reform.

Much has already changed in the health service. From the front line to the boards of national bodies, things are happening and being done which would have been inconceivable before the Mid Staffordshire inquiries two years ago. 

The system is on its way to becoming more transparent, and shortcomings are more readily admitted and more actively addressed than before. However there is still much to do.

I believe that the proposals being announced today will continue the process started by my report. They will encourage the commitment and enthusiasm of so many in the service to be focussed on what really matters in the NHS: the provision of safe, effective and high quality care to all patients, on each and every occasion they need it.

They will contribute to the development of the openness, transparency and candour that will maintain the public's confidence and promote a true partnership with patients.

From Dr Mark Porter, chairman of the BMA

Patient safety should always be paramount, which is why safe staffing levels should always be set in accordance with the best available evidence and with a dynamic consideration of patients' needs at any one time. 

Centrally imposed mandatory staffing levels would be difficult to implement as they fail to recognise that not every patient is the same and, as such, safe levels will vary from time to time across hospitals.

The Government is right to want to deal with this through a combination of evidence-based guidance, rigorous governance, transparency and openness.

From Dr Peter Carter, chief executive of the Royal College of Nursing

The RCN has been calling for some time for greater transparency in identifying the number of staff on each ward. By making this information available on a monthly basis we are going some way to ensuring that each hospital in the country offers patients access to the care they deserve.

We also welcome the focus on consistent training for healthcare support workers through the care certificate. Although we remain convinced that the mandatory regulation of all healthcare support workers is the most effective way of protecting patients, the announcement today is an important first step.

From Emma Jones, from law firm Leigh Day, which represented more than 120 victims of abuse and neglect at Stafford Hospital

We are very pleased to see the way in which the government has adopted the majority of the proposals put forward by Robert Francis QC; however, we believe many proposals have stopped short of covering every incident of abuse or negligence and may not extend throughout all providers of care within the NHS. 

We are also disappointed that a duty of candour has not been be extended to individuals.

From Niall Dickson, chief executive of the General Medical Council

We all need to step up to the challenge of the Francis report - patients should always be at the heart of healthcare but we know this is not always the case. We welcome the Government’s response and in particular the emphasis on greater consistency between healthcare regulators.

Through our guidance, we have already done a great deal to encourage a duty of candour among doctors, but we are not complacent. We know there is more to do. We must strengthen the link between our guidance and doctors' practice on the front line, the words on the page and actions on the ward. 

From Catherine Foot, assistant director of policy at The King's Fund 

We welcome today's focus on making honesty and transparency the guiding principles for patient safety. Implementing the change set out by the government will be a long haul and requires culture change right across the NHS. This will take place against a backdrop of severe financial pressure, with NHS organisations already facing difficult decisions about whether to prioritise patient care or balance the books.

From Cathy Warwick, chief executive of the Royal College of Midwives

Overall this is a robust and comprehensive response by the government. Safety, staffing and openness and transparency should be at the heart of the NHS.

If the government really follow up their commitments in this response then I hope we will see an even safer and better NHS and, a maternity service that has the right number of staff, with the right skills. This will lead to better care for the millions who rely upon the NHS to safeguard themselves and their loved ones, and who place their lives in its hands.

From Jackie Smith, chief executive of the Nursing and Midwifery Council

We particularly welcome the commitment to legislate at the earliest opportunity to provide all healthcare regulators with a modern and efficient legal framework. We believe this will make fitness to practise faster, more efficient and more effective.

From Peter Walsh, the chief executive of Action against Medical Accidents. He said he was "dismayed" that the legal duty of candour on organisations would only apply in relation to death or severe harm cases. 

The case for a full duty of candour about any significant incident and applying to everyone in the organisation, from board to ward, is overpowering. It would be the biggest advance in patient safety and patients' rights in a lifetime. The current proposals would be disastrous - in effect legitimising cover ups of the vast majority of incidents which cause serious harm to patients. 

From Gina Dowding, a Green party spokesperson

It is vital that the public have confidence that their hospitals have safe staffing levels. The debate about safety in hospitals is extremely important. Per head of population the UK spends far less than most of our European counterparts.

From John Lister from the National Health Action party

It’s vital that staffing levels are consistent with clinical evidence on patient safety. It’s now widely recognised that when the registered nurse to patient ratio is worse than 1 to 4 or 5 on day shifts, the risk of adverse events rises rapidly. A ratio of 1:8 represents the danger level. The overall ratio in is England 1:8.6. That is a dangerous level. 

We will see more tragedies like mid-Staffs unless the government introduces safe and appropriate staffing levels. It’s useless just making hospitals publish snapshot figures of how many nurses are on duty in wards without guaranteeing appropriate levels. How will hospitals pay for new nurses to ensure safe care at a time when this government is imposing a financial squeeze on the NHS and over half of NHS trusts are in financial difficulty? It’s fine to want to have staffing based on patient need, but let’s see the money to match it.

