GP Services (Tower Hamlets)

Dan Poulter Excerpts

Tuesday 13th May 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Streeter, for what I believe is now the third time, and to respond to this debate. I congratulate the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) not only on securing the debate but on his advocacy on behalf of local patients. We have discussed that before during meetings in my office in the Department on other issues. I am sure that my noble Friend Earl Howe will be happy to meet him, and I extend that invitation on my noble Friend’s behalf.

[Jim Fitzpatrick]

I apologise for intervening so early, but I do not remember having any meetings with the Minister in his office on any subject. I would not want to mislead the House, or for people to think that we had held meetings in which I had not raised this issue.

[Dr Poulter]

A congregation of MPs from London came to see me and I believed that the hon. Gentleman had been there, but I am obviously mistaken. I apologise for that mistake, but I can recall similar conversations in the past during meetings with other MPs from other parts of the country, in which we talked about not just GP services but other local health care services of a similar nature. During those meetings there was advocacy of similar strength to that which we have heard today.

Indeed, a previous debate in Westminster Hall, led by my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron), focused on the impact of the minimum practice income guarantee changes on more rural practices in his constituency. The topic has come to the fore for many hon. Members, who I know will wish to discuss it further with the relevant Minister. I therefore want to put on record a formal invitation to come and see my noble Friend Earl Howe to discuss the subject further at some point after this debate.

It may be helpful if I outline why the minimum practice income guarantee was set up in the first place and why it is important to change the payment structure for general practice. The minimum practice income guarantee is a top-up payment to some general medical services—GMS—practices. It was introduced as part of the 2004 GP contract to smooth transition to what were then new funding arrangements, so it is now 10 years out of date. Last year, we announced that the minimum practice income guarantee will start to be phased out from April 2014. We consider minimum practice income guarantee payments to be inequitable because under the system, two surgeries in the same area serving similar populations may be paid different amounts of money per registered patient.

The MPIG will be phased out over a seven-year period, as the hon. Member for Poplar and Limehouse will know. We are phasing it out to make sure that there is more equity between what different practices in comparable areas receive per patient, and that funding follows the patient more accurately, rather than the practice. I am sure we can all sign up to that in principle. The payments will be phased out gradually with the overall intention that the funding for GP practices will be properly matched to the number of patients they serve and the health needs of the local population.

The money released by phasing out the MPIG will be reinvested in the basic payments made to all general medical services practices. Those payments are based on numbers of patients and key determinants of practice work load such as patients’ ages and health needs—deprivation is of course a driver of patients’ health needs. We are committed to making sure that patients have access to high-quality GP services wherever they live and ensuring that in the same geographical area similar practices receive effectively the same amount of funding for each patient they look after.

It is also worth highlighting the overall impact for practices, both in the country more generally and in London in particular. NHS England has undertaken analysis regarding the withdrawal of the MPIG. Inevitably, a small number of practices will lose funding, and NHS England has considered the very small number of significant outlier practices for which alternative arrangements may need to be made to ensure appropriate services are maintained for local people.

We appreciate that this is a matter of concern for some practices, including some in the hon. Gentleman’s constituency that he has mentioned today. That is why we have decided to use the next seven years to implement the changes to the MPIG, introducing them gradually through a phased transition to a new funding arrangement, rather than taking a big bang approach. Phasing the changes in over that seven-year period will allow the minority of practices that lose funding to adjust more gradually to the reduction in payments.

As the hon. Gentleman highlighted in his remarks, the changes cannot be seen in isolation but should be looked at together with the changes to the quality and outcomes framework payments for GP practices; those changes need to be set alongside the global sum paid to GMS practices. When all those factors are put together, I understand that practices in London with a GMS contract, of which there are 721, will see an overall funding increase of £731,000 resulting from the net effect of all the changes. I will write to the hon. Gentleman to outline that in detail ahead of his meeting with my noble Friend Earl Howe.

[Jim Fitzpatrick]

When we have that meeting with Lord Howe, it would be useful if NHS England could provide the Minister and his officials with an accurate breakdown of figures for the practices in Tower Hamlets. Given the order of deprivation, the chronic ailments and conditions, the age profiles of very elderly and very young people, and the language problems, even NHS England, as I quoted, is saying that the combination of changes to the minimum practice income guarantee and the quality and outcomes framework reductions is creating specific difficulties in Tower Hamlets that are not generally replicated across the rest of London.

[Dr Poulter]

I am happy to write to the hon. Gentleman after the debate to outline the more general points, and I am sure that we can ensure that more specific details are available for him to discuss in his meeting with my noble Friend Earl Howe. NHS England has made it clear that it has been looking carefully at how it can support the practices that are most affected, through its area teams, and I am sure that it will be happy to continue a dialogue with local practices and with the hon. Gentleman to work out how further local support could be given if some practices are struggling as a result of the changes. That offer has been made to those practices that have already been identified as most affected, but NHS England is continually reviewing the matter as a pathway process for phasing in the changes.

NHS England has also suggested that those practices with very small lists, which may be particularly affected, could collaborate through federating, networking or merging with other practices nearby to provide more cost-effective services. It also suggested that it would be possible to identify other ways in which practices might improve cost efficiency, such as reviewing staffing structures and other commissioning or contracting options—for example, how some patient care services are offered in the area by collaboration. Sometimes, back office costs and inefficiencies can be reduced to free up more money for patient care. We must remember that, on the whole, GP practices are small businesses in their own right. We expect NHS England to work with GPs to support best practice and technology, and to encourage general practices to collaborate and work together, and it is happy to do so. It is expected that general practices will do what they can to help themselves, and that NHS England will work with them to facilitate that for them as small business owners.

[Jim Fitzpatrick]

I recognise that there is some logic in the Minister’s suggestion about smaller practices. The Jubilee Street practice has 13,000 patients. It is a big practice and is multi-handed with clinicians and staffing, and is considered to be extremely efficiently run.

[Dr Poulter]

Indeed. I will talk in more detail about Tower Hamlets, but the hon. Gentleman is right to say that it has a long history of collaboration, efficiently run practices and good working between GPs and other community health services to support some of the most vulnerable people in our society and to address specific issues of health care and equality. The hon. Gentleman outlined that in his speech and local GPs should be proud of what they have done and their work and efforts in many cases to help deliver greater efficiencies. Nevertheless, the offer is there from NHS England to engage with area teams to see what more support can be provided. It is keen to ensure that if particular practices believe they are disadvantaged, the teams will do what they can to work with the practices to mitigate that.

It is worth talking briefly about the changes in the quality and outcomes framework. In addition to the minimum practice income guarantee from April this year, we have also made changes to QOF and reduced it by more than a third to free up space and time for GPs to provide more proactive and personalised care for their patients, particularly the frail elderly. One of the great frustrations that we are all aware of—medical staff, health care staff and particularly GPs—has been the amount of bureaucracy that GPs are sometimes required to undertake, which has got in the way of their being able to deliver front-line patient care and spend time with patients. The changes to QOF were welcomed by the British Medical Association and GPs because they will help reduce the bureaucratic burden and allow GPs to spend more time with patients and focus more on personalised care and more vulnerable patient groups. I think we all believe that to be a good thing and a great achievement from those GP contract negotiations.

As part of the QOF changes, we have retired indicators when they were either duplicating other incentives in the health care system, or were of low clinical value and use—for example, if they were just process measures rather than measures linked directly to patient care. We are ensuring that the payment system is strongly linked to delivering better care and improving care for patients rather than to process measures. That has sometimes been a criticism of QOF payments in the past, not least by GPs. Removal of these indicators will help to reduce bureaucracy, unnecessary patient testing and unnecessary frequency of patient recall and recording.

The money released from the changes to QOF will be reinvested in the basic payments made to all general medical services practices, to which I alluded earlier. The global sum will be reinvested through the GP contract and I understand that practices in London with a general medical services contract will overall be net beneficiaries to the tune of roughly £700,000. We welcome that, and I will give the exact figures in my letter to the hon. Gentleman, but I believe that what I have said in this debate is an accurate reflection of the situation.

I turn to Tower Hamlets and will address some of the concerns that have been raised in the debate today. We understand that some practices have particular concerns about the changes to the minimum practice income guarantee and to QOF funding. I assure the hon. Gentleman and his constituents that the Government and NHS England are committed to ensuring that good, high quality primary care for local people, such as his constituents, is a priority. I understand that despite being one of the most deprived boroughs in London, Tower Hamlets has developed some outstanding general practices often as a result of the hard work and dedication of the GPs who want to address health care needs, to look after vulnerable people in society, and to ensure that the health care inequalities that we have discussed are properly addressed. His local GPs and all health care staff delivering care on the ground should be proud of that.

As the hon. Gentleman outlined, Tower Hamlets is top in the country for blood pressure and cholesterol control for patients with diabetes, resulting in reduced complications of diabetes and reduced admissions for heart attacks. It is also top in London for MMR vaccination and for flu vaccination for the over 65s. That is an example of how, even in one of the most deprived areas with some of the greatest health care needs, local GPs, local primary care and local community care are delivering very good results for patients. It is also one of the 14 national pioneers for integrated care, a programme in which primary care will play an increasingly important role. We want to keep people out of hospital and it is vital that they are supported in their own homes and communities. Integrating primary care with community care and effective adult social services care from the local authority will be key in delivering that.

I understand that NHS England’s area team has set up a task and finish group to look at the support that might be offered to practices with membership drawn from local medical committees and the London office of the clinical commissioning group’s chief officers and the local area primary care commissioning team. I understand that NHS England’s area team in London has been in regular contact with individual practices in Tower Hamlets to offer them ongoing support regarding these changes. I am sure that after this debate, that important input and dialogue will intensify to recognise some of the issues that the hon. Gentleman raised.

We also recognise some of the challenges facing small practices in delivering the increasingly wide range of primary care services as more services move from hospital settings into the community. All health services, hospital trusts, community and mental health care providers, as well as GPs, are facing the challenge of meeting increasing demand with small increases in funding. That demand is coming from an ageing population with increasing levels of long-term conditions as well as the costs of new drugs, and patients’ expectations. Those issues are faced throughout the health service, but they are acute in Tower Hamlets. Local GPs recognise the need for flexibility in the way in which future services are provided and we need to support practices to work together to demonstrate how best to use their resources for the benefit of all their patients.

