Oral Answers to Questions

Anne Milton Excerpts

Tuesday 26th April 2011 Commons Chamber

[Mr John Leech (Manchester, Withington) (LD)]

14. What progress the NHS North West Specialised Commissioning Group has made in reviewing neuromuscular services in the region; and if he will make a statement.

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

I understand that the North West Specialist Commissioning Group received a report from its neuromuscular services review group at the end of March, and that it has since circulated it to all primary care trust chief executives with a request that it is shared with board members and GP commissioning consortia leads.

[Barbara Keeley]

The north-west has not seen the investment in extra services, such as transitional care and extra care advisers, that the report recommends, and now the Government’s proposed reforms are causing turmoil in specialised commissioning and real worries about how the commissioning of tertiary services will work in future, so will Health Ministers issue guidance to commissioners to ensure that the investment is made to cover those critical gaps in the north-west, and that emergency admissions are avoided?

[Anne Milton]

I thank the hon. Lady for her question, but I reject her assertion that the changes to the NHS—the modernisation of the NHS—have thrown the process into difficulty. Clearly, she feels that there is a problem in the first place. As I am sure she will agree, however, it will be down to the commissioning of the GP consortia and the primary care trusts to decide the best way to provide services in the light of all the information that they have. I understand that the commissioners will feed back to the specialised commissioning group on how they will deal with the recommendations.

[Mr Leech]

The report highlighted that, for an investment of less than £30,000, Manchester primary care trust could ensure that all muscular dystrophy sufferers, including my constituent Ben Dale, have access to specialist care adviser support, saving an estimated £5 million in hospital admissions costs. Does the Minister agree that that investment would be excellent value for money, given that it would help my constituent Ben to live a more fulfilling life and save money for the NHS?

[Anne Milton]

The hon. Gentleman specifically mentions a constituent of his, and I have every sympathy with people coping with muscle-wasting diseases, and indeed with their families. The burden can be quite considerable. The multidisciplinary group that examined services throughout the north-west deserves our thanks for its work, but the fact is that it is for NHS commissioners, PCTs and the emerging GP-led consortia to consider the evidence that they have. Indeed, if money can be saved by commissioning services in a different way, so they should be, but that decision should be taken locally.

[Kate Green (Stretford and Urmston) (Lab)]

2. What steps he is taking to ensure the provision of acute services in Trafford district.

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[Mr David Hanson (Delyn) (Lab)]

6. What discussions he has had with Ministers in the Welsh Assembly Government on the cross-border implications of the Health and Social Care Bill.

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

The Secretary of State for Health met Ministers of the Welsh Assembly Government on 1 December last year to discuss the future of the cross-border commissioning protocol, and I am meeting the Under-Secretary of State for Wales in the next few weeks. It was agreed that until the forthcoming changes in the Health and Social Care Bill are finalised, no substantial changes to the cross-border protocol should be introduced, as is right. The protocol, which expired on the 31 March this year, has therefore been renewed for one year with minimal changes.

[Mr Hanson]

More than 200,000 people from Wales, including people from my constituency, access services in England at the Countess of Chester hospital, Clatterbridge, the Christie, and the Walton in Liverpool. More than 50,000 people from England access health services in Wales. What guarantees can the Minister give me that the proposed changes in the Health and Social Care Bill will not wreck those arrangements?

[Anne Milton]

There is absolutely no reason why they should. I thank the right hon. Gentleman for raising this issue. It is worth pointing out that there are many areas of commonality between the health services in England and Wales. Of course, it is up to the Welsh Assembly Government to decide what scale of finance and resource they provide. I am aware that there are some cross-border issues that clearly need to be resolved.

[Richard Drax (South Dorset) (Con)]

Will the Minister confirm whether funds will be held by the consortia or the GPs in the practices, because there is confusion among GPs in my constituency of South Dorset on that point?

[Mr Speaker]

With reference to the discussions that have been held with the Welsh Assembly Government.

[Anne Milton]

I am grateful, Mr Speaker. I was going to make that point. Although Dorset is a long way from Wales, I assure the hon. Gentleman that GPs will not have the money in their personal bank accounts.

[Hywel Williams (Arfon) (PC)]

The Minister will know from the Welsh Affairs Committee report that there is considerable traffic of people accessing GP services across the border in both directions, with the net benefit going to England. Will she reassure me that the interests of people on both sides of the border will be served when the Health and Social Care Bill is finally enacted?

[Anne Milton]

Yes, I assure the hon. Gentleman that the Health and Social Care Bill aims to resolve as many of the problems that we know about on the border as possible.

[Mrs Linda Riordan (Halifax) (Lab/Co-op)]

7. What estimate he has made of the number of local authorities which changed their eligibility criteria for social care in the last 12 months.

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[Simon Danczuk (Rochdale) (Lab)]

8. What plans he has to visit NHS services in Rochdale; and if he will make a statement.

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

My right hon. Friend the Secretary of State for Health visited the Pennine Acute Hospitals NHS Trust, which delivers services to the people of Rochdale, in June last year. There are no immediate plans to repeat the visit.

[Simon Danczuk]

The reason I asked the question is that the people of Rochdale are extremely concerned about how Rochdale infirmary is being run and believe that the Pennine acute trust is not accountable. The Minister and the Secretary of State will be aware of the recent Channel 4 “Dispatches” programme, which showed the trust and its chief executive in a very poor light. The reconfiguration of services there has been handled very badly. May I ask the Minister, as a matter of urgency, to act upon all the concerns and investigate the management of the Pennine acute trust?

[Anne Milton]

I thank the hon. Gentleman for his question. I am aware of the recent “Dispatches” programme and the fact that the Pennine Acute Hospitals NHS Trust is implementing a number of service changes in a number of areas, including Rochdale. Those changes are part of the “Healthy Futures” and “Making it Better” programmes, both of which have been subject to full consultation with local people. NHS North West has confirmed that both programmes meet the four tests for service change, but if the hon. Gentleman continues to have concerns, I am sure one of the ministerial team will deal with them personally.

[Chris White (Warwick and Leamington) (Con)]

9. What steps he is taking to maintain front-line services in the NHS.

--- Later in debate ---

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

17. How much funding he plans to allocate to local authorities in order to perform their new public health duties in each of the next three years.

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

We want local authorities to have the powers and the resources that they need in order to make a real difference to the health and well-being of their local populations. Shadow allocations for the local ring-fenced public health budget will be announced later this year.

[Diana Johnson]

Hull’s Lib Dem council does not have a very good record on public health. It is currently slashing services delivered to children through its children’s centres and early years services. We all know that public health can be improved by that early investment. What is the Minister going to do to ensure that councils take their wider public health responsibilities seriously?

[Anne Milton]

I thank the hon. Lady for her question. With resources come responsibilities. I am pleased that the hon. Member for Hackney North and Stoke Newington (Ms Abbott) has welcomed the shift in public health. There is no doubt about it: local authorities have a long history of delivering public health improvements, and this will give them the opportunity to see again some of the improvements that were long awaited under the last Government.

[Helen Jones (Warrington North) (Lab)]

20. What assessment he has made of progress in providing co-ordinated medical assessments for children with disabilities.

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

The Department for Education Green Paper, “Support and aspiration: a new approach to special educational needs and disability—a consultation”, was published in March and includes a proposal to develop a single new co-ordinated assessment for education, health and care plans by 2014. The consultation on the Green Paper continues until June 2011, and I hope that the hon. Lady will respond to it.

