Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right to say that NHS resources must be allocated in a way that fairly reflects the need for the NHS in every area. Rurality and age are two important factors in that regard. I can reassure him that the current allocations are not set in aspic. The problem with the recommendations from the Advisory Committee on Resource Allocation that NHS England received before was that they would have meant increasing resources to the areas with the best health outcomes at the expense of those with the worst ones. NHS England thought that that would be inconsistent with its duty to reduce health inequalities, but it is looking at the issue this year and we all hope that it will make good progress.

[Andrew Gwynne (Denton and Reddish) (Lab)]

We all know that one of the most important drivers for improving the quality of care for vulnerable and elderly patients is to ensure the adequate training and regulation of health care assistants. That is something that Labour and Sir Robert Francis QC have called for, but that the Government have so far ducked. Will the Secretary of State now accept that crucial Francis recommendation to help to drive up care standards for the elderly and the vulnerable—yes or no?

[Mr Hunt]

The reasons that Robert Francis recommended statutory regulation of health care assistants were twofold. First, he wanted to ensure that people who had been involved in incidents of poor care could not pop up somewhere else in the system. Secondly, he wanted to ensure that everyone had proper training. We are going to solve both those problems, but I am not convinced that a big new national database of 300,000 people is the way to do it.

Herbal Medicine (Regulation)

Andrew Gwynne Excerpts

Tuesday 9th July 2013 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to see you in the Chair, Mr Bone. I congratulate the hon. Member for Bosworth (David Tredinnick) on securing the debate. As someone who, over the past few days, has been suffering with quite bad hayfever, I would quite like a remedy, herbal or otherwise, for my suffering. I am pleased that we have had a chance in today’s debate to discuss some very important issues in relation to the regulation of herbal medicine. I know from the hon. Gentleman’s previous contributions in the House that he takes a very keen interest in and is a committed supporter of various forms of alternative medicine, including homeopathy and herbal medicine. He continues to raise these issues passionately in the House, most recently in the estimates day debate last week. I also congratulate the hon. Members for Strangford (Jim Shannon) and for Kettering (Mr Hollobone) and my hon. Friend the Member for Vauxhall (Kate Hoey) on echoing the many issues and problems. There are issues with the provision of non-manufactured herbal medicine due to the absence of regulation of herbal regulation practitioners. There have admittedly been delays in making progress on the regulations, which all relevant parties agree with, and all sides agree that the unexplained delays are frankly unacceptable. I will return to that later in my contribution.

As we know, the MHRA is responsible for medicines. It explains the licensing of manufactured herbal medicines as follows:

“The new European Traditional Herbal Medicinal Products Directive…came into effect on 30 April 2011. The Directive establishes a regulatory approval process for herbal medicines in the European Union...It requires each EU Member State to set up a traditional herbal registration scheme for manufactured traditional herbal medicines that are suitable for use without medical supervision. Companies are no longer able to sell manufactured unlicensed herbal medicines unless they have an appropriate product licence”.

The supply of non-manufactured medicines is permitted, but there remains a long-standing concern with the non-regulation of herbal medicine practitioners. Currently, anyone can set up as a practitioner. The guidance states:

“Regulation 3 of The Human Medicines Regulations 2012 (formally Section 12(1) of the Medicines Act 1968) is commonly referred to as the ‘herbalist exemption’ and permits unlicensed remedies to be made up and supplied by a practitioner to meet the needs of an individual patient following a one-to-one consultation. The existence of this regime is greatly valued by herbal practitioners and by many members of the public. However, there are widely acknowledged weaknesses in the public health protection given by the regime. Regulation 3 remedies are not subject to a regime of specific safety or quality requirements. There are no restrictions in terms of those who operate under the regime. Anyone—irrespective of qualifications or experience—can practise herbal medicine and, after making a diagnosis and forming a judgment about the treatment required, can make up and supply an unlicensed herbal medicine.”

As we heard in the debate, there was a great deal of discussion about regulation under the previous Government. They supported moves towards statutory regulation of herbal medicine practitioners, which was the subject of consultation in 2004. The consultation report stated:

“The majority of the responses indicated strong support for the introduction of statutory regulation, in order to ensure patient and public protection and enhance the status of the herbal medicine and acupuncture professions.”—

That point is important in its own right. In 2008, a report to Ministers from the Department of Health steering group on the statutory regulation of practitioners of acupuncture, herbal medicine, traditional Chinese medicine and other traditional medicine systems practised in the UK concluded:

“The Steering Group is strongly of the view that the decision to statutorily regulate professions practising herbal medicine and acupuncture is in the public interest.”

It also urged that there be no Government delay in introducing regulation, saying:

“The Steering Group is of the view that there is an urgent need to proceed without delay with the statutory regulation of practitioners of acupuncture, herbal medicine, traditional Chinese medicine and other traditional medicine systems. The Department of Health has been working with practitioners from these sectors, in some cases for over a decade, and a timeframe has been published that has not been adhered to.”

On 3 August 2009, the four Health Departments of the UK published a consultation paper on statutory regulation of practitioners of acupuncture, herbal medicine, traditional Chinese medicine and other traditional medicine systems practised in the UK. A clear majority of responses—85%—were in favour of statutory regulation, but, as we have heard, there has been little progress, despite the then Secretary of State for Health, the right hon. Member for South Cambridgeshire (Mr Lansley), pledging on 16 February 2011 to regulate herbal medicine practitioners, as the hon. Member for Bosworth pointed out. The Health and Care Professions Council was asked to establish a statutory register for practitioners supplying unlicensed herbal medicines, but there has been no further progress. When does the Minister expect that he will establish a statutory register for practitioners supplying unlicensed herbal medicines? The National Institute of Medical Herbalists is rightly critical of the lack of progress:

“In February 2011, the Secretary of State for Health announced that UK herbalists were to be statutorily regulated. He pledged that, subject to the usual procedures, the Department of Health (DH) would have this ready by 2012. Statutory Regulation (SR) is urgently needed to protect the public from untrained herbalists and also to allow trained herbalists to continue to practice within the constraints of EU Directives. Regulation will be via the Health and Care Professions Council (HCPC) which regulates dentists, dieticians and physiotherapists. Two years later the DH has failed to publish the draft legislation and there is no sign of progress. The fear is that with many other priorities the DH will let the issue drop. Failure to implement SR for herbal medicine practitioners is disastrous…In short, statutory regulation is clearly in the public interest!”

