Alun Cairns (Vale of Glamorgan) (Con)
12. What recent representations he has received on the operation of the interim cancer drugs fund; and if he will make a statement.
The Secretary of State for Health (Mr Andrew Lansley)
Clinically led arrangements are in place in all strategic health authorities for determining the best use of the additional funds that we have made available for cancer drugs from 1 October 2010. Information provided by SHAs shows that, as of 15 November, funding had been agreed for the treatment of more than 250 patients in England. I have received representations from hon. Members, noble Lords, and members of the public on how the interim arrangements for cancer drugs funding are operating. Many of those representations have welcomed the additional support we are giving to cancer patients in need.
Nigel Adams
I am grateful to the Secretary of State for his response. Last week, my constituent, Trudy Cusworth, received the news that she is to be given the cancer drug Avastin, despite the panel at St James’s university hospital, Leeds initially refusing to do so. In this case, the emergency cancer drugs fund has done its job, but what can the Secretary of State say to assure other cancer patients in North Yorkshire who are also in desperate need of such life-prolonging drugs and who are currently being denied access to them?
Mr Lansley
I am grateful to my hon. Friend for his question. Indeed, I want to thank him for the support he has given to Trudy Cusworth. I am very pleased that she was able to take her case, with her clinicians, to the panel and that it has been approved. There are a number of people in the York and Selby area for whom that is true. The panels are working across the country to ensure additional access to cancer drug treatments where a clinical case is made for that.
Alun Cairns
My constituents are pretty angry and disappointed that the cancer drugs fund will not apply to them because health matters have been devolved to the National Assembly for Wales. Will the Secretary of State give an assurance that he will champion the merits of the policy in the hope of convincing the Welsh Assembly Government to follow the lead that he is offering?
Mr Lansley
I agree with my hon. Friend, who is obviously an advocate for his constituents to the Welsh Assembly Government. These are matters for the devolved Administrations and they must decide how to allocate their resources. In this instance we have shared with the devolved Administrations the consultation on the cancer drugs fund, which will start next April, although the policy proposed will apply in England alone.
Toby Perkins (Chesterfield) (Lab)
2. What recent representations he has received on the effect of the abolition of primary care trusts on the co-ordination of preventive health care.
The Minister of State, Department of Health (Paul Burstow)
The Government have set out a number of proposals to support integrated working and preventive action, including ensuring that local councils take a key role in joining up local NHS services, social care and health improvement. There is a strong preventive focus in the NHS public health and social care outcome frameworks, and an additional £1 billion will be provided by 2014-15 for the NHS to support social care. Some of that money will be spent on preventive services. The public health White Paper sets out the Government’s plans to return the leadership of public health to local government. That proposal has been widely welcomed.
Toby Perkins
Before the Secretary of State and the Minister embarked upon the biggest reorganisation of the NHS in the past 60 years, what consideration did they give to the impact that such changes will have on the co-ordination of services? Primary care trusts are being described as in meltdown at the moment. PCT staff whom I meet are deeply worried about the co-ordination of services, as linking such services is about so much more than the work of GPs.
Paul Burstow
Let me start with the point of agreement: this is about more than just the work of GPs. That is why the Government are proposing the establishment of health and well-being boards in local authorities to drive the integration that was never delivered under the Labour party. Services were not integrated and, for many people, services did not fit around their lives as a consequence. This Government will change that. It seems that the hon. Gentleman is putting forward the campaign slogan, “Save the PCT; don’t trust your GP.” That is not a good campaign slogan.
Nadine Dorries (Mid Bedfordshire) (Con)
Will there be £2 billion going into two pots—one for public health and one for social care? What element of that budget will local authorities be able to use for preventive care? Some reports say that the budget is ring-fenced and some say that it is not, so some clarity would be appreciated.
Paul Burstow
In fact, there is a further pot of money, which relates to the proposals for a ring-fenced budget in respect of public health. One of the problems has been the NHS’s raiding that pot to spend on other things. We believe that public health is a priority, and we will therefore ring-fence those resources in future. The £1 billion that will go into social care directly through the local government settlement will be available for local government to support social care services. The £1 billion that will go in via the NHS will also be there to support social care, but it will particularly address issues such as reablement and preventive services.
Liz Kendall (Leicester West) (Lab)
The Government are abolishing all PCTs and handing £80 billion to GP consortiums that do not yet exist for services including the co-ordination of care. Is not this reorganisation a huge gamble for patients and taxpayers, which is why No. 10 and the Treasury are so concerned, as we see today in The Independent? Will the Minister finally agree to publish details about the financial assurance regime for GP consortiums, and will he guarantee that under his plans £80 billion of public money will be accountable to Parliament in the same way that it is today?
Paul Burstow
Of course the money will be accountable to Parliament, as it is now. The hon. Lady’s comments reflect an interesting campaign that the Labour party has dreamed up, which is very much to ally itself with the interests of primary care trusts rather than those of patients and ensuring that we improve public services. This Government’s proposals will improve the way in which services are commissioned, deliver better outcomes for patients up and down the country, and deliver the integration across health and social care that the previous Government failed to deliver.
Henry Smith (Crawley) (Con)
3. What recent progress he has made on the introduction of GP-led commissioning consortiums.
Mark Lancaster (Milton Keynes North) (Con)
13. What recent progress he has made on the introduction of GP-led commissioning consortiums.
The Secretary of State for Health (Mr Andrew Lansley)
On 21 October, I invited general practice-led commissioning consortiums to put themselves forward as pathfinders, and I have been absolutely delighted by the response. The pathfinder consortiums will be announced shortly. They have formed in response to the needs of local communities, and there is, sensibly, variation around the country to take account of those differing needs. Some consortiums map on to local authority boundaries; others organise themselves around catchments for hospitals or smaller populations. This bottom-up, locally determined approach is exactly in line with what we envisaged in the policy framework.
