Swine Flu

Lord Lansley Excerpts

Monday 10th January 2011 Commons Chamber

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

Thank you, Mr Speaker, for allowing this urgent question to ask the Secretary of State for Health if he will make a statement on the Government’s preparations for and response to the current flu outbreak.

[The Secretary of State for Health (Mr Andrew Lansley)]

Every winter, flu causes illness and distress to many people. It causes serious illness in some cases and, unfortunately, some deaths. I know that each death is a tragedy that will cause distress to family and friends.

The NHS is again well prepared to respond to the pressures that winter brings—it has responded excellently this year. I thank in particular general practitioners, who each year work tirelessly to look after the health of their patients—especially this winter when the weather, as well as flu and other viruses, has presented challenges.

The rate of GP consultations for influenza-like illness is currently 98 per 100,000 people, down from 124 per 100,000. Those figures are lower than the numbers recorded during the pandemic in 2009-10 and below epidemic levels, which are defined as 200 per 100,000 people. The most recent data showed that 783 people were in critical care in England with influenza-like illness.

Where necessary, local NHS organisations have increased their critical care capacity, in part by—regrettably—delaying routine operations that require critical care back-up. That is a normal local NHS operational process; critical care capacity is always able to be flexible according to local need. We have also increased the number of extracorporeal membrane oxygenation beds, for patients with the most severe disease, from five to 22. A seasonal flu vaccine is again available this year. Our surveillance data show that the vaccine is a good match to the strains of flu that are circulating.

GPs in England order seasonal flu vaccine direct from the manufacturers, according to their needs. Vaccine supply is determined in the early part of the year, for autumn delivery. We recently became aware of reports of flu vaccine supply shortages in some areas in England. We are working with the NHS locally to ensure available supplies of surplus vaccine are moved to where they are needed. In addition, the H1N1 monovalent vaccine is now available to GPs for patients who are eligible for the seasonal flu vaccine.

The Government continue to take expert advice from the Joint Committee on Vaccination and Immunisation. Last year, the JCVI advised for the first time that, in addition to usual risk groups, healthy pregnant women should be vaccinated with seasonal flu vaccine. It did not recommend that children under the age of five outside the at-risk groups should be vaccinated. On 30 December, the JCVI assured me that this advice remains appropriate.

The number of deaths in the UK this winter from flu, verified by the Health Protection Agency, currently is 50. The number of deaths from seasonal flu varies each year, with over 10,000 deaths from seasonal flu estimated in the winter of 2008-09.

Antiviral medicines can also help clinical at-risk groups who have been exposed to flu-like illness. We notified clinicians that the use of antiviral medicines in these groups was justified and, at their discretion, with other patients. We have given access to the national antiviral stockpile to support that.

We are making publicly available for the first time a range of winter performance information, published on the Winterwatch section of the Department’s website. I wrote to all Members last week to inform them of the NHS response to flu, and updated them further in a written statement published this morning.

[John Healey]

I thank the Health Secretary for that statement, but the truth is that he has been slow to act at every stage of this outbreak, and that is putting great pressure on the NHS across the country. It is working flat-out in our local hospital in Rotherham. We have had to open extra beds, and since last Tuesday have cancelled all non-urgent surgery. Four of the 50 patients in the UK who have so far died linked to this flu have been in Rotherham, and two were constituents.

The Health Secretary talks about seasonal flu, but we knew this would not be like normal winter flu because we knew swine flu would be dominant, so the central question for the Health Secretary is why he made less preparation for a flu outbreak that was expected to be more serious. Why did he axe the annual autumn advertising campaign to help boost take-up of the flu jab and help the public understand who is at risk and what treatment is available? We know it works, and this was a serious misjudgment.

Why was the Government’s first circular to midwives, urging them to help get pregnant women to take up the flu jab, not sent out until 16 December? Why has there been no move to offer vaccines through antenatal clinics, and why are the Government not publishing details of the numbers of pregnant women who are seriously ill or who have died, as they are with other groups that are most at risk?

With proper planning and preparation, we should not have seen GPs and pharmacies running out of the vaccine in some areas last week, nor should we have seen parents confused about the treatment available for their young children. I hope last week’s figures mean we may be over the worst, but, with 783 people in critical care and a long winter still ahead, what steps will the Health Secretary take if the numbers of ill people continue to rise? Can he now, today, give the House the reassurance he has failed so far to give the public, which is that he really has got a grip on this situation? Finally, when all the bodies he is relying on to sort out this situation will be abolished under his internal organisation, what assurance can he give the public that this will be any better handled in the future?

[Mr Lansley]

I share the right hon. Gentleman’s deep sadness at the deaths in Rotherham and join him in expressing clearly my condolences to the families of his and other Members’ constituents who have died. Regrettably, there will, I fear, be further deaths from flu—that is in the nature of the winter flu season—but I have to explain to him that we are in the midst of a seasonal flu outbreak that has not reached epidemic levels. Neither is it a pandemic, which is clearly a different situation in which a novel virus, to which there is not acquired immunity, is in circulation.

The right hon. Gentleman asked some specific questions. First, on having to cancel operations, I have made it clear that that is, unfortunately, a consequence: if the NHS’s critical care capacity is under pressure, it cannot admit large numbers of patients for elective operations that might require critical care back-up. The seasonal winter flu outbreak has led to an increase in the number of patients with flu in critical care beds, although they still constitute only about one fifth of the total number of critical care beds, and I pay tribute to hospitals across the country that have increased their critical care capacity, particularly in intensive care, to deal with the situation.

We are also providing assistance to the NHS. I am sorry that the right hon. Gentleman did not refer to my important announcement last Tuesday that, because we made savings in the Department of Health’s central budgets, on things such as management consultancy costs and the IT scheme, we have been able to issue this financial year—in other words, starting now—an additional £162 million to primary care trusts throughout England. They will be able to use that money directly with their local authorities to facilitate the discharge of patients. There are currently about 2,500 patients in hospital who could be discharged if the appropriate arrangements were in place. That will accelerate the relationship with social care that we are looking for.

It is pretty rich for the right hon. Gentleman and the Labour party to say that there should not have been any shortages. The number of vaccines supplied to the United Kingdom was determined before the Government took office. It was determined under the previous Administration, in the early part of last year, not by this Administration. Furthermore, it was equally not just presumptuous but unhelpful for him, during the Christmas period, to talk inaccurately about whether children under the age of five should be vaccinated. He knows perfectly well that like his predecessors we take advice from the Joint Committee on Vaccination and Immunisation. With the chief medical officer, we asked the committee to look at the issue again, and it met on 30 December and reiterated its advice that young children should not be vaccinated. So for him to stimulate press reports suggesting that parents should have their children vaccinated, when the expert advice was not that that should be done, was deeply unhelpful.

The right hon. Gentleman’s final point was about the organisations. It is clear to me that, by abolishing the Health Protection Agency and bringing its responsibilities inside the Department of Health under the new Public Health England, we will have a more integrated and more effective system for responding to seasonal flu in future years.

[Several hon. Members]

rose—

[Nicky Morgan (Loughborough) (Con)]

The Secretary of State is right that general practitioners are on the front line, and it is to them that patients will turn. Does he have any thoughts on the case of a constituent of mine who contacted me yesterday to say that he has been trying to get a vaccination, but has been unable to do so because he wants to have one after 4 o’clock in the afternoon, when he can get away from work? He does not want to jeopardise his job and is finding it difficult to access the vaccination before then, but GPs would rather vaccinate in the morning.

[Mr Lansley]

The arrangements that individual GP surgeries make for ordering and administering doses of the vaccine have been, since October, for them to make. From our point of view, as soon as we were aware that local supply would not necessarily match local demand in the places it should, we took the decision last week to make available the NHS stockpile—there are 12.7 million doses of the H1N1 vaccine—and I can tell my hon. Friend that 20,000 doses began to be distributed this morning. There is no reason why we cannot meet the requirement for vaccinations, whether through GPs’ own doses and local arrangements, through issuing NHS prescriptions that can be fulfilled at local pharmacies or through surgeries ordering the H1N1 vaccine from us.

[Sir Gerald Kaufman (Manchester, Gorton) (Lab)]

Happy new year, Mr Speaker. Is the right hon. Gentleman aware—he should be because I have written to him about this—of serious concerns in my constituency about the shortage of flu vaccine, including for chronically sick people? Will he tell the House, in the most specific way, what action he is taking to ensure that sufficient flu vaccine is available in the city of Manchester and in Greater Manchester?

[Mr Lansley]

May I reiterate to the right hon. Gentleman that the amount of vaccine supplied to the United Kingdom is determined by manufacturers on the basis of discussions with not only the Department, but others, and that the vaccines are ordered by individual GP surgeries? The total amount of vaccine was 14.8 million doses, which is comparable to the level in previous years. Although GP surgeries have shortages, because of the preparations made during the pandemic in 2009 and given that the principal strain of flu circulating is the H1N1 strain—it is not the only strain, but it is the most relevant to guard against for many in the at-risk groups under the age of 65—we made it clear that we would back up GPs who had any shortages with access to our stockpile of H1N1 vaccine. Orders have come in and they are being filled.

[John Pugh (Southport) (LD)]

Governments do not control diseases yet, but in my constituency elective surgery has been cancelled and pharmacies have run out of vaccine. What is the serious long-term alternative to the over-provision of last year and the localised under-provision of this year?

[Mr Lansley]

I do not think one can say that there was over-provision during the pandemic, because one could not have been at all clear about the nature of the progress of H1N1. However, what that meant is that we have the stockpile of vaccine available to back up the NHS this year. My hon. Friend makes a very good point, because there is clearly an issue to deal with regarding how this is properly managed. Before Labour Members start talking from a sedentary position, they might wish to re-examine the 2007 flu review. It was conducted by the Department of Health under the previous Administration and recommended that there should be central procurement of flu vaccine in England, but the previous Administration did nothing about it.

[Mr Kevin Barron (Rother Valley) (Lab)]

Can the Secretary of State tell us why the midwives association was not written to until 16 December?

[Mr Lansley]

We made it very clear that everyone in the at-risk groups was going to be contacted through their GP surgery, and it is the responsibility of GPs to have done that.

[Mark Pawsey (Rugby) (Con)]

I am grateful to my right hon. Friend for the information that he has provided so far, but I wonder whether he could reassure the parents of a 13-year-old boy. They came to see me on Saturday because their son is egg allergic and also suffers from asthma, and they are concerned about the availability of a flu vaccine this year.

[Mr Lansley]

I will certainly write to my hon. Friend about this, but I am confident that one of the number of vaccines that are available will be suitable for his constituent.

[Hugh Bayley (York Central) (Lab)]

Last week, 30 beds at York hospital were occupied by people with suspected or confirmed cases of flu. That is costing the local NHS £7,500 a day—£50,000 a week—and that money could be spent on treating patients with unavoidable conditions. What lessons will the Secretary of State learn from the failure to promote the uptake of the flu vaccine this year to ensure that we do not encounter a similar problem next year?

[Mr Lansley]

The hon. Gentleman’s question is based on a false premise, because the level of vaccine uptake this year among over-65s is 70% and among under-65s is 45.5%, which is comparable to previous years. He did not refer to this, but because we made savings we provided the NHS with considerable additional resources in the last three months of the year precisely to manage winter pressures and ensure that beds in hospitals are available.

