Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 27th November 2012 Commons Chamber

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

The previous Labour Government gave foundation hospitals additional freedoms to set their own pay terms and conditions for staff and, as a result, the information is held locally, not centrally.

[Mr Bain]

I thank the Minister for that non-answer. Will he recognise that with average wages 6.8% lower for full-time workers than they were when this Government took office, people are right to be sceptical about the Government’s record in pay? Why is he sitting back and doing nothing while the national character of our health service is being destroyed through regional pay arrangements?

[Dr Poulter]

It is worth reminding the hon. Gentleman that, as I outlined in my first answer, it was the previous Government who gave foundation trusts additional freedoms to set their own pay terms and conditions outside national frameworks. This Government are working closely with NHS employers and the trade unions to make sure that we maintain “Agenda for Change” and national pay frameworks as fit for purpose, and we are very pleased with that. If the hon. Gentleman wants to ask why there is regional pay and freedoms for employers to set regional pay, he should ask those on his own Front Bench, some of whom were Ministers when these freedoms were set.

[John Pugh (Southport) (LD)]

Does the Minister recognise that the recent progress in national negotiations over greater flexibility is very encouraging and makes the efforts of the south west consortium and others both disruptive and pointless, in context?

[Dr Poulter]

We have had encouraging results from national pay negotiations at the recent NHS Staff Council, and unions are to consult their members on those results. There is general agreement that we need to maintain national pay frameworks, provided they are fit for purpose. I hope my hon. Friend will find that the south west pay consortium, which has been somewhat heavy-handed in the way that it has conducted its affairs, also sees the benefit of maintaining national pay frameworks. That is why we would like to see a quick resolution of the matter at a national level.

[Pauline Latham (Mid Derbyshire) (Con)]

6. What recent assessment he has made of the cancer drugs fund.

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[Kate Green (Stretford and Urmston) (Lab)]

12. What steps he is taking to ensure that primary care trusts do not ration access to NHS treatments and operations.

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

Rationing on the basis of cost alone is completely unacceptable. That is why the Government are increasing the NHS budget by £12.5 billion over the life of this Parliament and giving front-line health care professionals the power to decide what is in the best interests of patients.

[Luciana Berger]

I listened closely to the Minister’s answer. My constituent, Raymond Hickson, has been told that he has a leaking valve in his upper leg, causing varicose veins. His leg will eventually fill with blood, rendering him unable to walk and, therefore, to work, as he is currently employed in a manual job. He has been refused a simple operation on the basis that he now does not fit the PCT criteria, although he has had two similar operations in the past 15 years. What advice would the Minister give Mr Hickson and others like him, who are clearly the victims of treatment being rationed?

[Dr Poulter]

It is worth pointing out to the hon. Lady, who raises a legitimate point about that gentleman’s case—[Interruption.] The right hon. Member for Leigh (Andy Burnham) says “Do something”, but this type of rationing of varicose vein surgery occurred when the previous Labour Government were in power—[Interruption.] It did, and rationing of many other types of services was much worse. It is this Government who have introduced the cancer drugs fund to stop the rationing of cancer treatments to patients, which has benefited 23,000 extra patients, and many more elective procedures are taking place across the NHS every single day. On the specific case the hon. Lady raises, obviously if her constituent has a specific concern, there are safeguards in place locally for him to raise it if he thinks the decision is not based on clinical criteria.

[Kate Green]

Trafford primary care trust offers one cycle of in vitro fertilisation treatment to women up to age 29. The Minister will be aware that the National Institute for Health and Clinical Excellence guidance is for up to three cycles and up to age 39. Last year the all-party group on infertility pointed out that a very large majority of PCTs were not meeting the NICE guidance. Why does he think that is, and what is he going to do about it?

[Dr Poulter]

Of all Ministers in the House, the hon. Lady has probably asked the right one about this issue. This is a long-standing problem that goes back many years. There has been great variability in the availability of IVF in different parts of the country, and, at a national level, NICE finds that unacceptable. I will be taking the matter forward, and I assure her that we will make sure that we do all we can to iron out that variability and follow NICE guidelines so that everyone can receive the best IVF treatment.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does my hon. Friend agree that the best way to ensure that high-quality care continues to be available to all patients, as and when they need it, is to ensure that the health and care systems are brought together into a single joined-up system so that, in the words of Mike Farrar of the NHS Confederation, we operate a care system with a health adjunct rather than a health system with care support?

