Oral Answers to Questions

Anne Milton Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Nick Smith (Blaenau Gwent) (Lab)]

2. What plans he has to implement the recommendations of the strategic review of health inequalities by Professor Marmot.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

The public health White Paper “Healthy lives, healthy people” gave details of our response to the Marmot review, and addressed the social determinants of health in people’s lives. I am sure that the hon. Gentleman has read it. Yesterday we launched the University college London institute of health equity with Professor Sir Michael Marmot as its director, supported by the Department. The institute will help to promote the findings of the review across the NHS, public health and local government, and will ensure that health inequalities remain a priority.

[Nick Smith]

Parts of my constituency are more than 1,200 feet above sea level. We know about the impact of cold homes and fuel poverty on health. According to the latest figures, cold has caused 25,000 excess deaths in England and Wales. What discussions has the Minister had with the Chancellor about the need to invest in making our homes warmer to reduce the number of such deaths?

[Anne Milton]

I thank the hon. Gentleman for that question. He will be aware of the 27,500 excess winter deaths that occur across the country, which is an increase of 17% on the deaths that occur at other times of the year. We have invested £30 million in total—£10 million to the Department of Energy and Climate Change and £20 million that local authorities can bid for—which will help to reduce those figures. It is encouraging that despite a very harsh winter last year the number of excess winter deaths has not risen.

[Dan Rogerson (North Cornwall) (LD)]

There is an access issue when considering the rural dimension of health inequalities. The dispensing doctors play a huge role in meeting need in rural areas, yet there are concerns about changes in regulation that have affected them. Will the Minister or one of her colleagues agree to meet me and representatives of that group to discuss their concerns?

[Anne Milton]

My right hon. Friend the Secretary of State for Health has already agreed to meet some people. The hon. Gentleman is right to say that health inequalities are not just something faced by the urban poor and deprived; they are also an issue in rural areas. We must make sure that people have adequate access.

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

The Minister will be aware of the emphasis that Professor Michael Marmot places in his review of health inequalities—which I have read, so I can quote it—on

“giving every child the best start in life”,

on creating

“fair employment and good work for all”

and on reducing “inequalities in income”. Yet, under this Government, 90% of local councils will be forced to make cuts to Sure Start, unemployment continues to spiral—it is at a 17-year high—and, far from reducing income inequality, the House of Commons Library has calculated that an area such as mine in Hackney, which is one of the poorest in the country, will lose at least £9.6 million in cuts to housing benefit alone and a further £2.84 million through cuts to child tax credit. However desirable some of the organisational changes in public health are in principle, how can the Government possibly make progress on tackling health inequality in that context?

[Anne Milton]

How can the hon. Lady give Government Members lectures on health inequalities, given that those got worse under the previous Government? Life expectancy in Kensington and Chelsea is 85 whereas it is 74 in Blackpool, and that is after 13 years of a Labour Government. Family nurse partnerships have doubled and we are well on track to get the additional 4,200 health visitors. Through the public health Cabinet Sub-Committee we are determined to raise the standard of living for all, by providing new strategies on child poverty, social mobility, tax, pension retirement ages and so on. We are doing something, whereas the previous Government did nothing.

[Nic Dakin (Scunthorpe) (Lab)]

3. What plans he has for the future of children's cardiac services in England; and if he will make a statement.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

For the first time, public health money will be ring-fenced and from April 2013 local authorities will receive that ring-fenced public health grant, targeted at areas with high population need and weighted for inequalities. In the preceding year—that is 2012-13—the shadow allocation will be published to allow local authorities to plan for the following year.

[Emma Reynolds]

As the Minister knows, public health problems are much more acute in areas of high deprivation. Wolverhampton primary care trust has been incredibly successful in reducing teenage pregnancies and increasing childhood nutrition. Will she reassure me in detail on exactly what weighting will be given to deprivation so that that good work in Wolverhampton can continue?

[Anne Milton]

We have commissioned advice from the independent Advisory Committee on Resource Allocation and recently completed a survey of current NHS spend on public health. As the hon. Lady says, allocation needs to be weighted for inequalities and we are particularly keen that the committee develops a formula that captures within-area deprivation, which has been an issue in the past. Otherwise, affluent areas with pockets of deprivation tend to be ignored. If we want to improve the health of the poorest fastest, we must consider the heath need and deprivation.

[Fabian Hamilton]

Will the Minister reassure my constituents that when the money is transferred to local authorities, the staff will also be transferred from the NHS to those local authorities? Will there be sufficient resource within them to keep employing some of the excellent staff who currently work in the NHS?

[Anne Milton]

The hon. Gentleman is right to draw attention to the excellent work that has been done despite the fact that public health budgets have not previously been ring-fenced. Indeed, what we have seen previously is PCTs raiding public health budgets for service provision, which is one reason why inequalities in health have got worse. It is extremely important that we transfer expertise, and employment law will ensure that all the transition is managed smoothly.

[Grahame M. Morris]

We are having problems getting reports published by the Department of Health. Will the Minister tell us about the public health outcomes framework by which we will measure progress in tackling and reducing health inequalities? What does the fact that the framework still has not been published say about the Government’s commitment to reducing health inequalities?

[Anne Milton]

I am sure that the hon. Gentleman would not want us to rush this. It is extremely important that for the first time we will have a public health outcomes framework. There was no such framework under the previous Government, so it is important that we get it right. It will be an important signal to local authorities about what we expect them to achieve—with, as I have said, a focus on improving the health of the poorest fastest.

