Erdington Walk-in Centre

Dan Poulter Excerpts

Tuesday 5th March 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 second time, Mr Weir, and to reply to the hon. Member for Birmingham, Erdington (Jack Dromey), whom I congratulate on securing this debate. I acknowledge his hard work on behalf of his constituents in campaigning for the retention of Erdington walk-in centre, and the strength of feeling locally, which he eloquently outlined.

Before I move to the local context, it would be remiss of me not to pick up the issues of national consequence raised by the hon. Gentleman. This Government will have invested £12.5 billion more in the NHS between the last election and the one in 2015, which is providing some, albeit small, real-terms growth in the NHS budget. Even though we are in difficult economic times, the Government have made a clear commitment that the NHS is a special case that needs further investment, which we are providing. It might be worth the hon. Gentleman taking that up with one of his Front-Bench colleagues, the right hon. Member for Leigh (Andy Burnham), who in contrast said that such investment was irresponsible. Indeed, the Labour party running the NHS in Wales intends to make an 8% real-terms cut in its budget. It is worth reflecting on the reality of the situation before getting drawn into any political rhetoric.

The hon. Member for Birmingham, Erdington is right to raise the specific pressures on A and E. We know that A and Es are being accessed by increasing numbers of patients, and we know from history that one key driver of that was the previous Government’s decision to contract out-of-hours GP care away from local GPs. One direct consequence of that has been additional pressures on accident and emergency departments. In many ways, that pulls against what he spoke about and what I believe in, which is the need to deliver more and higher quality care in the community. That cannot be nine-to-five or nine-to-six care in the community; it has to be all-day, 24/7 care, which is what integrated good health care looks like. I believe that the decision was bad. I saw its consequences when I worked as a casualty doctor in A and E. We have lived to regret it, and it has been badly to the detriment of patients.

The report on the Mid Staffordshire NHS Foundation Trust graphically outlined the fact that targets have often got in the way of front-line patient care. That is why this Government, when they came to power, relaxed the 98% target for the four-hour wait in A and E and set it at 95%, which doctors, nurses and my fellow health care professionals said was in the best interests of patients. Too often the four-hour target meant that a patient who perhaps had a broken toe was given priority ahead of a patient with potentially life-threatening chest pain. That was not good medicine or patient care, but showed targets getting in the way of looking after patients effectively, a lesson that was graphically depicted in the Francis report on the Mid Staffordshire trust. We must learn such lessons and acknowledge that although targets can have a place in health care, we have to trust and listen to front-line health care professionals if we are to deliver high-quality care for patients.

On the national context of urgent care and accident and emergency care, the Government are committed to developing a more coherent 24/7 urgent care service in every part of England. That will provide universal access to high-quality 24/7 urgent care services, so that whatever people’s needs or location, they will get the best care from the best person in the best place and at the right time.

The NHS has always had to respond to patients’ changing expectations and advances in medical technology. As lifestyles, society and medicine continue to change, the NHS will also need to change. The reconfiguration of urgent care services is therefore about modernising the delivery of care and facilities to improve patient outcomes, develop services closer to home and, most importantly, save lives. We are clear that, as the hon. Gentleman outlined, the reconfiguration of front-line services is a matter for the local NHS. That was the previous Government’s policy and is this Government’s policy.

Services should be tailored to meet the needs of the local population. We expect proposals for service changes to meet four tests: to demonstrate a clear clinical evidence base underpinning any proposals, focusing on improved outcomes for patients—in other words, to save lives—and to show clear support from GPs as the commissioners of local health-care services, strengthened arrangements for public engagement and support for patient choice. Even when all those tests are met, if the responsible local authority is concerned about a decision, it will have the option to refer such a decision to the Secretary of State.

Our vision for urgent care is to replace the ad hoc, unco-ordinated system that has developed over the past few years—characterised by poor quality and too much variation in care throughout the country—with a more consistent system that delivers improvements in patient care. The Government are committed to putting GPs in charge of commissioning urgent care services. We believe that empowering GPs and other health professionals will achieve better and more patient-focused services.

It would be wrong not to talk about the winter pressures faced by the NHS. In response to those pressures, we have put about £330 million of additional money into the NHS to deal with them. I am aware that local hospitals in the Birmingham area recently issued a statement advising patients to attend A and E only for matters requiring urgent attention, because of the pressures of demand experienced by emergency departments. There is always more pressure on the NHS during winter months, with more demand on urgent and emergency care services, and this year is not different. During October and November 2012, NHS Midlands and East scrutinised winter plans, escalation triggers and protocols across its health economies, and it is monitoring pressure on health services during the winter across the whole of the strategic health authority area to ensure that patients continue to have access to high quality NHS care in Birmingham and elsewhere.

I turn to the local context, which is obviously of importance to the hon. Gentleman and his constituents. He is a tremendous advocate for his constituents, and has eloquently outlined some of the local concerns, which relate to an NHS review of urgent care provision in Birmingham and Solihull. The clinical commissioning groups in the area are developing an urgent care strategy to improve access to and integration of services for people with urgent health care needs, to make the system simpler to navigate and to avoid duplication.

I understand that local commissioners have engaged stakeholders in the process, and they include clinicians, patient groups, providers and health overview and scrutiny committees. The local NHS has collected evidence from local people to understand the usage of current urgent care services, such as walk-in centres.

The hon. Gentleman will be aware that the local NHS is now developing a draft strategy outlining some initial options. However, it is important to make it clear that as yet no decisions have been made. That is for local determination, and it would not be appropriate for me to comment further on the detail of the urgent care review.

I am assured by the local NHS that engagement with local people and other stakeholders will continue over the coming months to ensure their input in the final proposals ahead of the formal consultation later in the year. Of course I expect any proposals to meet, where appropriate, the four tests for service change.

I understand that the hon. Gentleman met representatives of Birmingham CrossCity CCG in December 2012 to discuss the review, and I encourage him to continue engaging with local NHS staff on the matter.

[Jack Dromey]

It is certainly true that we had a meeting in December and that it was clear beyond any doubt that there was a real threat to both the walk-in centres. A commitment was given that by the end of January there would be a route map of the next stages of process and engagement, but here we are in the first week of March and it has yet to be produced. The suggestion now is that it might not be with us until mid-April at the earliest. Although I understand what the Minister is saying in good faith about the importance of proper engagement with the community, I have to say that those responsible in the national health service in Birmingham have been dragging their heels.

[Dr Poulter]

The hon. Gentleman is right to say that when there is talk of service change, effective engagement is important and must be dealt with in an expedient manner. There must be an awareness that the prospect of any change can lead to understandable concerns among both staff and patients. A time of change is always potentially unsettling. I know that he, like me, will want to encourage the CCGs to come to the table and address this matter more effectively than they have done. I will endeavour to ensure that there are representatives from the CCGs at the meeting that we have later in the month, as that will be an effective way of helping to facilitate matters and bring them to a more speedy resolution.

In conclusion, I encourage local people in Birmingham and Solihull and their elected representatives, including the hon. Gentleman, to participate in the engagement process and subsequent consultation to ensure that their views are taken into account. I look forward to meeting the hon. Gentleman later this month to ensure that we do all we can to facilitate a speedy resolution of the matter and to ease these times of uncertainty that are faced by his constituents.

Health Professionals: Regulation

Dan Poulter Excerpts

Monday 4th March 2013 Commons Chamber

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

I congratulate my hon. Friend the Member for North East Cambridgeshire (Stephen Barclay) on securing the debate. He made a number of serious allegations, but he was absolutely right to say that it is completely unacceptable to manipulate any patient information deliberately in order to falsify reports of a trust’s performance, and there will be serious consequences for any part of the NHS that is found to be doing so. He was right to say that if we are to have an open and accountable NHS in which patients and the public know how hospitals are doing, the hospitals must be open and honest about their performance.

My hon. Friend was also right to say that we want the NHS to have the lowest mortality rates in Europe. Sir Bruce Keogh, the NHS medical director, is currently leading an investigation into hospitals with higher mortality rates to understand why they are higher and whether they have all the support they need to improve. To pick up on the point that my hon. Friend the Member for Bristol North West (Charlotte Leslie) raised in her intervention, that will involve senior clinicians with background expertise going into those hospitals to ensure that proper scrutiny is brought to bear.

[Charlotte Leslie]

Will the Minister give way?

[Dr Poulter]

I will, very briefly, although my hon. Friend did not notify me previously that she intended to intervene.

[Charlotte Leslie]

I thank the Minister for his courtesy and apologise for not notifying him in advance. Does he have any indication of where our current mortality data lie in relation to comparable countries and, if not, will he speak with Sir Brian Jarman of the Dr Foster website, because I believe that he has some rather depressing news on that front and it is probably time to start speaking the truth about that as well?

[Dr Poulter]

I thank my hon. Friend for her intervention. We have made it clear, both in opposition and in government, and indeed in the health care mandate, that we do not find it acceptable that Britain, compared with some other European countries, is not doing well when it comes to survival rates for a number of diseases, including some types of cancer and some respiratory diseases. We all know that the NHS must achieve more in that regard. It is not necessarily an isolated issue that applies to one particular trust. That is why we made it a priority in the NHS mandate set by my right hon. Friend the Secretary of State for Health at the end of last year, but the priority should be clinical outcomes, and a key priority is improving mortality for a number of diseases, particularly those that are attributable to patients with long-term conditions.

I thought that it might be worth discussing in more detail a few of the points my hon. Friend the Member for North East Cambridgeshire raised. He talked in particular about the Francis report. For everybody who cares about the NHS and works in it, as I still do, the day the Francis report was published was a humbling one. There was failure at every level: a systemic failure, a failure of regulation, a failure of front-line professionalism, a failure of management and a failure of the trust board. There are systemic problems with the NHS that we need to focus on and address. That is what my right hon. Friend the Secretary of State will outline when we give our further response to the Francis report later this month.

My hon. Friend the Member for North East Cambridgeshire was also right to highlight that there has been too much covering up in the past and not enough transparency. If we are to put right some of the systemic failings highlighted in the Francis report, we need to be grown up enough to acknowledge that sometimes the NHS does not come up to standard and the care that we would expect to be delivered to patients is not always good enough. If we care about our NHS, and if we want an NHS we can continue to be proud of and that will continue to be the envy of the world, we must acknowledge when things go wrong and ensure that we face up to the problems in an open and transparent way. We must ensure, as many hospitals with a more transparent culture do, that good audit and proper incident reporting are in place for when things go wrong. We must ensure that, rather than having recriminations and closed doors, bad things are learned from, and that where things have gone wrong and patients have not been treated properly, hospitals and the whole the NHS make more active efforts to deal with problems and failures of care.

[Dr Julian Lewis (New Forest East) (Con)]

I thank the Minister for his courtesy in giving way. It might be helpful, Mr Speaker, if you would give us guidance on whether pre-notification is still required. What the Minister says is all well and good but why is it, after so many people died in such an unacceptable way, that nobody seems to have carried the can or taken responsibility?