We have announced that NHS England is supporting practices as they phase in the changes to the minimum practice income guarantee and to QOF payments. There is an offer to meet my noble Friend Lord Howe and I know that NHS England will continue to do what it can to support local practices in Tower Hamlets.

Again, I put on the record my congratulations to the hon. Gentleman on securing this debate and to the local GPs who deliver some of the best health care outcomes in England for the patients they look after.

Question put and agreed to.

Health Education England (Mandate)

Dan Poulter Excerpts

Thursday 1st May 2014 Written Statements

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

Today the Government have published the Health Education England(HEE) mandate for 2014-15. This will come into effect immediately and was developed following consultation with stakeholders.

The mandate is published every year and sets out what HEE will need to deliver with its nearly £5 billion budget in the coming year, on the areas of:

Work force planning;

health education; and

training and development.

It complements the work set out in the Government’s mandate to NHS England and the Government’s response to the Francis report, focusing on how we can support the health care work force through excellent education and training so that they can continue to deliver the very best care to patients.

The mandate will make sure that HEE delivers the right health care work force with the right skills, values and competencies. The Government’s priority in developing the mandate is to train and retain a health care work force equipped with the skills to deliver much more proactive care and support for patients in the community, and with the right skills to support people with long-term medical conditions to live with dignity in their own homes.

Specifically, the mandate will:

support families through pregnancy by creating a work force that can deliver personalised maternity care, improving the specialist skills needed to provide care to mothers with mental health and substance misuse issues so that specialist perinatal mental health support is available for every woman who needs it by 2017;

allow care assistants and health care support workers to break through the NHS careers glass ceiling and progress into careers in nursing and midwifery by improving the access to fully funded part-time degree courses for health care assistants and maternity support workers in order to ensure that staff with strong caring experience can access higher education;

place greater emphasis on children’s health by:

a) ensuring the training is available to enable more GPs to develop a specialist interest in children’s health;

b) improving training in child health for all GP trainees through new courses; and

c) further expanding health visitor capacity and equipping them with the skills they need to carry out the important work they do;

make sure mental health is given the importance it deserves by:

a) ensuring the training is available to for more GPs and nurses to pursue a specialist interest in mental health;

b) ensuring post-registration training in perinatal mental health to ensure that trained specialist mental health staff are available to support mothers in every birthing unit by 2017; and

c) developing training programmes that will allow all staff to have an awareness of mental health problems and how they may affect their patients by January 2015;

improve training available to GPs on the psychological and physical needs of veterans and their families by making a specially trained GP available to every clinical commissioning group (CCG);

roll out specialist dementia training to an additional 250,000 staff by March 2015, and make these opportunities available to all staff by the end of 2018 to improve the care of people with dementia;

train and develop a work force with skills that are transferable between different care settings by working with partners across the health and care system to review current curricula and training pathways, and develop common standards and portable qualifications. This will support the delivery of integrated health care and ensure staff can more readily work across different care settings as increasingly more health and care is delivered in the community and via primary care services;

contribute to improvements in public health outcomes by continuing to develop public health specialists and improving the public health skills of all health care staff supporting important priorities such as antimicrobial resistance and immunisation; and

ensure all recruitment into NHS funded training posts incorporates testing of compassionate values and behaviours, in addition to technical and academic skills, by March 2015.

The mandate also tasks HEE to deliver value for money, transparency and the reform of education and training funding.

“Delivering high quality, effective, compassionate care: Developing the right people with the right skills and the right values: A mandate from the Government to Health Education England: April 2014 to March 2015” has been placed in the Library.

Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Type 1 Diabetes (Young People)

Dan Poulter Excerpts

Wednesday 30th April 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship for the second time this week, the first time being during the Defence Committee sitting yesterday.

I pay tribute to the right hon. Member for Knowsley (Mr Howarth) for securing the debate and for his articulate and reasoned contribution to it, and for his passionate advocacy of the needs of people with type 1 diabetes. He has family experience of these issues that will have strongly informed his understanding of them. The balanced, perceptive way that he approached the debate, raising important issues, particularly about tariff-setting, which is in my view the strongest and best way to drive up the quality of care available for patients with type 1 diabetes, is of great credit to him and helped set the tone for a consensual debate. It is also a pleasure to respond to the right hon. Gentleman formally, because he responded to my maiden speech when I was first accepted into the House. He was kind to me then and I hope that my response will do this debate justice and will bring some comfort to hon. Members who have raised concerns.

I also pay tribute to hon. Members’ contributions to the debate. As always, the hon. Member for Strangford (Jim Shannon) makes important points about how, although we have devolved health systems, we need to learn lessons from best practice throughout England and Northern Ireland. It is important, even in a devolved health system, that we work collaboratively together to improve standards of care. I will try to deal with points raised in the contributions from the right hon. Member for Tynemouth (Mr Campbell) and the hon. Member for Brighton, Pavilion (Caroline Lucas).

My hon. Friend the Member for Cities of London and Westminster (Mark Field) eloquently outlined for all of us what this means on a day-to-day basis for a young person with type 1 diabetes. In many respects, that sets out the challenge for our health service: working together with the education sector and with other parts of our health and care system, it needs to help improve the day-to-day quality of life for people with type 1 diabetes. My hon. Friend the Member for Torbay (Mr Sanders) made a similar point. My hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) raised the importance of research funding. I will address those points later in my remarks.

As we have heard, type 1 diabetes has a potentially devastating effect on children’s health. Poor diabetic control for children increases their risk of developing long-term complications over the course of their lives—we have heard about renal complications, diabetic retinopathy and the consequences of diabetes-related peripheral neuropathy. Such consequences are potentially life changing, and so it is important that we do all that we can to address them and to support people with type 1 diabetes. It is a question not just of early diagnosis but of the right care and support in the secondary care setting, in primary care and in the community, to give better support to people with the condition so that they can stay well and be properly looked after. That is a challenge that we face in all aspects of the care that we provide to young people.

The children and young people’s health outcomes forum, which was set up by my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), highlighted a number of challenges faced by children with long-term conditions such as diabetes and by their families. It is worth highlighting two or three. The first was that there are poor arrangements for transition to adulthood—that has been highlighted throughout our debate. Secondly, there is a need for better integration of care, with co-ordination around the patient—the child or young person. We need a comprehensive, multidisciplinary team approach to care, with a much greater emphasis on better support for young people in the community and in their own homes. There also needs to be much speedier diagnosis of long-term conditions in young people, including asthma, diabetes and epilepsy.

The NHS atlas of variation has identified an unacceptable variation between different areas, a point raised by the shadow Minister. That is clearly unacceptable to us all. There is variation in the quality of management of children’s diabetes, and in the number of children with previously diagnosed diabetes admitted to hospital for diabetic ketoacidosis. We all know, then, that we have some way to go on improving the care of children and young people with diabetes. I hope my remarks will be able to give some reassurance that we are now firmly on the right track, particularly with our best practice tariff.

[Jim Shannon]

In my contribution I outlined the diabetes strategy that was in place for the 10 years up to 2013. I have asked Ministers about that issue a number of times and am keen to see a continuing initiative for a UK-wide strategy. Will the Minister give us an idea of his intentions in that regard? That strategy could address regional variations.

[Dr Poulter]

As I mentioned earlier, it is important that we learn from good practice, not just in the UK but elsewhere. A key driver of improving practice is clinical audit of the quality of services delivered. Outcomes for people with diabetes in England will also be assessed by the national diabetes audit, which includes a core audit, the national in-patient diabetes audit, a diabetes pregnancy audit, the national patient experience of diabetes services survey and the national diabetes foot audit, which is due to be launched this summer. Having that high quality comparative data, gathered through clinical audit from different care settings across the UK, will help us to understand where services are and are not delivered well. Audits in particular care settings always make recommendations for improvement, and the following year there is another audit. Exposing where care is good or not so good and putting in place plans for improvement on the ground will be a big step forward. At a national level, we can then look at which improvement plans have worked and which have been less successful. That learning is a good way of driving up standards and can be shared with Northern Ireland and other devolved parts of the United Kingdom, and indeed on an international basis. I believe that in this country we are historically good at collecting data. The purpose of national audits is to drive up standards of care, which is why NHS England is putting many more national audits in place throughout the health service. We will be able to compare what is done in different care settings, learn where care needs to be better and drive up standards throughout our health service.

We all understand the importance of the integration of mental health care and diabetes care for the young people who have serious health issues resulting from that combination of issues, which puts them at high risk of complications and premature death. The Government are investing £54 million over four years to enhance the children and young people’s improving access to psychological therapies—CYP IAPT—programme. That programme is helping to transform services through training in evidence-based therapies to support children and young people with a range of mental health issues. I am sure we all support that programme and want to see it expanded further.

I am glad to say that investment in type 1 diabetes research by the Medical Research Council and the National Institute for Health Research has risen from more than £5.8 million in 2011-12 to more than £6.5 million in 2012-13. The National Institute for Health Research is funding a £1.5 million trial focusing on children and young people with type 1 diabetes, which is comparing outcomes for patients treated with multiple daily insulin injections to outcomes for those using pumps, one year and five years after diagnosis. The report of the trial is due to be published in a few months. When we are looking at how best to support people with type 1 diabetes in leading as normal a life as possible, whether that be in education or in the workplace, it is important that we understand which interventions and methods of support work best. I am sure that that research will put us in a much better place on that.

[Mr Jamie Reed]

Is the Minister aware of the JDRF’s “#CountMeIn” campaign? It is calling for an investment of £12 million per annum by the MRC and NIHR to bring the UK in line with recent per capita spending by Governments internationally. Has he given any thought to that and if so will he comment on it?

[Dr Poulter]

With research funding there is often a bidding process, and it is up to organisations to bid for funding. I am pleased that the amount of money going into diabetes research is improving and that there is a now a project specifically on type 1 diabetes that is looking at the impact of different interventions and support—such as the use of pumps—on young people’s lives to see which methods work better. The emphasis is not just on clinical outcomes but on how young people’s experience and quality of life is affected, so that that is taken into account in how we look at diabetes. Health care research funding is moving in the right direction, and not just for diabetes—research funding has increased considerably over the past few years in a number of areas of health care, something that we should welcome.

