health
Dan Poulter Excerpts(12 years, 2 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I thank hon. Members for their kind comments. A lot of ground has been covered in this debate and many good points have been raised about local NHS services. I hope that hon. Members will forgive me if I cannot give comprehensive answers about everything that has been raised, but I will do my best in the time that is available.
It was clear from all the points that were made in the debate that every hon. Member sees the NHS through the prism of the patient. That is the right way to regard how NHS services are delivered. Patients are the priority for our NHS services and for the Government, and they were the priority for the former Secretary of State, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), in his decision to push ahead with the NHS reforms. The basis of the “No decision about me without me” policy is that patients are the most important thing. They are why doctors and nurses do their work and why all Governments endeavour to fight for a better NHS.
I turn now to the concerns of individual Members. I believe that I am right to wish my hon. Friend the Member for Milton Keynes South (Iain Stewart) a happy birthday. A number of hon. Members have concerns about the competitive procurement processes for community health services in Milton Keynes. He mentioned the concerns of my hon. Friend the Member for Milton Keynes North (Mark Lancaster). Our policy is clear that it is for the local NHS, and the primary care trust in particular, to look at the options for different procurement procedures and to decide what is best for local people. The local strategic health authority has played an important role in assuring the PCT’s decisions. Whichever option is chosen, it must be possible to put it in place before 31 March 2013, to avoid the continuing and damaging uncertainty for staff. I am happy to meet my hon. Friend the Member for Milton Keynes South and other hon. Friends to discuss the matter further.
My right hon. Friend the Member for Berwick-upon-Tweed (Sir Alan Beith) talked about maternity services, which is a matter close to my heart. This morning, I visited Newham university hospital, which faces different challenges in maternity care. I looked at the fantastic new unit that has been opened at Newham, which will meet those challenges and provide high-quality maternity care to that part of London.
My right hon. Friend was right to point out that the challenges for maternity services—indeed, for all health care services—in more rural areas such as Berwick-upon-Tweed are different from those in more urban parts of the country, such as London. Women and families in Berwick, like women and families everywhere, deserve maternity services that focus on improving the delivering of high-quality health care for women and babies, and on improving women’s experience of care.
The decision temporarily to close the midwifery-led maternity unit and in-patient post-natal services at the Berwick infirmary, to which my right hon. Friend alluded, was difficult for the local trust to make. He is right to say that in making such decisions there should be regard to the rurality of the area. He made good suggestions about the potential for rotating staff to support rural maternity units. I understand that the decision was made to protect the quality and safety of maternity services in the area and, in particular, to protect the quality of care and safety of women in labour.
I have been assured that the trust is working closely with commissioners to look at the future of maternity services in Berwick. The review will be completed in the coming months. My right hon. Friend may be aware of the recent birthplace study, which discusses good and bad practice in supporting smaller maternity units. I am sure that the commissioners will have regard to that study in making decisions about the future of the unit in his area. He should be assured that I will take a close interest in the matter and support his advocacy on behalf of his constituents.
My hon. Friend the Member for Ealing Central and Acton (Angie Bray) made some points about the service reconfiguration of health care services in London. The hon. Member for Mitcham and Morden (Siobhain McDonagh) also mentioned that issue, and I am sure she would like to pay tribute—as I do—to my right hon. Friends the Members for Carshalton and Wallington (Tom Brake) and for Sutton and Cheam (Paul Burstow), for their work over the years campaigning for services at St Helier hospital.
Key tests must be passed to ensure that clinical services are suitable for reconfiguration. First, there must be support from local clinicians, and, secondly, arrangements for public and patient engagement and consultation—including with local authorities—must be strengthened and put in place. Thirdly, we need greater clarity on the clinical evidence bases underpinning proposals, and, finally, any proposals should take into account the need to develop and support patient choice.
The reconfiguration of front-line health services is up to the local NHS, and no decisions will be taken until there has been a full public consultation. St Helier hospital is part of the south-west London reconfiguration scheme “Better Services, Better Value”, which is in its pre-consultation stage and is led by local GPs, nurses, acute clinicians, other health care professionals and patient representatives. Under “Better Services, Better Value”, the number of accident and emergency and maternity units will be reduced from four to three, and the likely recommendation is for St Helier to become a local hospital with an urgent care centre.
Ealing hospital is part of the “Shaping a healthier future” scheme in north-west London. Proposals for that scheme include centralising A and E units, and having maternity facilities on fewer sites. However, I reassure my hon. Friend the Member for Ealing Central and Acton that there are no plans to close any hospitals, and certainly not Ealing hospital. As she said, a full public consultation began on 2 July this year and will finish no earlier than 8 October, and I encourage my hon. Friend and her constituents to continue engaging with that process. She outlined the good campaign that she has been running to encourage local engagement, and I am sure she will continue with that so that local voices can be heard when health care decisions are made in the area.
The issue of children’s congenital heart surgery was raised by a number of hon. Members, including my hon. Friends the Members for Leeds North West (Greg Mulholland) and for Pudsey (Stuart Andrew). My hon. Friend the Member for Sittingbourne and Sheppey (Gordon Henderson) spoke passionately about Jacob, the son of one of his constituents.
A number of hon. Members are concerned about the “Safe and Sustainable” review of specialist paediatric services, and particularly its focus on the reconfiguration of heart surgery services. However, as was made clear in a number of contributions, its findings were based on Professor Kennedy’s review of paediatric heart services at Bristol after the heart scandal there, and the “Safe and Sustainable” review is independent of the Government, as it should be. In those circumstances, and given the notice of legal proceedings and referrals to the Secretary of State, it is not appropriate for me to comment further on that review or its outcome, and that stands for my statement on the Floor of the House as well as for my correspondence with constituents. I know that my hon. Friend the Member for Leeds North West has written to the Department on this matter, and the Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry), replied with details of how anyone who wishes to raise concerns about the review can get their voices heard.
Greg Mulholland
I commend the Minister for his professionalism in both his previous career and his current role. Although I accept what he says, does he agree that our statutory process must be allowed to look at whether this review is, as we believe, a dodgy decision, or, as the Joint Committee of Primary Care Trusts contends, a fair one? Does the Minister at least agree that such scrutiny should take place, and that the fact that it is being prevented because documents have not been released is wrong and must be rectified? That is all I ask him to say today.
Dr Poulter
As my hon. Friend is aware, there is a process for scrutinising all decisions and, as I have outlined, if the correct procedure has not been followed, decisions are open to judicial review. To reassure hon. Members, we have accepted, from a medical perspective, the principle that fewer units deliver better care for patients and better surgical results for children. Therefore, this review is not about closing units in any particular hospital, but about specialist surgical services. Day-to-day care of patients and paediatric care for those who have had surgery will continue locally even after this review, and that should reassure local patients.
Mr Cash
On that point, and in the light of the way this legislation has been redressed over the past year and half, does the Minister accept that before the legislation was introduced, and now, ultimate responsibility and accountability for all matters affecting the health service turned on the duties, accountability and statutory responsibilities of the Secretary of State? That is why the Minister is now at the Dispatch Box, just as the Secretary of State would be in other circumstances.
Dr Poulter
I accept that the Secretary of State has always had responsibility for the health service, and that was implicitly made clear in the Health and Social Care Act 2012. It is, however, important that we no longer have a system in this country that micro-manages the delivery of local health care services. We must listen to local doctors and nurses, and put them in charge of the configuration of local services because they are often the best advocates for the needs of local patients. Reconfiguring local services should be led—as per the four tests I outlined previously—on good clinical grounds where there is a clinical case for reconfiguration and where local communities have been consulted. That is something we should listen to and we must move away from the Whitehall micro-management of local health care delivery.
Gordon Henderson
Does the Minister accept that local people wanted Royal Brompton hospital to be kept open, and that the decision to remove the intensive care unit was not taken by local people? The Minister is arguing against himself.
