Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 22nd October 2013 Commons Chamber

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

On 12 November last year, I announced the allocation of a £25 million capital fund to the NHS to improve maternity services across the country, and that has supported improvements in 110 maternity care settings. I am pleased to say that, of that figure, Gloucestershire Hospitals NHS Foundation Trust was awarded £150,000 to refurbish the Stroud maternity unit.

[Neil Carmichael]

I thank the Minister for that encouraging answer. We now have 1,400 new midwives since 2010. Coupled with the very welcome recent investment in Stroud maternity unit, does he agree that this represents a real choice for expectant mothers and an excellent maternity service in general?

[Dr Poulter]

My hon. Friend is absolutely right to highlight the fact that when we came into Government there was a historical shortage of investment in maternity and midwifery care. We now have almost 1,400 more midwives in the work force, training commissions are being maintained at a record high, and we are continuing to invest in on-the-ground capital projects to support the birthing environment for women.

[Julian Smith (Skipton and Ripon) (Con)]

3. What assessment his Department has made of the effect of the European working time directive on patient care and the professional development of doctors.

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

We are aware that concerns exist about the impact of EU legislation on some areas of training and service delivery within the NHS, specifically the impact of the EWTD on patient experience and continuity of care, and the detrimental effect on the quality of training for doctors.

[Julian Smith]

Harrogate hospital, which serves much of my constituency, suffers very badly from recruitment and retention issues as a result of the working time directive. Does the Minister agree that it, and other areas of social and employment law, should be front and centre of our renegotiation strategy prior to the referendum in 2017?

[Dr Poulter]

My hon. Friend is absolutely right to highlight some of the concerns that have been raised by the Royal College of Surgeons and other groups about the impact of the European working time directive in medicine. That is why we have tasked the royal college with investigating and doing some work on exactly what the impact is on surgical trainees and elsewhere in the health sector. We look forward to its reporting back, and I hope that that will be very informative for future discussions on other work force regulations.

[Nick Smith (Blaenau Gwent) (Lab)]

4. What estimate he has made of the number of NHS Trusts forecasting a financial deficit at the end of 2013-14.

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

The Trust Development Authority and Monitor, for foundation trusts, indicate that there will be a financial surplus across the health care provider sector in 2013-14.

[Nick Smith]

With so many NHS trusts in deficit and many missing their A and E targets, when will the Minister stop blaming everybody else and get a grip on the A and E crisis?

[Dr Poulter]

I am disappointed that the hon. Gentleman used a pre-prepared question and did not listen to my answer. Throughout the health care provider sector, over 80% of trusts and foundation trusts are in financial surplus, and the overall end-of-year forecast is pointing to a surplus of £109 million across the sector. To support hospitals through what can be very difficult winter periods, with flu and other seasonal problems, we have put in place measures including a £500 million fund for winter pressures. That will take the pressure off A and E—unlike in Wales, where the Welsh Administration are cutting the budget for the NHS. In Wales the NHS has failed to meet A and E waiting targets since 2009.

[Mr Stephen Dorrell (Charnwood) (Con)]

While I welcome the fact that the provider sector as a whole is in surplus, will my hon. Friend confirm that some trusts are indeed anticipating that they will be running deficits? Will he also confirm that the National Audit Office has estimated that up to 30% of acute hospital admissions would be avoidable if we had properly integrated services, and that that would allow us to deliver not only better financial management but, much more importantly, better quality care for patients?

[Dr Poulter]

My right hon. Friend is absolutely right to highlight the fact that a very small minority—20%—of trusts across the health care provider sector, including trusts and foundation trusts, are anticipating a deficit. Many of those trusts have a direct legacy of debt from the private finance initiative arrangements that the previous Government put in place. That is one of the direct legacies of the poor PFI deals that were arranged. He is absolutely right to highlight the importance of integrated and joined-up health care. That is exactly what the £500 million we are providing for winter pressures is designed to do by focusing on better preventive care to keep people out of hospital.

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

Trust balance sheets are bound to be affected by the resources allocated to the commissioning groups. On 12 June last year, I asked the then Minister for

“a clear assurance that he will not downgrade the importance of economic deprivation in his resource allocation formula”.

He told the House:

“Yes, I can give that assurance.”—[Official Report, 12 June 2012; Vol. 546, c. 167.]

Why is the Minister’s Department now consulting on doing precisely what the then Minister said he would not do and taking £230 million out of the budget for the north-east and Cumbria?