As we know, NICE has national standards, but in the few minutes left I want to discuss the best practice tariff. The way that we set up commissioning arrangements and the best practice tariff will help us make a difference in the future. The tariff ensures that payment is linked to the quality of care provided, an important driver of how services are delivered to patients.

I will briefly set out aspects of the diabetes best practice tariff. A young person’s diagnosis is to be discussed with a senior member of paediatric diabetes team within 24 hours of presentation, to get early specialist support in place. All new patients are to be seen by a member of the specialist paediatric diabetes team on the same or the next working day, and each patient is to have a structured education programme, tailored to their needs and the needs of their family, to support them and help them understand how they can better cope with their condition and manage it themselves as best as they can. The tariff places a strong emphasis on multidisciplinary team work, including support from dieticians—we have heard about issues connected to eating disorders, and dieticians will have a key role on that. Many other aspects of the tariff focus on multidisciplinary working to put things on a better basis for young people with diabetes.

The right hon. Member for Knowsley raised a number of other issues in the debate; I will write to him about those matters. The issue is complex and important, but I hope that I have been able to offer some reassurance. The tariff and the increased spending on research mean that we are moving to a better place with our support for people with type 1 diabetes.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 1st April 2014 Commons Chamber

[Pat Glass (North West Durham) (Lab)]

10. How many staff have been made redundant and subsequently re-employed by NHS organisations since May 2010.

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

Since May 2010 and up to December 2013, 4,050 staff across the whole NHS have been re-employed in the NHS following redundancy. This covers all staff grades, not just managers, and is a tiny proportion of the total NHS work force of currently around 1.2 million.

[Mr Spellar]

May I thank the Minister for that utterly complacent answer? Is it not outrageous that, while front-line health service staff are having their salaries frozen, the fat cats at the top are getting monstrous pay-outs and then being re-employed straight away elsewhere in the NHS?

[Dr Poulter]

The Opposition will have to do better than these prepared questions. We have been lumbered with their redundancy terms, which were negotiated when the right hon. Member for Leigh (Andy Burnham) was a Minister in the Department of Health.

On NHS pay, we believe in having enough front-line staff to care for patients. That is the lesson of Mid Staffs. What the previous Government would have done—and the Opposition would have us do—is give some staff in the NHS two pay rises, not just one. That is unacceptable. We need to have enough staff to ensure that we can look after patients. All staff in the NHS will receive a pay rise of at least 1%, but unfortunately, because of the terms that the previous Government set, some managers are still treated better than patients. We will change that.

[Pat Glass]

Some time ago, the Prime Minister promised to stop the revolving door in the NHS and recover payments from those staff who had got huge payments and come back, sometimes to the same job. How is that going? How many people and how much money?

[Dr Poulter]

I think this is an own goal from the Opposition. They set the redundancy terms in 2006, when the shadow Secretary of State was a Minister in the Department, which have allowed extraordinary, eye-watering redundancy payments to be made, particularly to managers. That is to the disadvantage of front-line staff and patients. It is why we are currently in negotiations with the unions to ensure that we improve redundancy terms, stop those eye-watering payments and have more money to care for front-line patients.

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

21. Talking of eye-watering payments, may I refer to the six-figure pay-off of £300,000 reportedly paid to Jo-Anne Wass, one of the 10 highest earners in the NHS? Despite the fact that she is leaving this month, the NHS is said to be paying for a two-year secondment for her, even though she will not return. How many 1% pay rises for nurses could be found out of that £300,000?

[Dr Poulter]

These are questions that the Opposition should have thought about—the hon. Lady was a Minister in the previous Government—when they negotiated the redundancy terms. They are Labour’s redundancy terms, which we are changing. When we look at the figures, under the previous Government’s NHS reorganisation in 2006 to 2008, we see that the NHS spent more than £360 million on redundancy and early retirement alone, which compares with only half that—£178 million from 2011 to 2013—under the current Government. How much more money would have been available for staff pay had the previous Government got that right?

[Ann Coffey (Stockport) (Lab)]

4. What representations he has received on community pharmacies.

--- Later in debate ---

[John Howell (Henley) (Con)]

14. What recent steps he has taken to improve maternity care.

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

We have made improving maternity services so that women have a named midwife responsible for ensuring personalised maternity care the key objective in our mandate to NHS England. Since May 2010 the number of full-time equivalent midwives increased by more than 1,500, and over the past two years I have set up a £35 million capital investment fund, which has already seen improvements to more than 100 maternity units.

[Stephen McPartland]

The Diamond Jubilee maternity unit at the Lister hospital in Stevenage is doing an amazing job for young mums, and the neonatal unit has just won a national award. I will be visiting the staff on Friday to thank them for their hard work. Would the Minister like to record his support for the staff who do such a great job?

[Dr Poulter]

I would be happy to do so. I am aware of the positive difference that the Diamond Jubilee unit has made to local maternity services. My hon. Friend will be aware that the East and North Hertfordshire NHS Trust and the unit have received £314,000 of this Government’s capital funding to support the hard-working staff on that unit delivering high-quality care to women.

[Henry Smith]

In 2001 the then Labour Government closed the maternity unit at Crawley hospital, despite a growing birth rate since then in my constituency. The local clinical commissioning group proposes to reintroduce a midwife-led maternity unit. Will my hon. Friend meet me and the CCG to discuss those plans further?

[Dr Poulter]

I would be delighted to do so. As my hon. Friend knows, I have a particular knowledge of his local hospital trust. It was a very short-sighted decision by the previous Government to downgrade and effectively close Crawley hospital, given the demographic pressures there. There is a good case for a midwifery-led maternity unit. Under this Government we are seeing the numbers of those increase. I would be happy to meet him to discuss these matters further.

[John Howell]

I welcome the increased number of midwives, but what are the Government doing to support women who suffer from post-natal depression?

[Dr Poulter]

My hon. Friend makes an important point. We were talking earlier about improving parity of esteem between mental and physical health. When we came to power, only 50% of maternity units had specialist perinatal mental health support, and we will make sure, through the mandate to Health Education England, that by 2017 all maternity units have specialist perinatal mental health support. That is something that this Government will be very proud of.

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

Last December the UK national screening committee advised against offering all pregnant women a routine test for group B streptococcus. The Minister will recall that I asked about this matter in Health questions last time. The issue is not to screen in all cases, but to ensure that the enriched culture medium test is available where clinicians deem it appropriate. Will the Minister look at how that test can be made available whenever it is clinically necessary?

[Dr Poulter]

That is a good point. On screening, we have to listen to the advice of the national screening committee, as I am sure hon. Members on both sides of the House would agree, but on the enriched culture medium test, I have had further meetings with Group B Strep Support and with the former editor of the obstetricians and gynaecologists journal, the BJOG. On the back of that meeting I have written to the Royal College of Obstetricians and Gynaecologists to ask it to look at the clinical evidence on that test, and it will take the matter forward.

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

I thought that answers to questions were improving after 12 noon, but the last answer on post-natal depression was not as good as I expected. We have a campaign on post-natal depression, which is the biggest killer of healthy young women through suicide. The Minister is being complacent. Early diagnosis and good GPs are essential. What is he really doing about that?

[Dr Poulter]

The hon. Gentleman is absolutely right. I thought it was disgraceful, when we came to power and inherited the legacy of the previous Government on post-natal depression, that only 50% of maternity units had perinatal mental health support. That was not good enough, and that is why I have ensured that in the mandate to Health Education England, and working with NHS commissioners, all maternity units will have specialist perinatal support by 2017. There is more training going in for the work of the Royal College of General Practitioners on mental health support for GPs in helping women, and we are now increasing the number of health visitors by almost 2,000, and health visitors do a fantastic job in providing perinatal mental health support to so many women.

[Mr David Nuttall (Bury North) (Con)]

17. Following the closure of the special care baby unit at Fairfield general hospital in my constituency, new mothers and families are now faced with travelling to either Bolton or north Manchester. In the light of the recent report from the charity Bliss on the costs of having a premature or sick baby, will my hon. Friend ensure that appropriate support is in place for Bury families who are struggling with a baby who needs specialist hospital care?

[Dr Poulter]

My hon. Friend makes an important point, and he has been a strong advocate for local mothers and families in his constituency. But he will also be aware that there was a review of maternity services in the Greater Manchester area that recognised that, by changing the way in which services were delivered, there could be improvements and 25 young children’s and babies’ lives could be saved each year. There has been a review, and that review is saving lives, so I commend any similar service reconfiguration that delivers similar benefits to women and patients.

[Nick Smith (Blaenau Gwent) (Lab)]

13. What steps the Government is taking to reduce the amount of sugar in children’s diet.

--- Later in debate ---

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

The hon. Lady will be aware, of course, that it was the right hon. Member for Leigh (Andy Burnham) who had the most to do with introducing the private sector and agreeing ambulance service contracts in the Greater Manchester area. I think that Opposition Members need to remember their record on private sector involvement. If she has concerns, we will of course look into them.

[Mr Speaker]

The Minister’s answers are too long. He really has to get that into his head. I do not know how hard I have to try. I try to help the hon. Gentleman, but he is not very good at helping himself.

--- Later in debate ---

[Mr Dave Watts (St Helens North) (Lab)]

T7. How is the Government’s pledge to get hospitals operating on a seven-day basis going? Many GP commissioners are refusing to provide the funding for hospitals to provide that service.

[Dr Poulter]

As the hon. Gentleman will be aware, we are in negotiations with the British Medical Association and other health care unions about the future shape of the NHS consultant contract and junior doctors contract. We are determined to have a contract that remains fit for purpose in future and to reform the contract that we inherited from the previous Government, which was not fit for purpose. We will continue to work with the BMA to make sure that we protect the interests of patients and deliver better care.

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

I very much welcome the taskforce reviewing the effects of the working time directive; as my hon. Friend knows, I have campaigned long on the issue. Given the severity of the evidence, which shows that more than a quarter of a million hours of surgical time are lost per month because of the directive, will my hon. Friend assure me that he will not only listen to, but act bravely and robustly on, any recommendations to rid the NHS of this very dangerous directive?