Dr Poulter
The initial process for the reconfiguration was started, I believe, by John Reid when he was Secretary of State in 2002, after listening to evidence at the time. We should remind ourselves why we are discussing congenital heart services. All speakers have accepted the principle that there is good clinical evidence—acknowledged by doctors and specialists—that having fewer units actually delivers better care for patients. That was accepted by my hon. Friend the Member for Pudsey. I am not going to go into the rights and wrongs of individual units as that is under judicial review and I will not be drawn further on that point today.
Dr Poulter
I have been very generous and indulgent but I must make some progress. The process was led by doctors and nurses, and there is an ongoing consultation to engage with, review and reflect on decisions at a local level. That came out clearly in comments by my hon. Friend the Member for Leeds North West, but some of those processes are under judicial review and I will not, therefore, be able to comment further. I hope that my hon. Friend the Member for Sittingbourne and Sheppey will accept my reassurance that these reviews are carried out on good clinical grounds that take into account local factors such as whether local health care services are well designed. The important thing is that they are being led and developed by local doctors and nurses. We need such clinical leaders in the NHS, because they are the best advocates of patients’ needs.
My hon. Friend the Member for Stafford (Jeremy Lefroy) has been a strong advocate of the needs of his constituents and the staff of Mid Staffordshire NHS Foundation Trust. I know that we will be meeting tomorrow to discuss his concerns further, and I will also meet my hon. Friend the Member for Stone (Mr Cash), who has sadly now left the Chamber. We will talk about a number of issues, and I reassure my hon. Friend the Member for Stafford in advance of that meeting that I and other Ministers will continue to do all that we can, as our predecessors did. He rightly paid a full tribute to my right hon. Friend the Leader of the House for all the work that he did as Secretary of State for Health to support staff of that trust and ensure that there are good outcomes for patients. On behalf of all members of the Health team, I commend my hon. Friend the Member for Stafford for his work as a strong advocate of the needs of local patients, and I look forward to meeting him tomorrow.
My hon. Friend the Member for Pendle (Andrew Stephenson) rightly raised the issue of paramedic prescribing. He talked about the need for more flexibility in urgent and emergency care services, on the basis that it is better to have prevention than cure. We know that paramedics do a great job every day of looking after people and providing essential care on the spot and in the ambulance that saves lives before people get to hospital. The more we can do to support paramedics in providing preventive care in the community, the better for patients.
As well as allowing flexibility in urgent care services, paramedic prescribing would allow eligible paramedics to deliver more treatment in the home and the community where appropriate. That should prevent hospital admissions and reduce demand on the system. At the moment, paramedics can administer a range of medicines, but they cannot write prescriptions for patients. A new system of paramedic prescribing should benefit both patients and the NHS. Due to resource and capacity issues it has not been possible to take forward that work yet, but it will be considered within the new architecture of the NHS Commissioning Board along with other work programmes on resources and capacity. I shall certainly raise the matter, and the good points that my hon. Friend made, with ministerial colleagues.
My hon. Friend the Member for Mid Derbyshire (Pauline Latham) talked about diabetes care, particularly for type 1 diabetes. It is commendable that a lot of her focus was on younger people with diabetes. The number of patients with type 1 diabetes and known to be on insulin pumps has increased. At the moment, at least 3,700 children and more than 10,000 adults are on insulin pumps, and they are particularly important for younger people who may find it more difficult to control their diabetes. However, they are important for all people who have difficulty with their insulin and their diabetes control.
We want people to lead more independent lives, and we want to support people with long-term conditions to enjoy the same life as anybody else, so it is right that we do more to support people with type 1 diabetes. Those with difficult diabetes control have to be mindful of their disease on a daily basis, and if we can do more to ensure that their diabetes is not a factor in how they live their lives, that has to be a good thing.
The NHS operating framework for 2011-12 highlights the need to do more to make insulin pumps available. The NHS Diabetes insulin pump network is promoting good practice, but as we have discussed, pump therapy is not suitable for everybody. We are waiting for the conclusion of the first ever national insulin pump audit early next year, which will give us a clearer picture of the number of pumps provided and the services that are available. Importantly, it will also include the first investigation of how services are provided compared with the guidance issued by NICE in 2008 and updated in 2011, which my hon. Friend outlined.
My hon. Friend also raised the issue of artificial pancreases. There is small-scale use of them in children, but the clinical trials are not yet conclusive as to their effectiveness and ease of use and there are currently no NICE guidelines on the subject. We need to use the commissioning process to address the disparities in NHS care and better reflect good medical practice, and nowhere is that more true than in diabetes care. We need to ensure that where there are NICE guidelines on good practice, that practice is carried out.
Finally, I wish to reflect on service reconfiguration and social care, which my hon. Friends the Members for Pudsey and for Milton Keynes South raised. Social care reform is important, and we need an integrated approach to health and social care. We must ensure that we reflect the health care needs of local populations and do more to support people with long-term conditions. That is a key driving force behind the vision for the NHS that my right hon. Friend the Leader of the House outlined in 2010 when he was Secretary of State for Health. It drives what should happen, and what does happen, at local level every day as doctors and nurses look after their patients.
Decisions about integration and what it means to have good joined-up care, particularly for older people and those with diabetes, chronic obstructive pulmonary disease, asthma, dementia and other long-term conditions, need to be made at local level, drawing on the best of local health care provision. The Government will ensure that the NHS Commissioning Board’s mandate includes guidance on what is good commissioning. I am sure that from 2013, when the Government’s reforms have gone through and we have an NHS that is truly locally led, there will be properly joined-up and integrated care that better looks after people with long-term conditions, focuses on prevention rather than cure and particularly focuses on looking after older people better.
Nursery Milk
Dan Poulter Excerpts(12 years, 2 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
The Government’s consultation on the “Next Steps for Nursery Milk” is currently under way. We have received a large number of responses from a range of organisations including child care settings, specialist milk suppliers, and milk industry.
Due to the summer break, we have been asked to provide extra time to schools and nurseries to respond to the consultation. The Government are therefore extending the consultation period for an extra six weeks, to ensure that anyone who wants to contribute can do so. The new closing date of the consultation is Tuesday 23 October 2012.
The Government are committed to continuing the nursery milk scheme. Through this consultation, we are exploring three different options for improving the operation of the scheme.
We will publish a formal response to the consultation on the future operation of the nursery milk scheme taking full account of all the consultation responses.
“Next Steps for Nursery Milk” has already been placed in the Library.
National Health Service
Dan Poulter Excerpts(12 years, 4 months ago)
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Andrew Gwynne
We set out the Nicholson challenge, but I notice that the hon. Gentleman does not defend the decisions being taken by his Government to restrict or stop these treatments.
It is becoming increasingly clear that there is a gap between Ministers’ statements on the NHS and people’s real experience of it on the ground. In opening, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) incorrectly said that GP referrals have gone down. Figures published by the Department of Health on 13 July 2012 show that GP referrals are up by 1.9% year on year. Those are statistics from the Minister’s own Department’s. He is out of touch. Furthermore, the Minister said that NHS Hull is not restricting procedures on ganglia, but a freedom of information request we received says:
“NHS Hull will not routinely commission excision of ganglia”.
That was in April 2012, and it is a fact, again showing that Ministers are out of touch. The Secretary of State claimed that there is no such evidence of treatments being restricted or decommissioned.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
Will the hon. Gentleman give way?
Andrew Gwynne
I will not, as I do not have time now.
In the Secretary of State’s annual report to Parliament, he dismissed restrictions on bariatric surgery as “meaningless” and continued to say:
“Time and again, he says”—
that is my right hon. Friend the Member for Leigh (Andy Burnham)—
‘“Oh, they are rationing.’ They are not”.—[Official Report, 4 July 2012; Vol. 547, c. 923.]
