Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 16th July 2013 Commons Chamber

[Stephen Timms (East Ham) (Lab)]

2. What recent assessment he has made of the effects on NHS services of changes in local authority spending on adult social care.

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

Data on delayed transfer of care suggest that the interface between health and social care has improved since this Government have been in office. In 2012-13, the number of bed days lost because of delays attributable to social care was nearly 50,000 lower than in the previous year.

[Stephen Timms]

In May, the King’s Fund report,“Paying for social care” warned that local authority spending is continuing to fall and that fewer people are getting help. It is my understanding that last month an internal NHS document recognised that pressure on social care budgets meant “more delayed discharges”, increasing the problem in accident and emergency. Therefore, cuts to care budgets are increasing delayed discharges. What will the Minister do to tackle that problem?

[Dr Poulter]

The right hon. Gentleman would have done well to listen to my answer before he read out a pre-prepared question. In 2012-13, the number of bed days lost because of social care delays was 50,000 fewer than the year before. However, he is absolutely right that we need to do more to ensure better integration and better joined-up care between the NHS and social care. That is what this Government are doing, and that is why we have allocated a £3.8 billion fund to do just that in the spending review.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does my hon. Friend agree that there is no solution to the economic challenges facing the health and care system—still less any solution to the quality challenges that are increasingly coming to light—that does not involve proper integration of health and care? Is not the decision announced by the Chancellor a couple of weeks ago the first tangible step of a Government delivering a policy that Governments have talked about for a generation?

[Dr Poulter]

My right hon. Friend is absolutely right, as always. He is a tremendous advocate—and has been since his time in office—of integrated health and social care, and of the transformation in the delivery of care that we need to make if we are to better look after patients with long-term conditions and the frail elderly. This Government are the first Government who are committed to doing that. Compare that with the real-terms cut in funding for social care that happened under the last Government, according to the Dilnot report.

[Julie Hilling (Bolton West) (Lab)]

17. Bolton hospital has told me that it needs a much greater concentration on social care. Indeed, a recent NHS Confederation survey of NHS chief executives and chairs said that two thirds said that a shortfall in local authority spending had impacted on their services over the past year. Will the Minister finally accept that the Government’s deep cuts to social care are having a serious effect on the ability of the NHS to deliver safe care?

[Dr Poulter]

I am not sure whether the hon. Lady is referring to the Association of Directors of Adult Social Services report that was published recently. It is important to look at that report in context and not misinterpret the figures. The report shows that spending has been roughly flat in social care, and the last survey also shows that councils are expecting a small increase in expenditure on social care next year. The 20% or £2.7 billion that is often touted by the Opposition in fact represents savings that councils have made through efficiencies, and that money is obviously being reinvested in front-line care.

[David Tredinnick (Bosworth) (Con)]

Will my hon. Friend give an indication of the long-term cost savings of integrating health and social care, as against the short-term cost of making the changes?

[Dr Poulter]

My hon. Friend is right to highlight the fact that the figures show that last year alone 50,000 bed days that would otherwise have been wasted were saved by investing in social care and implementing the service transformation that we all require. However, this is about making all NHS and social care budgets go further, and recognising that if we are to improve the care of older people, particularly frail elderly people, we have to invest in more community prevention and community-based care, which is what this Government are doing.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

As we have heard, two thirds of NHS leaders have said that the shortfall in social care spending is having an impact on their services. The Minister can try to get rid of that and talk it away, but in week after week of taking evidence in our inquiry into emergency care, the Select Committee on Health has heard the same thing. We know that elderly patients now form a much larger proportion of admissions—40% of admissions to emergency units are people aged 65 to 85. Is not the £1.8 billion cut in spending now really hitting NHS services and making the emergency care crisis worse?

[Dr Poulter]

I am afraid that the Opposition are very confused about their figures. As I explained earlier, the £2.7 billion—or 20%—figure represents the savings that councils have made to meet demand, and real-terms spending next year is expected to go up. The point from the ADASS and other surveys is that integration works. This Government are investing in integration. According to the Dilnot report, it was the last Government who cut in real terms the amount of spending going to social care between 2005 and 2010—and the hon. Lady was a member of that Government.

[Bob Stewart (Beckenham) (Con)]

3. What steps he is taking to change negative perceptions of mental health issues.

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[Mr Henry Bellingham (North West Norfolk) (Con)]

6. What plans he has to meet the acting chief executive of the East of England ambulance trust to discuss that trust’s recovery plan.

