Oral Answers to Questions

Anne Milton Excerpts

Tuesday 10th January 2012 Commons Chamber

[Nick Smith (Blaenau Gwent) (Lab)]

6. What discussions he has had with ministerial colleagues on the effects of fuel poverty on health.

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

I and my officials have worked closely with the Department of Energy and Climate Change on the development and implementation of the cold weather plan for England, which aims to reduce the health impacts of cold weather on vulnerable people. We have also put £30 million into the warm homes healthy people fund to fund local authority projects to reduce the impact of cold weather.

[Nick Smith]

The Marmot report confirmed that cold homes are bad for our health. My local newspaper has highlighted the case of a low-income working family who have to choose between food and heat every day, with no help from their energy provider. Will the Minister ensure that energy companies do more to tackle fuel poverty, so that the NHS does not have to foot the bill for their profit?

[Anne Milton]

As I said, my colleagues in DECC are working closely with the energy companies. I point out to the hon. Gentleman that this coalition Government are the first to put in place the cold weather plan to reduce those 27,000 excess winter deaths. Perhaps his local paper would like to contact the Welsh Assembly Government to see what they are doing.

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

Fuel poverty clearly shows the link between housing, health care and well-being. Last week, the Prime Minister called for a merger of health and social care. Does the Minister agree with me that if we are to have a true merger of health and social care, housing—through health and wellbeing boards and other mechanisms—has to be a key ingredient of that?

[Anne Milton]

Of course, my hon. Friend is absolutely right that the integration of health and social care is critical, particularly for issues such as this. The changes we are making to public health and the movement of public health into local authorities will only ensure better integration, so that we can reduce those 27,000 excess deaths.

[Mrs Madeleine Moon (Bridgend) (Lab)]

7. What research his Department has undertaken on the prevention of suicide.

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[Mr Philip Hollobone (Kettering) (Con)]

9. If he will consider proposals to introduce a national screening programme to detect group B streptococcus in pregnant women.

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

The UK National Screening Committee is reviewing the evidence for screening for group B streptococcus carriage in pregnant women, and I am sure that my hon. Friend will be pleased to hear about that. The committee will review the international literature, and a public consultation on the results will open in spring 2012.

[Mr Hollobone]

Group B streptococcus is the UK’s most common cause of life-threatening infection for newborn babies. Will my hon. Friend agree to meet me and Group B Strep Support, the excellent campaign group, to see how calls for a national screening programme might best be advanced?

[Anne Milton]

I am certainly happy to meet my hon. Friend. I should point out that the Royal College of Obstetricians and Gynaecologists is updating its guidelines and that NICE is also developing guidance. The issue is complex, however, and even testing is not 100% effective. Women who produce a positive result during pregnancy might be negative during labour and, more importantly, those who are negative during pregnancy might be positive during labour. It is important that we get the most up-to-date evidence and ensure that we reduce the tragic consequences of this infection.

[Dame Joan Ruddock (Lewisham, Deptford) (Lab)]

I welcome the Minister’s statement, but may I urge her to consider carefully the kind of testing, as the false negatives and positives to which she refers come with the current testing and there are better tests? About 340 babies are affected every year of which one in 10 dies and one in five is permanently disabled. This is a very serious matter and I hope she will do all she can to deal with it.

[Anne Milton]

I will certainly do all I can to deal with it. As the right hon. Lady says, the consequences are tragic but this is a complex area that has changed quite rapidly. I think the US is now at a similar level of infection to us, but what remains a challenge is ensuring that we have an effective test that does not produce false positive or, more seriously, false negative results and that we have effective treatment that works in 100% of cases.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

10. What recent estimate he has made of the cost to the public purse of NHS reorganisation.

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[Mr Graham Allen (Nottingham North) (Lab)]

15. What steps his Department is taking to prevent ill health and its associated costs through early intervention.

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

The public health reforms have at their very heart the prevention of ill health and its associated costs, and the hon. Gentleman in his question clearly recognises the critical impact that intervening early can have. The health visitor work force are an important part of early intervention. We picked up a very demoralised and depleted health visitor work force, so I am pleased to report that training commissions for health visitors are up 200%, and we plan to double the number of family nurse partnerships available by 2015. We are also developing a vision for school nursing.

[Mr Allen]

The introduction of the family nurse partnership and the enhancement of the amount of money available to it is a great credit to the previous Labour Government and the current coalition Government. It enables single teen mums to get one-to-one help from a health visitor. Given the economic circumstances, does the Minister accept that we need to be a bit more inventive to ensure that that very good scheme goes even further? Will she discuss with the city of Nottingham and its health service a payment-by-results system to extend the family nurse partnerships further?

[Anne Milton]

Yes, we are supporting the development of social investment and outcome-based funding models, and I am pleased that the hon. Gentleman has raised the issue of being innovative about how we do that, because it is important. We had a rather static situation previously, so I welcome his interest in developing and testing a payment-by-results scheme in Nottingham, and we will be interested to see his detailed proposals and how that develops locally soon. What matters are the results that we get from the schemes.

[Mr Graham Stuart (Beverley and Holderness) (Con)]

I pay tribute to the hon. Member for Nottingham North (Mr Allen) for his work on early intervention and applaud the efforts made by the Minister to recruit more health visitors, but when will the Government be able to deliver the additional health visitors on the ground, trained and in service, in order to reverse the cuts in the health visitor service under the previous Government?

[Anne Milton]

My hon. Friend is right; we picked up a very depleted and demoralised health visitor work force. We have 26 health visitor early-implement sites and, as I said, a 200% increase in planned training commissions for health visitors. Turning this round takes a long time. I am sorry that we could not get started on it earlier, but this will have the critical impact: 4,200 health visitors by the end of this Parliament will give us the results that we need in turning round the fortunes of some of the most vulnerable families in this country.

[Liz Kendall (Leicester West) (Lab)]

Early intervention can transform health for children and young people and prevent bigger and more expensive problems down the line, yet the Government have cut funding for early intervention programmes, including Sure Start, teenage pregnancy and mental health in schools, by 11% this year and 7.5% next year. Is not the reality that it is this Government who are depleting and demoralising the health visitor work force, and that their short-sighted, short-term policies will make it harder to prevent poor health and cost us all more in the long run?

[Anne Milton]

The reality is that the Government are picking up a very depleted health visitor work force. School nurses, health visitors and the family nurse partnership are all critical. We picked up a very sorry state of affairs. The hon. Lady is right; early intervention matters, which is why we are doing it. I am just sorry that the previous Government did not take the action that was needed.

