HIV/AIDS

Anne Milton Excerpts

Thursday 27th October 2011 Written Statements

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

We have today laid before Parliament the Government response to the House of Lords Select Committee’s report “No vaccine, no cure: HIV and AIDS in the United Kingdom” (Cm 8190).

The Department of Health took part in the inquiry and the Government are grateful for the Committee’s report and agree with many of its recommendations.

Twenty-five years have passed since the Government’s first response to HIV and AIDS. At that time there was no effective treatment and an HIV diagnosis was seen as a life-limiting condition resulting in death. Today the availability of highly effective treatment has transformed the outlook for people with HIV.

As the report makes clear, we need to reduce undiagnosed HIV so people can benefit from effective treatment and to prevent HIV transmission. The Government’s modernisation of the NHS and priority for public health provides a good opportunity to improve outcomes for HIV and improve prevention.

The House of Lords ad hoc Committee’s report will also help inform the Department of Health’s new sexual health policy framework planned for 2012.

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

Public Health (Bexley)

Anne Milton Excerpts

Wednesday 26th October 2011 Westminster Hall

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

It is a pleasure to serve under you this morning, Ms Osborne. I do not believe that we have met in Westminster Hall before.

I congratulate my hon. Friend the Member for Bexleyheath and Crayford (Mr Evennett) on securing the debate. He does not miss an opportunity to raise issues of public health in his constituency. As my hon. Friend and all of us do, I want to see a public health system worthy of its name, set up with the sole purpose of protecting and improving the health of everyone in this country. The public health White Paper outlines how we intend to achieve that, with ring-fenced funding, health and well-being boards and joint strategic needs assessment all playing a big role. Every element is designed with local needs in mind, so communities and local organisations in his constituency will be able to play a bigger role than ever in improving the public’s health. On the whole, the residents of Bexley are healthier than the national average, but that does not mean for one second that a great deal of work is not still to be done. People living in the most deprived areas of Bexley can expect to live up to seven years less than those living in the wealthiest areas, which is a staggering figure.

It was a pleasure to be joined by my hon. Friend the Member for Dartford (Gareth Johnson) and the hon. Member for Erith and Thamesmead (Teresa Pearce). My hon. Friend rightly mentioned the importance of cross-authority working. In particular, as we move into the new systems, I stress the need for public health leadership. People in Bexley will need a strong and visionary public health system with expert leadership. I am sure that the council and the local primary care trust are considering carefully how to provide such leadership after April 2013, when the breadth and importance of the local council’s responsibilities will increase enormously. Those are big challenges, but they also represent a fantastic opportunity, and Bexley is well placed to capitalise.

My hon. Friend the Member for Bexleyheath and Crayford discussed his grave concern about obesity and gave us some figures, such as that 20% of year 6 children are obese, which is 2% higher than the national average. That is a shame, and the problem is not unique to some areas of the country, because England has among the highest rates of obesity in the developed world. Recent figures show that levels of childhood obesity are stabilising and that adult obesity rates may be levelling out, but the overall rates remain extraordinarily high.

We published a document, which my hon. Friend referred to, “Healthy Lives, Healthy People: A call to action on obesity in England”, on 13 October to set out our approach. Through projects such as the healthy child programme, the national child measurement programme and the responsibility deal, we want to give clear and consistent messages on what the healthiest choices are and how people can make them. People need information and to recognise the harm that they do to their health by ignoring such choices. As I have said, local authorities will be at the forefront, and they will have that ring-fenced public health budget to use in ways that suit local people, doing far more good than a uniform approach that descends from on high in Whitehall.

The local NHS is taking steps to fight obesity and to encourage physical activity, in particular in children. The Bexley healthy schools project is working with every single one of Bexley’s schools and children’s centres, teaching children about the importance of healthy eating and physical activity. The parents’ education and children’s health project educates parents and carers about healthy and economical cooking. School food policies are also being reviewed with parents, pupils and staff, to ensure that children receive nutritionally balanced packed lunches that they will actually eat—there is no point in putting healthy food in front of children, if they then fail to eat it.

My hon. Friend mentioned Silver Star, and I am pleased that he got a tick for his own health, but he is absolutely right that type 2 diabetes is of considerable concern. I understand that the Bexley community diabetes project has had contact with nearly all diabetic patients in the borough. That project is centred on empowering patients and putting them at the heart of managing their condition while calling on health care professionals, when necessary. It is about personal responsibility, ownership and understanding that if people feel they have some control over their lives they do very much better. He also mentioned physical activity, and I thank him for specific mention of “Change for Life”—one of its successes is that it does not look like a Government-run programme—which has had a big impact. He might be interested to know that the brand will be used for action on alcohol in the new year.

We will be publishing an alcohol strategy in which communities and local government will again play a big part, because they will be able to take action based on what they think will work. Local councils are already involved with some of the social harms of alcohol—certainly anti-social behaviour and crime is of considerable concern—and with licensing. Local schemes and projects have contributed to Bexley having a lower than average rate of alcohol-related harm. For instance, the Bexley business support unit offers counselling, group work and medical help to people with alcohol problems. However, a great deal remains to be done. In April, an outreach service was commissioned to help people in the borough who had not used the services before or who find it difficult to access treatment. Data from the first six months of that service show that it has been successful.

On London as a whole, the Secretary of State for Health has backed a statutory London health improvement board, chaired by the Mayor of London. It is already drawing up plans for priority areas such as alcohol and childhood obesity and looking into promoting the use of existing licensing powers, helping accident and emergency departments share data on violence resulting from alcohol misuse and getting early interventions in place so people who misuse alcohol can get quick and effective advice, which is so important.

Smoking kills 80,000 people a year, and yet a persistent minority, which includes a significant number of people, continues to smoke. Each year, an estimated 320,000 children try smoking for the first time. The tobacco control plan to which my hon. Friend referred outlines our ambition to cut smoking rates in adults down to 18.5%, in 15-year-olds down to 12% and in pregnant women down to 11%. Many of us still feel that those figures are too high. Again, we need to give people information, but people also need support to quit. The plan demonstrates how we aim to achieve that. At the beginning of the month, tobacco sales from vending machines became illegal, which is a big start because such machines were a source of tobacco for children, and large, brightly coloured tobacco displays will soon be joining them in the ashtray of history. Displays will end on 6 April 2012 in large shops and three years later in small shops and other businesses in England.

