Suicide Prevention

Norman Lamb Excerpts

Wednesday 6th February 2013 Commons Chamber

[The Minister of State, Department of Health (Norman Lamb)]

I shall try to behave, Mr Deputy Speaker, and to address the Chair, as you rightly instructed us to do.

We in the House of Commons frequently find ourselves at loggerheads, and common ground is often hard to come by, but we unite—as a Parliament and as a country—in lamenting the number of people who die by suicide every year. I pay tribute to the hon. Member for South Antrim (Dr McCrea) and his colleagues for selecting this issue for debate, because it is so easy to go for other less difficult issues. The hon. Gentleman has done the House a service by choosing this subject and giving it a proper airing so that we can debate it and demonstrate to the country that we are focusing on things that matter a great deal. I thank him genuinely for that.

I noted what the right hon. Member for Wythenshawe and Sale East (Paul Goggins) said about the importance of families and their role. As he said, it is important to listen to them, to understand their perspective, and to recognise what they go through. Once someone has taken his or her own life, the impact of that lost life lasts with the family for the rest of their lives. We owe it to families to listen to them, and to do better in preventing suicide.

The hon. Member for South Antrim produced the shocking statistic that 1 million lives are lost globally, and told us that in many countries young people are now the highest-risk group. He also told us that males are more susceptible to suicide—both middle-aged and young men—and that suicide is the biggest single killer of men under the age of 35. That in itself is deeply concerning. We need to stop and think about the turmoil that is often associated with individuals in the lead-up to the moment when they make their decision. We have a responsibility to do all we can to address that.

The hon. Gentleman spoke of the importance of recognising the prevalence of self-harm and the disturbing trends that we are seeing. That is of real concern, and, as the hon. Gentleman said, it is a serious problem in Northern Ireland. My hon. Friend the Member for Beckenham (Bob Stewart) wondered whether it was sometimes a post-conflict issue. I know that a lot of work has been done in relation to post-traumatic stress following conflict, wherever it takes place in the world, and the risk that young men and young women may take their own lives as a result. I join others in paying tribute to organisations such as the Samaritans and Papyrus for their work in helping people at moments of real risk.

[Simon Hughes]

I think it is important to provide signposting, so that young people, from secondary school onwards, know where they can go for help. It should not necessarily lead to teachers, family or pastoral care workers, because young people may not want to share their problems with them, especially when the first signs of self-harm appear. We should also do much more to ensure that university health services provide cognitive behavioural therapies and similar services much more quickly than many are able to at present, because the lack of such services has been a real cause of crisis, tension and, indeed, increased suicide risk.

[Norman Lamb]

One of the things that I am determined to do while I am in this job is give mental health services, and access to them, the real priority that they deserve. Our first mandate to the NHS Commissioning Board gives mental health a much higher priority than it has ever had before. In establishing the principle of parity of esteem, we have asked the board to pay particular attention to access to mental health services in order to ensure that people with those problems have the rights of access that people with physical health problems have had for some time. Every life taken by suicide is one too many.

[Lady Hermon (North Down) (Ind)]

I am grateful to the Minister for taking a second intervention so soon after the first. He has rightly paid tribute to the work of the Samaritans, who undoubtedly prevent a huge number of people from taking their own lives and who do tremendous work in Northern Ireland. What public funding do groups such as the Samaritans, who do such tremendous work, receive from the Government?

[Norman Lamb]

I cannot give the hon. Lady precise figures here and now, but I will write to her and make sure she gets a full response to that legitimate point.

This debate serves as a timely reminder that suicide continues to be a major public health issue, particularly at a time of economic and employment uncertainty. The suicide rate in England is relatively low on international comparisons, and good progress has been made in reducing the rate in England over the past 10 years. That is something to be proud of, but it must not be the end of the struggle. We must be vigilant. About 4,500 people took their own lives in England alone in 2011, an increase on the previous year of about 6%. Although the three-year average suicide rate has remained steady since 2005-07, the rise in the number of people dying by suicide in 2011 is deeply worrying.

We know that suicide rates vary across the UK, and the hon. Member for South Antrim made the point that the suicide rate in Northern Ireland is higher than in England. In fact, it is the highest in the United Kingdom, and Scotland and Wales also have their own very real challenges. The coalition Government are working with the devolved Administrations to share evidence on suicide prevention and effective interventions. Suicide is still a major taboo. The hon. Gentleman highlighted the importance of our collectively speaking up about the subject. The way to reduce the number of suicides is not to comply with that taboo and keep it under wraps; on the contrary, we must tackle the problem and the surrounding issues head on.

We published a new suicide prevention strategy for England in September last year. It was written to help to reduce the suicide rate and it prioritises the importance of supporting families, so that those who are worried about a loved one know where to go for help, and supporting those who are bereaved as a result of suicide. They must receive help. There are excellent organisations such as Cruse Bereavement Care—I should declare an interest as my wife works for it—that provide support for people who are bereaved.

The strategy is backed up by up to £1.5 million for research, and it highlights the importance of helping the groups at highest risk of suicide by targeting interventions in the right way and at the right time. In-patient services are getting better at that. The most recent national confidential inquiry into suicide and homicide shows that the long-term downward trend in patient suicides continues.

Giving greater priority to mental health services is also critical. We are championing parity of esteem for physical and mental health, and through our improving access to psychological therapies—IAPT—schemes we are treating more people than ever before for mental health problems. Through the Government’s NHS mandate, we have gone much further than ever before in emphasising the priority the NHS must give to mental health. The mandate also makes specific reference to the need for mental health services to seek to reduce the suicide rate among users of their services, although I take on board the point made by the hon. Member for Bridgend (Mrs Moon): we must also be acutely aware that many people—I think she gave the figure of 75%—who take their own lives are not known to the statutory services. It is very important that the statutory services do everything they can, but that is not the whole problem; there is a very significant issue beyond that.

We also need to make sure there is enough information about treatment and support, and that it is freely available to those who need it, including those who are suffering bereavement following a suicide. A lot of that planning and work will happen locally, with local agencies deciding on how best to reduce the suicide rate and support families. Our recent strategy is not an instruction manual; it is more a tool to support local agencies in working out what is needed.

Suicide prevention will also be a priority for the new public health system. The public health outcomes framework has the suicide rate as an indicator. That is a horrible piece of jargon, but this project addresses what outcomes and results the whole system is trying to achieve, and one of them is the need to reduce the suicide rate. A shared indicator with the NHS outcomes framework also focuses on reducing the number of premature deaths of people with serious mental illness—such deaths also, of course, include suicides.

We are tackling stigma in relation to mental health, which the hon. Member for South Antrim rightly mentioned, with the brilliant Time to Change programme led by the charities Mind and Rethink Mental Illness, which is designed to reduce stigma and break isolation. A few months ago, we had a brilliant debate in this House when Members talked about their own experiences of mental health. That, in itself, was very important in bringing the issue out into the open and recognising that successful people, as well as many others, suffer from mental health problems and it is nothing to be ashamed of.

Children and young people have an important place in the new suicide prevention strategy. The suicide rate among teenagers is below that in the overall population, but that does not mean it is not a problem. For example, suicide is still the most common cause of death in young men, as I mentioned earlier. In addition, about half of mental health problems begin to emerge by the age of 14.

[Bob Stewart]

I apologise for intervening, as the Minister was perhaps going on to deal with this matter. We have now heard four or five times that the level of suicide among young men is much higher than that among young women, but nobody has said why that might be. Is there an answer to that question?

[Norman Lamb]

I thank my hon. Friend for that intervention. I would not want to indulge in cheap speculation about that. The statistics are clear on the prevalence of suicide among young men and clear that it is significantly higher than among young women. It is important that we carry out the research, which is why the Government have also committed to that as well; it is so that we gain a better understanding.

[Mrs Moon]

The Minister will be aware that research suggests that women and young girls are less vulnerable to suicide because they are help seekers, whereas young men are not and they will not articulate the problems they are facing. That is the major difference. Women and girls will go to their friends and talk about their problems, whereas men bottle things up so that they grow and grow and they can no longer manage them.

[Norman Lamb]

I thank the hon. Lady for that helpful intervention. What she says makes sense and I am most grateful to her for coming to my rescue on that—

[Several hon. Members]

rose—

[Norman Lamb]

More people are coming to my rescue.

[Simon Hughes]

I am always ready to try to rescue, but on this occasion that was not necessary. If sufficient research does not exist on the extent to which people know where to access services, it would be really helpful if the Minister worked with local government and the health and wellbeing boards to try to ensure that such research was carried out. I have a strong feeling that lots of young people, including young men, do not yet know where to go. If they did know, there would be a much better chance that they would do something about their problems and not keep them all inside, with the worst consequences.

[Norman Lamb]

I am grateful to my right hon. Friend for that intervention, and he is right to say that ensuring that youngsters know exactly where to go to find help is really important. Gaining a better understanding of that must be a priority.

[Mr Nigel Dodds (Belfast North) (DUP)]

I wish to support the point made by the hon. Member for Bridgend (Mrs Moon) a moment ago about the reasons why suicide is more prevalent among men. It was backed up for me by a recent piece of work carried out in my constituency that showed it is much more difficult to get young and middle-aged men to visit a GP or confide in someone about their health problems than to get women to do the same. The work showed exactly the same problem: a lack of willingness to seek out help early enough. That is a major problem and it needs to be dealt with by more education and information, particularly for young men.

[Norman Lamb]

I thank the right hon. Gentleman for that constructive intervention, and he is absolutely right.

The suicide prevention strategy also recognises that the media have a significant influence on what children do and think. As well as promoting responsible reporting in the media, the strategy emphasises the importance of working with the industry to tackle websites that encourage suicide. That is, in a sense, at the heart of the motion and of the points raised by the hon. Member for South Antrim.

Misuse of the internet to encourage vulnerable people to take their own lives is utterly wrong. It is deeply worrying that young people can easily be exposed to such pernicious material, but we should not dismiss the internet as a source only of harmful material. It also provides an opportunity to reach out to vulnerable people who might otherwise refuse support or information, including those young men who might not come forward. It is worth remembering that when used well the internet can be an incredibly valuable way of helping vulnerable people.

Only last week, I convened a meeting bringing together internet security companies, charities and Departments to explore how to protect children and young people from harmful suicide-related internet content. The industry representatives at the meeting told me about some of the good work they are already doing. For instance, McAfee informed me that it has valuable learning to share from its work with the Australian Government on an online safety campaign in schools. I think my right hon. Friend the Member for Bermondsey and Old Southwark (Simon Hughes) will be interested to hear about that. McAfee has campaigned to get the message out to schools in Australia so that youngsters have information about how to seek help. There is a lot we can learn from that.

At that meeting—

[Lady Hermon]

I am grateful to the Minister for giving way; it was terribly rude of me to interrupt and I apologise. Will he reassure us that when he convened that critical meeting with those who provide internet services, representatives from the devolved Administrations and from the Health Departments in Northern Ireland and Scotland were invited to attend? When we debate the United Kingdom, even though we have a devolved Administration in Northern Ireland I like to know, as someone who feels passionately about remaining in the United Kingdom, that we have joined-up government.

[Norman Lamb]

I am very grateful to the hon. Lady for her intervention. Those representatives were not invited to the meeting, but let me make a clear commitment that we will work with the devolved Administrations. I mentioned that earlier and it is in all our interests that we tackle the problem together.

At that meeting, I urged the security companies, such as McAfee and Symantec, to work collaboratively with interest groups who were present, such as Samaritans and BeatBullying, and internet service providers to sign up to a concordat that would help to speed up the process for reporting harmful content and the blocking of harmful websites. They gave me positive assurances that they would explore such a concordat, and in turn we as a Government would be willing to facilitate and support such an initiative however we can.

The UK Council for Child Internet Safety is already making parental controls more accessible so that children can access less harmful content. The Under-Secretary of State for Education, my hon. Friend the Member for Crewe and Nantwich (Mr Timpson), who is the Minister responsible for children and families, will explain more about the work his Department has been doing when he sums up.

As I said at the outset, this is one of the issues that unite us all.

[Tracey Crouch]

I thank the Minister for giving way, as he has been very generous in doing so. We have heard that there are a host of reasons why people are driven to suicide, one of which is alcohol dependency. Is the suicide prevention strategy working alongside the alcohol strategy so that there is a holistic, joined-up approach to dealing with some of these complex issues?

[Norman Lamb]

Yes, very much so. I am grateful to my hon. Friend for her intervention. In each area in England, the health and wellbeing boards will be able to co-ordinate all that work. In considering their strategic needs assessments, they will be able to identify issues relating to suicide and alcohol and drug dependency.

I hope that I have satisfied the House that the Government take suicide extremely seriously indeed and that we are taking real action to help. I am grateful to the hon. Member for South Antrim for bringing the matter to the House’s attention.