[Dr Poulter]

My hon. Friend has campaigned with great vigour on the issue, and rightly so. The European working time directive, to which the previous Government signed up in a headlong and reckless way, has damaged continuity of patient care and the training of the consultants of tomorrow. That is why we set up the independent review. We look forward to its recommendations and we will make sure that we respond to those appropriately in due course.

[Andy McDonald (Middlesbrough) (Lab)]

T8. The Health Secretary talks about Welsh patients flocking to the English NHS, but is he aware that the number of English patients going to Welsh hospitals has increased by more than 10% since 2010? Does that mean that the English NHS is in crisis?

[Mr Douglas Carswell (Clacton) (Con)]

There is due to be a consultation on the future of maternity units at Clacton and Harwich hospitals. Last week, however, the management team at the already troubled Colchester trust decided to shut the units anyway. That has caused great anger and concern locally. Will my hon. Friend write to the board to ensure that it does not prejudice the outcome of the consultation and that decisions are made on the basis of fact, not muddled management?

[Dr Poulter]

I will certainly be happy to look into the issue. My hon. Friend will be aware that the closure decisions were made on clinical safety grounds, for the safety of women. It is a temporary issue. One of the outstanding problems in my hon. Friend’s part of the world and elsewhere when we came into government was a historical shortage of midwives. That is why we are investing in more midwives. There are already 1,500 more in the NHS and I believe that six more will be recruited to the local NHS in his area.

[David Wright (Telford) (Lab)]

T9. Mental health services in Telford are under review and the Castle Lodge facility has been closed for a considerable time. It has been heavily used by people in the community who do not have to be admitted into Shrewsbury. Will the Minister confirm that if local people want to retain Castle Lodge, as I believe they do, it will be retained?

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

Rural surgeries such as Ambleside, Coniston and Hawkshead in my constituency are under threat because of a combination of historical funding difficulties and the removal of the minimum practice income guarantee. Will the Minister agree to look into the setting up of a strategic small surgeries fund, so that rural surgeries have a confident future?

[Dr Poulter]

My hon. Friend and I have discussed the issue before. As he is aware, price premiums are already built into the funding formula to support rural practices. NHS England has already identified about 100 practices that may need additional and special support. Commissioners will be looking to provide that and work with those rural practices and others that may have challenges.

--- Later in debate ---

[Mr Philip Hollobone (Kettering) (Con)]

Ten babies a day are born at Kettering general hospital. May I welcome the recent award of £400,000 of NHS modernisation funds to the hospital’s 33-bed maternity unit and urge the Minister to encourage NHS England to prioritise areas of high population growth such as Kettering for future funding?

[Dr Poulter]

I know that the staff at my hon. Friend’s maternity unit work tremendously hard to look after patients, and it is important that we gave them the right facilities in order to do so. I am delighted that, like over 100 other birthing units in the country, they have received money to make sure that women are treated with greater dignity and that the quality of care is as high as it can be.

[Bill Esterson (Sefton Central) (Lab)]

I cannot speak highly enough of the staff at Southport hospital who cared for me when I spent three days there as a patient last month. They told me that GPs now routinely send older patients straight to A and E because their funding has been cut and that community services are no longer in place to support people in their own homes, which is all leading to a crisis at A and E. Is not the sad reality that what is happening at Southport is being repeated up and down the country as a result of the Government’s disastrous reorganisation and cuts to front-line services?

Sir Robert Peel Hospital

Dan Poulter Excerpts

Tuesday 1st April 2014 Commons Chamber

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

I congratulate my hon. Friend the Member for Tamworth (Christopher Pincher) on securing the debate. I am well aware of his long-standing interest in matters affecting his constituency, including his well-documented support for the Sharon Fox cancer centre. I fully understand why he has raised the matter of the Sir Robert Peel hospital today. I hope that the discussion about the future of services in Tamworth and the surrounding area will move forward constructively following this debate—certainly more constructively than it might have done recently.

Before looking at the local situation in detail, it is important to say a few words about the importance of high-quality engagement between the NHS—in this case the trust—and local patients and commissioners. Decisions about patient care and NHS services should, where possible, be taken in as open and transparent a way as possible. It is important that patient groups and the wider public are properly consulted in decisions about local NHS services. That is clearly outlined in the tests for reconfiguration laid down by my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) when he was Health Secretary earlier in this Parliament. My hon. Friend was right to highlight the importance of public and patient engagement in the design of local NHS services, in this case for the benefit of his constituents in Tamworth.

The situation at the Sir Robert Peel hospital is of course complicated by events that have taken place with the Keogh review, to which I will return in a moment. The hospital is part of the Burton Hospitals NHS Foundation Trust. It might help the House to understand the situation better if I briefly describe the foundation trust and some of the issues relating to the way the Keogh review is affecting services. The foundation trust provides hospital-based services from four main sites: Burton Hospitals NHS Foundation Trust in Burton-on-Trent, with acute hospital services including an emergency department; the treatment centre on the Burton Hospitals site, a dedicated centre for day case surgery and treatments; the Samuel Johnson community hospital in Lichfield, with local services, including a midwifery-led maternity unit and a 24/7 minor injuries unit; and the Sir Robert Peel community hospital in Tamworth. I will say a little more about those services in a moment.

The foundation trust provides a wide range of services to a population of around 360,000 across south Staffordshire, south Derbyshire and north-west Leicestershire. Over 47,000 planned and emergency admissions, more than 70,000 A and E attendances and around 13,000 day case procedures take place each year in the foundation trust hospitals across all the hospital sites. The Samuel Johnson hospital in Lichfield, as a community hospital, provides services that are similar to those provided by the Sir Robert Peel hospital in Tamworth. Both community hospitals had previously been run by the South Staffordshire primary care trust. The issue for the foundation trust is therefore much wider than the Sir Robert Peel hospital, because it is required to look across the entire population it serves and, on the basis of the services commissioned, provide a safe and high-quality service for the benefit of patients. The trust has only comparatively recently become responsible for the two community hospitals it operates, both of which it took over in 2011.

[Andrew Griffiths]

The Minister mentioned that Queen’s hospital is a Keogh hospital. The staff there are working incredibly hard to improve standards and are taking big strides forward. The Minister will have heard about the precarious situation in relation to Queen’s and the East Staffordshire clinical commissioning group. My hon. Friend the Member for Tamworth (Christopher Pincher) requested a meeting. Will the Minister agree to meet me, other colleagues and the team from Queen’s hospital and the CCG in order to discuss our concerns and find a solution that improves services locally.

[Dr Poulter]

I will be delighted to meet my hon. Friends to talk further about local issues. There are long-standing concerns, not least the processes triggered by the Keogh review in the trust and the wider health economy.

I turn to the local reconfiguration process. To ensure that the foundation trust would continue to provide the best level of service to the local population, the trust commissioned a report from Deloitte in December 2012. The intention was to address the long-term challenges faced by the trust by refocusing community services, such as those provided at the Sir Robert Peel community hospital, and concentrating on the most vulnerable patient groups.

The Deloitte report set out a number of options. However, as we are all aware, in 2013 the trust was inspected under the Keogh review, which we took forward following the Francis report on Mid Staffordshire foundation trust. Burton was inspected because it had higher than expected mortality rates. The Keogh review was not reassured by what it found. As a result of the inspection, the foundation trust was placed in special measures by Monitor, the regulator of foundation trusts. Monitor continues to work with foundation trusts in special measures to ensure that they return to safe and efficient services as soon as possible. The Keogh review made six urgent recommendations for Burton. Those recommendations have been the drivers for the changes at Burton and at the Sir Robert Peel community hospital.

Sir Bruce Keogh challenged the foundation trust on what its long-term plans would be for the community hospitals. For example, patient activity at both sites in Lichfield and Tamworth has been decreasing across minor injuries, in-patient and out-patient services for a number of years, and is, I understand, on a steadily decreasing trend. There is a need to make changes because, as well as the higher than expected mortality rates, the trust and its local commissioners believe that the health needs of the population they serve are changing.

As a nation, we face changing challenges in health care—for example, the demographic pressures imposed by an ageing population. As the health needs of the population change, it is right that the services provided at local hospitals and in the local health economy also change and that a more integrated approach is taken between local authorities and the NHS in delivering more personalised care, particularly for the frail elderly, and more care in people’s homes and communities.

The foundation trust has already responded to the Keogh review challenge, although much is still to be done. I understand that the reconfiguration to which my hon. Friend the Member for Tamworth refers follows on from and continues the response to the Keogh review. Certainly, the aims are the same—to ensure that health care services are of high quality and meet the needs of local patients.

The Keogh review has affected the Sir Robert Peel community hospital, which currently offers local services for people living in and around Tamworth—including, for example, a 24/7 minor injuries unit, in-patient, X-ray and ultrasound department, and an out-patient service. There is one ward providing rehabilitation, care of older people, general medical care and palliative care. Consultant and nurse-led clinics accommodate consultations, investigations, minor procedures, post-treatment follow-up and health promotion.

That is not the full range of services that one would expect at larger NHS hospitals. However, having close-to-home community-based facilities is an important part of meeting the challenge of looking after older people in their own homes. Some such facilities are found at Sir Robert Peel community hospital. I am sure that the local population welcome that and believe it important in delivering high-quality health care in the months and years ahead.

There are currently discussions about the relocation of day case surgery and there is a review of endoscopy. I understand that that would affect about 30 patients a week, with services moving to local GP surgeries, Good Hope hospital at Sutton Coldfield about eight miles away, or the main trust site at Burton.

I understand that further changes are being considered in response to Keogh. However, planning is at a very early stage. I understand that the trust board will be receiving an outline paper this coming Thursday and that no decisions have yet been taken. I am sure that my hon. Friend will agree that it would be highly inappropriate for me to speculate about what option or options might be considered or chosen by the local NHS. I would certainly not want to suggest that there is a Government-preferred option that should be followed; I am not in a position to do that. Whitehall micro-management of the local NHS invariably leads to bad things happening; that is what we have tried to avoid through the health reforms that we instigated in 2012. As I said a few minutes ago, such decisions are local decisions and must be seen to be taken by the local NHS and local commissioners, in consultation with local patients.