My hon. Friend referred to Bexley’s stop smoking team, which helped 1,611 people give up last year, exceeding its target for the third year running. It has won awards, and he goes to great efforts on its behalf—this is not the first occasion on which he has mentioned it. Many people criticise local services, but it is right to acknowledge the tremendous job that they are doing. I hope that the Bexley team can spread that good practice around the areas in the vicinity. Anyone living or working in Bexley can access the service for free via a GP or participating pharmacy and, if that is not convenient, the team regularly provides services in more convenient locations such as libraries, children’s centres or a special bus outside a local supermarket.

My hon. Friend mentioned TB, and he rightly stated the specific problems for London. We always keep the evidence under review, and we are guided at all times by the Joint Committee on Vaccination and Immunisation. He is right that the issue is complex, but there is no doubt that London has more than its fair share of the problem. As I have said, strong public health leadership in such fields will be extremely important. I assure my hon. Friend and the other two hon. Members present in the Chamber today that the Department of Health and the London strategic health authority support the Mayor of London’s health inequalities strategy. Inequalities simply have no place in modern society, and everything that we can do to lessen them is worth pursuing. I want to see local councils arguing across the council chamber about how it is no longer fair for their residents to live less long that those of another council in the same area.

I thank my hon. Friend for giving me the opportunity to raise yet again the need for the public to improve their health. It matters to stop illness, disability and premature death, but it also matters as we live longer, because staying well as we live longer is becoming increasingly important to us all.

Oral Answers to Questions

Anne Milton Excerpts

Tuesday 18th October 2011 Commons Chamber

[Duncan Hames (Chippenham) (LD)]

1. What plans he has to promote new initiatives to encourage organ donation.

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

Sustained work at national, regional and local level has seen an increase in donor rates by some 28% since 2008. We continue to work with a large number of organisations, such as the Give and Let Live initiative in schools, which is run by NHS Blood and Transplant. Other initiatives include requiring people to answer a question about organ donation when applying for a driving licence and to sign on the organ donor register when applying for a European health insurance card or for a Boots advantage card. We also have specific initiatives within the black and minority ethnic populations, such as working with faith groups and local radio stations.

[Duncan Hames]

I recently met young campaigners from Sign Up, Speak Up, Save Lives whose organ donation campaign features on Channel 4’s “Battlefront” programme. Will the Minister please meet Hope, Abby and me, together with the Minister responsible for constitutional reform, so that we may discuss with them both our idea of inviting people to join the organ donor register at the same time as they will soon be asked to join the electoral register?

[Anne Milton]

I congratulate Sign Up, Speak Up, Save Lives. I am happy to meet Hope, Abby and the hon. Gentleman, along with the Parliamentary Secretary, Cabinet Office, my hon. Friend the Member for Forest of Dean (Mr Harper). The electoral registration form has been used as an opportunity. In 2000 there was a campaign called Vote for Life, which was stopped after about 15 months because of problems with the Representation of the People Act. I would be happy to revisit it and would enjoy an opportunity to discuss the matter further. Anything we can do to get those rates up matters.

[Grahame M. Morris (Easington) (Lab)]

The reorganisation of NHS procurement has been described in a National Audit Office report as fragmented and poor value for money. The report shows—

--- Later in debate ---

[Hywel Williams (Arfon) (PC)]

What discussion has the Minister had with Welsh Ministers who are bringing forward legislation for an opt-out system of organ donation? If she has had such discussions, what conclusions has she drawn?

[Anne Milton]

The Government will examine thoroughly the detail of any Assembly Bill when it is laid before the Assembly, but I urge Wales to look at the evidence. We can look back to what happened in Spain, where there was presumed consent for 10 years without any shift in organ donation rates. The issue is more complex than that. It is about organ donor transplant co-ordinators and increasing donations from emergency medicine. A number of measures need to be put in place to increase those rates.

[Mr Philip Hollobone (Kettering) (Con)]

Will my hon. Friend be kind enough to meet Mr Adam Crizzle, who was the original inspiration behind the Give and Let Live organ donation programme in schools, to see how the promotion of this excellent scheme might be further improved?

[Anne Milton]

I would be very happy to meet that gentleman. There is no doubt that promoting this in schools has a profound impact and is an opportunity to change people’s attitudes to organ donation and, more importantly, makes families discuss it, which is critical. It is not just about signing on to the register.

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

Last week I had the opportunity to meet members of the Ticker club, an organisation of former heart patients who continue to provide support to patients at Wythenshawe hospital, a specialist centre for cardiac and thoracic surgery, including heart and lung transplants. They have strong opinions on organ donation, so will the Minister agree to involve such groups in ongoing campaigns to raise awareness of the benefits?

[Anne Milton]

I thank the hon. Gentleman for raising that issue. My right hon. Friend the Secretary of State has visited that hospital, and I am happy to work with any group. I reiterate the fact that we particularly need to work with black and minority ethnic groups, in which the rates of donation are truly dreadful: 23% of people on waiting lists are from black and minority ethnic communities, but only 1.2% of those on the register are from that same group. We need to do everything we can to improve those rates.

--- Later in debate ---

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

4. What assessment he has made of the potential effects of NHS reorganisation on the protection and improvement of public health.

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

Our reforms put public health at the heart of the new system. The creation of Public Health England, alongside significant new functions and, for the first time, ring-fenced budgets for local authorities, will give public health an unprecedented level of priority. The new local authority role integrates public health with other local authority functions that impact on people’s health.

[Diana Johnson]

Under the previous Government, NHS Hull saw excellent results in improving public health. Under the current Government, Kingston upon Hull’s teaching primary care trust has seen a 2.6% cut this year compared with Kingston upon Thames PCT getting a 2% increase—and Hull city council has a 9% cut in its funding as well. What does the Minister think will happen to public health in areas such as Hull with those kinds of cuts?

[Anne Milton]

I think that public health in areas such as Hull will do exceptionally well. I point out to the hon. Lady that under the previous Government, what happened in practice was that public health budgets were raided constantly and we did not get improvements. If she looks at the figures, she will see that inequalities in health widened.

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

Does my hon. Friend agree that despite the previous Government’s good intentions on public health, health inequalities have widened, as she has rightly said, obesity rates are going up, smoking among young girls is going up, and alcohol abuse is a serious problem? Does she agree that it is right to deliver services with local authorities and to get into local communities and schools if we want to address these big public health challenges?

[Anne Milton]

My hon. Friend is absolutely right. Local authorities have a long and proud tradition of improving the public’s health. Public Health England will bring together a fragmented system and strengthen our national response on emergencies and health protection. It will help public health delivery at a local level with proper evidence and leadership.

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

Contrary to the Minister’s statement that the Health and Social Care Bill will put public health at the heart of the health service, 40 directors of public health and 400 public health academics, including Michael Marmot, wrote to The Daily Telegraph to say that the Health and Social Care Bill will

“widen health inequalities; waste much money on attempts to regulate and manage competition; and undermine the ability of the health system to respond…to communicable disease outbreaks”,

and that it will

“disrupt, fragment and weaken the country’s public health capabilities.”