Epilepsy

Norman Lamb Excerpts

Tuesday 29th January 2013 Commons Chamber

[The Minister of State, Department of Health (Norman Lamb)]

I think I must have broken the record for the time it takes to get from Committee Room 11 to the Chamber. It took under a minute, even though I bumped into our Chief Whip on a staircase and came off worse.

I congratulate the hon. Member for Vauxhall (Kate Hoey) on securing this important debate and on setting out the issues so clearly. I also thank hon. Members for their valuable interventions, which have been helpful. Occasions such as this are valuable because they expose to public attention issues that do not get debated enough in this place. They also force Ministers to think about particular conditions and their consequences. If I do not have ready answers to all of the issues that the hon. Lady has raised, I would be very happy to write to her to ensure that everything gets a proper and full response.

By way of introduction, I join the hon. Lady in paying tribute to Epilepsy Action for its work and the excellent report it has produced. It is great that we have this opportunity to highlight the issues that it has raised. She referred to the low level of engagement at the local level. She pointed out that there is good practice in many areas, but that there are also too many places where not enough is being done. In a sense, the thing that causes frustration is also the prize: the fact that we know that if we do things better we can improve the lives of people so much. That is a great prize to be secured. Along with Epilepsy Action, the Joint Epilepsy Council, which is the overarching group, also does very important work.

I should also mention that I met representatives of Epilepsy Bereaved before Christmas to discuss sudden, unexpected death resulting from epilepsy, and I found it an incredibly useful session. I learned a lot about the extent to which, through better care, we could significantly reduce the number of people who die in such circumstances. It is, therefore, incumbent on the whole NHS to ensure that we raise the level of care to the standard of the best. If we can do that, we will make a real difference.

I was concerned to hear the hon. Lady say that mortality in epilepsy is rising. Given that we know that if we do the right things we can significantly reduce mortality, that is a real concern. Epilepsy Bereaved made the case for a national register of deaths, which I strongly supported when I met its representatives. It would be a good innovation, because we need to understand much more why things are happening and where failures have occurred.

Epilepsy is the most common serious neurological condition and it affects almost 500,000 people in the United Kingdom alone. Each year a typical GP will treat 10 people with epilepsy, diagnose one or two new cases and care for 20 people who have had seizures in the past but who are currently not in treatment.

The hon. Lady mentioned Jemma, who had spoken at the launch of the report about her experience of good primary care and about the difference that it makes to have a doctor who shows an interest and understands. When one hears stories directly from such individuals, it is so much more powerful.

I should also mention the hon. Lady’s constituent, Ashleah Skinner, who sounds like a true expert patient. The more that we can spread such understanding and allow people to self-care more effectively, the better.

[Bob Stewart]

If we know pretty accurately the number of people who are suffering from epilepsy in our country, would it be crass or wrong for the Government to write to each of those individuals to ensure that they know exactly what they can do to improve their circumstances and for what benefits they might be eligible? Perhaps that is happening already. If it is, forgive my intervention.

[Norman Lamb]

I am very grateful to my hon. Friend for that intervention. Whether it is provided by the Government or at a local level by primary care general practices, he is right to highlight the importance of much better guidance on how people can self-care. The role of expert patients can also be powerful. It can be of great value to somebody who is diagnosed with epilepsy to get guidance and support from somebody who already has the condition.

I am aware of the historical problems in this area and acknowledge that the services have not always been good enough for those living with epilepsy. Indeed, I acknowledge that the services are still not good enough in some parts of the country. There was some uncertainty, and perhaps some scepticism, over whether the coalition Government’s reforms would deliver the improvements that were so desperately sought. That was understandable, given that epilepsy has rarely found itself in the same starting position as other long-term conditions.

I am pleased to report that the Department of Health has taken a number of steps recently to improve the diagnosis and treatment of epilepsy. It will work with the NHS Commissioning Board, which takes on its full responsibilities from April, to drive further improvements for those living with the condition.

[Laura Sandys]

As the Minister rightly recognises, epilepsy has been a Cinderella condition. It has been ignored and has not received the profile that the numbers warrant. He is saying that there will be a step change in how the Department looks at the condition. Will he ensure that there is an understanding of what outputs we expect and that there are barometers to measure them, particularly given that the report states that only a third of commissioners currently put in place programmes for people with epilepsy?

[Norman Lamb]

I am very grateful to my hon. Friend. Clearly, the role of the Commissioning Board will be central in holding clinical commissioning groups to account. The register that Epilepsy Bereaved is calling for could, combined with action from the Commissioning Board, be powerful in helping us to understand more about the condition and in driving better practice.

I understand that there are no specific tests for epilepsy and that it can be difficult to diagnose. The hon. Member for Vauxhall talked about the problem of mis-diagnosis. Some people are diagnosed as having epilepsy who do not have it, and some people who have epilepsy are diagnosed as having a different condition. Such mistakes result in poor or substandard care. Increasing the awareness of the condition among health care professionals is a key factor in improving its early diagnosis and treatment. Detailed advice on epilepsy has therefore been made available on the NHS Evidence website. That is supported by the updated clinical guideline on the diagnosis and management of the condition that was published last year by the National Institute for Health and Clinical Excellence.

The treatment of long-term conditions is one of the NHS areas prioritised by the Secretary of State for Health, and it has featured prominently in the mandate to the NHS Commissioning Board and the NHS outcomes frameworks. The hon. Member for Vauxhall mentioned the awful jargon with which we all have to deal. I have my own personal war against jargon in the Department of Health, confronted with it as I am on a daily basis. As a quick aside—given that we have a bit more time than usual—we need to use language that people understand, rather than jargon that too often excludes people.

The mandate and outcomes framework set out the Government’s objectives for the NHS, and highlight the areas where we expect to see the biggest improvements. The mandate sets an objective for everyone with a long-term condition to be offered a personalised care plan by 2015 that reflects their preferences and agreed decisions. There is a legal requirement for the Commissioning Board to seek to meet the terms of the mandate, and it is potentially powerful to say that everyone with a long-term condition should have a personal care plan that they have been involved in designing and drawing up. Too often, whether for epilepsy or mental health—another area I have great interest in—people simply do not have such a plan and have never been asked for their views on their care and treatment. If we can effect the transition so that everyone with a long-term condition benefits from it, we can make a real difference. Epilepsy Action and other voluntary sector organisations have been requesting such a plan for some time now, and it should be seen as a positive step.

The NHS Commissioning Board has responded to the mandate and the outcomes framework by incorporating long-term conditions into the structure of the organisation with

“enhancing the quality of life for people with long-term conditions”

as one of its five areas of focus. Strong national leadership for epilepsy services has been raised time and again in the House, and I am pleased to announce that, as part of this work, the NHS Commissioning Board is appointing a national clinical director for chronic disability. They will not deal specifically with epilepsy, but having such a director for chronic disability, including epilepsy, is a positive step.

The NHS Commissioning Board is setting up four strategic clinical networks, which is important. We have seen the benefit of such networks with cancer, and those benefits are now being spread to other areas, including neurological disorders. The networks bring together groups of health professionals to improve services for neurological disorders and other specific conditions. They will receive an investment of £42 million and play an important part in driving up quality and consistency in treating those conditions. If everyone within the service is linked into expert networks, the chances of improving treatment on the ground become greater. Health and well-being boards will play an important role in driving up standards locally, given their role in agreeing local priorities and influencing commissioning decisions.

This year will see the publication by NICE of new quality standards for children and adults with epilepsy—that has been called for repeatedly in this House. Those quality standards, which are expected to be published in February and March, will help clinicians make informed decisions about referrals, tests and ongoing care, and ensure a more consistent application of NICE guidelines in that area.

The Department also understands the importance of providing the best possible information to people with epilepsy and promoting better self-care—the point correctly raised by my hon. Friend the Member for Beckenham (Bob Stewart). GPs have an important role to play in that, and in ensuring that those living with epilepsy have their condition kept under control with correct medication. Ultimately, however, responsibility for self-care lies not with health professionals, but with patients. Through NHS Choices, the expert patients programme, and support from health professionals and voluntary sector groups, people with epilepsy can receive the information they need to stay safe and independent, and to manage their condition on a day-to-day basis.

On the wider Government response, the hon. Member for Vauxhall referred to the role of education and schools. I understand that the Department for Education is working to support children and young people with epilepsy, as some are not reaching their full potential in school and further education. For example, the Department has issued guidance to schools on how best to manage medicines for pupils diagnosed with epilepsy and other conditions. For those pupils who cannot attend school because of their condition, the Department has provided guidance on what alternative provision should be made.

In addition, the forthcoming children and families Bill will introduce a duty on local authorities and clinical commissioning groups to commission services jointly—a much more integrated approach than we had in the past—to meet the needs of young people with special educational needs and disability, including those with epilepsy. The Bill will introduce a streamlined, single assessment for the young person. It will also inform an education, health and care plan for the individual. The plan will enable families and young people to buy services through direct payments—we are putting the individuals in charge and giving them real power—thus extending their choice and control. That approach is currently being piloted across 20 pathfinder sites. I understand that the lessons learned will inform the development of secondary legislation and codes of practice, and help with implementation.

For many adults with epilepsy, employment is a major quality-of-life issue—the hon. Lady rightly raised the importance of employment. Studies have shown that people with epilepsy are up to twice as likely as people without the condition to be at risk of unemployment or under-employment relative to their skills and experience. The Department for Work and Pensions has confirmed that, although it does not target employment programmes exclusively at individuals with particular conditions, its programmes, including specialist disability employment programmes, aim to identify and meet the needs of the individual, including those with epilepsy.

The Department for Work and Pensions also recognises the important role that cash benefits can play in supporting people with a disability or long-term condition to remain independent. Entitlement to disability living allowance, and to its planned replacement, the personal independence payment, is not based on a specific health condition. However, my understanding is that people with epilepsy may be eligible for support, depending on the severity of their condition. The hon. Lady mentioned the Atos-conducted work capability assessments and made the legitimate point that they should concentrate on the individual. We can have guidelines to help to steer assessors, but the individual’s needs should be properly and fully assessed. That is outside my departmental responsibilities, so I will refer her remarks to the right place.

The Department for Work and Pensions has advised that, throughout the development of the new personal independence payments policy, it has engaged and consulted with a wide range of disability organisations. That includes a discussion with Epilepsy Action on the assessment criteria for the new policy. For those who face barriers to work because of their condition, financial support may also be available under the employment and support allowance—that, too, is subject to eligibility.

I should refer to some of the hon. Lady’s specific questions—I will ensure I give her a full reply later. She mentioned bus passes. I understand that some local authorities in England have implemented their own bus pass concessions and extended the hours of free travel to include peak times, but the majority have not. Ultimately this has to be a matter for local decision making. I recognise that such variations are not ideal, but the local authority has the power to do this, and pressure can be put on the local authority in any particular area to do what others have already done.

I was slightly confused because the hon. Lady referred to both the National Audit Office and the Audit Commission. The point is that we should focus on the important issue. She argued the case for some sort of inquiry into epilepsy care to see where we can improve its quality. The right approach is probably through the work that NICE is doing. If we can establish what good care looks like, we can encourage all clinical commissioning groups to seek to deliver that quality of care.

The hon. Lady also talked about outcome indicators, and I will look at that and come back to her. We need to try to understand the jargon, but the important point is that we should, as far as possible, be seeking to focus on the results for individuals. Too often in the past we have focused on processes and not enough on what we seek to achieve through health care. If we can, through the outcomes framework, identify things that we are seeking to achieve for patients—improving their quality of life—and that can then drive the system, that would be a good thing. We will look specifically at that.

The hon. Lady talked about the constitution and the right of involvement. We have been updating the constitution and putting patients’ rights much more centre stage—focusing on the personal rather than a more paternalistic approach. That is the right approach, and through the combination of what the constitution will say with what the mandate will require of the NHS in providing the personalised care plan—with the involvement of the individual and based on their priorities, not just presented to them—we can make real progress in putting the patient centre stage.

The hon. Lady talked about the lack of engagement of CCGs. That point has been heard, and it is good that she has had this opportunity to make the point. The Commissioning Board will do what it can to ensure that the quality of care is improved at local level, and it will be the board’s responsibility to engage with CCGs on that.

The hon. Lady also mentioned children and the fact that they are not achieving their full potential. I think that I have addressed that point already, but I will come back to her if I have missed anything. She and others referred to the absolute importance of a speedy referral from GP to specialist, and the hon. Member for Walsall South (Valerie Vaz) also mentioned the action plan for children in schools. She is right to raise both those issues, which were addressed in her ten-minute rule Bill.

I hope that I have addressed the key issues that were raised in the debate and I apologise if I have missed any. I thank the hon. Member for Vauxhall for introducing this debate, which has given me an important opportunity to highlight some key concerns, as well as the fact that much work remains to be done to improve the quality of care across the country. The Government are working to support people with epilepsy and to keep those living with the condition as safe and independent as possible.

