The Parliamentary Under-Secretary of State for Health (Anne Milton)
I welcome all the contributions. We have had an excellent run-around of some hon. Members’ interests and specific issues relating to their constituencies.
I start with the hon. Member for Worsley and Eccles South (Barbara Keeley). As she rightly pointed out, the Government have recently announced that they will provide additional funding of £400 million to the NHS in the next four years to enable more carers to take breaks from their caring responsibilities. I commend her for her continued interest in the subject. I trained as a nurse and worked in the NHS for 25 years, and the question is now, as it always has been: who cares for the carers? The hon. Lady is right to highlight the problems that carers suffer—the impact on their physical and mental health and well-being, as well as the immense emotional burden that many bear.
The spending review has made available additional funding in primary care trust baselines to support the provision of breaks for carers. The new moneys will go into PCT budgets from April 2011 and into GP consortium budgets from 2013. The 2011 NHS operating framework, which was published on 15 December, makes it clear that PCTs should pool budgets with local authorities to provide carers with breaks as far as possible via direct payments or personal health budgets, which will doubtless ensure some progress.
The new funding is part of a package of measures that we announced in the recently published update to the carers strategy. The next steps set out the priorities for action in the next four years, focusing on what will make the biggest impact on carers’ lives. It is important to recognise that the subject is of interest to hon. Members of all parties. I do not think there is division along party lines. The hon. Lady’s insight into and knowledge of what is happening on the ground will be important to ensure that future policy and direction is well informed.
Barbara Keeley
Will the Under-Secretary say more about what will happen if PCTs do not spend the money on carers’ breaks? The Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), who is responsible for social care, campaigned in the House when the Labour Government had a similar problem. As I said earlier, the problem is that, according to a survey, only a quarter of the money had been spent on carers’ breaks. It is fine to allocate it, but the trouble is getting the PCTs to spend it.
Anne Milton
I thank the hon. Lady for that intervention. She is right to suggest that there can be an intention at Westminster, but the point is ensuring that it is effected on the ground. I will say a little more about that shortly.
We do not believe that a legislative approach is always the way to proceed when requiring health bodies and GPs to identify patients who are carers or have a carer and refer them to sources of help and support. Indeed, often it is not. We feel more comfortable with that as a weapon, but it does not necessarily produce the result that the hon. Lady wants.
It will be for PCTs and subsequently the GP consortiums to decide their priorities in the light of their local circumstances. However, we believe that GPs and their staff will play a vital role in identifying carers; many carers have not yet been identified. That is why we are investing £6 million from April 2011 in GP training, which will mean that more GPs and their practice teams gain a better understanding of carers and the support that they may need. That is important.
I believe that GPs are much better placed truly to understand the value and needs of carers. I do not need to tell the hon. Lady that the considerable social, human and, indeed, financial value that carers offer cannot be overestimated—she is aware of that. However, centrally driven methods are not always the best way forward. I welcome her continued feedback to ensure that we get the money spent where it is needed most.
Let me deal now with the speech made by my hon. Friend the Member for Colne Valley (Jason McCartney). I take the opportunity to pay tribute not only to midwives but to all the staff who will be working to deliver babies safely into the world, while we are enjoying our turkey or whatever we choose to eat on Christmas day.
The Government are committed to devolving power to local communities—to people, patients, GPs and councils—which are best placed to determine the nature of their local NHS services. I pay tribute to my hon. Friend for raising the matter previously and for continuing to raise his constituents’ concerns.
The Government have said that, in future, clinicians and patients must lead all service changes, which should not be driven from the top down. To that end, the Secretary of State has outlined new, strengthened criteria that he expects decisions on NHS changes to meet. They must focus on improving patient outcomes, consider patient choice, have support from GP commissioners and be based on sound clinical evidence. I think that that was what my hon. Friend was getting at.
The Department has asked local health services to consider how continuing schemes meet the new criteria. Some will be subject to further review. That does not necessarily extend to reopening previously concluded processes, as in Huddersfield—I would not like to lead my hon. Friend down an alley—or halting those that have passed the point of no return, with contracts signed and building work started. However, NHS Yorkshire and the Humber has advised that the decision to implement the looking to the future programme and change in maternity services in Huddersfield was clinically driven, with strong emphasis on patient safety and quality of care. It was also made after considerable scrutiny and consideration, including a formal period of public consultation and advice to the then Secretary of State for Health from the independent reconfiguration panel, whose recommendations were endorsed in full.However, I know that my hon. Friend will continue to gather local evidence and experience and feed it back, which I welcome.
Let us look at the problem described by the hon. Member for Blaenau Gwent (Nick Smith). I disagree with much of what he said. We have a bold public health strategy for the first time, and it has been widely welcomed. He should not believe everything he reads in the newspaper—it could lead him into all sorts of misapprehensions. The Government alone cannot improve public health; we need to use all the tools in the box.
