NHS England

Dan Poulter Excerpts

Tuesday 10th December 2013 Ministerial Corrections

[Liz Kendall]

To ask the Secretary of State for Health what the (a) total budget, (b) total number of staff and (c) budget for staff salaries is for those employed by NHS England but not for NHS England local area teams.

[Official Report, 28 November 2013, Vol. 571, c. 415W.]

Letter of correction from Dan Poulter:

An error has been identified in the written answer given to the hon. Member for Leicester West (Liz Kendall) on 28 November 2013.

The full answer given was as follows:

[Dr Poulter]

NHS England's total revenue budget for 2013-14 is £95.873 million, of which £2.016 million is to be spent on administration. How all spending is allocated is a matter for NHS England. NHS England has informed us that the administration budget for NHS England, excluding area teams and commissioning support units (its National Support Centre), is £332.2 million.

As at the end of October 2013, NHS England had 886.15 whole time equivalent staff in post within its National Support Centre.

The total pay budget for the total agreed staff numbers within the National Support Centre (1,106.48 whole time equivalent) is £75.2 million. There are currently vacancies within this staff structure.

The correct answer should have been:

[Dr Poulter]

NHS England's total revenue budget for 2013-14 is £95.873 billion, of which £2.016 billion is to be spent on administration. How all spending is allocated is a matter for NHS England. NHS England has informed us that the administration budget for NHS England, excluding area teams and commissioning support units (its National Support Centre), is £332.2 million.

As at the end of October 2013, NHS England had 886.15 whole time equivalent staff in post within its National Support Centre.

The total pay budget for the total agreed staff numbers within the National Support Centre (1,106.48 whole time equivalent) is £75.2 million. There are currently vacancies within this staff structure.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 26th November 2013 Commons Chamber

[John Glen (Salisbury) (Con)]

9. What steps his Department is taking to improve the health of veterans.

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

We have made excellent progress in improving the health care of our veterans by investing £22 million to support their physical and mental health. The Government have also made available £35 million of the LIBOR bank fines to support veterans and armed forces projects.

[John Glen]

I thank the Minister for that response. Will he outline the steps being taken to ensure that there is a co-ordinated approach between those commissioning services for veterans, including Salisbury district hospital, which does so much to service the veterans in Wiltshire, so that that they get the right revenue at the right time and do not go into deficit?

[Dr Poulter]

My hon. Friend is right to highlight the importance of co-ordinating veterans services, and getting the continuity of care right between a soldier or a member of the armed forces leaving the armed forces and being looked after by the NHS. I hope he will be reassured to hear that in terms of specially commissioned services, we now have nine super-prosthetic centres available for veterans who have lost limbs, 10 specialist mental health teams looking after veterans, a 24-hour mental health support line for veterans and many other measures. We are also making IVF available to veterans who have lost genitalia as a result of combat injuries.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

Given that health is a devolved matter, is the Minister satisfied that the Administrations in Wales, Scotland and Northern Ireland are providing similarly sufficient services for our veterans?

[Dr Poulter]

Obviously, we work closely with the devolved Administrations on all such matters. We have UK armed forces, and with health being a devolved responsibility, it comes to each part of the United Kingdom to put in place the right support. On the whole, that is done very well, but I am particularly proud of the efforts the Government have made on veterans’ mental health and on specialist prosthetic centres, which can be commissioned by the devolved Administrations if they wish to make such facilities available.

[Penny Mordaunt (Portsmouth North) (Con)]

Many veterans are young men and women, and I know from my own constituency case work that a tremendous burden is often placed on elderly parents in caring for them, especially if they are suffering from post-traumatic stress disorder. Does the Minister agree that better integration between medical services in the armed forces and the NHS will benefit those families as well as the veterans themselves?

[Dr Poulter]

My hon. Friend speaks with considerable knowledge of the subject from her tradition and strong record of service. She will know that an important aspect of providing proper support for veterans is ensuring that we give their families the right support. We are working very closely with armed forces families and services charities to ensure that we do exactly that. That is why we have also put in place mental health first aid support for the families of servicemen and women to ensure that families know how to support veterans when they run into difficulties with post-traumatic stress disorder.

[Stephen Gilbert (St Austell and Newquay) (LD)]

10. What assessment he has made of the effectiveness of section 64 grants in supporting children’s hospices.

--- Later in debate ---

[Paul Burstow (Sutton and Cheam) (LD)]

14. What steps he has taken in response to the findings of the report by the Chief Medical Officer, “Our Children Deserve Better: Prevention Pays”, published in October 2013.

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

The chief medical officer’s report warmly welcomes the Government’s commitment to increasing health visitor numbers and support in the early years, and I shall be working with the children and young people’s outcomes forum to inform future improvements in children’s health.

[Paul Burstow]

My hon. Friend the Minister will know that about half the burden of mental health disease can first be identified during the teenage years. In her report, the CMO says that our information about the prevalence of childhood mental health problems and the level of under-diagnosis of mental health problems among that population is out of date. When will the Government commission the next survey? The last one was done in 2004. Is it not time to do another?

[Dr Poulter]

My right hon. Friend raises important issues. I should like to pay tribute to the work that he did in expanding children’s talking therapies and IAPT—improving access to psychological therapies—services to make better provision for mental health support. He is right to highlight, as the CMO did, the fact that we do not have enough data on children’s mental health. That has been a historical problem, and we are looking at ways to improve the data so that we can use them to improve health outcomes in mental as well as physical health.

[Dr Sarah Wollaston (Totnes) (Con)]

In Devon and Cornwall since the beginning of this year there have been three occasions when children as young as 12 and 13 with acute mental illness have been detained in police cells instead of an appropriate place of safety, and 25 occasions when children of 17 and under have been so detained. Will the Minister meet me to discuss how we can end this appalling situation and make sure that all children who are detained under section 136 are seen in an appropriate location?

[Dr Poulter]

My hon. Friend is right to highlight this problem, which is unacceptable. My hon. Friend the Minister of State is looking into it. A lot of anecdotal evidence is stacking up that this practice is happening. We do not find it acceptable, and I or my hon. Friend will be happy to meet her to discuss the matter further and ensure that it is stopped.

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

15. How many NHS walk-in centres have (a) closed and (b) restricted their opening hours since May 2010.

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

The information is no longer collected centrally. Since 2007, under the changes introduced by the previous Government, the local NHS has been responsible for walk-in-centres, and it is for local commissioners to decide on the availability of these services.

[Karl Turner]

Official NHS figures show that attendances at accident and emergency departments have increased more than three times faster under the Tory-led Government than under the Labour Government. Does the Minister regret allowing so many walk-in centres to close?

[Dr Poulter]

As I outlined, there are not any official figures, because the data are now held locally. Monitor carried out a survey of some trusts, but that is not a measure of all trusts. The hon. Gentleman wants to look at the reasons why there have been changes to walk-in centres. There was a reduction in central funding of over 90% under the previous Government. I believe that the right hon. Member for Leigh (Andy Burnham) was a Minister at the time; if the hon. Member for Kingston upon Hull East (Karl Turner) wants to look at the reasons for that, he should perhaps ask his right hon. Friend why he reduced central funding for walk-in centres by 90%.

