Life Expectancy (Inequalities)

Anne Milton Excerpts

Thursday 3rd March 2011 Westminster Hall

[Mr Bacon]

I am interested in the hon. Lady’s comments. Of course, if we made sure that every schoolchild got a tangerine every day as part of their five a day, it would not be difficult to make a strong case for that being in the interests of public health. It would not be necessary to be a member of the tangerine growers association to make that argument.

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

I hesitate to intervene at this stage, because I will have an opportunity to speak later, but I must say, as it is such an important point, that the fact that the child gets the tangerine is not the point. The point is, does the child eat it?

[Mr Bacon]

I am pleased to say that my son would eat it, if given a chance, but he has been indoctrinated by my wife to think that fruit is the best thing going. However, to go back to what the right hon. Member for Barking said earlier, that is what happens in middle-class households, where children have lots of fruit and vegetables. My son is three and one of the things he loves the most is cucumber; he adores it. I am sure it is full of the right nutrients, although I think it is 99% water. The point is that we must make sure that those messages are getting across.

When I think about a cross-section of the population of my constituency, and ask whom I would most trust to persuade a little boy to eat tangerines—the local councillors or the general practitioners—I am not sure that I would immediately plump for the councillors, particularly given the fact, as the hon. Member for Hackney North and Stoke Newington (Ms Abbott) has said, that councillors have a lot of other pressures on them and have other priorities. I asked when a ring fence is not a ring fence, but of course there is another question about whether there should be one. One thing that we apparently feel unable to admit is that if we take off the ring fences and tell people, “We mean it when we say that you at the local authority will decide what happens,” the natural concomitant will be variation between different parts of the country. The rhetoric and the argument is that it is down to local people and if they do not like it, they can choose a different councillor.

I attended a meeting with a senior Minister in the Cabinet Office. It was just after the general election and he had been to a meeting with local councillors from across the country. He relayed a story about how a group of Conservative councillors had asked him, “Right, Francis”—that gives away who I am talking about—“we have won the election, or partially won it, at least. What do you want us to do?” He replied, “I want you to stop asking that question.” In other words, the Government seriously want to give local authorities the power to make these decisions. The obvious concomitant, however, is that there will be differences in different parts of the country. If that is the case—and in the light of the fact that, even when we have tried to have a co-ordinated strategy to get the same outcomes and reduce health inequalities, we have managed simultaneously to improve life expectancy and to widen the gap between the best and the worst—how much more likely is it to go wrong when we have this degree of local autonomy?

These things always come in waves—localism and centralisation have gone backwards and forwards. Some may remember Tony Crosland saying in 1974, “The party’s over,” and I am sure that we will come to a “party’s over” moment, although it is probably a few years away yet. I am interested in what happens on the ground to achieve change, and it sounds like my hon. Friend the Minister is as well. I shall not speak for much longer, because I am keen to hear her response.

I shall conclude with one further point to make my hon. Friend’s job a little easier, although no one pretends that this is easy. Indeed, we say in conclusion 7 of our report:

“Addressing health inequalities is a complex challenge requiring sustained and targeted action. The Department’s experience to date shows that greater focus and persistence will be needed to drive the right interventions.”

That is about strong leadership, as we go on to say in that paragraph. That is why the examples from other areas, such as Professor Sir Mike Richards’s cancer strategy, may have something to tell us about what we ought to do about reducing health inequalities. We all agree on the ends, but there still seems to be a lot of confusion about which means will work best. It is important for the whole country that we sort out that confusion and start seeing improved results.

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

It is a pleasure to be here this afternoon serving under your chairmanship, Miss Clark, for what I think is the second time.

I will endeavour to answer all the issues that have been raised in the debate. I welcome the report from the Public Accounts Committee. There is no doubt that health inequalities belong to another age and certainly have no place in modern society. Anything that brings this issue to the fore is entirely welcome. As the right hon. Member for Barking (Margaret Hodge) said, health inequalities are terrible, and it is shocking that they exist to such a great extent. I shall deal later in my remarks with the questions that have been raised. If Members wish to intervene, I will be happy to take interventions, but if they hang on, I will get to all their questions in time.

The hon. Member for Hackney North and Stoke Newington (Ms Abbott) was absolutely right to say that lessons should be learned. The problem with government generally, at every level and irrespective of political party, is that people tend to turn up bright-eyed and bushy-tailed but do not take any notice of what has gone before. In fact, the Government and politicians should have the humility to recognise that if things were not achieved earlier, it was not necessarily because of the incompetence of the previous incumbents but because sometimes it is difficult to do something, and this is one area where that applies. As was said earlier, this is not a partisan issue. It is something that we need to act on across the board. The important thing is truly to understand what we are talking about when we talk about public health.

I do not think that, strictly speaking, I have to register an interest, but I should mention that my husband is a public health physician, although not working as a director of public health. It is extraordinary that we have had this discussion this afternoon without yet mentioning the public health profession or directors of public health—members of the public health profession will be somewhat disappointed, because they are pivotal to many of the changes that we want to introduce.

My Government want to improve the health of the poorest most quickly. If we are to achieve better health outcomes, particularly compared with other countries, that must be more than a pipe-dream. My hon. Friend the Member for South Norfolk (Mr Bacon), who is, indeed, my favourite member of the Public Accounts Committee— [Interruption.] This is a love-in. He mentioned that it is extremely easy to assert things, but we do not want assertions but real action. That must be a fundamental part of our strategy in health care and in other areas such as housing, education and social care. We believe that the more devolved health system that we are developing will enable a sharper focus on disadvantaged areas across the country.

The Government want to provide far more opportunities for local people and organisations, including statutory organisations, to plan and run health initiatives specifically tailored to their communities. We have set out proposals to reform the delivery of health services in England. They are contained in two White Papers, which I am sure Members are familiar with: one is for NHS services, and the other is for public health. Reducing health inequalities must, and will, be embedded in the reformed architecture that we propose.

[Margaret Hodge]

I believe that, in principle, all of us would support devolution of power, but I draw to the Minister’s attention constituencies such as mine—this is more a constituency point than a general point. My constituency, which is a working-class area, is quite uniform in class structure. The whole public service infrastructure is weak, whether one looks at education, health, public health, GPs or the voluntary sector. If there is devolution to the poorest areas with poor infrastructure, it will be extremely difficult for them to grow from within themselves the necessary capabilities to tackle some of these deeply entrenched problems. There is a role for the centre, through Government, to intervene and try to build capability so that we can achieve an impact. I am concerned that if the whole mantra is about devolution, we will leave large areas of the country with concentrations of poverty and need struggling to achieve the kind of outcomes that she and we would want.

[Anne Milton]

I thank the right hon. Lady for that intervention. She is absolutely right to mention capacity building. There are areas where there is weakness across the board, and that is certainly something that we need to address. However, it is quite interesting what local areas can do with good leadership and the right levers and safeguards in place. I believe that it was out her way that I visited a scheme in an area with a high incidence of domestic violence. The local authority connected the council’s noise nuisance helpline and the domestic violence team, on the basis that where there is noise from neighbours there will probably be violence in the home. After a certain number of calls about a certain address, the domestic violence team is alerted and then goes in—a simple intervention, and a kind of capacity. Some of that is down to the confidence of the people working in the area, some of it is to do with expertise, and some of it—general practice has been mentioned quite a lot—involves putting in incentives to ensure that we get people with the skills that are needed to build that capacity.

I was not going to mention this, but we have made, for instance, a commitment to increasing radically the health visitor work force. One of the modules in health visitor training that we are looking at is about teaching new health visitors how to build capacity in communities. It is a nebulous thing, but it is important that we understand it. There is no doubt that communities, Governments and even empires have struggled for donkeys’ years with the question of how to improve public health. The hon. Member for Hackney North and Stoke Newington mentioned that in 1948, the NHS itself was a major public health advance. It secured health services for all, regardless of ability to pay. I make no apology for giving a history lesson. I am not a history scholar, but it is important to take on board the history of public health. At the same time, local authorities were given responsibilities for the health of children and mothers, and for the control of infections. At the same time, they retained their role in planning, sanitation and overseeing the health of their local population through medical officers of health.

In the NHS reforms of 1974, further unification of health services resulted in the transfer of some of those health functions from local government to the NHS, including many that we would recognise as public health functions. I draw Members back to the comments of the hon. Member for Hackney North and Stoke Newington about the status of public health. One of the reasons why the medical profession at that time pulled public health out of local authorities was to do with status, and the clout that they felt they had. Clearly, if one looks at what we are doing now, that was probably a mistake, but there were issues to deal with. The Government have to be clear about how we want the public health profession to look.

That period coincided with advancing knowledge that allowed us to identify the causes of chronic disease and health inequalities. All of those things needed to be tackled as they became apparent. The hon. Member for Blaenau Gwent (Nick Smith) mentioned the Black report, which was published in 1980. It showed that although there had been a significant improvement in health across society, there was still a relationship between class and infant mortality, life expectancy and access to medical services. It is shocking that one could write the same thing today, 31 years on.

That report was followed by the first public health White Paper, “The Health of the Nation”, which recognised that there were considerable variations in health by area, ethnic group and occupation. A new public health agenda was set, and it provided a foundation for action over the past 30 years. There has been a great deal of work, with the best of intentions. I do not doubt the previous Government’s intentions. As I said in my opening remarks, it is important to have some humility and understand that the intent was there. However, we did not get the results that everyone wanted.

We need a new approach, and that is backed up by recent data from the London Health Observatory and from the Marmot review team, which show that although life expectancy is increasing in all socio-economic groups, it also reinforces inequalities. The data also show the variation in life expectancy at birth between men and women and between local authorities, and the pronounced inequalities even within local authority areas including, for example, Westminster, which has the widest within-area inequality gap, at just under 17 years for men: a man born in one part of the borough can conceivably expect to live almost two decades longer than his friend born a short distance away.

I do not apologise for using figures, because when we talk about health inequalities, people glaze over and are not terribly sure what it is about. They think it is something to do with obesity, smoking or something like that, but the figures tell the real story. The smallest inequality gap for men is in Wokingham in Berkshire, at less than three years, and for women the smallest gap is in Telford and Wrekin, at slightly less than two years—so we all know where to move. It is worth repeating that those are the smallest differences in the entire country, so even in the areas with the best outcomes, we are still talking about differences in years.

It stands to reason that a community in Lancashire, for example, might face different health problems from one in Hackney, where I used to work. The public health White Paper therefore sets out a new way of working. It gives a different flavour to how we view public health, looking at our lifecycles and highlighting the points where we can intervene to make a difference. It is a way of working that shifts power away from central Government and into the hands of communities.

We had a short discussion about devolving power, and it is a brave Government who devolve authority for something for which they will be held responsible in the end. That is why I disagree with my hon. Friend the Member for South Norfolk, who said there has been a yo-yo between local devolution and centralised power; there has not. All Governments like to centralise things and keep control, because at the end of the day at a general election they will be blamed or otherwise for what has happened. It is quite brave to devolve power, but sometimes it is the right thing to do.

The new way of working will enable local areas to improve health throughout people’s lives, reduce inequalities and focus on the needs of the local population. The White Paper also underlines the priority we have given to tackling inequalities in supporting the principles of the Marmot review, which is important. The White Paper recognises the value of an approach that sees the importance of starting well, even before a child is born. Life chances are set well before someone pokes their head out into the world.

The new body, Public Health England, will have an important role. It will bring together what I suggest is a rather fragmented system and will span public health; it will improve the well-being of the population, targeting the poor in particular; and it will protect the public from health threats, which have not been mentioned, but they are an issue. There are inequalities in public health threats and, without a doubt, there are inequalities worldwide. Public Health England will need to work closely with the NHS, to ensure that health services continue to play a strong role and that NHS services play an increasingly large part in that mission. There has been a tendency for NHS services to see themselves simply as services to cure an immediate problem, rather than as part of a wider, more holistic approach to improving individuals’ health.

