Advisory Committee on Clinical Excellence Awards

Dan Poulter Excerpts

Thursday 15th January 2015 Written Statements

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

I am today announcing the start of the triennial review of the Advisory Committee on Clinical Excellence Awards (ACCEA).

All Government Departments are required to review their non-departmental public bodies (NDPBs) at least once every three years. Due to the wide-ranging reforms made by the Health and Social Care Act 2012, the Department was exempt from the first round of reviews in 2011-14. In order to ensure that the Department is an effective system steward and can be assured of all the bodies it is responsible for, we have extended the programme of reviews over the next three years to all its arm’s length bodies and Executive agencies.

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

[HCWS192]

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 13th January 2015 Commons Chamber

[Mr Stewart Jackson (Peterborough) (Con)]

1. What steps he is taking to improve mental health care for pregnant women and new mothers in (a) Peterborough and (b) England; and if he will make a statement.

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

The Government have prioritised improving mental health care and support for pregnant women and new mothers in its mandate to NHS England, with a clear objective to reduce the incidence and impact of post-natal depression. In order to implement the Government’s priority to improve perinatal mental health services, Cambridgeshire and Peterborough NHS Foundation Trust is working closely with local authority commissioners in Peterborough to develop a joint perinatal mental health strategy to improve care for women.

[Mr Jackson]

The Maternal Mental Health Alliance has estimated that the long-term cost of mental health care for new mothers is £8 billion, which is perhaps not unconnected to the fact that only 3% of clinical commissioning groups have a perinatal mental health strategy. Does the Minister think that this is a very serious issue and needs immediate action?

[Dr Poulter]

My hon. Friend is absolutely right to highlight the challenges posed by perinatal mental illness. The damage it does to women’s lives, and indeed to the wider family, was highlighted in the recent independent inquiry into maternal deaths. It is therefore important for the Government to invest, as we are doing, in improved care for the perinatal mental health of women. That is why we have made it a priority for each and every maternity unit to have staff specially trained in perinatal mental health skills by 2017.

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

The Minister will know that I have been part of an all-party group campaigning on post-natal depression, which is the most likely thing to kill a healthy young woman. Is he aware that this area of mental health is under-resourced, and that mental health facilities for children and young people are desperately under-resourced? That is partly because clinical commissioning groups have been commissioning in the wrong way, which has disturbed existing arrangements and demoralised staff.

[Dr Poulter]

The hon. Gentleman makes the important point that there has been an historical disparity between the priorities given to mental health and physical health conditions. That is why we have legislated for parity of esteem between mental and physical health, why we are introducing access targets for patients using mental health services for the first time—that is a big step forward—and why we have increased funding for mental health services by £300 million this year.

[Maria Miller (Basingstoke) (Con)]

In the first few weeks of a child’s life, the mother often visits their general practitioner regularly, so I applaud the Government’s work on recruiting more health visitors and midwives. Does the Minister agree that GPs need to be sharper at identifying post-natal depression in mothers, because it can be so destructive to the lives of both the mother and the child?

[Dr Poulter]

My right hon. Friend is absolutely right. A lot of work is going on with the Royal College of General Practitioners and the Royal College of Psychiatrists to improve GP training and skills in mental health more generally. The specific key to this is providing the right early years work force, which is why it is so important that this Government have invested in additional health visitors to give each and every child the best start in life. The latest figures from NHS England show that the number of health visitors has increased by more than 3,000 under this Government.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

What steps is the Minister taking to make sure that awareness of domestic violence is incorporated in guidance for mental health care? We know that pregnancy can sometimes be the first time there is violence in the home, and we obviously need a strategy to address that.

[Dr Poulter]

The hon. Lady makes very important points. I have certainly seen in my clinical practice that some women present when there are domestic violence issues or other issues in the home, and such issues can be heightened and exacerbated during pregnancy. A lot of work is now going on to improve the awareness of all NHS staff of domestic violence and, more broadly across training, of mental health issues.

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

For many people with mental health problems, the first emergency service with which they come into contact at a point of crisis is the police. What steps are the Government taking to ensure that such a crisis is treated as a health crisis, not a criminal incident, and will the Minister undertake to do whatever he can to ensure that no children end up in a police cell as a place of safety?

[Dr Poulter]

My hon. Friend makes an important point. It is absolutely right that we do not want people with mental health problems to be looked after in police cells. A lot of work has been going on. The Government have set up the crisis care concordat to look at exactly that issue, and as a result the number of people with mental illness going to police cells is now falling rapidly.

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

2. What steps he is taking to improve ambulance response times.

--- Later in debate ---

[Bill Esterson (Sefton Central) (Lab)]

3. What the average waiting time was for a GP appointment in the most recent period for which figures are available.

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

The latest GP survey results suggest that the majority of patients can get GP appointments at a time convenient to them, but we want to do more. We are offering 7.5 million more people evening and weekend appointments through the Prime Minister’s £100 million challenge fund. NHS England does not directly collect data for GP waiting times.

[Bill Esterson]

I think many people up and down the country will be surprised by the Minister’s answer, including my constituent Lynne Taylor who had a chest infection but was sent to A and E by a locum because of a lack of appointments at her GP surgery. That was done on the phone without seeing her. The A and E doctors told her that she certainly should not have been sent to A and E. Will the guarantee of a GP appointment within 48 hours help patients like Ms Taylor who need to see their own doctor? Would that not also be a big step in reducing the huge pressure on A and Es?

[Dr Poulter]

I hope the hon. Gentleman will be reassured to hear that, according to the latest GP survey, 87% of patients in Southport and Formby clinical commissioning group were able to get an appointment or to see somebody they wanted to see at an appropriate and convenient time. It is important to note that Labour’s 48-hour target did not work. From 2007 to 2010, the percentage of patients who were able to get an appointment within the 48-hour target actually fell.

[Mr Speaker]

Order. Let me explain to the Minister, which I have done several times, that we have a lot of business to get through. We need answers to questions and no more than that.

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

Last month, I contacted one of my excellent GPs in Chesham concerning the waiting time for one of my constituents. In his response, he reminded me that Buckinghamshire patients receive less funding per head than almost anywhere in the country. What can be done to address that inequality, so that my constituents can benefit from the same level of funding for services and treatment enjoyed by other parts of the country?

[Dr Poulter]

As my right hon. Friend will be aware, the funding formula is now reviewed regularly. That is done independently and is free from political interference. Looking at areas such as hers, where there are a lot of frail and elderly patients, is now more paramount in the funding formula. In the future, I am sure that the funding formula will better reflect local health care needs.

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

One in four patients now wait a week or longer to see a GP. Last week’s official NHS survey revealed that almost 1 million people had to turn to A and E because they could not get a GP appointment. Will the Minister accept that his Government have made it harder to see a GP, and have caused the A and E crisis in the process? Will he respond to Labour’s call for GPs to be placed in major A and Es to help ease the pressure?

[Dr Poulter]

I do not think that people wanting to see their GP was at all helped by the previous Labour Government’s disastrous decision to contract out the GP out-of-hours service. Many patients are now struggling to receive appointments in the evenings and at weekends. The previous Government also broke the link with family doctors. To reassure the hon. Lady, the latest GP patient survey results suggest that less than 2% of patients who want GP appointments have to resort to walk-in centres or A and E departments. Under this Government, we have put in place an extra 1,000 GPs.

[Caroline Nokes (Romsey and Southampton North) (Con)]

4. What progress his Department has made on its long-term plans for easing pressures on A and E departments and preparing the NHS for the future.

--- Later in debate ---

[Robert Halfon (Harlow) (Con)]

5. What steps have been taken to help Princess Alexandra hospital in Harlow to deal with extra pressure over the winter.

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

The West Essex system, which includes Princess Alexandra hospital, has received an additional £4 million in winter resilience funding. Of that, £842,000 has been spent on additional community beds, £211,000 on putting GPs into A and E departments, and £205,000 on reducing delays in the discharge of medically fit patients.

[Robert Halfon]

Harlow’s A and E has seen more attendances per bed than some of the biggest hospitals in the country. Although the staff at Princess Alexandra hospital are outstanding, they are still more than 40 nurses short. The chief executive says that recruitment is difficult because pay is better in the neighbouring London hospitals, although they are not far away. I welcome the 6,000 extra nurses, but will the Secretary of State consider what more can be done to help recruitment in Harlow and ease pressure on my local hospital?

[Dr Poulter]

I expect the additional £4 million for winter resilience to be directed towards the recruitment of additional front-line staff when that is appropriate, but there is flexibility in the current “Agenda for Change” pay scales to allow for the provision of recruitment and retention premiums if there are problems with recruitment.

--- Later in debate ---

[Jeremy Lefroy (Stafford) (Con)]

T5. The recent extraordinary pressures on A and E in the north midlands underlined for me and my constituents the importance of returning the A and E at Stafford County hospital from 14 to 24-hour opening. Given that consultant-led maternity is due to transfer from Stafford to Stoke this week and the remaining serious emergency surgery next month, will my right hon. Friend set out what steps have been taken to ensure that the safety of my constituents and other users of the services is the top priority, and advise me whether he is confident in them?

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

I have been in contact with the NHS Trust Development Authority. I have been reassured that the safety of patients in Stafford is the primary concern and that the transfer of services should help to ease pressure on local services and improve patient care.

[Mr Jim Cunningham (Coventry South) (Lab)]

T7. Government-inflicted cuts on local government funding and subsequent reductions in adult social care services have increased the pressures of bed-blocking at University hospital Coventry, with a number of patients unable to be discharged as they wait for a nursing home place or a package of care in their own home. Does the Minister agree that this is a problem, and what steps has his Department taken to remedy it? Will he not do the Pontius Pilate act but take responsibility for his actions?

--- Later in debate ---

[Greg Mulholland (Leeds North West) (LD)]

All the talk about appointments concentrates on GPs and A and E, but does not seem to focus on pharmacies, which have a hugely important role to play, considering how many years pharmacists train for. My constituent Mr. Dhand of the Headingley pharmacy is undertaking a pilot to see how many people could and should have gone to a pharmacy rather than to a GP. Would Ministers support that?

[Dr Poulter]

I very much welcome what the hon. Gentleman’s constituent is doing locally. For many patients the pharmacy is often the first point of contact with the NHS, so the more we can do as a Government to support local pharmacists in delivering community services, the better.

[Mr David Anderson (Blaydon) (Lab)]

Despite all the warm words we hear every week from the Government about their support for the staff of the NHS, which I welcome, the Government still refuse to pay the award recommended by the independent review body. At the same time the chief executive of the trust in my part of the world has had a 78% salary increase and the people who set the allowances, the board of governors, have had an 88% increase in their allowances. Is this what is meant by “we are all in this together”?

Health and Social Care (Safety and Quality) Bill

Dan Poulter Excerpts

Friday 9th January 2015 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

I thank the hon. Member for Copeland (Mr Reed) for tabling new clause 1, which allows us to debate the issue. I am most grateful to him for his full and constructive engagement with the Bill. A consultation on making the role of the national data guardian statutory is extremely important, and I fully appreciate the reasons why he has tabled the new clause.

I welcome the appointment last November of Dame Fiona Caldicott as the first national data guardian. Her extensive knowledge and experience in this area will ensure strong and visible leadership. She, together with her panel, will act as a source of clear authoritative advice and guidance across the health and care system. The Secretary of State said at the time of her appointment:

“We need to be as determined to guarantee personal data is protected as we are enthusiastic to reap the benefits of sharing it. Dame Fiona will oversee the safe use of people’s personal health and care information and hold organisations to account if there is any cause for concern, ensuring public confidence.”

Let me make it quite clear that the clauses on the duty to share information are not about care.data, which is another issue for another time. My Bill is about data being shared only with those who are directly responsible for an individual’s care for the purposes of that care. Its remit is very restrictive.

A consultation should, as the new clause provides, include reference to

“oversight of data sharing as set out in”

the Bill. Understandably, concerns have been raised that a duty to share information might somehow dilute the vital principle of patient confidentiality, which is protected by statute and common law. As I have explained before, I do not believe it will do so.

The seventh of the revised Caldicott principles, as set out in “The Information Governance Review”, is that

“The duty to share information can be as important as the duty to protect patient confidentiality. Health and social care professionals should have the confidence to share information in the best interests of their patients within the framework set out by these principles.”

As was set out on Second Reading and in Committee, clause 3 introduces a duty to share information. That must be done when it is in the person’s best interests and it is

“likely to facilitate the provision to the individual of health services or adult social care”.

Having a statutory duty to share information for the benefit of a person’s care, within the clear limits set out in the Bill, would, alongside the existing strong statutory protection for confidentiality, provide health and social care professionals with the confidence to which Dame Fiona’s report refers.

The consultation on the national data guardian will provide the opportunity to set out how oversight would work for the duty introduced by the Bill, should it become law, under the legislation that will make the role of the NDG statutory. If the consultation cannot be established through a clause in the Bill, which I understand may be the case due to the timing of the general election—the Minister will go into that, I believe—it needs to happen at the earliest possible opportunity.

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

The new clause relates to clauses 2, 3 and 4. Clause 2 will place a duty on providers and commissioners of publicly funded health and adult social care to use a consistent identifier in a person’s health and care records and correspondence. The consistent identifier must be specified in regulations, and the Government’s intention is that the NHS number will be specified. It is important to note, as my hon. Friend the Member for Stafford (Jeremy Lefroy) outlined, that the duty to use the NHS number would apply only in the direct provision of care and when it was in the individual’s best interests. As he articulately said, this matter is very different from the issues with care.data that we have discussed. There is a duty on professionals to share information in the best interests of patients in respect of the provision of direct care.

Clause 3 will introduce a duty to share information that is held by providers and commissioners when it is in an individual’s best interests and will support their direct care and treatment. As we discussed in Committee, that is an essential part of the delivery of safe, effective and high-quality care.

Clause 4 defines health or adult social care commissioners or providers. Its effect will be that the duties imposed by clauses 2 and 3 will apply only to relevant health or adult social care commissioners or providers. They are defined as public bodies exercising health or adult social care in England and any person, other than an employee, who provides such services or care under arrangements within a public body.

I welcome the constructive support of the shadow Minister, the hon. Member for Copeland (Mr Reed), throughout the passage of the Bill. There has been a great deal of consensus, and rightly so. I am grateful for his support for the role of the national data guardian. As was discussed in Committee, the Government are committed to consulting on the role of the national data guardian and the Secretary of State has given his unequivocal support to the consultation. We believe that having a data guardian is an important additional safeguard in the system.

As the House will be aware, Dame Fiona Caldicott has been appointed as the first national data guardian and has already built up significant credibility in her role of challenging and scrutinising the way in which information is shared across the health and social care system. Strengthening and broadening the role of the national data guardian will further enhance the confidence of patients and the public that there is a strong voice for their rights and protections in this area.

Even without a legislative basis, Dame Fiona’s panel, which was previously known as the independent information governance oversight panel, has built its reputation as an effective and authoritative voice. It has helped to ensure that data and information are shared in a way that allows the health and care system to access what it needs to improve outcomes for patients, while protecting against their inappropriate use. Having made significant progress, there is now clear agreement across the House that it is important to embed the national data guardian in the health and care system as a powerful independent voice, and to put that role on a statutory footing.

--- Later in debate ---

[Mr Jamie Reed]

I listened closely to the hon. Member for Stone (Sir William Cash). As I said earlier today, and on Second Reading, in Committee and throughout the passage of the Bill that became the Care Act 2014, patient safety is our guiding principle, and we are responsible for ensuring that all that we do is intended to improve it. The purpose of NHS regulation should always be to improve safety and achieve better patient outcomes. I therefore strongly sympathise with the principle of the new clauses. However, I should be grateful if the hon. Member for Stone explained why he does not agree with the hon. Member for Stafford (Jeremy Lefroy) that the duties for which they provide are already covered by the Bill and by other legislation.

