Maternity Services: Expenditure

Anne Milton Excerpts

Thursday 1st March 2012 Ministerial Corrections

[Ms Abbott]

To ask the Secretary of State for Health how much was spent on maternity services in each (a) region and (b) NHS trust in (i) 2010 and (ii) 2011.

[Official Report, 20 February 2012, Vol. 540, c. 695-98W.]

Letter of correction from Anne Milton:

Errors have been identified in the written answer given to the hon. Member for Hackney North and Stoke Newington (Ms Abbott) on 20 February 2012. The 2009-10 figure given for Barking and Dagenham PCT should be ‘8,335’; for Barnet PCT ‘21,662’; and for Bassetlaw PCT ‘5,114’.

The full answer given was as follows:

[Anne Milton]

This information is not collected in the format requested. The Department collects accounting data based on commissioning, of secondary health care by financial year. Information regarding expenditure on the purchase of secondary health care relating to maternity services by strategic health authority (SHA) region and primary care trust in 2009-10 and 2010-11 is set out in the following tables.

[Anne Milton]

This information is not collected in the format requested. The Department collects accounting data based on commissioning, of secondary health care by financial year. Information regarding expenditure on the purchase of secondary health care relating to maternity services by strategic health authority (SHA) region and primary care trust in 2009-10 and 2010-11 is set out in the following tables.

Oral Answers to Questions

Anne Milton Excerpts

Tuesday 21st February 2012 Commons Chamber

[Penny Mordaunt (Portsmouth North) (Con)]

5. What recourse patients have when denied facilities to which they are entitled under the NHS constitution.

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

The patient may complain either to the local organisation that provides the service or to the primary care trust. If it proves impossible to resolve the complaint locally, the complainant has the right to ask the health service ombudsman to look into their case. They have the right also to make a claim for judicial review if they think that they have been directly affected by an unlawful act or decision of an NHS body.

[Penny Mordaunt]

In the short time that I have been a Member, I have had to challenge my local trust over its policies on cancer drugs, metabolic surgery, IVF and a raft of other issues in order to get my constituents the treatment that their doctors say they need. When will all NHS patients in Portsmouth and elsewhere be able to have treatment based on clinical need?

[Anne Milton]

My hon. Friend’s constituents are fortunate to have such a vigilant MP who has taken up their individual cases. Patients have the right to expect local decisions on the funding of drugs and treatments to be made rationally, following proper consideration of the evidence. I suggest that she, like many other Government Members, will not be going out to march to preserve the PCTs, which often make flawed decisions.

--- Later in debate ---

[Dame Joan Ruddock]

On a very serious issue, a waiting list clerk of 17 years has just resigned because she was asked to adopt a range of devious methods to make sure that people coming up to the 18-week target for treatment were taken off lists. Does the Minister understand that patients will not always know whether they have had proper treatment, and that it will be far too late to refer them to an ombudsman at some later date?

[Anne Milton]

I thank the right hon. Lady for her question. I am devastated to say that I have not seen the article to which she refers, but I am sure that I will. The Department has made it very clear to the NHS that clinical priority is and remains the main determinant of when patients should be treated. When I was in opposition I made various visits to various hospitals and saw them fiddling around at the edges, with admin staff forced to do things that they did not want to do, in order to tick boxes for the previous Government.

[Mr Speaker]

Right. Can we now speed up a bit? We have a lot to get through, and I should like to accommodate the interests of colleagues, so everybody needs to tighten up.

--- Later in debate ---

[Mr Stephen Hepburn (Jarrow) (Lab)]

15. What recent representations he has received from health care professionals on the Health and Social Care Bill.

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

The Government have received a wide range of representations throughout the passage of the Health and Social Care Bill, including from health care professionals, the public and voluntary bodies, and the trade unions.

[Mr Hepburn]

The vast majority of people, whether they work for or use the health service, see the Bill for exactly what it is: a Tory plan to privatise the national health service. When will the Minister listen to people, stop trying to pull the wool over their eyes—it is not working—and scrap this tawdry Bill?

[Anne Milton]

The only bit of the hon. Gentleman’s supplementary question that I recognise is a diatribe from the Labour party that perpetuates a myth about the Bill and fails to understand that the Bill is about the public of this country. This is about the people—patients—getting the health care that they need and deserve.

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

May I pass on the representation of a health care professional in my constituency—one of the general practitioners involved in the commissioning group—who said that he felt the Health and Social Care Bill had been written for GPs, and that it was perfect for improving care in our community?

[Anne Milton]

My hon. Friend echoes many of the comments that I have heard as I have gone around the country. Without the Bill, we cannot strip out primary care trusts and strategic health authorities, which will save £4.5 billion over this Parliament. I cannot see anybody going out on a march to save PCTs and SHAs. The public want the outcomes and the quality of care that they deserve, which they were denied under the previous Government.

[Mr Speaker]

I remind Members on both sides of the House—Back and Front Benchers alike—that topical questions and answers must be brief.

Haemophilia

Anne Milton Excerpts

Wednesday 8th February 2012 Westminster Hall

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

It is a pleasure to serve under you, Mr Weir. I thank the hon. Member for Kingston upon Hull North (Diana Johnson) for securing the debate. I am grateful for the opportunity to discuss the issue. I also thank her particularly for her comments about the contact that we have had. I will continue to keep in contact with her and many other Members who continue to highlight the specific issues suffered by their constituents. I know that Glenn Wilkinson and others, some of them not still with us, have worked tirelessly on the issue.