[Ms Abbott]

The Minister spoke about enabling communities, which is one of those things that sound very nice. How could one disagree with it? My right hon. Friend the Member for Barking made a point about how social infrastructure in some communities has never been robust, but there is also a point about the social capital of some of those communities. Many of them are simply not socially homogenous. Representing Hackney, my fear is that enabling communities is all well and good, but it will enable the parts of the community with more social capital and confidence, who are generally noisier, at the expense of socially excluded groups.

[Anne Milton]

The hon. Lady is right to raise the issue. That is what has happened. On a more general point, cherry-picking is a problem. It is very easy to get certain people to lose a couple of stone—[Interruption.] Actually, sometimes it is quite hard to get them to lose a couple of stone and go down the gym. To be rather crass and non-specific, it is easier to get the middle classes to go to the gym and to eat a better diet.

The hon. Lady is absolutely right to highlight the fact that some areas are very disparate and disconnected. I am an optimist, and I believe that there is social capital. Central Government are very poor at delivering in local areas. I have worked in the most deprived part of the country and lived in the most affluent, and there is a world of difference. It is extraordinary to see—they could be different planets. Central Government is a clumsy tool to deliver something that is very difficult to bring about on the ground, so we must ensure that we have levers and build social capital.

I mentioned health visitors as an example, and a universal health visiting service is extremely important. When we think about hard-to-reach communities, we forget just how hard to reach they are. For some people, the only interaction they have with any health or social service is when they have their baby. Their kids might not go to nursery school or might frequently play truant from school, and they are extremely difficult to get hold of. To be honest, a universal health visiting service is probably the single most important measure we have announced, because it will get hold of those families who are so difficult to reach.

There has been talk of increased health funding. I will not deny that the previous Government put a significant amount of money into health, and I welcome the rather cross-party approach in this debate to acknowledging that that did not always produce returns, certainly not in public health. One problem was that the budget was not ring-fenced, but it will be ring-fenced now. I will return to some points made on ring-fencing and localism and the tension between them. It is important that local government be given the responsibility and freedoms to make a major impact on improving health, backed by ring-fenced budgets.

The right hon. Member for Barking gave an interesting example about the ineffectiveness of one-to-one smoking cessation programmes. More generally, she said that it is extraordinary that we do not drive or back up with evidence what we do in health, which to most people is a science-based discipline with science-based professions. I may have a higher opinion of local government than my hon. Friend the Member for South Norfolk. I think that local government knows a lot about its local area and is often better at dealing with evidence than health services are.

The size of the ring-fenced grant will be important, because when the money was not ring-fenced it was an easy pot from which to pinch. The trouble is that the tabloid newspapers—I hesitate to mention one in particular—do not come out screaming about the poverty of the public’s health, although they come out screaming when services go. It was too easy to pinch the money, which is why it needs to be ring-fenced. It must also be based on relative population health need and weighted for inequalities, so that the areas with the greatest need will get the most.

Directors of public health will lead on action to address health inequalities. Public health physicians have done tremendous work. The public health observatories have done fantastic work, but they have tended to work in a cupboard and do not feel that they are getting their message across. Locating them in local authorities will bring together the threads that influence health, not only health care itself, but other determinants such as housing, transport, employment—the causes of the causes of poor public health, if you like.

There will be financial rewards for progress, and greater transparency so that people can see the results achieved. The new health premium will provide an incentive to reduce health inequalities and reward progress. That does not necessarily mean cherry-picking the easy cases. The programme will be designed to reward instances where progress has been made, and those places that have seen the greatest impact in areas with a poverty of outcomes in reducing inequalities. Almost by definition, those will be the areas where health inequalities are greatest.

[Margaret Hodge]

I understand the thinking behind the incentives and rewards, but my point was about the other side of that coin. Will there be penalties for those high-need areas with huge health inequalities that fail to perform? Although it is good to reward the good performers, that does not help people living in communities where there are bad performers. What are the Government’s intentions on that point?

[Anne Milton]

The right hon. Lady is right to raise that point. I was trying to stress that the healthiest areas will not necessarily be those that receive the most money. In theory, those areas that start from the lowest base should have the greatest opportunity to get those rewards.

Perhaps I can connect the right hon. Lady’s point with that made by the hon. Member for Hackney North and Stoke Newington. This debate is slightly premature because a consultation on the outcomes is currently under way, and we are also looking at the finances, at how much each local authority will have and at the size of the health premium. We are acutely aware—as I am sure are all Opposition Members—of the problem of unintended consequences.

Let us take an obvious example of A and E waiting times. It is right to want people not to wait in A and E for very long, and indeed they did not. If that is given as a target, the health service is good—as are most professionals—and it will fulfil that target. It will get people out of A and E. However, what was never measured was whether people got the care they needed. Did they get better or were they just transferred up to a ward sooner than they should have been? It is important to look at that. To some extent, this matter is a work in progress and we are keen to learn and listen to what people have to say. It is important not to have perverse incentives but to put in place the levers that we need to produce the right results in areas where there is possibly poor capacity, or areas that need building up or contain inequalities.

In some areas there are difficult cultural issues. To return to the issue of domestic violence, sometimes those working in the health service will collude with some of the men who perpetrate that violence. It gets very complicated and we need a system that takes account of all those issues.

[Nick Smith]

I commend the Minister’s emphasis on the directors of public health. The director of the Aneurin Bevan health board in south Wales is terrific and I will meet with her in a few weeks’ time. She has a good action plan together with her comparable officer in the local authority, and I hope that they will build a good partnership working together on public health. Will the Minister let us know how negotiations are going with the British Medical Association, and whether as part of the contract with GPs, public health will be given enough attention and emphasis?

[Anne Milton]

I will give a politician’s answer and say that we are currently having a constructive dialogue with the BMA. I cannot give the details of that and I am not personally involved. However, it is important to get that matter right, and I am sure that details will emerge. The Health and Social Care Bill is currently in Committee, and some of the details about how the mechanisms will work have been considered during that process. The negotiations are ongoing, and we will let hon. Members know.

[Ms Abbott]

Everybody always has a constructive relationship with the BMA.

[Anne Milton]

I was not being ironic.

[Ms Abbott]

Neither am I. My point is that some parts of the GP profession may be resistant to hearing anything from a local authority director of public health because they might see that as local authority bureaucrats telling them what to do. There may be some parts of the GP profession that think they know what public health is. They think that it is about injecting people and about cash money per hundred. It must be clear in the contract negotiation that GPs are signed up to public health in the sense that we in this debate understand it, rather than in the way that some of them have historically understood it.

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[Anne Milton]

I am sure that those GPs are few and far between, but it is important to acknowledge that point. I say to the hon. Lady that the world just changed. The NHS has a key role to play in helping to reduce inequalities that affect disadvantaged people, and GPs are part of that. I know that there has been a lot of debate and discussion about the issue, and bringing decision making closer to home for GPs will be an extremely important part of levering-in better commissioning and focus on public health. Services are often commissioned because people’s health is poor. GPs will be faced with the consequences of poor public health every day, and they will commission services to deal with those consequences.

The White Paper set the proposals for the establishment of the independent national health service commissioning board and the new NHS outcomes. The proposed outcome frameworks for the NHS and public health will have the promotion and protection of equality at their heart. That aim underpinned everything when the frameworks were developed and it is no less relevant now.

As the hon. Lady said, the Health and Social Care Bill introduces specific duties on health inequalities that are enshrined in law for the first time. I share her cynicism a little. Governments often enshrine duties in law, but what matters is who holds them to account. The Secretary of State will be held to account, but Parliament has a role. Although this debate is not attended by many people, it is part of that process of holding the Government to account.

[Mr Bacon]

I was interested in that exchange and the intervention by the hon. Member for Hackney North and Stoke Newington (Ms Abbott). I draw her attention to the evidence taken by the Committee on Tuesday morning from the GP running the consortium in Essex. Together with the chair of the Royal College of General Practitioners, we were exploring the fact that there is great variation among GPs that cannot all be explained by the health variations and socio-economic conditions one would expect.

It was acknowledged that there are serious and challenging questions that need to be put to GPs. The GP from Essex is involved with teaching and improving the capacities of the consortia, and he has conversations with other GPs as he goes around his patch to look at the variations. I asked him how important it is during those conversations that he is also a GP and a clinician. He said, “It is essential. I would not be able to have the conversation otherwise.” I listened to the intervention by hon. Member for Hackney North and Stoke Newington with some interest. When that conversation between the director of public health and the GP takes place, the question will be whether the GP is listening.

[Anne Milton]

There is a question of whether the GP is listening and of whether the levers exist to make the GP listen.

This is a nebulous point to make, but I have to make it. Improving public health is about changing a mindset. We always underplay the importance of not only ministerial but parliamentary leadership on issues such as this. I am talking about a shift of focus on to public health, ensuring that the professions involved in health service delivery and the professions involved in the delivery of other services that affect people’s health receive a clear message that that is now a priority for the Government. When we talk to people who work on the ground, particularly at senior management levels, we see that that message is heard very clearly by them; it does filter down. Ministerial leadership is required, as is leadership from all of us on our individual patches.

[Nick Smith]

Does the Minister anticipate growth in the number of GPs in areas of multiple deprivation, which therefore have high levels of health inequalities? That has emerged from this afternoon’s debate as one of the big issues that need to be addressed. How easy will it be for practice-based commissioning to allow for growth in GP numbers in those areas, which are suffering the greatest health inequalities?

[Anne Milton]

As many people have pointed out—the Public Accounts Committee report focused on this—access to GPs is a major issue, and not just in urban areas such as Redcar but in rural and isolated communities. I will come on to that.

Subject to parliamentary approval, because the Health and Social Care Bill is in Committee at the moment, the NHS commissioning board and GP commissioning consortia will be duty bound to have regard to the need to reduce inequalities in access to and the outcomes from health care. That does not make it happen, but the duty is in the Bill and will be important. GP commissioning consortia will have to keep on improving the quality of their services, reducing geographical variations in standards. To increase the democratic legitimacy of health services, health and well-being boards will have elected councillors to represent the views of local communities.

To be truly successful, we need to be sure that the most vulnerable groups experience the most pronounced benefits. That is an obvious thing to say, but it is important. We are therefore driving ahead with the “Inclusion Health” programme, to focus on improving access and outcomes for the most vulnerable groups. Those are often the groups of people who are not registered with GPs or who are homeless. It is important that the really hard-to-reach groups get that additional focus, because they are not necessarily swept up by the other things that we are doing. We need to keep an eye on that.

I apologise if I am incorrect, but I believe that the life expectancy of the average Traveller is 59 years. The figures for the most excluded groups are truly shocking. Therefore, I fully welcome the Public Accounts Committee report and its recommendations. They were formally responded to in the “Treasury Minutes” dated 16 February. I know that many questions remain, but those minutes give a flavour of how we propose to embed the recommendations in the reformed health care system.

We need to ensure that the GP-patient relationship is as effective as possible. If we are not talking about a family who perhaps have contact with health care services only when they have a baby, the GP is the most important point of contact. On average, families with children under the age of two will visit their GP eight times a year. That is a massive opportunity to put additional emphasis on information and action to improve the health of families. We want to renegotiate the GP contract. The idea is to ensure that disadvantaged areas get the right level of access to GPs. The way to do that, as has always been the case, is to provide incentives to make it happen.

GPs need to improve the health of vulnerable people, not cherry-pick the easiest ones at the top of the pile. They need to encourage the uptake of good-practice preventive treatments. Changes to the quality and outcomes framework prevalence adjustment reward practices in a fairer way, particularly because deprived communities often have a higher prevalence of many of the QOF conditions.