[Helen Jones]

That was a very interesting answer, particularly as the Prime Minister told me on 30 March that this

“idea is rapidly becoming Government policy.”—[Official Report, 30 March 2011; Vol. 526, c. 340.]

Can the Minister tell us whether she intends to table an amendment to the Health and Social Care Bill to ensure that those crack teams of medical experts that the Prime Minister promised would be set up will be set up by GP consortia?

[Anne Milton]

Families of children with disabilities and special needs will welcome the single, co-ordinated assessment. We have to see health and social care working more closely together, because those families bear a considerable burden of care. I would point the hon. Lady towards the consultation, and I suggest that she points her constituents towards it as well, as it is extremely important that we get their feedback.

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

22. What steps he is taking to extend the choice that patients have over the treatment they receive from the NHS.

Reciprocal Health Agreement (United Kingdom and Jersey)

Anne Milton Excerpts

Friday 1st April 2011 Written Statements

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

Following discussions between the Department of Health, the States of Jersey Government and the devolved Administrations, a new reciprocal health agreement between the United Kingdom and Jersey will come into effect from 1 April 2011.

The new agreement will ensure that UK residents visiting Jersey will receive free, state-provided immediately necessary treatment while on a temporary visit to Jersey, as will Jersey residents visiting the UK. No public money will change hands under the agreement, which is a common feature of all of the United Kingdom’s non-European economic area reciprocal health arrangements

The new agreement will provide certainty for travellers and represents a mutually beneficial agreement for both the United Kingdom and Jersey.

Carmel Bloom

Anne Milton Excerpts

Tuesday 29th March 2011 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Miss McIntosh. I congratulate my hon. Friend the Member for Ilford North (Mr Scott) on securing this debate. He has set out, with considerable passion, some of the detail that led to the death of Carmel Bloom following her operation to remove a kidney stone. It was a moving speech and I commend him for the support that he has given to Ms Bloom’s brother, Bernard, who has worked tirelessly to try to establish the sequence of events that led to his sister’s death.

My hon. Friend has worked tirelessly to give support not only to Ms Bloom’s brother but to the family. I should like to take this opportunity to extend my sympathies to the family. Being unable to find out the circumstances of Ms Bloom’s death or to get any closure is a terrible burden to live with.

As my hon. Friend has eloquently said, there have been numerous investigations and inquiries into the treatment that Ms Bloom received. I know that in 2002 there was a coroner’s inquest that recorded a verdict of death by natural causes. The second post mortem did not provide conclusive statements and a further inquest in the presence of a jury found the cause of death to be

“progression of pre-operative infection following surgery, to which the absence of post-operative intubation, ventilation and monitoring contributed.”

However, none of those investigations or inquiries has brought the closure that is required by the family, or a feeling that they have found out the true circumstances of what happened.

As my hon. Friend has said, there were fitness to practise hearings into the behaviour of two clinicians, but those hearings found that the failings of neither clinician amounted to misconduct. The hearings came to the judgment that it was not necessary to issue a warning in either case. As I say, none of those investigations or hearings has resulted in an explanation that has satisfied my hon. Friend or indeed Ms Bloom’s relatives.

I have nothing but admiration for people who pursue answers to questions, sometimes, sadly, in the face of considerable adversity. Unfortunately, it is really down to their tireless efforts that we learn more and more about the failings of systems. What is important is that we ensure that we learn lessons and that those failings do not happen again.

As my hon. Friend said, Mr Bloom has taken up his case with the Metropolitan Police Service and so my hon. Friend will appreciate that, in the light of ongoing inquiries, I cannot comment further on any police action. I know that that might be a disappointment to Mr Bloom, but it is essential that due process is allowed to take its course free from interference from the influence of Government Ministers.

I also want to commend my hon. Friend for his tribute to Julie Moody. Whistleblowers, for want of a better word, are an important part of this process and we have strengthened the protection of people who have information that we feel is important. That information, when it reflects on the safety and efficacy of treatment, is absolutely vital and it is important that those people are protected.

Services provided by independent hospitals such as the Spire Roding hospital are subject to regulation and inspection. All health care providers in England, whether they operate in the independent sector or in the NHS, are subject to both professional regulation and system regulation. It is important that those things work and are effective.

Health care professionals are required to be registered with their relevant professional regulator. As my hon. Friend knows, in the case of doctors, that is the General Medical Council. He is absolutely right that the GMC’s purpose is not to act as a trade union—the British Medical Association is the trade union for doctors—but to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine. It does that by controlling entry on to its register, and by setting standards for medical schools and postgraduate education and training. The GMC registers doctors to practise in the UK and, where necessary, it has the power to issue warnings, remove a doctor from the register, suspend a doctor or place conditions on a doctor’s registration.

Interestingly, in preparing for this debate, I got out some figures about the GMC. In the last year that we have figures for, the GMC undertook 270 fitness to practise hearings, which resulted in 68 instances of doctors being struck off the register and 77 instances of doctors being suspended. I think that those figures give my hon. Friend some idea of the sort of activity that the GMC is engaged in.

At the time of Ms Bloom’s death, independent hospitals were registered with the then Commission for Health Improvement, but since that time a new system of registration has been introduced, which focuses on the outcomes of care that matter most to patients. Although I will not be able to respond to all my hon. Friend’s comments and questions today, it is perhaps important for me to set out some of the changes that have been made.

All health care providers are required, as part of their registration with the Care Quality Commission, to have an effective complaints mechanism that will enable them to learn from the experience of patients. That is an important point to make. Often we cannot change what has happened and we cannot always correct mistakes. People want to know what happened, but most importantly they want to know that things have changed as a result of what has happened to them or to their family and that lessons have been learned.

In the first instance, a complaint would be considered by the provider itself. In the case of the Spire Roding hospital, if a complaint is not resolved to the satisfaction of a patient at the hospital level, I understand that an independent review can be requested from Independent Healthcare Advisory Services. On 1 October last year, the registration of independent health care providers was transferred to the new registration system operated under the Health and Social Care Act 2008. Under that new system of registration, all providers of a regulated activity—whether they are privately or publicly funded—are legally required to register with the CQC. Providing a regulated activity without being registered is indeed a criminal offence and in order to be registered a provider has to meet and must continue to meet 16 registration requirements. Those requirements set out the essential levels of safety and quality for the provision of health care and adult social care in England. Those are essential levels of safety and quality, and as I have said already they focus on the outcomes that matter to patients and all service users.

Where a provider provides services that do not meet those essential levels of safety and quality, the CQC now has additional enforcement powers that were not available in 2002. For example, it can now issue a warning notice for non-compliance and a new financial penalty notice can be issued in lieu of prosecution through the courts. In extreme cases, the CQC has the power to close down a specific service or ward, or to cancel a provider’s registration and/or to bring a prosecution for non-compliance. If the CQC does bring a prosecution, the courts are now able to impose a larger fine of up to £50,000 where a provider has failed to meet essential levels of safety and quality. Those powers should provide some assurance to patients and service users that wherever they access health and adult social care they will receive a service that at the very least meets essential levels of safety and quality.

The CQC is risk-based and it should be a transparent regulator. That transparency is very important. Its inspections are informed and guided by the intelligence that it gathers about providers, and its inspection reports are publicly available on its website. I understand that there have been three inspections of the Spire Roding hospital in the last few years and that there were two inspections in 2009.

