Birth Environment (Improvements)

Dan Poulter Excerpts

Monday 12th November 2012 Written Statements

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

I am announcing a £25 million capital funding in 2012-13 for the NHS to improve the birthing environment in the maternity units that need it most, so both mothers and fathers, and the staff who work in the units, can benefit from a more pleasant and appropriate environment.

Women should receive excellent maternity services that focus on the best outcomes both for them and their babies, based on women’s experience of care. It is important for all women to be able to give birth in a safe, high quality environment that is best suited for them. Birthing environments should be designed so to provide for the safe care of mothers, fathers and baby in a comfortable, relaxing environment that facilitates what is a normal physiological process, enabling one-to-one midwife care during labour and birth in privacy whenever possible, while enhancing the family’s enjoyment of an important life event.

This builds on the Government’s pledge to improve maternity care by making sure:

women will have one named midwife who will oversee their care during pregnancy and after they have had their baby;

every woman has one-to-one midwife care during labour and birth; and

parents-to-be will get the best choice about where and how they give birth.

Providers will be able to bid for central funding in the current financial year to support the refurbishment of wards, for example, by adding ensuite facilities, providing new facilities to allow fathers to stay overnight at the birth and new equipment such as birthing pools. Bids will need to meet the criteria set out in “Maternity care facilities: Planning and design manual, Version:0.8:England (2011)”.

The criteria for applying for funding and the deadline for receipt of applications will be announced shortly. It is important that the views and experiences of women and their families locally inform the development and design of birthing environments. The successful projects will have demonstrated involvement and support from service users and the ability to deliver the project in the current financial year.

Kettering General Hospital

Dan Poulter Excerpts

Friday 9th November 2012 Commons Chamber

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

It is a pleasure to respond to this debate and I congratulate my hon. Friend the Member for Kettering (Mr Hollobone) on showing great concern for his local hospital, and on expressing so eloquently his support for local NHS services and staff in Kettering and throughout his region. I recognise his long-standing dedication to ensuring that the health needs of all his constituents are met and, throughout his time in the House, he has been a strong advocate for his constituency, not just in today’s debate. He has consistently raised issues on how to improve the quality of health care and outcomes for the people of Kettering, and I congratulate him on that.

It is worth providing a little background to today’s debate. As my hon. Friend eloquently outlined, Kettering hospital had just under 370,000 patient contacts in 2011-12, including more than 85,000 attendances at A and E. That is more than ever before which, as he pointed out, is due to rising population pressures in Kettering and increased population growth. Indeed, the fact that people are living longer presents new and different challenges to the way we deliver health care throughout the NHS.

Let me take this opportunity to recognise, as my hon. Friend did, the hard work and dedication shown by NHS staff in his constituency. There are more than 3,200 staff at the trust, in addition to those who work hard to look after patients in primary care. The dedication and commitment they show to improving the health and well-being of my hon. Friend’s constituents, and those of other hon. Members, makes us all proud of our NHS and the dedicated front-line staff who work tirelessly on a day-to-day basis, often going above and beyond the call of duty to deliver high-quality patient care.

I reassure my hon. Friend that A and E and maternity services at Kettering hospital are safe. The Prime Minister has put that clearly on the record, and I confirm it again today.

[Lilian Greenwood (Nottingham South) (Lab)]

Will the Minister give way?

[Dr Poulter]

It is interesting to find a Member from Nottingham, who I hoped would be in her constituency on a Friday looking after her constituents, taking such an active interest in this debate. However, I am happy to give way once on this issue.

[Lilian Greenwood]

I am attending this debate because I was here earlier to deal with a private Member’s Bill on behalf of the shadow transport team. Whatever the Minister says, is it not a fact that in the official documents, the “best” option is downgrading Kettering general hospital’s accident and emergency, maternity, children’s and acute services, and cutting a significant number of beds? How can he say that those services are safe?

[Dr Poulter]

The hon. Lady is turning this into a political debate, which is exactly what the Labour candidate in the Corby by-election has done. That is completely wrong and what she says is not true—it is scaremongering. There are no official documents at the moment because there is no consultation of that nature at the moment. There is no NHS consultation. Perhaps she should focus more on Nottingham, which is where her constituency is. I am sure her constituents would rather she were on the train back to hold a constituency surgery, which is what I will be doing after this debate, rather than making silly, ill-founded and mistaken political points about matters that bear no resemblance to her constituents’ concerns. I hope she will draw a lesson from this. I know she has been put up to making that point, but this is not the time.

The hon. Lady’s point was ill-founded. There is no consultation active in Kettering at the moment. There were some leaked documents about a range of options, which incorrectly set a number of hares running. The Labour candidate in the Corby by-election has already retracted his position. My hon. Friend has held the debate today because of that scaremongering, and because he is such a strong advocate for the needs of his patients in Kettering and his hospital. He wants to reassure them that Kettering hospital has a viable future.

[Lilian Greenwood]

Will the Minister give way?

[Dr Poulter]

I will not give way again. This is an Adjournment debate, not a general debate on the Floor of the House. The hon. Lady did not contact me before the debate to say that she would make a point—no Labour Member did. This is not a time to raise those points. The debate is about reassuring my hon. Friend that Kettering hospital has a viable future, which it does. That is confirmed clearly by Healthier Together, which has also confirmed that no active consultation is taking place; that, at the moment, we have only potential options appraisals; that A and E and maternity are safe; and that Kettering hospital has a viable future. I hope that the hon. Lady will put as much dedication into standing up for her hospital services in Nottingham as she has to making cheap party political points in a debate about a different part of the country.

I should now like to address some of the points, questions and legitimate concerns that have been raised, mostly as a result of the outrageous scaremongering by the Labour party. The Healthier Together programme has been put together, but, as I have said, there is no formal consultation at the moment. I am sure the concerns my hon. Friend so eloquently raised will be fed into it, and that the debate, and the comments of the Prime Minister and Health Ministers, will be part of it.

We recognise, as my hon. Friend has outlined, the importance of proper public engagement throughout any consultation process—as and when it comes. He will be aware that there has already been significant public and stakeholder engagement on how services in the midlands might need to look in future. As he rightly said, there are new demographic challenges—more people are moving into that part of the country—and the process of engagement must continue. If a formal consultation is opened in future, it is important that it meets the clear clinical tests for service reconfiguration. However, I should repeat that no formal consultation has been opened and it would be incorrect to allow any further Labour party scaremongering on that point.

It is worth bearing in mind that part of the reason for the concerns about services in my hon. Friend’s part of the world is the massive private finance initiative debt signed off by the previous Government to Milton Keynes hospital, which has struggled ever since the PFI was signed. That has led to significant pressures on Milton Keynes and other hospitals in the region. As we know, some services are specialist centres. It might be worth reflecting, before any further cheap political points are made, that one reason why there was a discussion about a consultation on services was the big PFI legacy of debt, which is stopping the delivery of high-quality front-line care. That is a direct legacy of the previous Government signing off bad PFI deals in health care. It is worth reflecting on that before any more scaremongering takes place.

When reconfiguration of health care takes place, the previous Government—and this Government—have laid down some key tests of what makes a good reconfiguration. It has to be led locally by local commissioners and decision makers, and my hon. Friend made that point very clearly. Any significant proposed changes to services would be subject to four reconfiguration tests set out by the previous Secretary of State for Health. They are local support for the changes from GP commissioners and clinical leaderships; robust arrangements for public and patient engagement, including local authorities; greater clarity about the clinical evidence basis underpinning proposals; and the need to take into account the development and support of patient choice.

In my hon. Friend’s region there are considerable distances between the hospitals involved and, if at some point in the future a consultation opened up, those greater travelling distances between hospitals would be taken into account as it may impinge on patient choice. I hope that restating those configuration tests is helpful. If there is concern that those tests have not been met, an independent review can be carried out by the independent reconfiguration panel, at the discretion of the Secretary of State. I hope that my hon. Friend finds that reassuring. I reiterate that at the moment there is no consultation formally on the table in Kettering, and its accident and emergency and maternity services are safe.