The creation of an offence of “wilful neglect” is an attempt to dump the blame on individuals and lets completely off the hook those who are actually responsible: the Trust Boards who were slammed by the Francis Report in Mid Staffs for their cavalier disregard for the impact of cuts; medical directors and senior management whose inadequately staffed services generate these problems; and of course the ministers whose unprecedented cash squeeze on the NHS is creating this chaos and forcing dozens of Trusts into cuts bigger than those at Mid Staffs. This government, with its cuts and chaotic NHS re-disorganisation, has created a backdrop for neglect.

Robert Francis QC
Robert Francis QC. Photograph: Martin Godwin Photograph: Martin Godwin


Turning away from health for a moment ...

In Borgen Birgitte Nyborg is setting up a new political party. In Westminster, Nick Boles, the planning minister, seems to have the same idea. He floated the proposal in a speech to Bright Blue, a Conservative campaign group promoting liberal, modernising ideas in the party.

After 2010 Boles suggested the Tories should form an electoral pact with the Lib Dems in 2015. Now he has changed his mind.

I had misjudged the Liberal Democrats. Although there are some true believers in freedom in the party - and they appeared to make the running in the first year of the coalition - the heart of the Liberal Democrats beats on the left and the party's instincts are statist. In recent months we have seen their leader twist and turn in a desperate attempt to position himself for coalition with a deeply illiberal Labour Party after the next election – and render himself principle- free zone in the process. 

Boles says the Conservative party is too monolithic.

Modern Britain is a place in which people prize their individuality and define themselves by their interests and pastimes, likes and dislikes. Yet when they look at the Conservative Party they see an old fashioned monolith. Big retailers and consumer brands have found that they cannot rely on a single brand with one undifferentiated message to attract and hold the attention of all the customers they need. They have turned themselves into loose but coordinated collections of brands and product ranges, all operating from a common platform but free to express themselves individually and craft a more targeted appeal to particular consumer niches. 

And this is where the idea for a new party (or, rather, the revival of an old one) comes in.

In 1947 the National Liberal Party (previously the Liberal National faction of the gradually disintegrating Liberal Party) merged at constituency level with the Conservative Party. Until 1968 it continued to maintain a distinct political profile and national brand. Candidates who were associated with this new affiliate stood under a variety of labels: 'National Liberal, National Liberal and Conservative, Liberal and Conservative'. Michael Heseltine stood as a National Liberal in Gower in 1959. And John Nott began his parliamentary career in 1966 when he was elected as National Liberal MP for St Ives.

My question is this. Is it impossible for us to contemplate reviving the National Liberal Party, or something like it, as a an affiliate of the Conservative Party, which only puts up candidates for election jointly with the Conservative Party? Existing MPs, councillors, candidates and party members of liberal views would be encouraged to join. And we could use it to recruit new supporters who might initially balk at the idea of calling themselves Conservative. In three-way marginals and the key target seats that we have to take off the Liberal Democrats, an explicit National Liberal pitch might make the difference between victory and defeat. 

Planning minister Nick Boles immigration
Nick Boles. Photograph: Rex Features Photograph: Rex Features


Jeremy Hunt's statement on the Francis report - Summary

In the past Jeremy Hunt has lapsed into using the Mid Staffs scandal for blatantly partisan purposes. It was as if, having been brought in as health secretary after Labour mauled his predecessor, Andrew Lansley, over the Health Act, he decided it was best to retaliate by using Mid Staffs to suggest that Labour in general, and Andy Burnham in particular, were somehow directly responsible for the deaths of countless patients pre-2010. It was not pretty, and I'm not sure how many people believed it, but it has been how the debate on Mid Staffs has been conducted for most of this year.

Today, though, Hunt adopted a slightly different tone. There was still a partisan undercurrent to his remarks, but today he sounded more like a man promoting transparency in the NHS primarily because he believes in it, not primarily for base political purposes. 

Here are the main points. 

• Hunt has announced that hospitals that try to conceal mistakes could have to pay compensation out of their own funds, instead of having medical negligence cases settled centrally. They could even lose their insurance cover in some cases, he suggested. This was the most striking new measures in a wide-ranging package of announcements, some of which have been trailed in advance. There are full details in the Department of Health's news release. Hunt said they would make the NHS the most transparent health system in the world.

This is probably the boldest step forward towards transparency of any healthcare system anywhere in the world. 

He also said it was "absolutely shocking" that the NHS was spending more than £1bn a year on litigation claims and that the only way to cut this figure was to raise standards.

• Hunt claimed that "cruelty became normal" in the NHS under the old system. Here's the quote.

One of the most chilling accounts of the Francis report came from Mid Staffs employees, who considered the care they saw as being normal. Cruelty became normal in our NHS and no-one noticed. The Francis report made 290 recommendations. I accept the principles behind all of them and wherever possible have adopted the practical solution suggested by the inquiry. 

When a Labour MP challenged him, Hunt said that he was not saying all NHS staff were cruel, but that he was trying to make a point about Mid Staffs.

• An explicit "duty of candour" will be imposed on doctors, nurses and other health professionals, Hunt said. But this will be a professional duty, not a legal duty. Here's what the news release says.