Henry Smith
Under the previous Government, Crawley hospital saw the removal of services such as accident and emergency and maternity. Can my right hon. Friend explain how, under the new GP-led consortiums, doctors will have the freedom and the flexibility to be able to refer their patients to local services if they so choose, as well as to new services?
Mr Lansley
That is exactly what our reforms will allow. We are putting not only the freedom to refer in the hands of general practices but choice in the hands of patients, and allying that to the power on the part of commissioners to commission services that meet the needs of their local community. That is precisely the change that will empower front-line clinicians and patients.
Mark Lancaster
Having consulted widely in Milton Keynes, I am pleased to say that the Government’s plans have been broadly welcomed. However, one area of concern that has been raised with me by patients, in particular, is the amount of time that they will get to spend face to face with their GP. Can the Secretary of State reassure my constituents and outline the administrative support that GPs will get in fulfilling their new functions?
Mr Lansley
I am grateful to my hon. Friend. In Milton Keynes, GP Healthcare MK and Premier MK consortiums are shaping their services in order to be able to deliver better and improved services for their patients. We do not intend that all GPs individually should become managers, by any means; there will be clinical leadership, but the consortiums should have commissioning support. The primary care trust in Milton Keynes has had some good commissioning support arrangements, as I know from having visited it in the past. It is open to the new commissioning consortiums to take teams from the primary care trust into their new consortium support arrangements, but they can go elsewhere. They can look to the local authority and to the independent sector to provide them with the commissioning support that they need so that clinicians provide leadership but continue to be responsible for clinical care.
Mr Ben Bradshaw (Exeter) (Lab)
What impact does the Secretary of State think that this change and the rest of the upheaval that he is inflicting on the health service will have on hospital waiting times?
Mr Lansley
I think that the reforms will have a positive impact on performance right across the NHS, because they will enable patients who want to exercise choice to see the quality and standard of services, including waiting times. Unlike in the past, they will be able to see waiting times for individual hospitals, rather than just a single target. They will be able to make choices based on information about the quality of services.
Derek Twigg (Halton) (Lab)
If the reforms are so good, why have they been criticised by the chairman of the Royal College of General Practitioners, Dr Clare Gerada? She said:
“I think it is the end of the NHS as we currently know it, which is a national, unified health service”.
The British Medical Association has expressed concerns about competition, and we hear in this morning’s edition of The Independent from an unnamed “ally” of the Secretary of State that
“There is no wobble. No 10 and the Treasury are fully behind the principle of the reforms”—
obviously a very brave ally. Why has the Prime Minister asked the Cabinet Office Minister who is in charge of Government policy to review the plans? Is it because the Secretary of State is the only one who believes in them?
Mr Lansley
The hon. Gentleman should not believe all that he reads in the newspapers. The curious thing is that the Minister with responsibility for Government policy is engaged with Government policy. That is a good and positive thing. The hon. Gentleman referred to the Royal College of General Practitioners and to Dr Gerada. In response to the White Paper, the RCGP said:
“General Practice is the central plank in our world-class healthcare system. The College thoroughly agrees that it makes a great deal of sense to give GPs, with their unique patient-centred perspective, a central role in commissioning and directing healthcare services.”
Dr Gerada said:
“I fully support placing clinicians at the centre of commissioning decisions”.
Mr Stephen Dorrell (Charnwood) (Con)
I very much welcome the steps that my right hon. Friend is taking to encourage the early emergence of pathfinder consortiums, so that the shape of the new commissioning structure is made clear as quickly as possible. Given the nature of the quality, innovation, productivity and prevention challenge—QIPP—that the health service faces, does he agree that the process must be carried forward as quickly as possible so that the new framework is clear for all concerned as quickly as possible?
Mr Lansley
Yes, I do. I was delighted by the response of general practice to the emerging consortiums, because one of the central reasons it wants to make progress quickly is to shape clinical service redesign, which is at the heart of delivering the efficiency savings that will enable us all to improve outcomes.
David Miliband (South Shields) (Lab)
The Secretary of State has said that GPs are the best people to manage the health service. Will he confirm that in the eight years of GP training, not a single hour is dedicated to the commissioning work that he has described?
Mr Lansley
The right hon. Gentleman should understand that what I said was that GPs are the best people to commission services. Commissioning and management are not the same thing. GPs are already responsible for commissioning most services in the NHS, but they have no power over resources and contracting. I intend to ally clinical leadership and commissioning decisions with commissioning support that involves management. The people who should determine the shape of local services to meet the needs of patients are those who are already at the heart of designing services and referring patients.
Andrew Stephenson (Pendle) (Con)
4. What recent representations he has received on management and administration costs in the NHS; and if he will make a statement.
The Minister of State, Department of Health (Mr Simon Burns)
Administration costs across the health sector will reduce by a third in real terms over the spending review period. That is a £1.4 billion cash reduction and a £1.9 billion real-terms reduction, from a baseline of £5.1 billion. Every penny of the savings will be reinvested in front-line services.
Andrew Stephenson
I thank my hon. Friend for that answer. Will he give me and my constituents examples of how the billions that are saved will make a difference on the front line when invested in patient care?
Mr Burns
I am extremely grateful to my hon. Friend and I will certainly give such examples. Every penny that is saved by cutting excessive management and bureaucracy will be spent on providing health care and drugs for his and other hon. Members’ constituents, and on ensuring that we have proper front-line services that provide the best quality care for all the people of England.
Nick Smith (Blaenau Gwent) (Lab)
Due to the snow, many falls and fractures have been reported in my constituency and around the country in the last few days. What plans are there to cope with such winter pressures?
