Contaminated Blood and Blood Products

Anne Milton Excerpts

Thursday 14th October 2010 Commons Chamber

[Mr Robinson]

I entirely agree with my right hon. Friend—this is indeed a good moment to do that—but sadly I disagree with the hon. Member for Poole, because we have had reviews.

In passing, let me make a positive reference to a former colleague in the Government at the time. As I understand it, the previous Secretary of State for Health—my right hon. Friend the Member for Leigh (Andy Burnham)—opened up one aspect of the issue, through the Skipton Fund in particular, although if I am wrong and the Minister wants to correct me, I should be only too happy to take an interjection from her. He did that last year to see whether there was any way of increasing Skipton to the levels of HIV/AIDS compensation—that proposal was put to me forcefully at meetings with the victims yesterday, and I am sure. that it will be again when we meet them at 4.30 pm If we could do that, it would be a step forward and we would feel that we were going in the right direction. If the Minister wants to tell me that that is the case, I would be very pleased to hear that.

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

I have to ask the hon. Gentleman whether he has read the written ministerial statement, because at the end it points out that we will be reviewing certain aspects.

[Mr Robinson]

That is my whole point: “We will be reviewing.” This has been going on for a year already. Who can put his hand on his heart and honestly say that anything more will come out of the review than we have already had? Nobody with any experience of this House or how Government works can say that. Today is the moment.

--- Later in debate ---

[Anne Milton]

I have to ask again whether the hon. Gentleman has read the written ministerial statement. I have said that I will look at certain aspects and I will report by Christmas, because I am acutely aware that campaigners on the issue have been left hanging for far too long.

[Mr Robinson]

Very good, but let me say this to the Minister, who is obviously genuinely concerned about the issue, as all Ministers have been. As my right hon. Friend the Member for Knowsley said, there are always two or three big issues, and this is certainly one of them, so we wait to hear. [Interruption.] The Minister should not tell us that we have not read the statement; we spent all yesterday trying to get a copy of the amendment, which seemed to be in the ether somewhere. Indeed, I asked her to e-mail me a copy yesterday at about 6 pm, but we could not see it even then. I have referred to the statement, which I think is useless, but why is it not referred to in the wording that is before the House? She did not want it there because it would carry more weight.

--- Later in debate ---

[Mr Deputy Speaker]

In fairness, the Minister is going to speak and there will be an opportunity to intervene on her. I am sure she will want to point out the figure at that stage. What I want to do is get on with the debate until she comes to speak, and then I am sure Members in all parts of the House will be able to intervene.

[Anne Milton]

indicated assent.

[Mr Deputy Speaker]

I am getting the nod from the Minister that that will be dealt with in due course.

--- Later in debate ---

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

Let me start by congratulating the hon. Member for Hackney North and Stoke Newington (Ms Abbott) on her new post. We have something in common, inasmuch as I worked in Hackney for most of my life before I entered politics.

This has been a moving debate and I, too, welcome this opportunity to discuss these issues and to air people’s situations openly in the House. The story of those who have been affected by contaminated blood and its products is a dreadful human tragedy. I wonder whether, but can only hope that, an expression of sympathy from me can go some way towards making a difference to those affected. I am deeply sorry about the events that led to the infection of people who were treated with blood products with HIV and hepatitis C.

We always welcome new knowledge, but with that knowledge often comes deep regret about events that happened in the past. If we only knew then what we know now. We should always make sure, individually and as Governments, that we have the humility to learn from our past. I thank hon. Members for raising so many issues—about the terrible loss of life, of course, and about stigma and the additional cost of things such as dentistry. Yes, I would happily meet a delegation of hon. Members and my door will be open during this period of review.

I shall do all I can, in the time and on the terms available, to make sure that people’s views on access to psychological support are heard. I shall not be able to deal with all the points that have been raised today, but officials will come back to hon. Members, who, if they have further questions, can always contact me.

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

Will the Minister address an issue that has not been raised—the medical assessments that people on benefits now have to go through under the new welfare reform programme? Will she consider making representations to her colleagues in the Department for Work and Pensions about passporting this group of claimants so that they do not have to go through medical assessments again?

[Anne Milton]

The hon. Lady makes an important point that has crossed my mind already. I shall talk to colleagues and officials in the DWP to make sure that that issue is addressed.

It is important to put on record some relevant events. In the early 1960s, the life expectancy of someone with haemophilia was less than 40 years. In the early 1970s, the development of a revolutionary new treatment—clotting factor concentrates produced from large pools of human plasma—led to what was then considered an exciting new era of treatment. It offered the potential to extend significantly the length and quality of the lives of patients with haemophilia. The risk of viral transmission through blood and blood products was recognised at that time, particularly the risk of post-transfusion hepatitis. Generally though, the consensus within the scientific community was that the risk of using multiple donors was low and worth taking. Significantly, at that time, the Haemophilia Society said, in a bulletin published in September 1983, that

“the advantages of treatment far outweigh any possible risk”.

Sadly, we know how wrong that was. Tragically, the society was wrong and a devastating blow was dealt. The initial hope was ultimately replaced by the dreadful realisation that, although lives were extended, almost 5,000 patients with haemophilia in the UK and thousands more throughout the world had been infected with hepatitis C, HIV or indeed both.