I urge my hon. Friend the Member for South Norfolk to exercise some caution when talking about single-handed GP practices. His point was well made, in that practitioners who practise independently—single-handed—do not necessarily have the best outcomes, but in saying that, we should not exclude the very good single-handed practices. I saw one such practice recently. The GP there has recently been accredited for training and was serving his community absolutely brilliantly.

We have also proposed that at least 15% of the current value of the QOF should be devoted to evidence-based public health and primary prevention indicators from 2013. That answers a point raised by the right hon. Member for Barking. The funding for that element of the QOF will be within the public health England budget.

As the Public Accounts Committee report says, the most cost-effective interventions to improve life expectancy have been developed. Now we need to ensure that they are rolled out as far and as effectively as possible. The report of the review by Professor Marmot has helped us to understand the steps that we need to take, and we shall take them. The public health White Paper adopts the review’s framework of lifelong attention, which will mean a truly cradle-to-grave approach.

In thinking about public health, we must not forget that that is not just about physical health. It is also about people’s mental health and well-being. We need only consider some of the difficult issues that surround young people when they are growing up. We can consider the incidence of sexually transmitted diseases. In the last year for which there were figures, there was a rise of 3%. There has been good progress on unwanted pregnancies and abortions. There has been some progress on unintended conceptions among under-18s, but there are still 36,000. There are still 189,000 abortions every year, of which one third are repeat abortions. We can consider the figures for drinking and young people and the fact that 320,000 young people take up smoking every year. We have a lot to do with regard to young people’s health.

We can split health services into NHS services and public health. We can split public health further, into preventive work and curative work. What do we do when people have started to smoke or drink or have had sex when they should not have done? Then we can consider how to prevent that. There is no doubt that we need to do a great deal to ensure that young people have the skills, the self-confidence and the self-esteem that mean that they are equipped to make decisions about the difficult issues that they face.

[Mr Bacon]

Before the Minister finishes speaking, will she give way?

[Anne Milton]

I have not quite finished yet, but I will happily give way. I will not keep my hon. Friend long!

[Mr Bacon]

I mistook what the Minister was saying for her peroration; it was the dulcet way in which she was speaking. On single-handed practices and particularly because she mentioned mental health, I want to say for the record that I do not doubt for one minute that there are some superb single-handed practices. The point that we made in our report, at paragraph 13, was this:

“A contributory factor to low levels of GP coverage has been the presence of single-handed GP practices.”

I was also making the point that people generally work better together, and it is better for someone’s mental health as a worker if they are working with people rather than alone. I speak from experience, having worked in a large agency in London with 200 employees and then having set up my own business and worked solus. What surprised me most—apart from my clients, of course—was the amount of contact that I had in the workplace, which was much lower. That was quite an unexpected aspect of it. All other things being equal, surely it must be better for GPs to work in groups than to work alone. That is in addition to the effect that it would have on overall levels of coverage.

[Anne Milton]

My hon. Friend is right to say that it is better to work together. Peer support is important, as is peer review. The identification of children at risk in A and E is important, but it is often junior paediatricians who see such children when what is actually needed is access—it can be by phone—to someone who has been doing the job a lot longer so that they can run through with them the signs and symptoms that they have seen at A and E. That sort of support is invaluable. A single- handed GP might well miss out on that. Where there are good single-handed GPs, we should encourage them to work together—not necessarily in the same practice, but perhaps in the same building. What matters to me, and my hon. Friend mentioned it earlier, is not how things happen, but doing what works.

The right hon. Member for Barking spoke about evidence, which is crucial. She rightly highlighted the issue of cancer, which was the subject of a recent Committee report, and the need for early diagnosis and early intervention. I accept what the hon. Member for Hackney North and Stoke Newington said about not everyone having access to computers or other fancy communications equipment, although most people can text these days, so there other ways of communicating. However much the Government do and whatever is done locally by GPs on early diagnosis, at the end of the day, we rely on people going to the doctor with their symptoms.

For instance, when it comes to bowel cancer, we are not very good at talking about what is in our knickers or underpants, and men are particularly bad at it. The problem with bowel cancer is that men do not go to their doctor when they have symptoms. We need to get the information out there, but improving the public’s health is largely about giving people the information, levering them into settings and giving them lots of opportunities to do so.

The right hon. Lady said that some things are much easier to do than others. For instance, it is easier to do things on which figures can be collected. However, smoking is still difficult to deal with. We and, I think, Canada perform better than almost any other country. We have made huge progress on that front, but there is a great deal more to do.

I have probably touched on most of the matters raised during our debate, but I wish to say a final word about public health. Public health goes back a lot further than people might think. The first report into the health of the working man was the Chadwick report of the 1840s. Many remember John Snow and the Broad street pump in 1854, and the outbreak of cholera that killed 500 in the first 10 days. Then we had the London sewers in 1858 and the Royal Sanitary Commission of 1871. Interventions in public health go back a long way, but it is important to remember that most of them derived from local authority action. Public health is not just about the health service.

I sit on many committees, including two Cabinet sub-committees—one on social justice and one on public health. The one on public health is particularly successful. It brings all Departments together because it recognises that public health is everybody’s business. It is a transport issue, an environment issue, a local government issue, and an education issue. It spans all the Whitehall Departments. It therefore has to span all the ministries. One of the challenges for the Department of Health is to ensure that every Department is taking whatever action it can to improve people’s health.

I know that the matter is well suited to local government. Everyone loves to hate the local council, particularly at this time of year, but they are complex organisations, dealing with a multitude of things and they know the local community well. I want to get to the day when, instead of seeing local councillors in the council chamber arguing about whether Mrs Smith at 17 Acacia avenue puts an extension on the back of her kitchen, they are saying things such as, “It’s a disgrace that the people who live in your ward live 17 years longer than those in my ward.” That would be a real success. I look to local councillors to take up the baton and to fight for public health in their areas.

We know what we need to do in the short and long terms, and we know that it can be done. Indeed, some disadvantaged areas are already narrowing some of the gaps in health outcomes. I know that our proposed reforms will put incentives in place to drive delivery at a local level, allowing local authorities and the NHS to work together.

There are health imperatives and there are financial imperatives, but there is also a moral imperative. We in Government can spend a lot of time legislating and making regulations. A lot of things are going on at the moment; we have a very difficult economic climate, and foreign affairs are now exercising us. We have to remember sometimes that there are strong and ever-present moral imperatives to take action and to improve public health.

Maternity Services

Anne Milton Excerpts

Tuesday 1st February 2011 Westminster Hall

[Emily Thornberry]

Although the Government have said that, in principle, there is a ring fence to the NHS budget, a closer analysis will show that that is not true. The real position is that there is double-counting of over £2 billion—

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

indicated dissent.

[Emily Thornberry]

The hon. Lady is welcome to intervene if she wants to get into an analysis. The Government’s promise of a ring fence and a year-on-year increase in the NHS budget is one that does not stand up to scrutiny. There is double-counting going on. Currently, given the increased demand, we must have 4% efficiency savings each year in the NHS. In fact, we will see cuts. It is simply not right for the Government to continue to say that the NHS budget is ring-fenced, that the NHS is safe with them and that services will not be cut. The reality is that the NHS is going through a very difficult time, and, on top of that, this Government are putting it through an absolutely needless reorganisation, which means that we will not get a national steer on things such as maternity services.

Simply giving commissioning to GPs will not help. It has been a matter of policy for years that we keep pregnant women away from doctors if we can, because they are not ill. We pass their care into the hands of the midwives, and hopefully everything will be fine. If a doctor is needed, bring the doctor in. Essentially, women go to a GP to find out that they are pregnant. They then go to a midwife and the midwife looks after them. That has always been the case. GPs do not have an understanding of midwifery or services for pregnant women. The difficulty is that such services will be sidelined and that is not fair on women. That argument was made to the Government when the point was being made that midwifery and post-natal services should be commissioned nationally. I do not know why the Government have changed their mind about that, and it is one of the questions I want to ask the Minister.

The NHS is going through great economic trauma. It is used to having a year-on-year increase in budget. Now, its budget will be cut year on year at the same time as the service is being reorganised. Will we have proper tactical decisions on midwives, community nurses and all those things on which mothers rely, or will we simply allow such services to be given to GPs—at a time when a cold wind is blowing through the national health service?

I think I have got through most of my questions to the Minister. I have just a few more. How will she drive improvements in maternity services? Before the election, the Prime Minister talked about maternity networks. What levers does he have that will make them a reality? Why did the Government ignore the representations of professional bodies such as the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists in relation to commissioning? Furthermore, why has the Prime Minister handed over commissioning to GPs and maternity services? Will the Minister give us an assessment of the involvement of midwives in GP pathfinder consortia?

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

May I say what a pleasure it is to be under your chairmanship, Mr Gale? I congratulate the hon. Member for Birmingham, Edgbaston (Ms Stuart) on securing this debate. She was right to emphasise the good work that goes on in our maternity services and to praise the staff for the care that they give to women and their families. Pregnancy is an exciting, but sometimes bewildering, time for us all. I have had four children in four different hospitals in four different parts of the country. As is the case for many women, the care that I received had a significant impact not only on me but on the care that I was able to give my children at the time.

The hon. Lady raised three issues. She referred to the excellent work of Professor Gardosi, an article from The Sun—much reference has been made to The Sun—and the debate yesterday on the health Bill. The hon. Member for Solihull (Lorely Burt), who is no longer in her place, also mentioned the excellent work of the Stillbirth and Neonatal Death Society. Let me also take the opportunity to praise that organisation for its work in this difficult area. It would be an honour for me to be at the opening of the Forget-Me-Not suite at the Royal Surrey county hospital in my constituency.

My hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) made an important intervention. As he said, the birth rate rose by 19% between 2001 and 2009, and the midwifery work force rose by only 9% in that period. Listening to Opposition Members this morning, one wonders where the Government have been for the past 13 years. In that period, significant amounts of money were going into the NHS. So, as my hon. Friend asked, what exactly did the previous Government do in that time?

I want to mention some of the other points that my hon. Friend made. His dedicated service to his constituents is legendary and this morning he spoke with his usual passion. He has already raised his concerns about reconfigurations of services and I know that he will listen to what GPs, midwives and, most importantly, women and their families have to say about those reconfigurations. I know that he will use every tool at his disposal to ensure that his constituents’ views are heard loud and clear.

My hon. Friend the Member for Montgomeryshire (Glyn Davies) also reiterated his concerns about reconfigurations. I must say, Mr Gale, that he should relax about parliamentary procedures, which confuse even the most experienced Members at times. As a new Member, you often feel that it is just you who is confused. But fear not—people who have been in the House for 20 years or more can also get confused by procedure.

I was very heartened to hear of my hon. Friend’s positive tale of his wife’s four home births. Clearly, they were successful and happy experiences, which were doubtless helped enormously by the excellent support of a midwife on the spot. He rightly raised the difficult issue of cross-border care and it is critical that we get that care right. Arbitrary lines do not wash with the public, and I am sure that people will listen to his contributions on this subject when the reconfigurations are considered. The first duty of maternity services is to provide safe, high quality care for mothers and babies. Women should rightly expect to receive consistently excellent maternity services, no matter what time of day they have their baby or where they are treated.

I did not have any home births, but I am very aware—this is slightly contrary to the hon. Member for Birmingham, Edgbaston—of what an important choice having a home birth is for many women. Personally, I am a little more nervous. I quite enjoyed my stay in hospital after each of my babies arrived; I put that down to the fact that I always feel the need to do housework if I am at home, so a hospital stay gave me a few days off. However, having a home birth is an important choice and I know that many women gain enormously from the opportunity to have a baby in their own home, and our aims reflect that. We have made provision of maternity services that are focused on improving outcomes for women and for their babies, along with improving women’s experience of care, an absolute priority for the NHS. The Government set out our long-term vision for the future of health care in our White Paper and there was an extensive debate in the House on many of those issues yesterday.