A recent MHRA survey showed that about a quarter of the population use over-the-counter herbal medicines. If that continues, as I suspect it will, surely the Government have a responsibility to ensure that arrangements are in place to make certain that such medicines are safe, as far as they can be, and that those who prescribe and dispense such medicines are appropriately qualified and regulated. It is therefore important that we get a clear view from the Government today on whether they will continue with the statutory registration proposals. It is also important that they give us some confidence that it will be done within a reasonable time frame, so that we can give that confidence back to the industry and those who use herbal medicines.

I commend the hon. Member for Bosworth for his persistence in this matter and for securing the debate today. I look forward to the Minister’s assurances that the Government still take regulation seriously—I hope— and are looking for practical ways to ensure that it can proceed swiftly.

Health and Care Services

Andrew Gwynne Excerpts

Wednesday 3rd July 2013 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

May I begin by thanking the Health Committee and its Chairman for the report and the clarity with which he presented its findings, and Members from all parties for the thoughtful way in which they have debated the issues today? The right hon. Member for Charnwood (Mr Dorrell) is known for his diligence and attention to detail, and his speech clearly illustrated those instincts.

Before I address the points raised by the report, let me put on record our gratitude to the many thousands who work in our health service. As we approach the 65th anniversary of the NHS, we should take a moment to pay tribute to those staff who are doing a tremendous job, often in difficult and challenging circumstances.

With the indulgence of the House, I would also like to place firmly on the record my support for and appreciation of the dedicated doctors, consultants, nurses, carers and support staff in Tameside general hospital, many of whom will be feeling battered and bruised today. Tameside general hospital serves most of my constituency and today’s media reports highlight some of its failings. Deep-seated issues need to be grappled with urgently, but we should also recognise and listen to the many decent, good and hard-working staff who work there, because they often have many of the solutions and have not been listened to in the past.

I also apologise for leaving the Chamber briefly during the speech of my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley). There was no discourtesy intended to either her or the House: I was dealing with the BBC’s breaking news that both the chief executive and the medical director of Tameside general hospital have resigned, which I support. Sadly, it has come three years too late—I called for it to happen three years ago—but, nevertheless, it is a step in the right direction to ensure that Tameside general hospital has a safe and secure future.

[Barbara Keeley]

We heard from the hon. Member for Southport (John Pugh) about the value of executive leadership. Our conurbation of Greater Manchester has one of the best and safest hospitals in the country. The Salford Royal hospital is the seventh safest in the country and has an excellent chief executive. Today the leadership of Tameside hospital has changed and I hope that the people of Tameside will end up with an excellently led hospital. I agree with the hon. Member for Southport. My example shows the difference between a hospital that is well led and one that is not.

[Andrew Gwynne]

I agree with my hon. Friend. Had she been listening to BBC Radio Manchester this morning, she would have heard me making precisely that point. The situation at Tameside is incredibly frustrating for me and my hon. Friends the Members for Stalybridge and Hyde (Jonathan Reynolds) and for Ashton-under-Lyne (David Heyes). Whenever we meet the chief executive and chair of Tameside hospital—we do so frequently—they always give us excuses as to why Tameside is different from the rest of Greater Manchester because of the industrial legacy and poor health outcomes in the borough, but one could make exactly the same arguments for Salford: there is no reason why one part of Greater Manchester should have an excellent hospital while another has one with long-term problems.

Following that slight indulgence, I want to turn to the report and focus on four key areas. First, the right hon. Member for Charnwood made some pertinent points about the Nicholson challenge. To be fair, in previous reports the Health Committee has taken the consistent view that the Nicholson challenge can be achieved only by making fundamental changes to the way in which care is delivered. It makes that argument in this report too. It states:

“Too often…the measures used to respond to the Nicholson Challenge represent short-term fixes rather than long-term service transformation.”

The Select Committee is right about that.

If we are to sustain the breadth and quality of health and care services, we need a fully integrated approach to commissioning—something that the right hon. Member for Charnwood and others have spoken about powerfully. The Opposition agree with that. I hope that the right hon. Gentleman will agree that we have put forward bold proposals for a genuinely integrated NHS and social care system that brings physical health, mental health and social care into a single service to meet all our care needs.

We know that that approach works. In Torbay, integrated health and care teams have virtually eliminated delayed discharges. Partnerships for older people have helped older people to stay living independently in their own homes and have delayed the need for hospital care—something that my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) rightly referred to. Where physical and mental health professionals have worked closely together, they have shown that a real difference can be made.

An integrated, whole-person approach is the best way to deliver better health and care in an era when money remains tight. As the Committee’s report notes,

“the care system should treat people not conditions.”

The right hon. Member for Charnwood was right to point out that developing the role of health and wellbeing boards is the best way to plan such integrated care. He reaffirmed that he is “happy to endorse” the Burnham plan. We were happy to hear that. He is right that there is an issue with single commissioning budgets without checks on local government. As somebody who has a background in local government, I think that he is right about the need to extend the ring fence to social care spending. Unless those budgets are protected, there will be a temptation to siphon off the money that is needed to provide the integration that we all want to see.