But Opposition Members all know the truth. Aside from the evidence presented by the Labour party and the GP magazine, verified by Full Fact, primary care trusts acknowledge that they are restricting access to bariatric surgery. The National Institute for Health and Clinical Excellence recommends surgery for anyone with a body mass index of 40 or a BMI of 35 and co-morbidity. Many PCTs, including NHS Stockport in my own constituency of Denton and Reddish, impose additional restrictions.
Recent freedom of information requests of PCTs and shadow clinical commissioning groups across England have revealed that 149 separate treatments, previously provided for free by the NHS, have been either restricted or stopped altogether in the last two years, with 41 of those being entirely stopped in some parts of the country. This provides the clearest evidence yet of random rationing across the NHS and of an accelerating postcode lottery, which appears to be part of a co-ordinated drive to shrink the level of NHS free provision. From our study, it is clear that many patients are facing difficulties in accessing routine treatments that were previously readily available, and there is evidence that some patients are being forced to consider private services in areas where the NHS has entirely stopped providing the treatment.
Of course, there has been a real reduction in the number of nurses working in the NHS. The Government have claimed that there are only 450 fewer nurses, and at Health questions last month, the Minister, the right hon. Member for Chelmsford said that the figure was “nowhere near 4,000”. But now we all know the truth: figures for the NHS work force in March 2012 showed clearly that there are 3,904 fewer nurses than in May 2010. We have seen broken promise after broken promise, including on reconfigurations.
It was this Government who, when in opposition, spent millions of pounds during the general election putting up posters throughout the country reassuring the electorate that under the Conservatives there would be a moratorium on hospital and A and E closures. Indeed, in opposition, they pledged to overturn some very difficult reconfiguration decisions taken by the previous Labour Government. Yet, as we have seen, the moratorium has not materialised, and there is now evidence of major changes to hospital services across the country.
It is worth remembering that the Prime Minister gave a firm pledge not to close services at Chase Farm hospital, but in September 2011, this Secretary of State accepted the recommendations and approved the downgrading and closure of services at Chase Farm. And there are several others, such as the Hartlepool, the King George hospital in Ilford, the East London, the Trafford General, the North London, the St Cross in Rugby and, as we have heard today, the West London, too, that have either closed or are set to close. What is becoming clear is that when it comes to reconfiguration, Ministers are hiding behind their new localism and are happy to blame the soon-to-be-abolished structures for the forthcoming closures.
In the brief time remaining, I want to deal with Government spending on the health service. As we have learned, actual Government spending on the NHS in 2011-12 fell by £26 million.
Adult Social Care
Dan Poulter Excerpts(12 years, 4 months ago)
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Liz Kendall
We remain serious about trying to achieve cross-party consensus. If one party comes forward on its own and proposes a controversial and difficult decision, that always leads to a political fight; we saw that only too clearly before the last general election. However, we need cross-party consensus because this is a long-term challenge. We have to try to get agreement so that, whichever party is in power, people know there is a system that they can understand and pay for in future.
Government Members have criticised Labour’s record in government, but we are proud of our achievements on social care. We increased spending by 53% when we were in government. We helped drive up quality through national performance assessment of local councils and independent inspection of care services. We championed integration, with new legal powers for the NHS and local councils to pool budgets, and new care trusts jointly to commission care. Those care trusts will be swept away under the Health and Social Care Act 2012. We supported carers through the carers grant and new rights for carers. We introduced the first ever national dementia strategy, and we backed improvements in housing through the Supporting People programme and extra care housing. [Interruption.] The hon. Member for Reading East (Mr Wilson) mutters from a sedentary position that that is not real action. He should try telling that to the carers we supported through breaks that are now under threat, and the people who have benefited from extra care housing and the Supporting People programme, which his Government have cut by 12%.
We understood that we had much further to go, however. That is why before the last general election we published plans for fundamental reform, including difficult decisions on how care should be funded. We tried to get cross-party agreement. We did not succeed, but we are determined to try again now.
A year ago, my right hon. Friend the Leader of the Opposition made an open and sincere offer of cross-party talks, and it is a matter of genuine regret that the Government unilaterally decided to publish their own progress report on funding, rather than the joint report we had wanted to agree. Labour remains committed to serious and meaningful cross-party talks.
I hope that the Minister will tell the House whether the Government will commit to addressing the current funding gap as well as future reform. Andrew Dilnot says that that is vital. Will they also set a clear timetable for reform, with legislation on funding reform in this Parliament, as Labour has called for? Will they agree to include their Treasury team in the talks, which Labour has offered from the start?
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
One of the authors of the Dilnot report was Lord Warner, who was a member of the previous Labour Government. He made the point that one of the reasons for the funding crisis is that the previous Government failed to invest adequately in social care; it received only 70% of the funding compared with the NHS. That was one of the major failings of the previous Government. They should have invested more in social care when the sun was shining and the country had the finances to do that.
Liz Kendall
I politely say to the hon. Gentleman that we did not cut local council budgets by a third. I have always said that social care budgets have been under increasing pressure for many years, which is why we desperately need funding reform. I know that he supports that reform and will work with us in the years ahead.
The Government’s decision to kick the issue of long-term care funding into the long grass is a bitter blow for older and disabled people and their families. It is a huge disappointment for local councils, which are desperate for a new social care settlement, and it is a disaster for our NHS, which will face intolerable pressure as our care system crumbles further still. This issue will not go away, because our population is ageing. Our care system needs fundamental reform—reform this Government have so far failed to deliver. I commend the motion to the House.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
It is a great pleasure to follow the hon. Member for Luton North (Kelvin Hopkins). I commend him for his ability to get Europe into almost every debate we have in this House. I am not sure whether his sums quite added up at the end of his speech, but it is commendable that we have seen a commitment across the House this evening to improving the dignity and quality of elderly care, which is something I am sure we would all like to see.
All previous Governments have taken steps in that direction, but I believe that the White Paper and the draft Bill that this Government have brought forward represent the most significant steps towards improving dignity in elderly care for a generation. The “in-principle” support for Dilnot and the Dilnot proposals is a good recommendation, and it needs to be considered in the context of whole-government spending at the next spending review. However, for the first time there has been an in-principle agreement by a Government that social care is one of the most important issues and challenges facing our country. How we are going to provide dignity in elderly care—high-quality care in the community—is a clear priority for this Government, and that should be commended.
I want to outline some of the real challenges that face people who are in receipt of social care, particularly the frail elderly. The hon. Member for Blaydon (Mr Anderson) pointed out that it can be difficult to distinguish between NHS care and social care, because they often involve exactly the same things. They include supporting the activities of daily life that we all take for granted, such as washing, dressing, getting in and out of bed or the bath and going up and down stairs. Those are the kinds of things that we mean when we talk about providing high-quality social care, and this Government have put forward strong measures that will make it much easier to provide such care for the people who most need it.
The White Paper and the draft Bill provide for support for carers, and for improving the personalisation of care, which is particularly important for younger people in receipt of social care, as the hon. Member for Scunthorpe (Nic Dakin) said. Respite care is also recognised as an important means of better supporting carers, giving them a break from the hard work of looking after people and ensuring that the role of carers is properly supported. The proposals also include a commitment to portability of care, and to a universal care assessment.
Glyn Davies (Montgomeryshire) (Con)
I raised the issue of portability with the Secretary of State last week. It is crucial that a debate should take place about what we are doing here and what is happening in Wales, as this is a devolved matter. There must be close liaison between us. I understand that the initiative must come from the Welsh Government but, without that liaison, people will fall between the two countries.