[David Tredinnick (Bosworth) (Con)]

I congratulate my right hon. Friend on the increase in the critical case capacity and in the number of extra corporeal membrane oxygenation—ECMO—beds from five to 22, which has made a difference. Will he also pay tribute to others who help in these situations, such as the manufacturers of homeopathic medicines and homeopathic chemists? They provide preparations that may be suitable for people, such as the constituent of my hon. Friend the Member for Rugby (Mark Pawsey), who are unable to take flu vaccines and others who choose not to do so.

[Mr Lansley]

I am grateful to my hon. Friend for that question. His local hospital, the Glenfield in Leicester, leads on specialised ECMO bed services. In this country, we have increased the number of ECMO beds; we have more per head of population than any of the developed health economies, including the United States. As for treatments and vaccinations, I continue to rest upon the scientific and expert advice. Indeed, I hope that patients will consult their clinicians about their treatments.

[Valerie Vaz (Walsall South) (Lab)]

Will the Secretary of State say whether he took the decision to delay the advertising campaign and, if so, when?

--- Later in debate ---

[Mr Lansley]

I announced just after Christmas the “catch it, bin it, kill it” campaign. I had not—[Interruption.] Let me explain to Opposition Members. In 2009, the campaign took place in November. Why? It was because the spread of flu took place in late October, early November. Therefore, it occurred at the point at which there was a substantial spread of the influenza in the community. That is precisely what we did this year.

[Henry Smith (Crawley) (Con)]

As an asthma sufferer, I am pleased to report that just this morning I had the benefit of the flu jab and it was professionally and painlessly administered. However, constituents have come to me concerned about, in one case, a child who has had the respiratory syncytial virus, or RSV and, in another case, an adult who has had pneumonia, who have been denied the flu vaccine. Will he examine how the guidance to GP practices can be amended to include such groups?

[Mr Lansley]

I will of course write to my hon. Friend about the nature of the advice provided by the joint committee, but we follow and have followed at each stage the advice given to us by that independent expert committee, the Joint Committee on Vaccination and Immunisation. I will certainly write to him to explain how it has determined the at-risk groups for these purposes.

[Mr John Spellar (Warley) (Lab)]

Earlier, the Secretary of State made the astonishing admission that he has done nothing since the Labour Government left office. He rightly drew attention to the work being done for at-risk groups. However, emergency planning requires the sustaining of the emergency services. Why is he not giving priority to those who work for the emergency services—the police, the fire and ambulance services?

[Mr Lansley]

I have two points for the right hon. Gentleman. First, all NHS staff, including ambulance staff, are eligible for the vaccine. Regrettably, when I last looked, under 20% had availed themselves of that opportunity. I wish that it were higher.

[Liz Kendall (Leicester West) (Lab)]

“Wish”? Does the Secretary of State think wishing is enough?

[Mr Lansley]

They are all offered it, so they can all be provided with it. I am not in a position to require people to take a vaccine. We are not providing mandatory vaccination in this country yet, and I do not suppose that we shall.

Secondly, I was not admitting that I had done nothing—on the contrary. What the right hon. Gentleman perhaps does not understand is that one cannot simply order additional large-scale supplies of a vaccine. A long process of manufacture is required, as it is an egg-based culture system. The amount is ordered in the spring for autumn delivery, so the amount was determined in the spring. When I entered office in May, there was not any reason particularly to think that we would need more than in other flu seasons, and we knew that we had the back-up of the H1N1 vaccine if we needed it. In early August, I made it clear that I intended to review further the system of procurement, distribution of flu vaccine and its supply. That review is ongoing and will be published shortly.

[Jeremy Lefroy (Stafford) (Con)]

Does my right hon. Friend agree that the reason that acute beds are under such pressure at this time of swine flu is that we do not have sufficient step-down or community beds into which people can transfer from acute beds?

[Mr Lansley]

My hon. Friend makes an important point. Primary care trusts and local authorities working together should now be able to have confidence that the resources are available in this financial year—and £648 million will be available in the next financial year, and more in years beyond—to improve the relationship between health and social care not only through things such as step-down beds, but through operating, for example, hospital at home services, community equipment services and home adaptations to ensure that only those people who need to be in hospital are in hospital.

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

There have been several reports about children having to travel extremely long distances to access critical care in children’s hospitals. Is the Secretary of State satisfied that there is sufficient capacity for paediatric intensive care and high dependency care?

[Mr Lansley]

Yes, I am. The hon. Lady will know that there have always been occasions when paediatric intensive care capacity in a particular hospital is full and when it is necessary for children to be taken a distance. On Christmas eve, I was at the intensive care unit at Alder Hey and I want to pay tribute to the tremendous work done by staff there. They acknowledge that this was not just about H1N1. One reason the committee did not recommend vaccinating all children under the age of five was that children, particularly very young children, were in intensive care because of a combination of H1N1 and/or bronchiolitis and RSV. A range of conditions was impacting at that moment on very young children.

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

Several chemists and GPs’ surgeries in Merseyside have run out of the flu vaccine, leaving at-risk patients unable to obtain the jab. The Health Protection Agency has highlighted Liverpool as having significantly higher rates of swine flu than the English average. Will Liverpool therefore receive a higher proportion of the £162 million that the Secretary of State has made available to primary care trusts to help those affected?

[Mr Lansley]

The £162 million will be allocated to primary care trusts based on the social care allocation formula, which will be the same for next year. Any GP surgery, or for that matter the primary care trust in Merseyside, is free to come to us to order supplies from the national stockpile of the H1N1 vaccine to ensure that those who require vaccination can receive it.

[Kevin Brennan (Cardiff West) (Lab)]

In his answer to my hon. Friend the Member for Walsall South (Valerie Vaz), the Secretary of State was clearly giving an after-the-fact justification for his failure to act on the winter awareness campaign earlier in the year. He is fond of telling anyone who ventures to criticise him that they are completely wrong. Will he admit that on this occasion, as far as the awareness campaign is concerned, he was the one who was completely wrong?

--- Later in debate ---

[Mr Lansley]

No, absolutely not. I was simply pointing out to Opposition Members that the principle that applied in 2009, which was that the point at which flu was circulating in the community was the point at which the “catch it, bin it, kill it” campaign was initiated, was precisely the same principle that I applied this year.

May I say in response to the hon. Member for Liverpool, Wavertree (Luciana Berger) that the supplies of vaccine provided to primary care trusts or GPs’ surgeries from the national stockpile of swine flu vaccine will be provided free?

[Chris Leslie (Nottingham East) (Lab/Co-op)]

To be absolutely clear on that answer, does the Secretary of State have any regrets whatsoever about not proceeding with the flu publicity campaign?

[Mr Lansley]

No. I have made it perfectly clear that the principle we applied is exactly the same and was based on the medical advice given to me, which was to pursue an awareness campaign on respiratory and hand hygiene at the point at which flu was circulating in the community. That is what I was asked and that is the decision I took.

[Tom Greatrex (Rutherglen and Hamilton West) (Lab/Co-op)]

Will the Secretary of State comment on the worrying media reports emanating from Scotland that at a time when there were shortages of vaccine the Department of Health was scrabbling around trying to get supplies from other countries when there was a surplus in Scotland, but it never asked the Scottish Government? Is that the case, or is it nationalist mischief making from Edinburgh?

[Mr Lansley]

All I can tell the hon. Gentleman is the simple truth. In the early part of last week, we asked manufacturers whether they had additional supplies. I believe that some additional seasonal flu vaccine that is licensed for use in this country probably will be made available. In any case, we have the H1N1 vaccine to support the immunisation, where required. Early last week, we did ask Scotland. The amounts that would have been available in the short run were not significant at all, so it was better for them to be retained in Scotland because there might be a continuing need for the vaccine there, rather than here.

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

Will the Secretary of State explain when in the course of the year the vaccine would normally be ordered?

[Mr Lansley]

It would normally be ordered between March and May.

[Paul Flynn (Newport West) (Lab)]

H1N1 deaths are especially tragic because they involve people with expectations of a long life. Last year, 65,000 deaths were anticipated but fewer than 500 died with swine flu and 150 died of swine flu. If the priorities of the health service are not to be distorted, should not we approach this problem with a sense of both caution and proportion?

[Mr Lansley]

I share the hon. Gentleman’s deep regret. H1N1, unlike many previous flu strains, does not particularly impact on the elderly; it impacts on younger people and on younger adults in particular. That is the principal reason why we are seeing a relatively larger number of people occupying critical care beds. The NHS response has been to accelerate the provision of critical care capacity and of ECMO beds in particular.

[Ian Paisley (North Antrim) (DUP)]

The Secretary of State will be aware that tragically there have been 14 flu-related deaths in Northern Ireland during this winter. Given that that figure is proportionately higher than in other parts of the United Kingdom, what discussions has he had or does he intend to have with his counterpart in Northern Ireland to assess why the proportion is so much higher and whether there is a black spot with regard to that disease?

[Mr Lansley]

The figure of 50 deaths to which I have referred is the total number of deaths verified by the Health Protection Agency. There have been more deaths than that, but they have not been verified to have been caused by flu. I cannot comment on the relationship between the number that I quoted for the United Kingdom as a whole and that for Northern Ireland, because we are not dealing with comparable figures. My colleagues in the devolved Administrations and I will continue to keep in touch. It is important for us not to be simplistic about this. There are differences in vaccine take-up between Administrations—they are not major, but they exist. There are differences in the prevalence of swine flu, and the prevalence of flu in Northern Ireland is very high compared with England—it is even a great deal higher than that in Scotland. Happily, the number of deaths is only ever a very small proportion of the people who contract flu. To that extent, it is difficult to draw from the number of deaths conclusions about the nature of the response to flu overall, not least because the prevalence is overwhelmingly among people who are not in the at-risk groups, who, I hope, were vaccinated.

[Mr Denis MacShane (Rotherham) (Lab)]

Mr Speaker, I am not sure whether you have noticed that since the Secretary of State started making his excuses for this problem, Government Front Benchers and Back Benchers have looked more and more unwell. Will the Secretary of State confirm that he has had the flu jab and that he has made sure that his Front-Bench team have had it?

[Mr Lansley]

I take this issue seriously, even if the right hon. Gentleman does not. As it happens, I fall into one of the at-risk groups, because I had a stroke in 1992, so I have had the flu jab. I would not ask members of my ministerial team who are not in the at-risk groups to have the vaccination, because it is not recommended.

[Toby Perkins (Chesterfield) (Lab)]

The biggest tragedy is that the Secretary of State has learned no lessons whatsoever from what has happened. As a result, it is likely that the same mistakes will be made in the future. His answers about the advertising campaign are completely unconvincing. Will he explain why he cancelled the advertising campaign, which GPs were demanding at the time, to increase the take-up of vaccinations?

[Mr Lansley]

I cancelled no campaign; I proceeded only with the awareness campaign on respiratory and hand hygiene. An advertising campaign aimed at the general population would not have been effective, and I was advised that there was no evidence that it would be effective. We knew who the at-risk groups were, and it was possible to reach them directly rather than engaging in wider advertising.

[Owen Smith (Pontypridd) (Lab)]

Will the Secretary of State tell us what role primary care trusts and strategic health authorities are playing in dealing with the crisis? Will he explain what dismantling the SHAs and PCTs will do in terms of central planning for future crises?

