Oral Answers to Questions
Dan Poulter Excerpts(10 years, 8 months ago)
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Steve Brine (Winchester) (Con)
2. What recent steps he has taken to improve maternity care.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
We have made improving maternity services—so that women have a named midwife responsible for ensuring personalised care—a key objective in our mandate to NHS England. Since May 2010, the number of midwives has increased by more than 1,500 and a record number—in excess of 5,000—are now in training. Over the past two years I have set up a £35 million capital investment fund, which has already seen improvements to over 100 maternity units.
Steve Brine
My local foundation trust is currently exploring a major service change which would see the creation of a new acute care hospital to handle the sickest and most complex patients. It would leave midwife-led units only in Winchester and Basingstoke, and centre consultant-led services on the new site. Does the Minister feel confident that the clinical case for this kind of centralisation has been made? Would he be comfortable to see it rolled out across the NHS?
Dr Poulter
My hon. Friend is right to highlight the fact that such decisions are clinical decisions and need to be made at a local level to ensure safe care, both with appropriate numbers of obstetricians in obstetric-led units and to give women the choice to deliver in midwifery-led units where appropriate. I am pleased that we, as part of the fund that I outlined earlier, have been able to give Hampshire Hospitals NHS Foundation Trust £50,000 to provide enhanced facilities in birthing rooms at Florence Portal house.
Kate Green (Stretford and Urmston) (Lab)
In 2012 representatives of Group B Strep Support met the Minister and received a commitment that the gold standard of enriched culture medium testing would be introduced, which can facilitate preventive treatment for women in labour. Just before Christmas, Public Health England announced that the testing would not go ahead from 1 January. Can the Minister say why not and when the test will be introduced?
Dr Poulter
Group B strep is an important issue. I have seen in my clinical practice the devastating effect that the disease can have on newborn babies and on families, so we are doing all that we can to support work on it and ultimately to develop a vaccine to prevent the condition. I would like to correct the hon. Lady on the record. I met Group B Strep Support with the Chief Medical Officer and we undertook to investigate the applicability of the test. The clinical evidence unfortunately does not support its introduction, and we have to be guided by clinical evidence.
Guy Opperman (Hexham) (Con)
17. My hon. Friend has visited the Hexham midwife-led maternity unit, which provides exemplary care. Can he update the House on what steps the Department of Health is taking to prevent excessive screening of pregnant women away from midwife-led units? Surely health care is about choice, not diktat.
Dr Poulter
My hon. Friend is right. It was a pleasure to visit and open the new facilities at his local birthing unit. He has been a tremendous champion for the midwifery-led unit in his constituency, and I pay tribute to him for that. He is right that it is important that women have choice. These are local decisions by local health care commissioners, but I hope that it will give him some reassurance that the number of midwifery-led units has increased from 87 in 2007 to 152 in 2013 precisely because of the investment that the Government are making.
Keith Vaz (Leicester East) (Lab)
During pregnancy, two out of 10 women become diabetic. What additional funding is being given to train nurses to deal with this very difficult situation?
Dr Poulter
The right hon. Gentleman makes an important point. We need to provide additional personalised one-to-one support for all pregnant women, in particular those who have or who develop medical problems. That is why we are investing in more midwives—we have 1,500 more than in 2010—and why the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists have developed guidelines and protocols to support front-line professionals in making sure that those women get extra support and have a safe delivery.
Karen Lumley (Redditch) (Con)
21. As my hon. Friend is aware, we have been in a two-year battle to secure services at the Alexandra hospital in Redditch, including maternity. Will he meet me to discuss the best way forward to secure safe maternity care for all the mums-to-be in Redditch?
Dr Poulter
My hon. Friend has a distinguished record of more than four years of campaigning hard for local health care services in Redditch, and her constituents should be proud of what she has done on their behalf, fighting for Redditch hospital and local services. I shall be delighted to meet her to talk further about the local challenges for maternity care.
Mark Durkan (Foyle) (SDLP)
In the Minister’s earlier answer, was he saying that enriched culture medium testing is not a safe, simple and effective test for group B strep carriage?
Dr Poulter
We have had many debates in this House about group B strep and the effects of the disease. The point about enriched culture medium testing is that it takes time for bacteria to grow in culture, and the fact is that there is also evidence from the Royal College of Obstetricians and Gynaecologists. Public Health England has looked at that evidence and it has decided that it is not a test that is effective to be introduced during pregnancy. That is the medical evidence and we have to be guided by it. There are many other things that we need to do about group B strep, not least supporting the development of a vaccine, which is ultimately the best way forward.
Mr John Leech (Manchester, Withington) (LD)
Will the Minister tell the House what assessment he has made of the impact of the Immigration Bill on the maternity care of vulnerable women who would be expected to pay for their care?
Dr Poulter
Of course we need to have a health service in this country that is self-sufficient, and we have a national health service, not an international health service. However, it is right that we ensure that we look at all areas of the health service when we are applying new policies and directives, and make sure that we protect vulnerable patient groups. That is exactly what the Government are doing and we are working with the NHS to ensure that women always receive high-quality maternity care at the point of need.
Laura Sandys (South Thanet) (Con)
3. What progress has been made on introducing a cap on care costs.
Chloe Smith (Norwich North) (Con)
13. What steps his Department is taking to improve the health of veterans.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
We are rightly proud of the courage and dedication of our armed forces and it is our duty to ensure that veterans receive the best possible care. We continue to improve the health care of our veterans. The Government have invested £22 million in providing enhanced mental health and prosthetic services over the past few years.
Julian Smith
Alex Bentley, who chairs the Royal British Legion in Skipton and is the most incredible, passionate campaigner for our armed forces, has serious concerns about how the armed forces covenant is being applied by hospitals and local councils. Is there anything the Minister can do to champion the cause of this excellent Government scheme at local level?
Dr Poulter
Aside from the cash investment of £22 million directly in veterans services, we have made it a clear priority in the NHS mandate to make sure that the armed forces covenant becomes a reality in the NHS. We have now identified nine specialist prosthetic centres for veterans who have lost limbs and been injured in combat, and a massive amount of investment is going into services for veterans with mental health problems, including a 24-hour helpline. A lot of investment is being made at the national level and locally, and there will also shortly be dedicated resource for training local professionals on the ground.
Chloe Smith
I welcome that response. Will the Minister reassure me that he will properly join up his work with that of the Department for Work and Pensions and the Ministry of Defence? Like many other Members, I know of at least two veteran constituents who clearly need joined-up health and welfare. The voluntary sector helps—including the Matthew Project’s new “Outside the Wire” service in Norfolk—and I expect the same of the Government, who have rightly signed the armed forces covenant.
Dr Poulter
My hon. Friend makes an important point. This is not just about providing good health care services, but doing so in a joined-up way. We now have a seriously injured leavers protocol to help the transition of servicemen and women who leave the armed forces and return to civilian life. That is about taking a holistic view of their health and care needs, and any other needs that they may have, in providing the right support when they return to civilian life. It is being rolled out very effectively across the country.
Andy Sawford (Corby) (Lab/Co-op)
10. What assessment his Department has made of the availability of mental health services.
Ms Margaret Ritchie (South Down) (SDLP)
T5. There are nearly 500 UK-trained medical practitioners now working in Australia, of whom 6% never return owing to the better conditions available there. What steps will the Secretary of State and his ministerial team take to ensure that we retain those qualifying in emergency medicine this year, to keep local A and E departments open in Britain and Northern Ireland?
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I would like to point out to the hon. Lady that it is not unusual for doctors in training to work overseas to improve their medical experience. Many of my contemporaries did that, and every one I know has returned to work in the NHS in the UK. It is a common phenomenon that benefits doctors’ experience. What we have done, unlike the previous Government, is ensure that we now have a 100% fill rate for people entering A and E common stem training.
Pauline Latham (Mid Derbyshire) (Con)
T6. What assessment have the Government made of the decision by the National Institute for Health and Clinical Excellence not to recommend ipilimumab as a first-line treatment for advanced melanoma, except in clinical trials? Will the Minister join me in calling on NICE to reverse this decision and ensure that patients receive earlier access to this treatment to improve their chances of survival?
Dr Julian Huppert (Cambridge) (LD)
T8. Papworth hospital is a world-renowned heart and lung hospital. For years, it has wanted to move to Cambridge, supported by Addenbrooke’s hospital, Cambridge university, the British Heart Foundation, AstraZeneca and many more, but it has been put on hold yet again. Will the Secretary of State make sure that this move, which will help patients, help to develop new treatments and save money, will happen?
Dr Poulter
My hon. Friend will be aware that local commissioners take decisions on local services. I will be happy to meet him to discuss this matter further, so we can talk through his concerns and ensure that local health care services are as strong as possible.