I was interested to hear about the new campaign. Of course I will meet its representatives, as I continue to do. This is an opportunity to say that Whitehall can be distant from the rest of the population. As a Minister, I will, as all Ministers should, use the opportunity that Back-Bench and Opposition Members have given us to ensure that we stay in touch and do not become insulated from what is happening in people’s lives.

I wish that I could make up for what happened. It is a very long and sad saga. I can do only what I can do starting from here. I am also aware of the fact that it will never really be enough, because I cannot turn back the clock, but what matters is that we keep contact going.

The hon. Lady asked specifically about future commissioning arrangements and specialised services for haemophilia and other related bleeding disorders. As she has rightly said, those services are currently commissioned at a regional level by specialist commissioning groups. We are working with the NHS to produce a list of specialised services to go in a new set of regulations for the NHS Commissioning Board. At the moment, we are not able to produce a final list, but a list of services currently set out in the Specialised Services National Definitions Set—the titles that the Department of Health and others come up with are extraordinary—will form a basis for the Commissioning Board’s final list. I expect that we will be in a position to announce that list of services in the coming months, at which point it will be subject to consultation.

The hon. Lady is right to say that that will be an opportunity to share best practice. I get frustrated when I hear that some areas do things well, while others do not or do not adopt the same sort of best practice. The hon. Lady has voiced her concerns and fears that this could lead to services being levelled down, but I think there will be an opportunity—I was born an optimist—to share best practice. The financial arrangements for this particular group of people affected by contaminated blood will remain an issue for the Department of Health. What matters on services, however, is that we ensure that best practice is shared.

The hon. Lady mentioned care plans. As somebody who trained as a nurse and who worked in the NHS for 25 years, I get frustrated about this issue, because everybody should have a care plan and everybody should be involved in it. The plan should involve all the different agencies, including the local authority on housing and social services on social care. It could also involve the voluntary sector for people who are isolated. A number of agencies can improve the quality of life and ensure that people’s lives are fulfilling and meaningful.

Today, treatment for haemophilia is much improved. On the issue of blood safety, which the hon. Lady raised, some haemophilia patients still need to be treated with products that have been manufactured from human plasma, but those products are manufactured under very strict safeguards. Many haemophilia patients are now treated with synthetic products, and both types of product are extremely safe. Lessons have been learned. The shadow of what happened all those years ago continues to hang over us and everybody involved with the safety of blood products.

Synthetic and plasma-derived clotting factors are procured nationally by the Department, with commissioners and clinical and patient representatives involved from an early stage. That means that the NHS buys products that are not only cost-effective, but reflect what patients and doctors actually need. In turn, manufacturers and suppliers can better understand what matters to the people who use those products. At the end of the day, that is what should matter to us.

To further improve patient involvement, the Department of Health has brought the Haemophilia Alliance into discussions on all the issues that affect haemophilia patients. The alliance is made up of patients, clinicians and other professionals involved in haemophilia care, and I am grateful to those who give up their time to involve themselves in it so positively.

A decontamination research funding initiative worth about £2.4 million over four years was announced in 2011. It will address the decontamination of surgical instruments, improving the effectiveness of washer disinfectors and exploring contamination and novel technological approaches to the decontamination of endoscopy scopes. These products will also have wider applicability to human prion diseases, such as CJD, and other health-care-associated infections. Some issues are unresolved, because the proven and effective technologies needed to address them do not yet exist. There will continue to be money in research until we are absolutely sure that we have done all we can.

When people were infected with hepatitis C and HIV, it also had a significant effect on their families. We often forget that such issues have a massive ripple effect, not just on immediate family but on distant family. In January 2011 the Secretary of State announced that we would provide additional support, not just for haemophilia patients, but for anyone infected with HIV or hepatitis C by NHS blood transfusion. That support includes ensuring that the annual payment for those infected with HIV is linked to inflation; introducing a similar payment for those most seriously affected by hepatitis C; and increasing the value of the lump sum. The support will also make £300,000 available over three years for counselling services. I find it interesting to look at the uptake for such things, because it lets us know when we have hit the target. It is so important that I continue to get that feedback. The combination of fixed and discretionary payments provides flexibility to enable them to be tailored to meet individual personal needs.

I know that there is concern that insufficient support is available for people who have developed hepatitis C, particularly the Skipton Fund stage 1 recipients. The scientific and clinical advice that we received during the review that we conducted in autumn 2010 did not support regular annual payments to everyone infected with hepatitis C, many of whom go on to clear the virus. I was delighted to hear from one such person, who has campaigned actively. New treatments are available, improving the prognosis for some infected patients, but I know—I think the hon. Lady was at the same meeting as me recently—that concern remains about the cut-off.

I know that one of the constituents of the hon. Member for Kingston upon Hull North has worked out the potential cost of removing the distinction between stage 1 and stage 2, but the current system of payments for hepatitis C is itself based on expert clinical and scientific review, which continues to support the two-tier system. Evidence, however, evolves and it would be arrogant of a Minister to say, “That’s it for ever.” It is terribly important, as I hear about the experiences of the constituents of individual Members, that I continue to receive advice, so that what we do is relative to the current expertise.

