HIV

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, Mr Leigh; I do not believe that I have been in this position before. I am grateful to the hon. Member for Inverclyde (David Cairns) for securing this debate. I congratulate him on his chairmanship of the all-party parliamentary group on HIV and AIDS, and I congratulate the group itself on continuing to raise awareness in Parliament, in the UK and internationally.

Today, as we all know, is world AIDS day, so this debate is timely; I believe that Mr Speaker has some influence over when debates occur. It is an opportunity to reflect on what we have achieved, where we stand and the challenges ahead, many of which have been mentioned. I thank my hon. Friend the Member for Pudsey (Stuart Andrew) for his gracious comment that this is a chance for us to pay tribute to those whom we have lost along the way to the present improvements in life expectancy for those with HIV/AIDS. A dear friend, Eric, with whom I worked in the 1980s, died from AIDS; I am sure that many of us know people who lost their lives. It is so tragic when we consider the advances made.

The hon. Member for Inverclyde focused on the situation in the UK. The hon. Member for Hackney North and Stoke Newington (Ms Abbott) mentioned the global situation. It is important to note that the number of new infections decreased by 19% between 2009 and 2001. Today, more than 5 million people have access to life-saving antiretrovirals. That is more than a thirteenfold increase in five years, but significant challenges remain. More than 33 million people are living with HIV, 2.1 million children are infected and the World Health Organisation estimates that at least 10 million people still need treatment. There is a great deal more to be done, and no room for complacency.

I would like to mention my noble Friend Lord Fowler, and welcome the announcement of next year’s inquiry into HIV and AIDS. Like the hon. Member for Inverclyde, I am old enough to remember when the disease came on the scene. A great friend of mine, a professor of virology who went over to the States, came back and said that it was extraordinary to see an acquired deficiency, as the disease’s name suggests. He talked about a curious illness that people were getting.

At that time, a tremendous amount of work was being done by many people, not least my noble Friend, to fight HIV/AIDS. It is still a powerful model for public health campaigns; we cannot forget those tombstones. Such images enabled a lot of the preventive work from which we still benefit. I reassure the hon. Member for Inverclyde that mass communication had an effect. The rate of sexually transmitted diseases decreased across the board. However, he also mentioned targeted messages, which is where we need to focus our efforts.

Although prevalence is relatively low in the UK population as a whole, some groups are disproportionately affected, including men who have sex with men, and black African communities. In 2009, they accounted for 42% and 36% respectively of the 65,000 individuals living with diagnosed HIV infection. However, as my hon. Friend the Member for Hove (Mike Weatherley) rightly pointed out, stereotypes are dangerous, and the figures that I have quoted must be used with caution.

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On resuming—

[Anne Milton]

My hon. Friend the Member for Hove also mentioned the specific problems with late diagnosis, which I shall return to. The outlook for most people with HIV in the UK is more positive than it used to be, and the vast majority can now plan for their future with a great deal more certainty, which is to be welcomed. We must not forget that we have the dedicated work of many scientists around the world to thank for that, along with action from Governments from both sides of the House.

However, challenges remain. As Members have pointed out, despite our successes, a quarter of people with HIV do not know that they are infected and so are unable to benefit from the treatment available, and they can unwittingly infect others. Around half of the newly diagnosed infections are diagnosed late, after the point at which people should have started treatment. The hon. Member for Ealing, Southall (Mr Sharma) raised that as an ongoing and growing problem, along with the fact that many of the people affected have serious mental health problems. The mental health and well-being of people with HIV and AIDS is seldom mentioned, but it is extremely important to recognise.

I share the concerns raised in the debate about the need to reduce the number of people with HIV who are undiagnosed or diagnosed late. We need to increase testing, especially in those areas that have a higher prevalence of HIV. We have seen a good uptake of HIV testing in sexual health clinics and antenatal settings, but all health care professionals need to be alert to the importance of offering appropriate HIV tests.

[Ms Abbott]

Does the Minister have any practical proposals for increasing testing, such as different contexts in which it can occur?

[Anne Milton]

I thank the hon. Lady for raising that point, which is important. I will return to it later in my remarks. The hon. Member for Cardiff Central (Jenny Willott) mentioned the automatic testing when she had her baby. The Department of Health has funded eight pilot projects, which have now been completed, that looked at the feasibility and, importantly, acceptability of providing an HIV test as part of routine services offered to newly registered adults. I am encouraged by the findings from those projects, which confirm that offering HIV tests in GP practices, hospitals and community settings is acceptable to patients.

The pilots picked up a significant number of previously undiagnosed people in high prevalence areas. It is good news that people are happy to be tested, because it means that we can pick up cases of HIV that would otherwise be missed. We are working on the best approaches to expand HIV testing in a variety of settings and, as the hon. Member for Hackney North and Stoke Newington said, that is really important. If a wide variety of settings was available, a GP practice is not necessarily where people would go for a test—far from it, I would say.

I am also pleased to note that, thanks to the leadership and drive of local HIV clinicians and others, findings from the pilots in Brighton, Lewisham and Leicester have now been embedded in local practice, which is to be congratulated. The Health Protection Agency will publish its final report on the pilots early next year, which many people will look forward to seeing. We need to see what we can do to put into practice what we have learnt. It is vital to increase testing for HIV, as it is for a number of sexually transmitted diseases, so we continue to fund targeted programmes for the groups most at risk from HIV in the UK. We have also funded the Medical Foundation for AIDS and Sexual Health to provide training resources for health care professionals in secondary care.

I would like to thank the hon. Member for Dudley North (Ian Austin), who kindly sent me a note to explain that he has had to leave the debate, for raising the work of Summit House Support. We will be looking at the findings of the pilots I have mentioned, and I would certainly not like to miss an opportunity to go to Dudley, should the opportunity arise, to have a look at what Summit House Support is doing.

For HIV, as for all STIs, prevention remains the most important response. In the UK, the majority of HIV infections are sexually transmitted, and the vast majority of those could have been prevented; that is a message that we really must hang on to.

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On resuming—

[Anne Milton]

We need to ensure that safer sex messages are clearly communicated and understood by all.

I think that we also have to clamp down a bit on irresponsible marketing. I have been approached by those who are unhappy about the promotion of DVDs and other material promoting “bareback” sex. We need to address such issues and I know that a lot of people and organisations, such as the Terrence Higgins Trust, are doing all they can to stop the promotion of such material. To those who are most at risk of HIV in the UK, I say that the Government work very closely in partnership with the Terrence Higgins Trust, the African Health Network and a huge number of other voluntary and community groups.

Yesterday, we published a White Paper on public health and later this month we will publish a number of supporting documents, including a public health outcomes framework. We will be thinking about what the best outcomes might be for HIV and they will be included in that document. I know that Members will look at that document with care and feed back to us their feelings on it. In the spring, we will publish a position paper on sexual health which will, of course, include HIV. That paper will take into account many of the issues that have emerged this afternoon.