Bill Esterson (Sefton Central) (Lab)
T10. The village of Melling has grown in recent years, yet its surgery hours have been cut drastically. Elderly and disabled residents now face a four-hour round trip by public transport to see their doctor. How can cuts in surgery hours, like those in my constituency, be justified if the Government are serious about having a first-class NHS?
Barry Gardiner (Brent North) (Lab)
The Minister earlier told the House that 1,500 new midwives had come on stream since the Government started, but, of course, the Government promised that there would be 3,000 delivered by 2015. Midwives are very good at delivery; how good is the Department?
Dr Poulter
We have trained more midwives. To go back to a previous question, it was under the previous Government that trained midwives from this country were having to go and work overseas. That is no longer the case. We now have 5,000 more in training—a record number—to make sure that we provide more midwives. I would also like to welcome the hon. Gentleman back to this country.
Andrew Bridgen (North West Leicestershire) (Con)
Last year I spent a busy and informative day with the East Midlands ambulance service on the road. It was clear speaking to those professionals that a large proportion of individuals taken to A and E would be better served by going to their GP or by accessing other services. However, the ambulance service felt completely disempowered to advise or even to refuse to take anyone to A and E who requested it.
Cosmetic Interventions
Dan Poulter Excerpts(10 years, 9 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
On 23 April 2013, the independent “Review of the Regulation of Cosmetic Interventions”, chaired by Sir Bruce Keogh, was published. A copy has already been placed in the Library.
The review highlighted how the rapid growth of the cosmetic interventions sector is exposing people who undergo these procedures to a concerning lack of safeguards. It made recommendations to improve the quality of care, to inform and empower the public and to ensure resolution and redress when things go wrong.
We fully accept the principles of the Keogh review and the overwhelming majority of the recommendations. Work is already underway on a number of them, in particular to address the issue of ensuring proper training for cosmetic practitioners. The Royal College of Surgeons has set up an inter-specialty committee to ensure standards for cosmetic surgery and will work with the General Medical Council on a code of ethical conduct. Health Education England is leading on a review of training for providers of non-surgical interventions, such as botulinum toxin—commonly known as “Botox”—and dermal filler injections.
Work is also underway on a breast implant registry to reassure women that if problems arise they can be contacted, kept informed and called in for treatment if necessary.
There are examples of high-quality surgical and non-surgical cosmetic interventions provided by trained staff to high standards of care and satisfaction. It is these high standards that must be universal. We must protect the public and ensure proper training and oversight of non-surgical as well as surgical cosmetic interventions. We shall legislate where required to achieve this.
Today I have pleasure in laying before Parliament “Government Response to the Review of the Regulation of Cosmetic Interventions” (Cm 8776). Copies are available in the Library.
Medical Records (Confidentiality)
Dan Poulter Excerpts(10 years, 9 months ago)
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Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
It is a pleasure, Mr Hollobone, to serve under your chairmanship. I congratulate the hon. Member for Leeds East (Mr Mudie) on securing this debate and all hon. Members on their contributions.
I pay particular tribute to my hon. Friend the Member for Mid Norfolk (George Freeman) for his excellent speech, in which he highlighted the importance of sharing data to improve patient care. He talked about empowering patients to take greater control over their health care. That is important and the key to it is ensuring that patients have the right data to do so. He also talked about improving research, ensuring that we can properly combat disease and linking data properly to understand exactly how to find cures for rare diseases. Importantly, he referred to the fact that we need properly to understand how good health services are, and to recognise where there is good practice. That is particularly important following the Francis inquiry and report, which outlined the importance of delivering high-quality care and transparent and properly used data to deliver that. He made those points very well.
Dr Julian Lewis
My hon. Friend the Member for Mid Norfolk (George Freeman) also referred to a major project involving people at the Maudsley hospital who had suffered serious mental illness. I want to hear from the Minister that there is no way under the sun that people who have suffered mental illness, for example, would find their data getting into the wrong hands. Without that guarantee, the project seems to be very dangerous.
Dr Poulter
In the time available, it is difficult to speak about detailed points. I apologise to my hon. Friend for that and I will write to him addressing some of the points that he raises. However, I can assure him that robust safeguards are already in place to protect patients with mental illness, and those safeguards will remain robust, if not more so under the systems that we will put in place.
It is important to recognise that the big challenge facing the health and care system is the fact that in the past we have had too much silo working, which has been to the detriment of patient care. The health system has often operated in a fragmented and siloed way. The operation of the health and care systems is not integrated and joined up. Key to driving improvements in patient care is ensuring that we join up the information that informs what good care looks like. Integration involves ensuring that a process exists to join up health and care information to improve care for patients.
We want to look after people with diabetes, dementia and long-term illnesses and to give them dignity of care in their own homes. It is important to do that and to have the right information and evidence to do so. We are well into that journey. The £3.8 billion integration fund will help with the provision of services, and the health and social care information centre will help us to get the right evidence base to drive properly joined-up, integrated care.
George Freeman
Will the Minister confirm that the situation at the moment—that is, under the previous Care.Data initiative—is more or less that GPs have patients’ records, many of which are not electronic but in paper format with treasury tags, but there is no formal link across to hospital records? Hospitals can say whether a patient has been admitted, but most of them do not have an integrated system to know what treatment a patient received in different parts of the hospital. Normally, someone pushes a wagon along the corridor with the treasury-tagged information. Also, there is no integration at the moment with the care system. The data of many of my constituents who go in and out of hospital for acute care and community care are chaotic. That makes transparency difficult, and it was one of the things at the heart of the Francis report and some of the Winterbourne View issues. We must remember that we would all gain from this public health benefit.
Dr Poulter
My hon. Friend makes an excellent point, and he is right to highlight the fact that we are talking about an evolutionary process. The health and social care information centre is not a sudden revolution. It will allow better use of information to join up care in exactly the way that he describes. It is no good having a £3.8 billion integration fund for better provision of services unless we have the right information and can join up intelligence to understand what good care looks like.
Mr Mudie
The two professionals in the Chamber are having an interesting conversation, but the public want to know whether the Minister is content, first, that the use of personal data will not lead to the identification of individuals and, secondly, with the present system of consultation on opting-out.
Dr Poulter
We already have robust procedures in place, and they will exist under the new system to protect patient confidentiality. I would describe them in more detail if I had more time, but it is worth highlighting some of the history. It is not revolutionary to store information; it is evolutionary. Hospital episode statistics started being collected in the following care settings in, I believe, the following years: in-patient data in 1989, out-patient data in 2003, A and E data in 2007-08, and primary care data from 2014.
We already have systems for collecting and analysing information, and patient safeguards exist in those systems. We will now see a system that better joins up and builds that evidence base to drive better care for patients, which is exactly the point that my hon. Friend the Member for Mid Norfolk made. We need to expand the evidence base, and it is absolutely right that we ensure patient confidentiality when doing so. I believe that we have the right safeguards in place to do that.
A number of points have been raised in the debate, and I will write to hon. Members with further clarification. I hope that that will be helpful.
Mrs M. Barnes (NHS Treatment)
Dan Poulter Excerpts(10 years, 9 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I congratulate the right hon. Member for Rother Valley (Kevin Barron) on securing the debate and commend him for all the work he has done on behalf of his constituent, and for the work he did in the previous Parliament, before I was a Member, as Chair of the Health Committee. I know that he has a long and distinguished record of fighting on health issues in the House, for his constituents and more generally. I also congratulate him on his recent knighthood. I am sure that the House will echo those congratulations.
We can all agree that good-quality patient care is expected, regardless of which part of the country we live in, and that all patients should expect it. I pay tribute to the NHS staff in the right hon. Gentleman’s constituency for the work that they do.
I am sorry to hear about the difficulties that Mrs Barnes has experienced and that she is dissatisfied with the quality of the care she has received. It is never acceptable for a patient to receive anything less than the very best treatment and service from our NHS. However, I am sure that all hon. Members will appreciate that the provision of local health care services is a matter for the NHS locally and that the Department of Health and Ministers do not play a role in directly investigating individual localised health care complaints, which should, quite rightly, be investigated without political interference to ensure that there is no question of bias. There is an NHS complaints procedure to resolve concerns and to help local NHS organisations to learn from the experiences of their patients. On the anniversary of the Mid Staffordshire scandal and the Francis inquiry, it is right that we reflect on the fact that we have to learn from things that have gone wrong in our health service and make sure we put them right for the benefit of future patients.