Health professionals will have to be candid with patients about all avoidable harm and the guidance will make clear that obstructing colleagues in being candid will be a breach of their professional codes. Speaking up quickly may also be considered to be a mitigating factor in a conduct hearing and this will further encourage individual candour. Inspired by normal practice in the airline industry, “near misses” of serious harm will also be subject to a professional duty of candour, fostering an NHS culture in which reporting and learning from mistakes is the norm.

• Andy Burnham said that Monitor, the health regulator, has admitted that in the long run nursing numbers are set to fall again. Hunt said that NHS trusts are due to hire another 3,700 nurses. But Burnham said "Monitor has warned trusts are planning major nurse redundancies in the 2014 to 2016 period that far outweighing any increases this year". Labour aides pointed to a line in a Monitor report saying:

Across 2014/15-15-16 there is planned disinvestment, largely through reductions in nursing numbers (4%). This suggests that the previous year's investment is seen as a short-term fix for operational pressures.

Jeremy Hunt
Jeremy Hunt Photograph: /BBC Parliament Photograph: BBC Parliament

I'll post some reaction soon.


Peter Bone, a Conservative, says the current NHS complaints system is deliberately long. Managers deliberately delay complaints, he says.

Hunt says he agrees. Hospitals should be interested in complaints, because that will show them how to improve their services, he says.

And that's it. The statement is over. I'll post a summary soon.

Here's Denis Campbell's story for the Guardian about today's announcement. And here's how it starts.

Hospitals that are not honest about medical blunders could have to pay some of the damages that follow and even lose their insurance cover, under government plans to improve NHS patient safety.

Jeremy Hunt, the health secretary, proposed the move on Tuesday as part of the government's response to Robert Francis QC's landmark report on the Mid Staffordshire hospital scandal.

Under his plan, hospitals that mislead or conceal information from patients affected by mistakes or from grieving relatives could either lose their indemnity cover or have it reduced.

They may also be punished by having to pay out of their own funds part of the cost of settling lawsuits brought by patients, which can cost up to £10m in compensation and legal fees, to force them to be much more open when medical negligence occurs.

Hunt says true culture change is "incredibly difficult" to achieve unless you have the support of staff on the frontline.

Hunt says the new rules applying to managers, designed to stop bad managers being able to move on to new jobs, will apply to ambulance trusts.

Labour's Emily Thornberry says she does not agree with what Hunt said about cruelty becoming normal in the NHS. (See 1.54pm.) People in the NHS are not cruel, she says. But they can be placed under stress by their environment. Hunt is going to publish information about staffing levels. But why won't he ensure that something happens if staffing levels fall too low.

Hunt says generally the exchanges today have been bipartisan. He is disappointed by the way Thornberry twisted his words. He did not say everyone in the NHS was cruel. He said it was a problem at Mid Staffs.

Hunt says people know who well their local schools are doing, because they have Ofsted. But they do not know how well their local hospitals are doing. But having a chief inspector of hospitals will remedy this.

Hunt says it is "absolutely shocking" that the NHS is spending more than £1bn a year on litigation claims. The only way to cut that figure is to make the NHS safer, he says.

Labour's Barbara Keeley says Salford Royal hospital already published staffing levels on its website every day. Why can't other hospitals do the same?

Hunt says the recommendations published today are based on what happens at the Salford Royal hospital. Publishing staffing figures on a month-by-month basis will be a minimum, he says. Hospitals can publish them daily.

Bernard Jenkin, a Conservative, asks how the government will ensure that every patient has the ability to make a complaint.

Hunt says the NHS ombudsman is the last point of call. She has said she will handle a vastly increased number of complaints. But patients need help to complain locally too. He wants a sign in every ward telling people how to do this.

Here are some quotes from Hunt's opening statement.

The NHS is a moral being or it is nothing. It was set up 65 years ago with the noble ideal that no one should ever be prevented by background or finance from accessing the best care. That is why it remains the most-loved British institution, and rightly so. But each and every case of poor care betrays those worthy aims. I do not simply want to prevent another Mid Staffs, I want our NHS to be a beacon across the world, not just for equity but its excellence. 

I want it to offer the safest, most compassionate and most effective care available anywhere and I believe it can. But only if there is a profound transformation in the culture of the NHS. The inquiry shows the devastating effects of overly-defensive responses, hurting families, suppressing the truth and preventing lessons being learned. Failure cannot be addressed when it is being covered up and so today I am announcing new measures to promote a culture of openness and transparency ...

One of the most chilling accounts of the Francis report came from Mid Staffs employees, who considered the care they saw as being normal. Cruelty became normal in our NHS and no-one noticed. The Francis report made 290 recommendations. I accept the principles behind all of them and wherever possible have adopted the practical solution suggested by the inquiry. 

Robert Francis has today welcomed today's announcement as a carefully considered and thorough response to his recommendations, which he says will contribute greatly towards a new culture of caring and making our hospitals safer places for their patients. Today's measures are a blueprint for restoring trust in the NHS, re-enforcing professional pride in NHS frontline staff and above all giving confidence to patients that after Mid Staffs, the NHS has listened, the NHS has learnt and the NHS will not rest until it is delivering the safest, most effective and most compassionate care anywhere in the world.