I apologise to the hon. Lady for not responding to her e-mail about my meeting with the expert group, but I was delaying my response while departmental officials worked out the details of the meeting. I am pleased to say that I will write to the relevant patient groups, asking them to nominate two people—I think that seems about right—to represent them at the meeting. I think that will be important.

The hon. Lady is probably aware of the Caxton Foundation, which provides support tailored to the needs of those affected. All payments made by the foundation are for the trustees to decide. I have met the trustees and their feedback is important in enabling us to see how the support works. The charity’s objectives are laid out in its trust deed, and it is accountable to the Charity Commission. I do not have any powers to direct it, but it has to be kept under review.

[Paul Goggins]

On the Caxton Foundation, in future will the Minister take particular notice of the needs of carers? It is important that that fund is in a position to support carers as well as those directly affected.

[Anne Milton]

Yes. I thank the right hon. Gentleman for that point. The discretionary ability to distribute funds is important. He is absolutely right to raise the issue of carers, who are all too often forgotten.

The hon. Member for Kingston upon Hull North mentioned the capability assessment. She might want to initiate a similar debate on that issue. Health conditions are not automatically a barrier to work, but we recognise that they are for some people. Indeed, some people will never work and we must make sure that we support them. It would probably not be right—this is certainly not in my gift—to give automatic exemptions, but I urge the hon. Lady to raise the issue with the Secretary of State and the Minister responsible.

[Diana Johnson]

It would be powerful if the Minister made representations to a fellow Minister. Has she had the opportunity to do that with her colleagues in the Department for Work and Pensions?

[Anne Milton]

As the hon. Lady rightly states, in my ministerial role, my responsibility is the health and well-being of the population. I will always continue to make representations, which often taken place—although sometimes they do not happen in the public eye. Just a word about the Lord Penrose inquiry: we will give assistance, but we will not be commenting on that. I have had a few letters about that. I will comment at the end of the inquiry.

The issue of trust has been raised. I will finish by saying that I know a lot of trust was damaged and that that has flavoured many things since then for good but also for ill. That is an extremely difficult issue and I would not presume to say that I can ever get anyone’s trust back for what has happened and what successive previous Governments have done or failed to do. I hope that we will continue to work constructively with other hon. Members to ensure that this group of people get the help and support that they need.

Health Select Committee Report on Public Health (Government Response)

Anne Milton Excerpts

Tuesday 7th February 2012 Written Statements

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

Today we have laid before Parliament the Government’s response to the Health Select Committee report on public health (Cm 8290). The response summarises the Government’s plans to modernise the public health system, including giving local authorities a new leadership role in public health and the creation of an integrated public health body, Public Health England, to provide expert advice and support.

Copies of the Government’s response are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper office.

Alcohol Strategy

Anne Milton Excerpts

Tuesday 7th February 2012 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Miss Clark. I congratulate my hon. Friend the Member for Totnes (Dr Wollaston) on securing the debate. As a GP, she has experienced at first hand the devastation alcohol can cause, and we all agree with her that excessive drinking affects our communities, ruins lives and all too often ends them.

The debate is very timely, because it marks the start of a big push by the Government to get information to people about the harm that alcohol can cause. We have the Change4Life adverts, which some Members may have seen, and 2 millions leaflets are being distributed. I can also recommend to hon. Members an online calculator that will help people to start understanding how many units they actually drink. Awareness of the harms of smoking is high among members of the public, and most people these days understand that being overweight is a problem and that they should probably exercise more, but the harm alcohol can cause is less well understood.

The constructive tension in the Chamber has been quite useful, and it is interesting that it is cross-party. Often on such occasions, the reporting of the evidence is somewhat selective, but one difficulty with the question why we drink so much and why drinking is a particular problem for northern Europeans is that it is complicated and the picture is complex. Some 57% of people drink fewer than three times a week, and a further 15% report abstaining from drink completely. However, 22% of adults drink more than the lower-risk guidelines, drinking 70% of all the alcohol consumed, which means that just under a quarter of people drink almost three quarters of the alcohol consumed.

As those figures suggest, the majority of people who drink do so in an entirely responsible way, but we cannot ignore those for whom drinking is a problem and those who cause others misery as a result of alcohol-fuelled crime and disorder. The ripple effect on families is, of course, also significant.

Some 21% of men and 15% of women are binge drinkers. Some 44% of violent crimes—almost 1 million crimes—are carried out by individuals under the influence of alcohol. Alcohol-related crime and disorder are estimated to cost our economy between £8 billion and £13 billion a year. There are also 1.1 million admissions to hospital as a result of alcohol-related crime, making alcohol the third biggest burden in terms of disease after smoking and obesity.

A problem that size needs a proper long-term solution. That is why we are developing a cross-Government alcohol strategy that will set out how different Departments can work together to reduce the harm alcohol can do to people’s health, as well as to society and our local communities, which are often blighted by alcohol-fuelled crime. The strategy will be published in the coming weeks, and I know the hon. Member for Hackney North and Stoke Newington (Ms Abbott) is desperate to see it. It will be here soon, and it will highlight the importance of collective work, setting out the courses of action for all the relevant Departments across Whitehall, as well as describing the future roles of central and local government, the third sector, and other organisations and people.