I understand that, as the right hon. Gentleman outlines, Mrs Barnes has been pursuing this matter for many years and has made use of the NHS complaints system, up to and including the health service ombudsman, on a number of occasions. I also understand—this is an important point in the context of the ombudsman and other issues—that a number of the concerns that Mrs Barnes raises about her care relate to events involving non-NHS health care. I should make it clear that what I say relates to the NHS, and not to health care providers working outside the NHS with whom Mrs Barnes may have decided to undertake treatment.
It is relevant at this stage to say a few words about how the ombudsman system works.
Kevin Barron
I accept, to some extent, the Minister’s point about the wider issues, which were not a matter of referral to the ombudsman. However, a constituent might often go to the private sector needing to get things done because they are in pain, for example, and might then see a consultant they could also see under the NHS. Often the staff are the same people, and there is no great difference between the clinicians they meet. Does he agree with that?
Dr Poulter
The right hon. Gentleman is absolutely right. It is difficult, in terms of the care pathway, for any patient to draw these distinctions. However, the NHS complaints procedure relates to NHS care, and the ombudsman’s role is as a public sector ombudsman. That goes to the heart of some of the difficulties we are talking about.
If a complainant is dissatisfied with the outcome of their complaint locally, they have the right to take it to the health service ombudsman, whose office was set up under the Health Service Commissioners Act 1993. When complaints are escalated, it is important that they are investigated independently, free from the political process, to ensure that there is no question of bias. The health service ombudsman is completely independent of the Department of Health, the Government, and the NHS. It is therefore difficult for me to comment on the ombudsman’s decisions directly.
If a complainant is dissatisfied with the ombudsman’s decision, they may make use of her own complaints process. The recourse open to anyone after the ombudsman has made a final decision is to seek a judicial review. During the entire complaints process, we assume that patients would take legal advice whenever they think it necessary. That is in their best interests and, in some cases, it is often important that patients have advice from a completely independent source.
If, on the basis of the legal advice received, patients decide to commence legal action against the NHS, that is, of course, to be expected. The House will understand that I cannot comment on legal advice given to patients, including Mrs Barnes, as that is entirely a matter between the patient and her lawyer. Complaints about lawyers are not a matter for the Department of Health or the NHS, nor for this House to consider in this context. I am aware that Mrs Barnes has exhausted all the legal remedies open to her. Her case has been considered by a number of courts, including the Court of Appeal, and has on each occasion been rejected. It goes without saying that these matters will have been considered carefully by the various judges involved, and I should not and will not cast any doubt on their judgments.
Dr Julian Lewis
I was not familiar with this case until I heard it outlined in such detail, but as I understand it the pointed issue is not about the merits or otherwise of this lady’s original arguments with the health service. I think I am right in saying that the only pointed issue is that the Information Commissioner’s Office directed that certain data should be removed from the record. They were not and she complained to the ombudsman, who does not seem to want to say whether it was right that they were left on her record or whether they ought to have been removed.
Dr Poulter
My hon. Friend will be aware that patients have open access to their records and can request to see them, but it is not for a patient forcibly to remove relevant clinical information from them. I am not sure whether that was the case in these particular circumstances, but I hope to be able to reassure the right hon. Member for Rother Valley.
It is worth pointing out that, during the long line of litigation, in 2007 Mr Justice Simon said, following a hearing, that
“this is not a case of professional conspiracies by the medical or legal professions; it is a case where the balance of the evidence before the Court fell decisively and conclusively in favour of the defendant”,
meaning the NHS. There is a long history of legal rulings that make that point clearly. Indeed, I understand that the NHS Litigation Authority obtained cost orders in its favour for that case, although it was unable to recover its costs. I reassure the right hon. Gentleman, however, that I shall look into the issues he has raised about the ombudsman and the Information Commissioner and write to him about them.
Kevin Barron
I appreciate that. I know that there is some history to the case of Mrs Barnes, but in my humble view—I understand that the ombudsman and politicians should not get mixed up—this specific issue is not about what happened in the courts. It is about what did or did not happen at the request of the Information Commissioner. My reading of the situation is that it could have been managed and handled by the health service ombudsman and compensation could have been paid. In my view, the ombudsman sat back, possibly because of the history to which the Minister has just referred, and thought, “It’s got to go to litigation and that’s it.” When other avenues were closed off, the ombudsman’s office could have managed the situation, but it seems to me that it backed off, looked at the whole history of the case of Mrs Barnes and said that it had to go to litigation. I think that is unfair and that the ombudsman’s office could have handled things much better and smarter on behalf of my constituent.
Dr Poulter
I note what the right hon. Gentleman says. I have committed to looking further into the issue and to writing to him, and I hope that will reassure him further about the processes that have been followed in this case.
As I said at the outset, I am very sorry to hear that Mrs Barnes is unhappy at the care and treatment she has received from the NHS. I am also aware that, over the years, she has been seen and treated in a private capacity on a number of occasions, which, as we have discussed, complicates the issues, because it can make it difficult to establish whether the responsibility sits with the NHS—as part of either the ombudsman’s process or the NHS complaints procedure—or elsewhere. Her case has also been considered by the courts on a number of occasions and I have alluded to their conclusions.
I understand that Mrs Barnes made full use of the various NHS complaints processes, but remains dissatisfied, which we have discussed in detail today. Accordingly, she has involved the health ombudsman, but the outcome has not been as she would have wished.
As I have said—this is worth repeating—the ombudsman is independent of Ministers, the Department of Health and the Government. An option open to anyone dissatisfied with the ombudsman’s actions is judicial review, but it is not to be embarked on lightly and those considering doing so should ensure that they take legal advice.
I wish Mrs Barnes well and I appreciate the intentions of the right hon. Gentleman and his strong advocacy of her case.
Question put and agreed to.
NHS
Dan Poulter Excerpts(10 years, 9 months ago)
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Andy Burnham
We are seeing this across the NHS. We have also seen contracts going to companies whose shareholders are Tory party donors. The closeness of the links between the Tory party and private health care is worrying.
Since April, when their Act came in, seven out of the 10 contracts let have gone outside the NHS. That is the clearest of all wake-up calls about what is happening to the NHS under this Government: it is being broken up and sold off. Under section 75 of the Act, clinicians have to put services out to tender, regardless of whether they are performing well, and that is the big difference between this Government and the last one. They are enforcing competition and marketisation in the NHS, but nobody voted for it.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
Why, when the right hon. Gentleman was Secretary of State, were the previous Government prepared to pay private sector providers 11% more than NHS providers?
Andy Burnham
Let me explain the difference to the Minister. When we were in government we used the private sector in a supporting role to help bring down NHS waiting times; he is using the private sector to replace the public NHS. There is a very big difference. He might remember that as Secretary of State I introduced the NHS preferred provider policy. At the time, his party complained—it said it was wrong—but I did it because I believed in the public NHS. I believe in what it stands for, unlike him and his party.
Dr Poulter
I remind the right hon. Gentleman that, unlike him, I have worked for the NHS and understand what it is like to work on its front line. Will he confirm that the previous Government introduced private sector provision into the NHS and paid 11% more to private sector providers than to NHS providers? This Government will not allow that.
Andy Burnham
The Minister looks pleased with himself, but I am afraid he has got his facts wrong. We did not introduce the private sector into the NHS; it has always worked with the private sector to relieve pressure on waiting lists. As a doctor, he should know that. He might also know that waiting lists and times came right down under the last Government, because the private sector supported the NHS, and I am proud of how we brought waiting lists down, but he is using the private sector to replace the public NHS. He is saying that any qualified provider can provide NHS contracts. I had a policy of designating the NHS as the preferred provider. So let us get the facts straight. There is a major difference between the two positions.
Acute Hospital Wards (Staffing)
Dan Poulter Excerpts(10 years, 10 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I pay tribute to the dedication and commitment to safe staffing and minimum staffing levels that my hon. Friend the Member for St Ives (Andrew George) has shown over the last year. I have much enjoyed our many conversations about the matter, and although he understands that we have different views about the right thing to do, both he and we are coming from the right position, which is about ensuring that we properly respond to the scandals exposed as a result of the Francis inquiry into Mid Staffs and ensuring we support all staff and hospitals to look after patients.
Jeremy Lefroy (Stafford) (Con)
Given that one of the problems at Stafford hospital in the mid-2000s was a sharp reduction in the number of nurses in order to cut costs, will my hon. Friend and the Department of Health be looking at cases where trusts substantially reduce the number of nurses at one point to see whether that constitutes a risk to safety?
Dr Poulter
As I will come on to say, if my hon. Friend will bear with me, it is now a matter for the CQC to inspect trusts on issues such as quality of patient care and safety. I will outline those measures later in response to my hon. Friend the Member for St Ives.
