Vascular Services (Wycombe Hospital)

Dan Poulter Excerpts

Monday 14th January 2013 Commons Chamber

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

I congratulate my hon. Friend the Member for Wycombe (Steve Baker) on securing the debate and raising issues that are pertinent not only to his constituents but to those of my right hon. and learned Friend the Attorney-General, who has been sitting next to me on the Front Bench listening to the debate and who shares a number of my hon. Friend’s concerns.

Before I discuss the substantive points about Wycombe, I should address my hon. Friend’s point about failing management in the NHS. He is right that there is a tendency to recycle failing managers in the NHS, and I am sure that the House will return to that point when my right hon. Friend the Secretary of State responds to the concerns raised in the Mid Staffordshire inquiry, following the Department’s receipt of the report.

It is worth paying tribute to the dedicated health care workers in Wycombe and the surrounding areas of Buckinghamshire, because my hon. Friend has a number of excellent clinicians. He highlighted several local successes in delivering high-quality care through vascular surgery, and I know that there are good outcomes locally in specialties such as carotid endarterectomy. He has many excellent doctors and nurses and other front-line health care professionals, and also some very good managers, who have the best interests of their patients at heart and deliver high-quality health care outcomes for local patients on a daily basis, 365 days a year.

My hon. Friend rightly highlighted some local concerns about the ongoing loss of services at Wycombe hospital, and it is worth reiterating some of his words. He said that the hospital had lost A and E, consultant-led maternity—retaining a midwifery-led unit as a concession —and paediatrics, and this year the emergency medical centre was downgraded to a minor injuries unit, resulting in a repeat of much of the local outcry at the loss of A and E, and now he has highlighted eloquently the concerns over the potential loss of some of the vascular services at the hospital.

It is worth pointing out that I was reassured today before coming to the debate by local health care commissioners in the Wycombe area that there is a strong future for Wycombe hospital. There is no threat of the hospital being downgraded to the point of closure. Commissioners today reassured me—and I hope that this reassures my hon. Friend—that in many areas Wycombe provides a very good site further to develop health care services the better to meet the needs of the local population. It is an excellent satellite site, combined with Stoke Mandeville, for providing high-quality, close-to-home health care. From discussions that I have had, I believe that there may be the possibility of improving further some of the cardiac care that is offered.

I come specifically to the issues that my hon. Friend raised about vascular services, which are particularly important in Wycombe, which has a large Asian population, among whom, as we all know, there is a higher rate of cardiovascular disease. It has a higher rate of diabetes and many cardiovascular illnesses. My hon. Friend highlighted eloquently the number of local vascular services provided, and particularly referred to amputation services. We know that one of the complications of vascular disease and diabetes is the higher rates of amputation among some patients. It is quite right that he wants to make sure that high-quality services are provided locally to meet the established need for patients who require vascular services, and that those patients have a holistic service that looks not just at their immediate medical needs but provides high-quality surgical care.

We know that as lifestyles, society and medicine change, the NHS must continually adapt. The NHS has always had to respond to patients’ changing expectations and to advances in technology. When we do change and reconfigure services, it must be about modernising facilities and improving the delivery of high-quality patient care. In that context, it is also important that while we have to recognise that some services are better provided in larger centres of care— for example, the John Radcliffe centre, which can offer super-specialist services—where the clinical outcomes for patients are better, we must also provide high-quality local services, particularly for older people. We know that the majority of vascular patients often fall into an older age demographic, and it is important that when there is any service reconfiguration, those day-to-day outpatient clinics for vascular patients are maintained locally. I am reassured that in the potential reconfiguration, bread-and-butter outpatient clinics and continuity of care for vascular patients will be maintained.

The Government are also clear that the reconfiguration of front-line health services is a matter for the local NHS. Services should be tailored to meet the needs of local people, and the four tests laid down in 2010 by the previous Secretary of State for Health, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), require that local reconfiguration plans demonstrate support from GP commissioners, strengthened public and patient engagement, clarity on the clinical evidence base and support for patient choice. If my hon. Friend is worried that these tests have not been met in the local reconfiguration, he has the opportunity directly to challenge them or to ask the local health scrutiny committee to refer them to the Secretary of State for review.

[Tim Farron]

The Minister rightly says that the NHS reforms allow local councillors to vote to refer such matters to Ministers. In my area of Morecambe bay, that opportunity comes on 22 January. Will he assure councillors that Ministers will take such referrals very seriously and look into them with great rigour?

[Dr Poulter]

Yes. I assure my hon. Friend that when a referral is made by a local overview and scrutiny panel the Secretary of State will look at it and decide whether to refer it to the independent reconfiguration panel. That is often the decision that is made in these cases, but it lies initially with the Secretary of State, who will then have to consider whether to refer it. I am happy to write to my hon. Friend further to outline these steps if that would be helpful.

It is worth highlighting the national parameters that are being set for the delivery of good vascular surgery by the NHS Commissioning Board, which takes over full responsibility for commissioning from April this year. The board published a draft national service specification for vascular surgery for consultation. The consultation commenced in December 2012 and will conclude on 25 January 2013. It identifies the service model, work force and infrastructure required of a vascular centre. It says:

“There are two service models emerging which enable sustainable delivery of the required infrastructure, patient volumes, and improved clinical outcomes. Both models are based on the concept of a network of providers working together to deliver comprehensive patient care pathways centralising where necessary and continuing to provide some services in local settings…One provider network model has only two levels of care: all elective and emergency arterial vascular care centralised in a single centre with outpatient assessment, diagnostics and vascular consultations undertaken in the centre and local hospitals.

The alternative network model has three levels of care: all elective and emergency arterial care provided in a single centre linked to some neighbouring hospitals which would provide non arterial vascular care and with outpatient assessment, diagnostics and vascular consultations undertaken in these and other local hospitals. All Trusts that provide a vascular service must belong to a vascular provider network.”

In essence, this is about making sure that we deliver high-quality vascular care. There are two or three circumstances in which someone would require vascular care. First, there is emergency care—for example, when there is a road traffic accident, or when someone has a leaking aortic aneurysm, which is a very severe and potentially life-threatening emergency. We know from medical data that such service provided in an emergency is much better provided in a specialist centre—an acute setting such as the John Radcliffe, which would be the hub and the central focus. There is also good evidence that trauma care in any setting, including the requirement for neurological specialists potentially to be involved, is better served in a specialist trauma centre. A specialist centre provides better care in emergencies.

At the same time, it is clear from those models that there can also be a strong role for other hospitals as satellites of the central hub at the John Radcliffe. My hon. Friend clearly made the case for the high-quality outcomes at Wycombe hospital for carotid endarterectomies and other vascular services. I would suggest that there is a role for challenging local commissioners if they wished to remove some elective procedures from Wycombe when there is a case that they can still be delivered in a high-quality manner and to a good standard for patients.

[Steve Baker]

I apologise for intervening on the Minister when there is so little time left, but I can see the campaigners leaping up and down and saying that the clinical evidence in this case is that Wycombe is doing better than Oxford on aneuryism repair.

[Dr Poulter]

The evidence on the outcomes of patients from many trials does stack up over a period of time. Generally speaking, all surgeons need to do a minimum number of procedures in order to maintain regular competency, and to maintain continually high and good outcomes for patients when carrying out aneuryism repair. That is the reason for the service reconfiguration. The argument can be made, as my hon. Friend has done, that Wycombe should continue to provide those services, but we know that the national data and best evidence point to the fact that the services are best provided at specialist centres.

However, there is a good case for my hon. Friend to take forward to the local commissioners about ensuring that more of those elective procedures and elective amputations remain local, and I am sure that he will do that. I am sure that he will also want to talk to his local health scrutiny committee to ensure that it refers cases to the Secretary of State for review, if required. I thank him once again for raising the matter in the debate.

Question put and agreed to.

Newark Hospital

Dan Poulter Excerpts

Monday 7th January 2013 Commons Chamber

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

I congratulate my hon. Friend the Member for Newark (Patrick Mercer) on securing this debate and on his continued, long-standing dedication to and strong advocacy for his constituents, and his local health care services and all the patients who use them. It was good to hear interventions from hon. Members on both sides of the House; we heard from my hon. Friends the Members for Sherwood (Mr Spencer) and for Lincoln (Karl MᶜCartney), and the hon. Member for Mansfield (Sir Alan Meale). That shows that on important issues such as local hospitals we can put party differences aside to come together for the benefit of the people who matter most in the NHS—local patients. I was pleased to hear that party politics had been put aside today and I was glad to hear the hon. Member for Mansfield say that he will continue to do so in the future for the benefit of patients in Nottinghamshire.

