NHS Specialised Services

Anne Begg Excerpts

Thursday 15th January 2015 Westminster Hall

[Stephen Gilbert (St Austell and Newquay) (LD)]

It is a pleasure to open this debate and to serve under your chairmanship, Sir David. May I be one of the first to congratulate you on your recent knighthood? “Sir David Amess” looks very good on the name plate. I welcome the many hon. and right hon. Members who have made the time today to come and discuss this important issue. I know that there are many Members who would have been here today, but have other commitments, including my hon. Friend the Member for Meon Valley (George Hollingbery) and my right hon. Friend the Member for North West Hampshire (Sir George Young). They have both contacted me about particular cases and share the general concerns that we will be expressing this afternoon, and I am sure they are not the only ones.

I want to speak up for patients and reflect the concerns of those with rare and complex conditions, whose voice is often not heard. There are two principal issues here: concern over changes to commissioning arrangements for specialised health care and whether it is right that morbid obesity and renal dialysis are no longer considered to be specialised services. The debate comes at a vital time. We are in the middle of a six-month period during which NHS England is developing plans to change radically the way specialised services are planned and funded. NHS England is doing that with remarkable secrecy, militating against external scrutiny. Today is an opportunity to discuss what we know and to test its fitness for purpose.

[Dame Anne Begg (Aberdeen South) (Lab)]

I have to declare an interest as someone with a rare condition. Although I live in Scotland, I benefit from a specialised service delivered by NHS England in Cambridge. Does the hon. Gentleman agree that the importance of specialised services means that they should be managed nationally so that they are not competing against local priorities? That is particularly important for cross-border matters. National management builds expertise—few people know a great deal about my condition—and ensures that there are national standards across the whole of the United Kingdom, and not just in one part.

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[Stephen Gilbert]

There is a huge danger that we will move away from the improved patient experience that we have seen during the past year while national commissioning has been in place for specialised services towards more of a patchwork quilt approach in which patients may not get the same care in different parts of the country or the same pathways to care.

[Dame Anne Begg]

A number of rare diseases are genetic and, therefore, they often come in pockets, which means that some local health commissioners may face a heavy burden while others face none. The beauty of the specialist commissioning is that the cost is spread across the whole country, rather than falling on individual commissioning bodies.

[Stephen Gilbert]

The hon. Lady is entirely right. I will continue to set out the case that she so powerfully makes from personal experience.

In a board paper last November, NHS England published its next steps on specialised commissioning. Frankly, that was to the dismay of patient organisations, some of whom have been involved with specialised services for more than a decade, yet none was contacted or engaged with about the paper’s contents. It set out several principles for co-commissioning, perhaps the most alarming of which was the intention to move towards population accountability and lay the groundwork for place-based population budgets. That would essentially represent a return to the status quo ante under primary care trusts and, therefore, contravene Parliament’s wishes as embodied in the Health and Social Care Act 2012.

In particular, budgets allocated to local populations will usher in that patchwork quilt of provision for patients throughout England that hon. Members have referred to, with varying standards of care to match. NHS England suggests that its national standards would continue to apply, but experience shows that that would be untenable. The history of the PCTs is likely to be repeated, with the clinical commissioning groups going their own ways.

Despite opposition from key stakeholders, which I will touch on shortly, NHS England seems determined to implement its proposals. In December it took the unprecedented step of publishing notional local allocations of its own specialised commissioning budget. The sums have already been done and NHS England is now showing local CCGs the sheer scale of the budget that it expects to make accessible to them. Remarkably, only £1 billion of the £14.6 billion of allocated expenditure for 2015-16 is exclusively for national commissioning. Therefore, more than £13 billion of services that are currently commissioned nationally will be subject to co-commissioning. That is a huge transfer of resources and responsibility in the making, which surely requires prior, not retrospective, parliamentary and public scrutiny. Remember: that is funding for complex heart surgery, teenage cancers and chronic liver and blood diseases that affect some of the most vulnerable people in our community.

Why is this move so risky? First, we can say with certainty that local commissioning of such services does not work. As I alluded to already, before April 2013 responsibility for those services was with local commissioners. The 2006 Carter report brought about significant improvements, but the results remained mixed at best. The Select Committee on Health produced a report on commissioning in March 2010 that reviewed local primary care trusts’ performance in funding specialised services. It found that

“many PCTs are still disengaged from specialised commissioning…In addition, specialised commissioning is weakened by the fact that as a pooled responsibility between PCTs, it sits in a ‘limbo’, where it is not properly regulated, performance managed, scrutinised or held to account.”

In view of NHS England’s intention to move towards place-based budgets, it is also worth quoting the Committee’s remarks on the

“danger that the low priority”

given to specialised services by local commissioners

“will mean that funding for specialised commissioning will be disproportionately cut in the coming period of financial restraint.”

Perhaps because of that, patients’ groups and others have been emphatic in their opposition to local control of the specialised budget. Last year, the Specialised Healthcare Alliance, a coalition of more than 100 patient-related organisations and 15 corporate members that has campaigned on behalf of people who use specialised services for more than a decade, ran a survey of more than 100 representatives of patient groups, companies and expert clinicians that sought views on potential changes to commissioning arrangements for specialised services. It found that 90% of respondents preferred their service to remain part of specialised commissioning at a national level and none favoured leaving specialised commissioning arrangements. It also found that 82% favoured either no change to commissioning responsibilities for their service or for more of their service to be incorporated within specialised commissioning. Only 9% opted for more commissioning responsibilities to fall to CCGs. On co-commissioning, while respondents were open to collaboration between NHS England and local commissioners, only 15% would be happy to see that include pooling of budgets with CCGs.

I am grateful to the Muscular Dystrophy Campaign, the British Kidney Patient Association, the Cystic Fibrosis Trust, the Motor Neurone Disease Association, the Association of British Pharmaceutical Industry, the Royal College of Physicians, the NHS Clinical Commissioners, NHS Providers, the Medical Technology Group, AbbVie and Novartis for engaging with the debate. Uniquely, all the groups that have been in discussion with me share my concerns about the timing and content of these proposals.

Despite the clear views being expressed by the patient community and others, neither NHS England nor the Department of Health has opened any consultation on the developments. No stakeholder events have been held and NHS England has not even published full and explicit details of its plans for co-commissioning.

Given the magnitude of the plans, I hope that my right hon. Friend the Minister will give us assurances today. I ask for specific guarantees to satisfy the concerns that have been raised with me. First, will he commit to ensuring that NHS England will remain the sole budget holder for specialised services? Specifically, will he commit to that not just for 2015-16, but for the years that follow? That is crucial to clear accountability and consistency in those specialised services.

Secondly, will the Minister guarantee that national service standards and clinical access policies will remain in force throughout England, with no variation from the core standards permitted? Again, will he specifically give these assurances not just for 2015-16, but for future years?

Mental Health

Anne Begg Excerpts

Thursday 16th May 2013 Commons Chamber

[Paul Burstow]

I entirely agree. That is one reason why the Government have committed to the talking therapies service for children and young people that has so far been rolled out. I am meeting head teachers in my constituency tomorrow to discuss how we can ensure that they commission the right mix of services to support children and young people, not least because conduct disorders, for example, cost society hugely and hold young people back from realising their potential, academic or otherwise. That is undoubtedly the case with integration, which is a key theme of tackling these issues more effectively. That is why I welcome the fulfilment of the commitments made in last year’s care and support White Paper, which my hon. Friend the Minister announced earlier this week, regarding integration pioneers and the new integration framework.