It is important that we support staff as much as possible when they raise concerns, whether about minimum staffing levels or other quality-of-care issues—this was the point just raised by my hon. Friend the Member for Stafford (Jeremy Lefroy)—and to do that we are facilitating and enhancing a duty of candour on trusts to ensure a more candid and open approach and to ensure that staff who have concerns are better supported and are better able to raise them.
Turning specifically to the matters at hand, superficially the principle of minimum staffing ratios sounds seductive, but when it comes down to it, we will see that they do not guarantee safe staffing or care. For those reasons, the Government do not support them. The principle of good care is about having the right staff in the right place at the right time. As we will all be aware, the needs of patients can change not just daily, but hourly—a patient can rapidly deteriorate—and just having ticked a minimum-staffing box does not mean that the right care is necessarily being applied. The lesson to learn from Mid Staffs is that we followed the bureaucratic tick-box approach and that led to failings in care, and that just ticking boxes saying we have done something, however seductive or good it might sound, does not necessarily mean that patients are being treated right. That is a matter of clinical circumstances and the clinical judgment of staff.
Andrew George
I am well aware of the Minister’s line, but if we followed its logic to its conclusion, we would withdraw minimum staffing levels from paediatric wards, intensive care and, in other sectors, child care, which is a topic that has been hotly debated politically as well.
Dr Poulter
As my hon. Friend will be aware, the CQC inspection regime inspects all parts of hospitals. Good care in a cardiac or intensive care unit is not necessarily about having one-on-one nursing; it is also about ensuring that all the other additional supports and other parts of the multidisciplinary team are in place to deliver high-quality care. That is at the heart of what the Government are trying to do. I believe that the CQC, looking not just at staffing levels but at wider determinants—for example, using the NHS safety thermometer, which looks at the issues my hon. Friend raised about bedsores—and putting together a whole picture of what the care at a trust is like, is well placed to make judgments. Part of the CQC’s inspection regime entails full clinical involvement, so it has become more of a peer-review process about what “good” looks like from one hospital to another—an important improvement in the quality of the inspection regime, which enables it to weigh up staffing issues.
My hon. Friend will be aware that we are going to support the CQC and provide greater transparency throughout the health system—in regard to staffing levels, by ensuring that they are published in future. Trust boards will have a requirement specifically to look at their staffing levels and to address problems. We shall not simply wait for the CQC to react to staffing issues as part of its wider inspection regime; there will be a requirement on trust boards to look at them. On Christmas day, I visited my local trust and found that staffing levels were discussed on a daily basis, in direct response to improvements following the Francis inquiry. I believe the same thing is taking place in a number of hospital trusts throughout the country.
Let me deal with my hon. Friend’s specific questions. He asked whether there were a significant number of hospital settings in which the number of registered nurses on duty was insufficient to ensure patient safety, professional standards and morale among many in the nursing profession. Our patients, their families and the public need to be assured that, wherever they are cared for and treated, there is a strong and positive patient safety culture, led from the top and embedded in every organisation.
There can be cases where hospitals are under-staffed and there is an impact on the quality of care provided, but these cases need to be addressed from a whole-care perspective, in which staffing numbers form just one element of a broader safety assessment. It is right that clinicians and trust boards have the freedom to agree their own staff profiles, which should not be dictated from Whitehall or by some blanket tick-box approach saying “You have met the minimum staffing number; you are therefore delivering good care”. We know from what happened at Mid Staffs that that is not the case. We must do everything we can to support good decisions made in the best interest of patients on the ground. This approach will give trusts the flexibility to respond swiftly to changes in patient demand or to meet the urgent needs of patients who have deteriorated, ensuring that safety and quality care is available.
We need to make sure that patient safety is a constant concern to each and every NHS trust and NHS employee, ensuring that risks to patient safety are always acted on as soon as they are identified, whether it relates to a “never event” or to the number of staff on a ward at any time of the day or night. We expect trust boards to sign off and publish information on staffing levels at least every six months to demonstrate that they are using evidence-based tools to calculate their staffing levels and provide assurance on the impact on quality of care and patient experience.
My hon. Friend asked whether the Safe Staffing Alliance proposal for a fundamental standard of no less than one registered nurse to eight patients would be a useful tool for inspection, surveillance and as a benchmark for management to use alongside other safe staffing tools. I hope he will understand that no single dimension and no single tool can ensure patient safety and that setting minimum staffing levels does not necessarily ensure that patients get the best possible care. Patient safety is not just about safe staffing; it is about listening to patients, assessing their needs and staff taking action where there are concerns. The number of staff—not just nurses, but doctors, physiotherapists, health care assistants and all other important members of a multidisciplinary team—needed to look after patients in a cardiac intensive care unit will differ from the numbers and skill mix required in a rehabilitation setting or another care setting—and it will differ from day to day, ward by ward and sometimes even from hour to hour, depending on the care needs of patients.
Ticking boxes on minimum staffing levels does not equate to good care. As the Berwick review made clear, ticking boxes in relation to minimum staffing levels does not equate to good care. Patients must be assessed individually, and the level of care required to ensure their safety must be determined by front-line staff locally, supported in their decision making by a range of factors that determine safe care. That should include staffing levels, but they are not the only issue: the Berwick review made that clear as well.
The Care Quality Commission also considers staffing levels in its inspections of registered providers, including acute hospitals. All providers registered with the CQC must ensure that at all times there are sufficient numbers of suitably qualified, skilled and experienced staff. In time, the guidance that we are developing on safe staffing will help providers to understand how to calculate reference staffing levels. It will also be used by the CQC when it assesses whether the right number of staff are employed to provide safe patient care.
My hon. Friend asked whether I agreed that in future the CQC should concentrate more on using safe staffing tools and clear measurements, and on how many registered nurses were on a ward. I do not want to dictate from Whitehall—indeed, I am sure that none of us do—the details of what the CQC will look for; it is important for the CQC to take a flexible approach to its inspections, and to be prepared to pursue different avenues depending on what it finds. What we can all agree on is that the provision of enough trained and skilled staff is vital to the delivery of acceptable care, and that CQC inspections should continue to consider staffing levels.
I must end my speech shortly, so I will write to my hon. Friend about the other points that he raised. I know that we are approaching this issue from the same position, and that all of us care about supporting staff and delivering high-quality care. However, I hope my hon. Friend will agree that safe staffing levels could have perverse consequences, that they are only a part of the picture when it comes to delivering good care, and that it is for the CQC to ensure that it takes an accurate and holistic view when carrying out its inspections to ensure that high-quality patient care is provided in the future.
Question put and agreed to.
Oral Answers to Questions
Dan Poulter Excerpts(10 years, 10 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Valerie Vaz (Walsall South) (Lab)
4. How much has been spent on medical locums in accident and emergency departments in each year since 2009-10.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
Staff employment is a matter for NHS trusts and we do not collect that data centrally. We recognise the challenge in recruiting and retaining A and E doctors, who can take up to six years to train. However, growth in the medical work force has kept pace with the increase in attendances since 2010.
Valerie Vaz
I am sure the Minister will agree that it is a grotesque situation where a trainee doctor working as a locum is paid as much as a fully qualified doctor. That is the result of not listening to legitimate concerns during the passage of the Health and Social Care Act 2012, so will the Minister not blame women in the work force or overpaid doctors but do something quickly to stop this drain on public money?
Dr Poulter
I hope the hon. Lady will be pleased to hear that under the current Government we have reduced locum costs to the NHS by about £400 million. That is, of course, good medical practice: it is good for patients to receive better continuity of care from permanent doctors. In A and E, specifically, we have seen the work force grow by more than 350 since 2010.
Simon Kirby (Brighton, Kemptown) (Con)
Last week, my son had to visit A and E in Brighton and spent the week in hospital. Will the Minister join me in thanking the hard-working doctors and nurses, including locums, in Brighton for their outstanding care and dedication, and for the excellent service they provide?
Dr Poulter
Yes. My hon. Friend will be aware that I have a particular knowledge of his local trust. I pay tribute to the dedication of the many high-quality front-line staff working there, and to those who put in extra hours to work as locums, usually from within the existing trust work force, who often have to cover maternity leave and other periods of staff sickness.
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
17. The Minister talks complacently about improvements in A and E consultants, but in Queen’s hospital in Romford only seven of the 19 posts have permanent A and E medical doctors in post. Surely he is fiddling while Rome is burning. People are not getting the service they need, while he is spending a fortune on locums.
Dr Poulter
The important point the hon. Lady has to remember is that it takes six years to train an A and E consultant, so it would be much better to put the question about advanced work force planning to the former Secretary of State, the right hon. Member for Leigh (Andy Burnham), rather than to members of this Government. Since we have taken charge of medical education and training, the number of those entering acute common training—those who may go on to become A and E consultants—has increased. We are now seeing a complete fill rate for those entering that training—something that the previous Government were not able to achieve.