[David Cairns]

I will let the Minister catch her breath and I appreciate that we are really up against the clock. She says that there will be a position paper in the spring. Does she envisage that that will lead to a full new HIV strategy, or will it just remain a position paper?

[Anne Milton]

No, it will be a sexual health strategy. The Government and the NHS need to play their part, and we need to support individuals to make responsible lifestyle choices. We continue to provide the very best HIV treatment services, but others have a role to play and they are often better placed than the Government to make a difference. The hon. Member for Hackney North and Stoke Newington mentioned the role of churches in that regard and they can have a significant impact.

Voluntary community groups, industry, responsible media, churches and faith groups all have a part to play. That collaboration is so important in tackling stigma and discrimination, which is still a very real issue for many people affected by HIV. That is particularly important within those communities who find sexual health issues more challenging than other communities.

Stigma means that people refuse tests, do not take precautions and do not go for treatment. I was delighted to see that the Prime Minister highlighted the issue of stigma in his world AIDS day podcast. Tackling HIV is everyone’s business and we can all make a difference to reduce stigma, reduce new infections and enable people living with HIV to lead full and productive lives.

The hon. Member for Inverclyde raised issues about global funds. I am sure that he will also raise those issues with my colleagues in the Department for International Development. However, as my ministerial brief also covers EU health, it may be of note for him to realise that such issues are recognised by many people within Europe and across the world, and we continue to work both nationally—within our own member states—and internationally, because collectively we can do a great deal to help each other.

The hon. Gentleman also said that generally a one-size-fits-all approach does not work and, as my hon. Friend the Member for Hove said, anonymous testing and treatment is often crucial. We will announce our commissioning intentions soon. However, the hon. Gentleman’s point is well made.

I think that it was the hon. Member for Dumfries and Galloway (Mr Brown) who mentioned the issue of commissioning services in rural areas, which poses particular challenges and very real problems. It is absolutely crucial that we get that commissioning right. We will announce our intentions soon and I hope that they will address some of the points that he raised.

We need to talk about sex. We need to talk about people’s sexual health. We need to talk about people’s responsibilities in looking after their sexual health, and we all have something to offer and we all have something that we can do personally, particularly those of us who are Members of Parliament. As MPs, we have unprecedented access to media, particularly in our local areas. We need to do everything that we can to express the fact that this is everybody’s business and that people need to take responsibility for their sexual health. Their sexual health not only affects them; it affects the others around them and their families too. Only then will we be able to see a future for people living with HIV/AIDS that we all want to see.

Stem Cell Transplant Services

Anne Milton Excerpts

Wednesday 1st December 2010 Written Statements

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

As part of the Government’s desire to see improved services for NHS patients, the Department asked the NHS Blood and Transplant Authority to lead a review of stem cell transplant services.

The authority duly established the UK Stem Cell Strategic Forum, an advisory group of national and international experts, service providers, clinicians, patients and charities which has now reported on its findings. The report, “The Future of Unrelated Donor Stem Cell Transplantation in the UK”, contains 20 recommendations on how we can better deliver this type of stem cell technology for the benefit of NHS patients.

The Department welcomes the report. We will now begin work, in collaboration with the NHS, NHS Blood and Transplant and the Anthony Nolan Trust to develop improved partnership working and consider how the findings and recommendations in the report can be best translated into real service improvements.

A copy of the report has been placed in the Library and copies are available to hon. Members in the Vote Office.

Violence Against Women and Children Action Plan

Anne Milton Excerpts

Thursday 25th November 2010 Written Statements

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

Today, I formally launch the Department of Health action plan, improving services for women and child victims of violence. This document sets out how the Department, in partnership with others, will take action in response to the findings of the independent taskforce on the health aspects of violence against women and children (VAWC), which were published in March 2010.

The work programme aims to lay the foundations for embedding high-quality evidence-based practice within the national health service in response to violence and abuse and is set around four key themes: awareness-raising; workforce, education and training; improving quality of services; and evidence and information.



The action plan takes into account the key findings from the independent taskforce, which were informed by focus groups with women and children service users. An NHS implementation group on violence against women and children, established in June, will oversee progress of the implementation work.



The Department’s work in this important area also feeds into the cross-Government programme on violence against women and girls. This highlights the importance of partnership-working at both a national and local level to tackle violence and abuse.



I am placing a copy of the report in the Library and copies are available to hon. Members from the Vote Office.

Ward Closures

Anne Milton Excerpts

Wednesday 17th November 2010 Commons Chamber

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

I congratulate my hon. Friend the Member for Thirsk and Malton (Miss McIntosh) on securing the debate. I can fully understand her desire to ensure that the best possible health services exist for her constituents, which came across strongly when she met the Minister of State on 12 October to discuss Malton community hospital.

My hon. Friend is right to say yet again—we say it often, but we cannot say it often enough—that the NHS is a national treasure. It is much loved and much relied upon by all of us, and from my own point of view it was my employer for 25 years. As she rightly stated, patients are at the heart of the service, and need to continue to be. I am sad to say that the story she told this evening is not dissimilar to my experiences in my own constituency, and it shows a big gap: what managers in charge of the finances and commissioners are trying to achieve is very distant from what local people feel.

I wish to say a little about where we are, because I think I can reassure my hon. Friend that our vision of the health service is well aligned with her own. This Government trust professionals in the NHS, and our White Paper, “Equity and excellence: Liberating the NHS”, is about putting that trust into action and sweeping away the old system, which serves only to hamper and curtail the professional judgment of clinicians. We are replacing politically motivated process targets such as how many people are seen and the length of time they wait, which lump all patients together whatever their ailment, and introducing clinical standards generated by the professionals themselves, to hold them to account for the quality of care and outcomes that they provide. My hon. Friend also referred to the vital importance of professionals leading that process.

The future of local health services will not be dictated from the centre. They will not be directed by strategic health authorities or primary care trusts, they will be designed and commissioned from the bottom up by GPs and their colleagues across the health service, such as clinicians and managers, working in partnership in independent trusts to improve the quality of care. Patients will be armed with unprecedented levels of information and powers of scrutiny, and there will also be input from democratically elected local councillors. That bottom-up approach is important to prevent the present situation from happening again.

[Miss McIntosh]

What my hon. Friend is saying is music to my ears, but what concerns me is how we have reached a situation in which a major reconfiguration of services has happened without any regard at all to the bottom-up principle.

[Anne Milton]

I thank my hon. Friend, who is absolutely right. I will come to that.

As my hon. Friend stated, my right hon. Friend the Secretary of State has identified four crucial tests that all reconfigurations must now pass. First, they must have the support of GP commissioners. Secondly, there must be arrangements for public and patient engagement—no, I would rather say “involvement”, because “engagement” is not a favourite word of mine. This is about involvement—people being listened to and their voices being heard, which clearly has not happened in the case that she has described. Thirdly, there must be greater clarity about the clinical evidence base underpinning a proposal. Fourthly, proposals must take into account the need to develop and support patient choice. That is a recipe not for maintaining the status quo but for locally agreed, transparent, evidence-based and clinically led change. Decisions about the services at a local hospital will be driven by local clinicians, with the consent and input of patients and local authorities, not imposed or decided behind closed doors.

