Kettering General Hospital

Andy Sawford Excerpts

Tuesday 24th March 2015 Westminster Hall

[Mr Philip Hollobone (Kettering) (Con)]

It is a huge pleasure and privilege to serve under your chairmanship, Mr Gray. May I, through you, thank Mr Speaker for giving me the honour of debating what is an important subject for my constituents?

I welcome the Minister to his place. He has taken a keen personal interest in the future of Kettering general hospital. The hon. Member for Corby (Andy Sawford) and my hon. Friend the Member for Wellingborough (Mr Bone) are also here, and I hope they will make many interventions to stress the role they have played in working with me to secure the hospital’s future. Indeed, I am pleased to report that the three of us have been working closely together on a cross-party basis for the past few years, because we recognise that local people want party politics taken out of the future of our local hospital. It is a personal issue for the three of us, because we and our relatives use it, as do local people.

Kettering general hospital has been on its present site for 118 years. Local people have been born there and treated there, and they have died there. It is a much-loved district general hospital at the heart of the community of Kettering and north Northamptonshire. It is a key priority for local people that its future should be secure, so that it can continue to offer the best treatment to the increasing number of people living in the area. Kettering and north Northamptonshire are growing rapidly. Over the past decade the borough of Kettering had the sixth most rapid household growth out of 348 districts in the country, and that population increase is set to continue into the next decade.

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

I thank the hon. Gentleman for his kind remarks about our cross-party working, which our constituents throughout north Northamptonshire welcome. It has helped us in our approaches to the Minister and local health partners, and in bringing them together.

On the point about population, does the hon. Gentleman agree that we should emphasise the fact that as well as having, like most of the country, an ageing population, we also have one of the highest birth rates? Indeed, my constituency has the highest, but the birth rate is high throughout north Northamptonshire. There is demand at both ends of the population, as well as, of course, from people of working age.

[Mr Hollobone]

That is very pertinent. Demographic pressures are hitting us from every angle. There is a high birth rate in Corby and east Northamptonshire. Increasingly, in my constituency as well as the hon. Gentleman’s and that of my hon. Friend the Member for Wellingborough, the population is ageing. Whereas 30 years ago an elderly patient might go to hospital with a particular condition, now it is even older people who are going there, with multiple conditions needing treatment at the same time. Kettering general hospital, like all hospitals, must raise its game when treating such vulnerable members of the community. It is not only population numbers, but the number of young and old patients that creates a challenge.

Although Kettering general hospital has difficulties and challenges, it is raising its game, and that is due largely to the tremendous dedication of the doctors, nurses, ancillary staff, management and clerical staff at the hospital, who are in a joint endeavour to deliver the best care they can. There is extremely good news to report. The Department of Health tells me that in 2012-13 there were 85,497 in-patient finished consultant episodes at the hospital, compared with 84,602 in 2011-12. There has been a focus on accident and emergency waiting time targets, and in the past few years Kettering general hospital has moved from being one of the worst in the country to one of the best. All hospitals in the country have been under pressure this winter, but it would be wrong to give the impression that fewer people are being treated at Kettering A and E. The reverse is true. In 2010-11 76,099 people presented themselves to A and E. In 2012-13 the number was 84,055. Record numbers of people are being treated there.

[Andy Sawford]

The hon. Gentleman will have been struck, as I was, at being told that the accident and emergency department was built for 20,000 patient visits a year, given that recent figure of 84,000. I endorse his remarks about change and progress in the past few years. To what does he attribute that? He mentioned the staff, and I agree. There has also been a change in the leadership of the hospital. However, perhaps it is also to do with the way the local health partners and organisations, including the clinical commissioning groups, have come together with the hospital more effectively through the work that we have been involved in with them, particularly with a view to improving A and E.

[Mr Hollobone]

The hon. Gentleman is right, of course. He gives a tantalising flavour of the climax of my speech, which will be about the urgent care hub proposal for Kettering general hospital, on which he, I and my hon. Friend the Member for Wellingborough have been working together.

[Mr Hollobone]

Yes—not only have we three north Northamptonshire Members worked on a cross-party basis to secure the future of our local hospital, but we all dressed up in funny outfits on Sunday to walk around Wicksteed park in Kettering in support of Glennis Hooper and the marvellous work she does for Crazy Hats, which raises money for cancer treatment and care for our constituents. I suppose that it is part of an MP’s job on occasion to dress up in a funny costume and look silly for the benefit of constituents, and we are all pleased to do that.

Some further good news about Kettering general hospital, from Department of Health statistics, is that finished consultant episodes when any procedure took place in the hospital—which I think is bureaucracy-speak for the number of operations—went up from 49,638 in 2010 to 53,869 in 2013. I am told that there are 43 more hospital doctors and 55 more nurses than in 2010 and there is a 24% increase in diagnostic tests, a one third increase in the number of people treated for cancer and a 71% increase in the number of MRI scans performed. Of course just two years ago the £30 million foundation wing was opened. It has a 16-bed intensive care unit, a 28-bed cardiac unit and a 32-bed children’s unit. That was massive new investment in our local hospital.

It should not be forgotten—and we three Members of Parliament for the area do not forget—that increasingly Kettering general hospital offers our constituents world-class health care. The latest example of that is the cardiac investigations department, which has received national recognition for its high standards in heart ultrasound scanning. Every year 8,000 of our constituents are patients through that unit, which provides ultrasound scans of the heart. Those can reveal diseases such as heart failure and valve diseases.

[Andy Sawford]

That shows what huge progress has been made. A little over 10 years ago, my granddad had a heart attack and had to wait in a bed in Kettering general for six weeks to be transferred to Glenfield hospital in Leicester for a stent. Such operations can now be done as a day case at Kettering general.

[Mr Hollobone]

The hon. Gentleman is right. That is a good example of the way Kettering general hospital has raised its game to tackle local health needs. Increasingly, our constituents do not have to go to Glenfield, because they can get better care at their local hospital. In the case in question, that is because of the £300,000 investment in three state-of-the-art ultrasound scanners, which can show the heart in three dimensions. The 16-strong cardiac investigations team has been awarded accreditation by the British Society of Echocardiography, which is an affiliate of the British Cardiovascular Society. That accolade is not given lightly. Kettering hospital is one of only 38 in the country to have achieved that accreditation; some specialist centres, such as Glenfield, Papworth, John Radcliffe and Coventry, have not yet attained it.