Question put and agreed to.

Progressive Supranuclear Palsy

Norman Lamb Excerpts

Wednesday 23rd January 2013 Westminster Hall

[The Minister of State, Department of Health (Norman Lamb)]

It is a pleasure to serve under your chairmanship, Mr Bayley, and I congratulate my hon. Friend the Member for South Northamptonshire (Andrea Leadsom) on securing the debate.

A great value of these Westminster Hall debates is that, on something such as this, Ministers are forced to think about a specific issue that might not otherwise come across the radar and to devote some time and attention to it. They also get officials thinking about things as well, so I am grateful to the hon. Lady for securing the debate and for speaking so clearly and passionately about it. I know that she is a patron of the PSP Association, and I welcome anyone here who is from the association or associated with it in any way. It is so good to have you present this afternoon.

I join my hon. Friend in paying tribute to the work of the association. She described the support that it can give families who have a loved one with this condition. For those individuals, it is a lifeline of critical importance. The great value that disease-specific organisations can provide is in this real attention to detail and an understanding of the condition that the statutory services often cannot offer. Their role in supplementing the formal NHS is therefore of critical value. I pay warm tribute to the work that they undertake.

My hon. Friend mentioned Lord Coe. It is great to have someone such as him as an advocate for the condition and for the PSP Association. It was an extraordinary and unhappy chance that his own mother ended up with the condition and died from it. I should also, of course, pay tribute to the work of Brigadier Koe, who clearly has made a big impact in advancing the cause of better care and treatment of people with this condition.

Voluntary sector organisations will have a crucial role to play, offering their expertise, as in the care pathway guide that I know the PSP Association has pioneered. The expertise of such organisations will be invaluable locally to clinical commissioning groups, to which my hon. Friend referred, and the new health and wellbeing boards, which will be a crucial local forum for discussion of a range of conditions, including rare conditions. Such organisations will also offer their expertise at national level to the NHS Commissioning Board, the National Institute for Health and Clinical Excellence and others.

The Neurological Alliance is the collective voice of more than 80 brain and spine charities and, through its national leadership group and network of regional alliances, is an influential player in this field. I understand that the PSP Association is a member of the alliance and I would encourage it to feed into the alliance’s work as a means of getting its voice heard. That is clearly a very important route.

I turn to the question of research. With no cure as of now, research offers a source of hope for those living with PSP. The Department of Health funds NHS research and development through the National Institute for Health Research. In addition, the Medical Research Council funds a broad portfolio of medical research. Neither the NIHR nor the MRC usually ring-fences funds for expenditure on particular topics. Research proposals in all areas compete for funding, based on their strength as a proposal. Both organisations welcome applications for research into any aspect of human health. Those are subject to peer review and judged in an open competition, with awards being made on the basis of the scientific quality of the proposals made. The principle that decisions on individual research proposals are best taken by researchers through peer review is a cornerstone of science funding in the UK and is strongly supported by the coalition Government. Such decisions are rightly left to those best placed to evaluate the scientific quality, excellence and likely impact of the proposals under consideration.

My hon. Friend asked how people with PSP would benefit in April this year, when our new health and care reforms take effect. Through our reforms, we are aiming to ensure that, as far as possible, people with conditions such as PSP can maintain or enhance their quality of life. This Government are committed to providing the best possible quality of care for people with rare conditions. When we took office in 2010, we endorsed the right in the NHS constitution that says that no one should be left behind just because of the rarity of their condition. I recognise that there is often a problem within health services of a lack of knowledge among the clinicians themselves. I think that point was made in an intervention. It is always a challenge to ensure that we spread understanding and awareness.

From April 2013, the NHS Commissioning Board will directly commission services for people with rare conditions on a national basis. Those new arrangements for commissioning will bring real benefits to people with rare conditions such as PSP. By commissioning these services just once rather than reinventing the wheel all over the country, we will be able to avoid duplication in planning and ensure that the highest level of care is commissioned for patients, regardless of their geographical location. With rare conditions, that is the best way to ensure that there is a real concentration of expertise, so as to ensure that commissioning is carried out in the best possible way.

The NHS Commissioning Board will host four new strategic clinical networks for up to five years, including a clinical network covering mental health, dementia and neurological conditions. These clinical networks are potentially of enormous value. We have seen the value of them in treating cancer and other conditions. Now there is the potential for benefits to be gained in the treatment of neurological conditions. Through this particular network for mental health, dementia and neurological conditions, the board itself and clinical commissioning groups will have access to a broad range of expert clinical advice to inform decisions about the way that care for local populations is planned and delivered.

Through quality standards developed by the National Institute for Health and Clinical Excellence, commissioners, clinicians and providers of services will have evidence-based descriptions of what good care and support should look like. We have asked NICE to develop a quality standard on relatively uncommon neurological conditions, as part of a library of approximately 180 NHS quality standards. In addition, people with PSP will also benefit from the cross-cutting quality standards, which have already been published and which cover end-of-life care and patient experience in adult NHS services, the point being that a number of these standards are applicable across a range of different conditions. So people with PSP will also benefit from the quality standard on long-term conditions and people with co-morbidities and complex needs, which we have also referred to NICE for development.

My hon. Friend also discussed the importance of the patient voice within the local health system. That is of critical importance. As we move away from a paternalistic health system to a personal health system, listening to what the patient actually wants and what their priorities are will be vital. The theme of patient empowerment and voice is central to our health and care reforms, and local HealthWatch organisations—together with their national body, HealthWatch England—will champion patient voice in the health and care system.

I should also mention that in the mandate, which is the Government’s statement of our priorities for the NHS and which the NHS Commissioning Board is legally obliged to seek to implement, there is a specific requirement for people with long-term conditions to have a personal care plan, and they themselves will be involved in the preparation of that plan. That happens in places already, but it does not happen uniformly, and we must make it the norm rather than the exception. We have to absolutely recognise that everything must be focused on the patient’s interests in shaping the system to deliver that care.

Consequently I encourage those with PSP to feed their views into local HealthWatch organisations—the local patient voice—which formally take up their responsibilities on 1 April. Local HealthWatch organisations will have a seat on the new health and wellbeing boards, and through that they will be able to ensure that patient and public views are represented and can help to shape local health and care services.

I turn now to end-of-life care. My hon. Friend also spoke about the importance of palliative care. As she described, rapidly advancing diseases such as PSP may require palliative care throughout the progression of the disease, in order to support patients, as they face a declining physical and mental state, and their families. We know that the current system of care does not work well enough. Some patients receive excellent care and their families receive excellent support, while others miss out. This is partly a reflection of the origins of specialist palliative care as a discipline in the care of people with cancer, and that remains the main focus of palliative care services, but those services must be appropriate for all conditions, obviously including PSP.

We have highlighted the need to extend services to those with other conditions or diseases. The end-of-life care strategy aims to improve care for people approaching the end of life whatever their diagnosis and wherever they are, including enabling more people to be cared for and to die at home, if they wish. About 50% of people still die in hospital, although most people want to be able to die at home if that is possible, and we must ensure that their interests and priorities are respected in that regard. The National End of Life Care Programme has developed an end-of-life care pathway for neurological conditions, working with the Neurological Alliance and the National Council for Palliative Care. The pathway, which was published in 2010, sets out a framework to support the provision of improved care for that group, including those with PSP.

We are committed to increasing awareness of rare conditions—a point made by my hon. Friend in her speech—including PSP. That commitment has been demonstrated through the development of the UK plan for rare diseases. The plan will bring together a number of recommendations designed to improve the co-ordination of care and to lead to better outcomes for everyone with a rare disease, including people with PSP. We have consulted on the rare disease plan, and we published a summary of the consultation responses in November last year. Work is on track to produce the plan by the end of this year, which will help people with PSP and many others with rare conditions.

My hon. Friend also focused on education and training. Our doctors and other staff across the NHS receive some of the best training in the world, and as my hon. Friend recognises, it is important for that to include the right information and techniques to alert them to the possible presence of a rare disease when a patient presents to them. We must recognise that PSP is a rare condition, one among the hundreds that a health professional may see during their career, and it may not be feasible or practical to draw particular attention to it above all those other conditions. That said, we recognise the difficulties and, as part of our consultation on the UK rare diseases plan, we invited ideas on what more can be done to train doctors in the identification of rare diseases and on whether there are innovative ways of familiarising health professionals with rare diseases in their professional training. Furthermore, the consultation identified that training for all NHS staff to raise wider awareness and understanding of rare diseases was also important in promoting equality and in combating the stigma and discrimination sometimes associated with such diseases.

I entirely agree with my hon. Friend when she drew attention to the vital role that carers play in supporting people with conditions such as PSP. Between 2011 and 2015, the Department is providing the NHS with an additional £400 million to support individuals in their role as carers. The “Recognised, valued and supported: next steps for the Carers Strategy” document sets out Government priorities in the area, reinforced in the 2012-13 NHS operating framework, which sets out the priorities for that year.

My hon. Friend described the labyrinth that people with conditions and their carers often find themselves trying to negotiate. One aspect of the reform legislation, which I very much welcome, is the focus on integrated care. Too often, carers are in silos, and people are pushed from pillar to post. They can so easily fall into the gap. If we can develop a much more integrated approach to support people with a rare condition such as PSP, with clinicians at primary and secondary level working together much more closely, everyone would benefit.

I am grateful to my hon. Friend for raising the issue. As I said, the value of this debate is to draw the matter to Ministers’ attention and to obtain a wider airing for and focus on such conditions which would not otherwise be the case. I am happy to continue to engage with my hon. Friend to ensure that people with PSP receive the treatment and care that they deserve.

Question put and agreed to.

Dementia Services (Gloucestershire)

Norman Lamb Excerpts

Tuesday 22nd January 2013 Westminster Hall

[The Minister of State, Department of Health (Norman Lamb)]

It is a pleasure to serve under your chairmanship, Mr Robertson.

I congratulate my hon. Friend the Member for Gloucester (Richard Graham) on securing the debate and on speaking about his family’s experience—about his mother’s experience of having dementia, and about the role his father played caring for her and the strength that he gained when the moment arose to cope and get through it. My hon. Friend’s speech was moving, if somewhat breathless at the start—it was excellent to see him arriving in the Chamber just in time.

My hon. Friend is committed to ensuring that his constituents have access to high-quality care whenever and wherever they need it. He has demonstrated his commitment through his work as a member of the all-party group on dementia, which does really good work to raise awareness of the condition in Parliament and beyond.

We know that some 800,000 people in the UK have dementia, and that number is expected to double over the next 30 years. The consequences of that growth will be substantial, so we must recognise the scale of the challenge that we face. The Government are committed to meeting that significant challenge by providing high-quality care for people with dementia combined, crucially, with strong support for carers.

My hon. Friend talked about the role of carers, and we often have to stop and remember the impact on a loved one of someone getting dementia and then having that loss of recognition. We must understand how distressing it can be for someone to cope with that, and sometimes with changing and challenging behaviour, when they may have been married for a long time. We owe an enormous debt of gratitude to the army of carers who continue to give their care, love and support, sometimes under difficult circumstances. We will transform dementia services, achieve better awareness of the condition, and offer high-quality treatment at every stage and in every setting.

I will not go over much of the ground that I covered in last week’s debate because I know that my hon. Friend is well versed in many of the things we have achieved nationally. I should recognise the fact that some good work started under the previous Government, who produced one of the first dementia strategies in the world. The work that we are doing means that we are one of the leading countries on this but, as my hon. Friend said, we must recognise that there is much more to do.

My hon. Friend will be conscious of the dementia challenge that the Prime Minister announced last March, but an awful lot has happened since then. For example, we have set aside £54 million for the NHS to support dementia diagnosis in hospitals. We have asked local areas, through the NHS mandate, to set ambitious targets for improved dementia diagnosis over the next two years. Each area must understand its position on undiagnosed cases and set about dealing with the gap.

We have set aside a further £50 million to make health and care environments more dementia-friendly. We have launched a national advertising campaign to raise awareness, to reduce the stigma attached to dementia and to encourage people to contact their GP if they experience symptoms of dementia. Such contact often involves having that first, difficult conversation with a loved one about the need to see their GP to explore whether there might be dementia.

[Jim Shannon]

Does the Minister feel that lessons could be learned from the other regions of the United Kingdom, such as Northern Ireland, where a clear dementia care plan and strategy are in place? If the lessons learned there are beneficial for Gloucestershire and other parts of the United Kingdom, why should we not exchange information?