There are other significant challenges facing Kettering hospital and the local NHS, as my hon. Friend outlined. They are the same as those faced by the NHS everywhere— ensuring that we have services that are fit for purpose for the future to better look after the many older people—people are living longer—and the need to provide more dignity in elderly care. Part of that is having local bread-and-butter services. My hon. Friend rightly made the point that some health care services have to be regionalised, such as specialist trauma centres. The clinical evidence is that such centres save lives and, in my part of the world, we have one in Addenbrooke’s. Dedicated centres for stroke care also improve care for patients and the quality of outcomes for people with stroke, so that they can resume their daily activities much more quickly. Those day-to-day, bread-and-butter health care services that are so important, such as maternity and accident and emergency—and the cardiac services that Kettering is rightly proud of—are needed at a local level, and I am sure that any test of reconfiguration would confirm that they should remain accessible locally. We are very aware that many parts of the country are not urban. Many people face the challenges of rural life and the distances to travel between centres. Whenever services are redesigned in the future, it is important that those bread-and-butter services are available for local patients.

I reiterate the fact that there is no formal consultation proposal, and there is no place for scaremongering in these debates. I am sure that the future of Kettering hospital is a vibrant and successful one. I know that my hon. Friend has strongly advocated the dedication of local staff and I hope that he will take my reassurance back to them—so that they do not listen to the scaremongering—that Kettering hospital will still have a viable A and E and viable maternity services, and a very strong future.

Question put and agreed to.

Regional Pay (NHS)

Dan Poulter Excerpts

Wednesday 7th November 2012 Commons Chamber

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

It is a great pleasure to respond to today’s debate. I am pleased to start on a consensual note, in that we have heard some genuine concerns expressed by Members on both sides of the House on behalf of our NHS staff. All hon. Members very much value the dedication and hard work of all staff who work in the NHS on a daily basis. They often go above and beyond the call of duty to look after patients, and I would like to echo the comments made in that regard.

We have heard good contributions from the hon. Members for Blaydon (Mr Anderson), for South Down (Ms Ritchie), for Bristol East (Kerry McCarthy), for Hartlepool (Mr Wright), for Plymouth, Moor View (Alison Seabeck), for York Central (Hugh Bayley), for Worsley and Eccles South (Barbara Keeley) and for Stockton North (Alex Cunningham); my hon. Friends the Members for Kingswood (Chris Skidmore), for Southport (John Pugh), for Aberconwy (Guto Bebb) and for North Cornwall (Dan Rogerson); my hon. and learned Friend the Member for Torridge and West Devon (Mr Cox); and my hon. Friends the Members for North Devon (Sir Nick Harvey) and for St Ives (Andrew George). The contributions from the hon. Member for York Central and my hon. and learned Friend the Member for Torridge and West Devon were particularly thoughtful, putting on the record their genuine concerns for the NHS staff who work in their constituencies. Those contributions encapsulated the support that all Members of this House wish to show for the hard work that NHS staff do every day.

However, I was disappointed by the intervention from the right hon. Member for Exeter (Mr Bradshaw). I have looked at the Hansard record, and it is worth picking up on this. I have here the details of the exchange involving the hon. Member for Bristol East (Kerry McCarthy), and I want to set the record straight for the House now. She asked:

“When did the Department of Health first find out about the formation of the consortium?”

The Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry), replied that she was not aware—the Department was not aware—but that she would

“make further inquiries of …officials…and write to the hon. Lady”

to clarify that. It is clear that my hon. Friend has been misrepresented in this debate. That is in Hansard, it is on the record clearly, and I hope that hon. Members will accept the correction and withdraw their remarks. I wish to make it very clear, for the record, that we were made aware of the south-west consortium’s plans when its project document was leaked. That is when the Department became aware of the plans. We did not encourage the consortium in any way and it has the freedoms in respect of its own employment conditions that were given to it by the previous Government under their legislation.

It is worth stressing that Opposition Members, particularly those on the Front Bench, have made many attempts to rewrite history. The speech made by the hon. Member for Copeland (Mr Reed) bore little resemblance to reality when he talked about the involvement of the private sector. The right hon. Member for Leigh (Andy Burnham) said that breaking national pay frameworks is the first step towards the marketisation of the NHS. Yet, as one of his colleagues said later, it was the previous Labour Government who introduced the private sector into the NHS in the first place, who paid the private sector more than NHS providers for providing the same services, and who allowed those private sector providers to cherry-pick the best services from the NHS, to the detriment of NHS patients. Through the Health and Social Care Act 2012, this Government will be stopping that by having more of an emphasis on joined-up and integrated care for all health care providers.

It was the Labour Government who introduced the pay structure about which Opposition Members are so concerned into the NHS. It was the Labour Government who introduced regional pay into the NHS through incentives and London weighting. It was the previous Labour Government who endorsed the flexibility of local employers to set their own terms and conditions. It was the Labour Government—the Government of the right hon. Member for Leigh—who gave greater freedoms to employers to set their own terms and conditions when they created foundation trusts.

Let me set the record straight and make things perfectly clear. We cannot rewrite history. The right hon. Member for Leigh wants a change of direction, but does he mean a change of direction from the pay flexibility that he and his Government gave to the NHS when they were in power? The Government recognise that in some parts of the country it is important to have pay flexibility in the NHS. We believe that it is right to reward London workers with a £6,000 London weighting because the cost of living is much higher. Does he want to withdraw that flexibility?

[Andy Burnham]

On our watch, no trust opted out of the national pay agreement in the NHS, but on the Government’s watch, 32 trusts are trying to undercut it. The hon. Gentleman is in the Government—what is he going to do about it?

[Dr Poulter]

The right hon. Gentleman cannot rewrite history. He cannot stand at the Dispatch Box and say that he no longer agrees with the pay flexibilities he gave local NHS employers or with the “Agenda for Change” document that his Government put in place. That document recognises that in parts of this country premiums of up to 30% need to be paid to employees. It also recognises that the cost of living in London is much higher and gives a £6,000 premium to NHS workers who work in the centre of London.

In our amendment, the Government are pleased to support the comments made to the GMB by my right hon. Friend the Chief Secretary to the Treasury. That highlights the Government’s support for NHS and public sector staff and recognises implicitly that in some parts of the country—as the previous Government’s “Agenda for Change” makes clear—we need pay flexibility to recognise when the cost of living is greater.

Importantly, the Government have also made clear our intention to retain national pay frameworks and national collective bargaining while they remain fit for purpose. That is why we are encouraging NHS employers and the trade unions to come together at the NHS Staff Council to negotiate a settlement that remains fit for purpose so that we can continue to endorse national pay frameworks. That is the stated position of the Government and it is a shame that the Opposition are attempting to politicise an issue of their own making.

It is worth putting it on record that despite the financial challenge faced by the whole public sector, we have put an extra £12.5 billion into the NHS during the life of this Parliament. That is not to say, however, that there is no financial pressure, and the Opposition were right to highlight the Nicholson challenge and the need to cut away bureaucracy and waste in the NHS in order to put more money into the front line. We endorse that. The Government are meeting the Nicholson challenge, and the NHS reforms we have put in place will put the NHS in a much better place to do that in the future.

[Mr Reed]

Does the Minister agree that everyone in this House should pay close attention to the fact that another set of terms and conditions for public servants is being negotiated now, and that if Members of Parliament vote for regional pay in the national health service they should accept regional pay for Members of Parliament?