This issue affects us all. It affects people in different ways at different times of their lives. As has been stated, there is no one silver bullet that will turn these things round. As my hon. Friend the Member for Totnes and the hon. Member for Southport (John Pugh) made clear, we need to address this issue from lots of different directions. By taking a life-course approach, we can help young families and children to understand how much alcohol can affect them, putting them at risk of violent crime, exposing them to sexual dangers and having consequences for later life. We can help working-age adults to understand the seriousness of long-term drinking at levels above the guidelines, and we can help older people to understand how much such drinking can reduce their quality of life in old age.

My hon. Friend and the hon. Gentleman highlighted the lack of services for people dependent on alcohol, and we are running co-design pilots to address that. My hon. Friend the Member for Enfield, Southgate (Mr Burrowes) is working closely with me on that. As he said, we have a big ambition: we believe that people can recover from their addictions.

Home Office Ministers have legislated in the Police Reform and Social Responsibility Act 2011 to overhaul the Licensing Act 2003 and rebalance it in favour of local communities. Those new measures will give the police and licensing authorities the capabilities to tackle irresponsible premises and to crack down on unacceptable sales of alcohol to children. Those measures will come into force this year.

On top of that—very importantly, sending a critical message—designated responsible authorities under the 2003 Act will be, in the first instance, primary care trusts, so that they can make a fuller contribution to reducing acute harm from alcohol. We are keen for health organisations to play a much bigger part in the licensing decisions made by local authorities.

On tax, we have said that we will raise alcohol duty by 2% above inflation—the retail prices index—each year to 2014-15. We have introduced a new extra duty on high-strength beers to discourage people from drinking cheap, super-strength lagers. Likewise, there is now a reduced rate of duty on lower-alcohol beers to encourage people to switch. My hon. Friend the Member for Totnes talked about putting quality above quantity; that is something we are aiming for, and the industry is responding well.

Pricing will continue to be an issue. There are some misconceptions about the use of the phrase “minimum unit price”, although hon. Members have probably used it accurately today and described well what they meant. The fact is that shops sell alcohol at a loss to get customers through the door, and that can encourage binge drinking. That is why we are committed to banning the sale of alcohol below cost, and that is an important first step. There are many different ways to achieve that aim, and we will continue to review all the evidence. The alcohol strategy will outline what steps we are taking to tackle the issue. Interestingly, 65% of alcohol was bought in pubs a few years ago, but 65% is now bought in supermarkets.

I want to re-emphasise to my hon. Friend that the drinks industry does not dictate policy. If I do nothing else today, I want to dispel the myth that it is dictating policy to me or any of my colleagues in the Department. Through the responsibility deal, we are challenging the industry to take action. That can happen quickly, it does not need legislation and if we can make some progress, that will be a start. Some 119 different companies have signed up to collective responsibility deal pledges on alcohol, including on improving labelling to get information out to people and to ensure that 80% of alcohol products have unit and health information by the end of 2013. As a result of the deal, people will see information on the number of units in different drinks, whether they are buying from shops or in pubs and bars. We are also working with industry and non-governmental organisations to remove a significant number of units of alcohol from the UK market through changes in how alcohol is produced and sold. Customers can therefore expect a much wider choice—again, this is about targeting quality, rather than quantity.

There is no doubt that we need people to take more responsibility, but this is also about local communities, businesses and individuals, whether they are parents, people whose drinking is affecting others or those who are risking their own health. We all need to play a part in helping people to understand the risks better. Local authorities have welcomed our plans to transfer powers for public health to them. They will be well placed to decide which organisations to fund and how they can take action locally.

I want to take this opportunity to praise some of the work that is already being done in many areas. Street pastors have been mentioned—in my patch, they are called street angels—and there are also the local authorities. In my constituency, Guildford borough council has introduced byelaws and it is working closely with the licensed trade. Unfortunately, preloading means that the licensed trade gets an unfair reputation at times. People often go into pubs, clubs and bars having consumed considerable amounts of alcohol, and the licensed trade is left to deal with the problem. Areas such as mine are dealing well with the issue, and people have worked well with the council. As a result, we are seeing a difference on the streets; in fact, if Members walk around some of our towns where progress has been made, the difference is noticeable.

There needs to be action across the board from everyone, and our alcohol strategy will demonstrate that. That action must be based on evidence. I thank my hon. Friend once again for the debate. I must reiterate that we cannot, sadly, turn this problem around overnight, but we are deadly serious about this deadly problem, and that will be demonstrated in the forthcoming alcohol strategy.

Nursing and Midwifery Council

Anne Milton Excerpts

Thursday 26th January 2012 Written Statements

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

Today, I have asked the Council for Healthcare Regulatory Excellence (CHRE) to undertake a strategic review of the Nursing and Midwifery Council (NMC).

With a view to further strengthening the NMC’s leadership and governance, the Department also plans to consult on re-constituting the NMC’s council to reduce its size. This is in line with a recommendation by the CHRE. The Department believes that this option now warrants consideration for the NMC.

On 11 March 2008, a debate took place in the House of Commons that raised concerns about the NMC and its performance, Official Report, columns 46-51WH. In response, the previous Government asked that the CHRE expedite its annual performance review of the body. The report found that the NMC was performing its statutory duties, but not to the standard that the public had the right to expect.

Following that report, the NMC agreed an action plan to address the concerns. A new council, made up of equal lay and registrant members was independently appointed from 1 January 2009. A new chair was appointed on the same date and a new chief executive took office later that year.

