Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 21st October 2014 Commons Chamber

[Tim Loughton (East Worthing and Shoreham) (Con)]

2. What safeguards are in place for the sustainability of NHS facilities when clinical commissioning groups contract out local services.

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

The previous Government introduced greater competition to the NHS. This Government have ensured that it is for local doctors and nurses through clinical commissioning groups, rather than bureaucrats, to decide how best to procure NHS services in the interests of their patients.

[Tim Loughton]

As the Minister is aware, Coastal West Sussex CCG is controversially proposing to award a major contract for musculo-skeletal services to a social enterprise consortium rather than Worthing hospital. While I welcome new ways of working in the NHS, as long as the quality of care for patients remains key, what safeguards are in place to ensure that existing NHS services such as trauma and accident and emergency, which we campaigned so hard to protect at Worthing hospital, are not compromised?

[Dr Poulter]

The Health and Social Care Act 2012 ensures that commissioners must also have regard to delivering integrated health care services. I reassure my hon. Friend that the West Sussex CCG has clearly stated:

“The…CCG will continue to commission MSK related trauma from the current providers and the intention is for this to continue for the duration of this MSK…contract”.

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

23. What is the Minister doing to retain GPs as there is considerable concern in Coventry about the number who are leaving practice?

[Dr Poulter]

I hope that I can reassure the hon. Gentleman that there are now 1,000 more GPs in training and working in the NHS under this Government than when we came to power in 2010. We are committed to training even more GPs to ensure that we can widen access to general practice services.

[Andrew George (St Ives) (LD)]

In what circumstances can clinical commissioning groups treat the NHS as a preferred provider, and in what circumstances are they forced to contract out services?

[Dr Poulter]

As my hon. Friend will be aware, when commissioning services, it is important that regard is given not only to competition because, under the 2012 Act, we have ensured that there must be regard to delivering an integrated and joined-up approach for local services. That is an issue for local commissioners to decide in the best interests of the patients they look after.

[John Cryer (Leyton and Wanstead) (Lab)]

Are not certain CCGs starting to merge decision-making processes, meaning that some important strategic decisions are removed even further from local communities and there is therefore a complete lack of accountability?

[Dr Poulter]

For some more specialist services, collaboration between various parts of the local NHS will always be needed. That is about good health care commissioning and ensuring that services are joined up in a collaborative way. Whereas day-to-day, bread-and-butter services will be commissioned by a local CCG, for more specialist services, clinical commissioners will of course need to work together to ensure that local centres of excellence are commissioned.

[Steve Baker (Wycombe) (Con)]

The sustainability of NHS facilities is often prejudiced by the millstone of Labour’s private finance initiative deals. What is the Government’s expectation of how CCGs should make the best of the hand that they have been dealt?

[Dr Poulter]

My hon. Friend is absolutely right that PFI deals signed by the previous Government have crippled the finances of many hospital trusts, meaning that many of them are unable to invest as much in front-line patient care as they would like. It is important that the Government support the mitigation of PFI deals, when possible, and we have a group that is doing exactly that and supporting local commissioners to deal with the worst excesses of the previous Government’s mismanagement of the NHS finances.

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

3. How many patients waited longer than four hours in A and E departments in 2013-14.

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[Jesse Norman (Hereford and South Herefordshire) (Con)]

5. What steps he is taking to encourage hospital trusts to manage their PFI costs more effectively.

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

PFI schemes have had their contracts reviewed for potential cost savings. A major data collection on the results is currently under way. In 2013, the Treasury launched a code of conduct for operational PFI contracts which contained a number of new guidelines for better working relations between the public and private sector parties.

[Jesse Norman]

Thanks to determined work with which I have been closely associated and with outside experts’ advice, Hereford hospital has managed to save several million pounds on its exorbitant PFI contract—money that is already being ploughed back into medicine and services for local people. My studies make it clear that there are hundreds of millions, if not billions, of pounds still to be saved on the PFI across other NHS hospital trusts. Will my hon. Friend press Monitor and the NHS Trust Development Authority to do everything they can to encourage hospitals to take on specialist PFI contract advisers to help them make these savings?

[Mr Speaker]

Order. Questions must be shorter. I say with the greatest courtesy to the hon. Member for Hereford and South Herefordshire (Jesse Norman) that to read out a prepared script and be too long is doubly bad, and it really is not excusable.

[Dr Poulter]

My hon. Friend is right to highlight the fact that the annual cost of PFI left by the previous Administration is £1.79 billion, which will rise to £2.7 billion. It is right that we do all we can to support hospitals to reduce the costs of PFI that have been inflicted upon them, and we will continue to do that and work with the Treasury to make sure that that specialist advice is available for the NHS to reduce the cost.

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

I am worried that the members of the ministerial team are living in some sort of parallel universe. At the Calderdale and Huddersfield Trust we had a PFI. A hospital that has a long history of success is now struggling because it cannot get a management that works between the clinical commissioning groups and the trust. That is the truth—it is chaos.

[Dr Poulter]

There is nothing wrong with PFI schemes in principle; the point is the way in which they were put together by the previous Government. In 2011, the right hon. Member for Leigh (Andy Burnham) said:

“We made mistakes. I’m not defending every pen stroke of the PFI deals we signed”.

Those PFI contracts have damaged local hospitals and damaged local health care provision—

[Mr Speaker]

Order. I just said to a Back Bencher that his question was too long. I have said to the Minister several times that his answers are not just too long, but far too long, and if they do not get shorter I will have to ask him to resume his seat—which frankly, for a Minister, is a bit feeble.

[Nick de Bois (Enfield North) (Con)]

Will the Minister confirm that unlike the PFI agreements for my neighbouring hospitals in north Middlesex and Barnet, which were negotiated badly and ineffectively, the rebuild of Chase Farm hospital will be funded by proceeds from its own land sale and Treasury money, not PFI?

[Dr Poulter]

My hon. Friend makes an important point. Hospitals should always look to their own efficiencies first by improving procurement practices and freeing up surplus land to fund local schemes. His hospital has done that very effectively, and it has not pursued the policies of the previous Government, which have put so many trusts into difficulty.

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

Given the total forecast deficit across English hospital trusts, including PFI schemes, is it still the Government’s position that the situation can be dealt with by efficiency savings alone?

[Dr Poulter]

During this Parliament we are set to improve efficiency in the NHS and make £20 billion-worth of efficiency savings. There is much more that we can continue to do on improving hospital procurement practices, sharing business services across the NHS, and freeing up surplus land—which, as my hon. Friend the Member for Enfield North (Nick de Bois) outlined, is happening at his hospital. That is what we need to focus on in freeing up money for the front line.

[Guy Opperman (Hexham) (Con)]

Hexham hospital is outstanding but was built under a very expensive Tony Blair PFI. Does the Minister welcome the fact that Northumbria NHS trust is the first in the country to buy out the PFI and put it into public ownership, thereby putting millions more into front-line care?

[Dr Poulter]

My hon. Friend makes an important point. The PFI schemes negotiated by the previous Government were, quite frankly, disastrous for many hospitals. His hospital has seen that the way forward is to buy out the PFI and free up more money for front-line patient care. We will support as many more hospitals in doing that as can be achieved, because this is about making sure that we deliver more money for NHS patients.

[Kelvin Hopkins (Luton North) (Lab)]

I was fascinated by the question from the hon. Member for Hexham (Guy Opperman). Would not the simple solution be to take all PFI assets back into public ownership, reintegrate them with hospitals’ existing assets, and save millions of pounds for hospitals every year and billions of pounds for the public purse over time?

[Dr Poulter]

I understand that the hon. Gentleman is unhappy with the way in which the previous Government negotiated PFI contracts. We are unhappy with it as well, because it is costing the NHS almost £2 billion on current forecasts. We are making sure that we can put in place measures to support hospitals in mitigating the worst excesses of these poorly signed PFI deals.

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

Between 2010 and 2013, 52,528 new pre-registration nurse training places were filled, and this year Health Education England has made 19,206 new places available.

[Barbara Keeley]

It is interesting that the Secretary of State cannot follow his own advice about not making operational matters in the NHS political footballs. Perhaps we can try again. The number of nurse training places has been cut by thousands since 2010—a key issue given the need of hospitals to reach safe staffing levels. The Royal College of Nursing has said that Labour’s plans for 20,000 more nurses are absolutely necessary. Does the Minister agree?

[Dr Poulter]

It is right that hospitals respond when there are not enough staff working there, if that is affecting patient care. That is why under this Government 2,500 more nursing staff are working now than in 2010. That is progress to ensure that we are facing up to challenges in care where they exist at local hospitals.

[Margot James (Stourbridge) (Con)]

Russells Hall hospital in the borough of Dudley has appointed 56 new nurses from overseas since the Keogh review last year. Will my hon. Friend join me in welcoming the graduate trainee programme for nursing that Russells Hall has put in place, which will provide for 100 trained nurses over future years?

[Dr Poulter]

That sounds like a commendable programme. It is good to hear that my hon. Friend’s local trust, where there was a shortage of nurses, is facing up to that and employing more nurses to ensure that patient care is as good as it can be.

[Mr Stephen Hepburn (Jarrow) (Lab)]

16. What recent representations he has received on hospital walk-in centres.

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[Mr David Anderson (Blaydon) (Lab)]

The good people who work in the NHS have faced six years of pay restraint. How much longer must they carry the can for the failures of the people who got us into this mess—the moneylenders, the LIBOR fixers, the people who mis-sold mortgages? How much longer must front-line staff pay for the mistakes of capitalism?

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

Even in very difficult times this year, all NHS staff, either through their increments or through the 1% increase, will be getting a pay rise. Of course, we would like to do more, but the NHS finances are under pressure, and our priority is to ensure that we employ as many front-line staff as we can. We now have more than 13,000 more front-line staff working in the NHS than we did when we came into government.