[Dr Poulter]

The hon. Gentleman needs to be brought back to reality for a second. His Government introduced regional pay in the NHS through “Agenda for Change”, so he cannot stand at the Dispatch Box and rewrite history, saying that he is desperately concerned for the workers. “Agenda for Change” needs to remain fit for purpose, and it is the Government who are standing up for NHS workers. We will protect not just patients but jobs and workers in the NHS by ensuring that we support NHS employers and the trade unions as they come together to protect jobs and ensure that “Agenda for Change” remains fit for purpose in the future.

In conclusion, it is clear that the Opposition want to rewrite history, but it is time to cut the propaganda and get real about the debate. We all want to see individual employers given autonomy based on agreed national frameworks, but we want to make sure that “Agenda for Change” stays fit for purpose. In the end we must deliver high quality care for patients, and we understand that that also means looking after staff. That is why it is so important that the national pay frameworks remain fit for purpose, and that on both sides of the House we encourage NHS employers and the trade unions to negotiate a settlement within those frameworks.

The Opposition must stop attempting to play politics. They must support the NHS staff, as we on the Government Benches are doing. The Government are standing up for the NHS, its staff and its patients. That is why I urge all hon. Members to support the amendment and reject the motion.

Question put (Standing Order No. 31(2)), That the original words stand part of the Question.

Nursery Milk Scheme

Dan Poulter Excerpts

Monday 5th November 2012 Commons Chamber

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

I congratulate my hon. Friend the Member for Mid Dorset and North Poole (Annette Brooke) on securing this debate. During her years in the House she has not only shown a keen interest in the nursery milk scheme but has been a strong parliamentary ambassador for the National Society for the Prevention of Cruelty to Children and, since 2006, a champion of Save the Children. That is a long track record of supporting and standing up for issues that matter to children—in this case, the nursery milk scheme. She rightly outlined the tremendous health benefits not only of the nursery milk scheme but of a healthy diet in young children, and highlighted the benefits of drinking milk, given the proteins, minerals and vitamins that it contains. I want to confirm to the House again that the nursery milk scheme is here to stay.

Before I address the points that my hon. Friend raised, it is worth highlighting a few of the issues. While we fully endorse the provision of nursery milk, she is absolutely right to point out that the cost of the scheme has gone up considerably over the past few years. In an average supermarket, a pint of milk costs about 50p to 55p. According to the most recent figures of June 2011, within the scheme there are 23,000 claims—well over 50% of the total—where milk costs 70p to 79p per pint, and almost 9,000 claims where it costs over 90p per pint, which is almost double the cost in the supermarket.

Many hon. Members representing rural constituencies will be concerned that dairy farmers across the country are struggling, and that the increased cost of milk is not rewarding those farmers in the farm-gate price. We must reflect on the cost of the scheme. Since the scheme costs a lot of money, it would be nice if those companies that profit from it also recognised that some of that profit could be passed back to famers in the farm-gate price. The Government and the National Farmers Union do not see that happening as part of the scheme, and although the NFU and the Department for Environment, Food and Rural Affairs support the nursery milk scheme as a way of supporting dairy farmers, it is nevertheless disappointing that companies that supply nursery milk are not supporting our farmers in the way we would like.

As my hon. Friend rightly said, the nursery milk scheme is of long standing and has been running throughout Great Britain since the 1940s. The devolved Administrations in Scotland and Wales fund milk supplied through the scheme to children in their countries, and Northern Ireland has its own, similar scheme—I am pleased to see the hon. Member for Strangford (Jim Shannon) in his seat as usual.

As we know, the scheme funds free milk for around 1.5 million children under five years of age at 55,000 child-care providers throughout Great Britain. Nursery milk is a universal benefit, meaning that child-care providers can claim the cost of milk provided to any child, regardless of the child’s home circumstances. The scheme is valued by parents and pre-school staff, and its health care benefits were thoroughly outlined earlier in the debate.

The Government recognise, however, that the nursery milk scheme is expensive, and the consultation was about improving its operation and ensuring that it remained fit for purpose. The scheme remains largely unchanged since it was first introduced as a wartime measure, and in recent years prices claimed for milk purchased under the scheme have risen significantly, owing largely to third-party agents who seek to make considerable profits by delivering milk to child-care providers. As I said earlier, unfortunately those profits are rarely paid back to farmers in the farm-gate price.

The prices claimed for milk supplied under the scheme have risen significantly, with some claims reaching almost £1 a pint. That has led to a corresponding increase in the overall cost of the scheme. In 2007 and 2008, the scheme cost £27 million, but by 2010-11 that had risen to £53 million—it almost doubled in only four years. If we do nothing, that trend looks likely to continue, with costs potentially rising to £76 million by 2016.

Under the current system, there is no limit on the price at which child-care providers may purchase milk, or even a requirement for each provider to review their milk expenses. In many cases, agents supplying milk handle the claims themselves, rendering child care providers unaware of the price paid. For those reasons, the total cost of the scheme has risen dramatically over the past few years, and although the amount of milk supplied has risen by 25% since 2009-10, the total cost of the scheme has risen by 45%.

[Tessa Munt (Wells) (LD)]

Does the Department of Health have a grip on the procurement process involved in this scheme? When providing milk across the nation, surely we should be able to supply from local sources or distributors. The costs that the Minister mentions seem to have escalated greatly, but farm-gate prices have not changed much. It seems extraordinary that someone has not got a grip on procurement.

[Dr Poulter]

My hon. Friend is absolutely right, and that is why the Government launched the consultation in the first place. The scheme was devised in the second world war, and its provisions mean that the Department of Health currently has no role in active procurement. The Government embarked on the consultation in view of the rising costs, and my hon. Friend will rightly feel concern for dairy farmers in her area of Somerset. Profits from this scheme are going to intermediate companies, and the cost has recently escalated out of control. My hon. Friend also highlights the fact that farm-gate prices have not improved as a result of those increased prices and profits for intermediate suppliers of milk.

It is worth pointing out that an important factor contributing significantly to the scheme’s accelerating costs seems be embedded in its design. No mechanism exists to incentivise child-care providers to economise and search for the highest attainable value for money in their local markets, to support their local farmers or to source their milk from a certain provider. Over the last three years, the average price paid for a pint of milk in a supermarket has been 50p, but the average charged by agents is 78p, which is well over 50% higher. That shows that the scheme is rapidly becoming unfit for purpose, which is exactly why the Department embarked on the consultation.

[Annette Brooke]

Until recently, at least one school was not registered in the scheme because it feared the bureaucracy would be too great. A balance must therefore be struck to ensure that schools and child-care providers participate in the scheme.

[Dr Poulter]

My hon. Friend makes a good point. As part of our consultation, we are looking at a number of options as to how we can maintain an effective scheme and ensure that the one we offer and deliver is better value for money.

It is worth looking at the three options in the consultation. The first option was to cap the price that can be claimed for milk. Under that option, an upper limit on the price that could be claimed for milk would be introduced and increased each year in line with inflation in the retail price of milk. In special circumstances, arrangements would be put in place to vary the cap for child-care providers that, perhaps because of geographical isolation and rurality, to which hon. Members have alluded, do not have access to milk priced at the normal market rate.

The second option was to issue e-voucher cards with or without devolved incentives for child-care providers to buy milk economically. Under that option, child-care providers would no longer have to pay for milk and then claim reimbursement from the nursery milk reimbursement unit. On joining the scheme, child-care providers would indicate how many children would normally be attending for two hours or more per day. They would then be credited with a prospective monthly payment equal to the number of pints required, multiplied by a fixed reimbursement rate, which would be set at an average market price per pint.

The final and third option was to contract a company or consortium of companies for the direct supply and delivery of milk to all child-care providers. Under that option, the Department of Health would take a much more active role in procurement. It would contract a company, or a consortium of companies, for the direct supply of milk to all child-care providers registered with the scheme at an agreed price per pint supplied. That is one way to avoid the bureaucratic burden to which my hon. Friend has referred.