A little over 12 months ago, I was a member of the Committee that scrutinised the clause in the Care Act that amended the Health and Social Care Act 2008, which new clause 2 seeks in turn to amend. The new clause adds the following words:

“The assessment of the performance of a registered service provider is to be by reference to whatever indicators of quality the Commission devises, but must include indicators of the safety of health and social care services.”

That is sound in principle, but it seems to me that it would remove from the CQC the flexibility that allows it to exercise its own judgment. Existing legislation gives the CQC a duty to describe and justify its indicators, and to consult on them before carrying out inspections. As the hon. Gentleman said, the Care Act also gives it a power to amend and revise those indicators.

Section 3 of the 2008 Act states:

“The main objective of the Commission in performing its functions is to protect and promote the health, safety and welfare of people who use health and social care services.”

Will the hon. Gentleman explain why he thinks his new clause is needed on top of that, and in combination with the CQC’s duty to consult on the indicators that it uses to assess services? If we support the principle of independent inspection, we need to guard against making unnecessary changes to legislation that could deter the CQC from performing its central role of ensuring the safety of the services that is inspects.

New clause 2 requires the CQC to

“include indicators of the safety of health and social care services.”

We all want the best and most effective legislation to be passed, but I fear that the new clause could be open to significant misinterpretation. The section of the 2008 Act to which the new clause relates concerns CQC reviews of the performance of service providers. The CQC will inspect a number of different services, including services that do not directly involve social care. The new clause, however, could require it to include indicators of safety in social care services regardless of whether the service concerned involves social care. If that is the hon. Gentleman’s intention, will he explain why he believes the provision to be necessary? Furthermore, new clause 2 refers to “social care services”, whereas new clause 3 refers to “adult social care services”. I hope that the hon. Gentleman will be able to explain what appears to be a discrepancy.

As Labour Members have made clear, we believe that patient safety is paramount in our NHS, that effective regulation is key to securing it, and that producing such regulation is our role in the House. I should be grateful if the hon. Gentleman explained why he believes that his new clause is essential to more effective regulation, given that—as the hon. Member for Stafford has pointed out—it seems merely to repeat existing provisions.

[Dr Poulter]

I thank my hon. Friend the Member for Stone (Sir William Cash) for tabling these new clauses and I commend him on his tireless work in taking forward the interests of his constituents around the terrible events that occurred at Mid Staffordshire NHS Foundation Trust and the subsequent steps he has been involved with all the way through to improve standards of hospital care provided to the people of Stone and the surrounding areas. He is also right to pay tribute to my hon. Friend the Member for Stafford (Jeremy Lefroy), who has worked tirelessly not just on this Bill, but as an advocate for his constituents and local patients. He is a great credit to the people of Stafford and, party politics aside, being a Member of Parliament is about public service, and he embodies the very best of that in the work he has done in bringing forward this Bill and in his advocacy of the needs of his local patients.

--- Later in debate ---

[Mr Jamie Reed]

Thank you for calling me to speak, Madam Deputy Speaker, and happy new year.

I listened closely to the hon. Member for Stone (Sir William Cash) introducing his new clause 4 and to the other hon. Members who have spoken on it. They are correct to say that good communication between professionals and patients is crucial for ensuring positive health outcomes. I would go so far as to say that it is critical. One of the issues that we need to address in this regard is the needs of patients with sensory impairments, such as deafness and blindness. That is not covered by the new clause and it has no regard for nationality or language skills.

In April 2010 the Health Committee conducted an inquiry called “The use of overseas doctors in providing out-of-hours services” following the tragic death, to which the hon. Gentleman referred, of David Gray in 2008 after receiving medical treatment from Dr Ubani from Germany, who was working his first shift as an out-of-hours doctor in the United Kingdom. The report recommended that the Government make the necessary changes

“to enable the GMC to test the clinical competence of doctors and undertake systematic testing of language skills so that everything possible is done to lessen . . . the risks of employing another unsuitably trained . . . doctor in out-of-hours services.”

Following this case, I understand that the Government have, with the support of Labour, worked to strengthen the powers of the General Medical Council in this regard. We welcome that.

Notwithstanding all this, I am unsure what the hon. Gentleman is trying to achieve. Given the existing practice of the GMC, the new clause, although agreeable in principle, is superfluous. The GMC conducts English language assessments already, and failure to undertake an assessment or failing such an assessment can result in fitness to practise hearings, which can lead to a loss of registration to practise.

These assessments can be triggered in a number of ways. A single complaint from a patient, a health professional or another party can result in an assessment, as can prescribing errors and poor record keeping. Overseas medical regulatory authorities can prompt an English language assessment if they believe that a doctor does not have sufficient knowledge to treat patients in an English-speaking context. Indeed, the GMC website tells international doctors that

“you must satisfy us you have the necessary knowledge of English to get registration with a licence to practise”.

So the GMC needs to be satisfied before a licence to practise is granted. These tests relate to all forms of communication—speaking, reading, writing and listening. It is right that the GMC continues to be vigilant in its oversight of this requirement. Good communication is central to patient safety, and the GMC does a great deal to ensure that those practising in the NHS have the skills required to do so safely.

I want to place on record an acknowledgement of the contribution made to our national health service, which I know nobody doubts, by the many overseas health care workers without whom the NHS would not be able to cope, including in my constituency. On Second Reading of the National Health Service (Amended Duties and Powers) Bill, my hon. Friend the Member for Bolsover (Mr Skinner) commented that he had received a “United Nations heart by-pass” operation, by which he meant that people from all over the world had done a great deal for the health of this country, and we should all be thankful for that.

We have touched briefly on unintended consequences. Some politicians have recently sought outside the House to manipulate and inflame the issue with a view to creating an imaginary bygone Britain in the public consciousness as part of a long-standing flight from reality based on bizarre notions such as “gay rain”, the enforced segregation of breastfeeding mothers from public spaces and the right to use racist language. We must all be careful not to legitimise this abhorrent, detached, cultish behaviour or the perverted mindset which underpins it.

[Dr Poulter]

I am grateful to my hon. Friend the Member for Stone (Sir William Cash) for tabling the new clause. We all agree that it is vital that doctors can speak and communicate effectively in English. My hon. Friends the Members for North East Somerset (Jacob Rees-Mogg) and for Shipley (Philip Davies) made a number of important points.

I hope I can bring some reassurance to hon. Members that there are already in place, thanks to changes introduced by this Government, a number of strong tests for language competency and the ability to communicate. It is not good enough for a medical professional to be able to speak English; it is important in all aspects of health care that we can communicate effectively with our patients. The ability not just of doctors from overseas when they work in and contribute to the NHS, but of doctors who have been working here for many years to communicate effectively is at the heart of good medicine. There are a number of steps that this Government have taken to strengthen the tests in place.

To echo the comments of the shadow Minister, I have worked alongside many doctors and many health care professionals from all over the world who have come here to contribute to our NHS and to the care of patients. Many of those doctors have been outstanding and continue to look after patients today as we debate the new clause. One of the strengths of our diverse NHS is that because we have a world-class health service, doctors want to come here and contribute as part of their careers, often for a short period, before they return to New Zealand, Australia or the many other countries from which they have come. The diversity of our NHS and the fact that we attract doctors—often the very best doctors—from all over the world is a great strength, but it is vital that all doctors can both speak English and communicate effectively in English. That is not controversial, and it is what good patient care is all about.

Clause 5 and the schedule will introduce a consistent overarching objective for the Professional Standards Authority and professional regulators—the General Dental Council, the General Optical Council, the General Osteopathic Council, the General Chiropractic Council, the Nursing and Midwifery Council, the Health and Care Professions Council and the General Pharmaceutical Council—to ensure that public protection is at the heart of what they do.

The clause introduces the term “well-being” into the objectives of a number of these regulators. This has been a long-standing and established feature of the legislation for the General Pharmaceutical Council, the Health and Care Professions Council and the Nursing and Midwifery Council. The term encompasses those aspects of a health care professional’s role that may have an impact on individuals but may not directly impact on their health or safety: dignity, compassion and respect are all vital aspects of delivering high-quality care. This was highlighted most starkly in the Francis inquiry report of February 2013, which put into focus the terrible and serious failings in the care provided at the former Mid Staffordshire NHS Foundation Trust, which was the basis on which my hon. Friend the Member for Stafford (Jeremy Lefroy) introduced the Bill.

One specific area where real changes in the protection of patients are being made relates to the strengthening of arrangements to ensure that all health care workers have sufficient knowledge of English and the ability to communicate effectively with patients in English before being allowed to work in the UK. The General Medical Council has always been able to check the language skills of doctors from outside the European Union who want to practise medicine in the UK. It does this through the international English language testing system, which covers all four language skills—listening, reading, writing and speaking—and it is widely accepted by employers, the other health care regulators and professional bodies as a means of assessing proficiency in English in a professional environment. The GMC continually assesses the effectiveness of this test to ensure its robustness.

In addition to this test of their language skills, the GMC conducts a professional and linguistic assessments board exam—often called the PLAB exam—for doctors from outside Europe. This tests their reactions to a number of clinical scenarios and their ability to apply their clinical knowledge to the treatment of patients and is the main route by which international medical graduates demonstrate that they have the necessary skills and knowledge to practise medicine in the UK.

However, following the death of a patient, David Gray, and the tragic circumstances surrounding that death in 2008 after he received medical treatment by Dr Ubani, a German national, where language skills were a strong component in the incident, a House of Commons Health Committee report recommended that the Government change the law to allow the GMC to extend language tests to doctors within the European economic area, providing consistency in how doctors from both within and outside the EEA are treated with regard to assessing their language skills, before being allowed to practise medicine in the UK.

The Government made a commitment in the 2010 coalition agreement, which the shadow Minister has mentioned, to stop foreign health care professionals working in the NHS unless they have passed robust language tests. We have fulfilled that commitment in respect of doctors, and we are now putting in place additional measures, through section 60 orders, to introduce language testing for other health care workers.

[Sir William Cash]

Is the Minister satisfied that the measure complies with European law and that we do not need a notwithstanding arrangement? He may hope that it will not fall foul of the European Court of Justice, but has he taken advice on that? If not, will he do so after we have finished our proceedings?

[Dr Poulter]

I hope I can reassure my hon. Friend on that. I am absolutely sure that our measures are consistent with European law and I took advice consistently on that, although there was a difference of opinion in how the previous Government and this Government interpreted advice. I work very closely with the General Medical Council, which receives its own independent advice, and I worked with its former chair, Sir Peter Rubin, who has been a tireless campaigner for the measure. Together with the GMC, we introduced measures that are consistent with European law and mean that we are able to test the language competency of EU doctors. I am sure that there is consistency: a similar process is in place in Bavaria in Germany. Although there can be free movement of qualified health care professionals to different member states—their skills can benefit our NHS—it is also important that they can perform a doctor’s functions properly, and it is not possible for them to do that if they cannot speak English and communicate effectively with patients. Our measures are consistent with the advice I have received and, indeed, with the views of the GMC. This is the right thing to do and I am pleased that the coalition Government have put in place language tests.

Last April, I led through this House changes to the Medical Act 1983 to strengthen the arrangements to ensure that all doctors, including those from within the European economic area, must have sufficient knowledge of English before being able to work and look after patients in the UK.

I hope my hon. Friend will agree that patients are much better protected by the new powers the Government have given to the GMC. When the GMC implemented language checks for European doctors in June 2014, it also raised the pass mark for its language tests. The GMC has vigorously used the powers given to it by the Government. Since the Government changed the legislation last April to strengthen the language test arrangements, 128 EEA doctors have been refused a licence to practise medicine in the UK owing to inadequate language skills. That shows that the measure is working to protect patients in the UK from EU doctors who cannot speak English effectively. It is having an effect—it is biting—and making sure that patients are being properly protected. I will write to hon. Members to outline the measure further, and I will perhaps ask the GMC to contribute to that letter. The measure was long overdue and I am proud that we introduced it. It is protecting patients in the UK from doctors who cannot communicate effectively.

As part of a belt-and-braces approach to ensure that all doctors looking after patients can speak a good standard of English and communicate effectively with them, in 2013 responsible officers in England—senior doctors in health care organisations who oversee the employment of other doctors—were given additional statutory responsibility for ensuring that doctors

“have sufficient knowledge of English language necessary for the work to be performed in a safe and competent manner”.

In addition, on medical revalidation, which was raised by my hon. Friend the Member for Shipley, the Government have taken the important step of ensuring that all doctors must show evidence of competency on a maximum of a five-yearly basis in order to maintain their medical licence. That has improved checks on all aspects of a doctor’s work, including how well they work as part of a multidisciplinary team, how well they communicate with their patients and whether they are keeping up to date with medical practice.

--- Later in debate ---

[Philip Davies]

I welcome what the Minister has said and commend him for that initiative. In order for us to be able to see how robust the revalidation process is, can he tell us how many people have been through it and how many have failed as a result?

[Dr Poulter]

The revalidation process is ongoing and is reviewing everybody on the medical register. It is very easy to revalidate someone who is training to be a specialist as a surgeon or in some other hospital position, because they are assessed annually as part of their specialist training. The revalidation process for the consultant and general practice work force—which kicked off as a five-year programme—is ongoing. Some people have volunteered to come off the medical register, including retired doctors who have not practised for some time. I would be happy to write to my hon. Friend to update him on the revalidation process. It will not be completed for another couple of years, but once we have gone through the first cycle of revalidation the process will be easily repeated. I stress that doctors will be revalidated on a maximum of a five-yearly basis. It is possible for the GMC to seek reassurance with regard to certain specialties by requesting more regular competency tests as part of the annual appraisals.

The revalidation process is an important new power that is being implemented effectively. We need to keep it under review because it is important that all doctors, regardless of the proposed new clause on language testing, are competent, keep up to date with medical practice, able to communicate effectively and empathetically with their patients, and work as part of a multidisciplinary team for the benefit of patients. That applies to general practitioners, hospital specialists and those working in mental and physical health. It is an important step for which the GMC has been asking for many years and in which other health care professions are taking an interest. The Nursing and Midwifery Council is considering revalidating nurses in a similar way in future. It is a welcome measure that will help protect patients and the public. It is making good progress and I will write to my hon. Friend with further details in due course.

Medical revalidation is the process by which the GMC evaluates whether doctors can keep their licence to practise in the UK. In addition, a doctor wanting to work in general practice in the UK must also be on the national medical performers list, which is managed by NHS England. To be included on the list, the doctor must hold a licence to practise from the GMC and, as a consequence of the revalidation programme, he or she must have effective communication skills.

As I outlined earlier, the key step to improving checks on language competency for EEA doctors was the Medical Act 1983 (Amendment) (Knowledge of English) Order 2014, which made changes to the Medical Act 1983. My hon. Friend the Member for Shipley will be pleased to hear that the title of the order refers to English. After all, the General Medical Council regulates doctors on their ability to speak primarily that language, and I hope that that reassures him.

The order gave the General Medical Council the power to refuse a licence to practise to a medical practitioner from within the EU who is unable to demonstrate the necessary knowledge of English. It created a new fitness to practise category of impairment relating to language competence to strengthen the General Medical Council’s ability to take fitness to practise action where concerns are identified.