Miss Anne McIntosh (Thirsk and Malton) (Con)
How much of this difficulty might be caused by excellent staff working part time in accident and emergency? On a recent visit to the emergency department at York hospital trust, I was struck by the excellent work done by doctors, many of whom, by choice, worked long shifts three days a week. Will my hon. Friend look into this matter?
Dr Poulter
I will certainly do that and write to my hon. Friend to reassure her, although members of staff who work part time often put tremendous effort into their work, and we often get well rewarded by the broader experience they bring as a result of being part time, so there are benefits to having part-time staff in the NHS.
Andy Burnham (Leigh) (Lab)
Figures out today show a staggering 60% rise in spending on locum A and E doctors under this Government—in some trusts, 20 times more—because they cannot recruit staff. It has now come to light that Ministers were warned about this problem three years ago. Dr Clifford Mann, president of the College of Emergency Medicine, said that when he tried to raise this issue, he was left feeling like
“John the Baptist crying in the wilderness”.
Why did Ministers ignore an explicit warning in 2011 from the top A and E doctor in the country?
Dr Poulter
The first warnings about the challenges facing A and E were put to the previous Government in 2004. The shadow Secretary of State was a Health Minister in 2006 and Secretary of State in 2009-10, but he failed to act adequately to deal with the shortages. It takes six years to train A and E consultants, so it will take six years to deal with the problem. The good news is that under this Government enough doctors are entering acute care common stem training to fill the places available.
Mr Speaker
Order. I do not wish to be unkind to the hon. Gentleman, but his answers almost invariably suffer from the failing of being far too long. It is nothing to be smug about; he really has to improve.
Dr Poulter
It is the right hon. Gentleman who needs a lesson about not rewriting history. Dr Mann said that this issue had been building for the past decade. When the right hon. Gentleman was Secretary of State and before that a Minister in the Department, he failed to make those long-term work force decisions and also signed up to the European working time directive, which exacerbated the problems on medical rotas. Those were decisions that he made. He created this crisis; we are fixing it and increasing the number of doctors working in A and E.
Jesse Norman (Hereford and South Herefordshire) (Con)
5. What steps he is taking to promote the health and well-being of older people.
Chi Onwurah (Newcastle upon Tyne Central) (Lab)
7. What representations he has received on IT and data security issues relating to the GP extraction service; and if he will make a statement.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
Sharing and linking GP and other data—lawfully, securely and appropriately—helps to improve care and provides a solid basis for research to benefit everyone. In addition to more than 100 items of correspondence on the GP extraction service received since July 2013, the Department of Health has also had representations on these issues from the Solicitor-General.
Chi Onwurah
I strongly support the better use of data and ICT to improve national health services, but it must be done securely and with informed patient consent, especially when the data are to be sold on. Yet the Health Secretary admits that he has not carried out any risk assessment of the move to a paperless NHS. Has a risk assessment been carried out for the extraction service and, if so, will he commit to publishing it and any recommendations made?
Dr Poulter
We have, of course, constantly assessed it. I hope the hon. Lady is not criticising the principle of improving and joining up care through better passing of data between services, which obviously has to be a very good thing. Let me reassure her that making available patient-identifiable information to third parties without the patient’s consent or on some other legal basis would be illegal. Information is held securely.
George Freeman (Mid Norfolk) (Con)
I congratulate Ministers on the reforms to open data and transparency, which have been a powerful catalyst for accountability and improvement in the health service—in particular, the care.data reforms. The Minister will be aware of my ten-minute rule Bill on the subject. Will he give us some assurance on the steps that the Department is taking to ensure the integration of data between the care and the NHS sector?
Dr Poulter
I can reassure my hon. Friend that the absolute heart of what we are doing on joining up data is ensuring that we join up data better and promote integration. Some of that will come from the £3.8 billion we are providing for more joined-up and integrated care between health and social care as part of our integrated care fund, or better care fund as it is now termed.
Jenny Chapman (Darlington) (Lab)
But why is it harder to get a GP appointment now than it was five years ago?
Dr Poulter
I think the hon. Lady will find that it was getting harder under the previous Government. It was not helped by the fact that, as we know, although it was not the fault of GPs, the contract that GPs were presented with by the previous Government made it difficult for many patients in many parts of the country to access primary and community care out of hours.
Damian Hinds (East Hampshire) (Con)
8. What progress his Department has made on introducing a cap on care costs.
Sir Edward Leigh (Gainsborough) (Con)
9. What steps he plans to take to improve the quality of health care provision in the east midlands.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
Clinical commissioning groups in the east midlands will receive increases in funding in 2014-15. Specifically, Lincolnshire West CCG will receive an increase from £1,111 to £1,124 per head of population, and Lincolnshire East CCG will receive an increase from £1,249 to £1,258 per head.
Sir Edward Leigh
Does the Minister recall the very worrying Keogh report, published last year, which showed that Lincoln hospital in particular had a higher than average mortality rate? Some of us felt that if we had a stroke or a heart attack, it would be a lot safer for us to be taken to the nearest big city, such as Leicester or Nottingham. Will the Minister join me in welcoming the fact that Lincoln hospital has made progress since then, and is now expected to have a below-average mortality rate?
Dr Poulter
My hon. Friend is right to draw attention to the fact that the Government have taken seriously the need to deal with poor care where it exists. We have proudly taken a stand on that. It is also important for hospitals to understand that although they are making progress, there is still much more work to be done. I am sure that my hon. Friend and I are both keen to support the Care Quality Commission, Monitor and other regulators in order to ensure that care continues to improve in Lincolnshire.
Keith Vaz (Leicester East) (Lab)
There are currently 28,000 diagnosed diabetics in the city of Leicester, and it is clear that the whole of the east midlands—indeed, the whole country—faces a diabetes epidemic. What steps is the Minister taking to ensure that the CCGs and health and wellbeing boards in the east midlands work together and focus on prevention?
Dr Poulter
That is a very good question. Local health and wellbeing boards are an excellent vehicle for the adoption of a more joined-up approach throughout health care, enabling other key players in the health and wellbeing sector to drive forward improvements. It is for the boards to consider the local issues outlined by the right hon. Gentleman, such as increasing obesity and other public health challenges, and to ensure that they work with and direct funding towards local communities. The Government have provided 40% of their public health funding for that purpose.
Andrew Percy (Brigg and Goole) (Con)
My constituency is served by the Yorkshire and East Midlands ambulance services. Could we not make better use of our ambulance services and benefit those who require emergency admission by enabling paramedics to convey fewer patients and provide more care from the back of ambulances? I realise that that will probably necessitate tariff reform.
Dr Poulter
It is true that many parts of the medical and health care work force can contribute to the delivery of high-quality care, and paramedics have an opportunity to do that. As part of our “Refreshing the mandate for Health Education England” initiative, we will be considering how we can make progress in that regard during the coming months and years.
Mr Jamie Reed (Copeland) (Lab)
I wish you and Ministers a happy new year, Mr Speaker. We certainly hope that it is a much happier new year for NHS patients.
In the last 52 weeks, almost two in 10 patients who arrived in accident and emergency units at the University Hospitals of Leicester NHS Trust waited for more than four hours. In 2011, the local risk register for Leicester, Leicestershire and Rutland primary care trust cluster warned that the Government’s reorganisation of urgent care services would lead to the
“risk of…inability to develop a resilient, predictive, high quality, Urgent and Emergency Care System.”
Given warnings from local risk registers about the disastrous impact of the Government’s reorganisation, and following the worst week of the winter so far for accident and emergency services, will the Secretary of State come clean, act transparently, and publish the warnings contained in the national risk register?
Dr Poulter
I remind the hon. Gentleman that the last Government never published risk registers. The policy that we have adopted is therefore entirely consistent with theirs. However, as the hon. Gentleman will recognise, it is not for Whitehall to micro-manage local commissioners and health care services. Decisions of that kind need to be made locally, by local commissioners working with patient groups in the best interests of patients and local communities.
Geraint Davies (Swansea West) (Lab/Co-op)
10. What plans he has for regulation of the counselling and therapy professions.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
We support the system of accredited voluntary registration established by the Professional Standards Authority for Health and Social Care. It has already accredited counselling and psychotherapy registers and others are seeking accreditation.
Geraint Davies
But the Minister knows that under this Government the number of people referred to psychotherapists and counsellors has tripled to 1 million at a cost of £400 million, and some of them are faced with so-called gay to straight conversion therapy. When will he support my Bill to regulate psychotherapists and ban so-called “gay cures”, which cause enormous trauma among their victims and are being promoted this Thursday at a big conference in Westminster?