[Margot James (Stourbridge) (Con)]

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

--- Later in debate ---

[Mr Speaker]

Order. I was doing my best to listen attentively—it is very difficult to hear clearly when there is so much noise. If there is to be a reference to another right hon. or hon. Member, advance notice of it should be provided. These courtesies must be observed. They are there for a good reason.

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

I remind my hon. Friend that smoking kills over 80,000 people a year in the UK. We have published our tobacco control plan, are implementing the display ban and hope to consult soon on the future of plain packaging. The important thing to remember about improving public health is that it is not a party political issue. I cannot comment on the specifics of the case he mentions, but this is a matter that interests everyone across the House.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

T2. The people of Newcastle are more likely to die early from cancer, health disease and stroke. On average, a child born in Newcastle today is expected to die five years before a child born in the Secretary of State’s constituency, so why is he changing the health funding formula so that in Newcastle we will lose 2.5% of our funding, whereas his constituency will see a rise of 2.1%?

Stafford Hospital

Anne Milton Excerpts

Tuesday 20th December 2011 Westminster Hall

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

Thank you very much, Mr Hollobone, for calling me to respond to the debate. It is a pleasure to serve under your chairmanship today; I do not think that I have done so before.

I congratulate my hon. Friend the Member for Stafford (Jeremy Lefroy) on securing this debate and of course I join him in paying tribute to the staff of Stafford hospital, the staff of the local ambulance service and indeed the staff of the neighbouring hospitals for all that they are doing to provide local people with good accident and emergency services. I particularly pay tribute to them at this time of year. When many people will be enjoying their Christmas lunch, there will be many NHS staff working over the Christmas period and it is always important to acknowledge their contribution and the work that they do.

My hon. Friend raised a number of issues about the overnight closure of the A and E department at Stafford hospital, which is a measure that will naturally be a cause for concern for his constituents. I know that all of them have been through quite a tough time, but I also know that he will agree—in fact, he did agree—that the safety of patients must always come first. However safety can be protected, that is always the best course of action, so I must support clinicians at Stafford hospital in their request for the overnight closure, which they made so that standards of care in the A and E department can be kept high.

My hon. Friend mentioned A and E staff, but it is also important to note that this issue is not always about numbers. A certain number of staff are needed in an A and E department, but that department also needs expertise; it not only needs staff in the right quantity but staff with the right skills and competencies.

I also want to remind hon. Members who are in Westminster Hall today—it is a pleasure to see so many of them here—that for some time now the NHS at Stafford hospital has been routinely diverting all of the most critical patients, including those suffering from major trauma, heart attacks and strokes, to the larger hospitals to the north and south of Stafford. That is not because of the suspension of overnight A and E at Stafford but because the larger hospitals in the area are better able to cope with life-threatening emergencies. My hon. Friend pointed that out, but it is worth repeating it for the record.

The change at Stafford A and E is down to staffing levels; I understand that financial pressures do not come into it. Mid Staffordshire NHS Foundation Trust has the funding for the posts that it needs to fill, but it has found it difficult to find the staff to fill them. My hon. Friend mentioned the importance of reassuring the local community. The available health services need to reassure people; that is one of their important roles. They must also engender trust among those people who they are there to serve. That is a very important role that the NHS must play.

Since the summer of 2010, permanent staffing—both medical and nursing—at Stafford A and E has been low. The trust and the wider NHS in the midlands have been trying to get enough medical cover to keep standards at the right levels. It is also important to acknowledge the support from the neighbouring University Hospital of North Staffordshire. Without it, the situation would have been considerably worse. However, that regional support could never be kept going indefinitely. To buy some time to work out longer-term solutions, Sir Bruce Keogh, the NHS medical director, arranged the short-term loan of four members of staff—two doctors and two nurses—from Defence Medical Services to help at the trust. My hon. Friend paid tribute to those staff and it is always good to see organisations working together to deliver the best possible solutions for patients. As my hon. Friend pointed out, that arrangement started on 17 October and it is now coming to an end; again, it could not be kept going for an indefinite period of time. However, let us place on record our thanks to the members of staff involved and to the DMS for providing them. I know that everyone at the trust welcomed the expertise that the DMS staff brought with them.

In October, the Care Quality Commission issued a warning notice regarding the quality of care provided by the Stafford A and E department. The CQC’s concerns centred on nursing staff levels, which at the time of inspection were badly depleted because of staff sickness and the overall difficulty of filling vacancies. On 9 November, the trust decided to close its A and E department overnight, starting from 1 December. That decision was not made lightly. As my hon. Friend pointed out, people want A and E facilities close to where they live, so, as I say, such decisions are never made lightly, and they need to be taken locally; it is not appropriate for the Department of Health to interfere with them. It goes without saying that the trust is paying the closest possible attention to the situation at Stafford A and E. It believes that that situation cannot be improved quickly, however frustrating that is for hon. Members.

[Mr Cash]

Does the Minister agree that there is also a question that may be a national issue, of which Stafford may or may not be an example? That is the need to ensure that consultants are always available, as and when necessary, because I think that that issue is all part of the hierarchy of the problem.

[Anne Milton]

Yes, and I thank my hon. Friend for raising that important issue, which is one of delegation and cover. It is of concern to the Department of Health; I think that there have been a number of newspaper articles and some television programmes about it. It is important at all times that care is delivered safely. That sometimes requires cover, but it also requires appropriate levels of delegation. However, what must be uppermost in everybody’s mind is that patients’ safety is always preserved, and the Department of Health will obviously work with the NHS to ensure that nationally we have schemes to ensure that patients’ safety is maintained.

For that reason, it would be unwise to return to 24-hour opening at Stafford A and E department before it is safe to do so. To minimise risk, I understand that the trust has set criteria that must be met before overnight operating can resume, and I also understand that there are regular staff meetings to check progress against those criteria. Those meetings are an important means of reassuring staff and those criteria will become critical. They mean that staff will be aware of the current situation and fully up to speed with the progress that is being made.

At present, I understand that patients needing A and E treatment are being diverted by ambulance to A and E departments in Wolverhampton, Walsall, Burton and Stoke, every one of which has been fully involved in planning for the overnight closure at Stafford. West Midlands Ambulance Service has established a divert policy to deal properly with patients coming to the trust, and to alternative A and E departments, at night. To help to manage those arrangements, the trust has appointed a “repatriation co-ordinator” to ensure close co-operation between Mid-Staffordshire NHS Foundation Trust hospitals and the other hospitals affected. The thing that struck me as quite extraordinary is the amazing job titles that the NHS can come up with at times. However, that “repatriation co-ordinator” will be important, to ensure close co-operation between hospitals.

