NHS White Paper

Chris Leslie Excerpts

Monday 12th July 2010 Commons Chamber

[Mr Lansley]

There is good evidence that physician-led commissioning of services for patients is very effective. Precedents in this country and across the world have shown that. The hon. Lady mentioned teenage pregnancy and infant mortality, and this is principally about the relationship between NHS services and wider public health services. Given such responsibility, I am sure that the local authority will be able to deliver local health improvement strategies that will impact on those factors more effectively than has been possible with the NHS doing it solely using NHS services and resources.

[Chris Leslie (Nottingham East) (Lab/Co-op)]

If the Secretary of State is going to force GPs to spend all this extra time on bureaucracy and managing the NHS, does it not mean that they will have less time to spend with their patients? Is that the reason why he scrapped patients’ right to see a GP within 48 hours?

[Mr Lansley]

Many GPs will find that they spend much less time trying to negotiate services for their patients through a PCT and NHS bureaucracy that get in the way. Of course GPs are operating collectively in a commissioning consortium, and I am not going to turn them into individual managers. Some GPs will be leaders—I am looking for clinical leadership—but they will also look for commissioning support. They can derive that from existing primary care trust teams if they think they are doing a good job; they can do it via local authorities or from independent sector providers of commissioning services as well.

Child Health (Nottingham)

Chris Leslie Excerpts

Tuesday 6th July 2010 Westminster Hall

[Chris Leslie (Nottingham East) (Lab/Co-op)]

At the outset, I wish to provide a little context to the debate. Nottingham is the 13th most deprived authority in a total of 354, according to the Government’s 2007 deprivation index, with 81% of children falling within the first three deprivation deciles. In other words, the vast majority of young people form the poorest third of the population. There are some especially poor pockets of deprivation in the Nottingham constituencies. In my constituency, they can be found in the St Ann’s, Dales and Arboretum wards, and in Hyson Green and Forest Fields, to name only a few places.

In September 2009, about 700 young people were not in employment, education or training, the status of another 550 was not known, and 62% of all children lived in households where no adult worked or where earnings were so low that they received benefits or other state assistance. Although I am pleased to have the opportunity to debate child health in Nottingham, it is precisely because of the concentration of problems that afflict so many young people in the city that it was necessary to spend some time on that point.

It is important to recognise that much good work is being done, not least by the NHS services in Nottingham, the city council and others. I am glad that my hon. Friend the Member for Nottingham North (Mr Allen) is here, because it would not be possible to speak on the topic for more than 60 seconds without mentioning the early intervention approach of One Nottingham, the local strategic partnership that he has pioneered and championed. Breaking the cycle of poverty and poor lifestyle, and preventing problems from worsening or even occurring is critical to ensuring that we make progress. Poor health, particularly poor child health, is not new in Nottingham.

I pay tribute to Professors Elizabeth and John Newson—sadly John passed away last Monday—for their groundbreaking work on child health and psychology at Nottingham university. In their famous and influential book of 1963, “Infant care and motherhood in an urban community”, they followed 700 Nottingham families, particularly from the St Ann’s ward, considering the detailed habits of their lives and so forth. I shall briefly review some of the things that affect the city to illustrate the scale of the challenge that we face.

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

I thank my hon. Friend for raising this important matter on behalf of the city. Will he tell the Minister about Nottingham’s fight-back with a set of early intervention policies that try to break the intergenerational nature of these problems? There is great concern in the city that the pioneering work that we have undertaken, which may go to national level, is now under threat because of the public expenditure cutbacks. We managed 14 early intervention programmes in Nottingham on a shoestring. If that shoestring is snipped, the work that has been started will not last the generation, which is necessary if it is to have its massive impact.

[Chris Leslie]

I could not agree more with my hon. Friend.

I shall take the opportunity to pay tribute to some of Nottingham’s councillors. Councillors Mike Edwards, David Mellen, Jon Collins and others have been involved in ensuring a strong early intervention approach. Partnership work needs to be supported, not undermined—particularly, in this context, the Nottingham children’s partnership. That partnership’s “think family” approach is holistic and integrated. Like my hon. Friend, I worry that such preventive partnership work may now be at a high water mark, going down again because of the pressures on those funds. Apart from the NHS, agencies that are not ring-fenced have hitherto put money into their pooled endeavours; now they will naturally and instinctively pull back from those activities, and it will be difficult for them to do anything more than their core work, which will endanger their crucial efforts.

