Herbal Medicine (Regulation)

Dan Poulter Excerpts

Tuesday 9th July 2013 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Bone, for, I believe, the first time. I am sure that you were salivating, listening to the issues raised in the debate—

[Mr Peter Bone (in the Chair)]

Order. I want to make it clear to the Minister that when I sit in this Chair, I have no views on anything.

[Dr Poulter]

Indeed, Mr Bone, as you say, you have no views on anything when you are impartially chairing the debate, but I am sure you pay keen interest to the topics raised, in your position as Chair and otherwise.

I pay tribute to my hon. Friend the Member for Bosworth (David Tredinnick) for securing the debate, which I am sure is of interest to the consumers and practitioners who use herbal medicines, as well as to the many Members who attended the debate today. None of us disagree with the principles articulated here—we can all sign up to them—but good government is about working through the practicalities of proposals to ensure that they become good laws, as I will discuss later.

There have been many good and worthy contributions to the debate. The hon. Member for Strangford (Jim Shannon) showed his strong support for herbal practitioners in his constituency, and he was right to say that things in Government do not happen in a flash but have to be properly thought through. I want to reassure him that some of the products he mentioned—he talked about the benefits of vitamin E, for example—are freely available from herbal practitioners, and indeed from pharmacists and other places.

There were other strong contributions from my hon. Friend the Member for Kettering (Mr Hollobone), who is no longer in his seat, and the hon. Member for Vauxhall (Kate Hoey). The hon. Lady made her case eloquently, and I would be happy to meet with her at a later date to discuss sports therapists further, but I would not wish to intrude on Mr Bone’s patience by talking about the issue today and I hope she will forgive me for that.

I pay particular tribute to my hon. Friend the Member for Bosworth for his principled and long-standing support for herbal practitioners and his interest in alternative therapies, homeopathy and many other such issues. Today he has demonstrated his extensive knowledge of the topic under debate, and of alternative therapies in general. I am sure I am right in saying that he is the most informed Member of Parliament on many of these issues, and it is a great tribute to him that he has secured the debate today. I am sure that herbal practitioners and alternative therapists would wish to pay tribute to his great work and his advocacy on their behalf, and on behalf of his constituents.

My hon. Friend is right to highlight the chief medical officer’s challenge about the future of antibiotics, but we can make a clear distinction between those remarks and the subject of today’s debate. I am sure that the chief medical officer would not wish her remarks to be associated with a call for a greater use of herbal medicine—that was clearly not outlined in her paper. Although it is important that we always consider ways—via traditional medical routes or otherwise—of improving people’s health and providing the right therapies, the paper clearly laid out the long-standing challenges as being about antibiotic resistance, and it would be wrong, therefore, to allow the two issues to be confused.

By way of background, it is worth highlighting that although we support patient choice some herbal products have caused harm to consumers. There are a number of reasons why that might happen: the herb may be intrinsically toxic; the product may be accidentally or purposefully contaminated by harmful materials or heavy metals; people may choose herbal products for serious conditions when medicines with a solid evidence base would be more appropriate; and, if herbal products are taken together with conventional medicines, the interactions may be unpredictable. It is right, therefore, that we support the responsible use of medicines and have a licensing system.

Directive 2004/24/EC on traditional herbal medicinal products was introduced to harmonise the European Union internal market and remove barriers to free movement. The directive deals with products manufactured on an industrial scale, and makes all operators in the market comply with the same set of rules, facilitates free movement and ensures increased product safety, which, I am sure we agree, has a positive impact on patient safety and public health.

The question of whether herbalists and traditional Chinese medical practitioners should be statutorily regulated has been debated since the House of Lords Science and Technology Committee first reported on the matter in 2000. The hon. Member for Vauxhall and my hon. Friend the Member for Bosworth outlined in their remarks that there is a lot of background and history. The previous Government grappled with the issues, and the current Government are also considering how to address and fulfil the commitments made by the previous Health Secretary, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley). Hon. Members will be aware that on 16 February 2011 the Government announced their intention to take forward the regulation of herbal medicine practitioners and traditional Chinese medicine practitioners, specifically with regard to the use of third-party products in their practice.

Herbal products broadly fall into three categories. The first are the 310 herbal medicines that already have a marketing authorisation or a traditional herbal registration—in other words, a product licence. Those 310 medications are currently available for use and are effectively licensed. They are safe and widely used, and have undergone all relevant testing and checks. The second category, which is the one we are addressing today, covers products manufactured by a third party. Such products have been illegal since April 2011, following the implementation of the EU directive. The third category is products made up by a practitioner on their own premises following an individual consultation. Although such products are not affected by the directive, some of the herbal ingredients may be restricted by the Human Medicines Regulations 2012.

The previous Health Secretary’s concerns about the second category—products manufactured by a third party—prompted the decision to take forward statutory regulation of such products. The Government’s intention was to allow regulated herbal practitioners lawfully to source third-party manufactured herbal medicines, with appropriate safeguards in place to minimise the risks associated with the products, but since April 2011 the European directive has made it illegal for herbal practitioners in the UK to source such products for their patients.

Following the EU judgment in the case of the Commission v. Poland, which my hon. Friend the Member for Kettering mentioned, we have reassessed the risks. That case actually concerned unlicensed conventional medicines being used because they were cheaper, and although there is a clear distinction between those products and herbal remedies we had to look at what else the judgment said. It looked at the specials regime and, critically, it emphasised how strictly the regime must be applied. The judgment has a knock-on effect for what we propose for the use of herbal medicines manufactured by third parties without a licence, and it therefore needs careful consideration because there is a very high risk that we would be found to be in infraction of the European directive. We therefore need to consider further herbal products manufactured by a third party, and I will return to that point later.

The Government would, of course, like to find a way through the issue that supports responsible businesses and ensures public safety. Since the announcement in February 2011, the Department of Health has been working with officials in the devolved Administrations and with the Health and Care Professions Council to establish a statutory register for herbal practitioners. Alongside that, we have been considering a strengthened system for regulating medicinal products, to enable consumers to have access to a greater range of third-party manufactured herbal medicines. The process continues to be complex and lengthy, and it has been further complicated by the judgment in the European Union v. Poland case.

We acknowledge that there is strong support from some groups of herbal practitioners for the statutory regulation of the sector, but not all practitioners are in favour. I am sure, therefore, that hon. Members will appreciate that it would be irresponsible for the Government to undertake to alter the status of a group of workers without first ensuring that the policy and final decision offered an appropriate form of regulation and ensured that the proposals adequately addressed the risks posed to consumers of third-party manufactured herbal medicines.

As I stated earlier, complex issues are involved. We are discussing how to ensure that our proposals are fit for purpose and proportionate, and that they properly protect the public. I want to assure the hon. Member for Vauxhall that the matter has not been dropped. We absolutely support the principles outlined by my right hon. Friend the Member for South Cambridgeshire in his written ministerial statement to the House, and I fully appreciate that the delay is causing anxiety and concern to practitioners of herbal medicine and to consumers.

To ensure that we take forward the matter effectively, we want to bring together experts and interested parties from all sides of the debate to form a working group that will gather evidence and consider all the viable options in more detail, particularly because of the Polish case. I am aware of the concerns of my hon. Friend the Member for Bosworth about making timely progress, and I would therefore very much welcome his direct involvement in the working group to ensure that the interests of practitioners are properly looked after. We can meet when the House returns to work out how to take forward the proposal.

I hope that my commitment to setting up a working group will reassure my hon. Friend and all hon. Members that the Government are carefully considering this important issue. We recognise and agree with the principles, but the practicalities are such that we must have legislation that is fit for purpose—that does not trigger infraction proceedings from the European Union, but protects the public. That is vital in all health care matters, whether in relation to traditional medicines or to herbal medicines and alternative therapies. For that reason, we want to set up a working group and to work with my hon. Friend, and herbalists and others, to ensure that the legislation is fit for purpose. I look forward to discussing that with him in due course.