[Charlie Elphicke (Dover) (Con)]

T6. Can the Secretary of State confirm to the House whether there are any plans to sell off the NHS and will the NHS remain free at the point of delivery?

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

The NHS Litigation Authority is piloting a new approach to improve feedback and learning in response to allegations of negligence. Will the Secretary of State say how patients can find out what feedback the NHSLA has given to individual trusts and how the trusts have responded?

[Dr Poulter]

The hon. Lady raises an important issue, which is that the NHS Litigation Authority often picks up on things when they do not go well and when the communication between patients and trusts has broken down. That is one of the things that need to be put right. I will look into the matter and write to her, because it is important that when things go wrong patients are supported in the right way and the lessons are learned.

[Annette Brooke (Mid Dorset and North Poole) (LD)]

T9. Currently, there are no psychiatric intensive care unit beds for women in Dorset. One of my constituents was recently sent to a unit in Bradford. Will additional funding be available to address this appalling situation?

West Cumberland Hospital

Dan Poulter Excerpts

Monday 20th October 2014 Commons Chamber

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

I congratulate the hon. Member for Workington (Sir Tony Cunningham) on securing this evening’s debate, and I commend him for his interest in local health matters affecting his constituents, and for his clear advocacy of the needs of local patients.

We all understand that the configuration of local health services is an important issue for many Members—and for many of our constituents—particularly those who represent the more rural parts of the country such as Cumbria. We all agree that patients should receive high-quality care, regardless of where they live.

These are challenging times for the West Cumberland hospital. There have been difficult decisions to face up to, following the Keogh review, and the hospital has been put on special measures, following concerns about some aspects of patient care. I will say a little more later about that and about the importance of patient and public engagement in all decisions affecting the reconfiguration of local health care services.

First, I want to provide hon. Members with some reassurance about the future of local health services. It is important to note that for the first time in more than 50 years significant investment is being made under this Government in health care facilities in west Cumbria. The West Cumberland hospital is being redeveloped at a cost of £95 million, with this Government providing £70 million of that funding. The improved hospital will offer high-quality services and facilities fit for the 21st century, including significant local elective surgical services for the benefit of local patients.

The local doctors in the Cumbria clinical commissioning group are committed to keeping West Cumberland hospital clinically and financially viable, with the majority of Whitehaven patients continuing to access services, including A and E, at that hospital. I would also like to reassure the hon. Gentleman that it is the local doctors and nurses who run the clinical commissioning group—not me or anyone in Whitehall—who will make the decisions about health care in Whitehaven and Cumbria.

Before I move on to the specifics of the issues raised by the hon. Gentleman, it is worth noting the long-running issues at North Cumbria University Hospitals NHS Trust and the progress that has been made towards addressing them. Because of a history of high mortality rates—which means that more people were dying at the trust than should have been the case—the trust was placed into special measures in July 2013 as a result of Sir Bruce Keogh’s review. The trust is now working towards a merger with Northumbria Healthcare NHS Foundation Trust, which will further ensure that it can offer safe, high quality and sustainable patient services.

The trust has continued to work hard to tackle its long-running problems with recruitment of medical staff. It has recently implemented a nurse practitioner work force model to replace trainee doctors, who are currently not being placed at the trust due to long-standing difficulties in ensuring the necessary levels of senior medical training support. A recent positive development is that the trust has increased its consultant medical staff by 17%, as well as introducing a new nursing structure, which is helping to ensure safe nurse staffing levels on every ward.

[Sir Tony Cunningham]

Why does the Minister think there is such a shortage of doctors?

[Dr Poulter]

This has been a long-standing shortage; the trust has not been an attractive place for junior doctors to work for many years—probably for the past decade. However, the trust is now looking at ways in which it can better incentivise doctors to work there. That is an important step forward. If we want junior doctors to return to the trust—given that they have been removed from it because they were not getting the high-quality training they needed in order to become consultants—we must ensure that we incentivise the recruitment of more senior doctors to the trust. The hospital is now looking much more seriously at that than it has done in the past.

As I just outlined, recent measures have resulted in the consultant medical staff being increased by 17%, which is a positive step forward. Measures are also being put in place to ensure that nurse practitioners will be better used, where appropriate, to treat patients. The trust can be proud and pleased with the progress that it is making in that respect. An important aspect of looking after patients is to ensure that there is a full rota of junior doctors on site, and I am sure that if the progress in increasing the amount of consultant cover is maintained, that will become available again in the future.

On performance, the trust has put in place a recovery plan to meet waiting time targets from the end of 2014. It is currently working to reduce its backlog of patients who have been waiting for more than 18 weeks from referral to treatment, and it has received additional funding to support that. As hon. Members have pointed out, however, the trust has been financially challenged for some time. Last year, it reported a deficit of £27.1 million. The Department of Health provided significant financial support to the trust in 2013-14, as it has in previous years. The trust received £11.5 million from the Department, alongside support from the trust development authority and the clinical commissioning group, and £6.3 million in private finance initiative funding support. As we have discussed, however, that position is not sustainable in the long term. That is why further discussions about foundation trust status are being held.

Other critical challenges remain. Most significantly, some services at West Cumberland hospital remain fragile due to difficulties recruiting specialists and consultants and to the current heavy reliance on locums. However, I hope that that issue will be addressed in the near future if the trust can continue to recruit more consultants.

The Care Quality Commission inspection report published in July 2014 rated the safety of acute medical and outpatients services at the West Cumberland hospital “inadequate”. That reflects the difficulties that the hospital has faced for many years, and continues to face, in recruiting adequate staff to run some of its services safely and effectively. However, the trust has made significant progress in addressing the many challenges it faces. The CQC inspection acknowledged that, giving it an overall rating of “good” for providing a caring service to patients.

Another CQC inspection is expected to take place in early 2015, and I understand that the trust is working hard to make improvements ahead of that. For example, the outpatients service has greatly improved the availability of patient notes, an issue highlighted at the previous inspection. As I understand it, patients’ notes were not available when they came for an appointment. That is not helpful in providing an understanding of their previous history, which disadvantages the staff who are looking after the patient and trying to provide the best possible care. The trust has taken that issue on board and I understand that it is making good progress to address it.

The trust has made significant progress in other respects, most notably, and perhaps most importantly, in reducing high mortality rates. That means that patients in Cumbria who would have died had these changes not been introduced are alive today. Having been one of the highest in the country, the trust’s mortality rates are now within national confidence limits, and the trust and its staff must be commended for that turnaround. Further progress has also been made in, for instance, the meeting of the four-hour A and E standard, the implementation of a new patient experience programme, and a reduction in clostridium difficile infection rates. However, changes must continue to be made to secure a sustainable future, and to enable the trust to keep building on the good progress that it has made so far. It is important for the local NHS to be supported in that work to secure safe, high-quality patient care.

[Mr Reed]

Will the Minister explain why mortality rates increased sharply immediately after the summer of 2010?

[Dr Poulter]

I do not have the local knowledge that would enable me to understand why that happened, but what is important is the need for action to be taken in cases in which there is a history of higher than expected standardised mortality rates—cases in which patients have died when they should not have died. That is why the Government asked Sir Bruce Keogh to investigate this trust, and, indeed, many other trusts, as a result of which some were put into special measures.

Although a number of challenges remain, and the trust must address them, it appears to be making good progress in terms of standardised mortality rates, which means that—as I said earlier—patients who might have died in the past are now surviving. That is testimony to the hard work of the trust’s front-line staff. I know that Members will be pleased, and that, more importantly, local patients and their families will be very grateful.

The subject of reconfiguration was raised. The issues affecting west Cumbria were discussed during a debate secured in 2012 by the hon. Member for Copeland (Mr Reed), and I know that the future of services at the hospital is a matter of continuing concern to both him and the hon. Member for Workington. As I said earlier, the local NHS is committed to ensuring that West Cumberland hospital has a viable and successful future, and that west Cumbrian patients continue to receive treatment there. That is why £95 million—£70 million of it from the Government—is being made available to improve its facilities. The money will allow it to offer 21st-century facilities, including seven new operating theatres, four of which will have full laminar flow, which will make them suitable for use in any operation. That will allow the hospital to offer a wide range of surgical services, and to become a centre of excellence for elective surgical procedures.

The hon. Member for Workington asked what excellence would be provided at the hospital. I can tell him that the investment in new facilities will allow patients to receive elective surgical procedures of a much higher quality, which will hugely benefit the local population. That investment is supported by additional investment in other local health care facilities, including, not far away, the new £11 million Cockermouth community hospital—which was officially opened in August 2014—and the new health centre at Cleator Moor.

Alongside the financial investment in the hospital, there are continuing efforts to attract and recruit new clinicians to North Cumbria University Hospitals NHS Trust. International recruitment campaigns have already taken place, and financial incentives are now available to support recruitment to the posts that are the most difficult to fill. That point arose earlier in the debate. Hospitals often have the flexibility to offer incentives in the event of recruitment challenges and difficulties, and I am pleased that the local trust is taking advantage of the opportunity to offer such incentives to attract new consultants and permanent staff.

To build on the progress that is already being made, clinicians are working towards changes that offer the best opportunities for better outcomes to be given to patients suffering from the most serious illnesses. No changes will take place unless there is clear clinical evidence that they will result in better outcomes.

Understandably, people have concerns when any change to local health care services is being discussed, but it is important that such concerns are not exploited for any political or other purpose, and that all changes that take place are in the best interests of local patients. The five-year plan for the local health service being developed by local doctors and clinical commissioners is looking at how services can be delivered safely and sustainably in the future. In developing the plan, I expect the local NHS to give important consideration to the distance patients need to travel to access services, particularly emergency services. As we have discussed, rural areas are very different from urban areas, and the distance patients may have to travel to access services is an important factor in determining what is safe for patients. Local commissioners need to take note of that.