Mr Burns
I fully appreciate the hon. Gentleman’s concern, because particularly at this time of the year and throughout the winter months there is both an extra duty on the NHS and an increased problem. I can assure him that for over a month now, as is the custom, the NHS has been meeting regularly to plan for the winter and ensure that we have the services in place to help those who suffer falls or illnesses due to the inclement weather.
Simon Kirby (Brighton, Kemptown) (Con)
5. On what date he expects to make an announcement on compensation for those infected by contaminated blood products supplied by the NHS.
The Minister of State, Department of Health (Paul Burstow)
In October we announced a review of a number of aspects of Lord Archer’s recommendations, including the level of ex gratia payments and the mechanism by which they are made, access to insurance, prescriptions charges and access to nursing and other care services. The Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), expects to report the outcomes of the review by the end of the year.
Simon Kirby
I thank the Minister for his answer. Does he believe that, after all the years of inaction, that will draw a line under the matter?
Paul Burstow
The hon. Gentleman is absolutely right to indicate that the matter has not been dealt with thoroughly for many years, and that is why the Government have launched the review. Obviously I cannot pre-empt its outcomes, but we will bring it to the House as soon as we can.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
The Minister will be aware that no past Government have anything to be proud of in the way in which the matter was dealt with, and that Members on both sides of the House have campaigned on the issue. People hope that the Government will be able to live up to the promise in the October debate of producing a review before Christmas. Thousands of sufferers of HIV and hepatitis C, and thousands of dependants, are waiting for the announcement.
Paul Burstow
The hon. Lady makes some very important points. As she rightly says, the matter was debated in the House only recently, and the Government are determined to ensure that we are in a position to report back on the review before Christmas.
Andrea Leadsom (South Northamptonshire) (Con)
I know that the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), has done a lot of work on the review and is keen to see a fair settlement. May I urge Ministers to take into account the fact that this is perhaps one of the worst tragedies to have befallen the NHS in this country? Many people have suffered terribly, and I hope that Ministers will make every effort to ensure that those sufferers can at last receive closure.
Paul Burstow
I am grateful to the hon. Lady for her comments and will ensure that they are reported back to my hon. Friend the Under-Secretary for her consideration in the review.
Paul Goggins (Wythenshawe and Sale East) (Lab)
6. What steps he is taking to reduce energy consumption in hospitals.
The Minister of State, Department of Health (Mr Simon Burns)
The NHS continues to improve its energy efficiency. The Department provides guidance to the NHS and supports the NHS sustainable development unit, which promotes energy awareness and carbon management across health care providers. Hospitals are working with the Department for Business, Innovation and Skills to engage with suppliers who provide innovative solutions.
Paul Goggins
I thank the Minister for his answer and invite him to join me in congratulating all the staff at Wythenshawe hospital in my constituency, which was recently named overall winner this year in The Guardian public services award as the country’s greenest hospital and for reducing energy emissions by 26%. What further pressure is he putting on other hospitals and health service providers to ensure that they follow that fine example?
Mr Burns
I am happy to join the right hon. Gentleman in congratulating the university hospital of south Manchester on its fantastic achievement and the award that it has won. As he knows, his local hospital did that by reducing its energy consumption and carbon emissions by 26% over the past three years in ways such as the greater use of biomass fuels. It is a fantastic achievement and the staff should be justifiably proud of it. They are a beacon for other hospitals to follow to reach the same level of sustainability, and I am delighted that a number of hospitals throughout the country are striving to reach the position of the one in his area. I am confident that through greater sharing of information and work, more and more hospitals will make their contribution to reducing carbon levels.
Miss Anne McIntosh (Thirsk and Malton) (Con)
The Minister will be aware of the extreme weather conditions and extremely low temperatures of minus 17° C in and around Thirsk and in other parts of North Yorkshire where we have community hospitals and trust hospitals. Has he reviewed the impact on their funds of heating costs when low temperatures come so early in the winter and will carry on for such a long period?
Mr Burns
I can reassure my hon. Friend. She is absolutely right that the winter period and harsh weather impose extra costs, but I am pleased to tell her that partly through winter planning and partly through the experience of past years, hospitals are aware of that. They take into their planning and financial budgeting the possibility of weeks and perhaps longer—depending on the weather—when their costs will increase, and adjust to meet those demands. I am confident that bad weather will not impact on front-line services because of the work that hospitals do to account for it over the 52 weeks of the year.
Annette Brooke (Mid Dorset and North Poole) (LD)
7. What assessment he has made of the Health Protection Agency’s recent report on the incidence of tuberculosis.
The Secretary of State for Health (Mr Andrew Lansley)
I welcome the Health Protection Agency’s recent report on tuberculosis in the UK. There were 8,286 cases of TB in England in 2009, an increase of 4.3% on 2008. The rise has occurred mainly in people infected in countries where TB is common, who go on to develop active TB disease later in life.
Annette Brooke
I understand that that is a 30-year high. Evidence from New York shows that a co-ordinated approach across the city has made a real impact in controlling TB. How will the Secretary of State ensure that such co-ordination takes place, especially in cities, when GP-led commissioning is introduced?
Mr Lansley
The treatment services for individual patients will be commissioned through GP consortiums, but the identification and preventive work on TB is a public health responsibility. To that extent, I believe that we will be better placed to deal with it in future. Many local authorities—for example, in Birmingham, Manchester or Leeds—will be well placed as cities to respond to any incidence or outbreaks of TB on a preventive basis, using their powers as public health authorities.
Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)
In response to my question on the publication of the White Paper about the more than 500 TB cases in Birmingham the Secretary of State confirmed that there would be no changes to what such cities could do to control TB outbreaks. Will he elaborate on his answer? What more can Birmingham do under the new arrangements to prevent such exceedingly high numbers?