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

The NHS Trust Development Authority is working with the trust to review its action plan and monitor progress in response to the findings of the recent governance review and the Marsh report. Ministers will keep the situation under review.

[Mr Bellingham]

Is the Minister aware that, in spite of the efforts and professionalism of front-line staff, the organisation has been badly led and has lurched from crisis to crisis? Does he have confidence in the new management team and the recovery plan? Does he not agree that the time might have come to break up this large organisation and move it into smaller units that are closer to the communities?

[Dr Poulter]

I thank my hon. Friend for that question and his diligent local campaigning on the issue. He is absolutely right that the Marsh review highlighted a failure of leadership at the trust and in the trust board as well as a disconnect between the front-line staff, who work effectively and well, and that leadership. We now have a new team at the top and we must give it time to respond to the Marsh report and put in place the right measures. I believe that efficiencies can be made at a back office and regional level, but there is a good case for ensuring that more localised data are presented about ambulance response times countywide.

[Mr Jamie Reed (Copeland) (Lab)]

The East of England ambulance service is failing to meet the needs of patients on the Secretary of State’s watch. The hon. Member for Waveney (Peter Aldous) has said:

“This did not used to happen.”—[Official Report, 25 June 2013; Vol. 565, c. 19WH.]

The hon. Member for Witham (Priti Patel) has said:

“Lives are put at risk.”—[Official Report, 25 June 2013; Vol. 565, c. 2WH.]

Does the Minister agree with those Members, and does he believe that clinical outcomes for patients in the east of England have been affected by the collapsing service over which he has presided?

[Dr Poulter]

The hon. Gentleman would do well to heed the Marsh review before asking his questions, because it highlights a fundamental, systemic failure of leadership at the ambulance trust which dates back to the last Government’s time in office. As we know, the number of NHS managers in the east of England rose by 86.4% under the last Government, but there was a lack of connection between the managers of the trust and front-line staff. Government Members are promoting clinical leadership, and trusting clinicians and front-line paramedics to deliver a much better ambulance service. I suggest that the hon. Gentleman should prepare his questions more thoroughly in future, and should read the Marsh review before he asks them.

[Karen Lumley (Redditch) (Con)]

7. What recent assessment he has made of the joint service review on the future of health services in Worcestershire.

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

The configuration of local health services is a matter for the local NHS. Commissioners in Worcestershire are working with local health care providers and stakeholders to develop proposals for the future provision of acute services across the county, which will be subject to public consultation later this year.

[Karen Lumley]

Does the Minister agree that the people of Redditch deserve to see the implementation of the two options that he promised in Westminster Hall in February, after 18 months of indecision and uncertainty in Worcestershire about the future of our hospitals, including Alexandra hospital, which he visited with me?

[Dr Poulter]

It was a great pleasure to visit my hon. Friend’s local hospital, and I agree that it is time that consultation took place on firm proposals. The proposals that we discussed during the Westminster Hall debate appeared to me to have considerable merit, and I understand that local commissioners will present them in a timely manner later this year.

[Mr Philip Hollobone (Kettering) (Con)]

8. What assessment he has made of recent improvements in services to patients at Kettering general hospital.

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

Monitor, as the regulator of foundation trusts, is working with NHS England, the Care Quality Commission and local commissioners to ensure that the trust has robust plans to make the necessary improvements. The emergency care intensive support team has given the trust advice and support to help it to develop plans to improve its A and E performance.

[Mr Hollobone]

Will the Minister congratulate all those at Kettering general hospital who have been involved in various recent developments? For instance, urology patients are being given the anti-cancer drug mitomycin C, which halves the risk of a recurrence; a CT scanner that is 10 times more powerful than its predecessor is facilitating CT angiography; and 44% of colorectal operations—twice the national average—are being performed on a keyhole basis.

[Dr Poulter]

I am happy to commend Kettering general hospital for some of the improvements in care that have been made recently. My hon. Friend will, of course, want to ensure that that progress is sustained during the weeks and months ahead. As he will know, Monitor is still overseeing the trust to ensure that patient care and performance remain up to standard.

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

I welcome the comments of the hon. Member for Kettering (Mr Hollobone). Kettering general hospital also serves my constituents, and I look forward to meeting the Minister this week to discuss the pressures that are being imposed on it. One of the trust’s main problems is having to spend money from its acute budget on local care home beds. Does the Minister recognise that that should not be happening?