Hunt says these changes will lead to an increase in the amount of reported harm in the next few months. But that will not be a bad thing, he says. He will show that problems are being admitted and addressed.

Labour's Diane Abbott says Labour pushed for nursing to be an all-graduate profession. That may have led to nurses putting less emphasis on care.

Hunt says never has Abbott said something so likely to attract support on his side of the House. He says the government did consider stopping the requirement for nursing to be a graduate professions. But nurses do need to take complex decisions, he says. However, he is ensuring trainee nurses have to have hands-on experience.

Labour's Kevin Barron says he does not think what Hunt has announced will change the culture within the NHS. There has to be someone who can investigate complaints independently. New Zealand has a good model, he says.

Hunt says Robert Francis has said he thinks these measures will make a significant difference. And he says having a chief inspector of hospitals will put independence in the system.

Aidan Burley, a Conservative, asks Hunt to ensure that high mortality rates are properly investigated.

Hunt says Burley is right. High mortality rates have been a problem for many, many years. But little or nothing was done. Hunt says he hopes today's announcements will create a new culture.

Dame Joan Ruddock, the Labour MP, asks who will ensure that changes do occur when they need to.

Hunt says the chief inspector of hospitals will identify problems. And it will be his duty to "swoop" if there are any areas for concern.


Hunt says 25% of people in hospitals have dementia. Cases like Mid Staffs do tend to involve patients with dementia. In the past they have been deprioritised, he says.

Stories about full trays of food being taken away from patients, because staff did not realise they needed help to eat, were particularly shocking, he says.

Sarah Wollaston, the Conservative MP and former GP, asks if individuals being cared at home will also be able to find out if the healthcare assistants looking after them are compliant with the new standards.

Hunt says that is a good point. He will look into it.

Hunt says one problem at the moment is that hospital success is defined in terms of waiting times and financial management, not the standard of patient care.

Alan Johnson, the Labour former health secretary, asks Hunt for to remind MPs of the review of case notes at Mid Staffs.

Hunt says he does not have that information to hand.

Stephen Dorrell, the Conservative chair of the health committee, says that never again should there be closed systems in a closed institution.

Hunt says Dorrell is right. His plans are the boldest step towards transparency in any health system in the world, he says.

But exposing bad treatment in one place does not mean that there is bad treatment everywhere, he says.

Bill Cash, a Conservative, asks Hunt if he heard his constituent, Deborah Hazledine's, account of her mother's experience at Mid Staffs on the Today programme this morning.

Hunt says he did not hear her. But he has met Hazledine.

He says Labour should have held a public inquiry into Mid Staffs.

Labour's Ann Clwyd, who reviewed the way patients' complaints are treated in the NHS for the government, says Hunt said all patients would be able to get help to make a complaint. How will this happen?

Hunt says Clwyd's report was extremely good. He basically accepts everything she said, although he will have to look at how the recommendations are implemented.

One problem is that hospitals view complaints as a process, he says.

In every ward in every hospital, there will have to be a sign telling patients how they can complain, and how they can get help to do so.

Hunt says he has never met an NHS doctor or nurse who does not want to put patients first.

But structures have been created making this hard, he says.

Hunt is responding to Burnham.

He says it is normal for government's not to accept every single recommendation of a report like this. But he is accepting the principle behind every recommendation.

On staffing levels, Hunt says the number of nurses per bed has gone up since 2010.

On mandatory ratios, he says the government took extensive advise on this. In different situations different preferred minimums apply. The King's Fund and the BMA are opposed to mandatory ratios. And Burnham himself used to be opposed to them, says Hunt, although he acknowledges that Burnham has changed his mind.

Hunt says he decided that applying a statutory duty of candour to individual consultants would be counter-productive. It would create uncertainty. But there will be a professional duty of candour, he says. 

Andy Burnham, the shadow health secretary, is responding now.

What happened at Mid Staffs was a betrayal of the NHS's values. That is why the last government was right to apologise, he says.

He agrees with much of what Hunt says.

But it is his job to challenge him. In particular, he wants to know why 86 of the 270 Francis recommendations are not being fully accepted.

Burnham says NHS trust are planning staffing cuts from 2014 to 2016 that go well beyond the increases announced today.

It is unacceptable that security guards at hospitals are more tightly regulated than healthcare assistants.

He says the nursing assistant certificate will not count for anything unless it can be removed.

Burnham says he is glad the duty of candour is being extended to institutions. But why will it only cover the most serious incidents?

He says the duty of transparency should apply to all NHS organisations, including contractors. 

So will the duty of candour be extended to all NHS organisations?

And will the Freedom of Information Act be extended to all NHS organisations?

Burnham challenges Hunt to publish the risk register for the current NHS reorganisation.

He says he does not believe cruelty has became normal in the NHS.

But we need better care for older people. And we should not accept people being paid less than the minimum wage.

Hunt says Mid Staffs employers began to think of cruel treatment as normal.