I can assure my hon. Friend that we want robust and effective regulation of health care providers and that we want to improve current arrangements. The health reforms that are currently before Parliament will strengthen the role of the CQC, by giving it a clearer focus on regulating the essential levels of safety and quality. In addition, we have also set up HealthWatch as a new and powerful consumer champion for users of health and social care services. It is very important that that voice for patients and the public is heard. HealthWatch will be established as a committee of the CQC and it will provide a direct route for the views of service users to reach the regulator.

[Mr Scott]

Would the Minister be willing to get back to me on the points that time obviously has not permitted us to cover today?

[Anne Milton]

I know that time is running out on us and I will certainly get back to my hon. Friend. My door and the doors of other Ministers are always open if it would be useful to have a meeting to clarify some of the issues that we have discussed. Of course, as I have said we cannot necessarily interfere in processes that are already under way.

I know that what I have said today will not change things for Ms Bloom’s brother and the rest of her family and friends, and I also know that the ripple effect of a case such as this one goes far and wide. Sadly, what I say today cannot provide the closure that they want, but hopefully I can work with my hon. Friend to give him and Ms Bloom’s family and friends some of the answers that they so desperately seek.

Maternity Services (Hastings)

Anne Milton Excerpts

Thursday 24th March 2011 Commons Chamber

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

I congratulate my hon. Friend the Member for Hastings and Rye (Amber Rudd) on securing the debate. There is no more important issue for a politician or, indeed, a politician’s constituents than the health services available in their constituency. My hon. Friend spoke with passion about her concerns and those of her constituents. I note that she and the hon. Member for Eastbourne (Stephen Lloyd) paid tribute to Margaret Williams and Liz Walke, the campaigners from last time. They must have a heavy heart listening to or reading tonight’s debate. I do not think that my hon. Friend is panicking early. She is doing exactly what is right: highlighting early her concerns and fears in the light of some vigorous campaigning three years ago.

I would like to join my hon. Friend, as I am sure other Members for the area would, in paying tribute to the NHS staff in her constituency for their hard work and dedication. In common with NHS staff throughout the country, the health and well-being of the public is their driving motivation day in, day out. It is not an easy time for them, and we should not lose sight of that. The Government will support them and ensure that they have the power to provide people with the health outcomes that are consistently among the best in the world.

It would be remiss to pretend that the NHS is free from problems. It is right for people to be concerned when they see something going wrong. I can therefore understand why people in Hastings may have been anxious following the Care Quality Commission’s recent inspection. As my hon. Friend knows, the commission found that inadequate staffing was putting patients at risk, and that that affected the quality of services being provided in the maternity units and in A and E. From the very beginning, the Government have made it clear that safety must be at the heart of the NHS, and that substandard care will not be tolerated. I trained as a nurse and worked in the NHS for 25 years, and from my point of view, nothing but the best well do for the people of this country.

We expect the trust to work hard to resolve the issues raised, and my hon. Friend spoke quite warmly of its response. I understand that it is working closely with the PCT and the strategic health authorities to address the issues by 31 March. I hope and expect that it will meet that deadline.

My hon. Friend spoke of her constituents’ fears that the CQC’s concerns about the safety of the local maternity units will lead to the Conquest’s consultant-led maternity service being closed, and of the previous campaign on that. My constituency is not so very far away from hers. My constituents were also victims of “Creating an NHS fit for the future”, which I felt at all times was fit only for the bin.

I know that in 2008 the independent review panel advised the then Secretary of State for Health that consultant-led services should be retained in both Conquest and Eastbourne hospitals. Both my hon. Friend and the hon. Member for Eastbourne felt that that would be an end to matters, and I understand why people in East Sussex now worry about a new threat.

I gather that East Sussex Hospitals NHS Trust has sought to calm those fears by stating publicly that there are no plans for the closure of either maternity unit. However cynical we might become when we have campaigned over time on local issues, we must take what we hear at face value and believe it. I am also aware that the trust has advised local MPs that it will look at various options for the future of maternity services, and that those services will be linked closely to paediatrics, emergency services and gynaecology. The review will have input from external clinical experts, which is crucial for the confidence of local people. Irrespective of their cynicism, it is important to stress that no decision has been made in advance, and that the trust has no plans to close any of the units.

However, I understand the concerns of local people and my hon. Friend. Whatever decisions are made, they must be guided by the trust’s principal responsibility to provide high-quality and safe care. Decisions must be made in an open and transparent way, with the involvement of GP commissioners, staff, patients and public, and with full, real and meaningful consultation. As she knows, I cannot speculate on or prejudge the optimum size of the unit or the outcome of the exercise.

It is right that decisions are made locally without central interference. The Government believe passionately that local decision making is essential in improving outcomes, and in driving up the quality and sustainability of services for different communities. My hon. Friend ably highlighted some of the deprivation and health inequalities in her constituency.

To that end, the Health Secretary has identified four crucial tests that all service changes must pass: they must have the support of GP commissioners; arrangements for public and patient engagement must be strengthened; there should be greater clarity on the clinical evidence base underpinning any proposals; and any proposals must take into account the need to develop and support patient choice, which my hon. Friend mentioned. That means that service changes that do not have the support of GPs, local clinicians, patients and the local community should not happen, which gives patients, local professionals and local councils a far greater role in how services are shaped and developed, and ensures that changes will lead to the best outcomes for local people. That is in line with our proposals in the Health and Social Care Bill, in which we have said that local NHS services must be centred on patients, led by local clinicians and free from political interference, whether from this House or the various layers of NHS management.

My hon. Friend raised, in particular, the working time directive. The coalition Government are committed to limiting the application of the directive in the UK. It has caused immense problems in the health service, and the Health Secretary will support the Secretary of State for Business, Innovation and Skills in taking a robust approach to future negotiations on the revision of the directive to achieve that greater flexibility.

I also draw my hon. Friend’s attention to the King’s Fund paper that questions the assumptions that outcomes improve in bigger units. The King’s Fund is right that an effective skills mix is important to get the best out of maternity units, and the Department of Health has commissioned the national perinatal epidemiology unit to undertake a study comparing the outcomes of births planned at home, in different types of midwifery units and in hospital units with obstetric services. That report is expected in autumn 2011 and will be very important in providing the evidence for further action on choice of place of birth.

I fully understand my hon. Friend’s reasons for calling this debate. She is right to raise the matter at this very early stage, so that local people are clear that they are getting the support from their local MP—that was quite apparent from the passion with which she spoke—and so that all those working in the health service are aware of her close involvement. I applaud her determination to press for local health services that best meet the needs of patients, and to ensure that whatever measures are taken, following the CQC report and this review, the overriding concern of those services must be the interests of the local people.

Question put and agreed to.

NHS Access

Anne Milton Excerpts

Friday 18th March 2011 Written Statements

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

I am today publishing the Government’s response to the public consultation on access to the national health service by foreign nationals that was issued by the previous Administration before the election.

The NHS is built on the principle that it provides a comprehensive service, based on clinical need, not the ability to pay. However, it is not free of charge to all comers. Legislation dating back to 1977 permits persons who are not ordinarily resident in the United Kingdom to be charged for NHS services and subsequent regulations, first introduced in 1982, impose a charging regime in respect of hospital treatment.