The hon. Gentleman should note that health inequalities grew, rather than decreased, under the previous Government. There are massive opportunities to improve public physical, mental, emotional and spiritual health and well-being in England. As he rightly pointed out, we have some of the highest obesity rates of any country in the world. People living in the poorest areas die on average seven years earlier than people living in richer areas, and they have higher rates of mental illness, disability, harm from alcohol, drugs and smoking, and childhood emotional and behavioural problems. Changing people’s lifestyles and removing health inequalities could make double the improvement to life expectancy that we could make through health care, so we must address public health.
The Government published our strategy in our White Paper “Healthy lives, healthy people”. We will establish Public Health England, a national public health service, return public health leadership to local government, and strengthen professional leadership nationally by giving a more defined role to the chief medical officer, and locally through strong and inspirational leadership roles for directors of public health.
Historically, all the big public health improvements came via local authorities, and I am convinced that returning public health responsibilities to local authorities will achieve what we need, which is social and economic change as well as health change.
Mr Speaker
Order. The Minister is of course welcome to take the hon. Gentleman’s intervention, but she still has a few contributions to respond to, and we need to make some progress.
Nick Smith
I welcome the proposal to ask local authorities to take responsibility for public health—in the round, that is a good thing—but will they get the resources to do that job?
Anne Milton
Thank you, Mr Speaker. I am afraid that I got rather carried away with this new-style debate, but I am mindful of the time.
For the first time, public health spending is ring-fenced. Public health interventions have been cut because of spending by PCTs, so it is really important to ring-fence such funding. The Government will focus on outcomes that are meaningful to people and communities. We published proposals for a public health outcomes framework yesterday for consultation, to which I am sure the hon. Gentleman would like to respond. I hope I have reassured him that the Government are taking the action necessary to improve the public’s health. I would be happy to discuss that with him in more detail another time, and perhaps to correct some of the myths that he believes. Nothing is ruled out. We will do everything we need to do to improve the public’s health, but we must use all the tools in the box. We cannot improve public health by Government intervention alone.
My hon. Friend the Member for Suffolk Coastal (Dr Coffey) raised the issue of integrated drug treatment systems for prisons that aim to increase the volume and quality of treatment available to prisoners. I welcome her involvement in her local prison. Such systems also aim to improve integration between clinical counselling, assessment, referral and through-care services, and to reinforce continuity of care when prisoners are released into the community.
The Government must reshape drug treatment to focus on recovery and to improve the continuity of treatment in the community following release. Abstinence is where we need to go. As outlined in the Ministry of Justice Green Paper on sentencing reform and rehabilitation, and in accordance with the much more outcome-focused approach announced in the new drug strategy, a payment-by-results approach to commissioning drug treatment for prisoners on release will be trialled in two areas. Recovery wings will be trialled in four prisons, with an emphasis on offenders receiving short custodial sentences, who therefore require a co-ordinated approach from prison and community. The combining of prison drug budgets with the combined drug interventions programme and a community-pooled treatment budget will allow for great flexibility, which is what we need in configuring services. To my mind, we have failed adequately to address drug abuse and prisoner addiction, and in turn failed our communities. We have not spent much-needed resources well.
I probably answered many of the points made by the hon. Member for Newcastle upon Tyne Central (Chi Onwurah) in my answer to the hon. Member for Blaenau Gwent on public health more generally. My husband’s family are all from Hartlepool. The hon. Lady was right to raise the issue of health inequalities. “Healthy lives, healthy people” underlines the priority that we are giving to tackling inequalities and supporting the principles of the Marmot review. We are focusing on the health and social needs of disadvantaged groups and areas, including on how money is allocated to local communities for public health interventions.
Despite the fact that the previous Government doubled health funding, as the hon. Lady rightly said, health inequalities got worse. I do not think that that was because of a lack of commitment on Labour’s part. It is extremely difficult to tackle health inequalities head-on, which is why our White Paper is so widely welcomed. The action outlined in that paper will reduce those truly shocking health inequalities.
It is important to recognise that this is not just about the money that is spent, but about how it is spent. I welcome the hon. Lady’s non-partisan comments about the previous Government’s record. For the first time, we are consulting on public health and ring-fencing money, and I believe that we can make a real difference.
The last Back-Bench contribution was from my hon. Friend the Member for South Swindon (Mr Buckland) on autism. I should like to take this opportunity to pay tribute to the parents and carers—young and old—who care for children and adults with autism. For some, that is a considerable burden that we should not underestimate. The National Institute for Health and Clinical Excellence is currently developing three autism clinical guidelines. The recognition, referral and diagnosis of autism guidelines are scheduled to be published in September next year; the diagnosis and management of autism in adults guidelines are scheduled to be published in July 2012—that might feel a long way off, but it is coming—and the management of autism in children and young people was referred to NICE by Ministers in November this year.
I pay tribute to my hon. Friend for his interest in autism, which has been discussed on many occasions in the House since I became a Member. There is no doubt that the expertise and input of people like him—people who have personal experience—is crucial in ensuring that we get the right policies that can have an effect on the ground, including in his constituency. His expertise and that of other hon. Members is critical.
Mr Speaker, I apologise for going beyond my allotted 10 minutes, but I wish you and all the staff of the House a very happy Christmas. I thank them for all their support this year and wish them well for the next.