[Henry Smith (Crawley) (Con)]

In 2005, under the Labour Government, Crawley hospital had its accident and emergency department closed. Now we have an urgent treatment centre that has increased its operating hours and the services that it provides. What advice can the Department give to clinical commissioners about how we can expand urgent treatment centres?

[Dr Poulter]

My hon. Friend is absolutely right to highlight that these are local decisions that need to be made by local commissioners, because what looks good in Crawley will be very different from the needs in Bradford. That was the very reason that underpinned the previous Government’s decision to transfer responsibility for these services to local commissioners, but we often need more co-located services, because the Monitor survey picked up the fact that in the past, far too often, walk-in centres were isolated in the community; people did not know how to access them, or when they could do so. Monitor also recognised that there was duplication of effort, and sometimes patients who needed to be seen in accident and emergency were treated, inappropriately, in walk-in centres.

[Mr Speaker]

I am deeply obliged to the Minister, but we must leave time for Mr Mowat.

--- Later in debate ---

[Neil Carmichael (Stroud) (Con)]

T4. In contrast to the previous Government’s lack of focus, what have this Government done about hospital infection control, with particular reference to data management systems?

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

My hon. Friend makes an important point, and I hope that he will be reassured that under the current Government, clostridium difficile and MRSA rates are both about 50% lower than they were under the previous Government. We will continue to make sure that we reduce unacceptable hospital infections.

[Rosie Cooper (West Lancashire) (Lab)]

T2. Following Francis and Keogh, and in creating a more open and accountable NHS, will the Secretary of State, in the spirit of total transparency that he favours, order foundation trusts to publish all their board papers, have exactly the same publishing requirements as non-FTs, and hold all their board meetings in public?

[Dr Julian Huppert (Cambridge) (LD)]

T6. Cambridgeshire and Peterborough clinical commissioning group receives one of the lowest amounts of funding per head in the country. The Government’s own fair shares formula, which takes account of factors such as population, age and deprivation, says that we should have £46.5 million more each year. I know that it is not his decision, but does the Minister think that the new formula should be implemented?

[Dr Poulter]

My hon. Friend makes some important points about the funding formula. He will know that for the first time this year, it will be set independently by NHS England, and I am sure that it will take on board the points that he has made. He will recognise, however, that there are many other determinants of the funding formula, such as deprivation, which it will want to look at and take into account.

[Caroline Lucas (Brighton, Pavilion) (Green)]

T5. The last time I asked the Secretary of State about the £30 million-worth of cuts forced on hospitals in Brighton and Sussex, he said that it was all down to local discretion. Does he admit that behind his rhetoric about protecting the NHS budget there still lies a real 4% cut to the centrally dictated national tariff? Does he acknowledge, therefore, that hard-working nurses and doctors have to do more with less money while patients suffer? Will he reverse those cuts?

--- Later in debate ---

[John Cryer (Leyton and Wanstead) (Lab)]

Further to question 15, I understand that responsibility for walk-in centres has been devolved. Why does that necessarily prevent central Government from collecting those figures centrally? It is pretty staggering that a Minister should turn up and say, “Well, the decisions are made locally so we just don’t bother finding out.”

[Dr Poulter]

That is a question that the hon. Gentleman had much better address to his own Front Bench, who made the decisions to devolve these responsibilities locally. When it comes to commissioning health services, we believe it is down to doctors and nurses, who are now leading clinical commissioning on the front line, to determine which services are appropriate in local areas. There were clearly concerns about the way that urgent care centres had previously been commissioned. That is why so many of them are now being relocated and co-located in accident and emergency departments.

[Mr John Baron (Basildon and Billericay) (Con)]

T8. The Secretary of State is well aware that the all-party group on cancer has campaigned long and hard for the monitoring of one and five-year survival rates as a means of promoting earlier diagnosis, cancer’s magic key. Is he confident, though, that the mechanisms are sufficient to ensure that those clinical commissioning groups that are underperforming in relation to their one and five-year survival rates will face concrete action to improve earlier diagnosis, given the recent OECD report suggesting that 10,000 lives a year could be saved in this country if we matched European average survival rates?

--- Later in debate ---

[Dr Poulter]

It was a great pleasure to open the walk-in centre in Morecambe, which was led by local commissioners to meet local clinical need.

[John Healey (Wentworth and Dearne) (Lab)]

The European Union has just agreed a trade deal with Canada that excludes health care, so will the Secretary of State ensure that the proposed EU trade and investment agreement with the US also excludes health care?

UK Strategy for Rare Diseases

Dan Poulter Excerpts

Friday 22nd November 2013 Written Statements

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

The “UK Strategy for Rare Diseases” has been published today.



This strategy is the overarching framework document that sets out a shared strategic vision for improving the lives of all those with rare diseases.

In the UK, one in 17 people—or more than 3 million individuals—will be affected by a rare disease at some point in their life. Rare diseases are a major cause of illness and make considerable demands on the resources of the NHS and other care services.

The document commits each UK country to over 50 actions that will be taken to deliver the vision outlined in the strategy. These actions focus on five main areas:

empowering those affected by rare diseases;

identifying and preventing rare diseases;

diagnosis and early intervention;

co-ordination of care; and

the role of research.

The UK is already at the forefront of research, treatment and care for rare diseases. This strategy will further embed and enhance this reputation to the benefit of patients and the economy.

The “UK Strategy for Rare Diseases” 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. It is also available at:

www.gov.uk/government/publications/rare-diseases-strategy.

Pharmacies and the NHS

Dan Poulter Excerpts

Wednesday 20th November 2013 Westminster Hall

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

We have had a wide-ranging debate today on issues such as the deregulation and regulation of pharmacies, the local provision of pharmaceutical services and the extension of the role of pharmacists and what they do in our communities. Importantly, we have also discussed pricing and behaviour that, if not fraudulent, is certainly very irregular on behalf of some pharmacists and drugs companies. I hope that I will have time to deal with all those issues, but I will write in more detail to any Member here today who feels that more points need to be answered.

Before I go any further, may I say that it is a pleasure, as always, to serve under your chairmanship, Dr McCrea? We took part in many sittings together when the Health and Social Care Act 2012 was considered in Committee, and it is always a pleasure to serve under your chairmanship. I congratulate my hon. Friend the Member for Ipswich (Ben Gummer), my constituency neighbour, on securing today’s debate. It is important to recognise that our NHS is not only about doctors and nurses, but about midwives, physiotherapists, occupational therapists, heath care assistants and all the other people who contribute to the health of the nation every day, including pharmacists, who play an increasingly important role in delivering high-quality local health care and who are embracing the enhanced role that they have been offered under the 2012 Act. It is right that we put on record our thanks for the work that pharmacists do every day.

The right hon. Member for Rother Valley (Mr Barron), in an excellent, considered speech, made some very good points. In particular, he said that community pharmacists are the face of our NHS in many communities. He is absolutely right in saying that because, particularly in more deprived areas of the country, pharmacists are often the first point of call for advice—whether on simple details about medications or for important primary health care advice. Pharmacists perform that role every day. We should be grateful to them for what they do, and I put on record my thanks for that work.