[Mr Lansley]

The role of SHAs and PCTs is, as in previous years, to manage the NHS response to winter pressures. In future, the commissioning consortiums together with the NHS Commissioning Board, will fulfil similar responsibilities. In future years, there will be a stronger ability to integrate the response of the Department of Health and the Health Protection Agency, working together as one new organisation, Public Health England, which will have a stronger public health infrastructure.

Contaminated Blood

Lord Lansley Excerpts

Monday 10th January 2011 Commons Chamber

[The Secretary of State for Health (Mr Andrew Lansley)]

With permission, I would like to make a statement on hepatitis C and HIV-infected blood.

What happened during the 1970s and 1980s, when thousands of patients contracted hepatitis C and HIV from NHS blood and blood products, is one of the great tragedies of modern health care. It is desperately sad to recall that during this period the best efforts of the NHS to restore people to health actually consigned very many to a life of illness and hardship. As the current Health Secretary, and on behalf of Governments extending back to the 1970s, may I begin by saying how sorry I am that this happened and by expressing my deep regret for the pain and misery that many have suffered as a result?

It is now almost two decades since the full extent of the infection was established and two years since the independent inquiry led by Lord Archer of Sandwell reported. The majority of Lord Archer’s recommendations are in place, as are programmes of ex gratia payments, which are administered by the Macfarlane Trust and the Eileen Trust for the HIV-infected and by the Skipton Fund for those with hepatitis C. However, significant anomalies remain and I pay tribute to Lord Archer, to other noble Lords and to hon. Members in this place from all parties for highlighting them.

In October, the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), announced a review into the current support arrangements —to look at reducing the differences between the hepatitis C and HIV financial support schemes and to explore other issues raised by Members during the recent Back-Bench debate, including prescription charges and wider support for those affected. We also asked clinical experts to advise on the impact of hepatitis C infection on a person’s health and quality of life and to consider whether an increase in financial support was needed. My hon. Friend the Under-Secretary has met representative groups to understand the impact that these infections were having on people’s lives and has also met many Members of both Houses who have been strong advocates on behalf of those affected.

We have now considered the findings of the clinical expert group and we accept that the needs of those with advanced liver disease from hepatitis C merit higher levels of support. At present, the amount of money paid to this group depends on the seriousness of the infection. There are two stages at which the Skipton Fund will make a payment, the first of which is when the person develops chronic hepatitis C infection. At this point, a person is eligible for a stage 1 relief payment—currently a lump sum of £20,000. Some may reach a second stage of developing an advanced liver disease such as cirrhosis or cancer, or of requiring a liver transplant; they then become eligible for a stage 2 payment, which is currently another lump sum of £25,000. Under new arrangements that we will introduce, this second stage payment will increase from £25,000 to £50,000. This will apply retrospectively, so that if a person has already received an initial stage 2 payment of £25,000, they will now get another £25,000 lump sum, bringing the total to £50,000.

In addition, we will also introduce a new, annual payment of £12,800 for those with hepatitis C who reach this second stage. This is the same amount as those who were infected with HIV receive. Those infected with both HIV and hepatitis C from contaminated blood will now receive two annual payments of £12,800 if they meet the stage 2 criteria—one payment for each infection—along with the respective lump sums. All annual payments that are made, both to those so infected with HIV and to those with hepatitis C, will now be uprated annually in line with the consumer prices index to keep pace with living costs.

We know that some of those infected with HIV or hepatitis C from NHS blood and blood products face particular hardship and poverty. Those infected with HIV can already apply for additional discretionary payments from the Eileen Trust and the Macfarlane Trust, but no equivalent arrangements are in place for those infected with hepatitis C, so we will now establish a new charitable trust to make similar payments to those with hepatitis C who are in serious financial need. These payments will be available for those at all stages of their illness, based on individual circumstances. Discretionary payments will also be available to support the dependants of those infected with hepatitis C, including the dependants of those who have since died. Again, this will echo the arrangements in place for those infected with HIV and will enable us to give more to those in the greatest need.

We must also ensure that those infected through NHS blood and blood products get the right medical and psychological support. I can therefore announce two further measures. First, those infected with hepatitis C or HIV will no longer pay for their prescriptions. They will now receive the cost of an annual prescription prepayment certificate if they are currently charged for prescriptions. Secondly, the representative groups raised the issue of counselling support for those infected through blood and blood products. We fully recognise the emotional distress that they have experienced. As a result, we will provide £300,000 over the next three years to allow for around 6,000 hours of counselling to help those groups.

While we focus on those still living with infections, we must also recognise the bereaved families of those who have died. At present, no payment can be made to those infected with hepatitis C who passed away before the Skipton Fund was established. That is a source of understandable distress to those who survive them, and that is something that we now want to put right. I can therefore announce that, until the end of March 2011, there will be a window of opportunity in which a posthumous claim of up to £70,000 can be made on behalf of those infected with hepatitis C who died before 29 August 2003. A single payment of £20,000 will be payable if the individual had reached the first stage of chronic infection. Another single payment of £50,000 will be made if their condition had deteriorated to the second stage, in which they suffered serious liver disease or required a liver transplant. We will work with the Skipton Fund and various patient groups to publicise this new payment to those who may benefit. Those new payments, which will go to the individual’s estate, should help more families to get the support that they deserve.

Taken together, these announcements represent a significant rise in the support available to those affected by this tragedy. Putting an exact figure on the package is difficult, as there is some uncertainty about how many people will be eligible, and how their illnesses may progress. However, we believe that the new arrangements could provide £100 million to £130 million-worth of additional support over the course of this Parliament. All payments will be disregarded for calculating income tax and eligibility for other state benefits, including social care. Although the changes apply only to those infected in England, I will be speaking to the devolved Administrations to see whether we can extend the measures across the United Kingdom.

Today’s announcements cannot remove the pain and distress that individuals and families have suffered over the years, but I hope that the measures can at least bring some comfort, some consolation, and perhaps even some closure to those affected. I commend the statement to the House.

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

The Opposition welcome the review and today’s statement, and we note that Labour Health Ministers had agreed the review in principle before they left office. We are glad that the statement was made on the very first day back after the Christmas break, because we are aware that the statement was promised before Christmas. We appreciate it being made as soon as it could be made.

Does the Secretary of State agree that the House owes a tremendous debt of gratitude to the patient groups that have campaigned for more than 25 years on the issue? They include the Haemophilia Society, the Hepatitis C Trust, the Taintedblood group, the Manor House Group, and individuals such as Haydn Lewis, who unfortunately passed away before he could see this resolution. Without the campaigning of those groups and individuals over two decades, the issue would have been one of private misery and private suffering. It is because they campaigned and kept the issue before the public and before the eyes of politicians that we are able to move decisively towards a proper resolution today.

Many of the measures in the statement will be welcomed, particularly the help with prescription charges and the £300,000 for counselling—I have seen with my own eyes the awful mental effect of this tragedy on people—as well as the payments for dependants, the provision for posthumous claims, and above all, the move towards parity in the cases of HIV and hepatitis C. All that will be welcomed, but there will still be campaigners who will regret that we have not been able to achieve parity with the compensation that was offered and handed out in the Republic of Ireland. It would be silly to pretend that there will not be many people still saying today, “Why could we not achieve what was done in the Republic of Ireland?”.

Finally, when we remember that more than 4,500 completely innocent and trusting patients contracted HIV, hepatitis C or both as a consequence of tainted blood, and that more than 1,900 of those people have died, leaving thousands of dependants behind, should we not, as a House, resolve that it should never again take 25 years for perfectly innocent victims of errors and mistakes to have proper justice and recompense?

[Mr Lansley]

I am grateful to the hon. Lady and I entirely endorse her opening and closing remarks paying tribute to all the patient groups. My hon. Friend the Under-Secretary of State for Health has met many of those groups and individuals, and I know that she would heartily endorse what the hon. Lady said about how they have brought these issues time and again to the forefront of attention in the House and the other place. I do not want to underestimate the many in the House and the other place who responded to that and did so very well by bringing these cases forward. I hope that they will see in today’s statement a proper response.

We do not know whether there will ever be a similar case. I hope we can avoid it—it would be much better to avoid it—but if we were ever in a situation where such a consequence flowed from the NHS seeking to do its best to treat patients but such harm nevertheless occurred, I hope we would recognise that, be able to identify it and not allow decades to pass before proper recognition took place.

That brings me to the hon. Lady’s substantive point, which is the relationship between what we are doing and the compensation provided in the Republic of Ireland. As we explained in October, we do not regard these as comparable cases. In the Republic of Ireland, mistakes were made by the Irish Blood Transfusion Service which led to a recognition of liability, leading to a determination of compensation. In this country we are not providing compensation. We are recognising the harm that occurred, notwithstanding the fact that the NHS at the time sought to provide the treatment that it thought was in the best interests of patients.

That harm occurred. As an ex gratia payment and in recognition of the harm that occurred and the distress that followed, we have sought to ensure that there is proper support, financial and otherwise, for the victims and their families. I hope that by getting rid of the anomalies and recognising—in particular, through the work of the clinical expert group—the impact on those with hepatitis C, we are giving the support that those who were damaged should expect.

[Jonathan Evans (Cardiff North) (Con)]

Although I welcome my right hon. Friend’s statement, I should point out that Lord Archer recommended that there should be compensation along the Irish lines. That is a little of the context of what has taken place.

I take the opportunity of congratulating the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton) on all the work that she has done on the matter, which I know has been welcomed across the House.

May I ask my right hon. Friend about the position in Wales? I was a little taken aback by the fact that he said that he intends to speak to fellow Ministers in Wales. I have a statement from the Welsh Minister indicating that as far as she is concerned, these issues come next to be considered by her in 2014, which was the previous agreement with the Department of Health. Many of my constituents will want to know what discussions have so far taken place and whether the arrangements will be replicated in the Principality.

[Mr Lansley]

The Under-Secretary will have heard what my hon. Friend said. I am grateful for it, too.

I am speaking on behalf of England in this respect. As the Department of Health, we administer the payments system. We had to reach the decisions and we have done so. We always intended to do so as rapidly as we could for England, but as I explained in my statement, these decisions have yet to be made by the devolved Administrations. It is reasonable for them to see the review report that I am publishing today, not least the clinical expert review that goes with it, in order for them to make their own decisions. Those are decisions that they must make, but if they wished us to continue to administer the system on the same basis across the United Kingdom, we would be happy to do so.

[Diana Johnson (Kingston upon Hull North) (Lab)]

In the debate on the subject in the autumn, the Under-Secretary of State agreed to speak to her colleagues in the Department for Work and Pensions about the changes to benefits and how those would affect people who had received contaminated blood products. Can the Secretary of State give any guarantee about passporting people affected by the changes in benefits so that they do not lose out and have to go through a further set of medicals?

[Mr Lansley]

I am grateful for that. This is not a response to precisely the question that the hon. Lady asks, but Lord Archer made a point about whether payments should be made through the Department for Work and Pensions. We do not see that any tangible benefit would flow from that.

[Chris Bryant (Rhondda) (Lab)]

That was not my hon. Friend’s question.

[Mr Lansley]

No, I acknowledged that. I will of course respond to the hon. Lady, but I think it better for us to administer all the payments through the system that I have set out. As I say, they will be disregarded for the purposes of calculation of benefits, so to that extent they will not impact adversely on current benefits.