Many of those people have since lost their lives to those conditions, and more continue to do so by the week, and we should pay tribute to the many campaigners who have died. I fully understand the sense of grievance and anger that people feel. I am not in that position, and it is impossible to know fully what it feels like, but I do understand some of it. I also know that for some time, whatever the Government do, sadly it will be far too little, far too late.

At the time, however, no other treatment was available. The UK blood supply and the only alternative, a product called cryoprecipitate, were both contaminated. The only real treatment, therefore, was no treatment at all, and that was the case not only in the UK, but in countries throughout the world. At the time, France, Germany, Japan and the United States all took a similar view, which was widely held by the scientific community throughout the world.

When those treatments were first introduced, we had a very different view also of the risks from hepatitis C. It was not until the mid-1980s that scientific and medical literature began to reflect increasing concern about the seriousness of disease associated with hepatitis C, and I, as somebody who was working as a nurse at the time, remember it well.

[Dr Pugh]

The Minister will be aware that in the Government’s response to the Archer report, certain documents are described as “misplaced”—they no longer exist or can be found. Do they have any bearing whatever on the analysis, and if they were discovered would they correct it in any way?

[Anne Milton]

I thank my hon. Friend for his question. We are talking about a long time ago; that is the trouble. I know that campaigners have been concerned about cover-ups, and that not all the documents have been released. I assure him that officials have told me that all documents have been released, but somewhere in the back of a cupboard, somebody at some point might discover more. It is a mistake to think that there is any conspiracy, however. I do believe, in all honesty, that previous Governments and the current Government have done, and continue to do, all that they can to ensure that all information is in the public domain.

As the consensus on the virus developed and technological advances occurred, the Government and the NHS moved quite quickly to address the risks. Heat treatment was introduced in 1985, and that effectively killed the hepatitis and HIV viruses. Validated tests for screening blood donations were also introduced. Since then, Governments have introduced a number of important safeguards to protect the blood supply, not least, as we heard today, from newer risks such as new variant CJD. We carefully assess, and shall continue to assess, all new evidence as it comes to light, and we now have EU directives that set standards of quality and safety.

I fully understand again the financial difficulties that many of those affected by contaminated blood products face. I have met some of them, and they have told me in some detail of their extraordinary experiences of living with the aftermath of infection. Not only were many of them infected, but they went on to infect their partners. They are, understandably, very concerned about their own and their family’s financial security, and they look to the Government to provide a degree of certainty in the years ahead.

Going—what may feel like—cap in hand to the state is demeaning, I know, but it is worth laying out the financial settlements that are currently available. Those infected with HIV receive a flat-rate payment of £12,800 per year, and they may also be eligible for additional discretionary payments. In the year ending April 2010, the average total payment to an individual infected with HIV was £17,400, although of course some received less and some received more. Those infected with hepatitis C are eligible to receive an initial one-off lump sum payment of £20,000 when they develop chronic infection. Despite contracting the virus, some people will make a full recovery, but many do not and go on to develop serious liver disease. For that group, there is a second one-off payment of £25,000. All those payments are tax-free and not used when calculating an individual’s eligibility for state benefits. Therefore, if they were unable to work for health reasons they would receive those benefits, but I take the point made by the hon. Member for Kingston upon Hull North (Diana R. Johnson).

The independent public inquiry on NHS-supplied contaminated blood and blood products, chaired by Lord Archer of Sandwell, investigated the circumstances surrounding the supply of blood products. It made several recommendations, the majority of which are in place in one way or another. However, a small number of recommendations have not been implemented. These primarily relate to aspects of the ex gratia payments, free prescriptions in England, and access to insurance.

I have instigated a review of those recommendations to see what more can be done. I know that hon. Members would love me to finish that review before Christmas. I will do what I can in the time available; I know that time is of the essence. The review will be conducted by Department of Health officials, but with the support of relevant clinical experts and external groups. The terms of reference should be in the Library. At this stage, let me put on record that I will place in the Library how the costs of implementing the Irish scheme in the UK were arrived at. I know that that has caused some concern, but I will come back to it, because time is very short.

I do not have time to go into detail on what happened in Ireland, but it is important to place on the record that in an article in The Irish Times—I will ensure that this is also in the Library—Brian Cowen, then Minister for Health and Children in the Republic of Ireland, and currently Taoiseach, confirmed that the Irish Government knew in 1995 that the Blood Transfusion Service Board had been negligent and had attempted to conceal that fact.

[Mr Slaughter]

Will the Minister deal with the two points that I raised in my remarks? First, do the terms of reference permit the inquiry body to consider the issue of hepatitis C in it widest sense—that is, to give it full parity, including in relation to the ex gratia payments of £12,800 a year for HIV? Secondly, given that she says that there are only a small number of recommendations to be addressed, why does not the new inquiry consider all those remaining issues, including the level of ex gratia payments?

[Anne Milton]

I thank the hon. Gentleman. I will admit to a certain amount of ignorance. I do not know what I can do, but I will do everything I can within what I am allowed to do. It is important to say that I am very keen to get on with this. The danger with an inquiry that extends its remit is that it drags on and on, and this issue has dragged on for more than 25 years.

No fault has ever been found here in the UK—a fact that has been tested in the courts. In 1988, a group of haemophilia patients and their families sued the Government of the day. They settled their case outside court, midway through the proceedings, as their solicitors had advised that they had very limited chance of success.