[Jim Shannon]

The debate so far has been about the price of a pint of milk. My recollection, like that of the hon. Member for Mid Dorset and North Poole (Annette Brooke), is of a third of a pint of milk. If we reduce the quantity of milk for a small child, would that not reduce the price? Is that too simplistic?

[Dr Poulter]

We will see what the consultation says. One option, which I have outlined, takes into account the bureaucratic burden of the cost on schools. We value the scheme and want to keep it—that is implicit—but at the same time, we recognise that going through a bureaucratic process to claim for milk could increase the cost to nurseries and other child care settings. The third option in the consultation is therefore for direct procurement from the Department of Health. That would help to reduce the bureaucracy in the scheme, although the hon. Gentleman will be aware that there is an allied, parallel scheme in Northern Ireland that operates in a similar way to the schemes in England, Scotland and Wales.

The National Farmers Union values the nursery milk scheme as a well established and highly regarded programme that plays an intrinsic role in society, supporting our dairy farmers as a key part of the supply chain. At the same time, the NFU believes that every attempt must be made to ensure a fair return to the whole dairy supply chain, including the primary dairy farmer. We must not lose sight of that. When the intermediaries are making huge profits, the farm-gate price—the price paid to farmers, who we value, particularly in rural communities—must be recognised in how the scheme operates. For the NFU and all those concerned about the impact of the proposed changes on the dairy market, let me explain that, according to Dairy UK estimates, milk supplied under the nursery milk scheme represents less than 1% of the total value of the UK dairy market; nevertheless, it is an important part of that market.

We are consulting on the scheme. The consultation closed at the end of last month, and we will be considering the representations made. To conclude, I repeat that the nursery milk scheme will continue as a universal benefit. It has huge health benefits for young children, and all eligible children in the care of child-care providers will continue to receive their free milk. We need to establish a system, however, that makes the nursery milk scheme fit for purpose and makes it adapt to recognise the important role that farmers play in the supply of milk—

Stillbirth Certification

Dan Poulter Excerpts

Wednesday 31st October 2012 Westminster Hall

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

Thank you, Mr Owen, for calling me to speak. It is a great pleasure to serve under your chairmanship; like my hon. Friend the Member for Daventry (Chris Heaton-Harris), it is the first time that I have done so.

I pay particular tribute to my hon. Friend for raising this matter in Westminster Hall today. He and I have worked together in the past to raise awareness of the need to do more to support those families who have had the terrible experience of stillbirth. We have also worked together in the past to discuss the need for greater research in this area. He is absolutely right to highlight a number of the issues that he has raised today, and I will deal with the issues that he has raised in turn.

In my own medical career as a doctor, I have never seen anything more tragic than either a very badly injured or ill child, or a dead baby. The death of a baby is probably the worst situation that I came across, and losing a child is the worst experience for family and friends; it lives with people for ever. For some families, there is no coming to terms with the death of a child. It is a very difficult thing to live with and we must continue to do all we can to support those families, working with Sands and the other organisations that do a very good job in supporting those families; we must continue to do more.

My hon. Friend quite rightly highlighted the unacceptable regional variation in stillbirths. From the figures for 2011, we know that the strategic health authority for the north-east of England reported 5.8 stillbirths per 1,000 live births, whereas the SHAs for the east of England and the south-west of England reported 4.7 stillbirths per 1,000 live births. As I say, that is an unacceptable variation. There is an acknowledgment by the Royal College of Obstetricians and Gynaecologists, by the Royal College of Midwives and by Sands and many organisations that we need to do more to reduce the rate of stillbirths in this country. We must continue to do more to research the factors that cause stillbirth. As my hon. Friend said, in many cases the cause of a stillbirth is still unclear. We also need to continue to crack down on this unacceptable regional variation, and learn where there is good practice in combating and reducing stillbirth rates and where the NHS is doing things better, so that that good practice can be rolled out across the country.

As I said, the death of a baby, whether during pregnancy or following birth, is probably the worst tragedy that anybody can face, and that is true both from the point of view of a health care professional and from a family’s perspective. Stillbirth is not only the loss of a child, but the loss of all the hopes and dreams that the family would have had about what that baby would have become and what it would have meant to them in the years ahead. That is why it is particularly important that this is an area that we continue to focus on, to reduce stillbirth rates and so that both the Department of Health and medical professionals take this issue increasingly seriously. As my hon. Friend rightly highlighted, our stillbirth rates are 33rd out of 35 high-income nations and as a country we need to do better than that and improve on those rates.

[Jonathan Lord]

I am glad to hear my hon. Friend the Minister and my hon. Friend the Member for Daventry (Chris Heaton-Harris) talk about the work of Sands. I myself have had constituents come to me with the help of Sands, and my hon. Friend the Minister speaks very well about that organisation and about the real hurt of those families who have suffered a stillbirth.

However, could my hon. Friend the Minister just give us a little bit more information as to why he thinks the stillbirth rates in this country are higher than they should be, and why they are higher than the rates in many other western countries? What are the reasons behind that? That is the crucial thing—to stop this terrible tragedy happening to other families.

[Dr Poulter]

I thank my hon. Friend for that question, and he makes a very good point. As we have said today, we have high stillbirth rates in this country. One factor that the Royal College of Obstetricians and Gynaecologists has picked up on is the fact that there are sometimes variations in clinical practice, including in picking up on early warning signs that we know are associated with stillbirth, for example reduced foetal movements during pregnancy. That sort of thing always concerned me as a front-line professional and it concerns many midwives.

However, we need to have in place across the NHS better systems so that professionals can work with women to identify those early warning signs that something may be wrong in a pregnancy and to ensure that women come in quickly and seek help, or hopefully, rather than seeking help because something is going wrong, in many cases they can seek reassurance. However, where things are not right for a baby, we must ensure that the medical help is on hand to intervene quickly and to support the pregnant woman and hopefully mum-to-be.

There are parallels that can be drawn between where we are now with stillbirths and the situation with cot deaths a number of years ago. Back in the 1980s, the cot death rate was very high, peaking at 2.3 deaths per 1,000 live births in 1988. Following the launch of the “Back to Sleep” campaign in the early 1990s, the rate declined dramatically, falling to 0.6 deaths per 1,000 live births in 1995. This reduction has continued as awareness of the key messages on reducing the risk of cot death has increased. By 2010, the rate was 0.22 per 1,000 live births. To put that in real life rather than statistical terms, we are actually talking about a reduction from some 3,000 cot deaths a year to 300 or 400, which is not perfect, because we still have babies dying of cot death, but raising awareness and targeting cot death has proved to be an effective way of reducing rates. That is something we can learn from in the discussion we are having today about stillbirth.

The point that all hon. Members have made today is that the decline in stillbirths in the United Kingdom has not kept pace with that of comparable countries. According to The Lancet, we rank 33rd in the world for stillbirths. We need to ensure that we do better and take this issue seriously.

Both my hon. Friends have spoken about Sands. It is worth highlighting what that organisation has done. It provides tremendous support for families who find themselves in very difficult situations. It has highlighted the vital importance of the Government and the medical profession—midwives are taking this issue on board and are taking it more seriously—supporting families to make sure that in future pregnant women and families do not have to suffer the problems associated with stillbirth.

Sands has raised a number of issues, including research, which we have talked about and which I will come on to in a moment, and the fact that action is required to raise awareness, as we saw with cot death in the past, of the known risk factors for stillbirth so that prospective parents can make better choices and understand what could go wrong in pregnancy and what the warning signs may be—for example, reduced foetal movements. We need to ensure that parents are informed and that health care professionals know how to support parents and pregnant mums to help them to recognise the warning signs. They need to provide reassurance and care where appropriate and need to intervene when very serious concerns are raised.

We have said that it is not acceptable that the UK has one of the worst stillbirth rates in the developed world. We have developed a stillbirth prevention work programme, which my hon. Friend the Member for Daventry alluded to earlier. The Government are taking this piece of work very seriously, in conjunction with the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists, and the NHS to help to iron out the unacceptable variations in practice and the unacceptable regional variations that we have talked about.