[Dr Poulter]

My right hon. Friend has, over many years, been a very strong advocate—probably the strongest advocate in this House—for integrated care, which this Government are determined to make a reality. He is absolutely right that we need properly joined-up care that we properly deliver when we face up to the big health care challenges of how we better look after people with long-term conditions and older people. The only way to do that is to deliver more care in the community, and that has to be achieved through more joined-up and integrated care.

[Mr Nick Gibb (Bognor Regis and Littlehampton) (Con)]

My constituent, Jennifer Payten of Bognor Regis, needs dental implants because her temperomandibular disorder means that dentures cause pain and severe headaches. For the past 10 years, Ms Payten has been passed from NHS trust to NHS trust in a Kafkaesque nightmare that no one in modern Britain should have to tolerate. I have written to the Secretary of State about this matter. However, will the Minister personally look into Ms Payten’s case to help to unblock the logjam and ensure that my constituent receives the health care that she needs to enable her to return to a normal life?

[Dr Poulter]

I thank my hon. Friend for his question. He is right to raise this, because it has been a very long-standing problem. I am sure that he would welcome, with me, the fact that under the current Government over 1.1 million more people are receiving access to NHS dentistry. However, this is a difficult case, and I am happy to meet him to discuss it further and see what I can do to help to unblock the problem.

[Andy Burnham (Leigh) (Lab)]

Ministers have repeatedly promised to ban rationing of treatment by cost in the NHS. If the Minister is presented with evidence that this is still continuing, will he today give the House a categorical assurance that he will act immediately to stop it?

[Dr Poulter]

It has been very clear in all the criteria for NHS commissioners set by the previous Government and by this Government that decisions about local health care treatment have to be based on clinical need, and that those decisions are for local commissioners. The difference is that this Government will make sure that doctors, nurses and health care professionals are in charge of budgets and setting health care priorities rather than the managers the previous Government chose to favour, who did not always have experience of front-line care and did not always understand some of the challenges that patients were facing.

[Andy Burnham]

I will take that as a yes. The Minister is going to have a busy day, because this afternoon he will have on his desk new evidence that I will send him showing that an estimated 52,000 patients in England are being denied treatment and kept off NHS waiting lists because of new restrictions imposed under his Government on cataracts, varicose veins, carpal tunnel syndrome, and other serious treatments. Ministers boast of lower waiting lists, but that is because they have stopped people getting on to the waiting lists in the first place. Patients in pain and discomfort, unable to work, are being forced to pay for treatment. How many more people will have to suffer before he finally acts?

[Dr Poulter]

We have already highlighted in earlier answers the fact that under the previous Government health care rationing was far worse on varicose veins, which one of the right hon. Gentleman’s own Back Benchers mentioned, and elsewhere. This Government are very proud of our record whereby 60,000 fewer patients are waiting more than 18 weeks than under the previous Government and 16,000 fewer patients than in May 2010 are waiting longer than a year. Waiting times are coming down, infection rates in hospitals are coming down, and people are getting better care. This Government ended the worst health care rationing scandal of all—the fact that people with cancer were not getting access to the drugs they needed. Now, 23,000 people are getting access to that care. If he could not do anything about rationing, he should at least recognise that this Government have done something and have made a real difference to people’s lives, particularly patients with cancer, by reducing rationing.

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

Those of us who live in rural areas such as south Cumbria have faced the rationing of acute services for years—not rationing by price, but rationing by distance. Will the Minister encourage Morecambe Bay, which will undertake its review of the allocation of services in the coming months, to allocate accident and emergency services back to Westmorland general hospital, where they would be closer to the people whose lives they could save?

[Dr Poulter]

As my hon. Friend is aware, from next year the NHS Commissioning Board will have responsibility for commissioning local services and for setting the funding formula. I would be happy to raise his issue with the board, because it is true that, historically, the capitation formula has not recognised the fact that there are a lot of older people in rural areas and further distances to travel. The previous Secretary of State, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), took steps towards reviewing the formula and I assure my hon. Friend that the Government will be looking into it further.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

8. Whether he has put in place measures to ensure that clinical commissioning groups do not become for-profit organisations.

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

Since the south-west consortium’s plans were made public in May this year, Department of Health officials have been in contact with NHS employers, NHS trade unions and the south-west consortium better to understand the views of all parties. The Department of Health wants to find a resolution and supports national pay awards.

[Kerry McCarthy]

I thank the Minister for that response and for his acknowledgement earlier that the way in which the south-west consortium has handled the negotiations has been heavy-handed. It is appalling that staff found out about the plans only through the leaks as, it appears, did the Department. Will he go back to the director of the consortium and urge him to put everything on hold in the south-west while national pay discussions are continuing? As the Minister says, this ought to be about national pay, not regional pay.