[Mr Reed]

The Minister represents a rural constituency. Notwithstanding his medical expertise and knowledge, would he be happy for constituents of his who were in labour and showing complications to have to travel for more than 90 minutes, bed to bed?

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[Dr Poulter]

That actually may have to happen in my constituency, for example, in cases where my local hospital does not have the right support for a very premature baby in utero once it is born. Neonatal services are not always as well developed at every hospital, and some areas tend to have a regional centre of excellence for neonatal care. As the hon. Gentleman said, there may be a regional centre of excellence for cardiovascular services, heart surgery or other specialist services. We want to ensure that bread and butter, day-to-day medical services are always provided by local hospitals—that is particularly important in rural areas—but we have to ensure when taking these decisions that where there is a clinical case for better patient care to be delivered at a centre of excellence, that case is made and communicated effectively. So, for example, although I would want to ensure, as I have done, that in Suffolk patients are able to receive the best possible care from the local NHS, if they needed super-specialist services and other services that are better provided at a specialist centre, they receive that care from those centres. I have always advocated that important case on clinical grounds.

This is about seeking to provide high-quality day-to-day services, while recognising that some services have to be provided at specialist locations. So when dealing with the potential birth of a very premature baby, it is important that the right support after birth is available, and that is provided by more specialist neonatal intensive care units—for example, Brighton is a regional centre for the south of England for some of those services. It is also important that, where possible, an intrauterine transfer takes place to make sure that the right care is available upon birth and after delivery.

It is also important to stress that in designing and working through what the right patient services are, and in putting together the local five-year plan in Cumbria, certain guarantees and reassurances have been made to the local population. I spoke just now about important day-to-day medical services, and a commitment has been given that there will continue to be an accident and emergency department at West Cumberland hospital. That is part of what I was just speaking about: high-quality, immediate services available for patients in more rural and remote areas. An independent review is looking at maternity services across Cumbria and will feed into work locally to find the best possible solution to providing safe and sustainable maternity care in the future.

While the five-year plan outlines the direction of travel for the local health service, no definite proposals have yet been put forward, and work remains at an early stage. In developing its proposals, I expect the local NHS to ensure that patient safety is a key focus, and that any movement or change of services is based on clear clinical evidence of better outcomes for patients.

I wish to make some important points about public engagement, which was raised by both hon. Gentlemen. It is important that people who use NHS services get a say in any changes to those services. We are very clearly committed to that as a Government, and it is important that local clinical commissioning groups, and the doctors and nurses who run them, properly engage with the public when they are making the case for the future shape of local health care services. I encourage local patients to continue to engage with the NHS as plans for west Cumbria are developed.

I understand that Cumbria CCG has met local MPs and the local campaign group to discuss their concerns and is happy to maintain that dialogue and continue to meet to discuss issues of concern in the weeks and months ahead.

The local NHS held a period of engagement to inform the development of the five-year plan. Both the CCG and the trust are committed to undertaking more engagement and communication with local people in the coming months.

Any proposals put forward for significant changes to local health services will be subject to a full public consultation in which patient and public views can be fully engaged in helping to shape future health care services. That is an important reassurance to give Members. No decisions will be made without that full public consultation if and when any changes to services are proposed.

In conclusion, I know that local people care deeply about the future of West Cumberland hospital—that has come across clearly from the contributions this evening. The provision of health care services affects all members of the community. We have only to look at the example of 10-year-old Maddy Snell who last week received a reply from the Prime Minister to her letter about potential changes to local health care services to see how the whole community in west Cumbria wants to be involved in the future of its hospital.

Patients should keep up that engagement with the local NHS and make their opinions known to those developing proposals for the future of local health care services. I also want to encourage the people of Whitehaven to listen to the reasoning behind any proposals that their local doctors bring forward for improvements in the way in which people are cared for in the local area.

I should like to reiterate that local health services in west Cumbria have a strong future. There is a commitment from the local CCG, led by doctors and nurses, for a continuing accident and emergency service, and the Government support a £95 million investment in health care facilities at West Cumberland hospital.

[Mr Reed]

The Keogh report makes it very clear that meaningful engagement with the staff both at the Cumberland infirmary, Carlisle, and the West Cumberland hospital is nothing like it should be. That is one of the key reasons the trust entered special measures. All of us from all parts of the House want to see the hospital trust emerge from special measures as quickly as possible. However, latterly, that engagement internally has demonstrably worsened. How can we get out of special measures if these behaviours persist?

[Dr Poulter]

Part of the challenge may well be challenging some of the existing work practices at the hospital. I accept what the hon. Gentleman has said about the quality and commitment of local NHS staff. In my experience, I have never found a member of the NHS who has been engaged in health care with anything but the best intentions and the wish to help people. That is why I am a doctor and why many people go into health care; they want to provide compassionate care for people and to improve the human condition. I know that that is what drives local staff in Cumbria. Sometimes when profound issues have to be faced, such as higher than expected local mortality rates, challenging conversations have to take place. Such issues are the result of not a lack of commitment or dedication from the staff, but the fact that some working practices need to be improved. Additional training and support may need to be put in place to improve those working practices. It is important that that is done in a way that brings staff along in a collaborative working environment.

When things go wrong in health care, it is rare that there is one single causal factor, although sometimes there is; sometimes it is the negligent act of one person. Often, however, it is the system in a hospital that has let someone fall through the gaps. This is about challenging working practices, and as far as possible, that has to be done collaboratively. Clearly, there have been huge improvements in the way health care is delivered locally. Mortality rates have fallen, and patients are being looked after in the way we would all expect. That is down to the hard work of the staff who are facing up to some of the challenges, and making sure that they put right what may have been wrong.

It is important that when there are discussions about reconfiguring, changing or developing health care services, local clinical commissioners engage effectively with the hospital and properly with hospital staff. Part of the broader consultation and engagement exercise needs to be focused on proper engagement between the clinical commissioning group and the clinicians and other dedicated staff who work at the trust. From what hon. Members are saying, there may be more work to do in that area. I urge the clinical commissioning group to put right any issues, because it is important that everybody signs up to dealing with future challenges.

As I have said, I am confident in the local clinical commissioning group’s commitment to supporting a viable A and E at the hospital. The Government have provided investment to develop facilities further, particularly facilities for surgical procedures, in the hospital and the local area. With that investment, there is a strong future for local hospital services. It is important that local clinical commissioners continue to engage with staff at the trust, and particularly with local patients. After all, if we want a health service that is fit for purpose in Cumbria and elsewhere, it has to be based on the needs of local patients. It is to them, more than anybody else, that local commissioners need to listen.

Question put and agreed to.

NHS Litigation Authority (Triennial Review)

Dan Poulter Excerpts

Thursday 16th October 2014 Written Statements

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

I am today announcing that the Department of Health is commencing a triennial review of the NHS Litigation Authority. This review forms part of the first tranche of reviews to be announced this Session.

Triennial reviews of arms-length bodies are a key part of the Department’s stewardship and assurance of the health and care system, they also contribute to the Government’s wider programme of work on public bodies reform.

The review will consider the body’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.

I will announce the findings of the review later this year.

NHS Services (Access)

Dan Poulter Excerpts

Wednesday 15th October 2014 Commons Chamber

[Andy Burnham]

All the evidence from around the world tells us that more market-based health systems cost more than systems such as the NHS, and are more complex and fragmented. The clear conclusion I draw is that the market is not the answer to 21st-century health and care. The Government believe it is, which is why they must be defeated if we are to protect our national health service.

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

I hear what the right hon. Gentleman is saying. If he is concerned about other providers in the health service, will he explain why the previous Labour Government were happy to pay private sector providers 11% more than NHS providers for providing NHS services?

[Andy Burnham (Leigh) (Lab)]

We brought in other providers in a supporting role to add capacity to bring down NHS waiting lists to the lowest ever level. That is what the previous Government did. By contrast, this Government are doing something different. It is mandating tendering on GP commissioners, requiring people to compete, wasting money on running tenders and privatising the national health service, which is why they must be stopped.

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

It is a pleasure to conclude this debate and to speak to the contributions of hon. Friends and hon. Members. It is a pity that when we have NHS debates, they sometimes become unnecessarily tribal and partisan. Some Labour Members often seek to talk down the local NHS rather than to stand up for their hard-working NHS staff who deliver high-quality services on the ground.

I want to talk about some of the successes this Government have delivered for our NHS and then I shall address some of the points raised in the debate. We know that even in these difficult economic times, this Government have protected our NHS budget with £12.7 billion more during this Parliament. That was something that the shadow Secretary of State, the right hon. Member for Leigh (Andy Burnham) called “irresponsible”, but it is not irresponsible to make sure that we continue to support and protect the NHS front line. We have stripped out over £5 billion-worth of bureaucracy and reinvested that money into front-line patient care. That has been audited by the National Audit Office, but the hon. Member for Leicester West (Liz Kendall) did not choose to highlight that point in her remarks. It has been confirmed and we know it is true.

I make no apology for the fact that we as a Government have focused ruthlessly on having a more efficient health service that frees up as much money as possible for front-line patient care. We have reduced the number of administrative staff by around 20,000, increased front-line clinical staff by over 12,500 and set up a cancer drugs fund that has helped 55,000 people who would not have received cancer drugs to receive them. There has been an unrelenting focus on promoting a more joined-up approach to care, to help deliver more care in the community for people with long-term medical conditions, particularly the frail elderly.