By focusing on health outcomes and delivering maternity services through provider networks, we want to deliver high quality maternity services. Networks will bring together all the maternity services that a mother might need, linking local hospitals, GPs, charities, secondary and tertiary services, and, indeed, community groups, so that they can share information, expertise and services. Commissioners and providers will drive that process forward. Maternity networks will extend choice for women by encouraging providers to work together, offering expectant mothers and their families a broader choice of maternity services and allowing women to move seamlessly between the services that they want or need.

[Ms Gisela Stuart]

I am trying to understand these networks. How many will there be? I am concerned about the fragmentation of maternity services. Will there be one network in the west midlands, or will Birmingham have one network? Will there be 25 networks? How big are the networks?

[Anne Milton]

The important thing for central Government, and it is what we are doing, is to move away from being centrally very prescriptive. If I were to guess, I would say that networks will be on a regional level, but their size will depend on various things. Delivering maternity services in Birmingham is very different from delivering maternity services in Cornwall. We need a network that can offer all the services that women and their families need while not being too big and thus unresponsive to local need.

[Ms Stuart]

This issue is quite important. When we created primary care trusts, there was a kind of vision that they would each serve a population of around 250,000. That was a framework, but there were still some very small PCTs. Are we looking at a maternity network that would serve a million people, as in Birmingham, or a network that would serve 3.6 million people, as in the west midlands as a whole?

[Anne Milton]

The hon. Lady is already falling into difficulties. She wants central Government to prescribe what works on the ground. If one looks at the proposals for GP pathfinder consortia, one sees that the proposed consortia vary in size enormously. That is because local people on the ground know what size of consortium will work for them. We will see more details emerging as the health Bill goes through Parliament and as the consortia get going. What matters is to be locally responsive. The hon. Lady mentioned accountability; having the right accountabilities in the system is important. What also matters is using the commissioners in particular to drive up quality.

Our focus on public health is also critical to maternal outcomes. Healthier women have healthier babies and for the first time we will ring-fence public health money. The hon. Lady was right to mention inequalities. Increased rates of stillbirth are associated with deprivation. I must say that, despite the previous Government having what was doubtless the best will in the world, during the 13 years that they were in power, health inequalities widened. I do not think that that was because they were utterly incompetent; it was partly because it is extremely difficult to do something about inequalities. However, I believe that our focus on public health and our ring-fencing of public health money will have a significant impact.

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

Does the Minister agree that, although choice is very important, in a constituency such as mine, which is in the east end of London, public health issues, such as nutrition, access to advice and quite low-tech care during pregnancy are just as important to good maternal health outcomes? Underweight babies are one of the big problems in my constituency. They often have poor educational outcomes later, and cost the taxpayer tens of thousands of pounds, because they have to be put in incubators and so on. That problem is to do with the sort of advice that those young mothers receive and it is a public health issue.

[Anne Milton]

I thank the hon. Lady for her intervention; I think that we broadly agree on this issue. That is why we are focusing on public health. Preparation for pregnancy and having a healthy baby starts long before a woman gets pregnant. The education and support that women receive, the social networks that they are part of and improving the public’s health all matter. Nothing could be more important than improving the outcomes for women and, indeed, their babies.

Choice is important and it is also important that women can make informed choices; choices must be well informed to improve the outcomes for women and their babies. Furthermore, it is important that women have access to maternity services at an early stage in their pregnancy. In fact, ensuring such access is probably one of the most fundamental characteristics of high quality maternity care, which is why we have included the 12-week early access indicator as one of the measures for quality in the NHS operating framework for 2011-12.

Of course, it is also important that there are appropriate numbers of trained maternity professionals to provide the maternity service. The number of clinicians needed by mothers depends on several factors, ranging from the mother’s medical circumstances, to the complexity of the pregnancy, to wider societal factors, which can have a considerable impact.

Looking at the bigger picture, the birth rate must be considered when we are planning maternity services. Although the number of births in England has been rising since 2001, as I mentioned earlier, the birth rate peaked in 2008 and fell, by just less than 1%, in 2009 to about 671,000 live births. We are determined that staffing rates should be calculated purely on how many staff are needed to provide safe, quality care. We are considering ways to improve midwife retention and recruitment, and the planned number of midwives in training in 2010-11 is at a record level of about 2,500. Therefore we expect a sustained increase in the number of new midwives who will be available for maternity services during the next few years.

Complete and absolute focus on staffing numbers is totally ridiculous. If the birth rate shot up, 3,000 extra midwives would not be enough. Ensuring that the maternity work force has an effective skills mix is also an important consideration. I was recently in an extremely busy maternity unit, and the midwife there made it clear that what they needed was not more midwives but more support staff. Doubtless in other units there will be support workers in place, but not enough midwives. We want to focus on using the whole maternity team, including obstetricians, anaesthetists and support workers. It is not just the number of qualified midwives that is important, but their experience, and one issue that we need to address is attrition. A newly qualified midwife does not have the experience, nor perhaps the skills, to lead the team in a way that a midwife who has been in practice for 10 years or so can.

[Emily Thornberry]

Although I agree with what the Minister says, surely the difficulty she has is that the Prime Minister promised us 3,000 more midwives. Although I accept that we need experienced staff to ensure that midwives are trained up properly—the same applies to a number of different skills—the Prime Minister promised us the 3,000, so is it right that the Government are rowing back on that promise?

[Anne Milton]

There is no rowing back. We have always made it clear that the number of midwives will be in proportion to the birth rate. In fairness to the previous Government, they made concerted attempts, although much too late, to increase the number of midwives in training, and, as I have said, we have 2,500-odd in training now. We will continue to ensure that we have the right staff mix and the right number of midwives to ensure that women have safe births.

[Ms Gisela Stuart]

On that very point, I would be very happy for the Minister to write to me, stating that the Prime Minister himself said that that promise of 3,000 was contingent on the birth rate.

[Anne Milton]

I will happily discuss that further with the hon. Lady if she would like me to.

Significant progress has been made, and what matters is that the number of midwives that we have in place—the skills mix—provides good, safe outcomes for women and their babies. The NHS commissioning board will provide commissioning guidance and we are, of course, keen for it to support GP commissioning consortia in their commissioning of services. The Government will specify outcome indicators that demonstrate high quality and improving care, but it would not be appropriate for us to dictate models of care or how resources, including staff, are used. Instead, we will look for local leadership, from health and well-being boards for example, which will develop the joint strategic needs assessments and health and well-being strategies to inform commissioning, ensuring that trends in the birth rate and the growth in the number of more complex cases are taken into account by the local service. The complexity of a case is becoming more important than ever in determining the care and the number of staff needed to deliver babies safely, and its consideration will allow individual maternity services to adapt to the different pressures faced in different communities.

The hon. Member for Birmingham, Edgbaston rightly made important points about the deaths of the 25 babies in the west midlands between April 2008 and March 2009, and said that the report sadly states that 84% of those deaths were potentially avoidable. That is totally unacceptable, and I must admit that it comes as a shock to me, as it probably did to the hon. Lady, that we are still not good at using serious untoward incidents, and indeed the deaths of children and babies, to learn and to improve our practice. I met Professor Jason Gardosi, director of the west midlands Perinatal Institute and author of the report, to discuss the issue in more detail, and we have a lot of work to do to ensure that we learn from such tragic incidents. When I talk to women who have lost babies, they say that, more than anything, they want this not to happen again and lessons to be learnt from their experience.

The report outlines steps that could improve the safety of services, and we are looking at a number of ways in which they can be addressed. The NHS in the west midlands now has clear plans for improving standards of care and reducing preventable deaths, and it is important that those plans are implemented, including the urgent introduction of a system whereby maternity units and commissioners can learn from and respond effectively to adverse incidents, and a standardised regional perinatal death reporting system across all its maternity units. Interestingly, as a result of that, the west midlands in many ways now leads the way in this field.

Nationally, the National Patient Safety Agency has launched an intrapartum toolkit, which is valuable in helping maternity units improve safety. Sharing best practice is terribly important and we do not do it enough in the NHS. I hope that the new outcomes framework will act as a catalyst for driving up quality across all NHS services by measuring what is important: clinical outcomes. Such outcomes make a real difference to people’s experiences of services and to their health and well-being, and can sometimes save the lives of mothers and babies.

It would be unfair to say that there have been no improvements in the past few years; there have been improvements in antenatal care. The Care Quality Commission survey of women’s experiences of maternity services published in December 2010 found that 92% of women rated their maternity care as good or better. We should be proud of that, but it is the 8% sitting on the edge and those babies who die that are completely unacceptable, and we need to do much more.

The hon. Member for Birmingham, Edgbaston talked eloquently about the association between deprivation and poor outcomes, and rightly said that commissioning is weak. She described Professor Gardosi’s report as damning, but the previous Government presided over the years covered by the study. What exactly did her Government do? Where were they? Why were inequalities in health not reduced? What happened to the health visitor numbers? Why is commissioning so weak? It is the weakness of commissioners that has failed to drive up standards, and the hon. Lady spells out exactly the case for changing commissioning.

[Ms Stuart]

The report was the result of the chief medical officer’s concerns from the early ’90s onwards. What concerned the CMO was that, although we reduced inequality, this particular area was not addressed, going back to well before the Labour Government.

[Anne Milton]

I appreciate that, but for the past 13 years the hon. Lady’s party has been in government. In many ways, she could not have made a better case for changing commissioning. It is not very sexy to talk about it, but the weakness of commissioning is what has been at fault in many ways. It is what has failed to drive up the quality of services and achieve the outcomes that we want. The Health and Social Care Bill gives us the chance to refocus the NHS on what is important to its users and the staff providing the services, and to achieve the results that are important to them.

I assure hon. Members that I will continue to work on maternity services, and I remind the hon. Member for Islington South and Finsbury (Emily Thornberry) that it is simplistic in the extreme to say that this is just a numbers game. As far as health visitors are concerned, her Government presided over this dramatic loss in the health-visiting work force. We have promised to increase the number of health visitors to 4,200, and that vital work force will work with midwives and other professionals across the board to ensure a universal visiting service and targeted help for the most vulnerable.

The hon. Member for Birmingham, Edgbaston put across the exact case for why the changes to commissioning are so important, why our pledge to increase the number of health visitors is vital, why we need to create the maternity networks and why ring-fencing public health money is so important. Crucially, they are important because we are determined to improve the health outcomes of mothers and their babies.

Umbilical Cord Blood

Anne Milton Excerpts

Monday 31st January 2011 Commons Chamber

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

I thank my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) for securing this debate on a topic that is vital. He is right to state that this is yet another opportunity to highlight the issue. All opportunities are useful to raise it in the minds not only of those in the House this evening, but of the public and of those in a position to influence what goes on.

The Department recognised the importance of this issue when it asked the NHS Blood and Transplant Authority to review the UK’s collection, supply and use of stem cells from both bone marrow and umbilical cord blood. The general consensus was that the UK Stem Cell Strategic Forum did a superb job on the review. Its report, which was published in December last year, involved a well thought through, strategic and costed analysis. It provided us, probably for the first time, with an honest appraisal of the use of stem cell units in the UK in the public and charitable sectors. Unfortunately, as is often the case if such reports are honest and frank, some of it made uncomfortable reading.

The review found that the delivery of stem cell units for transplant in the UK is not as efficient or effective as it should be. As my hon. Friend stated, we lag behind many other comparative countries, including Germany and the United States. Some 400 patients each year fail to find suitable donors. Then delays in the system mean that those who find a donor are sometimes, sadly, much too ill to receive a transplant. For these patients the prognosis is very poor.