As has been articulately outlined by my hon. Friend the Member for Newark, Newark hospital provides an extensive range of consultant-led out-patient services and does so with short waiting times. It provides many high-quality day-case procedures, and diagnostic and other services. It also has a high-quality minor injuries unit and urgent care centre. Some 35 beds are available across two medical wards, with 21 more beds in the surgical ward. As my hon. Friend rightly outlined, one challenge that faces the NHS as a whole and patient provision in Newark is the fact that many people are now living longer and need high-quality, close-to-home community health care services. That is exactly what is provided at his hospital.

We also know that a new 12-bed facility is to open in Newark hospital in February 2013. The Fernwood community unit will be a specialist unit of single-sex bays and private rooms that will meet the needs of the growing number of elderly patients we have discussed, ensuring that people have the right to recuperation and recovery in an appropriate intermediate care setting before they return to their own homes.

The hospital receives full back-up from the teams at King’s Mill and the services provided by the two hospitals are compatible and work well in synergy. I want to put on record my congratulations on and gratitude for the dedication and hard work of all the NHS staff who work on the King’s Mill site and at Newark and who do excellent work to look after patients to a very high standard. I will be happy to take up my hon. Friend’s offer of a visit to Newark hospital when time permits later in the year, so that I can meet the staff and see first hand the excellent care provided there.

It is worth highlighting that there was a local agreement on Newark services, which was signed off on 18 December. Newark and Sherwood district council agreed across party lines to work with the Newark and Sherwood clinical commissioning group and the Sherwood Forest Hospitals NHS Foundation Trust to maintain what they see as essential elements for local services. When looking after older people, it is good to have cross-agency integrated care and working and a commitment to those principles from not only the NHS but local authorities, which play such an important part in the care of older people through housing and social services.

The commitments made in the agreement were that there should be high-quality primary and secondary health care for the people of Newark and Sherwood; a strong and positive future for Newark hospital within Sherwood Forest Hospitals NHS Foundation Trust; and accessible and safe health care services for patients across Newark and Sherwood district that are as close to people’s homes as possible. As has been outlined throughout the debate, it is important that we ensure that older people do not have to travel many miles to receive high-quality care and that they receive that care, if not in their own homes, as close to their homes as possible. That is why I am confident that Newark hospital will always have a strong and viable future as a setting for the provision of high-quality care for many older people and for all the other patients it looks after so well.

My hon. Friend also raised the question of the PFI debt at the hospital trust and he was right to do so. Monitor, the independent regulator of foundation trusts, recently expressed concern about the financial situation at Sherwood Forest Hospitals NHS Foundation Trust. The trust signed its £320 million PFI deal in November 2005 for the redevelopment of King’s Mill, and in 2012-13 the trust’s PFI cash outflow is £42.5 million, which equates to 17% of the trust’s income—a very large PFI debt, with 17% of the income spent on PFI repayments. If we were not already aware of the great damage inflicted on our NHS by PFI agreements, which were sometimes signed in haste and which we have often lived to regret, that agreement would make the case very clearly.

On 21 September, Monitor published a breach of compliance report which referenced a McKinsey’s report it had commissioned. The report concluded that the trust’s PFI commitments were affordable only with additional activity from the local health economy. That means it does not qualify for Department of Health national PFI support. The report outlined the fact that the trust has potential for additional health care activity, which would benefit it financially and put it on a more stable financial footing. The emphasis on additional activity in the report seems to suggest that more can be done potentially at Newark to develop services for the benefit of local patients. That could bring revenue and income into the trust and would do more better to serve the needs of a growing population and its future health care demand.

To answer one of the points my hon. Friend raised, enhancing facilities in the minor injuries unit could play a part in putting the trust on to a more stable financial footing. The new chief executive is keen to look into the issues, as my hon. Friend said, and he is right to highlight the fact that good, dynamic leadership can turn around the trust’s financial fortunes, notwithstanding the massive PFI debt repayments. There are clearly further opportunities to develop what the hospital can do to put itself on a stable financial footing while doing more to look after local patients better. I know that the chief executive and the team at the trust are listening to the debate, and that they will take on board what I have said and the concerns that my hon. Friend raised.

My hon. Friend talked about ambulance services in the Newark area. It is worth pointing out the distances that some patients have to travel to reach a fully functioning, 24-hour A and E service. King’s Mill hospital, one of the acute settings, is 23 miles away, which is about 42 minutes by road. The Queen’s Medical Centre in Nottingham is 22 miles away, a 50-minute road journey, and Lincoln county hospital is 20 miles away, which is 45 minutes from Newark by car. Those are average journey times; there may be busy times and road congestion.

There are particular challenges in making sure that in an emergency patients can get to an appropriate A and E care setting in a timely manner. My hon. Friend pointed out that according to East Midlands Ambulance Service NHS Trust figures, in the years 2009-10 and 2010-11 and in the first quarter of 2012-13, Nottinghamshire did not reach its A8 response targets. Sometimes, those targets are skewed: they can be better in urban areas, such as Nottingham, but worse in more rural settings. I am sure my hon. Friend will want to take things further with the ambulance service and drill into the data for Newark by postcode, to compare response times in a more rural area, where there is a long distance to travel to an A and E, with those in some of the more urban settings in Nottinghamshire. It is obviously unacceptable to all of us if patients in rural communities have to wait a long time for an ambulance and life-saving treatment.

In the ambulance service review and the consultation on its proposals, it is vital that rurality and travel distances to A and Es and other urgent care settings are taken into account in any changes to the service. From the figures I referred to, we already know about the challenge the ambulance service in Nottinghamshire faces, because it is not meeting response targets. If we break down those targets by postcode and by area, we may find that rural areas are even further behind. When the review takes place, it is important that the rurality of Newark is properly taken into account so that patients in rural areas have the same quality of ambulance response as those in more urban settings.

In conclusion, I am pleased to confirm that there is a strong and viable future for services for local patients at Newark hospital. I very much look forward to taking the discussions further with my hon. Friend in early February, and to visiting the hospital later in the year.

Question put and agreed to.

Parliamentary Written Questions (Correction)

Dan Poulter Excerpts

Thursday 20th December 2012 Written Statements

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

I regret that the written answers given to the hon. Member for Hartlepool (lain Wright) on 6 November 2012, Official Report, column 584W, the right hon. Member for Warley (John Spellar) on 22 October 2012, Official Report, column 711W, the right hon. Member for Leigh (Andy Burnham) on 20 February 2012, Official Report, column 713W and the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) on 10 January 2012, Official Report, column 120W, contained some incorrect information.

The written answers pertained to the cost of exit packages incurred by primary care trusts (PCTs) and the information provided in the original answers incorrectly included a negative figure for one PCT, due to an error in compiling the figures for the annual report and accounts within the Department.

In respect of the answer given to the hon. Member for Hartlepool (lain Wright), a table showing the corrected figures is given below.

NHS Funding

Dan Poulter Excerpts

Wednesday 12th December 2012 Commons Chamber

[Andy Sawford]

I want to keep my remarks to Kettering general hospital, and I do not think that PFI is the issue there.

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

The hon. Gentleman mentioned the Healthier Together programme; it is clear that many of the hospitals in that programme have very high PFI debts. We will get the figures for him, to clarify that, in the closing remarks.

[Andy Sawford]

A few weeks ago, the hon. Gentleman—I am sure that he had no intention of misleading the House—talked about the funding issues at Kettering general hospital being driven by PFI deals in Anglian hospitals, which are not really part of the group that I am talking about.

[Dr Poulter]

rose—

[Andy Sawford]

I will not give way; I want to make important points for my constituents. It is important that these things are put on record, so I shall not be giving way to the hon. Gentleman again. He has not done a great service to people in my constituency in the way that he has addressed these issues.

Hospital Food (Animal Welfare Standards)

Dan Poulter Excerpts

Wednesday 12th December 2012 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Turner. I pay tribute to my hon. Friend the Member for Tiverton and Honiton (Neil Parish) for securing the debate and for his ongoing keen interest in ensuring the highest standards of animal welfare in farming and food production. We know how important that is because we both represent rural parts of the country, although I have a slightly more mixed constituency than he does, with a strong urban component. It is always in consumers’ interests for the quality of production to be high, and we do what we can to protect and support our food producers and farmers. We know that to be true, and it is something the Government take seriously.