[Jason McCartney (Colne Valley) (Con)]

Having spoken in the debate in October and having asked a question in Prime Minister’s questions in November, I very much welcome a number of elements in the Secretary of State’s statement, particularly those on free prescriptions and counselling help. Will he, however, promise to meet the Taintedblood campaigners and perhaps even to look at the overall level of compensation?

[Mr Lansley]

May I say two things to my hon. Friend? My hon. Friend the Under-Secretary has met those groups and will continue to meet them, because we want to ensure not least that those who are now eligible for enhanced payments and so on make proper applications. We have looked very carefully with the clinical expert group at the support that we ought to give. It is not compensation as such; it is an ex gratia form of support. We have made judgments, and if we were to go further, there would be significant additional costs. My hon. Friend the Under-Secretary and I have made it clear to the House in the past that to provide payments on the scale of the Republic of Ireland might involve up to, or perhaps even in excess of, £3.5 billion a year, so I am not in a position to say to my hon. Friend the Member for Colne Valley (Jason McCartney) that I expect to go beyond the support that I have set out today.

[Mr Andy Slaughter (Hammersmith) (Lab)]

It is to be regretted that the review’s terms of reference were so narrow, as it did not consider overall levels of compensation or HIV. If the Secretary of State believes that the Republic of Ireland case is simply too expensive, will he please say so and not rely, as the Department has, on either the idea that the Taintedblood campaigners and others are asking him to look at that and tying us to the Irish system, or the idea that they are asking us effectively to look at those levels of compensation because negligence was involved? That was not the case in Ireland. Is not the result likely to be more litigation? The levels of remuneration are still far too low.

[Mr Lansley]

With respect to the hon. Gentleman, in response to previous questions I made it very clear that the question was not simply about the amount of money. The situation in the Republic of Ireland is unique in respect of its determination of liability because of mistakes made by the Irish Blood Transfusion Service. To that extent, we are making ex gratia payments. The nature of our payments stands comparison to other countries, particularly now, in respect of hepatitis C and my announcements this afternoon.

[Jenny Willott (Cardiff Central) (LD)]

I really welcome today’s statement and, in particular, the apology, which will go a long way to ease some of the pain that some of the victims have suffered. Proper support for those infected with hepatitis C is also long overdue. Gareth Lewis, who was a leading Taintedblood campaigner—I believe he met the Under Secretary—tragically died just before Christmas, only a few months after his brother, Haydn, whom the hon. Member for Hackney North and Stoke Newington (Ms Abbott) mentioned. That highlights the urgency of my question. Governments are not known for moving quickly, particularly when it involves handing out money, so will the Secretary of State reassure us that everything that can be done will be done to ensure that the payments announced today are made as soon as is humanly possible?

[Mr Lansley]

May I pay tribute to my hon. Friend, who has on many occasions spoken up on behalf of her constituents and others who were affected by the tainted blood and blood products? The answer to her question is yes—absolutely we will. When we came into office, we were determined to implement the review. As she said, we sought to complete the review before Christmas—technically speaking, we did, but we were not in a position to announce it before Christmas. We are doing this at the first available moment, and we will do everything that we possibly can to ensure that potential beneficiaries are notified and reached as quickly as possible so that the payments are in place as soon as possible.

[Chris Bryant (Rhondda) (Lab)]

It would be one of the greatest catastrophes if what happened were able to happen again. That is why it is so vital that the Government constantly keep under review the policy on donating blood. As the Secretary of State will know, men who have had sex with men are one of the categories of people who are not able to give blood at the moment, and that seems intrinsically unfair and prejudiced. I urge the Secretary of State to look only at the scientific evidence in the ongoing review; that, and not any other political consideration, is the basis on which the decision should be made.

[Mr Lansley]

Yes, I entirely agree.

[Andrea Leadsom (South Northamptonshire) (Con)]

I have to say that I am a bit disappointed; I am not sure whether today’s announcement will give closure to many people. A constituent of mine told me about a very good friend of his who died in Spain over Christmas. Sadly, his family could not afford to bring the body home, so he had to be cremated in Spain. Under the circumstances, it is very important that the ex gratia payments, available through the new charity to be set up, take into account the tragic and particular problems of individual sufferers.

[Mr Lansley]

Yes, indeed. I know that they will; that is one of the reasons why, in addition to the lump sum payments and annual payments that I have announced, we wanted to ensure that there was scope for discretionary payments based on individuals’ needs.

[Mr Elfyn Llwyd (Dwyfor Meirionnydd) (PC)]

May I take the Secretary of State back to the point raised by the hon. Member for Cardiff North (Jonathan Evans)? It is rather surprising that there has not hitherto been any discussion with the devolved Administrations. If such payments are to be made in Scotland and Wales, is it anticipated that they will be made out of existing budgets? How will the matter be handled?

[Mr Lansley]

What I have announced today will, of course, be funded from the Department of Health’s budget in England and the matter would be a responsibility for the devolved Administrations in relation to their budgets —from within the budgets set through the spending review.

[David Tredinnick (Bosworth) (Con)]

I, too, congratulate my right hon. Friend. I also congratulate the Under-Secretary of State for Health on all the work that she has done. The statement deals with what Lord Archer called the worst treatment disaster in the history of the national health service. It has to be said that the last Labour Government could have dealt with this, but they did not.

Following the comprehensive package that he has announced, will my right hon. Friend assure us that he will take active steps to contact the families of the bereaved and that no stone will be left unturned in making sure that all those who should have payments receive them?

[Mr Lansley]

I give my hon. Friend that assurance. We will take all the steps that we possibly can, not least on behalf of the bereaved families of those who died before 29 August 2003. That anomaly, among others, ought to have been rectified long ago.

[Owen Smith (Pontypridd) (Lab)]

I, too, welcome the statement—in particular the serious and commendable way in which the Under-Secretary of State has dealt with this important issue. However, the people who really need to be congratulated today are the campaigners such as the family of my constituent Leigh Sugar.

I take the Secretary of State back to his comment that the measure will apply to England only. Will he explain the rationale for that? The previous schemes applied to England and Wales, although they predated devolution. Is he saying that no additional funds will be available for Welsh patients, under the Barnett consequentials, to provide similar funding in Wales?

--- Later in debate ---

[Mr Lansley]

I share the view of the hon. Gentleman. Today the people who should feel that we are expressing our support are those who have been harmed and their families. Those are the people whom we are really supporting today. I hope that they will feel that although not everything that they have hoped for is being provided, we are at least making very substantial progress and doing a great deal to show recognition of the harm that occurred to them.

At this Dispatch Box, I speak on health matters for England; I do not speak for Wales and I am not in a position to say what the decisions of the devolved Administrations are. I have set out what we are going to do in England. We are funding the measure from within allocated budgets, so no Barnett consequentials flow from it. These matters will be determined within each of the other Administrations in respect of whether they wish to share in the arrangements that I have described.

[Mr Adrian Sanders (Torbay) (LD)]

There cannot be a Member of this House who does not have at least one constituent who is affected or who knows someone who is affected by this. I am sure that every hon. Member would like to congratulate the Government on the statement. Will the Secretary of State give an assurance that the bureaucracy needed to process matters forward has been looked at, so that it is kept to a minimum?

[Mr Lansley]

Yes, we have done that. My hon. Friend is absolutely right: hon. Members will have met constituents or the families of constituents who have been harmed, or the families of those who died. I hope that hon. Members will take the opportunity to bring the terms of today’s statement to their attention, so that people can access the additional support at the earliest possible opportunity. We will seek to do what my hon. Friend mentions. What I am describing builds as far as possible on existing mechanisms and, with the exception of the new discretionary trust, will not create any additional bureaucracy.

[Several hon. Members]

rose—

--- Later in debate ---

[Mr Lansley]

My hon. Friend will know from the response that my hon. Friend the Under-Secretary gave to October’s Back-Bench debate that we intended to place a note in the Library. We have done so. She has had further occasions to discuss these arrangements with colleagues in the House. The discussions between my officials and officials in the Republic of Ireland have confirmed that a figure of about £750,000 is not inappropriate as an estimate of the level of compensation per individual paid in the Republic of Ireland. That would support the view that we took in the House that the cost of providing compensation, if one were to do so, on the scale required in the Republic of Ireland would be in excess of £3 billion. As I said to the hon. Member for Hammersmith (Mr Slaughter), it is not on the basis of cost alone that we have reached that view; it is on the basis that the circumstances in the Republic of Ireland are unique and do not apply in this country. Therefore, we have assessed the case for support on the basis of the circumstances here and on an ex gratia basis, not on the basis of liability and consequent compensation.

[Stephen Barclay (North East Cambridgeshire) (Con)]

I also thank the Minister for the welcome measures announced in the statement and for the progress that has been made after so long. May I return to the average figure of £750,000, because there is a concern that that figure could be confusing the average and the mean? If we take a figure between 500 and a million and say that it is the average, it does not provide an average figure. Such an approach is akin to saying that the price of a car ranges from £10,000 to £1 million and therefore the average price of a car is £500,000. In relation to the discussions that the Minister has had with officials in Ireland, will he confirm that the total paid in Ireland—the total payment in terms of Irish settlements on this matter—is less than £1 billion?

[Mr Lansley]

As I have said in response to previous questions, I pay tribute to the work that my hon. Friends have done in support of their constituents and others. It is not simply a question of trying to calculate what the level of compensation is in Ireland; that is not the issue. We are not making a comparison with Ireland; we are making a judgment. In this case, we have especially done so in relation to hepatitis C, on the basis of the report of the clinical expert group, to try to assess the level of harm and the consequences that have flowed from the transfusions that took place, albeit that in this country the NHS acted on the basis of its best efforts to provide the best possible care for patients. The Republic of Ireland is a unique, and quite distinct, case in that because of mistakes made, a finding of liability was arrived at which leads to compensation. In our case, we are not in that position. We are in the position of recognising the harm and distress that has occurred and, through an ex gratia scheme, providing support to those who have been harmed and their families.

[Duncan Hames (Chippenham) (LD)]

I thank the Secretary of State for bringing the Government’s deliberations on the issue to this conclusion. Will he reassure the House that those experiencing the symptoms of advanced liver disease who received contaminated blood will not in all cases be required to have a liver biopsy in order to demonstrate and establish their eligibility for these payments?

[Mr Lansley]

No, they will not. From our point of view, eligibility will simply be based on a diagnosis of their condition.

[David Mowat (Warrington South) (Con)]

I, too, welcome the statement, particularly the attempt to get better parity between HIV and hepatitis C. However, I remain slightly concerned about the definition of stage 2. What proportion of hepatitis C complainants does the Minister expect to progress to stage 2? He must have estimated that number in order to put a financial amount on the settlement.

[Mr Lansley]

I regret that I cannot give such an estimate to my hon. Friend. The estimate that I have given is a range that extends from £100 million to £130 million during the life of this Parliament. If one were to go beyond that period, the parameters of the range would widen, not least because we do not, and cannot, know to what extent this infection is likely to progress to the second stage of these diseases.