It is important to put on record that pharmacies are in robust health. Although we debate deregulation and difficulties, we know that there are more NHS community pharmacies than ever before—more than 11,400 in England—and they are offering health care, treatment and healthy lifestyle advice and support throughout the country. They dispensed more than 900 million prescription items last year, which is up 53% from 10 years ago, and about 2 million prescriptions are handed out every day by pharmacists. Therefore, we have an industry, as part of our NHS and in its commercial activities and other work, that is in robust health and is performing a valuable service for our NHS.

Of course, we could get into the issues that the right hon. Gentleman rightly raised on the appropriateness of prescribing medication. The chief medical officer talked in some detail in a report about the need for GPs to look sometimes at the appropriateness of the antibiotics that they prescribe and about how we need to look at antimicrobial resistance in this country. The right hon. Gentleman made his points very well, but I hope that he will forgive the fact that I shall not address them directly in today’s remarks. However, he was right to make them and the chief medical officer certainly agrees with him, as do I.

I shall deal with other points that have been made, but initially, I would like to address the important points made by my hon. Friend the Member for Ipswich. We rightly value the innovation and the opportunities that pharmacists have to innovate and support their local communities in different ways. Because they are centred in the community, only pharmacists are able to use such methods. I had the pleasure of attending the annual pharmacy awards and looking at some of those ways. I saw pharmacies, embedded in local communities, making a real difference in providing health and lifestyle advice and improving the quality of care available to local patients.

At the same time, although we want to encourage and support innovation—the pharmaceutical price regulation scheme, or the PPRS, was recently renegotiated and enhanced to give pharmacists the opportunity to innovate exactly as I have described—we also need to recognise that we have a publicly funded national health service, which is a point that has been made across the Chamber today, and we are very proud of it. It is free at the point of need, and it is important to ensure that the money that is given to the health service, whether to pharmacies or to other parts of the NHS, is properly spent, and there is also a role in ensuring that services are provided in a safe and effective way. I shall come on to some of those points later.

My hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) has been a consistently strong advocate for the role of pharmacists, and he made his points very well today. The hon. Member for Strangford (Jim Shannon) also made a useful and powerful contribution, which was picked up by the hon. Member for Copeland (Mr Reed) a few moments ago, about the importance of ensuring that there is no fraud in the system and that pharmacists always behave appropriately. I am sure that the majority of the time pharmacists behave appropriately and make a very valuable contribution. When there may be fraudulent behaviour, it is right to pick up on that and investigate it. I will come back to that in a moment, because we all want to see high value for money from our NHS and to make sure that the money is spent on patients and not wasted. I think that that is something that we all agree with and believe in across the House.

I turn to the important issue of pricing. The vast majority of drugs that are prescribed are either covered by the PPRS or are generics, where competition helps to keep the price down. We recently introduced a price for common specialists, but a small number of prescriptions, as has been mentioned in the debate, fall outside the pricing mechanisms that are in place. We are working with the Pharmaceutical Services Negotiating Committee to find a better mechanism to encourage pharmacists to seek lower prices.

Where there may be cases of fraud, it is right that we investigate them, and they are investigated. NHS Protect exists to safeguard—to protect—against fraud in the NHS. That has been a consistent policy; it was followed by the previous Government, and it has been followed by the current Government. The reason why we need services such as NHS Protect is to ensure that if there is fraudulent practice—in this case, potentially in the behaviour of a small number of pharmacists in dealing with small, unique areas of pricing—it is investigated properly. I will ensure that either I or Earl Howe, who is the Minister responsible, writes to the hon. Member for Copeland to inform him of where we have got to with the investigation.

The other point, which was made by the hon. Member for Strangford and is very important, is that we want to ensure that money goes on patients. There is increasing demand for drugs. It is very good that the NHS is continually innovating and developing more treatments, better surgical techniques and improved drugs and mechanisms. Of course, when drugs are used in the NHS, they need to be evidence-based, but I hope that he will agree that it is good that we have set up the cancer drugs fund, which has helped to increase the speed at which people with cancer receive drugs. More than 30,000 people have benefited from the cancer drugs fund and received cancer drugs. We should all be pleased about that and proud of it.

[Jim Shannon]

I thank the Minister for that positive response. I outlined in my contribution a couple of examples of people who did not access the cancer drugs fund, but in my mind clearly should have qualified. Is he prepared to look at that issue to satisfy those people who need drugs urgently because of the time they have left on this earth?

[Dr Poulter]

On how drugs are accessed, one of the problems—this was why the cancer drugs fund was set up—was that some people, as the hon. Gentleman rightly outlined, had been receiving drugs in other countries for many years, but we in this country were a little slower to respond to some of those innovations. But of course we need to ensure that, whatever fund we set up for providing medications, those medications are shown to be effective and there is an evidence base for them. However we do things, there will always be new treatments on the horizon that we would like to get through to people more quickly, and we need to ensure that those treatments are always evidence-based. I think that we can be pleased that the cancer drugs fund has made a significant difference by providing treatments in a more effective and much quicker manner, but if the hon. Gentleman would like to discus the matter further, I would be very happy to see him and talk it through in more detail.

I think that it would be useful for me, picking up on the points raised early in the debate, to outline the processes involved in opening a pharmacy. Anyone can open a pharmacy anywhere, subject to the premises being registered with the General Pharmaceutical Council, when the owner’s service model includes the sale or supply of pharmacy medicines or prescription-only medicines against prescriptions from that pharmacy. However, there are extra criteria for providing NHS pharmaceutical services. Anyone wanting to provide NHS pharmaceutical services is required to apply to the NHS to be included on a pharmaceutical list.

Before September 2012, there were control of entry requirements. The NHS (Pharmaceutical Services) Regulations 2005 determined whether a pharmaceutical contractor could provide NHS pharmaceutical services. In England, no new contractor could be entered on to a PCT pharmaceutical list unless it was “necessary or expedient” to secure the adequate provision of pharmaceutical services locally. That was the control of entry test. If a new service provider was judged neither necessary nor expedient, the NHS, or the PCT in question, had to refuse the application. There were rights of appeal to the family health services appeal unit, which is run by the NHS Litigation Authority. That was available if there was a concern.

Part of the reason for the strict criteria relates to the pricing mechanism and how pharmacists are paid, which I will come to later. Obviously, the local health economy is an issue, and pharmacists are not paid just for the number of prescriptions that they provide; they are also given a baseline fee. When we have a publicly funded health service and we need to ensure that need and demand are aligned, it is important that we look at this in the round. I sympathise very strongly with the points about the need to de-bureaucratise the NHS where possible—those were good points well made—but we also have to recognise that this is not just about arbitrary mapping; it is about aligning need and demand for a service within the pricing framework in place. That is not just about the number of prescriptions that are provided; it is a much more complex mechanism. I will come to those points later.

[Mr Jamie Reed]

I am grateful to the Minister for giving way; he is being typically generous. On pharmacy numbers, does he think that we have too few or too many, or is the number about right?

[Dr Poulter]

The hon. Gentleman will be aware that under the previous Government, the Office of Fair Trading did a review and recommended total deregulation of the pharmacy industry. That was in 2003. The previous Government put in place a strong package of reforms to recognise that we need some degree of what my hon. Friend the Member for Ipswich would call market forces but I would probably refer to more as patient choice. We need to support patient choice as much as we can, but within the context in which we have a publicly funded service that needs to be regulated. It is a health care service; it is treating and looking after patients. We need not only to secure good value for the taxpayer, as part of how we fund that service, but to ensure that there is independent regulation and some regulation by Government as well. That is about ensuring that we have the highest-quality services available.