[Christopher Pincher]

Of course my hon. Friend is absolutely right. These are local decisions for local communities and their local NHS. It is not for Ministers to dictate what services should or should not be provided for any particular hospital; it is for the local community to determine that, based on need. Does he agree, however, that when the local community decides, it should be based on proper consultation, and that listening exercises should be based on what people want and not what the clinical professionals and managers want?

[Dr Poulter]

My hon. Friend makes an important point. Of course clinical leadership in the NHS is important in designing services, but he is absolutely right that it is important that patients and the public locally are properly consulted in decisions about health care services. That is something that we believe in. Far too often in the past, patients have felt that decision making is done to them rather than their being involved in it. That is exactly why we introduced new tests for the reconfiguration of services that put patient and public consultation at the very heart of designing how medical and health care needs are addressed in the future.

As I am sure my hon. Friend agrees, the heart of the matter—this is certainly my reading of the situation from what he has said—is that there is a need for good communication from the foundation trust. That means proper engagement by the trust with local communities, patients and the public and local commissioners in all decisions. It is understandable that people will respond negatively to speculation in the media, and sometimes by word of mouth, about any change or improvement to services unless there is proper communication. It seems that in this case that communication has not been of the highest standard, and that has led to some of the concerns raised by my hon. Friend. I know that he has recently met the chair and chief executive of the trust, and I encourage him to build on that contact. I am sure that the local NHS would welcome the opportunity further to share its thinking with him. That would be very desirable for all hon. Members, including my hon. Friend the Member for Burton (Andrew Griffiths).

I hope that the trust and local GP commissioners will continue to work together to explain clearly what they are doing and why. Elected representatives also play a strong leadership role in helping to work with trusts. It is in the interests of trusts to work with local MPs to ensure that there is a proper understanding of what they are trying to achieve in the way that they deliver health care to the local community.

I was pleased to hear that my hon. Friend has received reassurances from the trust about a strong future for Sir Robert Peel hospital; that is good news. However, there is clearly a need for the trust to focus on improving its communications in future to ensure that the people of Tamworth and surrounding areas fully understand that delivering high-quality health care is about listening to the public. The public must feel that their views are being listened to and properly responded to when health care services are designed. To be absolutely clear, as my hon. Friend said, this is about making sure that patients and public in Tamworth do not feel that decisions are being done to them but that they are making decisions on their own behalf and are fully engaged in the process with local commissioners in deciding on the future health care needs of the local area. Hospital reconfiguration and good health care means listening to patients and the public and making sure that hospital services are improved and delivered in a better way.

That is all the more important in this case because of the consequences of the Keogh review. I know that my hon. Friend will go back from this debate and further engage with the local trust. As I said, I am very happy to meet him and my hon. Friend the Member for Burton to ensure that we can help to achieve better engagement with local health care commissioners and the trust.

I am glad to have had the opportunity to place on record this Government’s support for the local NHS in taking forward the difficult challenge of responding to the Keogh review. We would also like to put on record our gratitude to the local front-line staff who work very hard at the Burton trust. I am sure that as a result of their work and this debate, we will be in a much better position to make sure that the trust engages more fully with the public in Tamworth and surrounding areas when it comes to making decisions about future health care services.

Question put and agreed to.

Nursery Milk (Scheme)

Dan Poulter Excerpts

Thursday 27th March 2014 Written Statements

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

Today I am publishing the response to: “Next Steps for Nursery Milk”—a public consultation on the future of the nursery milk scheme.

The purpose of the consultation was to explore three different options for reforming the scheme: looking at where we can make it more efficient and improve its value for money, while ensuring that all children under five attending a child care setting for more than two hours a day continue to receive free milk.

Of the options for changing the scheme, 53% of respondents ranked the direct supply option as their first preference compared to 39% for the price capping option. Only 16% preferred the e-voucher option.

The nursery milk scheme has been running since the 1940s. The scheme currently funds free milk for around 1.5 million children under five years old in 55,000 child care settings throughout Great Britain. The Government remain fully committed to the nursery milk scheme, and to continuing to supply milk to children under five years old.

In recent years, the prices claimed for milk purchased under the scheme have risen significantly, with a corresponding increase in the total cost of the scheme from £27 million in 2007-08 to £61 million in 2012-13. This trend looks likely to continue with costs potentially rising to £80 million by 2015-16. The main reason for the increasing costs of the scheme has resulted from some suppliers of nursery milk charging as much as 92p per pint of milk when the average shop price is 49p per pint.

The direct supply option is the best way forward for the scheme as it provides best value for money to the taxpayer. Under direct supply, the scheme will be delivered with an estimated saving of £36 million per year, while providing only fresh milk to all eligible children in registered child care or early years settings.

We will engage with small and medium-sized enterprises (SMEs) while developing the new scheme and encourage SMEs to consider bidding as part of a consortia of potential suppliers and/or as sub-contractors working with larger organisations to supply and deliver nursery milk.

“Next Steps for Nursery Milk: Government Response” has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Minimum Practice Income Guarantee

Dan Poulter Excerpts

Wednesday 26th March 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship again, Sir Roger. I congratulate my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) on securing this debate, which is pertinent to many constituencies in England. Indeed, it is pertinent to my own constituency in Suffolk. Later in the debate, I hope to reassure him by giving good local examples from Suffolk of how the joint working he has described can be very effective. The issue is not just money, but improving the quality and availability of care for patients.

We all recognise the importance of local GP practices, particularly in rural communities such as those in my hon. Friend’s constituency. I would like to reassure him that the Government believe that high-quality local services can be maintained. I will not rehearse all the background to the 2004 GP contract negotiations, which we know changed the way that GP practices were funded, but it is worth drawing out a couple of points. Rather than receiving a series of fees and allowances, since 2004, GP practices have been paid based on a formula to take account of need and work load. Practices can also earn money by participating in the quality and outcomes framework—commonly known as QOF—or offering enhanced services.

To smooth the transition to the new system, a minimum practice income guarantee was introduced and used to top up practices’ core funding to match their basic income levels before the 2004 contract was introduced. We must also remember that many GP practices are of course small businesses in their own right. They value and enjoy the flexibility that the GP contract implicitly recognises, and that can bring great benefits to patients. In a moment I will talk a little more about the minimum practice income guarantee and the changes under the recent GP contracts, which from now on will be negotiated by NHS England, as my hon. Friend outlined.

It is worth talking a little about rural practices and highlighting some of the measures in place to support them—it is important to get that on the record. We recognise the fact that rural practices, in areas such as Hawkshead and Coniston in my hon. Friend’s constituency, play a vital role for their local communities. We also recognise the rurality and the often sparsely scattered populations that such GP practices look after. Both the Government and NHS England intend high-quality local services to be supported and maintained.

My hon. Friend will be aware that the funding formula for general practice already includes an allowance for rurality, and there is also provision for the costs of temporary residents. That can be a particular issue during the summer months with the arrival of tourists in the Lake district. The funding formula already includes additional support for rural areas and places with a more transient population because of tourism, or for the seasonal population fluctuations in more agricultural constituencies where there is a high reliance on temporary, summertime or seasonal labour.

Rural GPs may also be able to increase their income in other ways. For example, dispensing practices tend to be in rural areas, although not exclusively. That is potentially another way to provide additional income for a practice, as well as important support for the community, which can have closer-to-home access to prescribed medications and drugs.

I understand that NHS England is working with local GPs through the Cumbria clinical commissioning group to decide how to maintain accessible, responsive, high-quality primary medical services—my hon. Friend alluded to that in his speech. For example, NHS England can help practices to work more closely together. It is looking at doing that by sharing IT and other back-office support in order to improve care and practice efficiency. NHS England is also ensuring that, through practice patient participation groups and local healthwatch services, patients are being kept fully informed and are able to contribute to discussions.

I would like to talk briefly about the phasing out of the minimum practice income guarantee, which last year we announced would begin this April. As my hon. Friend outlined—I was pleased that he supported this—we consider that the payments are no longer equitable, because under the system, two surgeries in the same area serving similar populations could be paid different amounts per patient they serve. That is inequitable and does not make sense.

The payments of the MPIG will be phased out not simply overnight, but over seven years. The overall intention is for the funding for GP practices to be properly matched to the number of patients they serve and the health service needs of those patients.

Funding will also continue to take into account the unavoidable costs of providing services in rural areas. The issue is not one that affects only rural practices, as both rural and non-rural practices receive MPIG payments.

[Dr Wollaston]

Regarding the point about funding following the number of patients, the Minister will be aware that there is now greater flexibility for patients to register. Relatively young, mobile patients may choose to be registered near their place of work; indeed, they should have that flexibility. However, that is an additional income drain on small and sparsely located practices. Is the Minister aware of that?

[Dr Poulter]

Absolutely. I alluded to that point in some of my earlier comments. We know that there is the tourist trade, which is an important part of the local economy in the constituency of my hon. Friend the Member for Westmorland and Lonsdale. Recognition of that factor is built into the funding formula for GP practices. People moving locally to work somewhere is already taken into account as part of the formula, which will benefit the funding of some of the local practices in my hon. Friend’s constituency. I hope that is a helpful clarification of the point about people moving from one location to another.

[Dr Wollaston]

Does the Minister accept that not all sparsely populated areas will see that offset by incoming tourists? Many areas of the country will not see that offset benefit.

[Dr Poulter]

Absolutely. As I have outlined, other parts of the formula recognises rural areas; they are already recognised in GP funding allocation. Therefore, on both counts, additional support is available for areas such as those described by my hon. Friend the Member for Westmorland and Lonsdale in his constituency, and indeed those in Totnes and in my own constituency. Rurality is already factored into GP contracts and funding for GP practices and health care.

What will happen with the money that is recycled and released from the MPIG is an important point. The money released by phasing out the MPIG will be reinvested into the basic payments made to all general medical services practices, which are based on the number of patients and key determinants of practice work load, such as the age and health needs of patients and the unavoidable costs of rurality.

Another factor that we all recognise—I know it is a factor in Totnes and, I believe, in Westmorland and Lonsdale—is that many older people choose to live in rural areas. Older people once used to retire to seaside towns, but they are increasingly retiring to predominantly rural areas. The changes and the freeing up of cash from the MPIG will benefit all practices. In the health care funding formula—not necessarily the GP funding formula, but how clinical commissioning groups allocations are allocated—there is a strong weighting for age which will bring broad benefit to rural areas, particularly those that have a high proportion of older people.

