Patient Diagnostic Services

Dan Poulter Excerpts

Monday 4th November 2013 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a great pleasure to be speaking in the Chamber under your chairmanship for the first time, Madam Deputy Speaker. I congratulate you on your success in being appointed.

I congratulate the hon. Member for Brent North (Barry Gardiner) on securing this debate. Before I correct some of the assertions he has made, I want to highlight the fact that the diagnostic services in England, and especially in Brent, are in rather robust health under this Government. Average waiting times for a diagnostic test remain low and stable, despite the NHS carrying out over 2 million more key tests a year since May 2010. The percentage of patients waiting six weeks or more at the end of June and July 2013 was 0.9% of the total number of waits. We can therefore see that the number of diagnostic tests is increasing, the availability of diagnostic services to patients has improved under this Government, and very few patients are waiting in excess of six weeks for the services provided.

Latest provisional data from the diagnostic imaging dataset show that almost 32 million imaging tests were reported in England in the 12 months from June 2012 to May 2013. Diagnostics have a key part to play in reducing premature mortality, particularly as NHS England estimates that over 1 billion diagnostics tests are carried out within the NHS every year. Access to safe and high-quality diagnostic services, such as endoscopy, genetics, and imaging, is critical to all clinical pathways. They underpin over 80% of clinical decisions and they contribute to the holistic care of patients, not just single episodes of care.

It is worth reminding the hon. Gentleman that the previous Government introduced, and championed the role of, the private sector. I believe we are all Blairites in this Chamber, in that we all believe in respect of publicly funded care that where the provider—be it the NHS, a private provider or a local charity or voluntary sector organisation—gives high-quality patient care, that has to be a good thing because it improves the quality of care. It is also important to highlight that the previous Government introduced private sector providers into the NHS to reduce waiting times for operations, which were unacceptably high at that time. I think we would all agree that it was a good thing that waiting times were reduced so patients no longer had to wait unacceptably long times for treatment they so desperately needed.

The first independent sector treatment centres were opened in October 2003, under the previous Government, and they gave £250 million to private providers of independent sector treatments. To their shame, they paid the independent sector on average 11% more than the NHS price for the same treatment.

Our intention in the reforms we introduced was to look at the mistakes the previous Government made in commissioning private sector services, to make sure there was a level playing field. There is no competition on price, as the hon. Gentleman asserted; there is only competition on quality in NHS services. It is important that any provider of NHS services and care to patients does so in an integrated way that delivers joined-up and integrated care based primarily in the community. Providing early diagnosis and early treatment and improving diagnostic services is a key part of that.

The big challenge that faces the whole of the NHS and the health and care sector is the fact that many people are living longer, and often with multiple medical conditions like diabetes, dementia and heart disease. The challenge is to make sure that we treat them with dignity and respect. We must also make sure that when we can diagnose a problem or illness early, we do so. That is why we are very proud to have increased the amount of early diagnosis and the number of diagnostic tests available in our NHS. The remaining challenge is to make sure we continue improving early diagnosis in Brent, London and throughout the country.

We know that when disease is diagnosed early, patients have a better chance of a good outcome. One-year survival for kidney and bladder cancers is as high as between 92% and 97%. At a late stage, however, it drops to between just 25% and 34%. The clinical case for early diagnosis and the investment we are making in diagnostic services is very clear, therefore.

Of course, apart from the clinical benefits of early diagnosis, there are other benefits. When people are ill, they want to know as soon as possible what might, or might not, be the cause of their illness. Having to wait a long time for diagnostic tests can be hugely stressful for patients.

Let me deal with the issues the hon. Gentleman raised about the commissioning of services. Since the beginning of April 2013, clinical commissioning groups have been responsible for commissioning many health care services to meet the requirements of their population. In doing so, CCGs need to ensure that diagnostic services are considered fit for purpose and reflect the needs of the local people as part of their process for commissioning clinical pathways. Local clinicians are best placed to understand the needs of their local population and commission the diagnostic services they need.

Local clinicians are commissioning in a way that is increasingly effective in diagnostics and elsewhere, so more choice in diagnostic services is essential. Many patients who require diagnosis—perhaps an ultrasound scan—will be working, and traditionally some of the NHS diagnostic models have not embraced seven-day working. We know that it is much easier for working people to access NHS services in the evening or at weekends. Therefore, bringing providers that supply greater choice for patients into the NHS makes it much more likely that patients will receive appropriate services at the right time and in a convenient way. It also increases patient compliance, not only with treatments, but with making sure they have their scans and diagnostics in a timely manner.

[Barry Gardiner]

The Minister rightly says that clinicians are best placed to make clinical judgments about their patients’ needs, and there is no dispute between us on that. My concern is that in a case such as that of TDL the clinicians understood the clinical need but clearly did not have the expertise to ensure that the contract was properly engaged in; that it was risk-assessed in the first place; that it was properly monitored; and that it was executed in a manner that was going to ensure the proper relationship between the practitioner and the tests that were being done. Similarly, on the courier service, they had the clinical evidence right, saying that refrigeration was needed, but when it came to putting the contract in place there was no such refrigeration.