[Mr Speaker]

Order. I thought, in the circumstances, that I would let the debate flow, but for clarification I ought to say that there is a requirement that a Member who wishes to make a speech in someone else’s Adjournment debate secures agreement in advance, but there is no such requirement—this point is widely misunderstood—in respect of an intervention. It is purely for the Minister to decide whether to take an intervention. No impropriety has been committed by the hon. Member for Bristol North West (Charlotte Leslie); her virtue is unassailed.

[Dr Poulter]

Indeed, and thank you, Mr Speaker. I will, of course, do my best to take as many interventions as possible, but my hon. Friend the Member for New Forest East (Dr Lewis) will be aware that I have been generous so far and that the time allotted to Adjournment debates means that it is difficult to give as full an answer as possible to interventions. For that reason, it is useful to have some notice that an hon. Member intends to intervene.

My right hon. Friend the Prime Minister made the point clearly, as did Robert Francis in his report, that it was not for the Francis report to highlight individuals or blame them for what happened; the report was about ensuring that there was a clear acknowledgement that there had been systemic failure, which I talked about earlier. It was a failure of professionalism on the front line; a failure of the trust’s board; a failure of regulation and the regulators; and a failure of management at the trust. When systemic failure occurs, it is right that we put in place systemic solutions, and that is what my right hon. Friend the Secretary of State will do later this month.

My hon. Friend the Member for North East Cambridgeshire made the key point that a real culture change was required, and that that is about having transparency and openness in the NHS. He is right to highlight those points. If we want transparency and openness, we need to look at some of the steps that have already been taken. We know that the Public Interest Disclosure Act 1998, which in theory gives protection to whistleblowers and people who want to speak out, has not been effective. Legislative approaches have not been enough to ensure that people feel free to speak out. Legislation has so far not been effective in creating that culture of openness and transparency that we all believe is necessary.

However, we have seen two things in the past six months that will make a real difference, the first of which is the contractual duty of candour, which will be introduced in the NHS for hospital trusts. It will mean that there is support for openness and transparency as part of the NHS contract. The second is the strengthening of the NHS constitution, which brings direct support to the cause of whistleblowers. Those things will be further strengthened in our further response later in the month to what happened at Mid Staffordshire.

[Stephen Barclay]

I very much welcome the Minister’s assurance that there will now be changes for whistleblowers. I repeatedly raised my concerns with Sir David Nicholson in the Public Accounts Committee, so why did he continually tell me that there was no problem with the guidance or the legislation, and that adequate protection was in place for whistleblowers? The Minister is now accepting the need for change, but why did the chief executives tell me that there was no problem?

[Dr Poulter]

I say to my hon. Friend that the Department of Health has, like everyone who works for it, made it clear that gagging clauses are not and have never been acceptable in the NHS. There is a distinction to make between confidentiality clauses, which might be part of any financial settlement with anyone who works in either the commercial sector or the public sector, and a gagging clause. It is the duty of any front-line professional, according to and as part of their registration with the General Medical Council or the Nursing and Midwifery Council, to speak out when there are issues of concern. That is a part of good professionalism. That is what being a good professional is about. It is about someone saying that they recognise that there has been unacceptably poor care in a hospital or a care setting and that they have a duty, because they are a registered doctor or nurse, to speak out to highlight where problems have occurred. The point is that at Mid Staffordshire there was clearly a failure of that professionalism not only on the front line but at every level. Gagging clauses have never been considered by the Department of Health, certainly under the current Government, to be an acceptable part of the NHS. That was made very clear in a recent letter written by my right hon. Friend the Secretary of State to NHS hospitals and chief executives.

[Dr Phillip Lee (Bracknell) (Con)]

On the subject of gagging clauses, did the settlement that formed part of the severance payment of the former chief executive of Mid Staffs include a gagging clause? If the Minister cannot tell me that today, will he put it in writing?

[Dr Poulter]

I shall endeavour to write to my hon. Friend to clarify as I do not have the information immediately to hand. That does not detract from the fact, however, that a gagging clause in any form is unacceptable to this Government, should be unacceptable to everybody in this House and is unacceptable to every doctor and nurse who works in the NHS. We will continue to do all we can through the contractual duty of candour and through strengthening the NHS constitution to make it easier for NHS staff to feel that they can speak out openly and feel supported in doing so, so that we have an open and transparent NHS of which we can be proud.

My hon. Friend the Member for North East Cambridgeshire also raised a very important point about open and transparent data on surgical outcomes. It was Professor Sir Bruce Keogh, the current NHS medical director, who put together the purple book of cardiac surgery, which has made a huge difference through greater transparency of outcomes in that specialty. That was in reply to the findings of the Bristol heart surgery inquiry, and it is regrettable that we have not seen similar advances in openness and sharing of data in other specialities in the NHS. That is not necessarily because the data do not exist, because they often do. In some specialties, such as urogynaecology, national databases are being put together to consider the long-term data on certain operations, which, to some extent, will give data on individual surgeons.

In the NHS, we often have a plethora of data and a lot of audit information that is collected at a local level, and we must ensure that those data are used in a better way in future. A lot of work can be done to add transparency and to share audit data in different trusts so that they are openly comparable to build a national picture of certain types of care and how we can improve patient care. That was a good point that was well made, and I know that Sir Bruce Keogh is continuing and will continue to develop that work in his role on the NHS Commissioning Board. I had a very encouraging meeting recently with a number of senior surgeons who recognise the importance of such work in their specialties. I am sure that the NHS will continue to develop it at a greater pace in the future, not least because of what we have heard from the Mid Staffs inquiry.

In conclusion, throughout the debate the point has been made that we have legislation in place to protect whistleblowers, but it has not been effective—[Interruption.] My hon. Friend the Member for Bracknell (Dr Lee) says from a sedentary position that it does not work. He is absolutely right—it has not been effective and that is why we are considering the Mid Staffs inquiry and the issues of culture that have existed and that have failed and let down patients. We will have a robust response to those failings to put right what has gone wrong and to ensure as best we can that another Mid Staffs will never happen again in the NHS. I am sure that we will all support what our right hon. Friend the Secretary of State says in his further response later this month.

Question put and agreed to.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 26th February 2013 Commons Chamber

[Jeremy Corbyn (Islington North) (Lab)]

5. What recent discussions he has had with the Whittington hospital on the proposed disposal of its assets and reductions in medical and non-medical staff.

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

This is a matter for the local NHS, in particular the Whittington Hospital NHS Trust. Neither the Secretary of State nor the ministerial team have met with the trust recently on this subject.

[Jeremy Corbyn]

That is a disappointing reply from the Minister. Is he aware that the Whittington is a successful, popular, local district general hospital, yet, as part of its application to become a foundation trust, it is proposing to: sell off a quarter of its land; make 500 of its staff, including many nurses, redundant; and reduce the number of beds to 177, roughly half the current figure? This is, apparently, to provide a better service to the community, a point totally lost on the thousands of local people who are angry at the reduction in their hospital services. They see it as a prelude to its ultimate closure as a district general hospital with an A and E department. Will the Minister take an interest and perhaps intervene to protect a very good local hospital from this not very sensible plan?

[Dr Poulter]

The hon. Gentleman is right to highlight the fact that the trust has handled this issue badly at a local level, but, as he will know, decisions about local health care reside with local trusts. The point is this: if we look at the plans, the trust is talking about selling off land that is mostly not used for clinical purposes and reinvesting that money in front-line patient care: investing £10 million in improving the maternity department, which has already benefited from £750,000 from the Government only this year; £2.9 million in the same-day treatment centre to support A and E and treat patients faster; and £1.9 million for a new undergraduate education centre and library. Those assets are being sold off to directly influence and improve patient care, which has to be a good thing.

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

Is the Minister aware of how angry and concerned Londoners are about the threats to their health service—not just about the £17 million property sales at the Whittington and the drop in bed numbers, but about the threat to four A and Es in north-west London and, of course, the A and E in Lewisham? Ministers have accused campaigners of overstating the case. Is that not a complacent attitude? Surely doctors and residents on the ground know the value of these services better than Ministers in Whitehall. Is he aware that Londoners came out in unprecedented numbers to fight for Lewisham hospital and will continue to fight for the best possible NHS services in our region?

[Dr Poulter]

The hon. Lady is absolutely right to highlight the fact that service changes have to be clinically led, meet the tests we have outlined and engage with communities effectively, but the point is that the previous Government also redesigned and changed services, very often for the benefit of patients. When the redesign of services is clinically led and services are better delivered for patients, that has to be a good thing so let us look at these proposals. If they are clinically led, let us see whether they deliver improved care for patients, and if they do, it is the right thing to do.

[Kelvin Hopkins (Luton North) (Lab)]

6. What assessment his Department has made of harm caused to babies by alcohol consumed during pregnancy; and if he will make a statement.

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[Karl MᶜCartney (Lincoln) (Con)]

9. What recent discussions he has had with officials in his Department on the forthcoming NHS investigation into mortality indicators.

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

Ministers have discussed the terms of reference for the review of hospitals that have been highlighted as outliers for the last two consecutive years using nationally published mortality indicators. The terms of reference were published by Professor Sir Bruce Keogh on Friday 15 February.

[Karl MᶜCartney]

Just over a year ago, I asked the previous Secretary of State a question about gagging orders and the specific case of Mr Gary Walker, the former chief executive of United Lincolnshire Hospitals NHS Trust. In the light of the recent news that our local health trust is now being investigated amid concerns over patient safety, what assurances can the Minister give the House that such Stalinist gagging orders, which have cost the taxpayer £15 million in the past few years, will be outlawed as soon as possible, to ensure that, under this Government, it will not take 81 requests to ensure that patient safety is paramount?

[Dr Poulter]

My hon. Friend is absolutely right to highlight the fact that all staff in the NHS should feel able to speak up and raise concerns about patient safety, so that the organisations for which they work can take up their concerns and investigate them. He will be aware that the people who raise such concerns are protected under the Public Interest Disclosure Act 1998.

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

Last week I visited Salford Royal hospital, which has the lowest death and weekend mortality rates in the north-west, and the seventh lowest in the country. It is interesting to note that Salford also has higher ratios of nurses per in-patient bed, and that individual wards in the hospital publish data on their rates of MRSA, ulcers and falls. Does the Minister accept that good practice at hospitals such as Salford Royal should be investigated alongside the poor practice and high mortality rates in other hospitals?

[Dr Poulter]

The hon. Lady is absolutely right. That is exactly what the review is about. It is going into the 14 hospitals in which concern has arisen over mortality data, looking at the practices there and commissioning a peer review of them from leading clinicians and patient groups. That will help to raise standards of practice where required.

[Sir Peter Tapsell (Louth and Horncastle) (Con)]

In supporting the points that have just been made by my hon. Friend the Member for Lincoln (Karl MᶜCartney), may I tell the Minister that, as he might expect, there is considerable anxiety among my Lincolnshire constituents over the fact that the United Lincolnshire Hospitals NHS Trust has a higher than average mortality rate? Will he tell us when the promised review of the situation will begin, and who will be conducting it?