Whatever happened all those years ago does not change the facts of today. In the United Kingdom, decisions over tax and spend are made here in this Parliament. The decisions of the Irish Parliament, like those of any other national Parliament, have no authority here in the UK. The debate on contaminated blood products has continued for many years, and I would like to close my remarks by again offering my sympathy and expressing my deep regret at the events, and by saying how sorry I am that this ever happened.

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

Does the Minister accept that the nervousness that follows her logic of not looking at other countries means that on a whole range of compensation issues the Government are now simply saying, “We are washing our hands of our responsibilities”?

[Anne Milton]

I am not washing my hands of any responsibility—I am taking full responsibility. I am determined to see this review completed by Christmas within the terms that I have laid out.

My right hon. Friend the Member for Charnwood (Mr Dorrell) summed up the implications of voting for the motion more eloquently than I ever can. We cannot commit to aligning our compensation payments to those made in Ireland, and we cannot support the motion.

This debate has been useful in two ways. It has given hon. Members a chance finally to let the depths of this tragedy be heard. It is absolutely dreadful that no time has been found to debate this issue on the Floor of the House before. Secondly, it has enabled us to discuss how we can move forward. I want everyone, including hon. Members and campaigners, to be able to make their views known and know that they will be taken into account. I want the review to be dealt with openly and honestly, with clarity, without party politics, with humility and with empathy.

I cannot turn the clock back and change events, but I will do what I can in the time I am in office to bring some closure to those affected.

[Mr Robinson]

I think the whole House would agree that this has been an outstanding debate and has very much justified the new process for nominating Back-Bench business. I hope that in future we will have many such debates on important issues, debated in the same spirit as Members in all parts of the House have shown today in discussing a non-party political issue.

In essence, the heart of the motion, which I will press, is that an apology is due to the victims. I know that it is very difficult for Governments to give apologies, and the Minister came very close to giving one in saying that she much regretted what had happened. If it had been given in the same spirit as the Prime Minister’s statement on the Saville report on Bloody Sunday, it would have been different, but it needed something a little more.

The second important element at the heart of the motion is the question of compensation. Some Members have said that they cannot vote for the motion because of the reference to Ireland, which is a foreign jurisdiction, and concerns about where we might go from there. However, whatever we had put in the motion, we would have had the same approach from the Government. Members can try to salve their consciences in that way if they want, but the stark fact remains that the victims feel that they need an appropriate minimum level of compensation. They have asked us strongly to stick with the motion and put it to Members. We are going to put a marker down on how we think the Minister’s review should come out.

I do not doubt the Minister’s sincerity, and she has a long and distinguished history in the medical profession, but it is hardly an auspicious beginning for the Government to table an amendment intended to void the Back-Bench motion of its substance, then get their Whips up complaining to Mr Speaker about it, especially when it contains a figure that is out by a factor of three. The costs involved would not be more than £3 billion, as we learned from the distinguished hon. Member for Bracknell (Dr Lee), who is a medical practitioner. He said that they would be more like £1 billion. I cannot imagine how the Government have allowed that figure, which is not just salient but material to the debate, to continue to be discussed without correction.

[Anne Milton]

rose—

[Mr Robinson]

I give way to the Minister so that she can explain that to us.

[Anne Milton]

I have said that I will place in the Library details of how those figures were arrived at. They came about not through a typo in Lord Archer’s report but through careful consideration. The comparison with Ireland is difficult to make because the circumstances of those receiving compensation there are different, but that is not the salient point of the motion—it is whether we should align ourselves with a scheme set up by Ireland.

[Mr Robinson]

That is not the central point of the motion at all; it is utterly irrelevant to the debate. The debate is about justice for the victims of a terrible disaster, and whatever we had put in the motion we would have had the same attitude from the Government, which after all is the one that we have had from all previous Administrations. When I opened the debate I said that that we now had a golden opportunity for the Secretary of State to break with the past. He bears no responsibility for what went on, unlike some of us, including me when I was at the Treasury and the right hon. Member for Charnwood (Mr Dorrell) when he was at the Department of Health. The Secretary of State had a golden opportunity to put the past behind us and say, “A great injustice was done and a terrible misjudgment was made.” Several Members have made it clear that the suffering of the victims and their families goes on, and he should have said that the Government would now take steps to correct it. To say that it would cost £3 billion when it would actually be less than £1 billion is, as I said, hardly an auspicious start.

[Anne Milton]

May I reiterate that recommendation 6(h) of the Archer report states that

“payments should be at least the equivalent of those payable under the Scheme which applies at any time in Ireland”?

Contaminated Blood

Anne Milton Excerpts

Thursday 14th October 2010 Written Statements

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

On 16 April 2010 judgment was handed down on a judicial review of a decision made by the previous Government not to accept a recommendation made in the report of Lord Archer of Sandwell’s independent inquiry into infections transmitted some decades ago through contaminated blood products. The recommendation in question, 6(h), which concerned payments to those affected by this tragedy, stated that:

“We suggest that payments should be at least the equivalent of those payable under the scheme which applies at any time in [the Republic of] Ireland”.

The judgment found against the Government, therefore I am now required to look again at this recommendation, and decide whether or not to accept it.