Dr Poulter
My hon. Friend makes an important point. Social care and NHS care do not recognise county borders, which is why portability is so important. They certainly do not recognise the boundaries between England and Wales or between any other parts of the United Kingdom. We have devolved responsibility for the NHS, and the fact that there are different funding priorities in the different parts of the UK, with the Government in England supporting investment in the NHS and the Labour Administration in Wales cutting NHS spending, highlights the importance of my hon. Friend’s point. I am sure that the Minister will be able to reassure us that the coalition Government are taking steps to ensure that portability can take place across those borders wherever possible.
The White Paper also contains a commendable commitment to improving integrated care and ensuring that more joined-up working takes place between the NHS and social care.
Sarah Newton
Would my hon. Friend like to comment on some of the Opposition’s assertions that the efficiency savings from reductions in management levels in NHS are not being put back into front-line services to enable integration, and that they are somehow being siphoned off to the Treasury? I do not believe that—
Dr Poulter
I thank my hon. Friend for her intervention, and I agree with her. The Government are making a clear commitment to encouraging integrated care and to putting savings made in the back office back into the front line of NHS care. Many billions of pounds have already been committed, and there is more money in the draft Bill to encourage better integration between the NHS and social care services.
As the Minister of State said, it is important to shift the emphasis away from crisis management and towards preventive care. The focus on housing as part of the integrated care system is important. My hon. Friend the Member for Congleton (Fiona Bruce) made the point that, far too often, older people fall over and injure themselves as a result of poor lighting or a lack of handrails in their homes, ending up in the accident and emergency department, when better lighting and preventive care in the home would have provided a much more effective way of looking after them properly, as well as saving the NHS and social care a lot of money. That key commitment to more integration between the NHS, providers of housing and social services providers is a fundamental ingredient of the way in which we can improve the day-to-day quality of adult social care, while also saving a great deal of money, which can be spent on improving care for everyone else.
Finally, let me talk a little about funding. The Dilnot proposals have been agreed to in principle, and I hope that the Opposition will at least give the Government some credit for the fact that there has been a once-in-a-generation attempt to deal with this issue. It is not good enough to say, 13 years into an Administration, “Three weeks before the general election, we will publish a White Paper.” No one could consider that a serious commitment to tackling the challenges that we face.
The way forward now must be the cross-party working that we all believe is desirable. That means that all parties must work together and support the Government’s White Paper, support day-to-day improvements in care for older people, and support the agreement in principle to the Dilnot proposals that the Government have presented.
Care and Support
Dan Poulter Excerpts(12 years, 4 months ago)
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Mr Lansley
I am not attempting to hoodwink anybody. I have made the point very clearly that in this financial year the Association of Directors of Adult Social Services is making total savings of £891 million, of which only 13%, some £113 million, is being achieved through reductions in services. We are investing in and supporting such services. In 2012-13, £930 million of extra funding will go to local authorities through formula grant to support social care. The NHS is transferring £622 million and we are doubling last year’s figure so that £300 million will be available through the NHS for re-ablement. Those are major additions to the support for care.
On the other point that the hon. Gentleman made, even the right hon. Member for Leigh did not try to return to the debate that we had before the election, and rightly so. The right hon. Gentleman eschewed party political point scoring; the hon. Member for Easington (Grahame M. Morris) did not. I think he should have done.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
I warmly welcome the statement. There is clear commitment in a number of good areas, including improving the portability of services, providing greater support for carers, improving respite care and having more joined-up working between the NHS and adult social services, which will save social services and the NHS money, and improve the care that is delivered to patients. Does the Secretary of State agree that when local government commissions services, it should do so with a view to improving the quality of care and moving away from the care-by-the-minute mentality to which many local care providers seem to adhere?
Mr Lansley
My hon. Friend is absolutely right in all respects. I know that local government will welcome the philosophy of commissioning for quality, rather than commissioning simply on the basis of watching the clock. That will also be welcomed by older people who are in receipt of care.
Cosmetic Surgery
Dan Poulter Excerpts(12 years, 4 months ago)
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Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
It is a pleasure to follow my hon. Friend the Member for Bosworth (David Tredinnick), and, indeed, all the hon. Members who have spoken. I pay tribute to my right hon. Friend the Member for Charnwood (Mr Dorrell), who has worked very hard on putting together a good Select Committee report, championed the cause diligently over the past few months in Parliament, and helped to bring about this debate.
One thing that came across from the remarks of all right hon. and hon. Members, but which was highlighted particularly by the right hon. Member for Rotherham (Mr MacShane), is the concern, which unites the House, for the women who have been exploited and, in many cases, treated badly by some private sector cosmetic providers.
The expert group appointed by the Department of Health published its report on 6 January and concluded that there was no causal link between PIP implants and cancer, and on 1 February the European Commission’s Scientific Committee on Emerging and Newly Identified Health Risks published its report on the matter, which reached similar conclusions. Although there may not be a risk of cancer, we know that PIP implants are not of good quality, and their rate of rupture is six times greater than that of other implants. It is because of that inferiority, and the concern and worry that it has caused many women, and because of wider issues about the cosmetic surgery industry, that we are having this debate; and those are the issues that I want to talk about.
To me, the primary issue is duty of care. NHS providers, whether traditional ones or private providers commissioned by the NHS, have a duty-of-care relationship with their patients, whether women or men. Clearly, in the cases that we are considering, the cosmetic industry has not shown that duty of care because of the contractual relationships that women were in.
My right hon. Friend the Member for Charnwood highlighted the problem of the Medicines and Healthcare products Regulatory Agency failing to keep a sufficiently vigilant eye on PIP or other implants, and I do not want to dwell on that. However, the cosmetic industry’s wider role, and the governance and culture of not only plastic surgery and cosmetic clinics, but the surgeons and others in the industry, are key to how we improve—how we take matters forward and make things better for women in the future.
On the duty of care, all the women whom we are talking about are patients. If an invasive procedure is performed on someone’s body, they must be considered a patient—someone to whom a duty of care is owed. It does not matter if the procedure is done by the NHS or a private provider outside the NHS, as in the cases we are considering. That duty of care should exist. Yet with the cosmetic industry, because there is a contractual relationship, it is clear that that duty of care does not exist and that many of the women have been exploited, potentially, and misinformed by the cosmetic industry. The relationship has not protected women or acted in their best interest.
Mr Dorrell
I hope that my hon. Friend would agree that the mere existence of a contract between the provider and the patient does not in any way undermine the duty of care that the one owes the other. As I said, a surgeon who provided the service without giving proper advice to the patient would be in violation of their professional duty of care to the patient, and the provider would not be providing the service required by the contract, either.
Dr Poulter
I fully agree. Unfortunately, although a contractual duty should inherently also be a duty of care, in this case there has been poor medical practice and poor medical accountability on the part of some surgeons in a number of clinics—a point highlighted by my right hon. Friend, and by the right hon. Member for Rotherham. Some providers have not behaved with the kind of responsibility and care for their patients that we would expect of anyone offering a service, particularly one involving invasive bodily procedures.
My right hon. Friend the Member for Charnwood was right to highlight the doctrine of top-up charges, because women have, in some cases, been forced to have two operations in order to have their implants replaced with better ones. That is not only unacceptable medically, but also on the basis of the duty of care. Given that many cosmetic surgery clinics that work under a contractual arrangement cannot claim back money under their insurance when the data do not necessarily show a risk from PIP implants, they are not in a position to offer the replacement procedures without going bankrupt. Although they have a moral duty to offer those procedures, they are not always in a financial position to do so, and that goes to the heart of the matter.
When people take up private procedures outside the NHS, and a contractual duty is in place, there needs perhaps to be a levy on the private providers to ensure that when things go wrong, other providers—either in the private sector or the NHS—can ensure that things are put right. I would be grateful if the Minister could reply on that suggestion of a course of action that the Government could look into. We want our primary concern to be the care of the women affected, and there are providers that, as my right hon. Friend the Member for Charnwood says, consider themselves to have a duty of care, but are, because of the financial consequences, perhaps unable to put things right. We might, therefore, need a levy or some kind of insurance to safeguard against such a situation occurring again.
