Acute Hospital Wards (Staffing)

Dan Poulter Excerpts

Wednesday 15th January 2014 Commons Chamber

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

I pay tribute to the dedication and commitment to safe staffing and minimum staffing levels that my hon. Friend the Member for St Ives (Andrew George) has shown over the last year. I have much enjoyed our many conversations about the matter, and although he understands that we have different views about the right thing to do, both he and we are coming from the right position, which is about ensuring that we properly respond to the scandals exposed as a result of the Francis inquiry into Mid Staffs and ensuring we support all staff and hospitals to look after patients.

[Jeremy Lefroy (Stafford) (Con)]

Given that one of the problems at Stafford hospital in the mid-2000s was a sharp reduction in the number of nurses in order to cut costs, will my hon. Friend and the Department of Health be looking at cases where trusts substantially reduce the number of nurses at one point to see whether that constitutes a risk to safety?

[Dr Poulter]

As I will come on to say, if my hon. Friend will bear with me, it is now a matter for the CQC to inspect trusts on issues such as quality of patient care and safety. I will outline those measures later in response to my hon. Friend the Member for St Ives.

It is important that we support staff as much as possible when they raise concerns, whether about minimum staffing levels or other quality-of-care issues—this was the point just raised by my hon. Friend the Member for Stafford (Jeremy Lefroy)—and to do that we are facilitating and enhancing a duty of candour on trusts to ensure a more candid and open approach and to ensure that staff who have concerns are better supported and are better able to raise them.

Turning specifically to the matters at hand, superficially the principle of minimum staffing ratios sounds seductive, but when it comes down to it, we will see that they do not guarantee safe staffing or care. For those reasons, the Government do not support them. The principle of good care is about having the right staff in the right place at the right time. As we will all be aware, the needs of patients can change not just daily, but hourly—a patient can rapidly deteriorate—and just having ticked a minimum-staffing box does not mean that the right care is necessarily being applied. The lesson to learn from Mid Staffs is that we followed the bureaucratic tick-box approach and that led to failings in care, and that just ticking boxes saying we have done something, however seductive or good it might sound, does not necessarily mean that patients are being treated right. That is a matter of clinical circumstances and the clinical judgment of staff.

[Andrew George]

I am well aware of the Minister’s line, but if we followed its logic to its conclusion, we would withdraw minimum staffing levels from paediatric wards, intensive care and, in other sectors, child care, which is a topic that has been hotly debated politically as well.

[Dr Poulter]

As my hon. Friend will be aware, the CQC inspection regime inspects all parts of hospitals. Good care in a cardiac or intensive care unit is not necessarily about having one-on-one nursing; it is also about ensuring that all the other additional supports and other parts of the multidisciplinary team are in place to deliver high-quality care. That is at the heart of what the Government are trying to do. I believe that the CQC, looking not just at staffing levels but at wider determinants—for example, using the NHS safety thermometer, which looks at the issues my hon. Friend raised about bedsores—and putting together a whole picture of what the care at a trust is like, is well placed to make judgments. Part of the CQC’s inspection regime entails full clinical involvement, so it has become more of a peer-review process about what “good” looks like from one hospital to another—an important improvement in the quality of the inspection regime, which enables it to weigh up staffing issues.

My hon. Friend will be aware that we are going to support the CQC and provide greater transparency throughout the health system—in regard to staffing levels, by ensuring that they are published in future. Trust boards will have a requirement specifically to look at their staffing levels and to address problems. We shall not simply wait for the CQC to react to staffing issues as part of its wider inspection regime; there will be a requirement on trust boards to look at them. On Christmas day, I visited my local trust and found that staffing levels were discussed on a daily basis, in direct response to improvements following the Francis inquiry. I believe the same thing is taking place in a number of hospital trusts throughout the country.

Let me deal with my hon. Friend’s specific questions. He asked whether there were a significant number of hospital settings in which the number of registered nurses on duty was insufficient to ensure patient safety, professional standards and morale among many in the nursing profession. Our patients, their families and the public need to be assured that, wherever they are cared for and treated, there is a strong and positive patient safety culture, led from the top and embedded in every organisation.

There can be cases where hospitals are under-staffed and there is an impact on the quality of care provided, but these cases need to be addressed from a whole-care perspective, in which staffing numbers form just one element of a broader safety assessment. It is right that clinicians and trust boards have the freedom to agree their own staff profiles, which should not be dictated from Whitehall or by some blanket tick-box approach saying “You have met the minimum staffing number; you are therefore delivering good care”. We know from what happened at Mid Staffs that that is not the case. We must do everything we can to support good decisions made in the best interest of patients on the ground. This approach will give trusts the flexibility to respond swiftly to changes in patient demand or to meet the urgent needs of patients who have deteriorated, ensuring that safety and quality care is available.

We need to make sure that patient safety is a constant concern to each and every NHS trust and NHS employee, ensuring that risks to patient safety are always acted on as soon as they are identified, whether it relates to a “never event” or to the number of staff on a ward at any time of the day or night. We expect trust boards to sign off and publish information on staffing levels at least every six months to demonstrate that they are using evidence-based tools to calculate their staffing levels and provide assurance on the impact on quality of care and patient experience.

My hon. Friend asked whether the Safe Staffing Alliance proposal for a fundamental standard of no less than one registered nurse to eight patients would be a useful tool for inspection, surveillance and as a benchmark for management to use alongside other safe staffing tools. I hope he will understand that no single dimension and no single tool can ensure patient safety and that setting minimum staffing levels does not necessarily ensure that patients get the best possible care. Patient safety is not just about safe staffing; it is about listening to patients, assessing their needs and staff taking action where there are concerns. The number of staff—not just nurses, but doctors, physiotherapists, health care assistants and all other important members of a multidisciplinary team—needed to look after patients in a cardiac intensive care unit will differ from the numbers and skill mix required in a rehabilitation setting or another care setting—and it will differ from day to day, ward by ward and sometimes even from hour to hour, depending on the care needs of patients.

Ticking boxes on minimum staffing levels does not equate to good care. As the Berwick review made clear, ticking boxes in relation to minimum staffing levels does not equate to good care. Patients must be assessed individually, and the level of care required to ensure their safety must be determined by front-line staff locally, supported in their decision making by a range of factors that determine safe care. That should include staffing levels, but they are not the only issue: the Berwick review made that clear as well.

The Care Quality Commission also considers staffing levels in its inspections of registered providers, including acute hospitals. All providers registered with the CQC must ensure that at all times there are sufficient numbers of suitably qualified, skilled and experienced staff. In time, the guidance that we are developing on safe staffing will help providers to understand how to calculate reference staffing levels. It will also be used by the CQC when it assesses whether the right number of staff are employed to provide safe patient care.

My hon. Friend asked whether I agreed that in future the CQC should concentrate more on using safe staffing tools and clear measurements, and on how many registered nurses were on a ward. I do not want to dictate from Whitehall—indeed, I am sure that none of us do—the details of what the CQC will look for; it is important for the CQC to take a flexible approach to its inspections, and to be prepared to pursue different avenues depending on what it finds. What we can all agree on is that the provision of enough trained and skilled staff is vital to the delivery of acceptable care, and that CQC inspections should continue to consider staffing levels.

I must end my speech shortly, so I will write to my hon. Friend about the other points that he raised. I know that we are approaching this issue from the same position, and that all of us care about supporting staff and delivering high-quality care. However, I hope my hon. Friend will agree that safe staffing levels could have perverse consequences, that they are only a part of the picture when it comes to delivering good care, and that it is for the CQC to ensure that it takes an accurate and holistic view when carrying out its inspections to ensure that high-quality patient care is provided in the future.

Question put and agreed to.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 14th January 2014 Commons Chamber

[Valerie Vaz (Walsall South) (Lab)]

4. How much has been spent on medical locums in accident and emergency departments in each year since 2009-10.

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

Staff employment is a matter for NHS trusts and we do not collect that data centrally. We recognise the challenge in recruiting and retaining A and E doctors, who can take up to six years to train. However, growth in the medical work force has kept pace with the increase in attendances since 2010.

[Valerie Vaz]

I am sure the Minister will agree that it is a grotesque situation where a trainee doctor working as a locum is paid as much as a fully qualified doctor. That is the result of not listening to legitimate concerns during the passage of the Health and Social Care Act 2012, so will the Minister not blame women in the work force or overpaid doctors but do something quickly to stop this drain on public money?

[Dr Poulter]

I hope the hon. Lady will be pleased to hear that under the current Government we have reduced locum costs to the NHS by about £400 million. That is, of course, good medical practice: it is good for patients to receive better continuity of care from permanent doctors. In A and E, specifically, we have seen the work force grow by more than 350 since 2010.

[Simon Kirby (Brighton, Kemptown) (Con)]

Last week, my son had to visit A and E in Brighton and spent the week in hospital. Will the Minister join me in thanking the hard-working doctors and nurses, including locums, in Brighton for their outstanding care and dedication, and for the excellent service they provide?

[Dr Poulter]

Yes. My hon. Friend will be aware that I have a particular knowledge of his local trust. I pay tribute to the dedication of the many high-quality front-line staff working there, and to those who put in extra hours to work as locums, usually from within the existing trust work force, who often have to cover maternity leave and other periods of staff sickness.

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

17. The Minister talks complacently about improvements in A and E consultants, but in Queen’s hospital in Romford only seven of the 19 posts have permanent A and E medical doctors in post. Surely he is fiddling while Rome is burning. People are not getting the service they need, while he is spending a fortune on locums.

[Dr Poulter]

The important point the hon. Lady has to remember is that it takes six years to train an A and E consultant, so it would be much better to put the question about advanced work force planning to the former Secretary of State, the right hon. Member for Leigh (Andy Burnham), rather than to members of this Government. Since we have taken charge of medical education and training, the number of those entering acute common training—those who may go on to become A and E consultants—has increased. We are now seeing a complete fill rate for those entering that training—something that the previous Government were not able to achieve.

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

How much of this difficulty might be caused by excellent staff working part time in accident and emergency? On a recent visit to the emergency department at York hospital trust, I was struck by the excellent work done by doctors, many of whom, by choice, worked long shifts three days a week. Will my hon. Friend look into this matter?

[Dr Poulter]

I will certainly do that and write to my hon. Friend to reassure her, although members of staff who work part time often put tremendous effort into their work, and we often get well rewarded by the broader experience they bring as a result of being part time, so there are benefits to having part-time staff in the NHS.