Dr Poulter
As I am sure the hon. Gentleman is aware, the reason there have been increased referrals to therapists is that this Government are investing in early intervention and ensuring we invest in improving access to the psychological therapies programme so we can get to people with mental health problems much earlier and give them better support before they reach the point of crisis.
If I may beg your indulgence for one second, Mr Speaker, on the hon. Gentleman’s specific point about gay to straight conversion therapy, I also find that absolutely abhorrent in principle, but the issue is—it is an important issue and he should listen to this—that if we were to ban or put in place regulations on that it may have unintended consequences. That may stop counsellors practising who are supporting people coming to terms with their sexuality. That is an important service, and I hope we can support it on both sides of this House.
Grahame M. Morris (Easington) (Lab)
11. What assessment he has made of the effect of social care budget changes on the number of accident and emergency attendances.
Barbara Keeley (Worsley and Eccles South) (Lab)
16. What recent assessment he has made of the effect of social care budget changes on accident and emergency attendances.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
Although councils have reduced social care budgets, the evidence suggests that this is not having an impact on the NHS. In fact, the data published by NHS England show that councils are getting better at getting people out of hospital at the appropriate time.
Grahame M. Morris
The National Audit Office reports that cuts to social care led to nearly 500,000 delayed bed days in accident and emergency in 2012-13, so will the Government see sense and commit to investing in lowering the eligibility threshold to moderate, ensuring that older and disabled people’s needs in Easington and throughout the country can be met in their community so they do not need to present to A and E causing further pressures on it?
Dr Poulter
Taking the hon. Gentleman’s question in the spirit he intends, I think there is a misunderstanding of the statistics. We need to reduce the pressure on A and E, and evidence from NHS England already shows that improvements in how social care works with the NHS over this Parliament are delivering improvements to care. In 2011-12 there were about 523,000 bed days lost because of delays attributable to social care, but in 2012-13 the number had fallen to 476,000, a drop of nearly 50,000. That shows that social care is working well to reduce pressure on A and E.
Robert Flello
I am absolutely amazed at the answer the Minister has just given. Stoke-on-Trent, which, despite the local authority having to cut a third of its budget, has managed to make cuts—or efficiency savings as the Government would call them, of course—and move money into social care. Despite that, however, it still has less to spend this year than it had just three years ago, and that is resulting in people not getting social care because of cuts to the budget and to eligibility. When is the Minister going to wake up and do something about it?
Dr Poulter
There is always a lot of political smoke around this, but spending has roughly been flat in cash terms according to the Association of Directors of Adult Social Services survey and councils are budgeting to spend more this year than they were last year on social care. In addition, we are setting up the integrated care fund of £3.8 billion to better join up health and social care, and that will help to improve the care available to patients as well as reduce pressure on budgets.
Barbara Keeley
But Government budget cuts have forced Salford local authority to change its eligibility criteria. For 1,400 people it is going to be zero-day social care, not seven-day social care, and even our excellent Salford Royal hospital is going to struggle when those 1,400 people find that the hospital is the only option for them. Age UK says these cuts make “no financial sense” and are “morally wrong”. When are Health Ministers going to see that point?
Dr Poulter
I make two points. First, the eligibility criteria began to change under the previous Government, so it is wrong of the hon. Lady to try to make political points which do not stand up to scrutiny. Secondly, I am disappointed that she is unable to recognise that there is very good integration of health and social care in Salford, in her own constituency. That is a model that we could look at to see how good care can be delivered elsewhere.
Sarah Newton (Truro and Falmouth) (Con)
I am delighted that Cornwall has been chosen as a pioneer area for joining up health and social care. It is the only pioneer area to be led by the voluntary sector. Will the Minister meet me and the Cornwall team to enable us to deliver that care in Cornwall?
Dr Poulter
I can confirm that the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), will be delighted to meet my hon. Friend to take that further, and that he and I will be visiting Cornwall in the next few months to see at first hand the excellent work that is being done there.
Mr Philip Hollobone (Kettering) (Con)
Would the Minister like to congratulate the Northamptonshire Healthcare NHS Foundation Trust, Kettering general hospital and the Northampton General Hospital NHS Trust for coming together to form the frail and elderly crisis hub in Northamptonshire, to prevent unnecessary admissions of elderly people to local accident and emergency departments?
Dr Poulter
I would very much like to do that. It is important, given that we sometimes have adversarial discussions on these matters, to highlight the examples of good practice. The example in my hon. Friend’s local area of Kettering is exactly the sort of initiative that we need to see elsewhere in the country. That is why we have given £3.8 billion to better support the integration of health and care.
Mr Marcus Jones (Nuneaton) (Con)
Changing working practices in hospitals is an important way of reducing pressures on social care and on A and E. Will my hon. Friend join me in praising the staff of the George Eliot hospital, who, through changes to working practices implemented under the supervision of the Keogh process, achieved the second-best A and E four-hour target performance in the country over the busy Christmas and new year period?
Dr Poulter
My hon. Friend is absolutely right to highlight the fact that integrated care working, better intermediate care and ensuring that GPs work closely with accident and emergency departments are exactly the kind of factors, along with joining up health and social care, that take pressure off A and E departments. I am delighted that things are going so well in his local area.
Liz Kendall (Leicester West) (Lab)
Happy new year, Mr Speaker.
People want a care system that gets the best results for patients and one that makes the best use of taxpayers’ resources, but under this Government they are getting neither. Half a million fewer people are now getting social care services to help them to continue to live at home, and half a million more older people are being admitted as more expensive hospital emergency cases that could have been avoided. Will the Minister tell us how that record represents good care and good value for taxpayers’ money?
Dr Poulter
The point I made earlier is that the number of cases of bed blocking due to social care delays has decreased under this Government. Also, it was the previous Government who began to change the eligibility criteria. Labour Members talk about a crisis in social care, but per-head funding for social care fell in the last term of the previous Government. That is the legacy that we are dealing with, and we are sorting it out—
Mr Speaker
Order. I do not wish to be unkind to the Minister, but I am quite interested in making progress with Back-Bench Members, who have had to wait too long.
Hugh Bayley (York Central) (Lab)
T5. On 1 January, the York Teaching Hospital NHS Foundation Trust ceased providing antenatal advice classes for pregnant women and refers them instead to online advice on its website. Is that an approach the Government support, and will they urgently invite the National Institute for Health and Clinical Excellence to review the change in policy and look at its effectiveness?
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I am sympathetic to the point that the hon. Gentleman raises, and I am happy to meet him to discuss it further so that we can see whether the matter needs to be addressed.
Mr Gary Streeter (South West Devon) (Con)
T6. On any given day in the Derriford hospital in Plymouth, 75% of patients are over 65 years of age and rising. Does that not demonstrate the demographic pressures that face our acute hospitals, and what more can this Government do to ensure that people, especially elderly people, are treated in the community?
Ms Margaret Ritchie (South Down) (SDLP)
Given the ongoing crisis in A and E units in the UK, particularly in the area I represent in Northern Ireland, will the Minister confirm whether the Health Minister in Northern Ireland has had discussions about possible solutions to finding and recruiting extra doctors?
Dr Poulter
I am not aware of any direct conversations with Ministers here, but as the hon. Lady will be aware, the Minister responsible for A and E services is my right hon. and noble Friend Earl Howe. I will write to her about the discussions that have been had with the noble Lord and Health Education England.
Mr Robert Buckland (South Swindon) (Con)
T10. I warmly welcome initiatives such as the introduction of personalised GP care for the over-75s, but what more can be done to ensure that personalised care treats the individual’s well-being as opposed to merely a collection of symptoms?
Health Funding (Telford and Wrekin)
Dan Poulter Excerpts(10 years, 10 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
It is a pleasure to serve under your chairmanship for the third time, Mr Dobbin.
I congratulate the hon. Member for Telford (David Wright) on securing today’s Westminster Hall debate, on his strong advocacy for the needs of his constituents and on his highlighting of the importance of political consensus on these issues. He is absolutely right to do so.
We know that the single biggest challenge facing our health services is how better to look after older people and people with long-term disabilities and how to provide dignity in the care of people as they grow older. The key to delivering better health services for that group—and for all patients, including those in the early years of life—is an increased focus on integration and more joined-up health care services. That is very much at the heart of the hon. Gentleman’s contribution, and I hope my remarks will reassure him that it is very much the focus of the Government’s stewardship of the health care system.