The development of this work programme has been informed by a workshop jointly hosted by Sands and the Department of Health, which took place on 1 March this year. Discussions focused on key areas such as raising awareness and improving identification of babies at risk and improving perinatal reviews. We are continuing with this work to ensure that we can put that into practice throughout the NHS so that we provide pregnant mums with the support that they deserve.

My hon. Friend rightly raised the issue of research. It is important that we fully understand stillbirths. We do not always know what the cause of a stillbirth was. It is important that we do research and look into what the unknown causes and reasons might be. What are the factors that cause stillbirths? We know some of the causes; we do not know all of them. Continuing to research and focus on that is important.

The Government have funded a number of research programmes. Most recently, the Department has funded research through the National Institute for Health Research and the policy research programme. An estimated spend relating to maternal and foetal health has increased from £4.4 million in 2006-07 to £12.7 million in 2010-11. The issue of improving foetal health, babies’ health and maternal health is something that we take very seriously.

Working with Sands, the Department’s policy research programme has funded a policy research unit in maternal health and care at the national perinatal epidemiology unit at Oxford university. Research themes focus particularly on pregnancy loss, perinatal morbidity, maternal morbidity and maternal mortality.

The National Institute for Health Research in Cambridge has an ongoing programme of research on women’s health. A major focus of that research is understanding the determinants of stillbirth risk and using that understanding to improve clinical care of pregnant women. Indeed, last week I visited Manchester where there is a very high quality of care for pregnant women and for newborn babies. The university of Manchester’s maternal and foetal health research centre is currently leading projects in understanding the reasons for stillbirth. I know it will be looking to feed that in nationally so that we can continue to reduce stillbirth rates.

Research on its own is not enough. When we have the research, we have to ensure that we get it out there to the professionals, sharing it and the information from that with parents, to help them to make informed choices about their care and to be aware of the risks and the possible warning signs of stillbirth. Raising awareness is so important. It is an issue highlighted in particular by the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists. They have said that there is unacceptable variation, as we have accepted in this Chamber, in the rate of stillbirth and in how some health care professionals interact with families and pregnant women during pregnancy. Working up national guidelines that focus on professionals supporting families, as well as being aware of the other factors, is an important part of reducing stillbirth.

Another point made by my hon. Friend is that families who have suffered a stillbirth have not always received good bereavement support. We know that a lot of care and attention has been paid to ensure that more support and care is given to families—the royal colleges have taken that on board—and we are looking seriously at how we can provide more support. Many hospitals and trusts have invested in bereavement rooms and quiet areas for families when they have had early pregnancy loss or a stillbirth. That is right, because although maternity things generally go well and we have a good outcome, when things go badly we need to ensure that we are prepared and have a supportive environment to look after families in such circumstances.

Finally, it is important to focus on certification, an issue raised by my hon. Friend. I will look into the matter in more detail and get back to him in writing as well, rather than try to put together an answer in the two or three minutes available to me. He made the point that some mums who give birth have to go through the whole birthing process—they actually give birth to a dead baby—and that is an incredibly traumatic and difficult thing to do, because they know that their baby is not alive. Some mums, however, have to do that. In such situations, although the law, with such things as birth and death certificates, is there for good reason, the human reality is sometimes not recognised in the law as effectively as we might like. There will, though, sometimes be difficulties with law, however we have it. As best we can, we have tried to mitigate such situations by beginning to provide more supportive environments for parents after a stillbirth and by providing certificates recognising that there has been a stillbirth after 24 weeks. That goes some way towards recognising the difficult and tragic event—we recognise that a baby has been born, although the baby was not born alive. I will write to my hon. Friend in more detail in the next few weeks, because the issue deserves more than a few sentences at the end of the debate.

I thank my hon. Friend and pay tribute to his work on raising awareness of such an important issue. The Government are very much committed to taking forward our work with Sands and ensuring that we reduce stillbirth rates in this country, as well as providing more research to investigate the causes of stillbirth and better support for bereaved parents in what is perhaps the most difficult thing I have ever seen in my medical career.

Question put and agreed to.

Acute and Emergency Services

Dan Poulter Excerpts

Friday 26th October 2012 Commons Chamber

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

I congratulate my hon. Friend the Member for Bracknell (Dr Lee) on securing this debate and on making such an eloquent speech about the importance of modernising the NHS so that it can continue to deliver high-quality care. That often goes hand in hand with both improving efficiencies in care delivery to patients and reducing the cost of delivering care.

My hon. Friend outlined how the NHS crisis management system focuses on the acute sector. If we were designing the NHS today, it would look very different. My hon. Friend explained the importance of community-delivered care and pointed out that we need to keep people living well and healthily in their communities, rather than picking up the pieces in the hospital setting after they become unwell. He rightly made the point that the length of time of hospital stays for surgical operations has fallen. It has fallen from about nine or 10 days over the past decade or 15 years to an average of about five or six days. Increasing use of keyhole surgery and other minimally invasive procedures have also increased the quality of care we can provide, reduced the cost and, importantly, ensured that patients are treated in a more effective way. These developments also take account of the fact that people are much better off at home than in hospital, or when being treated as day cases rather than long-term admissions.

My hon. Friend rightly highlighted that there is a big challenge facing our health service in the decade ahead: we have many people with long-term medical conditions who need to be treated and we have many older people. People with diabetes, heart disease and dementia are also living longer. The way we should look after them is not to wait for them to get unwell and then pick up the pieces when they arrive at A and E, but to prevent them from getting unwell in the first place. We must deliver more care in the community and, where we can, focus on prevention rather than cure. We need to do more to ensure that proper rehabilitation is available for people after a stroke or an operation. That needs to be delivered, as much as possible, in the community and people’s homes, as it produces much better care.

We already see good examples of where that is working. In Wigan there has been a cost-saving to the NHS of £700,000 through a new service that makes sure people who have suffered a stroke spend no longer than 50 days in hospital. They are in hospital for a much shorter period and they get the vital rehabilitation and care they need to improve their outcome and improve their recovery. That care is now delivered in the community, rather than the hospital setting. That is cheaper for the NHS and better for patients. It is a good model of care that we can take elsewhere.

As my hon. Friend said, it is important that politicians are brave in how we talk about these matters. He should be commended for the way in which he has approached the issues and been very honest about the fact that medical care will need to look different in future. Sometimes the politician is the worst enemy of the physician. We are both medical doctors—we both still practise medicine—and we understand that good care will look different in the years ahead. It is important to make the case in our roles both as physicians and as politicians that what matters is delivering high-quality patient care, which will have to look different if we want more care at home and more preventive care.

My hon. Friend talked about the need for service reconfigurations that provide specialist centres and more focused centres of care. Among the many examples that he outlined, he said that the reconfiguration of stroke services in London was massively to the benefit of patients and that having fewer centres for stroke care has been saving many hundreds of lives every year; indeed, there are good clinical data to support that. Yesterday I visited hospitals in Manchester, where I saw another good example of where service reconfiguration has worked well after a case was made for reconfiguration of maternity care and neo-natal care. Having fewer obstetric-led maternity units and more midwifery-led units is saving the NHS money but also saving 30 babies’ lives every year in the Manchester area. Mike Farrar, the former head of the strategic health authority, delivered that change very effectively.

Although I take on board what my hon. Friend said about nationally led service reconfiguration, a key thing that we can derive from the changes to services in Manchester and London is that they were driven at a local level by good clinical leadership and effective engagement of local communities. There are many good examples of strong clinical leadership at a local level delivering improved patient care as well as saving money which is being ploughed back into the NHS to improve care for other patients.