[Andy Burnham (Leigh) (Lab)]

Figures out today show a staggering 60% rise in spending on locum A and E doctors under this Government—in some trusts, 20 times more—because they cannot recruit staff. It has now come to light that Ministers were warned about this problem three years ago. Dr Clifford Mann, president of the College of Emergency Medicine, said that when he tried to raise this issue, he was left feeling like

“John the Baptist crying in the wilderness”.

Why did Ministers ignore an explicit warning in 2011 from the top A and E doctor in the country?

[Dr Poulter]

The first warnings about the challenges facing A and E were put to the previous Government in 2004. The shadow Secretary of State was a Health Minister in 2006 and Secretary of State in 2009-10, but he failed to act adequately to deal with the shortages. It takes six years to train A and E consultants, so it will take six years to deal with the problem. The good news is that under this Government enough doctors are entering acute care common stem training to fill the places available.

[Mr Speaker]

Order. I do not wish to be unkind to the hon. Gentleman, but his answers almost invariably suffer from the failing of being far too long. It is nothing to be smug about; he really has to improve.

[Mr Speaker]

We’ve got it. We’ve got to have an answer.

[Dr Poulter]

It is the right hon. Gentleman who needs a lesson about not rewriting history. Dr Mann said that this issue had been building for the past decade. When the right hon. Gentleman was Secretary of State and before that a Minister in the Department, he failed to make those long-term work force decisions and also signed up to the European working time directive, which exacerbated the problems on medical rotas. Those were decisions that he made. He created this crisis; we are fixing it and increasing the number of doctors working in A and E.

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

5. What steps he is taking to promote the health and well-being of older people.

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[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

7. What representations he has received on IT and data security issues relating to the GP extraction service; and if he will make a statement.

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

Sharing and linking GP and other data—lawfully, securely and appropriately—helps to improve care and provides a solid basis for research to benefit everyone. In addition to more than 100 items of correspondence on the GP extraction service received since July 2013, the Department of Health has also had representations on these issues from the Solicitor-General.

[Chi Onwurah]

I strongly support the better use of data and ICT to improve national health services, but it must be done securely and with informed patient consent, especially when the data are to be sold on. Yet the Health Secretary admits that he has not carried out any risk assessment of the move to a paperless NHS. Has a risk assessment been carried out for the extraction service and, if so, will he commit to publishing it and any recommendations made?

[Dr Poulter]

We have, of course, constantly assessed it. I hope the hon. Lady is not criticising the principle of improving and joining up care through better passing of data between services, which obviously has to be a very good thing. Let me reassure her that making available patient-identifiable information to third parties without the patient’s consent or on some other legal basis would be illegal. Information is held securely.

[George Freeman (Mid Norfolk) (Con)]

I congratulate Ministers on the reforms to open data and transparency, which have been a powerful catalyst for accountability and improvement in the health service—in particular, the care.data reforms. The Minister will be aware of my ten-minute rule Bill on the subject. Will he give us some assurance on the steps that the Department is taking to ensure the integration of data between the care and the NHS sector?

[Dr Poulter]

I can reassure my hon. Friend that the absolute heart of what we are doing on joining up data is ensuring that we join up data better and promote integration. Some of that will come from the £3.8 billion we are providing for more joined-up and integrated care between health and social care as part of our integrated care fund, or better care fund as it is now termed.

[Jenny Chapman (Darlington) (Lab)]

But why is it harder to get a GP appointment now than it was five years ago?

[Dr Poulter]

I think the hon. Lady will find that it was getting harder under the previous Government. It was not helped by the fact that, as we know, although it was not the fault of GPs, the contract that GPs were presented with by the previous Government made it difficult for many patients in many parts of the country to access primary and community care out of hours.

[Damian Hinds (East Hampshire) (Con)]

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

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[Sir Edward Leigh (Gainsborough) (Con)]

9. What steps he plans to take to improve the quality of health care provision in the east midlands.

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

Clinical commissioning groups in the east midlands will receive increases in funding in 2014-15. Specifically, Lincolnshire West CCG will receive an increase from £1,111 to £1,124 per head of population, and Lincolnshire East CCG will receive an increase from £1,249 to £1,258 per head.

[Sir Edward Leigh]

Does the Minister recall the very worrying Keogh report, published last year, which showed that Lincoln hospital in particular had a higher than average mortality rate? Some of us felt that if we had a stroke or a heart attack, it would be a lot safer for us to be taken to the nearest big city, such as Leicester or Nottingham. Will the Minister join me in welcoming the fact that Lincoln hospital has made progress since then, and is now expected to have a below-average mortality rate?

[Dr Poulter]

My hon. Friend is right to draw attention to the fact that the Government have taken seriously the need to deal with poor care where it exists. We have proudly taken a stand on that. It is also important for hospitals to understand that although they are making progress, there is still much more work to be done. I am sure that my hon. Friend and I are both keen to support the Care Quality Commission, Monitor and other regulators in order to ensure that care continues to improve in Lincolnshire.

[Keith Vaz (Leicester East) (Lab)]

There are currently 28,000 diagnosed diabetics in the city of Leicester, and it is clear that the whole of the east midlands—indeed, the whole country—faces a diabetes epidemic. What steps is the Minister taking to ensure that the CCGs and health and wellbeing boards in the east midlands work together and focus on prevention?

[Dr Poulter]

That is a very good question. Local health and wellbeing boards are an excellent vehicle for the adoption of a more joined-up approach throughout health care, enabling other key players in the health and wellbeing sector to drive forward improvements. It is for the boards to consider the local issues outlined by the right hon. Gentleman, such as increasing obesity and other public health challenges, and to ensure that they work with and direct funding towards local communities. The Government have provided 40% of their public health funding for that purpose.

[Andrew Percy (Brigg and Goole) (Con)]

My constituency is served by the Yorkshire and East Midlands ambulance services. Could we not make better use of our ambulance services and benefit those who require emergency admission by enabling paramedics to convey fewer patients and provide more care from the back of ambulances? I realise that that will probably necessitate tariff reform.

[Dr Poulter]

It is true that many parts of the medical and health care work force can contribute to the delivery of high-quality care, and paramedics have an opportunity to do that. As part of our “Refreshing the mandate for Health Education England” initiative, we will be considering how we can make progress in that regard during the coming months and years.

[Mr Jamie Reed (Copeland) (Lab)]

I wish you and Ministers a happy new year, Mr Speaker. We certainly hope that it is a much happier new year for NHS patients.

In the last 52 weeks, almost two in 10 patients who arrived in accident and emergency units at the University Hospitals of Leicester NHS Trust waited for more than four hours. In 2011, the local risk register for Leicester, Leicestershire and Rutland primary care trust cluster warned that the Government’s reorganisation of urgent care services would lead to the

“risk of…inability to develop a resilient, predictive, high quality, Urgent and Emergency Care System.”

Given warnings from local risk registers about the disastrous impact of the Government’s reorganisation, and following the worst week of the winter so far for accident and emergency services, will the Secretary of State come clean, act transparently, and publish the warnings contained in the national risk register?

[Dr Poulter]

I remind the hon. Gentleman that the last Government never published risk registers. The policy that we have adopted is therefore entirely consistent with theirs. However, as the hon. Gentleman will recognise, it is not for Whitehall to micro-manage local commissioners and health care services. Decisions of that kind need to be made locally, by local commissioners working with patient groups in the best interests of patients and local communities.

[Geraint Davies (Swansea West) (Lab/Co-op)]

10. What plans he has for regulation of the counselling and therapy professions.

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

We support the system of accredited voluntary registration established by the Professional Standards Authority for Health and Social Care. It has already accredited counselling and psychotherapy registers and others are seeking accreditation.

[Geraint Davies]

But the Minister knows that under this Government the number of people referred to psychotherapists and counsellors has tripled to 1 million at a cost of £400 million, and some of them are faced with so-called gay to straight conversion therapy. When will he support my Bill to regulate psychotherapists and ban so-called “gay cures”, which cause enormous trauma among their victims and are being promoted this Thursday at a big conference in Westminster?

[Dr Poulter]

As I am sure the hon. Gentleman is aware, the reason there have been increased referrals to therapists is that this Government are investing in early intervention and ensuring we invest in improving access to the psychological therapies programme so we can get to people with mental health problems much earlier and give them better support before they reach the point of crisis.

If I may beg your indulgence for one second, Mr Speaker, on the hon. Gentleman’s specific point about gay to straight conversion therapy, I also find that absolutely abhorrent in principle, but the issue is—it is an important issue and he should listen to this—that if we were to ban or put in place regulations on that it may have unintended consequences. That may stop counsellors practising who are supporting people coming to terms with their sexuality. That is an important service, and I hope we can support it on both sides of this House.

[Grahame M. Morris (Easington) (Lab)]

11. What assessment he has made of the effect of social care budget changes on the number of accident and emergency attendances.

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

16. What recent assessment he has made of the effect of social care budget changes on accident and emergency attendances.

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

Although councils have reduced social care budgets, the evidence suggests that this is not having an impact on the NHS. In fact, the data published by NHS England show that councils are getting better at getting people out of hospital at the appropriate time.

[Grahame M. Morris]

The National Audit Office reports that cuts to social care led to nearly 500,000 delayed bed days in accident and emergency in 2012-13, so will the Government see sense and commit to investing in lowering the eligibility threshold to moderate, ensuring that older and disabled people’s needs in Easington and throughout the country can be met in their community so they do not need to present to A and E causing further pressures on it?

[Dr Poulter]

Taking the hon. Gentleman’s question in the spirit he intends, I think there is a misunderstanding of the statistics. We need to reduce the pressure on A and E, and evidence from NHS England already shows that improvements in how social care works with the NHS over this Parliament are delivering improvements to care. In 2011-12 there were about 523,000 bed days lost because of delays attributable to social care, but in 2012-13 the number had fallen to 476,000, a drop of nearly 50,000. That shows that social care is working well to reduce pressure on A and E.

[Robert Flello]

I am absolutely amazed at the answer the Minister has just given. Stoke-on-Trent, which, despite the local authority having to cut a third of its budget, has managed to make cuts—or efficiency savings as the Government would call them, of course—and move money into social care. Despite that, however, it still has less to spend this year than it had just three years ago, and that is resulting in people not getting social care because of cuts to the budget and to eligibility. When is the Minister going to wake up and do something about it?