To date, very few patients have turned up at Stafford A and E at night, which is a testament to how well the trust has publicised the current arrangements. That is another important point; explaining the reason for the closure, and how and where to get help when Stafford A and E is closed, is vital. My hon. Friend the Member for Stafford mentioned older people in his speech. As I say, the fact that few people are turning up at Stafford A and E at night means that the message that the department is closed overnight has got through, even to older people, who of course often attend A and E departments.

[Mr Cash]

On a purely practical level, diversion signs are important. My hon. Friend is referring to the importance of getting the message through, but however much we try to get the message through, I suspect that people will still turn up anyway. Therefore, the most important thing at that point is to know that the signing system—as provided by the highways authorities, or whoever—will actually provide the right information to help people to get to the other hospitals. Does my hon. Friend agree?

[Anne Milton]

I agree entirely, and I am sure that my hon. Friends the Members for Stone (Mr Cash) and for Stafford are in touch with the local authorities, because it is extremely important, as my hon. Friend the Member for Stone rightly pointed out, that diversion signs are clear to people and that people do not turn up at an A and E department that is closed. It is actually quite extraordinary how resilient people are to those diversion signs. Information needs to be given to people in words of one syllable, so that they are quite clear that the A and E department is not open for business at the moment.

Stafford is taking, and it will continue to take, GP-referred maternity, paediatric and medical patients 24 hours a day, seven days a week, which will be of some reassurance to local people. I know that my hon. Friend the Member for Stafford has visited Stafford A and E department several times since the overnight closure came into effect, and I am pleased to hear that he is satisfied that the measures that have been put in place will ensure patient safety and good access to A and E services. I know that some of his constituents are concerned about the impact of increased demand on neighbouring A and E departments. The situation is being closely monitored and the local NHS is content that the arrangements are working well.

Of course at this time of year, the pressure on A and E departments gets greater. We have not suffered particularly severe weather in the south of the country, but some places have done so. Such weather always takes its toll on the NHS, and therefore the monitoring of how things go is very important.

As I have said, the closure took place on the advice of clinicians with the aim of ensuring patient safety. The trust continues in its efforts to recruit additional staff, and patients can be assured that it will not reopen its A and E department full time before it is safe to do so. The trust, the Staffordshire PCT cluster, emerging clinical commissioning groups and others are looking at a range of options to achieve a clinically safe and financially sustainable service, and will present their report on the way forward to the NHS Midlands and East strategic health authority cluster at the end of January next year.

I will say a word about emergency medicine nationally. The number of emergency medicine consultants has risen by more than half in the past five years, but we agree that it must continue to increase and we are working with the College of Emergency Medicine on how best to make that happen. In the short term, some trusts have been employing more GPs in A and E. GPs are primary care experts, so their presence in A and E allows emergency specialists to concentrate on the cases for which their skills are needed. We are, however, looking at a number of areas, because this matter is of national concern. We are considering revising the person specification for training in emergency medicine to make entry more accessible, and redirecting into emergency medicine some of the doctors who cannot secure other higher specialty training posts.

My hon. Friend the Member for Stafford pointed out the importance of specialist services, and what I have said about the national situation highlights exactly why they are so important. As my hon. Friend the Member for Stone mentioned, the particular needs of people in rural communities, for whom travelling long distances causes additional problems, must also be taken into account. It has long been the case that specialist services need to be provided in specialist centres, and during my own working life as a nurse we had regional neurosurgical centres for the specialties that required highly skilled and specific care. That is important, because we are always balancing patient safety with the accessibility of local services.

[Jonathan Lord (Woking) (Con)]

I join colleagues in commending the thoughtful leadership role that my hon. Friend the Member for Stafford (Jeremy Lefroy) has taken. May I ask the Minister two things? Can we be reassured that the awful lessons of Stafford have been learned nationally? If I may crave the indulgence of my Staffordshire colleagues, I have happy memories of fighting with the Minister during the previous Parliament, when I was chairman of her association, to save the A and E at the Royal Surrey, so perhaps she would care to extend her warm words to all the medical staff who will be working there over Christmas and the new year holiday, just as she did to those at the Stafford hospital and elsewhere in Staffordshire.

[Anne Milton]

I thank my hon. Friend for his imaginative use of this debate to point out that I joined with him to fight a long, hard battle to save our hospital in the Guildford constituency. It is important, of course, to extend our thanks and tributes to staff working not only in our own constituencies, but across the country. On the first question, there is no doubt that lessons need to be learned, and I think that we sometimes feel that the NHS is slow to learn the lessons it should.

Work is being carried out nationally to address the skills mix, by developing non-medical roles within A and E departments. Enhanced nursing roles have genuine potential, and in countries with very remote populations, such as Canada and the USA, they are an extremely important part of the general skills mix. Emergency nurse practitioners who can look at the minor injuries and illnesses that in most departments account for 40% of the work load can be a major contribution to ensuring that A and E services remain available for local people, and advanced clinical practitioners, such as nurses and paramedics, can therefore treat many more of the major conditions.

I thank my hon. Friend the Member for Stafford for securing this debate, and other hon. Members for attending on the last day before recess. A number of Staffordshire MPs have met with the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns), and I know that he will continue to keep in close touch, but should any new concerns arise I am sure that my hon. Friend the Member for Stafford will raise them with him. That leaves to me just to wish you, Mr Hollobone, and all the House of Commons staff a very happy Christmas and a prosperous and safe new year.

[Mr Philip Hollobone (in the Chair)]

I thank all Members for taking part in this debate and I, too, wish everyone a very merry Christmas.

Question put and agreed to.

Health Services (Disabled Children)

Anne Milton Excerpts

Thursday 15th December 2011 Commons Chamber

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

I begin by congratulating the hon. Member for Mid Dorset and North Poole (Annette Brooke) on securing a debate on this extremely important issue. I know that, like many Members, she has shown a very strong personal interest in it. I share that interest, and I thank her for acknowledging that. I hope that what I say today will reassure her that we are doing what we can to improve the availability and quality of health care for all children and young people, including those with disabilities.

I cannot answer all the questions that the hon. Lady asked. Interestingly, from listening to her questions we could hear the complexity of the current system. I share her sadness about the years that have been lost to many children, and I am sure we also share sadness about the terrible struggle and battle that a lot of parents of disabled children have faced. The debate provides an opportunity for us to put on record our tribute to those parents, who struggle in unbelievable circumstances and feel unsupported. I cannot quantify the traumatic nature of what they have to face, not only in dealing with a child with disabilities but in getting everything they can for them.