[Norman Lamb]

I think that the hon. Gentleman said in his earlier intervention that the diagnosis rate is quite good in Northern Ireland. I applaud the work that is done there, but the support services might not be as good as in some parts of England, Wales and Scotland. We are learning about these things together, and there must be close collaboration between England, Northern Ireland, Wales and Scotland. Scotland has done good work to achieve high diagnosis rates. It has also introduced the concept of dementia advisers, which my hon. Friend the Member for Gloucester talked about in relation to his county. We need to be willing to learn from anywhere and, critically, not to reinvent the wheel, so I am absolutely up for collaboration with colleagues in Northern Ireland. Just a week ago, the Secretary of State announced a year of dementia awareness to improve understanding of the condition and diagnosis rates nationally.

Let me deal with research. My hon. Friend the Member for Gloucester said that the Government are doubling the amount we spend on research, although it must be said that that is coming from quite a low base, compared with other conditions. One of the difficulties is that we cannot just make a massive increase to the amount that we spend, because building the research community’s capacity to do the work has to happen hand in hand with any increase.

There were several things I was unable to cover in detail during the recent debate granted by Backbench Business Committee because we ran out of time—my hon. Friend was a victim of that. One of them was research, on which we have genuine cause for optimism. A lot of the media narrative has been about high-profile failures of research, but there is positive and encouraging news out there.

Before I give some examples of that, however, I should mention one thing. My hon. Friend talked about the importance of the scientific community and the Government collaborating closely to meet the challenge we face. Last autumn, I spoke at a conference that brought scientists from not just the UK, but around the world, together with the Government and interest groups, such as charities that campaign on this issue. Such a useful gathering is a way of bringing the best brains to bear on this subject, so that collaborative work must continue.

On 21 December, the Government made £22 million available to 21 pioneering research projects to boost dementia diagnosis rates and to trial groundbreaking treatments. The funding was designed to cover all areas of scientific activity that are relevant to dementia across the fields of care, cause and cure, including prevention. For example, we can do a lot to prevent the condition of vascular dementia from ever starting, so if prevention is possible, we must be much smarter. We have also provided £36 million for a new National Institute for Health Research dementia research collaboration to work on better treatments and care for, and understanding of, the condition, as well as £9.6 million to expand the UK Biobank. Last year there were potentially interesting developments in treating early-stage dementia, particularly in Alzheimer’s disease.

As drug companies continue to invest in research, there is now a real prospect of a treatment within the next decade—that seems to be the time frame we are dealing with—that could have an impact on helping to slow or prevent the disorder, if it is caught early enough. For instance, there have been key recent developments from Eli Lilly, which is conducting an additional phase 3 study of a new drug for patients with mild Alzheimer’s disease. I have also heard about promising plans to expand the testing of a drug for patients with pre-dementia.

My hon. Friend rightly emphasised the importance of sharing best practice, of avoiding reinventing the wheel and of encouraging innovation, which is vital for improving dementia care. I am delighted that Gloucestershire benefited from the additional funding of £10 million from NHS South West. It is by learning from the innovative projects that he describes that we will find out what works and how we can improve services.

My hon. Friend asked me to highlight examples of best practice of people taking the lead on dementia. One involves the fire and rescue service, which has made a pledge to take action to increase the safety of people with dementia. That is a critical area, because someone living with dementia can be at risk, and the fire and rescue service can do a lot to help them to remain safe. The service has made a commitment to raising awareness among staff. Already 28 services have signed up, and I applaud them for that work. In addition, Tesco has made a commitment to increase dementia awareness and understanding among its staff and worked with the Alzheimer’s Society to produce a DVD to achieve that. The moment when a customer gets confused about change or forgets their PIN is the one when a caring and understanding approach from the checkout operator who is coping with them is particularly important. It is encouraging that companies such as Tesco are prepared to do such work.

When my hon. Friend mentioned the demographics in his constituency, that rang true for me, because my constituency, similarly, is rural with an elderly population. I am pleased that the diagnosis rate in Gloucester has risen from 40% to more than 45% in the past year but, as in many places, there is still massive room for improvement to match the best performing areas, such as Islington, where the diagnosis rate is 75%. There is an enormous gap between the best and the worst, and a long way to go. We have developed an analytical tool to support the NHS to achieve an increase in local diagnosis rates, and we are working with the Royal College of Psychiatrists to assure and improve the quality of memory services when the actual diagnosis takes place.

I join my hon. Friend in paying tribute to some of the excellent work in his area, which is in many ways mirrored by that of the Norfolk and Suffolk Dementia Alliance, which is led by an inspiring guy called Willie Cruickshank. He demonstrates the difference that can be made by bringing all parts of the system together. In his area, there is now a comprehensive, multidisciplinary memory assessment service that provides support to primary care and outreach to communities. We must ensure that we bring down waiting times, which are far too long in some areas.

Community dementia nurses and advisers are working closely with GPs throughout the country. Last week, I met a group called Uniting Carers, which is part of Dementia UK, which talked about the fantastic work of Admiral nurses in many parts of the country.

[Rebecca Harris]

Sometimes the problem for carers arises when they reach the point at which they admit that they can no longer look after their loved one who has dementia, because it can be difficult to choose the right kind of care home or environment. The gap at such a point might need to be filled by the voluntary sector or Admiral nurses, as the Minister was describing, to help people to ensure that they are putting their loved one into a suitable and dementia-friendly environment.

[Norman Lamb]

I absolutely agree, and that is a role for an Admiral nurse or equivalent, or for dementia advisers, who are now in place in Gloucestershire, my own county of Norfolk, Suffolk and other parts of the country. It is of real value if someone is able to go into the home to provide practical advice to the carer and the person with dementia.

Fantastic work is ongoing to bring district councils, volunteers and community groups together to establish a network of memory cafés. The care home support team supports staff with training, development and management guidance. There is county-wide education for carers and a carer emergency respite scheme, which provides an agreed plan of personal support to the cared-for person.

My hon. Friend the Member for Gloucester raised the important issue of ethnic minorities and faith groups. At last week’s meeting, I met an Indian woman who spoke movingly about how she and her father were cast aside by their local community once he had received a diagnosis of dementia. It is critical that stigma is challenged in all communities. She also explained how her father had reverted to his mother tongue, which further complicated his care arrangements and made a difficult situation more difficult.

I want to consider how we can give specific help to people such as that woman. There is a role for everyone in society to improve the lives of people with dementia, which includes faith, community, and black and minority ethnic groups and charities. My hon. Friend is aware of the plan to sign up 1 million dementia friends by 2015, which will have dramatic effect on spreading awareness throughout the community. All such groups have a role to play in creating the dementia-friendly communities we want to see. Only through all of society—not just government—coming together will we improve the lives of people with dementia and their carers.

Regarding my hon. Friend’s kind invitation to visit, he may be interested to know that the Secretary of State and I are between us embarking on a road show to every region in the country, involving conferences and visits, to bring people together to drive change at a local level. I will certainly pass on my hon. Friend’s suggestions to the team that is planning the visits and the south-west regional event, and I will ensure that he is kept updated.

I am encouraged by the commitment shown in Gloucestershire, as in other parts of the country, to tackle the problems that we face. I was pleased to hear that Gloucestershire county council had ring-fenced funding for social care so that money is prioritised in that most critical of areas. We are expecting an announcement soon on funding for and reform of social care, and that will start to help people to cope with dementia and the costs incurred as a result of it. Although the challenge remains great, the collaborative effort demonstrated by the NHS and its partners in Gloucestershire, including businesses, community groups and volunteers throughout the county, is showing how concrete steps can be taken to improve dementia services and to enhance the day-to-day lives of people with dementia and, crucially, their carers.

Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 15th January 2013 Commons Chamber

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

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

[The Minister of State, Department of Health (Norman Lamb)]

Age is the main driver of an individual’s need for health care, as reflected in recent funding formulae. This is for the NHS Commissioning Board, but the independent advisory committee recommends continuing to review the case for additional resources in rural areas, particularly as more information on community provision becomes available.

[Nigel Adams]

It is disappointing to hear that the NHS Commissioning Board has decided not to implement a fairer funding formula. What does the Minister suggest I say to my constituents who potentially face having services withdrawn, when, in the same region, areas such as Barnsley receive almost 30% per head more in funding?

[Norman Lamb]

As a Member of Parliament for a rural area with an elderly community I understand the hon. Gentleman’s concerns, but allocations have to be based on solid evidence. The area where we do not have the evidence is on community services. The data will start to be collected on that and we will therefore be able to demonstrate whether community services cost more in rural areas, as I suspect they do. If that is the case, the allocation formula will be able to reflect that.

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

The north-east suffers some of the worst health outcomes in the country, despite having excellent care services. On many occasions, the Government have said that they are committed to reducing health inequality, specifically in the north-east. Why then did Ian Dalton say that using the new advisory committee on resource allocation formula

“on its own would have…moved resources from areas where people…have worse health outcomes to those where people have much better outcomes”.

Does that not show that the Government have no commitment to reducing health inequalities?

[Norman Lamb]

I think the news on the allocations for public health budgets is actually a remarkably positive story. Every part of the country will see real-terms increases in funding for public health. This is an historic moment where we shift the emphasis away from repair to prevention of ill health. The hon. Lady’s own area will see real-terms increases. Across the country as a whole, there will be an average of 10.8% over two years real-terms increases in public health funding. I am very proud that the Government are doing that.

[Priti Patel (Witham) (Con)]

6. What steps he is taking to ensure that patient experience is a priority for the NHS.

--- Later in debate ---

[The Minister of State, Department of Health (Norman Lamb)]

We plan to publish our policy document on sexual health and HIV shortly. Improving sexual health is very important for individuals and communities.

[Nick Smith]

Can the Minister explain why the sexual health policy has been delayed for almost two years? Does he accept that this delay is affecting the ability of PCTs to deliver effective sexual health services?

[Norman Lamb]

From April, local authorities will be responsible for commissioning services. Because we have seen this really impressive increase in funding for public health, local authorities will have the ability to maintain and indeed improve sexual health services for their local communities. That is something of which we should be proud.

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

On the sexual health strategy, the Minister will be aware that nearly half of the national incidence of HIV is in London, so what steps will be taken from April to co-ordinate the prevention of HIV London-wide?

[Norman Lamb]

I am very much aware of the situation in London, and I acknowledge that some good work has already been undertaken there. Local authorities are very much aware of their responsibility that will apply from April and are already working with clinical commissioning groups in London to ensure that comprehensive services are in place for the London community.

[Mike Freer (Finchley and Golders Green) (Con)]

Pan-London preventive health care is important, but with the devolution of funding to local authorities, there is a great risk of them refusing to pool funds and of preventive health programmes in London collapsing. Can the Minister reassure Londoners that pan-London programmes will continue?

[Norman Lamb]

Yes, I can absolutely reassure the hon. Gentleman that there will be comprehensive services, which will cut across local authorities. We have to remember that local authorities will be under a legal responsibility to provide confidential open access to sexual health services and contraception services. Local authorities in London are aware of the need to ensure that comprehensive services are available from April this year.

[Ian Swales (Redcar) (LD)]

9. What recent assessment he has made of the number of health care appointments and operations which are postponed.

--- Later in debate ---

[The Minister of State, Department of Health (Norman Lamb)]

We published the Government’s alcohol strategy on 23 March 2012, and we are taking a comprehensive approach to reducing the incidence of alcohol-related disease and crime. Our strategy includes the introduction of a minimum unit price for alcohol, actions at local level, and pledges from industry under the responsibility deal.

[Kelvin Hopkins]

The number of UK deaths from liver cirrhosis has increased by five times since 1970, while in France, Italy and Spain it has halved, and is now lower than the number in Britain. Even more disturbing is the fact that thousands of babies are still being born every year in Britain permanently damaged by alcohol. When will the Government take urgent, effective action to deal with this crisis?

[Norman Lamb]

I entirely share the hon. Gentleman’s concern. The Government have already taken action: we set out a strategy in March last year, and we are now consulting on the introduction of a minimum alcohol price. That could save up to 700 lives a year in 10 years’ time, which would make a dramatic difference. I am sure that the hon. Gentleman supports what the Government are doing.

[Sarah Champion (Rotherham) (Lab)]

Damage to health as a result of alcohol consumption often leads to wider social damage. I have seen that at first hand when visiting shelters for the homeless in Rotherham. Many homeless people cannot gain access to rehabilitation services because they do not have GPs to refer them. What steps is the Minister taking to ensure that those services are available to everyone, especially those who need them most?

[Norman Lamb]

The hon. Lady has raised a really important point. One of the consequences of the responsibility deal is that by 2015, 1 billion units of alcohol—about 2%—will be taken out of the market, and that will help some problem drinkers significantly. Moreover, the money that the Government are investing in public health gives local authorities an opportunity to invest in prevention services in order to deal specifically with the core group of people to whom the hon. Lady has referred.

[Lorely Burt (Solihull) (LD)]

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

--- Later in debate ---

[Iain Stewart (Milton Keynes South) (Con)]

T9. Many of my constituents are concerned by the Care Quality Commission’s recent findings at Milton Keynes hospital, which came despite an increase in nursing staff since 2010. What reassurances can my right hon. Friend give my constituents that the problems are being rectified and that they will be able to enjoy high-quality care?