As the hon. Member for Hackney North and Stoke Newington (Ms Abbott) pointed out, for patients from a black or minority ethnic background, the problem is compounded by the lack of donors or suitable stem cell units available in the first place. Disadvantaged from the outset, their chances drop drastically. On average, about 90% of Caucasians can find a suitably matched donor, compared with only 30% to 40% of those from other ethnic backgrounds. That is unacceptable and pretty shocking. As I said when I announced the report’s publication at a meeting of the all-party group on stem cell transplantation, I am determined to do all that I can to see services improve. I want service providers to develop plans for providing the most effective and efficient service possible in the interests of both the patient and the taxpayer.

My hon. Friend has highlighted a rapidly developing area. Some progress has been made, but it is going at an extraordinary pace. The report not only highlighted what needs to be done, but contained 20 recommendations for the improvement and development of services for the benefit of patients. They include comprehensive changes to the way services are delivered, with a view to establishing the UK once again as a world leader; a more streamlined collection, processing and delivery service, with much more of a focus on results, rather than process; and a radical reconfiguration of transplant services.

The greatest improvements and the quickest gains will be delivered by better bone marrow and umbilical cord blood stem cell services. By making services more efficient, we will see a marked improvement in the treatment, care and support received by patients. We will be able to reduce the time it takes to find a matching donor, address any inequalities in the current system and provide a better service with fewer resources. That will lead to better quality, better management, better planning, better delivery, better outcomes and, crucially, more lives saved. We want those principles to be diligently and consistently applied across the board. The objective is clear: to improve the life chances of those in need of a stem cell transplant.

A considerable amount of work has been done behind the scenes since the publication of the report to see that vision implemented. I have asked officials to work with the forum, NHS Blood and Transplant and Anthony Nolan to develop ways to get a single bone marrow register and cord blood inventory for the NHS in England. We will explore what can be achieved by collective effort, using what is already available and planning for the provision of future services.

[Thomas Docherty]

Further to that point, has the Minister had any discussions with the Scottish Government on their plans for ScotBlood, which is the equivalent service in Scotland? Does she agree that the solution is to have a single register for the whole UK?

[Anne Milton]

There is no doubt that close discussions with all the devolved Administrations are critical. We have a patchy and disjointed service, but as the hon. Gentleman rightly says we need a single register. I am pleased to say that some work is already bearing fruit. At the last meeting of the forum, well-advanced plans were put forward on how NHSBT and Anthony Nolan can work together in future, with targets for reducing the average search time by six weeks and the establishment, for the first time in England, of a single bone marrow register and cord blood inventory. However, we must go further. I cannot praise enough that type of innovative and professional approach. It is collaboration like that that means real improvement for patients. We must have notable improvements on the wards, not just on the spreadsheets.

The UK Stem Cell Strategic Forum review was a Department initiative, and the work was paid for by the Department. We have heard of the efforts of organisations such as Round Table. I would like to take the opportunity to thank Lynda Hamlyn, the chief executive of NHSBT, Henny Braund, her counterpart at Anthony Nolan, and their dedicated, hard-working staff for the work they have done so far. I have no doubt that there is more work to be done and that it will continue in the future.

[Claire Perry (Devizes) (Con)]

I am grateful to my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) for securing this incredibly important debate. I confess that this is something about which I knew nothing. He mentioned the importance of education and the need for a programme that is similar to that for organ donations so that mothers are informed about the value of umbilical blood and blood products before giving birth. Certainly, that is something that I was never informed about. Is the Department considering any sort of education programme so that people can opt in to the system as donors?

[Anne Milton]

I thank my hon. Friend for that intervention. It would be terribly simplistic to think that it is just a matter of donors coming forward. We know from organ donation—it is also the case for umbilical cord blood—that it is important to streamline the processes, because there are unacceptable delays. The report’s recommendations cover the whole process from beginning to end. I do not underestimate the need to raise the importance of this issue. Many hon. Members can play a critical role in their local areas and with their local media by highlighting the importance of organ donation.

[Mark Tami]

Will the Minister give way?

[Anne Milton]

I am conscious of the time but happy to give way, because the hon. Gentleman has done a lot of work on this issue.

[Mark Tami]

Does the Minister agree that Anthony Nolan has done an awful lot—particularly with the introduction of spit and swab tests—to help people to take that first step on the ladder? Before, when it was a case of just giving blood, that put a lot of people off, particularly males, such as myself, who are rather squeamish about these things, but it is very important to get the maximum number of people to take that first step forward.

[Anne Milton]

Yes, absolutely. The hon. Gentleman is quite right to highlight yet again the work of Anthony Nolan, which is crucial, but I urge him and all male Members to remember that they have nothing to fear from needles and no need to be squeamish about those things; it is about potentially saving lives.

It is a challenging time financially, and we cannot put that behind us. It is important that we get the UK back on a secure financial footing, and that means funding will be tight, but I want to reach out further to our partners in charities to see how we can work together. We are not short of offers in that field. My hon. Friend the Member for Enfield, Southgate will know that I am shortly meeting Cord Blood Charity to see what part it can play, and Anthony Nolan is making every effort to provide additional funding for the important work that I have spoken about.

On Government funding, the Department of Health will provide some £4 million in additional funding to help with service development, but, more than that, we will continue to help in other ways, bringing together key stakeholders to ensure that all opportunities to bring about those further improvements and to implement those recommendations are taken. We are also working towards increasing the size of the cord blood bank by funding NHS Blood and Transplant to increase the bank to 20,000 units by 2013—an increase in stored units of almost 100% since 2008. I know that my hon. Friend would like to me go on, and as part of future strategic planning I shall ask NHS Blood and Transplant to consider the options for developing the bank even further, with the final goal of reaching a stock of 50,000 stored cord blood units, accessible to all NHS patients.

In the development of that new commissioning structure within the NHS, we will listen closely to the recommendations of the forum report, with respect to improving NHS practices and commissioning. The forum has met since the report’s publication, and I hope that it will continue to meet to advise the sector on best practice and to provide innovative solutions to implement those recommendations. I shall keep closely in touch with all those who have shown such a close interest.

Improving the health care pathway for stem cell transplantation to treat life-threatening diseases is a vital part of that work. I use those words cautiously, but I want to see NHS patients having access to the best possible services. We are meeting my hon. Friend soon to discuss the issues raised in the report and some that have come out of this debate. As always, his contributions to the debate are welcomed, highly respected and, like those of many Members, motivated by the best possible intention, which is to save lives.

Question put and agreed to.

Oral Answers to Questions

Anne Milton Excerpts

Tuesday 25th January 2011 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

5. What recent steps he has taken to reduce levels of alcohol misuse among young people.

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

The public health White Paper, “Healthy Lives, Healthy People”, sets out how society can harness the efforts of individuals, families, local and national Government, and the private, voluntary and community sectors to take better care of our children’s health and development.

[Fiona Bruce]

I thank the Minister for that reply. Hon. Members will be aware of the recent publicity given to vodka eye-balling, which is a dangerous practice. Members of the ArcAngel volunteer team in my constituency are going into schools seeking to alert young people to this and other dangers of binge drinking and excessive alcohol abuse. What support can the Minister offer to ensure that we can eradicate, in particular, the dangerous practice of vodka eye-balling?

[Anne Milton]

I thank my hon. Friend for her question, particularly in highlighting this extraordinary practice. I have to say, it was news to me. I congratulate the efforts of that local organisation on highlighting this sort of issue with school children. There is no doubt that vodka eye-balling can cause damage to the surface of the eye, ulceration and scarring. Although it has got some publicity, however, a lot of young people are likely to be drunk in the first place when they do it, so the effects are probably overestimated.

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

Did the Minister hear the report on Radio 4 this morning that in the past decade there has been a 50% increase in the number of young people in their 30s being admitted to hospital with alcohol-related liver disease? Does she think that we ought to be looking at how alcohol is promoted and advertised around young people?

[Anne Milton]

I thank the right hon. Gentleman for his question. I heard the report, and I think that it made particular reference to the worrying trend among young women as well. There is no doubt that our public health White Paper is timely. We need to do something about this. It is important to remember that no one tool will fix this problem; we need to take a wide variety of measures and alter, in particular, young people’s relationship with alcohol. However, we will not do that until we get a proper strategy out there.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

Do Ministers clearly understand that the price of alcohol is a relevant consideration? Will they look at whether we can get relatively cheaper prices for soft and sports drinks? They are a viable alternative for many young people, but the price is often double that for alcohol.

[Anne Milton]

I thank the right hon. Gentleman for his question. There is no doubt that price is one of the tools to which I referred. However, we need to take a huge number of actions. Reforming the Licensing Act 2003 via the Police Reform and Social Responsibility Bill will bring in a number of measures—for instance, doubling the fines for under-age alcohol sales to £20,000 and giving councils and the police the power to shut permanently shops or bars that persistently sell alcohol to children. That is one other way. Also, the Bill will make local health bosses responsible authorities for licensing decisions. That is an important shift and demonstrates the fact that this is everybody’s problem—no one public body can cure this on its own.

[Alison McGovern (Wirral South) (Lab)]

7. What recent representations he has received on his plans for the internal reorganisation of the NHS; and if he will make a statement.

--- Later in debate ---

[Nic Dakin (Scunthorpe) (Lab)]

12. If he will take steps to increase the availability of the BCG vaccine for children.

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

I should point out to the hon. Gentleman that there are no problems with the availability of the BCG vaccine. I am also aware that he takes a personal interest in this subject because of his local experience. I am confident that those most at risk of contracting tuberculosis are being offered the BCG vaccination as part of a targeted national programme.

[Nic Dakin]

Does the Minister not think that it is time to widen that targeted national programme? Tuberculosis is an airborne infection, and it covers a broader area than the areas that are being focused on at the moment. Would not the widening of the programme improve protection?

[Anne Milton]

Yes, I would just like to point out to the hon. Gentleman that TB has changed from being a disease of the whole population to one that affects high-risk groups. In fact, the Joint Committee on Immunisation and Vaccination looked at this in 2005 and reaffirmed it in 2009. We are confident that this targeted approach is the best way of addressing the problem.

[Mr Ben Bradshaw (Exeter) (Lab)]

13. What assessment he has made of the likely effects on waiting times of his proposed reorganisation of the NHS.

--- Later in debate ---

[Andrew Selous (South West Bedfordshire) (Con)]

15. What recent estimate he has made of the monetary value of medical aids issued to patients by hospitals and not returned in the latest period for which figures are available.

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

As my hon. Friend knows, NHS patients are provided with NHS aids free of charge and requested to return them when they are no longer required. Obviously the cost of recovery must be weighed against the cost of the items being lent, but it is the responsibility of the local NHS to monitor the position and arrange for the recovery of medical aids when that is safe and cost-effective.

[Andrew Selous]

For many years the experience of my constituents, and indeed my own family, has been that hospitals often provide patients with, for example, crutches, without ever asking for them back. I accept that this is a matter for the management of local hospitals, but does my hon. Friend agree that the Department has an interest in ensuring value for taxpayers’ money, and that the medical aids involved could be used by other patients who need them?

[Anne Milton]

I agree. One always hopes that people will act responsibly, and that they or their families will return medical aids. My hon. Friend may know that Bedford hospital has organised a scheme for the collection of aids, and that a number of voluntary organisations are also involved. However, the cost of collection and decontamination or cleansing is sometimes greater than the cost of the equipment itself. Crutches, for instance, cost between £11 and £20. Such is life today.

[David Rutley (Macclesfield) (Con)]

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

--- Later in debate ---

[Karen Lumley (Redditch) (Con)]

T7. In support of national obesity fortnight, which is currently running, I wish to raise awareness of this serious condition, which causes numerous deaths and other serious health conditions. Redditch has high levels of obesity compared with the average in England. NHS Worcestershire is doing a fantastic job, but what more can the Government do to ensure that the NHS will not be overly burdened with increasing obesity problems?