Let me deal with some of the comments and contributions to the debate. I would like to reassure my hon. Friend the Member for Morecambe and Lunesdale (David Morris) that the hospital in his constituency is, of course, not going to close and that any local scaremongering by the Labour party is wrong and misplaced. I would also like to reassure the hon. Member for North Durham (Mr Jones), who raised concerns about the north-east ambulance service, that the service has generally been performing well. In 2013-14, it met all its national targets. I urge the hon. Gentleman to write to me if he has any further concerns on behalf of local patients.

We heard strong contributions from my hon. Friend the Member for Norwich North (Chloe Smith), who made important remarks about the services delivered at the Norfolk and Norwich hospital, and I look forward to accepting her invitation to visit that hospital once again in the near future, and from my hon. Friend the Member for Bosworth (David Tredinnick) who made one of his regular pleas for more alternative medicine in the NHS. Importantly, he talked about the benefits of clinically driven commissioning. Under this Government, we have put doctors and nurses in charge of our NHS to make sure that services are delivered at local level. Patient services are run by doctors and nurses, not by bureaucrats, which has been a tremendous step forward. My hon. Friend the Member for St Ives (Andrew George) made a considered contribution about the previous Government’s record on encouraging private sector providers in the NHS—a point to which I shall return.

[Lilian Greenwood]

What does the Minister think about what happened to the clinical commissioning group in North Staffordshire, which decided not to allow people with mild to moderate hearing loss to have hearing aids, even though that was clearly not the view of the local health scrutiny committees or local patients? Is that not precisely putting in jeopardy preventive services, which would keep people in work and keep them active in the community rather than being isolated? It is stopping those people from participating.

[Dr Poulter]

If the hon. Lady has concerns about local commissioning decisions, she should take them up with local commissioners. Time forbids me from going into the rationing of services by the previous Labour Government. It is important that clinical services are now designed and delivered by front-line health care professionals, and if she is concerned about them, I am sure she will take that up with her local CCG.

The right hon. Member for Leigh (Andy Burnham) referred to a work force crisis in GP training. It is clear that under this Government 1,000 more GPs are now in training and working in the NHS than in 2010 when we came into government. If it is not accepted that that is good start, we have committed to training an extra 5,000 because we want more people working in general practice.

We have ensured that 1.3 million more people are being treated in A and E compared with the number in 2009-10. We have halved the time that people must wait to be assessed, and every day we are treating nearly 2,000 more people within the four-hour target compared with the number in 2010.

Competition was introduced into the NHS not by the Health and Social Care Act 2012 but by the previous Labour Government, of whom the right hon. Member for Leigh was a Minister. The Labour Government opened the door to private sector providers when they opened the first independent sector treatment centres in 2003. The Labour Government gave £250 million to private companies and independent sector treatment centres, regardless of whether they delivered that care. Labour was more concerned about giving money to the private centres than about ensuring that quality care was delivered. Labour paid independent private sector providers 11% more to provide the same care as NHS providers. That is Labour’s record on the private sector in the NHS—a record that shows that it is more committed to the private sector than any previous Conservative Government.

[Kevin Barron]

If that is the case, will the Minister—as a Back Bencher, he sat on the Health Committee—tell us why there were so many clauses in the Bill that introduced the Competition Commission and the Office of Fair Trading into our national health service?

[Dr Poulter]

The right hon. Member will be aware that Labour’s legislation, which gave the private sector the opportunity to tender for contracts, saw 5% of NHS activity—I believe that figure is correct—provided by the private sector at the end of the last Labour Government. In the Health and Social Care Bill, we wanted to stop the unregulated approach. We wanted greater emphasis on integration of health care services. It was not just about the private sector provider fixing someone’s hip and forgetting what sort of care was available when their hip had been repaired and they had gone home. It was about ensuring greater emphasis not just on competition and what was best for patients, but on integrated and joined-up services to ensure that people were properly looked after when they left a treatment centre. We stopped the cherry-picking of services that happened under Labour, and we are proud of that.

We will take no lessons from the Labour party on NHS finances. Labour was the party that crippled the finances of so many NHS trusts with PFI deals, and it was the party that during its final year in government saw the number of managers rise six times as fast as the number of nurses.

I am proud of this Government’s record on the NHS and I am proud of our record on integration. There will be a clear choice at the general election next year: a Conservative-led Government who have delivered for patients, a Conservative-led Government who have delivered on cancer services and a cancer drugs fund, and a Conservative-led Government who will continue to ensure better care for people with long-term medical conditions. We have a proud record on the NHS and I urge my right hon. and hon. Friends to oppose the motion.

Question put.

Health

Dan Poulter Excerpts

Tuesday 14th October 2014 Ministerial Corrections

[Gloria De Piero]

To ask the Secretary of State for Health how many training posts for nurses were commissioned in England in each of the last five years.

[Official Report, 7 May 2014, Vol. 580, c. 241-43W.]

Letter of correction from Dr Poulter:

An error has been identified in the written answer given to the hon. Member for Ashfield (Gloria De Piero) on 7 May 2014.

The full answer given was as follows:

[Dr Poulter]

The following table shows the number of new pre-registration nursing places that were filled in the last five years. The table includes the students enrolled on the degree and diploma courses.

[Dr Poulter]

The following table shows the number of new pre-registration nursing places that were filled in the last five years. The table includes the students enrolled on the degree and diploma courses.

Hospital Car Parking Charges

Dan Poulter Excerpts

Monday 1st September 2014 Commons Chamber

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

I would like to begin by congratulating my hon. Friend the Member for Harlow (Robert Halfon) on securing this debate and my hon. Friend the Member for Thurrock (Jackie Doyle-Price) on her opening speech, which outlined a number of the key issues, about which we are all concerned and to which a number of Members have referred. I understand and have listened to the concerns expressed, both in this House and by the public more generally, about car parking in our NHS, especially where the cost is high and can be considered a rip-off for patients, their families and, sometimes, NHS staff. That is why we published the new NHS patient, visitor and staff car parking principles last month, which will lead to new guidelines at the beginning of next year.

Before I address those principles and respond in more detail to some of the points raised, it is important to pick up on the key issue that has been outlined—my hon. Friend the Member for Thurrock raised it in her opening remarks—which is that, for a patient, driving to hospital is not a choice; it is essential in order to receive important and, often, life-saving treatment. It is also important for relatives and those wishing to support and look after friends and others who may be admitted to hospital through no fault of their own. It is right to say, as my hon. Friend did, that Basildon was a challenged trust, but addressing the challenges of that trust, both financial and in terms of patient care, should not come at the expense of short-changing patients. There are many other measures that trusts need to look to—such as improving their procurement practices, better managing the NHS estate and, in the long term, lowering costs by reducing their dependence on temporary staffing—to balance their books and ensure that as much money as possible is directed to front-line patient care.

My right hon. Friend the Member for Sutton and Cheam (Paul Burstow) made a number of important points, including the key one that car parking should not be a cash cow and needs to be seen in the context of the wider sustainability challenge of the NHS, and that many trusts are still paying the price for poor PFI deals that they signed up to under the previous Government. He also asked what role the CQC could play in addressing the issue if parking charges were prohibitive. Of course there is a role for the CQC. If concerns were raised about patients being prevented from accessing the NHS care they needed as a result of prohibitive car parking charges, the CQC could of course make recommendations and raise that with the trust as part of its inspection regime. The power for the CQC to do that exists at the moment, and I am sure the chief inspector of hospitals will be mindful of that as part of the inspection regime.

We had many other good and important contributions, including from my hon. Friends the Members for Harrow East (Bob Blackman) and for Harlow, who spoke very eloquently and outlined clearly the reasons for calling this debate. We also heard from my hon. Friends the Members for Peterborough (Mr Jackson), for South Derbyshire (Heather Wheeler), for Worcester (Mr Walker) and for Hexham (Guy Opperman), all of whom spoke eloquently. In the time available to me, I will do my best to pick up on some of their points in my broader remarks.

We talk about the fact that there are many examples of unacceptable practice in hospital car parking, but it is important to highlight the fact that 40% of hospitals that provide car parking do not charge and of those that do, 88% provide concessions to patients. However, I am aware that there are 40 hospital sites—which is 3.6% of hospitals in acute and mental health trusts—that have charges and do not allow concessions to patients who need to access services. As a Government, we want to see greater clarity and consistency for patients and their friends and relatives about which groups of patients and members of staff should receive concessions and get a fairer deal when it comes to car parking. It is exactly for those reasons that we published the principles that will underpin the guidance that will be published in February or March next year about how we deliver fairer car parking charges, of which all trusts will be expected to be mindful.

I want briefly to outline some of the key points in that guidance. We want to see concessions, including free or reduced charges or caps for the following groups: disabled people, frequent out-patient attenders, visitors with relatives who are gravely ill, visitors to relatives who have an extended stay in hospital, and staff working shifts that mean that public transport cannot be used. Other concessions—for example, for volunteers or staff who car share—should be considered locally. The list I have given is not exhaustive—we will return to it as part of the guidance we produce early next year—but it is important that we have much greater consistency and clarity from all hospitals about which groups should receive parking concessions and free parking when that is appropriate.

[Mr Frank Field]

It is quite clear that the Government have a model in mind of the minimum standards that hospitals should subscribe to, which is welcome. Will the next round of consultations that the Government undertake with hospital trusts outline what will happen to those that pay scant regard to what the Government are suggesting?

[Dr Poulter]

It is exactly because a small minority of hospital sites have no concessions at the moment, which is unacceptable and not fair to patients—I outlined 40 such sites that I am aware of in acute and mental health trusts—that we brought forward the principles and are refreshing the guidance. We need to see hospitals respond to that guidance. Powers are already available to the CQC and the chief inspector of hospitals for the CQC to take action, if appropriate, if there is behaviour in a hospital that makes it prohibitive for patients to receive treatment. However, we also need to look at what other measures we can introduce against trusts that still show disregard for the guidelines, to make it clear that doing so is no longer acceptable. For example, mechanisms are available to us when we give finance to trusts to ensure greater conditionality on that finance in future.