My hon. Friend will be pleased to hear that, earlier this week, I met and discussed this matter with James Martin, a fairly well known—I recognised him—television chef. I am encouraged by the fantastic work that he is doing to raise the quality of food in hospitals throughout the United Kingdom, but particularly in parts of the north of our country. As a doctor as well as a Minister, I know how important it is that we always provide patients with high-quality nutritious food; it is especially important when looking after older patients, who need to receive high-quality nutrition as part of their recovery. That is precisely why my right hon. Friend the Secretary of State for Health has been so keen, early in his tenure, to support both high quality and dignity in care for older people, and to make sure that as a Government we actively promote greater consistency among hospitals in the provision of high-quality nutritious food and good buying standards.

It is worth outlining what the improving hospital food project is about. Good food is an essential part of hospital care, improving both patients’ health and their overall experience of their stay. Clinicians have a duty to ensure that patients get the right treatment for their condition, but it is also important that patients receive the right supportive care to enable a good recovery, and nutritious food is essential. Catering to everyone’s taste can be a challenge, and there are many ways to produce good food in hospital. It is right that local hospitals have the flexibility to decide which method is best for them in the context of the needs and preferences of their local population. People in Bradford or Liverpool will obviously have different preferences from people in more rural areas—demographic mixes and tastes differ. I am sure that my hon. Friend agrees.

Our improving hospital food project highlights eight fundamental principles that patients should expect hospital food to meet. One is that Government buying standards for food and catering services should be adopted where practical and supported by procurement practices. The standards cover nutrition, sustainability and animal welfare—the issue my hon. Friend rightly raised in today’s debate. They apply to all food procured by Departments and their agencies and came into force for all new catering contracts from September 2011. They are not mandatory for the NHS, as he said, but via the improving hospital food project, we are strongly encouraging hospitals to adopt them.

[Neil Parish]

I can understand that the Government are slightly reticent to bring in mandatory controls, but are they going to monitor the provision of good food in hospitals? Will they keep an active eye on whether the situation is improving with contracts and whether the higher welfare standards for meat and eggs are being used? They need to monitor the situation, not just bring in a system.

[Dr Poulter]

Indeed. We are looking into that at the moment, with a committee and working party looking at how to roll out good practice.

If we have a mandatory system, we may stifle the potential of what we are seeing locally under the current system. My hon. Friend has highlighted many examples of good practice, and I could add to them: in Sussex, there is a good programme, from plough to plate, which is managed by the head of catering there, William McCartney; and there are other good examples in Nottingham and Scarborough. Local innovation is driving up standards, and that happens in different ways in different parts of the NHS. One of the fundamental principles in which we believe, and it has always been thus, is that hospitals are able to determine how they respond to local conditions. Only this Government have taken seriously the need to support and encourage local innovation better. Through the approach that we have adopted and my right hon. Friend the Secretary of State’s interest in promoting good food in hospitals, we are now seeing many examples of local innovation driving up standards in local hospitals, and through such innovation we can identify and spread across the NHS better and good practice. The problem with a rigid framework or set of criteria is that it might stifle local innovation that can improve standards, as we have seen elsewhere in the NHS.

Our approach is for central Government to take an active interest in good hospital food for the benefit of patients, working through commissioning for quality and innovation payments. To promote good practice, the project is developing an exemplar pay framework within the CQUIN scheme, which enables health care commissioners to reward excellence by linking a proportion of providers’ income to the achievement of local quality improvement gains. We are developing two new CQUIN exemplars related directly to hospital food, one linked to the adoption of Government buying standards for food and one to excellence in food service. I hope that my hon. Friend is reassured by the fact that animal welfare is part of those standards. We are looking at linking CQUIN payments in the NHS to good, ethical Government procurement. We recognise and value the local innovation of various hospital food schemes, which have benefited patients from Scarborough to Sussex. That is better than a rigid framework and enables the NHS to learn from examples of good practice.

[Mr Andrew Smith]

The Minister referred to the more general application of Government buying standards. What is his response to the argument from the National Farmers Union that the standards would operate better if the red tractor standard of production was generally adopted as part of them?

[Dr Poulter]

Many of us are great fans of the NFU work to support the red tractor standard. Many great benefits can be obtained from British farmers, who often operate to higher standards of animal welfare and traceability. That is something that we are proud of, and there are great benefits for consumers in supporting such farmers. The Government therefore have an ethical framework for how food should be procured.

We are looking, through the CQUIN payments, at how to support and reward good practice in hospitals, taking into account the Government framework for welfare. When the NFU and other organisations highlight good local practice and support British farmers to lead the way in animal welfare through the red tractor standard, we want to ensure that we do not set up rigid frameworks that might prevent local hospitals from supporting such good ethical standards. Through local flexibilities that hospitals currently have, we are enabling the bar to be raised for animal welfare and the quality of hospital food.

Time forbids my going into greater detail, but we are encouraging friends-and-family testing in the NHS, putting patients and their relatives in charge of inspecting the quality of care and health care. That can be no more important than for hospital food. Recently, I visited Darlington hospital, which had had a patient-led inspection of hospital care, a key part of which was to look at hospital food, to ensure that every patient was served with nutritious food, cooked locally and on site.

A number of the issues raised in the debate cut across the responsibilities of Ministers in the Department for Environment, Food and Rural Affairs, so I will write to them and highlight the concerns expressed by my hon. Friend the Member for Tiverton and Honiton today. In my Department, however, we encourage hospitals to use and maintain ethical standards in the buying of their food, but we also enjoy and support local flexibilities that benefit patients and raise standards throughout the NHS.

Clevedon Community Hospital

Dan Poulter Excerpts

Wednesday 5th December 2012 Commons Chamber

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

I congratulate my right hon. Friend the Member for North Somerset (Dr Fox) both on securing the debate and on his strong advocacy for Clevedon community hospital.

Members who represent more rural constituencies know the importance of high-quality community health care facilities, including community and cottage hospitals. They provide important close-to-home care for patients in more rural areas, particularly frail and elderly patients who have long distances to travel to receive health care.

We know the importance of such hospitals in meeting the long-term challenges of the NHS. We need to redesign services and deliver more services closer to home, and prevent inappropriate hospital admissions to big acute hospitals such as those in Bristol or Weston-super-Mare. That means ensuring that we have the right community resources properly to support local people, including those with long-term medical conditions such as asthma, diabetes and dementia. In particular, we need to ensure that we have community-based support for older people—the biggest group with long-term conditions.

We want to move the emphasis of care in this country away from acute crisis management, to which the NHS is accustomed, both to save the NHS money and to provide better care for people in their homes and communities. Community hospitals such as Clevedon are important in delivering such care. They provide invaluable beds for people with long-term conditions to give their carers respite, and important rehabilitation in a setting close to home, family and support networks for people who have broken hips, or who have had strokes or heart attacks. They provide the opportunity for step-up care for people who are not so unwell that they need to be admitted to an acute setting, but who can be better looked after temporarily in an environment that provides the additional care that people need. The Dr Foster report, which was published this week, highlights that 29% of patients did not necessarily need to be in acute hospital beds. If we are to meet the challenge of ensuring that people are better looked after and are not in hospital beds when they do not need to be, it is important that we invest properly in community resources, and Clevedon community hospital is just one of those resources.

I share with my right hon. Friend and the community he represents their frustration with the primary care trust, as I have Hartismere community hospital in my constituency. My predecessor, Lord Framlingham, had considerable struggles with the PCT about the potential closure of an important rural hospital. From what my right hon. Friend says, his constituents and local patients have been having considerable struggles and difficulties with the local PCT in Somerset.

I acknowledge the special role the League of Friends plays in the life of Clevedon community hospital, a point my right hon. Friend made in his speech. It has worked to raise a lot of money for the hospital and to ensure that it is retained as an important community health care resource. It is dismayed and disappointed, as are others in the local community, by the attitude of the PCT. I understand his disappointment, but under the PCT arrangements the provision of local NHS services remains with the local NHS. However, he is concerned that approximately £1.5 million or £1.6 million has been spent on project costs and other costs over a four-to-five-year period, in proposing to develop a new and sustainable community hospital facility in Cleveland. The money has been spent, but there is still no new facility. As physicians, we would rather the money had been spent on a new facility or on community care.

If it is any consolation to my right hon. Friend, I had a conversation with local health care representatives yesterday. They reassured me that even without the new facility at the allocated site, there are no concerns about any loss of services with the transfer from the PCT to the clinical commissioning group that will have responsibility for running community services. I hope it reassures my right hon. Friend to hear that when the new arrangements come into place in April next year services will remain as they are now.