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

I very much welcome much of what has been said in the statement, particularly the fact that the decision has been made to force closure on an issue that has been going on for so long. One of the things that has upset so many of the sufferers is not only that such a scandal happened but the subsequent failings, as they would see it, not of Government but of the Department of Health in being clear and transparent during those years in providing information on exactly what happened. Will the Secretary of State give an assurance that he will have to provide information to help those people who are still affected when they ask questions, perhaps through freedom of information requests, about what occurred in the past?

[Mr Lansley]

May I once more express my thanks to my hon. Friend for having been a forceful advocate in these matters? The answer to her question is yes, not least because my hon. Friend the Under-Secretary has been very open and willing to talk to everybody concerned, and she will continue to be so, because we are determined to give people confidence that we have not only exercised what we believe to be a responsible and reasonable judgment in these matters but are doing so in an open and transparent fashion.

NHS South West

Lord Lansley Excerpts

Monday 10th January 2011 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

On 17 June 2010, I asked Sir David Nicholson, chief executive of the NHS in England, to initiate a review into the approach and behaviour of the NHS South West (the strategic health authority) in relation to Royal Cornwall Hospitals Trust (RCHT), in particular, to the dismissal of John Watkinson and, by association, the trust’s position in relation to the provision of upper gastro-intestinal services in Cornwall.

Verita, a specialist company that conducts independent investigations, reviews and inquiries, carried out the review. The report was published on the Department of Health website on Tuesday 4 January 2011.

In the written ministerial statement of 17 June 2010, Official Report, column 57WS, I committed to updating the House on the findings of the report and my response. The key findings of the report were:

the strategic health authority put appropriate pressure on the RCHT board to suspend John Watkinson but was not involved in the decision to dismiss him;

the strategic health authority was justifiably concerned about many aspects of RCHT’s performance in the period leading up to the RCHT board’s dismissal of John Watkinson;

the RCHT chair and non-executive directors were relatively inexperienced within the NHS and it was good practice for them to take advice from the more experienced strategic health authority before making their own decision what to do; and

NHS South West is considered to have acted appropriately given its performance management responsibilities for NHS organisations in the south west and the fact that RCHT was not a foundation trust.

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

Seasonal Influenza Update

Lord Lansley Excerpts

Monday 10th January 2011 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

Seasonal flu virus circulates each year and this year is no exception. This statement is to update Parliament following developments during recess.

Seasonal flu is different from the outbreak of pandemic flu in 2009, when a new flu virus emerged (H1N1, or “swine flu”) against which humans (particularly those aged under 65) had little or no natural immunity. When the pandemic flu virus emerged in 2009, our pandemic preparedness plans were triggered. These plans entailed the mass distribution of “antiviral” drugs, the launch of the “National Flu Line”, and a “Catch it. Bin it, Kill it” advertising campaign designed to help members of the public understand how they could limit the spread of flu.

There is no flu pandemic this year, so these plans have not been triggered. Although the H1N1 virus is circulating, it is now one of the seasonal flu strains. This is because when it circulated in 2009-10, it helped to establish a residual level of immunity in people exposed to it, which means that H1N1 now circulates like other seasonal flu viruses.

In the United Kingdom, the H1N1 and influenza B viruses are the strains of flu that are circulating widely. H1N1 is the predominant virus, and is behaving—as expected—as it did in 2009-10. This means that H1N1 is likely to infect younger people—particularly those with underlying disease—and pregnant women.

A seasonal flu vaccine is available this year, as in previous years. This vaccine protects against all three strains of flu which the World Health Organisation identified would be most likely to circulate this year. Surveillance data show that these strains are circulating and that the vaccine is a good match.

General practitioners (GPs) order seasonal flu vaccine direct from the manufacturers according to their needs. This system is different from the childhood vaccination programme where the Department procures vaccine centrally and distributes it free of charge to the NHS.

We are aware of some reports of flu vaccine supply issues in some areas in England. We are working with NHS at the local level to ensure available supplies of surplus vaccine are moved to where they are needed. If efforts to source seasonal flu vaccine locally are not successful, the H1N1 monovalent vaccine (Pandemrix) is now available to GPs, for patients who are eligible for the seasonal flu vaccine.

I have already agreed for a review of procurement options of the seasonal flu vaccine to be undertaken, including central procurement, although no decisions have yet been made.

As in previous years, and on the basis of procedures which have existed for decades, the Government take expert advice from the Joint Committee on Vaccination and Immunisation (JCVI). This year, as last year, the JCVI advised that those aged 65 and over, and those in clinical at-risk groups, should be vaccinated. Because of the specific characteristic of the H1N1 virus, the JCVI also advised for the first time that healthy, pregnant women should be vaccinated with seasonal flu vaccine. The JCVI has recently assured me that this advice is appropriate for this year’s flu season.

As in previous years, only certain groups are being targeted for vaccination. We have therefore focused our efforts on ensuring that these groups are vaccinated. Current information for vaccinations given up to 2 January 2011 shows that 70.0% of over 65s have been vaccinated and 45.4% of those in clinical at-risk groups have been vaccinated, which is broadly in line with previous years.

The latest data indicate that the rate of GP consultations for influenza-like illness (ILI) is currently 98 per 100,000 people but we need to be cautious about interpreting the data due to the holiday period. The highest recorded level this year was 124 per 100,000, which is lower than that recorded during the pandemic in 2009-10 and below the epidemic level of 200 per 100,000 people. Nevertheless, given that they reached these levels I have taken the decision to reinstate the “Catch it, Bin it. Kill it” campaign.

Data indicate that this year’s flu has resulted in greater than usual numbers of patients requiring critical care. These patients have largely been infected with H1N1, and the pattern is consistent with H1N1’s characteristics last year. As a result, where necessary, local NHS organisations have increased their critical care capacity, in part by delaying routine operations requiring critical care back-up. This is a normal operational process which is initiated by NHS organisations at the local level; critical care capacity is not “fixed” but is always able to flex in this way according to local need.

In addition, over the last month we have increased the number of so-called “ECMO” beds—for patients with the most severe disease—from 5 to 22.

The number of deaths this winter from flu verified by the Health Protection Agency currently is 50, with 45 of these being associated with the H1N1 infection. The number of deaths from seasonal flu varies each year, with over 10,000 deaths from seasonal flu estimated in the winter of 2008-09.

Some have queried why statistics for the number of deaths in pregnant women are not available. The only reason the Health Protection Agency has not published the breakdown is to protect those individuals from being personally identifiable, the number of such cases being small.

When influenza is circulating, antiviral medicines can also help clinical at-risk groups who have either been exposed to or have contracted a flu-like illness. This season we notified clinicians that the use of antiviral medicines in these groups was justified, but also, as a higher than normal number of patients outside the clinical at-risk groups were becoming seriously ill with flu, general practitioners (and other prescribers) were recommended to exercise their clinical discretion so that any patient who they feel is at serious risk of developing complications from influenza may receive antiviral treatments on the NHS. In response, demand for these medicines continued to rise.

We have taken prompt action to ensure that all patients have access to appropriate antiviral medicines when they need them, and there is no shortage of antiviral medicines in the country.

There is always more pressure on the NHS during the winter, but the NHS is well-prepared and is coping well. In summary, we are taking the following action:

the first line of defence against flu is vaccination, and we want to see vaccination rates increase still further. That is why we are currently working with the BMA and RCGP to ensure everyone in an at-risk group who has not been vaccinated contacts their GP and books an appointment;

the second line of defence is to practice good respiratory and hand hygiene. That is why we reinstated the Catch it, Bin it, Kill it campaign. In addition, and in advance of the new school term, we are encouraging parents to educate their children to use good hand and respiratory hygiene; and

the third line of defence is a well-prepared NHS with the ability to treat those who do need help. That is why we are working with local NHS organisation to help them escalate critical care capacity where necessary, and have increased the number of ECMO beds available for patients.

We are making available a range of winter performance information publicly available. This is published on the Winterwatch section of the Department’s website at: http://winterwatch.dh.gov.uk/.

Funding and Commissioning Routes for Public Health

Lord Lansley Excerpts

Tuesday 21st December 2010 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

Today I am publishing a consultation document, “Healthy Lives, Healthy People: Consultation on the funding and commissioning routes for public health”, seeking views on proposals that were initially outlined in the White Paper “Healthy Lives, Healthy People: Our Strategy for public health in England” (Cm7985).

We are consulting on proposals for the commissioning and funding arrangements for delivery of public health services in the future. The consultation also asks questions about how the Department should implement some of our proposals.

The White Paper described a new era for public health, with a higher priority and dedicated resources. There will be ring-fenced public health funding from within the overall NHS budget. Local authorities will have a new role in improving the health and well-being of their population as part of a new system with localism at its heart and devolved responsibilities, freedoms and funding.

Directors of Public Health will be the strategic leaders for public health and reducing health inequalities in local communities, working in partnership with the local NHS and across the public, private and voluntary sectors. There will also be a new, dedicated, professional public health service—Public Health England—that will be part of the Department of Health.

This consultation is an opportunity to collect the views of public health professionals, NHS commissioners, local authorities, service providers—particularly the voluntary and independent sector—and all other interested parties.

The consultation will close at the end of March 2011.

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

Transparency in Outcomes

Lord Lansley Excerpts

Monday 20th December 2010 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

Today marks the beginning of an important shift in focus for the NHS and public health, away from focusing on politically motivated process targets, and towards what matters most: improving quality and delivering health outcomes that are among the best in the world.

I am publishing the first NHS outcomes framework, “The NHS Outcomes Framework 2011-12”, which will serve three purposes:

provide a national level overview of how well the NHS is progressing, so far as possible with international comparisons;

provide an accountability mechanism between the Secretary of State for Health and the NHS Commissioning Board: and

act as a catalyst for driving quality improvement and outcome measurement throughout the NHS by encouraging a change in culture and behaviour, including a renewed focus on tackling inequalities in outcomes.

This framework has been developed building on the proposals set out for consultation in “Transparency in outcomes—a framework for the NHS”, published in July, and the nearly 800 responses to the consultation.

This first NHS outcomes framework looks only to set the direction of travel for the NHS, and will not be used in this coming year for accountability purposes. No levels of ambition are attached to the indicators. For 2011-12, the business, finance and performance rules are set out in “The NHS Operating Framework for England 2011-12”. The NHS outcomes framework will be refined annually, and the next iteration, for 2012-13 will be published in 2011, and will be used to hold the proposed NHS Commissioning Board to account once it takes its statutory place (subject to parliamentary approval).

Alongside the NHS outcomes framework, I am publishing a formal Government response to the consultation “Transparency in outcomes—a framework for the NHS”, an impact assessment and equality impact assessment for the first framework and technical detail on the indicators presented in the framework.

Today I am also publishing “Healthy Lives, Healthy People: Transparency in Outcomes—Proposals for a Public Health Outcomes Framework”, which seeks views on a new strategic outcomes framework for public health at national and local levels. This document was proposed in the recent public health White Paper.

This consultation is an opportunity to collect the views of public health professionals, NHS commissioners, local authorities, service providers, particularly the voluntary and independent sector, and all other interested parties. The consultation will close at the end of March 2011.

Both outcomes frameworks have been designed so that where joint working and alignment is essential to improving outcomes, the NHS and Public Health England are held to account for working together.