For example, if I, as a doctor, worked with a doctor about whose language competency I had concerns, or if a doctor was not able to communicate effectively in their day-to-day work, I, fellow health care workers and patients could report the doctor to the GMC, which—in addition to the existing initial point-of-entry language testing powers and the revalidation process—now has new powers to take action specifically in relation to such language concerns. That is another important measure that the Government have introduced to strengthen the GMC’s powers on language testing.

The change enables the GMC to require evidence of English language capability as part of the licensing process in cases where language concerns are identified during registration. Just as doctors from outside the European economic area can be tested on their language competency, the same competency tests now apply to doctors coming to work in the UK from within the European economic area, thanks to the new regulations. We hope that the wrongs identified following the dreadful Daniel Ubani case and the tragic death of David Gray have now been righted through very strong legislation to ensure the competency and ability to communicate in English of all doctors coming to work in the United Kingdom. As I have outlined, additional measures are now in place to enable the GMC to take action if concerns are raised during the ongoing medical practice of any doctor about their ability to speak English and to communicate effectively with their patients.

The process for determining whether a person has the necessary knowledge of English is set out in the General Medical Council (Licence to Practise and Revalidation) Regulations Order of Council 2012. The GMC has published guidance setting out the evidence required to demonstrate that a person has the necessary knowledge of English. With regard to the fitness to practise changes that have been introduced, a new category of impairment relating to English language capability has been created, which allows the General Medical Council to request that a doctor about whom concerns have been raised undertakes an assessment of their knowledge of English during a fitness to practise investigation.

The changes have hugely strengthened the General Medical Council’s ability to take fitness to practise action where concerns about language competence are identified in relation to doctors already practising in the UK. We are in the process of bringing in similar powers for the Nursing and Midwifery Council, the Pharmaceutical Society of Northern Ireland, the General Pharmaceutical Council and the General Dental Council to ensure that the health care professionals they regulate—nurses, midwives, pharmacists, pharmacy technicians, dentists and dental care professionals—will also have appropriate language skills for the roles that they perform. The consultation on our proposed legislative changes for those four regulators closed on 15 December, and we will publish the outcome shortly with a view to immediate legislation.

I want to pick up the good point made by my hon. Friend the Member for North East Somerset about the need for primary legislation. I hope that he is reassured that the existing legislation, and the ability to bring in regulations underpinning that through section 60 orders underpinning the Medical Act 1983 and other Acts, provides the ability to bring in strong regulations to protect patients and the public in respect of language competency. The Government have done exactly that. There will be future opportunities to legislate in the form of a Law Commission Bill, which would make it possible to neaten up the already very robust and strong regulation on language testing that we have introduced. I am sure that we will consider doing so at the first opportunity.

I hope that such measures will reassure my hon. Friend the Member for Stone. Thanks to this Government, strong laws have been passed, and very strict new rules are now in place to ensure that doctors practising medicine in the UK can do so only if they can communicate with patients using a high standard of written and spoken English. With that reassurance, I hope that he will withdraw his new clause.

[Sir William Cash]

I have listened to the Minister with great care and interest on the question of language skills. Despite his comprehensive description of the measures brought in, I feel that one or two areas might yet be usefully considered in the other place. I would be extremely glad if somebody raised them, just to test those measures further. This is the first time that we have heard such an excellent and comprehensive analysis on the Floor of the House in relation to a Bill of such importance. We are talking about situations in which there should be zero harm, so we do not want any doubts on the question of English language skills. In practice, I am prepared to withdraw the new clause, with the proviso that the matter should be looked at again in the other place at a future date. I beg to ask leave to withdraw the clause.

Clause, by leave, withdrawn.

Third Reading

--- Later in debate ---

[Dr Poulter]

We have had a productive debate, and I thank hon. Members on both sides of the House for their contributions. I put on record my appreciation for the consensual way that the Bill has been approached by all parties, and I thank the hon. Member for Copeland (Mr Reed) for his constructive attitude. Few private Members’ Bills make it beyond Second Reading, and there is determination across the House to improve patient safety. I hope we can get the Bill on to the statute book as soon as possible.

I commend my hon. Friend the Member for Stafford (Jeremy Lefroy) who, with tireless effort, is doing his best to ensure that the terrible experiences at his local hospital never happen again. The Government have thrown their full support behind this important Bill, which will do much to improve the safety of patients and protect the public. I also commend my hon. Friend the Member for Stone (Sir William Cash) on his dedication to raising some of the issues that led to the Francis inquiry and to this Bill, and for his tireless advocacy on behalf of his constituents in Stone and its surrounding areas.

We would not be where we are with this Bill without my hon. Friend the Member for Stafford. All MPs can learn from his example of outstanding public service and putting the interests of his constituents and local patients first. I congratulate him on his dedication and hard work on the Bill. I also thank my officials in the Department of Health, the Clerks of the House, and everybody who has contributed and put a lot of work into the Bill. It is rare for a Bill to get past Second Reading, and a lot of work has been done. I thank everyone who has supported my hon. Friend’s efforts to make these important changes.

I will not dwell on the importance of the Bill because we had that debate on Second Reading, in Committee and on Report. I am sure we all agree that ensuring that the CQC is operationally independent from the Secretary of State and free from political interference is vital. Not Whitehall nor the Secretary of State, but independent, professional inspectors on the ground who understand what good care looks like must carry out hospital inspections, and the Bill will further support the independence of the CQC.

The Bill will also ensure that we improve the use of information for the purposes of direct care. In Committee we discussed the importance of joined-up care, so that a doctor who receives a vulnerable patient with dementia from a care home is better able to care for them because they have access to care records for the immediate purpose of delivering care to that patient. That saves doctors and nurses time and means they can understand their patient better, and the patient will therefore be cared for in a better way. These important measures will help health care professionals to look after their patients more effectively. As Fiona Caldicott said, there is a duty on professionals to share information for the provision of direct care. That is what the Bill is about and it will hugely benefit patients. I reiterate the Government’s commitment to consulting on the role of the national data guardian in the future.

In conclusion, the Bill is about patient care and safety, which should be at the heart of everything our NHS does. This is what everyone engaged in the delivery of health care is primarily concerned about, and that is why many people—including myself—became health care professionals. We care about patients and want to do our best for them. The Bill will do much to improve the safety of patients and protect the public. It is a welcome Bill, and patients in Stafford and across the country will be grateful to the hon. Member for Stafford for introducing it. I thank him for that and urge hon. Members across the House to give the Bill their full support.

Question put and agreed to.

Bill accordingly read the Third time and passed.

Health Services (Lewes)

Dan Poulter Excerpts

Friday 9th January 2015 Commons Chamber

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

My right hon. Friend the Member for Lewes (Norman Baker) has raised a number of issues and I will do my best to address them in the limited time available. I will, of course, write to him about any issues I am unable to get on to today.

I congratulate my right hon. Friend on securing the debate. A number of the points he has made are of great importance to both him and his constituents. Before I continue, I want to highlight the extra work carried out every day by all those who work in the NHS in his constituency, including staff alongside whom I have worked during my time in the NHS. During a busy time in winter, we should be proud of our front-line staff and the hard work they continue to do, even with the increased demand caused by winter pressure on our health service.

My right hon. Friend was right to say that there is now less bureaucracy in our health service and more money for the front line. Thanks to our having stripped out some of the bureaucracy, we will have £6.5 billion more for front-line care over this Parliament than we would otherwise have had. That has been independently audited, and I am sure that all patients in Lewes and elsewhere are very pleased with that.

Primary care trusts have been replaced with clinical commissioning groups. My right hon. Friend talked about some of the historical frustrations with PCTs in his constituency. I hope that the changes made on the introduction of CCGs—their clinical leadership is provided by clinicians who have actually looked after patients and understand their needs—will already have led to improvements in care in his constituency. The fact that some of the reviews now taking place are led by clinicians who run the process of allocating local health care funding will ensure that the right decisions are made about local health care priorities and about meeting the needs of patients.

Health and wellbeing boards now ensure that health and social care services are better joined up, which is important for looking after vulnerable patients, the disabled and the frail elderly. Health and wellbeing boards provide an opportunity to integrate services further, which is particularly important in a very diverse county, such as East Sussex, with rural as well as urban areas. East Sussex health and wellbeing board is grasping the opportunity to join up the local provision of primary community care, the acute sector and social services care.

An important part of meeting some of the challenges faced by the local NHS—my right hon. Friend mentioned the issue of the throughput of patients at Brighton—is to join up adult social care with NHS services better to ensure that acute beds can be freed as quickly as possible for those who are the most sick, with others being transferred into the most appropriate care setting. I know that the local health and wellbeing board takes an active interest in that issue.

My right hon. Friend raised issues about health services in Seaford and Polegate. As he rightly outlined, high-quality premises are an important part of ensuring high-quality primary care services. I understand that NHS England’s Surrey and Sussex area team is working with the Old School surgery in Seaford to explore options for the improvement of its facilities. The capital funding to create new consultation rooms for the Downlands surgery in Polegate has been agreed, and the work is intended to be completed by April 2015. That will bring improvements to patients who attend that surgery. I understand that there have been some quality issues with the premises of another practice in Polegate, the Manor Park medical centre. From memory, it is on a crossroads in the town centre. That issue is in the forefront of the mind of the Surrey and Sussex area team, which reassured me yesterday that it is looking at how to improve the situation.

Such issues are not just for the local clinical commission group; there might be a role for the local authority—perhaps with contributions from developers, where available—to support the local NHS by building new facilities. In areas of housing growth, such as around Eastbourne, the local authority could work collaboratively to collect developers’ contributions to put in place local infrastructure for schools and the local NHS. I am sure that that will be considered as a result of this debate. There is also an opportunity for the local NHS to work more collaboratively with the local authority to address some of the premises issues and to improve the quality, size and capacity of places in which local patients are treated.

As I have said, local clinicians and local authorities have been empowered through the creation of clinical commissioning groups and health and wellbeing boards to bring together health and social care. That is particularly important in the context of the issues relating to Seaford that were raised by my right hon. Friend. I am aware of the changes made at Seaford day hospital, and he outlined some long-standing frustrations with earlier decisions made by the PCT. I understand, however, that Horder Healthcare has taken over the hospital to run services, and that physiotherapy services are being provided there, which is at least a step in the right direction.

As part of the East Sussex Better Together programme, plans are being developed to bring as many services as possible, such as out-patient and diagnostic services, closer to people’s homes and communities. It is particularly important to minimise the travel that frail and elderly patients have to undertake when they need access to local health care services. Seaford is one of the key local communities that is under consideration as part of the Better Together programme. More generally, the Better Together programme is about the three local CCGs in East Sussex and the county council working together to ensure that there is a more integrated approach to delivering more community-based care across the county. That is a welcome step forward.

I am sure that the important addition of clinical input now that clinicians are leading CCGs will ensure that there is more joined-up working. The Better Together programme will look at where it is possible to join up primary and community health services, as well as at where out-patient clinics can appropriately be provided in a primary care setting. As far as is possible, we should have a one-stop shop for patients, particularly older patients. There could be blood testing for warfarin control, diagnostic services, GP services and other high-quality local community health care services in one location. Where that can be offered, it is of huge benefit to patients. In my conversations with the CCG yesterday, I was very pleased to hear that the Better Together programme is looking at exactly how to achieve that in the Seaford area. I have asked it to discuss further with my right hon. Friend how it intends to take that forward over the next few months.

It is important to talk briefly about the issues that my right hon. Friend raised about the future of Lewes Victoria hospital, which I know well, having performed some day operations there in the past with my then consultant. I understand that in October 2014, High Weald Lewes Havens CCG initiated a formal procurement process to enhance and improve the community services contract. As part of the general review of services, community services will clearly play a key part in delivering services closer to home. Lewes Victoria hospital has a track record of delivering high-quality community-based care.

A new contract for the hospital is expected to be awarded in spring 2015. That will be followed by a period of transition planning, with a view to having the new community services contract in place by the autumn. The CCG has confirmed that it plans to continue providing community health services from Lewes Victoria hospital and it is keen to ensure that the skills and expertise of the existing community services staff and the three community hospitals in the area are at the heart of plans to improve patient care and experience. I am very reassured by my conversations with the CCG that the future of Lewes Victoria hospital as a centre for delivering community-based care, day case operations and other high-quality care for people in Lewes and the surrounding areas is very secure. I am sure that that will be welcomed by the people of Lewes and the surrounding areas.

In the time that is left, I turn to the services at Eastbourne district general hospital. The hospital continues to offer a wide range of services, including emergency, out-patient, medical, surgical, diagnostic and day surgery services. I am aware that some of the services provided by East Sussex Healthcare NHS Trust have been relocated since 2013 and that improvements in patient safety have been achieved through that. I will come back to that a little later.

Although consultant-led maternity services, overnight paediatrics, orthopaedics and emergency general surgery have been sited at the Conquest in Hastings, other services, such as acute stroke care and ear, nose and throat services, have been centralised at Eastbourne, so it would not be fair to say that Eastbourne district general hospital has been the loser in the redistribution of services. It has gained from the addition of acute stroke care and ear, nose and throat services. I will turn to maternity services in a moment.

Health care commissioners are assured that there have been significant improvements in patient outcomes since stroke services have been centralised at Eastbourne. Better care is being delivered to patients as a result, which is something that both my right hon. Friend and I welcome. The trust is performing above the national average against a number of standards for stroke care.

Maternity care has been a challenge for the trust, and an emotive and controversial issue locally. One historical issue concerned safe staffing levels for maternity units, because I believe that the Conquest and district general hospitals both managed fewer than 2,000 births a year. There was a particular challenge with a lack of consultant senior cover out of hours—that is important to protect patient safety—and a challenge in encouraging and recruiting junior doctors to staff the middle-grade rotas at those trusts. Although I understand that the changes are emotive and controversial, they were about ensuring that the highest quality of care could be delivered for women, and a midwifery-led unit at the DGH now promotes choice. There are ongoing enhancements to the midwifery-led unit in Crowborough, and acute obstetric services are being centralised at the Conquest.

Perhaps it will reassure my right hon. Friend to know that following the changes, the number of serious incidents at the trust decreased from 17 between June 2012 and May 2013, to six for the same period in 2013-14. Clinical evidence points to a safer and better service for women, although I understand that these are emotive issues. East Sussex county council’s health, overview and scrutiny committee continues to provide rigorous scrutiny of those services, and has agreed that the decision to single-site consultant level maternity and in-patient paediatric services was in the best interests of the health service and the residents of East Sussex.

I am running out of time so I will wrote to my right hon. Friend about the issues he raised about St George’s park and ambulance response times, but I congratulate him again on securing this debate on an issue that I know is of great importance to him and his constituents. I encourage him to liaise directly with the local NHS and to continue championing these important issues.

Question put and agreed to.

Autism: Diagnosis of Children, Hull

Dan Poulter Excerpts

Monday 5th January 2015 Commons Chamber

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

I congratulate the hon. Member for Kingston upon Hull North (Diana Johnson) on securing this debate on what is an important issue for her constituents and for many families, both in Hull and across the country. She made a strong advocacy for the needs of Thomas and many of her other constituents, and discussed some of the challenges locally as well as the flooding of facilities in Walker street, which has affected services. I think she would agree that the situation that has developed locally over time is unacceptable. I hope I will be able to reassure her that improvements in access to services are taking place and that improvements have been made over the past 18 months or so.

The National Autistic Society estimates that there are about 700,000 people in the UK with autism. We know that the right support from an early age, as the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) said, can make a huge difference to the quality of life for children and adults with autism and for their families.