Mr Lansley
We can do a number of things. For example, the Department has funded TB Alert, which is the UK’s national TB charity, to raise awareness of TB among public and primary health care professionals, which will help. In London, we have supported a find-and-treat outreach service. In a similar vein, that could happen in cities where there is a rising prevalence of TB. TB is not general across the country, but likely to occur in particular areas. Those kind of initiatives enable us to identify TB outbreaks, and we can then structure services around that.
Penny Mordaunt (Portsmouth North) (Con)
8. What assessment he has made of the merits of steps to increase the standard of end-of-life care in an acute setting; and if he will make a statement.
The Minister of State, Department of Health (Paul Burstow)
The Government are committed to increasing choice for people at the end of life, which will result in fewer people dying in hospital. However, there will always be a need for hospital-based end-of-life care. The national end-of-life care programme has published a guide for achieving quality in acute hospitals, which includes recommendations on holistic assessment, advance care planning, training, and improved multi-disciplinary working. The guide has been widely welcomed as a blueprint for improving the quality of end-of-life care.
Penny Mordaunt
Ministers will be aware of the Queen Alexandra hospital’s withdrawal of its G5 service to create a mobile model of end-of-life care. That will extend services across the hospital, but my constituents and I have grave concerns at the number of quiet and appropriate beds that will be left. Will Ministers agree to meet me to discuss what can be done to encourage the QA to meet the public’s concerns?
Paul Burstow
I am grateful to the hon. Lady for her question and I know that she has campaigned on that issue. She will know that on 25 October, the Secretary of State asked the independent reconfiguration panel to consider the issue that was raised by the Portsmouth health overview and scrutiny committee regarding a referral of ward G5. The advice has now been tendered, and the Secretary of State has asked the panel to undertake a full review of the case. He expects that report by March of next year and I am sure that during that period, conversations at ministerial level will be helpful.
Emily Thornberry (Islington South and Finsbury) (Lab)
Most people want to die at home, but they are prevented from doing so by the lack of out-of-hours support. Also, 24/7 community nursing is popular with the National Audit Office because it saves money. Even the Government say it is crucial, so why do they not use some of the £3 billion they are wasting on top-down reorganisation to ensure that everybody gets a community nurse at the end of their life, if they want one? How can the Government guarantee care for the dying if they abolish primary care trusts?
Paul Burstow
Perhaps a little humility might have been a necessary preface to that question, including, not least, an acknowledgment that the hon. Lady’s question is based on the failings of the previous Administration to deliver the necessary improvements in end-of-life care. On GP commissioning, there is undoubtedly an opportunity to integrate health and social care to deliver more timely and appropriate community-based end-of-life care, and we intend to deliver it.
Jonathan Lord (Woking) (Con)
9. What steps he is taking to improve the information provided to patients on their diagnosis and treatment.
The Minister of State, Department of Health (Mr Simon Burns)
As part of our White Paper reforms, a wide-ranging review of the information required to empower patients is in progress. Related current initiatives include the information standard scheme, information prescriptions and quality standards produced by the National Institute for Health and Clinical Excellence.
Jonathan Lord
I am grateful to the Minister for his reply. Currently good comparative data on the individual performance of doctors and surgeons are not readily available. How does he envisage compiling that data in a way that does not create too much bureaucracy or use up too much of doctors’ valuable clinical time?
Mr Burns
My hon. Friend is absolutely right: if we are to put patients at the heart of an NHS in which it is their care and views that are important and drive the provision of health care, we must empower them by giving them information that is consistently accurate, unbiased and easily understandable. We are currently consulting on our information revolution papers, and we await a chance to study the responses. However, we are determined to empower patients by giving them far more information, so that they can exercise their right of choice to get what they deserve, which is the very best health care.
Keith Vaz (Leicester East) (Lab)
I would like to declare an interest and remind the Minister that we currently spend £1 million an hour dealing with diabetes-related illnesses. One key way of helping to reduce that cost is giving patients diabetes tests and ensuring they get as much information as possible so that they can change their lifestyles.
Mr Burns
The right hon. Gentleman is absolutely right. We have to supply all patients, including those suffering from diabetes as well as other conditions, with as much information that they can understand as possible, so that they can make the choices about the health care they need. They also need to be backed up with advice from their GPs, community pharmacists and others in the health sector, because that will empower them to take decisions in their best interests to manage their medical condition.
Mr John Baron (Basildon and Billericay) (Con)
The Government have rightly announced, in the consultation document on patient choice, that all patients with long-term conditions will be offered a care plan. May I urge the Minister to ensure that that will apply also to cancer patients?
Mr David Blunkett (Sheffield, Brightside and Hillsborough) (Lab)
10. What decisions he has reached in respect of additional funding for the purpose of the tariff applying to specialist children’s hospitals.
The Secretary of State for Health (Mr Andrew Lansley)
Following a very constructive meeting with the specialist children’s hospitals on Friday 3 December, I am pleased to be able to tell the House that we are working on a proposal to set the top-up payment for specialised services for children at 60%, over and above tariff prices. In addition, I intend to help the trusts by extending the number of procedures that will attract the top-up payment in 2011-12. I believe that the children’s hospitals will find that entirely acceptable.
Mr Blunkett
I would like—uniquely—to thank the Secretary of State for signing off the technical agreement from last Friday, and to say that the specialist children’s hospitals will welcome his announcement this afternoon. Is it not time to take the uncertainty away from the children’s hospitals and have a system that allows them to put in place a forward plan that does not result in this annual farrago? Would it not also be nice to congratulate the staff of the children’s hospitals on their terrific work, not least the dedicated way in which they will be working with these children over Christmas?