[Mr Stephen Dorrell (Charnwood) (Con)]

As we transfer public health responsibilities to local Government—something that has been very broadly welcomed—is it not important that in addition to a clear definition of the funds that are going to be transferred, subject to a ring fence, we also have a clear definition of the responsibilities that local authorities will be expected to discharge in the new world? When can we expect that definition to be put into the public arena?

[Anne Milton]

My right hon. Friend is absolutely right. Conditions will be attached to the ring-fenced money to determine how it can be spent, but any expenditure will need to refer to promoting or protecting public health. I hesitate to use the word “shortly”, which the previous Government used on many occasions, but it will be published along with the outcomes framework. It is important that we get it right.

[Charlie Elphicke (Dover) (Con)]

Will the Minister join me in congratulating Kent county council and Dover district council on their enthusiasm for taking over public health responsibilities and on the fact that they are looking at how to expand the resources that are available by considering the co-commissioning of social services with local GPs? Finally, may I inject a note of caution about the new community health trusts?

[Anne Milton]

I am happy to join my hon. Friend in congratulating Kent county council. As he rightly points out, these moves have been welcomed by many local authorities, many of which already do much to improve the health and well-being of their populations. It is extremely important that councils are eager to start, as I know they are, and eager to get that money and see the public health outcomes framework so that they can build on some of the good work they have already done.

[Robert Halfon (Harlow) (Con)]

Harlow has one of the highest levels of obesity in the east of England. Will my hon. Friend ensure that the resources that are directed to local authorities are properly used to solve such problems?

[Anne Milton]

Yes, this is not only about resources, as my hon. Friend rightly says. Some 60% of adults are overweight or obese, and those figures are even higher in some areas. It is extremely important not only that any money is followed by that public health outcomes framework, but that it is effective. This is not something we can simply chuck money at, as the previous Government did.

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

6. What steps he is taking to raise the standards of care provided by health care workers and care assistants.

--- Later in debate ---

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

T5. Will the Minister with responsibility for public health update the House on her plans to review the criteria whereby people with haemophilia who have been infected with hepatitis C can claim stage 2 payments from the Skipton fund? Specifically, will she tell us how she intends to involve patients and carers in that review?

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I know that the right hon. Gentleman has campaigned hard on this issue. I can assure him that I recently met a group of MPs, and constituents of theirs who are suffering from hepatitis. As he knows, there is a wide spectrum of illness associated with chronic hepatitis C infection. We are aware that people could be suffering financial hardship as a result, and I would urge them to apply to the Caxton Foundation. The Department’s expert advisory group on hepatitis C will continue to keep the evidence under review.

[Henry Smith (Crawley) (Con)]

T7. In a number of surgeries in my constituency, and in many across the country, physicians’ assistants play a very important role in enhancing capacity. Can my hon. Friend say whether there are any plans in the Department of Health to allow physicians’ assistants to be able to prescribe medication?

[Anne Milton]

The medicines legislation governs the range of health professionals who can prescribe. The Government’s policy is that only registered and regulated health professionals should be able to train for that; physicians’ assistants are neither.

[Nic Dakin (Scunthorpe) (Lab)]

T6. After speculation about the future of the Department of Health’s free nursery milk scheme, will the Secretary of State assure families and nurseries that he recognises the value of free nursery milk in preparing young people for a good future and well-being in life?

[Anne Milton]

I assure the hon. Gentleman that we do recognise the value of nursery milk. The only shocking thing is that the previous Government presided over a scheme whereby nursery milk is now costing double the retail price, and we urgently need to look at that. We are committed to continuing the scheme, but shocked at what has gone on before.

[Stuart Andrew (Pudsey) (Con)]

T8. An independent study of the patient assumptions of the Safe and Sustainable review has confirmed what many of us already knew: that, contrary to the review’s claims, most families in Yorkshire and the Humber will travel not to Newcastle but to Leicester or Liverpool. Will my right hon. Friend seek confirmation from the Safe and Sustainable review body that it will revise its options in the light of that new evidence?

--- Later in debate ---

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

T9. Last year in Westminster Hall, the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton) rightly praised the work of midwives and the Royal College of Midwives. Does she share my concern that locally, there could be a downgrading of community midwives, leading to an overall reduction in the number of midwives in our area?

[Anne Milton]

I thank my hon. Friend, and I will take this opportunity to praise again the work of midwives and the Royal College of Midwives. It was a pleasure to be at its conference only last week. I would point out that there are now more than 20,000 full-time equivalent midwives. That is an increase of 2.4% on last year. We have record numbers of midwives in training, with 2,493 this year and an increase on that next year. What matters is that we get the right services for women who are pregnant, ensure that they can exercise the choices that they need, and get the right skills mix.

[Jim Shannon (Strangford) (DUP)]

Figures today reveal that older women are being discriminated against in breast cancer treatment, with some 20% of women over 65 receiving chemotherapy compared with some 70% of women under 50. Will the Minister assure the House that those who are over 65 will receive equitable treatment, and that this discrimination will stop?

--- Later in debate ---

[David Tredinnick (Bosworth) (Con)]

Has my right hon. Friend the Secretary of State or any of his ministerial colleagues been able to visit the People’s Republic of China to consider traditional Chinese medicine?

[Anne Milton]

I thank my hon. Friend for that question. He must be psychic, because I recently visited China, and it was fascinating to meet Ministers there. He will also be very pleased to hear, as I am sure the whole House will, that I visited a hospital and community centre that combines western medicine and traditional Chinese medicine.

[Phil Wilson (Sedgefield) (Lab)]

The coalition agreement states that public sector employees, including health care employees, will be given a new right to set up employee-led co-operatives to run services. Can the Minister detail how many NHS co-operatives have been established and how many employees are involved in them?