The £4 million upgrade of the maternity department at Kettering general hospital started in December. An average of 10 babies per day are delivered at the hospital—including the babies of Members who are here today. It is part of an £18 million investment in the hospital.

In coming to the climax of my remarks, I want to talk about the innovative proposal for an urgent care hub at the hospital—my colleagues will appreciate this, because we have been working on it together. Over the past few months, the hospital has been liaising with partners and developing a strategic case for an urgent care hub on the hospital site to tackle long-term, urgent care pressure relating to population growth, about which we have spoken; age and acuity; and increasing public demand for prompt access to urgent care.

In December, the trust shared its strategic case with the foundation trust regulator, Monitor, which is currently considering the proposal. If Monitor approves the case, it will go on to an outline business case and finally a full business case for approval by Monitor, the Department of Health and the Treasury. The key to its success is that the hospital has been working in close collaboration with its health and social care partners. It is developing what is essentially a one-stop shop for our constituents who need urgent medical care.

The aim is to develop a £30 million urgent care hub on the hospital site that will combine secondary care, hospital A and E and urgent care assessment with primary care—in other words, GP services, minor injury care and social and community care services. The proposal has arisen because there has been significant growth in demand for that type of urgent care in the local health economy of our three constituencies, partly due to a 30% population growth over the past 19 years, with another 9% expected by 2020, and a rise in the population of older people, about which we have spoken. There has also been a massive 83% increase in the use of A and E over the past 20 years as a means of accessing urgent care.

[Mr Hollobone]

My hon. Friend has rightly made that issue a priority for his constituents, and he has led an effective campaign on it. That facility will be similar to the facility currently in operation in Corby. The idea is to treat people as locally as possible so they do not have to present themselves at Kettering’s A and E department. It is all part of making local health care delivery more efficient and effective, and my hon. Friend is right to highlight it.

[Andy Sawford]

Does the hon. Gentleman agree about one of the things we have made progress on—particularly through the cross-party campaign and the cross-working of the organisations involved? Although there are sometimes particular interests in individual towns and communities, we have looked at the bigger picture for the whole of our area. There are benefits for individual towns. The hon. Gentleman is right to say that I want to build on the success of the urgent care centre, but, in the end, when A and E—in particular, trauma services—is needed, it is going to be there relatively locally for everybody in north Northamptonshire.

[Mr Hollobone]

The hon. Gentleman is absolutely right. Although we want to see far more local delivery of efficient NHS services in particular constituencies, all three of us accept that the vital part of the local health economy is the success of Kettering general hospital. If it were not there—if it were in Northampton, Milton Keynes, Bedford or Luton—local NHS delivery for our constituents would be far worse. We have to make Kettering general hospital a success. We can help it along its way with the innovative establishment of success stories such as the urgent care centre in Corby and the new facility at Isebrook, but the key to success for all our constituents is to make Kettering general hospital a success story for the future.

The hub concept developed by the trust and supported by all three of us is a partnership with the bodies that purchase NHS services, such as the clinical commissioning groups, the Northamptonshire Healthcare NHS Foundation Trust and the social care provider, Northamptonshire county council. If successful, the urgent care hub would effectively provide a one-stop shop for GP services and out-of-hours care; an on-site pharmacy; a minor injuries unit; facilities for social services and mental health care; access to community care services for the frail elderly; a replacement for the hospital’s A and E department, which is now 20 years old; and a new A and E services area, which will provide even better acute emergency care and integrated assessment to ensure that patients see the right specialists right away.

The three of us have been to see the Minister with the hospital and the CCGs, so the Minister knows that we are all as one in believing that the urgent care hub concept is the right one for the health economy in north Northamptonshire. It mirrors the way in which NHS England would like to see pioneering health care delivered in the future. As David Sissling, the chief executive of the hospital, said,

“This integrated approach is also something that NHS England has highlighted is an important principle in its Five Year Forward View for the NHS and it also fits with”

the collaborative programme happening in Northampton- shire.

I hope that when the Minister responds to this debate, in which all three MPs have sung from the same hymn sheet and said with one voice that we need the urgent care hub for the betterment of our constituents’ health, he will reiterate his support for the proposal. Whoever wins the election in our three constituencies and whoever forms the next Government, this important proposal must happen, for all our constituents.

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

It is a pleasure to serve under your chairmanship, Mr Gray. I congratulate my hon. Friend the Member for Kettering (Mr Hollobone) on securing this debate. I also commend him and our colleagues in the Chamber—my hon. Friend the Member for Wellingborough (Mr Bone) and the hon. Member for Corby (Andy Sawford)—for their consensual and cross-party approach to tackling the challenges of the local health economy and addressing the needs of local patients. It is working together, as a group of MPs, that has helped to deliver success for the local hospital. That cross-party consensus is an example of what should be done. My hon. Friend the Member for Kettering is right that good health care is not political; it is about doing the right thing by patients, and that is the approach that hon. Members here today have taken in addressing local health concerns.

A number of the points raised today are ones we have talked about in meetings at the Department of Health. I have taken a keen interest in supporting Kettering in its future ambitions and in supporting my hon. Friend in his strong advocacy of the needs of local patients and his local hospital. As he rightly outlined, this is a part of the country with a growing population, due to increasing housing growth and the plans to increase housing growth in the future. As in all parts of the country, there is increased pressure on medical services from an ageing population with complex health care needs. By 2018, we will have 3 million patients with not one or two, but three long-term medical conditions—it could be diabetes, dementia, heart disease or chronic obstructive pulmonary disease.

Caring for patients with complex medical needs is a challenge for our whole country, and I know it has been one of the main drivers of increased admissions to A and E in Kettering. The acuity, which is the severity of the illness or medical admission, is a key issue that has been picked up by the A and E consultants and doctors with whom I have discussed the challenges faced locally by the trust. Supporting a better way of caring for people with long-term conditions and the frail elderly is at the heart of the proposals for the care hub that my hon. Friend outlined.

I want to take this opportunity to recognise the outstanding work done by NHS staff up and down the country. On this occasion, it is appropriate to draw attention to NHS staff working in and around Kettering—not only in the hospital, but in general practice, community mental health teams and palliative care teams. The commitment across the board in Kettering to delivering the highest-quality patient care is an example of what the NHS is all about, and it is right to recognise the dedication of front-line staff in the Kettering area.