I do not think I will be saying anything very controversial by acknowledging that the NHS, as it currently works, does not get everything right for children and young people. The hon. Lady referred to Sir Ian Kennedy’s report “Getting it right for children and young people”, which made it clear that the quality of health care for children was very variable and that the outcomes for too many children were poor compared with those in other countries.

We have 12 million children and young people in England, which is a fifth of the total population, and the number of them with disabilities is high. For example, some 108,000 have been diagnosed as having an autistic spectrum disorder, and some 70,000 would benefit from mobility support, including wheelchairs. Their well-being, as with all children and young people, must always be at the top of our list. We must pay particular attention to services that help the most vulnerable children or those with the greatest needs. They are our future, and the NHS needs to do better for them.

I am particularly pleased that the hon. Lady mentioned children who are on the autistic spectrum. There is no doubt that those children and young people in particular, like adults with autism, often fall through the net. Child and adolescent mental health services do not necessarily fill the gap.

The Department of Health has simple but ambitious goals. It may be stating the obvious to say that they include the right start to life in the foundation years, improved support for mental health and well-being, more co-operative and joined-up services for children with disabilities, and improved health in adolescence. Those ambitions lie behind the health reforms that the coalition Government are proposing. We are moving towards a service in which the use of evidence-based treatment is adopted consistently and to the best effect; in which promoting good health is of equal importance to caring for the sick; and in which children, young people and their families are always involved in decisions about their care. “No decision about me without me” applies as much to children as to anybody else, and I think we often underestimate the ability of young people and even quite young children to be involved in decisions about their care. We also a want a service in which commissioning is underpinned by informed and expert knowledge. I believe that it is in commissioning services that we have often got things wrong.

As the hon. Lady will know, those ambitions are supported by measures such as the increase in health visitors by 4,200 and the expansion by 50% of the family nurse partnership programme. Health visitors and family nurses play a vital role in identifying, intervening in and sorting out babies’ and children’s problems early. We frequently hear about the need for early diagnosis so that we can have early intervention and support, which prevents problems later on. That includes children with disability and other special care needs.

I would also like children’s health to be built in throughout the new system, so that everything we do is geared towards supporting children. We have made our intention clear to put in place a system that achieves better outcomes for everyone, and one that delivers services for individuals, not organisations. We often end up believing that we need to get the processes right and the arguments on that continue without our seeing the outcome that we are trying to achieve.

Of course, not just the NHS has a role to play in the health of children with disabilities. Schools, children’s centres and wider children’s services all have a part to play. That is why we are putting in place a system of health and wellbeing boards in each local area, the job of which will be to achieve a truly jointly owned assessment of local need, which leads to a joint health and well-being strategy and commissioning decisions that span the NHS and local government. Joint leadership and joint responsibility is for the whole population, including disabled children. Local authorities have a key role to play.

I should take this opportunity to commend the work of Disability Challengers in my area, which is well supported by people locally and offers an invaluable service to parents. It is those sort of initiatives and third sector organisations that we can bring together to make joint leadership and joint responsibility actually work. We always talk about integration—we have been talking about it for years—but now we need to make it happen. We need to stop that fragmentation of services. We need to stop arguing about who will pay for what and ensure that people get what they need.

The hon. Lady and others have concerns about the priorities that general practitioners will give to children and young people when commissioning services, but in fact it is estimated that about 40% of the average GP’s work load is to do with children and young people. Nobody is in a better position to understand children’s needs. On top of that, the clinical commissioning groups will have access to advice from people with a broad range of professional expertise, including those who work particularly closely with children, such as paediatricians, nurses, other clinical professionals, and health and wellbeing boards, the membership of which will include, for example, directors of children’s services in the local authority.

The hon. Lady mentioned speech and language therapy, which is much talked about. Its critical role in meeting many children’s needs is much underestimated. The allied health professionals, which we often miss off our list after we have mentioned nurses and doctors, are critical in ensuring that those children get what they need.

To ensure that that happens, the NHS Commissioning Board will be accountable to Ministers for improving health care provision for children and young people. They will be judged on their delivery of improved outcomes. The NHS outcomes framework and the public health outcomes framework include measurable outcomes to demonstrate improvement in critical areas relating to children and young people. As the data get better and more meaningful—it is important to say that the data must be meaningful—we will refine the outcomes that the NHS needs to deliver, along with our understanding of the outcomes that are important to disabled children, young people and their families. That will be an evolving work in progress, but the focus on outcomes is important.

One important matter—the hon. Lady will be interested in this—is how the integrated care pathway can be used to provide children with disabilities, long-term conditions or complex needs with the best opportunities to make progress and live life more independently. A number of activities are under way at the moment to ensure that that happens. The learning network for health and wellbeing board early implementer programme includes a learning set on effective joint working to improve those outcomes for children and young people. That work is just getting under way—it was launched only about three weeks ago—but there is incredible energy and enthusiasm to develop and share innovative ways in which to change things for the better. One of the priorities for the network is tackling health inequalities and increasing access for those groups that traditionally have had difficulty in securing the provision that they need. I refer here to the group of children that we are talking about.

Similarly, there is a small group of early implementing clinical commissioning groups that are focusing on children and young people’s issues. With my colleagues in the Department for Education, we have set up 20 pathfinder groups, including 31 local authorities and primary care trust clusters, to test the ambition of the Government’s Green Paper to support children with special educational needs. They will test improvements to the current system, including the new single assessment process with a single education, health and care plan, along with the option of a personal budget. Things happen incredibly slowly in Government and it is very frustrating for the people who are in receipt of services. It is important that we use this opportunity to capture the enthusiasm and energy and to use the reforms that we are making to get this right once and for all. The lessons that we learn from those early implementers will be crucial. They will help inform more effective commissioning and service provision. Where these effective integrated care packages and personal budgets are available, the impacts are very dramatic.

I hope that the hon. Lady is reassured by the fact that we are committed to children with disabilities. I have a personal interest in the matter, and we want to ensure that the NHS plays its full part. It sounds a cliché to say that the NHS works in partnership with local authorities and schools to improve the lives of children and young people, but I mean it from the bottom of my heart. We have to ensure that partnership becomes a reality.

I pay tribute to organisations such as Every Disabled Child Matters. My noble Friend Earl Howe has answered a letter to that organisation quite recently. We are talking about special children with very special needs and some very special parents. We must ensure that those needs are met and that the terrible battle that the parents and young people face is halted and they get what they need to live those independent lives. There can be no better words to end this debate on than these: young, disabled and in control.

Question put and agreed to.