Before I address some of the specifics of the local issues in Hull, I think it is worth talking about some of changes this Government have made to improve lifelong support for people with special educational needs such as autism. I hope that will address the questions the hon. Member for Kingston upon Hull North asked in her closing remarks about improving services for people in Hull with autism.

The Children and Families Act 2014 introduced, from September, new joint arrangements for assessing, planning and commissioning services for children and young people with special educational needs and disabilities. In the past, many children and their families have encountered a disconnected and fragmented system. Families, particularly those with a child with complex needs, have often faced a battle to secure all the necessary support services, finding themselves repeating the same story over and over again to different providers who are not integrated or working together properly.

The new framework will change that. It is designed greatly to improve integrated working across health, education and social care, and to deliver improved outcomes for children and their families. CCGs and local authorities will work together to agree a local package of support services for children with special educational needs and to develop personalised education, health and care plans for each child who needs one, focusing on the outcomes that will make a real difference to the individual child and their family and friends.

Each child, and each young person up to the age of 25, who needs an individual education, health and care plan will have one tailored to their individual needs, including their options for future employment and independent living. Involving the child and the family at every stage of the process is, of course, essential. The plan must be developed in collaboration with the child and the family, and should cover the range of services that the child will receive and the specific outcomes each service will deliver. The plans will also have a section for the child and the family to talk about themselves, their wishes and their aspirations, to set the context for the assessment of need. I am confident that this new approach will be a powerful tool to better join up and integrate services across the local NHS, education services and local authorities for the benefit of both children and adults with autism.

On the specific issue of waiting times for diagnosis in Hull, we know that children with autism can benefit from receiving specialist services as early as possible. The hon. Lady made that important point. The new education, health and care plans will help to ensure that children receive all the support they need, but a diagnosis is of course crucial in identifying from which services a child might benefit.

Hull CCG has committed to commissioning services with the aim of providing autism assessments and diagnoses within 20 weeks of referral, as the hon. Lady said. The CCG acknowledges that it is currently far from meeting that target. I agree with her that the situation at the moment is unacceptable. The current longest wait is almost 64 weeks, which is not appropriate or good for families. It is not right that anyone should have to wait that long, and it adds stress to what is often already a difficult time for families and children.

It is vital to recognise that NICE has guidelines on the importance of early and timely access to autism services for a diagnosis, but we must also accept that when the CCG took over commissioning from the primary care trust in April 2013, it inherited an even worse position than the one we have now. The hon. Lady was disparaging about CCGs, but I hope that will give her some reassurance that the clinical leadership of the CCG—together with the changes put in place as a result of the local education, health and care plans—are improving the quality of services.

Although only 52 children were waiting when the PCT transferred its responsibility to the CCG in April 2013, the longest wait at that point was 129 weeks, which is two and a half years. Hull CCG is working hard to address the issue of long waiting times for the assessments, and it has made substantial progress. The longest wait is now less than half the figure of 129 weeks. That reduction has been achieved while demand for autism services has been rising rapidly. The number of children requiring an assessment has increased sixfold, from 52 in April 2013 to 299 in December 2014. However, the long wait for services has halved, so some progress has been made.

Like many areas across the country, Hull has seen a large increase in the number of children referred for autism assessments and diagnoses. If the growth in the number of referrals means that more children with autism are receiving a diagnosis and therefore access to the services that they need to succeed in life, then the trend is obviously positive. However, it does of course put pressure on the multidisciplinary teams working to provide the assessments needed for autism diagnoses.

The hon. Lady drew attention to the fact that, in accordance with NICE clinical guidelines, Hull CCG commissioned an autism team made up of staff from a range of specialties and working for various providers. In response to the increase in demand for assessments, the CCG has been working with local providers to recruit additional staff to the autism team. However, it has found that recruiting to some specialties in the Hull area, particularly speech and language therapy, has been a challenge.

The CCG is continuing to work with local health and care providers. I had a conversation with the CCG area team earlier today, and I was reassured that it is now looking with greater vigour to recruit more permanent staff where there are challenges. In the meantime, there is an agreement with current staff for them to put in additional hours to support better access to services. That is only part of a short-term solution, however; the long-term one has to be to recruit more staff, particularly in vital services such as speech and language therapy. I was encouraged to learn, during my conversation earlier today, that greater emphasis will be put on long-term recruitment in the Hull area.

The CCG has also improved working practices in the autism team, which has freed up time to allow more assessments to take place. However, it is important to remember that, as the hon. Lady mentioned, Hull CCG lost an important clinical space when the Walker street children’s centre, a critical area for the service, was flooded during a tidal surge in December 2013. The centre allowed complex, multi-therapist diagnoses to be made, and its loss has had serious repercussions for the local service, which is not good for the delivery of timely access to diagnostic and other care services for people with autism. However, the CCG plans to reopen the centre early this year, which will go some way to reducing the waiting times for assessment. I hope that that reassures the hon. Lady and her constituents.

In the meantime, while the local NHS continues to work towards its commissioned target of a 20-week waiting time for autism assessments and diagnoses, it is also working to assist parents who are facing the current long waits for such assessments. The CCG is ensuring that while families are on the waiting list, they are able to contact the autism team. That enables them to access appropriate information and support services pending a formal diagnosis, which I believe is available from both voluntary and private providers in the area. That does not, of course, make the long wait for assessment and diagnostic services acceptable, but it means that families are not left completely unsupported and alone at what can be a difficult time.

[Diana Johnson]

I am listening carefully to the Minister and I am grateful that the CCG has been willing to brief him in a way that it was not willing to brief the local Member of Parliament. Does he find it acceptable that families are being told there is a 20-week wait for a diagnosis when clearly that is not the case? The wait is much longer, yet parents and families are still being given that false information.

[Dr Poulter]

I agree that the current situation is not acceptable, but the CCG inherited a much worse position from the primary care trust, and it has made progress in addressing the needs of those who have been waiting the longest. As I described earlier, in April 2013 when the CCG came into existence, the longest wait was 129 weeks. In October 2014 that had fallen to 81 weeks, and by December 2014 to 63 weeks. Progress is being made to deal with those unacceptably long waits, but ensuring that all families receive timely access to services must be the next priority. I am sure that the reopening of the Walker street service will be helpful in that respect, and that the hon. Lady will hold the CCG to account and bring the matter back to the House if it does not deliver improved services in the near future. Progress has been made in dealing with those long waits, but there is a much greater need to ensure that all patients receive timely access to a service. While a 20-week waiting time is a strong move in the right direction, in future patients should expect the service to move towards NICE guidelines.

Let me talk briefly about the broader issues that were raised in some of the interventions, such as training for staff. It is important that all NHS staff have a greater awareness of autism. The mandate for Health Education England was set by the Government and includes a requirement to develop a bespoke training course to allow GPs, who are often the first point of contact for many families, to develop a specialist interest in the care of young people with long-term conditions—including autism—by September 2015. Hon. Members may also have seen this week’s announcement by the Royal College of General Practitioners, which has launched a training programme for its members to improve the diagnosis of autism and support. I welcome that because when primary care is the initial point of contact for so many families, it is important that general practitioners have greater awareness and training in the challenges facing families with autism, and in how to recognise a child that may have autism.

The Government have provided grant funding to the Royal College of Paediatrics and Child Health to lead a consortium of voluntary sector partners and medical bodies to develop an extensive programme of resources—Disability Matters—to be launched in early 2015. It is designed not only for health professionals but for the wider work force that engages with children, and will help to raise understanding in the NHS about how to support families and young people with disabilities, including autism. Importantly, the more we do to educate not just the health work force but those who work with children with autism more generally, the more we will encourage early access to the support that those children and families need.

I commend the hon. Lady for her important and well-made case on behalf of her constituents with autism, and for raising an important matter about what has been unacceptably poor access to autism services in Hull for a number of years. I hope she is reassured that the CCG is beginning to make some progress, and I know that she and the right hon. Member for Kingston upon Hull West and Hessle, who is sitting next to her, will do all they can to hold the CCG to account. I know they will not hesitate to bring this matter back to the House if improvements are not made in the months ahead.

Question put and agreed to.

General Dental Council

Dan Poulter Excerpts

Tuesday 9th December 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Hollobone, and a great pleasure to respond to my hon. Friend the Member for Mole Valley (Sir Paul Beresford). I congratulate him on securing the debate and on bringing to bear his front-line experience of working as a dentist, both in this debate and more generally. He has shown his experience today in getting to the heart of some of the issues he raised, as he has done in many debates in the House on issues relating to health care.

The General Dental Council is an important part of the health care regulatory framework that ensures the fitness to practise of health care professionals and the safety of patients. It is right that we should debate the GDC’s performance, particularly in the light of a less than complementary performance review by the Professional Standards Authority, and given the major rise in the fee that dentists will be expected to pay to their regulator.

My hon. Friend will be aware that the General Dental Council is an independent statutory body that is directly accountable to Parliament. However, as he rightly highlighted, I have no legal basis to intervene in matters such as the level of the fee, which are deemed to be part of the body’s operational running. However, in my role as Minister, I have a keen interest in the performance of the professional regulators and have regular contact with them, including the GDC, on a whole range of issues.

The background to today’s debate is that the General Dental Council recently took the decision to increase the annual registration fee for dentists by 55%, from £576 to £890, which is a significant and unprecedented increase. All professional regulators, including the GDC, are aware of the Government’s position, as set out in our 2011 Command Paper, “Enabling Excellence: Autonomy and Accountability for Health and Social Care Staff”: we do not expect registration fees to increase unless there is a clear and strong case that the increase is essential to ensure the exercise of statutory duties.

While the General Dental Council has consulted its registrants on the proposed fee rise, I am aware of, and sympathetic to, a strong body of opinion among its registrants that they are yet to be presented with compelling evidence to justify such an unprecedented fee increase. The proposed fee is more than double the £390 that the General Medical Council requires licensed doctors to pay. That is why, when I met the GDC, I raised concerns about the fee increase and reconfirmed the Government’s position on the need for a strong and transparent case for any such increase.

I have also strongly suggested to the GDC that it considers a differential rate for newly qualified dentists. Newly qualified doctors are required to pay £185 for their registration with the GMC, while newly qualified dentists pay the same as established dentists. The GDC stated to me as justification for its fee rise that there has been a 110% increase in the number of complaints from patients, employers, other registrants and the police about the dental profession, and that the cost of handling such complaints has been the key driver of the increase. However, I have not been presented with what I consider to be compelling evidence that a fee rise of that magnitude is justified by a 110% increase in the number of complaints.

It is worth noting that other health care regulators, as my hon. Friend suggested, have experienced increases in complaints but have not felt compelled to raise their fees to the same extent. I therefore understand why the British Dental Association has chosen to test this decision and issued judicial review proceedings challenging the setting of the fee. The hearing is set to take place next week, so I am sure that hon. Members will understand that it is inappropriate for me to comment further on those proceedings.

[Toby Perkins (Chesterfield) (Lab)]

I am grateful to the Minister for giving way, and I congratulate the hon. Member for Mole Valley (Sir Paul Beresford) on securing this debate. I have been written to by Derbyshire county local dental committee, which is concerned that the General Dental Council, under the leadership of its current chair, is investigating much more minor concerns than it did previously. That expansion in its role is one of the reasons why it is now asking dentists for more fees. Will the Minister let us know whether he thinks that the direction that the General Dental Council is taking is the wrong one, as my constituents clearly do?

[Dr Poulter]

As I said, under legislation, I am unfortunately powerless to intervene directly on fee setting. We recognise the independence of health care regulators and would not want them to be micro-managed by Government; that would be wrong. However, my view is very clearly, as I have outlined, that a strong evidence base is needed to justify a fee rise. Given that other health care regulators faced with similar challenges have not raised their fees to the same unprecedented degree, I have not myself been convinced that the evidence base is strong enough to justify this fee rise. I hope that that answers the hon. Gentleman’s question.

In that context, it is worth drawing attention to the section 60 order currently in progress in the House, and to the consultation process that has been taking place. The fee rise is perhaps all the more surprising as we are making good progress with the GDC on bringing in the legislative changes that will reform the way that it operates. Those changes, in the form of a section 60 order, will assist with reducing its operational costs by an estimated £2 million a year through potential efficiency savings. My hon. Friend the Member for Mole Valley made the point that all regulators need to look at better ways of working and efficiency savings in their own practice. Of course, that, as well as patient protection, is a benefit of introducing a section 60 order: it will help to reduce the running costs, potentially, of the GDC and streamline processes.

The public consultation on the GDC-related section 60 order recently closed, and the vast majority of respondents were supportive of the proposals. We therefore intend to proceed with the measures and will publish our response to the consultation in due course. My hon. Friend may be surprised to learn, as I was, that the GDC did not wait for the outcome of the section 60 order consultation before announcing the fee rise.

The changes proposed in the section 60 order will: enable the GDC to delegate the decision-making functions currently exercised by its investigating committee to officers of the GDC, known as case examiners; enable both case examiners and the investigating committee to address concerns about a registrant’s practice by agreeing undertakings with that registrant, which have the same effect as conditions on practice, without the need for a practice committee hearing; introduce a power to review cases closed following an investigation—rules to be made under that power will provide that a review can be undertaken by the registrar if she considers that the decision is materially flawed, or new information has come to light that might have altered the decision and a review is in the public interest—introduce a power to allow the registrar to decide that a complaint or information received did not amount to an allegation of impairment of fitness to practise; introduce a power to enable the investigating committee and the case examiners to review their determination to issue a warning; and ensure that registrants can be referred to the interim orders committee at any time during the fitness to practise process.

Very similar section 60 orders have been laid before Parliament in conjunction and consultation with other regulators, and a great benefit of those orders is that they are about not just protecting the public but supporting the regulators to have more streamlined processes and reducing costs. Of course, when costs are reduced, we would always expect the savings to be passed on to the people who pay the annual fee.

[Sir Paul Beresford]

Is there evidence that the other registering organisations have reduced their fees, or keep them down, in the light of the anticipated savings, which would be sensible?

[Dr Poulter]

If we look at similar organisations, we see that the GMC, for example, has similar practices and processes. The Nursing and Midwifery Council has a very small fee rise, but has seen a similar section 60 process take place. All those regulators, in my view, have taken every step possible to look at their annual fee in the context of the section 60 orders, and with the mindset that any fee rise needs to be fully evidence based and appropriately proportionate. From my conversations, and from the practice of other health care regulators, I think that there is very good evidence that that is a consistent pattern of behaviour. As I said, the GDC’s fee rise is unprecedentedly large, and its behaviour is not consistent or in keeping with that of any of the other health care regulators, from what I can see.

In addition to the GDC-related section 60 order, the Government are taking forward a number of key pieces of secondary legislation in this Parliament to address priority areas that we have identified after discussion with the regulatory bodies and other stakeholders; I mentioned other section 60 orders. We are also working on a response to the Law Commission’s valuable work on proposals for more wide-ranging reforms.

I am aware that the decision not to progress a professional regulation Bill in the current Session has come as a disappointment to interested parties. However, that decision provides an opportunity to invest time in ensuring that that important legislative change is got right, for the benefit of those who will ultimately be affected by it. My hon. Friend outlined very articulately some of the challenges that need to be considered in putting together the Bill. We are committed—I would like to put this on the record again—to bringing forward primary legislation to address wider reforms to the system of professional regulation when parliamentary time allows, but in the meantime, working with the regulators, we have put in place, or have in train, a number of section 60 orders. They are about streamlining processes, providing efficiencies to the regulators and, most important of all, protecting patients and the public.

Let me say a quick word about the GDC’s general performance. It is very important that the GDC manages its rising volumes of complaints as well as the other issues raised by the Professional Standards Authority as part of its annual performance review. In due course, the GDC will need to demonstrate what it has done to address the recommendations made.