[Dr Poulter]

There is always a lot of political smoke around this, but spending has roughly been flat in cash terms according to the Association of Directors of Adult Social Services survey and councils are budgeting to spend more this year than they were last year on social care. In addition, we are setting up the integrated care fund of £3.8 billion to better join up health and social care, and that will help to improve the care available to patients as well as reduce pressure on budgets.

[Barbara Keeley]

But Government budget cuts have forced Salford local authority to change its eligibility criteria. For 1,400 people it is going to be zero-day social care, not seven-day social care, and even our excellent Salford Royal hospital is going to struggle when those 1,400 people find that the hospital is the only option for them. Age UK says these cuts make “no financial sense” and are “morally wrong”. When are Health Ministers going to see that point?

[Dr Poulter]

I make two points. First, the eligibility criteria began to change under the previous Government, so it is wrong of the hon. Lady to try to make political points which do not stand up to scrutiny. Secondly, I am disappointed that she is unable to recognise that there is very good integration of health and social care in Salford, in her own constituency. That is a model that we could look at to see how good care can be delivered elsewhere.

[Sarah Newton (Truro and Falmouth) (Con)]

I am delighted that Cornwall has been chosen as a pioneer area for joining up health and social care. It is the only pioneer area to be led by the voluntary sector. Will the Minister meet me and the Cornwall team to enable us to deliver that care in Cornwall?

[Dr Poulter]

I can confirm that the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), will be delighted to meet my hon. Friend to take that further, and that he and I will be visiting Cornwall in the next few months to see at first hand the excellent work that is being done there.

[Mr Philip Hollobone (Kettering) (Con)]

Would the Minister like to congratulate the Northamptonshire Healthcare NHS Foundation Trust, Kettering general hospital and the Northampton General Hospital NHS Trust for coming together to form the frail and elderly crisis hub in Northamptonshire, to prevent unnecessary admissions of elderly people to local accident and emergency departments?

[Dr Poulter]

I would very much like to do that. It is important, given that we sometimes have adversarial discussions on these matters, to highlight the examples of good practice. The example in my hon. Friend’s local area of Kettering is exactly the sort of initiative that we need to see elsewhere in the country. That is why we have given £3.8 billion to better support the integration of health and care.

[Mr Marcus Jones (Nuneaton) (Con)]

Changing working practices in hospitals is an important way of reducing pressures on social care and on A and E. Will my hon. Friend join me in praising the staff of the George Eliot hospital, who, through changes to working practices implemented under the supervision of the Keogh process, achieved the second-best A and E four-hour target performance in the country over the busy Christmas and new year period?

[Dr Poulter]

My hon. Friend is absolutely right to highlight the fact that integrated care working, better intermediate care and ensuring that GPs work closely with accident and emergency departments are exactly the kind of factors, along with joining up health and social care, that take pressure off A and E departments. I am delighted that things are going so well in his local area.

[Liz Kendall (Leicester West) (Lab)]

Happy new year, Mr Speaker.

People want a care system that gets the best results for patients and one that makes the best use of taxpayers’ resources, but under this Government they are getting neither. Half a million fewer people are now getting social care services to help them to continue to live at home, and half a million more older people are being admitted as more expensive hospital emergency cases that could have been avoided. Will the Minister tell us how that record represents good care and good value for taxpayers’ money?

[Dr Poulter]

The point I made earlier is that the number of cases of bed blocking due to social care delays has decreased under this Government. Also, it was the previous Government who began to change the eligibility criteria. Labour Members talk about a crisis in social care, but per-head funding for social care fell in the last term of the previous Government. That is the legacy that we are dealing with, and we are sorting it out—

[Mr Speaker]

Order. I do not wish to be unkind to the Minister, but I am quite interested in making progress with Back-Bench Members, who have had to wait too long.

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[Hugh Bayley (York Central) (Lab)]

T5. On 1 January, the York Teaching Hospital NHS Foundation Trust ceased providing antenatal advice classes for pregnant women and refers them instead to online advice on its website. Is that an approach the Government support, and will they urgently invite the National Institute for Health and Clinical Excellence to review the change in policy and look at its effectiveness?

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

I am sympathetic to the point that the hon. Gentleman raises, and I am happy to meet him to discuss it further so that we can see whether the matter needs to be addressed.

[Mr Gary Streeter (South West Devon) (Con)]

T6. On any given day in the Derriford hospital in Plymouth, 75% of patients are over 65 years of age and rising. Does that not demonstrate the demographic pressures that face our acute hospitals, and what more can this Government do to ensure that people, especially elderly people, are treated in the community?

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[Ms Margaret Ritchie (South Down) (SDLP)]

Given the ongoing crisis in A and E units in the UK, particularly in the area I represent in Northern Ireland, will the Minister confirm whether the Health Minister in Northern Ireland has had discussions about possible solutions to finding and recruiting extra doctors?

[Dr Poulter]

I am not aware of any direct conversations with Ministers here, but as the hon. Lady will be aware, the Minister responsible for A and E services is my right hon. and noble Friend Earl Howe. I will write to her about the discussions that have been had with the noble Lord and Health Education England.

[Mr Robert Buckland (South Swindon) (Con)]

T10. I warmly welcome initiatives such as the introduction of personalised GP care for the over-75s, but what more can be done to ensure that personalised care treats the individual’s well-being as opposed to merely a collection of symptoms?

Health Funding (Telford and Wrekin)

Dan Poulter Excerpts

Tuesday 7th January 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 third time, Mr Dobbin.

I congratulate the hon. Member for Telford (David Wright) on securing today’s Westminster Hall debate, on his strong advocacy for the needs of his constituents and on his highlighting of the importance of political consensus on these issues. He is absolutely right to do so.

We know that the single biggest challenge facing our health services is how better to look after older people and people with long-term disabilities and how to provide dignity in the care of people as they grow older. The key to delivering better health services for that group—and for all patients, including those in the early years of life—is an increased focus on integration and more joined-up health care services. That is very much at the heart of the hon. Gentleman’s contribution, and I hope my remarks will reassure him that it is very much the focus of the Government’s stewardship of the health care system.

The hon. Gentleman will be aware that a £3.8 billion integration fund has been set up that will, in the longer term, drive and improve joined-up services between local authorities and the NHS. For far too long, there has been too much silo working. Silo budgets have sometimes reinforced the silo working, and it is often patients who have fallen through the gaps and paid the price. That is why the Government are determined to fix the situation and ensure that, not just through the changes we are introducing in the Care Bill but through the integration fund, there will be greater synergy of joint commissioning and pooled budgets between local authorities and the NHS, where that is to the benefit of patients.

It was a pleasure for me to visit the Princess Royal hospital in November 2013 to see the birthing centre and the development of the new women and children’s centre. As the hon. Gentleman will be aware, the trust has benefited from some £35 million of external capital money to support its capital investment programme, including the development of the women and children’s centre, which is due to open in autumn 2014.

Before we proceed, there are two issues. First, there is the key issue of how the national funding formula is set. I reaffirm that throughout the NHS, including in Telford and Wrekin, there have been real-terms increases in NHS funding under this Government. Secondly, the local CCG has discretion on how it allocates its budget, so there is some local discretion, which probably goes to the heart of some of the hon. Gentleman’s concerns.

Until recently, the funding allocation was set by the Department of Health, but under the new arrangements politics has been taken outside the setting of health care funding; NHS England now has direct responsibility for funding allocations. The NHS, through NHS England, relies on the Advisory Committee on Resource Allocation, or ACRA, and its assessment of the expected need for health services to help set allocations for each area.

We were all pleased that, for the 2013-14 allocations, NHS England decided that following the ACRA recommendations exactly would lead to higher growth for areas with better health outcomes and possibly reduced budgets for areas with less good health outcomes. Given that, like NHS England, we are all concerned about reducing health inequalities, the important decision was made to maintain the substantial weighting in the formula for areas of deprivation and health care inequalities. The ACRA formula was not directly followed, an issue on which we have touched in previous Westminster Hall debates. NHS England’s thinking, in outline, was that the recommendations were inconsistent with the responsibility to reduce health inequalities. NHS England conducted a fundamental review that has informed the allocations.

On 17 December 2013, NHS England’s board met and agreed CCG planning guidance and allocations for 2014-15, which will help commissioners to commission services for the benefit of local populations. The Government have protected the overall health budget, and NHS England has ensured that every CCG in England will continue to benefit from at least stable real-terms funding for the next two years.

The Government’s mandate for NHS England makes it clear that we expect it to place equal access for equal need at the heart of its approach to allocations; to consider health inequalities; to ensure a transparent process; and to ensure that changes to allocations do not destabilise local health care economies. A rapid change to or endorsement of the ACRA recommendations would have led to mass destabilisation of local health care economies. NHS England was mindful of that, and of the need to prioritise funding for areas of deprivation, in its allocations.

The 2014-15 allocation for Telford and Wrekin CCG will be almost £187.8 million—the per capita allocation is £1,058 a head, about the same as my constituents receive in Suffolk. That is a cash increase of 2.14% on the funding that the CCG received this year. The CCG will also receive a 1.7% increase on its allocation for 2015-16, which means that its funding will go up to almost £191 million. Additionally, NHS England has announced that the Shropshire and Staffordshire area team will receive a 2.38% rise in primary care funding in 2014-15 to almost £342 million and a further 1.8% increase in 2015-16 to more than £348 million. Those increases are higher than average, which reflects the historical underfunding in those areas against the primary care funding formula adopted by NHS England. I hope that is some reassurance to the hon. Gentleman that, in a general sense, increased funding is coming to his part of the country.

The hon. Gentleman will be aware that the Government have also provided £221 million in additional funding to the NHS to help cope with winter pressures this year so that patients get the treatment they deserve. Winter is a challenging time for all health care services, and it is right that we have put in place additional money for the NHS. The local health economy has received £4 million in additional funding, of which £1.2 million will be directly invested in Shrewsbury and Telford Hospital NHS Trust to staff all escalation areas.

The trust has also outsourced a proportion of day surgery to the Nuffield hospital to protect elective activity, should that be necessary at times of high demand during the winter. The remaining £2.8 million is being used to improve unscheduled care capacity and flow outside the hospital. An additional 69 beds have been sourced outside the trust, including intermediate care, care home and specialist dementia beds.