Let me turn to service reconfiguration in Bracknell, my hon. Friend’s part of the world. As he is aware, this Government, like previous Governments, have set a number of tests for service reconfiguration. There are four key tests. First, while it is important that local health care services should be designed around local needs, the Government are clear that the NHS should develop and implement plans for service change in a consistent way that gives confidence to local communities. The four tests clearly outline that there should be strong local clinical leadership and ownership of how services are redesigned, as well as strong community engagement. As in the example of Manchester, where community engagement was achieved and people are buying into the change because it is saving 30 babies’ lives every year, we can not only deliver better-quality care for patients but bring the community with us in doing so.

Under the third test, the change, as well as being clinically led, should encourage choice and availability. In more rural parts of the country, focusing on bigger and better centres will often reduce choice, because due to their rural nature such areas need more service providers—more hospitals. People may therefore have to travel long distances to receive their care.

Finally, even if the proposed change involves cost savings to the NHS, the key focus should be on its ability to deliver better-quality patient care. Where all four tests for local reconfigurations can be met, we should all welcome it. My hon. Friend mentioned that the new arrangements are already working well in London, Manchester and elsewhere.

I am happy to meet my hon. Friend to talk through the service reconfigurations that he is advocating in his part of the country, if he wishes to do so. I know that he is already working with his primary care trust and strategic health authority, and with fellow MPs whose constituents and hospitals will be affected by the proposals, and I urge him to continue to engage at local level with the PCT and the SHA, and with colleagues. If he continues to advocate the case that he has outlined today, he will bring people with him.

It is important to stress, however, that the decisions will be taken at local level. As PCTs turn into local clinical commissioning groups, it will be a matter for those groups to work together to decide what health care services will look like at local level. I am sure that my hon. Friend and other parliamentary colleagues will want to continue to engage with them and to make a strong case for proposals such as these. Given the eloquence with which my hon. Friend has put forward his proposals today, I am sure that he will have some success.

Question put and agreed to.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Mrs Mary Glindon (North Tyneside) (Lab)]

3. What his policy is on upholding national pay arrangements in the NHS.

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

NHS trusts and foundation trusts have the freedom to determine the terms and conditions of the staff they employ. As the hon. Lady will be aware, the “Agenda for Change” was negotiated and brought in during 2004 by the then Secretary of State, John Reid, to agree a national framework for pay in the NHS. In general, most trusts support the agreed pay framework and the “Agenda for Change”, and they are likely to continue to use national terms, provided they remain affordable and fit for purpose.

[Mrs Glindon]

In fairness, a truly national health service demands a national pay scheme, and the British Medical Association has warned that the move to regional pay undermines the ethos of “national” in our national health service. How does the Minister intend to act on that warning?

[Dr Poulter]

I remind the hon. Lady that it was the previous Government who set up the current national pay framework in 2004, and that framework has been amended 20 times to support employers over that period. The previous Government gave foundation trusts the freedom to amend those pay terms and conditions. Regional pay does exist in the NHS. On the basis of what she has said, does the hon. Lady wish to remove the London weighting for those workers who live in London? I am sure she would not want to do that because we recognise that it is more expensive to live in certain parts of the country, and workers should be rewarded for that.

[John Pugh (Southport) (LD)]

The Lib Dem conference rejected regional pay entirely, but not the London weighting, and 25 honourable colleagues endorsed a submission to the pay review body. With that in mind, is it not odd that the south-west consortium remains part of national pay bargaining?

[Dr Poulter]

My hon. Friend makes a good point and it is important that we support national pay bargaining where we can. There is an agreement in principle, endorsed by NHS employers, that national pay bargaining is supported throughout the NHS. It was supported throughout the NHS under the previous Government, who set up the “Agenda for Change”, and during their tenure, that agenda remained fit for purpose. Twenty changes during the previous Government’s tenure benefited employees in the NHS, and rightly so. The current Government believe that we must continue to ensure that the system is fit for purpose.

[Mr Jamie Reed (Copeland) (Lab)]

It is most unusual to find the ghost of Christmas past sitting next to the invisible man. The truth is that in May this year, the Deputy Prime Minister stated:

“There is going to be no regional pay system. That is not going to happen.”

Regional pay will strip millions from local NHS services; it will hit the poorest areas of the country hardest, damage front-line NHS care, and there can be no justification for it. Will the Minister categorically rule out continuing with these ruinous proposals—yes or no?

[Dr Poulter]

The arguments presented by the hon. Gentleman are fatuous, and the previous Government endorsed regional bandings for London workers. If today he is saying that he does not agree—[Interruption.] You might learn something if you listen. If he is saying that he does not agree with London weighting for London workers, which is a form of regional pay—[Interruption.]

[Mr Speaker]

Order. The Minister is entitled to be heard.

[Dr Poulter]

If the hon. Gentleman listens, he may well learn something about what his Government did when they were in power. They endorsed the fact that in the NHS it is important to recognise that we need inducements in some parts of the country to encourage workers to work there. That is why we have central London and outer London weighting. If it was good enough under the previous Government, it should be good enough now.

[Mr Speaker]

Order. We are immensely grateful to the Minister, but we have a lot to get through and we really must press on with rather greater dispatch from now on.

--- Later in debate ---

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

6. What assessment he has made of the role of community hospitals in the range of local health care and hospital provision.

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

My hon. Friend is right to highlight the importance of community hospitals in his constituency and elsewhere. They can provide high-quality care close to home, particularly for people with long-term conditions and the frail and elderly.

[Mr Gibb]

I am grateful to my hon. Friend for that answer. If there is a conflict between local health officials and local people as to the desirability of a community hospital, as there is in Littlehampton in relation to the Littlehampton community hospital, which most people in the town want to see rebuilt, whose views should prevail—the NHS employees or the local residents of Littlehampton?

[Dr Poulter]

I thank my hon. Friend for his question. As he is well aware, it is down to local commissioners—local doctors—in Littlehampton to decide, in consultation with local communities, what is good health care. Of course, we must not get fixated on buildings in the NHS. I know there is a local campaign to support the re-establishment of Littlehampton district hospital, and although that may be a very desirable end, there may be many other ways in which high-quality health care can be provided for his constituents closer to home.

[Graham Jones (Hyndburn) (Lab)]

From April, my local health centre will be transferred to a national property company, a quango, in Whitehall. How can local people in Hyndburn regain some influence over this health centre and its use after April?

[Dr Poulter]

Part of reorganising services and delivering good health care is about clinical leadership—I hope that is supported across the House—and local doctors, nurses and health care professionals saying what is important for their patients and what local health care priorities are. Obviously, local communities need to be engaged in that process, but what really matters is what is good for patients and delivers high-quality care for them. We need to deliver more care in the community, and in doing so we have to recognise that some of the ways we have delivered care in the past—picking up the pieces in hospitals when people are broken—need to change. We have to do more to keep people well at home and in their own communities.

[Sir Alan Beith (Berwick-upon-Tweed) (LD)]

Given that the maternity unit at Berwick infirmary has been suspended since the beginning of August for safety reasons, with births being referred to a hospital 50 miles away, will the Minister take into account the urgent need to provide the necessary clinical support for community hospitals in remote areas so that they can provide local essential services to the highest standards?

[Dr Poulter]

I thank my right hon. Friend for that question. We discussed this issue in the Adjournment debate before the autumn recess. He is a strong advocate for his local maternity services. The concern was that only 13 births take place at his local maternity unit every year, and whether staff can continue to deliver high-quality care with such a low number of births. Of course, his local providers will want to consider the rurality of the area and the potential, as outlined in the Birthplace study, of rotating staff in and out of the hospital to support his local unit.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

7. What steps he plans to take to ensure that providers of domiciliary care employ staff who are properly qualified and security checked.

--- Later in debate ---

[Mr William Bain (Glasgow North East) (Lab)]

12. What recent representations he has received on regional pay in the NHS.

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

I refer the hon. Gentleman to an answer I gave earlier today.