[Dr Poulter]

The approach that must be adopted to ensure that health and social care services are joined up in the way that we need will vary in different parts of the country, and in accordance with differing health care needs and demographic challenges. I look forward to discussing that and other issues further when I meet the hon. Gentleman and my hon. Friend the Member for Kettering (Mr Hollobone) tomorrow or on Thursday.

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

9. What assessment he has made of the roll-out of the NHS 111 telephone service.

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[David Rutley (Macclesfield) (Con)]

T5. Integrating health and social care is an especially important priority in areas with the fastest-ageing populations. With that in mind, do Ministers agree that it is vital to support joined-up initiatives such as Caring Together in north-east Cheshire, which involves the local clinical commissioning group, council and NHS trust?

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

My hon. Friend is absolutely right to highlight such initiatives. That was why the Government, as part of the Health and Social Care Act 2012, set up health and wellbeing boards, which bring together housing providers, the NHS, the third sector and social care locally so that they can look at how to improve and better integrate personalised care, especially for the frail elderly.

[Yasmin Qureshi (Bolton South East) (Lab)]

T2. In the 1960s and 1970s, the drug Primodos was given to pregnant women, resulting in serious birth defects in thousands of babies, who are now adults in their 40s. The then Committee on the Safety of Medicines failed to act in time, the scientist at Schering, the drug manufacturing company, accepted subsequently that he had made up his research, and the solicitor Peter Todd has described the events as the biggest medical and legal cover-up of the 20th century. Will the Secretary of State meet me and the victims of Primodos so that we can present our evidence on what has happened?

[Dr Poulter]

The hon. Lady is right to highlight the fact that when we have scientific and clinical data, they must be used responsibly, as the MMR scandal also indicated. Of course I would be delighted to meet her to talk through this matter further.

[Stephen Metcalfe (South Basildon and East Thurrock) (Con)]

T8. In advance of the publication of the Keogh report later today, and following the revelations that Basildon hospital had one of the highest standard mortality rates following catastrophic failures, will my right hon. Friend assure the House and my constituents that he will support the new management regime in its attempts to improve the quality of care? Will he also tell the House if he found any evidence of a systematic attempt by the previous Prime Minister and the previous Government to cover up figures—

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[Rosie Cooper (West Lancashire) (Lab)]

T6. Does the Secretary of State believe that making data on individual consultants public is pointless if hospitals are using informal mechanisms to frustrate patient choice, such as having a team of specialist nurses decide which consultant a patient is referred to? Will he reinforce patient choice and dissuade hospitals from doing that?

[Dr Poulter]

The hon. Lady is absolutely right to highlight the fact that we need more transparency in data and that patients have a right to know about the quality of surgical care, but it is also right that we need to look at that carefully across the different surgical specialties, and particularly at the different criteria that might also impact upon good care and good health care outcomes, particularly in oncology.

[Andrew Stephenson (Pendle) (Con)]

Two-year-old Oliver Rushton in my constituency has cerebral palsy and needs a selective dorsal rhizotomy if he is to be able to walk or stand on his own. Unfortunately, after considerable delay, Oliver’s request for NHS treatment has been turned down. He is now getting the treatment, but only after an incredible fundraising effort from his parents, who have personally raised £40,000 to pay for it. Will my hon. Friend meet me to discuss the case?

[Dr Poulter]

I would be very happy to meet my hon. Friend to discuss that case and the commissioning arrangements for the procedure, and indeed other treatment for patients with cerebral palsy.

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

T7. The guidance that the Government have produced on transferring funds from the NHS to local authority social care makes it clear that the money can be used to plug gaps in social care caused by cuts. Does that not just mean that the local authorities that are under most pressure because they have had the biggest cuts will not be in a position to develop the integrated health and care services that we would all like to see?

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[Richard Fuller (Bedford) (Con)]

At the end of this month, the East of England Multi-Professional Deanery will remove junior doctors in paediatric services from Bedford hospital. That will reduce paediatric services, which will obviously cause major concerns for families with children in Bedford and Kempston and north Bedfordshire. Will my right hon. Friend join me and my hon. Friend the Member for North East Bedfordshire (Alistair Burt) in calling for an open and independent inquiry into why clinical supervisory failures continued at Bedford hospital and were not addressed, and into the terrible consequences that resulted from that?

[Dr Poulter]

I am sure my hon. Friend will be pleased that Health Education England, supported by the General Medical Council, took such rapid action to address concerns over patient safety and the supervision of junior doctors at his hospital. It is right that a rapid action plan has been brought in by local health care commissioners and Health Education England in order to support that, put in place the right supervision for medical staff, and ensure we put things right as quickly as possible.