That must stop, Hunt says.

The NHS must not rest until it is delivering the safest and most compassionate care in the world.

Hunt says at Mid Staffs ministers put pressure on regulators that may have led them to tone down bad news.

Measures will be taken to stop this. The chief inspector will become the NHS's whistleblower-in-chief.

There will be legal sanctions for those found guilty of wilful neglect.

And there will be tighter tests for management, Hunt says.

Hunt says you cannot run safe hospitals without safe staffing levels.

Some 3,700 extra staff are being hired.

Health care workers and support workers will be required to have a new certificate.

The title "nursing assistant" will be widely used in hospitals.

The talent pool from which NHS managers are selected will be widened.

Hunt says the government has appointed new chief inspectors of social care.

Today he is publishing the government's further response to the Francis inquiry. And it is publishing its response to the Commons health committee report, he says.

The NHS is a moral institution or it is nothing, he says.

He says he wants it to be a beacon across the world for its excellence.

This can happen. But there has to be a "profound transformation", he says.

He is introducing measures to promote transparency.

There will be a legal duty of candour.

And the government will consult on whether hospitals found not to have been candid risk having their indemnity limits reduced.

There will be a strengthened professional duty of candour. This will follow practice in the airline industry, where reporting of mistakes is strongly encouraged.

Reporting errors will be a mitigating factor in disciplinary proceedings, Hunt says.

Trusts will publish information about the number of complaints received, and the action taken.

And the NHS ombudsman will dramatically increase the number of cases taken up.

Jeremy Hunt's statement on the government's response to the Francis report on Mid Staffs

Jeremy Hunt is making his statement now.

He starts by paying tribute to the campaigners who demanded justice. They suffered personal losses as a result of their campaign. All MPs stand in the shadow of their bravery, he says.

Lunchtime summary

• Jane Cummings, the chief nursing officer for England, has defended the government's decision not to impose mandatory patient:nurse staffing ratios in hospitals. (See 9.26am.) She was speaking ahead of this afternoon's statement from Jeremy Hunt, which will see Hunt present the government's final response to the Francis report on Mid Staffs.

• Alex Salmond, Scotland's first minister, has published a 200-page report showing how an independent Scotland could use corporation tax cuts and other measures to boost its economy. Here's the report (pdf). And here's an extract from the news release.

In “Economic policy choices in an independent Scotland” Mr Salmond set out key policy areas which will transfer to an independent Scotland to build greater long-term economic security, growth and job opportunities including:

  • Establishing an industrialstrategy which rebalances the economy and diversifies Scotland’s industrial base - promoting manufacturing, innovation and boosting productivity. An increase of just one per cent in Scotland’s productivity performance has the potential to boost employment by around 21,000 over the long-term.
  • Promoting participation in the labour market by delivering more efficient employability, welfare and skills programmes and transforming child care. An increase in Scotland’s economic activity rate of one percentage point would be equivalent to an extra 30,000 plus people in the labour market.
  • Targeting measures to reduce outflow of labour and attract skilled workers to enhance Scotland’s population growth and build on the current projections of nine per cent growth over the 25 year period of 2012 to 2037.
  • Using tax incentives to support growth in key sectors (e.g. tourism & creative industry) and target areas – such as international connectivity – through initiatives such as reforming Air Passenger Duty.
  • Using carefully targeted tax measures, such as a reduction in corporation tax, to counterbalance the pull of London and the South East an initiative that is forecast to create approximately 27,000 jobs.
  • Boosting the internationalisation and brand recognition of the Scottish economy including reforming the structures that support trade, integrating business and industrial strategies, with trade, foreign policy and international engagement. A 50 per cent increase in the value of Scottish exports could boost output by around £5 billion and create over 100,000 jobs in the long-term.

• The Organisation for Economic Co-operation and Development has revised upwards its growth forecasts for the UK, but significantly revised downwards its forecasts for the world as a whole.

• Labour has come under pressure to return a £50,000 donation backed by the former Co-operative Bank chairman hit by claims of hard drug use.

• Boris Johnson, the mayor of London, has said he will consider the possibility of banning cyclists from wearing headphones, following a spate of deaths in the capital.

• G4S, the private security firm, has agreed to pay back £23.3m after admitting the way it billed the UK government for tagging offenders was "not appropriate".

• The Sri Lankan government has accused David Cameron of breaching protocol during his visit to the country last week.

• A thinktank report has revealed that more than £75m has been cut from England's parks and open spaces since 2010.

• The Home Office has announced that £29m is being made available to allow police and crime commissioners to run restorative justice schemes.

Sir Nick Harvey, the Lib Dem MP, asks what is progressive about a free school meal policy that gives money to pupils from wealthy families.

Clegg says Harvey "fundamentally misunderstands" how free school meals can help to close the attainment gap.

Labour's Steve Rotheram asks Clegg if the Lib Dems' position on the bedroom tax is in the best tradition of liberalism.

Clegg says that the principle that housing support for families should be related to the number of rooms they need was accepted by the last Labour government, and has also been accepted by this one.