Having carefully compared the circumstances pertaining here and in the Republic of Ireland during the period when most of the infections occurred, and having taken account of the fact that this tragedy similarly affected many other countries; I do not consider there is a case for accepting Lord Archer’s recommendation 6(h) that levels of payment here should match those made in Ireland. Every country must make its own decisions on financial support for those affected, taking account of its own particular circumstances, and affordability. The scheme in Ireland was set up on that basis, and has not been replicated in any other country, as far as we know. However, our ex-gratia payment schemes for HIV compare well with those of other countries.

In addition, it is estimated that implementing a similar scheme to Ireland’s here in the UK, would cost in excess of £3 billion.

I recognise that this decision will disappoint those who are living with serious health problems as a result of their infections, as well as their families and the families of those who have already died. During the summer I met representatives of those affected, and heard first hand about the hardships that they have to face on a daily basis.

I believe that to a large extent the recommendations are already in place. The previous Government increased the level of payments to those affected with HIV to a minimum of £12,800 per annum, and has increased the discretionary funding available to their dependents. I do not intend to revisit that decision, but I am persuaded that there are some aspects of Lord Archer’s recommendations that should be looked at afresh. These include:

the level of ex-gratia payments made to those affected by hepatitis C, including financial support for their spouses and dependants, and taking account of the level of payments made to those infected with HIV in the UK and via schemes in other countries;

the mechanisms by which all ex-gratia payments are made;

access to insurance;

prescription charges;

access to nursing and other care services in the community.

I am initiating a review of the issues raised by these recommendations, which will take place in the context of the current financial climate and results of the spending review. Terms of reference have been placed in the Library. I expect to be able to report the outcome of this work and my intentions by the end of 2010. I will be speaking to the other UK Health Ministers to seek their confirmation whether they wish to participate in reviewing the UK-wide aspects within this timescale or whether I will proceed on an England only basis.

Maidstone Hospital (Maternity Services)

Anne Milton Excerpts

Tuesday 14th September 2010 Westminster Hall

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

It is an outstanding pleasure to speak under your chairmanship, Mr Walker. I congratulate my hon. Friend the Member for Maidstone and The Weald (Mrs Grant) on securing this debate on the future of maternity services at Maidstone hospital and, in particular, the consultant-led maternity services there. I know that the future care of women and their babies in Maidstone is extremely important to her, her constituents and their families. No one could have done more to represent their views. She brought to the debate her own experience as a mother, as indeed do I. Interestingly, I had four children in four different hospitals, so I feel that I have quite wide experience on a personal level of maternity services. We also heard from my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who has professional experience in obstetrics. There is a wealth of experience in the Chamber on an issue that is clearly dear to many people’s hearts.

I want to take this opportunity to pay tribute to the NHS staff in Maidstone and, indeed, across the south-east region, who provide such wonderful care to all the people who use it. I pay tribute in particular to those who deliver babies, by the second, around us, bringing joy to many of us.

It may be helpful if I briefly describe the wider context of NHS reform, before turning to some of the more specific issues. All health care constantly needs to adapt to changes in demography, changing lifestyles, changes in disease patterns, innovation in health care and, indeed, rising health care costs. Change is always unsettling, however. Constituents rely on local health services and, naturally, any suggestion of those services being moved or reorganised always causes concern. However, as my hon. Friend the Member for Maidstone and The Weald stated, that does not always mean that people are resistant or see change as a negative thing. That assertion—people always hate change—is sometimes used unfairly to dismiss concerns, but what is clear about any change is that it must be managed openly and transparently. It should not be dictated by politicians from the Dispatch Box or in this Chamber. It must be a collective, informed and locally made decision, genuinely driven by clinical professionals, genuinely grounded in firm clinical evidence and genuinely recognising the views of the local community.

My right hon. Friend the Secretary of State has therefore been clear about the four crucial tests that any future change to the NHS service must pass. First, it must have the support of GP commissioners. Secondly, the public must be fully involved, with public and patient engagement duly strengthened. Thirdly, there must be greater clarity about the clinical evidence base underpinning any proposals. Fourthly, any proposals should take into account the need to develop and support patient choice. That will mean that patients, local GPs and clinicians, local people and local councils have a far greater say in how services are shaped in the future.

I understand that the proposals to centralise the consultant-led obstetrics and in-patient paediatric service in the Maidstone and Tunbridge Wells area to the new Pembury hospital were consulted on in 2004, and that the plans to consolidate consultant-led obstetrics and in-patient paediatric services at the new Pembury site have been agreed since 2005.

There are often strong arguments for centralisation. It is not, as is often believed, always about saving money, but is sometimes about delivering higher standards of care. There is no doubt that centres of excellence achieve that status by seeing critically high numbers of complex cases. I can cast my mind back to my own experience as a nurse and someone who worked in the NHS for 25 years. Even back in those dark days—it was a long time ago—we had centralisation of neurosurgical services and other specialties for exactly that reason. Critically high numbers of patients being seen produced centres of excellence that could deal with and make better people with rare and not commonly occurring conditions and diseases.

However, I am aware of the considerable public concerns about changes to services in Maidstone. I know that two petitions have been submitted—one to No. 10 Downing street and one to the Department of Health—and that my hon. Friend the Member for Maidstone and The Weald has written on numerous occasions to the Department to express concerns about the transfer of consultant-led obstetric services from Maidstone to the Pembury. Indeed, she has brought with her today a wodge of letters expressing those concerns.