[David Tredinnick]

Before my hon. Friend sits down—I think that he was about to do so—may I thank him for his remarks? I am sure that knowing there is some progress is welcome, but I remind him that there have been many working groups in different guises over a long period, and the image that springs to mind is of the long grass. I am grateful to him for suggesting that I might be part of the process, but I want to be reassured that we are in the short grass. Lastly, is there general agreement with the devolved Administrations or is that a sticking point?

[Dr Poulter]

I reassure my hon. Friend that I am not aware of any points of disagreement with the devolved Administrations, but I will write to him and provide reassurance if there are any issues of which I am unaware. My understanding is that there is a unified position across all of the different health Departments.

[Jim Shannon]

On the devolved Administrations, I speak with some knowledge of the Northern Ireland Assembly, where my colleague Edwin Poots is the Minister of the Department of Health, Social Services and Public Safety. We and the Minister in the Northern Ireland Assembly are keen to have a focus of attention and a continuity of thought among all the regions of the United Kingdom to ensure that we can support the Under-Secretary of State for Health. The quicker he and the Government move that on, the gladder the regions—especially Northern Ireland—will be to jump in behind and support them.

[Dr Poulter]

The hon. Gentleman is absolutely right to highlight the strong working relationships, particularly with his colleague in Northern Ireland. We are grateful for that continuing strong working relationship on both this and other issues, and I look forward to working with him.

I reassure my hon. Friend the Member for Bosworth, who was concerned about the short and the long grass, that the intention behind his involvement in the working party is to keep it firm to its task. I am sure that he will want, as part of his involvement, to ensure that that happens. When we meet to discuss this further after the House returns in September, we can ensure that the proposals are proportionate and fit for purpose, and that they protect the public, including through giving people an informed choice about the use of herbal products.

[Kate Hoey]

Will the Minister give way?

[Dr Poulter]

I will give way for the last time.

[Kate Hoey]

I tend to agree about the long grass: officials are always coming up with another working party, because it is a nice way to postpone things. Will the Minister give us some idea of the time scale?

[Dr Poulter]

We need to sit down together. I very much want to involve my hon. Friend the Member for Bosworth, and the hon. Lady would be very welcome to join that discussion when the House returns. The idea is to get a working party up and running in the early autumn to ensure that we progress matters. We obviously need to discuss issues raised today about statutory regulation and third-party manufactured products, and to look at such products in detail to see which might be classified as more akin to food additives or vitamin and mineral supplements and which as more akin to medications, because there is a spectrum. We need to work through such issues to make sure that we get to the right place.

It is important that any legislation not only passes the test of principle—we are all signed up to it—but is practical and fit for purpose. Particularly in light of the judgment in the case of the EU Commission v. Poland, we have other issues to consider that make the matter a little more complex. I reassure my hon. Friend the Member for Bosworth and the hon. Member for Vauxhall that we are committed to making timely progress, and when we meet on our return in September, we can progress things. I am sure that my hon. Friend’s involvement will keep the Government keen to their task.

[Mr Peter Bone (in the Chair)]

I thank hon. Members for taking the time for an absolutely splendid debate.

Stafford Hospital

Dan Poulter Excerpts

Thursday 4th July 2013 Commons Chamber

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

It is a great pleasure to reply to the debate. Let me begin by congratulating my hon. Friend the Member for Stafford (Jeremy Lefroy), and expressing my great admiration for the work that he has done so tirelessly during his time in the House. He has been a tremendous advocate for all his constituents, for the hard-working staff at the trust who are doing their best in very difficult circumstances, for all the people who have rightly spoken out about earlier problems at the trust, and for the patients. He is an example to us all of what a hard-working and dedicated constituency Member should be.

I also congratulate my hon. Friend the Member for Stone (Mr Cash), who has been raising this matter tirelessly for many years. It is a tribute to the efforts of both my hon. Friends that we have got to where we are today.

I can reassure my hon. Friend the Member for Stone that the findings of the Mid Staffordshire inquiry are at the forefront of the Government’s mind. As he will recall, our response to the Francis report set in train a number of important pieces of work. First, we asked Sir Bruce Keogh, medical director of NHS England, to look into 14 hospitals where there had been two years of higher than standardised mortality ratio indicators. That work is now reaching fruition. Following a report as damning as the Francis report, which looked into the culture of the NHS, we thought it right to investigate other hospitals that could give rise to concern, and we now think it right to examine the findings of Sir Bruce Keogh’s report before we report back to the House. We also set in train Camilla Cavendish’s review of nursing and Don Berwick’s inquiry into a minimum-harm and no-harm culture in the NHS. All those inquiries have formed part of our response to the Francis inquiry, and they have all been independent of Government. We shall have the reports in the next few weeks, and we shall then be able to arrange the more considered debate on the Floor of the House for which my hon. Friend has rightly called.

My hon. Friend the Member for Stafford was right to highlight the fact that the health care challenges in more rural areas, where travelling distances are longer, are by definition different from the health care challenges in urban areas. He was also right to highlight the fact that, throughout the NHS, in Stafford and elsewhere, we face the challenge, in both human and financial terms, of better looking after an ageing population and better providing dignity in elderly care.

My hon. Friend was right to highlight the fact that we need to support people such as Julie Bailey, who was treated appallingly in the light of her great courage and conviction. We must support people inside and outside the NHS who have the courage to speak up when there are concerns. We have made that clear in our initial response to the Francis inquiry report. That is why we have set up a whistleblowing hotline and are tackling the cultural issues in the NHS. We will support staff who want to raise concerns, so they can do so free of fear and intimidation. That is absolutely the right thing to do.

It is admirable that local people have continued to come out in full support of their hospital through the Support Stafford Hospital campaign. That was demonstrated by the 50,000 people who marched through Stafford with my hon. Friend in April and by other local events such as the Night of Light event in May. I am sure that we all agree that it is vital that the trust special administrator, currently in place at the trust, develops the right proposals for the future of services at the hospital to provide high-quality, affordable and sustainable services. I will return to that later.

The NHS is about to celebrate its 65th anniversary and its 65th year has perhaps been its most challenging. In that year, we have perhaps questioned some of the things that we held dear. I work in the NHS, I believe in it and I believe that our NHS should be and is one of the very best health services in the world, but when things have gone so badly wrong it is right that we learn lessons from what has happened, that we ensure that we put them right and that we support staff when they raise concerns. It is right that we drill into how to ensure that we listen to staff in learning how to put things right in local hospitals. We must also ensure that we create a culture in which trust managers always listen to what front-line staff tell them. In my experience, when things go wrong in front-line patient care, it is often because there is a disconnect between management and front-line staff. That is why the Government, through the Health and Social Care Act 2012, are embedding in the NHS a culture of clinical leadership, which will benefit patients massively.

On the future of Stafford hospital and the issues raised in the debate, the events that took place led Monitor to intervene and, over the past few years, there has been a whole health economy approach to improving services at the trust. That has led us to where we are today. Monitor, as the regulator of foundation trusts, appointed a TSA at the trust in April 2013 to determine the future provision of services at the trust. As we know, that process is ongoing.

I should be clear that, while the TSA is developing its proposals, I cannot discuss that in much detail. Nor is it known what the TSA is likely to propose. It is right that that process is free of political interference. However, what I would expect, and I am sure that my hon. Friend would agree, is that the TSA fully engages with key stakeholders during that process, including clinical commissioning groups, local health care providers, local authorities and local MPs, which I have been assured is the case. The TSA is legally bound to consult on its proposals and I would expect that any proposals meet the four tests for any service change and reconfiguration, which were set by the former Secretary of State for Health, now the Leader of the House of Commons.