[The Minister of State, Department of Health (Norman Lamb)]

First, let me say that substandard care simply will not be tolerated and it has to be taken extremely seriously. I understand that the trust involved is reviewing its staffing levels so that the necessary improvements can be made. It has also started two-hourly checks, during which nursing staff check that patients have everything they need to be both safe and comfortable. There is clearly a big challenge and the trust has to meet it.

[Pamela Nash (Airdrie and Shotts) (Lab)]

T7. The implications of HIV go well beyond health issues alone, yet the Government have so far refused to implement a new, cross-departmental HIV strategy. The Scottish and Welsh Governments have implemented their own such strategies, but 95% of people in the UK living with HIV reside in England. Will the Secretary of State commit to discussing this issue with his Cabinet colleagues, particularly those in the Department for Work and Pensions and the Department for Education?

[Norman Lamb]

I take extremely seriously the point that the hon. Lady makes. It seems to make more sense to be part of a comprehensive, integrated sexual health strategy, which the Government are planning and which will be published very soon. Services tend to be delivered together in the same units, so it makes sense to have a single strategy to deal with all those issues.

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

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

--- Later in debate ---

[Norman Lamb]

I thank my hon. Friend for that question. The Government take the development of talking therapies extremely seriously and I can confirm that I met Lord Layard yesterday, together with representatives of the NHS Commissioning Board. There will be a central team and we are absolutely determined to keep driving this approach forward, as there is real evidence of results.

[Mrs Madeleine Moon (Bridgend) (Lab)]

Today’s edition of The Daily Telegraph carries an article on dementia, including a quote from a GP who says that it is not useful to give an early diagnosis when there are no drug or care needs. Does the Minister agree that that GP, like many others, fails to realise that for pre-senile dementias in particular, early diagnosis allows planning and allows families to understand the confusion created by altered personalities, behaviour, emotional responses and language skills?

Dementia

Norman Lamb Excerpts

Thursday 10th January 2013 Commons Chamber

[Paul Burstow]

One of the great things about devolution is that we can try out different things in different jurisdictions, but it is great only if we learn from that by taking the best and using it elsewhere. I therefore agree entirely with the hon. Gentleman that that is an important part of this debate. The ability to exchange and learn—and, yes, sometimes reject things that others are doing—is important.

My final point is about reform. I hope this year might be a tipping point for dementia. Reform of our broken care and support system has never felt closer. For people with dementia and the families who care for them, it cannot come soon enough. When the Prime Minister launched the dementia challenge back in March last year, he acknowledged the catastrophic costs that some people incur as a result of drawing the card in the lottery of life that says “Dementia”. He said:

“We are determined to do the right thing by these people”.

A dementia diagnosis is traumatic enough, without the knowledge that care costs can often spiral out of control as the disease progresses. While care financing is left unreformed, people with dementia face the prospect of losing both who they are and everything they have ever worked for.

I therefore very much welcome the news in Monday’s mid-term progress report that the Government are to press ahead with a cap and increased means test, and the confirmation that the House received on Tuesday from my right hon. Friend the Deputy Prime Minister that the necessary legislation will be enacted in the lifetime of this Parliament. In my capacity as Chair of the parliamentary inquiry into the draft Care and Support Bill, let me tell the Minister that the Committee has made it clear to me—and I absolutely agree—that we expect as much detail as possible on any new clauses or other changes that will flow from the introduction of a capped cost system into the legislation, so that we can do the House the service that we have been asked to perform, which is to report on and scrutinise the provisions and help the Government to introduce the best possible legislation to Parliament.

[The Minister of State, Department of Health (Norman Lamb)]

Let me confirm to my right hon. Friend that I want to do everything I can to ensure that the Committee is as informed as possible, so that it can do the important scrutiny work that it is charged with doing. Let me also take this opportunity to pay tribute to the work that he did as my predecessor to push the dementia debate forward and make substantial progress.

--- Later in debate ---

[The Minister of State, Department of Health (Norman Lamb)]

I would like to thank the Backbench Business Committee and every right hon. and hon. Member who has spoken, and pay tribute to the former Minister, my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), for his dedicated work on the subject and to the work of the all-party group on dementia, which works tirelessly on a subject that, in the past, has been too much ignored but which, at long last, is starting to get the attention it deserves.

I cannot begin to do justice to the many extraordinary contributions made in the debate, so I commit to write to all hon. Members who have taken part to answer each of the specific challenges put to me, if I cannot deal with them now. A forum such as this—less combative than many of the debates on the Floor of the House—is the perfect place to talk about dementia. I have listened with humility to the contributions of many hon. Members and I completely associate myself with the comments of the shadow Minister: the contribution from the hon. Member for Bridgend (Mrs Moon) was remarkable. She spoke with authentic authority, having experienced all these problems—the isolation, the impact on the family and so on.

I have learned much in this debate, as a Minister learning my trade, and will take on board much of what has been said. I should also mention the right hon. Members for Cynon Valley (Ann Clwyd) and for Salford and Eccles (Hazel Blears) and the hon. Member for Liverpool, Walton (Steve Rotheram), who, along with others, paid tribute to the fantastic work of the Alzheimer’s Society, which I have seen in my own constituency. It is a brilliant organisation doing invaluable work. I totally agree also with the shadow Minister about the analogy with cancer. Getting to grips with Alzheimer’s has to be seen as the challenge of the 21st century. I am sorry I missed the contribution from the hon. Member for Oldham East and Saddleworth (Debbie Abrahams), but I have heard all about it and thank her as well.

There is no party political divide on dementia. There can be discussions about the funding of social care and so forth, but there is a consensus about what needs to be done. The work was started by the last Labour Government, who took a lead internationally in setting out a proper strategy for dementia, and this Government have taken on that strategy and developed it. I pay tribute to the Prime Minister for his personal commitment, as others have done. Whatever our political affiliations, beliefs or background, we all know that dementia is one of the most important health and social care issues facing society. It is also one of the most pressing. As mentioned, we know that dementia costs society about £19 billion a year. In 30 years, as the number of people with dementia doubles, even that vast sum will look like chicken feed.

As with all health and social care issues, however, we do people a disservice to reduce dementia to money and budgets. It is about much more than that; it is about people and how we treat them, about the individual with dementia, their families and their friends, all of whom have to live with the effects of what can be the most terrible of conditions, but a condition that many people can and do live well with. That is an important message to get out. It does not necessarily mean the end of the world. People can live well with it.

Dementia affects all of society. It is a universal concern. Study after study shows that it is the condition that people fear the most—more than cancer or anything else—so we need to be better prepared. The Department of Health is doing all it can to stitch dementia awareness into every part of the community—not just GP surgeries, hospitals and other health-focused places, but banks, supermarkets, bus stations, post offices and all the different forms of local public services, and the private sector too. The whole of society has to play its part in changing attitudes and making society dementia friendly. All those places can become more dementia aware and dementia friendly, and if they do, people with dementia will benefit and live better.

On 26 March last year, the Prime Minister gave a speech about the Government’s challenge on dementia. He said that we would do more to translate the national dementia strategy into greater action on the ground in three key areas: first, improving health and care; secondly, making communities more dementia friendly, so that people with dementia are better understood and catered for; and, thirdly, doing more research into dementia. When he launched the challenge, the Prime Minister said we would set out plans to make life better for people with dementia and their carers. Indeed, the hon. Member for Worsley and Eccles South (Barbara Keeley) spoke movingly about carers and mentioned that she had invited me. I think I am going, and I very much look forward to hearing about the good work done in Salford.

That announcement was almost 10 months ago. I am pleased to say that since then there have been significant developments in each of the three strands in the Prime Minister’s challenge. Each has been run by a champion group that includes experts in their fields—Sir Ian Carruthers from the NHS, Sarah Pickup of the Association of Directors of Adult Social Services from social care, Sir Mark Walport and Dame Sally Davies from research, and Jeremy Hughes from the Alzheimer’s Society, as well as Angela Rippon. Those groups have looked at the current situation in their fields and identified priorities for improvement. They include changing how society views people with dementia, improving diagnosis rates and getting researchers to work together in pursuit of better treatments. Several hon. Members have mentioned the stigma of dementia. We face similar challenges in mental health generally. “Time to change” is a fantastic campaign, but the challenge is just as great with dementia. There is still an awful lot of work to do.

I would like to read a quick summary of what we have undertaken since last March. We have launched a new dementia friends scheme to make 1 million people more aware of what dementia is, helping to break down barriers between people with the condition and their local communities. The hon. Member for Liverpool, Walton and many others talked about the importance of raising public awareness; the dementia friends scheme can be an effective way of doing so. Indeed, I urge all hon. Members present to sign up—they can do it now by registering online—and become dementia friends. He made the point that public awareness was, in his words, scandalously low. I share that view.

We have set aside £54 million for the NHS to support dementia diagnosis in hospitals and now to ensure clinical leadership in hospitals. We have set aside a further £50 million to make health and care environments such as hospital wards and care homes more dementia friendly. The Government’s first mandate for the NHS prioritises dementia. We have launched a national advertising campaign to raise awareness, reduce the stigma attached to dementia and encourage people to contact their GP if they experience symptoms of dementia and have that difficult early conversation—the sooner it is had, the better for the person with dementia and their carer. We have developed a toolkit for clinicians to increase diagnosis rates—we have heard about the interesting work in Plymouth and how diagnosis rates have been significantly improved as a result of that clinical leadership.

Through a consultation, we asked the public what action they wanted to see and incorporated those views into the work of the three challenge groups—the hon. Member for Bridgend was absolutely right that people must be involved, engaged and listened to in dementia research. We have also supported the launch of the call to action to create dementia-friendly hospitals. Some 65 hospitals have signed up so far, but I take the view that every hospital in the land should sign up. I urge them to get on with it, because it is so important. The hon. Member for Chatham and Aylesford (Tracey Crouch) and the right hon. Member for Cynon Valley gave powerful testimonies and told some deeply disturbing stories about what happens in some of our hospitals. That reinforces just how important this is and why the Secretary of State is right to be clear that the quality of care is just as important as the quality of treatment.

The hon. Member for Bridgend talked about the crucial importance of communication between care staff, nursing staff and relatives. The hon. Member for Banbury (Sir Tony Baldry) talked about getting compassion back into the NHS. There is actually an enormous amount of compassion in the NHS, but there are sometimes situations where it falls below the acceptable standard. That is what we have to address.

We have provided £36 million for a new National Institute for Health Research translational research collaboration on dementia, with research into better treatments, care and understanding of the condition. We have also provided £9.6 million to expand the UK Biobank.

I am conscious that I am not going to have nearly enough time to deal with all the issues that have been raised today. A great deal of emphasis has been placed on the importance of early diagnosis. The right hon. Member for Salford and Eccles talked about the completely unacceptable regional variations. All clinical commissioning groups will have to set ambitious objectives to close the gaps, and they must be held to account for that. The National Commissioning Board will build up a national picture of the challenges in each local area. The hon. Member for Plymouth, Moor View (Alison Seabeck) talked about the encouraging progress that can be made in that regard. People want timely, good-quality information that helps them to make the right choices about their care. The hon. Member for Bridgend talked about the importance of the GP discussing with the family the approaches that they want.

In conclusion, the coalition Government are doing as much as possible, but there is much more to be done. We will make an announcement soon on funding for elderly care. The Care and Support Bill must, in my view, include paving clauses on Dilnot. We have a real opportunity now to secure the reform that is so long overdue. We should also remember that the Dilnot recommendations included raising the threshold for means-tested support to £100,000, which would help an enormous number of families who are experiencing real difficulties.

To address the challenges of dementia, we need a response not just from the NHS, not just from the Government and not just from businesses, but from society as a whole. There are promising signs. The Prime Minister’s dementia challenge is not only about geeing up the NHS and our local authorities, but about all the resources that our communities have to offer. I completely agree with my right hon. Friend the Member for Sutton and Cheam that we need to develop the strategy beyond 2015. Of course, we will need to assess and learn the lessons from the current strategy, but we must then apply it beyond that date. The same applies to research as well; I completely agree with him on that.

There is a lot of hard work being done by the NHS, by social care professionals and by others across England—work that is increasing diagnosis rates, and reducing the prescription of antipsychotic drugs for people with dementia, to name but two. As a consequence, many more people are getting the treatment and care that they need and that their loved ones deserve. Long may that continue.

I am on a learning curve as a new Minister, and I have found this debate immensely helpful. As I said earlier, I have learned a lot from it. I dedicate myself to doing everything I can, for as long as I have this job, to try to make a difference.