I want to touch on the governance of the plastic surgery industry. The professional responsibility of plastic surgeons and everyone involved in the industry should be no different from that in other parts of medicine, but we have seen some very bad practice by some cosmetic surgeons. Earl Howe’s report states that under General Medical Council guidance and rules for good governance, there is a duty on doctors and other medical professionals to have good auditing and record keeping, but far too often, data on the care of the women affected have not been properly kept. Good medical records do not exist, and there has been a neglect of duty by some medical professionals. As my hon. Friend the Member for Totnes (Dr Wollaston) pointed out, that is something for the GMC to look into, and I am sure that the Royal College of Surgeons will look into that in further reviews.
We need to ensure that regardless of whether a procedure is carried out in the NHS or the private sector outside the NHS, good medical practice as regards audit and record keeping is always maintained. When things go wrong with the cosmetic industry and private operators outside the NHS, it is always the NHS that picks up the pieces, and NHS doctors therefore need to be put in the best position from which to look after the patients.
Finally, the exploitation of women in many of these situations has been talked about widely. The Committee has heard of many cases of women having gone in good faith to cosmetic providers and having received at best inducement, and at worst poor information, at the moment of consenting to an operation. The basis of all medical treatment is informed consent. A patient should understand the consequences of any operation, be fully availed of the facts, and together with a medical professional, make an informed decision about the right way forward and about how they should be treated. Far too often, the evidence has shown that women do not give informed consent and are not fully availed of the facts. That is bad medical practice and, as my right hon. Friend the Member for Charnwood pointed out, it is an issue for the cosmetic industry. The Royal College of Surgeons and the General Medical Council should investigate surgeons who have not done things in accordance with good medical practice, as set out by the GMC.
We need to consider the wider consequences, and to move the cosmetic industry from a purely contractual arrangement towards one involving a duty of care. We need to consider ways of properly looking after women when things go wrong and, given the doctrine of top-up charges, we must ensure that money is available to look after women. Perhaps there is a role for a levy on private operations. We must also ensure much greater accountability of medical professionals and better record taking, so that we can have proper patient care, which is what we all want. I am pleased to have taken part in the debate, and I look forward to the responses of the Minister and the shadow Minister.
EU Working Time Directive (NHS)
Dan Poulter Excerpts(12 years, 7 months ago)
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Charlotte Leslie (Bristol North West) (Con)
It is a pleasure, Mr Brady, to serve under your chairmanship. We have heard a lot during the past few months about structural reform of the NHS, but today I want to concentrate on something that underlies the success of any structural reform now or in future: safeguarding the expertise and professionalism of our medical work force, and our future consultants. I think we all agree that the NHS is not a system; it is the people who work within it. The expertise, dedication and professionalism of our clinical staff are what give the NHS its tremendous robustness to adapt to and, dare I say, withstand political restructuring. That is largely what has enabled it to meet the ever-increasing demand being placed on it by an ageing population, rising expectations, and all the other factors that we so often talk about. If the NHS loses that clinical expertise and professionalism, it will no longer exist as we know it. Under our watch, doctors are warning with increasing urgency that that professionalism and expertise is being severely eroded, and the expertise of our future consultants is being jeopardised, so patient care is being compromised daily.
What is having such a damaging effect on the future of our NHS? With the previous Government’s very badly structured new deal, the threat to the NHS is the European 48-hour working time directive. It was introduced with the reasonable aim of putting an end to junior doctors having to work 100 hours or more a week. Obviously, that was bad for junior doctors, and dangerous for patients. No one wants to be operated on by someone who has had a ridiculous lack of sleep. We do not want to return to those bad old days, but the effects of this well-meaning directive are devastating, and it would be utterly wrong and immoral to dismiss the arguments about the 48-hour working time directive simply by presenting a simplistic either/or argument: either a 48-hour working time directive, or a return to 100-hour weeks. That argument would be misleading, it has no strength, and it is wrong.
Doctors have been making the case strongly, and trying to get the political class to hear. They have warned that the working time directive is devastating the NHS in three ways. First, on doctor training, it is eroding the professional ethos that upholds the NHS, and beginning to replace it with a clock on, clock off culture. New generations of junior doctors will know only that. They will never know the old ethos that sustained our NHS. Secondly, the safety of patients—our constituents—is being seriously jeopardised daily. Thirdly, I am sure the Minister appreciates that the financial cost is absolutely massive. I will deal with those three issues in turn, before concluding on the final, biggest blow, which is that the directive does not achieve its aim of a better work-life balance for doctors, and in some cases it makes matters worse.
The previous Government estimated that the introduction of the European working time directive, given the existing new deal limitation of a 56-hour working week for doctors, would be the equivalent of taking 4,000 doctors out of circulation. The Royal College of Surgeons estimated the loss of surgical time per month to be 400,000 hours. To put that into perspective, that is equivalent to 45 years of surgical time per month being lost to the NHS. That means that doctor training is limited in two ways.
The first is simply the amount of time that doctors have to train, and we can all appreciate that. It is important to appreciate that the quality of the training that doctors can access has also been severely eroded. Hospital trusts have had to adopt a shift rota system to incorporate the working time directive. Under the old on-call system of working, a medical specialist—an expert—was always on call in case a problem arose, or there was an emergency out of hours. A specialist was always on hand to help any doctor on duty, but with the new system, that is not always the case, so patient safety is jeopardised.
Doctor training is also jeopardised. Trainees complain that they do not get the training they used to receive because they are increasingly meeting the demands of staffing hospitals out of hours and at night without the training and accompaniment of a consultant. The team-working relationship between trainee and consultant is what is so valuable to trainees, and its breakdown is detrimental to the quality of and amount of time for training. The Association of Surgeons in Training reported that two thirds of trainees believed that their training had seriously deteriorated since the introduction of the directive. Sadly, most doctors report that they break the rules—I will return to that—to access the sort of training they want. We are dealing with a work force that values clinical excellence and the welfare of their patients.
My second point is about the welfare of patients. From the patient’s point of view, the directive massively damages continuity of care. Under the shift system, we are seeing a clock on, clock off system, with a dramatically increased number of handovers between doctors. That is clinically risky, because handovers are when vital information may be missed, and under the directive those handovers take place under increasing time pressure. As with Chinese whispers, messages are distorted down the line.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
My hon. Friend makes an excellent point, but is it not also the case that medicine is traditionally about providing continuity of care for patients through having a dedicated team of doctors looking after them? If we move towards a clock on, clock off culture, as we now are, and a shift-based job, continuity of care will be lost, patient care will be damaged, and bad things will happen to patients.
Charlotte Leslie
My hon. Friend makes an extremely good point, and I know that he has first-hand experience in this area.
Professional expertise and intuition, not looking at a list of tick boxes, enables doctors to spot that something is wrong with a patient. If doctors are not able to make a subtle comparison between how a patient was yesterday and how they are today, their intuition and expertise will be undermined. We have all seen constituents who have felt that they have been subject to an endless conveyor belt of doctors, and have been made to feel like a product on a conveyor belt instead of the focus of a dedicated team looking after them. The move to treating patients as products on a conveyor belt is worrying, and undermines the very good ethos of our NHS. Clinicians back that up. One third of surgeons in a recent survey said that handovers had been inadequate and, worryingly, the Royal College of Physicians found that three in 10 thought that their hospitals’ ability to deliver continuity of care was poor or worse. A similar survey of GPs found that one third thought that their hospitals’ treatment was dangerous. I cannot emphasise enough the urgency of the matter.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
It is a great pleasure to speak under your chairmanship, Mr Brady. I pay tribute to my hon. Friend the Member for Bristol North West (Charlotte Leslie) for securing this debate on an important issue in medicine and in improving front-line patient care that affects every MP’s constituents, whatever the constituency. I also pay tribute to the hon. Member for North Antrim (Ian Paisley) for a real tour de force in his speech just now. In my contribution to the debate, I will touch briefly on some of the points that he made, but I will try to expand on some of the points made by my hon. Friend.