I want to take the opportunity also to commend formally my hon. Friend for the outstanding interest that he has shown in standing up for the best interests of local patients throughout this Parliament and for his dedication in never missing an opportunity to raise questions in this Chamber and in the main Chamber during Health questions or to raise the case of his constituents in the Department of Health with me as the responsible Minister. It has been a pleasure to do all I can to support him, his constituents and Kettering hospital.

My hon. Friend is right to highlight the recent investment in the hospital. That is due in no small part to his advocacy and that of other hon. Members in consistently raising the needs of Kettering hospital and the local population. My hon. Friend will recall that when we met in January to discuss health services in his constituency and the plans that his local NHS has to deal with some of the pressures that it faces, we talked about some promising ideas. I will discuss those in more detail in a moment.

Before I do so, it would be appropriate to say a few words more generally about the pressures that the health service has faced during a difficult winter, how they have been handled and what we have done to support the health service both in Kettering and more generally. We know that parts of the NHS can and have come under pressure because of unprecedented demand, linked to the challenges of our ageing population. Compared with four years ago, every day the NHS sees 16,000 more hospital out-patients, performs 10,000 more diagnostic tests and carries out 3,500 more operations, and there are 2,000 extra ambulance journeys. Every year, 1.3 million more people visit accident and emergency departments.

Despite the extra demand, our NHS is performing well and treating the vast majority of people quickly. It is particularly important that it is dealing with the most unwell patients first. That is possible because we have taken, even in difficult economic times, the decisions that have allowed us to increase the NHS budget by £12.7 billion over this Parliament. Of course, that has allowed us to support Kettering hospital with local investment, which my hon. Friend outlined.

The NHS is also on track to deliver up to £20 billion in efficiency savings over this five-year period. That challenge was outlined by the former chief executive of the NHS, Sir David Nicholson, in 2009. Even to stand still and even with increased investment going into the NHS, it needed to make greater efficiencies. As a result of reforms and modernisation, we expect to save £4.9 billion over this Parliament and £1.5 billion a year from 2014 onwards. All of that will go directly back into front-line care in Kettering and elsewhere.

[Andy Sawford]

I thank the Minister for generously giving way, especially as the debate was secured by the hon. Member for Kettering. The Minister makes a point about efficiencies, but will he comment on the issue of geography, which we have not really touched on? We have talked about demand, but this is a critical issue for north Northamptonshire. The geography of our area is such that for people to have to rely on a hospital other than Kettering would mean considerable travel time. As someone who represents a rural area, I can say that that is an efficiency that we would not want to make. We would prefer to say, “Look, we want our local hospital. We recognise that there are challenges in sustaining a local hospital, but the geography of our area is such that we want to keep hold of it.”

[Dr Poulter]

The hon. Gentleman makes a very important and valid point. As well as improving the way our NHS buys goods and services—improving procurement practice, an issue that we discussed with members of the local health care team from Kettering when they visited me in the Department of Health—improving estate management and taking other measures of obvious efficiency, there is a need, outlined clearly in NHS England’s “Five Year Forward View”, to radically transform the way we deliver care. My hon. Friend the Member for Kettering made that point. It is now a priority to care better for frail elderly people through better integrating health services. I am talking about using the hospital potentially as a hub for vertical integration of services, particularly in more rural areas. That will mean that other health services—community health services, general practice and mental health services—can be supported and integrated with the hospital service as a hub-and-spoke model of care.

Crucial to that as well is integrating what the social care service does at the same time and having an approach that joins up what health and social care have to offer. Taking advantage of the better care fund that has been set up at local level, so that the local authority can work more collaboratively with the NHS, is very important. It is often very difficult to define where social care ends and health care begins, because staff are dealing with the same person, with the same care needs, but traditionally a silo approach has been taken to the delivery of care. We need to break down institutional silos and deliver more personalised care. That is at the heart of integrating care—at the heart of the hub-and-spoke model built around Kettering hospital. It draws on the importance of joining up what the local authority does with what the NHS does. That is particularly important in more rural areas, such as the one that the hon. Member for Corby represents.

As I said, I have followed developments in Kettering with keen interest. It is worth saying that since October 2012, when Monitor found the trust to be in breach of its licence in relation to consistently poor A and E performance, considerable progress has been made. That is in no small part down to the work of the local NHS and the local health care teams. To date, in 2014-15—I am now bringing the House up to date—the Department has provided £7.4 million of revenue support and £5 million of emergency capital to the trust. Over the winter, the trust fully activated its winter plans, building on initiatives that proved successful in previous years.

That work included an enhanced weekend discharge team, detailed plans allowing escalation when there was a busy period, and appropriate use of short-stay facilities, including an observation unit and ambulatory care unit. Those short term measures are designed to ensure that services continue in times of pressure, but the intention, quite rightly—building on the point about better integrating health and social care and what happens in the community with what happens at the hospital—is to move to a position whereby there is the ability to cope with pressure all year round and not just during the winter. The urgent care hub has that integrated delivery model at its heart.

The hub, as my hon. Friend the Member for Kettering outlined, would incorporate existing A and E services and facilities, but also include, for example, GP services and out-of-hours care, an on-site pharmacy, a minor injuries unit, facilities for social services, facilities for mental health care—that is particularly important and sometimes overlooked, but not in this case—and access to community care services for the frail elderly. Those services would facilitate rapid assessment, diagnosis and treatment by appropriate health and social care professionals. Patients would be streamed into appropriate treatment areas to minimise delays and reduce the need for admissions.

The hub’s location is, I am told, still being finalised, but options include clearing and redeveloping existing areas of the hospital or developing a new build on the site. The local NHS envisages that a capital investment of approximately £30 million, as my hon. Friend outlined, will be required. However, that figure will be subject to further detailed assessment as part of the business planning process.

The principle of the hub is absolutely the right way forward for the local NHS. It is the type of integrated care model that we need elsewhere in the country, particularly where the NHS is servicing a broad population. In this case, it is servicing not just Kettering, but a partially rural county and rural area. This is a model that I am sure hon. Members will continue to support and that I will continue to have a keen interest in supporting. I hope the plans will be successful at making the improvements that patients in my hon. Friend’s constituency and the area surrounding Kettering want. There are encouraging signs. The improvements envisaged are significant and would ensure that the local area had a resilient and high-quality health care system to deliver the highest-quality patient care. I again thank my hon. Friend the Member for Kettering for securing the debate.