[Mr Dorrell]

I do not want to detain the House, but will the hon. Gentleman confirm that the Opposition support the proposals set out by the Chancellor last week that will provide exactly that principle?

[Andrew Gwynne]

I will come on to the Chancellor’s proposals. We do have concerns because there is an immediate care crisis that needs to be tackled now. There are also wider issues. My hon. Friend the Member for Worsley and Eccles South rightly raised the concern of local government that it will not have the funds to implement the new requirements in the Care Bill. We need reassurances about that.

My second point is about the cost of the Government’s reorganisation, about which my hon. Friends the Members for Easington (Grahame M. Morris) and for Birmingham, Selly Oak spoke eloquently. In the update from the Government last autumn, the overall cost was up by 33% or £400 million, making a total of £1.6 billion so far. What is that money being spent on? A full £1 billion has been spent on redundancy packages for managers, 1,300 of whom have received six-figure pay-offs and 173 of whom have received pay-offs of more than £200,000, all while the number of nursing posts has been cut by more than 4,000—six-figure pay-outs for managers; P45s for nurses.

The really unfortunate thing is that the reorganisation has diverted money and attention away from the front line. The Committee’s report notes that the reorganisation has

“had an impact on the NHS budget”.

I do not want to get into that debate. I will leave it to the UK Statistics Authority, which confirmed that spending on the NHS was lower in real terms in 2011-12 than in 2009-10, albeit marginally. We have seen reductions in NHS spending. Mental health spending has been cut in real terms for two years running, cancer spending has fallen in real terms and social care budgets have been slashed.

Let me now turn to the funding crisis in social care. The Library’s analysis, which is borne out by the Local Government Association’s statistics, shows that Government funding reductions have forced local authorities to reduce their adult social care budgets by £2.7 billion over the last three years. They have had to slash services and increase charges in order to balance their books, leaving thousands of vulnerable older and disabled people facing a daily struggle to get the care and support they desperately need.

That is why what the Chancellor announced last week in the spending review is at best a sticking plaster, or if I am feeling generous, a plaster cast. Sadly, it will not solve the financial pressures on councils, break the flow of funds into the acute sector or address the fundamental problem of two systems operating to conflicting rules.

To be fair, the Government have started talking Labour’s language of integration—the right hon. Member for Charnwood would say that it is the Select Committee’s language—but as the Committee notes, the only way to achieve what we want to see is by making fundamental system changes, which brings me to my final point, which is the Department of Health underspend.

I note that the Committee has raised concerns about the operation of the Department of Health policy on underspends and budget exchange. The small print of this year’s Budget revealed that the Department of Health is expected to underspend against its 2012-13 expenditure limit by £2.2 billion. That would be the biggest underspend of any Department in this financial year. Page 70 of the Budget document appears to show that none of this has been carried forward to be used in subsequent financial years as part of the Budget exchange programme. Perhaps the Minister could explain why—at a time when the NHS is facing its biggest financial challenge, when 4,000 nursing posts have been lost and when there is a crisis in A and E—they have decided to hand the full £2.2 billion back to the Treasury. Can the Minister also confirm that this means the underspend for 2012-13 would be 2% higher than the 1.5% figure that his Department says is consistent with “prudent financial management”?

We think that people will struggle to understand why this money has not been spent on the NHS. That is why we proposed that the Treasury exceptionally allows a £1.2 billion “end-year flexibility” carry-forward of around half of this year’s under-spend. We would ring-fence this money for social care budgets this year and next, to tackle the immediate crisis, with £600 million allocated for 2013-14 and a further £600 million allocated for 2014-15. With that extra investment, we could relieve the pressure on A and E and help to tackle the scandal of care services being withdrawn from older people who need them, enabling more people to stay healthy and independent in their own homes, and help families being squeezed by rising charges for care.

I thank the right hon. Member for Charnwood and members of the Committee—and other hon. Members on both sides of the House—for the sterling and thorough work that they have done and the powerful arguments they have made, especially on integration. They are right to highlight those issues, because it is the only way in which the NHS and care services will be able to make the necessary step changes to meet the challenges of an ageing society within the financial constraints we face. It is just as important that we get it right in terms of outcomes for patients, because the care services they receive will be greatly strengthened and improved through integration.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 11th June 2013 Commons Chamber

[Anna Soubry]

I very much do agree. That is why I am so pleased that the Care Bill that is making its way through both Houses has special provision for people who are caring for others with cancer in the way that the hon. Lady describes.

[Andrew Gwynne (Denton and Reddish) (Lab)]

Last week Monitor, the regulator for foundation trust hospitals, said that cancer patients are now waiting longer for treatment and diagnosis because of the A and E crisis in hospitals. Official NHS figures published that same day show that the number of patients waiting over three months for cancer, heart disease and other life-saving tests has more than doubled compared with only last year. Is it not obviously the case that this Health Secretary’s failure to cut the spin and get a grip on the A and E crisis is now seriously damaging patient care?

[Anna Soubry]

That was a very interesting speech but I am afraid that I do not accept the hon. Gentleman’s analysis at all. All cancer waiting time standards are being met, with over 28,000 patients being treated for cancer following a GP making an urgent referral for a suspected cancer. We have already heard about the action that this Government are taking to address the situation in accident and emergency; it was very well explained in last week’s debate

Accident and Emergency Waiting Times

Andrew Gwynne Excerpts

Wednesday 5th June 2013 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

We have had a full and thorough debate, with some 18—or perhaps 17 and a half—Back-Bench speeches. I pay tribute to my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson), my hon. Friend the Member for Lewisham East (Heidi Alexander), my right hon. Friend the Member for Exeter (Mr Bradshaw) and my right hon. Friend the Member for Cynon Valley (Ann Clwyd), who made a very personal contribution to the debate, as well as my hon. Friends the Members for Ealing North (Stephen Pound), for Harrow West (Mr Thomas) and for Mitcham and Morden (Siobhain McDonagh), my right hon. Friend the Member for Rother Valley (Mr Barron), and my hon. Friends the Members for Worsley and Eccles South (Barbara Keeley) and for Hammersmith (Mr Slaughter). I also pay tribute to the right hon. Member for Charnwood (Mr Dorrell) and the hon. Members for Totnes (Dr Wollaston) and for Southport (John Pugh), and other Members, too many to mention individually, who contributed to the debate.