How can the Minister put her judgment against that of those doctors and experts? Is not the proposal that more than 40 specialist neonatal units may lose staff in the coming year an example of the weakening of public health that is involved in the Bill and the Government’s proposals?

[Anne Milton]

I draw the hon. Lady’s attention to the fact that the Health and Social Care Bill proposes for the first time a duty on the Secretary of State to have regard to health inequalities, which, I repeat, widened under the previous Government. I also point out to her that the letter to peers signed by Professor Marmot and others welcomed the emphasis on establishing a closer working relationship between public health and local government. I suggest that the hon. Lady gets out more, because she would hear from public health doctors and local authorities on the ground who welcome these changes.

[Lorely Burt (Solihull) (LD)]

5. What steps he is taking to reduce the burden on NHS hospitals of (a) PFI repayments and (b) debt.

--- Later in debate ---

[Hazel Blears (Salford and Eccles) (Lab)]

13. What recent estimate he has made of the number of midwives working in the NHS.

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

There were 20,654 full-time equivalents in June 2011—a rise of 522 or 2.6% since May 2010. That is a record.

[Hazel Blears]

The Minister might know that the midwife-led unit at Salford Royal hospital is due to open in the next few weeks, and I want to put on the record my thanks to the midwives there who carry the heaviest work load in the north-west and are doing a brilliant job. She will not know, however, that last year there were 2,500 extra births in Greater Manchester that were neither expected nor planned for, that there are current vacancies for midwives at St Mary’s hospital and that mothers are being pressured to leave hospital sometimes within two or three hours of giving birth. What assurances can she give me that the same standards of safety and quality applying at Salford Royal will be available to Salford families in the future?

[Anne Milton]

We need to ensure that they are, which is one of the reasons we have asked the Centre for Workforce Intelligence to undertake a pretty in-depth study of the nursing maternity work force during 2011-12. I can reassure the right hon. Lady that the current number of midwifery students entering training is at a record level—more than 2,500—and I join her in paying tribute to our midwives.

[Tim Farron (Westmorland and Lonsdale) (LD)]

After the recent inquiry into the Furness General hospital maternity unit, will the Minister confirm that she will give full support to midwives across the Morecambe Bay trust area and that the excellent midwife-led unit at Westmorland General hospital in Kendal will be protected?

[Anne Milton]

I always give my full support to midwives, but we must not forget that this is about teamwork as well. There has been an increase in the number of maternity support workers, who also play a critical role, as do the obstetricians and gynaecologists, all of whom have increased in numbers as well.

[Mr Speaker]

There is just time for Mr Andrew Rosindell.

--- Later in debate ---

[Mr Kevin Barron (Rother Valley) (Lab)]

What progress has been made since the launch of the Secretary of State’s tobacco control plan last March in changing the behaviour of people who smoke in cars in the presence of children?

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

The right hon. Gentleman has a long-standing interest in this subject. We are working on a number of areas, but I think that the extension of public health duties to local authorities will open up many opportunities to persuade parents to think carefully about where they smoke, whether it is in cars or in their own homes.

[Mr David Evennett (Bexleyheath and Crayford) (Con)]

There is real concern throughout the country about the health inequalities left by the last Government. Will the Minister confirm that funding for areas with relatively large health inequalities will not be raided, as it has been in the past under Labour?

[Anne Milton]

As my right hon. Friend the Secretary of State said earlier, the Health and Social Care Bill proposes the introduction of the first ever legal duty for the Secretary of State to have regard to the reduction of health inequalities. That covers both NHS and public health functions. We are also addressing the health needs of some of the most vulnerable people through the “Inclusion Health” programme.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

My right hon. Friend the Leader of the Opposition and the officers of 12 all-party groups associated with care have urged the Government to commit themselves to the urgent reform recommended by Dilnot. Will the Minister update the House on the Government’s response to the Dilnot recommendations, and tell us when the cross-party talks will begin?

[Mr David Ward (Bradford East) (LD)]

In a recent ministerial response, I was informed that public health services were a matter for the local NHS and that it would not be appropriate for Ministers to become involved or intervene. The transfer of staff from PCTs to local authorities excludes staff delivering services relating to weight management, smoking cessation, physical activity promotion, sexual health, community development and diabetes awareness-raising. How on earth can local authorities pick up the responsibilities without being given the staff who would enable them to do it?

[Anne Milton]

The transition period is critical, and there is no suggestion that local authorities will not have all the tools in the box to enable them not only reduce to health inequalities, but to improve the public’s health. As we have stated many times, it is absolutely dreadful that under the last Government health inequalities increased rather than decreased.

[Several hon. Members]

rose—

NHS Blood and Transplant Commercial Review

Anne Milton Excerpts

Tuesday 18th October 2011 Written Statements

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

The Department’s commercial review of NHS blood and transplant (NHSBT) has now concluded.

The review was an outcome of the Department of Health’s review of arm’s length bodies (ALBs), which concluded that there were strong arguments for retaining the majority of NHSBT’s functions within a single national system. However, it also concluded that there could be opportunities for more cost-effective operations and commercial arrangement within the divisions of NHSBT.

The review examined NHSBT’s non-donor facing activities, including, estates, testing, processing and logistics, with the aim of helping NHSBT further improve the efficiency of its operations.

The review has made a number of recommendations to support the continued improvements in the efficiency and effectiveness of the organisation, which includes working with NHS and other organisations to make more efficient use of voluntarily donated blood.

There are nine recommendations from the review:

that more work, with strategic leadership from the Department of Health and the Welsh Government, should be done both at national and trust level to support trusts, in achieving and maintaining best practice, to reduce the inappropriate use of red cells, platelets and fresh frozen plasma; this would in turn reduce demand and direct costs on NHSBT;

that NHSBT should work with internal and external stakeholders, and publicise its operational and technical data requirements at the trust interface, so that the development of independent stock and operational systems at trusts remain compatible with NHSBT systems;

that NHSBT should continue to develop its pilot studies on integrated transfusion services and should publish the findings and results;

that as NHSBT pilots and launches services with particular trusts, it should maintain a clear segregation (in accounting and reporting) between its developing transfusion services and its core blood supply service;

that NHSBT should monitor alternative provider capability, particularly if there are “make or buy” decisions. Before investing in development projects, NHSBT should ensure it checks whether products or services are already available from existing providers;

that in its current investigation of the requirements for the NHS organ donor register, NHSBT should ensure it has access to all necessary skills and resources to ensure the register is successfully developed and is fit for purpose;

the Department of Health should pursue opportunities for efficiencies within the UK blood services with the other UK Health Departments;

that NHSBT should ensure complete transparency in its financial reporting between its different services and its separate funding sources. The Department of Health should review whether any formal changes to its financial instructions to NHSBT are required to facilitate this; and

that the Department of Health reviews and oversees the mechanism for setting the blood price. The new process to be agreed with NHSBT and the other key stakeholders as a method that continues to command the confidence of NHSBT’s customers, takes account of blood policy and safety requirements, drives improvements in operational and financial efficiency and is transparent.