Child and Adolescent Mental Health Services

Andy Sawford Excerpts

Monday 2nd February 2015 Commons Chamber

[Norman Lamb]

I am left totally confused. The hon. Lady has just referred to my complacency, whereas the person who was just sitting next to her, the hon. Member for North Durham (Mr Jones), paid tribute to my passion in fighting for mental health services. So which is it?

If there was any substance to the hon. Lady’s question, it concerned the importance of mental health services and education working more effectively together and, as was said earlier, the role of schools. As a result of the taskforce, I think we can achieve much better collaboration among schools and mental health services. I also point out, as have hon. Members on her own side, that this is a long-standing problem that goes back far beyond 2010.

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

The Minister might remember that I wrote to him about a local family who went through a living hell when a young girl was sent from East Northamptonshire to a hospital in Bury, where she was left for weeks; where there was conflicting advice about whether she should be there at all; and where the family felt she was getting worse not better. Will he look specifically at provision in Northamptonshire, particularly the provision of beds for teenagers, and reflect that, to be fair to CAMHS in Northamptonshire, ours is one of the worst-funded areas for health care in the whole country—way off the NHS England target?

[Norman Lamb]

I know that the hon. Gentleman is campaigning on this matter—he is right to do so—and I would be very happy to talk to him further about this case. The circumstances he describes are intolerable. As my hon. Friend the Member for Kettering (Mr Hollobone) said, the frustration is that, if some services and commissioners can avoid that, why does it happen in other areas of the country? However, I would be happy to discuss the matter with him.

NHS (Government Spending)

Andy Sawford Excerpts

Wednesday 28th January 2015 Commons Chamber

[Chris Leslie]

That is so unlike the hon. Member for Wyre Forest (Mark Garnier), and very out of character.

My hon. Friend the Member for Nottingham South (Lilian Greenwood) is a doughty fighter for NHS patients in our city of Nottingham. She knows very well that we have been trying our best, in working with local trusts, to press them to ensure that such services are safeguarded. Ultimately, when our constituents see the Government passing legislation encouraging trusts to move a private income level of 2% to potentially 49%, and when they see the pressure trusts are under, they are not surprised that many such problems are occurring in our area. It is only through making sure that we find resources and channel them towards investment for the care needs in our NHS that we will deal with those pressures.

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

Does my hon. Friend agree that, as well as ensuring there are finances at national level, we must ensure they are fairly distributed across the country? NHS England has a target funding allocation for Corby, but the National Audit Office and the Public Accounts Committee say that my local health authority is the worst funded in the country. Will shadow Ministers commit to fairness of funding when in government?

[Chris Leslie]

We know that the Conservative party has tried to distort funding formulas across the country by stealth. In fact, they have not done it stealthily; it has been pretty bleeding obvious. Given how local government funding formulas have been skewed—away from areas of need, and in a gerrymandering fashion—I certainly agree that such a situation must be reviewed.

A and E (Major Incidents)

Andy Sawford Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

I am happy to do that, and also to welcome the 80 new nurses in my hon. Friend’s local area over the past four years.

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

The Secretary of State will be aware that there are particular issues at Kettering General hospital’s A and E unit. It has improved its performance, but it has been described, to the shock of all the MPs in the area, as the worst seen in the country. We have done an awful lot of work. On Tuesday we are bringing the local health organisations together to the Department. Will he encourage his ministerial colleagues to give the green light to our plan for our area?

[Mr Hunt]

We will look at that very carefully. Of course, anything that can help to relieve pressure on A and E departments is our top priority at the moment.

Oral Answers to Questions

Andy Sawford Excerpts

Tuesday 25th November 2014 Commons Chamber

[Dr Poulter]

My hon. Friend will be aware that the NHS funding formula is set independently, free from political interference. It is reviewed annually. I should like to reassure him that the Nene and Corby clinical commissioning groups have both received higher than real terms growth in their funding allocations and will do so again next year, to move them closer to their target allocations.

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

I have been working closely with the hon. Member for Kettering (Mr Hollobone) in recent years on a campaign to support the hospital. We recognise the issues that the CQC has raised, and we support the journey that the hospital is taking towards improvement. When the hon. Gentleman and I come to see the Minister in a few months’ time, will he look favourably on our bid for £20 million of funding to improve our accident and emergency department, whose physical environment has been described by experts as being among the worst in the country?

NHS Services (Access)

Andy Sawford Excerpts

Wednesday 15th October 2014 Commons Chamber

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

In the time available, I want to make the case for fair funding for health services in my constituency. My right hon. Friend the Member for Leigh (Andy Burnham) set out powerfully the charge sheet against this Government: a costly reorganisation that nobody wanted; a push to privatisation that nobody wanted, except perhaps some of the Tory donors; and fragmentation where we need integration—nowhere more so than in health and social care, because of the massive cuts to care budgets.

In my constituency there are brilliant health care workers struggling to deliver the best possible care for patients against the backdrop of all this disruption and undermining of the NHS. I was elected on a promise to fight for our local hospital services. A project called “Healthier Together” proposed reducing the number of beds at Kettering general hospital by 500, taking away proper maternity and children’s provision and downgrading accident and emergency services. The Prime Minister claimed that the threat was not real, but when the evidence came into the public domain—the hon. Member for Kettering (Mr Hollobone) stood up to his own Whips and raised it on the Floor of the House—the proposals were ditched.

Some 6,000 people had signed my petition. We continued that cross-party working locally, with councillors from all parties, and the hon. Member for Kettering and I worked with commissioners in the hospital on a plan for major investment. A bid will soon be submitted. We met the partners last week and are seeking a meeting with the Minister soon. Our plan is to really develop the innovative integrated urgent and emergency care approach being pioneered in north Northamptonshire so that more people can be treated more quickly and effectively, whether in primary, urgent or emergency care.

I have to tell the Minister that although there is a real will and a proven ability to innovate and do the best they can with resources, our local health services are severely hampered by a lack of resources. The midwives I met this week told me that they are being asked to work harder for longer and with increasingly stretched resources. That is a pattern across the NHS work force. Ambulance workers trying to improve response times are working longer shifts with increasingly outdated equipment. I was out in a paramedic vehicle with East Midlands ambulance service workers over the summer—a car that had done 300,000 miles without a working phone. That is what our health care workers are struggling with.