As the hon. Gentleman will be aware, the winter pressures money is being used to fund intermediate care beds and the focus on rapid discharge, not only in Telford and Wrekin, but nationally to some extent. That benefits not only the NHS, but local authorities, and it is part of the drive to achieve more integrated and joined-up health and social care.

If an old person can be promptly discharged home with the right care package, it is important that that happens; that is better for the person and the care they receive, but also better for the NHS’s financial settlement. To put it crudely, stuffing beds with patients does not make good financial sense, and it is not good for patients, who would much rather be at home in their communities. I am pleased that the money is going towards making that possible in the hon. Gentleman’s area.

[David Wright]

I absolutely agree with everything the Minister says—it is basic common sense. Although I am glad to hear him say it, and it is really positive, it would be helpful if he could address one concern, although I am not necessarily suggesting he will have an answer today.

I accept that we want to get people out of hospital and into their homes if possible to ensure they are cared for effectively. However, he must admit that the figures I highlighted, as well as the local authority’s concerns, suggest there has been a fairly significant reduction in the CHC pot. Given the scale of the local authority’s budget, compared with the health service’s budget, that reduction has an enormous knock-on effect on the local authority. I hope the Minister will take some time to look at that.

[Dr Poulter]

The hon. Gentleman is absolutely right to highlight the issue. The point I was coming on to is that although the region’s funding allocation from the Government through NHS England is going up, the CCG obviously has some local discretion over how that allocation is spent, and that goes to the heart of the matter.

As has been highlighted, continuing health care funding is the crux of this matter, and it is relevant to mention NHS continuing health care, which is a package of ongoing care arranged and funded solely by the NHS where the individual is found to have a primary health need. The NHS provides that throughout the country, and it is vital that it does.

There is sometimes quite a blurred line between where NHS funding and care end and where local authority responsibility starts. The issue is not whose budget is involved or which budget the money comes from, and that is part of the reason why the Government set up the £3.8 billion integrated care fund. This is about joining up budgets. The hon. Gentleman and I, the doctors and nurses on the ground, and the local authority are interested in the person, rather than who pays for treatment. The fund is a recognition of that, and we are setting it up to drive forward joined-up working.

However, we have to look at where we are now and why we have come to the place the hon. Gentleman highlighted. He will be aware that audits were carried out in 2009-10 and 2010-11 of the then PCT’s accounts. It was decided that the continuing health care funding was not being allocated properly, appropriately or even, potentially, legally.

At that point, the PCT was putting a lot of additional money into continuing health care, but a similar approach was not being taken elsewhere in the country. The auditors therefore rightly took the view that funding had to be allocated in accordance with the correct public rules for spending money, including NHS money, and that if money was, potentially, being allocated in an illegal way, that needed to be addressed under the rules at that time.

[David Wright]

rose—

[Dr Poulter]

I absolutely accept—the hon. Gentleman may wish to elaborate on this in his intervention—that, fundamentally, this is not about rules, but about making sure we have a better service for people. That is what we need to focus on.

[David Wright]

Yes, indeed, I do believe that. My concern is that the figures I highlighted suggest that, in comparison with similar and surrounding authorities, we are doing very badly per head of population in terms of the assessment process for qualification for continuing health care. That suggests to me that the pendulum has swung too far in the other direction and that the assessment procedure is being used to ensure that the figures are kept down.

I am concerned that some people with care needs in the community will lose out—as the Minister rightly said, this is not about structures and silos in the health service, but about individuals and their families in the community who are trying to cope.

[Dr Poulter]

The hon. Gentleman is right. In terms of the per capita spend in CCG allocations, Suffolk similarly has large towns with very rural surrounding areas, and the CCG in the hon. Gentleman’s area has a fairly similar allocation to the one I represent.

There is also an issue about how the money given to CCGs is spent. In a knee-jerk reaction, perhaps, to the auditors’ findings and the fact that the spend was not allocated appropriately, Telford and Wrekin went from being almost one of the highest spenders on continuing health care to being one of the lowest, and that is the crux of the problem. That is down to decisions by the CCG, or the PCT as it was, about how to allocate the budget given to it.

If, in 2009, 2010 and 2011, the PCT was picking up funding responsibilities that should perhaps have been the local authority’s, but then, in response to the audit, changed the amount it allocated to continuing health care, that could clearly have a destabilising effect on the local authority. However, the PCT and then the CCG have done everything they can to mitigate that, and they have given the local authority discretionary funding.

In particular, just over £3 million has gone to the local authority thanks to the fund set up by my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) to facilitate exactly that kind of activity. At its own discretion, the CCG has also given the council £2.4 million on top of that, over and above what the council expected to receive. The CCG has therefore acknowledged and accepted that, in reacting to the auditors, there was perhaps an over-reaction, and it has now righted that by giving the local authority some discretionary additional funding.

That does not detract from the overriding point that, generally throughout the country, and particularly in Telford and Wrekin, we need to see increased emphasis on integration and joined-up care. It is in no one’s interests to have such discussions about funding, which waste a lot of time and effort on the part of the local authority and the CCG. If we can drive more joined-up working, more joint commissioning and more pooled budgets, where appropriate, as the Government will be doing through the Care Bill and the integration fund, the number of these turf wars will be reduced, because the emphasis will be on the patient, rather than the budgetary silo. That must be the right way forward.

I am sorry that, in this instance, the hon. Gentleman’s constituents and local authority have perhaps been caught up in errors made by the former PCT, although I am pleased the CCG is doing all it can to redress the balance by giving the local authority discretionary additional funding. I hope working relationships will improve and that, as we move forward, with further emphasis centrally on integrated health care and joined-up budgets, we will see greater improvements to the local health care economy and, more importantly, continuing improvements to patient care locally. If the hon. Gentleman wants to discuss the matter further or to meet me, I will be happy to do so.

Mid Staffordshire NHS Foundation Trust

Dan Poulter Excerpts

Tuesday 7th January 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Crausby. It is also a great pleasure, as always, to respond to my hon. Friend the Member for Stafford (Jeremy Lefroy) and, indeed, to all hon. and right hon. Members who have contributed to and supported this debate, which raises an important issue for patients and constituents, not just in my hon. Friend’s Stafford constituency, but across Staffordshire and the wider region.

It has been an incredibly difficult time for local patients and staff at the Mid Staffordshire NHS Foundation Trust. I entirely agree with my hon. Friend that the trust has come a very long way since the terrible events exposed by the inquiries and the Francis report last year. My hon. Friend has walked the journey every step of the way with his constituents and with the patients, and he should be congratulated and commended on his strong and superb advocacy of the needs of local patients, of all his constituents and of the families of those who were treated appallingly by the trust in the past. He should also be congratulated and commended on his strong advocacy for the improvements and the high-quality care that is now being delivered by parts of the trust today. I am sure we would all like to put on record our congratulations on his advocacy and on the work done by him and my hon. Friend the Member for Stone (Mr Cash), who for many years has also been a strong champion of local patients.

In responding to some of the points that have been raised today, it is important to talk a little about the trust’s background to provide some context. The trust has been operating at a deficit for some time, and certainly since 2009. In April 2013, the trust reported a deficit of £14.7 million. As my hon. Friend the Member for Stafford alluded to, that position is expected to get considerably worse. As a proportion of the trust’s turnover, the deficit forecast for 2014 is higher than that of almost any other trust in the country. For the past two financial years, the trust received approximately £20 million a year in support from the Department of Health. Without that funding to supplement its income, Mid Staffs would have been unable to pay its staff.

The contingency planning team sent into Mid Staffs in late 2012 concluded that the trust was delivering services at a cost substantially higher than most other trusts in the country. A key challenge faced by the trust is the recruitment and retention of staff and the high cost of temporary staff, which is no wonder, given that it must have been a very demoralising time for those working in the trust when there have been ongoing investigations into events that took place in the past. Additionally, some of the trust’s services are operating with consultant numbers significantly below Royal College guidelines. The 2012 contingency planning team reported that, despite improvements in clinical services, the trust is unlikely to be able to achieve the required cost savings without adversely affecting the quality of care provided to patients.

On the reasons why the special administration process has been set up, it is important to take the initial report into account and to recognise that we are where we are today because of that report. In cases such as this, where a trust is facing substantial financial challenges, it is crucial that action is taken quickly to secure services for patients and ensure that high-quality patient care can still be delivered. The special administration process for foundation trusts offers a time-limited and transparent framework for resolving the problems of a significantly challenged trust. Like the regime for NHS trusts, the special administration process is intended to be used only in the most serious circumstances.

As my hon. Friend the Member for Stafford is aware, Monitor made the decision to place Mid Staffs into special administration on the basis of the 2012 work. The CPT’s first report concluded that Mid Staffs is not financially or clinically sustainable in its current form and recommended the appointment of administrators as the best option for identifying the changes required in the years going forward to continue to secure high-quality patient care. Acknowledging the serious financial challenges facing the trust, the Secretary of State wrote to Monitor giving his support for the appointment of the trust special administrators.

It is worth touching briefly on the work of the trust special administrators at Mid Staffs. The TSAs have been in place since April last year, and they have had two tasks. First, they had to take over the day-to-day running of the trust. Secondly, they have had to work with the trust’s staff, commissioners, providers and other local stakeholders to develop a plan for services. The work undertaken by the TSAs builds on the earlier conclusions of the CPT and only strengthens the case for urgent change. If no action is taken, the TSAs estimate that Mid Staffs’ annual deficit will exceed £40 million in four years.

[Joan Walley]

I am conscious of the amount of time left to reply to the specific points made by the hon. Member for Stafford (Jeremy Lefroy) and in interventions, so will the Minister ensure that the issues flagged up will be responded to in detail in this debate?

[Dr Poulter]

I will of course respond to those that I can, but as the hon. Lady will be aware and as I will set out later, the TSAs’ report is currently with Monitor—I would expect it to be recommended to the Secretary of State by the end of this month—so it would be inappropriate for me to comment on it at this stage. I hope she understands that it would be wrong for me to make assumptions about a report that has not yet been submitted to the Secretary of State.

[Mr Cash]

Will the Minister give way briefly on that point?

[Dr Poulter]

I will, but I am conscious of the time.