On Malton community hospital, providing health services in rural areas can be challenging, and I understand that many patients in north Yorkshire have to travel for as long as 45 minutes to reach their nearest large hospital. Local health services can indeed find it difficult to meet national guidelines, particularly those involving clinical mass. I understand that it is against such a challenging backdrop that North Yorkshire and York PCT is currently considering its strategy for health services in Malton and Ryedale, ensuring that they are safe and sustainable for the future.

I am happy for my hon. Friend to come back to me on any points that I may raise. I understand that the PCT’s emerging strategy for future hospital service provision is based on four themes: prompt local access to assessment and treatment for those needing urgent care; local access to a range of rehabilitation services, delivering intensive rehab and support effectively to re-able patients; prompt and local access to diagnostic tests and, where desirable and feasible, minor surgery; and specialist out-patient services to promote access and to support patient management by local GPs.

I am also aware of press speculation that Malton community hospital may be closed. The PCT has made it clear that it sees the hospital as an integral part of local health services and that it has no intention of not having a community hospital in Malton. I do not know whether that will reassure my hon. Friend. Judging by the expression on her face, I fear that it may not.

North Yorkshire and York PCT is currently piloting a scheme of enhanced community service in the Malton and Whitby area. The PCT believes that treating patients closer to home will provide better outcomes and encourage patients to retain their independence. I gather that that pronouncement has been greeted with the same cynicism with which it is greeted in many areas around the country.

[Miss McIntosh]

No one believes a word that the PCT says any more. There was a cohort of patients—21 at a time—who were treated intensively and given rehabilitation on a ward. They will now not be treated as intensively, and will be less safe when they return home after a fall or a major injury. It is that cohort of patients who will not benefit from hospital at home.

[Anne Milton]

I understand what my hon. Friend is saying. One of the problems is that we will have to let the pilot run. It is using existing hospital staff to provide hospital care in patients’ homes. I gather that there will be no reduction in nursing staff, but delivering care in people’s homes is a very different process from delivering it on a hospital ward. Because of financial constraints, it is not possible to run concurrent hospital and community services, so as part of the pilot, the wards have been temporarily closed. I understand that there will be deep cynicism about the prospect of their ever opening again. However, I am assured by the PCT that this is a pilot, and that a full assessment will be made at the end of it.

The project implementation team meets each week to assess the ongoing impact of the ward closure and bed reductions, and that team includes community provider staff, community hospital matrons and representatives from the community nursing team. I hope that that will continue, and go some way towards reassuring my hon. Friend. The pilot scheme will finish at the end of March 2011, and a full evaluation will take place in April 2011. The PCT has developed criteria for its evaluation—with, I hope, full consultation of local people.

I reiterate that no final decision has been made about the future of Ryedale ward. If the pilot leads to proposals for permanent service changes, the PCT will need to conduct a full public consultation, underpinned by the principles that I have set out. I hope that the PCT may learn a little from this debate, and from the letters that it has doubtless received, and ensure that local people feel that the consultation is real. I understand that the strategic health authority is working closely with the PCT to ensure that proper process is followed.

The need to improve clinical outcomes means that local health services will need to evolve, but I hope that, unlike previous changes, any future changes will have the confidence of local communities and clinicians. People must feel that their voice is properly heard; that is what the new arrangements are about. It will not always be easy, but if the process is clear and transparent, and, crucially, if it is led locally by clinicians, it will have the confidence of local people.

The commitment and tenacity that my hon. Friend shows in fighting for local health services is commendable. I note that she is due to discuss the matter further with the PCT on 19 November. I know that she will continue to work with the local NHS and ensure that her constituents’ voices are properly heard and represented, as she always has done.

The list of enhanced services that my hon. Friend described is particularly significant in the light of the publication of the White Paper. The description of the way in which the ward was closed gives rise to concern and cynicism among local people. It is not useful when organisations act in such a way, because it simply fosters a belief that the PCT is trying to drive something through. We have to let the story run and let the pilot be properly evaluated against the criteria that my right hon. Friend the Secretary of State has outlined.

[Miss McIntosh]

I am most grateful for my hon. Friend’s full reply from the Dispatch Box. On the particular, indeed unique, point that the PCT is both commissioner and provider of the services, will she give me an assurance that the functions will definitely be separated and that such a position will never arise again? It causes undue confusion for all concerned.

[Anne Milton]

My hon. Friend is right to draw attention to the issues surrounding the commissioning and provision of services. We have grappled with that for some time and we will fully address it. The consultation on the White Paper that we published in July is now finished, and we need to guard against exactly that sort of problem. If there is no Chinese wall or division between commissioning and provision, cynicism and deep suspicion of the commissioning decisions ensue.

I know that my hon. Friend will continue to make representations and watch the process closely. I assure her that our door will be open to hear any representations that she wants to make.

Question put and agreed to.

Employment, Social Policy, Health and Consumer Affairs Council (6-7 December 2010)

Anne Milton Excerpts

Wednesday 17th November 2010 Written Statements

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

The Employment, Social Policy, Health and Consumer Affairs Council will meet on 6-7 December. The health and consumer affairs part of the Council will be taken on 7 December.

Legislative items on the main agenda, on which the presidency are likely to ask Ministers for political agreement are: a directive on prevention of the entry into the legal supply chain of medicinal products which are falsified in relation to their identity, history or source and a regulation on provision of food information to consumers. The UK supports the adoption of both of these proposals.

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

investing in Europe’s health work force of tomorrow: scope for innovation and collaboration;

a co-ordinated action for stimulating, measuring and valorising pharmaceutical innovation;

innovative approaches for chronic illnesses in public health and health care systems;

supply of radioisotopes; and

lessons to be learned from the HlNl pandemic—health security in the European Union.

The UK supports the adoption of these Council conclusions.

Under any other business, information will be provided from the presidency on a recast of the three directives on medical devices, on the fourth conference of the parties at the WHO framework convention on tobacco control, which took place on 15-20 November 2010, and on a number of conferences that took place under the Belgian presidency. In addition, we expect the Commission to provide information to the Council on the proposals for a directive and a regulation on information to the general public on medicinal products subject to medical prescription.

Oral Answers to Questions

Anne Milton Excerpts

Tuesday 2nd November 2010 Commons Chamber

[Kerry McCarthy (Bristol East) (Lab)]

2. What progress his Department has made in the provision of specialist neuromuscular care in Bristol; and if he will make a statement.

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

I thank the hon. Lady for her question. Of course, it is important that the commissioning of services, which is about getting the right treatment and services for people, is a decision that is made locally. The south west specialised commissioning group—SWSCG—has responsibility for commissioning specialised services for neuromuscular conditions in Bristol. I know that there have been some problems in the past, but since the Walton report the group has reviewed its provision of neuromuscular services and appointed both an additional paediatric neuromuscular consultant and a new adult neuromuscular consultant in Bristol, as part of the £l million investment for the south-west, which I am sure she will welcome.