[Joan Walley]

Can the Minister assure me that, following publication of the report by the trust special administrator, as well as the people and communities in Stafford, the people and communities in North Staffordshire will be consulted? There are wider concerns about how any further collaboration will affect health care, which has to be improved in North Staffordshire as well as in Stafford.

[Dr Poulter]

I thank the hon. Lady for her question. As I highlighted earlier, it is absolutely right that the TSA will look at the whole health and care sector in Staffordshire, and of course the implications of any potential change for neighbouring hospitals. That is implicit in the work that the TSA is doing. This is, of course, not an issue I can dictate from the Dispatch Box or the Secretary of State determines. It is for the TSA to decide what its own work is, and it is important that that is done without political interference, so the right decision for local patients in Stafford and surrounding areas can be reached. I am sure the hon. Lady will agree about that.

I appreciate the concerns of my hon. Friend the Member for Stafford that acute services should remain at Stafford hospital. However, the TSA is independent of Monitor and therefore it would not be appropriate for Monitor—or, indeed, Ministers or the Department of Health—to seek to influence this process. My hon. Friend is aware that, at the request of the TSA, Monitor granted an extension to the period in which it can develop its proposals and the consultation period. I understand that the TSA is expected to consult on its proposals between August and October 2013, and I am sure my hon. Friend and his constituents will play an active role in that, and that the views expressed in the House today will be listened to as a part of the deliberations of the TSA and in the consultation process that follows.

I appreciate my hon. Friend and his constituents will experience uncertainty while the TSA develops its proposals. However, the TSA is engaging widely with the broader health economy as these proposals are developed and I understand that includes speaking with my hon. Friend and the Stafford Hospital Working Group. I would, therefore, encourage my hon. Friend to continue this dialogue with the TSA to ensure that his views and those of his constituents are fully taken into account as proposals for the future of Stafford hospital emerge.

I pay tribute to the work of my hon. Friend and my hon. Friend the Member for Stone, because if it were not for their work, we would not be where we are today and the people of Stafford and Staffordshire would be much more poorly represented. Their record speaks for itself and they have our full support in the work they are doing as advocates for their constituents. I look forward to continuing to support them in my role as a Minister, and the Government stand ready to support Stafford hospital.

Question put and agreed to.

Health and Care Services

Dan Poulter Excerpts

Wednesday 3rd July 2013 Commons Chamber

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

It is a pleasure to close this debate and to respond to my right hon. Friend the Member for Charnwood (Mr Dorrell) and to his Committee’s report. I had the great privilege of serving under his chairmanship before I was appointed as a Minister, and he has been perhaps the greatest advocate of joined-up and integrated care, both as a distinguished member of previous Governments as Secretary of State for Health, and in all the work he has done as Chair of the Health Committee. His work has helped to lead to the great emphasis that the Government are placing on integrated and joined-up care, both through the Health and Social Care Act 2012 and in the statement by the Chancellor last week.

Friday marks the 65th anniversary of the NHS. I am proud to work in the NHS and to look after its patients. I think every Member in this House wants to see a health service of which we can all be proud. We are proud of our health service, but this 65th year of the NHS has also been marked by many challenges, which were outlined in the Mid Staffs report, the response to Morecambe Bay and in the comments on Tameside hospital made by the hon. Member for Denton and Reddish (Andrew Gwynne). We have to respond to those challenges, and the Government are taking strong steps to ensure that we deliver and stamp out the small pockets of poor care in the care system.

If we are to deliver a health service that is fit for the future, it has to be a joined-up health and care service. We can no longer afford to see the NHS and the social care sector as silos in their own right: we have to have a joined-up integrated approach. It is for that reason that we are proud to have increased the NHS budget by £12.7 billion. We are driving integration with that budget increase. We are encouraging local authorities and the NHS to collaborate in treating the needs of patients, and to address the problem highlighted by the Select Committee of people being passed, like pass the parcel, from one part of the system to another without any joined-up thinking or integrated care. I know that Members on both sides of the House want an end to that. In the spirit of consensus, we all want a health and care system that truly looks after the needs of individuals and is not run by the different financial and cultural silos of the whole.

We have heard strong contributions from hon. Members on both sides of the House in what has been a consensual debate. If we are to tackle the challenge outlined by Sir David Nicholson in 2009, when the previous Government were in power, to make 4% efficiency savings year on year just to stand still and to meet the increasing demand of an ageing population and the increasing health care expectations of patients, then we need consensus. To meet the challenge, we have to see a fundamental service transformation and redesign. We also have to see a far more productive NHS. Productivity gains and efficiency savings have to be made, while the challenges outlined by the Mid Staffs case and others are just as true today.

My hon. Friend the Member for Witham (Priti Patel) outlined clearly the importance of cutting back on bureaucracy and waste in the NHS where possible. Under the Health and Social Care Act 2012, £1.5 billion of bureaucratic savings will be put back into front-line care on an annual basis. She was right to highlight the importance of clinical leadership in delivering better services. There is good evidence that clinical leadership is not just about improving patient care. We can improve productivity through clinical leadership by improving the procurement of services and goods in the NHS. Procurement of services and goods makes up £20 billion of the NHS budget. There is good evidence that strong clinical engagement and leadership will help us to deliver greater productivity.

My hon. Friend the Member for Bosworth (David Tredinnick) talked about a number of other opportunities that the Health and Social Care Act offers to drive integrated care. I am pleased, as late converts, that the Opposition are now supporting the arguments we outlined during the passage of the Act about the importance of integrated health and social care. He also looked forward to the debate, which I will not enter into today—I hope he will forgive me—about the importance of complementary and alternative therapies. I look forward to furthering that debate with him next week.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for giving way—I asked to make an intervention beforehand, so he knows the subject matter. In the last year health tourism cost the NHS some £24 million, ranging from £100,000 in some trusts to £3.5 million in others. The Secretary of State made an important statement this morning about addressing that issue. Is the Minister in a position to set out the time scale for saving the NHS that £24 million a year?

[Dr Poulter]

The hon. Gentleman is absolutely right to highlight the fact that health tourism presents challenges. We need to look at them, which is why we have launched a consultation on exactly how to do so. We should recognise that we hugely value the fact—it is very beneficial to the British economy—that students come here from overseas to train and, sometimes, to work. Part of ensuring that they do so in a responsible manner and do not short-change British taxpayers and British patients means making provision for their health care needs, if necessary, and ensuring that the NHS does not pick up the tab. That is something we have opened a consultation on. It will report back later this year, and I am happy to discuss the matter further with the hon. Gentleman away from this debate.

In opening the debate, my right hon. Friend the Member for Charnwood was absolutely right to ask how we would deliver greater productivity in the NHS and to say that pay plays a part. Improving procurement, driving greater productivity and, crucially, service reconfiguration all play their parts too. It is worth highlighting the fact that the NHS needs to become more efficient at how it manages its estates, with £3.1 billion or so spent on NHS estates annually. There is much that can be done to improve the energy efficiency of those estates, which is why the Government launched a £50 million fund to support that work. A lot also needs to be done to reduce the £2.4 billion temporary staffing bill. That is something we will be talking about when we launch a paper later in the summer. There also needs to be greater focus on good leadership at board level—something we have touched on before—and engaging clinical leaders in helping to drive productivity and improvements in patient care.

It is also worth outlining the role of tariffs, which were touched on in the Committee’s report and in today’s debate, in driving more joined-up care. It is true that tariff change in itself is not good enough to drive improvements in patient care. Tariff change must drive service change and transformation at the same time, driving the more integrated care model that we all believe in. When my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) was Secretary of State, he initiated a review of the tariff system and looked specifically at best practice tariffs. We are now seeing the emergence of tariff change in a way that not only reduces costs, but drives service transformation. In the case of fragile hip fractures, day case procedures—such as cholecystectomies and similar procedures—and major trauma, we are seeing service change and transformation being driven by improved tariffs, which often cut across primary and secondary care.