Given that I am running short of time, I will write to my hon. Friend or I would be happy to meet him—whichever he prefers—to talk through the specifics of the context of mapping out a local needs assessment, which is now carried out by health and wellbeing boards. That is a pharmaceutical needs assessment. I am happy to talk through with him in detail how that interrelates with the pricing mechanism and how we need to ensure that the two are kept in balance in the context of the conversation that the hon. Member for Copeland and I have just had.

It is worth highlighting the fact that pharmacists and pharmacies play an increasingly important role in our NHS. Many pharmacies now provide additional services. They are contracted to do so outside those pricing frameworks. That is done locally by clinical commissioning groups. Health and wellbeing boards or local authorities can also contract pharmacists to provide services. As my hon. Friend will be aware, responsibility for public health—40% of that budget—has now passed to local authorities. Given that public health responsibility, there is a strong role for local authorities in commissioning local health care services if they feel that that would be in the interests of the local population.

Under the Health and Social Care Act 2012, other providers of health care services, outside the traditional framework of GP and community services and secondary care, were given more of an opportunity to put themselves forward and offer to provide valuable services. This is a real opportunity for pharmacists to bring forward to CCGs what they do and to make the case that they can provide many services in a way that will be focused on primary prevention and that will save the local health economy money but also deliver better care. The track record of pharmacies and pharmacists is very good in delivering community care—whether looking after people with diabetes or providing simple services for other patient groups. Under the 2012 Act, there is now a much greater opportunity for pharmacists to come forward and put in offers, within an integrated health service, and make the case about how they can provide services. They may be able to do that in a much better way, as they are often embedded in their communities, than some of the traditional mechanisms in the NHS.

I hope that my hon. Friend will be reassured by the fact that the legislation that we have put in place as a Government has given pharmacists a much greater opportunity to contribute to their local health economy, not just in economic terms and in terms of the economic benefits that that will bring for pharmacists, but by delivering the very good care that we know they can deliver.

We have had a wide-ranging debate. I think that we can be sure that there is in place a robust pricing mechanism, which on the whole works very well and secures good value for the taxpayer and for local patients, but there are issues about certain items that pharmacists can prescribe, and we do need to look into them. There is a role for NHS Protect in doing that. We value the innovation that pharmacists provide locally in delivering better—higher-quality—patient-centred care, and the 2012 Act has put us in a better place to support local pharmacists in delivering the kind of patient care that we all want to see in our local communities.

[Dr William McCrea (in the Chair)]

I thank Members for the courteous manner in which they conducted the debate.

Group B Streptococcus (Newborn Babies)

Dan Poulter Excerpts

Thursday 7th November 2013 Commons Chamber

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

I congratulate my hon. Friend the Member for Mid Bedfordshire (Nadine Dorries) on securing this debate and raising this very important issue. The death of a baby is devastating for parents and their families. It is important that we do all we can to minimise the risk of such deaths. My hon. Friend has presented a strong case, but, as I shall set out later, it is equally important that we are guided in our decisions by professional, evidence-based advice to ensure that any action taken does not lead to potentially greater adverse outcomes or unintended consequences.

Group B streptococcus is one of many bacteria that can be present in the human body. It is estimated that about one pregnant woman in five in the UK carries GBS. Around the time of labour and birth, many babies come into contact with GBS and are colonised by the bacteria. Most are unaffected, but a small number can become infected.

If a baby develops group B strep less than seven days after birth, it is known as early-onset group B strep. Most babies who become infected develop symptoms within 12 hours of birth, and it is estimated that about one in 2,000 babies born in the UK develop early-onset group B strep, or about 404 babies a year—my hon. Friend made these points earlier. Most babies who become infected can be treated successfully and will make a full recovery, but even with the best medical care, one in 10 babies diagnosed with early-onset group B strep will unfortunately die.

The infection can also cause life-threatening complications, such as septicaemia, pneumonia and meningitis. One in five babies who survive the infection will be affected permanently. Early-onset group B strep can cause problems such as cerebral palsy, deafness, blindness and serious learning difficulties, and rarely can cause infection in the mother—for example, an infection in the womb or urinary tract, or more seriously an infection that spreads through the blood, causing symptoms to develop throughout the whole body.

It is worth reflecting on how the UK compares internationally on rates of group B strep. The reported rate per 1,000 births is 0.38 in the UK; in the USA, where there is testing, it is 0.41; in Spain, 0.39; in France, 0.75; in Portugal, 0.44; and in Norway, 0.46. Even in comparison with countries where there is routine group B strep screening at 35 to 37 weeks, therefore, the UK has relatively low levels of group B strep.

It is also worth setting out some of the general improvements in maternity care that are helping to reduce group B strep and improve the quality of care available to women. We all agree that women should receive high-quality and safe maternity services that deliver the best outcomes for them and their baby. Maternity services feature prominently in the key objectives set out in the first mandate between the Government and NHS England. As set out in the mandate, we want all women to have a named midwife responsible for ensuring she has personalised, one-to-one care. To help deliver that, there has been significant investment in the maternity work force. Since May 2010, the number of full-time equivalent midwives has increased by 6.5%—just under 1,500—and in addition there are currently in excess of 5,000 midwifery students in training. There has, therefore, been considerable investment in maternity services to ensure much more personalised care and, consequently, much safer care for women and their babies.

[Nadine Dorries]

For the reasons I highlighted, we know that the risk-based strategy is not working effectively. Does the Minister not agree that in countries that have routine testing the chances are greatly improved? He drew comparisons with the US, France and other countries, but we do not know what their figures would be if they were using our risk-based strategy. The fact is that they are routinely testing, so does he not agree that only if we were also routinely testing could we make a like-for-like comparison with other countries? Also, why specifically does the UK, a sophisticated country with sophisticated maternity services, not routinely test?

[Dr Poulter]

I will come to those points a little later, but I will try to reassure my hon. Friend. Given that the majority of babies who die from group B strep are born prematurely, testing at 35 to 37 weeks would not benefit them. Tragically, they would have died in any case, so the screening test to prevent them from dying would not have been effective. I will say a little more about that later, if she will allow me to make some progress.

I pay tribute to my hon. Friend for raising this issue, because the first challenge is to raise general awareness of group B strep among the health care work force and women more generally. The Department of Health is working with the NHS, the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the National Institute for Health Research health technology assessment team and the pharmaceutical industry to raise awareness of group B strep and reduce the impact of this terrible infection. The Royal College of Obstetricians and Gynaecologists has produced an information leaflet for women who are expecting a baby or planning to become pregnant, and this sets out information about group B strep infection in babies in the first week after birth and the current UK recommendations for preventing group B strep in newborn babies. In addition, information is also available on the NHS Choices website.

As hon. Friends will agree, the focus must be on preventing early-onset group B strep infection from occurring in the first place. The Royal College of Obstetricians and Gynaecologists published updated guidelines on prevention of early-onset group B strep infection in neonates in July 2012, which takes into account the latest evidence. It is important that services undertake local clinical audits to ensure the effective use of intrapartum antibiotic prophylaxis as recommended by the guidance. Following the publication of the revised guidance, the UK national screening committee suggested a formal audit of practice to establish how well the new guidance is being implemented at a national level.