[Dr Poulter]

To reassure my right hon. Friend, the review is being carried out and led by Sir Bruce Keogh, the NHS medical director. We are already well under way in implementing the review. It should be in place by the very early summer to inform Members of this House and to make improvements to patient care at the local trust level.

[Ian Austin (Dudley North) (Lab)]

People in Dudley were concerned to discover that higher than average mortality rates have led to Russells Hall hospital in my constituency being investigated. I have written to Sir Bruce Keogh to ask whether he or a member of his team will meet me to discuss the inquiry, so that we can find out exactly what has been going on and local people can provide information to it. How does the Minister think that things at the hospital will be improved when nurse numbers in the NHS are being reduced, waiting lists at the hospital have gone up by 177% and the NHS in Dudley has had to spend £20 million on a costly and bureaucratic reorganisation instead of on improving front-line care?

[Dr Poulter]

I had thought that the hon. Gentleman had risen on a consensual note, raising his constituents’ concerns—and he was right to do that. The review is about making sure that any failings in care in local trusts are picked up and improved. The fact of the matter is that waiting times are down under this Government in comparison with the previous Government and many more additional clinical staff are working in the NHS—about 2,000 more than under the previous Government. At the same time, we have cut 18,000 administrative and management posts, and the money from that is being reinvested in front-line patient care.

[Mr Speaker]

If the hon. Member for Crawley (Henry Smith) wishes to come in on this question, he may, but he is not obliged to do so.

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[David Mowat (Warrington South) (Con)]

10. What assessment his Department has made of the effect of hospitals built under the private finance initiative on the work of neighbouring hospitals.

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

This Government recognise that no hospital operates in isolation. We are providing seven NHS trusts that are facing difficulties as a result of PFI agreements with access to a £1.5 billion support fund to pay for extra costs accrued as a result of those damaging PFI schemes.

[David Mowat]

I apologise for my voice—perhaps I shall soon be interacting more directly with the NHS.

The Warrington and Halton hospital has independent trust status. It is busy and getting busier. The previous Government built a huge PFI hospital about 10 miles away at Whiston, which does not have the patient volumes to sustain the demands of the botched PFI deal. It is heavily loss-making. Will the Minister provide assurance that there will be no forced merger and that my constituents will not pay for a bad decision made a decade ago?

[Dr Poulter]

I thank my hon. Friend for his question. He is right to highlight the very damaging PFI scheme signed by the previous Government for the St Helens and Knowsley NHS Trust. The percentage of annual turnover going on PFI payments at the moment is 14.2%. That is unsustainable, which is why this Government are trying to sort out the mess created by the previous Government’s signing up to too many PFI agreements.

[Mr Nick Raynsford (Greenwich and Woolwich) (Lab)]

The Minister will be aware that support for excess PFI costs was an important element in the report of the trust special administrator in south-east London, to which the Secretary of State referred in an earlier exchange. That recommendation was widely welcomed. However, as I highlighted in questions a month ago, the Government have not accepted the financial recommendations of the trust special administrator for the capital costs and the transitional costs inherent in his recommendations. If the Government wish to proceed with these changes, will the Government agree to meet those costs as well?

[Dr Poulter]

The right hon. Gentleman is in dangerous territory talking about PFI schemes to which the previous Government signed up. No hospital operates in isolation. The South London Healthcare NHS Trust was paying out 13.9% of its turnover on the PFI. That was unsustainable. It has caused huge difficulties in the local health care economy and affected patient care, which was a very bad thing to do. The right hon. Gentleman needs to recognise that this Government are providing £1.5 billion-worth of support to many trusts that have struggled under these PFI agreements—

[Mr Speaker]

Order. I am grateful to the Minister, but we have many questions to get through and the answers are sometimes just too long.

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[Nick Smith (Blaenau Gwent) (Lab)]

On performance data, what plans does the Minister have to expand the friends and family test so that it provides the reasons for patients’ views and real-time feedback on their experience of services?

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

I thank the hon. Gentleman for his question. The friends and family test will give real-time feedback about patient services, but we need to ensure that the data from the test are used effectively by local trusts and scrutinised by the Care Quality Commission and other organisations so that they can go in if there are problems to ensure that they stand up for the rights of patients.

[Alun Cairns (Vale of Glamorgan) (Con)]

T7. Kevin Davies, a constituent from Cowbridge, visited my surgery yesterday. He is a prostate cancer patient and robotic surgery was deemed to be the most appropriate form of care. Unfortunately, robotic surgery for prostate cancer is not available in Wales and he was forced to travel to Bristol and pay £15,000 for the treatment. Will my hon. Friend agree to work with the Welsh NHS either to come up with a formal agreement whereby facilities are available to Welsh NHS patients or to press it to invest in its own facilities?

[Helen Jones (Warrington North) (Lab)]

The Prime Minister promised a fight to save district general hospitals, yet the Secretary of State’s recent decision on Lewisham suggests something completely different. Will the Secretary of State therefore give the House an assurance that the north Cheshire hospitals trust will not be forced into a merger or to downgrade its services because of financial problems elsewhere?

[Dr Poulter]

I know that the hon. Lady had tabled a question on this matter. The point is that a foundation trust has autonomy and cannot be coerced or forced into a merger. It is for the board of that trust to make decisions for the benefit of patients.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

T8. Patients in Suffolk are very worried about the performance of the ambulance service. In the past two months, less than 60% of ambulances have hit the target for reaching emergency cases. The strategic health authority and others, including all the MPs in the region, are not happy about that. Will the Government intervene, too?

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[David Tredinnick (Bosworth) (Con)]

May I alert my right hon. and hon. Friends to the recently published road map for complementary and alternative medicine in Europe, which cost the European Commission £1.5 million? Will they look at it carefully to see where services can be extended in our own national health service?

[Dr Poulter]

I assure my hon. Friend that we will look carefully at anything that he wants to put forward, but any treatment on the NHS needs, of course, to be evidence-based.

[Helen Goodman (Bishop Auckland) (Lab)]

Every year 18,000 epileptic fits are triggered by video games and screen-based activity. Can the ministerial team tell us what research is being done on that and what discussions they have had with the industry to make video games safer and improve the labelling?

Health Committee's Report on the General Medical Council (Government Response)

Dan Poulter Excerpts

Monday 25th February 2013 Written Statements

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

We have today laid before Parliament the “Government response to the House of Commons Health Select Committee’s report of Session 2012-13: 2012 accountability hearing with the General Medical Council” (Cm 8520).

This Government welcome the Health Select Committee recommendations contained in this report, and would like to thank the Committee for its work.

The Government’s Command Paper, “Enabling Excellence” (Cm 8008), published in February 2011, sets out a comprehensive strategy for ensuring that professional regulation systems are robust and made it clear that the Government would like to see more effective accountability for the health professions regulatory bodies. We have taken forward the recommendations made in this report and its predecessor and the changes to the Responsible Officer regulations, subject to parliamentary approval, will be introduced in April 2013. The Government plan to consult on giving new powers to the General Medical Council to check the language skills of all doctors, through amendment to the Medical Act.

It is right that the independent bodies responsible for ensuring public protection through the regulation of healthcare professionals are held to account effectively by Parliament.



Copies of the Government’s response are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. The report is also available at: www.dh.gov.uk/health/2013/02/hsc-response/.

Accident and Emergency Provision (North-East)

Dan Poulter Excerpts

Wednesday 13th February 2013 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Crausby. I congratulate the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) on securing the debate and I thank all hon. Members who have come to advocate their constituents’ needs. The hon. Gentleman and I met earlier this year to talk through some of the problems and challenges in his local area. We discussed some of the individual cases that he has highlighted today, which we all agree to be unacceptable, in particular the case of one of his constituents who experienced a completely unacceptable 11-hour delay as a result of problems with getting the high-quality care they deserved.

There are several interacting issues: the ambulance service, the local A and E response, and the services provided at local A and Es. One key theme, as the hon. Gentleman and I discussed when we met, and as his speech made apparent, is the need to fundamentally change and improve how the NHS looks after older people. That point was brought home vividly last week by the report on the Mid Staffordshire NHS Foundation Trust. In addition, at the end of last year the Dr Foster hospital guide found that 30% of older people in hospital should not be treated there, and that more community-based support was needed. When we met, the hon. Gentleman rightly stressed the important role that local, smaller health care providers, in Guisborough and East Cleveland and elsewhere, can play in providing better community-based care. When people do not need to be in A and E in the first place, it is better for them to be looked after in their homes and communities, and it also brings financial benefits to the NHS. For older people, being admitted to hospital when they do not need to be there is distressing, and their length of stay tends to be much longer.

The hon. Gentleman threw down this challenge: will the changes being made to the health care system nationally put us in a better place to deal with the long-term challenge? The answer to that is yes, and I will briefly deal with that point before I come on to the local challenges that he has outlined.

Why do we need to change what we are doing in the NHS? I have set out clearly that we must do better, by keeping people well in the community. Before I came to the debate, I was talking, over the river at St Thomas’ hospital, about how we must improve children’s health, better look after children with long-term conditions, ensure that children with asthma and diabetes who do not need to be in hospital are not there in the first place, and provide better community-based care. Such improvements are particularly important for the care of the elderly. From April, we will put 80% of the NHS budget into the community, with clinical leadership through doctors and nurses. That is a strong step in the right direction of focusing on community-based and preventive care. I believe that we should all regard that as a good way forward.

[Pat Glass]

My recent experience reflects what the Minister has said. Older people who stay in hospital for long periods of time come out able to do less for themselves because things are done for them in hospital. When my father came out of hospital after five weeks, he was able to do far less. Will the transfer of funding into the community prevent that from happening? Will it allow people like him to be supported at home so that they do not have to spend long periods of time in hospital and come home with less mobility?

[Dr Poulter]

The hon. Lady makes a good point. A prolonged period of bed rest can have a huge impact on an older person’s mobility and their ability to look after themselves. The challenge, as she rightly outlines, is to get more support in the community. Putting the budget in the community is a step towards the provision of more preventive care, more community-based care and more care that keeps people, particularly older people, better supported and looked after in their homes.

The other challenge is to achieve a more joined-up approach between secondary care in an acute hospital—such as James Cook hospital—and care in the community. There is sometimes too much silo working, and we need to break that down and develop a more joined-up approach to care. That might be done, for example, through intermediate care teams that operate out of a hospital, who will help through physiotherapy and occupational therapy. When an older person arrives in A and E, we need immediately to gear up the right support in the short and longer term to enable them to go home more quickly. That is an important part of a more integrated and joined-up approach to ensure that an older person can be effectively supported and looked after at home if that is right for them. It is important that we get that more integrated approach across the whole country.