Our community health services are struggling. Older people are suffering from the withdrawal of podiatry services. Mental health services have been slashed, with people waiting and waiting for the therapy and treatment they need. Mental health nurses in my area are being made redundant and vital voluntary organisations that have been supported by public funding, such as Safe Haven in Corby, have been severely cut. Children are being sent to the other end of the country because care is not available for them locally, despite their being particularly vulnerable. Doctors’ surgeries are struggling— some more than others, but particularly in our small towns and rural areas. When I met residents in Stanwick the other day, they told me of their concern that, with plans to continue the growth of their village, the doctor’s services simply will not be able to cope.

I recently surveyed hundreds of my constituents about local health services. They told me that they support our cross-party campaign but are deeply worried about access to out-of-hours services, the difficulties of finding a GP surgery appointment and the increased privatisation of services. Specifically, they wanted me to put on record their concerns about the transatlantic trade and investment partnership and the impact that it could have on our national health services.

All these issues are being addressed in a context where we have the worst-funded health service in the country. A report published in September by the National Audit Office bears this out. It is called “Funding healthcare: Making allocations to local areas”. The NAO says that Corby is the worst-funded area of England for health care, receiving £186 less per person per year than the allocation that the NHS says it needs. Each year, the Department of Health and NHS England make these allocations to local commissioning groups, aggregating funding for local primary care, hospital, community and mental health services. The NAO’s analysis suggests that in Corby we are 12.8% below the target that is needed to meet local health needs. That compares with £508 per person above target in the highest-funded area in west London. The head of the NAO, speaking about the report, said:

“Funding allocations have reflected, among other factors, a desire not to upset local health economies by taking funding away or even increasing it by less than inflation. This has significantly slowed progress towards a fair distribution where funding fully reflects needs across the country. The Department and NHS England need to consider carefully whether this approach is fast-moving enough to sustain hard-pressed local areas in the next few years.”

It is totally wrong that health services in Corby are being starved of funds. How can it be right that people in Chelsea or in Kensington are allocated £694 per person extra per year for health funding? Corby’s health care service is doing a good job of managing with these limited funds. The new urgent care centre, for example, is a beacon, but other services are having to be cut back. The NAO found that the unfair distribution is taking place because many decisions are based on individual civil service judgments instead of evidence. The report’s detail and recommendations really stand up to the charge that the Government’s policy is not based on evidence.

The NAO found that the problem is exacerbated because proper account is not taken of population growth. My area has the highest birth rate in England; it is one of the fastest-growing towns in the country. This creates a real double whammy for our local services. It is a basic question of fairness that Corby should be funded according to needs. Therefore, in the coming months, I will be asking local people to join my campaign for fair health funding. Together, we will demand that the Government listen and end the injustice of filling the coffers of health commissioners in wealthy areas of the country at the expense of my constituents in Corby.

Ebola

Andy Sawford Excerpts

Monday 13th October 2014 Commons Chamber

[Mr Hunt]

The hon. Gentleman is absolutely right. We have numerous ports of entry to the UK. We are one of the most international countries in the world, and London is one of the most international cities in the world, so the actions that we take must be proportionate to the risk. The risk is currently low, so the advice is that having no screening procedures at those airports is proportionate to the risk now, but we are taking this precautionary approach, starting with the Heathrow, Gatwick and Eurostar terminals, because we want to prepare for a possible increase in that level. Were that to happen we would of course look at whether that screening process should be expanded to regional airports.

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

In a recent film of medical workers treating people in west Africa with Ebola, a young doctor said that the one benefit of her protective mask was that people could not see her cry. Even as the media focus inevitably moves on, we know that this will go on for months and months, so will the Secretary of State give us all an absolute assurance that we will continue, even though we cannot see her cry, to hear her voice and do whatever we can to help people in west Africa?

[Mr Hunt]

If that is the last question today, it is a fitting one on which to end. The hon. Gentleman is absolutely right: this is an appalling human tragedy. There have been more than 4,000 deaths so far, in countries that are already, in many ways, the unluckiest in the world in terms of the levels of poverty that they already have to cope with daily. We can be incredibly proud of the 659 NHS volunteers, and the military, diplomatic and development staff who are stepping up to the plate, and we should always remember our humanitarian responsibility never to forget those countries’ plight.

Oral Answers to Questions

Andy Sawford Excerpts

Tuesday 25th February 2014 Commons Chamber

[Dr Poulter]

My hon. Friend makes an important point. This is not just about providing good health care services, but doing so in a joined-up way. We now have a seriously injured leavers protocol to help the transition of servicemen and women who leave the armed forces and return to civilian life. That is about taking a holistic view of their health and care needs, and any other needs that they may have, in providing the right support when they return to civilian life. It is being rolled out very effectively across the country.

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

10. What assessment his Department has made of the availability of mental health services.

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

Our mandate to NHS England makes it clear that everyone who needs it should have timely access to the best available treatment. NHS England is currently gathering information about access to and waiting times for mental health services. We will use this information to set new national access standards for the first time, to be introduced from 2015.

[Andy Sawford]

The Safe Haven in Corby provided crisis out-of-hours support to 1,300 people with mental health problems last year. For the first time ever, it has been asked to tender for its future funding. It was eight minutes late with its tender, and the service is going to be cut. What will happen to the people who need that service in the future? Will the Minister meet me to discuss it?

[Norman Lamb]

I am very happy to talk to the hon. Gentleman about that. My understanding is that the local CCG undertook a retendering exercise with a view to maintaining and, indeed, improving mental health services locally. As he says, Safe Haven did not submit its tender in time. It had a right to appeal, and it chose not to appeal. The CCG is absolutely committed to ensuring that it improves mental health services locally.

Accident and Emergency

Andy Sawford Excerpts

Wednesday 18th December 2013 Commons Chamber

[Norman Lamb]

I will not give way; I do not have time.

Up until this week, A and E targets were met in the past 32 weeks in a row. Is that evidence of a crisis? The average wait for people in A and E during Labour’s last year was 77 minutes; it is now 30 minutes. Is that evidence of a crisis? Even though more people are coming through the doors, 2,000 more patients are being seen in less than four hours every day under this Government than under Labour. Evidence of a crisis? I don’t think so. The Opposition are scaremongering, plain and simple. In fact, the College of Emergency Medicine’s president, Cliff Mann, has today said that any crisis in accident and emergency is “behind us”.