NHS England has been undertaking specific analysis of the withdrawal of the MPIG. Inevitably, a small number of practices will find themselves in more difficult circumstances. NHS England has been considering the small number of significant outlier practices, as my hon. Friend the Member for Westmorland and Lonsdale mentioned, for which alternative arrangements may need to be made to ensure that appropriate services are maintained for local patients. We appreciate that that is a matter of concern for some practices, and my hon. Friend has outlined concerns in his own constituency. That is why we have decided to take seven years to implement the change to the MPIG funding. Phasing in the changes over that period will allow the minority of practices that lose funding to adjust gradually to the reduction in payments.

NHS England has been looking carefully at how its area teams can support the practices that are most affected. It has invited practices that believe they will have problems as a result of the phasing out of the MPIG to raise that concern with their area team. In a small number of cases where there are exceptional underlying factors that necessitate additional funding, NHS England has asked its area teams to agree different arrangements to ensure that appropriate services for patients continue to be available. That includes looking at how services are funded.

Importantly, NHS England has suggested that practices with small list sizes could look at collaborating with other practices, for example through federating, networking or merging with nearby practices, to provide more cost-effective and better services for patients, a point I will come to in a moment. Practices can also identify other ways they could improve cost-efficiency, such as reviewing staffing structures, and they can review commissioning or contracting options.

[Tim Farron]

I am grateful to the Minister for that explanation. I simply want to point out that neither Hawkshead nor Coniston, despite both being put in an unsustainable financial situation in the future, technically count as outliers. Will he guarantee that NHS England will look at the sustainability of all surgeries, not just those that have lost the most from the withdrawal of the MPIG?

[Dr Poulter]

The answer is in exactly the point made by my hon. Friend in his speech: it is about local area teams working effectively with practices.

Let me provide my hon. Friend with an example of how collaboration between services and GP practices can work well, from not just a financial perspective but a patient care perspective. In Debenham, Otley and Grundisburgh in my constituency, all of which have important rural communities, there is a practice that works collaboratively and a practice that serves and looks after populations across a number of sites. That works well for local populations, because they have an accessible local GP service.

That practice model has also produced considerable economies of scale. It has allowed the practices to invest in additional services for the benefit of local patients. Where there are pressures caused by an ageing population and the complex needs of older patients, that has allowed more money to be freed up to focus resources appropriately. In some cases, it has also allowed greater flexibility in the use of the infrastructure—certainly, surgery buildings —to provide greater community benefits.

The model can work, and it is important that practices, even though they are small businesses, consider that they need to collaborate and work with neighbours, where possible—not to lose their independence or identity, but to make efficiencies where they can, so that more money can be directed into front-line patient care. That is part of the answer.

Providing a sustainable solution is about practices working well with their neighbours. Sometimes it might mean rebuilding relationships that have broken down in the past. We know that, with the best will in the world, we do not always get on well with our colleagues, although we all do our best to look after patients. Sometimes it is about practices setting aside past disagreements, working collaboratively for the benefit of patients and making efficiencies where possible.

[Tim Farron]

Of course, many surgeries will be able to find ways of surviving and thriving through different working arrangements. There will be some, however, that are essential and strategically vital for rural communities such as mine, which will have done everything they possibly can but cannot make ends meet. Will the Minister confirm that funding will be available through NHS England to support those surgeries?

[Dr Poulter]

That is a matter for area teams to look at. The first approach that area teams will take is to ask, “Where can we make efficiency savings that will mean there is more money for front-line patient care, such as IT, back-office services and administration costs?” Hospital providers have been doing well in reducing administration and freeing up money for patient care. Are there economies that can be gleaned through better procurement practices and surgeries working together?

That has got to be the first thing: surgeries looking to help themselves. Later on down the line, if everything else has been exhausted, the area team will have to make a decision about whether other mechanisms are in place to provide additional support.

I am confident that, with a funding formula that recognises rurality, and a funding formula for CCGs that particularly identifies the importance of an ageing population, we have a formula that will support rural practices into the future.

NHS Patient Data

Dan Poulter Excerpts

Tuesday 25th March 2014 Westminster Hall

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

It is a pleasure to serve with you chairing the debate, Ms Dorries. In some ways, I wish that we had new issues to discuss; many of the issues that we are discussing today we have thrashed out on a number of occasions in the Care Bill Committee and the Report debate earlier this month, so I am not convinced that there is a lot of new information that I can bring, other than giving further reassurances along the lines of those that have been given. However, it is important to make two points at the outset.

I congratulate the hon. Member for Worsley and Eccles South (Barbara Keeley) on initiating the debate and on her ongoing interest in this topic, but if she has concerns about a witness not giving correct information to the Select Committee, it is of course at her disposal to speak to its Chair, my right hon. Friend the Member for Charnwood (Mr Dorrell), and ask him to take that up with the witness. If she has those concerns, I suggest she does that. Of course, it is very easy to take comments—a few sentences—out of context. It may be that that is the case here; it may be that there are genuine concerns, but if the hon. Lady has those, it is for her to take them up with the Chair of the Committee and ask him to take the matter further.

[Barbara Keeley]

Will the Minister let me clarify the point?

[Dr Poulter]

I will give way in one moment. It is also the case, in relation to a number of the other issues and concerns that have been raised during this discussion, that some of the events and some of the evidence given to the Select Committee have of course been superseded by the amendments made to the Care Bill that we debated a couple of weeks ago, so it is difficult to see those points—

[Grahame M. Morris]

Will the Minister give way?

[Dr Poulter]

I am giving way to the hon. Gentleman’s hon. Friend in one moment. Let me complete the explanation and then I will be very happy to give way. Events have moved on since some of those evidence sessions, because of course amendments were made to the Care Bill that gave greater clarity and greater reassurance about the protection of patients’ data.

[Barbara Keeley]

Before the Minister moves off the point about the misleading evidence given to the Health Committee, may I put this to him? The Minister was there with Max Jones and Tim Kelsey—they were there supporting him at the Committee—and I think that this really is down to the Minister. I have, of course, raised the matter with the Chair of the Select Committee, but if a Minister brings civil servants and NHS employees with him to a Committee and those civil servants mislead the Committee—giving incorrect answers not once but twice—I think that it is really down to the Minister to raise the issue as well.

--- Later in debate ---

[Dr Poulter]

The hon. Lady will recognise that NHS England is an arm’s-length body, so it has less accountability than—or certainly not the same accountability as—a civil servant does to a Minister, and it has a degree of independence. If there are concerns to be raised, as she has just outlined, it is for the Chair of the Committee to write to obtain clarification if he believes that to be appropriate. I am sure he will do so if he feels that that is right. It is not for me, as a Minister, to interfere with the workings of a Select Committee and I do not propose to do so.

[Grahame M. Morris]

Will the Minister give way?

[Dr Poulter]

No. I have listened to the same speech from the hon. Gentleman as did my right hon. Friend the Member for Chelmsford (Mr Burns). The hon. Gentleman is always very helpful in tying himself in knots and confusing debates. On this occasion, however, I will make some progress, because I have got 10 minutes left and I would like to put down some further reassurances. I may give way later on, time permitting.

Once again, I congratulate the hon. Member for Worsley and Eccles South on securing the debate, and I would like to say at the outset that we all believe care.data to be a good thing. It is good news for patients, for improving transparency in health care and for improving the quality of research. Those are undoubtedly good things, and we must not lose sight of them in our discussion. The lessons of Mid Staffordshire point out that if we do not properly expose examples of bad care—if we do not have the data, and the transparency in the use of those data, to expose good and bad care in the NHS—bad things can happen to patients. That is a lesson that we must heed.

We must also recognise that if we had had better data sharing in the past, we might have been able to learn better how to recognise patterns in prescribing that were to the detriment of patients, such as the example that has been cited of the use of thalidomide during pregnancy. We might have avoided some very bad things happening to patients if we had had the necessary data. That is what our proposals are about.

This is not a sudden, big-bang change. Opposition Members have put it about that we are dealing with a big change in approach to the use of data in the NHS, but I remind the Chamber that in 1989, hospital episode statistics were first collected for in-patient data, in 2003 for out-patient data and in 2007-08 for A and E data, and primary care data are now being made available.

Of course we understand that the use of data can be concerning, so I want to reassure everyone that the right safeguards are in place, many of them established by the Health and Social Care Act 2012. The new body, the Health and Social Care Information Centre, must have regard to the safeguards put in place by the 2012 Act. The Government take the safeguarding of patient data very seriously.

The commercial reuse of licences was raised in the debate. The Health and Social Care Information Centre has confirmed that some reuse agreements remain in place for specific organisations in relation to approved purposes. The purpose of each application is carefully considered by the HSCIC before it is agreed. That consideration includes the application’s benefit to the health and care system, a safeguard established by the 2012 Act for the use of data.

[Grahame M. Morris]

Will the Minister give way?

[Dr Poulter]

I will give way in a moment; I am just going to finish this point. Following concerns expressed by the Health Committee in its meeting of 25 February, Sir Nick Partridge, a non-executive director on the HSCIC board, has agreed to conduct an audit of all the data releases made by the predecessor organisation, the NHS Information Centre, and report on that to the HSCIC board by the end of May.

Furthermore, a report detailing all data released by the HSCIC, including the legal basis on which those data were released and the purpose to which they are being put, will be published by the HSCIC on 2 April. That report will be updated quarterly. I reiterate that the HSCIC will release information for health and care uses only.

[Grahame M. Morris]

The Minister is arguing that the scheme is an extension of what happened before, but there is clearly a quantum difference. There is general agreement that it is a wonderful thing to have data sets for research and public health purposes. The difficulty that the public have, about which we need to restore confidence, is when that information is being used for marketisation—for marketing purposes—by commercial reusers. I am not reassured by the Minister’s comments, but he has an opportunity to correct the problem in the House of Lords.

[Nadine Dorries (in the Chair)]

Order. Mr Morris, that is a very long intervention.