[Dr Poulter]

I fully agree with the hon. Lady and I take her concerns on board. However, because of the additional freedoms introduced by the previous Government, local employers in foundation trusts throughout the NHS have additional freedoms to set their own pay, terms and conditions. Under the rules introduced by the previous Government, it is impossible for us to intervene directly in the matter, except by continuing to encourage trade unions and NHS employers to meet the national agreements. If national terms and conditions are agreed to, I am sure that they will be endorsed at a regional level by the south-west consortium.

[Andrew George (St Ives) (LD)]

I am very pleased that the Minister will be meeting a cross-party delegation of MPs from the south-west next week to discuss this issue. In view of his answer to the hon. Member for Bristol East (Kerry McCarthy), is he confirming that Health Ministers have no powers at all to intervene in the negotiations between employers and their staff?

[Dr Poulter]

It is worth putting it on the record that it was the previous Labour Government who introduced foundation trusts in 2003 and set them free from direct accountability to Ministers. That includes the ability to set their own pay, terms and conditions. It was Labour that removed the power of the Secretary of State to direct foundation trusts, and it is Labour, not the Government, that needs to decide whether it supports the legislation that it put in place in government. We endorse national pay frameworks and will do all that we can to preserve them.

[Mr David Amess (Southend West) (Con)]

13. What recent representations he has received on strategies to support patients with osteoporosis.

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[Lisa Nandy (Wigan) (Lab)]

16. What assessment he has made of the possible effect on patient safety of reductions to ambulance trust budgets.

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

The budgets for individual ambulance trusts are set by local health care commissioners. In 2012-13, the budgets are increasing nationally by £2.5 billion. To ensure patient safety, ambulance trusts are required to meet national performance standards in respect of their response times.

[Lisa Nandy]

Does the Minister share my concern that 100,000 more patients than two years ago wait more than half an hour to be transferred from ambulance to A and E? If so, how on earth can he justify making his top-down reorganisation of the NHS a priority rather than sorting out that appalling situation?

[Dr Poulter]

The priorities for local ambulance trusts and the funding allocations are set locally. The hon. Lady will be pleased that between 2010-11 and 2011-12, an additional £9 million was put into the front line of the ambulance service in her area to help address some of the problems she outlines. Under this Government, more money is going to the NHS than before and more money is going into local ambulance services—£2.5 billion nationally. We should contrast that with the approach taken by the right hon. Member for Leigh (Andy Burnham) on the Opposition Front Bench, who said that to increase spending to address those problems would be irresponsible.

[Several hon. Members]

rose—

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

The Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), is my constituency neighbour. He will know that, although the East of England Ambulance trust is hitting its targets for the entire region, it is not helping in Suffolk. Will he advise on what more we can do locally to ensure that it serves all rural patients?

[Dr Poulter]

The problem has affected both Suffolk and Norfolk—the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), also takes an active interest in it. One problem was that the managers of the local ambulance trust were not listening to front-line staff on how to design and deliver services. In a staff survey, only 4% of front-line staff in the East of England Ambulance Service said they were being properly listened to, which is completely unacceptable. This Government, in contrast to the previous one, want to put front-line professionals in charge of running services, meaning that, in future, more patients will be properly prioritised and ambulance response times will be better met.

[Mr Speaker]

Order. These matters could be considered further in an Adjournment debate, which might be a suitable length for the subject.

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[Graham Stringer (Blackley and Broughton) (Lab)]

T3. What action does the Minister intend to take to reduce the number of unplanned emergency admissions to hospital by sufferers of muscular dystrophy and other neuromuscular conditions?

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

I thank the hon. Gentleman for that question and for his concern about this matter. One of the key challenges for the NHS is to ensure that we deliver better care in the community, deliver more preventive care and provide better support to people with long-term conditions, such as muscular dystrophy and diabetes, in their own homes. A key part of the reforms is to make sure that a lot of services are commissioned from the community by the local commissioning groups. We have already seen that that has reduced inappropriate admissions. For example, in my part of the world in Suffolk, they have been reduced by 15% for older people.

[Mr Aidan Burley (Cannock Chase) (Con)]

T4. Yesterday, I received a letter from the chief executive of Monitor, which asked me and the Asset Transfer Unit to undertake feasibility work to develop a professional business case for the local community to take ownership of Cannock Chase hospital. This would be done through its transfer to a community interest company, which would then take over running the hospital estate, securing the building for the people of Cannock Chase. Will the Secretary of State welcome these proposals, which would be the first of their kind in the UK, and work with us as we develop a plan for the local community to own its hospital?