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

I thank my hon. Friend for raising this issue, and I know that her local council is running a number of schemes. As she knows, we have published a White Paper on public health, “Healthy Lives, Healthy People”. In the spring, we will publish a document on reducing obesity, and we will set out how this will be tackled in the new public health systems and in the NHS. It is important to remember that at this time of year a number of people go on diets and try to lose weight and get fit, and I urge them all to carry on, including Members of this House.

[Alun Michael (Cardiff South and Penarth) (Lab/Co-op)]

Does the Minister accept that during times of illness people often experience associated problems, for example, difficulties with employment and housing, and personal problems, with which they can be helped by the information available through StartHere? Will he ensure that his Department and others treat StartHere as essential to the provision of high-level public service?

--- Later in debate ---

[David Tredinnick (Bosworth) (Con)]

Will my right hon. Friend the Secretary of State please explain why it is taking so long for him to come to the House about the regulation of herbal medicine? He has to do that before April to comply with European legislation. What is the hold-up?

[Anne Milton]

I thank my hon. Friend for his question and I know that he has a keen interest in this subject. I share his frustration that the previous Government spent a long time not doing anything about it. The Medicines and Healthcare products Regulatory Agency has identified the possibility of creating a national regulatory scheme, allowing authorised herbal practitioners to continue to commission unlicensed manufactured herbal medicines after 30 April. We are in discussions with the devolved Administrations, the Health Professions Council and the Complementary and Natural Healthcare Council about the feasibility of a statutory register. As I say, I share my hon. Friend’s frustration but we will make proposals shortly.

[Dr William McCrea (South Antrim) (DUP)]

Specialists in the field state that the figures that point to a more than 50% rise in young drinkers ending up in hospital are a gross underestimate of the serious problem. What further steps can the Department and the Government take to address this important problem?

Health

Anne Milton Excerpts

Tuesday 21st December 2010 Commons Chamber

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

I welcome all the contributions. We have had an excellent run-around of some hon. Members’ interests and specific issues relating to their constituencies.

I start with the hon. Member for Worsley and Eccles South (Barbara Keeley). As she rightly pointed out, the Government have recently announced that they will provide additional funding of £400 million to the NHS in the next four years to enable more carers to take breaks from their caring responsibilities. I commend her for her continued interest in the subject. I trained as a nurse and worked in the NHS for 25 years, and the question is now, as it always has been: who cares for the carers? The hon. Lady is right to highlight the problems that carers suffer—the impact on their physical and mental health and well-being, as well as the immense emotional burden that many bear.

The spending review has made available additional funding in primary care trust baselines to support the provision of breaks for carers. The new moneys will go into PCT budgets from April 2011 and into GP consortium budgets from 2013. The 2011 NHS operating framework, which was published on 15 December, makes it clear that PCTs should pool budgets with local authorities to provide carers with breaks as far as possible via direct payments or personal health budgets, which will doubtless ensure some progress.

The new funding is part of a package of measures that we announced in the recently published update to the carers strategy. The next steps set out the priorities for action in the next four years, focusing on what will make the biggest impact on carers’ lives. It is important to recognise that the subject is of interest to hon. Members of all parties. I do not think there is division along party lines. The hon. Lady’s insight into and knowledge of what is happening on the ground will be important to ensure that future policy and direction is well informed.

[Barbara Keeley]

Will the Under-Secretary say more about what will happen if PCTs do not spend the money on carers’ breaks? The Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), who is responsible for social care, campaigned in the House when the Labour Government had a similar problem. As I said earlier, the problem is that, according to a survey, only a quarter of the money had been spent on carers’ breaks. It is fine to allocate it, but the trouble is getting the PCTs to spend it.

[Anne Milton]

I thank the hon. Lady for that intervention. She is right to suggest that there can be an intention at Westminster, but the point is ensuring that it is effected on the ground. I will say a little more about that shortly.

We do not believe that a legislative approach is always the way to proceed when requiring health bodies and GPs to identify patients who are carers or have a carer and refer them to sources of help and support. Indeed, often it is not. We feel more comfortable with that as a weapon, but it does not necessarily produce the result that the hon. Lady wants.

It will be for PCTs and subsequently the GP consortiums to decide their priorities in the light of their local circumstances. However, we believe that GPs and their staff will play a vital role in identifying carers; many carers have not yet been identified. That is why we are investing £6 million from April 2011 in GP training, which will mean that more GPs and their practice teams gain a better understanding of carers and the support that they may need. That is important.

I believe that GPs are much better placed truly to understand the value and needs of carers. I do not need to tell the hon. Lady that the considerable social, human and, indeed, financial value that carers offer cannot be overestimated—she is aware of that. However, centrally driven methods are not always the best way forward. I welcome her continued feedback to ensure that we get the money spent where it is needed most.

Let me deal now with the speech made by my hon. Friend the Member for Colne Valley (Jason McCartney). I take the opportunity to pay tribute not only to midwives but to all the staff who will be working to deliver babies safely into the world, while we are enjoying our turkey or whatever we choose to eat on Christmas day.

The Government are committed to devolving power to local communities—to people, patients, GPs and councils—which are best placed to determine the nature of their local NHS services. I pay tribute to my hon. Friend for raising the matter previously and for continuing to raise his constituents’ concerns.

The Government have said that, in future, clinicians and patients must lead all service changes, which should not be driven from the top down. To that end, the Secretary of State has outlined new, strengthened criteria that he expects decisions on NHS changes to meet. They must focus on improving patient outcomes, consider patient choice, have support from GP commissioners and be based on sound clinical evidence. I think that that was what my hon. Friend was getting at.

The Department has asked local health services to consider how continuing schemes meet the new criteria. Some will be subject to further review. That does not necessarily extend to reopening previously concluded processes, as in Huddersfield—I would not like to lead my hon. Friend down an alley—or halting those that have passed the point of no return, with contracts signed and building work started. However, NHS Yorkshire and the Humber has advised that the decision to implement the looking to the future programme and change in maternity services in Huddersfield was clinically driven, with strong emphasis on patient safety and quality of care. It was also made after considerable scrutiny and consideration, including a formal period of public consultation and advice to the then Secretary of State for Health from the independent reconfiguration panel, whose recommendations were endorsed in full.However, I know that my hon. Friend will continue to gather local evidence and experience and feed it back, which I welcome.

Let us look at the problem described by the hon. Member for Blaenau Gwent (Nick Smith). I disagree with much of what he said. We have a bold public health strategy for the first time, and it has been widely welcomed. He should not believe everything he reads in the newspaper—it could lead him into all sorts of misapprehensions. The Government alone cannot improve public health; we need to use all the tools in the box.

The hon. Gentleman should note that health inequalities grew, rather than decreased, under the previous Government. There are massive opportunities to improve public physical, mental, emotional and spiritual health and well-being in England. As he rightly pointed out, we have some of the highest obesity rates of any country in the world. People living in the poorest areas die on average seven years earlier than people living in richer areas, and they have higher rates of mental illness, disability, harm from alcohol, drugs and smoking, and childhood emotional and behavioural problems. Changing people’s lifestyles and removing health inequalities could make double the improvement to life expectancy that we could make through health care, so we must address public health.

The Government published our strategy in our White Paper “Healthy lives, healthy people”. We will establish Public Health England, a national public health service, return public health leadership to local government, and strengthen professional leadership nationally by giving a more defined role to the chief medical officer, and locally through strong and inspirational leadership roles for directors of public health.

Historically, all the big public health improvements came via local authorities, and I am convinced that returning public health responsibilities to local authorities will achieve what we need, which is social and economic change as well as health change.

[Nick Smith]

rose—

[Anne Milton]

I am happy to give way.

[Mr Speaker]

Order. The Minister is of course welcome to take the hon. Gentleman’s intervention, but she still has a few contributions to respond to, and we need to make some progress.

[Nick Smith]

I welcome the proposal to ask local authorities to take responsibility for public health—in the round, that is a good thing—but will they get the resources to do that job?

[Anne Milton]

Thank you, Mr Speaker. I am afraid that I got rather carried away with this new-style debate, but I am mindful of the time.

For the first time, public health spending is ring-fenced. Public health interventions have been cut because of spending by PCTs, so it is really important to ring-fence such funding. The Government will focus on outcomes that are meaningful to people and communities. We published proposals for a public health outcomes framework yesterday for consultation, to which I am sure the hon. Gentleman would like to respond. I hope I have reassured him that the Government are taking the action necessary to improve the public’s health. I would be happy to discuss that with him in more detail another time, and perhaps to correct some of the myths that he believes. Nothing is ruled out. We will do everything we need to do to improve the public’s health, but we must use all the tools in the box. We cannot improve public health by Government intervention alone.

My hon. Friend the Member for Suffolk Coastal (Dr Coffey) raised the issue of integrated drug treatment systems for prisons that aim to increase the volume and quality of treatment available to prisoners. I welcome her involvement in her local prison. Such systems also aim to improve integration between clinical counselling, assessment, referral and through-care services, and to reinforce continuity of care when prisoners are released into the community.

The Government must reshape drug treatment to focus on recovery and to improve the continuity of treatment in the community following release. Abstinence is where we need to go. As outlined in the Ministry of Justice Green Paper on sentencing reform and rehabilitation, and in accordance with the much more outcome-focused approach announced in the new drug strategy, a payment-by-results approach to commissioning drug treatment for prisoners on release will be trialled in two areas. Recovery wings will be trialled in four prisons, with an emphasis on offenders receiving short custodial sentences, who therefore require a co-ordinated approach from prison and community. The combining of prison drug budgets with the combined drug interventions programme and a community-pooled treatment budget will allow for great flexibility, which is what we need in configuring services. To my mind, we have failed adequately to address drug abuse and prisoner addiction, and in turn failed our communities. We have not spent much-needed resources well.

I probably answered many of the points made by the hon. Member for Newcastle upon Tyne Central (Chi Onwurah) in my answer to the hon. Member for Blaenau Gwent on public health more generally. My husband’s family are all from Hartlepool. The hon. Lady was right to raise the issue of health inequalities. “Healthy lives, healthy people” underlines the priority that we are giving to tackling inequalities and supporting the principles of the Marmot review. We are focusing on the health and social needs of disadvantaged groups and areas, including on how money is allocated to local communities for public health interventions.

Despite the fact that the previous Government doubled health funding, as the hon. Lady rightly said, health inequalities got worse. I do not think that that was because of a lack of commitment on Labour’s part. It is extremely difficult to tackle health inequalities head-on, which is why our White Paper is so widely welcomed. The action outlined in that paper will reduce those truly shocking health inequalities.

It is important to recognise that this is not just about the money that is spent, but about how it is spent. I welcome the hon. Lady’s non-partisan comments about the previous Government’s record. For the first time, we are consulting on public health and ring-fencing money, and I believe that we can make a real difference.

The last Back-Bench contribution was from my hon. Friend the Member for South Swindon (Mr Buckland) on autism. I should like to take this opportunity to pay tribute to the parents and carers—young and old—who care for children and adults with autism. For some, that is a considerable burden that we should not underestimate. The National Institute for Health and Clinical Excellence is currently developing three autism clinical guidelines. The recognition, referral and diagnosis of autism guidelines are scheduled to be published in September next year; the diagnosis and management of autism in adults guidelines are scheduled to be published in July 2012—that might feel a long way off, but it is coming—and the management of autism in children and young people was referred to NICE by Ministers in November this year.

I pay tribute to my hon. Friend for his interest in autism, which has been discussed on many occasions in the House since I became a Member. There is no doubt that the expertise and input of people like him—people who have personal experience—is crucial in ensuring that we get the right policies that can have an effect on the ground, including in his constituency. His expertise and that of other hon. Members is critical.

Mr Speaker, I apologise for going beyond my allotted 10 minutes, but I wish you and all the staff of the House a very happy Christmas. I thank them for all their support this year and wish them well for the next.