Work on mental health must be embedded in physical health services, which must be embedded in mental health services. When we consider that people with severe mental illness die, on average, 20 years younger than the rest of the population, and that that is due mostly to physical health problems, we begin to understand just how profound that diagnostic overshadowing of mortality can be. It is a scandal and it needs to be addressed. I am delighted that the Government are taking many steps to tackle it.

[Dame Anne Begg (Aberdeen South) (Lab)]

The right hon. Gentleman is rightly concentrating on health services and how they can help mental health and well-being, but does he share my concern that other parts of Government, such as the Department for Work and Pensions, are exacerbating many people’s mental health problems through the way work capability assessments are being carried out, and that those people are having new mental ill health episodes as a result of the trauma of having to go through an Atos assessment?

[Paul Burstow]

Yes, and that issue, which I know is of concern to Members on both sides of the House through their constituency casework, for example, was raised in last year’s debate. Although some steps have been taken to try to improve those processes, they still do not seem to me to capture fully the important differences in dealing with mental health and, as a result, can exacerbate mental health problems. There is more to do in that area and I look forward to the Minister picking up on that issue. Given that the Cabinet committee that had co-ordinating responsibility for the mental health strategy, which is a cross-government strategy, is no longer in place, I wonder how tackling those sorts of issues will be co-ordinated in future.

It is worth noting that there are a considerable number of working-age people with a history of schizophrenia, for example, who are able and—I stress this point—willing to work. Indeed, Rethink’s schizophrenia commission identified employment rates in that group as being about 8%, with a range of 5% to 15% across the country, compared with the obviously much higher rates for the general population. Individual placement and support schemes, which are some of the most effective forms of employment support for people using mental health services, really can achieve remarkable transformations in people’s ability to take up employment. I hope that the Minister can say something on how such issues are being addressed with DWP colleagues, because that is where a cross-government strategy really should be making a difference, rather than simply addressing direct NHS provision.

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[Mr Walker]

I thank the hon. Gentleman for that information. I have campaigned alongside Mind for many years to ensure that people have such services. We talk about support within the community, but it is variable and people’s experience of it is variable. If we are to get things right when people go into crisis or feel a crisis coming on, they need to be confident that the support they require will be there for them. That is why having a crisis plan is so important: people’s wishes can be respected. We too often talk over the heads of people with mental health problems, unwellness or illness—however we define it. We need to be aware of their wishes, because have an absolute obligation to their welfare and to respect their wishes.

Daniel, from Changing Our Lives, is not a constituent; he is just one of the most inspirational people I have met in the 45 years I have tottered along this mortal coil. He is a wonderful man and I am full of admiration for what he is doing.

A couple of days ago, I met Liz Johnson from UK Changes, who works in Staffordshire to ensure that people with mental health issues can remain and keep a foothold in the workplace. For those who are out of the workplace due to illness, her organisation provides mechanisms to help them get back in. The organisation has some reach and I strongly recommend that the Minister meets its representatives. I know there is a drive to ensure that people who have suffered from mental health problems have the opportunity to re-engage with the labour market. One great sadness is that the chance of being in work for those with a diagnosis of psychosis or schizophrenia is approximately 8%. A 92% unemployment rate is unacceptable.

[Dame Anne Begg]

Generally, people with mental health issues have been in work—they are not young and may be in middle age—but have fallen out of it. Does the hon. Gentleman agree that there needs to be a lot more work done with employers to ensure that an episode of mental ill health does not lead to people being sacked and becoming unemployed? Employers need to be much more sympathetic, helpful and understanding to keep people in the job they already have.

[Mr Walker]

The hon. Lady makes a fabulous point. Many organisations are doing that at the moment. The Work Foundation launched a report in the House of Commons a couple of months ago, and I was delighted to be able to speak at that event. Some people who had been excluded from the labour market for many years but are now in work spoke at the launch downstairs in the Churchill room. It was moving and uplifting. Good news stories tend to be uplifting and we need to have more of them. There is still a lot of disappointment and sadness in this area, and that is why we have such an obligation in this place to work with all Governments to improve outcomes and ensure we get things right.

Coeliac Disease

Anne Begg Excerpts

Wednesday 7th September 2011 Westminster Hall

[Gordon Banks (Ochil and South Perthshire) (Lab)]

It is a pleasure to serve under your chairmanship, Dr McCrea, on an issue that is close to my heart or, perhaps I should say, to my small intestine, because I suffer from coeliac disease. I am also a member of Coeliac UK.

Coeliac disease causes damage, through gluten, to the surface of the small intestine and results in a reduced ability to digest and absorb food. This causes malabsorption of essential nutrients such as iron, folic acid and calcium. In infants and children this can result in health problems such as faltering growth, unexplained anaemia, chronic diarrhoea and abdominal distension. In childhood, the presenting features are often relatively subtle and it is much easier to diagnose if coeliac disease is on the radar with a GP at an early stage. For adults, coeliac disease often presents with symptoms of tiredness, reduced appetite, weight loss, mouth ulcers, abdominal bloating, diarrhoea and anaemia.

Many people with coeliac disease present with apparently mild or non-specific complaints, but from their perspective these complaints are anything but trivial. The type and degree of symptoms with which an individual presents are not always directly related to the gut damage that has been done. It can therefore be difficult to secure a diagnosis, and patients may present to primary care on a number of occasions with a large range of symptoms before any diagnosis is made.

Health risks linked to untreated coeliac disease include poor growth in childhood, osteopenia, osteoporosis, infertility, and an increased risk of non-Hodgkin’s lymphoma, Hodgkin’s lymphoma and intestinal malignancy. Other auto-immune conditions are also associated with coeliac disease. The prevalence of auto-immune thyroid disease in people with coeliac disease is up to 7%, and the prevalence of type 1 diabetes is between 2% and 10%. With all these complications, it is hard to understand why coeliac disease is not routinely checked for.

People can endure long periods of suffering before they are diagnosed, and the most recent research shows the time from the onset of symptoms to diagnosis as a lengthy 13 years, during which people are at risk of contracting a wealth of other conditions. One in 100 people in the UK have coeliac disease, but only 10% to 15% of them are clinically diagnosed. An estimated half a million people in the UK are living with the condition but do not know it. That is too many people whose quality of life is being diminished by years of ill health. Many people are living with a misdiagnosis of irritable bowel syndrome or other gut conditions, and receiving treatment for those conditions that is not effective. That costs the NHS money, which we are told it does not have, and which is wasted because of the lack of a quick and accurate diagnosis of the gut condition.

[Dame Anne Begg (Aberdeen South) (Lab)]

Does my hon. Friend agree that it is possible to diagnose or find out whether someone has a gluten intolerance through a relatively simple blood test? Kits can be bought at a pharmacy, so there should be no excuse for failing to pick up coeliac disease earlier in many patients.