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[Andrew George (St Ives) (LD)]

T6. There is mounting evidence that clinical care failure is as much to do with inadequate staff levels as anything else. In view of that, do Ministers agree that it is worth looking at the merits of establishing mandatory registered nurse to patient ratios across secondary and tertiary care wards?

[Dr Poulter]

I thank my hon. Friend for that question. This point has been raised before and although it sounds like a good idea in principle, the problem is that different aspects of care in different wards—for example, an older people’s ward compared with a ward that looks after younger people—will have differences in the intensity of nursing. Therefore, a mandated ratio would be difficult to implement. A ratio may be counter-productive to making sure that we can give more intensive nursing cover where it is needed, and could even encourage a race to the bottom.

[Lilian Greenwood (Nottingham South) (Lab)]

T8. A recent Schizophrenia Commission report highlighted catastrophic failings in the care of people with severe mental illness. We know that suicide rates rise during times of economic hardship and that record numbers of people are being detained under the Mental Health Act. The Government have said that mental health should have parity with physical health, so why has funding for mental health services been cut for the first time in a decade?

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[Steve Baker (Wycombe) (Con)]

Aylesbury constituent Mrs Evans-Woodward is a young woman who has had five heart attacks. One evening her husband drove her to Wycombe’s heart attack unit with a racing pulse, but she was turned away to the minor injuries unit, which again turned her away to the accident and emergency unit in Stoke Mandeville, before suggesting that she sit outside and call an ambulance, which she duly did—all of this with a racing pulse of 180. This is not good enough. It is an appalling prioritisation of bureaucracy over simple human care and compassion. Does it not show that the NHS needs to become much more accountable to patients?

[Dr Poulter]

My hon. Friend is absolutely right, and I am very sorry to hear of the case he outlined. Clearly the care that his constituent received was more than substandard. If a patient needs immediate treatment, they should always receive it. This Government are quite rightly ensuring that we embed good care in everything we do. We have beefed up the role of the Care Quality Commission to improve the inspection of care quality throughout the NHS and the care sector. We are also introducing a friends and family test to pick up on examples of bad care, so that the NHS can properly learn from them locally and so that these things do not happen.

[Mr Speaker]

We are extremely grateful. Extreme brevity is now required from Back and Front Benchers alike.

[Andy Sawford (Corby) (Lab/Co-op)]

On 12 November the Secretary of State gave a categorical assurance to my constituents that there was absolutely no threat to accident and emergency and maternity services at Kettering general hospital. Does he stand by it, will he repeat it today and will he specifically confirm that obstetrics and major injury and trauma services in accident and emergency are no longer at risk at Kettering general hospital?

[Dr Poulter]

I thank the hon. Gentleman for his question, and I welcome him to the House and congratulate him on his victory in the recent Corby by-election. I think he has already admitted on the record that there was a lot of scaremongering during the by-election campaign about the NHS locally. One of the main reasons for concerns about the NHS is the indebtedness of many hospitals in the east of England region, because of the record of the previous Government, who signed many of them up to private finance initiative deals. I will restate for the record once again today that, as I understand it, A and E and maternity services at Kettering at the moment are safe, and there is no consultation directly on the table at the moment. He should make sure he gets his facts right before he raises questions in the House.

[Mr Stewart Jackson (Peterborough) (Con)]

Last week it was a great pleasure to visit Age UK Peterborough, whose No. 1 priority is dementia care, which coincides with the NHS priorities that my right hon. Friend the Secretary of State outlined earlier this week. Will he put in place procedures to make available capital moneys for the construction of dementia care facilities locally?

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[Duncan Hames (Chippenham) (LD)]

Valued health workers in Wiltshire will appreciate the Minister’s commitment today to national pay negotiations, but they will be frustrated that he does not have the power to force them on foundation trusts. Will he at least make a direct appeal from the Dispatch Box today to the management of those trusts in the south-west consortium to participate fully in national pay negotiations?

[Dr Poulter]

I thank my hon. Friend for his question. He is absolutely right. I made it clear earlier that I felt there had been some heavy handedness in the way some of those trusts had behaved—although they are quite understandably exercising freedoms that the previous Government gave them. We want national pay frameworks to remain fit for purpose, which is why we endorse the national pay negotiations that are under way. I would recommend that trusts in the south-west listen to what happens in those negotiations, so that we can ensure that national pay frameworks are fit for purpose in the south-west.

[Mr Speaker]

Last but not least, Meg Munn.