Hon. Members may be aware that the Professional Standards Authority is also conducting an investigation of the GDC after claims were made by a whistleblower about the management and support processes of the GDC’s investigating committee. I understand that the Professional Standards Authority has concluded the evidence-gathering phase of the investigation, is in the process of compiling the investigation report, and will provide that report to the Select Committee on Health and publish it on its website in due course.

I have outlined a number of issues and concerns about the unprecedentedly high rise in the GDC fee. As we have discussed, it is out of keeping and inconsistent with the behaviour of many other health care regulators. I am not convinced, from the evidence that I have been presented with, that there is a strongly evidenced case to support that fee rise, and it goes against Government policy, which is to encourage regulators to set appropriate and proportionate fee rises, to show restraint where appropriate and to be mindful of the effects of fees on registrants.

I want to make it clear, in drawing to a conclusion, that I am not raising any doubt about the fact that the GDC continues to fulfil its statutory duties. However, it will need to make significant improvements to meet the challenges set out in the annual performance review undertaken by the Professional Standards Authority. Registrants, patients and the public need to be able to have confidence in the performance of the GDC and to see improvements in its operation, effectiveness and efficiency. I hope that I have answered all the points raised in the debate, and I again thank my hon. Friend the Member for Mole Valley for raising a very important issue that I am sure is filling many MPs’ postbags.

[Mr Philip Hollobone (in the Chair)]

I thank all hon. Members who took part in the debate.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 25th November 2014 Commons Chamber

[Kerry McCarthy (Bristol East) (Lab)]

2. What recent assessment he has made of the adequacy of provision of student health services.

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

All patients are eligible to register with local primary medical care services, and that includes students who are moving away from home and starting university.

[Kerry McCarthy]

I do not think that the Minister has entirely engaged with the question. Those who run the student health services at Bristol university are warning that young people’s health is very much overlooked and underfunded—particularly mental health, which accounts for a quarter of all consultations. They are being hit by the GP funding changes and by cuts in public health spending on sexual health advice, and they have had to introduce their own meningitis vaccination programme because the Government have not introduced one. What support can the Minister give specifically to student health services?

[Dr Poulter]

I certainly remember being actively encouraged to register with a local GP when I was a student at Bristol university, and I understand that that continues today. As for the important question of children’s and young people’s mental health, the children’s mental health and well-being taskforce is looking at the mental health and well-being of students. Student Minds is involved in the process, and that in particular will help to inform the work of the taskforce in improving access to students with mental ill health.

[Duncan Hames (Chippenham) (LD)]

Students do register with a practice in their university cities, but I was told recently by one of my constituents that she had experienced difficulty in gaining access to timely health care as a temporary resident when she was back at home. What options are available to ensure that students remain registered in the place where they are likely still to be spending half the year?

[Dr Poulter]

We recommend that all students register with university services, or with a GP in their university areas, but if patients are away from the GP with whom they are registered for more than 24 hours and less than three months—and that would include students—they can see a GP in the area where they are staying as temporary residents. GPs should be aware of that entitlement.

[Keith Vaz (Leicester East) (Lab)]

Students with long-term illnesses such as diabetes find it extremely difficult to manage their conditions, and there is evidence that a number of students are skipping their insulin injections. What further steps can be taken to make them aware of the necessity for them to take that important medication?

[Dr Poulter]

This is an incredibly important area of health care. How do we support young people through periods of transition? We know that people with long-term illnesses may struggle particularly, and diabetes and epilepsy are two of the conditions that have been identified. NHS England is currently examining transitional care tariffs to support people during the transition between children’s and adult health services, and educational support is part of that ongoing work.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

My right hon. Friend the Minister for Universities, Science and Cities recently announced that there would be no cap on the number of students wishing to study pharmacy. Does my hon. Friend agree that Plymouth university should now press ahead with the setting up of a pharmacy school given that it is the Peninsula medical school?

[Dr Poulter]

My hon. Friend makes an important point. I visited the Peninsula medical school and his local university to highlight some of their excellent work in training medical and dental students. I believe that there is ample scope to expand provision to train other health care professionals in what is becoming an outstanding medical and health care training facility.

--- Later in debate ---

[Mr Philip Hollobone (Kettering) (Con)]

4. How many patient episodes there were at Kettering General Hospital in (a) 2010 and (b) the last year for which figures are available; and what assessment he has made of the reasons for the change in the number of such episodes.

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

In 2012-13 there were 85,497 in-patient finished consultant episodes at Kettering General Hospital NHS Foundation Trust, compared to 84,602 in 2011-12. There has also been an increase in the number of accident and emergency attendances, from 76,099 in 2010-11 to 84,055 in 2012-13. That increase is largely attributable to a high demand for services from a growing, ageing population.

[Mr Hollobone]

Kettering general hospital serves one of the areas with the fastest population growth and greatest ageing in the whole country. Today’s report from the Care Quality Commission shows that, while the hospital has some of the most caring staff in the whole of the NHS, many areas of the hospital require considerable improvement. Will the Minister ensure that future NHS funding decisions are better targeted at areas such as Kettering which have such costly demographics?

[Dr Poulter]

My hon. Friend will be aware that the NHS funding formula is set independently, free from political interference. It is reviewed annually. I should like to reassure him that the Nene and Corby clinical commissioning groups have both received higher than real terms growth in their funding allocations and will do so again next year, to move them closer to their target allocations.

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

I have been working closely with the hon. Member for Kettering (Mr Hollobone) in recent years on a campaign to support the hospital. We recognise the issues that the CQC has raised, and we support the journey that the hospital is taking towards improvement. When the hon. Gentleman and I come to see the Minister in a few months’ time, will he look favourably on our bid for £20 million of funding to improve our accident and emergency department, whose physical environment has been described by experts as being among the worst in the country?

[Dr Poulter]

I am looking forward to that meeting in the new year. I should like to reassure the hon. Gentleman and my hon. Friend that the Department has provided a total of £5 million of temporary public dividend capital funding and a further £1 million of emergency capital to the trust in the past three months, so support is going into the delivery of high-quality services.

[Norman Baker (Lewes) (LD)]

5. What recent assessment he has made of the potential medicinal benefits of cannabis.

--- Later in debate ---

[Mr David Crausby (Bolton North East) (Lab)]

10. How many (a) NHS trusts and (b) foundation trusts are forecasting a deficit.

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

Thirty-three NHS trusts and 60 foundation trusts are forecasting an end-of-year financial deficit, with the remaining 65 NHS trusts and 87 foundation trusts forecasting an end-of-year surplus.

[Mr Crausby]

Earlier this year, Monitor announced that the number of trusts in financial breach had nearly doubled over the previous 12 months. How confident is the Minister that the number will not double again next year?

[Dr Poulter]

I am very confident that the measures already in place to drive efficiencies in the NHS are on course to save £20 billion during this Parliament. Many of those efficiencies are being delivered by improved procurement practice at a trust level. The Government have also invested £15 billion during this Parliament, which is a real-terms increase of £5 billion in NHS funding to support trusts.

[Robert Halfon (Harlow) (Con)]

The Government have invested hugely in the NHS in Harlow, including millions of pounds to our accident and emergency unit. However, for historical reasons the Princess Alexandra hospital has financial difficulties. Will my hon. Friend look at this and see what the Government can do to help?

[Dr Poulter]

Of course. As my hon. Friend is aware, every local health area—every clinical commissioning group—is receiving an increase in the funding available to it year on year. I would be happy to meet him to discuss the matter further, if that would be helpful.

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

As the Minister knows, North West London Hospitals is one of the NHS trusts that is in deficit. It has seen the accident and emergency departments at two nearby hospitals close, and its hospital board estimates that an additional 123 beds are necessary. Will the Minister meet me to discuss the problems of its historical deficit and the need for additional funding to make sure that those 123 medical beds are provided?

[Dr Poulter]

I can reassure the hon. Gentleman that, in the words of the medical directors of all the hospitals affected, there is a very high level of clinical support for the programme across north-west London, and the changes will save many lives each year and significantly improve the services that are available to local patients. I hope that is reassuring to the hon. Gentleman and to local patients.

[John Stevenson (Carlisle) (Con)]

Running a deficit can demonstrate short-term problems which, once resolved, will allow a trust to return to balance. Does my hon. Friend agree that there must be flexibility in the system, particularly for trusts such as North Cumbria, which have been in special measures?

[Dr Poulter]

It is absolutely right that trusts such as North Cumbria need to face up to challenges when those affect the quality of patient care, and that the focus of Care Quality Commission inspections and special measures is to drive up standards of care. It is also important that we continue to invest and support trusts where we can. That is why we are pleased to be increasing the NHS budget by £15 billion during this Parliament.

[Sir Gerald Kaufman (Manchester, Gorton) (Lab)]

Is the Minister aware that the Manchester primary care trust ought not to be incurring a deficit because it does not spend sufficient of its money and resources on investigating cases referred to it and on responding to hon. Members such as myself when they write to it over a period of months? Will he look into this incompetence and examine similar behaviour, or lack of it, by the Care Quality Commission?

[Dr Poulter]

It is very important that the NHS faces up to the situation when things have gone wrong so that it can put them right for the benefit of patients in future. If the right hon. Gentleman has concerns about his local NHS not investigating complaints that he has raised with it on behalf of his constituents who are patients of the local trust, I am very happy to investigate those issues for him if he would like to write to me about them, and see what I can do to ensure that he gets the answers that he and his local patients deserve.

[Douglas Carswell (Clacton) (UKIP)]

I understand that pretty much every hospital in Essex faces a yawning deficit, including Colchester hospital. Can the Minister guarantee that we can address the deficit without having to dramatically and radically reconfigure local services in Essex?

[Dr Poulter]

It is important to outline that for the first time this Government have put in place, via section 42 financial agreements with trusts where there is a requirement for interim financial support, measures that will ensure that trusts are held to account for delivering efficiencies—for example, reducing agency staffing costs, improving procurement practice, more efficient estate use and land disposal, and pay restraint of very senior managers. I am therefore confident that the local NHS can continue to deliver efficiencies to direct money to front-line care.

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

11. Whether it remains the policy of the cancer drugs fund to provide drugs which NICE has rejected for general use in the NHS.

--- Later in debate ---

[Alex Cunningham (Stockton North) (Lab)]

T3. My constituent Corron Sparrow was left lying in the road for two hours with a compound fracture of his leg despite a call from a policeman to the North East Ambulance Service pleading for help. Eventually the service responded by sending an ill-equipped St John Ambulance team who then had to call for professional assistance. There are many more failures. It is now three weeks since I wrote to the chief executive, Yvonne Ormston, asking for an inquiry into this, but she has not even acknowledged my letter. Will the Minister intervene and tell the North East Ambulance Service that it cannot just ignore these matters?

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

I am very sorry to hear about the difficulties experienced by the hon. Gentleman’s constituents, and of course I am happy to look into those and do what I can to help him with that. However, I would also like to make it clear on the record that because this Government have put £15 billion more into the NHS during this Parliament, we are making sure that we are keeping services running efficiently through the winter for the benefit of patients.

--- Later in debate ---

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

T9. Do Ministers agree that the patient transport guidance should be interpreted with an understanding of rural needs, rather than telling my elderly constituents to report to a hospital 60 miles away and to get three buses there and three back that do not connect with each other in order to have treatment or consultation?

[Dr Poulter]

It is particularly important in rural areas that patients with complex medical needs who have difficulties mobilising or who perhaps do not have access to a car are supported by the local NHS to access the services they need. There is provision for local hospitals, as well as for CCGs, to give financial assistance to support patients in accessing services and to give them lifts to hospitals, as appropriate.

[Mr Ben Bradshaw (Exeter) (Lab)]

T10. When I asked the Prime Minister two weeks ago about the financial crisis facing Devon NHS, he seemed completely unaware of it, so could the Health Secretary please explain why Devon NHS faces an unprecedented £430 million deficit and what he is doing to stop the rationing, cuts and total withdrawal of some services that is now being proposed?

--- Later in debate ---

[Charlotte Leslie (Bristol North West) (Con)]

One of the key challenges in improving access to GPs is improving recruitment of GPs. Will the Secretary of State work with the Royal College of General Practitioners and other medical groups to see whether there might be merit in introducing a mandatory stint of working in a GP surgery for junior doctors?

[Dr Poulter]

I am sure that my hon. Friend will welcome the fact that there are now just over 1,000 more GPs working in the NHS and training than when we came into government, but there is more we need to do. We have committed to delivering 5,000 more GPs for the NHS, and part of that work will be working with the Royal College of General Practitioners to ensure that we can support return-to-practice initiatives for GPs who have taken career breaks.

[Several hon. Members]

rose—

National Health Service (Amended Duties and Powers) Bill

Dan Poulter Excerpts

Friday 21st November 2014 Commons Chamber

[Mark Reckless]

I think that that is probably correct. I may be guilty of having believed the undertakings I was given by those on the Government Front Bench.

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

It might be helpful for the hon. Gentleman to bear in mind the words of his colleague, the hon. Member for Clacton (Douglas Carswell), who said:

“Never one to slavishly support the party line, I would be quite prepared to oppose these reforms”—

the 2012 Act—

“if I felt they were a step back. But I won’t. These changes are necessary—and contrary to much of the mainstream media coverage, in my experience they are quietly supported by many doctors too.”

Does the hon. Gentleman support what his colleague said, or does he not?

[Mark Reckless]

I think that my hon. Friend the Member for Clacton (Douglas Carswell) was right in saying that some doctors supported the Bill that became the 2012 Act. During the early stages of that Bill, a number of representative bodies supported it, or were presented as doing so. As the Bill proceeded, however, some of what had been claimed to be support from organisations such as the British Medical Association seemed to fall away. I believe that the Bill ran to 460 pages.

The problem was the way in which legislation is made in the House. The coalition agreement promised us a House business committee, but no such committee deals with the allocation of time for legislation. We have a Committee of Selection, but it is run by the usual channels—the Whips on either side of the House—and people with expertise such as the hon. Member for Totnes (Dr Wollaston), who might actually have improved the Bill, were excluded from it.

[Dr Poulter]

I feel I should quote further from what was said by the hon. Member for Clacton, when much of the Committee stage of the Health and Social Care Bill had been completed. He went on to say—on 11 February 2012, on his TalkCarswell.com website—

“If these proposals were defeated, it would be a setback for all those of us who would like to see public service reform. We need to keep our nerve.”

That rather contradicts what the hon. Member for Rochester and Strood (Mark Reckless) has just said, does it not?

[Mark Reckless]

That is an excellent website, which I recommend to all Members. The Minister has said that my hon. Friend made those observations when most of the Committee stage of the Bill had been completed. Was that during the “pause” that had been invented as a new mechanism for Parliament? My hon. Friend is not here at the moment, but I think he would agree with me that the 2012 Act is not as it was billed to us by those on the Government Front Bench. It has led to an extraordinary degree of additional complexity in the NHS, and the introduction of competition bodies—and, in particular, European competition law—into the NHS is not welcome.

--- Later in debate ---

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

I shall begin by returning to the founding moment of our NHS, when a national health service was created which remains to this day a world-class health service where care is available to all, irrespective of ability to pay and free for all at the point of delivery. These fundamental principles of our NHS have been cherished and protected by each and every Government throughout its proud history, and were in 2012, for the first time, put on to statutory footing by this Government through the Health and Social Care Act.

[Angie Bray]

Will my hon. Friend give way?

[Dr Poulter]

If my hon. Friend will bear with me, I am going to make a little more progress and then give way later on.