Liverpool Care Pathway

Norman Lamb Excerpts

Tuesday 8th January 2013 Westminster Hall

[The Minister of State, Department of Health (Norman Lamb)]

I do not have a Parliamentary Private Secretary sitting behind me, and I am most grateful therefore to you, Mr Weir, for your assistance with some Members’ constituencies.

I congratulate the hon. Member for Montgomeryshire (Glyn Davies) on securing the debate, and on the sober, serious and rational tone he deployed in his contribution. The whole debate, in fact, has been exemplary in that regard. I suspect that all of us in this room are after the same thing; it is how we secure it that matters so much. I have just over 11 minutes, which is not really enough to do justice to every contribution, so as soon as I possibly can, I will write to all the Members who have taken part, to update them.

I take the Liverpool care pathway extremely seriously. It has been much discussed recently: many hon. Members and members of the public have written to the Department of Health expressing their concerns, and there have been numerous parliamentary questions, too, all of which stems from a lot of media interest over the past few months. Several stories have appeared discussing the ways in which the LCP is used and what it is for. In particular, there have been a number of reports in the media alleging that patients are being placed on the LCP secretly, with no consultation with them or their relatives. It has been suggested that the LCP routinely involves medical staff withdrawing treatment, including food and fluids, from patients. Perhaps most seriously, the LCP has been accused of being a way to kill patients to save the NHS money. There have been suggestions that the Department of Health bribes hospitals with extra money for every patient placed on the pathway.

Those accusations paint a misleading picture of the purpose of the Liverpool care pathway, yet I take seriously the concerns raised by the families of patients who have experienced extremely poor end-of-life care. I am horrified by some of the stories that people have told me about the withdrawal of food and fluids from sick relatives in hospital and about the failure to inform loved ones that the patient has been placed on the pathway.

The hon. Member for Congleton (Fiona Bruce) spoke movingly of her experience, and I am pleased that she came to the round table that I held to discuss those concerns. As the hon. Member for Gainsborough (Mr Leigh) made clear, the concerns are legitimate and should be taken seriously, not dismissed because of exaggerated reporting. What happens on the front line and how we translate theory into practice are so important.

I agree with my hon. Friend the Member for Southport (John Pugh). I dislike the jargon: what on earth does “Liverpool care pathway” mean to patients and their families? We must use language that ordinary people understand, particularly at a most traumatic time for all involved. That is one thing we need to address.

One aspect of care that receives almost universal praise, as the hon. Members for Banbury (Sir Tony Baldry) and for Hackney South and Shoreditch (Meg Hillier) have made clear, is the hospice movement, which grew from Dame Cicely Saunders’s belief that, however ill, people matter at the end of their life and should never be abandoned. That is why the Marie Curie Palliative Care Institute Liverpool, led by Professor John Ellershaw, developed the Liverpool care pathway in the late 1990s. The pathway was designed to transfer the principles of hospice care—the shadow Minister, the hon. Member for Leicester West (Liz Kendall), made this point—so that terminally ill patients always get the best treatment, even if they do not receive specialist palliative care.

The Liverpool care pathway is not a treatment but a framework for managing treatments, which is important to understand. As the hon. Member for Montgomeryshire made clear, the LCP, when used correctly, is one way to ensure that the last hours or days of a patient’s life are as comfortable as possible. The guidance for using the LCP makes it clear that the aim is to support, not replace, clinical judgment. Sometimes there are questions about clinical judgment, but not about the pathway itself.

The Liverpool care pathway guidance sets out the following objectives and considerations for taking care of patients: determining whether any further medications and tests would be helpful; ensuring that the patient is as comfortable as possible—surely we all agree with that; helping the patient to take on food and drink for as long as possible, which means not denying them food and drink, as we sometimes hear; and taking care of the patient’s spiritual and religious needs, which is of acute importance to many people. The guidance reminds clinicians that unnecessary treatment or tests may cause harm rather than good.

The guidance states that regular review is acutely important. If their condition improves, the patient should be taken off the pathway. The 5% figure to which the hon. Member for Gainsborough referred is of concern and should be considered; it is essential that the medical team discusses the pathway with the patient, their family or their carers. Those people need to be fully involved in decisions about end-of-life care, even though those discussions may be very difficult. Obviously, those conversations need to happen as quickly as possible.

The Liverpool care pathway can work as intended only if each patient is fully consulted, unless that is not possible. Even then, the family must be fully involved. Through his interventions, the hon. Member for Stoke-on-Trent South (Robert Flello) made that point strongly. The opening section of the information sheet that comes with the pathway cites the absolute importance of discussion with the family. Staff must talk to the patient and their family as much as they need and want, to explain what is happening and why. That is non-negotiable. Any failure to do so is completely unacceptable.

The hon. Member for West Lancashire (Rosie Cooper) mentioned documentation, which is best practice and should always happen so that everyone can see what has been discussed. She also mentioned the constitution, and we are considering how we can give it greater traction. There is a sense that everyone agrees with the constitution, but what value is it? How can we make the constitution provide real power to patients in the NHS?

I agree with the shadow Minister’s concerns about translating across the whole system something that has been designed by experts. Such translation can be problematic and needs further attention.

[Rosie Cooper]

rose—

[Norman Lamb]

I am conscious that time is tight. I will write to the hon. Lady. If she wants to raise issues with me later, I will be happy to address them, but I need to respond to the debate.

From what people have said, it is clear that there are too many cases where patients have been put on the pathway without proper explanation, without the involvement of their family and sometimes without any notification, which is totally unacceptable. Yet again, we see how right Dame Cicely Saunders was when she said:

“How people die remains in the memory of those who live on”.

The impact is profound. My wife works for Cruse Bereavement Care, which does magnificent work helping people who have suffered bereavement. We have a duty to give such people the best possible experience as they lose a loved one.

On 26 November, I hosted a round-table meeting with patients, families and professionals—both supporters and critics of the pathway were represented—and at that meeting I announced that we will appoint an independent chair to consider how the LCP is used and experienced and to examine the accusations made in the press. We expect to announce the chair of that review very soon, and we expect that the chair will want to identify a small panel of independent experts from a range of backgrounds, including representatives from faith groups, which is important. I reassure hon. Members that the review will be independent.

The Liverpool care pathway is internationally recognised as good practice, and it is widely supported by organisations involved in end-of-life care. If people do not feel that they have received the best care or, worse, if patients cease to trust the pathway, that is a problem that needs to be addressed.

Training is fundamental, as the hon. Members for Hackney South and Shoreditch and for Congleton and the shadow Minister said, and it will be considered as part of the review. The review will systematically examine the experience of the Liverpool care pathway by patients, families and health professionals, and it will seek evidence to support or refute the accusations and to see where improvements might be needed. The review will hear directly from families. There will be a session dedicated to families so that they can tell the panel about their experiences.

The review will also consider the role of financial incentives in the use of the LCP. Like my hon. Friend the Member for Southport, the hon. Member for West Lancashire and others, I have concerns about the use of financial incentives. The review will report both to the Department of Health and to the NHS Commissioning Board by the summer.

Everyone wants their loved ones’ final hours to be as pain-free and dignified as possible. Used as intended, the Liverpool care pathway can help achieve that. The pathway prioritises comfort, dignity and appropriate care, but all that is undermined if the public distrust the pathway and if clinicians do not apply it properly. We do not dismiss people’s concerns, which I take extremely seriously. Instead, we have to ensure that care in the last few days and hours of life is always of the highest standard. Reinforcing the absolute importance of involving patients and their families in discussions on their care and treatment is essential.

Thalidomide Trust (Grant)

Norman Lamb Excerpts

Thursday 20th December 2012 Commons Chamber

[The Minister of State, Department of Health (Norman Lamb)]

With permission, Mr Speaker, I should like to report to the House on a new 10-year grant to the Thalidomide Trust to help it find more personalised ways of meeting the health needs of thalidomide survivors.

The current three-year grant, which comes to an end in March 2013, was introduced by the previous Government as a pilot scheme. Its aim was to enable the Thalidomide Trust and its members to explore more innovative ways of preventing further deterioration in the health of thalidomide victims and to help preserve their independence.

This Government are committed to improving outcomes for all disabled people and to supporting them to live independent lives. That is why we are pleased to be able to continue the excellent work begun by the pilot scheme through this 10-year commitment. Over the next 10 years, the grant will be in the region of £80 million. It will be paid on an annual basis, rising each year in line with inflation.

I was privileged to speak on this very subject on my first day as a Health Minister and then met, along with the hon. Member for Elmet and Rothwell (Alec Shelbrooke), the Thalidomide Trust and its national advisory council. They impressed on me the complex and highly specialised needs that thalidomiders have, particularly as they approach older age. At the meeting, members of the trust and a number of thalidomiders stressed the need for certainty and that any future grant would need to be for longer than just three years. I am delighted that we are able to give them that certainty.

Many thalidomiders have had to use their bodies to compensate for the damage to their arms or legs in such a way as to cause severe musculoskeletal problems, including lower back pain, sciatica, damage to the coccyx area and shoulder pain and stiffness. Treatments to relieve those symptoms, such as massage and physiotherapy, not only help to maintain their independence, but often mean that they can stay in work.

The Thalidomide Trust has provided evaluation reports for the first two years of the pilot scheme. I have read with interest how it has invested the money. It is clear from the reports that this scheme is the best way to continue to meet the complex needs of thalidomide survivors. One recipient of the grant has improved her independence by installing a table that rises and falls by remote control, enabling her to reduce overstrain on her muscles. Another recipient describes how regular physiotherapy and visits to the gym, paid for by the grant, have led to him losing weight, thereby relieving stress on his joints, reducing the pain and improving his mental well-being.

A small number of people said that they had reduced their need for prescription painkillers and the frequency with which they need to see their GP. The reasons for that varied, and included successful surgery, lifestyle changes and improved access to complementary medicines, but all of them were linked to the use of the grant. The continued funding will help individual thalidomiders to maintain control over their own health needs, because they are the experts in what really makes a difference.

There will be clear principles for the use of the money. It must be used only for health-related needs and it cannot be used to duplicate support provided through a different source, such as personal health budgets. The grant must also be used only for the benefit of thalidomide survivors living in England. Separately, the devolved Administrations will each consider how they will support thalidomiders after the end of the current three-year pilot, which is in March next year.

Naturally, the Department of Health will review the scheme annually to ensure that it remains the most appropriate use of funding and the best way of distributing it to those who need it. The trust will use its extensive expertise and knowledge of its members to distribute the funds to thalidomide survivors in England.

I pay tribute to the Thalidomide Trust. The contribution of both the trust and its national advisory council, many members of which are in the Public Gallery to hear this statement, cannot be overstated. The trust uses its expert knowledge to provide invaluable support to survivors of the thalidomide disaster and their families, while members of the national advisory council work tirelessly, despite their own impairments, in the cause of all thalidomiders.

Finally, I reiterate the regret and deep sympathy first expressed three years ago by the then Minister of State, Department of Health, the former Member for North Warwickshire, Mike O’Brien. We acknowledge the physical hardship and emotional difficulties faced by the children affected by this drug and their families, and the challenges that many continue to endure, often on a daily basis.

I commend the statement to the House and wish everyone, including all thalidomiders, a very happy Christmas.

[Liz Kendall (Leicester West) (Lab)]

I thank the Minister for the advance copy of his statement.

Thalidomide survivors waited far too long for Governments over many years to address the appalling physical and emotional difficulties that they faced as a result of thalidomide prescribed by the NHS from 1958 to 1961. The last Government took the first steps towards addressing this unacceptable situation. In January 2010, the then Minister of State rightly offered our sincere regret and deep sympathy for the injury and suffering endured by all those whose expectant mothers took the thalidomide drug. I want to repeat that sincere regret and sympathy today.

The previous Government also acknowledged the urgent need for extra help for thalidomide survivors to meet their care and support needs, by putting in place a three-year pilot scheme. The pilot, as this Minister said, has helped survivors to improve the quality of their lives and to cope with their increasing loss of mobility and independence as they get older by helping them to buy and put in place the things that they say make the most difference to their lives.

I welcome the Minister’s announcement that the Government will continue the scheme for 10 more years with a grant in the region of £80 million. That will mean a huge amount to the 431 thalidomide survivors living in the UK today. As the Thalidomide Trust says, the money will allow one survivor with no arms to buy the special adaptations she has been unable to afford, and a man with no legs to make a down payment on a van adapted so that he can drive it from his wheelchair. It will allow a deaf thalidomide survivor to continue to employ someone to be her signer when she goes out so that she can retain her confidence and ability to remain active and mobile.

I have a number of questions about the scheme that I hope the Minister will answer. He will be aware that Scotland, Wales and Northern Ireland made proportionate contributions to the fund set up by the previous Government. Will the devolved Administrations make similar contributions to the fund he has announced today? He says that the grant will be reviewed annually, but there might be concern that that is not as stable as some survivors would like. Will the Minister guarantee that the views, needs and concerns of survivors will be at the heart of those reviews, and will he explain why we need an annual review, and not a three-year review as under the previous Government?