In the light of the concerns, the council’s health overview and scrutiny committee referred the case to the previous Secretary of State in February this year. He asked the independent reconfiguration panel to provide advice, and in its response the panel concluded that due process had been followed. The current Secretary of State accepted those recommendations in July and therefore made it clear that plans for the centralisation of consultant-led obstetrics and in-patient paediatric services at the Pembury should continue.

As I have described, however, the new Government are determined that local voices should be properly heard and that any concerns are taken seriously. The Secretary of State has also asked the local NHS to work with clinicians, GPs, the local council and patient groups, to allay public concerns and demonstrate that those four tests are met. He has asked the strategic health authority to report to him at the end of September, and we would expect that report to set out clearly how the concerns mentioned by my hon. Friend the Member for Maidstone and The Weald—around accessibility, staffing, clinical quality and the huge concerns about transport—have been properly addressed.

I understand that the local NHS has to date conducted 26 one-to-one-interviews, 16 focus groups and addressed various other meetings and groups. Those included a focus group with nursing and midwifery staff, interviews with councils’ representatives and discussions with GPs across the area. Until the SHA report is submitted to the Secretary of State, it would, of course, be inappropriate—albeit, I am sure, disappointing to my hon. Friend the Member for Maidstone and The Weald—to speculate on what the report might say, but we must wait for that report to be published. The Secretary of State will look carefully at what the trust proposes to do, to allay those concerns and ensure that the voice of the whole community is heard in the implementation.

My hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) raised some concerns about the funding for Medway PCT. I understand that the service changes will have no impact on that funding. I also understand that South East Coast SHA has advised my officials that Maidstone and Tunbridge Wells NHS trust has had detailed conversations with all the surrounding trusts about the impact of additional activity. She detailed the large number of births and concerns for a rising number of births. There is no doubt that, for anybody working in the field of maternity and anybody representing constituents who have had babies or are about to, the continuing safety of mothers and babies is absolutely paramount. I want to reassure her that these changes will provide some choice in a birthing setting for local women, who will perhaps have increased rather than decreased choice. However, what will be important is that the SHA takes full account of the impact.

My hon. Friend the Member for Hastings and Rye (Amber Rudd) also detailed some of the issues surrounding the reconfiguration for the Conquest hospital, on which I know she has campaigned. She also raised the issue of the impact on vulnerable people. At times like these, it is extremely important that we remember that there are people out there who do not necessarily get good representation and who rely on their local Members of Parliament to provide that for them. The needs of the vulnerable are critical. I fully understand that these issues arouse strong feelings.

I again congratulate my four hon. Friends who have spoken in this debate on representing their constituents so well. These decisions involve finely based judgments around how available resources should be used to achieve the best possible care for patients. I applaud the determination of my hon. Friend the Member for Maidstone and The Weald to campaign for the best maternity services, and indeed all hospital services, for her constituents. I reassure her that it is a commitment that I share.

Reciprocal Health Agreement (UK and Isle of Man)

Anne Milton Excerpts

Thursday 9th September 2010 Written Statements

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

Following discussions between the Department, the Isle of Man Government and the devolved Administrations, a new reciprocal health agreement between the United Kingdom and the Isle of Man will come into effect from 1 October 2010.

The new agreement will put the current temporary arrangements on a permanent footing meaning that UK residents visiting the Isle of Man will receive free, state provided health care, as will Isle of Man residents visiting the UK.

Under the agreement, no public funds will change hands and this brings the Isle of Man into line with other agreements that the UK has with a number of non-European Economic Area countries.

The new agreement represents a sensible and logical conclusion and provides certainty for travellers on temporary visits between the UK and Isle of Man.

Oral Answers to Questions

Anne Milton Excerpts

Tuesday 7th September 2010 Commons Chamber

[Mr David Hanson (Delyn) (Lab)]

5. What recent discussions he has had with the Welsh Assembly Government on the effects of proposed changes to health services in England on patients living in Wales who use those services.

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

Since the election, there have been informal, but no formal, discussions between my right hon. Friend the Secretary of State for Health and the Welsh Assembly Government. However, I understand that a meeting is planned for later this year. Clearly, there have been discussions between officials about the impact of the White Paper and the changes.

[Mr Hanson]

May I respectfully suggest that someone in the Government gets on and talks to the Welsh Assembly Government? A third of my constituents, who live in Wales, use the Countess of Chester hospital in England, and they use hospitals in Manchester, including the Christie and the Clatterbridge for cancer services, as well as the Robert Jones and Agnes Hunt hospital in Shropshire for orthopaedic services. They are as appalled as I am by the changes being proposed by the Conservatives to destroy the NHS. Get on and talk to someone please.

[Anne Milton]

May I thank the right hon. Gentleman for his question and assure him that officials have got on with it and do it constantly? It is important that we ensure that any changes are synchronised across the two areas, and I know that he will continue to raise cross-border issues. I can reassure him that we have already got on with it and he need not remind us to do so.

[David T. C. Davies (Monmouth) (Con)]

Given that patients in Wales, served by the Welsh Assembly, have to wait far longer for routine operations and ambulance responses, is it not the case that the only problem that the Department will face is that the people of Wales will be galvanised by the excellent policies of this Government into suggesting that the Welsh Assembly Government ditch their failed health policies and copy those of the coalition Government?

