Kettering General Hospital

Dan Poulter Excerpts

Tuesday 24th March 2015 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a pleasure to serve under your chairmanship, Mr Gray. I congratulate my hon. Friend the Member for Kettering (Mr Hollobone) on securing this debate. I also commend him and our colleagues in the Chamber—my hon. Friend the Member for Wellingborough (Mr Bone) and the hon. Member for Corby (Andy Sawford)—for their consensual and cross-party approach to tackling the challenges of the local health economy and addressing the needs of local patients. It is working together, as a group of MPs, that has helped to deliver success for the local hospital. That cross-party consensus is an example of what should be done. My hon. Friend the Member for Kettering is right that good health care is not political; it is about doing the right thing by patients, and that is the approach that hon. Members here today have taken in addressing local health concerns.

A number of the points raised today are ones we have talked about in meetings at the Department of Health. I have taken a keen interest in supporting Kettering in its future ambitions and in supporting my hon. Friend in his strong advocacy of the needs of local patients and his local hospital. As he rightly outlined, this is a part of the country with a growing population, due to increasing housing growth and the plans to increase housing growth in the future. As in all parts of the country, there is increased pressure on medical services from an ageing population with complex health care needs. By 2018, we will have 3 million patients with not one or two, but three long-term medical conditions—it could be diabetes, dementia, heart disease or chronic obstructive pulmonary disease.

Caring for patients with complex medical needs is a challenge for our whole country, and I know it has been one of the main drivers of increased admissions to A and E in Kettering. The acuity, which is the severity of the illness or medical admission, is a key issue that has been picked up by the A and E consultants and doctors with whom I have discussed the challenges faced locally by the trust. Supporting a better way of caring for people with long-term conditions and the frail elderly is at the heart of the proposals for the care hub that my hon. Friend outlined.

I want to take this opportunity to recognise the outstanding work done by NHS staff up and down the country. On this occasion, it is appropriate to draw attention to NHS staff working in and around Kettering—not only in the hospital, but in general practice, community mental health teams and palliative care teams. The commitment across the board in Kettering to delivering the highest-quality patient care is an example of what the NHS is all about, and it is right to recognise the dedication of front-line staff in the Kettering area.

I want to take the opportunity also to commend formally my hon. Friend for the outstanding interest that he has shown in standing up for the best interests of local patients throughout this Parliament and for his dedication in never missing an opportunity to raise questions in this Chamber and in the main Chamber during Health questions or to raise the case of his constituents in the Department of Health with me as the responsible Minister. It has been a pleasure to do all I can to support him, his constituents and Kettering hospital.

My hon. Friend is right to highlight the recent investment in the hospital. That is due in no small part to his advocacy and that of other hon. Members in consistently raising the needs of Kettering hospital and the local population. My hon. Friend will recall that when we met in January to discuss health services in his constituency and the plans that his local NHS has to deal with some of the pressures that it faces, we talked about some promising ideas. I will discuss those in more detail in a moment.

Before I do so, it would be appropriate to say a few words more generally about the pressures that the health service has faced during a difficult winter, how they have been handled and what we have done to support the health service both in Kettering and more generally. We know that parts of the NHS can and have come under pressure because of unprecedented demand, linked to the challenges of our ageing population. Compared with four years ago, every day the NHS sees 16,000 more hospital out-patients, performs 10,000 more diagnostic tests and carries out 3,500 more operations, and there are 2,000 extra ambulance journeys. Every year, 1.3 million more people visit accident and emergency departments.

Despite the extra demand, our NHS is performing well and treating the vast majority of people quickly. It is particularly important that it is dealing with the most unwell patients first. That is possible because we have taken, even in difficult economic times, the decisions that have allowed us to increase the NHS budget by £12.7 billion over this Parliament. Of course, that has allowed us to support Kettering hospital with local investment, which my hon. Friend outlined.

The NHS is also on track to deliver up to £20 billion in efficiency savings over this five-year period. That challenge was outlined by the former chief executive of the NHS, Sir David Nicholson, in 2009. Even to stand still and even with increased investment going into the NHS, it needed to make greater efficiencies. As a result of reforms and modernisation, we expect to save £4.9 billion over this Parliament and £1.5 billion a year from 2014 onwards. All of that will go directly back into front-line care in Kettering and elsewhere.

[Andy Sawford]

I thank the Minister for generously giving way, especially as the debate was secured by the hon. Member for Kettering. The Minister makes a point about efficiencies, but will he comment on the issue of geography, which we have not really touched on? We have talked about demand, but this is a critical issue for north Northamptonshire. The geography of our area is such that for people to have to rely on a hospital other than Kettering would mean considerable travel time. As someone who represents a rural area, I can say that that is an efficiency that we would not want to make. We would prefer to say, “Look, we want our local hospital. We recognise that there are challenges in sustaining a local hospital, but the geography of our area is such that we want to keep hold of it.”

[Dr Poulter]

The hon. Gentleman makes a very important and valid point. As well as improving the way our NHS buys goods and services—improving procurement practice, an issue that we discussed with members of the local health care team from Kettering when they visited me in the Department of Health—improving estate management and taking other measures of obvious efficiency, there is a need, outlined clearly in NHS England’s “Five Year Forward View”, to radically transform the way we deliver care. My hon. Friend the Member for Kettering made that point. It is now a priority to care better for frail elderly people through better integrating health services. I am talking about using the hospital potentially as a hub for vertical integration of services, particularly in more rural areas. That will mean that other health services—community health services, general practice and mental health services—can be supported and integrated with the hospital service as a hub-and-spoke model of care.

Crucial to that as well is integrating what the social care service does at the same time and having an approach that joins up what health and social care have to offer. Taking advantage of the better care fund that has been set up at local level, so that the local authority can work more collaboratively with the NHS, is very important. It is often very difficult to define where social care ends and health care begins, because staff are dealing with the same person, with the same care needs, but traditionally a silo approach has been taken to the delivery of care. We need to break down institutional silos and deliver more personalised care. That is at the heart of integrating care—at the heart of the hub-and-spoke model built around Kettering hospital. It draws on the importance of joining up what the local authority does with what the NHS does. That is particularly important in more rural areas, such as the one that the hon. Member for Corby represents.

As I said, I have followed developments in Kettering with keen interest. It is worth saying that since October 2012, when Monitor found the trust to be in breach of its licence in relation to consistently poor A and E performance, considerable progress has been made. That is in no small part down to the work of the local NHS and the local health care teams. To date, in 2014-15—I am now bringing the House up to date—the Department has provided £7.4 million of revenue support and £5 million of emergency capital to the trust. Over the winter, the trust fully activated its winter plans, building on initiatives that proved successful in previous years.

That work included an enhanced weekend discharge team, detailed plans allowing escalation when there was a busy period, and appropriate use of short-stay facilities, including an observation unit and ambulatory care unit. Those short term measures are designed to ensure that services continue in times of pressure, but the intention, quite rightly—building on the point about better integrating health and social care and what happens in the community with what happens at the hospital—is to move to a position whereby there is the ability to cope with pressure all year round and not just during the winter. The urgent care hub has that integrated delivery model at its heart.

The hub, as my hon. Friend the Member for Kettering outlined, would incorporate existing A and E services and facilities, but also include, for example, GP services and out-of-hours care, an on-site pharmacy, a minor injuries unit, facilities for social services, facilities for mental health care—that is particularly important and sometimes overlooked, but not in this case—and access to community care services for the frail elderly. Those services would facilitate rapid assessment, diagnosis and treatment by appropriate health and social care professionals. Patients would be streamed into appropriate treatment areas to minimise delays and reduce the need for admissions.

The hub’s location is, I am told, still being finalised, but options include clearing and redeveloping existing areas of the hospital or developing a new build on the site. The local NHS envisages that a capital investment of approximately £30 million, as my hon. Friend outlined, will be required. However, that figure will be subject to further detailed assessment as part of the business planning process.

The principle of the hub is absolutely the right way forward for the local NHS. It is the type of integrated care model that we need elsewhere in the country, particularly where the NHS is servicing a broad population. In this case, it is servicing not just Kettering, but a partially rural county and rural area. This is a model that I am sure hon. Members will continue to support and that I will continue to have a keen interest in supporting. I hope the plans will be successful at making the improvements that patients in my hon. Friend’s constituency and the area surrounding Kettering want. There are encouraging signs. The improvements envisaged are significant and would ensure that the local area had a resilient and high-quality health care system to deliver the highest-quality patient care. I again thank my hon. Friend the Member for Kettering for securing the debate.

Non-Departmental Public Bodies (Triennial Reviews)

Dan Poulter Excerpts

Thursday 12th March 2015 Written Statements

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I am today announcing the start of the triennial reviews of the NHS Pay Review Body (NHSPRB) and the Review Body on Doctors’ and Dentists’ Remuneration (DDRB).

All Government Departments are required to review their non-departmental public bodies (NDPBs) at least once every three years. In order to ensure that the Department is an effective system steward and can be assured of all the bodies it is responsible for, the Department has extended the programme of reviews over the next three years to all its arm’s length bodies and Executive agencies.

The reviews of the NHSPRB and DDRB have been selected to commence during the first year of the programme (2014-15). The reviews will consider the two pay review bodies’ functions and corporate form, as well as performance and capability, governance and opportunities for greater efficiencies. The Department will be working with a wide range of stakeholders throughout the reviews.

[HCWS408]

NHS Charges

Dan Poulter Excerpts

Wednesday 11th March 2015 Written Statements

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

My right hon. Friend the Under-Secretary of State, Department of Health, Earl Howe, has made the following written ministerial statement.

Regulations have been laid before Parliament to increase certain national health service charges in England from 1 April 2015.

This Government have made tough decisions to protect the NHS budget and increase it in real terms, but health charges remain an important source of revenue to support the delivery of high-quality NHS services. This is particularly important given the increasing demands on the NHS, with spending on medicines alone doubling since 2000. It is therefore crucial that these charges increase to keep up with rising costs.

This year, we have increased the prescription charge by 15p from £8.05 to £8.20 for each medicine or appliance dispensed.

Ninety per cent of prescription items are already provided free of charge.

To ensure that people with the greatest need are protected, such as those who are not eligible for free prescriptions but who have long-term conditions, we have again frozen the costs of a prescription prepayment certificate (PPC). The three month certificate remains at £29.10, and the cost of the annual certificate will remain at £104. An annual certificate means that a person can have all the prescribed items they require during the year dispensed for £2 per week.

Regulations have also been laid to increase NHS dental charges from 1 April 2015. The dental charge payable for a band one course of treatment will increase by 30p from £18.50 to £18.80. The dental charge for a band 2 course of treatment will increase by 80p from £50.50 to £51.30. The charge for a band 3 course of treatment will increase by £3.50 from £219 to £222.50. The small increases this year are lower than in recent years.

Dental charges represent an important contribution to the overall cost of dental services. The exact amount raised will be dependent upon the level and type of primary dental care services commissioned by NHS England and the proportion of charge paying patients who attend dentists and the level of treatment they require.

Charges will also be increased, by an overall 1.6%, for wigs and fabric supports.

The range of NHS optical vouchers available to children, people on low incomes and individuals with complex sight problems are also being increased in value. In order to continue to provide help with the cost of spectacles and contact lenses, optical voucher values will rise by an overall 1%.

Details of the revised charges are in the following tables.

Royal National Orthopaedic Hospital (Stanmore)

Dan Poulter Excerpts

Wednesday 4th March 2015 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I will of course pass that message on, Sir Alan. It is a pleasure to serve under your chairmanship for, I think, the first time in the almost three years I have been a Minister. I heed and take note of your comments. I congratulate my hon. Friend the Member for Harrow East (Bob Blackman) on securing this debate on an issue that is important to him and his constituents—and, more broadly, to many others. As he rightly outlined, Stanmore is a centre of national excellence in orthopaedic care. It has an international reputation. With the care it provides to its patients, it is one of the best centres in the world.

Before I address the issues my hon. Friend raised, I pay tribute to all those who work in our NHS—not just in his constituency, but right across the country—for their dedication, determination and commitment in providing first-class services to all whom they care for. I know that he made his remarks in that spirit. First-class, dedicated NHS staff need to be supported with the right facilities to provide that level of care. That is exactly why he raised the issue today, and I hope my remarks will bring him some reassurance.

One issue I wanted to pick up on was consultancy spend. I agree with my hon. Friend that hospitals spending money hand over fist in that way on consultants is completely unacceptable. I hope he will be pleased to know that the consultancy spend in the NHS has been reduced by £200 million since the previous Labour Government were in power, which is a strong step in the right direction. Many of the issues that he raised on that are historical. We have introduced new section 42 guidance for trusts that are in deficit to ensure that they are much more rigorous in how they spend their money when they want to receive additional Government cash. Looking at consultancy spend and ensuring that money is not wasted in the way that he outlined are important parts of the new criteria.

As we have heard, the RNOH is the largest orthopaedic hospital in the UK and is regarded as a leader in the field of orthopaedics in the UK and worldwide. It provides a comprehensive range of neuromusculoskeletal health care, ranging from treatment for acute spinal injuries to orthopaedic medicine and specialist rehabilitation for those who suffer from chronic back pain. The range of specialist treatments provided by the trust includes: the rehabilitation of people with life-threatening conditions, including spinal cord injuries; the innovation of new treatments, which is increasingly important, particularly in the areas of care provided by the hospital; leading-edge research and development; the manufacture of state-of-the-art prosthetics; and the training of future orthopaedic specialists. The trust is a national provider of health care: 45% of the trust’s patients live in London, a further 22% are from the remainder of the south-east, 31% are from further afield in the UK and 2% are international, which shows the hospital’s outstanding reputation.