Contaminated Blood

Anne Milton Excerpts

Tuesday 21st December 2010 Written Statements

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

On 14 October 2010 I issued a written ministerial statement, Official Report, columns 30-31WS, announcing a review of aspects of support available to individuals infected with hepatitis C and/or HIV by NHS-supplied blood transfusions or blood products, In that statement, I said I expected to be able to report the outcome of this work and my intentions by the end of 2010. The review has been completed and submitted to Ministers, and I will update the House early in January when I publish the report.

Mobile Phones (Health Effects)

Anne Milton Excerpts

Monday 20th December 2010 Commons Chamber

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

I congratulate the hon. Member for West Bromwich East (Mr Watson) on securing this debate. I know that he takes a particular interest in this and all other matters of technology, both nationally and in his constituency. He is absolutely right to say that we must heed scientific fact, but his insight into reshuffles is perhaps lacking in a certain degree of fact—or perhaps he knows something that I do not, from sources unknown. However, I wish to thank him for his flattering comments.

At the last count there were a staggering 80 million mobile phones in the UK, and the number is still rising steadily. More than 12 million people own a smartphone in order to access the internet and other web-based technologies. The benefits of mobile phones are clear in terms of social networking and rapid communication, and they help people to feel safer and in touch. They are also a way of including people. I feel more comfortable knowing that my children have mobile phones and that I can contact them, as they can me, wherever they are. I am sure that my parliamentary office would say the same about contacting me, particularly during the recess.

The hon. Gentleman is right to say that mobile technology has also raised significant health worries. Many people are extremely concerned about the effect of electromagnetic radiation from phones, and we should understand and acknowledge those worries. We should answer them on the basis of the evidence and we should ensure that appropriate protections are in place, so that not only is everyone safe, but everyone feels safe—and the hon. Gentleman has demonstrated that that is not necessarily the case.

[Bill Esterson]

The planning Green Paper that the Conservatives published before the election stated that the party would

“review potential health issues related to mobile phone masts in the light of ongoing scientific research.”

Can the Minister tell us how that review is going, and if a similar one is being carried out on handsets?

[Anne Milton]

I thank the hon. Gentleman for his intervention, but may I suggest that he may be jumping the gun a little? I have been speaking for only about two minutes, and I will come to all those issues if he gives me a bit more time.

The independent expert group on mobile phones and health was set up in 1999, partly as a response to public concern. It was tasked with reviewing the health effects of mobile phone technology. As a newly elected councillor, I was acutely aware of the considerable concerns among people in my ward at that time. As has been mentioned, the group was chaired by Sir William Stewart, the former chief scientific adviser to the Government. Its report was published in May 2000.

The report was based on a thorough review of scientific evidence on the health effects of mobile telephones and it took account of work in progress, alternative views on the science and public opinion, which at that time was considerably concerned about those effects. In 2004, the then National Radiological Protection Board reviewed the evidence again—the hon. Member for West Bromwich East mentioned this—and reiterated Stewart’s recommendations, in particular the recommendation that a precautionary approach should be adopted. Current Government policy on mobile phones is based on the Stewart report and its recommendations. The headline conclusion in the Stewart report was that

“the balance of evidence to date suggests that exposures to”

mobile phone “radiation below” national

“guidelines do not cause adverse health effects.”

The report was referring to the National Radiological Protection Board national guidelines, which were in place at the time. It is none the less important to note that Stewart recommended that as a precautionary measure the guidelines should be replaced by more restrictive international guidelines.

In recognition of the incomplete scientific knowledge and significant public concern, Stewart made other precautionary recommendations. For example, he recommended that the widespread use of mobile phones by children for non-essential calls should be discouraged. As the hon. Gentleman said, however, warnings are difficult to find, and the small print is very small. I suspect that many people these days are unaware of that guidance. I shall return to the question of scientific evidence in a minute.

The Government accepted the advice of the Stewart report and followed a precautionary approach, and most of the recommendations were implemented in full. On Stewart’s recommendation, we moved to stricter international guidelines for exposure. Along with other member states, the UK supports the European Council recommendation to limit exposures to electromagnetic fields, which incorporates international guidelines. By 2001, industry, Government Departments and their advisers were working to the new exposure guidelines for mobile phone technology, so now all mobile phones and base stations comply with the guidelines.

An important development following the Stewart report was the setting up of a new research programme in this country—the mobile telecommunications and health research programme, or MTHR. Research has been carried out at centres throughout the country under the management of an independent programme management committee. It is important to mention that it is independent. In 2007 MTHR published a report from 23 completed projects. Since then, further work has been published from the programme.

MTHR is a very high-quality research programme and none of the research so far has shown that radio frequency emissions from mobile phones affected people’s health—at least in the short term, although that is obviously not the end of the story. The lack of long-term data, however, has been noticed by MTHR, the World Health Organisation and other regional and international advisory committees. It is also being addressed by an international cohort study on mobile phone use and health known as COSMOS, to which the hon. Member for West Bromwich East referred.

The UK forms a key part of the study, and our participation is funded under the MTHR programme. I understand that the COSMOS study aims to follow the health of approximately 250,000 European mobile phone users for up to 30 years. It is a very thorough process. COSMOS will consider any changes in the frequency of specific symptoms, such as headaches and sleep disorders, over time as well as the important risks of cancers, benign tumours and neurological and cerebrovascular diseases.

The Department also supports the World Health Organisation’s international electromagnetic fields project, which encourages research focused on specific gaps in our knowledge. There is no doubt that there are considerable gaps in our knowledge at this stage. Apart from the accident risk from using mobile phones when driving, present knowledge indicates no proven risk to health from mobiles, except of course in the easy access that one has to home delivery pizzas and the possible impact on our daily calorific intake, which cannot be ignored.

Let me address for a moment mobile phone base stations, which are often called masts. When I first entered politics as a local councillor, that was one of the subjects that caused most concern. Masts provide the communication links by radio waves to handsets, allowing connection to the rest of the telephone system and the wider world. Mobile phones need this infrastructure to function, and it is this infrastructure that has caused so much concern in the past. On masts in particular, Stewart concluded that on the balance of evidence there is no general risk to the health of people living nearby, on the basis that exposures are expected to be very small. However, it is of note that in that connection, too, he recommended a precautionary approach. It was interesting to learn from the Stewart report that the levels of radio frequency exposure from masts, which people thought were likely to be high, were much lower than those from mobile phone handsets held near the head. Indeed, yearly independent audits have shown that mast exposures are well below the international guidelines—in many cases tens of thousands or more times below.

The MTHR also reaffirmed that exposures from base stations were very much lower than international guidelines. An MTHR study specifically looked to see whether short-term exposure to radio frequencies from masts could affect people’s health. Although some people attribute their ill-health symptoms to mobile phone base stations—the hon. Gentleman raised this issue—the MTHR peer-reviewed study found no convincing evidence so far that their symptoms were caused by exposure to signals from mobile phones or masts. But, of course, we should not and shall not be complacent: we must continue to keep the science under review. The Health Protection Agency keeps us informed of the science in this area, and its independent advisory group on non-ionising radiation is currently reviewing worldwide scientific studies on radio frequency emissions as part of its regular review cycle, and will report in one to two years’ time.

[Mr Watson]

I am grateful to the Minister for her very gracious answer to my rather long presentation. Does she think there are merits in opening up discussion with the industry on how they can improve their packaging advice and how we can improve public education, particularly for young mobile phone users?

[Anne Milton]

Yes, the hon. Gentleman’s point is well made. As I have said, most people are unaware of the guidance available, and the small print is often extremely small.

I am aware of the ability of large and powerful vested interests to lobby, often very successfully. There are, without doubt, eye-wateringly large amounts of money at stake in the mobile communications industry. I assure the hon. Gentleman that I am old enough and cynical enough to apply at all times an appropriate level of scrutiny and cynicism to all information that comes my way—always seeking to find out whence it came and who paid for it. He is right to say that no stone must be left unturned, but the problem is to establish causality. That is why, with ongoing and international studies, following a cohort is essential. We must base any Government action on robust scientific evidence. He is also right to say that it matters who funds research, and I assure him that I will not be pushed around, and I will keep my level of cynicism. However, I cannot comment on phone hacking; he must address those comments to another Minister on another occasion. Within my own portfolio, I will keep my eye on what is going on. As I say, I look forward to the report of the HPA’s independent advisory committee in one or two years’ time.

Let me conclude by saying that the Government take extremely seriously public concern over possible health risks from mobile phone technology, as they do all threats. There is a particular issue in that we are aware that health effects might not become apparent for 10, 20 or even 30 years. It is important to remain vigilant and to keep this matter at the top of our list of priorities. We will continue to respond to people’s concerns and to support those high-quality scientific studies, both nationally and internationally, in an honest, open and transparent way, being clear at all times where the vested interests lie. I thank the hon. Gentleman for raising this issue, which is of concern to so many people.

Question put and agreed to.

Employment, Social Policy, Health and Consumer Affairs Council

Anne Milton Excerpts

Tuesday 14th December 2010 Written Statements

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

The Employment, Social Policy, Health and Consumer Affairs Council met on 6 and 7 December in Brussels. The health and consumer affairs part of the Council was taken on 7 December. I represented the UK.

At the meeting, following an exchange of views on the draft regulation on provision of food information to consumers, political agreement between member states was reached by qualified majority. The United Kingdom voted in favour of the proposal. The text will now be forwarded to the European Parliament for their consideration.

A policy debate on a possible mechanism for the joint procurement of vaccines and antiviral medication concluded that a voluntary framework should be developed.

Council conclusions were adopted on: investing in Europe’s health work force of tomorrow—scope for innovation and collaboration; innovation and solidarity in pharmaceuticals and on innovative approaches for chronic diseases in public health and health care systems.

The Commission provided an update on progress of the proposals on information to the general public on medicinal products, and the presidency provided information on a number of conferences and international events organised during their presidency.

Office of the Health Professions Adjudicator

Anne Milton Excerpts

Thursday 2nd December 2010 Written Statements

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

I informed the House on 26 July, Official Report, columns 65-66WS, of the Government’s intention to consult on whether to proceed with work surrounding the Office of the Health Professions Adjudicator (OHPA). A subsequent consultation on this issue, entitled: “Fitness to Practise Adjudication for Health Professionals: Assessing different mechanisms for delivery” was launched on 9 August 2010 and ran until 11 October 2010. The Government are grateful to those who responded.

After careful consideration of the responses received, the Government have decided to proceed with the taking of steps to abolish OHPA.

The Government’s full report and conclusion on the consultation, containing an analysis of the responses received 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. We shall bring forward primary legislation to enable OHPA’s abolition at the next available opportunity.

Candour in Health Care

Anne Milton Excerpts

Wednesday 1st December 2010 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 Gray congratulate my hon. Friend the Member for Poole (Mr Syms) on securing this debate. As Chairman of the Regulatory Reform Committee, he is no doubt acutely aware of some of the issues that exist around regulation, not least those that exist around the duty of candour. His humility and recognition of the impossible task that we face here today—to truly reflect the pain and suffering of those who have suffered as a result of medical harm—does him considerable credit.

We take candour and openness in the NHS extremely seriously. Everybody does, because it is a vital issue. As anyone who has ever been treated knows, a health care system is not just about how quickly someone is seen or how quickly their stitches come out; it is also about trust. Trust is fundamental—between patients, the patient’s family and health care professionals—and we must do everything we can to ensure that that trust is upheld.

As my hon. Friend may be aware, one of the early references to a statutory “duty of candour” was included in “Making Amends”, a 2003 report, which I know hon. Members have referred to. It was a consultation paper from the then chief medical officer, Liam Donaldson, and it set out proposals for reforming the approach to clinical negligence in the NHS, suggesting

“a duty of candour requiring clinicians and health service managers to inform patients about actions which have resulted in harm”.