[Anne Milton]

I thank my hon. Friend for that wonderful advertisement for the changes that we are bringing in. I agree with him and I am sure that the people of Wales will see the changes that we are bringing in and contact the right hon. Member for Delyn (Mr Hanson) to urge him to ensure that the changes are also introduced in Wales.

[Hywel Williams (Arfon) (PC)]

Fourteen thousand people from Wales are registered with GPs in England, and 19,000 people from England are registered with GPs in Wales. Will the Under-Secretary ensure that the changes that she brings in do not lead to any dangers to the services provided for both sets of people travelling across the border, and that adequate financial recompense is made as well?

[Anne Milton]

It is extremely important that people receive similar and safe passage and continuity of care across the borders, and we will continue to have conversations, both at ministerial level and between officials, to ensure that any hitches that arise are smoothed out as soon as possible.

[Caroline Flint (Don Valley) (Lab)]

7. How many GPs in Doncaster have expressed an interest in establishing GP consortiums.

--- Later in debate ---

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

8. What plans he has to assist GP commissioning in rural areas.

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

Our proposals in the White Paper will enable general practices to structure commissioning to reflect the character of the area they serve. Practices in rural areas, such as Cumbria and Cambridgeshire for instance, are exploring commissioning models. To support GP consortiums, we will create a statutory NHS commissioning board.

[Dr Poulter]

The Minister will be aware that many women make the choice to have a home birth and delivery, but unfortunately, in many rural areas, maternity services have historically been under-resourced. What steps does the Minister envisage better to support home delivery in rural areas, and to support GPs in their commissioning of these services in the future?

[Anne Milton]

I congratulate my hon. Friend on taking up the chairmanship of the all-party group on maternity. I know that his work with it will be very valuable, particularly in the light of his previous experience in the health service. Contrary to what Labour Members believe, this is an important opportunity to put general practices—in all their shapes and forms within all the professions—at the very heart of shaping services. As he said, home births and choice in maternity services are crucial for women.

[Ann Coffey (Stockport) (Lab)]

I have concerns about the effect of the Secretary of State’s proposals for GP commissioning on services in rural areas and urban areas such as mine. Greater Manchester PCT provided strategic leadership in the recent reconfiguration of children’s services, which was very contentious. Can the Minister clarify how that strategic leadership will be provided in the future reconfiguration of cancer, maternity and ambulance services in Greater Manchester, as GP commissioning will be focused on local health needs and national commissioning on national specialities?

[Anne Milton]

The hon. Lady made the point that urban and rural areas have very different needs. What is vital are the people on the front line, making decisions and offering the leadership and vision to shape those services. I do not think that she will find many people lining up to save PCTs, whose commissioning has not always been as successful as she would like to believe.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

I should like to suggest to the Minister that it might help GPs who are commissioning in rural areas if the formula for capitation were to include the information that their patients live in sparsely populated areas, as well as information about their age, especially in constituencies such as mine and that of my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter).

[Anne Milton]

My hon. Friend is right to raise the issue of the distances covered in rural areas. I believe that only ambulance trusts currently have the opportunity to reflect that. This is why it is so important that local commissioners will shape the services for their patients. It is they, not the pen-pushers in the PCT, who know best what is right for their patients.

[Keith Vaz (Leicester East) (Lab)]

9. What steps his Department is taking to inform young people about diabetes prevention.

--- Later in debate ---

[Hugh Bayley (York Central) (Lab)]

11. What recent assessment his Department has made of the clinical effectiveness of facet joint injections; and if he will make a statement.

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

Recommendations on facet joint injections were made by the National Institute for Health and Clinical Excellence in its 2009 clinical guidelines on low back pain. NICE did not find sufficient research evidence that strongly supported the effectiveness of facet joint injections and recommended that more research should be done. I understand that the National Institute for Health Research is looking at whether it will commission further research.

[Hugh Bayley]

Access to these injections is restricted in North Yorkshire and York PCT, although it is widely available on the NHS in other areas. The consultant in charge of York’s pain clinic believes that the PCT is not following the most recent NICE guidelines. What are the Government doing to reduce this kind of postcode lottery? Will the Minister contact the PCT and arrange for it to meet me and the consultant to discuss how these guidelines ought to be applied in North Yorkshire and York?

[Anne Milton]

I thank the hon. Gentleman for his remarks and point out that it is precisely because of the situation that he describes that we are bringing in some of our reforms. It is important that decisions about treatment and care are made by clinicians—GPs and a large number of other people, including some voluntary and charitable organisations—and that they are clinically led, evidence-based and also include patient choice.

[Mr Charles Kennedy (Ross, Skye and Lochaber) (LD)]

12. What recent discussions he has had on the effectiveness of the National Institute for Health and Clinical Excellence’s procedures to review the cost-effectiveness of drugs; and if he will make a statement.

--- Later in debate ---

[Andrea Leadsom (South Northamptonshire) (Con)]

16. What recent representations he has received on requirements for doctors to record the primary cause of death on a death certificate.

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

I am not aware of any such representations. Doctors are required under the Births and Deaths Registration Act 1953 to complete the medical certificate of cause of death “to the best” of their “knowledge and belief”. They receive information on this as part of their medical training. The Office for National Statistics produces reference material from time to time, including a video and training pack to assist doctors in completing the medical certificate on cause of death.