The RNOH plays a major role in teaching. More than 20% of all UK orthopaedic surgeons receive training there, which is testament to the desire of the surgeons of tomorrow to ensure that they train and have experience of providing care at an outstanding centre of excellence. Patients benefit from a team of highly specialised consultants, many of whom are recognised for their expertise both in the UK and abroad. As my hon. Friend outlined, according to the friends and family test, Care Quality Commission inspections and many patient indicators, Stanmore is a centre of excellence and produces the very best possible care and results for patients.

The RNOH’s proposed redevelopment of the Stanmore site is key to ensuring that it can continue to improve the care it provides. I am aware that most of the buildings at Stanmore date from the 1940s, and many are no longer appropriate or fit for purpose for the high-quality care and excellent clinical outcomes that the RNOH provides for its patients. The plan is to rebuild the hospital so that it can continue to provide its specialist orthopaedic care to thousands of patients, young and old, with conditions too complicated for other larger general hospitals to handle. The new hospital will be a state-of-the-art facility that reflects and enhances the medical excellence that already exists at the RNOH. It will provide 124 beds, the majority of which will be in single rooms, thereby greatly enhancing patient privacy and dignity and helping to reduce the transference of infection, the incidence of which, as my hon. Friend outlined, is remarkably low at the trust.

Patient experience will be enhanced through a number of en-suite single rooms and modern, spacious and well-equipped communal areas. Improved facilities for staff will give them a better environment in which to work, enabling them to provide the best possible care. The RNOH is renowned worldwide for its clinical excellence, and manages to maintain high standards of outcomes despite the condition of the estate. The trust looks forward to continuing that high standard of care in the new hospital, which will provide an enhanced setting both for patients, and for support staff delivering the highest possible quality of care.

I appreciate the concerns that have been expressed. My hon. Friend called some of the challenges Kafkaesque, and I share his frustration at the difficulties experienced in developing and improving the facilities at the trust. It has taken a long time to get the proposed redevelopment to this point. Nevertheless, it is important that the business case is affordable. We know some of the historical dangers and challenges of unaffordable private finance initiative deals. In fact, a PFI deal crippled the South London Healthcare NHS Trust; that serves as a reminder to us all of the challenges that hospitals will face in achieving sustainability and delivering high-quality patient care if they take on unsustainable and unaffordable PFI deals.

I know that it has been frustrating, but we must ensure that the financial arrangements for the loan, as well as those underpinning the new development package, are sustainable, in order to ensure that the future provision of services is not jeopardised by a rush into an imprudent financial arrangement. It is in that spirit that there has been a lot of due diligence, although I accept that it has been frustrating.

In April 2013, the NHS Trust Development Authority took over responsibility for approving business cases for estate redevelopment. Between April and December 2013, the TDA worked with the trust to address the additional assurances required on the draft appointment business case. Both the trust and the TDA are clear that the right solution must enable the provision of excellent services to patients, be affordable, and offer value for money.

In December 2013, the RNOH trust board determined that it was unable to give its continued support for the draft appointment business case, because the trust concluded that the risks to affordability and flexibility associated with continuing with the scheme as then proposed were not sustainable. At that point, recognising the importance of the proposed redevelopment, the TDA committed to supporting the trust in working up alternative options for funding. The TDA has been supporting the RNOH to develop a business case that offers value for money and stands a good chance of securing the necessary funding to enable important improvements to be made for the benefit of patients. Serious consideration must also be given to the impact on the long-term sustainability of the trust.

In January 2014, when the financial modelling was complete, the trust concluded that a PFI scheme was unaffordable and that it wished to pursue an alternative scheme. In May 2014, the trust presented to the TDA an outline of its new preferred option for the redevelopment of the Stanmore site. It is a smaller-scale capital redevelopment, costed at around £40 million, as my hon. Friend said. The cost is to be met jointly through public funds and the proceeds from land sales.

Hospitals and trusts sometimes have surplus land that is not used for patient care, and that it costs them money to maintain—money that does not go to front-line patient care. It is of course right that, if they would like to redevelop facilities for the benefit of patients, they should use some of the capital receipts from the sale of that land to contribute to any planned redevelopment. It is in that spirit that the new package was put together. Indeed, it is in that spirit that the section 42 guidance for trusts in deficit that require finance, which I outlined earlier, was drawn up. Where trusts have surplus land that they could release because it is not required for patient care, that land can be freed up in order to provide affordable homes for local people, support the construction industry and, of course, reduce the overall cost of running a trust’s estate. That is a win-win situation for the NHS, as well as for the local economy and, often, young families in the area. I am sure that that will be a benefit of the proposed new scheme, as my hon. Friend said.

The TDA supports the approach that has been put together as part of the £40 million package, and will advise and support the trust on the development and submission of its application for public funding and its business case for the sale of land.

Looking to the future, I understand that the TDA received the trust’s revised outline business case on 29 January. The TDA is now assessing the business case with the aim of making a decision at the earliest opportunity; its board meeting will be held on 19 March—in less than three weeks’ time. This morning, I spoke positively to the TDA about the business case. I have every hope that the outline business case will be strongly supported. We must obviously wait for the outcome of the meeting, but I hope that my hon. Friend and his constituents will hear good news later this month.

The TDA recognises the unarguably poor quality of the Stanmore estate, and the great challenges that that presents to the delivery of high-quality health care and a positive patient experience in the months and years ahead. It is mindful of the need to make a swift decision, so it is committed to working alongside the trust to agree a business case for clinical quality reasons. It is vital that that is done in a way that safeguards important services for patients. Now that the TDA has received a formal business case to review, the process will continue at pace. Once the business case is approved, the TDA will support the trust in developing a full business case and finalising any outstanding assurances that might be required, in the shortest time possible.

I hope that my hon. Friend is reassured that a very active process is now in play, with the Trust Development Authority proactively supporting the trust to progress its business case, which I am optimistic will be approved in its outline form later this month. I hope that my hon. Friend’s constituents will then receive some very good news that will be welcomed not only at Stanmore and by his constituents, but by orthopaedic patients in this country and elsewhere in the world who receive the best possible care from the trust.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 24th February 2015 Commons Chamber

[Graeme Morrice (Livingston) (Lab)]

9. How many NHS staff have been made redundant and subsequently re-employed by the NHS since May 2010.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

Over the four and a half years between May 2010 and October 2014, 5,210 people—equivalent to, annually, less than 0.1% of the NHS work force—have been made redundant and then returned to work elsewhere in the NHS.

[Julie Hilling]

But at a time when A and E is in crisis and there are not enough nurses, how on earth can the Minister possibly justify firing and rehiring thousands of NHS staff? What greater sign could there be of a Government with their priorities totally wrong?

[Dr Poulter]

I am not sure I recognise that picture of the NHS. We know that there are between 6,000 and 8,000 extra nurses, midwives and health visitors working in our NHS than there were under the previous Government. Also, in respect of A and E, the average length of stay in hospital has steadily come down from about eight days in 2000 to about five days now. So our NHS is getting better and improving under the current Government.

[Graeme Morrice]

Last year the Prime Minister promised to recover redundancy payments from people who have been rehired. Can the Minister tell us how many payments have been recovered and at what cost?

[Dr Poulter]

The hon. Gentleman will be aware that it was the previous Labour Government who in 2006 set these eye-watering redundancy payments for the NHS, and we have committed to making sure we reform and change that. Therefore, as part of our negotiations and pay offer to NHS staff we want to introduce a redundancy cap of £80,000. Since many Opposition Members are supported by trade unions, I hope they will encourage union members to back that pay and redundancy cap.

[Andrew Stephenson (Pendle) (Con)]

Can the Minister confirm that according to the latest figures there are more nurses working in the NHS now than there were in 2010, including an additional 391 at East Lancashire Hospitals NHS Trust and an additional 59 at Airedale NHS Foundation Trust, the two trusts that serve my constituency?

[Dr Poulter]

I am delighted to confirm that, and we have made a conscious decision to reduce NHS waste and bureaucracy. NHS administration spending is down from 4.27% under the previous Government to only 2.77% now, which has resulted in £5 billion of efficiency savings and meant we can invest in about 6,000 more nurses, midwives and health visitors.

[Maria Miller (Basingstoke) (Con)]

The extra NHS staff my hon. Friend talks about are welcome, but my constituents want to know that standards of care are the best as well. What progress is he making to ensure that hospital patients get the best possible care?

[Dr Poulter]

The most important thing we have done is support our front-line staff with additional investment in the NHS, which Labour called irresponsible, and there is about £13 billion more going into the NHS during this Parliament. We have also increased transparency to make sure that where there are isolated pockets of poor care, the Care Quality Commission can intervene and make recommendations to improve the quality of care for patients in those hospitals.

[Nic Dakin (Scunthorpe) (Lab)]

20. Given the significant challenges facing the NHS and the fact that this top-down reorganisation has led to this hiring and firing and therefore a distraction of energy and attention at crucial times, do not the Government now regret their top-down reorganisation?

[Dr Poulter]

A reorganisation of NHS services that results in administration spending being reduced from 4.27% under the previous Government to 2.77% under this Government, meaning that there is £5 billion more money for front-line patient care, is a good thing. That is something the Opposition should support, because it means that patients are getting a better service.

[Andrew Bridgen (North West Leicestershire) (Con)]

Can the Minister remind the House of the number of extra specialist A and E doctors working in the NHS in England now compared with 2010?

[Dr Poulter]

My hon. Friend is right to raise this important point. As part of our commitment to investing more money in the front line, we have been able to ensure that there are between 800 and 1,000 more doctors now working in A and E than there were under the Labour Government.

[Several hon. Members]

rose—

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

Those of us on the Public Accounts Committee have heard about the industrial scale of this revolving door of people going out of one job and into another with a fat redundancy payment. Does this not show that the Government have lost their grip on what is truly important in the NHS, which is paying front-line clinicians to serve patients?

[Dr Poulter]

That is extraordinary. The Public Accounts Committee will be aware that these redundancy terms were introduced by the previous Labour Government in 2006. We are committed to changing them and I hope that the hon. Lady’s party will support us in exerting pressure on the unions to support the pay deals on the table that will introduce an £80,000 redundancy cap.

[Mr Speaker]

Ms Johnson, do you have a similar question?

[Diana Johnson (Kingston upon Hull North) (Lab)]

21. Yes, Mr Speaker; I am grateful. I want to ask about the number of nurses who have been made redundant. Lots of hospitals in my area are now recruiting from Spain, and I wonder whether an assessment has been made of the cost to the NHS of using nurses from abroad after making other nurses redundant.

[Dr Poulter]

Our NHS has always benefited from overseas staff bringing their skills and coming to work here, and we can all welcome that as long as they have a good standard of spoken English, which is something that we are putting right through the legislation that we are introducing. As I outlined earlier, there are now around 7,500 more nurses, midwives and health visitors working in the NHS than there were under the previous Government.

[Douglas Carswell (Clacton) (UKIP)]

2. What contingency plans his Department has formulated to cope with the expected increase in the number of GPs retiring before 2020.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

In addition to the extra 1,000 GPs working in our NHS since 2010, our mandate to Health Education England will ensure that 50% of trainee doctors enter GP training programmes by 2016. This will enable the delivery of 5,000 additional newly qualified GPs by 2020.

[Douglas Carswell]

I am told that many young doctors are choosing not to go into general practice. That, coupled with the number of retiring GPs, is leading to real shortages in places such as Clacton. What more can be done to make general practice more attractive to young doctors, in order to offset the number of GPs who are retiring?

[Dr Poulter]

There have always been parts of our health service where it has been difficult to attract GPs to work; that is a long-standing problem. A new £10 million investment fund has been put in place, and a new 10-point plan is being delivered by NHS England to look at how we can better incentivise younger doctors to work in areas in which it has traditionally been difficult to recruit. I am sure that that will bring benefits to the hon. Gentleman’s constituency and elsewhere in the NHS.

[Sir Tony Baldry (Banbury) (Con)]

Does my hon. Friend agree that this is not just a matter of the total number of GPs? Quite a lot of GPs now want to work part time, and quite a lot now want to be salaried rather than being partners. Is he confident that the model that was set up in 1948, which effectively means that each GP practice is its own separate, private business, is still suitable in the 21st century?

[Dr Poulter]

My right hon. Friend asks an important question. We can of course support the existing model, and the innovation that comes with GPs being small businesses, and that is exactly what we are doing with the £1 billion investment fund for GP infrastructure and technology. We are supporting those GPs as small businesses to develop better patient services.

[Valerie Vaz (Walsall South) (Lab)]

On what is his last outing, will the Minister tell us how many GPs, in addition to those who have retired, have left the profession and how many have gone to work abroad?

[Dr Poulter]

It has always been the case—it was certainly the case among many of my medical contemporaries—that many people from our NHS go and work overseas for some time. They often come back to the NHS, bringing broader experience and skills. As I outlined earlier, there are now 1,000 more GPs working and training in our NHS than there were five years ago.

[Mr Philip Hollobone (Kettering) (Con)]

Following the retirement of a senior partner whom it has been impossible to replace, Dr Hadrian Moss of the Dryland GP surgery in Kettering has followed the advice of the British Medical Association and informally closed his expanded list of 2,500 patients on the ground of patient safety. He has now been taken to task by NHS England for a potential breach of contract. What is the Minister’s opinion on reconciling the views of the BMA on patient safety guidelines and those of NHS England on a potential breach of contract?

[Dr Poulter]

I am sure that my hon. Friend will understand that it is difficult for me to comment on an individual case, but I am very happy to look into the matter and get back to him about it.

[Ms Margaret Ritchie (South Down) (SDLP)]

Given that the needs of patients must come first and that young people are not choosing to pursue GP training as much as they used to, what discussions will the Secretary of State hold directly with the British Medical Association, the Royal Colleges, the training councils and his colleagues in the devolved Administrations throughout the UK to address this issue, to prevent further congestion in accident and emergency departments?