[Gordon Banks]

My hon. Friend is perfectly correct. The diagnosis for coeliac disease, or certainly the first part of the diagnosis, is extremely simple—it requires a simple blood test. In fact, as a coeliac sufferer, I never received a gut biopsy test, because my blood test was so overwhelmingly positive. It is relatively easy and the implementation of, or access to, these new tests, which are available in chemists, is a step in the right direction.

Simple though that may be, too many GPs do not recognise coeliac disease, never mind test for it, which is something that we urgently need to address. As I have indicated, it is first tested for via a simple blood test, followed by a gut biopsy. The blood test in itself is inexpensive. My hon. Friend has mentioned a test that the public can buy for only £20 in pharmacies. Within the health service, there is obviously an economy of scale.

I would like to describe some of the disease’s impacts in more detail, because it would be better for the Minister to hear it from the horse’s mouth rather than read about it on pieces of paper. When gluten is present in our diet, it destroys the villi in the small intestine. They are eroded so that the small intestine becomes basically like a garden hose. In good Scottish parlance, Dr McCrea, your food just scoots through it. As I have said, that prevents the absorption of nutrients, and the knock-on effects that that can have on young children and the elderly mean that this in itself—the pure lack of nutrients—can be life-threatening.

Gluten is a protein found in wheat, barley and rye. Although some might think that it is easy to avoid consuming such products, I would challenge them to try to do so for the rest of their lives. A gluten-free diet may sound like the latest Hollywood fad, designed to make a sylph-like body, but if that was the case I would want my money back, because it has not done that for me. The point that I am trying to make is that, while continuing to take gluten when diagnosed with coeliac disease has serious consequences for one’s health, diagnosis also comes with serious lifestyle trade-offs.

Imagine a busy day at work where all one wants to do is grab a quick sandwich from the cafeteria. I am sure that the Minister has eaten a sandwich at his desk many times. It cannot be done. Imagine the end of a long day at work when one would rather grab a take-away than cook dinner at home. That cannot be done either. Imagine an invitation from friends to go for a meal at an Italian restaurant. Although the pizza and pasta look nice, they just cannot be eaten. One may want to go to the pub and have a bottle of beer with friends, but that cannot be done either. One becomes an expert at reading the label on every piece of food that is bought, from crisps, sweets to soups—literally everything. Even Marks and Spencer’s diet coke has gluten in it.

I do not want to say much more about food lines at this point, but I want the Minister to think about the price of a loaf of bread. Tesco’s website states that an 800-gram loaf of white sliced bread can be bought for 47p, which is 6p per 100 grams. What does a loaf of gluten-free bread cost? It costs £2 for 400 grams, which is 50p per 100 grams—833% more. I will leave the Minister with that thought and return to it later.

[Dame Anne Begg]

I am glad that my hon. Friend has picked up the issue of gluten-free food, because I am also on a gluten-free diet, which is why—surprise, surprise—I am present at this debate. It is very expensive for people on gluten-free diets, but will my hon. Friend acknowledge that access to gluten-free products has improved immensely? Almost every supermarket now has some gluten-free shelves. I have seen a remarkable difference in the availability of gluten-free food during the four years in which I have been on a gluten-free diet. However, part of the problem is that the ready-meal versions of foods to which one would not add gluten if they were being cooked at home often include gluten, which makes it difficult for those who lead busy lives and do not have time to cook.

[Gordon Banks]

My hon. Friend is right. The range has improved, as indeed has the quality of food. In some ways, perhaps I was fortunate to be diagnosed in the past 10, 12 or 13 years. I am glad that I was not diagnosed 25 years ago, because I did not have to eat the rubbish that one had to eat 20 or 25 years ago to try to survive on a gluten-free diet. There is more choice. That is another issue about which we have concerns following the introduction of new regulations. We are worried about how supermarkets will react, because everything that they do is driven by the desire and the need to make profit at the end of the day.

I want to talk about my own experiences without being too graphic. In the early 1990s, feeling unwell I went to my GP, who eventually referred me to a specialist. After having cameras inserted everywhere, I was diagnosed with duodenal ulcers and put on medication. Unsurprisingly, that did not help much. I was then diagnosed with the catch-all complaint of irritable bowel syndrome. I endured a number of years where my routine comprised of largely being locked in the toilet until about 11 o’clock in the morning, and I had a rash on my face that looked like I had exfoliated with 80-grit sandpaper. I returned to my GP after a number of years and he referred me to another specialist who, simply on reading my notes, said, “I think I know what’s wrong with you. I think you have coeliac disease,” and he was right. If my memory serves me right, his name was Dr Wright and he turned out to be a bit of a wizard in the diagnosis of coeliac disease in the Forth valley and Scotland. I and others will be eternally grateful to him for that.

Hon. Members might be wondering why there has been a personal lesson from me and whether it is designed to foster sympathy. No, it is not. It is designed to highlight the fact that, as I have said, the average time for diagnosis in the UK is 13 years. That is sometimes 13 years of not being able to work; 13 years of worry about dying; 13 years of someone worrying that their wife thinks they are dying; and 13 years when the only people who are happy are the manufacturers of toilet roll. Part of the purpose of today’s debate is simply to stress that that is not good enough. Much more needs to be done to recognise coeliac disease and the array of symptoms in people presenting to a GP. They should not be told what my GP said to me when I returned to him after being diagnosed: “Oh coeliac disease. I never think of that. That’s two I have missed this month.” That is not good enough.

Why is it important to improve diagnosis times? It saves being given expensive drugs for other complaints that are totally unnecessary and, as I said, it saves a sufferer from not being able to lead anything like a normal life in all areas of work, rest and play. Early diagnosis reduces the risk of intestinal cancer, bowel cancer and osteoporosis among other things. In effect, early diagnosis saves not only lives, but money.

There is no cure for coeliac disease, which leaves the NHS with the task of managing sufferers’ condition. For me, diagnosis happened in my early 40s. However, that is not good enough and there remains a lack of guidance in the area. In 2009, the National Institute for Health and Clinical Excellence published guideline 86 on the recognition and assessment of coeliac disease. That short clinical guideline offers best-practice advice on the recognition and assessment of coeliac disease and the care of those undergoing diagnosis. Although that guideline was a great result for people with coeliac disease, it is not mandatory to follow it and more needs to be done.

Coeliac UK—the national charity for people with coeliac disease—has worked with NICE on that guideline, forming part of the guideline development group. It is anxious to take the matter further for very good reasons. Gastrointestinal disorders account for about 10% of NHS clinical work, and there is evidence that they are not always well managed in general practice. Few quality criteria are available to guide the management of such disorders. The treatment of coeliac disease requires support, with a gluten-free diet, the monitoring and management of symptoms and the screening and management of complications and other associated conditions for the rest of the patient’s life. There has been huge oversight on the part of the Department of Health, as GPs are struggling to meet targets for diagnosing conditions on the quality and outcomes framework and, with no points for gastroenterological conditions, there is an enormous gap.

The QOF is a key way to ensure that GPs are incentivised and is a means by which we could start to see an improved and accelerated rate of diagnosis and find the 500,000 people who are living with the condition but who do not know it. Sadly, a number of applications to QOF have been unsuccessful, which is not good news for people with coeliac disease.

[Gordon Banks]

I do and I will. I shall come on to that later. My hon. Friend is perfectly right.