All documents have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Work Force Education and Training Consultations

Lord Lansley Excerpts

Monday 20th December 2010 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

Today I am publishing a consultation document seeking views on proposals set out in the White Paper, “Equity and Excellence: Liberating the NHS” (Cm7881). We are consulting on proposals to create a new framework for education and training of the health care work force. Under these proposals, health care providers will be given responsibility for planning and developing the work force, while the quality of education and training will remain under the stewardship of the health care professions.

“Liberating the NHS: Developing the Healthcare Workforce” has been placed in the Library. Copies are available to hon. Members in the Vote Office and to noble Lords from the Printed Paper Office. The consultation is also available at www.dh.gov.uk/en/Consultations/Liveconsultations/DH_122590.

“Liberating the NHS: Developing the Healthcare Workforce” further develops the education and training commitments in the White Paper that:

Health care employers and their staff will agree plans and funding for work force development and training;

education and commissioning will be led locally and nationally by the health care professions; working with employers;

the professions will have a leading role in deciding the structure and content of training and quality standards;

all providers of health care services will pay to meet the costs of education and training with transparent funding flows supporting the level playing field between providers;

the NHS Commissioning Board will provide national patient and public oversight of health care providers’ funding plans for training and education, checking that these reflect its strategic commissioning intentions. GP consortia will provide this oversight at local level; and

the Centre for Workforce Intelligence will act as a consistent source of information and analysis, informing and informed by all levels of the system.

This consultation is an opportunity to seek the views of health care providers, health care professionals and the wider public to inform the development of a new framework for education and training and developing the health care work force.

The consultation period will close on 31 March 2011.

Value-Based Pricing (Consultation)

Lord Lansley Excerpts

Thursday 16th December 2010 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

I am launching today a consultation entitled: “A new value-based approach to the pricing of branded medicines”.

The consultation document sets out this Government’s proposals for introducing a system of value-based pricing for medicines, as stated in the coalition agreement. Such a system would enable patients to access the medicines and treatments their doctor advises they need by establishing a closer link between the price of a new branded medicine and the value which it offers in terms of benefits to patients, reflecting unmet need, therapeutic innovation, and where appropriate, benefit to society.

While the current system of pricing medicines has tried to achieve a balance between reasonable prices for the NHS and fair return for the industry to develop new medicines, it does not promote innovation or patient access in the way that we are looking for. We have committed to honouring the terms of the Pharmaceutical Price Regulation Scheme 2009 until its expiry, but there is a need to reform the way in which we pay for medicines from 2014 onwards. As we have made clear through the establishment of the cancer drugs fund prior to 2014, we are enabling NHS clinicians to have better access to the medicines required for their patients.

This consultation is an important opportunity to engage with different groups in order to gain their views on how we should best reflect the value of medicines in order to deliver the best health outcomes for patients. This consultation sets out the Government’s initial thoughts and invites engagement from interested parties in order that we can begin to develop a future model of medicines’ pricing.

Copies of the consultation document have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

NHS Consultation, Operating Frameworks and PCT Revenue

Lord Lansley Excerpts

Wednesday 15th December 2010 Written Statements

[The Secretary of State for Health (Mr Andrew Lansley)]

Today I am laying before Parliament “Liberating the NHS: Legislative framework and next steps” (Cm 7993), the Government’s response to the consultation on implementing the White Paper reforms set out in “Equity and excellence: Liberating the NHS”. Sir David Nicholson, the NHS chief executive, is also today publishing the NHS operating framework and revenue allocations to primary care trusts (PCTs) for 2011-12. The operating framework and revenue allocations have been placed in the Library. Copies of all documents are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

“Liberating the NHS: Legislative framework and next steps” shows how the Department has developed its plans in the light of consultation and sets out further detail on the reforms and a timetable for implementation. The document also sets out a timetable for implementation and explains how the consultation has shaped the health and social care Bill, planned for introduction in January. Overall, the document reaffirms the Government’s commitment to reforming the NHS so that it:

puts patients right at the heart of decisions made about their care;

puts clinicians in the driving seat on decisions about services; and

is focused on delivering health outcomes that are comparable with, or even better than, those of our international neighbours.

The Department received over 6,000 consultation responses from patients and members of the public, clinicians, voluntary organisations, patient representative groups, local authorities, local involvement networks (LINks), NHS organisations and staff, independent providers, pharmacists, academics, professional bodies and royal colleges, think-tanks and trade unions.

Responses contained a broad mix of support, suggestions for improvement and critical challenge. The insights and suggestions we have heard in consultation have not only strengthened our belief that the reforms are necessary but have also helped us refine our proposals in several areas. In particular, the Government have decided to:

significantly strengthen the role of health and well-being boards in local authorities, and enhance joint working arrangements through a new responsibility to develop a “joint health and well-being strategy” spanning the NHS, social care, public health and potentially other local services. Local authority and NHS commissioners will be required to have regard to this;

create a more distinct identity for Health Watch England, led by a statutory committee within the Care Quality Commission;

increase transparency in commissioning by requiring all GP consortia to have a published constitution;

change our proposal that maternity services should be commissioned by the NHS Commissioning Board;

extend councils’ formal scrutiny powers to cover all NHS-funded services, and give local authorities greater freedom in how these are exercised;

phase the timetable for giving local authorities responsibility for commissioning NHS complaints advocacy services, and allow flexibility to commission from other organisations as well as from local Health Watch;

give GP consortia a stronger role in supporting the NHS Commissioning Board to drive up quality in primary care; and create an explicit duty for all arm’s length bodies to co-operate in carrying out their functions, backed by a new mechanism for resolving disputes.

Equally important, the feedback we received through consultation has also helped us refine our approach to implementation, in order to create flexibility, empower local leadership, and support the significant cultural change and staff engagement that respondents highlighted would be needed to make our reforms a success. The Department has therefore decided to:

allow a longer and more phased transition period for completing our reforms to providers;

create a clearer, more phased approach to the introduction of GP commissioning, by setting up a programme of GP consortia pathfinders; and

accelerate the introduction of health and well-being boards through a new programme of early implementers.

To take forward these changes the Department has put in place a single, integrated programme for the whole of the transition across the health and care system. This will help sustain performance under the existing regime at the same time as building the leadership to implement the changes. Transition will occur through a carefully designed and managed process, phased over the next four years, to allow for rapid adoption, system-wide learning, and effective risk-management. It will be aided by the creation of a number of specific time-limited transitional vehicles, with a focus on sustaining capability and capacity.

Alongside “Liberating the NHS: Legislative framework and next steps”, the NHS chief executive, David Nicholson, has today published the NHS operating framework for 2011-12, which sets out the priorities for the next year. This includes how the NHS will go through a strong and stable transition over the next year to begin to deliver the vision of the White Paper. By the end of 2011-12 we expect NHS organisations to have made significant progress in moving towards a more liberated NHS. Organisations should be working across traditional boundaries to improve the quality of patient care while maintaining the quality and safety of NHS services.

I have also written today to every hon. Member in England detailing their PCT’s allocations for 2011-12, which PCTs will use to deliver our vision for reform and our national priorities as set out in the operating framework.

Total revenue investment in the NHS in 2011-12 will grow to over £102 billion. The allocations I am announcing today will provide PCTs with £89 billion to spend on the local front-line services that matter most, an increase of £2.6 billion, or 3%. This funding includes an increase of £1.9 billion in PCT recurrent allocations (including £150 million for re-ablement), £69 million in primary dental services, pharmaceutical services and general ophthalmic services non-recurrent allocations, and £648 million to support joint working between health and social care.

The recurrent allocations are based upon a revised weighted capitation formula that includes improvements, such as a new mental health formula. This lays the groundwork for the switch to allocations to GP consortia and local authorities from the NHS Commissioning Board and Public Health England respectively for 2013-14. These organisational changes will free the NHS from political interference, support the transfer of decision making and responsibility for local health services to the front line, and ensure that public health programmes are safeguarded.

PCTs and local authorities will use the funding for re-ablement and joint working to agree a work plan based on local joint strategic needs assessments to deliver services which may include current services, in particular telecare, re-ablement packages and home adaptations.

The allocations announced today place PCTs in a strong position to deliver the coalition Government’s vision for reform, as originally set out in “Liberating the NHS” and today reaffirmed in “Liberating the NHS: Legislative framework and next steps”. and our national priorities, today set out in the NHS operating framework.

Oral Answers to Questions

Lord Lansley Excerpts

Tuesday 7th December 2010 Commons Chamber

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

12. What recent representations he has received on the operation of the interim cancer drugs fund; and if he will make a statement.

[The Secretary of State for Health (Mr Andrew Lansley)]

Clinically led arrangements are in place in all strategic health authorities for determining the best use of the additional funds that we have made available for cancer drugs from 1 October 2010. Information provided by SHAs shows that, as of 15 November, funding had been agreed for the treatment of more than 250 patients in England. I have received representations from hon. Members, noble Lords, and members of the public on how the interim arrangements for cancer drugs funding are operating. Many of those representations have welcomed the additional support we are giving to cancer patients in need.

[Nigel Adams]

I am grateful to the Secretary of State for his response. Last week, my constituent, Trudy Cusworth, received the news that she is to be given the cancer drug Avastin, despite the panel at St James’s university hospital, Leeds initially refusing to do so. In this case, the emergency cancer drugs fund has done its job, but what can the Secretary of State say to assure other cancer patients in North Yorkshire who are also in desperate need of such life-prolonging drugs and who are currently being denied access to them?

[Mr Lansley]

I am grateful to my hon. Friend for his question. Indeed, I want to thank him for the support he has given to Trudy Cusworth. I am very pleased that she was able to take her case, with her clinicians, to the panel and that it has been approved. There are a number of people in the York and Selby area for whom that is true. The panels are working across the country to ensure additional access to cancer drug treatments where a clinical case is made for that.

[Alun Cairns]

My constituents are pretty angry and disappointed that the cancer drugs fund will not apply to them because health matters have been devolved to the National Assembly for Wales. Will the Secretary of State give an assurance that he will champion the merits of the policy in the hope of convincing the Welsh Assembly Government to follow the lead that he is offering?

[Mr Lansley]

I agree with my hon. Friend, who is obviously an advocate for his constituents to the Welsh Assembly Government. These are matters for the devolved Administrations and they must decide how to allocate their resources. In this instance we have shared with the devolved Administrations the consultation on the cancer drugs fund, which will start next April, although the policy proposed will apply in England alone.

[Toby Perkins (Chesterfield) (Lab)]

2. What recent representations he has received on the effect of the abolition of primary care trusts on the co-ordination of preventive health care.

--- Later in debate ---

[Mark Lancaster (Milton Keynes North) (Con)]

13. What recent progress he has made on the introduction of GP-led commissioning consortiums.

[The Secretary of State for Health (Mr Andrew Lansley)]

On 21 October, I invited general practice-led commissioning consortiums to put themselves forward as pathfinders, and I have been absolutely delighted by the response. The pathfinder consortiums will be announced shortly. They have formed in response to the needs of local communities, and there is, sensibly, variation around the country to take account of those differing needs. Some consortiums map on to local authority boundaries; others organise themselves around catchments for hospitals or smaller populations. This bottom-up, locally determined approach is exactly in line with what we envisaged in the policy framework.

[Henry Smith]

Under the previous Government, Crawley hospital saw the removal of services such as accident and emergency and maternity. Can my right hon. Friend explain how, under the new GP-led consortiums, doctors will have the freedom and the flexibility to be able to refer their patients to local services if they so choose, as well as to new services?