That is something we would certainly look at seriously as a mechanism for enforcing better behaviour, but I am hopeful, thanks to the fact that we will have refreshed guidance and that many patient groups are championing this issue at the local level. My right hon. Friend the Member for Sutton and Cheam made the point articulately that patient action locally meant that St Helier hospital, which was one of the worst offenders for car parking charges and disregarding the rights of patients and staff, has reformed its ways. Patient action has led to improvements. A number of mechanisms are already in place and, with the guidelines, I am sure we will get to a much better place across all trusts. However, if necessary, we have other measures, when we are giving finance to trusts, to put levers in place.

[Mr Frank Field]

Does the inspector have powers to instruct the groups that will probably pay scant attention to the guidelines to make the changes that the whole House wants?

[Dr Poulter]

If concerns are raised as part of a care quality inspection that patients are receiving substandard care or not receiving the quality of care that they should be as a result of being unable to access services, there would of course be a role for the chief inspector of hospitals and the CQC to raise that as part of their inspection report. I am sure the chief inspector will bear that in mind for the 40 hospital sites that at the moment do not have concessions for those who are very unwell or who are disabled. I am sure that those trusts, which will be listening keenly to this debate, will bear that in mind and will want to take action, hopefully before the refreshed guidance is produced.

I know that time is pressing and I do not wish to detain the House much further, but I want quickly to outline a few of the other measures that are in place as part of the principles that will underpin the guidance, which hopefully will reassure right hon. and hon. Members that the Government have taken appropriate steps to address these issues.

Staff parking is an important issue. I probably speak as the only Member—currently, at least—who, as a practising hospital doctor, has genuine, first-hand experience of this issue. It is important to look after our front-line staff. Car parking in hospitals should not be allocated according to staff seniority or because someone happens to be a senior manager; it should be allocated according to the needs of staff and the type of care and shift patterns they provide. That is made very clear in the principles underpinning the guidance to be published.

On payments for hospital parking, our principles say that trusts should consider pay-on-exit or similar schemes, whereby drivers pay only for the time they have used, and fines should be imposed only where they are reasonable and should be waived when overstaying is beyond the driver’s control. Details of charges, concessions and penalties should be well publicised, including at car park entrances, wherever payment is made, including inside the hospital. The issue has been raised of the sharp practice sometimes carried out by the management of car parks in hospitals, and we have made it clear in the principles underpinning the guidance that those practices are unacceptable.

Finally, on contracted-out car parking—another issue raised in the debate—NHS organisations remain responsible for the actions of private contractors who run car parks on their behalf. NHS organisations are expected to act against rogue contractors in line with the relevant codes of practice, where applicable. Contracts should not be let out on any basis that incentivises fines—for example, income from penalties only. This Government expect hospitals to take action against contractors who behave irresponsibly, short-change people and behave badly towards patients, their relatives and staff.

I hope that I have reassured the House, particularly those who brought this debate before us today, that this Government take the issue very seriously and believe that unacceptable behaviour by hospitals and unacceptable hospital car parking charges will become things of the past.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 15th July 2014 Commons Chamber

[Philip Davies (Shipley) (Con)]

7. What lessons his Department has learned from the Born in Bradford research study.

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

By tracking the lives of 13,500 children and their families, the Born in Bradford research study is providing information that will help us to understand the causes of common childhood illnesses, and to explore the mental and social development of a new generation.

[Philip Davies]

In the Born in Bradford study, 63% of Pakistani mothers are married to cousins, and within that group there was a doubling of the risk of a baby being born with a congenital anomaly. The report also found that “a larger number” of children born to cousins

“will have health problems that may lead to death, or long term illness for the baby.”

How much do health issues related to first-cousin marriages cost the NHS, and, given those findings, is it not time that such marriages were outlawed?

[Dr Poulter]

We do not have any financial information, but it is important to point out that the Born in Bradford study showed that there was an increase in the risk of birth defects from 3% to 6% in consanguineous marriages. However, that clearly highlights that not all babies born to couples who are related have a genetic problem, and the key issue is to help women to make an informed choice before they get pregnant and to direct them to genetic counselling where that may be required.

[Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab)]

8. What the new deadline will be for moving people with a learning disability out of assessment and treatment units and into community provision.

--- Later in debate ---

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

12. What recent advice he has received on NHS trust deficits in England.

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

We have regular conversations with the NHS Trust Development Authority and Monitor about the provider sector. For 2014-15, the TDA, NHS England and Monitor are establishing a joint package of support and financial improvement measures for some of the weakest local health economies.

[Mr Brown]

Even if the Department were able to achieve every possible efficiency saving, both Monitor and the King’s Fund are forecasting a substantial deficit in next year’s budget. What is the Department’s policy response to that? I understood that the Secretary of State ruled out charging in answer to an earlier question, so that leaves either applying more money to the problem or restricting the service.

[Dr Poulter]

The right hon. Gentleman asks a valid question about how to make efficiency savings. Under the previous Government, there was a requirement in 2009 to make £20 billion of NHS efficiency savings during this Parliament, which is being delivered at £4 billion a year. Improving procurement practice at hospitals, improving estate management, greater energy efficiency measures, ensuring more shared business services in the back office and reducing bureaucracy are all measures that will continue to ensure that the NHS meets the challenge and frees up more money for front-line patient care.

[Jeremy Lefroy (Stafford) (Con)]

Stafford hospital has struggled with deficits for many years, but it has substantially improved its care. On Friday, however, it was announced that 58 beds will be closed due to staff shortages. My constituents and others are extremely concerned that the trust special administrator’s plans, which the Secretary of State endorsed, to keep A and E, acute medicine and many other services at Stafford are at risk. Will the Minister reassure them and staff that that is absolutely not the case and that the TSA’s plans will be enacted as a minimum?

[Dr Poulter]

The most important thing in delivering local services is to ensure high-quality patient care and patient safety, so I would want the TSA’s plans to be delivered as quickly as possible to ensure that high-quality services are delivered locally and that patients’ best interests are protected.

[Jesse Norman (Hereford and South Herefordshire) (Con)]

13. What steps he is taking to improve care for people affected by stroke.

--- Later in debate ---

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

16. What assessment he has made of the adherence by NHS trusts and clinical commissioning groups to the healthy child programme (a) in general and (b) in respect of the provision of perinatal mental health services.

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

NHS England commissions the healthy child programme and the NHS England mandate includes an objective to reduce the incidence and impact of post-natal depression. NHS England is held to account through its regular assurance processes and we are well on track to deliver an additional 4,200 health visitors by 2015 who will provide individual one-to-one support for women in the post-natal period.

[Mrs Hodgson]

The National Childbirth Trust found that just 3% of clinical commissioning groups have strategies to provide these services and 60% have no plans to put them in place at all. The Minister might be aware that the all-party group on conception to age two, superbly chaired by the hon. Member for East Worthing and Shoreham (Tim Loughton), has recently announced an inquiry into factors affecting child development, with the first session last week considering this very issue. In advance of its conclusions, will the Minister give a pre-emptive guarantee that all expectant mothers will have access to perinatal mental health services and that it will not just depend on where they live?

[Dr Poulter]

The hon. Lady makes a very important point. We know the importance of good perinatal mental health not just for the mother but for the life chances of the child. That is very important if we are to ensure that we get the commissioning of maternity services right in the future. There is a commitment in the Health Education England mandate that by 2017 all maternity units will have specialist perinatal mental health staff available to support mums with perinatal mental health problems.

[James Duddridge (Rochford and Southend East) (Con)]

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

--- Later in debate ---

[Andrew Selous (South West Bedfordshire) (Con)]

T5. The Chavasse report on improving care for members of the armed services and veterans builds on the improvements that we have already made and has been welcomed by the Department of Health and indeed the Ministry of Defence. We owe it to our armed services to carry on making improvements to their care, so will the Minister encourage NHS England to look favourably on its recommendations?

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

My hon. Friend is right to highlight the importance of the Chavasse report. Its focus on improving care for veterans is warmly welcomed. There is a lot that we can work with to deliver better care and build on the specialist care centres already in place for veterans who have lost limbs and need prosthetic services and to provide additional support for veterans with mental health problems.

[Mr Speaker]

Mr George Mudie. Not here.

--- Later in debate ---

[Chris Bryant (Rhondda) (Lab)]

There is lots of evidence to show that chronic traumatic encephalopathy is now a major cause of depression, dementia and in many cases suicide, but the World cup showed that many sporting bodies are still not taking concussion seriously enough. Will the Minister, perhaps with colleagues in other Departments, bring in all the sporting bodies, the doctors and the teachers so that we can take concussion in sport seriously?

[Dr Poulter]

The hon. Gentleman makes a very good point. As we commission NHS services, it is increasingly important that there is more focus on sports injury and rehabilitation, not just in relation to our elite sports people, but in relation to those people who play sport regularly at weekends, to ensure that they are properly looked after. If it would be helpful, I am happy to meet the hon. Gentleman to discuss the matter further and see how we can take it forward.



BILLS PRESENTED

Protective Headgear for Cyclists Aged Fourteen Years and Under (Research) Bill





Presentation and First Reading (Standing Order No. 57)

Annette Brooke presented a Bill to require the Secretary of State to commission research into the merits of requiring cyclists aged fourteen years and under to wear protective headgear; to report to Parliament within six months of the research being completed; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 12 September, and to be printed (Bill 74).