[Mr Bain]

Has the Minister had an opportunity to study the research done by the New Economics Foundation a few months ago, which reveals that fully regionalised public sector pay could strip up to £9.7 billion a year from local economies, put 110,000 jobs at risk and hit women twice as hard as men? Given that, what possible justification could this Government have for such a crazy policy?

[Dr Poulter]

Let me bring the hon. Gentleman back to planet earth for a while—[Interruption.] He should have listened to the answer I gave a little earlier about allowing for flexibility in pay frameworks. Some degree of regional pay was introduced by the previous Government in “Agenda for Change”. On principle, then, the previous Government, the hon. Gentleman and his colleagues, including the former Secretary of State, were supportive of regional pay. However, on the current negotiations and discussions, we would like to see a collaborative relationship between employers, unions and employees in the NHS at the NHS Staff Council to make sure that we maintain national pay frameworks as long as they remain fit for purpose.

[Sir Tony Baldry (Banbury) (Con)]

Why should there be an assumption that local pay will lead to lower pay in the public sector? In a constituency such as mine, where the unemployment rate is below 2%, local pay could quite possibly lead to higher pay in the public sector so that people are attracted to it.

[Dr Poulter]

My hon. Friend makes an excellent point. It was the previous Government who, through the “Agenda for Change”, gave flexibility to NHS trusts to allow some employers to pay a 30% premium in areas with workplace shortages.

[Lilian Greenwood (Nottingham South) (Lab)]

17. At a time when NHS budgets are under exceptional pressure, my constituents simply do not understand why the Government are so intent on pushing trusts to divert money away from patient care and into wasteful local pay bargaining. Is there not a risk that Nottingham’s excellent NHS hospitals and community services will be unable to recruit and retain the best staff if regional pay results in cuts to their salary scales? The Government are supportive of the idea, endorsed by the previous Government, that local pay flexibility allows additional rewards to be paid to staff in areas with workplace shortages, as my hon. Friend the Member for Banbury (Sir Tony Baldry) just made clear. The Government are supporting the unions, employers and employees, as the NHS Staff Council, in coming together to try to agree how we need to modify the “Agenda for Change” and other agreements to ensure that they remain fit for their purpose of protecting employees.

--- Later in debate ---

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

We are working with the Department for Education to introduce integrated commissioning of education, health and social care for children and young people with special educational needs and disabilities. This will ensure that children with profound multiple learning difficulties can get the care they need while at school.

[Chi Onwurah]

I recently visited Hadrian school in my constituency, which caters for children with severe learning difficulties and profound and multiple learning difficulties. I saw fantastic teachers and carers doing fantastic work with fantastic children, but I also saw in the reception classes that more children with more severe health needs were entering the school. What guarantees can the Minister offer that funding will be in place for those children in five or 10 years so that Hadrian school can plan now for their needs?

[Dr Poulter]

The hon. Lady makes a good point. We know that the Government are putting more money into the NHS. However, this not just about putting in more money, but about how we deliver care in a more joined-up way. At the moment, education works too much in its own silo and the NHS works in another. The Government’s new commissioning arrangements will follow the more joined-up approach that we need to take properly to meet the needs of children with learning disabilities in the round. That must be a good way forward in properly joining up education and health care.

[Mr Mark Spencer (Sherwood) (Con)]

T1. If he will make a statement on his departmental responsibilities.

--- Later in debate ---

[Helen Jones (Warrington North) (Lab)]

T5. Before the last election, the Prime Minister promised a “bare knuckle fight” to save district general hospitals and promised that they would be enhanced. Now that we know that the board of St Helens and Knowsley hospitals is looking at a merger with Warrington and Halton to solve its problems, can the Minister give the House an unconditional assurance that no services at Warrington will be downgraded or removed, whether that merger goes ahead or not?

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

There was an option to discuss this issue at the board meeting on 29 August—not of the hon. Lady’s hospital trust but of the Halton hospital trust—because the Halton trust is looking to achieve foundation status. So I can reassure her that the services at Warrington hospital are safe.

[Mr John Redwood (Wokingham) (Con)]

T3. What is the administration overhead cost to the NHS and the Department this year and how does it compare with 2009-10?

--- Later in debate ---

[Rehman Chishti (Gillingham and Rainham) (Con)]

T4. Will the Secretary of State join me in welcoming the progress that has been made to reduce mixed-sex wards and improve patient privacy at Medway Maritime hospital in my constituency?

[Dr Poulter]

My hon. Friend is absolutely right to highlight the Government’s success in reducing mixed-sex wards not just in his hospital but throughout the NHS—we inherited a very different situation from the previous Government. Medway has been a pioneer in that area and my hon. Friend is right to commend the hospital and I put on record my thanks for all that it is doing.

[Paul Goggins (Wythenshawe and Sale East) (Lab)]

T8. Will the Secretary of State take a close personal interest in the proposed changes to the NHS in Trafford? Given the uncertainty about alternative accident and emergency provision, and indeed the delays in commissioning community services, will he ensure that any final decisions are deferred so that they can be considered as part of the wider review planned for NHS services across Greater Manchester?

Oral Health Services

Dan Poulter Excerpts

Wednesday 17th October 2012 Commons Chamber

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

I congratulate the hon. Member for Plymouth, Moor View (Alison Seabeck) on securing the debate. I do not think that she needs to justify her pursuit of this issue to her local press, because it is an important issue, and we should all pay tribute to her long campaign. The need to improve dental health is often underestimated, and it is not discussed enough in the context of the health service. I am sure that the hon. Lady will continue to campaign strongly, as a member of the all-party group, in the Chamber and in her constituency, where she supports the medical and dental schools. I should be delighted to take her up on her invitation: I intend to go to Plymouth in the near future, and I hope to be able to visit the dental school then.

The hon. Lady rightly observed that, in health care generally, we do not talk enough about the fact that prevention is much better than cure. In many parts of the health service, payment systems have not properly rewarded staff in line with the recognition that good health care is about preventing people from becoming unwell in the first place, rather than picking up the pieces when they have developed cancer or other problems. The new dental contract makes it easier to identify key prevention issues. It focuses on the desirability of spotting early symptoms of ill health—in this instance, oral ill health—rather than spotting them much too late, when a patient’s cancer is already well advanced.

The hon. Lady also referred to important public health concerns about smoking and alcohol consumption. She was right to draw attention to the problem of binge drinking, not just among young men but nowadays increasingly among young women, and to the effects of excessive smoking and drinking on oral health. The links between high alcohol consumption and smoking and a number of cancers—particularly throat cancer and other cancers in the mouth—are well established. I am optimistic about the possibility that the new dental contract and the important focus on preventive care will enable us to identify cancers, and those who are at risk of developing them, much earlier, rather than waiting to treat people later when they are very unwell. The health service in general needs to be geared up in order to do that better, particularly in the context of oral health.

The hon. Lady also raised the issue of the European platform on oral health. I believe that the all-party group hosted a reception on that recently, praising its work. All the work we have been doing in this country has been rightly highlighted in that report, and I shall discuss that a little later. It is worth dwelling on how over the past 20 or 30 years, under consecutive Governments, we have had a record of improving oral health and improving access to dentistry, particularly in the past few years. If we are taking oral health seriously, it is important that we improve access, and we are beginning to do that well.

As the hon. Lady knows, in 1973 the average 12-year-old in England and Wales had five decayed, missing or filled teeth, but by 2003 the UK average was 0.7 fillings. So we have made great strides in the past 30 or 40 years. That improvement was partially due to the introduction of fluoride toothpaste in the 1970s—that brings me to the issues raised by the hon. Member for Strangford (Jim Shannon) in his interventions—and to the hard work of dentists up and down the country. They, along with dental hygienists, highlighted the importance of good tooth care and preventive measures through effective tooth brushing using toothpaste.