Mr Lansley
Yes, I am very glad to do so. I have visited Sheffield children’s hospital, and I very much applaud the work that it does. I am sure that those at the hospital are grateful to the right hon. Gentleman, as I am, for the way in which he has represented their interests. I entirely agree with him: the purpose of developing the payment-by-results system is to arrive at a point where it is predictable and delivers a relevant payment, related to the costs that are genuinely incurred in the provision of that treatment. We are not in that position yet. The specialist top-up was put in place to reflect that, but I hope that it is temporary rather than permanent.
Mr John Leech (Manchester, Withington) (LD)
11. What progress has been made on improving the provision of specialist neuromuscular physiotherapy for people with muscular dystrophy and related neuromuscular conditions; and if he will make a statement.
The Minister of State, Department of Health (Paul Burstow)
Physiotherapy can help to manage the physical deterioration associated with muscular dystrophy and other neuromuscular conditions. Physiotherapists have a key role to play in reducing waiting times, improving access and choice, and providing more personalised services closer to home, thereby improving the quality of life of their patients. It is for local NHS organisations to decide how best to use the funds allocated to meet health needs.
Paul Burstow
I am grateful to my hon. Friend for that question, and I know that he plays an active part in the all-party muscular dystrophy group. He was involved in ensuring that we had a report from that body on access to specialist neuromuscular care—the Walton report, an important report that mapped out many of the deficiencies in the current service. I would be happy to meet him and his friends to discuss the matter further.
Gareth Johnson (Dartford) (Con)
14. What recent assessment he has made of the adequacy of provision of IVF treatment across the country.
The Secretary of State for Health (Mr Andrew Lansley)
Many primary care trusts have made good progress towards meeting NICE guidance recommendations on the provision of IVF treatment. However, I am aware that a small number of PCTs with historical funding problems have temporarily suspended local NHS provision of IVF services. I have already expressed my concerns about that approach. I expect all PCTs to have regard to the current NICE guidance and to recognise fully the significant distress and impact that infertility has on people’s lives.
Gareth Johnson
I am grateful to my right hon. Friend for his answer. He will be aware that Robert Edwards, the British inventor of IVF treatment, is due to receive the Nobel prize this week for his work. I am sure that Professor Edwards would be dismayed that PCTs have suspended their IVF provision, so would my right hon. Friend join me in urging those PCTs that have taken that step to reconsider their decision on this important issue?
Mr Lansley
Yes, I am indeed aware of that, not least because the Bourn Hall clinic, where Robert Edwards and Patrick Steptoe did their groundbreaking work, is in my constituency. As a former vice-chair of the all-party infertility group, I feel strongly that the reason the NICE guidance was written as it was, way back in 2004, was to recognise both the distress and the extent of the difficulties that couples face, and the need for them to be assured not only of good-quality investigation, but of good quality follow-up provision in fertility services throughout the NHS. I urge PCTs to have regard to the NICE guidance in their commissioning decisions.
Mr Kevin Barron (Rother Valley) (Lab)
If this unfair situation in the commissioning of infertility services continues, and if the reconfiguration goes ahead, would it be the responsibility of the national commissioning board to address it?
Mr Lansley
Beyond 2012 it would indeed. The reason we are in this position is not least because when NICE produced its guidance, my predecessor, John Reid, in effect told PCTs that they should not feel obliged to have regard to it and arbitrarily changed it. It is precisely that kind of political interference with what should be a clinically-led decision about the appropriate structure of commissioning services that I am proposing to do away with.
Chris White (Warwick and Leamington) (Con)
15. What support his Department plans to provide for front-line services in adult social care.
The Minister of State, Department of Health (Paul Burstow)
Protecting adult social care services is a clear priority for this Government. The spending review fully protects all existing grant funding for social care, and by 2014 an additional £2 billion a year will be available to support social care. Along with a programme of efficiency, those additional funds will enable councils to maintain access to social care while meeting demographic and other cost pressures and delivering new approaches to improve quality and outcomes over the next four years.
Chris White
I am grateful to the Minister for his response. In my constituency, residents of Whitnash are trying to set up a social enterprise to take over the running of a local care home. Will the Government encourage and support councils such as Warwickshire to respond positively to such initiatives, and will he meet residents of Whitnash so as to understand some of the issues that they face?
Paul Burstow
In our vision for adult social care, we very much argued the case for the greater use of social enterprises and the involvement of voluntary organisations as a way in which we can better deliver more personalised and appropriate public services of the very sort that the hon. Gentleman is talking about to our local communities.
Ann Coffey (Stockport) (Lab)
From April 2011, district nurses, health visitors and other specialist nurses working in the community in Stockport will be employed and managed by the Ashton, Leigh and Wigan Community Healthcare NHS Trust, and from April 2011, nurses providing community health services in Tameside will be employed and managed by the Stockport NHS Foundation Trust. Can the Minister tell me how that reorganisation will improve the delivery of front-line services to local people?
Paul Burstow
First and foremost, the hon. Lady should welcome the fact that this will provide opportunities for the greater integration of services, and that is a key way in which we can deliver better outcomes for her constituents and others up and down the country.
Paul Maynard (Blackpool North and Cleveleys) (Con)
16. How many patients in psychiatric care died of natural causes in the last five years.
The Minister of State, Department of Health (Paul Burstow)
Information on the number of people in psychiatric care who died of natural causes is not available. However, information about patients detained under the Mental Health Act is collected by the Care Quality Commission. The most recent information, covering the period 2005 to 2008, shows that there were 1,392 deaths of detained patients, of which 1,123 were ascribed to natural causes.
Paul Maynard
I thank the Minister for that reply. Does he share my concern that, almost uniquely in psychiatric care the state has a large degree of control over an individual’s circumstances, yet, unlike in prison or police custody, deaths from natural causes do not have to be reported to the coroner or be the subject of an inquest? Does he not think that the time has now come to end that disparity and to shed some light on to the real reasons behind many of the deaths from natural causes in psychiatric care?