A copy of “NHS Blood and Transplant Commercial Review” 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.

Health and Social Care (Re-committed) Bill

Anne Milton Excerpts

Wednesday 7th September 2011 Commons Chamber

[Ms Abbott]

I am grateful to the hon. Gentleman, who is, of course, a practising doctor who knows a great deal more about these matters than many of us in the House.

As hon. Members have heard, the amendments deal with matters that are amply covered by existing law and regulations that are well known to doctors and nurses. They deal with matters that must, at the end of the day, be between a woman and a doctor. I deprecate the extent to which amendment 1 is an attempt to import American sensationalism, confrontation and politicisation into these issues in a way that will be of no benefit to ordinary women.

There is no evidence base for the amendments, and on the basis of all the recent polls there is no substantive support for amendments of this nature. Legislation addressing the issues raised by Government Members is already in place. This House should have more respect for the medical profession and for the vulnerable women who put themselves forward for abortion in one of the most difficult periods in their lives, rather than support an amendment of this nature, which is spurious and baseless. I urge the House emphatically to reject the amendment.

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

I feel that I need to start by saying that this debate is about women; it is not about hon. Members. It is about ensuring that women get the very best possible services that they not only need but deserve.

There was much comment and speculation ahead of the debate, not all of it accurate or helpful. It might therefore be useful if I explain the Government’s approach to meeting the spirit of the amendments without primary legislation. I associate myself with my hon. Friend the Member for Bracknell (Dr Lee), who urged calm and balance. Today’s debate has not necessarily reflected either of those things.

How do the Government intend to meet the spirit of the amendments?

[Kate Green]

Will the Minister give way?

[Anne Milton]

I need to make a little progress.

The Bill gives new public health functions to local government. In some cases, the steps that local authorities must take will be prescribed in regulations, which include the provision of sexual health services and abortion services. That will be a duty of local authorities and not of clinical commissioning groups—some of the amendments in the group have caused confusion about that. We intend to specify in regulations that local authorities must ensure that part of what they commission is a choice of independent counselling.

Amendments 1 and 2 would fragment the service by splitting responsibility for the commissioning of counselling and for the commissioning of the rest of the service. If they and amendment 1221 were to be made, clinical commissioning groups and local authorities would have different but overlapping duties in relation to independent counselling, and the definition of “independent” would be different for each. We would have a fragmented service, which none of us wants. Most women go to their GP, which is not the same as a clinical commissioning group, or they self-refer to an abortion provider, so amendment 1221 would not work.

--- Later in debate ---

[Chris Bryant]

Will the Minister give way?

[Anne Milton]

I am afraid that time is against me.

I hope that what I have said reassures my hon. Friend the Member for Cambridge (Dr Huppert), who I believe is trying to be helpful, but we do not support any of the amendments. We intend to ensure that the independent counselling offered to women follows the highest standards of good practice. My hon. Friend’s amendment 1252 is therefore unnecessary, as well as, we believe, unenforceable as currently drafted. It does not define “information or advice”, and crucially, it does not mention independent counselling. Counselling is different from advice and support. However, the Government support the spirit of the amendments, and we intend to present proposals for regulations after consultation. Not only is primary legislation unnecessary, but it would deprive Parliament of the opportunity to consider the detail of how the service will develop and evolve.

Amendment 1180 would oblige the Government to make regulations requiring NICE to produce guidance on abortion services. It would also oblige NICE to make specific recommendations in the guidance. That conflicts with other provisions in the same clause that prevent central interference in the substance of the NICE recommendations. Clearly that would seriously damage the independence of NICE and its reputation for evidence-based guidance. The second part of the amendment would require health or social care bodies, or private providers of abortion services, to comply with all recommendations made by NICE, which would effectively mean that NICE was setting essential requirements for abortion services, which is not its job or function. That is the role of the Care Quality Commission, and those standards and qualities are driven by good commissioning.

[Andrew Selous]

We all greatly appreciate the calm and measured way in which the Minister is responding. Is she aware that, in 2006-07, a Labour-dominated Science and Technology Committee recommended that those functions should be taken over by NICE?

[Anne Milton]

No, and I thank my hon. Friend for raising the point. The only reason why I took his intervention was that NICE had not been given a mention yet.

[Chris Bryant]

Will the Minister give way?

[Anne Milton]

I will not, I am afraid. I must make progress.

The amendment would not, incidentally, require local authority commissioners of abortion services to comply with NICE recommendations.

This does not, of course, mean that NICE has nothing to contribute. Hon. Members may know that it is currently considering a draft library of NHS quality standards, which includes a proposed topic on abortion services. We may have an opportunity to air the issue further at that point.

I hope that hon. Members are reassured by our proposals and by my personal involvement in the issue.

[Chris Bryant]

rose—

[Anne Milton]

The hon. Member for Rhondda (Chris Bryant) is clearly not reassured, but perhaps he will let me finish.

It is a very long time since I worked in a maternity unit, but I worked in one run by the Salvation Army, and I have seen many young women go through the trauma of an unplanned and unwanted pregnancy. Yes, we need to do a great deal more to prevent unwanted pregnancies from happening in the first place, but when faced with such a situation, young, and indeed older, women need help and support to make the decision that is right for them without interference from any vested interests. The amendments were tabled in a spirit of improving services for women, but they will not work. They will not deliver what my hon. Friend the Member for Mid Bedfordshire (Nadine Dorries) wants, or what I want. They will not work for women. I urge my hon. Friend to withdraw her amendment and to work with me to ensure that we secure the right services for women.

[Mr Frank Field]

I will be brief, because I know that others wish to speak.

I thought that I would be addressing the House about an amendment with my name on it, but, for reasons unknown to me, my name was dropped from it. What I wanted to say, however—and it is reinforced by the way in which the Minister has approached the matter—is that while I thought that the original amendment involved an issue that we should consider, I believe that the Minister has dealt with it. The hon. Member for Mid Bedfordshire (Nadine Dorries) and I embarked on this journey together, and my plea to her now is not to press the amendment. The Minister has provided us with an advance which I hope will signal a change in the temper of the abortion debate in the House.