I start by paying tribute to the thousands of doctors, nurses and health care assistants who provide extraordinary and professional care in our A and E departments. They are there for us when we need them most and we owe them a huge debt of gratitude. It was apparent from the Secretary of State’s speech that he has absolutely no plans to deal with the disastrous situation in A and E that is entirely of this Government’s own creation. We know that, since this Government came to power, there are 4,000 fewer nurses, the disastrous NHS 111 service is in meltdown, walk-in centres are being closed and social care is in crisis. All those factors contribute to the current crisis in our A and E. We have all seen the news reports of ambulances queuing outside hospitals, with unacceptably long waits and some people even having to be treated in tents in car parks. It is time for Ministers to stop blaming others and to get a grip on the crisis in A and E.

Bluntly, what we are seeing today in A and E is the culmination of three full years of mismanagement of the NHS, with a needless top-down reorganisation and the waste of billions of pounds that could and should have been spent on front-line care. The truth is that there is no grip on the NHS in England. No wonder things are going so wrong so quickly.

When Labour left office, A and E was performing well, with 98% of patients seen within the four-hour target time. Since the election, the number of patients waiting more than four hours has nearly trebled and ambulance queues have doubled. Only yesterday, in a report by the King’s Fund, we saw that A and E waits are at their worst for nine years, with more than 313,000 patients waiting more than four hours between January and April this year. Simply put, under this Government more people are waiting longer. The proportion of patients attending A and E who have to wait longer than four hours is at its highest for 10 years. What more proof do Ministers need to understand that A and E departments are under real pressure and that action is needed, and needed now?

Many patients cannot even get through the doors of our hospitals. We have a shameful situation in which growing numbers of patients are waiting in ambulances to get into A and E because those departments are full. Equally shameful is the number of patients experiencing the indignity of waiting for hours on trolleys in A and E before they can be found a bed on the main hospital wards. It is almost as though we are back to the future—back to the bad old Tory days of the 1980s and ’90s.

There are many other factors that have pushed A and E into the danger zone. Indeed, A and E is a bellwether for the overall state of the NHS and social care. The Government’s cuts to local authority budgets have seen £2.6 billion taken out of adult social care since the election alone. As a result, many older and vulnerable people are having services withdrawn that could have helped them to stay healthy and independent in their own homes, and many others face rising charges for the care that they need. That is a major cause of the A and E crisis, as fewer older people get the care that they need at home, and ever more have to be admitted to hospital. It also means that there are delays in ensuring that appropriate support is available at home, or in the community, which delays a patient’s discharge. That has a knock-on effect right through the hospital: with no free beds on the wards, A and E staff cannot admit patients to the hospital wards, and with A and E full, ambulance staff cannot hand over patients.

As we have heard, under-staffing is also causing huge problems in the health service. Since the election, more than 4,000 nursing posts have been lost from the NHS, and the Care Quality Commission has warned that one in 10 hospitals is failing to meet the standard for adequate staffing levels. Hospitals are continuing to make severe cuts to front-line staffing, with many operating below recommended levels. Under this Government, right across England, we are seeing the closure of well-used NHS walk-in centres, meaning that more people are having to go to major A and E departments when they could be helped elsewhere.

Lastly, there is the meltdown of the 111 helpline; NHS England identified the poor roll-out of 111 services as one of the main reasons for the deterioration in A and E department performance. As the 111 service uses staff who do not always have clinical training, they are more likely to play it safe, meaning that more people are being directed towards A and E departments. Over Easter, callers in 30 areas waited for more than an hour for a call back, and in some regions more than 40% of calls were abandoned by patients. One patient waited 11 hours and 29 minutes.

It is no good Ministers arguing that there has been a large increase in the number of people attending A and E, driven by changes to out-of-hours care that were caused by Labour’s renegotiation of the GP contract in 2004; that was nine years ago. The Secretary of State’s spin was blown out of the water by the Chair of the Select Committee on Health, the right hon. Member for Charnwood—and by the chief clinical officer at Stockport clinical commissioning group, who said:

“The focus on the 2004 GP Contract as a main cause is not only a incorrect assumption but also serves to distract the public from the urgent debate that’s needed about the choices the NHS, the public, media and politicians now need to make”—

his words, not mine.

The Government parties should and must do more to protect the NHS from the immediate crisis, so will they now implement our A and E rescue plan? The Secretary of State derided our initiative to use underspends in the NHS budget to put an extra £1.2 billion into social care over the next two years, but that investment would not only relieve pressure on A and E, but help tackle the scandal of care services being withdrawn from older people who need them.

Will the Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry), review all 111 contracts? Early indications are that the number of cases referred to nurses has fallen from 60% through NHS Direct to just 17% with 111. What will she do about that? Will she also ensure that all hospitals have safe staffing levels, and intervene to prevent further job losses? Will she halt the closure of NHS walk-in centres and await the review that is being conducted by Monitor to see what the impact is on the local community and the NHS? Will she immediately and personally review all planned A and E closures and downgrades, and use the very latest evidence of local pressures to ensure that plans are based on robust clinical evidence?

Instead of accepting responsibility for the mess that they have created, the Government have spent recent weeks casting around for scapegoats. We have seen them blame the winter weather; influenza; bank holidays; immigrants; GPs; and today’s latest from the public health Minister, female doctors, because they get married, have children and work part time. [Interruption.] She protests, and I notice she had to put out a statement this afternoon to

“clarify discussion on female GPs” .