Pregnancy Counselling

Anne Milton Excerpts

Monday 12th December 2011 Commons Chamber

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

I thank the hon. Member for Luton South (Gavin Shuker) for bringing this important issue to the fore in the House again. It is testament to how important the issue is that, at this late hour, the House is filled with many Members who take an interest in it. People rightly feel very strongly about it, and he has made some very important points. In this debate, whatever our respective positions, I think we all agree that women who face a decision about whether to proceed with their pregnancy need support, advice and, indeed, counselling; often, it is a very difficult decision for women to make.

The hon. Gentleman supported the amendment introduced by my hon. Friend the Member for Mid Bedfordshire (Nadine Dorries), and since that debate officials in the Department of Health have been developing and looking at proposals for a consultation on the counselling options in the independent sector and in the NHS for all women considering abortion.

I am working with Members from both sides of the House to look at how we might proceed with the consultation, and I have been impressed by what the hon. Gentleman referred to as the “maturity” of that group of people, who, despite starting from quite opposite ends of the debate, have come together to find out where we agree and, at the end of the day, to ensure that we put forward a consultation that looks at what is best for women.

The consultation will consider how to develop an offer of counselling that is impartial and supportive and, as part of the process, we will look at who is best placed to offer counselling. It is not about automatically including or excluding any one type of organisation; what matters is that we define clearly the outcomes that we want for women. It is important to focus on the process, but we need to be clear about what we are trying to achieve.

Officials have visited several counselling providers to find out more about the services that are offered in terms of the process, the qualifications that their counsellors hold, and what people should expect on booking a counselling appointment. Some organisations are abortion providers, some are services that refer people to abortion providers, and others do not make direct abortion referrals. Official recently visited a Marie Stopes International clinic and a BPAS clinic, and what they found was quite interesting. During the consultation, I am sure that we will hear from many other people with experience of those services.

The proposals are still being developed, and, on an issue that has sought to divide the House in the past, and on which there are sometimes very strong views, it is important that we go into the consultation with one mind. We are confident that, as a result of the work, counselling arrangements will be improved. That is the purpose of the work, and we want to take into account everyone’s point of view so that we put together for consultation the right document that asks the right questions and includes the right options, and so that we hear and know exactly what is the best way forward.

It is clear that good work, delivered by different providers, is going on in many places, but we need to make sure that all women are offered a consistently good service. The repercussions of that not being the case are very serious. The aim of the consultation will be to propose ways to strengthen existing counselling options for women where they are good, improve the services where they fall short, and set out detailed options to achieve that goal.

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

I commend my hon. Friend the Member for Luton South (Gavin Shuker) for securing this well-measured debate. The Minister will be aware that the Health and Social Care Bill is going through the House of Lords. Will she guarantee that before the Bill leaves the other place and comes back here, she will bring forward a measured package to make sure that there is a consultation about these issues?

[Anne Milton]

I thank the hon. Gentleman for his intervention, but there is no need for this to be dealt with in legislation. Before today, I have given my word at this Dispatch Box that we will carry out the consultation and bring forward the best options in finding the best way to make sure that women have an offer of counselling should they wish to take it up. It is important to remember that women who access services sometimes do so from a wide variety of directions—they may self-refer or come from their GP. What matters is that we get the offer in the right place. We need to consider whether the woman should have the one offer or whether the offer needs to be continually open because she might turn it down in the first instance, at the first appointment, but want to take it up, say, a week down the line. It is important that we get the detail right. We do not need to put it into primary legislation; in fact, it would arguably be inappropriate to do so. I repeat that I have said from this Dispatch Box, on more than one occasion, what we will do.

As the hon. Member for Luton South said, there is concern that there is a conflict of interest in that counsellors are paid for procedures and yet also expected to provide entirely impartial advice to women. Although there are no formal quality standards in place for counsellors and no minimum standards for training or qualifications, we have found that the majority of counsellors who work in independent sector abortion providers are registered with the British Association for Counselling and Psychotherapy. Underpinning membership of, and accreditation by, this organisation is a thorough ethical framework that counsellors must abide by. However, sufficient concern has been expressed, so we are looking at everything in the round to make sure that the sector is not only independent but has the confidence of the public that it is independent. It is important to say that independent sector abortion providers and organisations that refer women for an abortion are subject to the Secretary of State’s approval and monitoring by the Care Quality Commission. Marie Stopes International, which is one of the leading abortion providers, has reported that 20% of its clients decided not to go through with the termination following counselling. That is an interesting statistic.

Pregnancy counselling is about providing women with a non-directional and non-threatening service in which they can explore the issues. Some will immediately decide on their course of action, and others will still be unsure about what to do at their first appointment with a health professional. This can sometimes make it very difficult to provide the uniform standard of care that is so important. What is right for one woman will not necessarily be right for another, and so a flexible service that can respond as far as possible to individual women’s needs is essential. Moreover, we do not want to create barriers or to instil delays in the service. Counselling can help a woman to recognise conflicting emotions and feelings and allow her to accept that there may be no perfect, straightforward answer to this crisis in her life. Most importantly, it allows her time and space to reach an informed decision. There is evidence that counselling can help women, particularly vulnerable women, to make a decision with which they are comfortable. We have also heard anecdotal evidence from women who feel that they could have been helped by counselling before making their decision to have an abortion.

Counselling must be balanced. Effective counselling must be confidential, non-directive, non-judgmental, supportive and understood by the person to be independent of any assessment for legal approval for abortion. It needs to happen away from the influence of family or friends. The hon. Member for Luton South highlighted the case of a woman who felt pressurised by her boyfriend and I know that some women feel pressurised by their families.

Contraception has been free on the NHS since 1974. It has helped millions of people to avoid unintended pregnancy and to plan their families as they wish. There are 15 methods of contraception and we have seen a recent increase in the number of women choosing highly effective methods of long-acting contraception.

Although abortion rates for all ages have remained stable, between 2007 and 2010 the abortion rate fell for those aged 24 and under, and the number of abortions overall fell. In 2007 there were just shy of 200,000 abortions, whereas in 2010 there were 189,574, which is a decrease of nearly 10,000 in the space of three years. That is good, but we clearly have a great deal of work to do. Ideally, we do not want to face anything near those numbers. We must ensure that young people have good relationships and sex education so that they can make good choices for their lives.

In conclusion, this work is about ensuring that all women considering an abortion get the best possible service, which they not only need, but deserve. We are looking to build on the recent early successes of the increasing access to psychological therapies programme and to use that model to develop options for pregnancy counselling. We have had discussions with the officials leading that team in the Department and there is a lot of opportunity. I have no doubt that when we offer young women counselling, it will be an opportunity for some women to unearth all sorts of other issues in their lives, such as domestic violence and sexual abuse. I hope that all Members agree with the principle behind this, as I think they do, even though we sometimes disagree about the small print. I hope that the hon. Member for Luton South and all hon. Members will continue to work with us to get this right.