[Dr Poulter]

There is a lot of work going on in this area. First, we are encouraging and supporting GPs who have had career breaks, perhaps because they have started a family, to get back into the profession more easily than they have been able to do in the past. Secondly, we also have the commitment that 50% of medical students and doctors leaving foundation training will become GPs in future. That will make sure that we have 5,000 more GPs by 2020.

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

But the Government’s reorganisation took billions of pounds away from the NHS front line. Figures released last week show that fewer than a quarter of medical students now enter general practice, because they can see the pressure that Ministers have put on it, while GP morale has collapsed. Should the Minister not now admit that the reorganisation was a mistake and instead match Labour’s pledge to invest an extra £2.5 billion a year to recruit 8,000 more GPs and guarantee appointments within 48 hours?

[Dr Poulter]

I know that the Labour party is full of professional politicians, but medical students do not just leave medical school and straight away become GPs; they become foundation doctors. As I have outlined, 50% of the people leaving their foundation training will become GPs in future, which will increase the number of GPs by 5,000. Under this Government the number of GPs in education, training and working in the NHS has increased by 1,000, which is a move in the right direction.

[Stephen Mosley (City of Chester) (Con)]

3. How many CT scans were performed at the Countess of Chester hospital in (a) 2010 and (b) 2014.

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[Steve McCabe (Birmingham, Selly Oak) (Lab)]

11. How many nurses per million population were working in the NHS in each of the last five years.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

The full-time equivalent number of nurses, midwives and health visitors working in the hospital and community health services in England per million population from September 2010 to September 2014 inclusive has remained broadly constant at 5,872, 5,768, 5,703, 5,712 and 5,781 respectively.

[Steve McCabe]

In response to 11 parliamentary questions that I submitted in the past year, the Minister has admitted that he does not know how many part-time, agency and locum GPs are in the health service, the number of agency and part-time nurses, the number of part-time doctors in our hospitals, or how many working nurses and midwives are also drawing their pensions. Given that he has so little detail on staffing, where did today’s figures come from, and what faith can anyone have in them?

[Dr Poulter]

They are in the monthly staff statistics survey. As the hon. Gentleman would like some detailed information, I am sure he will be pleased to hear that in his constituency there are now 386 more nurses than there were in 2010 under the previous Government, and nationally there are 7,500 more nurses, midwives and health visitors working in the NHS.

[Andrew George (St Ives) (LD)]

Does my hon. Friend agree with me and with the nursing profession that if nurse staffing levels on acute hospital wards fall below one registered nurse to seven acutely ill patients, excluding the registered nurse in charge, it will significantly increase the risk to patient care and result in avoidable excess deaths?

[Dr Poulter]

My hon. Friend and I have discussed this many times and I do not agree with him, as he knows. What is important is that patients are assessed on their clinical needs. A rehabilitation ward will need a different number of nurses—indeed, it may need physiotherapists and occupational therapists—from intensive care nursing, which often requires one-to-one care, so setting arbitrary staffing ratios is not in the best interests of patients.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Does the Minister accept that the issue is not just broad numbers, but the shortage of specialised nurses in many departments, certainly in Calderdale and Huddersfield, where we are finding it difficult to recruit the right qualified nurses for very specialist tasks, as well as the doctors to go with them?

[Dr Poulter]

In many parts of the country we are seeing more specialist nurses working, particularly in areas such as diabetes, and supporting patients with complex care needs. As we need better to support people with those complex care needs at home in their own communities, the Government will continue to invest in specialist nurses not just to provide care in hospital, but to work in the community at the same time.

[Ian Austin (Dudley North) (Lab)]

Russells Hall hospital is being forced to lose one in 10 staff, which could include midwives, to deal with Government efficiency savings of £12 million every year. This morning the hospital’s chief executive has written to me and says that these

“excessive efficiency requirements place care at risk”.

She goes on to say that

“the financial challenge has reached unviable levels”

and that NHS providers

“can no longer guarantee sustainable and safe care”.

What will it take for Ministers to listen not just to us, but to NHS staff, and ensure that hospitals such as Russells Hall have the resources they need to provide care for local people?

[Dr Poulter]

I am sure the hon. Gentleman will be pleased that, as part of our winter pressures funding, Dudley received £3.5 million to support the hospital during a difficult winter period. There are now 69 more doctors and 324 more nurses, of whom 29 are extra midwives, working in the area than in 2010.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

12. What discussions he has had with (a) the Haven project in Colchester and (b) NHS bodies in north Essex on the need for continuing funding for support for people with moderate to severe personality disorder.

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[Glyn Davies (Montgomeryshire) (Con)]

T3. Not enough GPs want to practise in rural Wales. I am told that one of the reasons is that GPs registered in England have to go through a bureaucratic process to be able to work in Wales. Will my hon. Friend the Minister work with the Welsh Government to ensure that we have a common registration process so that GPs can move between England and Wales without having lengthy, time-wasting new bureaucracy?

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I am very happy to look into that issue and to do what we can to support our NHS work force to move as freely as possible between England, Scotland, Wales and Northern Ireland. GP numbers in England have increased because we have protected the NHS budget, unlike in Wales, where it has been cut by the Labour Administration.

[Karl Turner (Kingston upon Hull East) (Lab)]

T2. A recent Ashcroft poll shows that only 15% of the public think that this Government have the best approach to running the NHS. Will the Secretary of State stand up at the Dispatch Box and apologise for his top-down reorganisation of the NHS and his Tory privatising Health and Social Care Act, and accept that the public will never trust the Tories with the NHS?

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[Paul Blomfield (Sheffield Central) (Lab)]

T8. When I asked the Minister last June what guarantees he would give to GP practices at risk because of the withdrawal of the minimum practice income guarantee, I was told that NHS England would ensure threatened practices “get to the right place.”—[Official Report, 10 June 2014; Vol. 582, c. 400.]Over the past seven months, those discussions have not alleviated the threat to two highly regarded practices in my constituency that face closure. Will the Minister agree to meet me and representatives of the practices to discuss what is really happening, and to consider what can be done to save them?

[Dr Poulter]

I am very happy to meet the hon. Gentleman, but he will be aware that the move away from the historical funding formula towards a per head or capitation formula is a move in the right direction. If there are certain local concerns, I am very happy to meet him to discuss them.

[Robert Jenrick (Newark) (Con)]

May I commend the Government on raising the priority for dementia in their announcement last week? Will the Secretary of State and the Department of Health put all their resources behind towns such as Newark, which are trying to establish themselves as dementia-friendly towns and are working with shopkeepers, banks and the business community to make it easier for older people with dementia to lead fulfilling lives?

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[Mark Reckless (Rochester and Strood) (UKIP)]

Medway clinical commissioning group is looking at putting GPs at the front of our accident and emergency department to help relieve pressures on emergency doctors. Do Ministers believe that that is a promising way forward?

[Dr Poulter]

There is certainly a lot of benefit from having general practice co-located alongside A and E so that people with more minor ailments or concerns can be seen by GPs. That can often take the pressure off A and E services, but more senior expertise is also on hand when required.

[Sarah Newton (Truro and Falmouth) (Con)]

Will my right hon. Friend update the House on what steps he is taking to prevent avoidable deaths from sepsis?

[Bridget Phillipson (Houghton and Sunderland South) (Lab)]

GPs across the north-east say that they are facing a work force crisis, with falling numbers of family doctors. Does the Secretary of State not recognise the connection between people being unable to get an appointment to see their GP and the rising and major pressure on our A and E department?

[Dr Poulter]

I am sure that the hon. Lady would like to support the plans we have put in place to ensure that we increase the number of GPs by 2020, and to ensure that 50% of doctors leaving foundation training go into careers in general practice.

[Mr Adrian Sanders (Torbay) (LD)]

In order to combat fraud, the previous Government quite rightly introduced five-year prescription charge exemption certificates. Now that the certificates are coming up for renewal, people are finding that they have to pay for their medicines once their certificate has expired, and they have even been fined. Unlike for a TV licence, there is no renewal reminder. Will the Government look at how to ensure that people are told they need to renew their prescription exemption certificates?

[Dr Poulter]

As my hon. Friend will be aware, 90% of patients receive free prescriptions either because they are older—over the age of 60—or because of long-standing or other factors. If his constituents are running into difficulties and have problems with renewing their certificate, I am very happy to look into that and to meet him to discuss it further.

[Mr David Anderson (Blaydon) (Lab)]

Despite assurance from the Prime Minister, it is now clear that the drug Translarna will not be available until after NHS England has concluded its internal consultations. The Secretary of State and others have told me repeatedly that they have no control over the issue, but can the Minister give the House any idea when the drug will be available for young boys suffering from Duchenne muscular dystrophy in this country, in the same way as it is across Europe? The drug is saving young boys from going into wheelchairs earlier. Does the Minister have any idea when it will be available?

GP Services

Dan Poulter Excerpts

Thursday 5th February 2015 Commons Chamber

[Derek Twigg]

The right hon. Gentleman makes an important point. Clearly, if there is a large housing development or one that results in a large population increase in an area of the country, planning for that should include the need for proper GP services. Of course to do that we need more GPs—that is a crucial part of it. The other point to make, which other Members may want to raise in the debate, is that we also need good facilities and buildings, because unless we have those we are not going to attract as many people into general practice. Some facilities and buildings around the country, including some I have had in my constituency, are just not up to the job. Trying then to get new facilities or new buildings built, or passed through the NHS system, is remarkably difficult and takes years. I can give examples of that in my constituency. The right hon. Gentleman raises an important point, but we need to have more GPs to do what he suggests.

I am conscious that other Members wish to speak, but I want briefly to discuss the Government’s record. Like others, I believe strongly that the Government made a major mistake in embarking on a massive reorganisation of the NHS, despite saying that they would not do so, which according to different estimates has cost between £2 billion and £3 billion. Whatever my political differences, why do I think that was such a major mistake? Well, it distracted the health service at a time when it was under massive pressure, and used up crucial resources. The massive increase in financial pressure was also building.

As a result of the creation of the clinical commissioning groups, many GPs have had to spend more time away from their surgeries. Let me just add that the CCG in Halton works very well; it is very progressive and forward thinking. It is determined to try to improve health and has worked very well in partnership with the local borough council. But the health service was distracted by the change, which cost a lot of money and took away vital time and resources that should have been put into ensuring that we had the right number of GPs and the organisation that we needed.

This Government have not done nearly enough to prevent the shortage of GPs. We are still waiting to see whether their plans will add up and create the number of new GPs that we need. I was shocked by one revelation. I would have thought that if someone wanted to decide on the number of GPs that are needed, they would have to know how many vacancies there were, but when I tabled a parliamentary question recently, I found out that the Government no longer kept a record of GP vacancies. I then asked the House of Commons Library how that could be. It told me that the survey suspension coincided with a fundamental review of data returns, which was initiated by the present Government in September 2010 in response to a commitment in the White Paper, “Equity and Excellence: Liberating the NHS” to

“initiate a fundamental review of data returns, with the aim of culling returns of limited value.”

How such information on GP vacancies could be deemed as being of “limited value” is a mystery to me.

The Library has also told me that Health Education England’s work force plan indicates an estimated gap of around 3,000 full-time equivalent GPs between the number of staff in post and the forecast demand. I understand that the Government are saying that the supply and demand gap is expected to close by 2020 if an additional 3,100 new GP trainees can be found every year, but we have already heard about the problem of recruiting trainees to work in general practice.

Dr Maureen Baker, chair of the Royal College of General Practitioners, said that the threat was one element of a “shocking” wider crisis in front-line community care, with more than 1,000 GPs expected to leave the profession every year by 2022. The number of unfilled GP posts has nearly quadrupled in the past three years to 7.9% in 2013. The RCGP has estimated that we need some 8,000 more GPs in England, and 10,000 across the UK, by the end of the next Parliament in order to meet growing demand from patients.

The Government’s decision to get rid of NHS Direct and replace it with NHS 111 was short-sighted. Members do not have to take my word on that. They can just listen to the words of a GP in my constituency, who said:

“NHS 111 has been a complete disaster. Lay people/call centre staff working from a crib sheet/flow chart are creating huge demand in both primary care and A and E. Quite a bit of controversy about this in the last few days. They call for ambulances at the drop of a hat and seldom advise the patient to self-care. The callers not admitted are advised to see their GP within a few hours. The contact summaries are unintelligible.”

Those words are not mine but those of a GP: NHS 111 has caused some real concerns.

The Government have also cut GP training. The shortage of GPs is, without doubt, one reason why we are finding it harder to see a GP. It is also holding back the NHS from meeting the challenges of the future, such as providing better care outside hospital to support an ageing population. Of course the right hon. Member for Chelmsford (Mr Burns) will remember that that was one of the key reasons why the Government introduced the Bill they did.

My right hon. Friend the Member for Leigh (Andy Burnham) has stated that a future Government will raise something like £2.5 billion for a time to care fund from a mansion tax on properties worth more than £2 million, cracking down on tax avoidance and a new levy on tobacco firms. Such investment will enable a Labour Government, by the end of the next Parliament, to provide 20,000 more nurses and 8,000 more GPs to help people stay healthy outside hospital and to tackle GP access problems.

In 1997, only half of patients could see a GP within 48 hours. The previous Labour Government rescued the NHS after years of Tory neglect. By the time we left office, 98% of patients were being seen within four hours at A and E and the vast majority of patients—80%—could get a GP appointment within 48 hours.

One of the Prime Minister’s first acts was to scrap Labour’s guarantee of getting a GP appointment in 48 hours and to cut the funding for extended opening hours.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

The hon. Gentleman is making some important points, but does he recognise the fact that it takes a number of years to train any medical specialist, including a GP? While he is talking about the previous Government’s investment in the NHS, would he like to explain why that forward work force planning was not done and how such planning may have helped with some of the issues that he is raising today?