Peter Bone, a Conservative, asks Clegg if he has enjoyed being deputy prime minister, and if he wants to continue after the election.

Clegg says it's nice to get a supportive question from Bone (who is normally very critical of Clegg).

Labour's Sheila Gilmore says the social mobility and child poverty commission says the impact of the government's cuts has been regressive. Will Clegg accept its call for money allocated for childcare to be diverted to low-income families.

Clegg sidesteps the question, and instead rattles through a list of government measures, like the pupil premium, which he says are tackling the attainment gap.

Labour's Harriet Harman asks Clegg to confirm that the cost of childcare has risen five times faster than wages since 2010 and that, for every week Clegg has been deputy prime minister, three Sure Start centres have closed.

Clegg says that on both counts Harman is wrong. Only 45 Sure Start centres have closed, he says. Harman should stop "peddling these misleading statistics". And he says childcare costs increased by 46% between 2002 and 2010.

(The discrepancy between the Labour figures on Sure Start closures and the government figures is explained by Labour, unlike the government, counting mergers as closures.)

Clegg says the political class as a whole does not provide a good example of social mobility.

Labour's Hazel Blears says that in 1979 just 3% of new MPs came from a political background (for example, they had been advisers). At the last election that figure was 25%.

Clegg says all parties need to diversify in this respect.

The Conservative MP Philip Hollobone asks Nick Clegg about the report in today's Times about ministers being allowed to hire political advisers. (See 11am.)

Clegg says this is not a plan to allow ministers to bring in endless numbers of special advisers. It is an idea promoted by outside thinktanks to allow ministers access to specialist expertise.

David Ruffley, a Conservative, asks what will be done to ensure these are proper advisers, not political spin doctors.

Clegg refers to a report from the Institute for Public Policy Research saying ministers need advisers of this kind.

Sadiq Khan, the shadow justice secretary, asks why the Lib Dems have broken their promise to cut the bill for special advisers.

Clegg says Labour hoovers up all the Short money (taxpayers' money to fund the opposition in parliament) it can. Khan's question was probably written by a trade union, he says.

Nick Clegg is taking questions in the Commons now. I won't be covering it in detail, but I will flag up anything interesting.

Here's Chris Leslie, the shadow chief secretary to the Treasury, on the OECD report. (See 10.38am.)

After three damaging years of flatlining this OECD forecast for the UK is welcome, but for millions of families this is still no recovery at all. As the OECD says, real wages are still falling in Britain. In fact working people are on average £1600 a year worse off since David Cameron came to office ...

The OECD is also right to warn that we need to boost housing supply. We need a recovery that’s built to last, so we must also bring forward infrastructure investment now to build thousands of affordable homes. And we need to make long-term changes so that our economy works for working people. That’s why Labour will cut business rates for small firms, reform our banks, strengthen the minimum wage and introduce a compulsory jobs guarantee for the long-term unemployed.

There's an urgent question at 12.30pm. That means the Jeremy Hunt statement won't come until about 1pm.

Urgent Question from Bill Cash the status in the UK of EU Charter of Fundamental Rights after ruling by Justice Mostyn at 1230

— Labour Whips (@labourwhips) November 19, 2013

Here's some background to the Mostyn ruling.

You can read all today's Guardian politics stories here. And all the politics stories filed yesterday, including some in today's papers, are here.

As for the rest of the papers, here's the PoliticsHome list of top 10 must reads, here's the ConservativeHome round-up of today's political stories and here's the New Statesman's list of top 10 comment articles.

And here are four articles I found particularly interesting.

• Jill Sherman in the Times (paywall) says the government is going to allow ministers to hire around 10 political appointees as civil servants.

Ministers are to hire hundreds more political appointees in a move likely to inflame tensions with civil servants. Each member of the Cabinet will be able to pick ten or more “ministerial cronies” from outside Whitehall to join their private offices in a step towards a more personalised US-style system.

Unlike existing special advisers, known as “spads”, the new external experts will be able to give orders to civil servants. This will create friction with departmental officials, who will resist being told what to do by political appointees.

The experts, who will be paid millions of pounds of taxpayers’ money, will work in “extended ministerial offices” that will include “spads” and conventional civil servants. The offices could double in size to more than 20 people. As many as half of these people could be external experts on five-year fixed-term contracts, but there is no limit, one official said.

Opponents say that the change will lead to ministers being advised by their friends or party hacks. “Ministers will hear what they want to hear but not what they need to hear,” one union official said. 

• Sarah O'Connor in the Financial Times (subscription) says recent graduates are earning 12% less than their pre-crash counterparts.

The earnings of recent English graduates have deteriorated so rapidly since the financial crisis that the latest class is earning 12 per cent less than their pre-crash counterparts at the same stage in their careers. They also owe about 60 per cent more in student debt ...

Each cohort of graduates since the financial crisis is earning less than the one before. New graduates who earned £15,000 or more in 2011-12 – enough to start repaying their loans – were paid on average 12 per cent less in real terms than graduates at the same stage of their careers in 2007-08.