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

I congratulate my hon. Friend on the stand that she is taking, even though some of her statistics have slightly mystified me. Before she completes her speech, will she tell the House roughly when, after the consultation next January or February, she believes we will come to a new arrangement for abortion counselling?

[Anne Milton]

As I have said, I am working with Members on all sides of the debate to get the consultation document right, with the right options and the right offer. The consultation will last for 12 weeks and I then hope to bring forward the arrangements. There are issues with the number of counsellors who are available and with the pathways. These things never happen as quickly as I would like. I always wish that things could happen yesterday, but sadly they cannot.

[Thomas Docherty]

Will the Minister confirm whether she thinks that it will happen before or after the Health and Social Care Bill passes from the House of Lords?

[Anne Milton]

It is not for me to prejudge the passage of any Bill, particularly when it is in another place. I am determined to get on with this work. It is not dependent on the Bill. We need to move forward so that we can get the process in place for the offer to be made as soon as possible.

The hon. Member for Luton South rightly said that no one is neutral. We want women to receive advice on all the available options and to get support in making their decisions. We want them to have the offer of independent counselling so that when they make a decision, they feel sure in their hearts that it is right for them not just for today, but for the rest of their lives.

Question put and agreed to.

Employment, Social Policy, Health and Consumer Affairs Council

Anne Milton Excerpts

Thursday 8th December 2011 Written Statements

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

The health part of the Employment, Social Policy, Health and Consumer Affairs (EPSCO) Council met on 2 December in Brussels. Andy Lebrecht, Deputy Permanent Representative to the European Union, represented the United Kingdom .

Council conclusions were adopted on:

closing the gap in health between member states through action on determinants of health, especially nutrition and physical activity;

non-communicable diseases: prevention and control of respiratory diseases in children; and

prevention and control of communication disorders in children, including innovative approaches to treatment.

The Commission provided an update on the health for growth programme and the presidency asked member states to comment on the priorities for the programme. The Commission underlined that the programme would focus on areas where the EU could genuinely add value, in particular, ensuring a smarter investment in health.

The UK welcomed the intention of the proposed programme, but indicated a preference for it to be brought forward as a decision rather than a regulation. A number of member states also emphasised that the programme should respect the principle of subsidiarity, particularly in relation to the health system elements.

The Commission gave an update on the suggestion of splitting the pharmacovigilance provisions from the Commission’s recently published information to patients proposals. It confirmed it would positively pursue this approach.

In addition, Denmark spoke about the plans for its presidency. It confirmed the intention to focus on innovation in health, anti-microbial resistance, and chronic disease (taking diabetes as a model).

Organ Donation

Anne Milton Excerpts

Wednesday 30th November 2011 Westminster Hall

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

Thank you Mr. Crausby. It is a pleasure to serve under you today. I congratulate my hon. Friend the Member for Montgomeryshire (Glyn Davies) on securing this debate on presumed consent. I also thank him for his thoughtful contribution. Like him, I am fixed only on the evidence. I do not have an ethical position on this—I will act on the medical evidence in front of me. Sometimes, with an issue like this, there is a huge danger that the plight of those waiting to have a transplant clouds the ability for some to consider the evidence clearly. What matters is what actually works. The hon. Member for Denton and Reddish (Andrew Gwynne), the shadow health spokesman, outlined some of the complex issues around presumed consent and what faces the public.

This is not a party political issue. It is an issue decided on by politicians, but I would be saddened if it became a party political issue. It is also not an opportunity to exchange insults. Rather, it is an opportunity to make a difference. So, if nothing else, I would urge hon. Members to leave the Chamber today, and call their local press to see whether. together, they can start a campaign to raise awareness and to begin a conversation in their constituencies. Politicians generally have considerable access to the press. On the whole, we are not averse to having the odd photo of ourselves. I am sure that we have opportunities to raise awareness of this important subject.

There are now about 10,000 people requiring a transplant. Three of them die every day waiting for a transplant or after they are taken off the list because, tragically, they are too ill. Research shows that the majority of people in the UK support transplantation. Extensive reference has been made to Wales, and we shall study those proposals carefully before we respond. But I want to make it clear that the Government do not believe that the introduction of presumed consent, by itself, will necessarily lead to an increase in donor rates. It is important that any Government keep the evidence under review.

As many hon. Members have said, the organ donation taskforce considered the issue of presumed consent in great detail. As my hon. Friend the Member for Cardiff North (Jonathan Evans) said, many of those involved in the taskforce changed their minds, and that is an important point to make. In its second report, published in 2008, the taskforce did not recommend introducing an opt-out system. It felt that an opt-out system would have the potential to deliver benefits but, as my hon. Friend said, it would also present significant challenges that would need to be overcome. Instead, the taskforce believed then, and believes now, that a significant increase in donor rates can be achieved by acting on the recommendations in the first report.

The UK needs to maximise its potential for donation and make organ donation a usual part of health care. We still believe that the implementation of those recommendations will result in an increase in organ donation rates at least 50% by 2013, and that is still on track. Through NHS Blood and Transplant, the number of specialist nurses, clinical leads, donation committees and donation chairs in acute trusts have all increased, and that has borne considerable fruit—since 2008, an increase of 31%, up from 28% —those are the most recent figures.

Some studies suggest a link between presumed consent and higher donor rates, but closer examination shows the picture to be very much more complex—my hon. Friend the Member for Kettering (Mr Hollobone) was so right. Spain has been quoted at length. It has a donor rate of 32 per million of population, compared to the UK’s 16 per million. They have presumed consent, but the architect of the “Spanish model” has repeatedly stated that the legal basis of consent is irrelevant to organ donation. What is critical is the organ donation and retrieval system in place, with highly trained staff and a well-designed donation framework, supported by high public awareness of the issues and benefits. We need awareness and a conversation with our families. In practice, I doubt whether there is a surgeon anywhere who would take an organ from somebody without the consent of their family.

I am pleased to report that organ donor rates have increased by around 31% since 2008 and we are on track to meet the 50% improvement. On top of that, over 18 million people, some 29% of the United Kingdom population, have added their name to the organ donor register. In 2010-11, there was a record number of deceased organ donors—1,010 donors compared with 745 in 2001-02. That year also saw a record number of transplants from deceased and living owners—3,740 transplants were carried out in the UK, compared with 2,600-odd in 2001-02. However, despite the progress, there is still a shortage of organs and I am surprised that more has not been made of the inequalities that surround this issue.