[Derek Twigg]

The Minister makes an interesting point. At Prime Minister’s Question Time, we keep hearing the Prime Minister say, “Look how many extra GPs and nurses we have recruited,” but how long does it take to train them? I suggest that the Minister look at the figures on the number of additional GPs and nurses recruited between 2003 and 2009.

[Derek Twigg]

Again, that is an interesting point. There is a perception that every GP practice provided out-of-hours cover with the GPs themselves going out to see their patients. Of course, some of them did that, but many did not. Many of them were already using locums. During my childhood, I was a particularly bad asthmatic, and most of the doctors who came out to see me were locums, not my GP. We must look at how we organise out-of-hours services, but the key thing to focus on today is that we have not got enough GPs.

[Dr Poulter]

On long-term work force planning, the hon. Gentleman suggests that there is suddenly a crisis in GP recruitment—which I do not think is necessarily correct—but if the previous Government were serious about investing in general practice, they should have trained a lot more GPs than they did.

[Derek Twigg]

I know the Minister’s background, but he should read the figures on the number of GPs recruited by Labour when we were in power. Between 2000 and 2009, there were thousands of extra GPs, compared with the additional recruitment since this Government came to power. He should compare the two records.

I will not take any more interventions, Mr Speaker, because other Members want to speak.

Many local initiatives are trying to deal with the crisis in general practice and gaining access to GPs, or certainly to mitigate the effect. Clinical commissioning groups, such as Halton CCG, are working closely with partners to develop a strategy within the financial constraints. Halton CCG has told me:

“Delivery may be across the whole CCG on a Halton-wide footprint; by bringing more than one GP practice together to service distinct communities through a ‘hub’ based approach; by sustaining individual practices wherever appropriate and by giving local people and communities more opportunities to self-care and create resilience”.

It is working with partners to try to improve the situation, despite the financial constraints and the shortage of GPs, but we must attract more GPs.

The Royal College of GPs has told me that, in its view, it is vital that we increase the share of the NHS budget spent on general practice in England from 8.3% to 11%. That is one of the key parts of its campaign. That increase would help to reduce pressure on other parts of the NHS by supporting the delivery of more patient care in the community and keeping people out of hospital wherever possible.

The fact is that general practice cannot go on in this state. We need a sustainable, funded plan to ensure we have enough GPs to meet the population’s needs and to provide better care outside hospital. Clearly, patients should not have to wait days and sometimes weeks to see a GP or be constantly denied the opportunity to see the GP of their choice. We need to relieve the pressure on hard-pressed GPs, by ensuring that general practice is where more young doctors want a career, and in doing so we would have much better integrated care. We need better buildings to make general practice a more attractive place. We must of course constantly challenge the medical profession on how they can work better and deliver better services to patients within available resources. In the end, both politicians and clinicians must put the interests of patients first, while getting the best value for the taxpayer.

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[Sarah Newton]

My right hon. Friend makes a good point. The plan that NHS England has put forward is about shifting resources from the acute emergency care sector into primary care sectors, especially GP practices. The point that he makes about flexible working fits well with my point about enabling more women to stay in the NHS or to return to it. Many walks of life are addressing the issue of enabling women to combine their caring responsibilities with their desire to play a full part in society, whether that is in public service as a GP, as a Member of Parliament or in business. Much more work needs to be done by the NHS to look at ways to enable women to combine caring for children or elderly parents with being a GP or fulfilling other roles in the NHS.

Women often take a break to look after their families—it is something that I did myself—and it can be difficult for women in their late 30s or 40s to find the ladder back into their previous careers and occupations. I note that many former GPs could make excellent GPs again if they were given the opportunities to retrain and reskill. They could contribute enormously, through working flexibly, to enable GP practices to open more hours.

[Dr Poulter]

My hon. Friend makes an important point. I hope that she will welcome the opportunity we may have to revisit the issue of the annual performers list. At the moment that means that if a GP is out of practice for a year, it is very difficult to return. That is something that we need to address, and I hope that she will be supportive of the Government’s efforts to address it with NHS England.

[Sarah Newton]

I welcome the Minister’s intervention. That sounds like an excellent initiative and I am sure that more will follow, because we need to use the talents of everyone in our nation to address the challenges that we face. Women can play an enormously important role in the NHS, as they can in all other walks of life.

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[Caroline Lucas (Brighton, Pavilion) (Green)]

I add my congratulations to the hon. Member for Halton (Derek Twigg) on securing the debate. I am very pleased to have worked with him to have this opportunity today to discuss the vital issue of building sustainable GP services.

Proper funding for our GP services is vital for good patient care, easing pressure on hospitals and ongoing sustainability. The question we need to ask is this: why have Ministers allowed a trend of consistently falling GP funding? The Royal College of General Practitioners made its own concern clear back in June 2013 with an urgent call for an increase in GPs’ share of the NHS budget, so that 10,000 more GPs could be hired. However, recent figures reveal funding to be at an all-time low of 8.3%, something which shows a worrying complacency. In response, more than 300,000 people, including many in my constituency, have signed the RCGP’s petition, “Put patients first: back general practice”. The petition calls for more money to be allocated to GP services. Alongside the campaign, the BMA has conducted clear analysis of the serious work load pressure facing GPs, an issue so many hon. Members have raised today.

As the Minister well knows, the drop in share of the NHS budget for our doctors’ surgeries comes at a time when GPs are under increasing pressure and are having to see more and more patients. A situation in which they are seeing 40 to 60 patients a day is simply unsustainable for both patients and doctors. It is horrifying that 80% of GPs say that they do not have sufficient resources to provide high-quality patient care.

GPs in my constituency are telling me that good patient care is being destroyed because of what they see as impossible demands, including as a result of privatisation and a lack of funding for primary care services. For example, in a joint letter to me, seven local GPs said:

“There is no doubt that general practice is really suffering from the lack of investment, impossible demands and never ending re-organisations. If we could stop having administrative battles and spend our precious hours on patient care we would all be much happier, and the service would be better and significantly cheaper to run.”

[Dr Poulter]

I commend the hon. Lady for making points on behalf of her local GPs. She talked about privatisation. Would she not accept that the funding model for GPs as small businesses in their own right has existed since 1948, when Nye Bevan created the NHS?

[Caroline Lucas]

I accept that, of course. When I talk about privatisation, I guess what I am referring to is constant fragmentation: the way in which NHS England, CCGs and others are still struggling to get a streamlined process, which makes it more difficult for patients to be seen when they need to be seen and by the person who needs to see them.

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[Paul Burstow (Sutton and Cheam) (LD)]

I thank the hon. Member for Halton (Derek Twigg) for securing this debate. My name was on the application, but he was the person who made the argument that persuaded the Backbench Business Committee. I apologise to him for not being here for his opening remarks or for those of others who have contributed so far.

I was keen to contribute to the debate because it goes to the heart of how we make the NHS fit for the future and do more in the community. As the hon. Member for Brighton, Pavilion (Caroline Lucas) said in her closing remarks, the focus has moved from treating episodes of ill health and diseases of individual body parts to people living with a complex range of diseases. It is that complex co-morbidity that is driving the need to change how health care is organised and delivered in this country. If that does not happen, the system will become unsustainable. At the heart of that is the family doctor and their relationship with their patients and communities, which is a key component of building the system we need for the future.

About two months ago, I and my right hon. Friend the Member for Carshalton and Wallington (Tom Brake) met a group of GPs in my constituency to discuss some of the issues being aired today—Dr Chris Elliott, Dr Brendan Hudson, Dr Alan Froley and Dr Mark Wells—along with a practice nurse. I was pleased that a practice nurse was present, because although we are discussing the sustainability of GP practices, we need to recognise, as I am sure others have, that we are talking about the wider primary care family and the contribution made by many other professionals. We discussed the pressures on practices in our constituencies. The demands have been well documented, but I want to rehearse a couple. One frustration—it has long existed, but some of the GPs felt it had got worse—concerns the expectations around paperwork and reporting, which they feel have now got out of control. That needs to be kept under review and, where possible, streamlined. I hope the Minister will say something about that.

According to data available at CCG level on the performance of primary care and, in particular, access to GPs, in my patch, Sutton scores above average when it comes to getting an appointment, which is good news, but once someone has an appointment and arrives at the surgery, it turns out they have to wait longer than average to actually see their GP. So they can get there, but then have to wait far longer than is acceptable, and often in substandard accommodation. My constituency is a suburban part of Greater London and most of its GP practices are situated in larger houses that cannot accommodate the 21st century primary care we need. We need the investment from the infrastructure fund to flow through and allow for innovation.

[Dr Poulter]

I thank my right hon. Friend for his point about the money from the Government for GP infrastructure, but is there not also a responsibility on local authorities, when there is additional house building, to look at the contribution developers can make to support local GP and health services by developing GP and other community health care facilities?

[Paul Burstow]

Absolutely, and certainly in its local planning my local authority does exactly that—it looks at what the community facility needs are. In the southern part of my constituency, in south Sutton, there has been some controversy over plans for a new GP centre. It is planned on a piece of land that was NHS land but which does not sit within easy reach of public transport and is perceived to be in the wrong place. It is also less than a mile from a soon-to-be-unused hospital site that many of my constituents feel would be a more sensible location. It will be the basis of a new housing development in the coming years and so will be the perfect place for a consolidation of existing substandard GP surgeries currently based in houses.

In its briefing, the Royal College of General Practitioners has set out some of the pressures on GPs, including increased levels of stress and depression. In a ComRes poll it conducted, eight out of 10 GPs expressed concern that those pressures were leading to an increased risk of misdiagnosis. Yesterday was world cancer day but there are still serious issues with the number of people who do not get a cancer diagnosis until they are in an accident and emergency department, by which point it is far too late, and consequently their lives are cut short.

GPs are at the heart of delivering health care: nine out of 10 NHS consultations take place in a GP surgery, while the number of consultations has increased by 40 million since 2008 to 340 million. Interestingly, according to the 2012 GP patient survey, 1.2% of patients went to a walk-in centre or A and E department because they could not get a GP appointment at a time that worked for them, but that figure has now risen to 1.7%. I am sure the Minister will tell us that those are very low percentages and therefore not a cause for concern, but given the number of consultations—340 million—it does not take a very high percentage to have a significant impact on our A and E departments. Given that there are nearly 14.6 million A and E attendances, we can see that the gearing is such that ensuring sustainable and easily accessible GP and primary care services is critical to getting the balance in the system right.

I hope the Minister will say something about the piloting of 24/7 access to GPs and ensuring we have the right data to better understand which areas are under-doctored so that we do not have to rely on anecdotal evidence. There is clearly a concern about deprived and rural areas not having sufficient doctor cover, but at the moment we cannot map that accurately. I hope he can tell us what is being done to target resources to support areas crying out for better GP coverage. In addition, I hope he can say what will be done to address the fact that, despite the Government’s having identified the need to train more GPs and despite the number of places having increased significantly under this Administration, not enough places are being filled. What is being done to get up to the right number?

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I thank the hon. Members for Halton (Derek Twigg) and for Brighton, Pavilion (Caroline Lucas) for securing this debate today. I commend them for raising important issues about the resourcing of general practice, access to GP services and the future shape of general practice and how it will continue to deliver high-quality care to patients. In particular, I should like to praise the many GPs who work exceptionally hard every day for our NHS and deliver high-quality care to patients.

The hon. Member for Halton made some other important points about mental health training for GPs. Historically, GPs have not always received training in mental health. That must change. The Royal College of General Practitioners and the Royal College of Psychiatrists support that change, and that is why we have stipulated in Health Education England’s mandate that GPs should receive compulsory training in mental health in future. Health Education England is now working with the royal colleges to put that in place. That important step forward will benefit many patients throughout the country.

I will ask my right hon. and noble Friend Lord Howe to look into the issues raised by the right hon. Member for Knowsley (Mr Howarth) and the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) and to get back to them in due course. Although the hon. Member for Halton raised some important issues, some of which were echoed by the shadow Minister, the hon. Member for Copeland (Mr Reed), it is frankly not good enough to complain now about a GP work force crisis when they were in power for 13 years. It takes three years from the end of foundation training to train a GP, and training a part-time GP takes longer. If there is a work force crisis in general practice, it is because the previous Labour Government did not have the foresight to train enough GPs when they were in power.

[Derek Twigg]

rose—

[Dr Poulter]

I will give way in a moment.

Under this Government, 1,000 more GPs are working in the NHS or training. That is a move in the right direction. We have put in place long-term work force plans to ensure that there are 5,000 more by 2020. We have recognised the pressure that GPs are under, and we have trained and are training more. I hope that the hon. Gentleman will do better than he did in his speech and at least acknowledge the point I have made.

[Derek Twigg]

With respect to the Minister, I am not suggesting that everything that the Labour Government did was perfect or that we met every demand on us. I tried to make it clear, although he does not want to recognise this, that there were massive improvements in the number of GPs. The Library’s figures for 2003 to 2009 show an extra 5,000 GPs. Many of the GPs now coming into place were trained under the Labour Government.

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[Dr Poulter]

Indeed, there was an increase in the number of GPs, as there has been under this Government, but it is not good enough to lay the blame for a lack of GPs at this Government’s door, as the hon. Gentleman and the shadow Minister tried to do, when it takes a long time to train more GPs. What may have been a better decision for the previous Government in the advanced work force planning would have been to follow this Government’s example, by saying that 50% of medical graduates should become GPs. Currently, the rate is 40%. That needs to rise to 50%, and we need to encourage more people to become GPs. If we had more equality in where medical graduates end up practising medicine, that would be a big step in the right direction in training the extra GPs needed. If that had been done 10 years ago, we might not have some of the problems that the hon. Gentleman outlined. Indeed, he said that only 27% of GPs were under the age of 40. That reinforces my point about medical graduates.