[Kerry McCarthy]

I thank the Minister for that comprehensive response. Families who live with muscle disease, such as the Arshad family, in Brislington, in my constituency, have welcomed the work of the SWSCG but are very worried about the impact that the introduction of GP-led commissioning will have on these services. They really feel that families like them will be left by the wayside. What reassurances can she give them?

[Anne Milton]

May I point out to the hon. Lady that, in fact, GPs are often very aware of the services that are needed? The neuromuscular team attached to the SWSCG has worked with the South West Muscle Group on the development of a provider register for hydrotherapy services, for example. Such things are best decided by GPs, who know exactly what people need, what treatment is needed and what care services are needed to ensure the best possible outcomes and the best possible quality of life.

[Mr James Gray (North Wiltshire) (Con)]

The national service framework for long-term conditions such as multiple sclerosis, in which I am very interested, was much praised at the time it was launched. Does the Minister feel that it was properly funded and that it has been run properly since? Has it lived up to the expectations that we all had of it three or four years ago when it was launched?

[Mr Speaker]

With particular reference to the care provided in Bristol.

[Anne Milton]

With particular reference to the care provided in Bristol, the one thing that I would say is that commissioning is not something that has done well. There is never any room for complacency in the provision of services or in the provision of treatment. We always need to strive to do better.

[Chris Heaton-Harris (Daventry) (Con)]

3. What steps his Department is taking to increase the provision of preventative health care.

--- Later in debate ---

[Graham Evans (Weaver Vale) (Con)]

9. What progress he has made on increasing the provision of specialist neuromuscular care in (a) the north-west and (b) England.

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

I thank my hon. Friend for that question. I pay tribute to the Muscular Dystrophy Campaign and a number of other organisations that have been so successful in raising these issues. A review of specialist neuromuscular services in the north-west was completed in September 2010. I understand that the focus of the review was the particular pressure areas of service provision highlighted by Muscular Dystrophy Campaign reports and corroborated locally by key stakeholders.

[Graham Evans]

I thank my hon. Friend for that answer. Muscular dystrophy is a particularly terrible muscle-wasting disease that afflicts many constituents of mine. Will the Minister agree to meet me and the NHS north-west specialised commissioning group to discuss the action required to reduce the £13.6 million spent on unplanned emergency admissions for neuromuscular conditions in the region?

[Anne Milton]

I know that I speak for all the ministerial team in saying that we are always very happy to meet groups to go through some of the situations. I would also urge continuing to campaign locally. If services are not provided adequately and properly, the unnecessary admissions due to that poor provision are considerable, as are the costs associated with them.

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[Natascha Engel (North East Derbyshire) (Lab)]

13. What plans he has for future public funding for the hereditary breast cancer helpline.

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

I congratulate Wendy Watson on starting the helpline in 1996. I also congratulate the hon. Lady and my right hon. Friend the Member for Derbyshire Dales (Mr McLoughlin) on the support that they have given it. I know that it has experienced difficulties in gaining funding from primary care trusts, with only 36 of the 152 PCTs providing it, but the cancer networks are working on an interim solution to fund the helpline through the transition period prior to the NHS commissioning board and GP commissioning coming online.

[Natascha Engel]

I thank the Minister, but what I am most concerned about is the fact that Wendy Watson is running the helpline on a shoestring from her home in Derbyshire. She is getting small grants from PCTs, but once PCTs are abolished, where will the money come from? Can the Minister commit to funding the national helpline, which is the only one of its kind, directly from the Department of Health?

[Anne Milton]

I point out to the hon. Lady that with the new commissioning consortiums, those decisions will be made at a much more local level. Only 36 of 152 PCTs are currently contributing to the helpline, which is nonsense when one considers that they are being asked for only £422 each. It is right that such decisions should be made locally, particularly in view of the sort of emotional support that the helpline can give.

[Caroline Nokes (Romsey and Southampton North) (Con)]

14. What steps his Department is taking to increase the provision of preventative health care.

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[Mr Philip Hollobone (Kettering) (Con)]

T6. May I invite the Minister to congratulate my local newspaper, the Northamptonshire Evening Telegraph, on running a successful campaign to encourage people to sign up to become organ donors? Given the success of that campaign, perhaps the Department might like to encourage other local newspapers to do the same.

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

I would certainly like to join my hon. Friend in extending those congratulations. Local papers can have a huge impact in raising the issue of organ donation. Donor rates have risen in this country by 20% since 2007-08, which happened on the back of the organ donation taskforce, which looked at the system in 2008. The issue is complicated and quite sensitive in some areas, but the most important thing is to raise awareness in local communities. Local papers are an ideal vehicle for that.

[Mr Ben Bradshaw (Exeter) (Lab)]

Since when has handing over the running of any service to a powerful producer interest been good for the consumer—that is, the public? In the absence of primary care trusts, who will do the difficult but important job of performance-managing underperforming GPs and, where necessary, weeding out incompetent ones?

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

Is the Secretary of State prepared to make a statement on the vital work of the co-ordination of organ donation at the hospital level, particularly given that under the current system there is no specified organ donation co-ordinator at the Westmorland general hospital in Kendal?

[Anne Milton]

Organ donation co-ordinators are a vital part of the team in increasing organ donation rates. The organ donation taskforce recommended 100 extra organ donation co-ordinators, but we must not forget that there are other things. For example, training for staff who are likely to come into contact with potential organ donors is vital. We have got to get those rates up.

[Alex Cunningham (Stockton North) (Lab)]

How can the Minister justify the already increasing delay in people having cancer diagnostic tests?

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[Annette Brooke (Mid Dorset and North Poole) (LD)]

I recently met a group of Bournemouth and Poole college health and social care students whose research indicated that the average age for repeated sexual activity in the UK is now 16. With that and other information, they have set up a campaign to reduce the age for cervical screening to 20. What action will the Minister take?

[Anne Milton]

I thank the hon. Lady for her question. She is right to raise the issue of the reducing age of sexual activity, and certainly the public health White Paper that we will publish later this year will have a significant impact on that. Cervical screening must be addressed, and it is important to raise the uptake rate to a much higher level to ensure early diagnosis.

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

Dr Clive Peedell, a consultant oncologist at James Cook university hospital in Middlesbrough, said that the coalition Government’s plans for the NHS

“are a roadmap to privatisation”.

That was his reaction to the King’s Fund report, which argues that the plans to make savings in direct NHS expenditure while dismantling local PCTs has the support of fewer than one in four doctors. What is the Secretary of State’s response to that overwhelming opposition from local doctors to the Government’s plans?