[Mr Lansley]

That is exactly what our reforms will allow. We are putting not only the freedom to refer in the hands of general practices but choice in the hands of patients, and allying that to the power on the part of commissioners to commission services that meet the needs of their local community. That is precisely the change that will empower front-line clinicians and patients.

[Mark Lancaster]

Having consulted widely in Milton Keynes, I am pleased to say that the Government’s plans have been broadly welcomed. However, one area of concern that has been raised with me by patients, in particular, is the amount of time that they will get to spend face to face with their GP. Can the Secretary of State reassure my constituents and outline the administrative support that GPs will get in fulfilling their new functions?

[Mr Lansley]

I am grateful to my hon. Friend. In Milton Keynes, GP Healthcare MK and Premier MK consortiums are shaping their services in order to be able to deliver better and improved services for their patients. We do not intend that all GPs individually should become managers, by any means; there will be clinical leadership, but the consortiums should have commissioning support. The primary care trust in Milton Keynes has had some good commissioning support arrangements, as I know from having visited it in the past. It is open to the new commissioning consortiums to take teams from the primary care trust into their new consortium support arrangements, but they can go elsewhere. They can look to the local authority and to the independent sector to provide them with the commissioning support that they need so that clinicians provide leadership but continue to be responsible for clinical care.

[Mr Ben Bradshaw (Exeter) (Lab)]

What impact does the Secretary of State think that this change and the rest of the upheaval that he is inflicting on the health service will have on hospital waiting times?

[Mr Lansley]

I think that the reforms will have a positive impact on performance right across the NHS, because they will enable patients who want to exercise choice to see the quality and standard of services, including waiting times. Unlike in the past, they will be able to see waiting times for individual hospitals, rather than just a single target. They will be able to make choices based on information about the quality of services.

[Derek Twigg (Halton) (Lab)]

If the reforms are so good, why have they been criticised by the chairman of the Royal College of General Practitioners, Dr Clare Gerada? She said:

“I think it is the end of the NHS as we currently know it, which is a national, unified health service”.

The British Medical Association has expressed concerns about competition, and we hear in this morning’s edition of The Independent from an unnamed “ally” of the Secretary of State that

“There is no wobble. No 10 and the Treasury are fully behind the principle of the reforms”—

obviously a very brave ally. Why has the Prime Minister asked the Cabinet Office Minister who is in charge of Government policy to review the plans? Is it because the Secretary of State is the only one who believes in them?

[Mr Lansley]

The hon. Gentleman should not believe all that he reads in the newspapers. The curious thing is that the Minister with responsibility for Government policy is engaged with Government policy. That is a good and positive thing. The hon. Gentleman referred to the Royal College of General Practitioners and to Dr Gerada. In response to the White Paper, the RCGP said:

“General Practice is the central plank in our world-class healthcare system. The College thoroughly agrees that it makes a great deal of sense to give GPs, with their unique patient-centred perspective, a central role in commissioning and directing healthcare services.”

Dr Gerada said:

“I fully support placing clinicians at the centre of commissioning decisions”.

[Mr Stephen Dorrell (Charnwood) (Con)]

I very much welcome the steps that my right hon. Friend is taking to encourage the early emergence of pathfinder consortiums, so that the shape of the new commissioning structure is made clear as quickly as possible. Given the nature of the quality, innovation, productivity and prevention challenge—QIPP—that the health service faces, does he agree that the process must be carried forward as quickly as possible so that the new framework is clear for all concerned as quickly as possible?

[Mr Lansley]

Yes, I do. I was delighted by the response of general practice to the emerging consortiums, because one of the central reasons it wants to make progress quickly is to shape clinical service redesign, which is at the heart of delivering the efficiency savings that will enable us all to improve outcomes.

[David Miliband (South Shields) (Lab)]

The Secretary of State has said that GPs are the best people to manage the health service. Will he confirm that in the eight years of GP training, not a single hour is dedicated to the commissioning work that he has described?

[Mr Lansley]

The right hon. Gentleman should understand that what I said was that GPs are the best people to commission services. Commissioning and management are not the same thing. GPs are already responsible for commissioning most services in the NHS, but they have no power over resources and contracting. I intend to ally clinical leadership and commissioning decisions with commissioning support that involves management. The people who should determine the shape of local services to meet the needs of patients are those who are already at the heart of designing services and referring patients.

[Andrew Stephenson (Pendle) (Con)]

4. What recent representations he has received on management and administration costs in the NHS; and if he will make a statement.

--- Later in debate ---

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

7. What assessment he has made of the Health Protection Agency’s recent report on the incidence of tuberculosis.

[The Secretary of State for Health (Mr Andrew Lansley)]

I welcome the Health Protection Agency’s recent report on tuberculosis in the UK. There were 8,286 cases of TB in England in 2009, an increase of 4.3% on 2008. The rise has occurred mainly in people infected in countries where TB is common, who go on to develop active TB disease later in life.

[Annette Brooke]

I understand that that is a 30-year high. Evidence from New York shows that a co-ordinated approach across the city has made a real impact in controlling TB. How will the Secretary of State ensure that such co-ordination takes place, especially in cities, when GP-led commissioning is introduced?

[Mr Lansley]

The treatment services for individual patients will be commissioned through GP consortiums, but the identification and preventive work on TB is a public health responsibility. To that extent, I believe that we will be better placed to deal with it in future. Many local authorities—for example, in Birmingham, Manchester or Leeds—will be well placed as cities to respond to any incidence or outbreaks of TB on a preventive basis, using their powers as public health authorities.

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

In response to my question on the publication of the White Paper about the more than 500 TB cases in Birmingham the Secretary of State confirmed that there would be no changes to what such cities could do to control TB outbreaks. Will he elaborate on his answer? What more can Birmingham do under the new arrangements to prevent such exceedingly high numbers?

[Mr Lansley]

We can do a number of things. For example, the Department has funded TB Alert, which is the UK’s national TB charity, to raise awareness of TB among public and primary health care professionals, which will help. In London, we have supported a find-and-treat outreach service. In a similar vein, that could happen in cities where there is a rising prevalence of TB. TB is not general across the country, but likely to occur in particular areas. Those kind of initiatives enable us to identify TB outbreaks, and we can then structure services around that.

[Penny Mordaunt (Portsmouth North) (Con)]

8. What assessment he has made of the merits of steps to increase the standard of end-of-life care in an acute setting; and if he will make a statement.

--- Later in debate ---

[Mr David Blunkett (Sheffield, Brightside and Hillsborough) (Lab)]

10. What decisions he has reached in respect of additional funding for the purpose of the tariff applying to specialist children’s hospitals.

[The Secretary of State for Health (Mr Andrew Lansley)]

Following a very constructive meeting with the specialist children’s hospitals on Friday 3 December, I am pleased to be able to tell the House that we are working on a proposal to set the top-up payment for specialised services for children at 60%, over and above tariff prices. In addition, I intend to help the trusts by extending the number of procedures that will attract the top-up payment in 2011-12. I believe that the children’s hospitals will find that entirely acceptable.

[Mr Blunkett]

I would like—uniquely—to thank the Secretary of State for signing off the technical agreement from last Friday, and to say that the specialist children’s hospitals will welcome his announcement this afternoon. Is it not time to take the uncertainty away from the children’s hospitals and have a system that allows them to put in place a forward plan that does not result in this annual farrago? Would it not also be nice to congratulate the staff of the children’s hospitals on their terrific work, not least the dedicated way in which they will be working with these children over Christmas?

[Mr Lansley]

Yes, I am very glad to do so. I have visited Sheffield children’s hospital, and I very much applaud the work that it does. I am sure that those at the hospital are grateful to the right hon. Gentleman, as I am, for the way in which he has represented their interests. I entirely agree with him: the purpose of developing the payment-by-results system is to arrive at a point where it is predictable and delivers a relevant payment, related to the costs that are genuinely incurred in the provision of that treatment. We are not in that position yet. The specialist top-up was put in place to reflect that, but I hope that it is temporary rather than permanent.

[Mr John Leech (Manchester, Withington) (LD)]

11. What progress has been made on improving the provision of specialist neuromuscular physiotherapy for people with muscular dystrophy and related neuromuscular conditions; and if he will make a statement.

--- Later in debate ---

[Gareth Johnson (Dartford) (Con)]

14. What recent assessment he has made of the adequacy of provision of IVF treatment across the country.

[The Secretary of State for Health (Mr Andrew Lansley)]

Many primary care trusts have made good progress towards meeting NICE guidance recommendations on the provision of IVF treatment. However, I am aware that a small number of PCTs with historical funding problems have temporarily suspended local NHS provision of IVF services. I have already expressed my concerns about that approach. I expect all PCTs to have regard to the current NICE guidance and to recognise fully the significant distress and impact that infertility has on people’s lives.

[Gareth Johnson]

I am grateful to my right hon. Friend for his answer. He will be aware that Robert Edwards, the British inventor of IVF treatment, is due to receive the Nobel prize this week for his work. I am sure that Professor Edwards would be dismayed that PCTs have suspended their IVF provision, so would my right hon. Friend join me in urging those PCTs that have taken that step to reconsider their decision on this important issue?

[Mr Lansley]

Yes, I am indeed aware of that, not least because the Bourn Hall clinic, where Robert Edwards and Patrick Steptoe did their groundbreaking work, is in my constituency. As a former vice-chair of the all-party infertility group, I feel strongly that the reason the NICE guidance was written as it was, way back in 2004, was to recognise both the distress and the extent of the difficulties that couples face, and the need for them to be assured not only of good-quality investigation, but of good quality follow-up provision in fertility services throughout the NHS. I urge PCTs to have regard to the NICE guidance in their commissioning decisions.

[Mr Kevin Barron (Rother Valley) (Lab)]

If this unfair situation in the commissioning of infertility services continues, and if the reconfiguration goes ahead, would it be the responsibility of the national commissioning board to address it?

[Mr Lansley]

Beyond 2012 it would indeed. The reason we are in this position is not least because when NICE produced its guidance, my predecessor, John Reid, in effect told PCTs that they should not feel obliged to have regard to it and arbitrarily changed it. It is precisely that kind of political interference with what should be a clinically-led decision about the appropriate structure of commissioning services that I am proposing to do away with.

[Chris White (Warwick and Leamington) (Con)]

15. What support his Department plans to provide for front-line services in adult social care.

--- Later in debate ---

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

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

[The Secretary of State for Health (Mr Andrew Lansley)]

My responsibility is to lead the NHS in delivering improved health outcomes in England, to lead a public health service that improves the health of the nation and reduces health inequalities and to lead the reform of adult social care, which supports and protects vulnerable people.

[Jonathan Reynolds]

The Secretary of State will be aware that primary care trusts across the country are being asked to cut between 35% and 50% from their management costs. This inevitably leads to job losses, but can he confirm that he is confident that the jobs being lost as a result of this policy are purely management roles and that there are no losses of jobs that combine some management role with front-line clinical responsibilities?

[Mr Lansley]

We have been very clear that we are asking the whole of the NHS administration—we are applying the same discipline inside the Department, to arm’s length bodies and across the whole of government—to secure a reduction by a third of real-terms administration costs over four years. In the NHS in particular, I am looking for a reduction in management costs of 45% in cash terms. By that, I mean specifically the costs of managers and senior managers. By definition, that does not include clinical staffing.