The hon. Gentleman will be aware that a £3.8 billion integration fund has been set up that will, in the longer term, drive and improve joined-up services between local authorities and the NHS. For far too long, there has been too much silo working. Silo budgets have sometimes reinforced the silo working, and it is often patients who have fallen through the gaps and paid the price. That is why the Government are determined to fix the situation and ensure that, not just through the changes we are introducing in the Care Bill but through the integration fund, there will be greater synergy of joint commissioning and pooled budgets between local authorities and the NHS, where that is to the benefit of patients.
It was a pleasure for me to visit the Princess Royal hospital in November 2013 to see the birthing centre and the development of the new women and children’s centre. As the hon. Gentleman will be aware, the trust has benefited from some £35 million of external capital money to support its capital investment programme, including the development of the women and children’s centre, which is due to open in autumn 2014.
Before we proceed, there are two issues. First, there is the key issue of how the national funding formula is set. I reaffirm that throughout the NHS, including in Telford and Wrekin, there have been real-terms increases in NHS funding under this Government. Secondly, the local CCG has discretion on how it allocates its budget, so there is some local discretion, which probably goes to the heart of some of the hon. Gentleman’s concerns.
Until recently, the funding allocation was set by the Department of Health, but under the new arrangements politics has been taken outside the setting of health care funding; NHS England now has direct responsibility for funding allocations. The NHS, through NHS England, relies on the Advisory Committee on Resource Allocation, or ACRA, and its assessment of the expected need for health services to help set allocations for each area.
We were all pleased that, for the 2013-14 allocations, NHS England decided that following the ACRA recommendations exactly would lead to higher growth for areas with better health outcomes and possibly reduced budgets for areas with less good health outcomes. Given that, like NHS England, we are all concerned about reducing health inequalities, the important decision was made to maintain the substantial weighting in the formula for areas of deprivation and health care inequalities. The ACRA formula was not directly followed, an issue on which we have touched in previous Westminster Hall debates. NHS England’s thinking, in outline, was that the recommendations were inconsistent with the responsibility to reduce health inequalities. NHS England conducted a fundamental review that has informed the allocations.
On 17 December 2013, NHS England’s board met and agreed CCG planning guidance and allocations for 2014-15, which will help commissioners to commission services for the benefit of local populations. The Government have protected the overall health budget, and NHS England has ensured that every CCG in England will continue to benefit from at least stable real-terms funding for the next two years.
The Government’s mandate for NHS England makes it clear that we expect it to place equal access for equal need at the heart of its approach to allocations; to consider health inequalities; to ensure a transparent process; and to ensure that changes to allocations do not destabilise local health care economies. A rapid change to or endorsement of the ACRA recommendations would have led to mass destabilisation of local health care economies. NHS England was mindful of that, and of the need to prioritise funding for areas of deprivation, in its allocations.
The 2014-15 allocation for Telford and Wrekin CCG will be almost £187.8 million—the per capita allocation is £1,058 a head, about the same as my constituents receive in Suffolk. That is a cash increase of 2.14% on the funding that the CCG received this year. The CCG will also receive a 1.7% increase on its allocation for 2015-16, which means that its funding will go up to almost £191 million. Additionally, NHS England has announced that the Shropshire and Staffordshire area team will receive a 2.38% rise in primary care funding in 2014-15 to almost £342 million and a further 1.8% increase in 2015-16 to more than £348 million. Those increases are higher than average, which reflects the historical underfunding in those areas against the primary care funding formula adopted by NHS England. I hope that is some reassurance to the hon. Gentleman that, in a general sense, increased funding is coming to his part of the country.
The hon. Gentleman will be aware that the Government have also provided £221 million in additional funding to the NHS to help cope with winter pressures this year so that patients get the treatment they deserve. Winter is a challenging time for all health care services, and it is right that we have put in place additional money for the NHS. The local health economy has received £4 million in additional funding, of which £1.2 million will be directly invested in Shrewsbury and Telford Hospital NHS Trust to staff all escalation areas.
The trust has also outsourced a proportion of day surgery to the Nuffield hospital to protect elective activity, should that be necessary at times of high demand during the winter. The remaining £2.8 million is being used to improve unscheduled care capacity and flow outside the hospital. An additional 69 beds have been sourced outside the trust, including intermediate care, care home and specialist dementia beds.
As the hon. Gentleman will be aware, the winter pressures money is being used to fund intermediate care beds and the focus on rapid discharge, not only in Telford and Wrekin, but nationally to some extent. That benefits not only the NHS, but local authorities, and it is part of the drive to achieve more integrated and joined-up health and social care.
If an old person can be promptly discharged home with the right care package, it is important that that happens; that is better for the person and the care they receive, but also better for the NHS’s financial settlement. To put it crudely, stuffing beds with patients does not make good financial sense, and it is not good for patients, who would much rather be at home in their communities. I am pleased that the money is going towards making that possible in the hon. Gentleman’s area.
David Wright
I absolutely agree with everything the Minister says—it is basic common sense. Although I am glad to hear him say it, and it is really positive, it would be helpful if he could address one concern, although I am not necessarily suggesting he will have an answer today.
I accept that we want to get people out of hospital and into their homes if possible to ensure they are cared for effectively. However, he must admit that the figures I highlighted, as well as the local authority’s concerns, suggest there has been a fairly significant reduction in the CHC pot. Given the scale of the local authority’s budget, compared with the health service’s budget, that reduction has an enormous knock-on effect on the local authority. I hope the Minister will take some time to look at that.
Dr Poulter
The hon. Gentleman is absolutely right to highlight the issue. The point I was coming on to is that although the region’s funding allocation from the Government through NHS England is going up, the CCG obviously has some local discretion over how that allocation is spent, and that goes to the heart of the matter.
As has been highlighted, continuing health care funding is the crux of this matter, and it is relevant to mention NHS continuing health care, which is a package of ongoing care arranged and funded solely by the NHS where the individual is found to have a primary health need. The NHS provides that throughout the country, and it is vital that it does.
There is sometimes quite a blurred line between where NHS funding and care end and where local authority responsibility starts. The issue is not whose budget is involved or which budget the money comes from, and that is part of the reason why the Government set up the £3.8 billion integrated care fund. This is about joining up budgets. The hon. Gentleman and I, the doctors and nurses on the ground, and the local authority are interested in the person, rather than who pays for treatment. The fund is a recognition of that, and we are setting it up to drive forward joined-up working.
However, we have to look at where we are now and why we have come to the place the hon. Gentleman highlighted. He will be aware that audits were carried out in 2009-10 and 2010-11 of the then PCT’s accounts. It was decided that the continuing health care funding was not being allocated properly, appropriately or even, potentially, legally.
At that point, the PCT was putting a lot of additional money into continuing health care, but a similar approach was not being taken elsewhere in the country. The auditors therefore rightly took the view that funding had to be allocated in accordance with the correct public rules for spending money, including NHS money, and that if money was, potentially, being allocated in an illegal way, that needed to be addressed under the rules at that time.
Dr Poulter
I absolutely accept—the hon. Gentleman may wish to elaborate on this in his intervention—that, fundamentally, this is not about rules, but about making sure we have a better service for people. That is what we need to focus on.
David Wright
Yes, indeed, I do believe that. My concern is that the figures I highlighted suggest that, in comparison with similar and surrounding authorities, we are doing very badly per head of population in terms of the assessment process for qualification for continuing health care. That suggests to me that the pendulum has swung too far in the other direction and that the assessment procedure is being used to ensure that the figures are kept down.
I am concerned that some people with care needs in the community will lose out—as the Minister rightly said, this is not about structures and silos in the health service, but about individuals and their families in the community who are trying to cope.
Dr Poulter
The hon. Gentleman is right. In terms of the per capita spend in CCG allocations, Suffolk similarly has large towns with very rural surrounding areas, and the CCG in the hon. Gentleman’s area has a fairly similar allocation to the one I represent.
There is also an issue about how the money given to CCGs is spent. In a knee-jerk reaction, perhaps, to the auditors’ findings and the fact that the spend was not allocated appropriately, Telford and Wrekin went from being almost one of the highest spenders on continuing health care to being one of the lowest, and that is the crux of the problem. That is down to decisions by the CCG, or the PCT as it was, about how to allocate the budget given to it.
If, in 2009, 2010 and 2011, the PCT was picking up funding responsibilities that should perhaps have been the local authority’s, but then, in response to the audit, changed the amount it allocated to continuing health care, that could clearly have a destabilising effect on the local authority. However, the PCT and then the CCG have done everything they can to mitigate that, and they have given the local authority discretionary funding.
In particular, just over £3 million has gone to the local authority thanks to the fund set up by my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) to facilitate exactly that kind of activity. At its own discretion, the CCG has also given the council £2.4 million on top of that, over and above what the council expected to receive. The CCG has therefore acknowledged and accepted that, in reacting to the auditors, there was perhaps an over-reaction, and it has now righted that by giving the local authority some discretionary additional funding.
