The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I thank hon. Members for their kind comments. A lot of ground has been covered in this debate and many good points have been raised about local NHS services. I hope that hon. Members will forgive me if I cannot give comprehensive answers about everything that has been raised, but I will do my best in the time that is available.
It was clear from all the points that were made in the debate that every hon. Member sees the NHS through the prism of the patient. That is the right way to regard how NHS services are delivered. Patients are the priority for our NHS services and for the Government, and they were the priority for the former Secretary of State, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), in his decision to push ahead with the NHS reforms. The basis of the “No decision about me without me” policy is that patients are the most important thing. They are why doctors and nurses do their work and why all Governments endeavour to fight for a better NHS.
I turn now to the concerns of individual Members. I believe that I am right to wish my hon. Friend the Member for Milton Keynes South (Iain Stewart) a happy birthday. A number of hon. Members have concerns about the competitive procurement processes for community health services in Milton Keynes. He mentioned the concerns of my hon. Friend the Member for Milton Keynes North (Mark Lancaster). Our policy is clear that it is for the local NHS, and the primary care trust in particular, to look at the options for different procurement procedures and to decide what is best for local people. The local strategic health authority has played an important role in assuring the PCT’s decisions. Whichever option is chosen, it must be possible to put it in place before 31 March 2013, to avoid the continuing and damaging uncertainty for staff. I am happy to meet my hon. Friend the Member for Milton Keynes South and other hon. Friends to discuss the matter further.
My right hon. Friend the Member for Berwick-upon-Tweed (Sir Alan Beith) talked about maternity services, which is a matter close to my heart. This morning, I visited Newham university hospital, which faces different challenges in maternity care. I looked at the fantastic new unit that has been opened at Newham, which will meet those challenges and provide high-quality maternity care to that part of London.
My right hon. Friend was right to point out that the challenges for maternity services—indeed, for all health care services—in more rural areas such as Berwick-upon-Tweed are different from those in more urban parts of the country, such as London. Women and families in Berwick, like women and families everywhere, deserve maternity services that focus on improving the delivering of high-quality health care for women and babies, and on improving women’s experience of care.
The decision temporarily to close the midwifery-led maternity unit and in-patient post-natal services at the Berwick infirmary, to which my right hon. Friend alluded, was difficult for the local trust to make. He is right to say that in making such decisions there should be regard to the rurality of the area. He made good suggestions about the potential for rotating staff to support rural maternity units. I understand that the decision was made to protect the quality and safety of maternity services in the area and, in particular, to protect the quality of care and safety of women in labour.
I have been assured that the trust is working closely with commissioners to look at the future of maternity services in Berwick. The review will be completed in the coming months. My right hon. Friend may be aware of the recent birthplace study, which discusses good and bad practice in supporting smaller maternity units. I am sure that the commissioners will have regard to that study in making decisions about the future of the unit in his area. He should be assured that I will take a close interest in the matter and support his advocacy on behalf of his constituents.
My hon. Friend the Member for Ealing Central and Acton (Angie Bray) made some points about the service reconfiguration of health care services in London. The hon. Member for Mitcham and Morden (Siobhain McDonagh) also mentioned that issue, and I am sure she would like to pay tribute—as I do—to my right hon. Friends the Members for Carshalton and Wallington (Tom Brake) and for Sutton and Cheam (Paul Burstow), for their work over the years campaigning for services at St Helier hospital.
Key tests must be passed to ensure that clinical services are suitable for reconfiguration. First, there must be support from local clinicians, and, secondly, arrangements for public and patient engagement and consultation—including with local authorities—must be strengthened and put in place. Thirdly, we need greater clarity on the clinical evidence bases underpinning proposals, and, finally, any proposals should take into account the need to develop and support patient choice.
The reconfiguration of front-line health services is up to the local NHS, and no decisions will be taken until there has been a full public consultation. St Helier hospital is part of the south-west London reconfiguration scheme “Better Services, Better Value”, which is in its pre-consultation stage and is led by local GPs, nurses, acute clinicians, other health care professionals and patient representatives. Under “Better Services, Better Value”, the number of accident and emergency and maternity units will be reduced from four to three, and the likely recommendation is for St Helier to become a local hospital with an urgent care centre.
Ealing hospital is part of the “Shaping a healthier future” scheme in north-west London. Proposals for that scheme include centralising A and E units, and having maternity facilities on fewer sites. However, I reassure my hon. Friend the Member for Ealing Central and Acton that there are no plans to close any hospitals, and certainly not Ealing hospital. As she said, a full public consultation began on 2 July this year and will finish no earlier than 8 October, and I encourage my hon. Friend and her constituents to continue engaging with that process. She outlined the good campaign that she has been running to encourage local engagement, and I am sure she will continue with that so that local voices can be heard when health care decisions are made in the area.