Amenity Land (Adoption by Local Authorities) Bill

Presentation and First Reading (Standing Order No. 57)

Annette Brooke presented a Bill to amend section 215 of the Town and Country Planning Act 1990 to allow local authorities to adopt areas of amenity land which are unregistered or vested in the Crown, for the purposes of maintenance; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 12 September, and to be printed (Bill 75).

Sugar in Food and Drinks Bill



Presentation and First Reading (Standing Order No. 57)

Geraint Davies, supported by Jeremy Lefroy, Mr Mark Williams, Mrs Madeleine Moon, Mrs Linda Riordan and Dr Julian Lewis, presented a Bill to require the Secretary of State to set targets for sugar content in food and drinks; to provide that sugar content on food and drink labelling be represented in terms of the number of teaspoonfuls of sugar; to provide for standards of information provision in advertising of food and drinks; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 7 November, and to be printed (Bill 76).

Severe Eating Disorders (North-East England)

Dan Poulter Excerpts

Monday 23rd June 2014 Commons Chamber

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

I congratulate the hon. Member for Newcastle upon Tyne Central (Chi Onwurah) on securing the debate and not only raising important issues about the provision of services for people with eating disorders in her constituency, but doing so in the context of an important national debate, because many of us are aware that there has not always been a genuine parity of esteem between mental and physical health. If we are to have a holistic health service that focuses on better supporting people in their own communities, mental health will play an important part. In the north-east and elsewhere, it is vital that we try, in the first instance, to prevent people who have anorexia or other eating disorders from becoming so unwell that they need to be admitted as in-patients. That clear priority is not mutually exclusive to this debate, because it is clearly what good medicine and health care—whether for physical or mental health—is all about.

Eating disorders mainly affect young people, and I shall say a little about that as I address the specific concerns in the north-east that the hon. Lady outlined. Anorexia particularly affects women under the age of 25, from the early teens onwards. Research tells us that there might be more than 1 million people in the UK who are directly affected by an eating disorder.

Worse still, as the hon. Lady highlighted, anorexia kills more people than any other mental health condition, and the longer a patient is unwell with anorexia, the more likely the condition is to be fatal. Even before people begin to lose weight, they are failing to put on the bone mass that will sustain them as adults, and the disease is linked to osteoporosis and other conditions in later life associated with bone fracture. As the disease progresses, it becomes life threatening, particularly due to the muscle wasting that occurs to the internal organs, especially the heart. There can come a point, sometimes quite quickly, when as muscle mass deteriorates, it is lost preferentially from the heart. That increases the risk of heart attacks, which can often, tragically, be the cause of death in such cases.

We are also aware that eating disorders afflict young women at perhaps the most formative period of their lives. The peak age of onset of anorexia is 15. For bulimia it is two or three years later. On average, people with anorexia will recover, if they recover at all, after about six years of care. That highlights the importance of good out-patient services in delivering better care. If we can stop people getting to the stage where they become so unwell with anorexia, with better support through talking therapies and other interventions as part of good community-based care, that is a clear priority for mental health services and one that commissioners are taking very seriously in the hon. Lady’s part of the country, as she outlined.

Eating disorders span the transition between child and adolescent and adult services. This has sometimes led to unacceptable variations in care and fragmented services, as we heard. So how do we deal with this? Early diagnosis is key. We have to make sure that treatment is available to minimise the effect of these distressing conditions. But alongside this, and perhaps before this, we need to attack the causes as well. Eating disorders are often blamed on the social pressure to be thin, as young people in particular feel they should look a certain way. In reality, the causes are much more complex than that.

There are several risk factors—having a family history of eating disorders; depression or substance misuse; being criticised for eating habits, body shape or weight; being overly concerned with being slim, particularly if combined with pressure to be slim from society or for a job; and having an obsessive personality or an anxiety disorder. Other key causes of eating disorders are sexual or emotional abuse, the death of people who are close and other stressful situations. There are also issues specific to particular eating disorders, which I will not go into today. There are clear differences between anorexia, bulimia and binge eating disorder. Binge eating disorder has the added complication of the binge eating cycle, leading to increased blood sugar and potential links to diabetes.

It is important that such disorders are not looked at in the context of the mental health service in isolation. When we know that the cause of death may often be due to cardiac arrest in the case of anorexia, and when we know that there may be links between binge eating disorder and diabetes, it is important that an holistic approach is taken to the care of people who become very unwell. There is a link between the physical and the mental health services that are available to patients, and I know from conversations that local commissioners are looking at that in the way they deliver care.

Last year, the Home Office launched a report of its body image campaign, which highlighted the need to ensure that young people have healthier and happier futures where a wider spectrum of healthy male and female body shapes is represented. I am sure we would all support that.

I assure the hon. Lady that children and young people’s mental health, particularly in the north-east, is a priority for the Government. That is why we have invested £54 million in the four-year period from 2011 to 2015 in the children and young people’s improving access to psychological therapies programme, or children and young people’s IAPT services. This provides training in a number of evidence-based psychological therapies, not just the more common cognitive behavioural therapy or CBT, but systemic family therapy and interpersonal psychotherapy.

Given the complexity of the causes of eating disorders, that more holistic basis to the way that children and young people’s IAPT services work to get early intervention in place, and the £54 million supporting that deployment in the north-east and elsewhere, will, we hope, make a difference in the years ahead. We must recognise that we are coming from a baseline where there was no parity of esteem in terms of how the NHS prioritised eating disorders or how the NHS commissioned services for eating disorders. This investment in that early intervention will bring real improvements to the quality of care of people with eating disorders in the north-east and elsewhere. We know that early intervention is key. It is also important that we get a firmer understanding of the scientific basis and the research that underpins good treatment. The South London and Maudsley NHS Foundation Trust has conducted a £2 million programme of research specifically on the treatment of anorexia, which will improve treatment and care throughout the country.

In the north-east, child and adolescent mental health services have been transformed by the introduction of the children and young people’s IAPT services, which I outlined earlier, in the areas covered by three CCGs, namely Teesside, Newcastle, Hartlepool, Middlesbrough and Easington. Between them, they commission CAMH services for 61% of young people in the region already under other CCGs, and the other CCGs have agreed to follow them. Steps are being made in early intervention, in providing better support for people with eating disorders in the north-east.

[Tessa Munt (Wells) (LD)]

I recognise the similarities between what is happening in the north-east and in the south-west. We have young people being discharged from services when they reach the 18-week threshold or because they have reached a body mass index of 18, yet the Minister has accepted that this is a complex condition which sometimes takes five or six years to recover from.

[Dr Poulter]

That is absolutely right, and it is important that there is a strong link between what happens in the community and what happens at the specialist centre. We know that there are advantages to commissioning specialist beds for eating disorders. We know that there is good evidence supporting the fact that that delivers better care for patients. But it is important that there is a strong link between that and what happens to the patient and the young person when they are discharged from that care, and that there is proper support in the community for those people afterwards. That is what will be supplied in this context by the newly commissioned services at Benfield House, which specifically focuses on providing high-quality day services and real support for young people and their families.

[Chi Onwurah]

I considered the importance of continuity of care and the unique nature of in-patient care requirements, and the Richardson unit had both out-patients and in-patients, and that continuity of care was very important. Please will the Minister address the issue of the Richardson unit?

[Dr Poulter]

In the brief time available to me now, I will come on to the Richardson unit specifically. The hon. Lady outlined the decisions made in 2010 and why they were made. We must recognise that under the criteria brought in by this Government, there are now strengthened criteria for public engagement in future decisions about commissioning. In future, they will have to be clinically led by local clinicians and made on the basis of strong public engagement. I would hope that those decisions would not necessarily have been taken in the same way had they been made under the criteria introduced by this Government.

I invite the hon. Lady to have a further meeting with the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), when she will be able to raise more of those concerns with him directly, but it is important to recognise that there is now a change in the way in which consultations are carried out. That was not there at the time, and that is part of the reason why there was not the transparency that the hon. Lady wanted and desired; transparency that we would all find desirable, but unfortunately the criteria were laid down by the previous Government. People often felt done to, rather than done for and cared for. That is why we have changed and improved the criteria.

As well as offering that meeting with my hon. Friend, I want to say that it is completely unacceptable for patients to be travelling long distances for their treatment and care at specialist centres and units. That is not good health care. We know that part of the recovery for people with eating disorders is having a community-based package where there is a strong link with family support. On the basis of that, my hon. Friend and I will raise with NHS England the specific issues arising from this debate, and I would also like the hon. Lady to meet my hon. Friend to discuss this further. I hope she finds that reassuring, and that she also finds reassuring the important early intervention measures that have been put in place in her constituency.

Question put and agreed to.

Localised Health Care

Dan Poulter Excerpts

Wednesday 11th June 2014 Commons Chamber

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

I pay tribute to my hon. Friend the Member for North East Cambridgeshire (Stephen Barclay) for securing the debate and for his strong advocacy on behalf of his constituents and local patients. As he has continually reminded the House since his arrival here—I arrived at the same time—we, as a coalition Government, understand the importance of spending public money wisely and investing every possible penny in front-line patient care.

My hon. Friend raised a number of points, and I did not disagree with a word of what he said. In particular, he was right to emphasise the need for a radical transformation of the way in which we deliver care over the next five to 10 years. We need to deliver more care in the community, closer to people’s homes. It is a question not just of good health care economics, but of good patient care. It is right for people with complex care needs—people with diabetes, dementia and cancer—to be cared for as close to home as possible. That requirement is all the more acute and important in some of our more rural communities, such as my hon. Friend’s constituency in the fens.