--- Later in debate ---

[Anne Milton]

As I said earlier, the cancer networks are working on an interim solution for funding the helpline through the transition period to the new commissioning arrangements. I remind the hon. Gentleman that the Labour party tried to tell people what to do from the centre and micro-managed everything. What happened was that no local decisions were made. I do not doubt the value of the helpline. It is crucial that emotional and practical support for those at high risk of breast cancer is available, and the helpline is one way of doing that. It is extremely important that such decisions are made locally. Telling people what to do from the centre does not work.

[Several hon. Members]

rose—

Termination of Pregnancy (Information Provided)

Anne Milton Excerpts

Tuesday 2nd November 2010 Commons Chamber

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

I congratulate my hon. Friend the Member for Mid Bedfordshire (Nadine Dorries) on securing this debate on a subject in which I know she has had a long-standing interest. She rightly described it as a taboo subject, and the extract she read was moving, evocative and of concern to us all.

The debate comes at a welcome time for me, as I will be meeting representatives from the two biggest independent sector abortion providers later in the month to discuss how we might integrate contraception and wider sexual health provision into the services they provide. It will also be an opportunity for me to raise some of the issues my hon. Friend has highlighted tonight.

I also recently had a useful and productive conversation with a charity that supports young women and men in making informed sexual health decisions. For me and for the Government, reducing the abortion rate is an absolute priority, and to do that we have to ensure that women and men are given information and support to make responsible sexual health choices.

We have seen significant advances in the quality of abortion provision since the Abortion Act 1967 came into force. Early access to abortions has improved and evidence shows that the risk of complications increases the later the gestation. Currently, 75% of NHS-funded abortions take place at under 10 weeks, compared with 51% in 1992. Early abortion means that women have more choice as to the abortion method. Medical abortion using two tablets now accounts for 40% of the total number of abortions, as opposed to only 12% in 2001. However, abortion comes at the end of a failure of many other services in the lives of young women.

Independent sector abortion providers and those organisations that refer women for an abortion are hugely experienced, but are subject to Secretary of State approval and monitoring by the Care Quality Commission. That is why some of the issues that my hon. Friend raises are of considerable concern. We need to ensure that continued emphasis is placed on giving women and men advice and contraception, because it is needed. In the same way, women should be given access to tailored, appropriate and impartial advice on their pregnancy options.

The Government will be responding to the House of Commons Select Committee on Science and Technology recommendation to update advice on the mental health consequences of induced abortion. The Government have commissioned a systematic review of the evidence, and the report will be published in spring 2011.

Interestingly, we have recently seen a substantial increase in the number of men attending family planning clinics—there was a 16% increase in the number of young men attending clinics in 2009-10, with 162,000 attendances. That is a massive 93% increase on the figure in 1999-2000, when only 84,000 men attended. I welcome the fact that young men are taking the issue of sexual health and pregnancy more seriously; I hope that they are taking it as seriously as young women are.

There are some examples of truly excellent, innovative sexual health services that have grown up at local level. However, as my hon. Friend said, the total number of abortions currently being carried out is just over 189,000 a year. Since 1992, the number of abortions has steadily increased, with the exception of the past two years when there was a fall in the number, albeit small. Just under half of teenage conceptions end in an abortion. However, the trend in both teenage conceptions and births is downward and the teenage pregnancy rate for 2008 was the lowest annual rate for more than 20 years. We should welcome that, although we should never be complacent because that figure of 189,000 is still way too high.

Repeat abortion is a continuing issue. Some 34%—one third—of women undergoing abortions had one or more abortions, a figure that has risen from 29% in 1998. Some 25% of repeat abortions were to women under 25. There are also significant and concerning variations between primary care trusts in repeat abortion rates, with rates in some areas as high as 45%. Abortions are traumatic and stressful, and they are not a form of contraception, but sadly they are clearly used as such in some instances. Women are offered a follow-up appointment within two weeks of the abortion. That also provides an opportunity to have another conversation about contraception needs if the woman was unclear as to contraception requirements at the time of the abortion, but that is not always taken up.

[Mr Stewart Jackson (Peterborough) (Con)]

Is the Minister as concerned as I am that it is common practice for independent abortion providers to have their commercial relationship with PCTs and with other trusts in the health service hidden by the caveat of “commercial in confidence”? Therefore, people are not in a position to understand those providers’ commercial relationship with the NHS, and surely that offends against the principles of transparency in the NHS.

[Anne Milton]

Yes. I thank my hon. Friend for raising that point. The issues raised by conflicts of interest and hiding behind commercial sensitivity give rise to considerable concern. That is why I am pleased to be meeting some of the service providers in the next week or so to discuss those issues. It must be pointed out, with the greatest respect to my hon. Friend the Member for Mid Bedfordshire, that although the stories she talked about involved bad practice, there are a lot of instances of very good practice. We should not miss that in the discussion about where things are not going as well as they should be.

Contraception has been free for everyone and is readily available in the community from GPs, family planning clinics and abortion providers, but there are clearly barriers. Why are so many young women and men not using it? A number of factors can lead to risk-taking behaviour, such as sexual violence, alcohol, lack of contraception awareness and self-esteem. We need to use simple, effective messages about safe sex, sexually transmitted infections, condom use and contraception. We need to ensure that young people receive high quality education on relationships and sex and we need to tackle those issues in a holistic and effective way. We need to ensure that young people are equipped to make the choices and the sometimes challenging decisions that they face in their lives. Those decisions are increasingly challenging in this day and age.

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

Those thoughts from the Minister are all excellent, but it is my understanding that before the general election the now Prime Minister promised Government time so that the House could have an opportunity to have a free vote on legislation to change, for example, the upper limit. Will the Minister tell the House tonight whether the Government are still committed to providing time and, if so, when?

[Anne Milton]

I thank the hon. Gentleman for his question. Others in this House might know more about parliamentary procedure than I do, but I understand that abortion is a matter that is usually raised by Back Benchers. He may look bemused, but that is what I have been told. It is usually raised by Back Benchers and the Government do not normally take a view on it. It is an ethical decision and there are usually free votes on it—I have witnessed them myself.

Young women and men need to think about contraception before having sex. People have busy lifestyles—and, in some instances, very chaotic lifestyles—and there are barriers to accessing contraception. However, with long-acting reversible contraceptives there are ways to prevent unwanted pregnancy for everyone, whatever their lifestyle. We need young women and men to be equipped with the information and knowledge to look after their physical, mental and sexual health so they are not put in this position in the first place.

Some £11.5 million has been invested this year and the sexual health charities Brook and the Family Planning Association, with funding from Government, have developed a new web-based contraception decision tool to help people to choose the best contraception for them. Launched on 14 July, the “My Contraception” tool asks users a range of questions about their health, lifestyle and contraceptive preferences and recommends a contraceptive method based on the results.

The Government’s “Sex. Worth talking about” national campaign has been quite well received and early indications suggest that it has prompted positive action. Local areas will now be able to use the “Sex. Worth talking about” campaign resources to support their local work. That is a development that I am sure we will all welcome. There are also pages on the NHS Choices website with a huge amount of information and a helpline for confidential advice.