On endoscopy services, as clinicians we know that strict evidence-based clinical standards must be achieved when delivering endoscopy services, which, for patient safety and to maintain high-quality patient care, have to be adhered to. There were concerns that facilities at Clevedon hospital were not able to maintain those high standards. For example, arrangements for the decontamination of endoscopy equipment would have to be substantially improved if the service was to achieve external accreditation by the national joint advisory group for endoscopy, and that would need to be achieved for the service to return to the hospital.

Despite my conversation yesterday with representatives from local health care commissioners, I am alarmed by what my right hon. Friend tells me about the business case to all intents and purposes being approved and then suddenly, between March and June, being disapproved—an extraordinary turn of events. It is inexcusable to raise the expectations of local patient groups, effectively giving a green light suggesting things were going ahead, and then to remove that expectation. I am happy to look into the matter further and to write to my right hon. Friend about it in more detail, because I am concerned about the issues he has raised. When something like £1.5 million has been spent on planning, and various plans and business cases have been brought forward, it is all the more concerning. It is not a satisfactory state of affairs, as far as the local management of NHS resources is concerned, and it is certainly not a satisfactory state of affairs, as far as local patients are concerned. I shall further investigate the matter and write to him on the basis of those investigations.

On future provision, I would like to reassure my right hon. Friend that, according to what local health care commissioners told me yesterday, the services currently provided at the hospital are safe and will still be provided. Even though plans do not appear to be in place, as they once were, to build a new hospital on a new site, it would be relatively easy, I understand, to maintain the buildings and the facilities on the current site in a state that would allow for the safe delivery of high-quality patient care and the ongoing provision of services for patients in the area. I understand that the older building can be improved, if required, to ensure that it can still deliver high-quality patient care.

With those reassurances, I will further investigate why the business case has gone from being approved to disapproved, as my right hon. Friend said. We have been reassured that the services currently provided at the hospital will continue to be provided for the foreseeable future.

[Dr Fox]

If we are to maintain clinical services on the original site, substantial investment will be required. I am sure that my hon. Friend will be sympathetic to our view. If a business case can be perfectly fine in March but dumped in July, if we, the poorest funded PCT, can give money to other less well-performing PCTs and given that the transfer is being put forward again this year, how can we have much confidence in the local management? Then, when our questions are not answered, as they continue not to be, we feel that there is not only insufficient competence but a lack of transparency. I am grateful for his reassurance that the matter will be looked into, but I would also like him to kick our local PCT in the proverbials to ensure we get the money required from the sale of the Millcross site or from additional investment, so that we can get the facilities that our taxpayers contribute towards but which seem to be getting siphoned off into other areas, whether because of a lack of adequate priorities or competence.

[Dr Poulter]

My right hon. Friend makes a good case. From what he has outlined, I fully agree that some of the circumstances surrounding the decision seem extraordinary and completely unacceptable. He described it as being far from competent, and I would not wish to disagree, judging from his analysis.

We are interested in delivering high-quality front-line patient care. The challenge for the NHS is delivering that care close to home and close to people’s communities. That is what Clevedon does and what it needs to continue to do. We need to ensure that PCTs, as they are at the moment, and clinical commissioning groups, as they will be in the future, invest in high-quality local health care services in order to meet the challenge of better looking after older people. That is the clear challenge that David Nicholson set for the NHS in 2009 in the quality, innovation, productivity and prevention challenge. It is about the need to redesign services in order to deliver better and more affordable care in the community.

That was also the challenge that Dr Foster outlined for the NHS earlier this week. It is about time that my right hon. Friend’s local health care commissioners acknowledged that challenge, invested in local health care services and made the argument for keeping investment locally, rather than, as he said, siphoning it off elsewhere. I will clarify the matter further by investigating with the PCT what has happened. From our discussions so far, I can reassure my right hon. Friend that the PCT and the clinical commissioning groups reassured me yesterday that they would, they thought, be able to find the investment to continue with the current older buildings, maintaining them as fit for purpose to continue with patient care, and that patient care will continue on the current site, as it does now, in April. Nevertheless, there are clearly questions for the local health care commissioners to answer.

Question put and agreed to.

Liquid Nitrogen Drinks

Dan Poulter Excerpts

Friday 30th November 2012 Commons Chamber

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

I congratulate my hon. Friend the Member for Morecambe and Lunesdale (David Morris) on securing this debate and on his continuing strong advocacy for his constituents. I know that he has been a diligent and hard-working constituency MP since he was elected, and I pay tribute to his work in bringing forward this issue. As a doctor, I was sad to hear of the ordeal that Gaby Scanlon endured when she went out to celebrate her 18th birthday, and of the distress caused not only to her but to her family and friends. I acknowledge my hon. Friend’s determination, therefore, in following up on the serious injury suffered by his constituent.

As my hon. Friend rightly outlined, the incident on 2 October has attracted considerable media attention. Tonight being a Friday night, I am sure that many young people will be going out into bars and clubs in the places they live or perhaps further afield. This debate has also attracted attention in Australia and New Zealand. As we know, this is the first time that the Food Standards Agency has been made aware of a food incident involving the use of liquid nitrogen. I say “a food incident”. The FSA, a national body working in close partnership with local licensing authorities, has responsibility to ensure that food and drink in our restaurants, bars and clubs and elsewhere is served responsibly and safely. When it became aware of the incident, the FSA immediately issued a warning to raise consumers’ awareness of the dangers of consuming drinks containing liquid nitrogen. The FSA also encouraged all environmental health officers to be vigilant about the use of liquid nitrogen in food or drink when carrying out their routine inspections of food and hospitality premises.

I hope my hon. Friend will be reassured to hear about the controls that are already in place. Food law prohibits the sale of harmful foods and drinks in the UK. Manufacturers, retailers and businesses in the UK have a legal obligation to ensure that the food and drink they serve to the public is fit for human consumption. There are industry safety and handling guidelines around the use and storage of liquid nitrogen. Business owners are responsible for training their staff, making them aware of the potential risks of using liquid nitrogen and having appropriate safety measures in place to protect staff and consumers. Existing legislation prohibits the sale of food and drink that is unsafe. Enforcement of both health and safety measures and food safety legislation is the responsibility of the relevant local authority—in this case Lancaster city council. Businesses selling alcohol that are convicted of food safety offences can have their alcohol licences withdrawn by the local licensing authority.

It is worth touching on the wider point about the glamorisation of alcohol—sometimes by the food and drink industry, but particularly by wider sectors of the media. As I have said, tonight many young people will go out to bars, clubs and other settings in town centres and elsewhere, including the village and market town pubs in my constituency, to enjoy an evening out with friends. On the whole, things will pass successfully and without any adverse incident. However, we know that there has been a problem in parts of the country where certain bars and clubs have been irresponsible in their marketing of alcohol. It is the responsibility of licensing authorities to ensure good practice in the performance of their local bars and clubs and to ensure that they are run responsibly. With regard to the premises in question, that is something that I know the local council will look at seriously in the ongoing investigation in this case.

We expect those who sell and promote alcohol to do so responsibly. The alcohol industry in general has made a core commitment, through the public health responsibility deal, to foster a better culture of responsible drinking. We are grateful for the national recognition of the importance of the issue by the alcohol industry, but the Government’s alcohol strategy goes further in fostering responsible drinking, aiming to cut the number of people drinking to harmful levels. It addresses both health and social harms, describing co-ordinated actions across Government, and includes a commitment to introduce a minimum unit price for alcohol to tackle the sale of heavily discounted alcohol, with further action to ensure that local authorities have the licensing powers they need to protect local communities. The strategy will deal not just with binge drinking, but with all activities to do with responsible drinking, promoting safe places for people, young or old, to go out in town centres in the evenings. On 28 November, the Government launched a consultation on a number of areas set out in the strategy, including a recommended price of 45p per unit of alcohol. We are taking that action to ensure a sensible price for drinks that cause harm.

What is the local authority doing in this case? Lancaster city council is rightly investigating the events that led to Gaby’s very serious injury. The full details of what happened in this incident are not yet publicly available, because of the ongoing review and investigation of the case by the city council. However, I can reassure my hon. Friend that once they have concluded, government departments such as the Food Standards Agency will consider whether further guidance is necessary. As I outlined earlier, initial action has been taken to warn consumers of the risks of consuming drinks containing liquid nitrogen and to ensure that local authorities are vigilant in their inspection of food businesses with regard to the sale of this product. We do not yet have all the information about what happened in the bar in Lancaster, so we need to wait for the conclusion of the investigation by the council. However, I reassure my hon. Friend that we will take the results of that investigation seriously and the FSA will consider them. We must ensure that what happened to Gaby does not happen again to other young people.