Will the reviews look specifically at the increasing needs of thalidomide survivors as they get older? Evidence collected over the past two years confirms that their health and mobility is deteriorating rapidly now that they have reached their 50s. Because of those increasing needs, will the Minister commit today to ensuring that there will be no less funding in the years ahead?

I will conclude, as the Minister did, by thanking and paying tribute to the work of the Thalidomide Trust, its national advisory council, and all campaigners who have fought to make successive Governments face up to their responsibilities. Members across the House sincerely regret how badly thalidomide survivors were let down, and we will strive to ensure that that never happens again.

[Norman Lamb]

I appreciate the shadow Minister’s support for today’s announcement and she is right to say that people have waited far too long for an acknowledgment of the tragedy and for practical action. I acknowledge—as I did in my statement—the actions of the previous Government in initiating the pilot scheme, and the expression of regret made by the former Health Minister. One powerful thing about the scheme, as designed in the original pilot, is that it gives maximum power to the individual to determine and respond to their priorities and needs. That means that the money can be used in a host of different ways, as the hon. Lady described.

The hon. Lady raised a fair point about the devolved Administrations, and we must be equally concerned about thalidomiders in Scotland, Wales and Northern Ireland. The devolved Administrations did not feel able to commit to the 10-year period here and now, but they are fully committed to continuing that help and we will work closely with them to ensure that individuals in those Administrations are not left behind in any way.

The hon. Lady rightly mentioned the annual review, which is a question of proper accountability. The trust has done a brilliant job and I acknowledge its work. It is a completely responsible organisation that knows better than anyone how best to deploy the available resources, but as it acknowledges, it is right for it to be held to account for how public money is spent. There is no intention at all to question the purpose of the grant, and we want to give the certainty provided by the 10-year period. The fund will be index linked so that the value of money from the pilot scheme is maintained throughout that period. The review is simply to ensure that the scheme still makes sense and that we are using the available resource in the best possible way. I have every confidence that that will be the case and, as the hon. Lady requested, the needs of the thalidomiders who benefit from the money will be put at the heart of the reviews. We will not let those people down in the commitment that we are making today, and the funding will be maintained.

The hon. Lady rightly talked about deteriorating health because the body has been under such extraordinary strain. I spoke to thalidomiders earlier today. It is remarkable what their bodies have been able to do, often in the absence of limbs, but that puts an enormous strain them, and the wear and tear is now having its effect. We do not know what the prognosis is going forward. It is therefore right to take stock and see what their needs are after a 10-year period, but the commitment to those people must remain.

[Andrew Jones (Harrogate and Knaresborough) (Con)]

On 23 November, the first ever memorial to thalidomide victims was unveiled in Harrogate—a tree was planted and a plaque was unveiled to mark the 50th anniversary of the withdrawal of the drug. Thalidomide victims were present at the unveiling, which was carried out by Mr Guy Tweedy, a Harrogate resident and leading thalidomide campaigner.

The victims have waited a very long time for recognition, including financial recognition. I very much welcome the Minister’s comments, particularly those on the certainty required and the 10-year period, the challenges the victims face as they grow older and the sheer bravery that some have had to show during the course of their lives. I simply urge him to do all he can to support this special group.

[Norman Lamb]

I absolutely commit, on behalf of the Government, to do everything we can to support that group of people. As a society, we owe it to them to support them—they are often in very difficult circumstances. He is right to note the bravery that they have shown—not just the individuals, but their families too—in facing those circumstances.

[Mr Frank Field (Birkenhead) (Lab)]

I pay tribute to victims of the drug and to the trust that so admirably serves them, and thank the Minister for his statement, but how did he fix on that sum? Was it the sum that the trust asked for? Does it meet all the trust’s demands, or are other forces at work?

[Norman Lamb]

The right hon. Gentleman is right to pay tribute to the work of the trust over many years. We have based the sum on the amount of money provided as part of the pilot scheme, which appeared to work very well. It does not meet all needs, but many individuals get help in other ways—some have personal budgets, and so on. However, it is acknowledged that the amount is a massive help and support and gives them the reassurance for a lengthy period that continuing support will be available.

[Richard Fuller (Bedford) (Con)]

I join other right hon. and hon. Members in praising the dedicated, intelligent and sensitive leadership of the Thalidomide Trust over many years. The news from the Minister will be welcomed by thalidomide survivors throughout the UK, including in my constituency by a friend of mine and his wonderful family. The issue for many thalidomide survivors is the pursuit of an independent everyday life. Will the Minister advise me and the House why the decision was made to have a 10-year grant rather than a lifetime grant, which would have eliminated all uncertainty? I am very interested in the Minister’s comments on that.

[Norman Lamb]

We had a genuine judgment to make. On the one hand, I wanted to provide a good deal of certainty for a lengthy period, but this is a unique group of people. Their health is deteriorating, but we do not yet know what the prognosis is for the rest of their lives. It therefore might have been dangerous to allocate a sum of money for the rest of their lives. For all we know, their needs may grow considerably. It is therefore right to take stock in 10 years’ time and make a judgment on their needs at that stage.

[Mr Jim Cunningham (Coventry South) (Lab)]

I have met victims of thalidomide over many years, and I had the privilege of being Parliamentary Private Secretary to the former Member for North Warwickshire when he introduced the pilot scheme, so I really understand some of the difficulties that the Minister has faced. I therefore congratulate him, as I know that it was a difficult and emotional decision to take. The trust should also be congratulated on its efforts and tenacity over many years.

[Norman Lamb]

As I indicated in my statement, I had to respond to an Adjournment debate on the subject in Westminster Hall on my very first full day in the job. The presence of so many thalidomiders at that debate sent a very powerful message to me about the need for us to face up to our responsibility to support those individuals.

[Mel Stride (Central Devon) (Con)]

I very much welcome my hon. Friend’s statement, which will mean a huge amount to sufferers up and down the country, including those in my constituency. I wish to pay tribute to Ruth Daniels, one of my constituents, who has campaigned very hard on this issue.

The Minister mentioned that money would be made available for physical health needs. Can he confirm that it will also be made available for those suffering from mental effects as a result of thalidomide?

[Norman Lamb]

Ruth Daniels and many others have campaigned long and hard for justice, and it has taken too long for that to be properly acknowledged. I absolutely confirm that the money can be used for any health-related matter, and mental health can be affected as well as physical health, and is just as legitimate as any other health need.

[Thomas Docherty (Dunfermline and West Fife) (Lab)]

The Minister will be aware that the trust has also called for the manufacturer finally to acknowledge its culpability, something that it has repeatedly failed to do. Will he update the House on his assessment of the likelihood of getting those cowards finally to take responsibility?

[Norman Lamb]

Talking earlier to people from the Thalidomide Trust, they are deeply frustrated—as am I—by the failure of the manufacturer to face up to its responsibilities. I cannot provide a positive update that suggests that it is about to do what it should do, but I think we would all agree that it should acknowledge its culpability without delay.

[Cathy Jamieson (Kilmarnock and Loudoun) (Lab/Co-op)]

I thank the Minister for responding so positively—it was my Westminster Hall debate to which he responded on his first day in the job. I am glad that he has listened to the views of the thalidomiders. I also join in the tribute to the Thalidomide Trust, especially Mikey Argy and Liz Buckle, who first brought the information to me that persuaded me that a debate was needed.

The Minister mentioned the position in the devolved Administrations. Will he give the House an update on the discussions that he has had with the Cabinet Secretary for Health and Wellbeing in Scotland? Has he had any indication of when a statement or announcement will be made by the Scottish Government so that thalidomide victims in Scotland can have the same peace of mind as those in England?

[Norman Lamb]

I pay tribute to the hon. Lady for her campaigning on this issue, along with several other hon. Members, which has played a part in ensuring that the needs of thalidomiders are properly acknowledged. I cannot tell her that there will be a statement at any particular time, but I confirm that we are in touch with the Scottish Government and there is a desire to help. I will write to her to provide as much of an update as I can.

Science and Technology Committee Inquiry

Norman Lamb Excerpts

Tuesday 18th December 2012 Written Statements

[The Minister of State, Department of Health (Norman Lamb)]

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

The Government have today laid before Parliament their response to the House of Commons Science and Technology Committee inquiry into the regulation of medical implants in the UK and the EU (Cm 8496).

The Government welcome the Committee’s report and its focus on the importance of increasing transparency and accountability in the regulation of medical implants. The Government agree with the Committee on:

strengthening transparency;

improving the consistent quality of notified bodies across the EU;

increasing access to scientific expertise;

limiting the burden on small and medium-sized enterprises;

building on the current regulatory system;

introducing stricter rules on when manufacturers can rely on clinical data which is sourced from studies on a similar device; and

improving the environment for clinical investigations.

The Government are committed to further considering the Committee’s recommendations on requiring health care professionals to report serious adverse incidents and introducing a “Black Triangle Scheme”, which currently exists as a voluntary scheme for medicines, to medical devices. The Government will continue to consult with the National Joint Registry for England and Wales (NJR) on the Committee’s recommendation to publish raw data from the NJR.

As regards the Committee’s criticism that the Medicines and Healthcare products Regulatory Agency (MHRA) reacted too slowly to Australian data on the safety problems of metal-on-metal hips, the Government would like to reiterate that the MHRA was the first regulatory authority in the world to issue advice on monitoring and patient management in April 2010. The analysis of data from the National Joint Registry for England and Wales was key to the worldwide action to recall the particular metal-on-metal hip system in August 2010.

NHS Funding

Norman Lamb Excerpts

Wednesday 12th December 2012 Commons Chamber

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

I am sorry that the Secretary of State is leaving because, before going on to discuss what is happening in my local health community and local hospital, I want to pick up on a couple of the things that have been said. First, I am pleased that this very dry motion has been tabled because I hope that it will concentrate our minds on what is happening in the national health service and, in particular, to spending.

The Secretary of State said that spending is related to budgets. He did not respond to the point posed by my right hon. Friend the Member for Leigh (Andy Burnham) that in 2010-11, there was a £1.9 billion underspend in the national health service budget. No use was made of the budget exchange scheme, so none of that money was moved into the following financial year. We can assume that £1.9 billion went back to the Treasury.

In the following year, 2011-12, the underspend was £1.4 billion, and £316 million was carried over into 2012-13. An underspend in the region of £3 billion from the first two years of this Government—including the year they won the general election—has gone back to the Treasury. Those are the facts; I do not know if any Front Bench Member wishes to dispute them.

[The Minister of State, Department of Health (Norman Lamb)]

Does the right hon. Gentleman also acknowledge that the average underspend in the last four years of the Labour Government was £1.9 billion?

[Mr Barron]

I recognise that there has been underspend, but I take this debate, and the debate we had running up to the general election, a bit more seriously. The chairman of the UK Statistics Authority said that there had been an underspend, and what we have just heard is not true. As my right hon. Friend the Member for Leigh (Andy Burnham) said, the Conservative party manifesto stated:

“We will increase health spending in real terms every year.”

--- Later in debate ---

[Mr Barron]

The issue of allocation has been looked at by many Select Committees, including by the Health Committee when I chaired it in the last Parliament. We did not find the level of unfairness that people, particularly those from rural areas, used to say there was. We looked for it but we did not find it.

Let us look at what is happening in the real world. My local Rotherham hospital foundation trust is not a bad hospital trust in any way and scores quite well in many areas. It received foundation trust status a number of years ago, and when this Government took office, it is fair to say that the efficiency factor was there already. On 16 March 2011 the trust announced that more than 60 jobs were to be axed at Rotherham general hospital, and confirmed a potential reduction of 62 posts in medical and surgical areas. Earlier this year on 6 March 2012, the local BBC announced that more than 70 NHS staff were facing the threat of redundancy, and the trust is seeking to save about £4 million. On 26 October 2012, an internal report given to the local media stated that the trust now intends to cut 750 jobs—about 20% of its work force—by 2015.

The NHS trust said that it needed a smaller hospital with substantially fewer beds and a smaller work force to save £50 million over the next four years. The internal report—aptly named, “Creating Certainty in an Uncertain World”—said that it was necessary to save £50 million from the £220 million budget before 2015 to meet Government targets. That was confirmed by the trust in a press release.

On 5 November 2012, the chief executive of the trust said that it would show staff the plans and invite them to come back with alternative views on how things might be done differently. The trust stated:

“We’ve made it very clear that there may have to be redundancies, but to be honest with you until we have gone through the process, I don’t know how many we will be able to lose through natural turnover and how many will have to be made redundant.”

What type of planning is there in any of this when we have such a situation in a district general hospital on which about 80% of my constituents rely if they have to go into secondary care?