Subsequent reports by the CHRE have found some areas in which the NMC is improving. Regrettably, however, their most recent report on fitness to practise, published in November 2011, shows that the rate of improvement in this area falls below the standard that the public and registrants have the right to expect. That is why I have taken the decisions to commission the CHRE to conduct a wide-ranging review and to undertake a consultation on the constitution of the council.

The review will look at the NMC’s organisational structure, resource allocation and operational management. It will establish what further action is needed to ensure that the NMC is effectively carrying out its statutory duties to promote high standards of conduct and practice in order to protect the public. The NMC supports the review, which will report to Ministers by early summer.

How the NMC council might best be constituted to provide strong, strategic oversight will be the subject of a public consultation and views from all stakeholders will be welcomed and taken into account.

Health Inequalities (North-East)

Anne Milton Excerpts

Tuesday 24th January 2012 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mrs Riordan. I congratulate the hon. Member for Newcastle upon Tyne Central (Chi Onwurah) on securing this debate on a matter of considerable importance, and not only for the UK. Non-communicable diseases are a problem around the world, and inequalities also exist in Tanzania. I welcome Tanzanian MPs’ interest, as I do my new daughter-in-law, Maureen Rachel Mwasha, who married my son in Dar es Salaam at Christmas.

However, I will return to inequalities, if you will forgive me, Mrs Riordan. It cannot be right that people in one part of the country are likely to live about 11 years longer than people elsewhere, or that the likelihood of developing heart disease or cancer is determined to a significant degree by postcode. I stress that some of the detail of inequality is missed, and that it is necessary to consider large, significant but often hidden populations of inequality in otherwise affluent areas.

As the hon. Lady mentioned, inequalities in the north-east are particularly poignant and generally worse than in England as a whole, but although I recognise that spending on health increased under the past Government, so did health inequalities. As the hon. Member for Hartlepool (Mr Wright) stated, links between education, employment and health are well recognised, but we inherited a dreadful budget deficit, a terrible economic climate and worsening health inequalities.

[Debbie Abrahams]

Will the Minister give way?

[Anne Milton]

I am afraid that time does not allow me to.

Health in the north-east has historically been poor due to a legacy of heavy industries such as coal mining and shipbuilding, lifestyle choices and a complex web of factors. Levels of deprivation are high and life expectancy for both men and women is lower than the national average. Members might be interested to know that the Hartlepool shadow health and wellbeing board is already having a detailed debate about tackling the issues mentioned by the hon. Gentleman, including child immunisation. The proposed health reforms are enabling the people of Hartlepool to address the issues through local solutions instead of a top-down approach.

Even within local health authorities, wide and unacceptable health inequalities remain. Life expectancy can vary by as much as 18 years within a relatively small geographical area. On the plus side, although previously falling rates of early death from cancer have started to level off, death rates from all causes among males have fallen faster than the national average in recent years.

I reassure the hon. Member for Newcastle upon Tyne Central that I do not pretend about anything. She must look to her own party for the answers to her concerns. They were in Government for 13 years.

[Debbie Abrahams]

Will the Minister give way?

[Anne Milton]

I have only six minutes, and I have numerous questions to answer. The north-east has made commendable efforts to tackle its problems, acknowledging some of the things that happened under the last Government. At the core of Better Health, Fairer Health is a drive to tackle inequalities through multi-agency partnerships.

The north-east has its own tobacco control office, the first of its kind in the UK; Fresh began life in 2005. I am sure that the local authorities will recognise the work that has been done. It will be down to them to decide how the money is spent in local areas to improve their stubborn smoking rates. In the north-east, Fresh has managed to reduce the number of smokers by 137,000, and local NHS stop smoking services continue to provide support to the highest number of people in England. We in Government have introduced a tobacco control plan, and I assure the hon. Member for Newcastle upon Tyne Central that we will be consulting on plain packaging and continuing progress, as detailed in the plan, which I am sure she has seen.

However, the major part of poor health in the area will be remedied only by widespread changes in behaviour. It is this Government’s policy to encourage people to change how they live—[Interruption.] Hon. Members might gain slightly more from this debate if they listened to the answers rather than shouting at me from across the Chamber. We cannot frog-march people out of the off-licence, compel them to stop smoking or force them to practise safe sex. Our challenge is to make the case that freedom without responsibility is not sustainable, so for the first time, allowing for the progress of the Health and Social Care Bill through the House, the Secretary of State will have a specific responsibility to tackle health inequalities, whatever their cause, and will be backed up by similar duties— [Interruption.]

[Mrs Linda Riordan (in the Chair)]

Order. Will Members let the Minister be heard in this debate?

--- Later in debate ---

[Anne Milton]

Maybe they would do better to reflect on their own record.

For the first time, the Secretary of State will have a specific responsibility, backed up by similar duties on the NHS commissioning board and clinical commissioning groups, which will create a focus on reducing those inequalities.

Balance, the north-east alcohol office, was set up in 2009. Its remit is to change the culture of drinking to reduce alcohol consumption. The hon. Member who raised the issue might do well to remember that one of the problems with alcohol involves the discrepancy in price between supermarket alcohol and alcohol sold in pubs, and that the Licensing Act 2003, introduced by the previous Government, played a significant part in the availability of cheap alcohol.

We are doubling the number of family-nurse partnerships and increasing the number of health visitors by 4,200, and we have said that we will increase NHS funding, but critically, we will improve people’s life chances by ring-fencing public health money for the first time, so public health budgets will not be raided to fund services. We are introducing the first public health outcomes framework.