On local issues, the hon. Gentleman highlighted two-hour handover delays, which are clearly completely unacceptable. In my experience, the fault for handover delays might lie in two areas. First, the triaging system in a hospital might need to be reviewed to ensure that ambulance handovers are dealt with more promptly and quickly. Secondly, a delay in ambulance handover results in ambulance crews and ambulances being pinned down in A and E when they need to be back out on the road elsewhere. I know that the hospital will want to look at that closely.

In relation to having more community-based care, sufficient community-based resources must be available to better support people with day-to-day health care needs in the community, so that they are not forced to pitch up at a hospital’s main A and E department. At our meeting, the hon. Gentleman and I discussed the fact that the opening hours of the urgent care centres at Guisborough and East Cleveland hospitals are now 9 am to 5 pm during the week and 8 am to 8 pm at weekends, which has made it difficult for local people to access local health care service and created pressure on A and E departments. Having spoken to the trust, I am pleased to report that job interviews will be held on, I believe, 25 February for specialist nurse and other posts at those hospitals, with a view to extending the opening hours again in the future.

[Pat Glass]

I make a special plea on that issue. Weardale, in my constituency, is in one of the remotest parts of the country, but 5,000 people live there. Their out-of-hours GP service is at Bishop Auckland hospital, which for some of them is 20 miles away across roads that are among the most remote in the country, and particularly difficult to use in winter. Will the Minister look at that?

[Dr Poulter]

Absolutely. Sir Bruce Keogh will be conducting a review of emergency and other urgent care services, in which A and E services will not be lumped into one category but will be considered in a more nuanced way, reflecting the fact that rural communities face particular challenges. The review will consider how out-of-hours care, urgent care and emergency care should be delivered in such areas to take into account the rural nature and the distances that people have to travel. In some cities, there is a lot of A and E provision, but in other, more rural parts of the country where people have to travel further that is not the case. I am pleased that Sir Bruce will take that into account in his review.

[Pat Glass]

Will that review also cover services such as ambulance services? There are real concerns in Weardale, where I am involved in a campaign, that lives will be put at risk if ambulance services are not improved.

[Dr Poulter]

It is absolutely right to say that any review of A and E provision, and urgent care provision, must take into account travelling distances and transfer times to hospitals and between hospitals. Those issues will be part of the discussion and the review, although they are not the major thrust of what Sir Bruce is doing. However, a number of hon. Members have arranged to meet my ministerial colleague Earl Howe, who is currently examining several issues related to ambulances, and I am sure that he would also be pleased to see the hon. Lady to talk through some of the local issues in more detail.

Increased pressure on hospital services is not necessarily unusual for this time of year, notwithstanding the fact that it is completely unacceptable for there to be long handover delays or for people not to receive prompt and high-quality treatment. There are winter pressures that occur every year, and the Government will always do all we can—the previous Government did what they could as well—to ensure that the NHS is robustly funded and supported to meet such fluctuations in demand.

The Department of Health conducts daily monitoring of the winter pressures for all acute hospital providers. I am aware that South Tees Hospitals NHS Foundation Trust has James Cook University hospital as its main acute site—of course, it is also the local hospital that most of the hon. Gentleman’s constituents will attend—and the trust, like other organisations, has experienced some additional pressures in recent months. However, under the trust’s own internal criteria, the pressures that it experienced during late December and early January were identified as level three on a scale of one to six, which demonstrates that the trust has been busy. It is important to highlight, however, that it has been coping with those additional pressures, notwithstanding the issues raised in the debate, including the need to upscale the community-based response to prevent patients who would be better looked after in the community from being in an acute hospital setting in the first place.

It is also important to say that we expect all NHS commissioners and providers to ensure that appropriate measures are in place to manage any increases in demand, particularly during the winter. The delays in patient care that have been outlined eloquently by hon. Members are simply unacceptable, be they in A and E departments or in ambulance journeys to hospital. Delays are of concern, and the local NHS trusts and their partners must ensure that they step up their local strategies to cope with unexpected increases in demand.

We always needs to be aware of such seasonal variations in the NHS. That is why the Department of Health has given more than £300 million to the NHS specifically to deal with winter pressures. However, it is for local NHS providers to recognise that that extra investment has been made and to co-ordinate their response with the community, particularly through highly skilled community intermediate care teams, which help to get older people back home from hospital as quickly as possible so that they can be better looked after in their own homes.

The other main concern expressed by the hon. Gentleman was about ambulance performance. Delaying ambulances outside A and E departments, as a result of a temporary mismatch between A and E and hospital capacity and the numbers of elective emergency patients arriving, is simply not acceptable. There is a need for the local ambulance trust and the local hospital to work more constructively together, to ensure that such delays do not happen. That might be about having better triage, or the local ambulance trust might need to put more resources into the front line in the local area.

I also take this opportunity to say that the Government have provided £330 million of additional funding specifically to help the NHS cope with the winter pressures this year, so that patients receive the treatment they deserve. I understand that South Tees Hospitals NHS Foundation Trust received more than £1 million from that additional funding, and Middlesbrough primary care trust has received a further £264,000. Investment in social care services will also benefit the broader health system, but that requires the local trust to ensure that it uses the money wisely to address the concerns raised in the debate.

In January, the hon. Gentleman and I had what I thought was a constructive meeting with the trust, and I hope that will be the foundation for him and other local MPs to engage constructively with the trust to encourage a quick solution to the problems that have been outlined. One good thing that came out of the meeting, as the hon. Gentleman already knows, is that there is now an active process going on for the recruitment of specialist nurses to the smaller hospitals—the community hospitals —in the local area. When those nurses are in place, that will be a big step forward; I hope those hospitals will be open for additional hours, which will help to take pressure off acute settings.

In response to growing demand, an overall increase in ambulance activity and longer stays in hospital owing to more complicated medical conditions, I understand that the trust has already taken some specific measures, with £650,000 of investment being put into extra nurses and consultants. To deal with times of acute winter pressure, a bed winter ward will also open. The trust is also now working actively with its partners to redesign patient services, along the lines of the rapid response teams and intermediate care teams that I described earlier, to prevent inappropriate hospital admissions in the first place. In addition, it is exploring the development of a separate paediatric A and E department to create extra space for patients.

I am sure that the hon. Gentleman would have hoped that some of those measures would have been in train earlier, but following our meeting, and after the trust has listened to this debate, I am sure it will be all the more determined to do what it can to put things right in the future. As he knows, through our engagement I am taking an active interest in these issues and I will welcome further discussions if there are more problems in the future, because the delays that have been described today are unacceptable.

[Tom Blenkinsop]

The Minister has been very constructive in previous meetings and the response that he has given today has been very constructive as well. On specialist care staff for Guisborough hospital and East Cleveland hospital, he knows from our meeting that the trust has advertised those positions four times already. Would he be willing to meet me again if the fifth attempt also proves unsuccessful?

[Dr Poulter]

I have already made the offer, and I do so again now, that I am very happy to meet again. The trust is now taking the issue very seriously and is putting in place robust measures to deal with the concerns raised during this debate and when the hon. Gentleman and I met the trust. I understand that there are 16 applicants for the posts, so a good number of people have applied. I am hopeful that after the interviews on 25 February there will be additional nursing capacity in those local health care settings, to ensure that the scope of the community health care response is improved. Also, I hope that the number of hours that the services are available will be increased, because as the hon. Gentleman knows community health care is about taking pressure off acute A and E services wherever possible, and ensuring that people who can be treated locally are treated locally. That is why those two hospitals—Guisborough hospital and East Cleveland hospital—are such important care settings.

I hope that we are now in a better position, after this debate and through the actions that the trust is already taking—following our meeting earlier in the year—to deal with some of the challenges. I again congratulate the hon. Gentleman on securing the debate, which has been constructive, and I know that he and I will be meeting again if the situation in his area does not improve.

Thank you, Mr Crausby, for chairing the debate.

Alexandra Hospital, Redditch

Dan Poulter Excerpts

Tuesday 12th February 2013 Westminster Hall

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

Thank you, Mr Hollobone, for calling me to respond to the debate. It is a great pleasure to serve again under your chairmanship.

I pay tribute to my hon. Friend the Member for Redditch (Karen Lumley) for her advocacy on behalf of her constituents and local patients, and indeed for paying tribute herself to the hard-working staff at her local hospital. As she rightly points out, the future of the Redditch hospital has been discussed for far too long and I hope that, during the next few months, we can come to a conclusion that will not only be of benefit to local patients but bring higher-quality care to people in Redditch and the whole of Worcestershire. Any redesign of services must be led by local commissioners and—crucially—must also consider the best interests of local patients; those redesigning services must listen to the voices of local patients.

My hon. Friend rightly outlined in her speech the fact that no hospital or trust operates within a vacuum in the NHS, and she is also right to say that private finance initiative deals in the local area have been problematic and have left a very damaging legacy; that has happened not only in her part of the world but throughout the NHS. We must learn lessons from that in the future. It is distressing and regrettable that bad PFI deals sometimes have an impact on neighbouring hospitals, and it is a position that we, as a Government, have inherited. We will continue to do what we can, by working with trusts with difficult PFI deals, to try to mitigate those difficulties.

My hon. Friend rightly highlighted the fact that decisions about her local trust have an impact on the wider health economy in Worcestershire, and that that broader impact needs to be taken into account by those making decisions about the Alex hospital. When my hon. Friend and I met my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi)—my hon. Friend the Member for Bromsgrove (Sajid Javid) was unable to attend that meeting—the point was made clearly that many hospitals in the wider health economy of Worcestershire have natural links with Birmingham. That must be taken into account when services are redesigned for the benefit of patients.

Increasingly, clinical evidence is stacking up that some specialist clinical services need to be run from specialist centres, because those centres produce much better outcomes for patients, so the link to the major population centre for the surrounding counties should be taken into account. As I say, we need specialist centres of excellence for the benefit of patients.

My hon. Friend the Member for Redditch made the point that the Alex hospital has a historical legacy of difficulties, with big, intermittent deficits at the local trust. There have been commendable attempts to deal with those difficulties, but there has been a difficult situation for a number of years. Clearly, we want to see long-term stability for Redditch, for the local trust more broadly and for the local health care economy. Key to achieving those things is having high-quality medical personnel working in the hospital, and the ability to retain and recruit high-quality consultants.

[Peter Luff]

To be clear, for the majority of Worcestershire residents Birmingham and its services are a very long way away and very inaccessible.

[Dr Poulter]

With regard to “bread and butter” day-to-day medical services, my hon. Friend is absolutely right to say that. My point was that for some services—for example, trauma or stroke—having specialist centres brings better results for patients, and there is good clinical evidence to back that up. However, day-to-day, higher-quality “bread and butter” services for patients—such as heart care or children’s services—are often best provided locally, and he is absolutely right to make that point.

[Mr Robin Walker (Worcester) (Con)]

I congratulate my hon. Friend the Member for Redditch (Karen Lumley) on securing this very important debate.