Question put and agreed to.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 27th November 2012 Commons Chamber

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

The previous Labour Government gave foundation hospitals additional freedoms to set their own pay terms and conditions for staff and, as a result, the information is held locally, not centrally.

[Mr Bain]

I thank the Minister for that non-answer. Will he recognise that with average wages 6.8% lower for full-time workers than they were when this Government took office, people are right to be sceptical about the Government’s record in pay? Why is he sitting back and doing nothing while the national character of our health service is being destroyed through regional pay arrangements?

[Dr Poulter]

It is worth reminding the hon. Gentleman that, as I outlined in my first answer, it was the previous Government who gave foundation trusts additional freedoms to set their own pay terms and conditions outside national frameworks. This Government are working closely with NHS employers and the trade unions to make sure that we maintain “Agenda for Change” and national pay frameworks as fit for purpose, and we are very pleased with that. If the hon. Gentleman wants to ask why there is regional pay and freedoms for employers to set regional pay, he should ask those on his own Front Bench, some of whom were Ministers when these freedoms were set.

[John Pugh (Southport) (LD)]

Does the Minister recognise that the recent progress in national negotiations over greater flexibility is very encouraging and makes the efforts of the south west consortium and others both disruptive and pointless, in context?

[Dr Poulter]

We have had encouraging results from national pay negotiations at the recent NHS Staff Council, and unions are to consult their members on those results. There is general agreement that we need to maintain national pay frameworks, provided they are fit for purpose. I hope my hon. Friend will find that the south west pay consortium, which has been somewhat heavy-handed in the way that it has conducted its affairs, also sees the benefit of maintaining national pay frameworks. That is why we would like to see a quick resolution of the matter at a national level.

[Pauline Latham (Mid Derbyshire) (Con)]

6. What recent assessment he has made of the cancer drugs fund.

--- Later in debate ---

[Kate Green (Stretford and Urmston) (Lab)]

12. What steps he is taking to ensure that primary care trusts do not ration access to NHS treatments and operations.

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

Rationing on the basis of cost alone is completely unacceptable. That is why the Government are increasing the NHS budget by £12.5 billion over the life of this Parliament and giving front-line health care professionals the power to decide what is in the best interests of patients.

[Luciana Berger]

I listened closely to the Minister’s answer. My constituent, Raymond Hickson, has been told that he has a leaking valve in his upper leg, causing varicose veins. His leg will eventually fill with blood, rendering him unable to walk and, therefore, to work, as he is currently employed in a manual job. He has been refused a simple operation on the basis that he now does not fit the PCT criteria, although he has had two similar operations in the past 15 years. What advice would the Minister give Mr Hickson and others like him, who are clearly the victims of treatment being rationed?

[Dr Poulter]

It is worth pointing out to the hon. Lady, who raises a legitimate point about that gentleman’s case—[Interruption.] The right hon. Member for Leigh (Andy Burnham) says “Do something”, but this type of rationing of varicose vein surgery occurred when the previous Labour Government were in power—[Interruption.] It did, and rationing of many other types of services was much worse. It is this Government who have introduced the cancer drugs fund to stop the rationing of cancer treatments to patients, which has benefited 23,000 extra patients, and many more elective procedures are taking place across the NHS every single day. On the specific case the hon. Lady raises, obviously if her constituent has a specific concern, there are safeguards in place locally for him to raise it if he thinks the decision is not based on clinical criteria.

[Kate Green]

Trafford primary care trust offers one cycle of in vitro fertilisation treatment to women up to age 29. The Minister will be aware that the National Institute for Health and Clinical Excellence guidance is for up to three cycles and up to age 39. Last year the all-party group on infertility pointed out that a very large majority of PCTs were not meeting the NICE guidance. Why does he think that is, and what is he going to do about it?

[Dr Poulter]

Of all Ministers in the House, the hon. Lady has probably asked the right one about this issue. This is a long-standing problem that goes back many years. There has been great variability in the availability of IVF in different parts of the country, and, at a national level, NICE finds that unacceptable. I will be taking the matter forward, and I assure her that we will make sure that we do all we can to iron out that variability and follow NICE guidelines so that everyone can receive the best IVF treatment.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does my hon. Friend agree that the best way to ensure that high-quality care continues to be available to all patients, as and when they need it, is to ensure that the health and care systems are brought together into a single joined-up system so that, in the words of Mike Farrar of the NHS Confederation, we operate a care system with a health adjunct rather than a health system with care support?

[Dr Poulter]

My right hon. Friend has, over many years, been a very strong advocate—probably the strongest advocate in this House—for integrated care, which this Government are determined to make a reality. He is absolutely right that we need properly joined-up care that we properly deliver when we face up to the big health care challenges of how we better look after people with long-term conditions and older people. The only way to do that is to deliver more care in the community, and that has to be achieved through more joined-up and integrated care.

[Mr Nick Gibb (Bognor Regis and Littlehampton) (Con)]

My constituent, Jennifer Payten of Bognor Regis, needs dental implants because her temperomandibular disorder means that dentures cause pain and severe headaches. For the past 10 years, Ms Payten has been passed from NHS trust to NHS trust in a Kafkaesque nightmare that no one in modern Britain should have to tolerate. I have written to the Secretary of State about this matter. However, will the Minister personally look into Ms Payten’s case to help to unblock the logjam and ensure that my constituent receives the health care that she needs to enable her to return to a normal life?

[Dr Poulter]

I thank my hon. Friend for his question. He is right to raise this, because it has been a very long-standing problem. I am sure that he would welcome, with me, the fact that under the current Government over 1.1 million more people are receiving access to NHS dentistry. However, this is a difficult case, and I am happy to meet him to discuss it further and see what I can do to help to unblock the problem.

[Andy Burnham (Leigh) (Lab)]

Ministers have repeatedly promised to ban rationing of treatment by cost in the NHS. If the Minister is presented with evidence that this is still continuing, will he today give the House a categorical assurance that he will act immediately to stop it?

[Dr Poulter]

It has been very clear in all the criteria for NHS commissioners set by the previous Government and by this Government that decisions about local health care treatment have to be based on clinical need, and that those decisions are for local commissioners. The difference is that this Government will make sure that doctors, nurses and health care professionals are in charge of budgets and setting health care priorities rather than the managers the previous Government chose to favour, who did not always have experience of front-line care and did not always understand some of the challenges that patients were facing.

[Andy Burnham]

I will take that as a yes. The Minister is going to have a busy day, because this afternoon he will have on his desk new evidence that I will send him showing that an estimated 52,000 patients in England are being denied treatment and kept off NHS waiting lists because of new restrictions imposed under his Government on cataracts, varicose veins, carpal tunnel syndrome, and other serious treatments. Ministers boast of lower waiting lists, but that is because they have stopped people getting on to the waiting lists in the first place. Patients in pain and discomfort, unable to work, are being forced to pay for treatment. How many more people will have to suffer before he finally acts?

[Dr Poulter]

We have already highlighted in earlier answers the fact that under the previous Government health care rationing was far worse on varicose veins, which one of the right hon. Gentleman’s own Back Benchers mentioned, and elsewhere. This Government are very proud of our record whereby 60,000 fewer patients are waiting more than 18 weeks than under the previous Government and 16,000 fewer patients than in May 2010 are waiting longer than a year. Waiting times are coming down, infection rates in hospitals are coming down, and people are getting better care. This Government ended the worst health care rationing scandal of all—the fact that people with cancer were not getting access to the drugs they needed. Now, 23,000 people are getting access to that care. If he could not do anything about rationing, he should at least recognise that this Government have done something and have made a real difference to people’s lives, particularly patients with cancer, by reducing rationing.

[Tim Farron (Westmorland and Lonsdale) (LD)]

Those of us who live in rural areas such as south Cumbria have faced the rationing of acute services for years—not rationing by price, but rationing by distance. Will the Minister encourage Morecambe Bay, which will undertake its review of the allocation of services in the coming months, to allocate accident and emergency services back to Westmorland general hospital, where they would be closer to the people whose lives they could save?

[Dr Poulter]

As my hon. Friend is aware, from next year the NHS Commissioning Board will have responsibility for commissioning local services and for setting the funding formula. I would be happy to raise his issue with the board, because it is true that, historically, the capitation formula has not recognised the fact that there are a lot of older people in rural areas and further distances to travel. The previous Secretary of State, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), took steps towards reviewing the formula and I assure my hon. Friend that the Government will be looking into it further.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

8. Whether he has put in place measures to ensure that clinical commissioning groups do not become for-profit organisations.