If we are to deliver an NHS that is fit for the future, both financially and in human terms, that will be down to major service transformation and moving towards a system that provides integrated health and care. That is why last week my right hon. Friend the Chancellor outlined in his statement a £3.8 billion fund that will be shared between the NHS and local authorities to deliver integrated services more efficiently for older people and disabled people, ensuring that health and social care work together to improve outcomes for local people. Importantly, the Health Committee’s calls for health and wellbeing boards to play a vital role in overseeing the fund is something that we envisage becoming a reality.

In conclusion, we know that there are big challenges to the NHS in driving up productivity, and we know that we have already met some of them by cutting out, through our reforms, £1.5 billion of bureaucracy in the NHS—money much better spent on patient care. Crucially, in the years ahead, we will focus on the service transformation that is required to deliver a more integrated health service, continuing to develop those best practice tariffs that drive integration and bring together health and social care. It is not just about finances, because it is also about good care, which is why it is important to deliver the integrated system that patients deserve.

[Mr Dorrell]

rose—

NHS Funding (York and North Yorkshire)

Dan Poulter Excerpts

Tuesday 18th June 2013 Westminster Hall

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

It is a pleasure to serve under your chairmanship, I believe for the first time, Mr Streeter.

I pay tribute to the hon. Member for York Central (Hugh Bayley) for introducing the debate and raising the important issue of health care funding. He, like all Yorkshire Members in the Chamber, is a great advocate for his constituents. It is important to debate such issues and, in particular, to look at perhaps the greatest determinant of need in the NHS, which is that many older people have very expensive multiple care needs—dementia, diabetes, heart disease—and to look at the very big human need, which is how better to provide dignity in elderly care. That is exactly why my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) adjusted the formula, slightly changing the weighting for deprivation, to reflect such demographic challenges.

My hon. Friends and the hon. Member for York Central will be aware that the responsibility for health care funding now falls to NHS England. I have committed NHS England to reviewing the funding formula, and I am sure that it will listen carefully to today’s debate on north Yorkshire and elsewhere.

It is important to highlight how funding flows work in the NHS, and it may be helpful to say a few words about how the new arrangements have changed the way in which funding is allocated. As Members have pointed out, the NHS is paid for by taxpayers, and the money is allocated to the Department of Health by the Treasury. For 2013-14, the Department has set key priorities for NHS England through the mandate. I will outline the priorities that will help NHS England to prioritise funding within the NHS, and aid in the interpretation and use of the independent data given to it by the Advisory Committee on Resource Allocation.

The first priority in the mandate is the focus on preventing people from dying prematurely by improving mortality rates for the big killer diseases to be the best in Europe, through improving prevention, diagnosis and treatment. There is a clear priority to improve the standard of care throughout the system, so that the quality of care is considered as important as the quality of treatment or the clinical outcome. That will be done through greater accountability, better training, tougher inspections and paying more attention to what patients say, so that we have a truly patient-centred NHS, which is as important as providing care and dignity of care for older people.

There is a clear priority to improve treatment and care of people with dementia, and to focus on the important role played by technology—particularly in rural areas, through telehealth and telemedicine—in delivering better care in the community for older people. A key focus is on improving productivity and ensuring value for money to make sure that our health care system stimulates and supports the local economy in relation to not only the obvious importance of keeping local populations well and at work, but the benefits that can be gained from synergies with the life sciences and the supportive and stimulating research from such important places as Cambridge.

The Department of Health has set the mandate and a clear sense of direction for the NHS, with the priorities that are clearly there. The Department then makes allocations to several health bodies, including Public Health England, Health Education England, the NHS Trust Development Authority and NHS England. For 2013-14, NHS England received £95.6 billion, and some of that money will then, in turn, be allocated to clinical commissioning groups, but allocations to individual CCGs and the formula used to decide them are now the responsibility of NHS England, which has the key role.

In making those allocations, NHS England relies on advice from the Advisory Committee on Resource Allocation, as Members have said. ACRA provides detailed advice on the share of available resources available to each CCG to support equal access for equal need, as specified in the priorities set out in the mandate.

NHS England does not, therefore set income on an equal cost per head basis across the whole country; allocations instead follow an assessment of the expected need for health services in an area, and funds are distributed in line with that, which means that areas with a high health need receive more money per head. Under the formula, the 10% most deprived areas received more than 30% more per capita compared with the 10% least deprived, as the hon. Member for York Central outlined in his comments about Barnsley.

The calculation is based on several factors. In particular, it is increasingly based on the age of the population, the relative morbidity and unavoidable variations in cost. The objective is to ensure a consistent supply of health services across the country: the greater the health need, the more money that will be received. I am sure that we all support that.

The shift from a PCT funding formula to a CCG funding formula resulted in changes to the allocation for each particular area in 2013-14, as the hon. Gentleman commented. Funding now often takes place at a more local level—at the CCG rather than the PCT level—which we hope will ensure better prioritisation for local health care funding, with the funding formula being more sensitive to local health care needs.

The CCG model covers only non-specialised hospital and community care, as well as primary care prescribing, but the older PCT model also covered the whole of primary care, specialised services and public health, the costs of which were transferred to NHS England. There is, therefore, no direct comparability between the old PCT funding formula and the new CCG formula, for the reasons that I have outlined.

[Nigel Adams]

Whenever there are historical funding problems, such as those we experienced in north Yorkshire, there are inevitably leaks or stories about potential rationing and cuts to services. In my constituency in north Yorkshire, there has been lots of media speculation that a hospital opened by the Duke of Gloucester less than two years ago might close or lose its minor injuries unit. I have an awful lot of respect for the Minister, because he has done the job professionally, but I urge him to press NHS England to consider the funding case for north Yorkshire and other rural areas, and to consider the special circumstances that we have to deal with.

[Dr Poulter]

I will of course continue to press NHS England and raise concerns, as we have with representatives from the area, about the funding challenges being faced in north Yorkshire. It is also important to be aware that, because of how the new system works, with a mandate that sets clear priorities, NHS England recognises the need for a review of the funding formula for not only north Yorkshire, but nationally.

I agree with the remarks of my hon. Friend the Member for York Outer (Julian Sturdy) and the hon. Member for York Central about ensuring that funding goes to areas of greatest health care need. NHS England will obviously want to take account of rurality, age, the needs of older people and the complexity of care when it reviews the funding formula.

[Hugh Bayley]

The Minister says that Barnsley gets more money than north Yorkshire because of its higher level of deprivation, which I acknowledge, but why has the new formula given York less money than leafy Richmondshire and Hambleton, when York has higher levels of teenage pregnancy, drug addiction and deaths from asbestos-related diseases among people who had a career in industry. We have higher levels of deprivation than other parts of north Yorkshire, and yet we get less money. That cannot be right.

[Dr Poulter]

The hon. Gentleman makes a good case on his constituents’ behalf, but he should recognise that the Vale of York CCG—it serves not only his constituency, but others in the surrounding area—has received £357,891,000 which is the highest allocation in the area. He is right that its allocation is relatively lower per head than, say, that of Scarborough and Ryedale CCG, but I have outlined the factors that inform the capitation formula for funding, including density of population, and the obvious advantages of delivering health care in an urban environment.

I would be very happy to talk through such issues with the hon. Gentleman and my hon. Friends who are here today, and I am sure that we can arrange a meeting to do so in more detail than this debate allows. I also point out that NHS England will fundamentally review the funding formula to take account of demographics, age and rurality, which I am sure we all welcome. I look forward to meeting hon. Members in due course for further discussions and to see how I can assist them with the matters that they have raised.

Question put and agreed to.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 11th June 2013 Commons Chamber

[Mr David Amess (Southend West) (Con)]

2. What steps his Department is taking to ensure consistent and continuous provision of pre-natal and post-natal care.

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

The Government are committed to improving continuity of care during pregnancy and the post-natal period. To give women the personalised care that they deserve, we have increased the number of midwives by nearly 1,400 and the number of health visitors by more than 1,000 since May 2010. In addition, there are a record 5,000 midwives in training.