Those who believe that our NHS has always been run solely through public providers are of course very wrong. From its very inception, the NHS that Nye Bevan created has comprised providers in the public and the non-public sectors. In 1948, independent GPs, community pharmacists and dental practitioners contracted with our health service to provide primary medical services to patients, and they continue to do so to this day as part of the public-private partnership. It is worth reflecting on the fact that Tony Blair’s former political secretary, John McTiernan, said only this August that

“an NHS without private providers is unimaginable. For one thing, no one—even on Labour’s extreme left—is arguing that we should nationalise general practice. But GPs are private providers, acceptable to opponents of the ‘private sector’ because most encounters with the NHS are visits to your local doctor”.

We also take for granted the key role played by charities and the voluntary sector in providing NHS care to patients across the country, notably Macmillan Cancer Support and Marie Curie Cancer Care.

In opening my contribution to this debate, I reaffirm this Government’s commitment to the founding principles of our NHS, a health service free at the point of delivery, and recognise that since its creation by Nye Bevan in 1948 our NHS has always been a public-private partnership. For public services to be equitable and free at the point of use, they did not all need to be provided on a monopoly basis within the public sector, controlled in a rigid way by local bureaucracies often deeply resistant to innovation and genuine local autonomy.

“The aim should be to change fundamentally the way the NHS was run: to break up the monolith; to introduce a new relationship with the private sector; to import concepts of choice and competition”.

Those are not my words, but those of Labour Prime Minister Tony Blair about the reforms to the NHS that he introduced under the previous Labour Government.

[Angie Bray]

Does my hon. Friend agree that the most damaging thing for the NHS—patients and staff alike—is a lot of misleading scaremongering? I am afraid that we have heard more of that in the Chamber today. Will he correct the record to make sure that it is very clear that the pledge made by the Secretary of State for Health that the A and Es at Ealing and Charing Cross hospitals will both remain open for the long term still stands, and that they will allow themselves to be directed by Bruce Keogh’s report such that whatever recommendations he makes on A and E, they will make sure that they meet those requirements?

[Dr Poulter]

I am happy to confirm and to put on the record the points that my hon. Friend has made. It is important that the NHS is not used as a political football, and that services are always designed and delivered in the right way for patients. There is often too much scaremongering in these debates. I reiterate that what she said about the local A and Es is absolutely correct.

[Mr Slaughter]

Will the Minister give way on that point?

[Dr Poulter]

I have just dealt with it, and I am going to make a little progress.

I want to deal with the contribution made by the hon. Member for Rochester and Strood (Mark Reckless). He failed to address the issues that I had raised earlier about the support that the hon. Member for Clacton (Douglas Carswell), his party colleague, gave to the Health and Social Bill—now the Health and Social Care Act. In fact, as the right hon. Member for Leigh (Andy Burnham) said, the hon. Member for Clacton thought that the reforms did not go far enough. Indeed, the leader of his party is on record as talking about the need, in effect, to privatise our NHS. I would like to reaffirm the commitment that that will absolutely never happen under this Government or any Conservative Government.

Another important point needs to be made. Earlier this week, the hon. Member for Rochester and Strood expressed frankly unacceptable and distasteful views on repatriation. We must of course bear in mind that 40% of staff in our NHS come from very diverse, multicultural backgrounds. We very much value the contribution that doctors, nurses and health care staff from all over the world make to our NHS. I do not want to see those people repatriated; I want to see them continuing to deliver high-quality care for patients in our NHS—something that UKIP clearly opposes.

[Mark Reckless]

I have made absolutely no such remarks; I have said only that we wanted such people to be able to stay. The disgraceful remarks were actually made by the Conservative candidate, who juxtaposed the issues of unlimited immigration and fear of crime.

--- Later in debate ---

[Dr Poulter]

I think that the hon. Gentleman’s remarks are very clearly on the record, and I am sure that NHS staff, many of whom come from very diverse, multicultural backgrounds, will be very aware of them. In this Conservative-led Government, we are very proud of the contribution that people from all over the world make to our NHS, and I believe that that needs to continue in the future. As we have seen from the hon. Gentleman’s leader, his party makes it up as it goes along on things to do with the NHS. It is in favour of privatisation and does not value the contribution—[Interruption.]

[Sir Tony Baldry]

On a point of order, Madam Deputy Speaker. There is so much noise coming from the Opposition Bench below the Gangway that it is impossible even for someone who is as near to the Minister as me to hear what he is saying. Given that Labour Members appear to support this Bill, it would be a courtesy for them at least to listen to the Minister with some attention.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

The right hon. Gentleman knows very well that all Members exercise their right to speak loudly, quietly, in stage whispers and in other ways in this Chamber. I am listening very carefully to the level of noise, and if it reaches much higher than it already has, I will ask Members to be more courteous to the Minister. However, I am quite sure that the Members present will wish to be courteous to the Minister and to hear what he has to say.

[Dr Poulter]

Thank you, Madam Deputy Speaker. I am sure that Members in all parts of the House—although perhaps not the hon. Member for Rochester and Strood—would like to reaffirm their commitment to and the value they place on all NHS staff, no matter what background or culture they come from. We want those staff to continue to practise in and work for our NHS to the benefit of patients.

[Mark Reckless]

rose—

[Dr Poulter]

I think that the hon. Gentleman has said quite enough already, and I need to make some progress.

Let me move on to the second, substantive, point in this debate, on which I hope there will be a large amount of agreement. It was articulated—

[Mark Reckless]

rose—

[Madam Deputy Speaker]

Order. The Minister is not giving way.

[Dr Poulter]

Thank you, Madam Deputy Speaker.

The point was articulated very well by my right hon. Friend the Member for Banbury (Sir Tony Baldry) in one of the best and most accurate speeches of this Parliament in an NHS debate.

[Mark Reckless]

On a point of order, Madam Deputy Speaker. The Minister has made a false allegation to which he has not given me the right of reply. Of course I welcome all those immigrants in the NHS. They are very welcome and we want them to stay as much as he does.

--- Later in debate ---

[Madam Deputy Speaker]

There has been much discussion this morning about who has said what about what. My concern in the Chair is that the Bill should be discussed. That is the matter before the House, and we will discuss it.

[Dr Poulter]

Thank you, Madam Deputy Speaker. I think the tone of that point of order made my point for me better than I could have done.

As my right hon. Friend the Member for Banbury said in what was one of the best speeches on the NHS I have heard in this Parliament, the Health and Social Care Act 2012 did not introduce competition into our NHS. To say that it did is factually incorrect, scaremongering and distracts the NHS from addressing the key issues it faces. It was the creation of a mixed health economy, implemented by the previous Labour Government, that exposed our NHS to competition law, not the introduction of the Health and Social Care Act.

[Andy Burnham]

That is a very important point that goes to the heart of this debate and that really needs to be cleared up for those listening and watching. The Minister said that the Act did not introduce competition. Will he confirm that it gave, for the first time, a role to the competition authorities under the Enterprise Act 2002 and that since then they have intervened, for the first time ever in the history of the NHS, in Bournemouth and Poole?

[Dr Poulter]

What I will confirm is that it is factually correct, as my right hon. Friend the Member for Banbury made clear, to say that it was the previous Labour Government—Tony Blair’s Government—who introduced competition into our NHS. At the end of Labour’s time in office, I believe that £6 billion a year was going to NHS providers. The right hon. Member for Leigh was quite happy to pay private sector providers 11% more than NHS providers for providing the same service. That was Labour’s commitment to the private sector, which we have cleared up and put right in the 2012 Act.

Let us remember what the Labour party said in its last general election manifesto. I am sure Labour Members will remember it well—the right hon. Gentleman may well have written it. It said:

“All hospitals will become Foundation Trusts…Foundation Trusts will be given the freedom to expand their provision…and community care, and to increase their private services”.

That is from the manifesto that every Labour Member stood on at the last election. The facts are clear: competition in our NHS was introduced well before this Parliament and well before this Government came into power. It was introduced by policies made by Members who now sit on the Opposition Benches—the policies of the previous Labour Government.

As my right hon. Friend the Member for Banbury reminded us, it was Labour that introduced the use of independent treatment centres in 2003, the “any willing provider” policy and the advent of patient choice in 2006, and it was Labour’s policies when in government that brought NHS commissioning under the scope of European competition law through the Public Contract Regulations 2006.

[Mr Mike Weir (Angus) (SNP)]

There is an interesting argument taking place between the two Front Benchers about who is responsible for bringing competition into the health service, but the fact is that, no matter who is responsible, the health service could now come under the transatlantic trade and investment partnership. Why will the Government not specifically exclude health services from TTIP before it is negotiated?

[Dr Poulter]

I will come on to TTIP later, and I hope I will be able to reassure the hon. Gentleman.

The previous Labour Government attempted to make commissioners compliant with the law by publishing the “Principles and rules for cooperation and competition” in 2007 and establishing the competition and co-operation panel in 2009, to oversee Labour’s NHS marketplace. Let us be clear: it was the previous Labour Government who chose to introduce private providers into our NHS and it was the previous Labour Government who set up the legal framework to support private providers in the health service.

It has been said that

“the private sector puts its capacity into the NHS for the benefit of NHS patients, which I think most people in this country would celebrate.”—[Official Report, 15 May 2007; Vol. 460, c. 251WH.]

Once again, those are not my words, but those of the right hon. Member for Leigh when he was a Minister in the previous Government. That is a fitting memory of the previous Labour Government’s expansion of private providers in the NHS. Let us remind ourselves of the right hon. Gentleman’s words again: he said that most people in this country would celebrate the private sector in the NHS.

[Mr Ronnie Campbell]

The Minister talks about Labour privatisation, but why is it that so many Conservative Members are being paid by private companies? What are you getting money off them for? What are you doing?

[Dr Poulter]

I am just a doctor who still works in the health service and I practise medicine for free. Of course, we could go into the fact that I am the only Front Bencher present who has front-line experience of looking after patients. Professional politicians on the Opposition Benches are outlining a case that is incoherent with their record in government. We could also talk about the huge union funding that goes towards many Labour policies, but time would forbid us from doing so and I am sure that the Deputy Speaker would not want me to digress from the subject of this debate.

Let us come on to what the Health and Social Care Act actually did. First, it stripped out an entire layer of management from what was at the time an overly bureaucratic NHS. This is an important point that hon. Members would do well to listen to. The reforms will save our NHS £5.5 billion in this Parliament alone, and £1.5 billion every following year. That money is being put back into front-line patient care. In addition, as I notified the House in an answer to a recent written question, spending on administration as a proportion of the total NHS budget has fallen under this Government from 4.3% in 2010-11 to 2.9% in 2013. More money is going into front-line patient care because we have stripped out bureaucracy and administration and freed up that money to look after patients.

Between 2010 and July 2014, the number of infrastructure and administration support staff in the NHS has reduced by 10.3%, which is about 21,000. That includes a 17.7% decrease in managers and senior managers combined. Savings from reducing bureaucracy in this manner are being ploughed back into front-line patient care. For instance, we now employ 8,000 more doctors and 5,600 more nurses on our wards than in May 2010, and our NHS can do nearly 1 million more operations every year.

[Clive Efford]

The hon. Gentleman is taking us through a very detailed list of bureaucratic costs. Obviously, the Government are paying close attention to that, but why is it that when I asked them about the cost of overseeing the tendering process—the cost of lawyers, accountants and other advisers—they said that they do not collect that information?

[Dr Poulter]

I will come on later to the costs that the hon. Gentleman’s Bill would directly create. The point is that we should be proud—the Labour party should be supporting the Government—that we are reducing administration and bureaucratic costs, because that money is now being spent on patients. Why cannot Labour for once accept that a good thing has happened and that more money is now going into front-line patient care?

The second effect of the 2012 Act is that it empowered local doctors and nurses, as those closest to and most able to determine the needs of their patients, to design and lead the delivery of services around the needs of those patients. Thirdly, the Act placed great importance on and sought to drive increased integration across our NHS, a point clearly articulated by my hon. Friend the Member for Bosworth (David Tredinnick). Commissioners had duties placed on them by the Act to consider how services could be provided in a more integrated way, and we have since built on the Act by supporting a number of integration pioneer sites, which will trail-blaze new ideas to bring care closer together, particularly for frail elderly people and people with complex care needs. They will be leaders of change—a change we have to see in the health system, if we want to offer the very best quality of care to patients.

We are also supporting the health and care system through the £5.3 billion better care fund, with commissioners working in partnership with local authorities to deliver more integrated person-centred care. Offering seven-day services and delivering care that is centred on patients’ needs will encourage organisations to act earlier to prevent people from reaching crisis point. That is the sort of clinical leadership that the Act has fostered. It will refocus the point of care towards more proactive community-based care, for the benefit of so many patients.

[Grahame M. Morris]

The Minister is defending fragmentation, but may I, as a former member of the Health Committee, remind him that Sir David Nicholson, the former chief exec of the NHS, summed up the situation last year by saying:

“You’ve got competition lawyers all over the place, causing enormous difficulty. We are getting, in my view, bogged down in a morass of competition law which is causing significant cost in the system”.

Is the Minister saying that the chief exec is wrong in his assessment?

--- Later in debate ---

[Dr Poulter]

The chief executive makes exactly the point. It was of course the Labour Government who introduced competition into the NHS. If the hon. Gentleman has a problem, he should take it up with his colleagues further along the Front Bench who they introduced competition into the NHS. Monitor, as the sector regulator, must now have regard to having better integrated services, reducing fragmentation and putting more emphasis on the best interests of patients.

The fourth effect of the Health and Social Care Act has been to provide clarity about existing NHS practices on patient choice and competition that were introduced by the previous Government. Under the Act, nothing changed from the rules laid down under Labour on how commissioners should behave when they procure services. That has been borne out, despite the myths and scare stories surrounding the Act. Simon Stevens, a former Labour special adviser under Tony Blair and now head of NHS England, said to the Health Committee that

“if the claim was that CCGs have to start putting all of their health service purchases out to public procurement, that is clearly not true and it isn’t happening”.

That was the current head of the NHS making it clear and putting the record straight on the Opposition’s scaremongering. The NHS agrees: the NHS Confederation stated in its briefing on the Bill:

“The current rules are clear that no-one can pursue competition in the NHS if it is not in the interests of patients.”

Our NHS finances bear that out. In the last financial year, spending on independent health care provision by commissioners was shown to be about 6%, compared with 5% under Labour in 2010. That is hardly evidence of the sweeping privatisation of NHS services, but it is evidence of clinical commissioners making informed, clinically led choices for the benefit of patients.

Dr Steve Kell, chair of the NHS Clinical Commissioners, has made it clear that there is not a clinical commissioning group in the land that has any kind of “privatisation agenda”. What CCGs all share is clinical expertise and an unflinching desire to improve local health services for their patients. This Government will not stand in their way or play party politics with the judgments of doctors and nurses who are making the right choices in the best interests of their patients. Indeed, Dr Michael Dixon, chair of the NHS Alliance, and others wrote in The Daily Telegraph this morning:

“As NHS doctors, we are deeply concerned about the misguided and potentially disruptive National Health Service Bill being debated today.”

Working with other key health care organisations, NHS England—I hope that Labour Members will agree with this uncontroversial point—has set out how the health system must change over the next five years, looking at new models of care delivery and taking a more integrated approach to the delivery of health and care. Earlier in the year, the head of NHS England, Simon Stevens, made it clear that if the procurement, patient choice and competition rules stood in the way of delivering the required changes, he would say so. Clearly, he has not done so.