[Duncan Hames]

I agree with the Minister that there is no substitute for persuading more medical graduates to train as GPs, but will he look at what can be done to attract women who were GPs back into general practice after they have started a family if that was the reason why they left? Will he also look at the working practices that we require of GPs to find out how that can be a more reliable way to make the most of the GP training that we have committed to?

[Dr Poulter]

Indeed. My hon. Friend makes an important point and echoes that made earlier by my hon. Friend the Member for Truro and Falmouth (Sarah Newton). At the moment, a valuable part of our general practice work force, perhaps due to life circumstances or the fact that they have started a family and have had two children quickly one after another, face difficulties in going back into practice. Issues to do with the operation of what is called the performers list need to be looked at, and I will ensure that NHS England does so and considers how we can better support GPs to get back into practice when they have had career breaks for legitimate family and other reasons.

[Grahame M. Morris]

Will the Minister give way?

[Dr Poulter]

I hope that the hon. Gentleman will forgive me. I may give way later, but I want to make some progress because this is a debate for Back Benchers. I will address the points that he made a little later on.

General practice funding is, of course, important. We must have regard to the primary care work force, how patients access their GP and how we structure primary care to get the best results for patients. It is only by looking at all these together that we can properly ensure the sustainability of the general practice services, which we are all so rightly proud of in each of our constituencies. Some excellent points on local sustainability were made by my right hon. Friend the Member for Chelmsford (Mr Burns) in an intervention, and by my hon. Friend the Member for Henley (John Howell). They spoke about the importance of co-ordinating local planning processes with the local NHS to better support GPs to develop practices in areas of housing growth. I am sure all local authorities will want to look at that in more detail.

On work force issues, being a GP is still a rewarding and well-paid career, with the average salary for a GP close to £110,000 per year. GPs are often the first point of contact for patients when they use our national health service. We should not lose sight of that in this debate. We have already delivered an increase of 1,051 full-time equivalent GPs who are working and training in our NHS since September 2010. This brings the total number of full-time equivalent GPs to 36,294, which represents a real increase in capacity under this Government. However, we know that there is still more to do. A report undertaken by the Centre for Workforce Intelligence last year warned of a demand-supply imbalance emerging by 2020 unless there is a significant boost to GP training numbers.

Before the report came out we had already made plans through work that Health Education England was undertaking to increase the number of GPs. NHS England has been working closely with Health Education England, the Royal College of General Practitioners and the British Medical Association to produce a 10-point action plan to increase the size and capacity of the general practice work force, which we have backed with £10 million of funding. This plan covers a wide range of measures to recruit more young, aspiring medical students to take up a career in general practice, retain those doctors already working there, and provide support for those GPs who have taken a career break and help them to get back into work—an issue that a number of Members raised in the debate.

[Grahame M. Morris]

Will the Minister address the point that I raised about under-doctored areas, particularly deprived areas, where we find it difficult to attract GPs? Would he consider writing off the student loans of those individuals in order to make it attractive to work there?

[Dr Poulter]

The hon. Gentleman and I do not often agree, but I agree with him on this. We have to do more to support medical students and to encourage people from all backgrounds to become medical students. It was a sad indictment of the previous Government that social mobility into many degree courses was falling, and that was particularly the case in medicine. We have been working with the medical schools to look at the importance of early engagement, supporting people from a much younger age, and universities engaging with local communities, as is the case at my medical school, Guy’s, King’s and St Thomas’, where people from more deprived backgrounds are supported and encouraged into medicine by the medical school’s engagement with schools and with pupils from an early age. That is the sort of approach that works.

One of the challenges is the distribution of medical schools and medical places often around our larger cities. The challenge is to support smaller and important medical schools, such as Lancaster, which does a great job of supporting local young people to become medical students and then into medical careers. We need to support those universities to expand where that is appropriate. Many of our traditional models of medical training at medical schools tend to focus from day one on encouraging people to become surgeons. We know that we need to support more people to become general practitioners. What works well and what Lancaster and Keele universities in particular do through their syllabus is to encourage more young people to undertake more placements in general practice. That has a good effect in encouraging those medical students to want to become GPs in their later medical careers.

[Sarah Newton]

Does my hon. Friend agree that the university of Exeter medical school at the Royal Cornwall hospital is an important medical school because it enables people to see general practice in remote rural communities? We know from previous contributions to the debate that that is important in attracting people into remote rural areas.

[Dr Poulter]

My hon. Friend is right. I spoke to medical students and those teaching them in Cornwall on a visit earlier this year. It is important, particularly for rural areas, to encourage more placements in rural areas in general practice. Often at my hon. Friend’s medical school and other medical schools in remote rural areas, there is a good track record of recruiting more local young people so that they are being educated locally. The hope is that those people will stay and work in the local work force and contribute to the local NHS after they graduate. I hope all hon. Members will agree that that is a good thing, particularly in more deprived areas.

I must make progress as I do not want to intrude upon the House’s time for too much longer. There are two or three important points that I want to make. I mentioned that in the health education mandate in 2014 we mandated to increase the number of GP trainees from 40% to 50% of all trainee doctors. That will make 5,000 extra GPs available by 2020. It is important to note, however, that as well as having the appropriate size work force, we must plan for the future shape of the work force. The new models of care set out in the NHS England “Five Year Forward View” will require different models of staffing, and we need to plan with that in mind. That is why Health Education England has established an independent primary care work force commission, chaired by Professor Martin Roland of the university of Cambridge.

In line with the contributions to the debate from a number of hon. Members, including my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), the commission will identify models of primary care that will meet the needs of the future NHS, including a greater emphasis on community and primary services and the more integrated delivery of care, which will involve the better use of multidisciplinary teams. We have been talking about GPs today, but delivering better care in the community is also about nurses, physiotherapists, occupational therapists, pharmacists, speech and language therapists and the many other health care professionals who play a part in delivering high-quality care to patients in general practices and in the community every day through our NHS.

In response to concerns raised by hon. Members about access to services, GP services need to be available to patients in a convenient place and at a convenient time. Achieving improved access to general practice not only benefits patients, but has the potential to create more efficient ways of working, which benefits GPs, practice staff and patients. The previous Government attempted to improve access to GP services by establishing a 48-hour access target. We know now that that target did not work. From 2007 to 2010, the proportion of patients who were able to get an appointment within 48 hours when they wanted one declined by 6%.

A 48-hour target can make it more difficult for some of the more vulnerable patient groups who GPs look after, particularly people with complex medical co-morbidities, to get the important routine appointments that they need. We should bear in mind that targets can be perverse. That target did not work in its own right, and could make it more difficult for people with complex needs and the vulnerable and frail elderly to get the routine appointments that keep them well and properly supported in the community.

Many points have been made about Labour’s disastrous 2004 GP contract. I do not need to rehearse those. The single biggest barrier to access to care is not being able to see their GP when people need to, in the evenings and at weekends. We have put together the Prime Minister’s fund with £100 million to back it to improve access to GP services in the evenings and at weekends, to make sure that patients receive the better service that they deserve.

[Mr Reed]

In 1997, only half of patients could see a GP within 48 hours. By 2010 the vast majority could do so. Does the Minister agree with Maureen Baker of the Royal College of General Practitioners, who said:

“It is ludicrous to continue to blame a GP-contract that is more than ten years old for the woes currently besetting the entire NHS”?

[Dr Poulter]

It is easy for the hon. Gentleman to take quotes out of context. It is undoubtedly the case that A and E admissions rose dramatically and the pressure on A and E increased dramatically because people could not access their GP out of hours. Of course that is the case. The facts and the statistics bear that out. Also, many people work, so having access to their GP service in the evenings is increasingly important to working people, so that they can see their GP at a time that is convenient to them. We have a chronic disease burden, which all hon. Members are concerned about, so why should primary and community care services be unavailable at weekends? That is not a well structured GP contract or arrangement. It is important that we do our very best to put that right.

Mike O’Brien, who was a Health Minister in the previous Labour Government, is on the record as having criticised that GP contract and the damage it did to patient care. We want to support GPs to provide a seven-days-a-week service again, which is why we have put in place the Prime Minister’s fund. I hope that the hon. Member for Copeland, putting aside party political differences, will recognise that GP services need to be properly available to patients seven days a week.

[Mr John Baron (Basildon and Billericay) (Con)]

Will my hon. Friend give way?

[Dr Poulter]

I am encroaching on the House’s time and have been generous in giving way, so I will bring my remarks to a conclusion.

As the Prime Minister has said, a strong NHS needs a strong economy. As a result of this Government’s prudent economic policies and long-term economic plan, we have been able to proceed with several major investments in general practice and primary care more broadly. Between 2012-13 and 2013-14, the total spend on general practice increased in cash terms by £229 million. Many hon. Members, and the hon. Member for Walthamstow (Stella Creasy) in particular, raised concerns about the quality of GP premises. On top of the increased funding, therefore, we recently announced a £1 billion investment in primary and community care infrastructure over the next four years. It aims to improve premises, help practices to harness technology, give them the space they need to offer more appointments and lay the foundations for more integrated care to be delivered in community settings.

[Stella Creasy]

Will the Minister give way?

[Dr Poulter]

I will give way one last time, but then I will have to conclude.

[Stella Creasy]

In my contribution I specifically asked the Minister whether he would commit to a review of GP access in Walthamstow because of the combination of problems—the two-week wait for appointments, the poor quality of surgeries and the single-practice GPs. Will he make that commitment today to the people of Walthamstow?

[Dr Poulter]

I hope that I have given the hon. Lady some reassurance about the Government’s commitment to invest £1 billion in primary and community care infrastructure over the next four years, which will help many local GPs. I also gave a reassurance to her hon. Friends earlier in the debate. I will certainly ask my noble Friend Earl Howe to look into the matter and write to her. He might also be available for a meeting, if time permits, before the end of this Parliament.

Integrating care is of course a priority for the Government. The better care fund has already made headway by combining £5.3 billion of existing funding into local authorities and the NHS—combining health and social care pots, which will be of great benefit to the frail elderly and people with long-term conditions such as dementia and heart disease. In addition, we have backed the new models of care set out in NHS England’s “Five Year Forward View”, with a £200 million transformation fund. That will allow the NHS to pilot new models, such as multi-speciality community providers, which aim to provide more proactive, person-centred and joined-up care.

In conclusion, the initiatives that I have described are geared around not only increasing the cash and resources available for general practice in the short term, but radically transforming the way we deliver care, which will ensure that we have GP services fit for the future.

[Sir Gerald Howarth (Aldershot) (Con)]

Will my hon. Friend give way?

[Dr Poulter]

I will take one last intervention.

[Sir Gerald Howarth]

I am extremely grateful to my hon. Friend and to the House, because I have been following this important debate not only occasionally in the Chamber, but on the screens. In the area around Aldershot and Camberley, GPs have got together to provide out-of-hours services run by them, and it works, so there are good practices providing accessible out-of-hours services, where GPs have come together to provide that cover for their patients, not for other surgeries’ patients.

[Dr Poulter]

My hon. Friend makes an important point. We talked earlier about the GP contract changes in 2004. Many local GPs have recognised the barriers that can be put in the way of delivering high-quality, local patient care and have worked together to provide local solutions. My right hon. Friend the Prime Minister has provided £100 million to support the return to seven-days-a-week services, and I think that rural practices will increasingly want to bid for that fund. Initial funding has predominantly gone to urban areas, but areas such as Suffolk are now looking to bid, because local GPs recognise that it is in the best interests of patients to provide locally run, seven-days-a-week services. I commend my hon. Friend’s local GPs for what they are doing to deliver that care in Aldershot.

Under this Government, more money is going to general practice. We have returned to having a dedicated GP for every patient. There are over 1,000 more GPs, and we plan to train 5,000 more. If we have a Conservative-led Government after May, we will return to seven-days-a-week GP care for all by 2020. This Government are backing GPs and delivering the care that patients deserve.

Law Commission: Government Response

Dan Poulter Excerpts

Thursday 29th January 2015 Written Statements

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

The Government are today publishing, on behalf of all four countries, “Regulation of Health Care Professionals: Regulation of Social Care Professionals in England—the Government’s response to Law Commission report 345, Scottish Law Commission report 237 and Northern Ireland Law Commission report 18 (2014) Cm 8839.” The response has been laid before Parliament and is available in the Library of the House.

In accordance with the protocol between the Lord Chancellor and the Law Commission I am providing a full response to the Commissions.

I would like to thank the Law Commission, the Scottish Law Commission and the Northern Ireland Law Commission for their report, published in April 2014, and for their hugely helpful work reviewing complex professional regulation legislation.

The Government are grateful for this thorough and considered review of complex legislative framework governing regulation of health care professionals and in England, social care professionals. We have accepted the large majority of the Law Commissions’ recommendations in full, and others in part.

There are a small number of areas where we disagree with the Law Commissions’ recommendations—where we wish to take a different approach, or where further work needs to be done. However, we overwhelmingly support the Commissions’ ambition for improvements and where appropriate, greater consistency across the regulation of health professionals including robust governance structures for regulatory bodies, enabling innovation in education and leaner processes to enable the regulatory bodies to take swifter action to ensure public protection.

We are now taking the opportunity to consider the Law Commissions’ report and draft Bill, and to work closely with the regulatory bodies to build on the good work the Law Commissions have done. The Government remain committed to legislative change and we are seeking to make changes to enhance public protection through secondary legislation to address a number of priority areas that we have identified in discussion with the regulatory bodies.