[Mr Amess]

Will my hon. Friend visit Southend university hospital, and tell residents at first hand what steps the Government are taking to ensure that post-natal care meets clinical guidance and the Government’s aspirations to ensure that the maternity experience is continuous, with patients having one dedicated midwife?

[Dr Poulter]

I would be delighted to visit my hon. Friend’s constituency. He has been a tremendous advocate for maternity services, both nationally and in his constituency, in his time in the House. As I am sure that he has realised, if we want a genuinely personalised maternity service, we need to ask women about their experiences of care. That is why the Government are introducing a friends and family test in maternity from October this year.

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

The Minister knows full well that post-natal depression is the thing that is most likely to kill a healthy young woman, and we know how to deal with it, but in many areas across the country we are cutting the number of visits from midwives after births, and the support given. We know how to tackle post-natal depression. Why should it be that in some parts of the country the support is wonderful, and in others, it is non-existent?

[Dr Poulter]

The hon. Gentleman is absolutely right to highlight that there has, in the past, sometimes been unacceptable variation in the quality of post-natal care. That is why we are increasing the number of midwives and have done so by nearly 1,400, and why we are putting money and effort into increasing the number of health visitors, who play a vital role in supporting mums, babies and families in securing that important bond, and in supporting mums so that they get the right help when they suffer from post-natal depression.

[Stuart Andrew (Pudsey) (Con)]

3. What plans he has for the future of children’s heart surgery provision in Yorkshire and the Humber.

--- Later in debate ---

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

5. What estimate he has made of the optimal level of bed occupancy in NHS hospitals.

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

Average annual bed occupancy rates for all NHS beds open overnight have remained stable between 84% and 87% since 2000. The Government do not set optimal bed occupancy rates for the NHS. NHS hospitals need to manage their beds effectively in order to cope with peaks in both routine and emergency clinical demand.

[Luciana Berger]

I listened carefully to what the Minister said, but the Royal College of Physicians has warned that this winter there were more black alerts—when a hospital has no beds available—than there were over the previous 10 years combined. What urgent action are the Government taking to reduce bed occupancy levels and prevent next winter being even worse?

[Dr Poulter]

We had this debate last week. The long-term pressures on the NHS, as we know, are the result of an aging population, with increasing numbers of older people arriving in A and E with complex needs, so the challenge is to ensure that they are better treated in the community. That is why my hon. Friend the Minister of State launched the integrated care pilots last month. We are also seeing more patients treated as day cases than ever before. About 80% of elective admissions are now treated as day cases, which shows a massive improvement in the speed and quality of care in the NHS.

[Mr Philip Hollobone (Kettering) (Con)]

Kettering general hospital is located in an area that has one of the fastest growing populations in the country and above-average growth in the number of patients aged 80 or over. What more can be done to send the correct signals to local authorities that they need to act quicker to get elderly patients out of hospital once they have been treated so that they can have the care they need in the community, thus freeing up hospital beds?

[Dr Poulter]

My hon. Friend is absolutely right that local authorities have a key role to play in integrated care. That is why in April this year the Government set up local health and wellbeing boards, which will bring about greater integration of care between the NHS, housing providers and social care locally. That will hopefully ensure that across the country we have a much greater focus on local health care needs and, in particular, on better supporting older people and people with long-term disabilities at home and keeping them out of hospital.

[Andy Burnham (Leigh) (Lab)]

A moment ago the Minister mentioned more elderly people coming in through A and E, and I want to present the House with new, deeply troubling evidence of that. Nobody wants to think of a very frail elderly person with no other support at home having to come to A and E by ambulance, but that is what increasing numbers of elderly people are having to do. Buried in the general A and E figures is an appalling increase in people aged over 90 coming to A and E by blue-light ambulance, which is up by 66%, equivalent to more than 100,000 of the most vulnerable people in our society. That is an appalling failure and a sign of something seriously wrong in the way we care for older people, and it is set to get worse as home care is cut further this year. Will he investigate that increase urgently and act now to prevent the collapse of social care?

[Dr Poulter]

The right hon. Gentleman is absolutely right—there is almost an outbreak of consensus across the Dispatch Boxes on this issue. We both recognise, rightly, that there is a long-term challenge in providing more integrated, joined-up care to better look after older people. However, it is ironic that he should raise that concern, because a previous Minister in the other place, the noble Lord Warner, has made the case very clearly that the previous Government failed to invest adequately in elderly care throughout their time in office. That is why this Government—I hope that we can count on the right hon. Gentleman’s support for this—are investing in health and social care, more integrated services at a local level through health and wellbeing boards and—

[Mr Speaker]

Order. The answers are too long. They need to get shorter, because we have a lot to get through. It is very simple and very clear.

[Dr Poulter]

The hon. Gentleman is right to point out that historically there have been challenges with intensive care beds. We are now seeing increases in some areas of intensive care, particularly paediatric intensive care and paediatric cots, to ensure that there is greater support in that service, but he is absolutely right that we need a greater emphasis on specialist centres focused on intensive care. That is something that the NHS Commissioning Board, NHS England, is focused on delivering. We need to ensure that across each region of the country there is more focused care and more specialist intensive care.

[Stephen McPartland (Stevenage) (Con)]

6. What progress he has made on improving cancer waiting times and diagnosis.

--- Later in debate ---

[Chris Heaton-Harris (Daventry) (Con)]

13. What recent representations he has received expressing concern about the service provided by the East Midlands Ambulance Service.

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

Over the past year we have received more than 40 letters from MPs in the east midlands, including my hon. Friend the Member for Daventry (Chris Heaton-Harris), local authorities and members of the public, about the service provided by the East Midlands Ambulance Service NHS Trust and its being the best programme. My hon. Friend will also be aware that there was an Adjournment on the matter earlier this year.

[Chris Heaton-Harris]

The Minister will recall that I have raised a number of constituency cases with his Department and the Care Quality Commission about the standard of services provided by EMAS to my constituents, and how it treats its staff. Will he assure me that the Department will continue to monitor EMAS’s performance in the coming months?

[Dr Poulter]

My hon. Friend can be reassured that the trust development authority and the local chief commissioner for Erewash CCGs are closely monitoring the situation. Today, the Marsh review into the east of England ambulance service has been published, and lessons from that review about how management processes can improve front-line care for patients can be learned and applied across other ambulance services.

[Martin Vickers (Cleethorpes) (Con)]

My constituency is also served by EMAS and it is evident that my constituents have cause for concern. Coupled with uncertainty about the future of the Leeds children’s heart unit and higher than average mortality rates in local hospitals, the situation is causing considerable concern. Will the Minister agree to meet me and neighbouring MPs to discuss those problems?

[Dr Poulter]

I would be delighted to do so.

[Pauline Latham (Mid Derbyshire) (Con)]

14. What recent assessment he has made of the national cancer drugs fund list.

--- Later in debate ---

[Zac Goldsmith (Richmond Park) (Con)]

T8. More than 5,000 schools across the UK now serve good-quality, sustainable meals with the Food for Life catering mark, but only three hospitals have achieved the same. It is often said that hospitals cannot do so because of the cost implications, but the three that have done so not only have incurred no extra costs, but, in the case of Nottingham hospital, have actually saved significant amounts. May I urge my hon. Friend actively to encourage take-up of the Food for Life catering mark as a model of best practice?

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

We will certainly look into the issue that my hon. Friend raises, but he will be aware that there are campaigns throughout the NHS focused on supporting local food producers, which is important in many constituencies, particularly rural ones, and developing best practice and encouraging nutrition. Chefs such as James Martin have been involved in helping to drive up standards of care, particularly in Yorkshire and other parts of the country.