Some advances have been made to ensure that women are able to have safe, legal abortions, but we need to stop the tide of unwanted pregnancies. That is the position that we want to be in. That will take an effort on a number of fronts, and later this year we will publish our White Paper on public health, which will set out our approach in a great deal more detail.

My hon. Friend the Member for Mid Bedfordshire rightly points out that a woman faced with an unwanted pregnancy is extremely vulnerable. She also rightly points out that the consequences of abortion can be traumatic and far reaching. I am pleased that my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) raised the issue of fathers, who are often forgotten in relation to this subject but who should not be forgotten in legislation and in the mechanisms we put in place to ensure that we not only prevent unwanted pregnancies but deal with their consequences.

I shall be very grateful for the continued support of my hon. Friends in making sure that we get the very best services available for women at this critical time. Anecdotal and individual Members’ experiences are vital to ensuring that we get those services right. Having in place informed consent, appropriate counselling and the right support for women at this vulnerable time will ensure that we do not fail them for the future.

Question put and agreed to.

Maternity Services

Anne Milton Excerpts

Tuesday 26th October 2010 Commons Chamber

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

I will come to the speeches by other hon. Members when I have dealt with—that sounds awful, —my hon. Friend the Member for Southend West (Mr Amess).

I am aware that my hon. Friend has maintained an active interest in this issue for many years, and I congratulate him on securing the debate. I should like to start by agreeing with him that there is nothing in the world more wonderful than a baby being born. I have given birth to four children, at four different hospitals. As is the case for many parents, having a baby was the most amazing thing that has ever happened to me. Getting elected to this House was a close second, but nothing compares to giving birth.

Maternity care is so much more than a new arrival in the family. Pregnancy is a vital time for health promotion, and a time when parents are receptive to information and advice, and motivated to do the best for their children. For some of the more hard-to-reach people in our communities, pregnancy is one of the first opportunities that health service professionals have to talk to them about bringing up children, as well as about their own health and well-being. The impact that midwives can have is significant. Midwives and our maternity services can help us to tackle issues such as nutrition, physical activity and health inequalities, which are some of the biggest public health issues that we face. Later this year, the Government will publish a public health White Paper setting out more detail, but there is no doubt that pregnancy and childbirth are golden opportunities.

The Government set out their long-term vision for the future of the NHS in the “Equity and excellence: Liberating the NHS” White Paper. We are committed to extending choice in maternity, to enable women and their families to make safe, informed choices throughout pregnancy and about childbirth. Maternity networks will help to make this a reality. They will extend choice by encouraging providers to work together to offer expectant mothers and their families a broader choice of maternity services and to facilitate a woman’s movement between the different maternity services that she might want or need. Networks will also need to work closely with health visitors to ensure the very best support for families at this vital early stage in their child’s life. The extra 4,200 new health visitors that we plan over the lifetime of this Parliament will complement the work of maternity services to improve support for all new families and help to ensure extra support for those who need it most. The White Paper consultation period closed earlier this month and we are now considering the responses from the various royal colleges, stakeholders and the public.

I should like to join my hon. Friend the Member for Southend West in commending the work of the Royal College of Midwives, of Cathy Warwick and of all those who have gone before us. He mentioned the noble Baroness Cumberlege’s work on the “Changing Childbirth” report. That document has stood the test of time, with its insight into what is needed during this special time for families. I should also like to join the praise for the National Childbirth Trust. I am proud to say that I was chairman of its Hackney and Islington branch many years ago, when my first child was born. I certainly know only too well the contribution that it makes to many families.

Women and families who are well informed about the maternity care options available to them are more likely to receive the care that meets their particular needs, to feel more satisfied with their care and to feel confident about the transition to parenthood. In recent years, maternity services have faced increased challenges, including a rising birth rate and an increase in complexity in pregnancies. Demographic changes in childbearing, such as more women giving birth at a later age, increased rates of heart disease and obesity, and more births to mothers born outside the UK have resulted in a greater number of higher-risk births. We welcomed the recent guidelines produced by the National Institute for Health and Clinical Excellence on pregnancy and complex social factors.

[Stephen Lloyd (Eastbourne) (LD)]

Will the Minister confirm that the organisations that she has mentioned, including the National Childbirth Trust, all emphasise, as my hon. Friends have done this evening, that a key part of pregnancy and maternity services is that they should be close to the mothers-to-be? I believe that that is a clear objective of the White Paper, as well as of many of the organisations and groups that have been mentioned. Will she confirm that that will be a thread running through the findings of the White Paper when they finally come before the House in the form of a Bill?

[Anne Milton]

Absolutely. Proximity to the people for whom we are trying to design services to meet their needs is vital.

I should like to mention the Marmott review, “Fair Society, Healthy Lives”, which highlighted the strong associations between the health of mothers and the health of their babies. It also pointed to equally strong associations between the health of mothers and their socio-economic circumstances. This means that pre-conception care and early intervention before birth are as important as support during and after the birth. We need women to access maternity care early and for that to continue, exactly along the lines that the hon. Member for Eastbourne (Stephen Lloyd) suggests.

Family nurse partnerships will be extended so that we can provide the highly targeted, highly specialised support through pregnancy and the first years of life that the most vulnerable young families need. Our vision is for all women to have choice and equity of service standards and quality of care, wherever in England they are receiving care. However, we know that, in practice, not all women are offered a choice. “No decision about me without me” is what this is all about. It is about giving people the opportunity and support to make the choices that will make a difference to them, their babies and their families. It is also about giving them the information they need to exercise control, and of course the confidence to use it. Not all families find that easy.

The new outcomes framework proposes five national outcome domains covering all treatment activity across effectiveness, patient experience and safety. A number of indicators for maternity and children were proposed, including maternal death, infant mortality and the unexpected or unplanned admission of term babies to neonatal care. The consultation period has now closed and we are considering the responses. I hope that that will deal with many of the issues that have been raised this evening.

Midwives and the maternity team use their skill and compassion to help parents-to-be along their journey—a vital journey—to parenthood. We will make sure that any changes in services are led by local clinicians, patients and service users. The NHS White Paper is all about giving control of health services to the clinical staff who deliver them. My hon. Friend the Member for Maidstone and The Weald (Mrs Grant) spoke passionately about that this evening.

Effective skill mix in the maternity work force will be important. The NHS is focusing increasingly on utilising the whole maternity team and helping to use innovation and new technology to drive up the quality of care and deliver value for money.

In the next few months, we will receive information about women’s experience of maternity services from surveys conducted by the National Perinatal Epidemiology Unit and the Care Quality Commission. These survey results will give us a clear and up-to-date picture of what women think about the maternity services they receive and what more needs to be done.

My hon. Friend the Member for Gosport (Caroline Dinenage) raised local concerns about the closure of the Blake. Although I am assured that it is due to open again in January next year, I know how very unsettling it is to have local services closed. It causes a loss of confidence among local people.