We should bear in mind the challenge laid down by the former chief executive of the NHS and echoed by the current chief executive, Simon Stevens. We must ensure that we spend the NHS budget more wisely, and direct more money to front-line patient care. There have been real-terms increases in the budget, and, as a coalition, we are all proud of the fact that we are investing more money in the NHS even in difficult economic times. Nevertheless, we must ensure that that money is spent more wisely, and that the way in which care is delivered continues to become more efficient. We have an ageing demographic, and the effects of that are often experienced more acutely in rural areas. Our technology is continually improving, and patients rightly have rising expectations of the quality of care that they will receive. We must therefore ensure that we deliver care more effectively, and in a more patient-centred way.

To meet that challenge, more needs to be done on NHS procurement at local and national levels, as my hon. Friend highlighted. The Government support that. We need to do more in the health service to ensure that we reduce unnecessary administration and bureaucratic costs and back-office services. He highlighted that as a challenge for his local health economy.

It is crucial that we transform the way we deliver care. That means breaking down silos in Cambridgeshire and elsewhere, particularly between the hospital sector—Addenbrooke’s and Peterborough city hospital, for example—and the health care that is commissioned and delivered in the community by CCGs. That also applies to the social care sector run by the local authority. It is important that Cambridgeshire county council—my hon. Friend outlined the challenges—plays a key role in helping to transform the ways in which services are delivered. Sometimes, it will not be possible to decide whether an elderly and frail person in Cambridgeshire should receive care that is provided by social services or by the NHS. It is the same person; it is the same patient, and it is time that local authorities and the NHS dropped the silo working mentality, worked together and focused the money and attention on the patient. The better care fund that the Government are setting up will come into force next year. That will provide about £3.8 billion specifically to promote better integration of health and social care. I am sure that will be of great benefit in Cambridgeshire, including in the rural communities that my hon. Friend represents.

From an NHS perspective, there are three components to transforming the way services are delivered and to breaking down those silos. It is important we have the right leadership on the ground to deliver improvements. I know as a fellow east of England MP that we have had challenges sometimes in that regard. We need the right leaders to drive change. My hon. Friend was right to highlight that the changes under the Health and Social Care Act mean that we have clinical leadership through CCGs. That will bring benefits because decisions and resource allocations are being made by clinicians who understand where the money is best spent to improve patient care.

We also need the leadership from NHS England teams at an area level to be effective. I hope that my hon. Friend will agree that all MPs in Cambridgeshire and elsewhere need to hold those local area teams to account. We need to ensure that they are working to do their bit to support the clinical leadership on the ground at CCG level.

Hospital providers at Addenbrooke’s, Peterborough city hospital and elsewhere need to come together and work with the CCGs to deliver care. When we talk about delivering care in the community, one of the key aspects is having a work force who work across hospitals and the community—across both primary and secondary care. Far too often, a work force who work in, say, cancer services are based just in the hospital. In commissioning services, we need to recognise that the work force need to be commissioned across primary and secondary care. One example would be to have more specialist nurses in diabetes who not only work at the hospital base but are commissioned across the community. It is important to ensure that my hon. Friend’s CCGs work with the hospital provider, particularly Addenbrooke’s, a centre of international excellence, to deliver more holistic care for people with long-term conditions, and that the work force are not just based in the hospital but go out to where the patients are in the community. That is key to delivering improvements in care.

I want to highlight some of the important local issues that my hon. Friend has raised. I was pleased to hear him make the point about the St George’s surgery and that chemotherapy services are being delivered in the community. His constituents should be proud that they have a GP surgery that is delivering that sort of care in the community. Some of the sickest people, who often struggle to travel to hospitals, are being looked after close to home and receiving high-quality care in the local GP surgery. That sort of care needs to be regularly offered in the next five to 10 years in many more GP surgeries—not as an exemplar, but as a regular example of what good practice and good health care looks like. That is transforming services and delivering more care in the community. My hon. Friend should be very proud of the part he has played in helping to make that a reality, and proud of the fact that his constituents have a service many other people will be looking forward to having in the future.

We must also have the right preventive care so that people who do not need to go to hospital do not go there. My hon. Friend talked about intravenous therapy. Someone with an infection from a leg ulcer, for instance, who will need IV antibiotics could be given them in the community. Traditionally those patients have ended up in hospital not because that is the right place for them to be, but because the care in the community to provide IV antibiotic therapy was not available. That is not good for patients, nor is it good health care economics—it is expensive for the NHS. That is exactly the sort of service older people with complex care needs require, particularly in rural communities. I know my hon. Friend’s CCGs will want to prioritise that in the months ahead.

My hon. Friend highlighted the importance of having close-to-home blood testing facilities. Many older people may be on warfarin for atrial fibrillation or other medical conditions. It is important that for that, and other simple blood tests, the person is treated and looked after close to home by their general practice. In rural areas, particularly in Cambridgeshire and Suffolk, where my constituency is, the GP surgery is often the hub of care, so the more we can do to provide care in those environments and close to home, the better it will be for patients.

We will also find that more patients will turn up for their appointments. One of the major causes of non-attendance at appointments in rural areas is that frail older people struggle to get to where the care is. If that care is delivered by their GP much closer to home, that saves the health service money and makes those services much more accessible. Every general practice should be offering simple services such as blood testing and supporting patients with the management of warfarin. I am pleased my hon. Friend will be championing a campaign to make this a reality throughout Cambridgeshire.

If we are to deliver better services in the community, we must have the right training in place for our work force. We need to have a work force who have the right skills to look after people with complex care needs. Under our health care reforms, we now have Health Education England, with a £5 billion budget. At a local level there are now local education and training boards, which are responsible for delivering the right sort of training to staff in each locality. A particular priority for the local education training board in the east of England is recognising the rurality of places such as Cambridgeshire and making sure there is specialist training in dementia and other care areas that addresses the needs of rural communities and ensures that people can be treated close to home. We must have the staff with the right skills to make sure that that happens.

In that respect, there will be more specialist training for GPs in mental health and children’s health care. Much of GPs’ work load is in those areas, and it is extraordinary that in the past not all GPs have had the right training. Thanks to the changes we have made through the mandate to HEE, in future we will ensure not only that there are bespoke courses for GPs to specialise in these areas, but that the whole skill set of all GPs going through training is improved to provide better community-based care. That will bring benefits to my hon. Friend’s constituents.

My hon. Friend is right that the NHS has received real-terms increases in funding in this Parliament, and we are proud to have delivered that. Every CCG, including in Cambridgeshire, will be receiving increased funding. I can understand the frustration that perhaps the progress on changing the funding formula in accordance with the independent review findings has not been as quick as some of us representing more rural communities would have liked, but that is moving in the right direction. The funding formula is now set independently, away from political interference, and according much more to health care need rather than political drivers Ministers or others may set. We will see a funding formula that will be allocated much more in line with local health care needs, but NHS England will have an opportunity again this year to examine rurality as a factor in allocating the funding formula.

I hope my hon. Friend is reassured by some of the points I have made. More importantly, what has come from this debate is that we have seen that he is a champion for the local NHS and for local patients. In his work on the Public Accounts Committee, not only does he recognise the importance of spending taxpayers’ money wisely and putting money into front-line patient care, but he understands the long-term challenges involved in transforming care. We need much more collaboration between different GP surgeries. Local commissioners need to lead that, we need more back-office sharing to reduce costs in GP surgeries, and we need better management of estates. We recognise that many GPs are small businesses in their own right, but small businesses may need to work together in a publicly funded health service to realise economies and free up more money to deliver better patient care; and we need to invest in telehealth, telemedicine and the right technology to support people with long-term conditions at home.

We also need to ensure that the better care fund that comes into effect next year is used effectively to join up what social services do with the NHS, to focus more attention on the patient and to break down the historical silos between the NHS and social care. We also need to ensure that commissioners, involved in clinically led commissioning, drive this process. They need to challenge other commissioners to do the right thing and make sure that patients are always at the centre of what happens. That is the objective, it is what needs to happen, and I know that my hon. Friend will be championing the cause locally. The goal is there and I know that he will be at the heart of the debate locally to break down those silos and to transform radically the way care is delivered, because he cares about his local patients, and I know that his local clinical commissioning groups do too.

There will be different ways of doing things in future, but they will of course be to the benefit of patients. I am delighted that he is championing this agenda, and he can count on my full support and the support of the Government in taking it forward. Once again, I congratulate him on securing this debate and on the leadership he is showing to support his local NHS in delivering better care for patients.

Question put and agreed to.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 10th June 2014 Commons Chamber

[Graeme Morrice (Livingston) (Lab)]

2. If he will commission a review of the safety of polypropylene transvaginal mesh implants.

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

The Department of Health, NHS England and the Medicines and Healthcare Products Regulatory Agency—the MHRA—have been working collaboratively with the clinical community to address the serious concerns that have been raised about transvaginal mesh implants. A working group, chaired by NHS England, has been set up to identify ways to address them. The group will also have patient representation.

[Graeme Morrice]

Last week, I attended the Scottish Parliament’s Public Petitions Committee to hear from and support women who have suffered from the horrific adverse effects of mesh implants. Women spoke from wheelchairs or on crutches and were in constant pain. They could not possibly have been told about the risks of TVM implants because there are simply no accurate data available. Will the Minister or the Secretary of State meet me and mesh campaigners from across the country, so that they can fully understand the urgency of the situation and the kind of action that is required to end this scandal once and for all?

[Dr Poulter]

I would be very happy to meet the hon. Gentleman. It is important to note that work is under way to collect better data on urogynaecological procedures generally and on mesh implants, because the complications that occur post-surgery are often multifactorial. An NHS England-funded audit on urogynaecological procedures for stress urinary incontinence is currently taking place, which covers all procedures, not just mesh implants. I am sure that we can discuss that and what the working group will do to review the procedures when we meet.

