Heart Surgery (Leeds)

Lord Beith Excerpts

Monday 15th April 2013 Commons Chamber

[Mr Hunt]

I certainly accept the premise, on the basis of considerable clinical evidence, that for complex surgery greater specialisation leads to higher survival rates. On whether that is the right thing to do in this particular case, I would like to wait for the outcome of the legal process and the advice of the Independent Reconfiguration Panel, but I will just say this: I would like to conclude this as quickly as possible. I am subject, rightly, to legal due process. Families who feel strongly want this to be concluded quickly, but they also want to know that it has been concluded fairly, and I think that that underlies a lot of the concerns raised by Members this afternoon. The timetable is not within my gift but what is within my gift in terms of timings I will try to expedite as quickly as possible.

[Sir Alan Beith (Berwick-upon-Tweed) (LD)]

Does my right hon. Friend recognise that whatever challenge there may be to the evidence relating to Leeds, there has been no challenge to the evidence of the successful outcomes in Newcastle? Can he assure me that clinical evidence will predominate in his final decision?

[Mr Hunt]

I can absolutely give my right hon. Friend that assurance. It is very important, when dealing with very difficult decisions of this nature, that we are led by clinical evidence on what will save the most lives. We have an absolute responsibility to all of our constituents to ensure that clinical evidence informs the final decision.

Oral Answers to Questions

Lord Beith Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Dr Poulter]

Part of reorganising services and delivering good health care is about clinical leadership—I hope that is supported across the House—and local doctors, nurses and health care professionals saying what is important for their patients and what local health care priorities are. Obviously, local communities need to be engaged in that process, but what really matters is what is good for patients and delivers high-quality care for them. We need to deliver more care in the community, and in doing so we have to recognise that some of the ways we have delivered care in the past—picking up the pieces in hospitals when people are broken—need to change. We have to do more to keep people well at home and in their own communities.

[Sir Alan Beith (Berwick-upon-Tweed) (LD)]

Given that the maternity unit at Berwick infirmary has been suspended since the beginning of August for safety reasons, with births being referred to a hospital 50 miles away, will the Minister take into account the urgent need to provide the necessary clinical support for community hospitals in remote areas so that they can provide local essential services to the highest standards?

[Dr Poulter]

I thank my right hon. Friend for that question. We discussed this issue in the Adjournment debate before the autumn recess. He is a strong advocate for his local maternity services. The concern was that only 13 births take place at his local maternity unit every year, and whether staff can continue to deliver high-quality care with such a low number of births. Of course, his local providers will want to consider the rurality of the area and the potential, as outlined in the Birthplace study, of rotating staff in and out of the hospital to support his local unit.

health

Lord Beith Excerpts

Tuesday 18th September 2012 Commons Chamber

[Sir Alan Beith (Berwick-upon-Tweed) (LD)]

I am very glad to have this opportunity to raise the important issue of the lack of maternity services in Berwick, and I hope that it will prove helpful that the Minister replying to the debate is a specialist in obstetrics and gynaecology.

Berwick is 50 miles from the district general hospital—although there is one that is slightly nearer on the Scottish side of the border, the Borders general, which we also use quite extensively. That is a long way to travel for a birth, but on 6 August all deliveries at the Berwick midwife-led maternity unit were suspended. Along with that went all overnight recovery stays for people who had given birth in the Wansbeck or Borders general hospitals. There are now no facilities to support home births in the area, which is contrary to National Institute for Health and Clinical Excellence guidelines, and no evening antenatal clinics because the unit is open only during the day.

Two reasons for the suspension of the services were cited. One was that staff were not getting enough experience of deliveries. That has been a long-standing problem, and a review was taking place to address it—and the problem could have been addressed. Reference was later made to two incidents that were seen as a reason for taking more urgent action. However, the details of those incidents have not been disclosed, probably because proceedings relating to them may still be taking place.

The announcement caused great distress to the midwives concerned, who are much respected locally, and caused fury in the local community. Plans for Berwick’s new hospital are being drawn up, and many people believe that the trust might be trying to avoid providing maternity services there. The trust has often assured me that that is not the case, but there is increasing suspicion. Meanwhile, these services are absent, so mothers have to travel 50 miles to give birth. That is not the only issue.

One mother told me she had been driven the 50 miles to the Wansbeck hospital and examined there, but the hospital staff said, “No, you’ve come here too soon. Go home.” She was then driven 50 miles home. Within an hour or two of arriving back, she became convinced labour was about to start, so she was again driven by car 50 miles to the Wansbeck, where she was examined and the staff said, “No, we think you should go home. There’s no need for you to be here at present.” She dug her heels in, however, and said, “No, I’m not going. I’m staying here.” Within the time it would have taken for her to return home again—taking her total journey to 200 miles—the baby was born at the Wansbeck infirmary. That story serves to illustrate that the issue is about not births alone, but all the associated journeys that may be involved. That is one of the reasons why we generally try to provide maternity services reasonably locally.