Let me be absolutely clear: the NHS England “Five Year Forward View” did not call for further legislative change—that is what the Bill proposes—or for structural upheaval or a return to Whitehall control of our NHS. I am sure that we can all agree that NHS England’s “Five Year Forward View” was an important piece of work that deserves to have broad cross-party consensus.

Politicians now need to leave the NHS to get on with the job: let the doctors and nurses run the NHS as we have freed them up to do. We can support leaders in the system, and help to free more money for front-line care through improved NHS procurement, better estate management and reduced spending on temporary staff. However, making top-down legislative change to the system, as the hon. Member for Eltham proposes, would be disastrous at a time when we should focus on supporting our NHS to deliver better care for patients.

It is important to look at what the Bill would do. It is quite simply wrong to believe that removing the parts of the 2012 Act that relate to the competition will stop competition law applying to our NHS.

[Mr Anderson]

Is the Minister happy that, because of competition, groups such as Care UK have cut professional health workers’ pay by between 35% and 40%? How does he expect those people to feel motivated to go to work every day when they cannot afford to pay their mortgage or to look after their kids properly? Is that really what we should expect in this day and age?

[Dr Poulter]

The hon. Gentleman will be aware that Care UK provides a lot of the care in the social care sphere. I understand that much of the social care commissioned by local authorities is already provided by the private sector. The big idea of the right hon. Member for Leigh is about driving further integration. Under the integration plans that he has outlined, more power would of course be given to companies such as Care UK. We support integration, but it must be done in a way that always meets the best needs of local patients, and it must be evolutionary change rather than revolutionary change, working with front-line professionals to do the best for their patients.

[Several hon. Members]

rose—

[Dr Poulter]

Let me make a little progress on the damage that the Bill might do. As I have said, the belief that removing the parts of the 2012 Act that relate to competition will stop competition law applying to our NHS is simply wrong. That important point goes to the heart of what the right hon. Member for Leigh has said.

[Dr Eilidh Whiteford (Banff and Buchan) (SNP)]

rose—

[Dr Poulter]

If the hon. Lady will let me make some progress, I will come to her shortly.

The fact that such a belief is wrong was recently made clear in correspondence from Simon Stevens to the right hon. Gentleman—from one former Labour special adviser to another—which stated:

“We are, as appropriate, required to observe European procurement regulations, originally introduced in 2006, and related UK law. In everything we do we are also required to exercise our functions effectively, efficiently and economically. As a result we are advised that a blanket contracting ban would not be permissible.”

It would not be permissible because of regulations introduced by the previous Labour Government. That is another reminder that Labour introduced competition into the NHS.

As I explained earlier, under changes introduced by the previous Labour Government, health commissioners were subject to EU competition law for several years prior to the Act, and they would continue to be subject to it even if the Act was repealed.

[Dr Whiteford]

The points the Minister is making about competition take us back to the transatlantic trade and investment partnership. He must be aware that the NHS across these islands is developing in very different directions, and competition has not been at the heart of what has happened in other parts of the UK. I want him to give us cast-iron guarantees today that there will be no obligation on the NHS in Scotland to open up because of that trade agreement, even if the UK decides in its favour. What opportunities are there, if the treaty exposes the Scottish Government to—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. The hon. Lady must sit down.

[Dr Poulter]

I will come to TTIP shortly, and I think that I will be able to reassure the hon. Lady and the hon. Member for Angus (Mr Weir).

The Health and Social Care Act put in place an alternative route to the courts, through Monitor, to address abuses of the rules around procurement. The Bill would remove that alternative route, meaning that future complaints under the law would result in hugely costly legal processes for health care commissioners, and complaints would be considered by the courts, rather than by Monitor, a health expert regulator. That cannot be good for patients. The Bill would result in more money for the lawyers, and much less money for our NHS and the patients that it looks after.

Another important point is that by favouring NHS over non-NHS providers, the Bill would be a move against the voluntary and charity sector providers, such as Macmillan and Marie Curie, who have done so much to help care for patients for many years.

[Jeremy Lefroy]

I am glad that my hon. Friend has mentioned Macmillan. At the moment, Macmillan is in the middle of tendering for end-of-life and cancer care in Staffordshire, which hon. Members have mentioned. Although the integration that the tender requires is absolutely vital—I think that it is supported by all Members, including the hon. Member for Stoke-on-Trent Central (Tristram Hunt) in a recent article—one of the real problems involves the mechanism. The fact is that the integration seems to require the tender to be for the entire service, rather than for just a small contract, say, to help with integration. Will my hon. Friend comment on that, because this is one of the problems at the heart of the matter? We do not want large private companies to run our cancer and end-of-life services.

[Dr Poulter]

In a moment I will address in a little more detail a couple of the points that were raised. I reassure my hon. Friend that the section 75 regulations that underpin the 2012 Act, which are almost identical to regulations that the previous Government were involved with, outline very clearly, under regulation 10, that integrated service, or encouraging co-operation between providers in the interests of patients should not be seen as anti-competitive. Regulation 15 makes it clear that Monitor cannot direct a commissioner to hold a competitive tender. There is strong support throughout those regulations, as there is throughout the 2012 Act, for integrated service delivery in the best interests of patients, where that is appropriate.

[Joan Walley]

Will the Minister give way?

[Dr Poulter]

I am going to make some progress—I hope the hon. Lady will forgive me—because Mr Deputy Speaker is looking at me.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Yes, I am looking at you.

[Dr Poulter]

Points were made about the voluntary and charitable sector supporting innovative new models of care. Through the Newquay pathfinder project Age UK has provided volunteer support to vulnerable older people considered at risk. Under the home scheme the British Red Cross provides volunteer support to patients in their homes, which is aimed at preventing admission to, or facilitating discharge from, hospital. The charity has care in the home contracts with more than 30 NHS trusts and social services departments, and the scheme enables reduced admissions, increased convenience to patients, and many other associated benefits.

My hon. Friend the Member for Stafford (Jeremy Lefroy) mentioned Macmillan. I like to talk about Macmillan, which has long provided vital support to patients right across the UK. It is collaborating with doctors in Staffordshire to transform cancer care and end-of-life care, and together they aim to commission care right across the patient journey. In cancer, that means commissioning prevention and health promotion, ensuring early diagnosis and prompt treatment through survivorship and improving end-of-life care.

In reality, the only route proposed in the Bill for recourse against unfair treatment by commissioners is to take us back to the previous Labour Government’s competition laws in 2006 and open up legal challenge through the courts. Only private providers with enough resource behind them are likely to be able to afford to exist in that court-based system, to pay high legal fees, and to invest in providing NHS care to patients, and smaller providers, especially charities, will lose out. Surely we do not want to see that in our NHS—an NHS in which, I hope we all agree, charitable and small local health care organisations have something important to contribute for the benefit of patients.

Before I conclude, I must briefly address some of the misleading commentary that has surrounded TTIP, which is serving only to distract from the real debate about our NHS. First, may I state that there is absolutely no agenda whatsoever to privatise our NHS through the back door? TTIP cannot force the privatisation of public services by EU member states. This position has been made explicitly clear by us and by the relevant negotiating parties. To suggest otherwise would be disingenuous and, frankly, wrong. I encourage Members to look at the recent negotiating mandate published by the European Commission, where this position is made absolutely clear. I note the comments of Ignacio Garcia Bercero, EU chief negotiator, on the record at the end of round 7 negotiations—

[Dr Whiteford]

rose—

[Dr Poulter]

I am addressing the hon. Lady’s point, so I hope she will let me do so. Ignacio Garcia Bercero said:

“I wish…to stress that our approach to services negotiations excludes any commitment on public services, and the governments remain at any time free to decide that certain services should be provided by the public sector.”

That is a very clear reassurance, and I hope it will be accepted by all hon. Members. I will give way just once more, because I do not want to test Mr Deputy Speaker’s patience as I come to a conclusion.

[Dr Whiteford]

I am grateful to the Minister, but my understanding is that the Commission has said that if one part of the UK market is opened up through privatisation—perfectly democratically, as it could be—then all parts will be opened up. I want his assurances that Scotland will not be forced, by the back door, to privatise its NHS on the coattails of this House.

[Dr Poulter]

I believe I have given the hon. Lady those reassurances.

[Clive Efford]

rose—

[Dr Poulter]

The Government’s health care reforms ensured that, as under the last Labour Government, day-to-day decisions of care delivery became the responsibility of clinically led NHS commissioners. It is for the local NHS to decide which providers, whether from the public, private or voluntary sectors, can best meet the needs of their patients and deliver high-quality care.

[Clive Efford]

rose—

[Dr Poulter]

I will give way one more time in a moment, and then that really will, I am afraid, be the lot, because I know that Mr Deputy Speaker would like me to come to a conclusion.

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

On a point of order, Mr Deputy Speaker. I do not know what is going on with this speech. I know that the Minister is a distinguished medical person, but he is presenting the speech with so much jargon and such technical terms that very few people out there will understand the main thrust of it. The only thing many people have understood in the last few minutes is the back-door privatisation.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

That is absolutely not a point of order, but we will hear from some other speakers if we can get to the end of this speech. We might then hear some other parts of the debate.

[Dr Poulter]

Thank you, Mr Deputy Speaker.

I have mentioned the benefit to patients many times in my speech, because that is, after all, what I care about as a doctor and what I care about as a Health Minister, and what I hope all hon. Members care about; I know that the hon. Member for Huddersfield (Mr Sheerman) does so.

Additionally, and contrary to claims made by some, TTIP will not prevent any future Government from changing the legal framework for the provision of NHS services. Neither will it prevent the termination of the private provision of such a service in accordance with the law or contracts entered into, as is already the case today. The reassurances that we and the European Commission offered were sufficient for the right hon. Member for Wentworth and Dearne (John Healey), a previous shadow Health Secretary, when he stated:

“On the NHS....my direct discussions with the EU’s chief negotiator have helped produce an EU promise to fully protect our health service including, as the chief negotiator says in a letter to me, so that: ‘any ISDS provisions in TTIP could have no impact on the UK’s sovereign right to make changes to the NHS.”

If it was good enough for the right hon. Gentleman—

[Clive Efford]

rose—

[John Healey]

rose—

[Dr Poulter]

I will give way to the hon. Member for Eltham and then I will conclude.

[Clive Efford]

That really will not wash. The Minister is saying that we must trust the Government and that they will not allow TTIP to apply to the national health service. The Bill says that this House will be sovereign; this House will decide whether TTIP applies to our national health service. Does he support that?

[Dr Poulter]

I was simply quoting the reassurances that his right hon. Friend had given to all hon. Members, which was that

“any ISDS provisions in TTIP could have no impact on the UK’s sovereign right to make changes to the NHS”.

If TTIP is good enough for the right hon. Member for Wentworth and Dearne , it should be good enough for everyone in the Labour party.

[John Healey]

Would the Minister be good enough to concede that that has absolutely nothing to do with what the Government have been arguing; that is to do with the EU and their negotiation. The Trade Minister in charge has said that he does not want the NHS to be excluded in the way that we want.

[Dr Poulter]

No; I am simply quoting what the right hon. Gentleman has already put on the record about reassurances that he has received from the EU about an EU trade settlement. Surely, if the reassurances were good enough for him when he wanted to communicate them more broadly to his colleagues, and more broadly to members of the public, they are good enough now. It is very difficult to climb down from those reassurances, which he has previously given, and in the remarks I have made I have further reassured the House about the protection that this Government have made for the NHS in TTIP.

I am immensely proud of the way our NHS has already responded to the challenges of a growing and ageing population, meeting increased demand through a purpose and drive to improve the quality of patient care. That is why our NHS was recently ranked No. 1 in the Commonwealth Fund’s assessment of 11 global health care systems. This is at a time of unprecedented challenge to public finances across the globe, and testifies to the incredibly hard work of NHS staff and a very tough choice by this Government to protect our NHS budget and increase it by £12.7 billion between 2010 and 2015—a decision that the right hon. Member for Leigh called irresponsible but one of which we are very proud.

I remind the House of the words of the right hon. Member for Leigh when he was a Health Minister defending Labour’s record on introducing private providers into our NHS:

“I think the NHS can finally move beyond the polarising debates of the last decade over private or public sector provision”.

I agree: it is definitely time to move on. Our NHS focus needs to be on delivering for patients, so let us put distractions aside and let our hard-working doctors, nurses and health professionals get on with the job.

Language Controls (Healthcare Professionals)

Dan Poulter Excerpts

Monday 3rd November 2014 Written Statements

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

The Department of Health has been working with the General Dental Council (GDC), the Nursing and Midwifery Council (NMC), the General Pharmaceutical Council (GPhC) and the Pharmaceutical Society of Northern Ireland (PSNI), along with other stakeholders to look at ways to ensure that the English language capability of nurses, midwives, dentists, dental care professionals, pharmacists and pharmacy technicians working in the UK is sufficient. We greatly value the contributions that health care professionals from all over the world have contributed, and continue to contribute to our NHS, but it is essential that they have a sufficient knowledge of the English language, in order to provide safe patient care. Earlier this year, changes were introduced to strengthen the law around language controls for doctors, by introducing language controls for European economic area (EEA) doctors wishing to practise in the UK. Ministers from the four UK Health Departments are firmly committed to improving public protection by preventing health care professionals who do not have sufficient knowledge of English from working in the UK.

Today the Government launched their consultation “Language Controls for nurses, midwives, dentists, dental care professionals, pharmacists and pharmacy technicians—proposed changes to the Dentists Act 1984, the Nursing and Midwifery Order 2001, the Pharmacy Order 2010 and the Pharmacy (Northern Ireland) order 1976”. The consultation document consults on proposals to amend the legislation governing the GDC, NMC, GPhC and PSNI so as to give them more explicit powers to satisfy themselves about the English language capability of EEA applicants for registration, as well as to take action where concerns arise about a registered professional’s ability to communicate adequately in English. The draft Health Care and Associated Professions (Knowledge of English) Order 2015 has also been published alongside the consultation document.

The consultation will close on 15 December 2014 and the Government welcome views on the proposals and invite comments through the consultation process.

“Language Controls for nurses, midwives, dentists, dental care professionals, pharmacists and pharmacy technicians––Proposed Changes to the Dentists Act 1984, the Nursing and Midwifery Order 2001, the Pharmacy Order 2010 and the Pharmacy (Northern Ireland) order 1976” and the draft Health Care and Associated Professions (Knowledge of English) Order 2015 have been placed in the Library of the House. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

General Practices (Coventry)

Dan Poulter Excerpts

Thursday 30th October 2014 Commons Chamber

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

Thank you, Madam Deputy Speaker, and I thank the hon. Member for Coventry South (Mr Cunningham) for his kind regards in that respect.

I congratulate the hon. Member for Coventry North West (Mr Robinson) on securing this debate. Like his hon. Friend, he raised a number of important broader points about the future of general practice and the work force—I hope to provide some reassurance in that regard—and some important local issues, which I also intend to address.

I commend both hon. Members for their interest in local health care matters as they affect their constituents, and I pay tribute to the dedication and professionalism of all the GPs and other staff working in primary care in Coventry and surrounding areas. The House will agree, I am sure, that good quality patient care is expected, regardless of which part of the country we live in. GPs are the bedrock of our NHS, with an estimated 340 million consultations taking place in general practice every year. We want to ensure that we always give GPs the right support so that they can deliver the best possible care for patients.

I am aware that the Coventry and Rugby local medical committee of the British Medical Association issued an open letter on 26 September, giving its views on national and local issues in general practice.