[Mr Cash]

I have asked nearly 10 times for a report to be debated on the Floor of the House in Government time, but it has not happened yet. Nobody can understand why it has not happened yet. Can we please have an assurance that a debate will take place and within a matter of weeks?

[Dr Poulter]

My hon. Friend makes an important point. The Secretary of State has previously given that assurance, and I give my hon. Friend that assurance again today. It is obviously for the Leader of the House to organise Government time, but I will have conversations with and write to him following this debate to ask him to expedite the issue.

Returning to the report, the TSAs have also highlighted the serious clinical implications of failing to act. They predict that services operating below the recommended consultant level, such as A and E, would need to be reduced. Low-volume services would risk being closed altogether, forcing patients to travel further for treatment. Throughout the process, the TSAs have stressed the fragility of the trust and emphasised the huge importance of agreeing to and implementing the changes required as soon as possible.

I will now move on to the next steps, about which all hon. Members are concerned. I know that it is frustrating for hon. Members wanting answers that I cannot provide them all today. The report is currently with Monitor, so it is for Monitor to make recommendations to the Secretary of State on the basis of that report. That will be the appropriate time for the Secretary of State and Ministers to comment. That may be frustrating for hon. Members, but that is the way that things need to be. We cannot comment on the matter until Monitor has made its recommendations. If Monitor is satisfied with the TSAs’ final proposals, the Secretary of State will have a maximum of 30 working days to consider them against a set of requirements defined in legislation. These aim to secure services for patients that are of a sufficient level of safety and quality and that offer good value for money. The Secretary of State will consider each requirement carefully before coming to his final decision.

As I have said, it would be inappropriate for me to pass further comment today on the TSAs’ final report because its final version has not yet been submitted. It is clear from the debate, however, that there is widespread interest from around the region and from local Members who are concerned about the wider impacts of the report on the health care economy and on services for other local patients. I am confident, however, given the interest from Members and the support provided to the trust from other health care trusts and hospitals in the area, that we will come to the right conclusion. We all want to see a strong and viable health care service for patients in Stafford and the surrounding areas, and I am confident that that is what we will have delivered once the Secretary of State has considered the report.

Maternity Care

Dan Poulter Excerpts

Tuesday 7th January 2014 Written Statements

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

On 20 December 2013 I published information about the availability of £10 million capital funding in 2013-14 to improve maternity care settings across England so both mothers and fathers, and the staff who work in the units, can benefit from a more pleasant and appropriate environment. “Improving Maternity Care Settings: Capital fund programme 2013-14: Information and criteria” 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.

Improvements to over 100 maternity units across the country funded by the £25 million improving birthing environments capital fund in 2012-13 are making a big difference to families, with more choice and better environments where women can give birth.

This year, the funding criteria prioritise:

services where the birth rate has increased quickly or where the environment needs to adapt to local demographic population changes, or

initiatives that can make a difference to women who have mental health or substance misuse problems.

Information on how to apply for this funding was made available to maternity units in December 2013 and can be found at:

https://www.gov.uk/government/publications/improving-maternity-care-settings-applying-for-funds

The closing date for applications is 5 pm on Friday 10 January 2014.

It is important that the views and experiences of women and their families locally inform the development and design of birthing environments. The successful projects will have demonstrated involvement and support from service users and the ability to deliver the project in the current financial year.

NHS England

Dan Poulter Excerpts

Tuesday 10th December 2013 Ministerial Corrections

[Liz Kendall]

To ask the Secretary of State for Health what the (a) total budget, (b) total number of staff and (c) budget for staff salaries is for those employed by NHS England but not for NHS England local area teams.

[Official Report, 28 November 2013, Vol. 571, c. 415W.]

Letter of correction from Dan Poulter:

An error has been identified in the written answer given to the hon. Member for Leicester West (Liz Kendall) on 28 November 2013.

The full answer given was as follows:

[Dr Poulter]

NHS England's total revenue budget for 2013-14 is £95.873 million, of which £2.016 million is to be spent on administration. How all spending is allocated is a matter for NHS England. NHS England has informed us that the administration budget for NHS England, excluding area teams and commissioning support units (its National Support Centre), is £332.2 million.

As at the end of October 2013, NHS England had 886.15 whole time equivalent staff in post within its National Support Centre.

The total pay budget for the total agreed staff numbers within the National Support Centre (1,106.48 whole time equivalent) is £75.2 million. There are currently vacancies within this staff structure.

The correct answer should have been:

[Dr Poulter]

NHS England's total revenue budget for 2013-14 is £95.873 billion, of which £2.016 billion is to be spent on administration. How all spending is allocated is a matter for NHS England. NHS England has informed us that the administration budget for NHS England, excluding area teams and commissioning support units (its National Support Centre), is £332.2 million.

As at the end of October 2013, NHS England had 886.15 whole time equivalent staff in post within its National Support Centre.

The total pay budget for the total agreed staff numbers within the National Support Centre (1,106.48 whole time equivalent) is £75.2 million. There are currently vacancies within this staff structure.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 26th November 2013 Commons Chamber

[John Glen (Salisbury) (Con)]

9. What steps his Department is taking to improve the health of veterans.

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

We have made excellent progress in improving the health care of our veterans by investing £22 million to support their physical and mental health. The Government have also made available £35 million of the LIBOR bank fines to support veterans and armed forces projects.

[John Glen]

I thank the Minister for that response. Will he outline the steps being taken to ensure that there is a co-ordinated approach between those commissioning services for veterans, including Salisbury district hospital, which does so much to service the veterans in Wiltshire, so that that they get the right revenue at the right time and do not go into deficit?

[Dr Poulter]

My hon. Friend is right to highlight the importance of co-ordinating veterans services, and getting the continuity of care right between a soldier or a member of the armed forces leaving the armed forces and being looked after by the NHS. I hope he will be reassured to hear that in terms of specially commissioned services, we now have nine super-prosthetic centres available for veterans who have lost limbs, 10 specialist mental health teams looking after veterans, a 24-hour mental health support line for veterans and many other measures. We are also making IVF available to veterans who have lost genitalia as a result of combat injuries.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

Given that health is a devolved matter, is the Minister satisfied that the Administrations in Wales, Scotland and Northern Ireland are providing similarly sufficient services for our veterans?

[Dr Poulter]

Obviously, we work closely with the devolved Administrations on all such matters. We have UK armed forces, and with health being a devolved responsibility, it comes to each part of the United Kingdom to put in place the right support. On the whole, that is done very well, but I am particularly proud of the efforts the Government have made on veterans’ mental health and on specialist prosthetic centres, which can be commissioned by the devolved Administrations if they wish to make such facilities available.

[Penny Mordaunt (Portsmouth North) (Con)]

Many veterans are young men and women, and I know from my own constituency case work that a tremendous burden is often placed on elderly parents in caring for them, especially if they are suffering from post-traumatic stress disorder. Does the Minister agree that better integration between medical services in the armed forces and the NHS will benefit those families as well as the veterans themselves?

[Dr Poulter]

My hon. Friend speaks with considerable knowledge of the subject from her tradition and strong record of service. She will know that an important aspect of providing proper support for veterans is ensuring that we give their families the right support. We are working very closely with armed forces families and services charities to ensure that we do exactly that. That is why we have also put in place mental health first aid support for the families of servicemen and women to ensure that families know how to support veterans when they run into difficulties with post-traumatic stress disorder.

[Stephen Gilbert (St Austell and Newquay) (LD)]

10. What assessment he has made of the effectiveness of section 64 grants in supporting children’s hospices.

--- Later in debate ---

[Paul Burstow (Sutton and Cheam) (LD)]

14. What steps he has taken in response to the findings of the report by the Chief Medical Officer, “Our Children Deserve Better: Prevention Pays”, published in October 2013.

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

The chief medical officer’s report warmly welcomes the Government’s commitment to increasing health visitor numbers and support in the early years, and I shall be working with the children and young people’s outcomes forum to inform future improvements in children’s health.

[Paul Burstow]

My hon. Friend the Minister will know that about half the burden of mental health disease can first be identified during the teenage years. In her report, the CMO says that our information about the prevalence of childhood mental health problems and the level of under-diagnosis of mental health problems among that population is out of date. When will the Government commission the next survey? The last one was done in 2004. Is it not time to do another?

[Dr Poulter]

My right hon. Friend raises important issues. I should like to pay tribute to the work that he did in expanding children’s talking therapies and IAPT—improving access to psychological therapies—services to make better provision for mental health support. He is right to highlight, as the CMO did, the fact that we do not have enough data on children’s mental health. That has been a historical problem, and we are looking at ways to improve the data so that we can use them to improve health outcomes in mental as well as physical health.

[Dr Sarah Wollaston (Totnes) (Con)]

In Devon and Cornwall since the beginning of this year there have been three occasions when children as young as 12 and 13 with acute mental illness have been detained in police cells instead of an appropriate place of safety, and 25 occasions when children of 17 and under have been so detained. Will the Minister meet me to discuss how we can end this appalling situation and make sure that all children who are detained under section 136 are seen in an appropriate location?

[Dr Poulter]

My hon. Friend is right to highlight this problem, which is unacceptable. My hon. Friend the Minister of State is looking into it. A lot of anecdotal evidence is stacking up that this practice is happening. We do not find it acceptable, and I or my hon. Friend will be happy to meet her to discuss the matter further and ensure that it is stopped.

[Karl Turner (Kingston upon Hull East) (Lab)]

15. How many NHS walk-in centres have (a) closed and (b) restricted their opening hours since May 2010.

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

The information is no longer collected centrally. Since 2007, under the changes introduced by the previous Government, the local NHS has been responsible for walk-in-centres, and it is for local commissioners to decide on the availability of these services.

[Karl Turner]

Official NHS figures show that attendances at accident and emergency departments have increased more than three times faster under the Tory-led Government than under the Labour Government. Does the Minister regret allowing so many walk-in centres to close?

[Dr Poulter]

As I outlined, there are not any official figures, because the data are now held locally. Monitor carried out a survey of some trusts, but that is not a measure of all trusts. The hon. Gentleman wants to look at the reasons why there have been changes to walk-in centres. There was a reduction in central funding of over 90% under the previous Government. I believe that the right hon. Member for Leigh (Andy Burnham) was a Minister at the time; if the hon. Member for Kingston upon Hull East (Karl Turner) wants to look at the reasons for that, he should perhaps ask his right hon. Friend why he reduced central funding for walk-in centres by 90%.