My hon. Friend the Member for Colne Valley (Jason McCartney) raised the closure of services in his area. I am sorry, but sadly we cannot always turn back the clock. I am delighted to hear that a new midwife-led unit has opened and I hope it will be possible to provide people with the services they need.

As I have already said, my hon. Friend the Member for Maidstone and The Weald also raised some constituency issues. Nobody but nobody could have done more or have campaigned harder on those issues. I know that the Secretary of State asked the strategic health authority to report to him at the end of September, and he now has that report. I am sure that my hon. Friend will agree that the Secretary of State must be allowed some time to consider the report’s content.

I thank my hon. Friend the Member for Southend West for calling this debate. He has raised a number of important points about maternity care and the provision of maternity services. Our White Paper gives us the chance to refocus the NHS on what is important to its users and staff, providing those services so that we achieve the results that are important to them—ensuring that all women and their families have access to the best possible care at this crucial time in their and their family’s lives.

Question put and agreed to.

Mental Health (Infants)

Anne Milton Excerpts

Tuesday 26th October 2010 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Bone, which I have not done before. I start by echoing the comments by the hon. Member for Islington South and Finsbury (Emily Thornberry): it is a shame that more people do not listen to some of these debates. This debate has been of a high quality and is particularly poignant in that the serious case review on baby Peter is published today. Perhaps somewhere out there a member of the press will pick up on it, and realise that hon. Members across the House from all political parties are working together, to a large extent outside party political lines, to ensure that we get this issue right for families.

I congratulate my hon. Friend the Member for South Northamptonshire (Andrea Leadsom) on securing this important debate on a subject that is almost fundamental to everything else that we do. I am aware that she has maintained an active interest in infant mental health for a number of years as the former chairman and trustee of the Oxford Parent Infant Project. Its work was rightly recognised earlier this year when it was one of five winners of a national award from the Centre for Social Justice. I congratulate it on that; it is good to see its invaluable work recognised in that way.

My hon. Friend described with some clarity the significant impact of early parenting, the huge challenges that exist for some families, and the problems that ensue from poor parenting that falls short of the therapeutic, loving and securing attachment that children so desperately need. She mentioned the UNICEF report that cited us as the lowest of 25 industrialised countries. It is shocking that we are at the bottom of that table for the well-being and mental health of our children. She highlighted the fact that there is not one best route to get this right. The hon. Member for Southport (Dr Pugh) also talked about it. A huge variety of support is needed if we are not to lose people in the gaps. It is vital that we approach the matter from a multifaceted direction.

Early years intervention is being actively examined by the Minister of State, Department for Education, my hon. Friend the Member for Brent Central (Sarah Teather). We are working closely together. I have been hugely impressed by the work that we have achieved to date and the work that is ongoing. There is no doubt that we will not achieve what we want if we come at the issue from different silos of Government Departments. My hon. Friend the Member for South Northamptonshire is right to cite the growing evidence for what interventions work and to refer to fostering, looked-after children, adoption and a number of other issues on which I can assure her that I am working and will continue to work with other Departments.

There is increasing evidence about the importance of early life and warm parenting. An infant’s early experiences have a long-lasting impact on their future health, relationships and happiness. There are also important intergenerational effects. Warm, positive parenting and a strong bond between a mother and baby, as well as the father, lay the foundation for health and happiness throughout life.

I am a mother of four children, aged from 26 to 14. I feel like getting out my 26-year-old from a cupboard and saying, “This is one I prepared earlier,” to demonstrate to those who are struggling through the teenage years with their children that it does all turn out right in the end. However, parenting, from whatever background we come, is a challenge. I found it challenging. Even though we might not be in quite the situation that other parents are—we might be better resourced; we might have more money and be in better housing—all of us, in our lives as parents, have had a taste of the tensions and stresses that people feel, and can only imagine what things might be like if we did not have adequate housing and were living with three children in a one-bedroom flat.

The Government are determined to ensure that all families have the right support at the start of life. Health visitors are central to that by providing advice and support through pregnancy, after birth and through the pre-school years, supporting healthy child development and promoting parent-child attachment and positive parenting models. It was a pleasure for me to talk at the health visitors conference last week and re-emphasise our support for health visitors. We want more people in the profession and more people back in the profession to ensure that we have that universal visiting service. That is why, as my hon. Friend will be aware and as hon. Members mentioned, we are investing in 4,200 new health visitors by the end of this Parliament. That is an ambitious target, but we will do everything, pull out all the stops, to ensure that we achieve it. In last week’s spending review, my right hon. Friend the Chancellor of the Exchequer confirmed that the money is there to recruit and train those health visitors.

We also have the healthy child programme to provide the opportunity for health professionals to identify where additional parenting support is needed. Leading and delivering the healthy child programme, health visitors are well placed to identify those families, give them extra support and help them to access more specialised services. We have seen quite a significant decline in the number of health visitors, from just over 13,000 in 2004 to just over 10,000 in 2010, at a time when the birth rate is increasing, and we need to turn that round. The message must go out loud and clear to health visitors: “We want you, we need you and parents and the future generation need you.”

The chief nursing officer is working with the Community Practitioners and Health Visitors Association to define what makes a modern health visitor. The hon. Members for Mid Dorset and North Poole (Annette Brooke) and for Islington South and Finsbury mentioned training and whether there is adequate training on things such as mental health issues. It is extremely important that we get that right. The service model that has been built makes clear the value of health visitors and the contribution that they make to better family and community health. Next year we shall move on to a national recruitment drive for health visitors, and we are working on better training options for returners and new recruits, so that a bit more flexibility can be built in to attract people into the profession.

I want to say a few words about family-nurse partnerships for the more vulnerable. The family-nurse partnership is a preventive, intensive programme for first-time teenage parents and their babies, whose outcomes are not good and fall well below those for other parents. Specially trained nurses work with girls from early in pregnancy until their children are two, giving them support to help them to adopt healthier lifestyles, provide good care for their babies and plan their future life goals. Following the spending review, we shall be extending the family-nurse partnership programme, so alongside the support that health visitors will offer for all families, there will be increased access to the highly targeted, highly specialised support that the most vulnerable families need. We shall set out our plans for that shortly.

The outcomes from family-nurse partnerships are very significant. Over the past 30 years, the evidence in the US has shown that family-nurse partnership children have better health development and better educational achievement and are less likely to be abused, neglected or involved in crime. Cost savings are also substantial. Early evidence in the UK is very promising. Family-nurse partnerships successfully engage disadvantaged young parents, including fathers; 87% of those offered a family-nurse partnership take up that offer, so they are significant.

There are many examples of mental health services for infants being improved. A number of regions have set up perinatal and infant mental health networks to encourage partnership working and the sharing of good practice. Volunteers from the charity Home-Start do valuable work in increasing the confidence and independence of families by visiting families in their own homes to offer support, friendship and practical assistance and by reassuring parents that their child care problems are not unusual or unique. My goodness, I could have done with someone from Home-Start myself. We believe that we are the only person going through what can feel like a rather traumatic experience. Those volunteers also encourage parents’ strengths and emotional well-being for the ultimate benefit of their children and try to get the fun back into family life.