[Dr Poulter]

The right hon. Gentleman has perhaps misunderstood the information imparted on that occasion. It is very clear that the allocation formula is now independently set and NHS England has primary responsibility for it. There is legitimate concern. There is a 10% deprivation weighting for some of the poorest communities in-built into that formula. It is also important that we recognise that demographics and an ageing population are putting pressure on a lot of CCG budgets, but these are matters for NHS England.

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

As Morecambe Bay trust seeks to recover from its financial crisis, one of the options put forward by clinicians is for a new, acute hub hospital to be created south of Kendal to improve safety, access and financial efficiencies. It is bound to involve a capital cost to start off with. If the new hub hospital is the option chosen by clinicians, will my hon. Friend give it his backing politically and financially?

[Dr Poulter]

My hon. Friend will be aware that this is a matter for local commissioners to decide and it is not for Whitehall to impose solutions on them. There are issues and efficiencies that Morecambe Bay trust can drive by better managing its estate and reducing temporary staffing costs. The hospital and trust will, of course, want to look into those issues in improving their financial outlook and the quality of care they can provide for patients.

[Liz Kendall (Leicester West) (Lab)]

Whatever the Minister claims, the reality is that the Secretary of State has lost grip of NHS finances just as he has lost grip of the crisis in A and E. Earlier this month, we learned that half of all NHS hospital trusts are now predicting deficits—up from one in 12 last year. As a self-proclaimed champion of openness, will the Minister now commit to publishing those deficit figures monthly and guarantee that all NHS acute trusts will balance their books by the end of the year? It is a simple question—yes or no.

[Dr Poulter]

The hon. Lady is being economical with the figures. I indicated earlier that 70% of trusts and 89% of foundation trusts are predicted either to break even or end the year with a financial surplus. That is hardly a difficult position. Those trusts that have deficits are often a direct legacy of the PFI deals negotiated by the previous Government and the right hon. Member for Leigh (Andy Burnham) when he was Secretary of State. The sector as a whole is predicting £109 million of surplus. That is hardly a deficit. I know that the Labour party is not very good with figures and cannot add up, which is why this country is in such an economic mess, but the figures speak for themselves: £109 million of surplus is predicted for trusts and foundation trusts.

[Martin Vickers (Cleethorpes) (Con)]

5. What recent progress he has made on improving the performance of hospital trusts placed in special measures.

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[Andrew George (St Ives) (LD)]

6. What the current (a) highest, (b) lowest and (c) mean average registered nurse-to-patient ratio is on acute hospital wards.

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

As my hon. Friend is aware, we do not hold information on registered nurse-to-patient ratios on acute hospital wards. Local hospitals must have the freedom to decide the skill mix of their work force and the number of staff they employ to deliver high-quality, safe patient care.

[Andrew George]

I am grateful to my hon. Friend. The Government should be monitoring the situation, but he will be aware of the concern, which I have consistently highlighted, about inadequate registered nurse ratios in acute hospital wards, and of the Health Committee’s report into the Francis inquiry, which made recommendations in that regard. In inspecting hospitals, what objective measure should the Care Quality Commission use when looking at safe staffing levels on acute hospital wards?

[Dr Poulter]

The CQC is working with the National Institute for Health and Care Excellence and NHS England to devise tools to do exactly that. As my hon. Friend will be aware, the number of front-line staff required, whether nurses or doctors, to look after a patient who is in a cardiac intensive care unit will differ from the number required in a rehabilitation setting. The tools that the chief inspector of hospitals will be able to apply are being developed.

[Mr Ben Bradshaw (Exeter) (Lab)]

Why do the Government continue to set their face against the essential recommendation of the Francis inquiry on minimum staffing levels?

[Dr Poulter]

The simple reason, as the right hon. Gentleman will be aware from his time at the Department of Health, is that ticking boxes on minimum staffing levels does not equate to good care. It can sometimes lead to a drive to the bottom, rather than to addressing the needs of the patients whom the front-line staff are looking after. The Berwick review has borne that out clearly. It is important to consider the patients and the skills mix on the ward, and to ensure that we get things right on the day for the individual needs of the patients.

[Sir Peter Bottomley (Worthing West) (Con)]

Will my hon. Friend ask the chief inspector to ensure that by the bed of every in-patient there is the name of the nurse and the doctor responsible, so that nobody gets lost in hospitals again?

[Dr Poulter]

I am very sympathetic to the point made by my hon. Friend. The chief inspector has indicated that he will look at how individual wards are run on a granular level to ensure there is the right skills mix to look after patients on any particular day, with proper accountability for patient care.