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

T5. I listened carefully to the Public Health Minister’s answer just three questions ago, but the Government have disproportionately cut funding to the most deprived local authorities, including Liverpool, and these local authorities have today been shown to have higher mortality rates. How does the Secretary of State expect to close, rather than widen, health inequalities?

--- Later in debate ---

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

T10. With the Department of Health having awarded Cleveland fire brigade £198,000 from its social enterprise investment fund, will the Minister confirm, pursuant to concerns raised by the Fire Industry Association, that his Department undertook an assessment as to the compliance with the European state aid regulations of the state’s funding of community interest companies that compete to take business away from the private sector?

[Dr Poulter]

I would be very happy to look further into the issue and to meet the hon. Gentleman to discuss it.

Budock Hospital Site

Dan Poulter Excerpts

Tuesday 11th June 2013 Commons Chamber

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

I congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on securing this debate and on her ongoing tremendous advocacy on behalf of her constituents. She talked eloquently of her own knowledge of the school—“care farm” is the expression I would use in my constituency—and the relationship between the school and the old hospital. She highlighted the importance when looking for value in NHS land of doing as much as possible to maximise the land receipt and put that money back into the NHS, but of course NHS land is community land, and it is important that, wherever possible, we work with surrounding communities to support them in local activities that benefit the population.

My hon. Friend also outlined eloquently the challenges faced by more rural parts of the country, and Cornwall in particular. We know that community resources and facilities are much scarcer in rural areas, as she highlighted in her speech. When we look at the affordability of local homes and the provision of community facilities, rurality is an important consideration and one that we always bear in mind in the NHS.

I appreciate my hon. Friend’s interest in the Budock hospital site and support her concern that best use be made of public sector land not only in releasing its monetary value, but regarding the availability of affordable homes for local people to live in. I understand that NHS Property Services has intervened to begin the process of facilitating a mutually beneficial resolution of the issues previously hindering the sale of this land to the local school. Those issues predate the transfer of ownership to NHS Property Services, and were between the former Cornwall and Isles of Scilly primary care trust and Falmouth school. Thanks to swift action since NHS Property Services took over control of the NHS estate, the issues are well on their way to being unlocked. NHS Property Services inherited a portfolio of 4,000 other properties from 161 disparate previous NHS organisations on 1 April, and a win-win resolution is now in sight.

I am sure we will have other debates on similar matters, so it is worth outlining to the House the role of NHS Property Services and some early successes that have occurred. On 1 April, NHS Property Services inherited about 4,000 NHS assets, including health centres, office accommodation, care homes and hospital buildings. It houses about 12,000 tenants and is valued at more than £3 billion. It also inherited more than 3,000 members of staff from former PCTs and strategic health authorities throughout England. This brand new organisation is already doing tremendous work in the face of this huge challenge to create efficient, fit-for-purpose facilities and services for the benefit of patients and the public. All too often in the past, there was an unacceptable variability in estates management—not just in this case, but throughout the NHS—by PCTs and SHAs. The advantage of having estate management under one central roof has already paid dividends throughout the NHS. The creation of NHS Property Services has generated an opportunity to explore options to bring together a fragmented system—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. May I just gently remind the Minister that this is a very tight debate? We are talking about one site; we should be dealing with Falmouth and nowhere else. There may be a good story to tell but we can save that for another day.

[Dr Poulter]

Indeed. Thank you, Mr Deputy Speaker, for bringing me back to the task in hand. There are many good stories to tell from other constituencies but you are quite right; we should focus on how successes in Ludlow and South Suffolk can be translated into success at the Budock hospital site.

The focus of NHS Property Services is about resolving some local planning concerns where PCTs have had difficulties in the past, which is what we are going to concentrate on. I understand that Falmouth school’s plans to purchase the Budock site pre-date the transfer of land to NHS Property Services on 1 April 2013. The school and the former Cornwall and Isles of Scilly primary care trust had previously agreed to enter into a land swap to release the school’s playing fields—which were difficult to access—for the hospital site. The NHS was then to dispose of the playing fields for housing land.

I understand that differences in the size and estimated value of the sites, and planning permission issues, had prevented both parties from reaching agreement to progress this proposal, which commenced some time ago in 2011.

The Government’s priority for easing the shortage of land for housing development is to see development take place in sustainable locations; the predominantly brownfield sites of some of the old NHS estate no longer used for clinical purposes can help bring forward land for affordable homes to be built for local families. The Budock site is brownfield land and is located in a settlement that is forecast to experience significant growth over the coming years, as my hon. Friend outlined.

The site was assessed under the Cornwall strategic housing land availability assessment and found to be suitable for approximately 100 dwellings. My hon. Friend will also be aware that Treasury guidelines on managing public money state that public sector organisations may transfer assets among themselves without placing the property on the open market, provided they do so at market prices. They also state that the organisations should work collaboratively on the transfer to agree a price, and that it is good practice to commission a single independent valuation to settle the price to be paid. My hon. Friend said that is the plan in this case.

I am pleased to report that NHS Property Services and the school have agreed that the original proposal can be revisited, with a planned joint instruction to the district valuer from both parties. NHS Property Services has agreed with Falmouth school that it will take the Budock hospital site off the market while reviewing the original land swap option. To enable both the school and NHS Property Services to deliver these proposals, support will be required from the local planning authority to ensure that a clear planning brief is available for both sites. I am sure my hon. Friend will be helpful in facilitating that accord. This will ensure that both organisations and the district valuer can understand and agree an estimated value for both sites.

This value can be demonstrated in land value and in wider community benefits such as housing, health and well-being, and education and leisure use. My hon. Friend eloquently outlined the many local sports and leisure groups that are hugely supportive of this project, and rightly so. The project will be for the sake of the local community and would be beneficial as well to the NHS through the profits from the land, which could be distributed elsewhere to support local NHS projects.

The potential outcome from this approach is a win-win situation for the local community, the school and the NHS. NHS Property Services will be able to maximise receipts from the sale of the current school playing fields for reinvestment in front-line NHS services. Falmouth school and the wider community will benefit from improved access to leisure facilities on the former hospital site, and much needed housing development in the Falmouth area will be brought one step closer. I understand that an initial report setting out the context and options for the proposed transaction can be delivered within six weeks. That will require the co-operation of the school, NHS Property Services and, importantly, the local planning authority. The report should set out a programme to include a target of three to six months for initial agreement, in the form of a contract to be reached for the transaction. This could take a number of forms, subject to the advice that both parties receive from the district valuer—contract for sale and option agreement.

This evening my hon. Friend has eloquently outlined the case for why the project should go ahead. I will of course be monitoring progress on the ground. The door is always open for her to come and see me if there are further problems or concerns. I am sure that her tremendous advocacy on behalf of her constituents will continue to unlock the potential of these proposals and make them a reality.

Question put and agreed to.

Care Bill

Dan Poulter Excerpts

Monday 20th May 2013 Written Statements

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

My noble Friend Earl Howe, the Parliamentary Under-Secretary of State, Department of Health, has made the following written ministerial statement:

The Government, in collaboration with the Care Quality Commission, Monitor, NHS England and the NHS Trust Development Authority, are today issuing a joint policy statement to provide further information on the changes to the regulation and oversight of NHS trusts and NHS foundation trusts proposed in the Government’s initial response to the Mid Staffordshire NHS Foundation Trust public inquiry and related clauses in part 2 of the Care Bill.

The policy statement has been placed in the Library. Copies are available to hon. Members in the Vote Office and to noble Lords in the Printed Paper Office.

Regulation of Cosmetic Interventions

Dan Poulter Excerpts

Wednesday 24th April 2013 Written Statements

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

Today the review of the regulation of cosmetic interventions has been published. I wish to express my thanks to Sir Bruce Keogh, the chairman, and the other members of the review body for their report.