[Henry Smith (Crawley) (Con)]

In 2005, under the Labour Government, Crawley hospital had its accident and emergency department closed. Now we have an urgent treatment centre that has increased its operating hours and the services that it provides. What advice can the Department give to clinical commissioners about how we can expand urgent treatment centres?

[Dr Poulter]

My hon. Friend is absolutely right to highlight that these are local decisions that need to be made by local commissioners, because what looks good in Crawley will be very different from the needs in Bradford. That was the very reason that underpinned the previous Government’s decision to transfer responsibility for these services to local commissioners, but we often need more co-located services, because the Monitor survey picked up the fact that in the past, far too often, walk-in centres were isolated in the community; people did not know how to access them, or when they could do so. Monitor also recognised that there was duplication of effort, and sometimes patients who needed to be seen in accident and emergency were treated, inappropriately, in walk-in centres.

[Mr Speaker]

I am deeply obliged to the Minister, but we must leave time for Mr Mowat.

--- Later in debate ---

[Neil Carmichael (Stroud) (Con)]

T4. In contrast to the previous Government’s lack of focus, what have this Government done about hospital infection control, with particular reference to data management systems?

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

My hon. Friend makes an important point, and I hope that he will be reassured that under the current Government, clostridium difficile and MRSA rates are both about 50% lower than they were under the previous Government. We will continue to make sure that we reduce unacceptable hospital infections.

[Rosie Cooper (West Lancashire) (Lab)]

T2. Following Francis and Keogh, and in creating a more open and accountable NHS, will the Secretary of State, in the spirit of total transparency that he favours, order foundation trusts to publish all their board papers, have exactly the same publishing requirements as non-FTs, and hold all their board meetings in public?

[Dr Julian Huppert (Cambridge) (LD)]

T6. Cambridgeshire and Peterborough clinical commissioning group receives one of the lowest amounts of funding per head in the country. The Government’s own fair shares formula, which takes account of factors such as population, age and deprivation, says that we should have £46.5 million more each year. I know that it is not his decision, but does the Minister think that the new formula should be implemented?

[Dr Poulter]

My hon. Friend makes some important points about the funding formula. He will know that for the first time this year, it will be set independently by NHS England, and I am sure that it will take on board the points that he has made. He will recognise, however, that there are many other determinants of the funding formula, such as deprivation, which it will want to look at and take into account.

[Caroline Lucas (Brighton, Pavilion) (Green)]

T5. The last time I asked the Secretary of State about the £30 million-worth of cuts forced on hospitals in Brighton and Sussex, he said that it was all down to local discretion. Does he admit that behind his rhetoric about protecting the NHS budget there still lies a real 4% cut to the centrally dictated national tariff? Does he acknowledge, therefore, that hard-working nurses and doctors have to do more with less money while patients suffer? Will he reverse those cuts?

--- Later in debate ---

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

Further to question 15, I understand that responsibility for walk-in centres has been devolved. Why does that necessarily prevent central Government from collecting those figures centrally? It is pretty staggering that a Minister should turn up and say, “Well, the decisions are made locally so we just don’t bother finding out.”

[Dr Poulter]

That is a question that the hon. Gentleman had much better address to his own Front Bench, who made the decisions to devolve these responsibilities locally. When it comes to commissioning health services, we believe it is down to doctors and nurses, who are now leading clinical commissioning on the front line, to determine which services are appropriate in local areas. There were clearly concerns about the way that urgent care centres had previously been commissioned. That is why so many of them are now being relocated and co-located in accident and emergency departments.

[Mr John Baron (Basildon and Billericay) (Con)]

T8. The Secretary of State is well aware that the all-party group on cancer has campaigned long and hard for the monitoring of one and five-year survival rates as a means of promoting earlier diagnosis, cancer’s magic key. Is he confident, though, that the mechanisms are sufficient to ensure that those clinical commissioning groups that are underperforming in relation to their one and five-year survival rates will face concrete action to improve earlier diagnosis, given the recent OECD report suggesting that 10,000 lives a year could be saved in this country if we matched European average survival rates?

--- Later in debate ---

[Dr Poulter]

It was a great pleasure to open the walk-in centre in Morecambe, which was led by local commissioners to meet local clinical need.

[John Healey (Wentworth and Dearne) (Lab)]

The European Union has just agreed a trade deal with Canada that excludes health care, so will the Secretary of State ensure that the proposed EU trade and investment agreement with the US also excludes health care?

UK Strategy for Rare Diseases

Dan Poulter Excerpts

Friday 22nd November 2013 Written Statements

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

The “UK Strategy for Rare Diseases” has been published today.



This strategy is the overarching framework document that sets out a shared strategic vision for improving the lives of all those with rare diseases.

In the UK, one in 17 people—or more than 3 million individuals—will be affected by a rare disease at some point in their life. Rare diseases are a major cause of illness and make considerable demands on the resources of the NHS and other care services.

The document commits each UK country to over 50 actions that will be taken to deliver the vision outlined in the strategy. These actions focus on five main areas:

empowering those affected by rare diseases;

identifying and preventing rare diseases;

diagnosis and early intervention;

co-ordination of care; and

the role of research.

The UK is already at the forefront of research, treatment and care for rare diseases. This strategy will further embed and enhance this reputation to the benefit of patients and the economy.

The “UK Strategy for Rare Diseases” 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. It is also available at:

www.gov.uk/government/publications/rare-diseases-strategy.

Pharmacies and the NHS

Dan Poulter Excerpts

Wednesday 20th November 2013 Westminster Hall

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

We have had a wide-ranging debate today on issues such as the deregulation and regulation of pharmacies, the local provision of pharmaceutical services and the extension of the role of pharmacists and what they do in our communities. Importantly, we have also discussed pricing and behaviour that, if not fraudulent, is certainly very irregular on behalf of some pharmacists and drugs companies. I hope that I will have time to deal with all those issues, but I will write in more detail to any Member here today who feels that more points need to be answered.

Before I go any further, may I say that it is a pleasure, as always, to serve under your chairmanship, Dr McCrea? We took part in many sittings together when the Health and Social Care Act 2012 was considered in Committee, and it is always a pleasure to serve under your chairmanship. I congratulate my hon. Friend the Member for Ipswich (Ben Gummer), my constituency neighbour, on securing today’s debate. It is important to recognise that our NHS is not only about doctors and nurses, but about midwives, physiotherapists, occupational therapists, heath care assistants and all the other people who contribute to the health of the nation every day, including pharmacists, who play an increasingly important role in delivering high-quality local health care and who are embracing the enhanced role that they have been offered under the 2012 Act. It is right that we put on record our thanks for the work that pharmacists do every day.

The right hon. Member for Rother Valley (Mr Barron), in an excellent, considered speech, made some very good points. In particular, he said that community pharmacists are the face of our NHS in many communities. He is absolutely right in saying that because, particularly in more deprived areas of the country, pharmacists are often the first point of call for advice—whether on simple details about medications or for important primary health care advice. Pharmacists perform that role every day. We should be grateful to them for what they do, and I put on record my thanks for that work.

It is important to put on record that pharmacies are in robust health. Although we debate deregulation and difficulties, we know that there are more NHS community pharmacies than ever before—more than 11,400 in England—and they are offering health care, treatment and healthy lifestyle advice and support throughout the country. They dispensed more than 900 million prescription items last year, which is up 53% from 10 years ago, and about 2 million prescriptions are handed out every day by pharmacists. Therefore, we have an industry, as part of our NHS and in its commercial activities and other work, that is in robust health and is performing a valuable service for our NHS.

Of course, we could get into the issues that the right hon. Gentleman rightly raised on the appropriateness of prescribing medication. The chief medical officer talked in some detail in a report about the need for GPs to look sometimes at the appropriateness of the antibiotics that they prescribe and about how we need to look at antimicrobial resistance in this country. The right hon. Gentleman made his points very well, but I hope that he will forgive the fact that I shall not address them directly in today’s remarks. However, he was right to make them and the chief medical officer certainly agrees with him, as do I.

I shall deal with other points that have been made, but initially, I would like to address the important points made by my hon. Friend the Member for Ipswich. We rightly value the innovation and the opportunities that pharmacists have to innovate and support their local communities in different ways. Because they are centred in the community, only pharmacists are able to use such methods. I had the pleasure of attending the annual pharmacy awards and looking at some of those ways. I saw pharmacies, embedded in local communities, making a real difference in providing health and lifestyle advice and improving the quality of care available to local patients.

At the same time, although we want to encourage and support innovation—the pharmaceutical price regulation scheme, or the PPRS, was recently renegotiated and enhanced to give pharmacists the opportunity to innovate exactly as I have described—we also need to recognise that we have a publicly funded national health service, which is a point that has been made across the Chamber today, and we are very proud of it. It is free at the point of need, and it is important to ensure that the money that is given to the health service, whether to pharmacies or to other parts of the NHS, is properly spent, and there is also a role in ensuring that services are provided in a safe and effective way. I shall come on to some of those points later.

My hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) has been a consistently strong advocate for the role of pharmacists, and he made his points very well today. The hon. Member for Strangford (Jim Shannon) also made a useful and powerful contribution, which was picked up by the hon. Member for Copeland (Mr Reed) a few moments ago, about the importance of ensuring that there is no fraud in the system and that pharmacists always behave appropriately. I am sure that the majority of the time pharmacists behave appropriately and make a very valuable contribution. When there may be fraudulent behaviour, it is right to pick up on that and investigate it. I will come back to that in a moment, because we all want to see high value for money from our NHS and to make sure that the money is spent on patients and not wasted. I think that that is something that we all agree with and believe in across the House.

I turn to the important issue of pricing. The vast majority of drugs that are prescribed are either covered by the PPRS or are generics, where competition helps to keep the price down. We recently introduced a price for common specialists, but a small number of prescriptions, as has been mentioned in the debate, fall outside the pricing mechanisms that are in place. We are working with the Pharmaceutical Services Negotiating Committee to find a better mechanism to encourage pharmacists to seek lower prices.