She said:

“I fully support women GPs, my comments were not intended to be derogatory.”

The truth is that this Government do not even know who to blame any more. It is just not good enough. While the components of the A and E crisis might be complex, the real cause is simple: you just cannot trust the Tories with the NHS.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 16th April 2013 Commons Chamber

[Anna Soubry]

All these things have to be evidence-based. I am reminded of the evidence that the chief medical officer gave recently on this subject.

[Andrew Gwynne (Denton and Reddish) (Lab)]

A freedom of information survey by Labour showed that cancer networks saw their funding cut by 26% between 2010 and 2013 and lost 20% of their work force over the same period, losing vital skills and expertise along the way, despite repeated reassurances from the Government that funding for clinical networks would be protected. Even more shockingly, all this is happening at a time when the Department of Health has handed back £2.2 billion to the Chancellor of the Exchequer. How can the Minister justify handing vital NHS funding back to the Treasury when cancer networks are being cut, specialist staff and skills are being lost and thousands of nurses are being axed?

[Anna Soubry]

I think that that was about four questions in one, but I would certainly dispute all that has been said. Let me make this absolutely clear: we know that there was great success in the cancer networks, which is why we have extended them, so that they now include, for example, dementia and mental health, and far from cutting the overall money going to all the strategic networks, we have increased it by 27%.

Heart Surgery (Leeds)

Andrew Gwynne Excerpts

Monday 15th April 2013 Commons Chamber

[Mr Hunt]

I do pay tribute to the staff at Leeds and to the families of patients. I recognise that this is an issue of huge concern. As my hon. Friend rightly says, they have behaved with great dignity in a difficult situation. I also pay tribute to him for the responsible way in which he has behaved in this difficult situation, as have many Leeds MPs.

My hon. Friend will understand, given that the NHS nationally was provided with data that suggested that mortality could be up to 2.75 times greater at that unit and given that there was a potentially busy holiday weekend ahead, when it did not know how complex the cases would be and when there were locums on the staff rota who may or may not have been up to the standard of the permanent staff, that Professor Sir Bruce Keogh had genuine concerns that led to his decision. But I hope the fact that surgery was restarted on 10 April will assuage my hon. Friend’s worry that the initial decision was linked to the Safe and Sustainable review—it was not; it was a concern about patient safety and because that concern has been addressed, surgery has restarted.

There were, however, issues about the quality of the data, which at least in part was because the hospital was not supplying data properly in the way it needed to. That was one reason why the mortality data were not as accurate and good as they should have been. Although I entirely agree that patient safety must always come first, and not NHS or national politics or whatever it may be, that also means that sometimes difficult decisions have to be taken. What happened at Mid Staffs, where we had a big argument about data that meant nothing happened for too long, and what happened originally at Bristol, where up to 35 children may have lost their lives, is a warning about the dangers of inaction. On this occasion, I think that overall the NHS got it right.

[Andrew Gwynne (Denton and Reddish) (Lab)]

First, let me apologise to the House on behalf of my right hon. Friend the Member for Leigh (Andy Burnham) who cannot be here today because he is in Liverpool attending the memorial service for victims of the Hillsborough disaster.

This situation has descended into yet another trademark Government shambles. Just 24 hours after the High Court announced that the decision to close the children’s cardiac unit at Leeds was “legally flawed”, Leeds Teaching Hospitals NHS Trust was effectively instructed to stop surgery. The timing of the decision was strange to say the least, but to quote the head of the central cardiac audit database:

“It rings of politics rather than proper process.”

We now know that the instruction was based on incomplete and unverified data, and that Dr Tony Salmon, president of the British Congenital Cardiac Association, was “very concerned” at the way the data were being used, and that any conclusions drawn from the data were “premature”. The Opposition are therefore pleased that this urgent question has been granted as the House clearly deserves some answers.

First, the Secretary of State needs to outline to the House exactly when he was informed that NHS England had concerns about the centre, and say whether he gave his approval to suspend surgery there. If so, was he satisfied that the data presented were accurate and had clinical support? On the issue of data, why did it take this recent episode at Leeds for the information to be released into the public domain—information that my hon. Friend the Member for Leicester West (Liz Kendall), and others, had asked to be released for some time?

Secondly, does the Secretary of State accept that the suspension of surgery, with all the consequent anxiety that it caused patients and staff, was at best a mistake and at worst an irresponsible and disproportionate action? Thirdly, does he accept that the timing of the decision to suspend surgery so soon after the High Court’s ruling caused a great deal of suspicion in Leeds and gave the distinct impression that it was a political decision and not based on clinical evidence? Finally—this point goes beyond Leeds—the Health Secretary’s record so far has failed to inspire confidence in the process of reconfiguration. Will he therefore conduct an urgent investigation into Leeds and how this happened, and consider what lessons can be learned from this unedifying episode for the children’s cardiac review and future reviews?

We owe it to the dedicated staff who work in our NHS to ensure that whatever disagreements we may have in Westminster, and whatever our politics, we do not hinder their ability to provide high-quality care to patients. We also owe it to patients and their families not to add to the anxiety and stress of undergoing treatment. On both those counts the Government have failed, and I hope that when the Secretary of State returns to the Dispatch Box, he will have the decency to apologise and start answering these very serious questions.

[Mr Hunt]

I am afraid the hon. Gentleman has let the Labour party down with the total inadequacy of that response. He spoke of an irresponsible and disproportionate decision, but I ask him to reflect on that as someone who would like to be a Health Minister. Would he seriously have wanted anything different to happen? If the NHS nationally is informed of data that show that mortality rates at a particular hospital could be up to three times higher than they should be, would he sanction the continuation of surgery, or would he say, “We need to get to the bottom of the statistics before deciding whether there will be any more operations”? If he is saying that he would have wanted surgery to continue, I put it to him that he and his party have learned nothing from the lessons of Bristol and nothing from the lessons of Mid Staffs. I did not authorise the decision, but wholeheartedly supported it because it was an operational decision made by NHS England. It is right that such decisions are made by clinicians, who understand such things better than we politicians do.