The Poly Implant Prothése (PIP) breast implant scandal highlighted the unacceptably poor quality of clinical practice in parts of the cosmetic surgery industry, as well as with other cosmetic interventions, including concerns about clinical safety and regulation. Sir Bruce Keogh, the NHS medical director, was asked in January 2012 by the then Secretary of State, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), to carry out a review of the regulation of cosmetic interventions. The review’s scope was broad, covering both surgical (e.g. breast implants) and non-surgical (e.g. “botox” injections) cosmetic interventions.

This review highlights how the rapid growth of the cosmetic interventions sector has outstripped the current legal framework, exposing people who undergo these procedures to a concerning lack of safeguards. It makes recommendations to improve the quality of care, to inform and empower the public and to ensure resolution and redress when things go wrong.

The review examined attempts at self-regulation to establish effective standards and found these wanting. It may be necessary, therefore, to consider new legislation or amendments to existing regulation for some of the recommendations. It may also be possible for much to be accomplished through revised professional standards and improved training.

I am supportive of the principal conclusions of the review, and the Government will make their formal written response to the recommendations before the summer recess.

“Review of the Regulation of Cosmetic Interventions—Final Report” 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.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 16th April 2013 Commons Chamber

[Christopher Pincher (Tamworth) (Con)]

4. What support his Department has given to local authorities and NHS commissioners to improve cardiovascular disease outcomes.

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

On 5 March, we published the cardiovascular disease outcomes strategy, which included 10 key actions for commissioners and providers to ensure patients and carers get the best possible support. As set out in the strategy, we will continue to make data available to local authorities to see where their areas of greatest need are and to shape their own response accordingly.

[Christopher Pincher]

Will my hon. Friend support the efforts of local clinicians, Tamworth borough council and charities such as Tamworth in the Community, which are working with parents, teachers and children to educate them about the importance of healthy eating and exercise, to deal with the health challenges we have in Tamworth and tackle the rather unfair notoriety that Tamworth gained in the press?

[Dr Poulter]

I commend the work being done locally in Tamworth to address this issue. As we know, one of the biggest public health challenges facing this country is obesity. The risk factors for cardiovascular disease include diabetes and high cholesterol. If we can tackle obesity and improve lifestyles, we will address both those risk factors directly, so I wish my hon. Friend’s local organisations every success in tackling those challenges.

[Keith Vaz (Leicester East) (Lab)]

As the Minister has said, those with diabetes are five times more likely than others to develop cardiovascular disease, which currently costs the national health service £9.8 billion a year. Will he commit to a public awareness campaign and issue guidelines for local health and wellbeing boards so that they make this a priority?

[Dr Poulter]

I commend the right hon. Gentleman’s work in raising the profile of diabetes. A lot of the Government’s work is focused on the importance of improving public health in this country and in particular on obesity, and if we are to tackle that we have to deal with diabetes. As a key part of that, we are now giving 40% of the public health money to local authorities to do exactly what he has just described: to focus money in the right places to tackle cardiovascular disease in those communities that most need it, particularly in inner-city areas.

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

The role of local authorities in scrutinising NHS decisions is now even more important, yet the joint health overview and scrutiny committee of Yorkshire and Humber councils was consistently denied a number of important documents, which was one reason the High Court ruled that the decision taken in the Safe and Sustainable review was unlawful. This is now in tatters. Will the Minister now confirm whether he will instruct NHS England not to appeal the High Court decision?

[Dr Poulter]

Surely the validity of evidence is a matter for the court. I am sure my hon. Friend would recognise that there has to be a distinction between what we do here in Parliament and what is done in the courts. If NHS England would like to appeal the decision and if it thinks there are good grounds to do that, it must do that. The decision will then ultimately be made in the courts, on the basis of how valid that appeal is.

[Liz Kendall (Leicester West) (Lab)]

The best way to improve outcomes for heart disease patients and get the best value for public money is to help people to manage their condition at home. Will the Minister therefore explain the thinking behind the Government’s strategy of cutting one in five district nurses, so that delayed discharges from hospital due specifically to a lack of NHS community services rise by 40%, costing taxpayers £6 million a month as a result?

[Dr Poulter]

The hon. Lady and Opposition Members are fond of saying that we are cutting the NHS. It is their party that has said it will cut; they think it is irresponsible to increase funding for the NHS. We on the Government Benches have invested £12.5 billion more in the NHS. There are 6,000 more clinical staff working on the ground, focusing specifically on early intervention, early strategies and lifestyle. We now have almost 1,000 more health visitors working in the NHS and we have expanded the family nurse partnership programme. All these things will make a difference. Indeed, there is now a lot more joint commissioning between hospitals and primary care, to ensure that commissioning arrangements are in place better to support the role of community nurses and district nurses in preventive care and better look after people with long-term conditions.

[Mark Menzies (Fylde) (Con)]

6. What steps his Department plans to take to improve dementia diagnosis rates and to reduce regional variations in such diagnoses.

--- Later in debate ---

[Mr Graham Allen (Nottingham North) (Lab)]

9. If his Department will make early intervention a priority for clinical commissioning groups and public health officers.

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

I commend the tremendous amount of work undertaken by the hon. Gentleman on early intervention. Yesterday, he and I attended the Early Intervention Foundation, which he has set up. We are talking a lot about legacies this week, and his legacy and the work that he has done to promote early intervention will certainly stand the test of time. The Government are committed to supporting that work, both through his foundation and through the work that we are doing to expand the family nurse partnership programme and the number of health visitors available to young families.

[Mr Allen]

I thank the Minister for those remarks, and I would like to thank those on both Front Benches for their support for the Early Intervention Foundation, which is greatly appreciated. Would the Minister accept that, in addition to having police and crime commissioners and councils promoting early intervention, the role of GPs, of directors of public health and of health and wellbeing boards will be absolutely central to getting early intervention plans and programmes to scale across the whole of England?

[Dr Poulter]

The hon. Gentleman is absolutely right. The health and wellbeing boards in particular will be well placed to bring together and join up what goes on in early interventions and to break down some of the silos that have existed in education, social services and health care. It is through the health and wellbeing boards that a lot of the work being done by health visitors and others to improve the life chances of many children, particularly those in the poorest communities, can be taken forward locally in a much stronger way.

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

What steps are being taken to encourage and help local authorities to focus on illness prevention and help people to lead healthier lives?

[Dr Poulter]

My hon. Friend will be aware that local authorities are now receiving 40% of the public health budget. That allows local authorities to have a much more nuanced approach to how and where they direct their budgets. It is of course desirable to focus on the early years to give each and every child the best start in life, to set good and healthy eating patterns and to support the work being done in the health service in expanding the health visitor programme. This also allows local authorities to address other public health challenges in the area by focusing, for example, on areas with high rates of teenage pregnancy, smoking or cardiovascular disease death.

[Mr Speaker]

I am grateful to the Minister, but we do have quite a lot to get through, so shorter answers would help.

[Mr Peter Hain (Neath) (Lab)]

What sort of early intervention have the Government ordered to prevent a contagious spread of measles from the outbreak in the Neath and Swansea area of more than 700 serious cases? Thousands of parents across Britain will have been tormented by the choice of whether to vaccinate their children for measles, mumps and rubella because of the scare. Surely the Minister should take serious action to instruct public health officials to combat this issue.

[Dr Poulter]

We are taking exactly that action to make sure that the vaccine is available and to promote the uptake of it. The right hon. Gentleman will of course be aware that the problems and concerns about the failure of some families to take up the vaccine resulted from some mis-used data in the past. That was a regrettable incident concerning the use of medical data, and is unfortunately causing great problems now. We are committed to making sure that those vaccines are available to the children who need it.

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

When it comes to early intervention with the one in 10 children in this country who have a diagnosable mental health problem, will the Minister confirm that it is the Government’s intention to ensure that those children all have access to talking therapies so that they get the right treatment at the right time, which will make a big difference for them?