[Andrea Leadsom]

I thank the Minister for that answer. We have in my constituency of South Northamptonshire the Progressive Supranuclear Palsy Association headquarters. That is a neuro-degenerative disease with some similarities to motor neurone disease, although the big difference is that I doubt that many Members will have heard of it before now. Many people suffer from it, however, yet it is often not recorded on the death certificate. It is always fatal, giving a life expectancy of about two years. Might the Minister be prepared to review the situation and give some consideration to requiring doctors to put the primary cause of death on the death certificate so that we can properly assess the magnitude of this awful degenerative disease?

[Anne Milton]

I thank my hon. Friend for raising this issue. As a result of inquiries from the Progressive Supranuclear Palsy Association and others, the ONS is carrying out a special exercise to attempt to identify the true number of deaths involving PSP. However, it is extremely difficult to diagnose. I should just point out that medical examiners, when appointed, will be confirming the cause of death in all cases not investigated by the coroner. I think that that will make a difference to the information recorded on death certificates.

[Caroline Flint (Don Valley) (Lab)]

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

Evidence Check: Homeopathy (Government Response)

Anne Milton Excerpts

Monday 26th July 2010 Written Statements

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

We are today laying before Parliament the Government’s response (Cm 7883) to the House of Commons Science and Technology Committee report “Evidence Check: Homeopathy”, which was published on 22 February 2010.

Complementary and alternative medicine, including homeopathy, have a long tradition, and very vocal proponents and opponents. The Committee’s report sets out evidence and opinion on each side, with a strong focus on efficacy as being one of the main criteria by which it would expect national health service decisions to be made.

The Government welcome this report. We remain of the view that the local national health service and clinicians are best placed to make decisions on what treatment is appropriate for their patients. We expect local clinicians to make decisions on what is best for their patients taking account of safety, evidence of clinical and cost-effectiveness (where it exists) and the availability of suitably regulated/qualified practitioners.

We remain committed to providing good quality information available about complementary and alternative treatments so that clinicians and consumers can make informed decisions if they are considering such treatments.



Today’s publication is in the Library and copies are available to hon. Members from the Vote Office.

Office of the Health Professions Adjudicator

Anne Milton Excerpts

Monday 26th July 2010 Written Statements

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

The Government have been considering the case for proceeding with work surrounding the Office of the Health Professions Adjudicator (OHPA).

OHPA was established in law in January of this year, but is not yet operationally active. It was anticipated previously that, from April 2011, it was to take over from the General Medical Council (GMC) the role of adjudicating on fitness to practise matters relating to doctors and, in due course, take on the adjudication role in relation to other health professionals from the remaining health regulators.

Having reviewed the case for OHPA the Government are not persuaded that the creation of another body is necessarily the most appropriate and proportionate way forward in terms of adjudication. We believe that steps can be taken to strengthen and modernise existing systems within the GMC to deliver substantially the same benefits as OHPA. The learning from these steps can then be reviewed and, in due course, applied to the other health regulators. We intend to consult with external partners on this approach shortly.

Healthier Food Mark and Government Buying Standards (Food)

Anne Milton Excerpts

Monday 26th July 2010 Written Statements

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

Over the last two years, the Department has been developing a scheme to improve the nutritional content and sustainability of food served in the public sector, provisionally known as the Healthier Food Mark. The Department has been working across Government on this, and particularly closely with both the Food Standards Agency and the Department for the Environment, Food and Rural Affairs (DEFRA). Two pilots, involving over 70 organisations from across the public sector, have been completed.



I am announcing today that the Healthier Food Mark will not be taken forward as a discrete scheme. Instead, the considerable body of evidence and learning from the development of both the nutrition and sustainability criteria will be used to help develop Government buying standards for food procurement in the public sector.

Government buying standards ensure that the public sector procures sustainable goods and services. They are mandatory for central Government Departments and their Executive agencies and are promoted to the wider public sector. The Government buying standards for food will take account of the evidence gained from the pilots of the Healthier Food Mark. DEFRA, working with the Department of Health and other Government Departments, will assess the costs and benefits of a number of options for criteria to be included in the Government buying standards for food to address both nutrition and sustainability. The standards will be consulted on in the autumn.

Informal Health Council

Anne Milton Excerpts

Tuesday 13th July 2010 Written Statements

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

European Union Health Ministers met in Brussels for an informal meeting of the EPSCO (Employment, Social Policy, Health and Consumer Affairs Council ) Council on 5 and 6 July. I represented the UK.

The morning session of 5 July consisted of a discussion of EU-level collaboration on cancer. A number of member states indicated their support for greater information sharing and production of comparable data on cancer outcomes at EU level.

There was also discussion of the EU’s response to the A(H1N1) pandemic (building on the expert conference held on 1 and 2 July by the Belgian presidency). Discussion focused upon the issues of vaccine procurement, and the wider EU co-ordination of pandemic response.

The EU structures for responding to health emergencies (such as pandemics) were also discussed. This included a discussion of the possibility of revising the mandate of the Health Security Committee, whose mandate expires in December 2010.