The RCOG, in partnership, with the London School of Hygiene and Tropical Medicine, has now appointed a clinical research fellow to carry out a one-year audit across the UK, which will undertake a review to see how units have revised and updated their local protocols since 2006, using well-designed case studies to gather specific information about maternity unit policies by asking clinicians whether they would screen for group B strep and/or other intrapartum antibiotic prophylaxis in the circumstances described. It will also assess the extent to which current maternity information systems are able to provide data on whether women have had an antenatal culture for group B strep, whether women have been given intrapartum antibiotics and, if so, the antibiotics prescribed, the dose and duration and whether the women had particular risk factors such as intrapartum fever. The audit aims to provide feedback and advice to all participating trusts about how they could further improve their adherence to the RCOG guidelines on the prevention of neonatal group B strep disease.

Clinical audit is a tool that is incredibly valuable in improving the quality of patient care. It is something that trusts do very often on an ad hoc basis. The fact that we now have a national audit focused on group B strep disease will help to standardise practice across all maternity settings and improve the quality of care that is available, so that we can look at which women are more vulnerable and susceptible to developing group B strep and, therefore, reduce infection rates.

[Nadine Dorries]

That is encouraging news but again the focus is on women who are at risk of group B strep. I am advocating that all women should be tested for group B strep. I recommend that every pregnant woman I meet now buys a kit to test for group B strep. It is encouraging and positive to hear what my hon. Friend the Minister is saying but it is still focusing on the at-risk women, which is what the risk strategy does now. We need to move from that and away from the at-risk women. We need to move from 35 to 37 weeks and forward to full-term and routine testing of all women for group B strep.

[Dr Poulter]

I am hopeful that the audit by the RCOG nationally—something I discussed with the group B strep groups and the chief medical officer at a meeting this time last year to progress the work at a greater pace—will put us in a better position to understand in particular which women are at high risk, whether birth units are picking up on those women in a timely manner and how we can improve the situation throughout the country. In the past there has been quite a lot of variation in practice, broadly based on the RCOG guidelines, but it is important—knowing the devastating effects of this illness—that we put together a comprehensive audit tool that gathers data at a national level so we can spread good practice and good guidance throughout. If my hon. Friend will be patient I hope to address some of the broader issues about screening later.

[Andrew Selous]

Earlier, my hon. Friend said that some countries that screen have higher rates of group B strep than we do. Does he have any data—he could perhaps write to my hon. Friend the Member for Mid Bedfordshire (Nadine Dorries) and myself—to show what the progression has been since testing was introduced in those countries? I think my hon. Friend the Member for Mid Bedfordshire said that it was falling in Spain but it would be interesting to see how it is moving following the introduction of widespread testing.

--- Later in debate ---

[Dr Poulter]

I would be delighted to do so. It is important to consider the confounding factors that arise in any research. For example, there is some evidence of different rates of carriage of group B strep among different population groups. Also, the clinical treatment of the disease in hospitals—which is separate from the screening process—can vary from country to country. We have to set the data alongside other practices that take place at local level in order to interpret them in the right way. I would be delighted to write to my hon. Friends, and to any other hon. Members who are interested, with that broader general information.

I shall turn now to the question of routine screening for group B strep. The UK national screening committee advises Ministers and the national health service in all four countries on all aspects of screening policy, and supports implementation. At its meeting on 13 November 2012, the screening committee recommended that antenatal screening for group B strep carriage at 35 to 37 weeks should not be offered, as my hon. Friend the Member for Mid Bedfordshire has pointed out. That is the reason for the debate. The reasons given included the fact that the currently available screening tests cannot distinguish between women whose babies would be affected and those that would not. As a result, about 140,000 low-risk pregnant women would be offered antibiotics in labour following a positive screening test result. The overwhelming majority of those women would have a healthy baby without screening and treatment. In other words, a woman who had screened positive for group B strep at one point in her pregnancy might not necessarily be carrying it at the time of delivery, and up to 140,000 women a year could be given antibiotics during labour even though they did not need them.

On the back of the evidence, concern was also expressed, understandably, about resistance to some of the antibiotics used to prevent early-onset group B strep, about the long-term effects on the newborn and about the potential for anaphylactic reactions in labour. Many of us will recall the report of the chief medical officer for England, in which she expressed particular concern about the risks posed by antibiotic resistance because of overuse. The use of antibiotics on that size of population could create a risk of resistance developing, which would have adverse consequences.

[Nadine Dorries]

I am interested in what the Minister has just said. As I mentioned in my speech, we are talking about a penicillin, a narrow-spectrum antibiotic. I know the Minister’s background, and he will know that GPs would prescribe it for a throat infection. This is a widely and commonly used antibiotic. Does he not think that these expressions of concern are over-egging the pudding slightly?

[Dr Poulter]

In the report that the chief medical officer published earlier this year, she made the point graphically that the overuse of antibiotics among people who do not need them can lead to resistance developing in bacteria. We know from hospital super-bugs such as MRSA and VRSA that many other resistant strains of bacteria are developing. Part of the challenge is to see responsible prescribing adopted more broadly across the NHS, to ensure that antibiotics are being targeted at the people who will benefit directly from them. The chief medical officer’s concern is that the screening that my hon. Friend is proposing could lead to many tens of thousands of women being given antibiotics inappropriately at the time of delivery, because they were not carrying group B strep at the time, and that that could result in resistance developing. We already know about the devastating consequences of group B strep infection, and the development of further resistant strains could be an unintended consequence of such screening that none of us would want to see. We need to be mindful of that possibility, as I believe the national screening committee was when it made its recommendations.

The majority of babies who die from early-onset group B strep are premature and are, sadly, born too early to be helped by screening at 35 to 37 weeks. Data from 2001 show that, in that year, there were 39 deaths due to group B strep, of which 25 occurred prematurely—that is, before the 35th week of pregnancy, when any screening would have been carried out. Those deaths would therefore not have been prevented by a screening programme.

It has been estimated that up to 49,000 women carrying GBS at 35 to 37 weeks of pregnancy may no longer be carriers when receiving treatment during labour. Studies of the test suggest that between 13% and 40% of screen-positive women will no longer be carriers at the point of delivery. There is also a potentially detrimental impact on maternity services, increasing the medicalisation of labour, with the increase in hospital births and increases in the birth rate that we are seeing. We know that once there is one intervention in labour, it can lead to other interventions and a high rate of Caesarian section when it might not have been necessary in the first place. I am not saying that that would always be the case and absolutely not with GBS—far from it—but we know that when a woman enters a medicalised pathway in a maternity unit, it can often lead to interventions that might otherwise have been unnecessary and that are sometimes quite distressing for the woman during labour. This is particularly the case when many of the women potentially put on prophylaxis would no longer be carriers of GBS.

The advice from the UK national screening committee is consistent with that of the Royal College of Obstetricians and Gynaecologists and the National Institute for Health and Care Excellence. I believe we have talked through a number of the issues about why that recommendation was made.

In the brief time remaining, it would be worth mentioning some of the research that is going on. It is estimated that a vaccine for GBS is approximately five years away from development. First-stage trials have now been undertaken, and wider population-based studies for safety and efficacy are in place in high-prevalence areas such as South Africa. I am sure we would all agree that a vaccine would be a very effective solution to GBS, and I shall certainly do all I can to push and nudge to make sure that such a vaccine is brought forward in as safe and appropriate and as timely a manner as possible.