The situation is very serious for people from African-Caribbean and Asian backgrounds, who are three to five times more likely to need a kidney transplant. Almost a quarter, 23%, of patients waiting for a kidney are from black or minority ethnic groups but they make up only 8% of the UK population. Three quarters of people from a BME background refuse organ donation when asked, compared with an average figure of 40%. There is particular and specific issue, which we need to address, but it is not insurmountable. We need more people from BME communities to register to donate their organs and, more widely, there needs to be a greater understanding in BME communities of the problems that they face—a greater need for kidney transplants, longer waits and less well-matched organs being donated for their communities.

We cannot be complacent and must carry on the work of the previous Government through schemes such as the give and let live initiative; requiring people to answer a question on organ donation when applying for a driving licence on-line; signing on the organ donor register when applying for a European health insurance card or a Boots advantage card; and specific initiatives within the black and minority ethnic populations, like working with faith organisations, radio stations, charities and community groups. What we really need is for people to sign up to having a conversation with their families. That is what really matters.

Work continues at every level on referring and procuring organ donors. We are also trying to make organ donation a usual part of end-of-life care. I hope hon. Members will think on that for a moment. When we think about making organ donation a part of end-of-life care, one realises what a complex, emotional and sensitive issue this. The hon. Member for Llanelli (Nia Griffith) mentioned families talking about this matter. That is so critical, so that when tragedy comes, the transition to donation is simple.

We have set up a transitional steering group, and it will focus on six key areas: increasing consent rates; brain stem death testing in all appropriate cases; donation after circulatory death to be considered in all circumstances; increasing donation from emergency medicine; referral of potential donors; and improving donor management.

I thank hon. Members for their thoughtful contributions. I know that this is an emotive issue that raises strong feelings. We need an evidence-based approach. I thank all those in this country who have donated the organs of family members in the midst of the turmoil of death. That death has and does give life to others—not just one person, but often two, three or four people. Nothing can ever relieve the burden of grief or loss, but nothing can replace the gift of life that organ donation represents. We have to use every tool at our disposal to increase those donation rates. We have to remind people, at every opportunity, that this is about a gift of life and in particular focus on those communities that are more disadvantaged than others.

HIV

Anne Milton Excerpts

Tuesday 29th November 2011 Westminster Hall

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

Thank you very much, Mrs Main, for calling me to respond to the debate. It is a pleasure to serve under your chairmanship for the first time.

I want to begin by congratulating the hon. Member for Airdrie and Shotts (Pamela Nash) on securing today’s debate. She rightly started her remarks by referring to the issue of stigma, and it has been raised by other speakers. I also want to pay tribute to the significant contribution that has been made to fighting HIV/AIDS by my noble Friend Lord Fowler. Political leadership is not often spoken of these days, but it was precisely that leadership from Lord Fowler that made the progress in the UK against HIV/AIDS so remarkable. However, the issue of HIV has been dogged over the years by stigma, and it is disappointing for people as old as me to realise that stigma is still alive and well in our communities and even in some aspects of the delivery of services.

HIV remains a serious global issue that must always be at the top of our priorities, particularly now, of course, as we approach world AIDS day in a couple of days’ time. I also congratulate the hon. Lady on her appointment this year as chair of the all-party group on HIV and AIDS. I know the work of the group well. It deservedly has an excellent reputation within Parliament and it tirelessly works to raise awareness of HIV, both globally and within the UK. As is the case with many of the things that she mentioned, that work needs to continue.

World AIDS day provides an excellent opportunity to reflect on the progress that has been made and on the continuing challenges that we face. There is much to celebrate. Globally, new HIV infections have fallen by 21% since 1997 and new infections have stabilised in many regions, including sub-Saharan Africa, the Caribbean and south and south-east Asia. Nearly 7 million people are on anti-retroviral treatments, which is an increase of more than tenfold in the past five years. However, nearly 8 million people still need treatment and are not receiving it. I have responsibility in the UK for global health matters, and I have taken the opportunity to speak to the South African Health Minister.

Thanks to effective treatment, in developed countries such as the UK people who are diagnosed early with HIV can expect to live to a near normal life expectancy. As the Health Protection Agency says in its annual report, which was published today, in 2010 87% of people who were diagnosed with HIV were accessing treatment services within a month of being diagnosed and 85% were reporting an undetectable viral load within 12 months of starting treatment. That is excellent; it is not the end of the story, but it is a good start. However, the challenges remain at home and overseas. There are 34 million people living with HIV globally. The title of the recent report by the House of Lords Select Committee on HIV and AIDS in the UK says it all, really—there is still “no vaccine, no cure”. That report comes many years after Lord Fowler led the national response to HIV and AIDS in the UK, and I remember that time well.

In October, we published the Government’s response to the report from the House of Lords Select Committee, and we made it clear that we agree with many of the Committee’s recommendations. The Committee’s report will be critical in helping to inform the Department of Health’s sexual health policy framework, which we will publish next year. It will be a vital source of information and current evidence.

Hon. Members and hon. Friends have rightly mentioned the challenges presented by late and undiagnosed HIV. In the UK, there are an estimated 91,500 people living with HIV, of whom around 25% are undiagnosed, which means that those people cannot benefit from treatment and, of course, they risk transmitting the virus to others. Late diagnosis is the most significant cause of HIV-related death in the UK and we cannot say that often enough. The 25% of people with HIV who are undiagnosed are more likely to die than the other 75% of people with HIV who have been diagnosed, and we all need to do absolutely everything we can to promote the benefits and the uptake of HIV testing. I will come on to some of the specific issues that the hon. Lady raised in that regard.

The Department of Health is considering the findings of the final report by the HPA, “Time to test for HIV”, in developing the new sexual health policy framework. That HPA report presented the findings of eight pilot projects that were funded by the Department, which assessed the feasibility and acceptability of routinely offering HIV testing in general practices and some hospital settings. It showed that testing was acceptable to most patients, and I am really pleased to see that some of the pilots have led to changes in local practice in high-prevalence areas, which is quite a significant step.

We are also funding the Medical Foundation for AIDS and Sexual Health to help it to develop ways of getting GPs and primary care staff to offer HIV tests more routinely. Both the Terrence Higgins Trust and the African Health Policy Network actively promote HIV testing as part of the national HIV prevention programmes. Also, we have asked the UK National Screening Committee to provide evidence-based views on increasing routine HIV testing. As the hon. Lady rightly commented, we are reviewing our policy on the ban on HIV home-testing kits and we will ensure that we consult on any proposals to remove the current ban.