On reconfigurations, the hon. Gentleman’s party closed or downgraded 12 A and Es and nine maternity units in its period in office. The shadow Health Minister, the hon. Member for Leicester West (Liz Kendall), has said that Labour would not fall into the “easy politics” of opposing every single reconfiguration, but that is exactly what the Opposition are doing. It is not just easy politics; it is what Tony Blair last week called the “comfort zone” of being a “repository for people’s anger” rather than having the courage to argue for difficult reforms.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 26th February 2013 Commons Chamber

[Mr Hunt]

I recognise that the hon. Lady has been campaigning hard for her constituents, but she massively overstates her case. The reality of the proposals is that 25% of the people who go to Lewisham A and E will no longer go there—the most complex cases among her constituents, who will get better treatment as a result. Those 25% will be spread among four other A and E departments, and we are allocating £37 million to help them upgrade their capacity. That is a sensible proposal that will save the lives of her constituents.

[Andrew Gwynne (Denton and Reddish) (Lab)]

Local Members of Parliament are right to raise concerns about future capacity at Guy’s and St Thomas’ and at King’s. The recent King’s Fund report showed that between October and December 2012, many A and E departments in England faced their worst winter in almost a decade. Standards of care are deteriorating, with too many people waiting too long to be seen and many being left on trolleys in corridors or waiting in ambulances stuck outside A and E. Does the Secretary of State now accept that the NHS is struggling to cope with the toxic mix of cuts and reorganisation, and that patients in south-east London and elsewhere are paying the price for this Government’s mismanagement of the NHS?

[Mr Hunt]

Really, from a party that closed or downgraded 12 A and E departments when in office, I would expect a slightly more mature attitude to an extremely difficult and complex problem. We will not take any lessons in meeting A and E targets from that lot. The reality is that we met our A and E targets last year, but in Wales, where Labour cut the NHS budget by 8%, they have not met their A and E targets since 2009.

Backbench business

Andrew Gwynne Excerpts

Thursday 14th February 2013 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Walker. I congratulate the hon. Member for Romsey and Southampton North (Caroline Nokes) on securing this important debate, particularly as we mark eating disorders awareness week, and on the extremely powerful case that she made in opening the debate. I, too, want to commend the work of the all-party parliamentary group, because it has ensured that this debate has been incredibly well informed. The debate has provided us with an opportunity to highlight the issue not only in Parliament, but, hopefully, in the media and the wider health sector, including among national health service staff, so that we can all examine what more we can do to help those with eating disorders. I also commend the personal contribution of the hon. Member for Braintree (Mr Newmark), who showed extreme courage in sharing his experiences with us today. He has really helped to inform the debate, and I thank him for sharing those personal experiences.

I pay tribute and offer my appreciation and thanks to Beat, a national eating disorders charity, and it would be unfair not to mention also Anorexia and Bulimia Care, and some of the other local charities that hon. Members have mentioned. According to Beat, eating disorders affect 1.6 million people in the United Kingdom, which is one in 39 people or 2.6% of the population. Statistically, that means that around 2,000 people at a top premier league club home game will have an eating disorder; 11 passengers on a jumbo jet; or more than 200,000 people here in Greater London. Therefore I am pleased that, throughout eating disorders awareness week 2013, Beat will highlight that the illnesses are far more common than perhaps most people would think or appreciate. The theme of this year’s campaign is “Everybody knows somebody”. It is a laudable aim of the campaign to encourage people to reach out to others—whether a partner, colleague, best friend, brother or sister—to talk about the illnesses, to express their concerns and to seek help before they reach hospitalisation stage.

Eating disorders primarily affect young women aged 18 to 25, but of course not exclusively. Most people would consider them as a young girls’ disease, and there is a great deal of stigma and misunderstanding still attached to the issue. Conditions such as anorexia, bulimia, binge eating and compulsive overeating have high mortality rates for mental health illnesses. Up to 20% of those affected may die prematurely. I was interested in the contribution of my right hon. Friend the Member for Knowsley (Mr Howarth) regarding diabulimia, which is something I was not aware of, so I thank him for sharing that with us today.

As we have also heard, an increasing number of men—some 20% of those affected—have an eating disorder. An important contribution was made by the hon. Member for South Basildon and East Thurrock (Stephen Metcalfe) in highlighting that issue. However, there can also be issues with older people, particularly the elderly and frail, for whom recognising an eating disorder may be problematic. Beat is right that the problem can affect anyone at any time in their life.

The media have a central role to play in the issue and, in many ways, have a great responsibility. Some media images of excessive thinness must play a large part in encouraging, particularly, young people to aim for an unrealistic body weight and risk becoming anorexic. What has perhaps been more worrying is the recent trend in social media that could encourage eating disorders. The hon. Member for Romsey and Southampton North and others have raised that issue in their contributions. I am a father of three young children. I have two sons—one has a birthday today; he is a teenager, because he is 13—but I worry particularly about my daughter, who is 11 and very conscious of some of the unrealistic images that she gets bombarded with. It is a concern of mine, as a father, and no doubt of other hon. Members who have children. I can see how the problem could start to escalate. There were concerns earlier this year with online sites such as Instagram, which appeared to allow users to view pictures encouraging eating disorders and self-harming. According to press reports, some of the messages on the website encouraged people not to eat. That is incredibly concerning, because Instagram has more than 80 million users worldwide. The growing influence of a variety of social media and the popularity of phone apps give people, especially young people, access to images that encourage the individual to believe that an eating disorder—we have heard this in the debate—is a lifestyle choice. Surely that is wrong, especially as the number of hospital admissions for eating disorders is growing.