The charging regime provides for some categories of non-residents to be exempt from charges, and international agreements provide reciprocal healthcare that benefits visitors from and to participant countries. It also takes full account of humanitarian obligations in the provision of healthcare, in particular ensuring that the emergency medical needs of any person are treated irrespective of their status or ability to pay.

The consultation was based on a limited review of access and charging policy. After considering the responses we received the Government have decided to take forward their main proposals, specifically to lay the new consolidated charging regulations including the specific changes that were consulted on:

extend the time UK residents can spend abroad without losing automatic entitlement to free hospital treatment from three months to six months;

allow failed asylum seekers who are on UK Border Agency support schemes for families or because there is a barrier to their immediate return, to continue to receive free hospital treatment (but retain charges for those other failed asylum seekers who refuse to return home); and

guarantee the provision of free hospital treatment for unaccompanied children while under local authority care.

In addition, we are taking this opportunity to introduce a limited term exemption for Olympic and Paralympic games competitors and officials in line with a commitment made in our successful 2005 bid, and to amend the trigger for exempting charges for pandemic flu treatment to protect public health.

We also support the Home Office’s plan to introduce proportionate immigration sanctions on overseas visitors who refuse to pay appropriate charges for treatment provided. The Department will therefore introduce measures to enable data-sharing with the Home Office to support this while guaranteeing necessary data privacy standards.

However, it is increasingly clear that the overall charging regime is neither balanced nor efficient. Overall entitlement to free healthcare, through residency or other qualifying exemptions is often more generous to visitors and short-term residents than is reciprocated for UK citizens seeking treatment in many other countries. Charging regulations only cover hospital treatment, so visitors may receive free primary care and other non-hospital based healthcare services. Although hospitals have a statutory duty to enforce the regulations, effective enforcement by hospitals appears to vary considerably.

For these reasons we believe that a further fundamental review of the current policy is needed. The review will include:

qualifying residency criteria for free treatment;

the full range of other current criteria that exempt particular services or visitors from charges for their treatment;

whether visitors should be charged for GP services and other NHS services outside of hospitals;

establishing more effective and efficient processes across the NHS to screen for eligibility and to make and recover charges; and

whether to introduce a requirement for health insurance tied to visas.

Access for European Union residents is determined by separate EU regulations. The review will not consider changes to these regulations.

The review will respect the NHS’s core values and its obligations to provide urgent treatment, as well as the need to protect public health and observe international agreements. Denying necessary access to any person or group is not an option. We will consider the full benefits and costs of introducing new charges including risks of deterred or delayed treatment and any other societal costs. It will be informed by exploring equivalent policies in other health economies and we will seek views and input from NHS managers and other interested parties. The scope of options is deliberately wide-ranging and we do not want to rule individual changes in or out pending this further evaluation. The proposals will be the subject of a full public consultation on completion of the review.

The Government’s response to the consultation 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 Care (West Cumbria)

Anne Milton Excerpts

Wednesday 16th March 2011 Westminster Hall

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

It is a pleasure to serve under your chairmanship for the first time, Mr Weir. I congratulate the hon. Member for Copeland (Mr Reed) on securing this debate. My goodness, it is quite a thing that he, his wife and his four children were all born in the West Cumberland hospital. The hospital also saved his life. Despite our political differences, I am sure that he will join me in saying that whenever we debate the NHS, we always pay tribute to the staff who work in it at every level. We tend to talk about doctors and nurses, but there are many members of staff who ensure the safe delivery of children and who save lives. I am sure that the hon. Gentleman would like to associate himself with those comments.

The hon. Gentleman has been actively involved in campaigning for the redevelopment of West Cumberland hospital, and he is also a strong supporter of community hospitals. He spoke with some passion about his role and his long history in that regard.

[Tony Cunningham (Workington) (Lab)]

The Minister mentioned community hospitals. There is one in my constituency at Cockermouth, and for a considerable period the authorities have been promising to rebuild it. After the terrible flooding in 2009, parts of the hospital are in portakabins. We are desperate for the new hospital. The funding and the planning permission are in place, yet we are still waiting for a decision. Will the Minister please look into that situation—she does not have to do it now—because the people of Cockermouth are desperate to get their new hospital?

[Anne Milton]

I thank the hon. Gentleman for his remarks. It is frustrating for local people when they are waiting for decisions to be made. General elections come along, disrupt things and, sadly, slow down the process even more. I can understand his constituents’ frustration. Later in my remarks, I will address how we can move forward.

The hon. Member for Copeland was right to make the point that local NHS organisations are precious not just for the services that they provide, but for the employment and economic support that they bring to the area. I note, in particular, his work with the west Cumbria strategic forum and the development of the energy coast master plan for west Cumbria. The development of local NHS services plays an important role in that.

The hon. Gentleman will also know that in west Cumbria, as in other parts of the country, the NHS is under tremendous financial pressure. Indeed, he alluded to that. We are where we are; we have inherited a substantial deficit. Both parties acknowledge the fact that we face some serious economic challenges, and we are determined to find £20 billion in efficiency savings so that we can then reinvest in quality care, and the need to do that is real and urgent. Such pressures would have existed whoever was in government. The fact that we have protected NHS budgets is an important step in ensuring that the challenges facing the NHS are slightly less than those facing other areas. None the less, the upshot is that every NHS trust in the country will have to make tough choices to put health care on a sustainable footing, and that is what is happening in west Cumbria.

I understand that the North Cumbria University Hospitals NHS Trust has struggled financially for a number of years. Clearly, there are some unresolved issues that people are now keen to sort out. Like the country as a whole, the trust is on a journey to restore balance to its finances, and we need to consider how we get better value for money. When I visit hospitals and trusts, it is interesting to see how substantial amounts of money have been taken out of costs by small changes in the way services are delivered. Although this is a challenge, it is also an opportunity, and I am impressed with the innovation that people are demonstrating.

As the hon. Gentleman is aware, the trust concluded in February 2011 that it would not be in a financially viable position for achieving independent foundation trust status by the 2014 deadline. It has made the difficult choice to pursue an arrangement with an existing foundation trust, through merger or acquisition, to ensure its ability to deliver high quality services in the future. The trust reached that decision for a number of reasons, including reduced contract income as more health care is provided outside acute settings, historical debts, costs associated with the private finance initiative scheme, to which the hon. Gentleman alluded, and ongoing requirements to meet cost saving targets.

Having trained as a nurse and worked in the NHS for 25 years, including as a district nurse, I am acutely aware that although our focus is always on acute care the majority of health care is delivered outside acute settings. It is the tension and the co-operation between those two elements of health care that we must now finally get right. The trust must address the issues that I have just mentioned. In particular, it must identify and agree an affordable clinical model that will deliver sustainable high-quality services. It is no good going for short-term gains. We need the process to be sustainable and lasting.

The hon. Gentleman will know that, back in 2007, the NHS in Cumbria set out its plan to reduce unnecessary hospital admissions by looking after people closer to their homes, which is where they want to be. The closer to home programme supported the development of community-based services and the redevelopment of acute facilities to meet local needs. In support of that programme in Cumbria, there is the redevelopment of West Cumberland hospital, which will deliver acute services with support from a wider range of community services.

Following recommendations by the national clinical advisory team last year, I understand that the north Cumbria health economy is now working to develop an affordable clinical strategy, covering primary, secondary and acute hospital services. I understand that the strategy will be published this summer. I suspect that it cannot come soon enough for the hon. Gentleman and many others in the area. In many ways, the strategy will build on the closer to home programme by considering how local health care services can be delivered more affordably, while keeping service quality at the very highest level, which is critical. As part of that process, it is true that the review group is looking at what will happen to acute services at West Cumberland hospital.