We are considering the consultation responses to the public health outcomes framework, which include a proposal for an indicator on late HIV diagnosis, and we will publish that framework very soon. We want to get it right, as it will be an important driver of what happens locally.

I am aware that some primary care trusts are already funding new HIV testing initiatives in both primary and secondary care, in line with guidelines from NICE and the British HIV Association. However, more work is needed to capture data through the HPA’s current HIV monitoring and surveillance programme.

Twenty-five years have passed since the first Government AIDS awareness campaigns in the UK, and who can forget those iconic TV adverts? At that time, we did not really know much about the virus and how it would evolve, and we certainly did not know very much about people’s sexual habits. As I say, I remember that period well and I want to pay particular tribute to the gay community and the terribly responsible attitude that it took to this issue at that time.

As our understanding of the virus has increased, our approach to it has changed. Our national prevention programmes focus on men who have had sex with men and people from sub-Saharan Africa, because they are the groups in the UK who are most at risk of developing HIV; the risks they face are significantly greater than those faced by other groups in the UK. We have invested £2.9 million in programmes of HIV prevention for those communities, delivered by the Terrence Higgins Trust and the African Health Policy Network, but of course that is only a fraction of the sum that is spent. A great deal more money goes in locally.

The programmes by the Terrence Higgins Trust and the African Health Policy Network both use evidence and a range of approaches to support responsible sexual behaviour and to reduce risk-taking behaviour. For example, to promote HIV testing they use social media and the internet, and for African communities they work with faith leaders. It is quite an uphill struggle in some areas to promote awareness, to reduce stigma and to encourage people to come forward.

Finally, it is vital that the public health system is versatile and sufficiently proactive to deal with HIV. Our modernisation of the NHS and the priority that we attach to public health provide an opportunity to reinvigorate HIV prevention and improve outcomes for those with HIV.

The hon. Lady is absolutely right to say that we need to bring everything together. What we do not want, although we sometimes have it, is fragmentation of services, not only for services dealing with prevention and diagnosis of HIV but, as she mentioned, for services dealing with the social and psychological impacts of HIV. Health and well-being boards and the joint strategic needs assessment will be critical. For the first time, ring-fenced public health funding is central to the NHS and to public health, and it will allow us to plan spending on prevention. In today’s restrictive financial climate, the fact that we will have a ring-fenced public health budget will be critical.

There is still a great deal of work to do, and everyone, in this House and outside, must work together to keep HIV at the very top of our list of priorities, because only by doing that can we improve the lives of people living with HIV. The hon. Lady is right to mention that young people’s awareness has slipped. Their awareness of the dangers they face and of the part they can play in ensuring that they maintain their sexual health is not as great as it should be. They need the skills to make some very difficult choices.

I finish by congratulating the hon. Lady on securing the debate. I am very keen to work with the all-party group to ensure that we get this right, and that the sexual health strategy reflects all the work that needs to be done to ensure that we decrease the level of late diagnosis of HIV, raise awareness and reduce stigma.

Abortion (Costs)

Anne Milton Excerpts

Thursday 24th November 2011 Written Statements

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

In response to detailed enquiries about the information provided in answer to previous parliamentary questions on the cost of providing abortions in the NHS in England the Department has concluded that it should change the methodology it uses to produce estimates of the costs of abortions.



There are discrepancies between the activity figures for abortion returned to the chief medical officer and the data submitted as part of the reference cost collection, which is the Department’s wider collection of NHS cost and activity data. As a result of this, and the lack of detailed information about the price NHS organisations pay to independent sector providers for the provision of abortion, we will, in future, estimate the costs to the NHS of providing abortion using the activity figures provided to the chief medical officer and an average of the national tariff paid within the NHS for procedures including abortion. This is likely to overestimate total costs as we are aware that contracts with independent sector providers are generally at a lower price than the national tariff.

The table below shows the data used to produce previous estimates of abortion costs and the revised approach:

Employment, Social Policy, Health and Consumer Affairs Council

Anne Milton Excerpts

Wednesday 23rd November 2011 Written Statements

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

The Employment, Social Policy, Health and Consumer Affairs Council will meet on 1-2 December. The health and consumer affairs part of the Council will be taken on 2 December.

The presidency is expected to propose the adoption of Council conclusions on the following:

closing the gap in health between member states through action on determinants of health, especially nutrition and physical activity;

non-communicable diseases: prevention and control of respiratory diseases in children; and

prevention and control of communication disorders in children, including innovative approaches to treatment.

The United Kingdom supports the adoption of these Council conclusions.

There is also expected to be an exchange of views on the Commission’s new public health programme, “Health for Growth”, to take effect from 2014-2020.

Under any other business, the presidency is likely to provide information on the information to patients legislative package: proposal for a regulation and a directive as regards information to the general public on medicinal products for human use subject to medical prescription and as regards pharmacovigilance. The UK supports the adoption of both of these proposals, while recognising the strong opposition from other member states towards them.

In addition, information will be provided from the presidency on several matters including a proposal for a regulation of the European Parliament and of the Council on food intended for infants and young children and on food for special medical purposes, on the Senior Level Group and on the European Innovation Partnership. The Danish delegation will also give information on the priorities for their forthcoming presidency, which will run from January until July 2012.

Oral Answers to Questions

Anne Milton Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Nick Smith (Blaenau Gwent) (Lab)]

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

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

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

[Nick Smith]

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

[Anne Milton]

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

[Dan Rogerson (North Cornwall) (LD)]

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

[Anne Milton]

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

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

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

“giving every child the best start in life”,

on creating

“fair employment and good work for all”

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

[Anne Milton]

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

[Nic Dakin (Scunthorpe) (Lab)]

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

--- Later in debate ---

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

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

[Emma Reynolds]

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

[Anne Milton]

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

[Fabian Hamilton]

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

[Anne Milton]

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

[Grahame M. Morris]

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

[Anne Milton]

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

[Mr Stephen Dorrell (Charnwood) (Con)]

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

[Anne Milton]

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

[Charlie Elphicke (Dover) (Con)]

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

[Anne Milton]

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

[Robert Halfon (Harlow) (Con)]

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

[Anne Milton]

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

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

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

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

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

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

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

[Henry Smith (Crawley) (Con)]

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

[Anne Milton]

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

[Nic Dakin (Scunthorpe) (Lab)]

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

[Anne Milton]

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

[Stuart Andrew (Pudsey) (Con)]

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

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

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

[Anne Milton]

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

[Jim Shannon (Strangford) (DUP)]

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

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[David Tredinnick (Bosworth) (Con)]

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

[Anne Milton]

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

[Phil Wilson (Sedgefield) (Lab)]

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