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

May I associate myself with the remarks made by the hon. Members for Kettering (Mr Hollobone) and for Wellingborough (Mr Bone)? We are pressing for funding to meet the additional demand in the Kettering accident and emergency department. Will the Minister encourage us in that?

[Norman Lamb]

I applaud the cross-party effort of those Members campaigning for their community, and I am very happy to engage with them further on that matter.

Podiatry Services

Andy Sawford Excerpts

Wednesday 4th December 2013 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Robertson. I am pleased to have secured the opportunity to speak about podiatry services. I hope the Minister will forgive me if I speak a little briskly, but there are a number of issues that I want to cover. I am delighted that other hon. Members also wish to contribute.

In my constituency, which covers Corby and east Northamptonshire, podiatry services are delivered through Northamptonshire Healthcare NHS Foundation Trust. In May this year, the Nene clinical commissioning group and the Corby CCG initiated a public consultation on their proposal to make changes to the delivery of podiatry services, based on categorising the needs of patients as high, medium or low risk. I received letters from constituents and had constituents attend my surgery. For MPs, multiple contacts from constituents is sometimes a warning sign that there might be a problem. My constituents were concerned about the consultation, first, because they regarded it as ineffective, as it failed to communicate or engage with the users of podiatry services to any reasonable degree, and secondly because they thought it token. We know that the public are at times sceptical about consultation exercises, and with reason. It does not help when they see them as being more about selling a solution—a predetermined decision—than about genuinely engaging people in finding the best way forward.

We all recognise that services need to change for all sorts of reasons, not least due to our ageing population and the financial challenges that our local health care providers face. We MPs want to engage in consultations in which the public are genuinely involved and in which we feel that there has been rounded discussion about how best to work together, across the public sector and the different parts of the health system, to find the best way forward.

[Jim Shannon (Strangford) (DUP)]

Podiatry is important for everyone, and those who need treatment in particular. The optician will diagnose things that other people might not see; the podiatrist, too, can diagnose things that are wrong with someone’s body—for example, he can spot the onset of diabetes and other health issues, including in elderly people who do not know they have them. Does the hon. Gentleman agree that podiatry is vital in checking for ailments that someone does not know they have?

[Andy Sawford]

The hon. Gentleman is absolutely right, and I shall turn to that point in describing the consequences of some of the changes in my area. There is a pattern across the country. I am sure that he, too, will be concerned to ensure that services are available in his area.

On 30 July this year, the clinical commissioning groups announced that their governing bodies would approve the cessation of “low risk” podiatry. They have been unable to explain to me what the standard assessment process will be for categorising patients in that way. They qualified the announcement by stating that the decision would not apply to children or vulnerable groups, which was a response to the strong feedback that the public and I, and perhaps other hon. Members, gave. I challenged the Nene CCG on the definition of “vulnerable groups”, and it told me that the term refers to

“The frail elderly and people who are likely to neglect foot-care for financial reasons”.

That is good to hear, but it is not clear who will make that assessment, and on what basis. We must ensure that the most vulnerable can access care.

[Mr Philip Hollobone (Kettering) (Con)]

I congratulate the hon. Gentleman on securing the debate. He is serving his constituents extremely well on this issue. I had an e-mail from a constituent who says:

“I have an appointment this morning, where I am expecting to be told that I shall not be receiving any more services from”

the podiatrist.

“I have Psoriatic Arthritis in my hand and feet and other joints”,

and

“insoles made to help me walk. ‘I am unable to reach down to do my feet myself’ I told the podiatrist, to which he replied, It can’t be helped. He then said I would have to get my husband to do my feet.”

She goes on to say that her husband

“has issues himself, I cannot ask him to do yet another task for me.”

That is an example of a vulnerable person who clearly does not feel that she has been included in the exemptions that the hon. Gentleman describes.

[Andy Sawford]

I thank the hon. Gentleman for his intervention. I welcome his support for the debate. He is assiduous in working on local health matters; indeed, we have worked together on some issues. I welcome him raising his constituent’s concern. It illustrates the worry about the impact of the changes and the reality of people already being advised that services will be withdrawn—even those who the hon. Gentleman and I would hope would fall under the definition of “frail” or “vulnerable”, including those who may not be able to afford care.

Access is part of the problem. At the same time when the consultation exercise was carried out, the foundation trust reviewed its estates and facilities to make savings. It closed some podiatry clinics and relocated some services, making them more difficult to access. We are talking about people who may not have transport or who may have mobility issues, so difficulty in accessing services is a further problem.

In Northamptonshire, 107 private podiatrists are registered with the Society of Chiropodists and Podiatrists. I am grateful to the society for its helpful briefing for today’s debate. Those private podiatrists are expected to provide care to low-risk patients. Costs vary across the area, so will the Minister comment on how we can safeguard our constituents’ interests by ensuring that costs are affordable where people are told that they must meet costs themselves and that as many people as possible are not charged at all where there is a clear need, in accordance with the CCG’s stated wish to include the frail and vulnerable?

I have received letters from Northamptonshire Healthcare NHS Foundation Trust podiatry staff, who told me that their jobs were being put at risk. There have been 16 whole-time equivalent podiatry posts lost, including leadership posts and the posts of musculoskeletal and diabetes specialists. That is inconsistent with the Government’s stated aim of maintaining high-quality clinical services. The reductions will create a high level of clinical risk by putting patients at an increased risk of falls, ulceration and amputation. We all want to ensure that our local hospital services, for example, can meet growing needs. We do not want more people presenting at accident and emergency or needing hospital admissions because they were not effectively treated through podiatry services.

The staff in the local podiatry service down-banded to bands 5 and 6 will be expected to carry out the same role that they currently deliver at bands 6 and 7. The view of the Society of Chiropodists and Podiatrists is that that is a deskilling or de-professionalisation of the service. I am concerned about that. Podiatry is not the most glamorous or attractive part of medicine. Not everybody wants to deal with people’s feet, for reasons we can all understand, but such work is incredibly important. Those who do it are proud of their professional skills, and we do not want them diminished, or want people not to be paid at the right level for their qualifications, because in the end that will lead to a recruitment problem

I understand the importance of the quality, innovation, productivity and prevention challenge to the national NHS strategy. I met the chief executive of the Northamptonshire Healthcare NHS Foundation Trust on Friday to discuss the issues. She talked to me about the rationale behind the changes, but she also said that there had been “learnings”. What I am learning is that the term “learnings” in health care usually means, “We recognise that we didn’t go about this in the right way. We perhaps rushed too quickly.”