The Minister mentioned the issue of recruitment of clinical staff. One thing that the NHS in Worcestershire has worked very hard on is a cancer strategy to keep cancer care within the county and to make the Worcestershire Royal hospital a centre of excellence for cancer care. We are looking to secure a radiotherapy unit in the near future. I urge the Minister, in taking whatever decisions are necessary to ensure that the county has the strongest, most sustainable NHS, to pay attention to that work and to the importance of having a cancer service for the county.

[Dr Poulter]

My hon. Friend is absolutely right to praise the high-quality work done in Worcester to look after cancer patients. It is exactly the point that I was making in response to the intervention from my hon. Friend the Member for Mid Worcestershire (Peter Luff): the high-quality day-to-day services that patients need must be delivered locally, but more specialist operations—such as for head and neck cancer—might be carried out at a specialist site that is geared up for such operations. Day-to-day oncology care, however, is often best carried out locally, particularly when people are unwell with cancer and receiving sometimes very intensive treatment. In those situations, they need to be looked after locally.

It does not benefit patients, for medical and many other reasons, to have very long distances to travel. However, when surgical outcomes might benefit from operations being carried out at specialist centres, we must differentiate day-to-day treatment from the more specialist care that may be required as a one-off surgical intervention. We should do that when the evidence stacks up that specialist centres for such surgical interventions often deliver better results and better care for patients. Nevertheless, my hon. Friend is absolutely right to pay tribute to his local trust for the work that it does on cancer care in Worcester, which I know is very important to him personally.

I will now respond specifically to some of the points that have been made in the debate, and consider how we go forward from where we are now. Hon. Members, particularly my hon. Friend the Member for Redditch, have made us well aware, through their articulate contributions, of the challenges that are faced by the local health care economy. Such ongoing uncertainty about the future of local health care services is wrong and completely undesirable. When local commissioners bring forward proposals for the two options that are likely to be considered later in the month, I urge them to move forward as promptly as possible to bring certainty to the situation. That will allow consideration of important issues, such as the need to have high-quality professionals working in hospitals. When there is uncertainty about the future of a trust or a particular site within a trust, it can be difficult, as my hon. Friend rightly outlined, to recruit high-quality staff to work in that trust. That is not in patients’ best interests, so the sooner we can have certainty, the better. I know my hon. Friend will join me in urging local commissioners to bring things forward as expediently and quickly as possible.

As we know, the trust is committed to providing the best-quality care for patients. That is essentially about finding the best solution for the people of Worcestershire so that they receive the best care in the future. As my hon. Friend outlined, Worcestershire Acute Hospitals NHS Trust and the West Mercia cluster have jointly commissioned a strategic review of services in the area. The review is essential to secure the clinical and financial sustainability of high-quality services for local people. That is about looking not just at getting through the next couple of years, but at what will be right for the local health economy in five or 10 years’ time.

I understand my hon. Friend’s concern that there have been delays with the review, and I once again urge local commissioners to take things forward as expediently and quickly as possible. The Worcestershire joint services review started in January 2012, and it was expected to be completed by November 2012. I hope my hon. Friend is somewhat reassured that we will move forward more quickly, notwithstanding a patchy history on resolving local health care issues. There is a need for certainty locally, and we must make sure that the time line is met and that we have a firm conclusion.

Importantly, the review involves clinicians and commissioners across the area and the NHS. It engaged with local people last summer to inform the development of proposals. As we know, developing proposals for the future of local services is about clinical leadership and about clinicians saying what is important and in patients’ best interests, but it is also about local involvement and engagement. When I met my hon. Friend before Christmas, we discussed that. The local newspaper has played a tremendous role in promoting local patients’ needs. My hon. Friend and the local population should be proud of the cross-party consensus on the importance of Redditch’s future.

Through the review, local people will have made, and will continue to make, their voices and views clear. That is important for the Government and for our four tests for reconfiguration. It is also important that local health care providers, the local trust and the trust’s board listen to local people and local health commissioners to make sure that their views are informed by what local patients want and need and by what local clinicians say is in patients’ best interests.

The joint services review steering group met on 12 September 2012 and, unfortunately, decided to delay the process again until it could explore all options to allow it to maximise service provision at the Alexandra hospital, including investigating the potential to work with other NHS providers—Birmingham being a case in point.

My hon. Friend will be aware that the Redditch and Bromsgrove clinical commissioning group has started initial discussions with three NHS providers in Birmingham to explore the feasibility of providing services from the Alexandra hospital: the University Hospitals of Birmingham NHS Foundation Trust, Birmingham Women’s NHS Foundation Trust and Birmingham Children’s Hospital NHS Foundation Trust. Those discussions are still in their early stages. However, my hon. Friend is right that when proposals are brought forward—hopefully, by the end of this month—we should move things forward quickly for the benefit of local patients.

No decisions have been made, and the discussions are only about the Alexandra hospital—that needs to be clearly set on the record. The Worcestershire Acute Hospitals NHS Trust would continue to provide all other services. Given the concerns my hon. Friends have raised, it is important to note that, although the services the trust provides need to be seen holistically, the ongoing discussions are about the specific future of Alex’s site in Redditch. That is an important distinction, and I hope it gives my hon. Friends some reassurance that any proposals are unlikely to disrupt local services to the patients they care about.

Ultimately, the decision is for local determination, and it would not be appropriate for me to comment on the discussions in further detail until we have firm proposals. We will continue to meet regularly. I am visiting Redditch in the near future, and will take a keen interest to make sure I can do all I can to support the right result for local patients.

[Mark Garnier]

The Minister will no doubt know what is coming: will he visit Kidderminster when he is next in Redditch?

[Dr Poulter]

I would be delighted to visit Kidderminster hospital. It might not be on the same day I visit Redditch, but I will make sure I put it on my list of priorities to visit. I would be delighted to see the excellent work done at Kidderminster hospital and, indeed, at Worcester, at some point in the near future. In addition to the bit of clinical work I still do, I prioritise going out on a Thursday as regularly as I can to see the NHS on the ground and to see what is going on. I would be delighted to visit other local trusts, when I can fit them into the diary, later in the year.

What are the next steps? If agreement is reached on a clinically and financially sustainable solution in the interests of local people, a robust process needs to follow. The Worcestershire joint services review steering committee will meet on 26 February to set out options for consultation. We are then likely to have two options regarding the way forward. One is likely to involve Worcestershire Acute Hospitals NHS Trust continuing to operate services from the Alexandra hospital. The other is likely to involve exploring the feasibility of the Birmingham foundation trust operating services at Alexandra hospital, if that is in local people’s best interests.

The final proposals will require the support of the NHS in Worcestershire. However, the local NHS has assured me that it will continue to engage with people while proposals are finalised. Of course, I would expect any proposals to meet the four tests for service change that we have clearly outlined—principally, that any changes are clinically led and have strong patient and public engagement. The local NHS expects final proposals to be ready for public consultation later in the summer. However, it is vital, as we have stressed throughout the debate, that we hold those involved firmly to their task and reach a conclusion for the sake of staff and patient certainty and for the benefit of the local NHS.

[Karen Lumley]

One of my questions was: who actually owns the Alexandra hospital?

[Dr Poulter]

As my hon. Friend will know, the local hospital is designated as part of a trust. It is a non-foundation trust, so there is direct regard to the Secretary of State in some matters relating to the trust. I hope that gives her some reassurance. Of course, the NHS is owned by all of us, which is why it was so important when we set out our four tests for reconfiguration that we made sure they were about strong clinical leadership in the best interests of patients, as well as strong patient and public engagement, so that patients and the public can clearly see that any changes to local services are in their best interests and so that they can properly engage in the process. There has been strong local feeling and opinion on this issue, and I am sure it will be listened to carefully when decisions are taken about the future.

In conclusion, I encourage my hon. Friends and local people to participate in the consultation process to ensure their views are fully taken into account. I will maintain a keen interest. I am looking forward to visiting each site in the trust in due course. I am always available to talk through matters if Members have concerns.

Neonatal Care

Dan Poulter Excerpts

Wednesday 6th February 2013 Westminster Hall

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

It is a great pleasure to serve under your chairmanship, Mr Streeter. I congratulate my hon. Friend the Member for Daventry (Chris Heaton-Harris) on securing this important debate on neonatal services. He strongly advocates the needs of his constituents, but also raises an important issue that we are already focusing on and improving, to give every child the very best start in life.

It is also a pleasure to hear from my hon. Friend the Member for Hexham (Guy Opperman), and I am looking forward to visiting his constituency in the near future. An April visit is in the diary at the moment, and I look forward to visiting and seeing for myself some of the excellent care delivered locally. He is right to highlight that midwifery-led units play an absolutely vital part in delivering high-quality care for women and their families. The Birthplace study absolutely supports his points and suggests that midwifery-led units may well play an even more vital role in the future provision of maternity services. I am sure that we will discuss such matters in future debates.

Before we get on to the specifics of neonatal care, I want to discuss some of the more general points made by my hon. Friend the Member for Daventry. He mentioned air ambulance services, and he is quite right to say that if we want a co-ordinated and integrated emergency response, particularly in more rural and sparsely populated areas, air ambulances must play an important part. The land and air-based responses need to be co-ordinated effectively, particularly for road traffic accidents. He makes a good point and I am sure that the local commissioners in Daventry and elsewhere will take note of our discussions today.

My hon. Friend was quite right to say that the payment- by-results system has been problematic in many areas of medicine. My right hon. Friend the Leader of the House, when he was Secretary of State for Health, made strides towards changing the tariff system in many areas of care, particularly the year-of-care tariff for people with longer-term and more chronic conditions. We also have changes being implemented to the maternity tariff to encourage a normalisation of birth. We want to view birth as a normal, everyday, natural process and to move away from births that need hospitalisation, by supporting people better in the round through antenatal care and more holistically throughout pregnancy, childbirth and the post-natal period.

My hon. Friend mentioned the unacceptable variations in care that exist across the country, which was highlighted poignantly today in the debate on the NHS in mid-Staffordshire. He has also previously advocated the reduction of stillbirths and supports the excellent work that Bliss does to raise the importance of high-quality neonatal care. More work is necessary, but I want to describe some of our achievements and the progress that the Government have made over the past couple of years, which shows that we are taking such issues seriously. As my hon. Friend quite rightly outlines, there is more that we can do and we intend to do more over the months and years ahead.

As has been said throughout the debate, we cannot divorce childbirth and midwifery care from neonatal care; the two are linked in terms of service provision and the care that is provided for premature babies. We want to provide more care and support for women during pregnancy, and the latest work force figures show that midwife numbers increased by 1,117 between May 2010 and October 2012. Training places in midwifery are at a record high, and we are ensuring that commissions for future training places will remain at a record high, so that we can continue to provide personalised, one-to-one midwifery care for women. The birth rate is increasing, and that is why we are employing more midwives and keeping training commissions high.

On neonatal care, 1,376 neonatal intensive care cots were available in December 2012, of which 951 were occupied. In December 2011, only 1,295 such cots were available. So in a period of 12 months—between 2011 and 2012—we have seen an increase in the number of neonatal intensive care cots available nationally, and I am sure that my hon. Friend will agree that that is a good thing.