During his tour of hospitals in Cumbria last year, my right hon. Friend the Secretary of State for Health acknowledged the importance of West Cumberland hospital to the local people. That view is shared by all of us and it is being taken into account by the Department of Health, the North West strategic health authority and the NHS in Cumbria, which is working on the full business case for the redevelopment of the hospital. That business case will need to reflect the clinical strategy. It is very important that these decisions are driven by clinical need and that they meet the needs of local people.

[Mr Reed]

The Minister talked about the trust’s unique responsibilities. Of course, one of the unique responsibilities that the trust must address is the unique service that west Cumbria provides to this country in the form of the nuclear industry, and the unique challenges that the industry poses for the trust. It is in the interests not only of my constituents but of the whole country that the issue is addressed, and it must be done on a cross-party basis. Would the hon. Lady care to say something about that?

[Anne Milton]

Yes. I thank the hon. Gentleman for that intervention. He is absolutely right to tie up the facts. As politicians, we tend to use the word “sustainable” in a rather flippant way, but what he has just said is what “sustainability” should be about. It should take account of the changing needs of the area; we should be building services not for the next five years but for the next 10, 20 or 30 years.

Tension between acute services and community services has always existed, as has tension between acute services and specialist services. If I think back to my own time in the NHS 30 or 40 years ago—I am very old and it was a long time ago—I recall that regional centres for neurosurgery were being developed. Specialist services need to be provided in specialist centres. Local people want to know that they can go to their local hospital for the majority of things that are wrong with them. That is important. There needs to be a clinical driver in the process, to ensure that people get the quality of care that they need. However, one also needs to take account of people’s wants and desires, and they want care on their doorstep.

The hon. Gentleman raised a number of issues. I recommend that he attends the debate that is happening elsewhere in the House today if he wants a fuller discussion of NHS services. He wanted a number of guarantees from me, so he wanted a number of guarantees from the centre and yet in the same breath he talked about “top-down” and “centrally imposed” diktats. Again, that is one of the key issues, because the centre is never very good at making local decisions. What matters locally is that changes and discussions have the support of clinicians, and ideally are led by clinicians. Those changes and discussions must also have the confidence of local people. That confidence is possibly what has suffered in the past.

The hon. Gentleman talked a little about GP commissioning, GP fundholding and “any other willing provider”. He asked what “any other willing provider” means. I suggest that he goes back to his own party to ask that question, because using “any other willing provider” was at one point its policy. I feel very strongly that the reforms in the NHS will bring decisions about commissioning and getting care right for people absolutely where they should be: with the GPs who know and understand their local communities. It is extremely important that GPs’ inputs and commissioning skills are used to the fullest.

I am told that the national clinical advisory team is reviewing the draft strategy and that a final version will be put to the strategic health authority in the months ahead. In addition, the full business case for West Cumberland hospital, together with the business cases for development of community services, will need to be considered alongside the final clinical strategy. I know that the delay is frustrating, but it is absolutely vital if the decisions are to be made. I or my ministerial colleagues will be very happy to have a meeting with the hon. Member for Copeland. In fact, it might be useful if a meeting was set up with a number of MPs from the area, to thrash out some of the more difficult issues when we have slightly more time to do so.

The process must be clinically led and choices must be made on clinical grounds. The primary care trust must also be satisfied that proposals are properly costed and can deliver sustainable solutions and a sustainable model of care for Cumbria. However, I emphasise that no final decisions have yet been made.

This is an important period in the story of the NHS. An ageing population, rising demand and increasing costs are combining to make it a uniquely challenging time. It is always challenging to deliver health care, with rising expectations and rising demands. That means that all parts of the country must look critically at how they can make the best use of resources to deliver effective health care, in whatever setting it can be most effectively delivered. It also means more care being provided in the home and in the community. I think most people see that development as a positive step, and there must be support for it. The difficulty is that realising cost savings ultimately means changing hospital services as demand changes. However, the NHS actually has a good history and a good record on evolving and changing to meet changes in demand and patient choice.

[Tony Cunningham]

I quite agree with the Minister, and we understand why there need to be more services in the community. However, the point that I was trying to make in my earlier intervention is that we are desperately in need of a new community hospital in Cockermouth. If we are to have acute services at the West Cumberland hospital, we need up-to-date modern community hospitals that can do the sort of work that she is talking about. Will she at least undertake to look personally into why there is such a delay in the development of the community hospital in Cockermouth?

[Anne Milton]

Yes. I thank the hon. Gentleman for that intervention and I understand completely his passion on the subject. It is terribly frustrating to wait for something and I will ensure that we come back to him specifically on that point, because the hospital has been delayed for too long.

[Tony Cunningham]

I thank the Minister.

[Anne Milton]

Our ministerial doors are open, so I urge Members to set up a meeting to thrash out some of the issues that we have discussed today. Obviously, no final decisions have been made yet and we are waiting for reviews to be completed, so that all the relevant information is on the table. However, it is terribly important that local politicians feel confidence in the process, which must always be led by clinical needs, and feel that they can bring the public with them.

It is not an easy time in west Cumbria. Change is not easy and we are in a difficult financial climate. However, change requires proper scrutiny and this debate has been an opportunity for some of that scrutiny. As I have said, change also requires public engagement. I hope—indeed, I am sure—that the hon. Member for Copeland and his colleagues in the area will play their part in making change happen and ensuring that there is public engagement with it.

NHS (Essex)

Anne Milton Excerpts

Tuesday 15th March 2011 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Williams. I do not believe that I have had the pleasure before. I congratulate my hon. Friend the Member for Witham (Priti Patel) on securing the debate. The fact that she has attracted so many of her fellow Essex MPs is a testament to the importance of the issue. The health services in any MP’s constituency are always of major concern and it is fantastic to have an opportunity to raise some of those issues in the Chamber.

I must add to the comments made about the staff in the NHS. The staff in Witham, and across Essex, should be congratulated on their work. I trained as a nurse, like the mother of the hon. Member for Hackney North and Stoke Newington (Ms Abbott), and worked in the NHS for 25 years. I understand, therefore, some of the complexities of their job, and their dedication and expertise in driving benefits for my hon. Friend’s constituents on a daily basis is valued greatly. As a Government, we want to ensure that we support all staff and give them the framework to provide the highest standards of care for everybody they treat.

Before I go further, the hon. Member for Hackney North and Stoke Newington need not feel sorry for Government Back Benchers at all. She does them a disservice by suggesting that they do not see the reforms for what they are. They are an opportunity, for the first time, to bring patients and their clinicians closer together in shaping the services that they need. She is right to say that the previous Government put untold investment into the NHS. Spending on health doubled, if not more, in the time that they were in government. It is important to realise, however, that just chucking money at services does not mean that they will get better—we need to have value for money. Taxpayers expect and deserve that, and for every pound of taxpayers’ money that goes in, £1-worth of services needs to come out at the other end, and that is central to the debate.

