Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 10th June 2014 Commons Chamber

[Graeme Morrice (Livingston) (Lab)]

2. If he will commission a review of the safety of polypropylene transvaginal mesh implants.

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

The Department of Health, NHS England and the Medicines and Healthcare Products Regulatory Agency—the MHRA—have been working collaboratively with the clinical community to address the serious concerns that have been raised about transvaginal mesh implants. A working group, chaired by NHS England, has been set up to identify ways to address them. The group will also have patient representation.

[Graeme Morrice]

Last week, I attended the Scottish Parliament’s Public Petitions Committee to hear from and support women who have suffered from the horrific adverse effects of mesh implants. Women spoke from wheelchairs or on crutches and were in constant pain. They could not possibly have been told about the risks of TVM implants because there are simply no accurate data available. Will the Minister or the Secretary of State meet me and mesh campaigners from across the country, so that they can fully understand the urgency of the situation and the kind of action that is required to end this scandal once and for all?

[Dr Poulter]

I would be very happy to meet the hon. Gentleman. It is important to note that work is under way to collect better data on urogynaecological procedures generally and on mesh implants, because the complications that occur post-surgery are often multifactorial. An NHS England-funded audit on urogynaecological procedures for stress urinary incontinence is currently taking place, which covers all procedures, not just mesh implants. I am sure that we can discuss that and what the working group will do to review the procedures when we meet.

[Andrew Bridgen (North West Leicestershire) (Con)]

3. What progress his Department has made in introducing a cap on care costs.

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[Jason McCartney (Colne Valley) (Con)]

8. What steps his Department is taking to improve access to and standards of dental care.

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

Between May 2010 and December 2013, 1.5 million more patients were able to see an NHS dentist. We are committed to reforming the current contractual arrangements to promote improvement in oral health and to increase access to dentistry services.

[Jason McCartney]

What specific advice would the Minister give to my constituents who are trying really hard to access good quality, local dental care on the NHS?

[Dr Poulter]

A recent HealthWatch report highlighted this issue in west Yorkshire, where access to dental services has been a long-standing challenge. NHS England is looking at the financial arrangements in west Yorkshire and will report back soon. I am happy to meet my hon. Friend and representatives from the local NHS to take this issue further forward and ensure that local patients get the service they deserve.

[Michael Fabricant (Lichfield) (Con)]

9. What steps he is taking to ensure that whistleblowers in the NHS are protected from (a) dismissal and (b) other punitive measures by their employers.

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[Paul Blomfield (Sheffield Central) (Lab)]

11. What assessment he has made of the potential effect on health outcomes of phasing out minimum practice income guarantee funding from GP practices in England.

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

The minimum practice income guarantee payment is unfair because practices serving very similar populations are paid very different amounts per patient. The payments are being phased out over a seven-year period to allow practices time to adjust. The money released by doing this will be reinvested in the basic payments made to all general medical services practices, which are based on numbers of patients and key determinants of practice workload, such as the age and health needs of patients.

[Paul Blomfield]

The minimum practice income guarantee was introduced to meet the specific needs of specific practices. Those needs have not changed. NHS England has drawn up a list of 100 practices across the country that will be threatened by its withdrawal. Five are in Sheffield and two are in my constituency. Will the Minister give a guarantee that no practice will close as a result of the withdrawal of the minimum practice income guarantee, and will he provide the funding to achieve that?

[Dr Poulter]

The point is this: the funding system set up by the previous Government was based on historical funding and did not necessarily recognise the needs of patients. One practice might have been paid more for historical reasons than another practice next door that might have been treating more patients. That was unfair; we have changed it. NHS England is working at local level with practices that are, for whatever reason, in financial difficulties to make sure that it can help them get to the right place.

[George Freeman (Mid Norfolk) (Con)]

The GP practice in Watton in my constituency is struggling with the recruitment of GPs and is now two short, which is putting pressure on services. Today I heard of the proposal from NHS England to deregister 1,500 patients and transfer them to neighbouring practices in the constituency, raising a whole series of issues. Will the Minister agree to meet me to talk about what should happen, including whether NHS England could fund some sort of locum service?

[Dr Poulter]

Yes, I would be delighted to meet my hon. Friend. It is important to see, where possible, collaboration between GP practices on back-office services and other savings that could be made—something the public sector needs to do more generally so that more money can be invested in patients. The Government are training more GPs; in future, we will see 50% of postgraduate medical training taking place in general practice, leading to a big increase in the number of GPs.

[Mr Andy Slaughter (Hammersmith) (Lab)]

Will the Minister look at the decision by clinical commissioning groups in north-west London to move funding away—contrary to what NHS England has proposed—from GP practices and primary care in deprived areas such as Hammersmith to areas that have much better health outcomes?

[Dr Poulter]

I do not believe that that is the case. In looking at the changes, we need to factor in the point that the minimum practice income guarantee, which was a historical payment and not based on patient need or patient demand, is being phased out in order to achieve a more equitable solution. As a result, we can see that the global sum payments to GPs have risen from £66.25 per patient in 2013-14 to £73.56 per patient in 2014-15. Clearly, the global sum payment to GPs per patient has increased, which is a good thing for patients and the equitability of services.

[Miss Anne McIntosh (Thirsk and Malton) (Con)]

Historically, there used to be a payment for the distance GPs or their patients travelled. The removal of minimum practice income guarantee funding may make certain rural practices unviable. Will the Government address that issue, and will the Minister look particularly at rurality and sparsity in order to address what is a very real issue for rural GPs?