This has been one of those debates in which people emphasise motives and rarely take voting records into account. I put my name to that amendment because in every vote on the subject that has taken place in the 30 years for which I have been in the House, I have voted against wrecking the Abortion Act, and I thought that there was an issue here that should be considered. However, I feel that the Minister has more than met the point, and she has widened the debate about what the inquiry will cover. I hope that the whole House will pay attention to her and to my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott). Presumably a report will be produced once the consultation has been completed, and perhaps we shall then be able to have a debate opened by Front Benchers in which Back Benchers’ speeches are time-limited.

Despite what has happened today, I think it important for us to try to use this event to make it clear that we will have different debates about abortion in the House of Commons in future, for we should have such debates. We should be more concerned with facts, and less concerned with trying to put our sticky fingers into other people’s souls and pronouncing that they have failed.

Employment, Social Policy, Health and Consumer Affairs Council

Anne Milton Excerpts

Thursday 14th July 2011 Written Statements

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

EU Health Ministers met in Sopot, Poland for an informal meeting of the Employment, Social Policy, Health and Consumer Affairs Council on 5 and 6 July. I represented the UK.

There was a discussion on the prevention and treatment of communication disorders among children. Member states stressed the importance of improving access to screening for communication disorders and early intervention.

The presidency presented an item on organ donation, which focused on sharing of best practice to improve donation rates across the EU.

The presidency highlighted the risks presented by the growing availability of “designer drugs”. Member states encouraged the sharing of information to help address the issue.

Member states received an update on the recent E.coli outbreak in Germany and France and the measures put forward by the European Commission to control the marketing of seeds from Egypt.

In a discussion on health determinants, diet and physical activity. Member states emphasised the importance of addressing inequalities between and within member states, through a range of mechanisms including social, economic and behavioural change.

During a discussion on e-health. Member states outlined development at a national level and considered work at EU level.

Finally, Sweden raised the issue of the environmental impact of pharmaceutical production in third countries. This attracted support from several member states, including the UK.

Oral Answers to Questions

Anne Milton Excerpts

Tuesday 12th July 2011 Commons Chamber

[Mark Pawsey (Rugby) (Con)]

8. What guidance his Department issues on the use by GP surgeries of premium rate telephone numbers.

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

The Department has amended the general medical services regulations to prohibit GP practices from using telephone numbers that charge patients more than the equivalent cost of calling a geographical number to contact the NHS. Since April this year, GPs have not been allowed to use a number that charges patients more than the cost of an equivalent geographical call.

[Mark Pawsey]

I have been contacted by a constituent who is a patient at a practice in Rugby that uses telephony based on 084 numbers. My constituent is concerned about the additional charges incurred by patients when contacting the surgery by phone, particularly by mobile phone. Will the Minister update the House on the work of the Department in ensuring that GP surgeries do not use such numbers unnecessarily?

[Anne Milton]

I thank my hon. Friend for raising this matter. I understand that five GP surgeries in NHS Warwickshire use 084 numbers, and that the primary care trust has been assured that patients using those numbers are not charged more than the cost of using an equivalent local number. It is absolutely clear that there is no distinction between landlines, mobiles or payphones. The directions are very clear that patients should not expect to be charged any more.

[Mr Andrew Love (Edmonton) (Lab/Co-op)]

I, similarly, have three GP practices that use those telephone numbers. I have made extensive contact with my local PCT about this, but it did not seem to know what to do. Can the Minister assure us that the clear advice she is giving here today will be distributed around the health service, so that we can put an end to this?

[Anne Milton]

The Department is very clear, and the general medical services contract makes it very clear, that GPs are not allowed to do it. There are a number of options open to GPs who already have such telephone contracts, such as calling patients back, altering the contract arrangements or, indeed, paying the costs themselves.

[Mr Matthew Offord (Hendon) (Con)]

9. What steps he is taking to improve NHS patient outcomes.

--- Later in debate ---

[Mr David Burrowes (Enfield, Southgate) (Con)]

14. What progress he has made in reducing rates of hospital-acquired infections.

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

As the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), has just said, clarity and vision are what is needed. The coalition agreement made it clear that the NHS should adopt a zero tolerance approach to all avoidable health care-associated infections, which have caused so many problems for the public over so many years. In 2010-11, there were just under 1,500 MRSA bloodstream infections. That is a decrease of 22% on the previous year. That means that infections are at their lowest level since mandatory surveillance was introduced. In the same period, there were just under 22,000 occurrences of C. difficile infections, which is a 15% decrease compared to the previous year. We will continue with our zero tolerance approach.

[Mr Burrowes]

I thank the Minister for that reply and the rapid progress made under this Government. I welcome the new C. difficile objective and the publication of weekly statistics, but does the Minister share my concern that it is the same hospitals that keep appearing with the highest number of C. diff cases? What is her Department doing to help those hospitals reduce such cases?

[Anne Milton]

My hon. Friend is absolutely right. Under the previous Administration there was a national target of reducing C. difficile infections by 30% by 2011, but that does not address the problem because, as he rightly says, there are hospitals that consistently had high rates of infections, so we changed that. Since April, every PCT and every acute trust has its own objective. The organisations with the highest rates of infection will have more ambitious objectives than those that are doing well.

[Nic Dakin (Scunthorpe) (Lab)]

16. What progress has been made on the review of children’s congenital heart services.

--- Later in debate ---

[Mr David Evennett (Bexleyheath and Crayford) (Con)]

Will my right hon. Friend join me in congratulating advisers working for Bexley stop smoking service, who helped more than 1,600 people stop smoking last year? Does the Minister agree that helping people stop smoking should remain an important public health priority?

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

I am happy to join my hon. Friend in congratulating those who are making efforts locally. As he will be aware, public health services will move to local authorities, and I am sure those efforts will continue. Some 80,000 people a year die of smoking-related disease, and 320,000 young people are taking up smoking each year. We must not only help those who are smoking to stop but prevent young people from taking it up.

[Kerry McCarthy (Bristol East) (Lab)]

The number of patients waiting more than four hours in A and E went up by 76% in the past year, which is an extra 200,000 people. I think we all know what a hellish experience waiting in A and E can be. Does the Secretary of State agree that that is a backward step, and that he ought to take steps to rectify it?

Edale Unit (Manchester)

Anne Milton Excerpts

Tuesday 28th June 2011 Westminster Hall

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

Still we are here, Mr Walker—how lovely!