The number of paediatric consultants has also increased, from 1,507 in 2001 to 2,646 in 2011, and the number of paediatric registrars—or middle-grade junior doctors—has also increased by almost fourfold in the same period, with some of those registrars specialising in neonatal medicine. Consequently, I believe that we must give some credit to the previous Government for some of the work that they did in this area, but this Government have taken their work forward with renewed vigour to make this a priority.

The number of full-time paediatric nurses has also risen, from 13,300 at the beginning of the century to 15,629 in 2011. So, in general, we are seeing good progress being made in putting more resources into children’s health care, giving every child the very best start in life.

Specifically on neonatal services, my hon. Friend is right to highlight the fact that we need to do more to ensure that there is no variability in the system. We made a commitment very clearly as a Government to high-quality, safe neonatal services, founded on evidence-based good practice and good outcomes for women and their babies. Improving outcomes, rather than focusing on process measures, is what we are all interested in. We want to ensure that babies who need neonatal care are given the very best care and have the very best outcomes in terms of their future life and, indeed, the care that they receive on neonatal wards.

In our mandate to the new NHS Commissioning Board, we will be holding it accountable for all health outcomes. We want to see the NHS in England leading the way in Europe on health care outcomes. The Secretary of State for Health has made it clear that mid-table mediocrity must be a thing of the past in all areas of medicine, and I will make sure that I work closely with Bliss and other organisations and, indeed, with my hon. Friend to make sure that we hold the NHS Commissioning Board to account for delivering high-quality health outcomes everywhere, particularly in this important area of neonatal care.

It is worth highlighting, and I think that I have time to do so, the different types of neonatal facilities that are available; the different types of special care baby units, or the level 1, level 2 and level 3 units. Special care units, traditionally known as level 1 units, provide care effectively just for the local population in the local area. They provide neonatal services, in general, for singleton babies born after 31 weeks and six days gestation, provided the birth weight is above 1,000 grams. For slightly more complicated births or slightly more premature births, there are level 2 units, which provide neonatal care for their own local population and for some sicker, or more premature, babies from elsewhere. They provide neonatal services, in general, for singleton babies born after 26 weeks and six days gestation, and for multiple-birth babies born after 27 weeks and six days gestation, provided the birth weight is above 800 grams. Then we have level 3 units as they are traditionally known, which are neonatal intensive care units, and they are sited alongside highly specialist obstetric and fetomaternal medical services. For example, there is a level 3 unit across the river from here, at St Thomas’ hospital. Such units take very premature babies.

That description highlights the fact that neonatal care must be considered alongside the provision of high-quality maternal care; the two go very much hand in hand. The point that my hon. Friend made—my hon. Friend the Member for Hexham made it as well—is that when services are being redesigned or reconfigured the most important thing is to provide high-quality patient care. Reconfiguration is about delivering those high-quality patient outcomes and that high-quality care.

The best example of where service reconfiguration has really benefited patients that I can think of was in Manchester, which I visited towards the end of last year. A redesign of the maternity and neonatal provision in Manchester in a very planned, systemic way resulted in about 30 babies’ lives being saved every year. When the case for reconfiguration is made in terms of patient care and not in terms of cost, as my hon. Friend the Member for Daventry outlined, that is the right reason to reconfigure and redesign services. What we cannot have, and what has been expressly ruled out under the criteria for reconfiguration, is redesigning services purely on the basis of cost. If we are going to redesign the way that we deliver care, it must be done in the way that it was done in Manchester, where—as Mike Farrar, who is now the chief executive of the NHS Confederation, said—it is about saving babies’ lives. That service reconfiguration in Manchester was right, because it is saving 30 babies’ lives every year. That is the right reason for reconfiguration.

My hon. Friend was absolutely right to highlight that in some cases, when we look at these issues in areas where there are long distances to travel and considerable rurality, all these factors need to be taken into account when redesigning services. However, the end result must always be for the benefit of patients. It may be the case that sometimes people have to travel a little bit further to get that high-quality care, but these decisions must be considered in the round and on the basis of achieving high-quality outcomes and doing the best things for mothers and their babies.

In conclusion, it might be worth highlighting a few other specific things about neonatal care that the Government are committed to doing. We now have a toolkit for neonatal care, and we are looking to ensure that it is properly implemented across the NHS. Some parts of the country are doing very well in ensuring that the majority of their staff working as nurses in neonatal units have specialist training, but that is not the case everywhere. We have established that toolkit; that was a direct challenge that the Government have picked up and taken forward, to ensure that we drive up the standard of neonatal care everywhere.

[Guy Opperman]

Does the Minister accept that, as the health care reforms kick in, it is incumbent upon GPs to make the point when they first advise expectant mothers that they can give birth at various places and that midwife-led units provide the full spectrum of care from well before the birth to well after it?

[Dr Poulter]

My hon. Friend is absolutely right. It is vital that whenever there is a discussion with any patient—in this case, it is a discussion with an expectant woman about where she should give birth—that an informed choice is made. That should not just happen initially, but that choice should be reviewed consistently, according to what the risk factors might be throughout the pregnancy, and women should be helped and supported into choosing the most appropriate birth setting for them. And all factors, such as the woman’s safety or what care might be required immediately after the birth, are vital ingredients in that decision-making process.

What we want to promote, and what we all believe in, is patient choice in the NHS. One thing that is facilitating patient choice in maternity care is having a national set of maternity notes now, so that all women effectively have a transferrable set of notes that they can take from one unit to another. That is something that is being driven across maternity care, and I think that it will make a real difference if the location of care needs to change in the future.

I will also say something specifically about how we will ensure that we better implement the toolkit, which we agree is a good thing in driving up the quality of training available to neonatal nurses. Very shortly, I will be devising and helping to set up the Health Education England mandate, which will be responsible for training health care professionals in England; not just doctors but all health care professionals. A mandate will be established for how that body will operate and what it will prioritise as areas of training. I am very happy to give a commitment, just as we did on the mandate for the NHS Commissioning Board, to ensure that giving every mum the right support in pregnancy and every baby the very best start in life is something that we will look to incorporate in that mandate, to make sure that high-quality training is available for health care professionals involved in all aspects of pregnancy, birth and beyond, and of course neonatal care is an important part of that.

That is something that I will take away from this debate, to ensure that it is clearly an important part of the Health Education England mandate that we look very seriously at neonatal services, to help to iron out the unacceptable variability in training that we have identified. I hope that that is reassuring to my hon. Friend the Member for Daventry. I thank him for securing this debate, and I thank you, Mr Streeter, for chairing it.

Question put and agreed to.

University Hospitals of Morecambe Bay NHS Foundation Trust

Dan Poulter Excerpts

Tuesday 5th February 2013 Westminster Hall

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

It is a great pleasure to serve under your chairmanship, Mr Howarth. It is not the first time, but nevertheless it is a pleasure.

I pay tribute to the hon. Member for Barrow and Furness (John Woodcock) for his advocacy on behalf of his constituents and all those in Cumbria who are looked after by the local trust and to my hon. Friend the Member for Morecambe and Lunesdale (David Morris), whose constituency I recently had the pleasure of visiting, for his advocacy on the behalf of his constituents. I have indeed received a copy of the letter sent to him by the chief executive of the NHS trust, which says:

“Whilst it would be wrong of me to second guess the future, I personally find it hard to imagine Lancaster not having emergency services.”

I hope that that is reassuring to him and his constituents.

On the main issues raised in the debate, I have already paid tribute to the strong advocacy on behalf of his constituents by the hon. Member for Barrow and Furness. He was very kind to brand me an expert in obstetrics. I would not go quite that far, but he is right to say that I have considerable understanding of the issues involved and of the importance of ensuring that we provide safe and comfortable environments in which women can give birth. He is also right to read out the case that I advocated in a debate here in Westminster Hall some time ago, and it is important that we recognise that uncomplicated deliveries can become more complicated. We know that for women in some parts of the country, particularly those in more deprived areas, there are often higher risk rates of prematurity. These are all issues that need to be taken fully into account whenever services for the safe delivery of babies, and for the safe care of women during pregnancy, delivery and the period afterwards, are examined.

The hon. Gentleman is also right to highlight that there are geographical considerations in Cumbria, as in many rural areas, including the fact that there is only one main road and the problems that presents in respect of allowing the local trust to transfer patients effectively and safely from one site to another. It potentially creates difficulties at certain times of day if the road is busy, as he is aware. However, it also requires the availability of ambulances, and he was right to point that out.

When decisions are made about changing services, whatever the reason may be for changing them, they cannot be taken in isolation. In this case––I will discuss this further later––I believe that the decision was made in good faith, although I share some of the concerns that the hon. Gentleman raised, given that we know that there have been a lot of problems at the trust with maternity services as well as the safety concerns he outlined. Those decisions cannot be taken in isolation. They need to be taken in collaboration and after discussion with local commissioners and indeed with the ambulance service, if they are to be made correctly and for the benefit of patients.

The hon. Gentleman was also right to outline the four tests for reconfiguration. In particular, he was right that reconfiguration must be clinically led, based upon evidence and always in the best interests of patients. Reconfiguration should never happen for cost reasons alone, and he was absolutely right to highlight that. Reconfiguration also needs to have the support of local GP commissioners. However, from what he has said today it appears that there are local concerns about the proposed changes, and that there has not been an integrated, joined-up approach in relation to this decision.

We have also discussed the concerns over the need to integrate ambulance transfers into any local decisions because of the travelling distance from Barrow to Lancaster. That is one of the issues that should have been take into account when these decisions about reconfiguration were being made, and I am very concerned to hear the hon. Gentleman say that he does not believe that they were taken into account and that local commissioners also have concerns about this matter.

I am very happy to meet the hon. Gentleman again in the very near future to discuss this; that would be very desirable. It is vital to ensure, as the hon. Member for Copeland (Mr Reed) said, that we do not see service reconfiguration by stealth or via the back door. We should have an integrated, joined-up approach to local decision making, particularly in view of what can only be described as the deficiencies of the past at the trust and the very sad cases that the hon. Member for Barrow and Furness and I have corresponded about, as well as the police investigations that are going on. He is aware that it would be inappropriate for me to comment directly on those.

There is a need to ensure that in the future decisions are made in a holistic way and in the best interests of patient safety. Such decisions are not just for the trust to make alone but must be made in conjunction with the local commissioners and the ambulance service, if we want to ensure patient safety. The hon. Gentleman and I can discuss that further when we meet.

The hon. Gentleman raised another important issue: the ongoing investigations at the trust. He was right to do so. As we know, tomorrow the Mid Staffordshire report will be published, which makes these sorts of issues all the more poignant and important. The NHS has sometimes had a history of covering up bad things that have happened to patients, and that is completely unacceptable. The result of that is bad care for patients, and cultural problems in trusts and hospitals. Those sorts of things cannot go on. When there are investigations, they need to be carried out transparently and openly, so that people feel the issues have been fully aired. It is also vital that those investigations have a degree of independence, as he suggested.