In addition, the Health and Social Care (Safety and Quality) Bill, presented by my hon. Friend, the Member for Stafford (Jeremy Lefroy) is also seeking, with Government support, to introduce consistent objectives for the PSA and for some of the regulatory bodies, and a requirement for those regulators’ panels and committees to have regard to the objectives when determining whether a practitioner is fit to practise and when determining what sanctions might be appropriate. This builds on the Law Commissions’ recommendations 13 and 85.

We consider the Law Commissions’ report and draft Bill are a significant advance towards making sure that our professional regulation system is fit for the future, and the Government are committed to legislate further on this matter in due course. As the Government move forward on professional regulation legislation, we will make sure it is right, not only for the regulatory bodies, but also for the public, patients, and registrants. The Government’s response can be viewed online at: http://www.parliament.uk/writtenstatements

[HCWS235]

Language Controls: Health Professionals

Dan Poulter Excerpts

Thursday 29th January 2015 Written Statements

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

We greatly value the contributions that health care professionals from all over the world have made, and continue to make to our NHS, but it is essential that they have sufficient knowledge of the English language to provide safe patient care. In 2014, changes were introduced to strengthen the law in this area for doctors, by introducing language controls for European economic area (EEA) doctors wishing to practise in the UK.

The Department of Health has since been working with the Nursing and Midwifery Council (NMC), the General Dental Council (GDC), the General Pharmaceutical Council (GPhC) the Pharmaceutical Society of Northern Ireland (PSNI), and with other stakeholders, to look at ways to ensure more rigorous language competency tests can be applied for nurses, pharmacists and dentists from within the EEA. This would bring language controls for EEA health care professionals in line with the language tests and controls applied to non-European applicants who wish to treat patients in the UK.

For this reason, on 3 November 2014 the Department went out to consult on proposals to allow these regulatory bodies to apply language controls to healthcare professionals seeking entry to their registers, to ensure they have a sufficient knowledge of the English language to enable them to practise safely in the UK.

The Department has today published a consultation report, “Language controls for nurses, midwives, dentists, dental care professionals, pharmacists and pharmacy technicians—proposed changes to the Dentists Act 1984, the Nursing and Midwifery Order 2001, the Pharmacy Order 2010 and the Pharmacy (Northern Ireland) Order 197—A four country consultation report” which sets out our findings has been placed in the Library of the House. It is also available online at:

http://www.parliament.uk/writtenstatements

The proposed legislative changes to strengthen language testing of health care professionals will be an effective way of ensuring the language competence of all overseas nurses, midwives, dentists, dental care professionals, pharmacists and pharmacy technicians. This change in the law will mark an important milestone in improving patient safety and care.

The Health Care and Associated Professions (Knowledge of English) Order 2015 will be laid in Parliament shortly.

[HCWS233]

Hormone Replacement Therapy Implant

Dan Poulter Excerpts

Wednesday 28th January 2015 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I congratulate my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) on securing this debate on the funding of hormone replacement therapy implants. She gives me the opportunity to discuss the issues she has raised on behalf of her constituent, Sarah, and others more generally.

Hormone replacement therapy is effective for treating women who are entering the menopause and experiencing hot flushes and night sweats as well as sleep and mood disturbances. There are a number of different types of hormone replacement therapies available, including an oral tablet taken daily, or a transdermal patch applied once or twice weekly.

We should acknowledge that there are risks for those who are prescribed hormone replacement therapy, and the guidance of the National Institute for Health and Care Excellence suggests that, among other risks, there is a small increased risk of breast cancer, stroke and gallbladder disease.

Turning to the issues raised today concerning hormone replacement therapy implants, I have been advised by the Health and Social Care Information Centre that the number of items prescribed and dispensed for hormone replacement therapy implants has been declining since 1996, from around 36,700 prescription items per year to around 5,300 in 2010, the year prior to the licence being withdrawn. HRT implant prescriptions are now down to negligible levels.

HRT implants are no longer routinely offered as a treatment for menopausal symptoms, as my hon. Friend said, and that has been the case since 2011 when the manufacturer of the licensed product, the pharmaceutical company MSD, stopped making the implants. The decision to cease manufacture was based on two main factors. First, therapeutic alternatives are available in the UK, including tablets taken by mouth, patches and gels. Secondly, cost-effective manufacturing processes are unsustainable because few countries use the implant formulation.

GPs and prescribers were advised in 2011 that treatment should be continued until a discussion could take place between the patient and their prescriber. I understand that most GPs and prescribers reviewed their patients at that time and agreed suitable alternative treatments to switch to. The Medicines and Healthcare Products Regulatory Agency advises me that the only HRT implant preparations now available are not licensed for use in England, as my hon. Friend pointed out.

There has been a change in the prescribing culture surrounding HRT implants. In the past, they were popular as they gave a steady amount of oestrogen over a period of time and women did not experience fluctuating hormone levels. However, the insertion of HRT implants requires a small surgical procedure, and that can only be done by certain clinicians. Some women increased their tolerance to HRT as a result of having an implant, and returned for higher and higher doses at reducing intervals.

Newer hormone replacement therapy patches now provide steady amounts of oestrogen hormone without the disadvantages of the implant, and this phenomenon of HRT tolerance occurs less frequently.

[Tracey Crouch]

I understand what the Minister is saying, but does he recognise that some women have allergic reactions to the patches? Certainly, my constituents who came to see me found that neither the patches nor the gel offered a suitable alternative to the implant, not least because the patches often fall off or there is some kind of reaction to them.

[Dr Poulter]

Indeed. My hon. Friend makes a fair point, and I shall make some reassuring comments in that regard in a moment. It is possible to have a reaction to a device or implant, and one would hope that if people have an allergy or reaction to any product, that would be taken into account before it is used. If it causes discomfort, irritation or any adverse reaction, its use should be discontinued and alternative therapies considered.

Clinical commissioning groups are responsible at local level for commissioning the majority of NHS services, and decisions about those services should be made, we would all agree, as close to patients as possible by those who are best placed to work with the patients and the public to understand their needs. Local NHS commissioners now have the freedom and autonomy to take responsibility for meeting the needs of patients in their area, and other health care professionals can work with the CCG, including in secondary care, to help to integrate and join up services more effectively. While clinical commissioning groups are led by primary care professionals, they are also guided by the expertise of other local clinicians.

I understand that my hon. Friend’s local CCG—Medway CCG—released new guidance on HRT implants in 2014. The guidance states that from April 2014, patients will no longer be able routinely to receive hormone replacement therapy implants from their GP. Medway CCG has advised me that the guidance was developed for HRT treatment following clinical input and review through a clear governance process. Because HRT implants are no longer licensed and more suitable alternatives are generally available, the CCG decided that it would no longer pay GPs for inserting such implants from 1 April 2014. The CCG’s policy is in accordance with General Medical Council guidance on prescribing unlicensed medicines, and my hon. Friend will appreciate that medical professionals and doctors have to have regard to those requirements under the licence that they hold, and because they are regulated by the GMC. The CCG has assured me that it does not prevent doctors from inserting an HRT implant if they think it is clinically necessary for an individual patient, having assessed their needs and tried alternatives, and providing that they have sufficient evidence to demonstrate the treatment’s safety and effectiveness.

In exceptional circumstances, where a licensed medicine is considered unsuitable or ineffective for an individual, I would expect those patients to be referred for expert opinion. I am pleased that that is exactly what happened in Sarah’s case, and that Chelsea and Westminster hospital provided her with excellent care and support. We would expect a similar process to be in place in other CCGs. If someone needs more expert support and care, perhaps because they are suffering from the menopause and their GP finds their symptoms and presentation complicated, there should always be a facility for referral to specialist care and support. What happened in Sarah’s case—thankfully, it has resulted in a positive outcome for her—is available at other centres of excellence. Expert care and advice is there, and available for patients.

Medway CCG has written to GPs locally to issue information that they can share with all patients who are still using HRT implants, and to ask them to discuss alternative forms of HRT with them at their next routine appointment.

The CCG advises me that patients should be referred to a gynaecologist for expert opinion if the GP and their patient consider that there is no suitable alternative to the HRT implant. I hope that that is reassuring to my hon. Friend. At a local level the CCG has taken the issue seriously and has written to local GPs and reminded them of the importance of reviewing the current treatment plan for women who have the implant, but if they need more specialist support and advice, to make sure that a referral is made to a specialist centre of care. That process should be available to patients throughout the country. Where specialist support is required, CCGs should routinely refer those patients on. That is part and parcel of good medical practice.

Most of the time, HRT therapy and the expertise of GPs in supporting patients through menopause is enough for the majority of patients, as my hon. Friend outlined, but sometimes there is a need for more specialist support. Centres of excellence such as the Chelsea and Westminster can provide that and consider alternative treatments and therapies where they may be appropriate.

I hope my hon. Friend finds that reassuring. I thank her once again for bringing the issue to the attention of the House. I hope I have been able to provide some reassurance to her on the issues she raised regarding support for women in Medway who need HRT therapy and potentially implants, and more generally on the process that is in place to ensure that women who need specialist care and support can receive it, and that all CCGs and all doctors would always be mindful to take the right action for the patients they look after.

Question put and agreed to.

NHS (Government Spending)

Dan Poulter Excerpts

Wednesday 28th January 2015 Commons Chamber

[Chris Leslie]

We have to do far more to create a joined-up health service and social care system. That is very much part of the 10-year plan for the NHS that we announced yesterday. Yes, this is a debate about resources and getting the investment in, but we have to do more than that.

I question why the Conservatives are not putting their plans for funding the NHS on the record. Is it that they do not have any plans to pay for it or, which is more likely, that they are committed to shrinking public service investment in this country? The Conservatives and the Liberal Democrats have signed off on projections that would shrink public services to just 35% of GDP by the end of the coming Parliament. [Interruption.] I say to the hon. Member for Daventry (Chris Heaton-Harris) that there was nothing in the charter for budget responsibility about shrinking the state to 35% of GDP. That is his plan. Public services have not been at that level since the late 1930s—before the NHS even existed.

That is the Conservatives’ vision, but what would it mean for the NHS? We are fortunate in this country that charging makes up just 10% of a patient’s out-of-pocket expenses. That includes prescriptions, optical services and dental services. Let us just look at how it works in those countries where public services form just 35% or less of GDP. There are four such countries across the OECD. In Switzerland, where public services make up 32.8% of GDP, more than a quarter of a patient’s income goes towards the cost of treatments. It has an insurance system in which the patient effectively pays an excess: as with a car insurance system, the patient has to pay the first amount and it is deducted from the total bill. Patients in Switzerland typically pay £1,800 out of their own pockets. In Mexico, charging makes up 44% of out-of-pocket expenses, in Chile it is 32% and in Korea it is 36%. Korea has a co-payment system, which means that up to half the hospital costs have to be borne by the patient.

Such things happen in every country where less than 35% of GDP goes towards public services. The Conservatives want to head us in the direction of such pressures. An NHS free at the point of use is not sustainable under the Conservative plans, and the risk that charges will be introduced is great.

The Conservatives have form on this issue, because their 2005 manifesto, which the Prime Minister and the Chancellor authored, encouraged people to go private. They wanted a patient passport that would have introduced charges for people who wanted to jump the queue. I wonder whether my hon. Friends recall that. The Prime Minister and the Chancellor wanted such charges for basic medical treatments. I have another question for the Minister and, again, I will give way to him. Would the Conservative party still introduce those plans in the dreadful event that they won the next general election? I will give way to the Minister if he wants to say that that is categorically not part of his party’s plans.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I am sure that the hon. Gentleman can be patient. I will reply to him in a few moments when he finishes his speech.

[Chris Leslie]

It was quite a simple question. The Minister could have dealt with it there and then, and pushed the matter to one side. I half expected him to do so. But no, that is not the answer he gave. Perhaps we are seeing the return of Michael Howard. The patient passport rears its head again.

What else can we expect from the Conservatives? More privatisation and more market-based changes.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I welcome this opportunity to discuss the NHS. In answer to the question from the hon. Member for Nottingham East (Chris Leslie), I reconfirm the Government’s commitment to an NHS free at the point of need and free at the point of delivery. Only with a strong economy can we afford to pay for our NHS.

It would be wrong to open my remarks without commenting on the Labour party’s increasingly regrettable approach of weaponising the NHS. I still work as an NHS hospital doctor. There are a lot of professional politicians on the Opposition Front Bench. In my capacity as a local MP, I have been out on the front line with the East of England ambulance service during night shifts over this busy winter period. Front-line NHS staff do not appreciate the way in which the Labour party is trying to run down our NHS. There are a lot of staff working incredibly hard over this busy winter period and they should be congratulated on the effort and dedication that they put into front-line patient care. I hope that the hon. Member for Nottingham East and the Leader of the Opposition will reflect on that.

As this is an economic motion, it is appropriate in my opening remarks to address the economic situation our country was in when we came into government. We inherited the worst economic record of any new Government since the 1930s. Labour’s record of economic incompetence and profligate spending meant that the annual deficit was £134 billion and that we were paying back £367 million each and every day in debt interest alone. I believe that the hon. Member for Nottingham East was a special adviser who advised on that profligacy and incompetence. Labour left Britain with its largest deficit since the second world war. One pound in every four that was spent by the Government came from borrowing. Labour’s outgoing Chief Secretary to the Treasury, the right hon. Member for Birmingham, Hodge Hill (Mr Byrne), summed it up in his note to his successor with the words, “Good luck. There’s no money left.” There we have it—Labour’s record of economic incompetence. Britain was bankrupted by the last Labour Government, but thanks to our long-term economic plan things have changed for the better and Britain is back on track. There are now 2.16 million more private sector jobs since the coalition came to power, and 2 million more people have started an apprenticeship. The Government are giving more young people a chance in life and the opportunity to take home a pay packet.