Child and Adolescent Mental Health Services

Anne Milton Excerpts

Wednesday 7th July 2010 Westminster Hall

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

I congratulate the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) on securing both this debate and his seat. The subject is of huge importance to him, and he brought with him his invaluable personal experience, as indeed did the hon. Member for Manchester, Withington (Mr Leech) and my hon. Friend the Member for South Swindon (Mr Buckland). Those personal experiences are crucial to the debate, as are the contributions from those who are experienced in the provision of services. This debate is vital, and I will ensure that all the representations that have been made today are fed back into the policy process. Time is short, but I will just say to the hon. Member for Worsley and Eccles South (Barbara Keeley), who speaks for the Opposition, that some of us were fortunate enough to have listened to and participated in debates on the Autism Act 2009, promoted by my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan), as it made its passage through the previous Parliament. At the time, there was an increasing dislike of and disillusionment with politicians, so I mention that measure because it showed this place in its very best light. It was about cross-party working and building a consensus. It was a genuine attempt by Members from all parts of the House to work together to improve the lives of others—in this instance it was the lives of those with autism. I pay tribute to Angela Browning, the former Member for Tiverton and Honiton, who was sometimes a lone voice calling for services for people with autism. She, too, brought her own personal experiences to the debate thereby helping to raise us to the next level.

I echo the comments made by the Minister of State, Department of Health, my hon. Friend the. Member for Sutton and Cheam (Mr Burstow), at the recent National Autistic Society reception. He said that the standards of care highlighted by the society in its “You Need to Know” report are unacceptable. He was grateful to the society—as indeed we all are—for its tireless campaigning, and was struck by the particular contribution of the young campaigners group. I am sure that he would pay tribute to them were he able to be here today.

The coalition’s programme for government makes it clear that we are committed to supporting the most vulnerable and to tackling health inequalities. There is strong consensus on what needs to be done to improve the emotional well-being and mental health of children and young people. More work is needed on prevention, early diagnosis and early intervention. Those are the key things that are needed by people with autism and mental health problems. We need better integrated working and more evidence-based approaches. The work force must be developed, and, crucially, we must do more to tackle stigma for people not only with autism but with mental ill health.

The National Advisory Council for Children’s Mental Health and Emotional Wellbeing report earlier this year reinforced the scale of that challenge. It called for action to strengthen leadership, build a confident and skilled work force, improve commissioning and ensure real participation by children and young people in service development. For me, commissioning is a vital part of that. It has never been done that well, but there is a general acceptance of the fact that if we improve commissioning, the services will then follow. As has been mentioned during this debate, there are examples of best practice, which we need to be able to transport to other areas. We need to consider all those issues to get the services that we want.

The Government have also promised to deliver measures in “Fulfilling and rewarding lives: the strategy for adults with autism in England”. There are many areas in which improvement in adult autism services will yield benefits for children’s services, such as developing local autism teams, improving access to diagnosis, better planning and better commissioning of services. As several hon. Members have said, raising awareness of the issue and improving skills in the work force should go much wider than just those working in the autism field, and should include teachers and sports clubs and all those who are involved with young people.

Our focus must be on improving the quality of services that we provide to all children. We must ensure that no one suffers the indignities and difficulties that are sadly all too common. I am referring to the frightened young person who is restrained by police because crisis services were not available; the child who feels isolated and frustrated, only to find that health care staff are not trained to help or able to understand them; the parents who desperately want to see an improvement but feel let down by services that do not treat their children as people with individual needs; and parents who are desperate, isolated and at the end of their tether. That is why it is so important to improve the standard of care across the board.

We must plan and build on the work that has been done on integrating services so that local partnerships can work together to deliver what we want. It will require incredible commitment from local NHS providers to engage with the work force to resolve difficult issues such as training and service design. Improving the reach and quality of child and adolescent mental health care means looking carefully at the different services that make up the whole picture. I am referring to universal services that play a pivotal role in promotion for all children and young people; targeted services that provide early interventions for vulnerable children and young people; and specialist services, which the hon. Member for Stalybridge and Hyde mentioned, for young people with complex, severe or persistent needs.

[Dr Pugh]

rose—

[Anne Milton]

I am sorry, there is no time. I already have far too many questions to answer. If hon. Members feel that their questions have not be answered or addressed, I urge them to write to me and I will make sure that we respond.

[Barbara Keeley]

When there have been a great number of questions, it is more usual for the Minister to agree to write to us rather than expect us to write to her.

[Anne Milton]

I am sorry for that error. I thought that I said that I would write. I thank the hon. Lady for raising that.

I have only two minutes left. The hon. Member for Stalybridge and Hyde said that staff working in child and adolescent mental health services should have the necessary values, competences and skills. That is vital. The coalition document made it clear that we are committed to supporting the most vulnerable and to tackling health inequalities, and we will make more announcements about public health. Appropriate tier 4 child and adolescent mental health services should be available to all children who require them, including children with autism. There are a number of other vital issues, including diagnosis and transition. I am proud of my own field, which was highlighted by the previous Government, for some of the things that they achieved on transition. I should also like to pay tribute to Sara Truman, who has done a huge amount of work with the National Autistic Society.

We have not touched on the health outcomes for people with autism and mental health problems, but if we look at them we will find that they are truly shocking. Parents and carers carry a huge burden. There are many issues that we have not covered, including respite and research. We still do not understand why people get autism. We also need to look at those children who are not yet diagnosed. There are significant challenges that will require real commitment and buy-in from the staff who work hard in CAMHS across the country, but I am greatly encouraged by the number of contributions here today and by the amount of expertise that is sitting here. There is a role for Government to play. I hope that hon. Members appreciate that we cannot provide all the answers—

[Mr Joe Benton (in the Chair)]

Order. We must move on to the next debate.