Let me turn first to one of the important points raised in the debate, which was that there has quite rightly often been a focus on the NHS as viewed through the prism of secondary care, yet the majority of engagements with patients is in primary care and in the community. We need to recognise the role of pharmacy, too, as many people’s first point of contact will be with the pharmacist and, in the NHS, with their GP or another element of primary and community health care. It is therefore important to challenge that traditional prism through which the NHS tends to be regarded. We know that it is not just about hospitals; it is about primary care, too, and about ensuring that we invest to support GPs and deliver other high-quality community health care services.

[Mr Robinson]

We are greatly reassured by the Minister and agree with what he said. Will he confirm the figure—I was quite surprised to discover it—that at least 90% of all initial contacts with the NHS are through primary services? As he rightly says, it is mainly GPs, but chemists and others, too. Is the 90% figure correct?

[Dr Poulter]

I believe that that estimate is correct, although it is impossible to give a totally accurate figure, because some of the consultations, particularly with a pharmacist, might be informal rather than registered as an official consultation. For many people, it is important to get advice from their local pharmacist about how better to manage their medication regime or just to seek simple advice about what to take for an upset stomach. Those informal consultations are not usually registered in the same way as GP consultations, even though they happen every single minute of every day in our health service. Those points of contact are in the community, not in secondary care. This is how most people will come into contact with the health service, although in this place we sometimes talk about the NHS through the prism of secondary care. It is a legitimate challenge for all us of to recognise the importance of primary and community care and to continue to invest in and support those people who deliver that when we design health care services in the years ahead.

As a doctor myself, I particularly recognise the work of GPs and the vital role that they play. Shortly after the local medical committee issued its letter, as highlighted in the remarks of the hon. Member for Coventry North West, the Government were pleased to see that NHS employers, on behalf of NHS England and the BMA, reached agreement on changes to the GP contract. The BMA made the point that these changes will provide much needed breathing space for general practice and greater stability for patients. However, we accept there is much more that we need to do in the longer term to support general practice, such as recruiting more GPs to help tackle GP burn-out. I shall say more about that later.

We are of course pleased to have reached agreement with the BMA, and I think it is useful to set out a few points about what we have done nationally and what we want to do in the coming years, as this will help to address some of the concerns raised by the hon. Gentleman.

First, it is worth highlighting some of the investment in general practice that has taken place. We recognise the need for a reversal of the shift that the hon. Gentleman described so articulately—the shift that has taken place, over decades of investment, away from community care and towards hospital care. I hope the hon. Gentleman will be reassured by the latest figures, which show that the total investment in general practice increased in cash terms by 2.92% between 2012-13 and 2013-14, from £7,863.8 million to £8,093.4 million. I shall write to him to confirm those figures, but I think we should all welcome the reversal of the traditional shift in favour of secondary care, towards general practice and other primary care. The hon. Gentleman may be aware that NHS England published its “Five Year Forward View” last week. In that report, it committed itself to more investment in primary care over the next five years, including investment in infrastructure.

I know that the hon. Gentleman is rightly concerned about GP numbers. Although the headcount figure in this year’s annual work force census shows a very small decrease of 29, the full-time equivalent figure has increased by 423, or 1.2%, which represents a real increase in capacity in the system. There are now 36,294 full-time equivalent GPs working in the NHS, including registrars and retainers. That is an increase of 423 since 2012, and an increase of more than 1,000 since 2010. There are 329 full-time equivalent GPs working in the Coventry and Rugby clinical commissioning group area, compared with 305 in 2010, so numbers are beginning to increase locally. I hope that that, too, is reassuring.

I understand that the NHS England Arden, Herefordshire and Worcestershire area team is working with the deanery, examining work force development issues and, specifically, ways of improving the process for GPs who want to return to general practice after a career break. The hon. Gentleman made the important point that the work force now includes many women GPs. That is one of the great strengths of the profession, but we must bear in mind the need to enable women who take career breaks in order to start a family to return to general practice. I know that a great deal of work is being done in that regard, not just locally but nationally, involving the Royal College of General Practitioners and the General Medical Practice.

We accept that the work force must grow to meet rising demand from an ageing population. That is why our mandate to Health Education England requires 50% of trainee doctors, after graduation—3,250, on the basis of current forecasts—to enter GP training programmes by 2016; the current figure is about 40%. That will enable further increases to be made in the GP work force: we expect an increase of about 5,000 by 2020. Although numbers are rising, we know that GPs need more resources.

[Mr Robinson]

My hon. Friend and I are very reassured by what the Minister has said. As for the numbers—which, of course, we always have to plan for—does the increase of 5,000 by 2020 mean an increase in the total number of doctors, or an increase in the number of GPs? Will that be enough, given that 10,000 doctors will retire from general practice alone in the next five years? Does the 5,000 figure relate to the position after those GPs have retired? How does the calculation work?

[Dr Poulter]

The figures that I gave are based on what we assume will be the attrition rate over the next five years. The total number of doctors has increased by, I believe, about 7,000 over the last four years, but the 2020 figure relates specifically to GPs.

The hon. Gentleman has made a good point. The same consideration has historically applied to health visitors. When a large proportion of that work force has been close to retirement over a five or 10-year period, it has meant the loss of a great deal of experience, but that is not the only issue: there is also the need to plan for those retirements in advance. The figures that we worked out with Health Education England take account of attrition rates.

Part of that is about ensuring that half those medical students become GPs on graduation; currently, only 40% do so. That is where the extra increase in capacity will come from. That will also address the fundamental issue that we have been discussing today—namely, that we need more people working in the community and in primary care. We need to move the prism of the discussion about what good health care looks like away from it being just about delivering good health care in hospitals.

The work being undertaken by Health Education England will improve the applications and fill-rate for GP training. The work includes: a review of the GP recruitment process; development of a returner and refresher scheme; development of a pre-GP year to give prospective GP applicants exposure to the specialty; and careers advice for foundation doctors and medical students. That careers advice is important. When I was at medical school, everyone in my year wanted to be a hospital doctor. I entered a hospital specialty. It is therefore important that, from day one at medical school, students are encouraged and supported to recognise the tremendous opportunities that a career in general practice could offer.

Part of the challenge is to set the aspirations of medical students appropriately and to recognise that the work of a general practitioner is as important as—if not sometimes more important than—the work of a hospital specialist. We need to encourage greater recognition of that fact in medical schools, given that we want to deliver more care in the community. I believe that it is Lancaster medical school that has done a very good job of placing a greater emphasis on prospective GPs doing more community-based and primary care placements during medical school training. That has encouraged more students to enter general practice afterwards. I think I am right in saying that it is Lancaster medical school, but I will write to the hon. Member for Coventry North West after the debate to outline exactly where that kind of initiative has been effective. When looking at how we should train our future work force, it is vital to ensure that more medical students focus on a career in general practice from an early stage of their development if we are to encourage more of them to choose that route. We know that that has worked in the past.

I shall not detain the House by describing the work that Health Education England is doing nationally. Instead, I want to respond to the hon. Gentleman’s questions by talking about what we are doing now to support GPs through technology to enable them to provide a better service to patients. This applies not only to the service available during the current opening hours but to how we might facilitate community and primary care services on a more seven-days-a-week basis.

Last autumn, the Prime Minister announced a challenge fund of £50 million to support innovative GP practices in improving services and access for their patients. As well as offering seven-days-a-week access and evening opening hours, pioneer GP groups will test a variety of forward-thinking services to suit modern lifestyles, including Skype, e-mail and phone consultations. We need to recognise that this is about engaging with people on their own terms. Someone who is working might want to engage with their GP in a different way from someone who is retired, for example. The challenge fund will help to address those questions.

The challenge fund is now supporting more than 1,000 practices covering every region. The pilots will draw best and innovative practice from GPs on the ground to determine what is needed and works locally. We recently announced a second wave of access pilots, with further funding of £100 million for 2015-16. Yesterday, NHS England published details of how to apply to become a wave 2 pilot site, including the application criteria, process and time scales. I hope that practices in Coventry will take advantage of that fund and make applications to support local patients.

The £3.8 billion Better Care Fund combines existing funding in a single health and care pot, promoting integrated care and joint working between health and care services. It aims to ease pressure on services by encouraging greater prevention and by supporting people to stay independent for as long as possible. I have been informed that, in 2015-16, the Coventry clinical commissioning group will receive £9 million to improve services in the local area. Demand continues to grow nationally, and Coventry is no exception to that trend. However, I am told that significant work has been done over the past few years to increase access and to support local initiatives. Significant investment has been made in premises to improve better access to services and an improved patient experience. Four practices co-located to the City of Coventry health centre in 2012 and three practices moved to the new centre at Clay lane in 2013. The hon. Gentlemen raised some issues about practice closures—

--- Later in debate ---

[Madam Deputy Speaker]

I am grateful to the hon. Gentleman for his attempt to be helpful, but I will invite the Minister to move that the House do now adjourn, after which he may recommence his speech.

Motion made, and Question proposed, That this House do now adjourn.—(Dr Poulter.)

[Dr Poulter]

Thank you, Madam Deputy Speaker. I apologise for the lack of the usual accompanying member of the Treasury Bench team to conclude proceedings, but I am pleased to continue the informative debate we have been having.

I was addressing the point about practice closures. The way the information is collected sometimes leads to a headline of “practice closures”, but it may well be that practices have merged, and it is important to recognise that when we have a debate, even an informed one such as this. When a number of practices have co-located locally to improve premises and there has been improved investment, that is an enhancement of services; it in no way diminishes the services available to patients. I do not know the details of each and every surgery in Coventry, but clearly collaboration has taken place, along the lines of the Darzi model outlined by the hon. Member for Coventry North West, whereby surgeries can pool their resources and work together. That can bring benefits to all their patients and mean an additional freeing up of money to invest in other community-based health services, for example, physiotherapy or speech and language therapy. That approach has worked well in many parts of the country, including in the examples I gave in Coventry.

I understand that NHS England has also given approval for new premises for the Prior Deram Walk practice in Canley, Coventry, with the new facility expected to be completed next summer. Ongoing investment is taking place locally. Practices in Coventry have a good provision of extended hours, through the enhanced service for extended hours, and have adopted online booking for appointments and repeat prescriptions. NHS England’s area team monitors complaints from patients and is currently receiving no complaints about access or difficulty in registering with a practice in the Coventry area, although if there are concerns, I would be happy to take an intervention.

[Mr Jim Cunningham]

I thank the Minister for his announcement about a new practice in Prior Deram Walk, which is badly needed and which we would welcome.

[Dr Poulter]

I am pleased to have brought some good news about future planning to the debate. As I will be writing to the hon. Member for Coventry North West in detail about some of the initiatives with medical students, I am happy to outline further the future plans for that practice in the letter.

GP patient survey results from 2014 indicate that 85% of people who responded in the Coventry and Rugby clinical commissioning group area rated their GP surgery as “very good” or “fairly good”. Although this is a high proportion, it could of course be improved further. The figure is, however, testament to the work of local GPs and the quality of care they provide, alongside everybody who works in those practices. I am also aware that Coventry local medical committee had concerns that Coventry and Rugby CCG was not following NHS England planning guidance and investing more in general practice to support it in transforming the care of patients aged 75 and older. I understand the LMC has now reached agreement with the CCG on that, which is good progress. Our plans for personalised care for the most vulnerable patients included NHS England asking CCGs to set aside £250 million from existing funds. However, as has always been the case, CCGs are not restricted to using this funding on general practice only. For example, in some areas, CCGs have used the funding to employ extra district nurses for local practices.

On the important point about the wider community work force, it is increasingly the case that although a nurse may be counted as a member of hospital staff, their role goes across not just the hospital, but the community. That is particularly the case for nurses who support patients with long-term conditions such as multiple sclerosis and diabetes. Although that nurse is officially counted as a hospital employee, they play an increasingly important role in supporting the patient in the community. Having visited the local hospital in Coventry, I know that there is a great emphasis on the hospital working much more collaboratively with the community. The role of the hospital is about not just picking up the pieces when things go wrong but proactively supporting patients, especially those with long-term conditions, when they are at home.

[Jim Fitzpatrick]

I apologise to the Minister for intervening on him while he is replying to a debate on Coventry. He just mentioned collaborative service. The Barkantine practice in my constituency combines a 10-handed GP practice with a walk-in centre. It is able to offer appointments from 8 o’clock in the morning to 8 o’clock at night seven days a week, which is what the Prime Minister made a big point about in his conference speech. However, because of restructuring, the practice is having to hand over its walk-in centre finances to the local CCG, which means that the critical mass for providing the 8 am to 8 pm service seven days a week is no longer appropriate. Will the Minister look at that with regard to collaborative working, as we are talking about breaking down a system that the Prime Minister wants to see replicated across the country?

[Dr Poulter]

I hope the hon. Gentleman will excuse me if I do not detain the House in addressing that specific point today, but I will look into it and write to him separately about it. We have discussed local issues in his constituency before. I will take away what he says and get back to him, hopefully with some reassurance on the points that he has raised.

The CCG is developing a pre-hospital model to help manage urgent care and reduce attendance and admission to hospital. The development includes operational and clinical staff from a number of organisations including patient champions, primary care, local trusts and authorities, and unscheduled care providers.

The model being considered at the moment describes a community urgent care system designed around the patient, ensuring easy and timely access at a convenient location without blocks or diversions. The CCG and its partners at the Coventry urgent care board have developed and agreed a winter capacity and resilience plan. NHS England has made £2.8 million available to support the plan, and a number of specific winter schemes are already being put in place. They include: additional home care capacity for both planned and unplanned support; additional social worker capacity to support A and E and ward board rounds; GP responders; and hospital at home.

The plan sets out a clear mechanism for engaging and developing leaders and staff to enable the cultural changes required to support clinical commissioning activities, performance improvements and services changes necessary in the changing NHS environment at a local level. As we have said, this is about ensuring that the emphasis is moved away from a reactive care model in the hospital—having met the staff in Coventry I know that it is a very good reactive care model—and giving people better support and care at home. That is what investment in local GP practices and increasing GP numbers is about. It is also about ensuring that the right relationships are engaged at a local level to support the right type of care being delivered to patients in Coventry. Its focus is on developing internal capacity and capability to ensure that the emphasis is on upstream interventions, preventing people from becoming so unwell that they need to go into hospital, and making sure that people with long-term conditions and disabilities get the proper community-based support that they need.

I hope that I have brought some reassurance to the hon. Members for Coventry North West and for Coventry South, and I have a couple of points on which I will write to both of them. Once again, I convey my gratitude to the front-line staff working in Coventry. I have seen the local hospital for myself and know how hard local staff work. It is clear that investment is going into GP premises locally and that there is a commitment to continuing to support general practice in Coventry and the development of improved community services to ensure that the big challenge that faces the NHS, which is to support people with long-term conditions, is met, not just nationally, but in particular for those patients who need services from the NHS in Coventry.

[Jim Fitzpatrick]

On a point of order, Madam Deputy Speaker. On 16 October, during the Backbench Business Committee debate on cycling, I said that

“the proportion of cars on that stretch of road is already less than 9%”.—[Official Report, 16 October 2014; Vol. 586, c. 502.]

Further research has clarified that the 9% figure refers to an assessment of the percentage of private cars using the A3211 route at certain times of the day. This is based on counts carried out by transport consultants Steer Davies Gleave for Canary Wharf Group. It would have been more accurate for me to have said, “the proportion of private cars on that stretch of road is already less than 9% at some times of the day.”

I am grateful to be able to set the record straight. I apologise for not accurately reflecting the position. I am not sure whether this qualifies technically as misleading the House as it was an incomplete picture, but I apologise unreservedly for doing so, as that was clearly not my intention.