The hon. Lady mentioned older people. This year, a £30 million budget is being distributed to local authorities so that they can take action locally in ways that will reduce the number of local resident deaths from cold weather. I remind hon. Members that the previous Government’s policy was to cut funding in the NHS. We are ring-fencing the public health budget and increasing duties on the Secretary of State.

The proposed mandate for the NHS commissioning board and the suite of outcomes frameworks for the NHS and public health will enable organisations to be held to account for the first time on health inequalities. The Health Secretary will also have new responsibilities to address health inequalities as part of the NHS reforms.

The hon. Member for Tynemouth (Mr Campbell) is confused about funding. I point out to him that the Department does not distribute funds to local hospital trusts. He mentioned alcohol in particular. It would be simplistic to suggest that the rise in alcohol harm and alcohol misuse is due to price alone. The issue is complex, and we will be introducing an alcohol strategy in the near future.

Tackling inequalities and supporting the principles of the Marmot review are a priority. Inequalities are deeply embedded in society and highly resistant to change. What echoes with this Government is the fact that public health funding will finally get the priority that this country deserves and that was missed by the previous Government.

Healthy Lives, Healthy People: Improving Outcomes and Supporting Transparency

Anne Milton Excerpts

Monday 23rd January 2012 Written Statements

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

Today I am publishing the new public health outcomes framework. “Healthy Lives, Healthy People, Improving outcomes and supporting transparency”. This will help enable Government, Public Health England, the NHS and local government to be held to account in how well we are doing in improving and protecting the nation’s health. To do this, we have focused on the most important things we want to do to improve and protect the nation’s health and wellbeing and improve the health of the poorest, fastest.



The White Paper “Healthy Lives, Healthy People: Our Strategy for public health in England” (Cm7985), described a new era for public health, with a higher priority and dedicated resources. We set out the scope for a new public health system refocused around achieving positive health outcomes for the population and reducing inequalities in health. This public health outcomes framework sets the context for the system, from local to national level. This is a national framework and local priorities and objectives will be set through local health improvement plans. The framework sets out indicators to measure how we are improving and protecting health at key stages in peoples’ lives and to reduce inequalities in health.



We will continue to work across Government and with our partners in public health, local government, the NHS, other public services and the third sector to improve the data we will rely upon to provide information on how we well we are doing to improve outcomes.



“Healthy Lives, Healthy People, Improving outcomes and supporting transparency” has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.



The document is also available at: www.dh.gov.uk/health/2012/01/public-health-outcomes.

Midwife and Maternity Services

Anne Milton Excerpts

Tuesday 17th January 2012 Commons Chamber

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

Let me begin by not only congratulating my hon. Friend the Member for Crawley (Henry Smith) on securing the debate, but thanking him for raising the high-profile issue of midwife and maternity services. Those services, and the midwives who work in them, are extremely important to women, and the provision of high-quality maternity care is non-negotiable for a Government and a health service. I want to outline some of the measures that we are taking to improve the quality of that care, but let me first pay my own tribute to the midwives throughout the country who do such a fantastic job.

I hope that you will allow me a brief personal comment, Mr Speaker. My four children were delivered in four different hospitals, but in each of those instances the midwife had a profound impact on the experience, and a profound impact on the start that we made with a new little family member. I know that it will have been the same for many other families. The importance of midwives and maternity services cannot be overestimated.

We want to ensure that all pregnant women and new mothers receive the best care that it is possible to give. As my hon. Friend has said, and as other Members will know only too well, maternity services face increasing challenges, and they will have to evolve to meet those challenges. Over the last few years the birth rate has been rising, and the number of complex pregnancies is rising as well. There are also more high-risk births. Women are having babies when they are older, heart disease and obesity are increasing, and more mothers born outside the United Kingdom are giving birth here.

Impressive improvements have been made in many services. The Care Quality Commission’s 2010 survey of women’s experiences of maternity services found that 92% of the women surveyed rated their care during pregnancy as excellent, very good or good, 94% rated their care during labour and birth as excellent, very good or good, and 89% rated their care after birth as excellent, very good or good. I hate statistics as they can seem meaningless and dry. It is important to congratulate the midwives who achieved those satisfaction figures, but we should never forget that if 94% of women rated their care during birth as good or better, then 6% thought they did not get care that was good enough. That might not seem like a large proportion, but for the women concerned it is all that matters.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

I have written to the Minister about the high-profile problems at the Furness General maternity unit, triggered by personal tragedies. What reassurances can she give on the future of that unit? More generally, what can she do to ensure that trusts with poor performing services in need of investment get the resources they need to deliver the first-class care people in my constituency and the whole country rightly expect?

[Anne Milton]

I acknowledge that the hon. Gentleman has written to me about those issues, and I will come on to discuss the measures we want to put in place to ensure such past tragedies do not happen again. CQC reviews have corroborated that there are problems. It raises concerns about the safety and quality of maternity care in some areas. They are small but significant areas of concern, and they must be of note to all involved in this area of care, especially as sometimes they involve personal and family tragedies.

Media and public attention on maternity services has picked up pace over the last year. In particular, there is anxiety about safety, capacity and changes to services. In many respects, there is a “perfect storm” of circumstances, which makes things difficult. The issue is how well we react, and how well services evolve and the work force are equipped to react positively.