Moving back to the QOF, approaches for groupings of gastroenterological conditions are being made. Those are important because coeliac disease is four times more prevalent among patients with clinical presentation of IBS, as in my case, than among the non-IBS population. There is also a NICE guideline that recommends the screening of patients with type 1 diabetes, but we do not know whether that screening is taking place. Without more stringent ways to incentivise and measure, we will not know.

As my hon. Friend says, screening family members when coeliac disease is present in the family is also a key concern. He might be interested to know that prevalence rates increase from one in 100 to one in 10 when a first degree relative has the condition. GPs should be screening, but we know that that is not happening routinely. I know full well is has not happened in my family, but it should. Coeliac disease is also more prevalent in people with other auto-immune conditions such as type 1 diabetes, as I have mentioned, and auto-immune thyroid disease. Hence, antibody testing for family members where coeliac disease has been diagnosed and for patients with autoimmune conditions is recommended by the NICE coeliac recognition and assessment guideline.

The Minister will be glad to hear that improving diagnosis is only one part of the answer; we also need improvement in the management of the condition after diagnosis. There are established clinical guidelines from, among others, the British Society of Gastroenterology, the British Society of Paediatric Gastroenterology, Hepatology and Nutrition and the Primary Care Society for Gastroenterology, which recommend an annual review for patients with coeliac disease and, indeed, dermatitis herpetiformis. Although that has traditionally been undertaken in specialist clinics in secondary care—or, indeed, not undertaken at all—it is an activity increasingly seen as suitable for primary care. We know of locally enhanced services where practices provide a structured annual review, but there are not enough of them. We would like annual reviews to be put more firmly into place to ensure that patients are complying with the gluten-free diets and safeguarding against potential associated conditions.

The improving management in gastroenterology—IMAGE—project provides a model for the development of quality markers for chronic disease management including coeliac disease. The project has developed patient-centred quality criteria based on current guidelines and has already been a source of a range of published papers, but health inequality is also a key concern in this area. Research has shown that coeliac disease is twice as likely to be diagnosed for the least deprived quintile of socio-economic groups than for the most deprived; it is usually the other way around. There is more work to be done to understand those results, but the working hypothesis is that the disease is under-recognised in the most deprived socio-economic groupings as a result of the wide-ranging nature of symptoms and, indeed, access to health care.

Where do we go from here? The NICE guidelines on recognition and assessment of coeliac disease showed that the “no diagnosis” strategy is the least effective strategy because of the low quality of life of patients and the costs resulting from undiagnosed coeliac disease. In applying accepted NICE thresholds, any testing strategy was shown to be more cost-effective than no testing strategy, despite the costs of the tests. Work also indicates that serological testing for coeliac disease in patients with symptoms such as irritable bowel syndrome, as I mentioned earlier, is, indeed, cost-effective.

The new NHS reforms may provide some opportunities for people with coeliac disease and provide different ways for them to be catered for within the new framework. Perhaps the Minister can say whether coeliac will be considered for one of the 150 quality standards soon to be rolled out, so that we can see diagnosis rates start to improve.

As I have said, once diagnosed, the only way forward is to manage the condition through a gluten-free diet. Many people do that through relying on prescriptions as the foundation of their condition management. On prescriptions, as the NHS looks to drive costs down during the past 12 months, a number of PCTs have placed strict limits on what can be prescribed for patients with coeliac disease. Those cuts, which include a blanket removal of almost 200 products prescribed to patients in Surrey, East Sussex and Kent, appear to be a knee-jerk reaction to costs linked to gluten-free foods on prescription. At the same time, they potentially threaten the long-term health of people with coeliac disease.

Hon. Members may have seen that, in July, a story broke in the national press that gluten-free bread on prescription was costing the NHS in Wales £35 a loaf. The story came from misinterpreted data following a question posed in the Welsh Assembly. Similar anecdotal figures had been used earlier in the year by medicine management teams linked to the south-east strategic health authority. Although the figures given in the national media were incorrect, sadly the story missed the real point about some high administrative charges added to a very small number of products, which appear to be unjustified.

[Dame Anne Begg]

People with coeliac disease rely on a gluten-free diet, and the fact they can only get gluten free through a prescription suggests that management of the condition is seen very much as a medical model rather than a disability model, which is what normally happens when someone has a chronic condition and they have learned to live with it. Instead of providing gluten-free food through a prescription, might not the Government consider making it one of the criteria that would allow people to get the lower care rate of disability living allowance? That would give people the money in their hand and give them the choice to buy off the shelf, particularly now that most supermarkets have a range of gluten-free goods available. It is more expensive, so it would be an extra cost of their disability, but that might be a cheaper and better solution for the Government. I wonder whether Coeliac UK, or anyone else, has thought of that.

[Gordon Banks]

In fact, Coeliac UK, myself and, I think, my hon. Friend the Member for North Durham met Ministers in the previous Government to discuss that very issue. It does not seem to be something that Governments want to embrace, but my hon. Friend the Member for Aberdeen South (Dame Anne Begg) is right—there are other ways to skin the cat. I will discuss those when I talk about the method of prescribing.

Overcharging or excessive charges within the NHS prescription process need to be investigated at national level to hold NHS suppliers to account. It is crucial to patients and to the taxpayer that we implement a cost-effective service that gives the NHS real savings and enhances provision to patients.

As I have said, people with coeliac disease must avoid all foods that contain gluten, a protein found in wheat, rye and barley. Wheat is the most widely consumed cereal in the UK, so a gluten-free diet requires the elimination of staple foods including bread, flour, pasta and biscuits. Gluten is also found in cakes, pastries and in foods that one might not expect, such as many sauces, soups, soy sauce, ready meals and some cooked meats and sausages. Removing wheat, barley and rye-containing ingredients from the diet can therefore result in a restricted and potentially unbalanced nutritional intake. People with coeliac disease may obtain gluten-free specialist foods from a wide variety of sources including supermarkets, health food shops, mail order and, as we have mentioned, on prescription, but some of the gluten-free brands that are available on prescription are not available from other outlets. It is extremely important that health care professionals provide advice, support and information to ensure that people with coeliac disease have a nutritionally balanced and varied gluten-free diet. Diagnosis should not lead the patient down the path to other unnecessary problems.

Coeliac UK, the Primary Care Society for Gastroenterology and the British Dietetic Association have written guidelines to help health care professionals in prescribing gluten-free foods. The guidelines define different categories—children, male adults, pregnant women and the ages of patients—allocating each a number of units per month per group to maintain adequate nutrition. Each gluten-free product is assigned a number of units: for example, a 400-gram loaf of gluten-free bread is one unit and a 800-gram packet of gluten-free spaghetti is two units. The recommended amount of gluten-free staple food, in units, is based on the total carbohydrate intake providing approximately 50% of the energy intake, with gluten-free foods on prescription making up 15% of that total.

As I have said, coeliac disease is unique in that a specific and effective treatment is available in the form of a lifelong exclusion of gluten from the diet. Those who adhere strictly to a gluten-free diet can lead full, active lives—they can even become Members of Parliament—and are protected from the development of health risks associated with the untreated condition. Research by Hall and Rubin in 2009 shows that among adult patients with coeliac disease, adherence to a strict gluten-free diet is variable, with compliance ranging from 36% to 96%. The evidence also shows that following a gluten-free diet is particularly difficult for those patients with no obvious symptoms. Medical experts and research agree that access to a range of gluten-free food on prescription is important to support people with coeliac disease and to help them to maintain their nutritional needs.