[Nadine Dorries]

Is the Minister informing us that that vaccine would be widely available? Let me ask him once more—after everything he has said today, for which I am incredibly grateful—why does he think countries like Spain, the United States and others have introduced routine testing when we still seem to be opposed to it?

--- Later in debate ---

[Dr Poulter]

It is sometimes difficult to explain variations in clinical practice and the care of women during maternity services between different states or within regions of countries like Spain and to understand why they are different from what we have in this country. Here we have robust guidelines in place for trying to identify at-risk women and we are trying to tighten them through audit while we have low rates. I am not sure whether the same can always be said elsewhere in the world. That is why other countries might have wanted to introduce a cruder tool through a screening test to help them reduce their rates. As I have said, I will look further into this matter and write to my hon. Friends in order better to inform them.

Research and clinical audit are important. We want to make sure that we have a proper national audit programme to carry out and develop good and better practice guidelines for GBS. Looking forward to a vaccine, we hope that that will be a long-term answer to this devastating disease, not just for the UK but throughout the world. Prioritising other research studies is also important. At the moment, a study is being carried out by the maternal health and care policy research unit. It is looking at women with GBS sepsis, which will help us understand the physical impact that GBS has on women’s health. A second study looks at providing information at a national level on the numbers of women and babies affected by anaphylaxis due to antibiotic use in labour for GBS or presumed GBS infection. As I mentioned, one concern about a blanket prophylaxis would be the potential anaphylactic reaction that we know can occur when someone is allergic to penicillin or other antibiotics.

I thank my hon. Friend the Member for Mid Bedfordshire once again for raising this important issue. I hope I have been able to clarify some of the reasoning behind the national screening committee’s decisions. I will write to and engage further with my hon. Friend and others to reassure them again that the Government take this issue very seriously. Together, I know we will get to a better place so that fewer families are affected by this tragic illness.

Question put and agreed to.

NHS Funding (North-East and Teesside)

Dan Poulter Excerpts

Tuesday 5th November 2013 Westminster Hall

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

It is a pleasure to serve with you in the Chair, Mrs Riordan.

A lot of political smoke has been blown across the Chamber today by the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop). I have a lot of time for him personally, and he came to see me earlier in the year to express some legitimate concerns about the performance of his local trust. On the basis of our meetings, I hope to reassure him that there has been considerable progress locally in his area.

More broadly, it is worth setting the record straight on some of the points made today. We have had discussion about the ambulance service, which I will come to, and we have talked about winter pressures, which I will address. First, however, on the funding formula, my hon. Friend the Member for Stockton South (James Wharton) was right to point out that it is set independently of the Government. Before we handed independent formula setting to NHS England, the Government made it clear that deprivation is a factor and it is taken into account in the current arrangements. There is a 10% weighting for deprivation in the funding formula, which as a Government we ensured was preserved in the formula. Under the new arrangements, there is more political independence in setting the funding formula.

[Grahame M. Morris]

Will the Minister give way?

[Dr Poulter]

Not at the moment. The independent Advisory Committee on Resource Allocation, or ACRA, as hon. Members have mentioned in the debate, historically has advised that the funding formula should be readjusted to take into account demographics and the increased health care needs of older populations in other parts of the country. The Government, however, in the past chose to maintain support for deprivation as a factor in health care funding, but the decision is now not one for the Government. It is now for NHS England to listen to the independent advice, but I would find it strange were there a sudden change in the funding formula that did not factor in deprivation, as done in the past.

It is important to set the record straight. The decision is not political; in the past, the Government preserved a weighting for deprivation, but now the decision will be taken separately by NHS England. Its decision will be made on the basis of clinical need, although of course deprivation will be a factor.

[Mr Nicholas Brown]

I asked the Minister’s predecessor for a clear assurance that he would not downgrade the importance of economic deprivation in his resource allocation formula. The Minister’s predecessor, once he had consulted the Secretary of State at Health questions, then said:

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

It is impossible to misunderstand what was being said. What weight can we put on that now?

[Dr Poulter]

My predecessor was in place when setting the resource allocation was in the Government’s gift. As the then Minister made it clear, a weighting in the formula for deprivation would be preserved—he stood by his word and that weighting was preserved. NHS England, not the Government, now sets the funding formula—to avoid political interference—and those in NHS England, in conversation, have made it clear that they also value a weighting apportioned to deprivation.

[Grahame M. Morris]

Will the Minister give way?

[Dr Poulter]

No, I will not give way. I have said things clearly for the record, without any political smoke.

As a Government, when we had control of the funding formula, we clearly put in a weighting for deprivation and for some of the poorest communities. I am proud that we did so, but it is now for an independent body to look at the case and at the independent advice that it has been given. I would find it extraordinary, however, if it were not to factor deprivation into its decision making, although there are other factors that it will want to put into the equation, such as the fact that older people are the greatest users of health care, so places with lots of older people also need to be recognised. A number of factors will be taken into consideration, and deprivation will be one of them. I have been reassuring about that, and I will not allow the Labour party or any hon. Member to make mischief with something that the Government have stood by.

[Ian Lavery]

Will the Minister give way?

[Dr Poulter]

No, I will not give way any more. I have clarified the point considerably, and the hon. Gentleman would do well to listen. I will not allow the Labour party to make political mischief, when my party has made it clear that we value the deprivation weighting. In fact, if we look at the public health allocations to every local authority, they have been generous. As I hope to reassure hon. Members, we can see that the health care funding allocations to the north-east have also increased under this Government, so the assertion that funding to the north-east is being reduced is clearly not the case.

The Government have increased the NHS budget, which the shadow Secretary of State described as “irresponsible”. At the same time, the Labour-led Welsh Assembly Government have cut the budget by more than 8%; in England, however, we have ensured that we have increased the health care budget in real terms. In the north-east specifically, CCGs have received an above-real-terms increase in funding for 2013-14 of 2.3%, compared with the primary care trusts’ funding for the equivalent set of services last year. Opposition Members should be pleased about increases in funding for the north-east, because if the Opposition spokesman were Secretary of State at the moment, he would have considered that irresponsible.

[Ian Lavery]

If the proposals in the consultation document had been implemented this year, can the Minister confirm that the north-east would have lost out to the tune of a little more than £228 million?

[Dr Poulter]

The hon. Gentleman is right in saying that had the Government followed the advice of the Advisory Committee on Resource Allocation in the past, we would potentially have cut the budget for the north-east. I can reassure him that we maintained the resource allocation budget, and the north-east has received an increase in real terms. Those are the facts. He may want to create political smoke, but there is none. We preserved and increased funding to the north-east for patients in Opposition Members’ constituencies and in those of my hon. Friends.

[Mr Nicholas Brown]

Will the Minister give way?

[Dr Poulter]

I will not give way again.

The hon. Member for Middlesbrough South and East Cleveland is being very disingenuous in the points that he is making, and I have put the record straight: health care funding has increased under the present Government. If I give way again, perhaps he will explain why the shadow Secretary of State said it would be irresponsible to increase the health care budget in real terms. We all think that would be irresponsible in the current environment.