Where there may be cases of fraud, it is right that we investigate them, and they are investigated. NHS Protect exists to safeguard—to protect—against fraud in the NHS. That has been a consistent policy; it was followed by the previous Government, and it has been followed by the current Government. The reason why we need services such as NHS Protect is to ensure that if there is fraudulent practice—in this case, potentially in the behaviour of a small number of pharmacists in dealing with small, unique areas of pricing—it is investigated properly. I will ensure that either I or Earl Howe, who is the Minister responsible, writes to the hon. Member for Copeland to inform him of where we have got to with the investigation.

The other point, which was made by the hon. Member for Strangford and is very important, is that we want to ensure that money goes on patients. There is increasing demand for drugs. It is very good that the NHS is continually innovating and developing more treatments, better surgical techniques and improved drugs and mechanisms. Of course, when drugs are used in the NHS, they need to be evidence-based, but I hope that he will agree that it is good that we have set up the cancer drugs fund, which has helped to increase the speed at which people with cancer receive drugs. More than 30,000 people have benefited from the cancer drugs fund and received cancer drugs. We should all be pleased about that and proud of it.

[Jim Shannon]

I thank the Minister for that positive response. I outlined in my contribution a couple of examples of people who did not access the cancer drugs fund, but in my mind clearly should have qualified. Is he prepared to look at that issue to satisfy those people who need drugs urgently because of the time they have left on this earth?

[Dr Poulter]

On how drugs are accessed, one of the problems—this was why the cancer drugs fund was set up—was that some people, as the hon. Gentleman rightly outlined, had been receiving drugs in other countries for many years, but we in this country were a little slower to respond to some of those innovations. But of course we need to ensure that, whatever fund we set up for providing medications, those medications are shown to be effective and there is an evidence base for them. However we do things, there will always be new treatments on the horizon that we would like to get through to people more quickly, and we need to ensure that those treatments are always evidence-based. I think that we can be pleased that the cancer drugs fund has made a significant difference by providing treatments in a more effective and much quicker manner, but if the hon. Gentleman would like to discus the matter further, I would be very happy to see him and talk it through in more detail.

I think that it would be useful for me, picking up on the points raised early in the debate, to outline the processes involved in opening a pharmacy. Anyone can open a pharmacy anywhere, subject to the premises being registered with the General Pharmaceutical Council, when the owner’s service model includes the sale or supply of pharmacy medicines or prescription-only medicines against prescriptions from that pharmacy. However, there are extra criteria for providing NHS pharmaceutical services. Anyone wanting to provide NHS pharmaceutical services is required to apply to the NHS to be included on a pharmaceutical list.

Before September 2012, there were control of entry requirements. The NHS (Pharmaceutical Services) Regulations 2005 determined whether a pharmaceutical contractor could provide NHS pharmaceutical services. In England, no new contractor could be entered on to a PCT pharmaceutical list unless it was “necessary or expedient” to secure the adequate provision of pharmaceutical services locally. That was the control of entry test. If a new service provider was judged neither necessary nor expedient, the NHS, or the PCT in question, had to refuse the application. There were rights of appeal to the family health services appeal unit, which is run by the NHS Litigation Authority. That was available if there was a concern.

Part of the reason for the strict criteria relates to the pricing mechanism and how pharmacists are paid, which I will come to later. Obviously, the local health economy is an issue, and pharmacists are not paid just for the number of prescriptions that they provide; they are also given a baseline fee. When we have a publicly funded health service and we need to ensure that need and demand are aligned, it is important that we look at this in the round. I sympathise very strongly with the points about the need to de-bureaucratise the NHS where possible—those were good points well made—but we also have to recognise that this is not just about arbitrary mapping; it is about aligning need and demand for a service within the pricing framework in place. That is not just about the number of prescriptions that are provided; it is a much more complex mechanism. I will come to those points later.

[Mr Jamie Reed]

I am grateful to the Minister for giving way; he is being typically generous. On pharmacy numbers, does he think that we have too few or too many, or is the number about right?

[Dr Poulter]

The hon. Gentleman will be aware that under the previous Government, the Office of Fair Trading did a review and recommended total deregulation of the pharmacy industry. That was in 2003. The previous Government put in place a strong package of reforms to recognise that we need some degree of what my hon. Friend the Member for Ipswich would call market forces but I would probably refer to more as patient choice. We need to support patient choice as much as we can, but within the context in which we have a publicly funded service that needs to be regulated. It is a health care service; it is treating and looking after patients. We need not only to secure good value for the taxpayer, as part of how we fund that service, but to ensure that there is independent regulation and some regulation by Government as well. That is about ensuring that we have the highest-quality services available.

Given that I am running short of time, I will write to my hon. Friend or I would be happy to meet him—whichever he prefers—to talk through the specifics of the context of mapping out a local needs assessment, which is now carried out by health and wellbeing boards. That is a pharmaceutical needs assessment. I am happy to talk through with him in detail how that interrelates with the pricing mechanism and how we need to ensure that the two are kept in balance in the context of the conversation that the hon. Member for Copeland and I have just had.

It is worth highlighting the fact that pharmacists and pharmacies play an increasingly important role in our NHS. Many pharmacies now provide additional services. They are contracted to do so outside those pricing frameworks. That is done locally by clinical commissioning groups. Health and wellbeing boards or local authorities can also contract pharmacists to provide services. As my hon. Friend will be aware, responsibility for public health—40% of that budget—has now passed to local authorities. Given that public health responsibility, there is a strong role for local authorities in commissioning local health care services if they feel that that would be in the interests of the local population.

Under the Health and Social Care Act 2012, other providers of health care services, outside the traditional framework of GP and community services and secondary care, were given more of an opportunity to put themselves forward and offer to provide valuable services. This is a real opportunity for pharmacists to bring forward to CCGs what they do and to make the case that they can provide many services in a way that will be focused on primary prevention and that will save the local health economy money but also deliver better care. The track record of pharmacies and pharmacists is very good in delivering community care—whether looking after people with diabetes or providing simple services for other patient groups. Under the 2012 Act, there is now a much greater opportunity for pharmacists to come forward and put in offers, within an integrated health service, and make the case about how they can provide services. They may be able to do that in a much better way, as they are often embedded in their communities, than some of the traditional mechanisms in the NHS.

I hope that my hon. Friend will be reassured by the fact that the legislation that we have put in place as a Government has given pharmacists a much greater opportunity to contribute to their local health economy, not just in economic terms and in terms of the economic benefits that that will bring for pharmacists, but by delivering the very good care that we know they can deliver.

We have had a wide-ranging debate. I think that we can be sure that there is in place a robust pricing mechanism, which on the whole works very well and secures good value for the taxpayer and for local patients, but there are issues about certain items that pharmacists can prescribe, and we do need to look into them. There is a role for NHS Protect in doing that. We value the innovation that pharmacists provide locally in delivering better—higher-quality—patient-centred care, and the 2012 Act has put us in a better place to support local pharmacists in delivering the kind of patient care that we all want to see in our local communities.

[Dr William McCrea (in the Chair)]

I thank Members for the courteous manner in which they conducted the debate.

Group B Streptococcus (Newborn Babies)

Dan Poulter Excerpts

Thursday 7th November 2013 Commons Chamber

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

I congratulate my hon. Friend the Member for Mid Bedfordshire (Nadine Dorries) on securing this debate and raising this very important issue. The death of a baby is devastating for parents and their families. It is important that we do all we can to minimise the risk of such deaths. My hon. Friend has presented a strong case, but, as I shall set out later, it is equally important that we are guided in our decisions by professional, evidence-based advice to ensure that any action taken does not lead to potentially greater adverse outcomes or unintended consequences.

Group B streptococcus is one of many bacteria that can be present in the human body. It is estimated that about one pregnant woman in five in the UK carries GBS. Around the time of labour and birth, many babies come into contact with GBS and are colonised by the bacteria. Most are unaffected, but a small number can become infected.

If a baby develops group B strep less than seven days after birth, it is known as early-onset group B strep. Most babies who become infected develop symptoms within 12 hours of birth, and it is estimated that about one in 2,000 babies born in the UK develop early-onset group B strep, or about 404 babies a year—my hon. Friend made these points earlier. Most babies who become infected can be treated successfully and will make a full recovery, but even with the best medical care, one in 10 babies diagnosed with early-onset group B strep will unfortunately die.

The infection can also cause life-threatening complications, such as septicaemia, pneumonia and meningitis. One in five babies who survive the infection will be affected permanently. Early-onset group B strep can cause problems such as cerebral palsy, deafness, blindness and serious learning difficulties, and rarely can cause infection in the mother—for example, an infection in the womb or urinary tract, or more seriously an infection that spreads through the blood, causing symptoms to develop throughout the whole body.

It is worth reflecting on how the UK compares internationally on rates of group B strep. The reported rate per 1,000 births is 0.38 in the UK; in the USA, where there is testing, it is 0.41; in Spain, 0.39; in France, 0.75; in Portugal, 0.44; and in Norway, 0.46. Even in comparison with countries where there is routine group B strep screening at 35 to 37 weeks, therefore, the UK has relatively low levels of group B strep.

It is also worth setting out some of the general improvements in maternity care that are helping to reduce group B strep and improve the quality of care available to women. We all agree that women should receive high-quality and safe maternity services that deliver the best outcomes for them and their baby. Maternity services feature prominently in the key objectives set out in the first mandate between the Government and NHS England. As set out in the mandate, we want all women to have a named midwife responsible for ensuring she has personalised, one-to-one care. To help deliver that, there has been significant investment in the maternity work force. Since May 2010, the number of full-time equivalent midwives has increased by 6.5%—just under 1,500—and in addition there are currently in excess of 5,000 midwifery students in training. There has, therefore, been considerable investment in maternity services to ensure much more personalised care and, consequently, much safer care for women and their babies.

[Nadine Dorries]

For the reasons I highlighted, we know that the risk-based strategy is not working effectively. Does the Minister not agree that in countries that have routine testing the chances are greatly improved? He drew comparisons with the US, France and other countries, but we do not know what their figures would be if they were using our risk-based strategy. The fact is that they are routinely testing, so does he not agree that only if we were also routinely testing could we make a like-for-like comparison with other countries? Also, why specifically does the UK, a sophisticated country with sophisticated maternity services, not routinely test?

[Dr Poulter]

I will come to those points a little later, but I will try to reassure my hon. Friend. Given that the majority of babies who die from group B strep are born prematurely, testing at 35 to 37 weeks would not benefit them. Tragically, they would have died in any case, so the screening test to prevent them from dying would not have been effective. I will say a little more about that later, if she will allow me to make some progress.