[Ian Swales (Redcar) (LD)]

T3. In the light of the recent damning report by the Care Quality Commission into Redcar and Cleveland council’s adult social care services, what steps is the Secretary of State taking to improve adult social care and will he meet me to address the issues raised in the report?

--- Later in debate ---

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

May I welcome the Secretary of State’s sensible rethink and change of mind on the funding of specialist children’s hospitals after Labour Members raised concerns during the previous Health questions? During those questions he also got his NHS funding figures in a twist, so what has he got to say about the updated inflation forecasts on page 83 of last week’s Office for Budget Responsibility report? They show that for the next four years the inflation increase will be bigger than the cash increase in the NHS—in other words, the NHS will get a real cut in funding, not a real increase. Does he accept the OBR figures? Does he accept that they are hard proof that the Government are breaking their promise to protect NHS funding?

[Mr Lansley]

Let me tell the right hon. Gentleman that it is not a change on specialist children’s hospitals. The previous Government initiated a study by York university, which reported. I made it clear, when we discussed it last, that we were examining the results of that together with the specialist children’s hospitals. We have reached what I regard, as I hope they do, as a very acceptable outcome.

The spending review gave a real-terms increase in NHS funding. That was the commitment we gave and it was set out in the spending review, and it remains true that revenue funding for the NHS continues to rise in real terms.

[John Healey]

Perhaps I should have asked the Secretary of State whether he has even seen the OBR report. Let me try to help him. The OBR’s inflation figures mean that the NHS will not get the 0.4% real increase that he bragged about and that was stated in the spending review; the NHS will get a 0.25% decrease—a cut—in funding, as has been confirmed today for me by the House of Commons Library. No wonder the Prime Minister is rattled and is asking what on earth the Health Secretary is doing with the NHS. Does the Health Secretary accept that this confirms that the coalition’s pledge to guarantee that health spending rises

“in real terms in each year of the Parliament”

is being broken? How does he explain that to the Prime Minister and how does he explain it to the public?

[Mr Lansley]

No, I do not accept that for a minute. At the spending review we set out what met our commitment. I am very clear that, as I just told the right hon. Gentleman, revenue funding for the NHS will increase in real terms. It will do so because we did not listen to the advice of the Labour party in the run-up to the spending review, which was to cut the NHS budget. We did not do that and we were committed at the spending review to an increase in real terms. The gross domestic product deflator will move from time to time, but the commitment that we set out was clear and will continue.

[Mr Speaker]

Just as the answers from the Minister of State, the hon. Member for West Chelmsford, were too long, those questions were too long as well.

--- Later in debate ---

[Michael Ellis (Northampton North) (Con)]

T6. Every day, ambulance service staff in my constituency and around the country deliver life-saving care to our constituents, but they are themselves occasionally put in harm’s way. What steps are Her Majesty’s Government taking to ensure that the protection that our ambulance staff get in my constituency and around the country is the best that we can provide?

[Mr Lansley]

I join my hon. Friend in paying tribute to the staff in ambulance service—in the current circumstances, with the winter pressures being what they are, we should especially do so. But those staff can come under particular threat from time to time and we have to prepare for all eventualities. For example, if an attack involving firearms takes place, as it did recently in Cumbria, it is possible that ambulance staff would be working alongside other emergency services in responding to it. It is only right, therefore, that they are offered as much training and equipment as possible to carry out that work.

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

T2. This morning, the Justice Secretary said that he was working with the Health Secretary on plans to divert more mentally ill offenders away from prison. I broadly welcome that, but could the Health Secretary tell us how much new money will be made available for that initiative, especially given the comments made by my right hon. Friend the Member for Wentworth and Dearne (John Healey) about the cut in the real value of health spending?

[Mr Lansley]

The right hon. Gentleman is in no position to make that point, given that his party wanted to cut the NHS budget. What my right hon. and learned Friend said this morning about our working together is indeed true. However, this is not a case of our diverting patients; it is about ensuring that people who have mental health problems are dealt with appropriately rather than there being a failure to deal with them. That applies whether they are in prison or in hospital. We are working together on that, and I know that my right hon. and learned Friend will be making a statement shortly.

[Richard Graham (Gloucester) (Con)]

T8. Can Ministers reassure me that, given the relative health deprivation in Gloucester, the ring-fenced funding promised in the White Paper on public health will in fact benefit people there?

--- Later in debate ---

[David Tredinnick (Bosworth) (Con)]

Is my right hon. Friend aware of the rally being held here in Westminster tomorrow by qualified herbalists who are coming to lobby for statutory regulation, which my right hon. Friend is obliged to provide under European law? When will he do that, please?

[Mr Lansley]

I am indeed aware of that, as my hon. Friend would expect. He will know that we are considering how we can give effect to the proper regulation of herbal practitioners and we will make an announcement shortly.

[John Mann (Bassetlaw) (Lab)]

T5. If a hospital service’s reconfiguration is demonstrably and overwhelmingly rejected by a local population, what notice will the Secretary of State take of the patients’ voice?

[Mr Lansley]

It was only under this Government, after the election, that tests were set out that such reconfigurations should meet. Those tests clearly included recognition of the voice of the public and of the local authority as well as current and prospective patient choice. To that extent, for the very first time, reconfigurations are not being dictated by an NHS administration but are responding to the views of patients and clinicians.

[Duncan Hames (Chippenham) (LD)]

The NHS Litigation Authority estimates an outstanding liability for clinical negligence claims of £15 billion, a sum that increased by £2 billion in the last year alone. How will the Minister bring that spiralling cost to the NHS to a halt?

[Mr Lansley]

I understand exactly my hon. Friend’s point. The increase in liabilities was, in part, an expression of the change in the discount rate rather than necessarily an increase in the number of cases coming through. It is a worrying figure and costs the NHS not far short of £1 billion a year through contributions to the clinical negligence scheme for trusts. My noble Friend Lord Young, in the course of his review of health and safety and other issues, made recommendations on dealing with conditional fee arrangements and clinical negligence. It set out that we would consider, for example, how we implement NHS redress arrangements, including whether there should be a fact-finding phase before any question of legal intervention. We will do that and report back to the House.

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

T7. My local hospital, Shotley Bridge hospital in Consett, has faced a degree of certainty over its future in recent years. However, with the demise of the local PCT, which owns the hospital and the land, uncertainty has returned. Is the Minister prepared to meet me and a delegation from the hospital to consider the future?

[Mr Lansley]

I am sure that I or one of my hon. Friends will be happy to meet the hon. Lady. I do not know why she thinks that the abolition of the PCT will make that change. We have yet to set out how PCT assets will be dealt with when they are abolished. She must talk to her local GPs as I know that GPs in Durham have come together in a consortium and they will be well placed to give precisely the kind of assurance about the security of services in the future that she is looking for.

[Nick de Bois (Enfield North) (Con)]

The Secretary of State will be aware that the Barnet, Enfield and Haringey clinical review has been concluded. It notes that the Secretary of State’s four tests have been passed, despite health scrutiny establishing that they have not. In addition, the majority of Enfield GPs do not support the proposals. Will the Secretary of State therefore conclude that the four tests have not been passed?

[Mr Lansley]

My hon. Friend will know that all that has not yet come to me, so I will not prejudge this issue. However, I have made it clear, not least in a letter I recently sent to Baroness Margaret Wall, who is the chair of the Barnet and Chase Farm Hospitals NHS Trust, that I expect us to examine not only the Barnet, Enfield and Haringey proposals, but any other proposals that the trust might put forward about the level of acute services provided through Chase Farm.

[Toby Perkins (Chesterfield) (Lab)]

T9. The Secretary of State seemed to suggest, in his answer to the shadow Secretary of State, that his definition of a real-terms increase includes changes in inflation. If he does not accept the Office for Budget Responsibility verdict that the increase in inflation means a real-terms cut in 2012, which definition of inflation is he using?

[Mr Lansley]

What I said to the shadow Secretary of State was entirely accurate.

[Gordon Birtwistle (Burnley) (LD)]

Does the Secretary of State agree that the abolition of unelected quangos such as primary care trusts and strategic health authorities will bring an end to the decisions they are taking to remove services from local hospitals against the wishes of GPs and local residents?

[Mr Lansley]

The reforms we propose will bring far greater accountability not only through local authorities but through patient choice and through front-line clinicians being able to commission services.

Let me also tell my hon. Friend that I have today referred to the independent reconfiguration panel, for initial appraisal, the question referred to me by Lancashire county council about the children’s ward at Burnley hospital.

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

Will the Secretary of State join me in deprecating the outrageous behaviour of the Prime Minister’s aides who told the Financial Times that the Secretary of State, on his reorganisation, has all the answers—unfortunately to all the wrong questions?

[Mr Lansley]

The hon. Gentleman should not believe what he reads in the papers and when he is trying to quote from them, he should do so accurately.

[Caroline Dinenage (Gosport) (Con)]

Blake maternity unit in Gosport is temporarily shut and its long-term future is by no means 100% secure. In conversations with local health care bosses, I have learned that it is not because of cost but because of a national shortage of midwives. Are there any policies or plans to address this issue?

[Mr Lansley]

I do not know the particular circumstances in Gosport, but I shall happily write to my hon. Friend. Nationally, we have more midwives than we have ever had—[Interruption.] I am being provoked by those on the Opposition Front Bench. There was a 16% increase in the number of live births in this country, but only a 4.5% increase in the number of midwives. That is the point I was about to make. The Government of whom the hon. Member for Halton (Derek Twigg) was a member failed to invest in midwifery when there was an increase in live births. That is why hospitals across the country have too few midwives, and that is why we are putting the investment in—because we did not listen to the Labour party when it said, “Cut the NHS budget.”

[Fiona Mactaggart (Slough) (Lab)]

Will waiting times for in-patient treatment in hospital increase or decrease next year?

[Mr Lansley]

They will respond positively to patient choice and GP referral.

[Joseph Johnson (Orpington) (Con)]

I am grateful to the Secretary of State for agreeing to visit Queen Mary’s, Sidcup, tomorrow, recognising the strength of local opinion there about the closure of accident and emergency and maternity services temporarily over the winter period. I hope that on his return he will reassure my constituents in Orpington that the closure will not mean that the review of reconfiguration of local NHS services will be prejudged and will not put neighbouring hospitals such as those in my constituency under undue pressure.

[Mr Lansley]

I am grateful. Tomorrow, I hope to assure myself, among other things, that the closure is temporarily demanded by virtue of the inability to secure enough staff to maintain a safe service for the time being and that it will not and does not pre-empt the question of availability of services at Queen Mary’s, Sidcup, on which a decision has not yet been reached locally or referred to me.

[Mr Dennis Skinner (Bolsover) (Lab)]

On the NHS campaign against obesity, does the Secretary of State welcome the magnificent support of the thousands of schoolchildren who have come down to demonstrate for school sports funding outside No. 10 Downing street? Will he fight in the Cabinet against the Education Secretary’s silly proposal, which will damage children’s health?

[Mr Lansley]

The Secretary of State for Education rightly believes in schools making decisions about how they should best use their resources, including for school sport. I hope the hon. Gentleman will welcome the fact that through my Department we have supported school sports clubs under Change4Life and intend to expand them.