The review that is taking place should look at how we can ensure that we have maternity services in Berwick that have the full confidence of the trust and the clinical staff. The majority of local mothers initially opt for births at Berwick, but by the time of delivery, the majority of them have accepted advice to have delivery at Wansbeck or the Borders. One has to ask why that is the case. Any mother reading the NICE guidelines, which are given to mothers, will say, “Oh, ambulance transfer might happen after labour has begun!” An ambulance transfer takes two hours; that is the specified NHS time for an ambulance transfer from Berwick to Wansbeck infirmary. It is clear that doctors often feel that they do not want to take any risk at all, so they recommend that delivery should take place at the distant hospital.

Some of the problems and other characteristics of a small unit that might have led to this situation arising can be addressed. The experience issue can be dealt with by staff rotation, so giving them time in a busier hospital to maintain their experience. Having consultants on call, and ensuring they can get to the local hospital more quickly than a transfer can take place, is another necessary feature. Such matters need to be examined much more carefully. Also, there is a role for telemedicine and the practice of having a consultant at the larger centre make an early assessment of whether problems are arising that need to be dealt with. The number of births at our maternity unit have at times been very low because the majority of mothers have been advised to go elsewhere. There was an entire year in which there were only 13 births, but the numbers have increased again, and at the time when the closure took place, 40 women were booked in to have their births at Berwick.

My overriding concern is for the safety of mothers and children, but it ought to be possible for most births to be safely carried out locally. In our debates on this topic, many Members have referred to problems in transfers to hospitals 10 or 15 miles away, but I am talking about a transfer of 50 miles for every birth to a Berwick mother. The majority of mothers in the Berwick area want to have their babies born in Berwick, and they should be able to do so and have confidence that the necessary skills and support are in place.

At last week’s Prime Minister’s questions, the Prime Minister set out that changes in clinical services should not be made without these four conditions being satisfied: support from GP commissioners, strengthened public and patient engagement, clarity on the clinical evidence base and support for patient choice. Those conditions are not satisfied in what is happening in my constituency, and they certainly would not be satisfied by a total withdrawal of maternity services, including delivery, at Berwick. I seek the Minister’s assurance that those conditions remain relevant and that the attention of the health care and primary care trusts involved in taking decisions about maternity services in my area will be drawn to their significance. I hope that the Minister and Department will assist the trusts in any way that they can to work up a good scheme to ensure that people in my constituency can have confidence in their future maternity services at Berwick.

Health Transition Risk Register

Lord Beith Excerpts

Thursday 10th May 2012 Commons Chamber

[Mr Lansley]

Thank you, Mr Speaker. Let me be clear. The right hon. Gentleman, as a Minister, refused requests for the publication of risk registers. This risk register, the transition risk register, at the point when it was requested and formulated, was absolutely part of the formulation and development of policy and has continued to be used as part of the development of policy.

To make it clearer what the Labour party actually thinks about the issue, I should say that a Conservative party member recently submitted a request for a risk register to the one place where the Labour Government remain in power—in Wales. What did the Labour Government say? On 12 April 2012, less than a month ago, the Welsh Assembly Labour Government said:

“Release of the risk register would inhibit the way in which such risks are expressed, which potentially makes the management and mitigation of risk more difficult. This in turn would impair the quality of decision making when determining the most appropriate response to an identified risk. Ultimately this could impede the delivery of Ministerial priorities and inhibit the effective management of NHS performance, in both delivery and financial terms.”

That request to a Labour Government for an NHS risk register was turned down for precisely the reasons we have rejected the request for risk registers in relation to the NHS. The Labour party says one thing, but in government it did another and in government in Wales it does another.

Instead of spending his time debating an 18-month-old document—it is now out of date, frankly—the right hon. Gentleman ought to be recognising the reality of what is happening in the NHS. Instead of the risks that he keeps talking about happening, NHS performance is improving, and he should celebrate that. Waiting times are down, there are more diagnostic tests, and waiting times for diagnostic tests have been maintained. There is extra access to dentistry, cancer drugs and new cancer medicines. Health care-acquired infections in the NHS are at their lowest-ever level and the performance of the NHS is continually improving. As shadow Secretary of State, he would be better off celebrating the performance of the NHS than trying to run it down.