Does the Minister accept that if people cannot access services where they are needed, the changes in Northamptonshire, and perhaps other areas, could create long-term problems and prove to be a false economy? I hope she agrees with that. Will she look at the staffing changes in Northamptonshire? I was asked on BBC Radio Northampton this morning what an Adjournment debate achieves, and I said that one thing is that the Minister will take an interest in what is happening in my area. I hope that one outcome of today’s debate will be that she will look at the changes in Northamptonshire, if she has not had a chance to do so already.

I do not want the Minister to override the proper role of local decision makers in deciding on the best pattern of services in our area, but a sense check on the Government’s intentions around the shift to prevention and the best use of resources, and how short-term decisions are made locally to find savings, may be a counter to that.

There seems to be a contradiction between the Department of Health’s vulnerable older people’s plan and policies that put older people at higher risk through the downgrading of incredibly important and much valued services. Along with the demographic time bomb that the NHS is facing, there is also a diabetes challenge; 2.9 million people, or 4% of those in the UK, have been diagnosed with diabetes.

[Nick Smith (Blaenau Gwent) (Lab)]

I congratulate my hon. Friend on securing this debate. I recently visited the foot clinic at the Aneurin Bevan hospital in Ebbw Vale in my constituency about a fortnight ago, and I spoke to the fantastic podiatrists there. They told me about the huge and growing demands on their services because of diabetes. Does he agree that raising awareness of diabetes and the effect that it can have, particularly on people’s feet, is really important?

[Andy Sawford]

I thank my hon. Friend for his supportive intervention. He is absolutely right that diabetes can cause problems for people’s feet. Also, by examining people’s feet, the podiatrist can diagnose cases of diabetes and ensure that people get the treatment, help and support that they need. I am concerned that some of the estimated 850,000 people who are undiagnosed might continue to go undiagnosed if podiatrists are not able to provide proper, professional attention to people’s feet when they come into contact with them.

The National Institute for Health and Care Excellence clinical guidance on the prevention and management of diabetic foot complications sets out a foot care management plan to reduce the risk of problems occurring in those with diabetes. It is the clear view of the Society of Chiropodists and Podiatrists that there are not enough podiatrists to comply with the NICE clinical guidelines. We might expect the society to make that argument, but it chimes with my concerns locally that we have lost 16 podiatrists in our area. At a time of increasing diabetes, a reduction in podiatrists gives me real cause for concern, because the society’s view might be right.

Some 500,000 hospital beds in England each year are occupied by people with diabetic foot ulceration—more than all other diabetes complications combined. Only breast and prostate cancer have a higher mortality rate than diabetic foot ulceration. The number of amputations in England has risen from 5,700 in 2009-10 to more than 6,000 in 2010-11. It is reported that, given the increasing incidence of diabetes, more than 7,000 amputations will be performed on people with diabetes in England alone by 2014-15, unless urgent action is taken. If we look at our acute hospital budgets and compare the costs of a bed and of performing an operation and amputation—not to mention the impact on the individual concerned—we see that an increase in amputations in our area could prove far more expensive than continuing to provide the podiatry services that people have come to expect.

Does the Minister accept that the prevention and management of foot disease in people with diabetes is an essential component of every commissioned diabetes pathway, and does she share my concern that 80% of amputations each week are preventable? That is a stark figure. Can she give me an undertaking that clinical outcomes for vulnerable older people, including those with diabetes, will not worsen in Northamptonshire?

I wish to mention briefly some other issues in the short time I have left. By standardising best practice in the work of podiatrists in the UK, there is the potential to make net savings and reduce the number of accident and emergency admissions and amputations. NICE clinical guideline 119 looks at best practice. I hope that the Minister will consider how we can make sure that that guideline is followed in Northamptonshire with the resources available.

Finally, there needs to be greater parliamentary and public attention to podiatry issues. I very much welcome hon. Members’ attendance at this brief debate, and their interest and support. The subject is not particularly glamorous. Toenails, amputations and ulcerations are not things we want to think about over our breakfast, but they are important issues, particularly for some of the most frail and vulnerable people.

--- Later in debate ---

[Jane Ellison]

Access is an important factor. The hon. Gentleman is right to highlight the fact that improving and maintaining access is important.

Sometimes education is about making sure that people understand when to seek help and what the warning signs are. Podiatry is an important component of early alert work, as well as an important provision for older people and for people with long-term conditions. In situations in which services need to be changed, the NHS commitment is to make sure decisions are made in a clear and transparent way, so that patients and the public can understand how services are planned and delivered.

Through the mandate, NHS England is responsible for services and for working with local clinical commissioning groups to ensure that their services are based on the needs of the local population within the resources available—the hon. Member for Corby acknowledged the constraints—and there has to be evidenced-based best practice.

An important part of the reforms was to establish CCGs at the level at which commissioning decisions are informed. They are closer to their local communities and can respond to local needs, but they have access to good advice through NHS England, clinical senates and local professional networks. That commissioning process also takes into account the local authority’s views, with regard to the joint strategic needs assessment and, of course, the local health and well-being strategy, so these decisions do not exist in a vacuum: they are taken within a framework, all of which is geared towards local services responding to the needs of local people.

Of course, a big part of that—it is something I am always keen to stress—is the engagement with local democratically elected representatives. I am really pleased that the hon. Gentleman is so engaged with this issue. Whenever I have the chance to talk to people from any part of the health service in the course of my work, I stress the need to keep local councillors and local MPs closely informed and to work with them in making these key decisions, because I know that we are often the early warning signal when people have concerns. Like the hon. Gentleman, I have had people come to my surgery about these issues and that has been an early alert about when people might have concerns. It also allows us to respond to concerns that perhaps arise sometimes when a misunderstanding of a decision is causing undue alarm.