A report last year from the health and social care information centre shows that the number of hospital admissions for eating disorders has risen by 16% to 2,288, a point that was eloquently made by my hon. Friend the Member for North Tyneside (Mrs Glindon).Of those admissions, 203 were men or boys. The statistics also reveal that more than 50 under-10-year-olds were admitted to hospital with an eating problem, and the biggest increase in admissions was among girls aged 10 to 15, which are up 69% since 2011. We must recognise that social media and pro-anorexia sites can affect those who may already be vulnerable to eating disorders and who already feel pressured. I am pleased to see that there have been at least some positive changes in the media. Last year, Vogue announced that it was banning models with visible signs of eating disorders from its glossy pages, and the editor of British Vogue pledged not to use any models under the age of 16, thereby helping to project an image of healthy models.

I also notice that Channel 4, alongside other broadcasters, has actively sought to raise awareness of body image issues, including a wide range of eating disorders, among its audiences through a number of programmes and online projects such as “Gok’s Teens: The Naked Truth”, which looked at British teenagers and offered advice on how to address their issues and anxieties, focusing particularly on teens suffering from body dysmorphia and anorexia. The programme also included an examination of the impact that the media and internet can have on young people’s body image. Clearly, the more programmes that highlight those problems, the better the chances of eliminating stigma and increasing understanding among the wider public. Media and social media have a role to play in addressing all of those issues, and I hope that media organisations work closely with eating disorder charities to introduce more positive stories and messages.

People who are experiencing an eating disorder often feel alone and need to be provided with good advice. We need to bring an end to the stigma surrounding the condition. There is also a need for good advice for those who may be able to spot the symptoms, such as family members or teachers, so that we can ensure that people are aware of the problems. Of course, the media have an important role to play in highlighting that. The symptoms of an eating disorder include finding reasons to skip meals, avoiding family meals or expressing a wish to eat alone, being noticeably self-conscious about body image or becoming very withdrawn. Those are all known warning signs. Clearly, anything that can help to identify the risk signs and help those affected to confide in parents or teachers can only be positive. We know that the sooner people come forward, the sooner treatment can start and the better the outcomes. Of course, we should also consider how to raise awareness in the national health service and to ensure that staff know about such conditions, can identify the signs of an eating disorder and are able to offer the right treatment as early as possible. We should consider how to ensure that all health professionals are fully aware of the symptoms.

This is not the time or the place to make political points. The Minister knows the concerns of Opposition Members about the new NHS structures, but I urge him, in the spirit of co-operation—the hon. Member for Romsey and Southampton North made this point in her opening contribution—to ensure that the commissioners within the new NHS structures take seriously the needs of those who may be at risk from eating disorders and ensure that their needs are seen in the round, because often a holistic approach to their health care needs is required. GPs, as commissioners of services, may not always recognise the symptoms of eating disorders. People must continue to receive the help they need when they need it. My right hon. Friend the Member for Knowsley, and the hon. Lady in an intervention, mentioned the treatment of diabulimia, which starkly highlights the issue. The experience outlined by the hon. Member for Enfield, Southgate (Mr Burrowes) further reinforced those concerns.

I hope that when people are diagnosed with an eating disorder they get the help they need. Clearly, different people will require different treatments, and in some cases they will need access to mental health services. When Opposition Members talk about whole-person care, we mean not only the adult social care needs of the elderly but all society’s health needs. Eating disorders are an important issue that should be included within the concept of whole-person care.

There is an increasing incidence of eating disorders among men, and both men and women are influenced by what they see in the media. Indeed, as reported in the Nursing Times, NHS figures show that there has been a 66% increase in hospital admissions for male eating disorders during the past 10 years. That rise has been blamed on the increasing pressure on men to look good, with the media again having a central role. The eating disorder charity Beat has said that men’s reluctance to be open about their health is hampering efforts to address the problem. Again, I commend the hon. Member for Braintree for his contribution to today’s debate. We should bear in mind that resources and treatments for eating disorders are relevant to both male and female patients.

I have a couple of questions for the Minister, the first of which is on monitoring eating disorders. At present, as I understand it, the Government do not collate national statistics on the number of people affected by eating disorders who seek treatment. That would be a useful tool for assessing the overall need and geographical breakdown of eating disorders. What plans does he have in place to begin monitoring eating disorders? Likewise, does he plan to review the guidance on eating disorders issued by the National Institute for Health and Clinical Excellence under the previous Government?

There is overwhelmingly broad agreement on both sides of the House that identifying eating disorders as soon as possible is important and that people should receive appropriate treatment as soon as possible, too. Again, I pay tribute to the work of eating disorder charities and the all-party group on body image, which have done so much to highlight the issue. Although they have done a great deal, there is clearly so much more that society can do to take on this challenge and to ensure that we all work together to prevent more tragedies and blighted lives.

Hospital Services (South London)

Andrew Gwynne Excerpts

Tuesday 22nd January 2013 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to see you in the Chair, Dr McCrea. I congratulate my hon. Friend the Member for Lewisham East (Heidi Alexander) on securing this incredibly important debate. The future of accident and emergency and maternity services across south London is of genuine concern to a great many of her constituents and, indeed, for the wider area, as this is definitely an issue of real significance across the capital. I know from a meeting that I chaired with Labour colleagues before Christmas that it goes to the heart of their communities. I applaud the way in which my hon. Friend the Member for Lewisham East, our right hon. and hon. Friends and others from across the party divide have put together a campaign that highlights their constituents’ concerns in such a high-profile and persuasive manner.