We have set out proposals to free the NHS from bureaucracy and central control. My hon. Friend the Member for Witham eloquently set out her concerns, as did a number of other hon. Members, about those levels of bureaucracy and about her constituents receiving the health care that they need, with the choices that they want and with the highest standards that they deserve. Like all members of the public, we want to end the overbearing top-down oppression and give front-line professionals the freedom to innovate and make decisions based on their clinical judgment and the needs of their patients, rather than centrally dictated, process-driven targets that have dogged the NHS in the past 13 years.

Responsibility for budgets and commissioning care will transfer from bureaucrats to consortia of clinicians, so that we can drive up the very highest standards of health care and achieve the highest outcomes that are specific to local communities. My hon. Friend the Member for Harlow (Robert Halfon) raised the issue of inequalities in health. It is critical to have outcomes that are consistent for everybody, not just a few, and a much simplified system—without two layers of management, the strategic health authorities and PCTs—which is, actually, reorganised in a way that is less top-down and more bottom-up. Why are we doing that now? Now is the time to do that, because now is the time that we are determined to drive down the overall administrative costs to the NHS, and achieve a better dialogue and partnerships with health and care professionals in all sectors.

Pathfinder consortia are now in place across all five Essex PCTs, involving a total of 146 practices and serving a population of almost 1 million people. The Essex commissioning consortia pathfinder in the area of my hon. Friend the Member for Witham consists of seven practices and serves a population of 70,000—debates are often an opportunity to demonstrate that we know all about the figures. I understand that the Witham practices are in negotiations about forming a mid-Essex consortium.

My hon. Friend the Member for Southend West (Mr Amess) raised a point on funding. As part of our desire to improve the standard of NHS care up and down the country, we are consistently increasing the amount of money that we provide. Total revenue investment in the NHS in 2011-12 will grow to more than £102 billion a year. The allocations announced on 15 December will provide PCTs with £89 billion to spend on the local front-line services that matter most—that is an overall increase of £2.6 billion, or 3%. Of that, Essex will receive £519.6 million, which is a cash increase of 3.2% above the national average. From 2013-14, the NHS commissioning board will allocate the majority of NHS resources to consortia, and funding will be arranged so that every area gets its fair allocation, based on the burden of disease and disability, which, again, is a point that my hon. Friend raised. Details of that will be announced shortly.

My hon. Friend the Member for Witham discussed population growth and demographics, and the pressures that they will bring to bear. I am pleased that the county council is taking a proactive approach—that is the thing to do—to get ahead of the game and make improvements to public health. With an ageing population, it is critical that people stay healthier for longer.

On redundancy and staff, there is, in fact, a great deal of natural wastage in the NHS already, and there are schemes such as the mutually agreed resignation scheme, which is intended to help the process. To some extent, redundancy is dictated by legislation and locally agreed terms and conditions of service. Some good staff will move on to assist the consortia.

The clusters that my hon. Friend spoke about are an important part of the transition, gradually moving upwards through the PCT organisation. The new consortia come in at the bottom. I suggest that she arrange monthly meetings with the PCT because, clearly, there are many issues that she wants to raise, in particular individual cases. She discussed the problems of Mr Shipton and Mr Cross not receiving Sativex. Of course, that will change when we have consortia, and clinicians make commissioning decisions. That will change things, and it will increase the opportunities for patients and their families to affect decisions.

My hon. Friend spoke about the case of Mrs Wetherilt, which sounds absolutely dreadful—no one should have to battle away like that—and she has raised the case of Bethanie on several occasions with the PCT. I do not know the details of it, and, as she recognises, I cannot intervene, but it is important that systems work for people who have complex needs or diagnoses. It is critical that we get that right.

On that point, I know that my hon. Friend the Member for Braintree (Mr Newmark) would have liked to mention the new community hospital in Braintree. It is a good example of a community hospital that serves the local community, which is what people want. I know that he campaigned long before the present Parliament on getting the right services for pregnant women who need maternity care.

My hon. Friend the Member for Southend West has a long and distinguished career on the Health Committee. I could say that I learned everything I know at his knee. Having sat on the relevant Bill Committee, his frustration over the formation of the PCTs must at times be unbearable. Being a prophet of the unwelcome consequences of legislation is not necessarily any comfort, albeit it is to his credit. His comments about leadership are so important, and it is not just clinical leadership but leadership across the board. Something that does not often get a mention is political leadership. Politicians and people in government have to be clear, when they are talking about health services, that nothing but the highest standards and quality of care will do. We have to keep saying that and be unrepentant about doing so. What the Government can do is set the right framework and outcomes. We get what we ask for, and if we ask people to wait more than four hours in accident and emergency, that is what we will get. Whether or not that is measured does not necessarily determine whether anyone gets better. Therefore, the Government have to be clear about exactly what they want, and not chase headlines.

Linear accelerators: does not everyone want one? Everyone would like a linear accelerator. However, my hon. Friend the Member for Southend West is right in saying that we have to take the public with us when we make such decisions. “Consultation process” is a hackneyed phrase now. I do not think that anyone has much confidence in consultation processes. What we have to do, and what I feel we will be able to do through the health and well-being boards and the involvement of local authorities, is get a real and democratic voice for local people. I share my hon. Friend’s dislike of the term “stakeholder”. We are taxpayers; it is our money.

My hon. Friend the Member for Harlow discussed inequalities, and was right to say that they are a matter of social justice. For instance, it is outrageous that in Westminster there is a 17-year difference in mortality: people born in some parts of Westminster may live 17 years less than those born elsewhere in the borough—that is truly shocking.

My hon. Friend raised the issues of alcohol-related deaths and obesity, and discussed the fantastic work done by many local organisations. Again, health and well-being boards will be an opportunity to put public health right at the heart of local authorities, which have a long and proud history of improvements in public health and bringing together all the organisations that do so much.

My hon. Friend was also right to say that there is tremendous social capital in our communities. In my travels around the country—I try to get out a lot, for fear someone might say that I do not get out enough—I have been fascinated to find in some of the most deprived areas the greatest social capital, innovation and response from local communities to do something about their problems. They want a way out of poor health outcomes and the crime in their area, and their resourcefulness is outstanding.

My hon. Friend the Member for Thurrock (Jackie Doyle-Price) discussed variations between Thurrock and Basildon. She was right to say that they are completely unacceptable. We cannot interfere from the centre with appointments, but she was right to reiterate the need for first-class leadership, and it was good to hear her positive comments about the new chief executive. The organisations around the country that do well have good leadership, and it is not about driving a coach and horses through something, which is what I fear the previous Government tried to do. They tried to dictate from the centre and tell people what to do. Actually, what good leaders need is inspiration and enthusiasm. They need to gather people up along the way and have a clear vision of what everyone is working towards. Such skills are hard to define, but we recognise them when we see them. I hope that Essex will get the leadership that it clearly deserves, and for which all Members of Parliament in that area have been fighting.

I agree 100% with my hon. Friend on getting accountability right. As a constituency MP who has a PCT with one of the worst financial records in the country, I know that, sadly, it is the public who suffer as a result of poor management. We are determined to get accountability right. Again, that comes to setting the right outcomes.

I believe that GP consortia, health and well-being boards and public health in local authorities will result in the kind of joined-up planning that all Essex Members want, and that we will see the improvements in health care services and public health that we want. I have outlined some of the ways in which we intend to transform the delivery of services and ensure that, in the transition from the old system to the next one, we get a patient voice that is loud and clear, and that patients get the services and the care that they need and deserve.