I turn to local services in the hon. Gentleman’s constituency. When we discussed the matter earlier this year, he raised specific concerns about Guisborough, East Cleveland and Redcar hospitals. He did not put on the record the fact that matters have improved considerably since that meeting with me and local commissioners. Guisborough urgent care centre is open from 9 to 5 on Mondays to Fridays and from 8 to 8 at weekends. East Cleveland urgent care centre is open from 9 to 5 on Mondays to Fridays and from 8 to 8 at weekends, and Redcar urgent care centre is open 24/7. There are currently no vacancies for clinical staff that affect opening hours, which have been aligned to match service and patient need. The centres will continue to evaluate the situation.

It is worth highlighting that three additional nurses were recruited to support the urgent care centres in June 2013, and they are now at full complement, apart from one vacant clinical lead post to which the trust is continuing to try to recruit. It is looking at better ways to manage staffing. In response to concerns raised by the hon. Gentleman, there are now fully functioning urgent care centres. There is a 24/7 service in Redcar and additional staff working at those centres. That is good progress and it is disingenuous of him to suggest otherwise.

[Tom Blenkinsop]

rose—

[Dr Poulter]

I hope that when I give way, the hon. Gentleman will put on the record the fact that considerable progress has been made by local commissioners for the benefit of local patients.

[Tom Blenkinsop]

I thank the Minister for giving way during a response to a speech I made in February, although I deliberately did not mention those points because they were not part of what I wanted to talk about today. The Minister says that South Tees NHS trust is successful, so why is it under investigation by Monitor?

[Dr Poulter]

The hon. Gentleman has raised issues of health care funding, and I am making the point that there has been considerable investment in local health care services, the very services that he said earlier this year had received no investment. He is also raising urgent care services and other services at his local hospital trust. I am reassuring him that considerable investment has been made locally, and it is worth highlighting the fact that further investment has been made. He is incredibly disingenuous to stand here and run down his local health service when considerable steps have been made to improve patient care services. For his benefit, I will outline a few more improvements that have been made, so that they are firmly on the record.

[Tom Blenkinsop]

Will the Minister give way?

[Dr Poulter]

I will not give way because the hon. Gentleman should listen to the answers to some of his questions and realise that his local health care services are improving thanks to the Government’s increased investment in the health service—[Interruption.] Hon. Members have been incredibly political in everything they have said today, and I am putting answers on the record. If the hon. Gentleman does not want to hear them, he should not have raised the debate.

The latest data for 27 October 2013 show that South Tees Hospitals NHS Foundation Trust’s performance against the 95% standard for A and E waits is 96.8%. Over the last 23 weeks, it has met the national 95% target for A and E four-hour waits. The local trust is performing very well in treating patients in a timely way when they arrive at A and E. That is contrary to the points that the hon. Gentleman was trying to make.

At James Cook university hospital, the acute admissions unit is adjacent to the A and E department, so enabling the trust better to manage the flow of patients and to ease pressure on A and E. The trust has recruited two additional consultants and six additional junior doctors to the acute medicine departments, so easing pressure on the A and E department. Considerable investment is being made, and additional nursing staff have been recruited to support 50 more acute hospital beds that will be in place this winter. The hon. Gentleman must be aware that there is a lot of investment locally, with more beds, more staff and better care. It is a pity that he could not acknowledge that in his speech. I am putting it on the record, so that his constituents are aware of it.

[Grahame M. Morris]

The Secretary of State announced an additional £250 million to relieve pressure on A and E, but none of it was allocated to any of the hospitals in the constituencies of my right hon. and hon. Friends here.

On the incidence of ill health in deprived areas, half of the people presenting to hospitals suffering from hepatitis C, which is completely treatable and curable, come from the poorest 20% and three quarters come from the poorest 40%. Is it not right that additional resources are provided to those poorest areas to tackle such diseases?

[Dr Poulter]

The hon. Gentleman is absolutely right, and that is why the Government have given local authorities the power to deal with sexual health services. He will be aware that a major cause of hepatitis C—for the record, it is not curable—

[Grahame M. Morris]

It is treatable.

[Dr Poulter]

Indeed, but it is not curable as the hon. Gentleman stated. He should get his facts right before making statements in the Chamber. It is not curable, but it is treatable and the best treatment is prevention, which is why we have given a considerable amount of money to local authorities to take on the public health responsibility and to ensure that local authorities are in the right place to look at primary prevention of transmissible sexual diseases. He will be aware that hepatitis C is sometimes transmitted via the sexual route. The Government have put us in a better place to deal with sexual health issues and to tackle them in future.

There has been talk about ambulances, and it is worth highlighting that the most recent data, for September 2013, show that the North East Ambulance Service NHS Foundation Trust is meeting the category A8 red 1 measure 80.6% of the time and the A8 red 2 measure 80.8% of the time against an operational standard of 75%. The ambulance service is doing marvellously well in the north-east. It is meeting category B19 with a performance of 97.7% against an operational standard of 95%. That is a good performance in the north-east by anyone’s standard. The ambulance service is performing very well. Other ambulance services that may receive more generous funding are struggling, sometimes due to mismanagement, particularly in my part of the country in eastern England.

It is very difficult for the hon. Member for Middlesbrough South and East Cleveland to make any case for lack of funding or other problems with his ambulance service when health care funding for the north-east is going up under this Government and the ambulance service is performing well according to national performance indicators. Those are the facts, and if he did not want them on the record, he should not have raised the debate.

It is more in sorrow than anger that I make those points. When the hon. Gentleman and I had a constructive meeting earlier this year to discuss local health care services, there was not the political smoke or the chorus backing him that there has been in this debate. Genuine issues were raised about his local health care service, and he and I, with local commissioners, worked to put improvements in place. As a result of that meeting, there are more staff, more winter beds and more investment in his local trust. The local community hospitals that he was so concerned about are in a much better place.

I am sure the hon. Gentleman will come back to me if further issues arise, but his part of the country is much better placed than many others to deal with the pressures of winter. He should be proud of that, and I hope he will take the opportunity after this debate to champion his local NHS and the good work at local level by front-line staff who are delivering improvements. I hope he will take that opportunity and that we will not have to come back here and listen to him running down his local health services.

Patient Diagnostic Services

Dan Poulter Excerpts

Monday 4th November 2013 Commons Chamber

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

It is a great pleasure to be speaking in the Chamber under your chairmanship for the first time, Madam Deputy Speaker. I congratulate you on your success in being appointed.

I congratulate the hon. Member for Brent North (Barry Gardiner) on securing this debate. Before I correct some of the assertions he has made, I want to highlight the fact that the diagnostic services in England, and especially in Brent, are in rather robust health under this Government. Average waiting times for a diagnostic test remain low and stable, despite the NHS carrying out over 2 million more key tests a year since May 2010. The percentage of patients waiting six weeks or more at the end of June and July 2013 was 0.9% of the total number of waits. We can therefore see that the number of diagnostic tests is increasing, the availability of diagnostic services to patients has improved under this Government, and very few patients are waiting in excess of six weeks for the services provided.