It has long been accepted that difficult decisions might well be needed to secure the sustainability of health services in south-east London, as the challenges facing South London Healthcare NHS Trust are complex and of long standing. As we have heard, the proposals to close the A and E and downgrade the maternity unit at Lewisham hospital are intended to assist a neighbouring hospital trust to find its way out of significant debt problems. It is a highly controversial procedure, to say the least, because Lewisham hospital, as we have heard, is well respected and well managed and recently underwent a £12 million refurbishment.

The proposals also introduce wider considerations that could affect the whole of south London’s health care. At the same time as the trust special administrator has been reviewing services at South London Healthcare NHS Trust, plans for changes to management structures and the merger of services have been progressing, led by King’s Health Partners and three foundation trusts—King’s College hospital, Guy’s and St Thomas’s and the South London and Maudsley—in conjunction with King’s college London.

Any plans for the whole area need to take full account of all the potential knock-on effects on the quality of care that people receive, and they need to consider how the merger plans will affect the health economy right across south-east London and potentially limit other long-term options for changes in south-east London. The figures provided by my right hon. and learned Friend the Member for Camberwell and Peckham (Ms Harman) illustrate the real problems associated with some of the changes being presented today: a 45% increase in emergency admissions and a 54% increase in births at King’s if Lewisham closes. Those huge capacity issues would need to be resolved. The Minister needs to look carefully at those figures.

As we have heard today, there are real concerns among the local Members of Parliament about the future of services at Lewisham hospital, so much so that recently a delegation of local doctors and my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) and my hon. Friends the Members for Lewisham West and Penge (Jim Dowd) and for Lewisham East presented a petition against the closure of Lewisham’s A and E and maternity departments to 10 Downing street. In only five weeks, the petition against the changes has been signed by more than 32,000 people, and the numbers are still growing.

We have also heard that, as part of the campaign, there have been a number of protest marches against the closures. I believe that there will be one this weekend. I am sure that that will attract equally heavy support as the earlier ones, which I believe from my right hon. Friend the Member for Lewisham, Deptford took place in rather grotty weather. Notwithstanding the snow that there may be this weekend, I am sure that the good folk of Lewisham will still be out in force.

[Bob Stewart]

I am intervening quickly to support what my friend—I call him that despite his being on the Opposition Benches—the hon. Member for Lewisham West and Penge (Jim Dowd) has said. This is a matter of fairness. It seems extraordinary that failing hospitals are being supported and allowed to continue essentially as they are, but Lewisham—a wonderful hospital that is within budget and is gaining an increasing reputation— is being kicked, slashed and destroyed. I just do not see that as right. It is a matter of fairness.

[Andrew Gwynne]

The hon. Gentleman is absolutely right. It is also telling that a very substantial number of GPs, including the chair of the new clinical commissioning group and the head of every single clinical area in the hospital, have written to the Prime Minister to express their concerns about the proposals. That clearly shows that the proposals do not have the support of local clinicians. I urge the Minister to read the very passionate article in Saturday’s Guardian online by Lucy Mangan as well. That helps to address some of those points.

As we have heard, more than 120,000 people visit the A and E at Lewisham hospital each year and more than 4,000 babies are born in the maternity department. With the prospect of the A and E being closed and the maternity unit being downgraded, a number of worries have quite rightly been expressed, not least because, as we have heard from my hon. Friend the Member for Lewisham East in the debate, Lewisham’s population is estimated to rise significantly in the next few years as a result of the huge increase in the birth rate.

As I have said previously, there is no doubt whatever about the unanimity among the professionals and the population about the importance of maintaining services at Lewisham hospital—something that Ministers have always stressed they would fully take on board. As we have heard in the debate today, the right hon. and hon. Members who represent the areas affected believe that the plans are based on inaccurate data and flawed assumptions and that the whole issue has been misunderstood and largely mishandled.

We have the final report from the trust special administrator, urging this closure at Lewisham, and the Secretary of State is to make the final decision by 1 February. However, it is difficult to understand how the Government can consider that that report constitutes a full strategic review of the sustainability of services across south-east London. Labour Members believe that the trust special administrator has overstepped its remit under the Health Act 2009 by including service changes to Lewisham hospital. In addition, the parallel work by King’s Health Partners on reconfiguration under three other south-east London trusts has yet to be completed.

It is quite concerning when the rules on making changes to hospitals seem to have been changed to allow back-door reconfigurations in the way that I have described, without the proper scrutiny and consultation that would ordinarily take place. Indeed, the trust special administrator used powers passed by the Labour Government in a way that was never intended. I take the point made by the right hon. Member for Bermondsey and Old Southwark (Simon Hughes). Nevertheless, what has happened sets a worrying precedent whereby the normal processes of public consultation are short-circuited and back-door reconfigurations of hospital services could be pushed through. This is a worrying situation, as it takes the NHS over a very dangerous line and is potentially the first back-door reconfiguration in that manner. If it is allowed to go ahead in that way, it could mean that any hospital services could be changed for purely financial reasons, which has never been the case in the past. We need to ask where the clinical case for change is in these proposals.

The 2009 Act clearly says that administrators must make recommendations relating to the trust that is failing. That has not happened in this case. Reconfigurations need to be based on solid clinical evidence that they will save lives. Where there is a clear clinical case, I think that that is right, and we should look carefully at changes before deciding whether we should oppose them. However, the TSA’s actions are leaving a very confusing and worrying situation surrounding hospital reconfigurations.

My hon. Friend the Member for Lewisham West and Penge got it right. We are starting to see a situation in which primary care trusts are moving quickly to try to secure service changes before the clinical commissioning groups take over, and it is becoming all too clear that it is financial pressures that are starting to lead to closures and health service changes. That is clearly wrong.

On the four tests for reconfigurations, does the Minister really think that they have been fully met and does she believe that this change has the support of local commissioners?