The issue of children’s congenital heart surgery was raised by a number of hon. Members, including my hon. Friends the Members for Leeds North West (Greg Mulholland) and for Pudsey (Stuart Andrew). My hon. Friend the Member for Sittingbourne and Sheppey (Gordon Henderson) spoke passionately about Jacob, the son of one of his constituents.
A number of hon. Members are concerned about the “Safe and Sustainable” review of specialist paediatric services, and particularly its focus on the reconfiguration of heart surgery services. However, as was made clear in a number of contributions, its findings were based on Professor Kennedy’s review of paediatric heart services at Bristol after the heart scandal there, and the “Safe and Sustainable” review is independent of the Government, as it should be. In those circumstances, and given the notice of legal proceedings and referrals to the Secretary of State, it is not appropriate for me to comment further on that review or its outcome, and that stands for my statement on the Floor of the House as well as for my correspondence with constituents. I know that my hon. Friend the Member for Leeds North West has written to the Department on this matter, and the Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry), replied with details of how anyone who wishes to raise concerns about the review can get their voices heard.
Greg Mulholland
I commend the Minister for his professionalism in both his previous career and his current role. Although I accept what he says, does he agree that our statutory process must be allowed to look at whether this review is, as we believe, a dodgy decision, or, as the Joint Committee of Primary Care Trusts contends, a fair one? Does the Minister at least agree that such scrutiny should take place, and that the fact that it is being prevented because documents have not been released is wrong and must be rectified? That is all I ask him to say today.
Dr Poulter
As my hon. Friend is aware, there is a process for scrutinising all decisions and, as I have outlined, if the correct procedure has not been followed, decisions are open to judicial review. To reassure hon. Members, we have accepted, from a medical perspective, the principle that fewer units deliver better care for patients and better surgical results for children. Therefore, this review is not about closing units in any particular hospital, but about specialist surgical services. Day-to-day care of patients and paediatric care for those who have had surgery will continue locally even after this review, and that should reassure local patients.
Mr Cash
On that point, and in the light of the way this legislation has been redressed over the past year and half, does the Minister accept that before the legislation was introduced, and now, ultimate responsibility and accountability for all matters affecting the health service turned on the duties, accountability and statutory responsibilities of the Secretary of State? That is why the Minister is now at the Dispatch Box, just as the Secretary of State would be in other circumstances.
Dr Poulter
I accept that the Secretary of State has always had responsibility for the health service, and that was implicitly made clear in the Health and Social Care Act 2012. It is, however, important that we no longer have a system in this country that micro-manages the delivery of local health care services. We must listen to local doctors and nurses, and put them in charge of the configuration of local services because they are often the best advocates for the needs of local patients. Reconfiguring local services should be led—as per the four tests I outlined previously—on good clinical grounds where there is a clinical case for reconfiguration and where local communities have been consulted. That is something we should listen to and we must move away from the Whitehall micro-management of local health care delivery.
Dr Poulter
I will give way one more time, and then I will make some progress.
Gordon Henderson
Does the Minister accept that local people wanted Royal Brompton hospital to be kept open, and that the decision to remove the intensive care unit was not taken by local people? The Minister is arguing against himself.
Dr Poulter
The initial process for the reconfiguration was started, I believe, by John Reid when he was Secretary of State in 2002, after listening to evidence at the time. We should remind ourselves why we are discussing congenital heart services. All speakers have accepted the principle that there is good clinical evidence—acknowledged by doctors and specialists—that having fewer units actually delivers better care for patients. That was accepted by my hon. Friend the Member for Pudsey. I am not going to go into the rights and wrongs of individual units as that is under judicial review and I will not be drawn further on that point today.
Dr Poulter
I have been very generous and indulgent but I must make some progress. The process was led by doctors and nurses, and there is an ongoing consultation to engage with, review and reflect on decisions at a local level. That came out clearly in comments by my hon. Friend the Member for Leeds North West, but some of those processes are under judicial review and I will not, therefore, be able to comment further. I hope that my hon. Friend the Member for Sittingbourne and Sheppey will accept my reassurance that these reviews are carried out on good clinical grounds that take into account local factors such as whether local health care services are well designed. The important thing is that they are being led and developed by local doctors and nurses. We need such clinical leaders in the NHS, because they are the best advocates of patients’ needs.