[Annette Brooke]

I declare an interest in the point that I am about to make. Along with many other voluntary groups, organisations such as Home-Start are very concerned about their funding. I am a patron of my local Home-Start, and already there has been a cut. I ask the Minister to do everything that she can to support the vital work by the voluntary sector, because, as we all know, it can get into places that the statutory services cannot.

[Anne Milton]

I thank the hon. Lady for her intervention. She took the words out of my mouth: I, too, must declare an interest as a patron of my local Home-Start. The important message to councils is that when funding is tight, they should think about what works, and as is always the case with the voluntary sector, £1 of taxpayers’ money buys significantly more than £1-worth of care and services. Councils need to think imaginatively about how they spend their money and how they get good value for money. That often involves looking to organisations such as Home-Start. It can be extraordinarily short-sighted to cut back on such schemes at a time when they offer much better value for money than can be had almost anywhere else.

There is no doubt that the need for early intervention has been recognised by us all. The hon. Lady rightly pointed out in her speech the huge variety of reasons why we end up in life where we do. I, too, must admit to having been a mother of the Penelope Leach generation, holding baby in one hand and my Penelope Leach book in the other and trying to look up what exactly parents do at 4 o’clock in the morning when their child will not go to sleep. Having been a chairman of the Hackney and Islington branch of the National Childbirth Trust, I must also admit to having been influenced by the likes of Sheila Kitzinger and Susie Orbach, who added to my knowledge base. Some of Susie Orbach’s words might still haunt me now, as my daughter approaches the age of 17 and I wonder what sort of effect I have had on her.

The hon. Lady emphasised the point about the nonsense of seeing, say, the fostering of looked-after children through the eyes of one Department. Clearly, that is nonsense—we have to look at it across the board.

I can give the assurance that mental health remains a priority. The Department is working closely with stakeholders to put together a mental health strategy—a child and adolescent mental health services stakeholder event was held earlier this year—and the mental health strategy will take a life course approach. I am determined, and I know that the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), who has responsibility in the Department, is determined that we have a mental health outcomes framework that sits alongside physical health outcomes. For too long we have concentrated on physical health, to the detriment of mental health.

The hon. Member for Southport went into some detail about the research, especially the problems with causality and, probably, the need for Governments to take account of continuing research that emerges, to see if we can better define why we are as we are. He is right that we do not do enough to talk about and inculcate parenting in school life and in the upbringing of our children. He is also right to highlight that one of the biggest determinants of educational outcomes is within the family.

In 2008, the hon. Member for Nottingham North (Mr Allen) and my right hon. Friend the Member for Chingford and Woodford Green (Mr Duncan Smith), now the Secretary of State for Work and Pensions—to whom my hon. Friend the Member for South Northamptonshire paid tribute—published “Early Intervention: Good Parents, Great Kids, Better Citizens”, which devoted a chapter to the importance of nought to three-year-olds and parental early intervention.

In July this year, the hon. Gentleman was asked by the Government to conduct an independent review of early intervention delivery. The review will focus on three key things: the identification of early intervention best practice, which goes back to the point about research; how we spread best practice, so we do not see the rather patchy outlook that we have at the moment; and new ways to fund early intervention in the future. What is impressive, and what we have seen again this morning, is the cross-party approach that has been adopted.

The Government have a role to play, but we all know that the first place that people turn to for help and advice is often their family and friends. We should not forget that. So, it is the individuals and organisations rooted in the community that can often have the greatest influence and impact, including local community groups, the voluntary sector and Sure Start centres.

Health visitors, as public health professionals working with families, are uniquely placed to bring people together across local communities to drive change on the problems that families face. As the health-visiting work force grows, there will be more opportunity for them to develop that wider role. We will provide support through a new training programme for health visitors, to be launched next year, to refresh and extend their community health skills.

The hon. Member for Islington South and Finsbury raised a number of issues. I hope that I have got them all down. I would like to touch on them before I conclude. We need to remember in so much of what we do that the issue is not necessarily about the quantity of money but how we spend it. We have an imperative to spend it more wisely than ever before, but the quality of what we get out of it is what matters, not necessarily the sum that goes in.

The hon. Lady rightly mentioned the importance of day care and the need for it to be of a high quality. It is not about whether parents stay at home or work, nor is it about making value judgments on how people live their lives. It is about providing a framework in which parents and children can thrive. Sure Start health visitors and the need for good-quality mental health awareness and intervention are crucial, and increasingly so. If one in four of us suffers from a mental health problem, we are looking at similar statistics among parents. The hon. Lady is right that universality is important—on stigma and access.

I must also point out that massive forms have been a feature of past Governments. They are always a feature of anyone trying to be a gatekeeper to scarce resources and are rarely effective. The Government are determined to banish them. The hon. Lady also mentioned early intervention grants. I can assure her that I met to discuss the matter with the Minister of State, Department for Education, my hon. Friend the Member for Brent Central, only yesterday. We are looking at it.

I have responsibility for public health, so I sit on a number of committees—a very large number—which is useful. I am in a group on families which the Prime Minister set up and a number of inter-ministerial groups, including the Cabinet Social Justice Committee. The same theme runs through all those areas—we have got to get this right, we have got to get the money focused in the right areas and we have got to get the money focused on areas giving us good outcomes.

In conclusion, I thank my hon. Friend the Member for South Northamptonshire for securing the debate. She made a number of important points about the mental health of infants. I hope that the NHS White Paper gives us a chance to refocus on achieving better results for them. The public health White Paper, which will be published later this year, will build on that. We also need an outcomes framework that will be a central driver of improvement, ensuring that the NHS treats the person as a whole—holistically—and not the disease.

Meeting parents’ needs effectively depends on good local partnerships. Groups such as the Oxford Parent Infant Project are a good example of that. I am keen on a strong dialogue with the voluntary sector. Indeed, the White Paper is all about opening the door to such organisations. By working together in that way, we can do much better for the mental health of our infants, families and communities. We have a duty to secure the future generation of parents.

[Mr Peter Bone (in the Chair)]

Thank you for that splendid debate. The sitting is suspended until 11 am.

Parliamentary Written Question (Correction)

Anne Milton Excerpts

Wednesday 20th October 2010 Written Statements

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

I regret that the written answers given to my hon. Friends the Members for Southend West (Mr Amess) on 10 June 2010, Official Report, col. 219W, and for Suffolk Coastal (Dr Coffey) on 13 July, Official Report, col.705-6W, were incorrect. They should not have included the line that information on these contracts is not collected centrally. I have been advised that the Department does collect limited information covering independent sector costs.

The correct reply to my hon. Friends the Members for Southend West and for Suffolk Costal is that the Department does collect limited information on the cost to NHS providers (NHS trusts and primary care trust provider arms) of contracting services from independent sector providers. A revised response to the questions is set out below.