Paul Burstow
My hon. Friend might be interested to know that the Ministry of Justice is reviewing sections of the Coroners and Justice Act 2009 and how they will be implemented. That review will include the subject of how deaths are reported to coroners. In fact, the statutory requirements to report deaths of mental health patients to coroners are the same as those for other patients, and NHS providers must report deaths of service users that occur during, or as a result of, care or treatment that they are providing.
Richard Graham (Gloucester) (Con)
17. What recent representations he has received on the management and administration costs of the NHS; and if he will make a statement.
The Minister of State, Department of Health (Mr Simon Burns)
As I said to my hon. Friend the Member for Pendle (Andrew Stephenson) earlier, administration costs across the whole health sector will reduce by a third in real terms over the spending review period. This is a £1.4 billion cash reduction and a £1.9 billion real-terms reduction, from a baseline of £5.1 billion. Every penny of the savings will be reinvested in front-line services.
Richard Graham
I am grateful to the Minister for his reply. Can he reassure my constituents in Gloucester that this is broadly the degree of savings that we should expect from NHS Gloucestershire’s expenditure on management, and that those savings will be spent on the rising demand for front-line services, including in the new, soon-to-be-opened women’s centre?
Mr Burns
Yes, I can give my hon. Friend the assurance that he seeks. We have made it quite clear that we will reduce management costs throughout the NHS by more than 45% over the next four years, and establishing GP consortiums will allow us to strip out the costly top-down bureaucracy that now exists. All the money that will be saved through these initiatives will be reinvested in front-line services, which will benefit the constituents of my hon. Friend and those of every other right hon. and hon. Member throughout England.
Rushanara Ali (Bethnal Green and Bow) (Lab)
I am concerned about the quality of services that patients and their families receive. In my constituency, 100 jobs are already going, and I am worried that the cuts in staffing will have an effect on the services that are available. Can the Minister guarantee that front-line services will be protected, because the reality is that, in constituencies such as mine, staffing is crucial to ensuring that decent services are available?
Mr Burns
I have to tell the hon. Lady that, in this very difficult financial situation, which we inherited from her Government, it is only by making efficiency savings and getting rid of excess bureaucracy that we can generate the income to reinvest to save front-line services—[Interruption.] She and the Greek chorus in front of her must understand that, if we had not been left in this mess in which £43 billion a year is being spent on the interest on the debt that we inherited, we would not have the problems that we now have—
Mr Speaker
Order. I think we understand what the Minister is trying to get at.
Mr Burns
My hon. Friend is absolutely right. Although the last Government significantly increased health spending —I do not dispute that; it is a self-evident fact—the trouble is that we did not see increases in productivity pro rata. That is the challenge that we face; that is what we are addressing; that is what we are going to achieve through QIPP—quality, innovation, productivity and prevention—by cutting out inefficiency, cutting out excess management and administration so that every single penny can be reinvested in improving front-line services and giving our constituents the finest health they—
Mr Speaker
Order. The Minister will resume his seat. His answers have been excessively long-winded and repetitive—and it must not happen again. I have made the position clear and I hope that the Minister will learn from that.
Mr Russell Brown (Dumfries and Galloway) (Lab)
18. What estimate he has made of the change in average waiting times for patients waiting for diagnostic tests since May 2010.
The Minister of State, Department of Health (Mr Simon Burns)
Patients are continuing to receive timely access to diagnostic tests. In September 2010, the median waiting time for 15 key diagnostic tests was 1.7 weeks, compared with 1.8 weeks in May.
Mr Burns
I suggest that the hon. Gentleman studies the response given earlier by my right hon. Friend the Secretary of State to the right hon. Member for Exeter (Mr Bradshaw). By concentrating resources and reforming the system to improve outcomes, we will provide enhanced health care for all our constituents in England.
Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)
T1. If he will make a statement on his departmental responsibilities.
The Secretary of State for Health (Mr Andrew Lansley)
My responsibility is to lead the NHS in delivering improved health outcomes in England, to lead a public health service that improves the health of the nation and reduces health inequalities and to lead the reform of adult social care, which supports and protects vulnerable people.
Jonathan Reynolds
The Secretary of State will be aware that primary care trusts across the country are being asked to cut between 35% and 50% from their management costs. This inevitably leads to job losses, but can he confirm that he is confident that the jobs being lost as a result of this policy are purely management roles and that there are no losses of jobs that combine some management role with front-line clinical responsibilities?
Mr Lansley
We have been very clear that we are asking the whole of the NHS administration—we are applying the same discipline inside the Department, to arm’s length bodies and across the whole of government—to secure a reduction by a third of real-terms administration costs over four years. In the NHS in particular, I am looking for a reduction in management costs of 45% in cash terms. By that, I mean specifically the costs of managers and senior managers. By definition, that does not include clinical staffing.
Ian Swales (Redcar) (LD)
T3. In the light of the recent damning report by the Care Quality Commission into Redcar and Cleveland council’s adult social care services, what steps is the Secretary of State taking to improve adult social care and will he meet me to address the issues raised in the report?
The Minister of State, Department of Health (Paul Burstow)
I am grateful to my hon. Friend for his question. I know of his concerns, which he has raised for some time. I understand that an improvement plan has been developed by Redcar and Cleveland and that it has been shared and agreed with the Care Quality Commission. The plan has a strong focus around ensuring a rigorous approach to improving the safeguarding of vulnerable people, and a peer review process is being established with the Local Government Group and the Association of Directors of Adult Social Services. I would, of course, be happy to meet my hon. Friend to discuss the matter further.