[John Woodcock]

I thank the Minister for giving way, and for the excellent and considered way that he is responding to my points. He referred to the Mid Staffordshire situation. Does he accept that that started as an internal inquiry, which was found to be insufficient to get to the bottom of the issues and required a greater degree of independence to be established? We are worried that the same thing may be apparent in Furness.

[Dr Poulter]

Absolutely. There will be a full response to the Mid Staffordshire inquiry tomorrow, so I will not pre-empt it or go into detailed discussion of that issue. However, it is absolutely right that we must encourage staff who have concerns about patient care to raise those concerns and air them in an open way. Moreover, when we know that there have been long-standing failings at a trust about the quality of care provided to patients and concerns raised about those failings—although Morecambe Bay NHS Foundation Trust, for example, has made some good progress in recent months, there are some long-standing issues there—it is important that, when an investigation is carried out, it is carried out in a transparent, open and independent way; there must be a great degree of independence involved.

If a trust sees fit to launch an investigation and a review of what has happened, it is important that the investigation and review pass the test of transparency. There may well be a role for local MPs and other interested parties in that process, and when the hon. Member for Barrow and Furness and I meet, that is an issue that I will be very keen to discuss further, to ensure that we can discuss with the local trust ways in which we can ensure that there is that transparency and independence in the process. That is very important to ensure that those patients, and their families who have had problems in the past—in some cases, there have been deaths at the trust—feel that the investigation addresses their allegations.

Obviously, this debate is not just about maternity services at the Morecambe Bay NHS Foundation Trust; there have been other issues around the trust, and any investigation will need to take account of all those issues. I understand that that is what will happen.

[Mr Jamie Reed]

I am very grateful to the Minister for his considered and thoughtful response to the debate. I agree with him wholeheartedly on the importance of transparency and openness. However, where there are different clinical groups commissioning services from a single trust that operates a number of different hospitals, who actually holds the ring and decides which services are commissioned where?

[Dr Poulter]

The hon. Gentleman asks a very good and thoughtful question. It is the duty of the commissioning groups to work collaboratively for the best interests of patients. They obviously have responsibility for their own budgets and, as I say, they all ought to work collaboratively for the benefit of patients. However, if there are concerns about that, there is also a role in this process for the commissioning board, which will have some oversight over the process, to help to ease it through. In many parts of the country, there is already good evidence that the emerging local commissioning groups are working together collaboratively in just the way that I have described. I hope that that is reassuring for the hon. Gentleman.

We know that the Morecambe Bay NHS Foundation Trust has had a very long and troubled history. We also know that it serves a very important purpose in looking after people throughout north Lancashire and Cumbria. My hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) made clearly the good point that the configuration of the trust geographically is challenging. We, as a group, are going to meet together to talk through some of these issues and the troubled history of the trust, to ensure that we can do our best to work through these issues.

There have been problems in the past with the trust and local patients have not been treated properly, and they and their families have suffered. There have been long-standing concerns over local care quality issues. That may mean that we have to redesign the way that services are delivered; that may be an inevitable consequence of improving patient care in the long run. Nevertheless, the driver of this process must be delivering high-quality local health care within the envelope of providing improved patient care with better outcomes and safer care for patients. However, the only way that we will achieve that is if all the commissioners are working collaboratively with the trust in a more integrated approach to care. The failure to do that is where things have gone wrong in the past, and that is what needs to change in the future.

Plasma Resources UK Limited

Dan Poulter Excerpts

Thursday 17th January 2013 Written Statements

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

Further to the written ministerial statement made on 13 July 2012, Official Report, columns 84-85WS, I am announcing today that the Government have decided to seek private sector investment in the Government-owned limited company, Plasma Resources UK Ltd (PRUK) through the sale of the majority or all of the shares in the company. We are taking this action to support the company and its employees in the next phase of the company’s development.

We have carefully examined the strategic options that will best allow the company—which includes the UK-based fractionation facility Bio Products Laboratory Limited (BPL) and the US-based plasma supply company, DCI Biologicals Inc—to grow and be successful in an established and highly competitive global industry. It should fulfil its potential as part of the strategically important bioscience sector of the UK economy. Our conclusion is that this route will best meet those requirements.

Patients will also benefit, as investment will not only allow continued improvements to the existing products but also the potential development of new treatments to create a better product portfolio. Resources will also be used to ensure that the facilities keep pace with the latest technology so the company can achieve its full potential. Overall, the investment will play a key part in ensuring the continued supply of high-quality products to patients.

Potential investors will need to show not just the level of resources they are willing to make available but also set out a credible plan as to how the operations will be grown and how products will be developed.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 15th January 2013 Commons Chamber

[David T. C. Davies (Monmouth) (Con)]

2. What recent steps he has taken to reduce hospital waiting times in England.

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

Latest figures for October 2012 show that 70,000 fewer patients are waiting longer than 18 weeks than at the last election. The Government’s mandate to the NHS Commissioning Board makes timely access to services a priority.

[David T. C. Davies]

Those figures compare extremely well with those in Wales, where most patients are waiting for 26 weeks, and many for 36 weeks. Would the Minister be willing to share some advice on how to get waiting lists down with his counterparts in Wales, and perhaps discuss with them why patients wait so much less time in the Conservative NHS in England than in the socialist NHS in Wales?

[Dr Poulter]

My hon. Friend is right to highlight key differences between the NHS in England and in Wales. The Labour-run Assembly in Wales is cutting funding by around 8%, which will—of course—impact on the quality of care available to patients and other front-line services. At the same time, in England we are ensuring that we continue to invest, with £12.5 billion in the NHS during the lifetime of this Parliament. I would be happy to point that out to colleagues in Wales and the Welsh Assembly, and to make the point that it is the Conservatives and the coalition Government who deliver better patient care through investing in the NHS.

[Julie Hilling (Bolton West) (Lab)]

Will the Minister tell the House how many NHS trusts failed to meet the accident and emergency target of 95% of people being seen within four hours last week? When was the last time that target was met nationally?

[Dr Poulter]

I am happy to inform the hon. Lady that we are meeting the 95% target nationally for the A and E wait. On the most recent figures available, 96% of patients were seen within that period—96 out of every 100 patients are seen within four hours in A and E. The key difference between this Government and the last Labour Government is that we trust clinicians to ensure that they prioritise those patients in greatest need ahead of purely meeting targets and ticking boxes.

[Andy Burnham (Leigh) (Lab)]

As winter bites, the NHS faces its toughest time of year, but there is mounting evidence that the Secretary of State has left it unprepared. For 105 of his 133 days in office, the Government have missed their own A and E target for major A and Es. Last week, for the first time, the figure fell below 90%. Right now in A and Es up and down England, ambulances are stuck in queues outside, patients are on trolleys in corridors, and people are waiting to be seen for hours on end. Does the Minister accept that there is a growing crisis in our A and Es, and if he does, what is he doing about it?

[Dr Poulter]

The right hon. Gentleman is good at putting across figures based on brief snapshots in the year. We know that on an annual basis we are meeting the target, and that 96% of patients are being seen on time in A and Es. We have made allowances for winter pressures, which we know are always difficult during the flu season every year, and we have put aside £330 million to ensure that we support the NHS during those winter pressures. Let me make it clear to the right hon. Gentleman that it is wrong to try and distort figures based on outcomes from a snapshot of just a few days or a week. It is important to put across the clear picture, which is that the Government are meeting targets in the NHS and patients are being treated in a much more timely manner than under the previous Government.

[Andy Burnham]

I suggest to the Minister that he needs to get out on the ground in the NHS a bit more. The figures I gave him were for major A and Es. If he got out more, he would realise that his complacency, which we have just seen at the Dispatch Box, is not justified. Let us look at Milton Keynes, which was identified by the Care Quality Commission as one of the 17 understaffed hospitals, and where last week just 72% of patients were seen within four hours. Milton Keynes is one of 15 trusts in England where A and E performance plummeted below 80%. These are the kind of figures that we have not seen in the NHS since the bad old days of the mid-1990s. Ministers like to blame nurses, but it is time they started accepting some responsibility. Will the Minister today ensure that all A and Es in England have enough staff to get safely through the winter?

[Dr Poulter]

I reassure hon. Members that, unlike any Member on the Opposition Front Bench, I still work in the NHS every week and I ensure that I see what happens on the ground. That cannot be said of any Front-Bench Opposition Member. The coalition has Ministers who are in touch with what is happening in the NHS on the ground. On A and E waits, we are trusting clinicians to exercise their judgment, which is why we now have a 95% target. We are ensuring—and the statistics show—that we are meeting that target on an annual basis. Patients are being treated in a timely manner. Furthermore, we have put in £330 million to deal with winter pressures. It is wrong of the right hon. Gentleman to try and mislead the House in this way—[Hon. Members: “Oh!”]—and use figures from a snapshot in time, rather than in a generality, which would indicate—

[Mr Speaker]

Order. Sorry, the Minister needs to withdraw the suggestion that anybody tried to mislead the House. That simply needs to be withdrawn; that is all.

[Dr Poulter]

Indeed. I do withdraw that comment, Mr Speaker, and I apologise for saying that there was any deliberate attempt to mislead the House at all. I was simply pointing out the fact that the right hon. Gentleman is highlighting a snapshot in time—

[Mr Speaker]

No, no. Order. I must say to the Minister that when a retraction is required, that is what is required and that is all that is required. We move on.

--- Later in debate ---

[Rehman Chishti (Gillingham and Rainham) (Con)]

4. What steps he is taking to support the recruitment and training of midwives.

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

The Government are committed to ensuring that the number of midwives in training matches the needs of the birth rate. There are now over 800 more midwives working in the NHS than there were in May 2010, and a record 5,000 currently in training.

[Rehman Chishti]

The Oliver Fisher neonatal intensive care unit at Medway Maritime hospital in my constituency is an excellent charity that looks after approximately 900 premature and sick new-borns each year. What further midwife support will the Government give to such care units?

[Dr Poulter]

My hon. Friend is absolutely right to point out the excellent work done at his local unit, which receives funding from the NHS and from charitable sources. We are investing more money into training midwives, and there are now more midwives working in the NHS. It is for local commissioners to capitalise on that, and to invest in support for neonatal units.

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

With births per midwife rising, maternity services being cut and newly qualified midwives unable to find a job, what on earth happened to the famous boast of the Prime Minister that he would recruit 3,000 more midwives and make their lives a lot easier?

[Dr Poulter]

With respect, perhaps the hon. Gentleman should listen to my answers before he pre-prepares a statement. I just outlined clearly that in the past two years there have already been 800 more midwives working in the NHS, and there are record numbers in training thanks to the investment being made by the Government. We are delivering on making sure that we are investing in maternity and investing in high-quality care for women. We are proud to be doing that—something the previous Government failed to do.

[Nigel Adams (Selby and Ainsty) (Con)]

5. What assessment he has made of the effect of the current NHS funding formula on rural areas with a large elderly population.