My hon. Friend the Member for Stafford (Jeremy Lefroy) has been a strong advocate of the needs of his constituents and the staff of Mid Staffordshire NHS Foundation Trust. I know that we will be meeting tomorrow to discuss his concerns further, and I will also meet my hon. Friend the Member for Stone (Mr Cash), who has sadly now left the Chamber. We will talk about a number of issues, and I reassure my hon. Friend the Member for Stafford in advance of that meeting that I and other Ministers will continue to do all that we can, as our predecessors did. He rightly paid a full tribute to my right hon. Friend the Leader of the House for all the work that he did as Secretary of State for Health to support staff of that trust and ensure that there are good outcomes for patients. On behalf of all members of the Health team, I commend my hon. Friend the Member for Stafford for his work as a strong advocate of the needs of local patients, and I look forward to meeting him tomorrow.
My hon. Friend the Member for Pendle (Andrew Stephenson) rightly raised the issue of paramedic prescribing. He talked about the need for more flexibility in urgent and emergency care services, on the basis that it is better to have prevention than cure. We know that paramedics do a great job every day of looking after people and providing essential care on the spot and in the ambulance that saves lives before people get to hospital. The more we can do to support paramedics in providing preventive care in the community, the better for patients.
As well as allowing flexibility in urgent care services, paramedic prescribing would allow eligible paramedics to deliver more treatment in the home and the community where appropriate. That should prevent hospital admissions and reduce demand on the system. At the moment, paramedics can administer a range of medicines, but they cannot write prescriptions for patients. A new system of paramedic prescribing should benefit both patients and the NHS. Due to resource and capacity issues it has not been possible to take forward that work yet, but it will be considered within the new architecture of the NHS Commissioning Board along with other work programmes on resources and capacity. I shall certainly raise the matter, and the good points that my hon. Friend made, with ministerial colleagues.
My hon. Friend the Member for Mid Derbyshire (Pauline Latham) talked about diabetes care, particularly for type 1 diabetes. It is commendable that a lot of her focus was on younger people with diabetes. The number of patients with type 1 diabetes and known to be on insulin pumps has increased. At the moment, at least 3,700 children and more than 10,000 adults are on insulin pumps, and they are particularly important for younger people who may find it more difficult to control their diabetes. However, they are important for all people who have difficulty with their insulin and their diabetes control.
We want people to lead more independent lives, and we want to support people with long-term conditions to enjoy the same life as anybody else, so it is right that we do more to support people with type 1 diabetes. Those with difficult diabetes control have to be mindful of their disease on a daily basis, and if we can do more to ensure that their diabetes is not a factor in how they live their lives, that has to be a good thing.
The NHS operating framework for 2011-12 highlights the need to do more to make insulin pumps available. The NHS Diabetes insulin pump network is promoting good practice, but as we have discussed, pump therapy is not suitable for everybody. We are waiting for the conclusion of the first ever national insulin pump audit early next year, which will give us a clearer picture of the number of pumps provided and the services that are available. Importantly, it will also include the first investigation of how services are provided compared with the guidance issued by NICE in 2008 and updated in 2011, which my hon. Friend outlined.
My hon. Friend also raised the issue of artificial pancreases. There is small-scale use of them in children, but the clinical trials are not yet conclusive as to their effectiveness and ease of use and there are currently no NICE guidelines on the subject. We need to use the commissioning process to address the disparities in NHS care and better reflect good medical practice, and nowhere is that more true than in diabetes care. We need to ensure that where there are NICE guidelines on good practice, that practice is carried out.
Finally, I wish to reflect on service reconfiguration and social care, which my hon. Friends the Members for Pudsey and for Milton Keynes South raised. Social care reform is important, and we need an integrated approach to health and social care. We must ensure that we reflect the health care needs of local populations and do more to support people with long-term conditions. That is a key driving force behind the vision for the NHS that my right hon. Friend the Leader of the House outlined in 2010 when he was Secretary of State for Health. It drives what should happen, and what does happen, at local level every day as doctors and nurses look after their patients.
Decisions about integration and what it means to have good joined-up care, particularly for older people and those with diabetes, chronic obstructive pulmonary disease, asthma, dementia and other long-term conditions, need to be made at local level, drawing on the best of local health care provision. The Government will ensure that the NHS Commissioning Board’s mandate includes guidance on what is good commissioning. I am sure that from 2013, when the Government’s reforms have gone through and we have an NHS that is truly locally led, there will be properly joined-up and integrated care that better looks after people with long-term conditions, focuses on prevention rather than cure and particularly focuses on looking after older people better.