John Healey (Wentworth and Dearne) (Lab)
May I welcome the Secretary of State’s sensible rethink and change of mind on the funding of specialist children’s hospitals after Labour Members raised concerns during the previous Health questions? During those questions he also got his NHS funding figures in a twist, so what has he got to say about the updated inflation forecasts on page 83 of last week’s Office for Budget Responsibility report? They show that for the next four years the inflation increase will be bigger than the cash increase in the NHS—in other words, the NHS will get a real cut in funding, not a real increase. Does he accept the OBR figures? Does he accept that they are hard proof that the Government are breaking their promise to protect NHS funding?
Mr Lansley
Let me tell the right hon. Gentleman that it is not a change on specialist children’s hospitals. The previous Government initiated a study by York university, which reported. I made it clear, when we discussed it last, that we were examining the results of that together with the specialist children’s hospitals. We have reached what I regard, as I hope they do, as a very acceptable outcome.
The spending review gave a real-terms increase in NHS funding. That was the commitment we gave and it was set out in the spending review, and it remains true that revenue funding for the NHS continues to rise in real terms.
John Healey
Perhaps I should have asked the Secretary of State whether he has even seen the OBR report. Let me try to help him. The OBR’s inflation figures mean that the NHS will not get the 0.4% real increase that he bragged about and that was stated in the spending review; the NHS will get a 0.25% decrease—a cut—in funding, as has been confirmed today for me by the House of Commons Library. No wonder the Prime Minister is rattled and is asking what on earth the Health Secretary is doing with the NHS. Does the Health Secretary accept that this confirms that the coalition’s pledge to guarantee that health spending rises
“in real terms in each year of the Parliament”
is being broken? How does he explain that to the Prime Minister and how does he explain it to the public?
Mr Lansley
No, I do not accept that for a minute. At the spending review we set out what met our commitment. I am very clear that, as I just told the right hon. Gentleman, revenue funding for the NHS will increase in real terms. It will do so because we did not listen to the advice of the Labour party in the run-up to the spending review, which was to cut the NHS budget. We did not do that and we were committed at the spending review to an increase in real terms. The gross domestic product deflator will move from time to time, but the commitment that we set out was clear and will continue.
Mr Speaker
Just as the answers from the Minister of State, the hon. Member for West Chelmsford, were too long, those questions were too long as well.
Mr Speaker
Order. I do not require any assistance from the hon. Gentleman. We must speed up from now on. That is the situation.
Michael Ellis (Northampton North) (Con)
T6. Every day, ambulance service staff in my constituency and around the country deliver life-saving care to our constituents, but they are themselves occasionally put in harm’s way. What steps are Her Majesty’s Government taking to ensure that the protection that our ambulance staff get in my constituency and around the country is the best that we can provide?
Mr Lansley
I join my hon. Friend in paying tribute to the staff in ambulance service—in the current circumstances, with the winter pressures being what they are, we should especially do so. But those staff can come under particular threat from time to time and we have to prepare for all eventualities. For example, if an attack involving firearms takes place, as it did recently in Cumbria, it is possible that ambulance staff would be working alongside other emergency services in responding to it. It is only right, therefore, that they are offered as much training and equipment as possible to carry out that work.
Paul Goggins (Wythenshawe and Sale East) (Lab)
T2. This morning, the Justice Secretary said that he was working with the Health Secretary on plans to divert more mentally ill offenders away from prison. I broadly welcome that, but could the Health Secretary tell us how much new money will be made available for that initiative, especially given the comments made by my right hon. Friend the Member for Wentworth and Dearne (John Healey) about the cut in the real value of health spending?
Mr Lansley
The right hon. Gentleman is in no position to make that point, given that his party wanted to cut the NHS budget. What my right hon. and learned Friend said this morning about our working together is indeed true. However, this is not a case of our diverting patients; it is about ensuring that people who have mental health problems are dealt with appropriately rather than there being a failure to deal with them. That applies whether they are in prison or in hospital. We are working together on that, and I know that my right hon. and learned Friend will be making a statement shortly.
Richard Graham (Gloucester) (Con)
T8. Can Ministers reassure me that, given the relative health deprivation in Gloucester, the ring-fenced funding promised in the White Paper on public health will in fact benefit people there?
Mrs Mary Glindon (North Tyneside) (Lab)
T4. The north of England cancer network has been working since 2007 to improve cancer commissioning across primary and secondary care and to improve standards of cancer care for my constituents. Can the Secretary of State confirm that it will continue to play that role after the introduction of GP commissioning?
Paul Burstow
In the not-too-distant future, we will publish the refresh of the cancer reform strategy. That will demonstrate how the Government will continue to build on past success while ensuring that we reduce and improve the survival rates for cancer. One of the real problems in this country is that we have some of the poorest survival rates for cancer. We will ensure that the networks’ expertise is incorporated into the way in which the reformed system will work.
David Tredinnick (Bosworth) (Con)
Is my right hon. Friend aware of the rally being held here in Westminster tomorrow by qualified herbalists who are coming to lobby for statutory regulation, which my right hon. Friend is obliged to provide under European law? When will he do that, please?
Mr Lansley
I am indeed aware of that, as my hon. Friend would expect. He will know that we are considering how we can give effect to the proper regulation of herbal practitioners and we will make an announcement shortly.
John Mann (Bassetlaw) (Lab)
T5. If a hospital service’s reconfiguration is demonstrably and overwhelmingly rejected by a local population, what notice will the Secretary of State take of the patients’ voice?
Mr Lansley
It was only under this Government, after the election, that tests were set out that such reconfigurations should meet. Those tests clearly included recognition of the voice of the public and of the local authority as well as current and prospective patient choice. To that extent, for the very first time, reconfigurations are not being dictated by an NHS administration but are responding to the views of patients and clinicians.
Duncan Hames (Chippenham) (LD)
The NHS Litigation Authority estimates an outstanding liability for clinical negligence claims of £15 billion, a sum that increased by £2 billion in the last year alone. How will the Minister bring that spiralling cost to the NHS to a halt?