We have put extending maternity choice as a key priority in the NHS operating framework. To help communities achieve the desired outcomes in the most individually suitable ways, when services change, that change will be led by clinicians, midwives, and women—the very people who run and use those services.

To make sure the maternity infrastructure is being put to best use, I want there to be maternity provider networks across the country, bringing together all the different elements of maternity services, so there are no gaps or hidden corners where mothers might get substandard care. The incident that the hon. Member for Barrow and Furness (John Woodcock) raised involves precisely such hidden corners and gaps, and such incidents often result in a personal tragedy. Hospitals, GP surgeries, charities and community groups can all be linked up to share information, expertise and services.

We also want more efficient use of skills in maternity wards themselves. Obstetricians and gynaecologists, maternity support workers and, of course, midwives can come together and use their complementary skills and expertise to get the best results for mothers, with appropriately trained support workers providing valuable assistance, for example with breastfeeding, leaving midwives to concentrate on the more specialist areas. This is not just a numbers game; it is about getting the skills, expertise and team mix exactly right. That will mean the talents of all 27,000 midwives can be put to the best, most efficient, use. That number shows that more midwives are working in the NHS now than ever before. The picture looks good for the future, too, because it is backed up by a record number of midwives entering training. Subject to the number of forecast births, that will be maintained.

In July, we published “Supporting Families in the Foundation Years”. That report does not have the catchiest of titles, but it is important because it sets out how everyone who commissions, delivers or leads on something can work to support parents and families. We cannot overstate the importance of the health and well-being of women before, during and after pregnancy; it is a critical factor in giving children a good start and in continuing that good health and well-being as they get older. The latest data show that more than 90% of women who gave birth in the third quarter of 2010-11 saw a maternity health professional within 12 and a half weeks. That is another dry statistic, but it is crucial. Early intervention and early contact with a maternity health professional is crucial to the well-being of not only the mother, but the child. Those meetings are about more than just basic maternity care. Work will have been done on, and discussions will have been had about, things such as diet, exercise, smoking and drinking. This is about improving the health of the baby, the mother and the whole family, and decreasing the kind of health inequalities that remain and are so persistent in our society. All those things affect the outcome for those women and their babies, and the lasting impact of those things cannot be underestimated.

To back all that work up, from April a maternity experience indicator will be introduced as part of the NHS outcomes framework. That will be an important part of identifying those gaps, as it will allow us to chart a woman’s experience of care throughout antenatal care, labour, delivery and post-natal care. It will also allow women and their partners to compare people’s experience of care and make choices about what they want to do. It will be a valuable tool for midwives as well, as they will be able to see how they are doing in relation to peer organisations. If they are doing well, this will drive them on to maintain their level and if there are weaknesses, the experience indicator will show specific areas to improve. As I say, this is not about the numbers; it is about getting the team mix right. In one busy maternity unit that I visited, it was simply about moving women around the labour facilities effectively and efficiently.

The Department of Health funded the “Birthplace in England” study, which was published in November last year. It provided evidence about the expected outcomes for women and their babies at “low risk” of complications. It was the first study of its type in this country, and the findings will be a very important part in shaping maternity services, as well as other, linked parts of the NHS, such as ambulance services, so that every part of the system is working together. It is an extremely important body of evidence. In addition, we have asked the Centre for Workforce Intelligence to carry out an in-depth study of the nursing and maternity work force to determine whether we have the right skill mix and professional teams, and whether they are able to deliver what is needed. That will start this year and will inform the future commissioning of training places.

I hope that what I have said reassures my hon. Friend the Member for Crawley and other hon. Members in the Chamber that we are continuing to improve maternity services to women, whoever they are, wherever they live and whatever their circumstance; it is not good enough to give excellent care in one place and for services to be patchy elsewhere. We want consistently high-quality care and we will carry on with that process, making sure maternity services and midwives are fully prepared for the demands of the modern maternity landscape.

I know that my hon. Friend has had specific issues to deal with in his local area and that they have been ongoing for many years. I am also aware that the picture is complex in terms of the circumstances of the women who end up using the local services. I hope that I have reassured him, to some extent, that we have taken note of what is going on. There is no doubt that the birth of a baby is a very special moment and we want it to be a positive experience that shapes the future of not only the child and their mother, but the whole family.

Question put and agreed to.

Care of the Dying

Anne Milton Excerpts

Tuesday 17th January 2012 Westminster Hall

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

Thank you very much, Sir Roger. May I say what a pleasure it is to be able to say “Sir Roger”? I congratulate my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) on securing this debate. It is timely that the House is reminded of the excellent work that goes on, and we have had tributes from all parts of the House this morning for individual hospices and the work of individuals. I also want to congratulate my hon. Friend on his comments on the fears that surround death. Death is an inevitable consequence of life, albeit for some it is tragically premature. We do not find death and dying a comfortable subject. It is thought frightening and mysterious. If nothing else, debates such as this may demystify some of the issues around death.

I also want to mention in particular the hon. Member for Hampstead and Kilburn (Glenda Jackson) and her comments on the privilege it is to be present at a member of one’s family’s death. The hospice movement, as she rightly said, has enabled that to be possible for so many more people today.

Services in some parts of the country are excellent and in some parts of the country they are patchy at best. As my hon. Friend the Member for Portsmouth North (Penny Mordaunt) pointed out, the quality of care does not always live up to what we expect. It also does not live up to what we expect in the treatment of certain conditions and in end-of-life care.