I wish to review some of the key questions that need to be tackled. Sadly, there are many of them. Child mental health is important and is often hidden, but many young people can be held back by such difficulties because of the behavioural consequences. Studies suggest that as many as one in 10 young children or young people in Nottingham are diagnosable with some sort of classifiable mental disorder that might require intervention. Apparently, 10% of five-year-olds experience difficulties that cause distress or have other impacts on their lives. Nottinghamshire Community Health, along with the council, has much of the responsibility for safeguarding vulnerable children, and it does incredibly important work. Again, I am worried about the lack of ring-fencing for other less visible services, particularly social services. I urge the Minister to assure us that social services funding for mental health services will be maintained, because it is incredibly important.

On the question of substance misuse, it is estimated that 3,700 young people in Nottingham under 18 regularly use class A drugs of one sort of another, but the figure could be higher. Although the proportion of young people drinking alcohol has not risen in recent years, it is still far too high when compared with figures for the rest of the country. The number of young people whose carers or parents are involved in drug or alcohol abuse is high; it is estimated that parental alcohol abuse affects between 10,000 and 20,000 young people in the city, which is an incredibly high number.

Smoking is a widespread cause of respiratory problems among young people. The British Lung Foundation report, “Invisible lives” suggested that residents in Nottingham are 40% more likely to be admitted to hospital with chronic obstructive pulmonary disease than the UK average, and respiratory conditions are among the most commonly reported in children.

Another crucial problem is that of teenage pregnancy. By national standards, the figure for Nottingham is still very high. The latest annual data suggest that, within local authority boundaries, Nottingham had the ninth highest rate at nearly one in every 15 teenage girls. Again, that is a shocking statistic. Some Nottingham wards have an under-18 conception rate of twice the national average; 15 of the 20 wards have rates that are among the highest 20% for wards in England.

[Mr Allen]

My hon. Friend is generous in giving way a second time. I would be failing in my duty as chair of the teenage pregnancy task force in Nottingham if I did not point out that we have had a fall in eight consecutive quarters because of the sort of things that my hon. Friend has pointed out, such as working together in partnership, and having clear leadership and lines of accountability. We have fabulous people working on the front line who are pushing down the rates. We also have a family-nurse partnership which gives intensive health visiting for young mothers, and we are doing many other things. I am sure that my hon. Friend will want to pay tribute to those people, particularly the front-line workers.

[Chris Leslie]

My hon. Friend takes the words entirely out of my mouth. I was explaining that the problem is still significant, but thankfully some good progress has been made, particularly through partnership work. That crucial support is funded through the working neighbourhoods fund, but recent Treasury announcements suggest that Nottingham’s fund will cut by £1.2 million. The name on the tin—“working neighbourhoods fund”—does not say what it will do; supporting the programmes that help reduce teenage pregnancy is one purpose. It is incredibly important that we hear about its good work as well as about the shocking statistics.

I want to take the opportunity offered by this debate to highlight the issues of poor child dental health. Although the statistics and methodology of calculating such issues change from time to time, recent reports suggest that Nottingham children have, on average, three decayed missing or filled teeth each compared with just over one in typical parts of the rest of England. Shockingly, in some schools in Nottingham, a few children have been reported to have nearly six missing, decayed or filled teeth. Fluoride in toothpaste is improving matters, but the main factors are still poor diet and nutrition and poor oral hygiene. Although programmes such as the City Smiles dental health promotion programme and community-based services have promoted good oral hygiene and the use of fluoride varnish on teeth, much more still needs to be done. I want the funding for the City Smiles campaign to be confirmed and redoubled by the PCT, and I hope that the Minister will pass on that request. Moreover, we must think about the contentious issue of fluoridation of the water supply. In areas where fluoride is naturally occurring or where it is added, there is some protection against dental decay. Although I cannot claim to be a scientific expert in this area, I none the less hope that the PCT and the east midlands health authority will speed up their review and put some options on the table within the next year if possible.

There is not enough time to address all the crucial issues, which include young people leaving care, children with learning difficulties and serious disabilities and how people can access services. I want to pay tribute to the NHS staff who work so hard in Nottingham. They have recently consolidated the children’s services of City hospital with those of the Queen’s Medical Centre to create the Nottingham Children’s hospital at the QMC site with 15,000 inpatient occurrences and 50,000 outpatient contacts taking place annually. The hospital is very strong in renal and urology services, with 13 kidney transplants taking place last year. It is world renowned for its child integrated cancer services, with 135 children being treated there in 2009. There are also cystic fibrosis services and many others. None the less, there is still room for improvement. In particular, there is not enough accommodation for parents whose children are in hospital. It is important that young patients have the support of their family around them. I urge the Minister to find a way to provide capital support for the PCT and the hospital to ensure that more bed space is provided.