--- Later in debate ---

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

Since the south-west consortium’s plans were made public in May this year, Department of Health officials have been in contact with NHS employers, NHS trade unions and the south-west consortium better to understand the views of all parties. The Department of Health wants to find a resolution and supports national pay awards.

[Kerry McCarthy]

I thank the Minister for that response and for his acknowledgement earlier that the way in which the south-west consortium has handled the negotiations has been heavy-handed. It is appalling that staff found out about the plans only through the leaks as, it appears, did the Department. Will he go back to the director of the consortium and urge him to put everything on hold in the south-west while national pay discussions are continuing? As the Minister says, this ought to be about national pay, not regional pay.

[Dr Poulter]

I fully agree with the hon. Lady and I take her concerns on board. However, because of the additional freedoms introduced by the previous Government, local employers in foundation trusts throughout the NHS have additional freedoms to set their own pay, terms and conditions. Under the rules introduced by the previous Government, it is impossible for us to intervene directly in the matter, except by continuing to encourage trade unions and NHS employers to meet the national agreements. If national terms and conditions are agreed to, I am sure that they will be endorsed at a regional level by the south-west consortium.

[Andrew George (St Ives) (LD)]

I am very pleased that the Minister will be meeting a cross-party delegation of MPs from the south-west next week to discuss this issue. In view of his answer to the hon. Member for Bristol East (Kerry McCarthy), is he confirming that Health Ministers have no powers at all to intervene in the negotiations between employers and their staff?

[Dr Poulter]

It is worth putting it on the record that it was the previous Labour Government who introduced foundation trusts in 2003 and set them free from direct accountability to Ministers. That includes the ability to set their own pay, terms and conditions. It was Labour that removed the power of the Secretary of State to direct foundation trusts, and it is Labour, not the Government, that needs to decide whether it supports the legislation that it put in place in government. We endorse national pay frameworks and will do all that we can to preserve them.

[Mr David Amess (Southend West) (Con)]

13. What recent representations he has received on strategies to support patients with osteoporosis.

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[Lisa Nandy (Wigan) (Lab)]

16. What assessment he has made of the possible effect on patient safety of reductions to ambulance trust budgets.

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

The budgets for individual ambulance trusts are set by local health care commissioners. In 2012-13, the budgets are increasing nationally by £2.5 billion. To ensure patient safety, ambulance trusts are required to meet national performance standards in respect of their response times.

[Lisa Nandy]

Does the Minister share my concern that 100,000 more patients than two years ago wait more than half an hour to be transferred from ambulance to A and E? If so, how on earth can he justify making his top-down reorganisation of the NHS a priority rather than sorting out that appalling situation?

[Dr Poulter]

The priorities for local ambulance trusts and the funding allocations are set locally. The hon. Lady will be pleased that between 2010-11 and 2011-12, an additional £9 million was put into the front line of the ambulance service in her area to help address some of the problems she outlines. Under this Government, more money is going to the NHS than before and more money is going into local ambulance services—£2.5 billion nationally. We should contrast that with the approach taken by the right hon. Member for Leigh (Andy Burnham) on the Opposition Front Bench, who said that to increase spending to address those problems would be irresponsible.

[Several hon. Members]

rose—

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

The Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), is my constituency neighbour. He will know that, although the East of England Ambulance trust is hitting its targets for the entire region, it is not helping in Suffolk. Will he advise on what more we can do locally to ensure that it serves all rural patients?

[Dr Poulter]

The problem has affected both Suffolk and Norfolk—the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), also takes an active interest in it. One problem was that the managers of the local ambulance trust were not listening to front-line staff on how to design and deliver services. In a staff survey, only 4% of front-line staff in the East of England Ambulance Service said they were being properly listened to, which is completely unacceptable. This Government, in contrast to the previous one, want to put front-line professionals in charge of running services, meaning that, in future, more patients will be properly prioritised and ambulance response times will be better met.

[Mr Speaker]

Order. These matters could be considered further in an Adjournment debate, which might be a suitable length for the subject.

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[Graham Stringer (Blackley and Broughton) (Lab)]

T3. What action does the Minister intend to take to reduce the number of unplanned emergency admissions to hospital by sufferers of muscular dystrophy and other neuromuscular conditions?

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

I thank the hon. Gentleman for that question and for his concern about this matter. One of the key challenges for the NHS is to ensure that we deliver better care in the community, deliver more preventive care and provide better support to people with long-term conditions, such as muscular dystrophy and diabetes, in their own homes. A key part of the reforms is to make sure that a lot of services are commissioned from the community by the local commissioning groups. We have already seen that that has reduced inappropriate admissions. For example, in my part of the world in Suffolk, they have been reduced by 15% for older people.

[Mr Aidan Burley (Cannock Chase) (Con)]

T4. Yesterday, I received a letter from the chief executive of Monitor, which asked me and the Asset Transfer Unit to undertake feasibility work to develop a professional business case for the local community to take ownership of Cannock Chase hospital. This would be done through its transfer to a community interest company, which would then take over running the hospital estate, securing the building for the people of Cannock Chase. Will the Secretary of State welcome these proposals, which would be the first of their kind in the UK, and work with us as we develop a plan for the local community to own its hospital?

--- Later in debate ---

[Andrew George (St Ives) (LD)]

T6. There is mounting evidence that clinical care failure is as much to do with inadequate staff levels as anything else. In view of that, do Ministers agree that it is worth looking at the merits of establishing mandatory registered nurse to patient ratios across secondary and tertiary care wards?

[Dr Poulter]

I thank my hon. Friend for that question. This point has been raised before and although it sounds like a good idea in principle, the problem is that different aspects of care in different wards—for example, an older people’s ward compared with a ward that looks after younger people—will have differences in the intensity of nursing. Therefore, a mandated ratio would be difficult to implement. A ratio may be counter-productive to making sure that we can give more intensive nursing cover where it is needed, and could even encourage a race to the bottom.

[Lilian Greenwood (Nottingham South) (Lab)]

T8. A recent Schizophrenia Commission report highlighted catastrophic failings in the care of people with severe mental illness. We know that suicide rates rise during times of economic hardship and that record numbers of people are being detained under the Mental Health Act. The Government have said that mental health should have parity with physical health, so why has funding for mental health services been cut for the first time in a decade?

--- Later in debate ---

[Steve Baker (Wycombe) (Con)]

Aylesbury constituent Mrs Evans-Woodward is a young woman who has had five heart attacks. One evening her husband drove her to Wycombe’s heart attack unit with a racing pulse, but she was turned away to the minor injuries unit, which again turned her away to the accident and emergency unit in Stoke Mandeville, before suggesting that she sit outside and call an ambulance, which she duly did—all of this with a racing pulse of 180. This is not good enough. It is an appalling prioritisation of bureaucracy over simple human care and compassion. Does it not show that the NHS needs to become much more accountable to patients?

[Dr Poulter]

My hon. Friend is absolutely right, and I am very sorry to hear of the case he outlined. Clearly the care that his constituent received was more than substandard. If a patient needs immediate treatment, they should always receive it. This Government are quite rightly ensuring that we embed good care in everything we do. We have beefed up the role of the Care Quality Commission to improve the inspection of care quality throughout the NHS and the care sector. We are also introducing a friends and family test to pick up on examples of bad care, so that the NHS can properly learn from them locally and so that these things do not happen.

[Mr Speaker]

We are extremely grateful. Extreme brevity is now required from Back and Front Benchers alike.

[Andy Sawford (Corby) (Lab/Co-op)]

On 12 November the Secretary of State gave a categorical assurance to my constituents that there was absolutely no threat to accident and emergency and maternity services at Kettering general hospital. Does he stand by it, will he repeat it today and will he specifically confirm that obstetrics and major injury and trauma services in accident and emergency are no longer at risk at Kettering general hospital?

[Dr Poulter]

I thank the hon. Gentleman for his question, and I welcome him to the House and congratulate him on his victory in the recent Corby by-election. I think he has already admitted on the record that there was a lot of scaremongering during the by-election campaign about the NHS locally. One of the main reasons for concerns about the NHS is the indebtedness of many hospitals in the east of England region, because of the record of the previous Government, who signed many of them up to private finance initiative deals. I will restate for the record once again today that, as I understand it, A and E and maternity services at Kettering at the moment are safe, and there is no consultation directly on the table at the moment. He should make sure he gets his facts right before he raises questions in the House.

[Mr Stewart Jackson (Peterborough) (Con)]

Last week it was a great pleasure to visit Age UK Peterborough, whose No. 1 priority is dementia care, which coincides with the NHS priorities that my right hon. Friend the Secretary of State outlined earlier this week. Will he put in place procedures to make available capital moneys for the construction of dementia care facilities locally?