Research undertaken by Coeliac UK, among the charity’s membership in 2006, suggests that access to gluten-free food on prescription is regarded as the most important factor for people with coeliac disease in terms of adherence to a gluten-free diet: nearly 87% cited it as an important factor in maintaining a gluten-free diet and 47% cited it as the single most important factor. A further survey on gluten-free prescribing undertaken by the charity in 2011 among 400 people with the condition showed that 60% of respondents rated gluten-free food on prescription as the most important way of obtaining gluten-free foods for their diet. Although people with coeliac disease have varying requirements for gluten-free foods, depending on their age, gender, occupation and lifestyle, having a wide range of specially formulated gluten-free products available on prescription and easily accessible is vital to promote strict dietary compliance.

On the cost of the gluten-free diet to the patient, having the disease does not entitle people to be exempt from prescription charges. People with coeliac disease in England are charged £7.10 per order unless they have a medical exemption due to different health conditions, age or financial circumstance—although they can use a pre-payment certificate, of course. Research from King’s College London earlier this year found that there is limited availability of gluten-free foods in different stores and that they are more expensive than their counterparts—I refer the Minister to my Tesco bread comparison. That finding has been supported anecdotally by stories from Coeliac UK members, who often report having to travel to more than one supermarket to complete a shopping trip owing to the limited range of foods in their local stores. The problem is noticeably worse for people living in rural communities, so it is not solely about price; access is also a factor. If one cannot travel to a range of supermarkets for shopping, the lack of a bus service may impact on health.

In the past three years, Coeliac UK has undertaken research into cost comparisons between gluten-free and gluten-containing foods on the high street. On average, gluten-free foods have been found to cost three to four times more than their gluten-containing equivalents. Some foods, such as gluten-free pitta bread, cost seven times more. Again, I refer the Minister to the Tesco bread comparison, to which we will keep coming back. For the average shopper, that can mean a difference of approximately £400 a year for staple foods such as bread, flour and pasta alone. Evidence suggests that people on lower incomes, or families with multiple members with coeliac disease, already struggle to maintain a gluten-free diet and that without access to gluten-free prescriptions their long-term health could be put at real risk.

I understand that there is a number of reasons for the higher cost of specialist gluten-free foods; they include the expense of buying alternative grains to replace wheat, product development, nutritional composition by fortifying with other items such as calcium and the considerable need for food science. However, that does not change the impact on the individual. It is therefore vital that gluten-free foods remain on prescription, as they have done for the past 40 years.

The Advisory Committee on Borderline Substances approves a number of products, such as foods and supplements, that can be available to patients on prescription. When a manufacturer applies to have its product available on prescription, it needs to have it approved by the ACBS. The ACBS will look at the type of product, its nutritional value, cost, and even its wrapping and the words written on the wrapping. The cost covers the cost of the product, plus postage and packaging. That cost should be the total cost to get it from the factory to the pharmacy. Slightly fewer than 200 products are currently approved by the ACBS for people with coeliac disease. They include a range of staple products, as outlined earlier, some ethnic foods and products such as biscuits, if they are necessary for an elderly person’s diet or someone who needs a high sugar intake.

Following an internal review earlier this year, the ACBS has agreed that in future it will consider only products that are considered to be dietary staples, including plain breakfast cereals, breads and rolls, crackers and crispbreads, flours and bread mixes, pastry mixes, pasta, pizza bases and xanthan gum. That list will become a very firm base to be adhered to. It is, however, worth spending a moment or two on the supply chain for these prescriptions, because that is where I will bring the Minister back to the cost implications that I spoke about earlier.

The supply chain is made up of a web of individual contractual agreements between manufacturers, wholesalers and other distributors and pharmacists. Those individual contracts are not regulated by the NHS. The end price to the NHS is agreed with the manufacturer by the ACBS, and that is the so-called drug tariff price. The end price should include any related transport costs—a point reinforced by the ACBS earlier this year. The costs associated with gluten-free prescriptions hit the NHS when the pharmacist reclaims them, and there are two potential components: the drug tariff price agreed by the ACBS and what are called out-of-pocket expenses, which are very interesting.

The headline costs to the NHS of gluten-free products arise largely from the impact of those out-of-pocket expenses claimed by pharmacists as a result of additional charges invoked by wholesalers and distributors for what is called non-standard supply. For example, the product might not be stocked as a standard item by the wholesalers, it might require ordering from an intermediary, or it might be treated as special because it has a short shelf-life, such as a fresh product has. Those additional costs remain relatively uncontrolled, however, because there is no specific agreement on how much may be charged by the wholesaler. The pharmacists will need to reclaim those out-of-pocket expenses if they are not to be disadvantaged.

The application of such costs varies considerably and depends on the individual contracts up and down the supply chain. It might be difficult for a manufacturer to control the addition of such costs further down the supply chain, just as it might be difficult for pharmacists to control such costs when they are tied to a particular wholesaler. Such practices may be seen in relation to other products supplied to the NHS, and might be increasing as the NHS strikes harder bargains on the supply of high-value contracts for more common treatments. The impact of such practices is not currently understood, so it would be useful if the Minister today commits to a robust assessment of the real costs to the NHS of additional charges associated with the supply of products—not only gluten-free ones—and to instructing relevant bodies to enter negotiations with the supply chain to explore the possibility of reducing costs overall. That might even involve looking at the drug tariff price.

We all recognise the financial constraints currently faced by PCTs and health boards throughout the UK, but responding to those constraints by eliminating access to gluten-free foods is potentially damaging to overall patient health, while there are more proven effective ways of managing the costs of gluten-free prescribing. The NHS should not be subject to excessive charging, but nor should patients be left unnecessarily paying the price of additional costs; instead, we need to be smarter.

We can be smarter by using local enhanced service contracts. Pharmacy-led prescribing schemes allow gluten-free foods to be supplied directly from community pharmacies, thus bypassing the GP. They allow commissioners to standardise prescribing habits, which would address NHS concerns about excessive and off-tariff prescribing. Furthermore, they might help to tackle handling charges by placing limits on what charges may be reclaimed by pharmacists without compromising patient satisfaction.

Looking for ways to streamline the system is not new. In 2001, the Cabinet Office regulatory impact unit published a report on reducing GP paperwork. It recommended that GPs should no longer need to issue prescriptions for gluten-free foods; instead, patients with coeliac disease should be able to obtain supplies from a pharmacy. The proposal was supported by the Royal College of General Practitioners, Coeliac UK and the Pharmaceutical Services Negotiating Committee. The National Pharmacy Association has developed a toolkit for NHS commissioners outlining the business case for an alternative supply route for gluten-free foods on prescription. That is due to be launched this month and is supported by the Primary Care Society for Gastroenterology and the Dispensing Doctors’ Association. The toolkit is being promoted to all PCTs, health boards and GP commissioning groups, which are urged to implement the pharmacy-led schemes as soon as possible—but why?