That does not detract from the overriding point that, generally throughout the country, and particularly in Telford and Wrekin, we need to see increased emphasis on integration and joined-up care. It is in no one’s interests to have such discussions about funding, which waste a lot of time and effort on the part of the local authority and the CCG. If we can drive more joined-up working, more joint commissioning and more pooled budgets, where appropriate, as the Government will be doing through the Care Bill and the integration fund, the number of these turf wars will be reduced, because the emphasis will be on the patient, rather than the budgetary silo. That must be the right way forward.
I am sorry that, in this instance, the hon. Gentleman’s constituents and local authority have perhaps been caught up in errors made by the former PCT, although I am pleased the CCG is doing all it can to redress the balance by giving the local authority discretionary additional funding. I hope working relationships will improve and that, as we move forward, with further emphasis centrally on integrated health care and joined-up budgets, we will see greater improvements to the local health care economy and, more importantly, continuing improvements to patient care locally. If the hon. Gentleman wants to discuss the matter further or to meet me, I will be happy to do so.
Mid Staffordshire NHS Foundation Trust
Dan Poulter Excerpts(10 years, 10 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
It is a pleasure to serve under your chairmanship, Mr Crausby. It is also a great pleasure, as always, to respond to my hon. Friend the Member for Stafford (Jeremy Lefroy) and, indeed, to all hon. and right hon. Members who have contributed to and supported this debate, which raises an important issue for patients and constituents, not just in my hon. Friend’s Stafford constituency, but across Staffordshire and the wider region.
It has been an incredibly difficult time for local patients and staff at the Mid Staffordshire NHS Foundation Trust. I entirely agree with my hon. Friend that the trust has come a very long way since the terrible events exposed by the inquiries and the Francis report last year. My hon. Friend has walked the journey every step of the way with his constituents and with the patients, and he should be congratulated and commended on his strong and superb advocacy of the needs of local patients, of all his constituents and of the families of those who were treated appallingly by the trust in the past. He should also be congratulated and commended on his strong advocacy for the improvements and the high-quality care that is now being delivered by parts of the trust today. I am sure we would all like to put on record our congratulations on his advocacy and on the work done by him and my hon. Friend the Member for Stone (Mr Cash), who for many years has also been a strong champion of local patients.
In responding to some of the points that have been raised today, it is important to talk a little about the trust’s background to provide some context. The trust has been operating at a deficit for some time, and certainly since 2009. In April 2013, the trust reported a deficit of £14.7 million. As my hon. Friend the Member for Stafford alluded to, that position is expected to get considerably worse. As a proportion of the trust’s turnover, the deficit forecast for 2014 is higher than that of almost any other trust in the country. For the past two financial years, the trust received approximately £20 million a year in support from the Department of Health. Without that funding to supplement its income, Mid Staffs would have been unable to pay its staff.
The contingency planning team sent into Mid Staffs in late 2012 concluded that the trust was delivering services at a cost substantially higher than most other trusts in the country. A key challenge faced by the trust is the recruitment and retention of staff and the high cost of temporary staff, which is no wonder, given that it must have been a very demoralising time for those working in the trust when there have been ongoing investigations into events that took place in the past. Additionally, some of the trust’s services are operating with consultant numbers significantly below Royal College guidelines. The 2012 contingency planning team reported that, despite improvements in clinical services, the trust is unlikely to be able to achieve the required cost savings without adversely affecting the quality of care provided to patients.
On the reasons why the special administration process has been set up, it is important to take the initial report into account and to recognise that we are where we are today because of that report. In cases such as this, where a trust is facing substantial financial challenges, it is crucial that action is taken quickly to secure services for patients and ensure that high-quality patient care can still be delivered. The special administration process for foundation trusts offers a time-limited and transparent framework for resolving the problems of a significantly challenged trust. Like the regime for NHS trusts, the special administration process is intended to be used only in the most serious circumstances.
As my hon. Friend the Member for Stafford is aware, Monitor made the decision to place Mid Staffs into special administration on the basis of the 2012 work. The CPT’s first report concluded that Mid Staffs is not financially or clinically sustainable in its current form and recommended the appointment of administrators as the best option for identifying the changes required in the years going forward to continue to secure high-quality patient care. Acknowledging the serious financial challenges facing the trust, the Secretary of State wrote to Monitor giving his support for the appointment of the trust special administrators.
It is worth touching briefly on the work of the trust special administrators at Mid Staffs. The TSAs have been in place since April last year, and they have had two tasks. First, they had to take over the day-to-day running of the trust. Secondly, they have had to work with the trust’s staff, commissioners, providers and other local stakeholders to develop a plan for services. The work undertaken by the TSAs builds on the earlier conclusions of the CPT and only strengthens the case for urgent change. If no action is taken, the TSAs estimate that Mid Staffs’ annual deficit will exceed £40 million in four years.
Joan Walley
I am conscious of the amount of time left to reply to the specific points made by the hon. Member for Stafford (Jeremy Lefroy) and in interventions, so will the Minister ensure that the issues flagged up will be responded to in detail in this debate?
Dr Poulter
I will of course respond to those that I can, but as the hon. Lady will be aware and as I will set out later, the TSAs’ report is currently with Monitor—I would expect it to be recommended to the Secretary of State by the end of this month—so it would be inappropriate for me to comment on it at this stage. I hope she understands that it would be wrong for me to make assumptions about a report that has not yet been submitted to the Secretary of State.
Mr Cash
I have asked nearly 10 times for a report to be debated on the Floor of the House in Government time, but it has not happened yet. Nobody can understand why it has not happened yet. Can we please have an assurance that a debate will take place and within a matter of weeks?
Dr Poulter
My hon. Friend makes an important point. The Secretary of State has previously given that assurance, and I give my hon. Friend that assurance again today. It is obviously for the Leader of the House to organise Government time, but I will have conversations with and write to him following this debate to ask him to expedite the issue.
Returning to the report, the TSAs have also highlighted the serious clinical implications of failing to act. They predict that services operating below the recommended consultant level, such as A and E, would need to be reduced. Low-volume services would risk being closed altogether, forcing patients to travel further for treatment. Throughout the process, the TSAs have stressed the fragility of the trust and emphasised the huge importance of agreeing to and implementing the changes required as soon as possible.
I will now move on to the next steps, about which all hon. Members are concerned. I know that it is frustrating for hon. Members wanting answers that I cannot provide them all today. The report is currently with Monitor, so it is for Monitor to make recommendations to the Secretary of State on the basis of that report. That will be the appropriate time for the Secretary of State and Ministers to comment. That may be frustrating for hon. Members, but that is the way that things need to be. We cannot comment on the matter until Monitor has made its recommendations. If Monitor is satisfied with the TSAs’ final proposals, the Secretary of State will have a maximum of 30 working days to consider them against a set of requirements defined in legislation. These aim to secure services for patients that are of a sufficient level of safety and quality and that offer good value for money. The Secretary of State will consider each requirement carefully before coming to his final decision.
As I have said, it would be inappropriate for me to pass further comment today on the TSAs’ final report because its final version has not yet been submitted. It is clear from the debate, however, that there is widespread interest from around the region and from local Members who are concerned about the wider impacts of the report on the health care economy and on services for other local patients. I am confident, however, given the interest from Members and the support provided to the trust from other health care trusts and hospitals in the area, that we will come to the right conclusion. We all want to see a strong and viable health care service for patients in Stafford and the surrounding areas, and I am confident that that is what we will have delivered once the Secretary of State has considered the report.
Maternity Care
Dan Poulter Excerpts(10 years, 10 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
On 20 December 2013 I published information about the availability of £10 million capital funding in 2013-14 to improve maternity care settings across England so both mothers and fathers, and the staff who work in the units, can benefit from a more pleasant and appropriate environment. “Improving Maternity Care Settings: Capital fund programme 2013-14: Information and criteria” has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
Improvements to over 100 maternity units across the country funded by the £25 million improving birthing environments capital fund in 2012-13 are making a big difference to families, with more choice and better environments where women can give birth.
This year, the funding criteria prioritise:
services where the birth rate has increased quickly or where the environment needs to adapt to local demographic population changes, or
initiatives that can make a difference to women who have mental health or substance misuse problems.
Information on how to apply for this funding was made available to maternity units in December 2013 and can be found at:
https://www.gov.uk/government/publications/improving-maternity-care-settings-applying-for-funds
The closing date for applications is 5 pm on Friday 10 January 2014.
It is important that the views and experiences of women and their families locally inform the development and design of birthing environments. The successful projects will have demonstrated involvement and support from service users and the ability to deliver the project in the current financial year.