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[Duncan Hames (Chippenham) (LD)]

Valued health workers in Wiltshire will appreciate the Minister’s commitment today to national pay negotiations, but they will be frustrated that he does not have the power to force them on foundation trusts. Will he at least make a direct appeal from the Dispatch Box today to the management of those trusts in the south-west consortium to participate fully in national pay negotiations?

[Dr Poulter]

I thank my hon. Friend for his question. He is absolutely right. I made it clear earlier that I felt there had been some heavy handedness in the way some of those trusts had behaved—although they are quite understandably exercising freedoms that the previous Government gave them. We want national pay frameworks to remain fit for purpose, which is why we endorse the national pay negotiations that are under way. I would recommend that trusts in the south-west listen to what happens in those negotiations, so that we can ensure that national pay frameworks are fit for purpose in the south-west.

[Mr Speaker]

Last but not least, Meg Munn.

NHS Trust Merger (Dorset)

Dan Poulter Excerpts

Thursday 22nd November 2012 Commons Chamber

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

It is a pleasure to respond to the debate. I congratulate my hon. Friend the Member for Christchurch (Mr Chope) on securing it, and on being a strong advocate for the needs of his constituents and of patients throughout his part of the world. I also pay tribute to my right hon. Friend the Member for New Forest West (Mr Swayne) and my hon. Friend the Member for New Forest East (Dr Lewis), who are also in the Chamber. They, too, are strong advocates for the patients they represent, and I know that their constituents are grateful to them for that.

It is right to highlight the importance of having a good working relationship between Members of Parliament and their local hospital trusts. It is never desirable for any hospital to embark on local service changes of any kind without properly engaging with the local Members of Parliament. In this case, we are talking about a merger, rather than a service reconfiguration; there is an important distinction between the two, which I will come to in a moment. Nevertheless, from what my hon. Friend the Member for Christchurch has said, it does not sound as though the local hospital trust has engaged with him in a way that we would all consider desirable, and I am sure that it will consider that in its future relations with MPs.

That point was strongly made when my hon. Friend read out the heavily redacted document. There is freedom of information, and certain issues can quite rightly be exempted from freedom of information requests under statute. However, to present a document bearing only the heading “Maternity” is not in the spirit of co-operative and collaborative working with Members of Parliament or in the spirit of being as open and transparent as we would like. I am sure that he has already raised these issues locally, but I would also like to place on record my concern at what he has told the House. It is important that MPs, as strong advocates for our constituents and the patients in our constituencies, should always be engaged at an early stage when decisions of this magnitude are being made.

My hon. Friend paid tribute to the dedicated front-line staff at the hospitals in Poole and Bournemouth. It is worth highlighting that some very good things have been happening in both trusts. At Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, a life-saving service that treats heart attack patients within 60 minutes is now available 24 hours a day, seven days a week at the Royal Bournemouth hospital. It treats heart attack patients from across Dorset, Hampshire and Wiltshire. Also, a new combined acute and rehabilitation stroke unit opened in 2012. It is designed to improve the experience and outcomes of stroke patients by providing specialist services, with a particular focus on the rehabilitation of patients, which is an important part of stroke care.

[Mr Chope]

I am glad that the Minister cited those examples, but are they not examples of how independent trusts can innovate and thereby create beneficial change rather than have a monolithic monopoly? Surely we would not have so much innovation if all our trusts were merged into one.

[Dr Poulter]

My hon. Friend is right that trusts—in their own right, or when they are merged together as they were historically over the river at Guy’s and St. Thomas’ and at the medical school of Guy’s, King’s and St. Thomas’ of which I am a graduate—can gain and improve the quality of care available to patients without losing their distinctness. Services are offered on each site, but at the same time they can add to the services they provide to patients in the totality. I believe my hon. Friend is right to say that these innovations have come from the independence and the good work of his local hospital, but I also believe there can be distinct advantages from hospitals coming together as well. The common purpose is making sure that good local service provision is maintained, while services of clinical excellence are also developed, further improving the offer to patients—not just in those towns, but throughout the area.

I want to highlight, and not leave out, some of the good things happening at Poole hospital, as it would be wrong for me, having highlighted a number of good developments at the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, not to mention them. At Poole hospital, the standard of care for cancer patients has been rated as among the best in the country in a national survey. The 2011-12 national cancer patient experience survey found that 94% of patients rated their care as “excellent” or “very good”, giving Poole the highest score recorded among participating trusts. I know all Members, as constituency Members, would feel very proud of that hospital’s achievements.

I am sure that my hon. Friend welcomes this Government’s investment in the NHS, even in very difficult economic times, as we put an extra £12.5 billion into NHS services over the lifetime of this Parliament. I am sure we all agree that that is a good thing.

What is the current position? Let me address some of my hon. Friend’s points. As to the proposals by the foundation trusts in Bournemouth and Poole, I appreciate that when any changes to local NHS services are mooted, people can become anxious and feelings can run high. However, I must be very clear to my hon. Friend that there is no formal role for Ministers or the Department of Health in approving mergers between two foundation trusts. I fully appreciate his concern to ensure that there is appropriate engagement and consultation on any proposals for service changes that may affect his constituents. I have already put on record some of my concerns about the process and engagement so far, which I think we would all accept is not ideal.

[Mr Chope]

I was not asking the Minister to have a role in approving the merger or otherwise. What I asked him to do, on behalf of the Government, was to say to the Office of Fair Trading that this is an issue of sufficient significance that it should be referred to the Competition Commission.

[Dr Poulter]

If my hon. Friend will be patient with me for a few moments, I will address that point a little later.

In acknowledging the understandable anxiety that can be stoked when any discussions about hospital services take place, it is important to highlight the fact that, as we saw over the river at Guy’s and St. Thomas’, although there was some good preservation of the individual and distinct offers to the local populations of the two institutions in their own right, by coming together they have been better together and provided better services.

One of the big problems we face in the NHS is concern about putting more money into front-line care and about cutting back on waste and bureaucracy. Clearly, if the administration across two trusts can be shared, it will free up more money to be diverted and put into what we all care about—front-line patient care.

Let me put on record once again that the trusts have clearly stated that this is not about the reconfiguration of clinical services. That is quite distinct. My hon. Friend was quite right to mention some of the points I raised in reply to my hon. Friend the Member for Bracknell (Dr Lee) about the important and distinct challenges faced in rural constituencies, and the fact that service reconfiguration challenges are very different in rural areas where there are longer distances to travel. As I have said, however, this is not about reconfiguring services, but about trusts merging and seeking what I think we would consider to be potentially desirable results, such as economies of scale and a reduction in unnecessary administrative burdens when possible. I think that, although the process and the approach taken to engagement with my hon. Friend and other Members of Parliament have not been ideal, some very positive elements have emerged from the discussion.

As my hon. Friend said, stringent tests would be applied to reconfiguration if it were on the table. The criteria would be strong public and patient engagement, consistency with current and prospective need for patient choice, a clear clinical evidence base, and support for proposals from clinical commissioners. Clinicians should always lead reconfiguration challenges, but today we are not talking about reconfiguration; we are talking about a hospital merger. It is the first of its kind to be proposed between foundation trusts in the country, and in that respect it is new territory for the NHS. There are distinct rules, including, as my hon. Friend said, referral of the case to the Office of Fair Trading.

The OFT’s role in reviewing the merger will be to establish whether there is a realistic prospect that it will result in a substantial lessening of competition. I am sure that it will also consider the issues of rurality and the choice of services available to patients. Should it refer the matter to the Competition Commission, which it has a right to do if it has concerns, the commission’s role will be to conduct an in-depth investigation, and to decide whether the merger does indeed represent a substantial lessening of competition and choice.

Concern has been expressed about the rurality of surrounding areas, and about the fact that there are long distances between hospital trusts. That may—

Mobile Technology (Health Care)

Dan Poulter Excerpts

Wednesday 21st November 2012 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Havard.

It is also a pleasure to respond to this debate, and I congratulate the hon. Member for West Lancashire (Rosie Cooper) on securing it and on highlighting an important focus of future health care policy. She is right to highlight the Nicholson challenge: for the NHS just to stand still and to continue performing at the same level so that patients continue to receive the high-quality care that we all believe and know they deserve, it needs to make £20 billion-worth of efficiency savings and to put that money back into front-line patient care. A key part of the debate is that better IT will improve the way we communicate with patients and keep people well and better supported in their own home and community, on the basis that preventive health care is much better than curative health care, both for the patient and, financially, for the NHS. Of course, I would be delighted to meet the hon. Lady and people involved in the IT industry at a later date to discuss things further.