The potential benefits of a pharmacy-led prescribing scheme are many and include: improved dietary compliance and health outcomes, as good dietary adherence is aided by the ease with which patients can obtain appropriate amounts of gluten-free products on prescription; and a reduction in the annual cost per patient for the supply of gluten-free foods. According to surveys of costs from Northamptonshire and Cumbria, savings of between 20% and 40% are possible in the ingredient cost of gluten-free foods. Members might be interested to note that the annual ingredient cost in England for the provision of ACBS-approved gluten-free foods in 2010 was approximately £28.6 million, yet gluten-free foods comprised only 0.32% of the total net ingredient costs of all prescribed products. However, the introduction of a pharmacy-led scheme in England for gluten-free products alone would be expected to produce savings of between £5 million and £11 million in the first year.

Another benefit would be the release of clinical time. In 2002, the Royal College of General Practitioners estimated that the initiative, had it been implemented at that time, would have saved 209,000 appointments or more than 20,000 GP hours of clinical time. In a survey undertaken by Coeliac UK, GPs have confirmed that a change to pharmacy supply eases demands on their time. Also, overprescribing could be prevented by application of national guidelines, as all pharmacy-led schemes are based on the 2004 prescribing guidelines. By following a set monthly allowance, it is possible to prevent individual or nutritionally unsuitable prescribing—that benefit was identified in the roll-out of the Cumbria PCT pilot scheme.

Better cost control could be another benefit, as the pharmacy-led schemes provide better individual patient cost control because the pharmacy supply schemes are based on a system of units of gluten-free foods linked to the patient’s dietary needs, rather than on patient-led prescribing by GPs using form FP10. There is a need for better cost control as more people with coeliac disease are diagnosed, in accordance with NICE recommendations. More diagnosis will itself bring a subsequent risk to GP prescribing costs and time, both of which could be better managed in pharmacy-led prescribing.

A pharmacy-led scheme would also be in line with the 2008 White Paper, “Pharmacy in England: Building on strengths—delivering the future”, in that it would reduce the time-consuming administration of repeat prescriptions in GP surgeries; contribute to the range of clinical services offered by pharmacies, in particular to those with a long-term condition; expand patients’ access to treatment, making better use of pharmacists’ skills; and improve the patient experience, giving more rapid access to gluten-free foods by eliminating the need for GP signature of repeat prescriptions, and allowing more flexibility as products are launched or removed from the market.

Feedback from GP, pharmacy and patient stakeholders in Cumbria and Northamptonshire has been overwhelmingly positive. Cumbria, a county I know well, having lived there as a child, has been at the forefront of GP commissioning and, as such, has been able to assess pharmacy-led prescribing from two different perspectives: that of a GP in a clinical practice and that of a commissioning GP with budgetary responsibility. Dr Fayyaz Chaudhri, a GP in Maryport, said:

“I have been involved with this scheme in Cumbria for a number of years and have first-hand experience of the benefits to both patient and GP. There is a real issue to address in ensuring the supply of gluten-free foods. It is cost-effective for NHS, patient and taxpayer, and I believe that this toolkit needs to be rolled out across the country.”

To sum up on prescriptions, I would like the Minister to take note of the price of the Tesco bread I referred to earlier—he wrote it down, I think. Many people cannot afford to pay 800% more for a loaf of bread, more than 100% more for spaghetti, or five times as much for a bag of flour. Prescriptions are important to maintain the health of coeliac sufferers. Evidence from Coeliac UK already suggests that those disadvantaged by such costs will find maintaining a gluten-free diet a real challenge and their heath might suffer in consequence. Experts in gastroenterology have confirmed that access to gluten-free food is an essential part of the treatment for sufferers of coeliac disease. I urge the Minister to look at smarter ways of achieving it and I condemn rash reactions such as withdrawing prescribing, as we have seen in some places.

Le me say a word or two about eating out, to reinforce what I touched on earlier. I know that it is not the Minister’s direct responsibility, but he will no doubt feed it back to the appropriate Minister—though he looks puzzled. Currently, eating out is a lottery for people with coeliac disease. The gluten-free diet is not well provided for in the catering industry and dealing with the issue would have significant impact on the quality of life of people with coeliac disease. Although the industry is responding to some degree to the needs of people on a gluten-free diet, provision is not uniform.

Those who eat out often have to draw attention to themselves, asking to see the chef or the list of the ingredients that make up the meal. Often, they are faced with a member of the front-of-house team who has no idea what they are talking about, or they are passed to the chef, who might have a better understanding of their diet, but not necessarily. Catering for a gluten-free diet is not uniformly included in training for chefs and front-of-house staff, and including such training would better equip staff as they move forward in their careers.

Many people with the condition feel that eating establishments lack knowledge and understanding when it comes to offering safe, gluten-free food, so they stay in, keeping their health and money safe at home. We have not discussed cross-contamination, but it is a serious concern, and the nature of the catering industry, with its high staff turnover, can make trusting others with one’s diet difficult. As I said, many people therefore take the easy way out and stay at home.

People with coeliac disease represent 1% of the population, or 600,000 people, but the loss to the catering industry is greater, because coeliacs drive the venue decisions of the people they eat with. Research among more than 3,000 people with coeliac disease found that those who eat out do so with a minimum of two to three other people. With an average spend of between £10 and £20 per head, each coeliac meal is technically worth £60.

As I said, however, fears about finding safe, gluten-free options keep thousands of people at home. Some 62% of people suffering from coeliac disease eat out once a month or less, while only 38% eat out once every two weeks or more. When people were asked how often they would eat out if more safe, gluten-free options were available, the figures nearly reverse, with 74% saying they would eat out once or more every two weeks, and only 26% saying they would eat out once a month or less.

In these difficult times for the UK economy, harnessing that untapped market has obvious potential financial benefits for the catering sector. More than 40 pubs and restaurants nationally close every week, and coeliacs represent a huge market, which the hospitality sector cannot afford to miss. People with coeliac disease want to eat out more often, and they would be ready and willing to spend their money, if only they felt confident about gluten-free provision. The catering industry needs to help, and with new EU regulations coming into force next year requiring a reduction to 20 parts per million of gluten for food to qualify as gluten free, it needs to do more to convince coeliacs that it is aware of the law and working within it.

Being elected to this place in 2005 was a challenge to me in more ways than one, given that I was diagnosed with osteoporosis during the election campaign and that I came down here not knowing whether I would be able to eat between Monday and Thursday because of my coeliac disease. However, as a result of contact with Coeliac UK, and with the help of others, such as Lord Bilston and my hon. Friend the Member for North Durham, it was possible to constitute the all-party group. That was done not only to help coeliacs in Parliament, but to allow parliamentarians to use their personal experiences of, or interest in coeliac disease to help to raise the issue directly with the Government, and I am happy that we have been able to do that further today.

I am glad to see both my hon. Friends in their places, and I am sure my hon. Friend the Member for North Durham will not mind me outing him as a fellow diagnosed coeliac. However, there is a serious point here. As I said, one in 100 people in the UK suffer from coeliac disease, but about 500,000 of them have yet to be diagnosed. While some of us in the Room share the unenviable label of being among the few MPs to have been diagnosed with coeliac disease, there is a good chance that other Members also have it—they just have not heard the good news yet.

We last debated issues related to coeliac disease in February 2007, so today’s debate is long overdue. I am grateful to have this opportunity to lay my thoughts and hopes before the Minister, and I look forward to hearing his comments in a minute.