[Sir Alan Beith (Berwick-upon-Tweed) (LD)]

My right hon. Friend quoted some of the evidence that the Justice Committee is receiving, including very interesting evidence from the right hon. Member for Blackburn (Mr Straw). It would help the Committee if it had an understanding of whether this instance is a special and particular case or whether it is seen by quite a lot of people in the civil service as a test case of whether there really is a safe space in which they can freely advance arguments about risk.

[Mr Lansley]

I am grateful to my right hon. Friend. This case is seen and was judged by me and my colleagues on its particular circumstances; as I made clear, it is an exceptional case. One of the arguments that underlay our decision was necessarily the one about the principle that we were assessing. That principle is very clear: the Freedom of Information Act envisages that there should be an exemption for the formulation and development of policy, and that under those circumstances the public interest in the proper development of policy could outweigh the public interest in disclosure.

In this case, we are very clear—and my colleagues have been very clear—that the risk register, when it was produced, was at that time instrumental to the formulation and development of policy and that therefore the public interest did not require its disclosure.

NHS Risk Register

Lord Beith Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Mr Lansley]

When the right hon. Gentleman was a Minister he and his colleagues never published such information, so I will not take any lessons on that. As a Treasury Minister, he refused to disclose a Treasury risk register.

Let me explain what risk registers are for, because an hon. Lady on the Opposition Benches keeps chuntering about them. A high-level risk register, such as those being considered by the tribunal on 5 and 6 March, is a continuously reviewed and updated document that enables officials, advisers and Ministers to identify and analyse the risks of, and to, particular policies. Risk registers present a snapshot of the possible risks involved at any one time. Their purpose is to record all risks, however outlandish or unlikely, both real and potential, and to record the mitigating actions that can ensure that such risks do not become reality.

For such a register to be effective and for it to serve the public interest, those charged with compiling it must be as forthright as possible in their views. The language of risk registers must be forceful and direct. That is essential for their operation, to enable Ministers and officials fully to appreciate those risks and to take the steps to mitigate them, or to redesign policy to avoid them.

It is important to note that such high-level risk registers are different to the risk registers of the organisations from which the shadow Secretary of State quoted, such as the risk registers of strategic health authorities. The latter concern operational matters and not matters of developing and designing policy, and they are written with publication in mind—they are intended to be published. By contrast, there are very clear reasons why Departments—under not just this Government, but previous ones—do not publish their high-level risk registers while they are still active and while policy development is ongoing.

[Sir Alan Beith (Berwick-upon-Tweed) (LD)]

The Justice Committee is currently inquiring into the workings of the Freedom of Information Act. It must identify where the proper boundary lines should fall to protect the ability of civil servants to advise Ministers, but that must be set in the context of legislation that the Government have committed themselves to supporting, and which the previous Prime Minister, Tony Blair, has now publicly disowned.

Oral Answers to Questions

Lord Beith Excerpts

Tuesday 2nd November 2010 Commons Chamber

[Paul Burstow]

I am grateful to the hon. Lady for her question, and particularly her acknowledgement of the previous Government’s failure to close the health inequality gap. The Office for Budget Responsibility identified that there will be growth in employment during the spending review period, and this Government are determined to make sure that we see that growth take place. When it comes to cancer survival, what we need to do most, and most importantly, is make sure that people are aware of the signs and symptoms of cancer, because if they are, they present earlier, they get a diagnosis earlier and their survival chances are greatly improved.

[Sir Alan Beith (Berwick-upon-Tweed) (LD)]

7. What mechanisms he plans to introduce for public access to financial information about general practices under his Department’s proposals for GP commissioning.

[The Minister of State, Department of Health (Mr Simon Burns)]

Under our proposals, commissioning budgets will be held by GP-led consortiums, which will be established as statutory bodies, rather than by individual GP practices. The commissioning budgets will be distinct from the income that GP practices earn under their contracts for providing primary medical care. GP consortiums will have to make their accounts available to the public.

[Sir Alan Beith]

I welcome the Minister’s reply. As GP practices have always been treated as private partnerships and are not open to financial scrutiny or freedom of information requests, it is important that £80 billion of public spending is, in the way he describes, subject to scrutiny, including by this House.

[Mr Burns]

May I reassure the right hon. Gentleman that the NHS commissioning board will not allocate commissioning budgets directly to GP practices? Neither will they be included in either partnership or individual GP accounts. As is the situation now, those GP accounts will remain entirely separate. Our proposals set out clear lines of accountability in respect of commissioning resources. Each GP consortium must prepare a set of annual accounts, which the NHS commissioning board will include in its consolidated account. I hope that that reassures the right hon. Gentleman.