National Blood Service

Anne Milton Excerpts

Tuesday 15th March 2011 Westminster Hall

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

Having not served under your chairmanship before, Mr Williams, I now find myself doing so twice in a day. It is a pleasure.

I congratulate the hon. Member for Heywood and Middleton (Jim Dobbin) on securing the debate and I pay tribute to his experience of this sector. I also echo the tributes that he paid to the staff who are part of such a fantastic organisation and who are one of the reasons why it has such a high reputation.

The debate is an important opportunity to discuss an issue that is not only important to the NHS and the public but which has been the subject of very unhelpful rumour and speculation. I become very disappointed when I see scare stories in the press that are not necessarily based on any foundation and that will only result in scaring people off donating blood, tissue or organs. Those stories are not helpful. I urge the hon. Gentleman and the other hon. Members sitting beside him that if they want to clarify the situation they should please feel free to contact me. That is much better than running scare stories, or a story getting out of hand, so that the issue becomes a disservice to the public we are all trying to serve.

Contrary to what some people have been saying publicly and indeed privately, there are no plans to privatise the blood service, which is part of NHS Blood and Transplant, or NHSBT. I can say categorically that we are not selling off the service. If I do nothing else in this debate, I want to knock that rumour on its head.

The Government have said previously that we will retain a single national system for blood with NHSBT at its helm and we stand by that statement. Under its current management team, NHSBT has done a great job and it continues to do so. It has maintained—indeed, greatly improved—the stability and security of the blood supply. It has also improved productivity in blood processing and testing by more than 50% in three years, which is a true achievement.

[Jim Dobbin]

I have a letter from Andrew Pearce, who is the head of donor advocacy in the NHS. The second paragraph says:

“The review is at an early stage and is likely to take a few months. Although we cannot rule out that the review might eventually suggest that some of our supporting activities should be market-tested, this is by no means certain.”

There is some doubt in that letter, which is from someone within the blood system itself, about whether market-testing is going on with a view to something else happening. People do not test something for the market if they are not intending to put it out to tender.

[Anne Milton]

I thank the hon. Gentleman for his intervention. What matters is that people get good value for money from the taxes that they pay. What also matters is that we do things effectively and efficiently, so we constantly market-test within NHS provision. We should do so. What matters to us is having a quality service. However, we are not selling off the blood service and we are not privatising it. As for performance, I am sure that the hon. Gentleman will agree that the performance of our blood service puts us in the top quartile compared with other European blood services. That is a fantastic achievement.

I reiterate the hon. Gentleman’s comments about what the improvements in the blood service mean. There has been a reduction in the price of a unit of blood, down by £15 from £140 in 2008-09 to £125 today. As he rightly pointed out, that reduction saves hospitals £30 million each year, which can be channelled straight back into patient care. Again, I pay tribute to the staff who have achieved that reduction.

It would be a huge oversight on my part if I did not also pay tribute to those who donate their blood for the benefit of others. I am pleased to learn that my hon. Friend the Member for Colne Valley (Jason McCartney) has donated blood himself. Every year, 1.4 million people donate blood, which means that 2 million units a year are donated in total. That equates to 7,000 new units of blood every day, or about five a minute. Statistics are wonderful when one is engaged in a debate such as this one; they show the scale of the donations that are made. Those donations have saved countless lives and continue to do so. Indeed, the altruistic donor system is one of the rocks that the NHS is built on and we will not do anything to jeopardise public confidence in it.

It would also be remiss of me not to mention organ donation. The one thing that we do not do often enough is to thank people who donate their organs and those of their loved ones, saving many lives in the process. We have made great improvements in organ donation, which is up by 28% since 2008, but we must continue to make improvements. I do not want anything, anyone or any public statement to jeopardise any of that. On the contrary, we want to carry out a review to help NHS Blood and Transplant to improve its operational efficiency even further and provide an even better service.

The blood service must be seen in the context of its role in the NHS. The hon. Member for Easington (Grahame M. Morris) mentioned courier services for getting blood around the place. We have been using courier services for many years—the previous Government did so as well—to deliver organs and tissue, and there is no question of putting the delivery of blood at risk.

[Grahame M. Morris]

Just for the record, it was my hon. Friend the Member for Bradford South (Mr Sutcliffe) who raised that issue, but it is one that I am concerned about.

Will the Minister address the new role of the economic regulator, Monitor, and the responsibilities that it will have regarding competition? Will its remit extend to the blood service?

[Anne Milton]

I apologise for confusing the hon. Gentleman with the Member who was sitting next to him. At least it gave me the opportunity to clarify the point. To ensure that I give the hon. Gentleman a precise answer, I will have to come back to him on Monitor because I do not have the information with me. I will happily do that after the debate.

The blood service is self-funding, in that it recovers the cost of collecting, testing and processing blood through the price paid by the NHS for each unit. The price of a unit is therefore directly related to the efficiency with which NHSBT conducts its operations; the one feeds into the other. If the cost of a unit of blood goes up, there is pressure on budgets, so the whole NHS has an interest in NHSBT being as efficient as possible and keeping the cost low. The £30 million that we have been able to put back in demonstrates that costs are being kept low, and more can be spent on patient care.

The review of NHSBT was announced in the report produced by the arm’s length bodies review in July 2010. The review is ongoing, and I cannot say what the outcome will be, but I would like to explain what the review is about, and in doing so, clarify what it is not about and hopefully reassure the hon. Member for Heywood and Middleton and all those who might share his concerns.

The review will identify opportunities both to help NHSBT further improve the efficiency of its operations, and to save money. Aspects of NHSBT’s activities covered by the review include IT, estates, testing, processing and logistics. NHSBT has recognised that those areas have room for improvement, in both developing services and increasing efficiency; such functions can often be carried out more efficiently. NHSBT already outsources some of its activities to private sector companies, for example facilities management, legal services and the call centre, so by exploring whether greater savings are possible, the review does nothing new. It simply takes a currently successful model, which has demonstrated that it can improve, and considers whether it would work if it were to be expanded.

As I said, we are looking to ensure maximum efficiency for NHSBT, and I am sure that the hon. Member for Heywood and Middleton agrees with that aim. We will do whatever works, and whatever can ensure a safe supply of blood to the NHS.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

Will the review of the British national blood service be subject to European competition law?

[Anne Milton]

I am pretty sure that it will, but I will check.

There have been suggestions that outsourcing some other functions might lead to donors declining to donate. We are absolutely clear that in exploring other opportunities, we will not put at risk any aspect of public health. I do not want donors or any Member here today to believe that this is privatisation of our highly respected National Blood Service.

[Jason McCartney]

I thank the Minister for clarifying that there will be no sell-off—no privatisation—of the National Blood Service. Some Opposition Members are concerned that if there was some privatisation there would be a drop in donations, which is something that no one in the House would wish. Hopefully, Members on both sides of the House can now pass on that information, so that there is confidence in the National Blood Service and we see an increase in donations. We welcome the efficiency measures as well.

[Anne Milton]

I thank my hon. Friend for reiterating that point. Blood is donated freely to the NHS to improve and save patients’ lives. Like any donation, it is a gift, and we want to maximise the opportunities for that gift. We do not want to do anything to discourage donors. I state categorically that the donor-facing aspects of blood donation are excluded from the review, which will ensure that the relationship between NHSBT and its donors is not compromised.