I congratulate the hon. Member for Manchester Central (Tony Lloyd) on securing the debate. I would join him, I am sure, in paying tribute to the skills and dedication of mental health professionals not just in Manchester, but throughout the country. They do a fine job, often in very difficult circumstances. However, he was right to say at the end of his speech that we must do better. Mental health services have often been the Cinderella services. It has been extremely difficult to get them the priority that they deserve. From my perspective as a Minister responsible for public health, I see the prevention of poor mental health as being as much a priority as the prevention of poor physical health. I know that the hon. Gentleman has campaigned locally on health issues in his constituency and is a very strong supporter of all that goes on. Unfortunately, my hon. Friend the Minister of State, Department of Health, who has responsibility for care services, is tied up with the Health and Social Care Bill today. However, I am sure that he will read the record of this debate with interest.

I cannot unravel this story in the time available to me, so I hope that the hon. Gentleman will bear with me when I raise a number of issues that are pertinent. I shall come in my conclusion to what I feel is the best way forward. There is no doubt that any change brings uncertainty. I can well understand how plans to transfer local mental health in-patient beds naturally provoke concern. I understand the hon. Gentleman’s surprise at the relocation of beds from a newly built facility. He particularly mentioned the central location of Edale as important, and the views of the police not having been sought. I cannot comment on that, but his point is well made.

Let me give a little background on where we are with mental health services. We have launched “No health without mental health: a cross-Government mental health outcomes strategy for people of all ages”, which has two aims: improving the population’s mental health and improving services. The mental health strategy takes a life-course approach and sends a clear message that prevention, early diagnosis and early intervention are key priorities.

We would expect the bulk of the strategy to be delivered locally by experts on the ground working with services users, their families and carers, and, in some circumstances, the local police. Through the Cabinet Sub-Committee on Public Health and the ministerial advisory group, Ministers will continue to pay close attention to the delivery of the improvements set out in the strategy. There is no doubt that services in the community and closer to patients’ homes are better for recovery and encourage independence, although in-patient beds are needed at times.

The ministerial advisory group will bring together the new NHS commissioning board, Public Health England and a range of stakeholders, including clinical commissioning groups, the voluntary and community sectors and local authorities—one cannot underestimate the role that local authorities have to play in providing services for people with mental illness. Once the proposed NHS commissioning board and Public Health England are fully operational, we anticipate that they will become the focus for all stakeholders to lead the implementation of the mental health strategy and to review its progress.

The NHS in Manchester is working to strengthen its community-based services and to reduce reliance on acute care for those with a mental illness. That should be about improving quality, not introducing cost-saving measures. That follows the strategy set out in the national service framework for mental health services, which the Labour party introduced when it was in government. Indeed, there is cross-party consensus that investing more in community-based support benefits patients, and there is a growing body of evidence to support that. What people are fearful of is that such support is a cost-cutting measure.

I am told that Manchester Mental Health and Social Care Trust has worked closely with staff, service users, carers and other stakeholders, including the Manchester local involvement network and the Manchester carers forum, to develop proposals for rationalising its in-patient services for adults and older adults with mental health problems. The hon. Gentleman might not feel that that work has been sufficient, but it is important to put on the record what the local NHS feels it has done, which, as he rightly said, involves reducing the number of in-patient sites

The proposals will maintain the same number of beds, and I am told that only one in 17 mental health service users requiring in-patient services in Manchester will be affected. Service users who are in receipt of community support from adult and later life community teams at the nearby Rawnsley building and those who attend out-patient appointments will not notice any changes to services as a result of the relocation of beds. Alternative accommodation for the non-in-patient services based at Edale house is being sought in more appropriate community settings. I do not know Manchester well, but I am sure that there are other community settings in which such services can be provided.

The trust expects to achieve a number of clinical benefits, although the hon. Gentleman is perhaps somewhat cynical about that. It feels that those benefits will include a greater concentration of staffing expertise, an improved level of support on wards, a reduction in delays for treatment and the development of specialist services. We probably need to concentrate specialist services ever more to get the expertise we need.

[Tony Lloyd]

I am genuinely sympathetic to the Minister, who has been given her briefing. I mean no disrespect to her or her speech, but the problem is that such claims are easy to make; indeed, the 100-bed Edale unit could deliver concentration in exactly the same way. It is just not obvious that the mental health trust is doing anything more than providing words as a façade for its decision. It has given no explanation of why the change is better, or why the present situation is worse, other than this fallacious nonsense about the Edale unit not being up to standard.

[Anne Milton]

I thank the hon. Gentleman for his intervention. I should probably have started with the end of my speech, but I will come to the direction I feel he should move in.

The Government have pledged that all service changes must in future be led by clinicians and patients, and not driven from the top. The Department has outlined and strengthened the criteria that any decisions on NHS service changes are expected to meet. Decisions must focus on improving patient outcomes, and the hon. Gentleman mentioned quality, although the issue is obviously open to debate locally. Decisions must also consider patient choice, have support from GP commissioners and be based on sound evidence.

I must stress that the NHS is not run from Whitehall, and a lot of local issues need to be looked at locally. The overview and scrutiny committee has confirmed that it is satisfied that appropriate involvement has taken place. The mental health trust is exploring the feasibility of introducing a defined transport system at the committee’s request to ensure that service users and their families have suitable access.

The hon. Gentleman mentioned the tragic case of Peter Thompson, and my sympathies are always with the friends and families involved in such situations. The case has clearly raised significant issues, not least that of good leadership, which is critical to ensuring that good services are available. I would expect the local NHS to learn from this tragic incident and to ensure that it does not happen again.

The chief executive of the mental health trust has written to the hon. Gentleman and offered him a meeting on three occasions—28 February, 25 May and more recently. I urge the hon. Gentleman to have that meeting, because he is clearly unhappy about a lot of issues. He mentioned the anonymous letter he had received, and if its authors get sight of this debate, I hope they will come to see him in confidence—like all Members, I know that he would keep their identities confidential. The letter has raised some concern, but it is difficult to do anything about it while it is anonymous. I am sure that the hon. Gentleman’s assurance that it is from clinicians would hold up.

I urge the hon. Gentleman to meet the chief executive. He clearly remains open-minded, but he is anxious to be convinced. He describes a complex story, in the middle of which we have a tragic death and the coroner highlighting some important issues. I am sorry that I cannot give the hon. Gentleman more in the debate, but the best way forward would be for him to meet the chief executive.

[Tony Lloyd]

I would, of course, be happy to meet the chief executive, but what I have really been offered is a meeting to tell me why the trust is going ahead with the decision that it has already made. I want explanations, and that is what the public and the taxpayer are entitled to. If I do not get that explanation, can I come back to the Minister and her colleagues and at least get some sense that they are engaged in dealing with what could be a scandal?