The paper also proposed to foster an environment of openness and honesty among all NHS staff; it encouraged “integrity”, which is a word that we perhaps do not use often enough, and it proposed exempting those who report adverse events or medical errors from disciplinary action, unless there are serious extenuating circumstances. It is a key belief of the coalition, and I would hope all Members of the House, that the focus should be on the performance of the organisation rather than on penalising individuals who bring matters of concern out into the open. The hon. Member for Southport (Dr Pugh) has already mentioned whistleblowing. I think that the point is that this debate is not necessarily about the protection of whistleblowers or a right to whistleblow; it is perhaps about a duty to whistleblow.

It is important to note the good work that is currently being done to promote candour. The previous Government should be congratulated for providing staff with advice and support to help them to communicate with patients, their families and carers following harmful incidents. The Health Act 2009 requires all NHS organisations to be aware of the NHS constitution, which places a duty on NHS staff to acknowledge mistakes, apologise for them, explain what happened and put things right. The professional codes of practice for doctors and nurses contain a similar duty.

As somebody who trained as a nurse and worked in the NHS for 25 years, I think that professional codes of practice and professional standards are not talked about often enough. We look for someone to blame: we look for the organisation to blame; we look for the board to blame, and we look for the chief executive to blame. What we do not talk about is individual professional standards and I feel particularly strongly that we need to do everything that we can to raise those standards right up.

The National Patient Safety Agency has been running its own campaign to promote candour in the NHS, as the hon. Member for Leicester West (Liz Kendall) said. That campaign, entitled “Being Open”, is a long-term process rather than a short-term push. It encourages the provision of verbal and written apologies to patients, their families and carers; it promotes continual communication with those involved in incidents, and it requires thorough record-keeping of all “Being Open” discussions and documents.

However, we all know that still more needs to be done, as hon. Members have said and as I know myself from my own constituency casework; I have a number of people who have continually fought to try to get the truth about what happened to their relatives. The recent White Paper, “Liberating the NHS”, states that

“we will require hospitals to be open about mistakes, and always tell patients if something has gone wrong”.

It is quite simple: we expect the NHS to admit to errors; apologise to those affected, and ensure that lessons are learned to prevent errors from being repeated.

In one year, the NPSA receives notification of more than one million incidents. Most of those incidents result in no harm and we welcome the high level of reporting. However, the incidents that result in harm obviously cause distress and anguish for the patients and families involved. In those cases, it is even more important that the lessons are learned and that organisations are open with those who have been affected.

[Dr Pugh]

I want to ask about the future of the NPSA. If it is going to be brought within the national commissioning body, will a Chinese wall be established between the NPSA and the other operations of that body? It crosses my mind that risks can allegedly be increased or decreased by commissioning decisions themselves.

Under those circumstances, the NPSA has got to be free to impute itself, as it were, if the national commissioning body is going to be part and parcel of the same organisation. So, can the Minister assure me that there will be no conflict of interest when the NPSA is placed within the national commissioning body, which may itself—through its commissioning procedures—be one of the risk factors?

[Anne Milton]

The hon. Gentleman is absolutely right. That is terribly important. It is not only important to have Chinese walls and be seen to be separate; it is important to be separate. I will come to that point in detail in a minute.

Measuring openness is not as straightforward as measuring reporting. We welcome high levels of reporting, as they are an indicator of an open and supportive culture of patient safety, but there are still reasons why people within the NHS and organisations shy away from openness. Without a doubt, professionals who strive for excellence are reluctant to admit errors. The higher up the tree one is, the harder it is to say, “I’ve made a mistake.” All of us face that issue in our professional lives.

People may have unfounded concerns about possible admissions of liability, even though apologising when something has gone wrong is not in any way an admission of liability. The fine line between the two sometimes prevents people from saying what relatives want to hear: “I am so sorry this happened.” That is not necessarily saying, “I have made a mistake.” It is such a shame when professionals resort to a defensive stance, often encouraged by myths about where liability lies. Also, at times, they may fear reprisal, blame and even bullying.

We are considering options for introducing a requirement for openness and will make a decision in due course. The hon. Member for Southport felt that we were hesitating, and was concerned about possible evidence of Sir Humphreys in the Department. We are considering, not hesitating. It is important to get it right. Members have discussed the three options, but I will run through them quickly and mention a few relevant issues.

The first option is using what is in the existing Care Quality Commission registration requirement regulations. It is already mandatory for NHS trusts to report all serious patient safety incidents. We could also require organisations to demonstrate that they have met the openness requirement, which would not require new legislation. It makes sense to use existing means to detect and investigate trusts that are not as open as they should be. The counterargument is that that approach is not specific enough, and that the wording of the guidance would need to be made more explicit. We have seen many cases in which guidance has failed.

The second option involves introducing a new legal, statutory duty of openness explicit within the CQC regulations. That would send a clear signal about the importance of openness and provide patients and campaigners with a single clear duty that they could use to demand full disclosure. However, the Government want to create new legislation only when absolutely necessary, although when necessary, it should be done. We would need to ensure that any new legislation or new approach was not counter-productive. We want to make it easier for staff to come forward; we do not want new legislation to have unintended consequences.

The third option involves incorporating an openness requirement into the new NHS contractual, performance and commissioning processes, to which the hon. Members for Leicester West and for Southport referred. It certainly appears possible to pursue openness through the new commissioning arrangements. For instance, it could be written into standard NHS commissioning board requirements that providers commit to being open. The hon. Member for Leicester West asked whether the NHS commissioning board would have time to take a role on patient safety. In many ways, safety underpins all commissioning decisions. Any decision on any service commissioned should have safety wrapped around it. That is fundamental.

As with any complex matter, each of the options has its pros and cons. It is imperative that a decision on the issue is not rushed. I reassure the hon. Lady that campaigners and organisations have good access to officials within the Department, and I am sure that all their views will have been taken into account when a decision is made, because we are aware of the importance of getting it right. It is terrible to think that the first duty of the NHS is to do no harm. Safety wraps around everything that we do.

The hon. Lady also mentioned the decision to abolish strategic health authorities. I understand that SHAs are the performance managers of trusts, yet that did not help in Staffordshire. In many ways, bringing commissioning decisions closer to the patient within general practice will mean that decisions about care and its consequences rest where they should.

[Liz Kendall]

The Minister raises the important issue of Stafford and the lessons to be learned there, and says that the SHA did not take action. Obviously, we will wait for the outcome of the independent inquiry, but as responsibility will move to GP commissioning consortiums, can she tell us whether any of the GPs in the area raised concerns about Stafford, or whether any of them have submitted evidence to the inquiry? I am not aware that they have.

[Anne Milton]

I did not point a finger at the SHA; I pointed out that SHAs were performance managers. Where performance fails, one must ask oneself what was happening in the management of that performance that it could fail so abysmally. The hon. Lady must not forget that the GP consortiums will involve a much wider range of professionals in commissioning decisions than just GPs, including a lot of people involved in care. They will not necessarily consist only of NHS professionals. Voluntary bodies and other organisations that provide care will also have input.

The sad truth is that when things go wrong, relatives want to know what happened, as my hon. Friend the Member for Poole pointed out, but they do not always find out. They want the truth and honesty, but we often see precisely the opposite. Doors close, the shutters go down and NHS organisations resort to a defensive stance, sometimes quite aggressively. My hon. Friend mentioned his constituents the Byes and the Powells, who have campaigned endlessly for the truth and continue to campaign. I pay tribute to all the people, some of whom we do not know about, who use their own tragic circumstances to ensure that the same thing does not happen to others. Their efforts should never be underestimated.

[Tom Brake]

The Minister said that the NHS sometimes adopts an aggressive stance. I remind her of my question to her about the possible impact of withdrawing legal aid in clinical negligence cases. Often, families use such cases as a way of trying to secure an apology because one has not been forthcoming. If that option is not available to them, it reinforces the need for a duty of candour.

[Anne Milton]

The hon. Gentleman pre-empts me by a second; I was about to come to legal aid. My experience is that even with legal aid, the courts are rarely an option for most people. Allowing discretion on the reporting of near misses would, I fear, open another minefield beyond which people could hide, as he also mentioned.

I have certainly brokered meetings between NHS organisations and my constituents to try to bring them together and make the NHS organisations stop feeling so defensive. I have been an advocate for people in my constituency just so they could hear what happened. I should think that many hon. Members rely on personal relationships, particularly within hospital trusts, for such purposes. Maybe they know a supportive medical director to whom they can say, “Look, this family, this couple or these relatives just want to know what happened; this isn’t going to go anywhere.” That is a leap of faith. The NHS organisation has to say, “Fair enough.” When that happens, closure can follow.

The hon. Member for Southport rightly pointed out that accidents occur across the NHS and mentioned, in particular, the failure to diagnose in general practice. That is an ongoing, rumbling issue that I hear about not only as a constituency MP, but as a Minister. I thank him for recognising that the solution to getting to a situation where we have effective measures in place to ensure candour is a dilemma. It is not an easy decision. He is also right to point out that the NHS is not alone in protecting itself. My goodness me, we know a lot of professions that close their doors when one of their members is under attack—the legal profession is one. People just want the truth, but sadly the shutters go down and the doors close, and closure cannot be achieved.

[Mr Syms]

I am pleased with the way the Minister is responding to the debate and recognise that a statutory duty of candour is one of a range of measures that the Government are considering. However, if they decide not to take that route initially, it is important that they do not rule it out, because the culture change that is needed might not come about as a result of what they are doing, but we will still need to get there at some point. I still think that a statutory duty of candour would be the biggest and most successful leap towards that goal—the hon. Member for Carshalton and Wallington made a good point on that—but even if the Government choose not to go there, they should not rule it out, because I think that ultimately that is where we will end up.

--- Later in debate ---

[Anne Milton]

I thank my hon. Friend for his intervention and am sure that the report of this debate will aid people in making their decisions on the matter.

On the point raised by the hon. Member for Carshalton and Wallington on legal aid, I understand that the Ministry of Justice proposal on restructuring and refocusing the scope of legal aid is currently out for consultation. There will still be an exceptional funding route for those not eligible for legal aid, but he might want to raise that specific point with the MOJ because it is important. The hon. Member for Southport rightly picked up on the fact that we included in the White Paper the principle of “No decision about me, without me”, and that probably needs to be extended to situations where harm happens.

A few Members mentioned international precedents, but we must be slightly careful, because what happens abroad cannot necessarily be transported to this country. Those precedents tell us that there can be problems in adopting a statutory duty of candour. It can be difficult to measure success and, therefore, find any evidence of where success or failure has occurred. We must also be mindful of the differing health care and legislative environments that exist around the world when looking at international examples. In Pennsylvania, for example, we have been told that a complicated set of requirements makes enforcing its version of a statutory duty particularly problematic.

In conclusion, there are complex issues at play in relation to a statutory duty of candour, and views are held on both sides of the argument for and against such a duty. What we can say, as has been documented in the White Paper, is that we are absolutely set on achieving that change in culture to achieve openness and candour in the NHS and all organisations that provide care. We are exploring those complex issues carefully. The culture of secrecy and denial is a disease that needs to be cured, but to do so we need to understand and treat its causes at their source, rather than simply treating the symptoms with an ineffective plaster.

As my hon. Friend the Member for Poole stated, the start of the healing process is about learning the truth. The Government will need to decide how we can provide the environment, with or without legislation, in which the truth can come out immediately—in a timely fashion—and openly. We need inspirational leadership and highly developed management skills in our NHS leaders to create that change in culture to create an open atmosphere among staff, not the closed culture that we have seen. We need a culture that replaces the fear of the consequences of openness with the courage to recognise that openness, honesty and truth will, ultimately, not only give families what they need to heal their wounds and achieve closure, but allow staff to learn from their mistakes, raise their standards and raise the bar on their professional standards.

The Government will consider all that when making the decision, but Members should rest assured that everything that has been said today and all the effort to highlight the issue will be taken in account to ensure that we get the right system in place to give people what works.