On 20 November 2012, the chief executive announced his retirement. On 3 December 2012, the hospital announced that staff will be informed about the decision to postpone the formal consultation launch into work force restructuring. It went on:

“We realise this an anxious time for all members of staff, but it is imperative that we do what is right for the Trust, our staff and our patients. This means that we need to take more time to ensure our workforce proposal is exactly what the Trust requires and we anticipate the launch to take place later in the month.”

On 7 December 2012—last Friday—a headline in the local newspaper stated that the trust had recently engaged the services of a director of transformation on a time-limited basis. The acting chief executive said:

“It is important that the trust acts quickly to take the action required to safeguard the future clinical and financial sustainability of the Trust. This appointment, which was made after a competitive process, is required to provide additional expertise and impetus to the changes we need to make, whilst allowing others to remain focused on delivering the healthcare services that the people of Rotherham need and deserve.”

I do not stand here and support the way the NHS has been structured now or in the past, and I have been critical about many areas of that. I agree with the chief executive of the NHS, David Nicholson, who said at the NHS confederation conference this year:

“We need to change the model of care to one which supports patients and focuses more on preventing ill health from happening in the first place...and move away from the default position of getting someone into a hospital bed.”

At the same conference the then Health Secretary said that closure decisions were not an issue for national politicians, and my right hon. Friend the Member for Leigh said that the current Health Secretary said very much the same thing—“It’s nothing to do with me, guv.”

Let me say to the Minister, and other hon. Members who have made relevant interventions, that if changes and reconfigurations inside the national health service are getting better care to more patients, that is fine. However, the chaos in my local health service is about cutting back and saving money. I have played an active role in health care in my constituency over many years and, as far as I know, there has been no debate with local Members of Parliament, patients, patient groups, local doctors or people engaged in health provision in Rotherham. There have been no discussions whatever about reconfiguring the district general hospital to improve the position of patients and of the people of Rotherham and the surrounding area. Instead there is a drive to save money, which is creating chaos in my local health service.

[Norman Lamb]

Does that not demonstrate a complete failure at local level to address the real problems that we are trying to grapple with? There is therefore a case for a changed system whereby a health and wellbeing board brings all the parts of the system together to debate such issues.

[Mr Barron]

The events of the past two months suggest to me that the people in whom the Minister has faith to reorganise health care in Rotherham do not know what they are doing. They have brought in new systems and produced a report inside the hospital, which I understand was given to the trade unions. It ended up on the front page of a local newspaper and was countered by a press release by the hospital itself. Where is the debate about improving health care for my constituents and others? It is absent.

I say to the Minister that it was wholly wrong for the previous and current Secretaries of State—he is not the Secretary of State himself, but we never know, he may be one day—to say “These are not matters for Ministers”. I have not been consulted about them. The three local MPs had an appointment with the chief executive of the trust about two weeks ago, but it was cancelled because he had announced his retirement the week before. That is not acceptable.

The hard reality on the ground is that no matter what we would like to happen in health care, trusts are charging into cutting budgets. They are cutting jobs, because that is where the major expenditure is in health care, and that is creating the chaos that I have described. It is not acceptable. My constituents pay their taxes to pay for health care—it does not come out of the budget down here in Westminster—and they deserve better than what they are getting at the moment.

--- Later in debate ---

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

I am grateful for the opportunity to speak in a debate that is incredibly important to my constituents. I thank my right hon. Friend the Member for Leigh (Andy Burnham) for opening the debate. He is aware of my grave concerns about the future of hospital services that serve people in Corby and east Northamptonshire.

It has long been the ambition of people in Corby—a large, important town that is growing—to have their own hospital. I hope that in future we can realise that ambition. For a long time, however—and for the foreseeable future—we will be served by Kettering general hospital for most of our hospital needs. At Kettering general hospital there are 650 beds and more than 3,000 staff. The hospital is more than 115 years old, and received massive investment, including under the Labour Government. I make that point not so much politically point but as a local person who remembers driving down Hospital hill in Kettering and seeing the fundraising barometer outside the hospital and wondering why we relied on car-boot sales to fund vital hospital services.

My right hon. Friend the Member for Leigh, a former Health Secretary, and his predecessors began to put that right, and there was huge investment. Kettering general hospital now has 17 operating theatres and an obstetrics unit that delivers more than 3,500 babies a year. It has something that serves only a few of my constituents but is incredibly important to all of us—a neonatal intensive care unit, or special care baby unit. My own family has had cause to be grateful to that unit and its brilliant staff.

Kettering general hospital offers a 24-hour accident and emergency service, with level 2 trauma services, which sees more than 2,000 trauma patients a year. There are concerns, however, and I have agreed with the hospital and local people to champion certain issues in the House as the local Member of Parliament, including per capita funding of Kettering general hospital, which we believe is inadequate and lower than average compared with other areas. With a growing population and growing health needs, that must be addressed.

Recently, a report on the hospital by Monitor raised serious concerns, particularly about accident and emergency. I have met the hospital chief executive and the chair of the trust to discuss those concerns, and to assure them that I will seek to do whatever I can, including making sure that a case for adequate funding for the hospital is made, so that those concerns are addressed.

The big issue that causes us all concern locally is a major review of health services—the kind of review that other Members have experienced in their areas. In Kettering, the Healthier Together review of five hospitals has already cost more than £2 million; that was the figure in the summer, and I have no doubt that it is rising rapidly. The review has also taken a great deal of time and effort. In early September, together with local nurses and others, I met the people leading that review, as a public member of the trust, and I was incredibly worried about what I heard, both as a user of the services, and as a representative of local people.

The Healthier Together team gave us a pledge card telling us about their plans and giving us some assurances. The context was also set. We were told that the review was driven by a desire for the best clinical outcomes, by expertise, and by research on how local people could be provided with the best health care. We were told that there were considerations to do with more services being provided in the community, and a shift to prevention, which are things I recognise it is important for our local hospital and its partners—the clinical commissioning group and the other hospitals—to consider.

It was slide 2 that really got to the heart of the problem. It told us that the five hospitals face a combined funding gap of £48 million, and that my local hospital, Kettering general hospital, faces a future funding gap of £6 million a year. I have no doubt that the comments that Andrew Dilnot recently made about the real-terms reduction in funding are very much connected to that, but I do not want to make that wider political point again; it has already been made eloquently by my right hon. Friend the shadow Secretary of State. I simply say that all local people recognise that resources are getting tighter and tighter at the hospital.

[Norman Lamb]

Does the hon. Gentleman share my view that in many local health economies, private finance initiatives are causing a massive strain on resources?

[Andy Sawford]

I want to keep my remarks to Kettering general hospital, and I do not think that PFI is the issue there.

--- Later in debate ---

[The Minister of State, Department of Health (Norman Lamb)]

I start by acknowledging the moving contribution of the right hon. Member for Cynon Valley (Ann Clwyd). Her testimony was shocking and should force the whole system to recognise that such experiences are utterly intolerable and have no place in a modern health system in which kindness and compassion must always take first place. My right hon. Friend the Secretary of State is absolutely right to put that at the top of his agenda. The hon. Member for Strangford (Jim Shannon) also spoke about that point.

I have sat in this Chamber for many debates on the NHS; I have spoken in many of them too. I have heard many arguments about a lot of different things, but unfortunately this is one of the most misguided motions I have ever seen. I get on well with the right hon. Member for Leigh (Andy Burnham), but on this occasion he is completely wrong. As my right hon. Friend the Member for Charnwood (Mr Dorrell) said, the debate should be about the massive challenge we face in caring for people with long-term chronic conditions.

The right hon. Gentleman blames us for his spending plans when he was in office—plans that he signed off when he was in government. Let us have a quick reality check. The coalition’s spending plans kicked in in 2011-12, not before, and in that year there was an increase in real-terms spending. However, hon. Members should not take my word for it: they should ask Andrew Dilnot, the chair of the UK Statistics Authority and a highly respected and eminent economist. He confirmed that in 2011-12, NHS spending increased in real terms compared with the previous year by 0.1%. It says it all that the right hon. Gentleman refused to complete the sentence from Andrew Dilnot’s letter and give the complete picture. Spending will carry on going up for years to come, despite the legacy of financial irresponsibility left us by the last Government—the billions frittered away on a failed IT programme; the vice-like grip of PFI schemes mortgaging—

[Lucy Powell]

Will the Minister give way?

[Norman Lamb]

I have very little time.

Seventy-three billion pounds outstanding on PFI projects, mortgaging the NHS’s future and causing a massive strain on local health economies—that was something alluded to by the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) and the hon. Members for Lewisham East (Heidi Alexander) and for Corby (Andy Sawford). The problems of PFI are massive. Labour also had 25,000 people working in health quangos. That is Labour’s legacy, but now, under the coalition, over the four years to 2014-15 the NHS budget will rise by more than £12.5 billion.

[Nigel Adams]

May I appeal to the Minister to ensure that rural areas such as North Yorkshire are given a fairer funding formula when the Secretary of State reassesses the formula shortly?

--- Later in debate ---

[Norman Lamb]

I understand the concern about rural areas and I will write to my hon. Friend about that. That £12.5 billion will go into improving services, hiring staff and keeping people well. That money will help to protect our health even as the age of the population goes up.

[Lucy Powell]

I thank the Minister for giving way. [Interruption.] Let me tell the Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry) that I am not going to read anything out. After such a long and lively debate, I just want to know whether the Minister will now clarify the matter that is before the House. Was NHS expenditure, in Dilnot’s words, lower in 2011-12 than it was in 2009-10? Yes or no?

[Norman Lamb]

The letter from Andrew Dilnot—the part that the right hon. Member for Leigh did not read out—also said that

“it might also be fair to say that real-terms expenditure had changed little over this period.”

In 2011-12, it went up according to Andrew Dilnot.

My right hon. Friend the Secretary of State for Health has already gone through the numbers outlining what is happening in the NHS today. He has already mentioned all those areas where the NHS is now healthier than under Labour—60,000 fewer people waiting longer than 18 weeks than under Labour; a determination to give access rights to those with mental health problems, as well as those with physical health problems, which was something bizarrely left out by Labour; more than 3 million more out-patient appointments every year than under Labour; more clinical staff, including 5,000 more doctors; and better access to drugs than ever before, including £600 million for the cancer drugs fund. On the cancer networks, the budget for networks as a whole is going up by 27%, which includes dementia and maternity—something that was also left out by Labour. Had the Labour party had its way and cut NHS spending, what would have happened to the networks in those circumstances?

Here is the important point, a point that Labour Members have unsurprisingly chosen not to mention throughout the length of this debate—that money would not be there under Labour. I have no doubt that they will protest, but it is there in black and white, immortalised in Hansard and in the press: for years, they have consistently advocated spending less than us on the NHS. In 2010, the right hon. Member for Leigh, in an interview with the New Statesman, said:

“Cameron’s been saying it every week in the Commons: ‘Oh, the shadow health secretary wants to spend less on health than us.’”

The interviewer fired back:

“Which is true, isn’t it?”,

and the right hon. Gentleman admitted ,“Yes, it’s true”. In the same year, as reported in The Guardian, the right hon. Gentleman said:

“It is irresponsible to increase NHS spending in real terms”.

Yet it goes even further than that. A year before those interviews, in 2009, he could not even promise that the NHS would be protected from cuts. The chief economist from the King’s Fund agrees. Commenting on Labour’s plans, he said that the implication of the overall budget for the NHS was that it would be cut in real terms from between a very small amount to up to 5% over two years. That is what would have happened, had Labour won the election. It will fool no one: it will not fool the public, patients, the professionals or this House. We all know that the coalition is moving heaven and earth to protect the proud heritage of the NHS and drive up standards for everyone—whoever they are and wherever they live.

As my right hon. Friend the Member for Charnwood rightly says, the challenge is how we rethink how services are delivered across the health and social care divide to prevent crises from occurring. Prevention is what we should be doing, as the right hon. Member for Rother Valley (Mr Barron) rightly pointed out. If Labour Members do not like our plans, it is up to them, but if they think the NHS would be doing better with less money, more mixed-sex wards, longer waiting times and fewer clinical staff, they are more than welcome to that position. They can cling on to that as long as they wish, but what is unforgivable is for them to try to hoodwink the public into belittling an NHS that is getting better and better all the time. We have an NHS that is treating more people than ever better than ever, an NHS that is preparing itself for new challenges every day.

Let us compare that with Labour’s real NHS project in Wales, where we see cuts—cuts that have resulted in half a billion pounds taken out of the NHS in Wales by Labour. Waiting times are longer than in England and a higher proportion of patients is waiting for treatment. That is the true face of Labour on the NHS, and in England we should fight it as passionately as we can.

We have seen clearly today the desperation of the Labour party—a desperation that has led it to try to misinterpret inconvenient statistics. Frankly—

[Ms Rosie Winterton (Doncaster Central) (Lab)]

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

Question agreed to.

Main Question accordingly put.