[Anne Milton]

I thank the hon. Gentleman for that intervention. That is absolutely right: he should see the chief executive and ask for an explanation. As he rightly says, he is open-minded and wants to be convinced. If he still does not get an explanation that satisfies him that things are being done to improve patients’ quality of care, I am sure that my hon. Friend the Minister of State would meet him. He would be welcome to come back to us with any issues, but I urge him to have a meeting with the chief executive first.

End-of-Life Care

Anne Milton Excerpts

Tuesday 28th June 2011 Westminster Hall

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

As ever, it is a pleasure to serve under your chairmanship, Mr Walker. I congratulate my hon. Friend the Member for Great Yarmouth (Brandon Lewis) on securing this debate. He is closely involved with charities in his constituency, and the issue is close to his heart, as it is to mine, having worked in the NHS for 25 years before entering this place. I congratulate him and all the local people who have worked tirelessly to raise funds in his area.

Many people receive excellent care at the end of life, but not everyone does. Services in some parts of the country are not as good as services in other parts, and people with some diagnoses are more likely to get good, high-quality, end-of-life care than others. My hon. Friend is right that choice is absolutely central. Choice is about where one is cared for and where one dies. The end-of-life care strategy, published under the previous Government in 2008, aimed to improve care for people approaching the end of life, whatever their diagnosis, wherever they were, including enabling more people to be cared for and die at home, if they wish. It is worth noting that the figures indicate that 17% of people, when asked where they would like to die, reply that it depends. That depends largely on the sort of support that they feel that they might get. My hon. Friend the Member for Waveney (Peter Aldous) mentioned respite care, which is an important element. People feel they might like to die at home if their family could get some respite from their responsibilities.

The end-of-life care strategy covers all adults with advanced progressive illness, and care given in all settings. We know people want choice about where they die. Some want to die at home, but not everybody. Some people are happy to die in a care home, where that has become somebody’s home, which we must not forget. However, we know that most people die in hospital; the figure is about 57%.

We want to ensure that the services are there to help people die and live the end of their lives in a comfortable setting. For choice to become a reality, we need commissioners and providers to ensure that the right services—including community-based services, such as 24/7 care, as mentioned by my hon. Friend the Member for Waveney—are available to support people at home. Ensuring that those services are available cannot be done overnight. We have said that we will review the progress we have made in developing and improving services in 2013; that will be an audit of where we have reached.

We also want to review the payment system to support end-of-life care, including exploring options for per patient funding. The funding has to be right to provide the incentives to commissioners to purchase the care that we want to see. We have set up an independent palliative care funding review to look at the matter, as mentioned by my hon. Friend the Member for Great Yarmouth. The review, covering both adult and children’s services, has been looking at options to ensure that the funding for palliative care providers is fair and encourages the development of community-based services. As I said, it is important to get the levers and incentives in the right place. We hope to be able to respond formally to the report by the end of the year.

Of course, hospices and the important role that they play are in the mix of care facilities that need to be provided. When I worked in this area of nursing there were very few hospices in the country. One cannot talk about end-of-life care without mentioning people such as Colin Murray Parkes who spearheaded the hospice movement. We want to see hospices flourish, develop and continue the expansion of their remit for caring for those with illness other than cancer, and into community-based support for patients, their families and their carers.

Only a comparatively small number of people die in a hospice, but a great many more benefit from their services and expertise in other ways, such as day therapy or hospice at home. My hon. Friend the Member for Great Yarmouth mentioned the £40 million capital grant for hospices, but that an area must have a hospice to get the grant. His point is well made. The one-off grant allowed us to fund 123 projects in 116 hospices, which is quite a far reach. For the longer term, the palliative care funding review will help us move towards a fairer funding system that puts the levers in the right place.

However, it remains for local NHS commissioners to determine what services should be provided locally. I urge all hon. Members to ensure that they work closely with the local NHS. I understand that the estimated need for palliative care is higher in Great Yarmouth and Waveney than in any other PCT. NHS Great Yarmouth and Waveney, together with Norfolk and Suffolk county councils, have commissioned the Marie Curie “Delivering Choice” programme, one of the first to be established in the east of England. That programme brings together local organisations, patients and carers. I can assure my hon. Friend the Member for Great Yarmouth that the Department of Health never forgets the third sector. The third sector is a very important part of the mix of health care providers. We never forget it because there are people around the country who work tirelessly in the third sector, not just to support people who are ill or at the end of their lives, but their families and carers.

My hon. Friend the Member for Great Yarmouth is right that hospice provision is part of the mix of care. Ideally, no care setting should have priority over any other. The settings are like the pieces of a jigsaw: the picture is not complete until all the pieces are in place. The choice is not there until all the choices are available locally. Many care homes have developed a lot of expertise in the area and are now delivering excellent end-of-life care. The knowledge and expertise owned by the professionals in end-of-life and palliative care are what matters.

I will return to the subject of the local area. NHS Great Yarmouth and Waveney have put together this programme, and a new end-of-life pathway has been defined and specifications written for the services required to deliver it. The new services that have been commissioned are specialist palliative in-patient services; a care resource and outreach service; and a nursing end-of-life care facilitator.

I fully understand the concerns that prompted my hon. Friend to secure the debate, and it wonderful that he has the support of other hon. Members. I am sure that working together with the local NHS, they will move the programme forward. I applaud his commitment to the campaign for the best-quality end-of-life care for his constituents. I believe that the initiatives and steps that the Government are taking will help improve this important area of health care. We look forward to continuing to work with everybody, including those in the hospice movement, to achieve that aim.

I would like to finish by mentioning the incredible efforts, not just of those in the east of England but around the country, who are tireless in their efforts to raise money, to support those at the end of their lives, and to support the families who are looking after them.

[Dr Coffey]

I welcome the Minister’s warm words for actions already undertaken by my hon. Friends the Members for Great Yarmouth (Brandon Lewis) and for Waveney (Peter Aldous). At some point, would she come to our part of the world, to meet people who are actively involved, and to hear about other aspects such as the community nursing care fund, which, as long as she helps us get a hospice, may provide a good role model for elsewhere in the country?

[Anne Milton]

I would be delighted to visit the east of England. The hon. Lady has struck a good deal. I am always interested to see progress made. As she says, it is important to spread good practice. For anybody who is in need of NHS services or care, nothing but the best will do. We should never lower our standards in trying to achieve that aim. Nothing but the best will do on the day one is born; and nothing but the best will do on the day one dies.

Maternity Services

Anne Milton Excerpts

Wednesday 22nd June 2011 Commons Chamber

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

I congratulate the right hon. Member for Barking (Margaret Hodge) on securing the debate, and thank her for bringing this important issue to wider attention. Her message came across loud and clear. She has campaigned vigorously in support of her local health services for many years, both on the Government and Opposition Benches, and Members are to be congratulated on their vigilance in doing exactly what they were elected to do.