[Dr Poulter]

I hope that the hon. Gentleman will forgive me for saying that many of the contracts to which he is alluding were put in place under the old arrangements, before this Government’s reforms, which have delivered clinical leadership. Many of these contracts were negotiated under the powers put in place under the previous Government, whereby people without clinical experience often negotiated the contracts and so did not always understand what the important clinical factors were. He rightly raised the point about potassium and the refrigeration of biochemical samples. It is important that we preserve the integrity of all samples collected. Of course, a clinician, a biochemist or someone with clinical experience would understand that, whereas someone who is commissioning services without that background might not. We saw that happen far too often with primary care trusts. The clinical input under the new arrangements will put us in a much better place to commission services in the future. Many clinical commissioning groups have been saddled with those old arrangements and so are having to enforce arrangements and contracts that they did not directly negotiate. We hope that when the contracts come up for renegotiation that problem will be put right, thanks to the reforms that we have introduced. They will lead to clinical leadership at CCGs, so that doctors and nurses are in charge of negotiations, rather than people who have not necessarily had the relevant clinical experience and do not have the knowledge to understand what the contract they are commissioning is about. National frameworks are being developed for some commissioning contracts by NHS England. So if concerns arise locally on the part of a CCG about the commissioning of contracts, NHS England is always available to provide advice.

I wish to reassure the hon. Gentleman that not just any old health care provider can deliver diagnostic services. By law, health care providers must register with the Care Quality Commission to carry out diagnostic services. That helps to ensure that patients receive only high-quality care, because the CQC, to which the Government are granting greater independence and strengthened powers to intervene where there are quality of care concerns, is the organisation that will be able to intercede if there are concerns about the quality of any health care service which may affect patient care. Service providers must be registered with the CQC and they must prove that they can meet strict quality criteria. That regulated activity includes a wide range of procedures related to diagnostics, screening and physiological measurement, including all diagnostic procedures involving the use of any form of radiation, including X-ray, ultrasound or magnetic resonance imaging. Regulated activities are listed in schedule 1 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

[Barry Gardiner]

The Minister will have been aware of the report on TDL in north-west London and in no sense could it have been said that a satisfactory service was being delivered. So why did the CQC not intervene in a timely fashion? Why, when the initial report by the GP was made about a serious incident, was it not taken seriously? Why did it take so long to make sure that these services were being provided properly and that my constituents were being kept safe?

[Dr Poulter]

Clearly, the events that the hon. Gentleman has raised were distressing and appear to have caused difficulties for patients, and I know that local commissioners found that regrettable. I do not know whether the case was reported to the CQC. He will also be aware that the CQC has come on a considerable journey, from being an organisation that was not fit for purpose a few years ago to being an organisation, with new chief inspectors in place, that is in a much more robust state of health now. The Secretary of State has put in place a number of measures to beef up and improve the inspection regimes in all care settings. We now have a chief inspector of care, a chief inspector of hospitals and a chief inspector of general practice. Following the Francis inquiry, there is now much more transparency, openness and passing of information between health care commissioners at a local level and the CQC. That did not happen as effectively as it should have done in the past, and that was to the detriment of those in Brent.

[Barry Gardiner]

This was in 2012.

[Dr Poulter]

Indeed, and the Francis inquiry took place this year and a lot of action has been put in place by the Secretary of State to recognise where there have been failings in the health system in the past. We know that the majority of the health service, however it is commissioned, be it through a provider of NHS services, through the voluntary sector or through private providers, provides fantastic care on a day-to-day basis. We are proud that we have a publicly funded health service that has many fantastic front-line staff—I count myself still to be one—who do a very good job of looking after patients.

We know that things sometimes go wrong: the hon. Gentleman has highlighted what went wrong in his constituency and in the wider NHS things went wrong, very tragically, at Mid Staffordshire. We need to learn from those mistakes and ensure that they are put right in future, whether they are in the commissioning process—clinically led commissioning should put us in a much better place in that regard—or in the care that is provided to patients. We need to ensure that all hospitals, as well as other health care providers and care sector providers, step up to the plate, recognise that patient safety must always be paramount and ensure that the lessons that need to be learned from the Francis report are learned. My right hon. Friend the Secretary of State will report back to the House in due course—later this month, I believe—with further recommendations that will, I hope, reassure the hon. Gentleman.

In conclusion, let me turn specifically to diagnostic services in Brent. I am aware that the hon. Gentleman has recently asked questions about referral processes for diagnostic services provided in his constituency. As he knows, the contracts for those services were originally let by the then PCT under arrangements encouraged by the policies of the previous Government and are managed by the North and East London commissioning support unit on behalf of the CCGs. The London NHS Diagnostic Service, provided by InHealth, offers GPs and other health care professionals direct access to high-quality diagnostic and imaging scans and tests throughout London delivered from a range of sites, including mobile, fixed and community-based facilities.

I hope that it reassures the hon. Gentleman to hear that between September 2010 and August 2011, 2,397,018 diagnostic tests were carried out in London but more recently, between September 2012 and August 2013, there was an increase of about 300,000 to 2,651,560. That shows that the service in London is in robust health and is being used to facilitate scans and other procedures to diagnose many more patients today than two to three years ago.

I understand that the hon. Gentleman has been in communication with local commissioners and that the relevant NHS England area team has advised him that GP practices do not receive any referral payment when patients are referred to the London NHS Diagnostic Service provided by InHealth. I know that that is an area of concern to him and he was possibly suggesting that there might be some cosy internal relationship among local health care services to the detriment of patients. I can reassure him that that is certainly not the case. GPs make clinical decisions on the basis not of financial bribes, but of what is best for their patients. I hope that he will be reassured by the answer he has received from the commissioners and I do not think that it is in any way likely that GPs or other health care professionals will act in a way that is outside the best interests of their patients. It has always been my experience that front-line health care professionals, with very few exceptions, act with openness and integrity and always advocate for their patients’ needs. I hope he will be reassured by that.

I hope that the hon. Gentleman is reassured that diagnostic services are in robust health under this Government nationally, and in Brent.

Question put and agreed to.