I am also concerned to hear that Nottingham’s speech and language therapy budgets, which are supported by the PCT, may be squeezed because of the financial pressures. Tragically, between 5% and 8% of pre-school children have speech and language problems, so there is a lot of concern about the loss of such resources in the Nottingham area.

I hope that the Minister will address recent policy changes. Childhood obesity and poor nutrition is one of the key underlying causal factors that come up time and again. A third of 10-year-olds in Nottingham are overweight or on the brink of the obesity category. Tragically, the free school meals pilot that had been on the cards has now been cancelled.

[Lilian Greenwood (Nottingham South) (Lab)]

Does my hon. Friend not agree that there are concerns over the cut in the health in pregnancy grant from next January? Such a grant can be used to support breastfeeding mothers—breastfeeding is vital to children’s health, and results in fewer infections and reduces the likelihood of children developing allergies. It also protects them from the very thing that my hon. Friend was talking about, which is the likelihood of people becoming obese, developing diabetes and, in the longer term, cardiovascular disease.

[Chris Leslie]

My hon. Friend is entirely right. It looks as if we will lose not only the opportunity to roll out greater nutritional standards through the free school meals pilot but the £190 health in pregnancy grant. To me, that was one of the most pernicious, mean-spirited decisions in the Budget. Young mums-to-be need not just warm words but financial support to back up what can be an expensive change in lifestyle. Folic acid and fresh fruit and vegetables do not come cheap. It is important that the support is there.

When we consider the other changes in the recent Budget announcement, the Minister needs to explain how young families can support some of the costs that are involved in healthy lifestyles. I am referring not only to the change in the health in pregnancy grant, but to the restriction on the maternity allowance to the first child only. Not much thought has been given to the effect that that will have on siblings. Cots, prams and children’s clothes are expensive. Those are all issues affecting the decent lifestyles of young families in our city. From next year, the Government will remove the baby element from the child tax credit and reverse the settlement for one and two-year olds, which was due in 2012 and 2013. When those measures are combined with others, such as the freezing of child benefit and, as a tangent to that, the removal of the child trust fund, there is a sense that children’s issues, which cover good child health, education and well being, are not as far to the front as I would hope.

I have mentioned some exceptionally serious issues and complex health problems. I have run over the key issues that need real action. In particular, I am referring to the partnership working that my hon. Friend the Member for Nottingham North discussed about. It is all very well suggesting that there will be increases in real terms for front-line health services, but health inflation goes far and above the retail prices index plus 0.5%. There will undoubtedly be pressures affecting hospital and ancillary services as well. The cuts in funding for local authorities and other public services—25% over the next four or five years—are unnecessarily fast and steep. Alternative strategies could be used. I fear that we will jeopardise some of the inroads that we have made into these problems. I hope that the Minister will do better than his other colleagues in government. There is a whole range of serious issues affecting child health in Nottingham, and I urge the Government to take them seriously.

Oral Answers to Questions

Chris Leslie Excerpts

Tuesday 29th June 2010 Commons Chamber

[Mr Lansley]

My hon. Friend is absolutely right. I was here just a few weeks ago, announcing a public inquiry into the events at Stafford general hospital. Of course, in that hospital the adherence to ticking the box on the four-hour target was one of the things that contributed to the most appalling care of patients. We have to focus on delivering proper care for patients—the right treatment at the right time in the right place—and delivering the best outcomes for them. We will focus on that—on quality—not on top-down process targets.

[Chris Leslie (Nottingham East) (Lab/Co-op)]

Is it really true that the coalition Government are going to scrap the right for people to see their GP within 48 hours? If so, will the Secretary of State publicise that, so people know that the right has been reduced? If it is true, is he not just axing public service quality under the pretence of dealing with so-called bureaucracy?

[Mr Lansley]

It is astonishing—the Labour Government spent money trying to achieve the GP access target, and the hon. Gentleman might at least have recognised that the latest data, published two or three weeks ago, show that public satisfaction with access to their GPs, and the things that the Labour Government had been paying for, had actually gone down. A consequence of the 48-hour access target was that patients were unable to access their GPs more than 48 hours in advance. Is it not reasonable to expect GPs to be able to manage their own services in order to deliver better patient experience and outcomes across the board? I think we can reasonably expect that.