I pay tribute to my hon. Friend for raising this issue, because the first challenge is to raise general awareness of group B strep among the health care work force and women more generally. The Department of Health is working with the NHS, the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the National Institute for Health Research health technology assessment team and the pharmaceutical industry to raise awareness of group B strep and reduce the impact of this terrible infection. The Royal College of Obstetricians and Gynaecologists has produced an information leaflet for women who are expecting a baby or planning to become pregnant, and this sets out information about group B strep infection in babies in the first week after birth and the current UK recommendations for preventing group B strep in newborn babies. In addition, information is also available on the NHS Choices website.

As hon. Friends will agree, the focus must be on preventing early-onset group B strep infection from occurring in the first place. The Royal College of Obstetricians and Gynaecologists published updated guidelines on prevention of early-onset group B strep infection in neonates in July 2012, which takes into account the latest evidence. It is important that services undertake local clinical audits to ensure the effective use of intrapartum antibiotic prophylaxis as recommended by the guidance. Following the publication of the revised guidance, the UK national screening committee suggested a formal audit of practice to establish how well the new guidance is being implemented at a national level.

The RCOG, in partnership, with the London School of Hygiene and Tropical Medicine, has now appointed a clinical research fellow to carry out a one-year audit across the UK, which will undertake a review to see how units have revised and updated their local protocols since 2006, using well-designed case studies to gather specific information about maternity unit policies by asking clinicians whether they would screen for group B strep and/or other intrapartum antibiotic prophylaxis in the circumstances described. It will also assess the extent to which current maternity information systems are able to provide data on whether women have had an antenatal culture for group B strep, whether women have been given intrapartum antibiotics and, if so, the antibiotics prescribed, the dose and duration and whether the women had particular risk factors such as intrapartum fever. The audit aims to provide feedback and advice to all participating trusts about how they could further improve their adherence to the RCOG guidelines on the prevention of neonatal group B strep disease.

Clinical audit is a tool that is incredibly valuable in improving the quality of patient care. It is something that trusts do very often on an ad hoc basis. The fact that we now have a national audit focused on group B strep disease will help to standardise practice across all maternity settings and improve the quality of care that is available, so that we can look at which women are more vulnerable and susceptible to developing group B strep and, therefore, reduce infection rates.

[Nadine Dorries]

That is encouraging news but again the focus is on women who are at risk of group B strep. I am advocating that all women should be tested for group B strep. I recommend that every pregnant woman I meet now buys a kit to test for group B strep. It is encouraging and positive to hear what my hon. Friend the Minister is saying but it is still focusing on the at-risk women, which is what the risk strategy does now. We need to move from that and away from the at-risk women. We need to move from 35 to 37 weeks and forward to full-term and routine testing of all women for group B strep.

[Dr Poulter]

I am hopeful that the audit by the RCOG nationally—something I discussed with the group B strep groups and the chief medical officer at a meeting this time last year to progress the work at a greater pace—will put us in a better position to understand in particular which women are at high risk, whether birth units are picking up on those women in a timely manner and how we can improve the situation throughout the country. In the past there has been quite a lot of variation in practice, broadly based on the RCOG guidelines, but it is important—knowing the devastating effects of this illness—that we put together a comprehensive audit tool that gathers data at a national level so we can spread good practice and good guidance throughout. If my hon. Friend will be patient I hope to address some of the broader issues about screening later.

[Andrew Selous]

Earlier, my hon. Friend said that some countries that screen have higher rates of group B strep than we do. Does he have any data—he could perhaps write to my hon. Friend the Member for Mid Bedfordshire (Nadine Dorries) and myself—to show what the progression has been since testing was introduced in those countries? I think my hon. Friend the Member for Mid Bedfordshire said that it was falling in Spain but it would be interesting to see how it is moving following the introduction of widespread testing.

--- Later in debate ---

[Dr Poulter]

I would be delighted to do so. It is important to consider the confounding factors that arise in any research. For example, there is some evidence of different rates of carriage of group B strep among different population groups. Also, the clinical treatment of the disease in hospitals—which is separate from the screening process—can vary from country to country. We have to set the data alongside other practices that take place at local level in order to interpret them in the right way. I would be delighted to write to my hon. Friends, and to any other hon. Members who are interested, with that broader general information.

I shall turn now to the question of routine screening for group B strep. The UK national screening committee advises Ministers and the national health service in all four countries on all aspects of screening policy, and supports implementation. At its meeting on 13 November 2012, the screening committee recommended that antenatal screening for group B strep carriage at 35 to 37 weeks should not be offered, as my hon. Friend the Member for Mid Bedfordshire has pointed out. That is the reason for the debate. The reasons given included the fact that the currently available screening tests cannot distinguish between women whose babies would be affected and those that would not. As a result, about 140,000 low-risk pregnant women would be offered antibiotics in labour following a positive screening test result. The overwhelming majority of those women would have a healthy baby without screening and treatment. In other words, a woman who had screened positive for group B strep at one point in her pregnancy might not necessarily be carrying it at the time of delivery, and up to 140,000 women a year could be given antibiotics during labour even though they did not need them.

On the back of the evidence, concern was also expressed, understandably, about resistance to some of the antibiotics used to prevent early-onset group B strep, about the long-term effects on the newborn and about the potential for anaphylactic reactions in labour. Many of us will recall the report of the chief medical officer for England, in which she expressed particular concern about the risks posed by antibiotic resistance because of overuse. The use of antibiotics on that size of population could create a risk of resistance developing, which would have adverse consequences.

[Nadine Dorries]

I am interested in what the Minister has just said. As I mentioned in my speech, we are talking about a penicillin, a narrow-spectrum antibiotic. I know the Minister’s background, and he will know that GPs would prescribe it for a throat infection. This is a widely and commonly used antibiotic. Does he not think that these expressions of concern are over-egging the pudding slightly?

[Dr Poulter]

In the report that the chief medical officer published earlier this year, she made the point graphically that the overuse of antibiotics among people who do not need them can lead to resistance developing in bacteria. We know from hospital super-bugs such as MRSA and VRSA that many other resistant strains of bacteria are developing. Part of the challenge is to see responsible prescribing adopted more broadly across the NHS, to ensure that antibiotics are being targeted at the people who will benefit directly from them. The chief medical officer’s concern is that the screening that my hon. Friend is proposing could lead to many tens of thousands of women being given antibiotics inappropriately at the time of delivery, because they were not carrying group B strep at the time, and that that could result in resistance developing. We already know about the devastating consequences of group B strep infection, and the development of further resistant strains could be an unintended consequence of such screening that none of us would want to see. We need to be mindful of that possibility, as I believe the national screening committee was when it made its recommendations.

The majority of babies who die from early-onset group B strep are premature and are, sadly, born too early to be helped by screening at 35 to 37 weeks. Data from 2001 show that, in that year, there were 39 deaths due to group B strep, of which 25 occurred prematurely—that is, before the 35th week of pregnancy, when any screening would have been carried out. Those deaths would therefore not have been prevented by a screening programme.

It has been estimated that up to 49,000 women carrying GBS at 35 to 37 weeks of pregnancy may no longer be carriers when receiving treatment during labour. Studies of the test suggest that between 13% and 40% of screen-positive women will no longer be carriers at the point of delivery. There is also a potentially detrimental impact on maternity services, increasing the medicalisation of labour, with the increase in hospital births and increases in the birth rate that we are seeing. We know that once there is one intervention in labour, it can lead to other interventions and a high rate of Caesarian section when it might not have been necessary in the first place. I am not saying that that would always be the case and absolutely not with GBS—far from it—but we know that when a woman enters a medicalised pathway in a maternity unit, it can often lead to interventions that might otherwise have been unnecessary and that are sometimes quite distressing for the woman during labour. This is particularly the case when many of the women potentially put on prophylaxis would no longer be carriers of GBS.

The advice from the UK national screening committee is consistent with that of the Royal College of Obstetricians and Gynaecologists and the National Institute for Health and Care Excellence. I believe we have talked through a number of the issues about why that recommendation was made.

In the brief time remaining, it would be worth mentioning some of the research that is going on. It is estimated that a vaccine for GBS is approximately five years away from development. First-stage trials have now been undertaken, and wider population-based studies for safety and efficacy are in place in high-prevalence areas such as South Africa. I am sure we would all agree that a vaccine would be a very effective solution to GBS, and I shall certainly do all I can to push and nudge to make sure that such a vaccine is brought forward in as safe and appropriate and as timely a manner as possible.

[Nadine Dorries]

Is the Minister informing us that that vaccine would be widely available? Let me ask him once more—after everything he has said today, for which I am incredibly grateful—why does he think countries like Spain, the United States and others have introduced routine testing when we still seem to be opposed to it?

--- Later in debate ---

[Dr Poulter]

It is sometimes difficult to explain variations in clinical practice and the care of women during maternity services between different states or within regions of countries like Spain and to understand why they are different from what we have in this country. Here we have robust guidelines in place for trying to identify at-risk women and we are trying to tighten them through audit while we have low rates. I am not sure whether the same can always be said elsewhere in the world. That is why other countries might have wanted to introduce a cruder tool through a screening test to help them reduce their rates. As I have said, I will look further into this matter and write to my hon. Friends in order better to inform them.

Research and clinical audit are important. We want to make sure that we have a proper national audit programme to carry out and develop good and better practice guidelines for GBS. Looking forward to a vaccine, we hope that that will be a long-term answer to this devastating disease, not just for the UK but throughout the world. Prioritising other research studies is also important. At the moment, a study is being carried out by the maternal health and care policy research unit. It is looking at women with GBS sepsis, which will help us understand the physical impact that GBS has on women’s health. A second study looks at providing information at a national level on the numbers of women and babies affected by anaphylaxis due to antibiotic use in labour for GBS or presumed GBS infection. As I mentioned, one concern about a blanket prophylaxis would be the potential anaphylactic reaction that we know can occur when someone is allergic to penicillin or other antibiotics.

I thank my hon. Friend the Member for Mid Bedfordshire once again for raising this important issue. I hope I have been able to clarify some of the reasoning behind the national screening committee’s decisions. I will write to and engage further with my hon. Friend and others to reassure them again that the Government take this issue very seriously. Together, I know we will get to a better place so that fewer families are affected by this tragic illness.

Question put and agreed to.