[Dr Poulter]

In his time in office, my right hon. Friend did a tremendous amount to promote the cause of mental health and to get parity of treatment between mental and physical health. That is exactly what we propose to do with the money going into the talking therapies—to get in place those early interventions, not just for adults, but for children, too. We shall be taking that work forward in earnest in the years ahead.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Does the Minister agree that the most important form of early intervention is for the public to get prompt advice on their symptoms? Does he share my concern that a leaked report on the national performance of the 111 line shows that the service is in crisis with staff shortages, delays, abandoned calls, 11-hour waits for call-backs, staff being wrongly diverted to attend cats with diarrhoea and ambulance crews going without breaks for 12 or more hours? Is this not a trademark Government shambles?

[Dr Poulter]

The hon. Lady will be aware that it is important not to rush the roll-out of any service. That is why we kept in place the NHS Direct service in areas where rolling out the 111 service has been slower. A lot of good work is going on in early intervention; it focuses on giving local authorities the budget and the powers to make a difference to local communities. The Labour party should get behind that and do much more to support it. It is this Government who are making a difference in early years, and I hope that the Opposition can support us on that.

[Dan Jarvis (Barnsley Central) (Lab)]

10. When the Government plan to respond to the consultation on standardised packaging for tobacco products; and if he will bring forward legislative proposals on standardised packaging.

--- Later in debate ---

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

Following a referral from the joint Manchester and Trafford health overview and scrutiny committee, the Secretary of State requested initial advice from the independent reconfiguration panel. That was received on 27 March 2013. The Secretary of State will consider the advice and make a decision in due course.

[Kate Green]

This issue is of huge importance to my constituents, who are concerned about access to accident and emergency and acute services and about delays in discharge into the community in the absence of adequate community provision. So far, Ministers have refused to meet me so that I can make representations about my constituents’ concerns. Will the Minister give me an undertaking that no final decision will be taken until that meeting can take place so that local concerns can be properly taken into account?

[Dr Poulter]

I am sure that we would be happy to meet the hon. Lady; I am certainly happy to do so. A number of the concerns she has outlined in the House and at a local level will be taken into consideration by my right hon. Friend the Secretary of State when he considers the report.

[Mr Graham Brady (Altrincham and Sale West) (Con)]

I welcome the Minister’s undertaking to meet local Members to discuss these important matters and I endorse the comments made by the hon. Member for Stretford and Urmston (Kate Green) about the importance of a timely resolution. The longer this goes on, the greater the cost will be to local health services.

[Dr Poulter]

My hon. Friend is absolutely right, and it is important that a timely conclusion is reached. It is also right, as the hon. Member for Stretford and Urmston (Kate Green) said, that the need to improve community services and preventive care and to provide better support for people with long-term conditions in the Trafford area should be considered.

[Paul Goggins (Wythenshawe and Sale East) (Lab)]

I also welcome the Minister’s agreement to meetings. Will he and the Secretary of State carefully consider the likely impact of downgrading accident and emergency facilities at Trafford general and the implications for nearby Wythenshawe hospital? Does the Minister agree that a failure to provide proper facilities at Wythenshawe for the anticipated additional 4,500 accident and emergency patients, the additional admissions stemming from that and the extra beds required could lead to long delays and a diminution in the service?

[Dr Poulter]

My right hon. Friend the Secretary of State has visited Wythenshawe hospital and can pay testament to the high-quality care available there. All the points that the right hon. Gentleman has raised will, of course, be taken into account when a decision is made.

[Mrs Linda Riordan (Halifax) (Lab/Co-op)]

16. What steps the Government plans to take to improve public awareness of the signs and symptoms of early rheumatoid arthritis.

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[David Morris (Morecambe and Lunesdale) (Con)]

17. Whether there are plans to close the accident and emergency department at the Royal Lancaster Infirmary.

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

I would like to reassure my hon. Friend that there are no plans and never have been any plans to close the accident and emergency department at Royal Lancaster Infirmary.

[David Morris]

I thank my hon. Friend for that robust answer. Does he agree that the local Labour party fabricated the scare story that the A and E department was going to close? It was never going to close, as he has just stated. Will he assist me in taking the local Labour party’s bogus petition offline?

[Dr Poulter]

My hon. Friend is right to highlight the fact that it is wrong of any political party—in this case, the Labour party—to focus on scaremongering when there is no basis in truth. At no point have there been plans to close Royal Lancaster Infirmary.

[Mr Philip Hollobone (Kettering) (Con)]

18. What assessment he has made of (a) the pressures faced by Kettering general hospital’s accident and emergency department and (b) what can be done by Kettering general hospital to achieve national accident and emergency transition time targets.

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

Local health care commissioners have worked with the trust, Monitor and NHS England’s Hertfordshire and South Midlands local area team to ensure that robust plans are in place to improve the trust’s performance against accident and emergency waiting time performance indicators.

[Mr Hollobone]

The greatest difficulty for Kettering is that it has the sixth fastest household growth rate in the country, and A and E admissions are up 12% year on year. Will the Minister ensure that the NHS Commissioning Board makes sure that population estimates are put into its funding formula?

[Dr Poulter]

My hon. Friend makes a very good point. I will take up the matter further with the NHS Commissioning Board because it is important that when we are commissioning services we take into account future population growth.

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

Along with the hon. Members for Kettering (Mr Hollobone) and for Wellingborough (Mr Bone), I shall meet the chief executive and chair of Kettering general hospital this Friday to discuss the latest steps in the Healthier Together review. Does the Minister agree that it is important that we urge on Kettering general hospital and all the other decision makers that we must maintain our proper accident and emergency and other vital services at Kettering general hospital?

[Dr Poulter]

It certainly sounds as though there is a need for an accident and emergency department in Kettering. These are matters for the local commissioning boards to take forward, but it would be wrong for the hon. Gentleman or anyone else to say that as part of the Healthier Together programme there are any site-specific proposals that would in any way threaten Kettering accident and emergency department.

[David Rutley (Macclesfield) (Con)]

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

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

That is an absolutely extraordinary question given that it was the previous Labour Government’s decision to contract out out-of-hours services in the first place, which has led to the massive pressure on so many A and Es. The regulations in place for many of these arrangements were laid by the previous Labour Government.

[John Pugh (Southport) (LD)]

T9. What is the Department doing to deal with the difficulties presented by poor data sharing between health and social care agencies and the threat to integration that that presents?

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[Andrew George (St Ives) (LD)]

If there is a smidgeon of space in any of the Ministers’ diaries, is there a chance that they could meet me and representatives of the nursing profession to address not the issue that I think the Government are saying they are opposed to—mandatory nurse to patient ratios on wards—but that of adequate registered nurse levels on hospital wards?

[Dr Poulter]

Of course, I would be very happy to meet my hon. Friend to discuss this matter further. He can be reassured that I have regular discussions on these matters with representatives from the nursing profession, both in my clinical work and, more specifically, in my ministerial roles.

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

The Secretary of State said earlier that 1 million extra people are attending A and Es annually, but a few minutes later he said that the figure was 4 million. Which one is it?

Health Education England

Dan Poulter Excerpts

Friday 22nd March 2013 Written Statements

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

On 1 April 2013, Health Education England takes over responsibility for national leadership of health education and training and ensuring that the health work force has the right skills, behaviours and training, and is available in the right numbers, to deliver high-quality patient care. We have already announced our intention to establish Health Education England as a non-departmental public body at the earliest opportunity, as set out in the Draft Care and Support Bill.

The creation of Health Education England will bring together responsibility for education and training; the outcome of which will be a better work force planning, education and training system for health and public health, and one that is clearly focused on continually improving the health of the public and services for patients.

Given the findings of the Francis report and the importance of reflecting the changes and improvements required in the recruitment, training and education of NHS staff in the Government’s response, the full mandate for Health Education England will be published at the end of April.