Although we know that simple things such as in-ear thermometers, improved hoists in hospitals and better-quality equipment in operating theatres has improved the quality of patient care over many years and driven down the cost of providing health care, the hon. Lady is right to highlight the fact that we need to harness and better utilise more modern types of technology such as telehealth and mobile technology to support people better in their own homes and to drive down the cost of care.

Last week, my right hon. Friend the Secretary of State for Health outlined the NHS mandate, in which he set out the vision for the NHS and addressed some of the key challenges that we face. In her speech, the hon. Lady rightly highlighted that we have an ageing population with many people living a lot longer with long-term medical conditions such as diabetes, cancer, heart disease and dementia. The challenge for the NHS is ensuring that we deliver care in a better way that meets people’s care needs while ensuring that, where we can, at the same time as producing high-quality care, we reduce costs so that there is more money to go around to look after more people.

My right hon. Friend the Secretary of State announced in the publication of the mandate that a real priority for the NHS is to improve the management of long-term conditions by helping people to better understand their conditions and to take control by supporting them to self-care, thereby realising the massive potential benefits offered by information technology both in supporting people to better understand and look after their conditions in the community, and in their own homes, and in supporting, better educating and better looking after the people who look after patients—the carers. That is an important part of providing high-quality health care.

We already know that there are 15 million people with long-term conditions, accounting for some 70% of all in-patient beds. We also know that many such hospital stays could be avoided through better management, including the better use of mobile technologies to prevent people from becoming so unwell in the first place that they need to be admitted to hospital. That would also help to prevent the revolving door of hospital admissions that sometimes happens when people do not necessarily have the support that they need and deserve when they are discharged from hospital, perhaps after a hip operation or similar stay.

Improving access and the quality of health care available to all patients is a key aim for the NHS, not just in meeting the Nicholson challenge but in improving day-to-day quality of care. Increasingly, technology will play a part in that: not just breakthroughs in simple day-to-day medical devices but changes in how we reach people in remote rural settings and in their homes and communities through the use of telemedicine, telehealth and mobile devices. We can and should take advantage of the deeply interconnected nature of modern society to improve people’s experience of health care and significantly increase our efficiency in delivering it.

There are infinite ways in which technology can transform how people access health and social care services. “Digital First”, a report published in July by the Department of Health, estimates that the NHS could save up to £2.9 billion by implementing just 10 simple actions to transform how people access health care. Those savings could be made almost immediately and with minimal investment by making use of existing technologies to reduce inappropriate face-to-face contacts.

There are many examples of simple things that can be done, such as having a doctor or nurse talk to a patient on the phone when they call to book an appointment or as an initial assessment. About one third of patients do not necessarily need a face-to-face GP appointment. Such conversations can reassure callers that they are okay and not that unwell, and that perhaps they should see how things go overnight or later in the day and call back if they need further help. They also help the patient access health care in the most appropriate way, as the GP triages the patient remotely.

Texting and e-mailing people to remind them of appointments has already been shown throughout the NHS to reduce the number of people who fail to turn up to their medical appointments. One big challenge in health care is getting patients to attend and comply with treatment, particularly those with longer-term conditions who must make multiple trips to a hospital or care setting. E-mails and texts are an effective way to remind people about their appointments and help educate them, removing the burden from the acute setting by ensuring that they understand how better to manage their conditions.

Those are simple changes, using the technologies that people use every day and are already familiar with, that can free hundreds of millions of pounds and provide more convenient access to NHS services, particularly for patients who live in more remote and rural parts of the country.

Technology can also improve the working lives of professionals. The funds that we are making available to nursing staff will enable them to access information faster so that they can spend more face-to-face time with patients, an important point that the hon. Lady made in her speech. Doctors, nurses and all health care professionals want to spend time looking after their patients. They do not want to be bogged down in paperwork. Technology, whether used on the ward or to access and look after patients remotely via telehealth or mobile technology, is a good way to ensure that front-line health care professionals have more time to do what they want to do and what they are trained to do: care for and look after the sick and patients.

I have seen at first hand the potential of telehealth and telemedicine to transform and save people’s lives. Earlier this month, I visited the telehealth hub at Airedale NHS Foundation Trust, which I know is on the other side of the Pennines from the hon. Lady’s constituency, but I am sure she will not mind my using it as an example. The hub is staffed 24 hours a day, seven days a week, by skilled nurses specialising in acute care. A consultant is also on hand if needed.

The aim of the service is to care for patients closer to home and keep them there whenever it is safe to do so. In other words, it ensures that people are properly supported and well advised in their own homes and other care settings, such as residential homes, so they do not become as unwell as they might otherwise. They are given appropriate health care advice, guidance and support in their homes and care settings, which helps reduce the burden on acute services in the area. It is particularly important in more rural areas, where the distances that professionals must travel to look after patients are so great that the only effective way to get around to as many patients as possible, in both financial and human care terms, is to use the benefits that telehealth brings to Airedale and the surrounding areas.

Evidence suggests that many patients are admitted into hospital when, as we have discussed, that is not always the best environment or the most appropriate place for them. Using telemedicine allows patients to manage their conditions with the hospital’s support. It can prevent time-consuming, costly trips to hospital for outpatient appointments. The patient’s GP is instantly informed and kept up-to-date about any consultations that occur via the telehealth care hub.

Importantly, the Government do not want such initiatives to take place in isolation. We believe, as I know the hon. Lady does, that we must ensure that they become day-to-day occurrences in the NHS as the years go on. Technology and the better use of information provide immense opportunities for improving the quality and accessibility of NHS care, not just in remote rural settings but in every care setting that we can think of.

The Government’s information strategy for health and social care, “The Power of Information”, is another example that highlights the importance of harnessing innovative new technology and delivering better health for patients. The strategy, of which I know the hon. Lady will be aware, was published in May, setting out ambitions for people to be offered online and mobile access to records, electronic communication with professional teams, online health and care transactions and the ability to rate services and provide feedback about how effective and convenient they were for the patient.

A small number of actions will need to be led nationally, such as setting common standards to allow information to flow effectively around the system. More detailed implementation planning will be led by organisations including the NHS Commissioning Board to ensure that current good localised initiatives in different parts of the country are rolled out nationally. We learn from areas such as Airedale, where looking after people in their own homes through the better use of technology is going well. Those examples should be rolled out to become the norm in the NHS. I know that the NHS Commissioning Board will be central to driving that through, which is why improving information technology was at the heart of the NHS mandate launched last week.

Mainstreaming assistive technology across the NHS is particularly important. As we have discussed, it is not good enough to have high-quality localised initiatives; we need a systematic, NHS-wide approach that embraces technology. My right hon. Friend the Secretary of State for Health announced at the Age UK conference last week that plans have been agreed that will ensure a further 100,000 people will be supported by telehealth in 2013, a sixteenfold increase in the number of people being helped by telehealth and telecare. It will make Britain the largest market in the world behind the USA, which is something that we can all be proud of.

The recently published results from the whole system demonstrator programme are potentially game-changing. We now have robust academic and scientific evidence that such technology can drive improvements not only in quality and value in the NHS but in patient satisfaction levels and outcomes. We all know that the most important people in all these discussions are the patients whom the clinician looks after and the telehealth provider wants to look after. Importantly, when we are designing telehealth services, like all other NHS services, we need feedback from patients in order to ensure that where services are working well, they can be rolled out elsewhere in the NHS, and that where improvements could be made and things are not going so well for patients, the NHS can learn from that and adapt technology to improve care in future.

At the Age UK conference last week, my right hon. Friend the Secretary of State announced some significant steps on the road to supporting the 3 million people who stand to benefit from telehealth and telecare by 2017. As the hon. Lady said, the key is improving care for older people. They are the biggest users of NHS services, so they will see the most immediate changes and feel the most immediate benefits from telehealth. We have a growing elderly population and growing numbers of people with multiple long-term conditions. In order to meet the challenge of looking after them properly and providing dignity in elderly care, we must ensure that we keep them well at home and in their communities. One significant part of the answer is doing more for telehealth. The Government are well on the road to doing so. I welcome further discussions with the hon. Lady about what more we can do to look after people, particularly the frail elderly, in their own homes.

[Mr Dai Havard (in the Chair)]

Thank you, Minister. I am sure that you will have interesting discussions with your colleagues in the devolved Administrations about interconnectivity as well.

Question put and agreed to.