This real terms fall is three times as deep as the decline in average pay for all full-time workers over the same period.

The data come from the Student Loans Company, which is owned by the government, and cover the repayments of all graduates in England who took out loans. Scottish universities are free for Scottish students.

• Jason Groves in the Daily Mail says Ed Miliband held private talks with Paul Flowers, the disgraced former Co-op Bank chair.

Ed Miliband held private talks in his Commons office with the disgraced Co-op Bank boss embroiled in a drugs scandal, it emerged last night ...

Labour sources confirmed that Mr Miliband had personally appointed Flowers to his elite Business and Industry Advisory Group in 2010 — and even invited him for private talks in his Commons office last year.

It also emerged that Flowers described Shadow Chancellor Ed Balls as a ‘political friend’ and boasted of helping to arrange a £50,000 donation for him from the Co-op last year.

Both Mr Miliband and Mr Balls deny being close to Flowers, who was suspended by Labour last night for ‘bringing the party into disrepute.’

• James Chapman in the Daily Mail says David Cameron has decided to install porn filters on his computers at home.

The OECD has published its global economic outlook report today.

As Katie Allen reports for the Guardian, the OECD is gloomy about the prospects for the world economy, but more optimistic about the UK. 

The outlook for the global economy has darkened as the prospects for emerging markets deteriorate and the United States approaches another potentially catastrophic debt deadline, according to the Organisation for Economic Co-operation and Development.

The thinktank upgraded its outlook for the UK but cut its forecasts for the global economy. The Paris-based group forecast that unemployment would remain stubbornly high in several of its 34 mainly rich countries, that growth would slow in many emerging markets and that there was a significant threat to financial stability from the US Federal Reserve unwinding its stimulus programme – a process known as tapering ...

For the UK, however, the Paris-based thinktank is more optimistic than many other forecasters and has revised up forecasts made in May. Predicting that stronger investment and household spending will drive faster growth, the OECD now forecasts the UK economy will grow by 2.4% in 2014. In May it had forecast 1.5%.

That outlook for next year is more optimistic than the 1.9% growth forecast by the International Monetary Fund and 1.8% predicted in March by the Office for Budget Responsibility (OBR), the Treasury's independent forecaster.

Here's what the Treasury has been tweeting.

.@OECD have revised their forecast for UK GDP up by more than any other G7 country over next 2 yrs.

— HM Treasury (@hmtreasury) November 19, 2013

And here's what the OECD says about the UK in summary.

Economic activity has picked up and broadened, supported by a turnaround in private sector confidence, continued monetary stimulus, a policy-induced recovery in the housing market and a more gradual pace of household and public sector deleveraging as automatic stabilisers operate. Growth is projected to strengthen further in 2014 and 2015, mainly supported by an upturn in gross fixed investment and exports. Despite exceeding the inflation target of 2%, headline inflation is projected to fall gradually in the next two years.

Consistent with its newly adopted state-contingent forward guidance, the Bank of England has announced its intention to keep interest rates low to support the recovery. The welcome efforts to speed up the recapitalisation of the banking sector should underpin financial stability. While headline deficits are expected to shrink as growth recovers, it is important to maintain existing consolidation plans to restore fiscal sustainability. Further relaxing the barriers holding back housing supply is an important policy priority to contain house price inflation.

Unison has criticised Jeremy Hunt for not introducing mandatory staff:patient ratios. This is from Christina McAnea, head of health at the union.

The government has missed another opportunity to introduce fixed, safe nurse-to-patient ratios. 

There is safety in numbers when it comes to caring for patients and this one step would bring about a revolutionary change on the wards. They are recommending a 'toolkit' to set minimum staffing levels but what will happen if these are ignored when wards are under pressure, which is almost a daily occurrence in today's NHS?

It shames this government that they have waited so long to announce that they are to recruit 3,700 more nurses - which still falls short of the 6,000 that have disappeared from the NHS since the Coalition came to power.

There is no doubt that some hospitals have become dangerously under-staffed because of the government cuts. They have ignored the warning signs and the calls from hospital managers, staff, patients and unions that more nursing staff were needed urgently.

For the record, here are today's YouGov GB polling figures.

Labour: 39% (no change from YouGov in the Sunday Times)

Conservatives: 32% (down 1)

Ukip: 12% (no change)

Lib Dems: 11% (up 1)

Labour lead: 7 points (up 1)

Government approval: -26 (up 4)

According to Electoral Calculus, this would give Labour a majority of 90.

According to James Chapman at the Mail, Jeremy Hunt is going to announce plans to make it easier for poor managers to be blocked from getting new posts in the NHS. Here's an extract from his story.

Blundering hospital bosses are to be barred from working in the NHS.

Health Secretary Jeremy Hunt will today unveil plans to prevent a ‘merry-go-round’ of executives who move from job to job despite disastrous performances.

Senior managers will also be assessed according to the success of their hospital – making it easier to sack failures without giving them huge pay-offs.

In the wake of the Francis Inquiry into appalling care at the Mid Staffordshire trust, hospitals will be given Ofsted-style quality ratings and told to publish staffing levels.