[Grahame M. Morris]

May I just point out one of the lessons from history? When the NHS was established after the second world war, the country was tasked with rebuilding and its debt and deficit were considerable. But the Labour politicians of the day had the strength of character and the will to make that investment in the interests of the health of the nation. Should we not do that now?

--- Later in debate ---

[Dr Poulter]

To take the intervention in the spirit in which it was intended, I recognise that the hon. Gentleman is committed to our NHS, as are Members on this side of the House. That commitment to and investment in the NHS has been made clear by the fact that we have increased NHS spending by £12.7 billion during this Parliament.

Opposition Members have also incorrectly asserted that our long-term economic plan is taking Britain back to the 1930s, but the latest forecast from the independent Office for Budget Responsibility shows that our plans would reduce total Government spending as a share of GDP from some 40% today to 35.2% by the end of the next Parliament in 2020—the same levels of public spending as were proposed under Labour in 2002, when the right hon. Members for Doncaster North (Edward Miliband) and for Morley and Outwood (Ed Balls) were in the Treasury. If it was appropriate to set public spending at that level under Labour when they were in government, they need to explain why it is somehow wrong for a Conservative-led or coalition Government to plan for a similar level of public expenditure in the future—something that the Labour party has completely failed to do to date.

[Rosie Cooper (West Lancashire) (Lab)]

The Minister referred to the goodbye note from my right hon. Friend the Member for Birmingham, Hodge Hill (Mr Byrne). Would the Minister’s goodbye note say, “Good luck, there’s no NHS”?

[Dr Poulter]

Such drivel, frankly, is beneath the hon. Lady. We have made considerable additional investment in the NHS. Comparisons between an NHS run by a coalition Government in England and the NHS in Wales bear up very well for the NHS in England.

[Caroline Lucas]

Just before I came into this debate I met a 10-year-old constituent, Margot, and her mother, who works for the NHS. She works all hours and still struggles to put enough food on the table. Can the Minister explain why the Prime Minister does not care about NHS workers? That is what Margot wants to know and that is what the rest of the country want to know.

[Dr Poulter]

I am familiar with the hon. Lady’s constituency, having worked as a doctor at a hospital in the area. Her question is very disingenuous when we have increased the number of front-line clinical staff working in our NHS, investing in more staff to treat patients. We have also recently agreed with the unions a pay deal that will see the majority of NHS staff receiving a substantial increase in pay, thanks largely to their increments. Other staff will receive 1%.

[Mr Mark Spencer (Sherwood) (Con)]

The Opposition appear to struggle with the concept that we can fund public services only if the economy is moving forward. The interest alone on the debts that the previous Government amassed would have been enough to build a hospital ward every 30 minutes.

[Dr Poulter]

My hon. Friend makes a very good point. On this side of the House we believe that when we spend public money we should do so efficiently and effectively. We have also made Government spending much more efficient—[Interruption.] Rather than heckling, the hon. Member for Liverpool, Wavertree (Luciana Berger) might do well to listen to what I am about to say, because efficient public spending should be a priority for any Government, although it certainly was not for the previous Government. Cabinet Office figures, endorsed by the National Audit Office, show that £14.3 billion of savings, relative to 2009-10, have been made across many areas of expenditure, including procurement, work force, major projects and transformation. That is £850 for every working household saved by this Government, and clearly shows that we are spending public money much more efficiently and wisely than Labour ever did when in office.

[Stephen Gilbert (St Austell and Newquay) (LD)]

Does the Minister agree that money can be spent only once? Labours say it wants to invest £2.5 billion from the mansion tax in the NHS, but it has already promised that to deficit reduction and introducing a 10p tax rate. That is nonsense.

[Dr Poulter]

My hon. Friend makes a very good point. The mansion tax, which is alluded to as a major plank of the Opposition’s funding plans for the NHS, has already been spent three times—that is economic incompetence if nothing else.

[Chris Leslie]

The Minister claims to be spending NHS resources effectively. Let us put to one side the £3 billion that he wasted on the NHS reorganisation—difficult though that is to do—and address the issue of clinical negligence in the NHS. My understanding is that it was at about 0.8% of NHS expenditure, but it has now gone up to an astonishing 1.1%. More than £20 billion has been set aside for clinical negligence provision because clinicians do not have the time they need to do the job and stop problems occurring. Should not the Minister apologise for that?

[Dr Poulter]

That is frankly not true and a misrepresentation of the facts. We have a very safe health service, and that was recognised by the Commonwealth Fund. We also know that even in a very safe health service bad things sometimes happen. This is not a controversial point: it is a sensible and important point. In some areas, such as obstetrics, we have very safe care in the main, but sometimes there can be a very high quantum of claims, such as £7 million for a lifetime of care in one case. We have to make sure that in the rare cases when things go wrong we look after people properly. That is uncontroversial.

The projected future trajectory for the litigation bill spend was exactly the same under the previous Government as it is now, and we are looking at dealing with lower value claims to save money on litigation in the future and removing the sometimes adversarial nature of litigation, which is much more beneficial for patients and their families.

[Chris Leslie]

To focus on the detail and take the politics out of this issue, I think that the Minister said that the clinical negligence bills have not gone up under this Government compared with those under the previous Administration. If he wishes to repeat those words, I am sure that his officials and others will correct him. Does he really think that there are no further clinical negligence liabilities under his watch?

[Dr Poulter]

The point is that the figures for the expected trajectory of clinical negligence were the same under the previous Government as under this Government. We know that even though the NHS and its front-line staff deliver safe and effective care in the main, the costs of looking after people—who may not previously have survived into adulthood, but do so now because care has improved—are now much greater. As a result, the quantum of settlements is sometimes greater than it used to be because our NHS is doing better at helping people, who previously might have died in childhood, to live longer. That means a greater lifetime of care costs, which the previous Government would have been familiar with when they looked at future litigation spending. We are, rightly, asking where we can save money on NHS litigation and we will announce soon the results of work on reducing the adversarial nature of low quantum claims, which will also benefit NHS finances.

As senior figures in the Labour party made clear this week, if the previous Labour Government had delivered efficiencies on the scale that we have delivered in our NHS, £40 billion more would have been available for front-line patient care. Let us remember that it was under Labour that £10 billion was wasted on a failed NHS IT contract; that hospitals were crippled by eye-watering PFI repayments, which currently total £2 billion a year; and that the pay bill for NHS managers doubled. Indeed, in the last year under the right hon. Member for Leigh (Andy Burnham), the number of managers in the NHS went up six times as fast as the number of nurses.

[Andy Burnham (Leigh) (Lab)]

I am grateful to the Minister, because I was going to mention my last year in office. Would he care to inform the House what the bill for management consultancy in the NHS was in 2010 and what it is now?

[Dr Poulter]

I have just told the right hon. Gentleman very clearly that the cost of NHS managers doubled under the previous Labour Government, a profligate record of spending that has taken money away from front-line patient care.

[Stephen Gilbert]

The Minister missed one thing from the list. A written parliamentary question revealed to me in 2010 that the Labour party spent £250 million paying private providers to do precisely nothing.

[Dr Poulter]

My hon. Friend makes a very important point. We could stand here all day talking about the inefficiencies and profligacy in running the NHS finances by the previous Labour Government. He is also right to highlight—

[Andy Burnham]

Will the Minister give way?

[Dr Poulter]

I am going to make some progress. I will give way to the right hon. Gentleman later. I have been very generous and I need to make some progress. I remind him that under the previous Labour Government, as my hon. Friend the Member for St Austell and Newquay (Stephen Gilbert) highlighted quite rightly, NHS providers were paid less than private sector providers. The right hon. Gentleman and the previous Labour Government paid the private sector 11% more than the NHS for performing the same NHS operations—something we have clearly outlawed under our legislation.

If we needed a further reminder of what Labour does when it runs the health service we need only look at Wales today, where almost every indicator of NHS performance shows that the Welsh NHS, run by Labour, is performing poorly when compared with the NHS in England. While we protected and increased our NHS budget in England, Labour in Wales has cut the NHS budget and patients are paying the price. Thanks to Labour in Wales, people have to wait about 100 days longer than patients in England for knee and hip operations. On finances and on care, Labour has let down our hard-working NHS staff and patients in Wales by its lack of investment in front-line services.

[Charlie Elphicke]

Will my hon. Friend give way?

[Dr Poulter]

I will give way one more time, but I do need to make some progress.

[Charlie Elphicke]

I am sure the Minister would agree that the shadow Health Secretary could have opened this debate, rather than trying to intervene now in a desperate way. Does my hon. Friend also recall the shadow Secretary of State, when he was Health Secretary in 2009, saying that we can

“move beyond the polarising debates of the last decade over private or public sector provision”?

That is what he said then. What does he say these days?

[Dr Poulter]

My hon. Friend is absolutely right. The fact that the shadow Health Secretary’s colleague, the hon. Member for Nottingham East, opened the debate perhaps shows a lack of confidence. The shadow Health Secretary’s record is very difficult to defend.

[Andy Burnham]

Will the Minister give way?

[Dr Poulter]

If the right hon. Gentleman wanted to contribute to the debate in such a meaningful way, why did he not have the courage to stand here and speak in this debate? I have been very generous in giving way. I know he does not like to be reminded of his record in office. Frankly, on NHS finances his record is abysmal, just like the previous Labour Government’s record of running our economy. If he wants to contribute he should speak in the debate. I will give way generously again later, but I want to make some progress.

On the Government Benches, we know that we cannot have a strong NHS without a strong economy. In spite of the profoundly challenging financial position we inherited from Labour, I am proud that this Government have increased NHS funding in each year of this Parliament. As a result of the additional funding announced in the autumn statement for 2015-16, funding will be £16 billion higher in cash terms in 2015-16 than it was in 2010-11. That equates to an increase of £6.8 billion in real terms for our national health service under this Government.

Our NHS is also on track to deliver up to £20 billion of efficiency savings this Parliament, having reported about £15 billion of efficiencies in the first three years. All of that has, or will be, reinvested into front-line patient care. Our commitment to our NHS has meant that, since the last election in 2010, there are now more than 17,200 more professionally qualified clinical staff, including over 9,000 more doctors, enabling 850,000 more people to have operations than in 2010, and over 3,300 more nurses, midwives and health visitors. Fewer patients are waiting to start treatment, and hospital infections have virtually halved. Mixed-sex wards, a great scandal of the previous Government, have largely become a thing of the past. I could, and will, go on in a moment.

[Alison Seabeck (Plymouth, Moor View) (Lab)]

The Minister talks about more nurses. Derriford hospital in Plymouth has had to fill more than 60 vacancies with nurses from overseas. Morale is so low among nurses in the UK—plus we are not training them—it cannot fill those vacancies. He spoke earlier about a substantial pay rise. Would he like to explain to the nurses in my constituency exactly how substantial that pay rise is, because they do not think they have had a substantial pay rise?

[Dr Poulter]

Through the “Agenda for Change” settlement, many nurses will receive an incremental pay rise worth an average, I think, of between 3.2% and 3.4%. On top of that, we have come to an agreement with the unions to give a 1% rise, particularly to the lower paid NHS staff. That is something I hope the hon. Lady welcomes. It is worth highlighting that one of the biggest things that supports front-line staff is increasing numbers. In Plymouth Hospitals NHS Trust, the number of hospital doctors since 2010 has increased by 25 and the number of nurses by 62. That shows that the investment we are making at national level is paying dividends at local level in her trust.

[Barbara Keeley]

Will the Minister give way?

[Dr Poulter]

I am going to make some progress and I am sure I will give way to the hon. Lady later on.

The investment we are making in the NHS also means that our NHS is caring for more patients than it has ever done before. Last year, compared with Labour’s last year in office, there were 1.2 million more episodes of in-patient care, including 850,000 more operations, 6.1 million more out-patient appointments, 3.6 million more diagnostic tests and almost 460,000 more GP referrals seen by a specialist for suspected cancer, meaning that under this Government more patients are receiving early referral for important care. We have also reduced the number of administrators in our NHS by 20,000. That is freeing up more cash to be reinvested in the front line of patient care.

[James Morris (Halesowen and Rowley Regis) (Con)]

While we are talking about future resources for the NHS, may I commend the Government for what they have done to move towards parity of esteem in mental health and investment in talking therapies? Is it not important, when we consider future NHS resources, to consider the balance of the £14 billion that we currently spend on mental health services and how we can further invest in mental health services over the next Parliament?

[Dr Poulter]

My hon. Friend makes an important point. We have made considerable progress under this Government in improving the funding in the past year—£302 million more for mental health services—and in making sure that from this year, for the first time, there will be genuine parity between mental and physical health when we introduce access targets. They will ensure that patients are seen in a more timely manner when they suffer from mental illness and need specialist care and referral. Our record in office on mental health is something I think we can be very proud of. We have for the first time in many years reset the debate. There is now becoming a genuine parity of esteem between mental and physical health.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

It is always important to hear the Government talk about parity of esteem. In practice, however, we have seen many examples in the past year where that has not actually applied, whether that is NHS England’s decision to apply a cut to a mental health trust that is 20% higher than for all other trusts, or the figures we saw this year showing that child and adolescent mental health services have been cut by £15 million. Is it not just warm words to talk about parity of esteem, when in reality people have to travel hundreds of miles to access in-patient care or not get any treatment at all?

[Dr Poulter]

Frankly, the previous Government’s record on investing in mental health was woeful. To reassure the hon. Lady—I think it would perhaps be worth her noting the points I have raised—we have increased the mental health budget this year by £302 million. I will talk a little more about support for children with mental ill health later in my remarks.