My hon. Friend the Member for Pendle (Andrew Stephenson) mentioned that people, in particular men who have had sex with men, are excluded from blood donation, and that issue is currently under consideration. I understand that there has been a lot of concern that the rules are outdated, and we will make an announcement on the issue at some point in the near future.

I feel that I have been repetitive, but I need to be to make the point, so I reiterate the Government’s support for, and belief in, a single national system for donated blood and organs, with NHSBT at its helm. That does not mean there is a blinkered belief that the system has already reached the peak of its potential; it would be remiss of the Government to think so. NHSBT, like all areas of public and private life, must continue to innovate and to challenge itself if it is to provide the best possible service. The current review is designed to explore how it can do that, to keep the price of blood—the cost to the NHS—as low as possible and to provide the high-quality blood service that donors and recipients deserve.

[Jim Dobbin]

I agree that we should continually look at research and at improving the system for the people of this country. I have no problem with that, except that I would like the service to remain within the NHS.

[Anne Milton]

In everything he does, the hon. Gentleman operates from a deep-seated belief in organisations such as the NHS, and he wants the best, not just for his constituents but for the people of this country. I therefore urge him, as I urge all Opposition Members, not to play politics with this issue, although I am sure that that is not his intention. If Opposition Members have any concerns, I urge them to discuss them with me; my door is open. It would be a tragedy if anyone did anything that reduced the number of donors coming forward. We are determined to ensure that that does not happen, but scare stories in the press can have that unintended consequence. We should not believe everything that we read in the newspapers.

Question put and agreed to.

Parliamentary Written Question (Correction)

Anne Milton Excerpts

Wednesday 9th March 2011 Written Statements

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

I regret that the written answer given to the hon. Member for Gravesham (Mr Holloway) on 11 February 2011, Official Report, column 477W, was partly incorrect.

Having given further consideration to the issue raised, I realise that the answer provided did not make it clear that while the protections provided to “employees”, under the Public Interest Disclosure Act 1998 (PIDA), do not apply to general practitioners (GPs) who provide primary medical services as independent contractors engaged under general medical services (GMS) contracts for services by local primary care trusts (PCTs), there are certain other protections under PIDA which do apply.

PIDA, which is inserted into the Employment Rights Act 1996 (ERA), is primarily designed to protect individuals who raise certain whistleblowing concerns (as defined in PIDA) relating to their work or workplace from suffering a detriment as a result of speaking out. This legislation has two layers of protection.

The first is for those who are “employees” of a particular organisation, who are protected from dismissal as well as other detrimental treatment such as being overlooked for promotion, denied training or a bonus. The second is for “workers”, which is defined in section 230(3) ERA, and includes those who work under a contract to personally perform work where their status is not that of client or customer. They have a more limited level of protection of not being subject to a detriment but they do not have unfair dismissal rights.

Generally, “workers” would not include self-employed individuals such as self-employed doctors. However, for the purpose of whistleblowing, PIDA has widened the definition of “worker” specifically to include other individuals. Section 43K(ba) ERA, includes a person who

“works or worked as a person performing services under a contract entered into by him with a Primary Care Trust under section 84...of the National Health Service Act 2006”.

Section 84 of the National Health Service Act 2006 relates to GMS contracts with GPs, and accordingly GPs who enter into such contracts with PCTs will be deemed to be “workers” for the purposes of PIDA.

Therefore if a GP raises a concern in the public interest (that falls within the PIDA criteria), relating to their GMS contract to the PCT with which they have the contract, this would be a protected disclosure. They would have a right to bring a claim under PIDA if they should suffer a detriment as a result.

While the Government’s priority since May 2010 has been to raise awareness for NHS employees about their rights and protections and to ensure that staff have a contractual right to raise concerns, the hon. Member for Gravesham has raised an important point about awareness of existing protection for GPs.

Oral Answers to Questions

Anne Milton Excerpts

Tuesday 8th March 2011 Commons Chamber

[Lorraine Fullbrook (South Ribble) (Con)]

12. What progress he is making in reducing mixed-sex accommodation in the NHS.

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

Mixed-sex accommodation breaches patients’ privacy and decency. The number of breaches is now coming down, but there are still far too many. That is why, from April, hospitals will be fined £250 for every breach of mixed-sex accommodation. That money will be reinvested back into patient care.

[Lorraine Fullbrook]

I welcome the Government’s move to increase accountability to patients by publishing all occurrences of a patient being placed in mixed-sex accommodation. Does my hon. Friend agree that this move, with the prospect of hospitals being fined £250 per patient placed in mixed-sex accommodation, shows that this Government are tackling a problem that the previous Government claimed was impossible to solve?

[Anne Milton]

We are taking this extremely seriously. I should point out to my hon. Friend that there should be no exceptions to providing high-quality care, which includes high standards of respect for people’s privacy and dignity. We need robust information and the monthly publication of the breach figures, which will tell the public what is going on and allow the NHS to make progress. The previous Government dragged their feet on this issue with a complex system that was neither transparent nor effective.

[Michael Connarty (Linlithgow and East Falkirk) (Lab)]

15. What steps he plans to take to reduce the incidence of tuberculosis.

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

We expect NHS organisations and their partners to ensure early detection, treatment completion and co-ordinated action to prevent and control TB. The Department and the National Institute for Health and Clinical Excellence have published supporting guidance. We are also continuing to support the charity TB Alert to raise public and professional awareness of TB.

[Michael Connarty]

I think the House should be concerned that in an excellent presentation back in September, it was explained that only 61% of people in London complete treatment for tuberculosis, that the incidence of tuberculosis in the UK is behind only the levels in Spain and Portugal, and that there were over 400,000 cases in the European Union in 2009. The London report that came out said that we had to invest in the service to provide a TB board for London and probably spread that to other big cities, where most of the people who have TB were not born in the UK.

[Anne Milton]

The hon. Gentleman is absolutely right. The World Health Organisation threshold for high instance is defined as 40 cases per 100,000. Of the 19 relevant primary care trusts in this country, 16 are in London. There is no doubt that this is a complex problem. In the past two decades, the increase in instances has come from people who were not born in this country. We are doing a number of things. The Home Office is reviewing the effectiveness of screening, and is running a pilot of pre-entry TB screening in areas of countries where there is a high instance. The problem is that it is not always detectable when people enter this country.

[Mary Macleod (Brentford and Isleworth) (Con)]

Tuberculosis is a key health issue for those in the London borough of Hounslow. What more does my hon. Friend feel we can do to build public awareness and to ensure early diagnosis?

[Anne Milton]

My hon. Friend is right. NHS London will continue to fund the TB find-and-treat outreach programme for the homeless and other vulnerable groups, which includes the use of mobile X-ray units. The Department will continue to provide money to support TB Alert, which builds capacity in the voluntary sector and raises awareness.

[Alex Cunningham (Stockton North) (Lab)]

16. What estimate he has made of the average amount of time per week GPs will allocate to the administration of commissioning consortia under his proposals for NHS reform.

--- Later in debate ---

[Stuart Andrew (Pudsey) (Con)]

What plans does my right hon. Friend have to increase the number of single rooms in the NHS? Increasing their number will help to tackle mixed-sex accommodation, and increase privacy and dignity in end-of-life care.

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

I thank my hon. Friend for that question. As was said earlier, privacy and dignity are central to all the care that we provide in the health service. Mixed-sex accommodation was not tackled by the previous Government; we are determined to tackle it now, and providing single rooms is part of that. Privacy and dignity must be maintained at all times.