My hon. Friend made a couple of very good points. Early in her speech, she pointed out the effect of the European working time directive, saying that it has effectively taken 4,000 doctors out of circulation. Effectively, therefore, hospitals throughout the country have to recruit an extra 4,000 doctors as a direct consequence of the EWTD. That is a huge financial burden, but it is something that hospitals have effectively had to do in many cases and in many specialities in a very quick fashion—indeed, almost overnight. That has been very difficult to do.
Many hospital services in many parts of the country, particularly the more remote rural areas, are reliant on locum doctors, who are often not necessarily trained in Britain—not that that is a bad thing, because a huge contribution is made to the NHS by overseas workers. However, as has been very publicly highlighted by the Dr Daniel Ubani case, some overseas doctors are not necessarily familiar with the British medical system.
The failings of the EWTD and its implementation go further than just increasing the strain on doctors and the loss of continuity of care for patients. They relate to the way that hospitals have been forced to deal with the shortfall in their rotas and the problem of how they will look after their patients and to the fact that the system that is used to employ locum doctors is not fit for purpose. The General Medical Council and the British Medical Association are looking into those matters. Nevertheless, the failings of the EWTD have exposed a very important issue, and patients are suffering.
My hon. Friend also said that medicine is a profession and a vocation; I know that, too, and I obviously speak from personal experience. Medicine is not about clocking on and clocking off. It is about looking after patients effectively, whenever that may be. The result of introducing the EWTD has been to encourage hospitals, through fear of litigation, to encourage doctors to have a clocking-on and clocking-off culture. That is wrong; it is against the duties of the doctor, as laid down by the GMC; it is against what medical professionals want to do, because they care about their patients; and it is actually bad for patient care, for all the reasons that were outlined earlier by my hon. Friend.
My hon. Friend said that we do not want to go back to the bad old days of 100-hour weeks. I worked those 100-hour weeks, and I am sure that the other medical doctors who are in Westminster Hall today did so, too. It was certainly not ideal to work 100-hour weeks; it was not good for patient care. However, the point that was made earlier is that there is actually a happy compromise between doctors working a rota pattern—one that allows for training, continuity of care and proper treatment of patients—and ensuring that doctors have proper rest and are in a fit state to look after their patients. That happy compromise can be achieved. As has been highlighted already in speeches and interventions, it has been achieved in many countries within the European Union, and we should be able to achieve it effectively in this country, too.
The point that has been highlighted is that the previous Government dressed up the introduction of these reforms in the idea that they would be better for doctors with families and better for doctors’ training. In fact, neither of those things have actually come to pass. Doctors’ training has suffered as a result of the introduction of the EWTD in this country. Doctors do not get enough on-the-hour time with patients, and because many hospitals are forced into looking at service provision—in other words, having enough doctors on the ground as a direct consequence of the EWTD—the time allocated for junior doctors to receive proper training has been reduced massively. Given the rigid nature of the rotas introduced under the EWTD, they are often less family-friendly than rotas were in the past when doctors were asked to work more hours than now.
My hon. Friend highlighted the increased rates of sickness, particularly among physicians but also in other specialities where—quite rightly—an increasingly high proportion of women are entering the medical profession. In many cases, the reason why those women are finding things difficult and taking time off work is that they are unable to meet the demands of looking after their family properly. The fixed rotas are damaging to family life. My hon. Friend has made some excellent points.
I will now talk about a few other issues that are important to highlight in this debate. The Minister is working hard on our behalf to address the EWTD issue, by raising it in Europe for the Government and ensuring that we can put right what the previous Government got wrong. The issue of locum doctors goes to the heart of out-of-hours care. Many hon. Members, particularly those of us with more rural constituencies, have experienced the previous Government’s reforms of out-of-hours care by GPs. Thanks to those reforms, we now have a system that is not fit for purpose. We have locum companies running local out-of-hours care on the basis of care models that are, in many respects, not fit for purpose. Many locum companies often employ out-of-area doctors who do not understand local patients to run those services.
Andrea Leadsom (South Northamptonshire) (Con)
I am grateful to my hon. Friend for giving me the opportunity to make my point. Does he agree that there is also a great concern about the fact that other European legislation means that the GMC cannot systematically check locum doctors’ ability to speak English and communicate with their patients and that that is also putting patients’ health at risk?
Dr Poulter
My hon. Friend makes a very good point and the issue that I was just raising—that of locums and out-of-hours care—ties in very well with it, because those checks and balances very much occur in the sector of locum work. To fill staff vacancies in GP rotas in primary care and in hospital rotas, doctors are often rushed in at short notice from locum firms, even though we have not necessarily got the proper checks that would be in place when doctors are working in hospitals.
As I have said, doctors from overseas make a huge and valuable contribution to the NHS, but they do so when they have been familiarised with the British medical system and they are embedded in our hospitals up and down the country. However, there is a real danger: when we have an over-reliance on locums, which is a direct consequence of the EWTD, the problems that my hon. Friend has highlighted occur, and that has damaging effects for patients.
The key issue for me in this debate is the continuity of care. The point has already been made in interventions that bad things happen to patients at weekends and out of hours, because there are fewer doctors, nurses and members of staff working in the hospital. If we have a system in place whereby doctors are clocking on and clocking off and they are encouraged to do so because hospitals are worried about the dangers of litigation and that encourages the handover of information to another professional because people think, “I’ve finished now; it’s not my job anymore,” that will encourage bad things to happen out of hours.
Rebecca Harris (Castle Point) (Con)
On that critical point, is my hon. Friend aware of the effect that that is having on patients and their relatives? They know that something is going on. People are saying, “How is it that highly qualified doctors did not recognise that my relative, who was chatty, friendly and bright eight hours ago, is now distant and uncommunicative?”—something as simple as that. Without years of medical training, they know something is going very wrong.
Dr Poulter
My hon. Friend makes a very good point. Continuity of care really matters in terms of what is good medical practice, good for relatives and good for patients. Traditionally, one team took responsibility for looking after a patient and providing holistic care to their family, particularly end-of-life care or when a patient took a turn for the worse. It is not acceptable for a doctor with no previous knowledge of that patient or their family to deal with sensitive circumstances. Indeed, it is very difficult to have any sense of good care when care is continually handed over, in a pass-the-parcel fashion, to the next person who picks up the baton after a shift is timed out—that is not good care. It is bad for patients, bad for families and particularly bad for distressing end-of-life care and the care of the elderly.
For all those reasons, we need to sort out the EU working time directive. It is bad for medicine. It is bad for doctors. It is bad for doctors’ training. It is bad for patients. I know the Minister is on our side and that the Government are working hard. I look forward to hearing the Minister’s comments, and I pay tribute again to my hon. Friend the Member for Bristol North West for securing the debate.
Oral Answers to Questions
Dan Poulter Excerpts(12 years, 8 months ago)
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Mr Burns
With regard to the transfer of patients, we are seeking to give greater choice to patients under the modernisation programme so that they can move from one GP, or one GP practice, to another in a way that they cannot do at the moment. That will help to enhance the power of patients to get the GP of their choice and preference.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
I am sure that the Minister would agree with me about the importance of addressing alcohol misuse through the alcohol strategy announced last week. On the performance management of GPs, however, does he agree that we need to do more than just monitor how much people drink, and that we need to ensure that GPs are incentivised to tackle the problem drinkers who attend their surgeries?