--- Later in debate ---

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

10. What estimate he has made of the number of patients who waited longer than four hours for treatment in accident and emergency departments in 2012; and if he will make a statement.

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

In 2012, the NHS saw nearly 22 million people in A and E across the country, with 96% seen within four hours, which I am sure the hon. Lady will agree is a great achievement. That means that the A and E clinical quality indicators for high-quality patient care are being met in the NHS.

[Kate Green]

Last week, the Manchester Evening News reported that more than 1,000 patients had waited more than four hours at A and Es across Greater Manchester in December. I am sure the Minister is well aware of the planned downgrading of services at Trafford general hospital, and I understand that last night the joint health scrutiny committees of Trafford and Manchester agreed that the proposals should be referred to the Secretary of State for decision. Given last month’s alarming figures, will Ministers assure me that in reaching a decision about the future of Trafford general hospital, full account will be taken of capacity across Greater Manchester?

[Dr Poulter]

I thank the hon. Lady for her question. I recognise her concerns for her constituents. As has been outlined, there are seasonal variations, and I am sure that local commissioners will want to take such issues into account when they make decisions, and they must meet the reconfiguration tests set out by the previous Secretary of State for Health, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley).

[Gavin Barwell (Croydon Central) (Con)]

The Better Services Better Value review of NHS services in south-west London identified that Croydon university hospital does not have sufficient senior doctors in its A and E, and nor did it under the previous Government. The review has been put on hold because Surrey has asked to be included. Will the Minister reassure my constituents that there will be a rapid solution to ensure that we have the A and E care that we deserve?

[Dr Poulter]

My hon. Friend is right to highlight a long-standing problem—it has not happened just recently —of a lack of particularly middle-grade doctors in A and Es. Although the number of consultants has increased by about 50%, as A and Es move rightly towards becoming a 24/7 consultant-led service, attracting middle grades to the specialty has been a problem. We set up a task force to consider that, as well as making better use of a multidisciplinary work force and emergency nurse practitioners to meet some of the staff shortages.

[Mr Jamie Reed (Copeland) (Lab)]

The performance of A and E services has an obvious and acute effect on the performance of ambulance services. In London, freedom of information requests show that the number of ambulances waiting more than 30 minutes from arriving at hospital to handing over their patients has gone up by two thirds over the last year, that ambulances are missing their targets in responding to the most serious life-threatening callouts, and that the average length of time that patients wait in ambulances before accessing A and E is going up, and in some cases patients are waiting almost three hours. The Care Quality Commission says that London Ambulance Service NHS Trust does

“not have sufficient staff to keep people safe”.

The question for the Secretary of State is simple: what is he going to do about it?

[Dr Poulter]

The hon. Gentleman is right to highlight the unacceptable variations in the quality of triage and handover between ambulance services and hospitals, not just in London but in other parts of the country. Many hospitals, however, do that well, and it is important that local MPs highlight the issue, champion good practice on handovers and ensure that that good practice is carried out at other A and Es. It is unacceptable that patients should wait for handover.

[John Pugh (Southport) (LD)]

Can the Minister update the House on the roll-out of the 111 service and its effect on A and E admissions and 999 calls?

[Dr Poulter]

As my hon. Friend knows, we are developing the 111 service further to improve triage and take pressure off accident and emergency services when that is appropriate. I am sure all Members agree that when patients do not need to go to A and E, it is best for them to be treated in the community or properly triaged.

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

11. What steps he is taking to improve the recruitment and retention of specialist accident and emergency doctors.

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

That is a long-standing problem. Recognising that emergency medicine is moving towards becoming a 24-hours-a-day, seven-days-a-week service, the Government have set up an emergency medicine task force to tackle the problem and encourage more recruitment of middle-grade doctors to A and E specialties.

[Eric Ollerenshaw]

Might it be time for us to take a leaf out of the Department for Education’s book, and consider offering scholarships or bursaries tied to doing the job for a certain number of years in order to improve recruitment and retention in this difficult area?

[Dr Poulter]

Bursaries are already available to medical students to encourage recruitment to the medical profession. As for the specific question of A and E recruitment, at the end of last year I published—alongside the report from the Doctors and Dentists Review Body on the consultant contracts and clinical excellence awards—a report on junior doctors in training. That has given us an excellent opportunity to consider what rewards and inducements may be available to encourage junior doctors to move into A and E and other specialties in which the work is particularly intensive and the meeting of staffing requirements has posed a long-standing challenge.

[Liz Kendall (Leicester West) (Lab)]

The Government say that the number of doctors in the NHS has increased by 5,000 since they came to power. When did those doctors start their training?

[Dr Poulter]

We know that it takes five or sometimes six years for doctors to complete their medical training. The key difference is that under the plans left by the last Government not all doctors were guaranteed places of work in the NHS after completing their training, whereas the present Government are ensuring that they find NHS jobs. That is why we have 5,000 more doctors in the NHS. The same applies to midwives: under the last Government they were not finding places after completing their training, but under this Government they are, and there are 800 more of them.

[Kelvin Hopkins (Luton North) (Lab)]

12. What steps he plans to take to address damage to health caused by alcohol consumption.

--- Later in debate ---

[Lorely Burt (Solihull) (LD)]

13. What plans he has to review urgent care services.

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

The configuration of urgent care services is a matter for the local NHS, and commissioners should ensure that there is provision of appropriate urgent care services locally to provide safe and effective care for patients.

[Lorely Burt]

A review of urgent care services by the new GP-led clinical commissioning group for Solihull is causing consternation as it is throwing the future of our highly regarded walk-in centre into doubt. Does the Minister agree that users must be properly consulted, as services must be designed around patients, and that allocation to cost centres must come second to delivering services?

[Dr Poulter]

I agree with my hon. Friend. Where there are well-functioning local services that have local support, commissioners should recognise that in their decisions, but it is also important to highlight that any reconfiguration of local services has to meet the four tests laid down by the previous Secretary of State: support from GP commissioners; strengthened public and patient engagement; clarity on the clinical evidence base; and support for patient choice. I hope that reassures my hon. Friend.

[Fiona Mactaggart (Slough) (Lab)]

One of the ways in which the Government are trying to prevent urgent care and A and E admissions is by holding down the funding for unplanned admissions to 30% above 2009 levels. That is proving very hard in places where many people who arrive for A and E or urgent care are not registered with a GP. What can the Minister do to help with the funding of services in communities where it has proved impossible to reduce A and E admissions?

[Dr Poulter]

The hon. Lady rightly highlights that there are challenges ensuring registration with GPs, particularly in areas with large migrant population groups. In some parts of London, each year as many as one third of patients move and change GP surgeries. This is a big challenge and we are encouraging local hospitals to make sure that people who turn up at A and Es inappropriately subsequently register with a GP.

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

14. What his policy is on community hospitals.

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

The Government are committed to supporting the NHS to work better by extending best practice on improving discharge from acute hospitals and increasing access to care and treatment in the community. Community hospitals play a valuable role in this process.

[Miss McIntosh]

I welcome my hon. Friend’s reply. Will he give an assurance that going forward there will always be a place for community hospitals in respect of palliative and rehab care, which can be more easily delivered in one place?

[Dr Poulter]

My hon. Friend makes an excellent point. Community hospitals can provide a good focus for palliative care, respite care, intermediate care and step-up and step-down care close to home, particularly for people in rural communities who may otherwise have to travel very long distances to attend hospitals. I hope the community hospitals in my hon. Friend’s constituency will have a long and vibrant future.

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

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

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

T5. The NHS has confirmed that North Yorkshire is the only part of the country that will inherit a £19 million debt, which has to be carried by the new clinical commissioning groups. That was the situation we were promised we would never be in. What is the Secretary of State going to do to urgently address the chronic underfunding of rural areas for the NHS in North Yorkshire?

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

My hon. Friend and I have previously discussed this matter, and she is right to highlight that there are particular challenges to address in rural areas, in terms of both distances to travel and an ageing population requiring considerable health care resources. That will of course be a matter for the NHS Commissioning Board to examine when it considers future funding allocations.

[Mrs Mary Glindon (North Tyneside) (Lab)]

T6. As one in three women who get cancer are over the age of 70, can the Minister say when the newly launched Be Clear on Cancer campaign will be rolled out nationally?

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

T10. In the light of widespread representations from constituents about the proposals for the centralisation of pathology services, will my right hon. Friend the Secretary of State consider the clinical concerns very carefully before any such changes are sanctioned?

[Dr Poulter]

I thank my hon. Friend for that question and he is right to highlight the fact that any decisions about service reconfigurations must be clinically led, as was outlined in the Government’s tests for any service reconfiguration.

[Heidi Alexander (Lewisham East) (Lab)]

T8. Last week, the Secretary of State refused my request to meet a small group of local GPs, hospital doctors and residents who are opposed to the closure of accident and emergency and maternity at Lewisham hospital, yet in his former role he seemed very happy to trade hundreds of texts with Rupert Murdoch’s lobbyists about the purchase of BSkyB by News Corp. Why is it one rule for Rupert Murdoch’s lobbyists and another for doctors in Lewisham?

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

Penalties on readmission rates were introduced to improve clinical practice, but patients suffering from sickle cell and thalassaemia in my constituency and elsewhere cause hospitals to be fined for readmission, even though it is often in the patient’s best clinical interest. Will the Minister once again reconsider exempting sickle cell and thalassaemia from the penalty?

[Dr Poulter]

The hon. Lady is right to raise concerns about specific groups. The direction of travel in reducing readmission rates has to be the right thing; far too many patients were bouncing back to hospital when they would have been better looked after in the community. The longer term answer for some conditions, such as heart disease and possibly sickle cell and thalassaemia, may be year-of-care tariffs, which we are looking at very closely, as is the NHS Commissioning Board.

[Sir Nick Harvey (North Devon) (LD)]

The Secretary of State just referred to the new strategic clinical networks. As the cancer networks are merged with them, what safeguards are there to stem the loss of expertise in cancer and what specialist support will be available to CCGs trying to achieve the targets we have heard about?

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[Natascha Engel (North East Derbyshire) (Lab)]

My 92-year-old constituent, Ron Lewin, was referred for minor oral surgery. He was eventually written to by the specialist, who said that waiting lists were very long and that assessment appointments were available in 18 weeks, but that they did offer an independent service if he wished to be seen earlier. Independent obviously means paying to jump the queue. Is that how the Government propose to cut waiting lists?

[Dr Poulter]

It is a decision for front-line medical professionals to outline when treatment should or should not be given. Treatment must always be given on the basis of clinical need, so I am sure the hon. Lady will be feeding that message back to local commissioners. There is an opportunity for people to appeal against decisions when they are not made on the basis of clinical need, as that is clearly not the right thing and not in the interests of patients.

[Zac Goldsmith (Richmond Park) (Con)]

Will my right hon. Friend’s Department make an assessment of the effects on local air quality and public health of a potential third runway at Heathrow, and will he submit those findings to the Davies commission on airport capacity?