The new barring system will mean that managers – like failed doctors – can be effectively ‘struck off’ and prevented from ever moving elsewhere in the NHS.

Andy Burnham, the shadow health secretary, has been using Twitter this morning to criticise the government for cutting nursing posts in the NHS. 

For 3 years, Govt has refused to stop nurse job cuts. #NHS today has 5,890 fewer nurses than 2010 but there are more patients in hospital.

— Andy Burnham (@andyburnhammp) November 19, 2013

He has also posted this to rebut claims that hospital standards got worse under Labour.

Keogh Report: "Mortality in all NHS hospitals has been falling over the last decade: overall mortality has fallen by about 30%".

— Andy Burnham (@andyburnhammp) November 19, 2013


Jane Cummings, the chief nursing officer for England, has been giving interviews this morning about today's announcement. She explained why the government was not setting a mandatory staff:patient ratio for nurses. That figure could become a maximum, she claimed.

The real danger is that we stick to a particular number and it doesn’t reflect the differing needs and the different services in different wards. I think the risk of doing anything that sets a target or a number like that is it could become a maximum. Some people do talk about a minimum of one to eight, and that may be appropriate on some wards, but for many it won’t ...

What we’re saying is that you need to determine [the right staffing level] depending on the type of ward that you work on. So for some it may well be one to eight; for others it may be one nurse to four patients or one nurse to six patients. The other thing you need to think about is the whole team. So for example, if you’re working in a stroke ward, you might need to have occupational therapy, speech therapy and physiotherapists working alongside nurses and doctors. What we’re talking about here is actually making that decision locally and actually making sure that we use evidence to determine that.

I've taken the quotes from PoliticsHome.

Jane Cummings.

It is more than nine months since Robert Francis QC published his report into the Mid Staffs hospital scandal and today we are finally getting the government's full response. The Department for Health has been briefing overnight and we know that Jeremy Hunt, the health secretary, is going to focus on staffing levels when he responds.

Here is some background.

• A summary of the key recommendations in the Francis report, published in February. 

• A summary of the government's preliminary response, published in March.

• Patrick Wintour's story previewing what Hunt will say today. Here's how it starts. 

Jeremy Hunt, the health secretary, will on Tuesday introduce monthly mandatory reporting of numbers of staff on hospital wards but will reject a fixed minimum nurse-patient ratio.

Hunt's proposal is in response to the Francis report commissioned in the wake of the Mid Staffordshire scandal, where hundreds of patients died amid appalling failings in care. He will propose that the National Institute for Health and Care Excellence (Nice) be required to draw up a "toolkit" suggesting minimum staffing levels in wards according to the size of ward, acuteness of patient illness, age profile and other factors.

NHS trusts will then be required by law to publish the staffing in each ward – and will be subject to an immediate health inspection by the Care Quality Commission if they are not meeting the guidelines.

The Safe Staffing Alliance, which includes the Royal College of Nursing, Unison and the Patients Association, backs the idea of a fixed staff ratio of no more than eight patients to one nurse. 

But Hunt's aides regard support for a fixed ratio as a mistake since they believe it was "Labour's target culture" that led to failures at institutions such as Mid Staffs. The shadow health secretary, Andy Burnham, has not backed a fixed ratio. Proposals for regular publication of ward staffing levels were backed by the health select committee.

I will be covering the statement at 12.30pm in detail, as well as all the reaction.

Here is the full agenda for the day.

9.30am: Police officers and police and crime commissioners give evidence to the Commons public administration committee about crime statistics.

9.45am: Jo Swinson, the business minister, launches an employee ownership report.

10am: David Anderson, the former Co-operative Financial Services chief executive, gives evidence to the Commons Treasury committee.

11.30pm: Nick Clegg takes questions in the Commons.

11.30am: Facebook and Twitter give evidence to the Commons culture committee on online safety. At 1pm Damian Green, the Home Office minister, Ed Vaizey, the culture minister, and Claire Perry, the prime minister's adviser on the commercialisation and sexualisation of childhoold, will give evidence.

12.30pm: Jeremy Hunt, the health secretary, makes a statement in the Commons anouncing the government's final response to the Francis report on the Mid-Staffs hospital scandal. 

1pm: Nick Boles, the planning minister, gives a speech to Bright Blue, the modernising Conservative pressure group, on “Who should a liberal vote for in 2015?”

2.45pm: Chief Constable Andy Bliss, the Association of Chief Police Officers lead on drugs, and Commander Simon Bray, the ACPO lead on psychoactive substances, give evidence to the Commons home affairs committee on drugs.

Also at some point today Alex Salmond, Scotland's first minster, and John Swinney, Scotland's finance minister, will be publishing with their economic plans for an independent Scotland.

As usual, I’ll also be covering all the breaking political news as well as looking at the papers and bringing you the best politics from the web. I’ll post a lunchtime summary before the Hunt statement at 12.30pm and another in the afternoon.

If you want to follow me on Twitter, I’m on @AndrewSparrow.


Andrew Sparrow

The GuardianTramp

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