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

The chief inspector of hospitals says he will monitor levels of unanswered call bells, but not the ward staffing levels that cause the bells to be unanswered. Is that not ridiculous? Is it not time that Ministers changed their minds on this important issue, as Robert Francis has now done?

[Dr Poulter]

As the hon. Lady will be aware, on the basis of the Francis report the Berwick review considered that issue in detail and highlighted the fact that safe staffing levels are not about ticking a box for minimum staffing, but about developing tools that recognise the individual needs of patients on the ward. The previous Government went down the route of tick-boxes in health care. I worked on the front line during that time and that route did not deliver high-quality care. We need the right tools to support front-line staff so that they make the right decisions in looking after patients. It is not about tick-boxes; it is about good care.

[Kerry McCarthy (Bristol East) (Lab)]

7. What recent assessment he has made of the effect of the public health responsibility deal on the products and marketing practices of the fast-food industry.

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[Mark Pawsey (Rugby) (Con)]

T5. There is evidence that a nutritional meal can be a real aid to the recovery of patients, yet the Campaign for Better Hospital Food found that 82,000 hospital meals are thrown in the bin every single day. Will the Minister update the House on the steps being taken to ensure that patients receive a hot balanced meal, served at an appropriate time?

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

My hon. Friend is absolutely right to highlight the importance of all patients receiving high-quality nutrition, and a lot of work has gone into promoting time for hospital patients to be fed and into protecting mealtimes, as well as into reducing hospital waste. Hospital food waste is now below 7 per cent nationally.

[Karl Turner (Kingston upon Hull East) (Lab)]

T2. We have a crisis in community nursing in Hull, with district nurses being stretched to breaking point. Does the Minister not agree that withdrawing funding from this service is economically short-sighted given that the foundation trust’s deputy chief executive says:“If the crisis continues, the nurses will not be able to care for patients in the community and it could result in them being readmitted to hospital”?

[Dr Poulter]

The hon. Gentleman is right to highlight the fact that local commissioners have a duty to ensure adequate community health care provision. I hope that that is an issue that he will take up with them. If he would like help in that fight, I am happy for him to come and meet me, and to bring in the local commissioners to talk this through, as it is important that we have enough community nurses to provide good care in communities and local commissioners need to listen to that.

[Andrea Leadsom (South Northamptonshire) (Con)]

T6. Can my hon. Friend update the House on what he is doing to support the earliest relationships of new families through early years intervention? Specifically, will he support the cross-party “1,001 Critical Days” manifesto?

[Dr Poulter]

I pay tribute to the work that my hon. Friend has done on the early years, and there are many good things in that manifesto. That is why we are investing in an additional 4,200 health visitors by 2015 and why we are supporting the most vulnerable families by increasing to 16,000 the number of families that will be supported by family nurses by 2015. A lot of investment is going into early years, which pays back to the Exchequer and gives much better care to families, too.

[Alison McGovern (Wirral South) (Lab)]

T3. Wirral council has said that anybody who wants to be involved in providing social care must show their commitment to the ethical care charter. Will the Minister congratulate leading councillors Phil Davies and Chris Jones on taking this initiative, which includes a move away from zero hours contracts? Will he say specifically what conversations he has had with the Local Government Minister and with Treasury Ministers about making sure that each and every local authority has sufficient funds to fulfil their legal obligations in care services?

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[Hazel Blears (Salford and Eccles) (Lab)]

The NHS, with its massive purchasing power, can make a real difference to local areas through jobs and through supply chains. Some hospital trusts are enthusiastically implementing the Public Services (Social Value) Act 2012, including Barts and King’s. Will the Minister ensure that his new procurement strategy recognises the importance of social value?

[Dr Poulter]

The right hon. Lady makes a good point. We want improvements to the procurement process not just to save money, so that hospitals have more money to spend on the front line, but to support small and medium-sized businesses appropriately, such as by simplifying the qualifying questionnaire process, which is often too complex for small businesses to become involved in and therefore rules them out of the market. There are a lot of good things and I am happy to meet her to discuss the matter further if she would like.

[Tim Loughton (East Worthing and Shoreham) (Con)]

The Secretary of State knows Worthing hospital well; he has rolled his sleeves up there. When I went there a few weeks ago, I was told that the average age of patients in the hospital, stripping out maternity, is 85, yet we have qualified for no winter pressures money and we have a diminishing number of community hospital beds. Will he look into this anomaly, as he well knows the specific pressures we have on the south coast?