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

3. What progress his Department has made in introducing a cap on care costs.

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[Jason McCartney (Colne Valley) (Con)]

8. What steps his Department is taking to improve access to and standards of dental care.

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

Between May 2010 and December 2013, 1.5 million more patients were able to see an NHS dentist. We are committed to reforming the current contractual arrangements to promote improvement in oral health and to increase access to dentistry services.

[Jason McCartney]

What specific advice would the Minister give to my constituents who are trying really hard to access good quality, local dental care on the NHS?

[Dr Poulter]

A recent HealthWatch report highlighted this issue in west Yorkshire, where access to dental services has been a long-standing challenge. NHS England is looking at the financial arrangements in west Yorkshire and will report back soon. I am happy to meet my hon. Friend and representatives from the local NHS to take this issue further forward and ensure that local patients get the service they deserve.

[Michael Fabricant (Lichfield) (Con)]

9. What steps he is taking to ensure that whistleblowers in the NHS are protected from (a) dismissal and (b) other punitive measures by their employers.

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[Paul Blomfield (Sheffield Central) (Lab)]

11. What assessment he has made of the potential effect on health outcomes of phasing out minimum practice income guarantee funding from GP practices in England.

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

The minimum practice income guarantee payment is unfair because practices serving very similar populations are paid very different amounts per patient. The payments are being phased out over a seven-year period to allow practices time to adjust. The money released by doing this will be reinvested in the basic payments made to all general medical services practices, which are based on numbers of patients and key determinants of practice workload, such as the age and health needs of patients.

[Paul Blomfield]

The minimum practice income guarantee was introduced to meet the specific needs of specific practices. Those needs have not changed. NHS England has drawn up a list of 100 practices across the country that will be threatened by its withdrawal. Five are in Sheffield and two are in my constituency. Will the Minister give a guarantee that no practice will close as a result of the withdrawal of the minimum practice income guarantee, and will he provide the funding to achieve that?

[Dr Poulter]

The point is this: the funding system set up by the previous Government was based on historical funding and did not necessarily recognise the needs of patients. One practice might have been paid more for historical reasons than another practice next door that might have been treating more patients. That was unfair; we have changed it. NHS England is working at local level with practices that are, for whatever reason, in financial difficulties to make sure that it can help them get to the right place.

[George Freeman (Mid Norfolk) (Con)]

The GP practice in Watton in my constituency is struggling with the recruitment of GPs and is now two short, which is putting pressure on services. Today I heard of the proposal from NHS England to deregister 1,500 patients and transfer them to neighbouring practices in the constituency, raising a whole series of issues. Will the Minister agree to meet me to talk about what should happen, including whether NHS England could fund some sort of locum service?

[Dr Poulter]

Yes, I would be delighted to meet my hon. Friend. It is important to see, where possible, collaboration between GP practices on back-office services and other savings that could be made—something the public sector needs to do more generally so that more money can be invested in patients. The Government are training more GPs; in future, we will see 50% of postgraduate medical training taking place in general practice, leading to a big increase in the number of GPs.

[Mr Andy Slaughter (Hammersmith) (Lab)]

Will the Minister look at the decision by clinical commissioning groups in north-west London to move funding away—contrary to what NHS England has proposed—from GP practices and primary care in deprived areas such as Hammersmith to areas that have much better health outcomes?

[Dr Poulter]

I do not believe that that is the case. In looking at the changes, we need to factor in the point that the minimum practice income guarantee, which was a historical payment and not based on patient need or patient demand, is being phased out in order to achieve a more equitable solution. As a result, we can see that the global sum payments to GPs have risen from £66.25 per patient in 2013-14 to £73.56 per patient in 2014-15. Clearly, the global sum payment to GPs per patient has increased, which is a good thing for patients and the equitability of services.

[Miss Anne McIntosh (Thirsk and Malton) (Con)]

Historically, there used to be a payment for the distance GPs or their patients travelled. The removal of minimum practice income guarantee funding may make certain rural practices unviable. Will the Government address that issue, and will the Minister look particularly at rurality and sparsity in order to address what is a very real issue for rural GPs?

[Dr Poulter]

My hon. Friend makes a very good point, and we know that rural practices have unique challenges. The point is that because the money from the minimum practice income guarantee is going to be reinvested in a global sum payment, and because the global sum payment per practice is increasing, one of the key determinants of that payment is, in fact, rurality, so that should be of benefit to many rural practices.

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

The situation is far more urgent than the Minister’s complacent answer suggests. One practice in a deprived part of London has said that it is weeks away from laying off staff and just months away from closure. The Royal College of General Practitioners says that 1,700 practices could be affected, with over 12 million patients potentially facing even longer waits for appointments. Is it not the case that until we have a Labour Government, GP services are going to be marginalised and patients are going to face ever-longer waits?

[Dr Poulter]

I am afraid that the distance between the real world out there for patients and the Labour Government’s record is very clear. Under the Labour Government’s record on general practice, 20% of patients were routinely unable to get a GP appointment within 48 hours, and a quarter of patients who wanted to book an appointment more than 48 hours in advance could not get one. That was what happened under Labour; that is Labour’s commitment to general practice and GP patients. Under this Government, we are making sure that there is equality of finance per patient according to patient need, and that is how health care decisions should be made.

[Mr Speaker]

Order. I encourage the Minister to learn to provide more succinct answers. They are always too long.

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

T2. A Birmingham trust has recently announced that it will be possible to cut 1,000 beds across the city by setting a maximum stay of seven days for most patients. Not surprisingly, this has caused some alarm. Are Ministers aware of that proposal? What guidance, if any, can they offer in regard to such proposals?

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

As the hon. Gentleman will be aware, patients need to be treated according to clinical need, and bed stays should not be determined by anything other than that. So if what he describes is actually the case, it would be very disturbing. If he would like to raise the issue further with me, I would be happy to look into it for him.

[Jesse Norman (Hereford and South Herefordshire) (Con)]

T5. Like other rural communities, Herefordshire has long suffered from chronic underfunding in health care. Does the Secretary of State share my view that setting clinical commissioning group allocations should be an evidence-based process that takes into account factors including sparsity and old age? Also, will he ignore the calls from the shadow Health Secretary, who was seeking to cut the previous NHS allocations in areas such as Herefordshire?

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

T7. The Government can be rightly proud that there are fewer managers and more doctors in the NHS than in 2010. However, recent research by the TaxPayers Alliance shows that in the Greater East Midlands commissioning support unit more than £1 million a year is being spent on 26 administrative jobs of dubious value such as communications managers, communications officers, three communications and engagement leads, and two equality and diversity managers. The list goes on, Mr Speaker, but I will not. What further steps can my right hon. Friend take to ensure that the NHS budget is spent on front-line medical services?

[Dr Poulter]

My hon. Friend is right to highlight the fact that as much money as possible always needs to be put into front-line patient care. Under the previous Government, spending on managers and administrators more than doubled from £3 billion to £7 billion, and we have seen the number of administrators fall by 20,000. There is clearly work to do in his area, because as much money needs to go on front-line patient care as possible, and I hope that local commissioners will be looking to share back-office services as much as possible with other commissioning groups to reduce costs and put money into front-line patient care.

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

Earlier the Secretary of State and his Minister said that the minimum practice income guarantee was unfair. What is unfair is that so many practices in Hackney and east London are set to close, in an area where there is great deprivation. What are they going to do to make sure that patients still have practices to go to?

[Dr Poulter]

We have had this discussion. A payments system that is almost 20 years out of date and is not funding patients according to clinical need or is not per head of population will not deliver good care. The payments system needs to be changed and NHS England is working with practices that are facing challenges to address those challenges and ensure that high-quality patient care can still be delivered locally.

[David Rutley (Macclesfield) (Con)]

T8. Following the recent speech by the new NHS England chief executive Simon Stevens about the important role of local hospitals, can my right hon. Friend confirm that district general hospitals such as Macclesfield will continue to play a vital role in delivering local health services in the years to come?

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[Ian Swales (Redcar) (LD)]

T9. My constituent, Beth Charlton, recently lost her father to pancreatic cancer and notes that patients have only a 3% chance of surviving five years. That is much lower than the survival rates for other cancers and has not improved in 40 years. Will the Minister invest more in early detection and diagnosis of this silent killer?

[Dr Poulter]

Spending on health care research, including cancer research, has considerably increased under this Government, and much of that funding is allocated independently. It is important to note that pancreatic cancer is, as the hon. Gentleman says, a silent killer, because presentation is often very late in the disease process. Patients can present suddenly with painless jaundice and are often only three months away from death. It is therefore important that we look at the causes of pancreatic cancer and focus on primary prevention and on helping people to develop a healthy attitude to alcohol.

[Mr Dennis Skinner (Bolsover) (Lab)]

In the last hour I have heard the Secretary of State and his Ministers complain about the problems with A and Es; I have heard them talk about the problems with GPs; now we hear that they have lost control of care of the elderly. Instead of continuing to blame the last Labour Government of four years ago, why does the right hon. Gentleman not admit that the NHS is not safe in his hands? Let us have an election and get a Labour Government.

--- Later in debate ---

[Kerry McCarthy (Bristol East) (Lab)]

The Stitch project in Bristol has contacted me with concerns about the number of overdoses by people on prescription medication and suggested that allowing medication to be dispensed in instalments would be a better way of handling those vulnerable patients. I was disappointed in the response that I got from the Department, and I urge the Minister to think again on this issue.

[Dr Poulter]

I am very happy to meet the hon. Lady to discuss this further and see what we can do because it is important that the vulnerable patient groups she highlighted are looked after in the right way.

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

As he heralds an era of transparency, can the Secretary of State update us on what steps he has taken to ensure that private providers in the NHS are every bit as transparent and accountable as public ones?