[Dame Anne Begg]

Before my hon. Friend finishes, I should pay tribute to the work that he has done to make sure that the catering outlets in the House of Commons offer a gluten-free alternative on every menu. That has made life a lot easier for those of us who are trying to follow a gluten-free diet. More restaurants are following that example, but he is right that eating out, which is often part and parcel of an MP’s job, is difficult. However, the House authorities should be congratulated.

[Gordon Banks]

They should, and I thank my hon. Friend for her comments. We are just waiting for one of us to be elevated to the House of Lords, because there are some difficulties over there.

I might be pushing my luck, but I would like to invite the Minister and his officials to come to a future meeting of the all-party group to talk a little more about what the Government are doing and to hear first hand from non-parliamentary coeliacs, because many of the issues that were relevant to the February 2007 debate are still relevant four years later.

I have talked about the challenges created by eating out. Research from Coeliac UK has shown that almost seven out of 10 people with coeliac disease prefer to eat at home, rather than to go out for a meal. I happen to be making one of my irregular sorties to a restaurant on Friday night, so I hope that the staff at Aldo’s in Alloa can cope with me. However, this is not just a social problem. Members of the all-party group will be aware of cases that have been brought to us in which sufferers of coeliac disease have been prevented from joining the police or the Army because of their condition.

Sufferers are looking not for sympathy, but for action, understanding and knowledge. Too often, that knowledge is missing, even among the professionals. I therefore return to some of the points I made earlier. We need to ensure that there is much wider knowledge and understanding of coeliac disease among the public and, perhaps more importantly, among the medical and catering communities. We need that knowledge not only among catering or hospitality staff in local restaurants or hotels; staff in hospitals need a greater understanding of the illness, too.

Let me give an example. A friend of mine who is a social worker told me about an elderly woman from his care home who had been hospitalised. Despite staff from the care home advising the hospital of her need for a gluten-free diet and of her coeliac condition, her social worker walked into the hospital one day and found her sitting up in bed eating toast. If we cannot get this right in hospitals, what chance do we have in the wider community?

We have talked about the economic impact on the hospitality sector, but there is a wider economic issue. For example, children who are off school unnecessarily may face educational challenges that impact on not only their schooling but their employability in later life. Similarly, having part of the work force stuck in the toilet rather than sitting at their desks is clearly something that the country needs to avoid. We all know that a healthier country is a more productive country. Indeed, figures obtained by Coeliac UK show that pre-diagnosis coeliac sufferers took an average of 21 sick days off per year, whereas those who had been diagnosed took an average of only three days off per year.

Work carried out by Coeliac UK suggests that the average age for diagnosis is 41, and the average time taken for diagnosis is 13 years. A great deal of work is therefore required to reduce those unnecessary years of suffering and the worry that accompanies them. There are a number of key messages I want the Minister to take away from the debate—I am sure he already knows them, but I would like to reinforce them. First, early diagnosis is vital. The later the diagnosis, the worse the condition and the worse the implications for other conditions that are likely to be inherited as a result of coeliac disease. Secondly, better management of the condition is possible and will save money.

I have moaned a lot this afternoon about the many problems facing those suffering with coeliac disease, and it would be wrong of me to create the impression that improvements have not been made. Indeed, my hon. Friends have mentioned some of them. Just to take Parliament as an example, the cafeteria was a risk too far for me when I came here in 2005, and my hon. Friend the Member for Aberdeen South alluded to that. Now we have better labelling and greater understanding among the staff, so it is much easier to eat in Parliament, and the staff deserve a big thank you for that. As my hon. Friend mentioned, however, that progress needs to be replicated in work canteens, restaurants, bars and shops across the UK. The products have also got better, even though that is reflected in their cost. It is important to accept that the food must be edible, not repulsive, as it was a number of years ago.

Before I wind up, I want to return to the issue of awareness and to say a few thanks. I never thought I would say this in my parliamentary career, but I would like first to thank the world’s No. 1 tennis player, Novak Djokovic, who has been following a gluten-free diet for the past year. That coincides with his rise to the top of the world rankings. It is difficult for me to admit this, but he may serve as a better ambassador for the health benefits of a gluten-free diet than me or any of my hon. Friends here today.

I also thank Phil Vickery, the well known chef, who has focused on gluten-free food and how it can be accommodated in the catering industry, and who is a Coeliac UK food ambassador, and Dr Chris Steele, the well known TV doctor, and another coeliac ambassador, who was fairly recently diagnosed with the condition. The biggest thanks must go to Coeliac UK, where Sarah Sleet and her staff, including Jo Archer, are committed to tackling all the matters that I have raised in a determined and professional way. They represent coeliac sufferers splendidly, and long may they continue to do so.

To sum up, coeliacs want and need better awareness of their condition among the medical profession, an informed approach from the catering and hospitality industry, and an understanding from the Minister that prescriptions are vital but that we may be able to do things better.

--- Later in debate ---

[Mr Jones]

I am disappointed about that, because I was looking forward to the right hon. Gentleman’s attendance. He is a good friend, but I will obviously leave it to the Department to decide who is the best person to come, and we will certainly issue that invitation in the next few days.

I want to pick up some of the issues that my hon. Friend the Member for Ochil and South Perthshire raised, including the products that are available. My hon. Friend the Member for Aberdeen South was right when she said that products have changed remarkably in the last 10 years from bread like cardboard that was hardly edible without a pint of water to some very good products on the market now. It is interesting that on the commercial side, large bread manufacturers such as Warburtons are producing gluten-free bread, so it obviously sees a market. I have tried its bread, and it is very good. Likewise, the invention of products such as Genius bread has completely changed the type of bread that is available, and the technology for producing it.

The supermarkets have also changed. Asda, Tesco and Sainsbury’s in particular have done two things. First, they have shelving dedicated to gluten-free products, which is important. Secondly, labelling has changed, which is important for people who suffer from coeliac disease, because it is amazing how many products contain gluten. Some flavours of crisps contain gluten, but others from the same producer do not. Correct labelling is important for all products so that people may buy with confidence, and see that the products that they are buying are gluten-free. It is important that the supermarkets recognise that there is a large and growing market for such products, so anything we can do to encourage better labelling of food content is important.

My hon. Friend referred to eating out, which can be difficult, although some restaurants recognise the problem of gluten in certain foods. However, the bane of my life is organisations that provide food on airlines and National Express, on which I sometimes travel. The people serving the food have no understanding of what a gluten-free diet is, and offer everything from sandwiches to sausages. When asked whether those foods contain gluten, they look blank.

The other reaction, which one gets from British Airways and which is amazing, is that whenever one asks for a gluten-free meal it thinks that that means vegetarian. I am not sure why, but it seems to think that one can eat what everyone else eats, but without the sauce. It seems to think that coeliacs are vegetarians, and my usual response is to ask whether I look like a vegetarian. There should be a campaign to persuade airlines and train companies that provide meals to ensure that their staff know what a gluten-free diet is. They could also be more imaginative about what they provide, because it is often inedible.