We have also put a lot of investment and support into tackling perinatal mental health. By 2017, for the first time, mums will have specially qualified and trained staff in every birthing unit to provide support for perinatal mental health. [Interruption.] The hon. Lady says that is not treatment. I am a doctor. I work in maternity. It is absolutely right that we put in place the right support for perinatal mental health. I am sorry, but frankly that is misunderstanding the clinical reality of what it is like to look after patients. It does the hon. Lady—and those on the Opposition Front Bench—a great disservice.

At a time of continued pressure on the public finances, the additional funding announced by the Chancellor in the autumn statement further highlights the priority the Government place on our NHS. The extra money we have provided will enable our NHS to continue to meet significant and rapidly rising patient expectations and demands in the short term, while allowing us to make important investment in new models of community-based care in order to realise the vision set out in NHS England’s “Five Year Forward View”.

The Government’s commitment to our NHS is clear. By ensuring a strong economy, we will also ensure that our NHS remains sustainable in the long term as a health service that is free at the point of need and of use—the health service we all believe in.

[Chris Leslie]

Because I’m a doctor.

--- Later in debate ---

[Dr Poulter]

Well, I am a doctor. It is a pity there are so many professional politicians in the Labour party. Had they experience of real life, they might be able to make a more valuable contribution to debates in this place.

In 2015-16, funding for front-line NHS services in England will be £2 billion higher. Of this additional funding, £1.5 billion will go to local NHS services to meet the ever-growing demand for services and to provide better care for the frail elderly and people with long-term medical conditions, such as heart disease and dementia. In addition, £200 million will go towards piloting new care models set out in NHS England’s “Five Year Forward View”; £250 million will provide the first tranche of the new £1 billion fund, spread over the next four years, for investment in new primary and community care facilities; and about £30 million will go to the NHS to develop the best approaches to caring for young people with eating disorders in both in-patient and community settings—which further answers the question from the hon. Member for Liverpool, Wavertree by confirming this Government’s commitment to providing better care for people with mental illnesses.

[Barbara Keeley]

rose—

[Dr Poulter]

I will give way one more time, but after that I will not give way for a while, as I want to make some progress.

[Barbara Keeley]

I thank the Minister for giving way, particularly as he is a doctor. He never took into account my real-life experience in IT when we debated care.data, so he wants to be careful about saying that people do not have real-life experience—several of us have real-life experience in different industries, but he does not take that into account.

--- Later in debate ---

[Barbara Keeley]

Will the Minister address the issue of delayed discharges and the impact of cutting community resources? We have touched on social care in general practice, funding for which has really been cut, but the big issue that comes up again and again before the Health Select Committee concerns the loss of thousands of district nurses. I heard yesterday that in the north-west agencies do not even have supply district nurses. Will he address the matter of those community resources? He is talking about community care for the elderly and vulnerable. What will be done about district nurses?

[Dr Poulter]

As the hon. Lady will be aware, front-line staff use IT and understand the importance of joining it up to benefit patient care while also protecting confidentiality. On the point about district nurses, she is right that we need to transform the model of care, which is why the Government set up the £5.2 billion better care fund—to ensure we join up more effectively what happens between our acute hospitals, the wider NHS and adult social care. This approach will be transformative, delivering better care for the frail elderly and providing more care in people’s homes.

Of course, part of that is about changing work force models and ensuring that staff who have traditionally worked only in hospitals, supporting people with long-term conditions such as multiple sclerosis, can also work in the community. [Interruption.] The hon. Lady is chuntering away, but I have answered her question in an informed and sensible way, having spoken about how our work force models need to change as part of our investment in integrating and joining up care so that patients looked after now in a purely hospital environment can have access to staff across both community and hospital care, which is important for people with long-term conditions such as diabetes, multiple sclerosis and dementia. I hope she can support that.

It is also important to consider some of the equally important funding decisions we have made in maternity care. In 2013-14, we provided £35 million of capital funding for the NHS to improve birthing environments, which represents the single biggest capital investment in maternity care for decades. That has benefited more than 100 maternity units, including through the establishment of nine new midwifery-led birthing centres in eight areas, and transformed many local maternity services across the country. Improvements delivered by our maternity investment fund include: more en-suite bathroom facilities in more than 40 maternity units, providing more dignity and privacy for women; more equipment such as beds and family rooms in almost 50 birthing units, allowing dads and families to stay overnight and support women while in labour or if their baby needs neonatal care; and bereavement rooms and quiet areas at nearly 20 hospitals to support bereaved families after the thankfully rare but always tragic loss of a baby.

Our £35 million maternity investment has made a big difference to the experience mums and families have of NHS maternity services.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

Will the Minister give way?

[Dr Poulter]

I have been very generous in giving way, but I must now make some progress.

[John Woodcock]

rose—

[Dr Poulter]

No, on this occasion, the hon. Gentleman will have to forgive me.

Our capital investment in maternity services, which, as I said, is the biggest for decades, is making a big difference to mums, dads and new families. Thanks to our investment in the midwifery work force, we now have the highest ever number of midwives working in our NHS—about 2,000 more than in 2010—providing more personalised care and support for women and new mums. However, we must all recognise the challenges facing our health and care system in the months and years ahead. NHS England’s “Five Year Forward View” argued that we needed to do more to tackle the root causes of ill health through a radical upgrade in prevention and public health; to give patients more control over their own care, including through the option of combining health and social care, and new support for carers and volunteers; to ensure the NHS changes to meet the needs of a population that lives longer; and to develop and deliver new models of care, local flexibility and more investment in our work force, technology and innovation, some of which I have already outlined.

That is why the Government have provided additional funding for NHS front-line services in 2015-16, including £200 million to pilot new care models and £250 million for the first tranche of the new £1 billion fund, spread over the next four years, for investment in new primary and community care facilities to support our GPs and primary and community care work force in the important work they do. In community care, we are committed to undoing the terrible mistake that was Labour’s 2004 GP contract, which left so many people, particularly the frail elderly, without the GP care they needed at evenings and weekends. Our investment will support GPs to provide care for patients seven days a week so that patients will once more be properly supported during evenings and weekends. We are also training an extra 5,000 GPs, in addition to the 5,000 extra we have already seen under this Government, to provide that care.

We are clear, however, that if the NHS is to meet the challenge of increasing patient demand and expectations, it cannot stand still. By 2018, 3 million people in our country will have three or more long-term conditions, so we must continually adapt and change how we deliver care to support patients, families and carers, and deliver more care in people’s homes and communities. For our part, and as part of our plan for our NHS, not only are we delivering a strong economy so that we can protect our NHS budget, but we will continue to be ruthless in delivering greater efficiencies in estate management and procurement and in reducing back-office costs so that we can reinvest that money in front-line patient care. Furthermore, we will continue to back front-line staff with the training, equipment and new technology they need to do their job and provide high-quality patient care, which is why we have already made available an additional £2 billion down payment to deliver NHS England’s “Five Year Forward View” and why the Prime Minister has committed to continuing to protect our NHS and ensuring that it has the additional money it needs to deliver first-class patient care in the months and years ahead.

In conclusion, I would like to thank the dedicated NHS staff working incredibly hard to keep us well looked after and safe in this busy winter period. As a practising doctor—I know Labour does not like it, given its dearth of real-life experience and the number of former special advisers on its Front Bench—I know how hard our NHS staff work and how dedicated they are to delivering the highest-quality patient care. I remind the House that we have been able to increase the money available to our NHS only because we have the growing economy to pay for it; because our long-term economic plan is working; and because, under this Conservative-led Government, there are more people in work than there were under Labour. Anybody who does not have an economic plan for the economy—and Labour has no plan for our economy, as has certainly been clear in today’s debate—does not have a plan for the future of our NHS. Through economic policies and by creating growth and jobs, we have been able to announce additional NHS funding for 2015-16 without having to raise taxes, including on people’s homes, as Labour would like to. This gives our NHS the funding it needs to begin implementing the plan set out in NHS England’s “Five Year Forward View”, so that it can continue to be a world-class, sustainable health service, delivered free at the point of need.

When we came into power, we took two big strategic decisions with our NHS: to increase funding and to cut bureaucracy and waste, and to reinvest that money in more doctors, nurses and front-line staff and to improve front-line patient care. That is exactly what we have done, so the choice on 7 May will be clear: between a Labour party that bankrupted Britain and would do so again, at the same time bankrupting our NHS, and a Conservative Government, committed to securing our NHS by delivering a strong, stable and growing economy.

[Several hon. Members]

rose

--- Later in debate ---

[Emily Thornberry (Islington South and Finsbury) (Lab)]

Let me begin by thanking the Minister for his contribution today—particularly as he is a doctor. I also thank him for helping those of us with our Tory NHS debate bingo cards to show that he has used all the words we were expecting—“weaponise”, “Wales”, “long-term economic plan”—and for the additional benefit of sharing his understanding of the international banking crash, which is that it was Mr Brown shovelling money out of the back windows at Lehman Brothers that caused the entire world economy to crash.

Let me move on to perhaps a much more important point. How are we going to fund the national health service in the future? What the Minister did not address—which is a grave disappointment—were some of the matters in the motion that we are supposed to be debating. My constituents prioritise the NHS probably over everything else. For them, it is all about our working together as one community and looking after everyone: no one is more important than anyone else; we all stick together; we pay our taxes and support the weakest; and all of us should be able to get world-class health care. We are very proud of the national health service, which has delivered that. However, my constituents are profoundly concerned about what is going to happen in the future. Can the national health service survive another five years of a Tory Government? The answer they come to very rapidly is no.

The question is a simple one. How can the Prime Minister stand up at the Tory party conference and say, “We’re going to make £7 billion worth of tax cuts,” and not tell us where the money is coming from? How can the Prime Minister or the Chancellor of the Exchequer say that state spending is going to decline to the level it was in the 1930s, when in the 1930s we did not have a national health service? How does that work? How do we square that circle? Without answers to profoundly important questions such as those, the public simply say, “We don’t trust you with the most precious thing we have as part of our British identity. We want to be able to have a national health service that will hold us together.” How can the NHS be safe in the hands of this Government?

[Dr Poulter]

rose—

[Emily Thornberry]

I give way to the doctor.

[Dr Poulter]

The hon. Lady will of course be aware that our plans for public spending will only put it back to the level it was in 2002, under the previous Labour Government, which is hardly the bleak picture she paints. At the same time, we will be able to invest money in our NHS.

[Emily Thornberry]

I still do not understand why, therefore, the Office for Budget Responsibility says that the percentage of state spending will be at the level it was in the 1930s. In the end, although the Minister is a doctor, I would prefer to take the word of the Office for Budget Responsibility. Indeed, I urge the Minister to speak again to his party leader and say to him, “When we come to make manifesto commitments, let’s run them past the Office for Budget Responsibility,” so that the public know whom they can trust on money and particularly on the NHS.

I remember serving on the Health and Social Care Bill Committee for many, many weeks—months, in fact; indeed, I believe it was almost a year of my life. I remember my hon. Friend the Member for Leicester West (Liz Kendall) and I pleading with the Government not to go ahead—not to waste time and money on a top-down reorganisation; not to waste people’s heart and soul on a reorganisation of the national health service in a way that was unnecessary. We said, “All you’re doing is opening the door to privatisation. What you are doing is wrong for the national health service. You must stop. You must think again.” And there was indeed a pause—a pause for an awful lot of spinning—but the Government still forced through a profound reorganisation of the national health service that has allowed the market to come into the NHS and wasted £3 billion.

We also said that if we needed to look again—and we did—at making our national health service appropriate for the 21st century, we should look at how to bring social care and health together. It is difficult, because social care is largely provided by local authorities. Very often it is means-tested and provided locally, with local accountability, whereas the national health service was much more nationally accountable, had much better funds and was not means-tested. However, without those two things moving and working together, we cannot have proper health care in our country, because—and we all know this—most people who use the national health service are elderly. They come to A and E in crisis, and once they are in they are unable to get out again. It is demeaning. It is humiliating. It is something that all of us in the Chamber will face unless something is done.

People must be supported in the community so that they are able to live their lives as healthily as possible—yes, fighting off three or four long-term conditions, but still as healthily as possible. However, while this Government have been cutting the money to local authorities—it is being shovelled out the back door by Eric Pickles—the Health team have been saying, “Oh, it’s all right: we’re giving more money to social care.” But the Government know—and all of us who have friends, relatives or constituents who are using social care know—that there is not enough of it around. Old ladies are getting up and being taken out of bed and are sitting in their chair three hours later than they were before. They are getting visits of 15 minutes. They are not being looked after properly. They have the choice between having a bath and having a meal. In the 21st century, in one of the richest countries in the world, that is a disgrace. How can we really be looking properly at the future of the health service and allowing that to happen? Of course, if people are kept in bed until 11 o’clock in the morning and then being put back to bed at 5 o’clock in the evening, they will become unhealthy. They will end up in A and E in crisis and they will not be able to get out again.

More and more local authorities are cutting back on social care and are giving social care only to those in the most acute need. In the time I have left—I do not have very long, so I am going to rattle through—I want to say what Islington does. Despite having the sixth-worst levels of child poverty in the entire country and one of the worst mental health records in the country, Islington provides social care on a level of which we should be proud. It provides social care at moderate levels. It is working with Whittington Health. The hospital in my constituency is working with the local authority, providing health in the community. The hospital sends people out; we have GPs working in the hospital. It is a model on which I hope the next Government’s—ours—model for proper health and social care will be based: the idea of people working together, looking at the whole person, giving the health service time to care and look after people properly, and giving people the right to die at home with dignity and support.

I want to use the 30 seconds I have left to give due credit to Camden health services for allowing my father-in-law to die at home with true dignity and proper palliative care. It gave him the choice to die in his bed, next to his wife, for which I am profoundly grateful. I know that he was very privileged in being allowed to do that, because up and down the country that is not being allowed. It saved money, gave him what he wanted and gave him pride. Why are we not dealing with problems like that, instead of introducing the private market into our precious national health service?