Mr Lansley
I understand exactly my hon. Friend’s point. The increase in liabilities was, in part, an expression of the change in the discount rate rather than necessarily an increase in the number of cases coming through. It is a worrying figure and costs the NHS not far short of £1 billion a year through contributions to the clinical negligence scheme for trusts. My noble Friend Lord Young, in the course of his review of health and safety and other issues, made recommendations on dealing with conditional fee arrangements and clinical negligence. It set out that we would consider, for example, how we implement NHS redress arrangements, including whether there should be a fact-finding phase before any question of legal intervention. We will do that and report back to the House.
Pat Glass (North West Durham) (Lab)
T7. My local hospital, Shotley Bridge hospital in Consett, has faced a degree of certainty over its future in recent years. However, with the demise of the local PCT, which owns the hospital and the land, uncertainty has returned. Is the Minister prepared to meet me and a delegation from the hospital to consider the future?
Mr Lansley
I am sure that I or one of my hon. Friends will be happy to meet the hon. Lady. I do not know why she thinks that the abolition of the PCT will make that change. We have yet to set out how PCT assets will be dealt with when they are abolished. She must talk to her local GPs as I know that GPs in Durham have come together in a consortium and they will be well placed to give precisely the kind of assurance about the security of services in the future that she is looking for.
Nick de Bois (Enfield North) (Con)
The Secretary of State will be aware that the Barnet, Enfield and Haringey clinical review has been concluded. It notes that the Secretary of State’s four tests have been passed, despite health scrutiny establishing that they have not. In addition, the majority of Enfield GPs do not support the proposals. Will the Secretary of State therefore conclude that the four tests have not been passed?
Mr Lansley
My hon. Friend will know that all that has not yet come to me, so I will not prejudge this issue. However, I have made it clear, not least in a letter I recently sent to Baroness Margaret Wall, who is the chair of the Barnet and Chase Farm Hospitals NHS Trust, that I expect us to examine not only the Barnet, Enfield and Haringey proposals, but any other proposals that the trust might put forward about the level of acute services provided through Chase Farm.
Toby Perkins (Chesterfield) (Lab)
T9. The Secretary of State seemed to suggest, in his answer to the shadow Secretary of State, that his definition of a real-terms increase includes changes in inflation. If he does not accept the Office for Budget Responsibility verdict that the increase in inflation means a real-terms cut in 2012, which definition of inflation is he using?
Mr Lansley
What I said to the shadow Secretary of State was entirely accurate.
Gordon Birtwistle (Burnley) (LD)
Does the Secretary of State agree that the abolition of unelected quangos such as primary care trusts and strategic health authorities will bring an end to the decisions they are taking to remove services from local hospitals against the wishes of GPs and local residents?
Mr Lansley
The reforms we propose will bring far greater accountability not only through local authorities but through patient choice and through front-line clinicians being able to commission services.
Let me also tell my hon. Friend that I have today referred to the independent reconfiguration panel, for initial appraisal, the question referred to me by Lancashire county council about the children’s ward at Burnley hospital.
Steve McCabe (Birmingham, Selly Oak) (Lab)
Will the Secretary of State join me in deprecating the outrageous behaviour of the Prime Minister’s aides who told the Financial Times that the Secretary of State, on his reorganisation, has all the answers—unfortunately to all the wrong questions?
Mr Lansley
The hon. Gentleman should not believe what he reads in the papers and when he is trying to quote from them, he should do so accurately.
Caroline Dinenage (Gosport) (Con)
Blake maternity unit in Gosport is temporarily shut and its long-term future is by no means 100% secure. In conversations with local health care bosses, I have learned that it is not because of cost but because of a national shortage of midwives. Are there any policies or plans to address this issue?
Mr Lansley
I do not know the particular circumstances in Gosport, but I shall happily write to my hon. Friend. Nationally, we have more midwives than we have ever had—[Interruption.] I am being provoked by those on the Opposition Front Bench. There was a 16% increase in the number of live births in this country, but only a 4.5% increase in the number of midwives. That is the point I was about to make. The Government of whom the hon. Member for Halton (Derek Twigg) was a member failed to invest in midwifery when there was an increase in live births. That is why hospitals across the country have too few midwives, and that is why we are putting the investment in—because we did not listen to the Labour party when it said, “Cut the NHS budget.”
Fiona Mactaggart (Slough) (Lab)
Will waiting times for in-patient treatment in hospital increase or decrease next year?
Joseph Johnson (Orpington) (Con)
I am grateful to the Secretary of State for agreeing to visit Queen Mary’s, Sidcup, tomorrow, recognising the strength of local opinion there about the closure of accident and emergency and maternity services temporarily over the winter period. I hope that on his return he will reassure my constituents in Orpington that the closure will not mean that the review of reconfiguration of local NHS services will be prejudged and will not put neighbouring hospitals such as those in my constituency under undue pressure.
Mr Lansley
I am grateful. Tomorrow, I hope to assure myself, among other things, that the closure is temporarily demanded by virtue of the inability to secure enough staff to maintain a safe service for the time being and that it will not and does not pre-empt the question of availability of services at Queen Mary’s, Sidcup, on which a decision has not yet been reached locally or referred to me.
Mr Dennis Skinner (Bolsover) (Lab)
On the NHS campaign against obesity, does the Secretary of State welcome the magnificent support of the thousands of schoolchildren who have come down to demonstrate for school sports funding outside No. 10 Downing street? Will he fight in the Cabinet against the Education Secretary’s silly proposal, which will damage children’s health?
Mr Lansley
The Secretary of State for Education rightly believes in schools making decisions about how they should best use their resources, including for school sport. I hope the hon. Gentleman will welcome the fact that through my Department we have supported school sports clubs under Change4Life and intend to expand them.