[Dr Poulter]

It is difficult to reply fully to such debates when we have very lengthy interventions, of which the hon. Gentleman is very fond. I would like to spell out to him what the quantum difference is. The Government have, through the 2012 Act, put in place safeguards for data protection that the previous Government never had. In particular, under the 2012 Act, data can be used only for the benefit of the health and social care system. We have put in place the safeguard that people can opt out from having their data collected and used. Those safeguards were not in place when the previous Government—

[Barbara Keeley]

Will the Minister give way?

[Dr Poulter]

No, it is important to make these points. The hon. Lady is very party political on the matter, and it is important that she recognises failings that existed in the past. I have mentioned the collection of in-patient data from 1989, out-patient data from 2003 and A and E data from 2007-08. I am not aware of any safeguards put in place by the previous Government to allow patients actively to opt out of the collection of those data. If she is aware of any, I would like her to clarify the record.

[Barbara Keeley]

The Minister is talking about opt-out, but I asked him a specific question about commercial reuse licences. I understand that there are at least six of those—six massive copies of all hospital episode statistics data—out there. How does an NHS patient get their data deleted from those copies, which sit with companies such as Harvey Walsh and OmegaSolver? How does that happen?

--- Later in debate ---

[Dr Poulter]

The point is that people have the opportunity to opt out of the programme if they wish to. The HSCIC can also put in place contractual safeguards if there are sensitivities around data. Our amendments to the Care Bill created a “one strike and you’re out” situation for any companies that use data, whereby if there is any misuse of data, they will be struck off.

The safeguards established by the Government—those in the 2012 Act and the announcement by my right hon. Friend the Secretary of State that people could opt out of the collection and use of their data—are welcome. Such safeguards never existed under the previous Government, and we have made good progress in protecting patient confidentiality, although that is not to say that we do not need to reassure the public further.

We must make sure that we have rigorous processes in place. In the brief time available, it is worth outlining some of the strong measures in the 2012 Act, which established the HSCIC and set out the framework in which it will operate to ensure that data are being used appropriately. Under section 260 of the 2012 Act, the HSCIC must not publish the information it obtains in a form that would enable an individual other than a provider of care to be identified. That is a strong protection for individual confidentiality in the publication of data.

Under section 261, the HSCIC cannot disseminate or share data that could be used to identify an individual other than a provider of care except where there is another legal basis for doing so, which, as we have said, would be only in extreme circumstances such as a civil emergency. Under section 263, the HSCIC must publish a code of practice clarifying how it and others should handle confidential data. Under section 264, the HSCIC must be open and transparent about the data it obtains by publishing a register with descriptions of the information. The HSCIC is working now to ensure that it is transparent about all the data it has released to others.

Moreover, the Government have already introduced the commitment that if someone has concerns about their data being used in such a way, they can ask their GP practice to note their objection and opt out of the system, after which no identifiable data about them will flow from their GP practice to the HSCIC. Directions to the HSCIC under section 254 of the 2012 Act, which are separate from the amendments considered by the House as part of the Care Bill, will ensure that that commitment to patients has legal force.

There are strong safeguards in place, and Opposition Members would do well to recognise that the 2012 Act has put us in a much better place. Safeguards are in place that never existed when the previous Government extended the use of data sharing in the NHS. We all recognise the benefits of care.data, and we must recognise that, with the additional safeguards in place, we will have a system that will help to improve health and care research and the quality of care available to patients.

NHS Funding (Ageing)

Dan Poulter Excerpts

Tuesday 25th March 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Edward, for what I believe is the second time. I congratulate my hon. Friend the Member for Suffolk Coastal (Dr Coffey) on securing today’s debate. As I am also an MP who represents Suffolk, which is a predominantly rural county, I recognise and support her interest in the allocation of NHS funding in areas with a high proportion of older people. I understand that she is meeting with colleagues at NHS England, who lead on clinical commissioning group funding allocations, to discuss the matter later in the month.

It is worth outlining at the outset that the funding formula allocations for this year mean that Suffolk and every other CCG is a winner. They have all seen an increase in their NHS funding. It is important to make that clear.

Before I go any further, I will pick up on some of the points made. I will not detain the Chamber by talking further on the issues raised by the hon. Member for Harrow West (Mr Thomas). His was a wide-ranging contribution, and I understand that he had to leave early, so I will write to him separately.

My right hon. Friend the Member for Banbury (Sir Tony Baldry) made an eloquent case, as he always does, for Oxfordshire and the issues faced in that county. He outlined in particular the challenges presented in rural areas by an ageing population.

My hon. Friend the Member for Warrington South (David Mowat), as ever, made a compelling case for his constituents and for the importance of changes in the funding formula being gradual. I think he was saying that it is important not to destabilise local health care economies. The funding formula was a political formula set by the previous Government, while the current formula is not political but set independently with no political interference. It is important, however, as has been outlined in the debate, that we move towards a new set of arrangements in a staged and managed manner. Otherwise, local economies will be destabilised and that could lead to unintended consequences and potential effects on local hospital services, something none of us wants to see.

The hon. Member for Strangford (Jim Shannon), as always, made a useful contribution on behalf of his constituents. I understand that Northern Ireland has the fastest ageing population in the UK, with the number of over-65s due to increase by 10.7% in the next few years. The only sustainable long-term strategy is one that engages actively with the population through not just the health sector, but the community and elsewhere, to ensure that the focus is on whole-person care in Northern Ireland, with communities working together with the NHS to deliver better care and dignity in care for older people. That was, I believe, outlined in the Budget and it is to the Northern Ireland Assembly’s credit that they highlighted the significance of an ageing population. That issue is a funding priority for them, and rightly so.

It is also important to highlight the context in which this discussion is taking place. My hon. Friend the Member for Suffolk Coastal was right to highlight the Nicholson challenge and to say that, to meet it, we need to transform radically the way we deliver care, in particular in rural areas and communities. She was also right to highlight that the £3.8 billion integration fund that the Government are setting up to join together and better integrate the primary care, secondary care, care in the community and adult social care delivered by local authorities—in her constituency, by Suffolk county council—is the way to do that. The focus is no longer on seeing a patient or a person within the silo of where they are cared for, but on joined-up, holistic care and ensuring that people with long-term conditions such as asthma, diabetes, chronic obstructive pulmonary disease and dementia are cared for in the right way throughout their care. The primary focus for that must be to deliver more care in the community and in people’s own homes. That is something we can all sign up to.

I turn briefly to the points raised by the hon. Member for Copeland (Mr Reed). I cannot let him get away with some of the things he threw into the debate today. He talked about fragmentation of services. Service fragmentation is shown no better than through the decisions on the use of private sector providers made by the previous Government. Let us not forget that they paid those providers 11% more than the NHS to provide the same service and care—something a Labour Government should have been ashamed of. This Government were certainly ashamed of that, which is why we put that right and ensured that the tariff is now set so that the private sector cannot be advantaged over NHS providers. We have also ensured that the tariff is much more focused on integrated care, rather than fragmented care.

The previous Government—understandably, to some degree—focused on reducing waiting lists, but unfortunately that did lead to fragmented services. For example, when an older person went in to have a hip replaced, the focus was purely on the operation and not necessarily on the rehabilitation and recovery that is so important after such operations. That led to fragmentation. That is why this Government and NHS England are looking at tariffs across primary and secondary care and the community to ensure that there is a genuine focus on holistic care for those who have operations, rather than just seeing people as a widget in the context of an operation, as the previous Government’s tariff setting did. We need to see such people, whether young or old, in the round and ensure that, importantly, there is a more holistic focus on rehabilitation and care.

I notice that although the hon. Gentleman said that he would get on to whether he supports an independently-set formula, he failed to do so. I am sure that all hon. Members find that disappointing. Not committing himself either way on that question suggests that he prefers the political, set formula encouraged and supported by the previous Government, which disadvantaged areas with ageing populations. I hope that at some point in the next few months when we have these debates, the Labour party will clarify its position and we will understand whether it does support an independently set formula or whether it would like to return to the political, fixed formula of which the previous Government were so fond. It would be useful for us to understand that.

[David Mowat]

I think the Minister is not doing do justice to the Opposition spokesman, who did semi-answer the question. He made it clear that he did not accept the independent, clinically driven formula. I think he called it obtuse. It is extremely interesting for, among others, my constituents and health care professionals in towns such as Warrington, who would have gained from a fairer formula, that the Labour party will not accept an independent, clinically driven formula as a basis for allocation. That very important point was made today.

[Dr Poulter]

If that was the case—I may have missed it—my hon. Friend has made an important clarification. It is important that we have a formula that is as far as possible beyond reproach and set according to clinical need—the needs of patients. It is important that a number of factors be taken into account when that formula is put in place, as has been articulated clearly by NHS England in the discussions about how the formula is set. Deprivation is a factor. It is important to note that one of the primary drivers for setting the funding formula is now age and the needs of an ageing population. That is an important factor to highlight in this debate.

I shall now deal with some of the points made by my hon. Friend the Member for Suffolk Coastal. She may be aware NHS England has undertaken a fundamental review of its approach to allocations, drawing on the expert advice of ACRA and other external groups. The review’s findings have resulted in a new formula that provides a more accurate model of health care need. Last December, NHS England published the allocations for 2014-15 and 2015-16, based on the new formula. That gives CCGs two years of certainty about what their funding allocation is, which we can all welcome.

I know that my hon. Friend is very busy and may not have had the time or opportunity to review in detail during the past three months the information relating to the new formula, but I hope I can reassure her on the direction of travel. The formula is putting us much more on the trajectory she wants to see. It is independently set and therefore has a lot of clinical merit.

[Dr Coffey]

Will the Minister also recognise that the concept of unmet need was reintroduced in a more significant way than previously, and that that does not necessarily help where we know there are elderly populations with specific conditions that need treating?

[Dr Poulter]

It may be helpful if I outline the way the new formula works and how some of the weighting has changed, which will help to address the point my hon. Friend has just made and shed more light on the direction of travel that is under way.

The new formula uses a new indicator to recognise how health inequality should be reflected, which is based on the standardised mortality rate for those aged under 75. Previously, adjustment has been made on the basis of a measure of disability-free life expectancy. The new indicator is technically better, in that it can pick up pockets of deprivation within more affluent areas. The formula focuses much more on real population need, rather than taking a blanket approach across the population.