[Dame Anne Begg]

My hon. Friend may agree that if one tells an organisation that is providing a sandwich lunch that one wants a gluten-free sandwich, it always seems to provide the worst possible gluten-free bread, without the same filling as everyone else. One is given processed cheese or a bit of cold ham, and looks lovingly at the filling in everyone else’s sandwiches. Not only does one get the worst bread in the world, one gets the worst filling in the world, when it would have been easier to take out the original filling and put it on a plate to make quite a good salad.

[Dr William McCrea (in the Chair)]

Order. Time is passing, and the Opposition Front Bench spokesman and the Minister must make their winding-up speeches, so perhaps the hon. Gentleman will draw his comments to a close.

Southern Cross Care Homes

Anne Begg Excerpts

Tuesday 12th July 2011 Commons Chamber

[Paul Burstow]

My hon. Friend tempts me to comment on an individual local authority’s decisions, the details of which I do not have. It seems to me that that is an area that the council in question will have to look at carefully. The key thing has to be that local authorities are responsible for looking at the availability of good- quality care home placements in their area and to supply individuals who are funded by the local authority and who need a decent care home with just that.

[Dame Anne Begg (Aberdeen South) (Lab)]

I have nine Southern Cross homes in my constituency, and they are sitting on some very expensive real estate. The problem for Southern Cross was that its rents were too high. What negotiations has the Minister undertaken with the landlords to ensure that that problem does not continue and beset the new operators who we hope will take over the running of those facilities?

[Paul Burstow]

I do not know the particulars of the homes to which the hon. Lady refers, but if she would like to write to me with more details, I will certainly look at that matter. Many of the homes that Southern Cross owns have been specifically built and designed to provide residential care for older people, and there is therefore no other purpose for which they could usefully be converted—[Interruption.] Opposition Members might chunter about that, but that is why a consensual, solvent restructuring is now the best and most likely outcome of the process.

Oral Answers to Questions

Anne Begg Excerpts

Tuesday 7th June 2011 Commons Chamber

[Paul Burstow]

Certainly I agree that MS patients should have access to clinically effective and cost-effective treatments. The National Institute for Health and Clinical Excellence has not issued any guidance on the use of Sativex, and it is for primary care trusts to make funding decisions based on the available evidence and the individual patients’ circumstances. Following consultation, NICE expects to make a decision later in the year on whether to update its clinical guidance on MS, and whether to re-evaluate Sativex as part of that.

[Dame Anne Begg (Aberdeen South) (Lab)]

There are 12 Southern Cross homes in Aberdeen, nine of which are in my constituency. Just in the past month, one of them, Eastleigh in Peterculter, received a damning report from the Scottish care commission. Is it any wonder that relatives of the people in those homes are concerned that the company that runs them is in financial difficulty, and that the quality of the care provided may suffer as a result? Over the past few years I have also been approached by constituents about self-funders facing unfair cost increases in order that their home might be able to overcome its financial difficulties.

[Paul Burstow]

As I said earlier, the key concern of this Government—and, I think, of all Members—is to ensure the continuity and quality of the care of residents in Southern Cross homes. That has been the purpose of the Government, and of all the other agencies involved, throughout our engagement with Southern Cross. It is also important that the quality inspectorates in both Scotland and England continue to discharge their role of making sure that the essential standards of safety and quality are being maintained.

Winterbourne View Care Home

Anne Begg Excerpts

Tuesday 7th June 2011 Commons Chamber

[Paul Burstow]

I will take away that point, reflect upon it and write to the hon. Lady rather than give her an off-the-cuff answer of any sort.

[Dame Anne Begg (Aberdeen South) (Lab)]

Like my right hon. Friend the Member for Croydon North (Malcolm Wicks), I too believe that we are kidding ourselves if we think that this is a one-off and it is not happening day in, day out. There will be vulnerable adults living in their own homes today, behind locked doors, who are in fear of the carers who are paid to look after them. Might not another way of getting an eye into the locked environment be the use of telecare to make sure that someone outside is aware of what is happening in these locked institutions?

[Paul Burstow]

I would not want to give the impression that we would see that as a substitute for any of the other points that have been made on this urgent question today, but undoubtedly telecare, telemedicine and assisted technologies have their part to play, both in improving the quality of care and increasing independence for individuals. That is why the Government support that as part of the way in which we see the future for social care unfolding.

Oral Answers to Questions

Anne Begg Excerpts

Tuesday 25th January 2011 Commons Chamber

[Paul Burstow]

The answer to all those questions is yes. The right hon. Gentleman is right to draw attention to the additional money going into social care via the NHS. It is intended to kick-start the collaborative working that was often so absent under the previous Administration.

[Dame Anne Begg (Aberdeen South) (Lab)]

The care that someone gets can be defined as either “social care” or “health care”, and that can determine the benefits to which an individual is entitled. With that in mind, what conversations has the Minister had with the Minister with responsibility for disabled people about the Government’s proposal to withdraw mobility disability living allowance from those staying in residential care?

[Paul Burstow]

I and the Minister responsible for disability issues in the Department for Work and Pensions meet regularly. In fact, a further meeting on this and other matters is coming up shortly.

Oral Answers to Questions

Anne Begg Excerpts

Tuesday 7th September 2010 Commons Chamber

[Mr Burstow]

The hon. Lady and I debated this issue in the Chamber back in July. One of the most concerning aspects of the case of William Barnard was a singular failure to listen to the concerns expressed by family members and carers on the part of those who could have taken the necessary action to improve matters. I continue to take a close interest in the investigations being undertaken by the local NHS. We want to ensure that when lessons can be learned nationally, they are reflected in the Government’s forthcoming mental health policies.

[Miss Anne Begg (Aberdeen South) (Lab)]

Have the Minister or others in his Department had any discussions with the Department for Work and Pensions, because in the coming months a large number of people with mental health problems will be called in for interview to be reassessed from incapacity benefit on to employment and support allowance? This is already causing a great deal of anxiety among my constituents because Aberdeen is one of the trial areas. I wonder whether any of the mental health professionals have been informed and are ready for the influx that might result from that change in policy.

[Mr Burstow]

There are several parts to that question. First, we have already made commitments to invest in talking therapies, which are improving hugely the quality of lives of many people with mental health conditions. Secondly, I and departmental officials have had meetings with colleagues in the DWP, and I will have further meetings shortly, particularly to discuss the DWP input into a cross-Government mental health strategy.

NHS White Paper

Anne Begg Excerpts

Monday 12th July 2010 Commons Chamber

[Mr Lansley]

The job of the NHS commissioning board will be to inform GP-led commissioning through scientific evidence, clinical evidence and guidelines, but it will be for GPs themselves, managing their budgets, to enable patients to exercise greater choice. The working out of what that choice looks like should not be dictated by politicians, but should be determined by patients and their clinical advisers.

[Miss Anne Begg (Aberdeen South) (Lab)]

The Secretary of State has not answered the question of my right hon. Friend the Member for Leigh (Andy Burnham) about the future of the Food Standards Agency. The Scottish arm of the FSA is based in Aberdeen, and I wonder whether the Secretary of State has had any discussions with the Scottish Government about its future. If not, is this yet another example of the new relationship that is meant to be in place between Scotland and the rest of the UK?

[Mr Lansley]

The shadow Secretary of State will have had the chance to see that there is nothing in today’s White Paper about the FSA—no such proposal.