It is never good enough for patients anywhere to experience poor-quality health care, and it is clear that the problems at Queen’s maternity unit must be fixed now, so that the people of north-east London can regain trust in their maternity units. Regaining such trust is never an easy business. When mothers go to a maternity unit to give birth, they implicitly trust that they will receive the best-quality care. That is a vital part of maternity services, and it means that mothers can feel comfortable and safe with midwives, wards and hospitals. The shocking deaths at Queen’s maternity unit have put that relationship and that trust at risk, and I know that local concern is running extremely high. I offer my heartfelt sympathy to the families involved. To lose someone at what was expected to be a time of celebration is especially traumatic, and no words that I can say today will console those families. However, I believe that the message has been conveyed by the right hon. Member for Barking, the hon. Member for Ilford South (Mike Gapes) and my hon. Friend the Member for Ilford North (Mr Scott).

I understand that two investigations of maternal deaths are taking place at the unit; I hope Members will understand that I cannot comment on them at this stage. I know that the Care Quality Commission found that maternity services at the trust were failing to meet essential standards of quality and safety, but, although that was partly due to unsuitable staffing levels, they are not the only issue.

Unfortunately we cannot turn the clock back, but what we can do is ensure that decisive action is taken immediately to improve the position and ensure that the Queen’s maternity unit performs as it should have all along. In response to the CQC’s report, the trust has drawn up an urgent action plan and is taking steps to improve its maternity services. I understand that it has recruited an extra 60 midwives, and that a further 60 are shortlisted for interview. I also understand that it has revised the training programme for all midwives, created a new triage system enabling all women in labour to be seen by an experienced midwife within 15 minutes of arriving at the unit—the right hon. Lady particularly mentioned waiting times—and introduced a telephone triage system so that women can get advice even before they leave home. That is a start, although it is a start from a very low base. Although all those facilities should have been in place already, it is good that they are there now.

I have met Averil Dongworth, the new chief executive of the trust. She has assured me that everyone at the hospital—particularly the midwives and the support staff in the unit—is determined to improve standards and rebuild confidence. That may sound hollow to the Members who are present, who have probably heard it before, but Averil Dongworth struck me as an impressive woman with a steely determination to turn things around. She has also promised to keep in touch with and meet the local Members of Parliament regularly. I think it important for them to feel that, on behalf of their constituents, they are monitoring the position regularly and frequently. I have asked Averil Dongworth to keep me up to date. The position is very simple: nothing but the best will do for anyone who is seen in the NHS.

I also understand that NHS London, the local strategic health authority, is taking action to improve clinical leadership. It is important for that leadership to be in place, because its absence is often the reason why things go wrong, particularly midwifery in this instance. I understand that the authority has asked a senior obstetrician and an experienced midwife to spend time working in the team.

The right hon. Lady mentioned the health for north-east London review, which includes proposals to change the way in which Barking, Havering and Redbridge University Hospitals NHS Trust delivers maternity care. As Members have mentioned, under those proposals King George hospital would continue to provide antenatal and postnatal care, but would no longer provide maternity services during delivery. Maternity services would be consolidated at Queen’s with a new midwife-led unit that could deliver more than 2,500 babies a year. I understand that the unit is empty. The situation is extremely disappointing, but the proposals have been referred to my right hon. Friend the Secretary of State for Health, and the independent reconfiguration panel will advise him within the month, no later than 22 July. I know that Members look forward to hearing the decision, but obviously I cannot prejudge it.

The financial payouts in litigation that the right hon. Lady mentioned really pale into insignificance when compared with the human cost. There is not just the human cost when things go tragically and irreversibly wrong, but the poor experience that women have had, which is a very bad start to their new family life. Nothing can compensate for any of those things. She mentioned Sareena Ali and the unresponsive nature of the trust in relation to complaints. That has to change and I sincerely hope that Averil Dongworth will turn that around so that local people can start what will be a very long and slow journey to building that trust.

The right hon. Lady also mentioned that the problem is not just about recruiting staff but keeping them. That is the real challenge. When local people have lost faith in a local NHS organisation, the recruitment of staff becomes increasingly difficult. Keeping up morale is very important, which is why I think it is an important step in that journey for the chief executive to keep in touch with local MPs.

The right hon. Lady rightly said that this should be about the care of women and their babies and families, and not about other people’s convenience. My hon. Friend the Member for Ilford North reiterated many of the same points and I am always impressed when there is cross-party support on issues such as this. This place does not always have a good reputation but at times like this our reputation should soar because that cross-party working is extremely important to get things done. The hon. Member for Ilford South also spoke about the cross-party support and referred to the culture and institutional problems, the issues that are so very difficult to dig into and turn around. I sincerely hope that we can start to do that.

The Government are doing all we can to stamp out instances of sub-standard care. As I have said, nothing but the best will do for anyone. New standards of care are being developed for antenatal services and the management and care of women in labour, as well as for delivery and post-natal care. We are also keeping up the record number of midwives entering training—nearly 2,500 this year and 2,500 next year. I want to see the potential of the whole maternity team being realised. There are new technologies out there and new techniques improve care and deliver value for money while improving the experiences of women, their babies and the wider family. We will continue to work with the Royal College of Midwives to make sure that we have an appropriately resourced but also skilled maternity work force with the leadership they need. Of course, that will be of scant consolation to many of the families involved, but sadly I cannot turn the clock back.

[Margaret Hodge]

I am grateful for the Minister’s remarks, but in the last couple of minutes available, may I ask her to comment on two other specific issues? First, I think that we need an independent inquiry. I recognise all that has been done, but will she respond to that point? Secondly, will she respond to my point about the Barking hospital site where we have a brand-new, state-of-the-art maternity unit that is being kept closed?

[Anne Milton]

I thank the right hon. Lady for making those points, but I honestly do not know that an inquiry is the right way forward. The tragedy of this is that we know what some of the problems are and there has been a failure to turn them around. Certainly, an empty building and a midwife-led unit that could deal with 2,500 deliveries a year for women of low risk would be an important development, but I do not want to prejudge the Secretary of State’s decision on that. I hope that the right hon. Lady, her constituents and the families involved will at least take some heart from the fact that steps are going to be taken to prevent any of this from ever happening again. I will make sure that those efforts remain at the top of the trust’s agenda. I can assure her, my hon. Friend the Member for Ilford North and the hon. Member for Ilford South that I will take a personal interest in this and make sure that we monitor progress towards giving local people what they deserve—the very best from their local NHS.

Question put and agreed to.