Health and Social Care Bill
Dan Poulter Excerpts(12 years, 8 months ago)
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Mr Speaker
Order. The Secretary of State has indicated that he wishes to speak later in the debate—[Interruption.] Order. That is his absolute prerogative. In view of the level of interest in the debate, it will be helpful for the House to know at this point that a five-minute limit on Back-Bench speeches is to be imposed immediately. I call Dr Daniel Poulter.
Mr Speaker
He was in, on the list and at the top. If he does not wish to speak, so be it.
Health and Social Care Bill
Dan Poulter Excerpts(12 years, 8 months ago)
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Liz Kendall
No, I am going to proceed.
Let me remind hon. Members that the Bill started out without any requirement for GP consortia—as they were then called—even to have a board to govern their work, let alone any measures to deal with potential conflicts of interest. On 3 March last year, in the first Commons Committee stage, Labour Members called for effective corporate governance and robust measures to deal with conflicts of interests in clinical commissioning groups.
Liz Kendall
I am going to finish this point.
The Minister of State, the hon. Member for Sutton and Cheam (Paul Burstow), said that all and any changes to those provisions were “unnecessary”, and denied that there was any lack of effective governance. I would remind Liberal Democrat Members that the Minister argued that putting a board in place or dealing with conflicts of interest would mean that clinical commissioning groups would fail to be “liberated”. Those criticisms were among the many issues that were supposed to be dealt with when the Government embarked on their now infamous “pause” in the Bill’s progress last spring, but they were not. The Government were therefore forced to return to the issue in the other place. However, the amendments before us are still weak, incomplete and ineffective.
The Government say that clinical commissioning groups will have to include in their constitutions how they intend to manage conflicts of interest. However, I am afraid the Government are deluded if they think that the national NHS Commissioning Board will be able adequately to scrutinise whether hundreds of clinical commissioning groups are properly implementing the measures in thousands of contracts, particularly when the board has already taken on so many other huge responsibilities for managing the Government’s new system. Giving Monitor powers to scrutinise clinical commissioning groups is inadequate for the same reason. Saying that Monitor can deem a clinical commissioning group’s contract to be ineffective, if it thinks that conflicts of interest have not been dealt with, will in effect mean closing the stable door once the horse has bolted. Indeed, there could be huge problems on the ground, as a provider may have already started delivering services to NHS patients by the time Monitor takes its decision.
Labour’s Front-Bench team in the other place tabled a comprehensive amendment to deal with conflicts of interest in clinical commissioning groups. It would have ensured a code of conduct for how clinical commissioning groups register, manage and report on conflicts of interests among its members and employees, and imposed a duty on CCG members to abide by the code. The amendment would have ensured that no member of a clinical commissioning group could take part in discussion or decisions concerning any provider of services with which that person had a registrable interest, and allowed the Secretary of State to appoint an adjudicator to investigate complaints about any breaches of the code, with a range of financial and other sanctions available, including the ability to suspend or remove a person from the clinical commissioning group. However, the Government rejected that comprehensive amendment, saying that such sanctions were unnecessary.
The Government have agreed to Lords amendment 31, which at least says that there must be a register of interests for a group, along with its governing body, sub-committee and employees, and that the register must be kept up to date, with information updated within 28 days. That change is welcome, but it does not go anywhere near far enough in ensuring that conflicts of interest are robustly dealt with. That is why our amendment (a) to Lords amendment 31 would ensure that members of a clinical commissioning group would not be able to take part in discussions or decisions about services in which they had declared a registered interest, which is the same format as in local government.
Grahame M. Morris
I have concluded my remarks, so perhaps the Minister can address those points in his summing up.
Dr Poulter
I shall make some brief remarks, but I first want to welcome the renewed focus on integrated care, as outlined by the Minister this afternoon. He clearly outlined the importance of mental health services and clarified that the primary duty in commissioning will be to ensure that there is integrated care.
We all know the importance of dealing with the biggest challenge facing the NHS, which is how we are going to look after our ageing population. How are we going to improve the care for the increasing numbers of people living longer, which is a good thing but poses a big financial challenge for the NHS as well as a big human challenge in how to look after them? How are we going to address the challenge of looking after people living at home with diabetes, heart disease and dementia?
This Bill goes a long way towards meeting those challenges, and I believe that the renewed focus on integration is key and vital. It is only by different services and different parts of the NHS working together effectively—with primary care working effectively with hospitals, as well as with social services—that we are going to meet the big financial and human challenge of improving the care of older people. That is why I am reassured—I hope that my Liberal Democrat colleagues will also be reassured—by this renewed focus on integration, which is at the heart of the debate and at the heart of the way in which we will make our NHS meet future challenges.
Let me deal briefly with the Opposition amendment 31, which deals with what they believe is an inherent conflict between people involved in delivering care—health care providers or GPs—and others when it comes to involvement in the clinical commissioning groups. The amendment ignores the fact that, at present, good commissioning involves a partnership with primary care trusts that were set up by Labour when they were in government. GPs who are engaged in the provision of health care in local communities are involved in PCTs and involved in the Government arrangements for PCTs, working in partnership with local managers. So, if it was good enough to have that inherent partnership in the current structures set up by the previous Government, I do not see why, when we all believe that clinical leadership is a good thing in the NHS, a conflict of interest should suddenly be created under the Bill. That does not make sense; it is not intellectually coherent. For that reason, we must oppose the amendment.
We have before us more reassuring amendments to promote integrated care, to focus it on more joined-up thinking between the primary and secondary care sector, and to ensure that we do not have to deal with patients with mental health problems only when they get to the point of crisis. The focus on integrated care will mean that they are better supported in their communities. Opposition amendment 13 is, as I have explained, inconsistent with how they managed the NHS when they were in government.
Dr Poulter
I thank the hon. Lady for her intervention, but I will give way to my right hon. Friend the Minister before I respond to it.
Dr Poulter
I thank my right hon. Friend for that clarification. The Government are clearly committed to the value that lay members bring to commissioning groups, and, as my right hon. Friend has said, two is the minimum. I hope the hon. Lady will accept that it is very disingenuous to suggest that lay members who are appointed to boards of hospitals or primary care trusts, or indeed to commissioning boards, show a lack of genuine care for patients in the way in which they commission services.
Given that the Opposition have tabled a bad amendment, and given the renewed focus on a commitment to integrated care for the benefit of older patients and people with mental health problems, I believe that we should support the Government this evening.
Alex Cunningham (Stockton North) (Lab)
I support the amendment relating to Monitor and NHS foundation trusts. The Government seek to amend the Bill to allow—[Interruption.]
Andy Burnham
I have answered the right hon. Gentleman’s question. It was an entirely different situation altogether.
On the suggestion that we are setting our face against reform, we have not said that, and I as Secretary of State initiated a review of the private patient cap, because the issue came up before the election. I was prepared to allow a modest relaxation of the cap if it could be demonstrated to benefit private patients, but I was talking about single percentage points: 1% or 2% becoming 2% or 3%. I was not in any way conceiving the possibility that 49% of a trust’s income might be made from the treatment of private patients—that half their theatre time, beds and car parking spaces could be turned over to the treatment of private patients.
Dr Poulter
I hope that the right hon. Gentleman will concede that those hospital trusts with a private patient cap that is set at perhaps 35%, such as the Royal Marsden hospital, do not necessarily do that much private work. The decision is at the hospital’s discretion, so the idea that raising the cap to 49% will mean that hospital trusts will per se undertake 49% private activity has been proven to be incorrect, on the facts as they stand at the moment in hospital trusts, because those trusts, the doctors and boards work for the benefit of their patients.