[Dr Poulter]

My hon. Friend makes a very good point, and we know that rural practices have unique challenges. The point is that because the money from the minimum practice income guarantee is going to be reinvested in a global sum payment, and because the global sum payment per practice is increasing, one of the key determinants of that payment is, in fact, rurality, so that should be of benefit to many rural practices.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The situation is far more urgent than the Minister’s complacent answer suggests. One practice in a deprived part of London has said that it is weeks away from laying off staff and just months away from closure. The Royal College of General Practitioners says that 1,700 practices could be affected, with over 12 million patients potentially facing even longer waits for appointments. Is it not the case that until we have a Labour Government, GP services are going to be marginalised and patients are going to face ever-longer waits?

[Dr Poulter]

I am afraid that the distance between the real world out there for patients and the Labour Government’s record is very clear. Under the Labour Government’s record on general practice, 20% of patients were routinely unable to get a GP appointment within 48 hours, and a quarter of patients who wanted to book an appointment more than 48 hours in advance could not get one. That was what happened under Labour; that is Labour’s commitment to general practice and GP patients. Under this Government, we are making sure that there is equality of finance per patient according to patient need, and that is how health care decisions should be made.

[Mr Speaker]

Order. I encourage the Minister to learn to provide more succinct answers. They are always too long.

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[Steve McCabe (Birmingham, Selly Oak) (Lab)]

T2. A Birmingham trust has recently announced that it will be possible to cut 1,000 beds across the city by setting a maximum stay of seven days for most patients. Not surprisingly, this has caused some alarm. Are Ministers aware of that proposal? What guidance, if any, can they offer in regard to such proposals?

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

As the hon. Gentleman will be aware, patients need to be treated according to clinical need, and bed stays should not be determined by anything other than that. So if what he describes is actually the case, it would be very disturbing. If he would like to raise the issue further with me, I would be happy to look into it for him.

[Jesse Norman (Hereford and South Herefordshire) (Con)]

T5. Like other rural communities, Herefordshire has long suffered from chronic underfunding in health care. Does the Secretary of State share my view that setting clinical commissioning group allocations should be an evidence-based process that takes into account factors including sparsity and old age? Also, will he ignore the calls from the shadow Health Secretary, who was seeking to cut the previous NHS allocations in areas such as Herefordshire?

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[Andrew Bridgen (North West Leicestershire) (Con)]

T7. The Government can be rightly proud that there are fewer managers and more doctors in the NHS than in 2010. However, recent research by the TaxPayers Alliance shows that in the Greater East Midlands commissioning support unit more than £1 million a year is being spent on 26 administrative jobs of dubious value such as communications managers, communications officers, three communications and engagement leads, and two equality and diversity managers. The list goes on, Mr Speaker, but I will not. What further steps can my right hon. Friend take to ensure that the NHS budget is spent on front-line medical services?

[Dr Poulter]

My hon. Friend is right to highlight the fact that as much money as possible always needs to be put into front-line patient care. Under the previous Government, spending on managers and administrators more than doubled from £3 billion to £7 billion, and we have seen the number of administrators fall by 20,000. There is clearly work to do in his area, because as much money needs to go on front-line patient care as possible, and I hope that local commissioners will be looking to share back-office services as much as possible with other commissioning groups to reduce costs and put money into front-line patient care.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

Earlier the Secretary of State and his Minister said that the minimum practice income guarantee was unfair. What is unfair is that so many practices in Hackney and east London are set to close, in an area where there is great deprivation. What are they going to do to make sure that patients still have practices to go to?

[Dr Poulter]

We have had this discussion. A payments system that is almost 20 years out of date and is not funding patients according to clinical need or is not per head of population will not deliver good care. The payments system needs to be changed and NHS England is working with practices that are facing challenges to address those challenges and ensure that high-quality patient care can still be delivered locally.

[David Rutley (Macclesfield) (Con)]

T8. Following the recent speech by the new NHS England chief executive Simon Stevens about the important role of local hospitals, can my right hon. Friend confirm that district general hospitals such as Macclesfield will continue to play a vital role in delivering local health services in the years to come?

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[Ian Swales (Redcar) (LD)]

T9. My constituent, Beth Charlton, recently lost her father to pancreatic cancer and notes that patients have only a 3% chance of surviving five years. That is much lower than the survival rates for other cancers and has not improved in 40 years. Will the Minister invest more in early detection and diagnosis of this silent killer?

[Dr Poulter]

Spending on health care research, including cancer research, has considerably increased under this Government, and much of that funding is allocated independently. It is important to note that pancreatic cancer is, as the hon. Gentleman says, a silent killer, because presentation is often very late in the disease process. Patients can present suddenly with painless jaundice and are often only three months away from death. It is therefore important that we look at the causes of pancreatic cancer and focus on primary prevention and on helping people to develop a healthy attitude to alcohol.

[Mr Dennis Skinner (Bolsover) (Lab)]

In the last hour I have heard the Secretary of State and his Ministers complain about the problems with A and Es; I have heard them talk about the problems with GPs; now we hear that they have lost control of care of the elderly. Instead of continuing to blame the last Labour Government of four years ago, why does the right hon. Gentleman not admit that the NHS is not safe in his hands? Let us have an election and get a Labour Government.

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[Kerry McCarthy (Bristol East) (Lab)]

The Stitch project in Bristol has contacted me with concerns about the number of overdoses by people on prescription medication and suggested that allowing medication to be dispensed in instalments would be a better way of handling those vulnerable patients. I was disappointed in the response that I got from the Department, and I urge the Minister to think again on this issue.

[Dr Poulter]

I am very happy to meet the hon. Lady to discuss this further and see what we can do because it is important that the vulnerable patient groups she highlighted are looked after in the right way.

[Charlotte Leslie (Bristol North West) (Con)]

As he heralds an era of transparency, can the Secretary of State update us on what steps he has taken to ensure that private providers in the NHS are every bit as transparent and accountable as public ones?