The new formula moves to the more powerful method of using individual rather than small area utilisation data—this is fundamental to the formula—to derive estimates of need. The main factors in the model are age, gender and 150 morbidity measures from the diagnoses of admissions to hospitals. That picks up on the point that my hon. Friend just raised. The formula looks at the pressure of long-term illness. Those 150 morbidity measures will pick that up. The increased need for health care in deprived areas is captured in the base formula by directly taking account of much of the increased need in deprived groups. In addition, further adjustments are made for factors such as the claimant rate for key benefits. That ensures that the model captures increased need that is linked to deprivation but is not linked to earlier utilisation of hospital services.

The new formula reflects more up-to-date data on population growth and measures population based on registered GP lists, rather than population projections based on the census. I am sure we can all recognise that where there has been growth in a population or changes are happening at local level, basing the formula on up-to-date GP lists is a much more accurate way of reflecting the health care needs of the local population than basing it on a 10-yearly census.

The new formula also reflects the responsibilities of CCGs rather than PCTs, as my hon. Friend outlined in her contribution. CCGs are not responsible for specialist services or primary care, although of course NHS England is now also taking over responsibility for the GP contract, as she will be aware. As a consequence, it is important to stress that the new formula for allocating funds to CCGs follows the advice provided by ACRA. A strong element of the allocation is focused on age. The primacy of age, an ageing population and the needs of older patients are very much built in, as are the needs of patients with long-term conditions. There is still a strong weighting for deprivation.

[Sarah Newton]

How does my hon. Friend the Minister feel that the market forces factor is reflected in the new formula?

[Dr Poulter]

These are obviously factors that NHS England will keep under review and take advice on from ACRA, but importantly, the new funding formula is not based on census data every 10 years but on real-time information coming in from GP practices. It looks at the health care needs of local populations, at deprivation, at areas where there are groups of patients with multiple medical co-morbidities. We know that as people live longer and our NHS is more successful, that will of course throw up new challenges. People are living longer not just with one long-term condition, but sometimes with two, three or four. Someone with dementia may also have heart disease, diabetes and a whole host of other conditions. A much more accurate reflection of real-time patient information is used to help set and adjust the formula for future years, and I think we would all welcome that. It is all part of having an independently set formula, rather than one based on the whims of a particular Government.

Almost two thirds of total NHS funding, as we are aware, now goes to clinical commissioning groups, which have the clinical expertise and local knowledge to best commission health services according to local needs and priorities. We are very proud that, as part of our reforms in 2012, we ensured a clinically led NHS at local level. Doctors and nurses are now making decisions for patients, which is already leading to improved services not just in Suffolk but throughout the country, because it is ensuring that the money from the increased budget that we are giving the NHS is being spent in a way that focuses on the needs of patients.

The Government have been able to ensure real-terms growth in funding until 2015-16, despite the stark financial challenges that we face as a country, and we should be very proud of the fact that we are continuing to put more money into the NHS. That means that NHS funding in England will be almost £15 billion higher in cash terms in 2015-16 than it was in 2010-11, and spending will rise from £100.4 billion in 2010-11 to £115.1 billion in 2015-16. Importantly, transforming care and delivering more personalised care under the integrated health fund—the £3.8 billion fund that my right hon. Friend the Chancellor of the Exchequer set up last year—is an important part of ensuring that that money is spent not just more efficiently, but in a more patient-centred way, particularly for patients with long-term conditions, both in Suffolk and in other parts of the country where there are many older patients.

In concluding, I want to highlight the fact that although, as we have already discussed, every CCG is receiving an increase in funding, the three CCGs in Suffolk in particular have seen funding growth. Ipswich and East Suffolk CCG’s funding allocation will increase by 2.85% in 2014-15 and by 2.19% in 2015-16 to reach £412.4 million in that year. As a result of the new funding formula that has been put in place, Suffolk is doing well, as are many other parts of the country.

Having a formula that is independently set according to clinical need and population information, and that is up to date and accurate, puts us in a much better place properly to look after the needs of patients, be they young or old, in the years ahead. That formula and the Government’s bold decision to ensure that it is independently set puts us in a strong position to deliver high-quality care for older people. That, together with the £3.8 billion integration fund, means that we will radically transform and improve the way in which we deliver care.

Atrial Fibrillation

Dan Poulter Excerpts

Wednesday 12th March 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship for the second time, Mr Turner. It is also a pleasure to congratulate the hon. Member for Huddersfield (Mr Sheerman) on securing the debate, and to thank my hon. Friend the Member for Montgomeryshire (Glyn Davies) for his important contribution about his own experiences of atrial fibrillation and its consequences. Although he spoke about the cardioversion treatment he received for sudden onset AF, much of the debate today has been about those who have chronic AF, which is often undiagnosed. The debate provides a good opportunity to raise such issues and ensure that those who are listening—in particular, bodies such as the Royal College of General Practitioners —take away messages about what more they can do to support GPs in earlier detection and diagnosis, where that is possible, and to make sure that the right treatment pathways and proper medications are provided to patients.

It may be useful if I talk briefly about the condition. The heart is not my area of medical expertise, but as a junior doctor I looked after several patients with AF, some of whom came through the front door of the hospital in a similar condition to that described by my hon. Friend the Member for Montgomeryshire, so I have seen it at first hand. AF is the most common sustained heart rhythm disturbance, and it occurs as a result of rapid, disorganised electrical activity in the heart’s upper chambers—known as the atria, hence atrial fibrillation—which results in an irregular heart rhythm. As we have heard, AF is a major predisposing factor for stroke and it accounts for approximately 14% of all strokes.

[Mr Sheerman]

On that point, would it not be a fine idea for the Minister or one of his colleagues to write to every Member of Parliament with the statistics? In the Calderdale and Huddersfield NHS Foundation Trust in my constituency, liaison between hospitals and GPs is not as good as it should be. When someone such as the hon. Member for Montgomeryshire (Glyn Davies) comes out of hospital after having an episode, there is no linkage of treatment between the hospital and the GP. Would it not be a fine idea to send a letter to every Member of Parliament giving them the statistics and urging them to talk to their clinical commissioning groups and GPs about the matter?

[Dr Poulter]

The hon. Gentleman is absolutely right about the importance of raising awareness of AF. He is also right to point out that co-ordination between primary and secondary care is not always as strong as it could be, not only in this area but throughout the NHS. Part of the reason the Government are investing in the £3.8 billion integrated health fund is to ensure that health and social care are better joined up, to achieve a more co-ordinated and holistic approach that is about individuals’ needs.

If someone has been diagnosed in hospital, it is important that they are given the right support in general practice and in the community. There is a lot of good practice out there, and there are a lot of good and well informed GPs. NICE is producing new guidelines and new draft recommendations on treatment—it has been looking at issues such as the use of anti-coagulants—and it is important that that information is disseminated quickly and effectively. My commitment to the hon. Member for Huddersfield is that I am happy to write to NHS England, which oversees CCGs, to raise the matter and ask it to disseminate NICE guidelines to CCGs and ensure that they are mindful of them.

[Mr Sheerman]

That is excellent news, but as someone with medical training, is the Minister not shocked that 36% of those with AF are being prescribed nothing or aspirin? Was he shocked to find out that rather than the 20% that NICE expected, only 3.4% of sufferers were on the new anti-coagulants?

[Dr Poulter]

The statistics that I am aware of are slightly less positive than those that the hon. Gentleman has cited. It is not for us in this place to micromanage medical professionals or to do their jobs for them. However, it is our job to raise legitimate concerns about care for AF or any other health conditions. We must do our best, as stewards of the health system, to push for good local commissioning that is mindful of best practice. I have undertaken to write to NHS England about that, and I will be happy to share the reply that I receive with the hon. Member for Huddersfield and other hon. Members and hon. Friends.

The exact causes of AF are unclear, but it is important to get the diagnosis right and to diagnose the condition as quickly as possible. We believe that some 18% of cases of AF are undetected, so there is more work to be done. NHS England has recognised that, and has suggested that CCGs should work with local practices to target people who are at risk from AF. The issue is already on NHS England’s radar, but I will write to obtain further assurances that it is being taken as seriously as it should be; I am sure that that is the case.

Research is under way into the condition. The National Institute for Health Research is funding a study into automatic diagnosis of AF in primary care using a hand-held device, which may help identify more patients who have AF and reduce the number of related strokes. If someone does not know that they have the condition, they do not know that they need to see a GP to get help. We must do as much as we can to support people to recognise that they have a medical condition and that help and treatment are available. I hope that the research into that technology provides better early detection of AF, and that that comes forward in a rapid and timely manner.

[Glyn Davies]

I thank the Minister for giving way and allowing me to correct an omission in my contribution. Does he agree that the excellent work of the Atrial Fibrillation Association in promoting knowledge of the disease has had a hugely positive impact, which we should all appreciate?

[Dr Poulter]

My hon. Friend is absolutely right to highlight that work. When NICE draws up guidelines, it consults best practice and tries to engage with key stakeholders. In addition, the Royal College of Physicians has developed some national clinical guidelines for stroke with the objective of encouraging higher levels of anti-coagulation. That is directly linked to some of the things we have debated today.

It is a testament to the work of groups such as the Atrial Fibrillation Association that we are helping to raise the profile of the condition and to get early support and help for people. There is clearly more to do, and NICE must continue to develop strong guidelines to support understanding of the best care and pathways for people who have AF. NICE is updating guidelines at the moment and developing a quality standard on AF, which will set out what a high-quality AF service should look like and drive improvement locally by helping local commissioners and CCGs understand what good looks like in AF care.

[Mr Sheerman]

Before the Minister, who is uniquely qualified to have an opinion, sits down, does he agree that more people should be on the new generation of drugs that will keep them alive and prevent them from having strokes?

[Dr Poulter]

It is not my medical specialty, but if new medication is developed, we need to evaluate it. The priority must be to give treatment according to clinical need. I, as a doctor, the Government and hon. Members on both sides of the House believe that it is right to treat patients according to clinical need and clinical priority. It is for CCGs to work with national guidelines, and we look forward to seeing the NICE quality standard on AF, which I hope will put CCGs in a much better position. I have already committed to writing to NHS England to ensure that it puts the matter high on its priority list, and that it supports and encourages all clinical commissioning groups to take AF seriously and make it a priority across the country.