Adult oral health has improved in a similarly impressive manner. In 1968, the first adult dental health survey found that 37% of the adult population of England and Wales had no remaining natural teeth, but the 2009 survey found that the proportion had dropped to 6%. Again, that is a mark of how this country is taking this issue seriously, and we must continue to do so. Access to NHS dentistry has grown steadily, with more than 1 million more patients having been seen by NHS dentists since May 2010.

The hon. Lady rightly highlighted the European platform on oral health report and outlined some of its recommendations. I have read the report and it rightly identifies the promotion of good oral health as one of the most significant health care challenges facing EU countries. However, as she said, England’s oral health compares well with all the countries surveyed in the report, and we are especially pleased that it highlighted the “Delivering Better Oral Health” toolkit, which was a guide to prevention in practice published jointly by the Department of Health and the British Association for the Study of Community Dentistry as an example of good practice. Notwithstanding the fact that we have made good progress historically and that the European platform on oral health report highlighted the good things we do in this country, we must never be complacent. We must continue to ensure that we drive further improvements and reduce the inequalities in access and in oral health that still exist and are very real in some parts of the country.

The hon. Lady raised the issue of the new dental contract. The reforms of the contract focus on a number of things, including improving access to care. There is an important focus on preventive dentistry—preventing bad things from happening to people and on picking up things early. As she is aware, the new contract that we are introducing will be based on registration, capitation and quality, rather than a more payment-by-results system. Such an approach will allow more focus to be put on those preventive measures, rather than on the more reactive measures that a payment-by-results system tends to deliver. The new contract will replace the existing model that rewards units of dental activity rather than taking a more holistic view of what is good for the patient. We can learn from this approach as a good model of health care as we develop tariffs throughout the health care system. Such a model is already being used well in some parts of the country—in stroke care and other areas of preventive care, for example, where a more holistic, joined-up approach to what happens before hospital admission and afterwards in rehabilitation is as important as immediate treatment in a hospital setting.

Elements of that contract are being tested in 70 practices at the moment, and we are rolling them out to an additional 20 to 25 practices as part of the pilot to make sure that that contract is fit for purpose. When the further results from those are available, I will be happy to share them with the hon. Lady, so that we can ensure that we design the best contract.

[Alison Seabeck]

Perhaps it might be appropriate to share some of that information with the all-party group, rather than one to one.

[Dr Poulter]

Absolutely, and I would be very happy to do so. The hon. Lady’s commendable focus on this area of health care would, of course, lead me to wish to share that information with her, but of course I would be delighted to share it with the all-party group, too. The work done by a number of all-party groups, including hers, helps to ensure that many of these important issues are never forgotten and that they are kept at the forefront of the minds of our fellow parliamentarians.

Of course, as the hon. Lady rightly highlighted, there are some inequalities across the country and, as we know, among different socio-economic groups. Improving access to care will play an important part in addressing those health care inequalities. I draw the attention of the House to our progress in preventive care, in addition to the new contract. The number of adults being treated with fluoride varnish, which is one of the most effective preventive treatments available, rose by 43% last year. Among children the figure was 64%. By investing in preventive treatment, we are ensuring that future generations will enjoy good oral health throughout their lives. In addition to promoting the application of fluoride varnishes, we will seek to promote the learning of lessons from the best performing areas of the NHS and to work with the devolved Administrations and local and regional government to iron out inequalities across different geographical areas. It is important that in all areas of health care, including dentistry and oral health care, we learn from things that have gone well so that we can roll out that good practice elsewhere and ensure that it is learned from. We should also be open and honest when things have not gone so well, so that we can learn lessons and improve services for the benefit of patients.

The hon. Lady mentioned the Peninsula dental school and rightly stated that it was opened in 2007, under the previous Government, as a joint venture between Plymouth and Exeter universities. The school has been a great success. I know that she has been a great advocate for it and is rightly very proud of what it has achieved and of what it is doing in Plymouth. Earlier this year, the two universities announced changes in how the school is run. Exeter will now operate a medical school of its own while the teaching of both medical and dental studies will continue in Plymouth. I know that it is important that her constituents are reassured about that and that as we have a successful dental school we should recognise that and support its continuing function. Many of the changes were purely administrative, rather than to front-line services.

I acknowledge the concerns expressed by the hon. Lady tonight and elsewhere, but both universities have stated that the split will improve the administration of medical education in the south-west and we expect the changes to have no negative impact on the dental school. I know that she will ensure that the voices of the dental school and her constituents are heard loudly both locally and in Parliament, and I am happy to support her in that.

Let me finally make a few points about dentistry in the south-west of England. The hon. Lady talked about NHS dentistry in her constituency, including the case of an individual constituent who had problems accessing it. We know that we have further to go in improving access, but the Government have made good strides in that direction, as did the previous Government. We have made significant progress and the latest NHS figures show that since March 2010 the number of people who accessed an NHS dentist in the south-west over the previous 24 months has increased by almost 150,000. That is a strong step in the right direction.

In Devon, £500,000 was invested in four practices in March to provide a further 6,500 dental places, which will become available over the next 12 months. I understand that at the same time a further two practices have increased their capacity and will provide an additional 3,000 places over the next 18 months. We are continuing to ensure that we widen access to dental services in the south-west.

In the south-west, as in the rest of England, we are making vital improvements to access to NHS dentistry and putting in place the measures needed to continue the improvements in this country’s oral health. Access is rising, rates of decay have fallen and continue to fall, and we are piloting a new contract designed further to increase access and improve oral health, focusing on prevention as a key part of our efforts to improve people’s oral health and general health, and to keep them well. We are committed to ensuring that NHS dentistry is available to those who want it, and improving oral health is at the heart of what dentistry does.

Of course challenges remain. We must make sure that pilot studies are effective and that we listen to any concerns that emerge from them, so that we can improve the new contract accordingly. The fundamental focus is on moving away from a reactive service to a preventive care service. That will both improve oral health by reducing the incidence of cancer, and give children the best start in life by engendering good dental health habits through the involvement of hygienists and other practitioners. Our aim is to move dental care on to a more stable footing. This Government are committed to continuing the progress that consecutive Governments have made in widening patients’ access to dental services, particularly those patients who have had difficulty accessing such services in the past.

Question put and agreed to.

Report on Sport and Exercise Science and Medicine (Government Response)

Dan Poulter Excerpts

Tuesday 16th October 2012 Written Statements

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

My noble Friend Earl Howe, the Parliamentary Under-Secretary of State, Department of Health, has made the following written ministerial statement:

We have today laid before Parliament the “Government Response to the House of Lords Science and Technology Select Committee Report of Session 2012-13: Sport and exercise science and medicine—building on the Olympic legacy to improve the nation’s health” (Cm 8452).

We welcome the Committee’s report and its focus upon the quality and application of sports and exercise science and medicine. The effective translation of scientific breakthroughs in this area into health benefits for patients and the public represents a major opportunity as a legacy of the London 2012 Olympic and Paralympic games. We are therefore targeting investment to support the translation of biomedical research.

Today’s publication is in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Nursing and Midwifery Council Grant

Dan Poulter Excerpts

Tuesday 16th October 2012 Written Statements

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

The Government have made an offer to the Nursing and Midwifery Council (NMC) of a one-off grant of £20 million to support it in improving its performance in dealing with fitness to practise cases.

The NMC is an important organisation with a vital role to play in protecting patients. The offer comes after a period when the NMC has experienced many years of financial and performance difficulties. This year, under new leadership, the NMC has already begun to make improvements to its operations and financial management, but much more still needs to be done.

The NMC has recently consulted on increasing its annual fee to £120. This would mean nurses and midwives would have to pay an extra £44 every year, at a time of significant pay restraint in the public sector.

The Government expect that this grant will provide the extra financial support required for the NMC to properly tackle a backlog of fitness to practise cases, as well as to allow it to reduce the effect of a fee rise for hard-working nurses and midwives.

It is a decision for the NMC Council whether or not to accept the Government’s offer of a grant.