[Andy Sawford]

On the point about misunderstandings, the Minister is right. I do not want to alarm people across my area about services that they may still be able to access, but will she look at this issue in relation to Northamptonshire? If she has any opportunity to talk to the local CCGs or Northamptonshire Healthcare NHS Foundation Trust, will she ask them to make clearer what guidance there is and what assessment process there will be to ensure that people who can still access these services know that they can do so and are assessed as being in the group that can still access them?

[Jane Ellison]

The CCGs and NHS England are obviously aware of the debates that we have here in Parliament; I always undertake to draw to the attention of the correct parts of the NHS the debates that we have here. It is obviously not for me to tell CCGs what to do or what to commission. However, this is the whole point such debates —to highlight Members’ concerns, to give Ministers a chance to respond to them, and to explore how more could be done to allay those concerns and respond to them—so I am very happy that we are getting this discussion on the record.

The hon. Gentleman raised the issue of the education and training of podiatrists. Health Education England is working to ensure that there is an appropriate balance between supply and demand. We have already talked about the likelihood—indeed, the certainty—that demand for podiatry services will grow, because of our ageing population. HEE looks at the number of training places being commissioned. In collaboration with HEE, employers are also obviously keen to ensure that there are sufficient podiatrists to deliver the services that are needed. HEE will publish the national work force plan for England in early December—so, any time now. This year, providers have forecast their future work force requirements, which are obviously based on local service demand and which local education and training boards have moderated, to make adjustments for their education and training commissions. That piece of work is being gauged sensitively to look at local demand and the need for service provision. The assessment will be available in the published plan, which will show the position right across England.

Obviously, that process looks to the future, but we already know that the number of podiatrists working in the NHS has increased during the last 10 years, from 2,916 full-time equivalents in 2002 to 3,067 full-time equivalents in 2012, which is an increase of about 5% during that time. We are also continuing to develop the profession. The hon. Gentleman rightly highlighted that this is an area in which we need growing expertise. We introduced legislation that came into force on 20 August 2013 that enables podiatrists and physiotherapists to prescribe independently, following recommendations from the Commission on Human Medicines. Therefore, podiatrists who successfully complete education programmes approved by the Health and Care Professions Council, including conversion courses to allow existing supplementary prescribers to become independent prescribers, can begin to prescribe independently in 2014. That is a helpful step forward. Extending prescribing in this way will also help to support the key role that podiatrists play in shifting care into the community and improving the patient experience. It will benefit patients by making it more convenient for them to get treatment, as well as hopefully freeing up some valuable GP time.

We recognise that some of the people accessing podiatry services will be vulnerable; we have talked about that issue and the hon. Gentleman expressed his concern about it in his speech. We are reviewing how primary care, urgent and emergency care, and social care services can all work together as part of the integrated out-of-hospital response, looking at the whole person and considering the essential point that the hon. Gentleman made about how we can keep people out of hospital when they do not need to be there, by doing the good early alert work and ensuring that things do not progress to a point where we have the unnecessary amputations that he described.

To support that vision, the Government are working with NHS England on an out-of-hospital care plan for vulnerable older people. In doing so, we are engaged with patients, carers, and health and social care staff—all those important groups—to test those proposals and implement them. The final plan will be published later. I think that the hon. Gentleman will realise from recent announcements that my right hon. Friend the Secretary of State for Health has put enormous emphasis on the need for joined-up thinking about supporting people, particularly the frail elderly, and that is a clear priority that we have talked about a lot. All the things that the hon. Gentleman mentioned in his speech this morning are part of that process, to ensure that people understand that they have a named GP who can support them and to ensure that we spot signs of problems early. That personalised, proactive primary care is essential.

[Andy Sawford]

I see the Minister looking at the clock and I sense that she has a little more to say, but can she just say whether GPs will be able to refer people to podiatrists, in such a way that the service is free? Can GPs be a helpful way of ensuring that people in Northamptonshire who really need this service can get it?

[Jane Ellison]

Right across the country I would absolutely expect GPs, when they see the warning signs of problems, to alert people to the need for further care. That is one of the advantages of having a named GP; hopefully, they will spot the signs of problems early and recommend whatever the appropriate services are. That is very much part of the system that we envisage.

However, we also need multi-disciplinary teamworking; we need people to be joined up in their thinking. Obviously podiatry services are part of that. The hon. Gentleman has eloquently raised the concerns of his constituents and his own concerns this morning. One of the things that he focused on was the question of who are low-risk patients and how is someone assessed as low-risk. I understand that the CCGs involved modified their recommendations for future service provision in response to feedback received during the consultation, so children and vulnerable patients will still be able to access community podiatry services. However, I sense that his concern is that further work might be needed to flesh that plan out, and I know that the CCGs will have heard him express that concern; he has put it on the record today, saying that he is still concerned that those recommendations might still not be fully understood and that he would like to see more work done in that regard. I believe that the analysis carried out by the CCGs showed that only 1% of low-risk patients move into the medium or high- risk categories, but I know that he will want to have ongoing discussions about the nature of that assessment and about that figure.

I also believe that the CCGs involved took into consideration the number of local independent podiatrists who are registered with their professional body, with regard to the low-level community-based care. They are also rightly exploring the potential of developing a broader range of low-level foot care and podiatry services via the third sector and social enterprises, as part of their emerging health and well-being strategy. That is the right thing to do. Some of these services do not need to be delivered by a clinician of any sort; sometimes they might be delivered more appropriately in another setting. I believe that one of the advantages of an increasing emphasis on local planning and integrated service planning at a local level is that people can think outside the box about where certain services—particularly these important early alert services and low-risk services that can prevent people from becoming a higher risk—can be delivered.

The hon. Gentleman has put his concerns on the record; it is right that MPs have the chance to do that. The local CCGs will have heard the concerns that he and other Members who have intervened in this debate have raised, and I am sure that they will be looking to respond to and allay them. However, some of those concerns were based on speculation about what might happen if this piece of work is not got right, and it is important that we find the balance between having due concern about what might happen if services are not got right and if the commissioning of them is not right, and at the same time sending a very clear signal to those people who have medical concerns, such as diabetes or the early onset of other problems, that they must seek help and that they will receive that help. They must not be put off seeking help because of concerns about the future commissioning of services.

It was useful to put all these issues on the record, and I am sure that the hon. Gentleman’s local CCGs and other CCGs will be looking to respond further to the concerns that he and other hon. Members have outlined today.