Andy Burnham
That is the ideological difference between us. The hon. Gentleman says that the decision should be at the hospital’s discretion, but the Bill essentially sets everybody on their own. Hospitals are being told, “You’re on your own. There’s none of the support from the centre any more, no bail-outs, as the White Paper said. That’s it, you’re out there, you’re competing in a market, and you’ve got to stand on your own two feet.” I differ from that opinion because I want systems regulation and a role for the centre in deciding whether a hospital should greatly increase its treatment of private patients.
This is not just a question of each individual hospital thinking about what it is going to do, because hospitals will have pressure on their bottom lines, as a colleague said earlier. They will be operating in a difficult financial context, and it might have a different effect on their individual interests. It might make sense for hospitals, individually, to increase the number of private patients, but it might not make sense for the NHS patients who live in that area, and that is the entire point: the Government are trading systems regulation for the individual decisions of local organisations, because that fits when we move to a competitive market in which every individual organisation is a competing business.
Dr Poulter
I am struggling to follow the coherence of the right hon. Gentleman’s argument. On the one hand he says that it was all right for non-foundation trusts, under the previous Government, to increase massively the amount of private work that they did, as long as the Department agreed with it; on the other hand he argues that it is very important to control the amount by which foundation trusts raise the private patient cap. He cannot have it both ways, and his argument is not intellectually coherent. Is this not about doing things for the benefit of patients and leaving it up to local hospitals to decide?
Andy Burnham
The hon. Gentleman should make a speech if he wants to make interventions of that length. We had a cap to protect the interests of private patients; he is getting rid of the cap, and he is going to have to explain to patients in his constituency, if waiting lists start getting longer, why that is happening. It is as simple as that. We had systems regulation, he is removing that with the Bill and we are moving to a more unregulated market, which is not what we want to see.
Andy Burnham
I am afraid that I am not at all reassured by that, or in fact by anything the Minister says. The letter that we have from the Deputy Prime Minister spoke of insulating the NHS from European competition law, but I am still waiting to see the amendment that delivers that. As I understand it, one of the Minister’s noble Friends tabled an amendment and then withdrew it, because they did not have the courage to press it to a vote, and accepted a statement on the record instead. This is different from what the Minister keeps saying that we did in government, because he is envisaging a huge expansion of the role of any qualified provider and the putting out to tender of commissioning support units. He has overseen a situation in which three community services have been compulsorily tendered.
The truth is that the Clegg-Williams letter, with the amendments that followed, does not only fail to deliver but sells out the national health service, as does so much of what the Liberal Democrats have agreed to. Our amendments, particularly amendment (b), would provide a measure of systems regulation in the best interests of the NHS, and that is why we will seek to press amendment (b) to a vote.
Dr Poulter
I rise to speak in support of the Government, and of what the previous Government did for the NHS. When the shadow Secretary of State was Secretary of State for Health—the same was the case with many of his predecessors—there was a consistent policy whereby the private sector should be used where it could add value to patient care in the NHS. That was done very effectively by the previous Government to bring down waiting times for operations, but it was not effective when it was not done in an integrated way. Very often, it was done without regard to post-discharge planning for patients but, as we heard earlier, the renewed focus on integration should help to deal with those problems.
We have some of the very best hospitals not only in this country but in the world, including the Royal Marsden and Moorfields eye hospital, where a relatively high proportion of activity is carried out by the private sector. No one doubts those hospitals’ commitment to their NHS patients or that they still provide those patients with the very high standards of care of which health care systems in other countries are very envious. We are very proud of what those hospitals do, and the Government would like to give other hospitals the same opportunity and freedom to follow their example. The Government believe that it is absolutely appropriate that we should use the private sector where it can enhance value to NHS patients. That is absolutely consistent with the previous Government’s policies, for which many Labour Members campaigned at the last general election. This Government are also committed to those policies.
Andrew George
I understand and respect the sincerity of the principle that my hon. Friend is describing, but can he reassure me, particularly given his understanding of the NHS and health systems, that under these proposals it would not be possible for a foundation trust to drive some NHS patients towards the private arm of the activities that they undertake, particularly in the case of procedures that are exactly the same in the private and the public sector?
Dr Poulter
My hon. Friend makes a valid point, and he is right to raise it. That happened in the past when, under the previous Government, private sector providers were paid 11% more for the provision of services than NHS providers, which created an incentive for the private sector to be used ahead of NHS services. This Government are committed to ensuring that that does not happen. My hon. Friend the Minister and my right hon. Friend the Minister and Member for Cheltenham—[Interruption.] I mean Chelmsford; I apologise, particularly as I get the train through his constituency on the way home every Thursday night. They have clearly stated that the Bill is about making sure that we use the private sector when it adds value for money. The hospital that uses the private sector the most—the Royal Marsden—does not have a two-tier service for NHS patients and private patients. The involvement of the private sector at that hospital greatly enhances the work of the NHS and the quality of service and care available to its NHS patients because of the increased research that is performed, the high quality of care, and the high standard of clinicians who are attracted to work there. That works well for the private sector and for the NHS.
I agree with the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) that, where possible, we should be using NHS providers. The Royal Marsden, where there is a high potential cap on private sector involvement, does not use the full capacity of that cap, and there is less private sector activity than it could undertake. That is because the Royal Marsden says, in effect, “Yes, the private sector is good, but it is not only about maximising our cap and maximising our profits but taking into account the best interests of our local patients and striking a balance.” That works very well.
Andrew George
As I understand it, the majority of the private work at the Royal Marsden is in areas such as research and development that are not in any way similar to the services it provides to NHS patients. I asked my hon. Friend whether he agreed that where the private sector and public sector were providing the self-same services for NHS patients, there was a risk that patients might be driven from the NHS towards the private sector.
Dr Poulter
I hope I reassured my hon. Friend with my earlier answer. Yes, he is right that that has happened in the past. However, there is a presumption in the Bill—particularly for rural areas such as Cornwall and in Suffolk, which I represent—that the renewed focus on integrated care that we heard about earlier is the primary focus and purpose of commissioning, over and above the use of any willing provider or private sector providers. That has given me great reassurance regarding our ability to take on and deal with the big demographic challenges of looking after older people better.
I am reassured by what the Minister has said, and I urge Government Members to support the Government.
Alex Cunningham
I rise to support the amendment and to speak against anything that will allow 49% of the capacity of our local hospitals to be used for private patients.
Along with other measures in the Bill, the Government have accepted various amendments that will result in lengthening waiting lists for NHS patients. The Government’s relaxation of NHS waiting times targets means that hospitals are free to devote more theatre time to private patients, and they will have a clear incentive to do so in order to maximise income, given the move towards full financial independence and a “no bail-outs” culture whereby hospitals in financial trouble are allowed to go bust with no help from the Government.
The Health and Social Care (Community Health and Standards) Act 2003 placed a cap on the level of income that a foundation trust could earn from private patients. It was based on the level of a foundation trust’s private income in 2003—the year when foundation trusts first came into being—which was typically about 2%. The Bill in effect sets trusts free to deploy as much as 49% of that capacity to generate income from private patients who can afford the fees to jump the queues, which ordinary hard-working people, and the most vulnerable in our society, cannot do. This is not what patients want, not what the professionals want, and not what the NHS needs.
The Government amendments must be changed to ensure that any increase in the proportion of patient income has the approval of Monitor. Allowing individual trusts to make the decision alone means that there is no strategic overview, which Monitor would offer, and so in theory it would be possible for all the trusts in a locality to make that increase to 49% if their individual boards approved it. I wonder what that would mean on Teesside. We have two major hospitals, so half the capacity for NHS patients could go. Labour’s amendment would set a tougher cap on private patient income. Without the amendment, the NHS will take a huge step towards privatisation and we will fail to put in safeguards to ensure that the needs of the general public are met. Rather than the NHS being free at the point of delivery, more and more people will be pushed towards insurance schemes, thereby putting money in the pockets of the insurance industry and denying the exceptionally important right to have free, high-quality health care when it is needed.