The Department of Health’s end-of-life care strategy was published in 2008 under the previous Government. I want to pay tribute to the progress that they made. It remains the blueprint for improving this area. Last September we published the third annual progress report on implementing the strategy. It is on the Department of Health’s website and I urge hon. Members to have a look at that.

[Robert Flello]

Will the Minister give way?

[Anne Milton]

I will not for the moment, because I have so little time.

Our plans for the NHS mean that we want people to have as much choice as possible in treatment in life but also in death. We want commissioners and providers to ensure that the right services, which include 24/7 community-based services, are available to support people at home.

Progress is frustratingly slow, but the examples around the country where it is working well are of note. We will review progress regularly to ensure that this becomes a reality for people. It is much overdue.

One development is the electronic palliative care co-ordination systems. I hate these names, but they can be effective tools. Through those, care providers can instantly share care plans and express preferences for care. We piloted that approach successfully in eight sites across the country and it is now being adopted more widely. We are also working to make sure care planning is a routine part of care for people who are dying. It is dreadful that care planning is not a routine part of care for all people. That has not been the case for some years, but it should be.

In November, NICE published its quality standard for end-of-life care of adults. That is an important contribution to this issue. It covers the whole of the end-of-care pathway, not just the medical bit. The 16 statements include social, practical, emotional and spiritual and religious support. We have also developed a national survey of bereaved relatives to get first-hand experiences of people’s care. The first survey should be completed by March. That will inform a new indicator on end-of-life care in the NHS outcomes framework.

To provide quality services, where and how people want them, hospices and other palliative care providers need support and funding. We will introduce a new per-patient funding system for all providers of palliative care, covering both adults’ and children’s services. We set up the independent palliative care funding review to help take that forward. The final report was published last year. It came up with some significant proposals, which we will consider in detail to ensure that we get that right. It is the first major step in local palliative care funding. We will have pilots to collect data and test the review’s recommendations, which will be established from April this year. The aim is to have the new funding system in place by 2015, which is a year earlier than was anticipated.

I also want to pay tribute to the voluntary sector. Palliative care was first developed in the voluntary sector and it still provides us with those beacons of best practice. Dame Cicely Saunders has already been mentioned and had tributes paid to her. She founded St Christopher’s hospice in 1967 and I want to associate myself with those tributes. I also pay tribute to people such as Dr Colin Murray Parkes, who has done so much in the area of bereavement and grief. That has been mentioned, but it possibly did not get the mention that it should.

The hon. Member for Strangford (Jim Shannon) and my hon. Friends the Members for Southend West (Mr Amess), for Congleton (Fiona Bruce), for Harlow (Robert Halfon), for Montgomeryshire (Glyn Davies) and for Portsmouth North all paid similar tributes. I would love to mention every contribution in detail, but they all surrounded the same issues: this is about dignity; this is about choice; this is about life. It is also about bereavement and the care of the relatives who live beyond the death.

My hon. Friend the hon. Member for Banbury (Tony Baldry) specifically mentioned assisted suicide, as have other hon. Members. This is a matter for Parliament as a whole to decide, not the Government. He talked about the perception of failure when someone dies. On a personal level, to be present at a good death is a privilege and an opportunity, not a failure. We need to right that balance a bit and see the success in someone dying well. As I have said, it is such an important part of the bereavement process.

We have a comparatively smaller number of people who die in a hospice, but so many more benefit from their services and expertise. We want to see hospices flourish and develop. In particular, we want to see them continuing to expand the care they give to those with illnesses other than cancer, as well as expanding into community-based support for patients, their families and their carers. That is where the work that we are doing on palliative care funding is so important. It will be key to moving us towards a fairer funding system for all providers, including hospices.

It would be remiss of me not to mention the one issue that has not been mentioned. In accepting that death is part of life, we also need to consider those who can be given the chance of life through another’s death. As I have ministerial responsibility for organ transplants, I have to mention that we need to make organ donation a normal part of end-of-life care. We need to recognise that through a sensitive approach to the family, we can, in death, give life to many others.

In conclusion, we come to this place to give our constituents and this country a better life, because we believe that everybody deserves a good life.

[Robert Flello]

Will the Minister give way?

[Anne Milton]

Very briefly.

[Robert Flello]

I just want to touch on the point that in my constituency, the Donna Louise Children’s Hospice Trust does some fantastic work. There is this difference between it and the work of the Douglas Macmillan hospice just outside the constituency. There is a mishmash and I would be grateful if the Minister looked at that in the future.

[Anne Milton]

We want to end any mishmash. We want a consistently high quality of care for everybody. Everybody deserves a good life and that is why we came to this place. This debate has allowed us to debate, discuss and share the opportunities that exist for Parliament to allow people a good death too, with dignity, without pain, in the company of those we love and at peace in death with the lives that we have led.

[Sir Roger Gale (in the Chair)]

Order. Just before we move to the next debate and while I am awaiting the arrival of the Minister, who is not late, may I thank all hon. Members for the tone and the self-restraint that has been exercised this morning? As a result of that, we have managed to accommodate the views of 21 Back Benchers, in addition to those on the Front Bench. I regard that as exceptional. I hope that many people outside the Chamber will have heard the quality of the House of Commons at its absolute best. Thank you.