Latest provisional data from the diagnostic imaging dataset show that almost 32 million imaging tests were reported in England in the 12 months from June 2012 to May 2013. Diagnostics have a key part to play in reducing premature mortality, particularly as NHS England estimates that over 1 billion diagnostics tests are carried out within the NHS every year. Access to safe and high-quality diagnostic services, such as endoscopy, genetics, and imaging, is critical to all clinical pathways. They underpin over 80% of clinical decisions and they contribute to the holistic care of patients, not just single episodes of care.

It is worth reminding the hon. Gentleman that the previous Government introduced, and championed the role of, the private sector. I believe we are all Blairites in this Chamber, in that we all believe in respect of publicly funded care that where the provider—be it the NHS, a private provider or a local charity or voluntary sector organisation—gives high-quality patient care, that has to be a good thing because it improves the quality of care. It is also important to highlight that the previous Government introduced private sector providers into the NHS to reduce waiting times for operations, which were unacceptably high at that time. I think we would all agree that it was a good thing that waiting times were reduced so patients no longer had to wait unacceptably long times for treatment they so desperately needed.

The first independent sector treatment centres were opened in October 2003, under the previous Government, and they gave £250 million to private providers of independent sector treatments. To their shame, they paid the independent sector on average 11% more than the NHS price for the same treatment.

Our intention in the reforms we introduced was to look at the mistakes the previous Government made in commissioning private sector services, to make sure there was a level playing field. There is no competition on price, as the hon. Gentleman asserted; there is only competition on quality in NHS services. It is important that any provider of NHS services and care to patients does so in an integrated way that delivers joined-up and integrated care based primarily in the community. Providing early diagnosis and early treatment and improving diagnostic services is a key part of that.

The big challenge that faces the whole of the NHS and the health and care sector is the fact that many people are living longer, and often with multiple medical conditions like diabetes, dementia and heart disease. The challenge is to make sure that we treat them with dignity and respect. We must also make sure that when we can diagnose a problem or illness early, we do so. That is why we are very proud to have increased the amount of early diagnosis and the number of diagnostic tests available in our NHS. The remaining challenge is to make sure we continue improving early diagnosis in Brent, London and throughout the country.

We know that when disease is diagnosed early, patients have a better chance of a good outcome. One-year survival for kidney and bladder cancers is as high as between 92% and 97%. At a late stage, however, it drops to between just 25% and 34%. The clinical case for early diagnosis and the investment we are making in diagnostic services is very clear, therefore.

Of course, apart from the clinical benefits of early diagnosis, there are other benefits. When people are ill, they want to know as soon as possible what might, or might not, be the cause of their illness. Having to wait a long time for diagnostic tests can be hugely stressful for patients.

Let me deal with the issues the hon. Gentleman raised about the commissioning of services. Since the beginning of April 2013, clinical commissioning groups have been responsible for commissioning many health care services to meet the requirements of their population. In doing so, CCGs need to ensure that diagnostic services are considered fit for purpose and reflect the needs of the local people as part of their process for commissioning clinical pathways. Local clinicians are best placed to understand the needs of their local population and commission the diagnostic services they need.

Local clinicians are commissioning in a way that is increasingly effective in diagnostics and elsewhere, so more choice in diagnostic services is essential. Many patients who require diagnosis—perhaps an ultrasound scan—will be working, and traditionally some of the NHS diagnostic models have not embraced seven-day working. We know that it is much easier for working people to access NHS services in the evening or at weekends. Therefore, bringing providers that supply greater choice for patients into the NHS makes it much more likely that patients will receive appropriate services at the right time and in a convenient way. It also increases patient compliance, not only with treatments, but with making sure they have their scans and diagnostics in a timely manner.

[Barry Gardiner]

The Minister rightly says that clinicians are best placed to make clinical judgments about their patients’ needs, and there is no dispute between us on that. My concern is that in a case such as that of TDL the clinicians understood the clinical need but clearly did not have the expertise to ensure that the contract was properly engaged in; that it was risk-assessed in the first place; that it was properly monitored; and that it was executed in a manner that was going to ensure the proper relationship between the practitioner and the tests that were being done. Similarly, on the courier service, they had the clinical evidence right, saying that refrigeration was needed, but when it came to putting the contract in place there was no such refrigeration.

[Dr Poulter]

I hope that the hon. Gentleman will forgive me for saying that many of the contracts to which he is alluding were put in place under the old arrangements, before this Government’s reforms, which have delivered clinical leadership. Many of these contracts were negotiated under the powers put in place under the previous Government, whereby people without clinical experience often negotiated the contracts and so did not always understand what the important clinical factors were. He rightly raised the point about potassium and the refrigeration of biochemical samples. It is important that we preserve the integrity of all samples collected. Of course, a clinician, a biochemist or someone with clinical experience would understand that, whereas someone who is commissioning services without that background might not. We saw that happen far too often with primary care trusts. The clinical input under the new arrangements will put us in a much better place to commission services in the future. Many clinical commissioning groups have been saddled with those old arrangements and so are having to enforce arrangements and contracts that they did not directly negotiate. We hope that when the contracts come up for renegotiation that problem will be put right, thanks to the reforms that we have introduced. They will lead to clinical leadership at CCGs, so that doctors and nurses are in charge of negotiations, rather than people who have not necessarily had the relevant clinical experience and do not have the knowledge to understand what the contract they are commissioning is about. National frameworks are being developed for some commissioning contracts by NHS England. So if concerns arise locally on the part of a CCG about the commissioning of contracts, NHS England is always available to provide advice.

I wish to reassure the hon. Gentleman that not just any old health care provider can deliver diagnostic services. By law, health care providers must register with the Care Quality Commission to carry out diagnostic services. That helps to ensure that patients receive only high-quality care, because the CQC, to which the Government are granting greater independence and strengthened powers to intervene where there are quality of care concerns, is the organisation that will be able to intercede if there are concerns about the quality of any health care service which may affect patient care. Service providers must be registered with the CQC and they must prove that they can meet strict quality criteria. That regulated activity includes a wide range of procedures related to diagnostics, screening and physiological measurement, including all diagnostic procedures involving the use of any form of radiation, including X-ray, ultrasound or magnetic resonance imaging. Regulated activities are listed in schedule 1 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

[Barry Gardiner]

The Minister will have been aware of the report on TDL in north-west London and in no sense could it have been said that a satisfactory service was being delivered. So why did the CQC not intervene in a timely fashion? Why, when the initial report by the GP was made about a serious incident, was it not taken seriously? Why did it take so long to make sure that these services were being provided properly and that my constituents were being kept safe?

[Dr Poulter]

Clearly, the events that the hon. Gentleman has raised were distressing and appear to have caused difficulties for patients, and I know that local commissioners found that regrettable. I do not know whether the case was reported to the CQC. He will also be aware that the CQC has come on a considerable journey, from being an organisation that was not fit for purpose a few years ago to being an organisation, with new chief inspectors in place, that is in a much more robust state of health now. The Secretary of State has put in place a number of measures to beef up and improve the inspection regimes in all care settings. We now have a chief inspector of care, a chief inspector of hospitals and a chief inspector of general practice. Following the Francis inquiry, there is now much more transparency, openness and passing of information between health care commissioners at a local level and the CQC. That did not happen as effectively as it should have done in the past, and that was to the detriment of those in Brent.

[Barry Gardiner]

This was in 2012.

[Dr Poulter]

Indeed, and the Francis inquiry took place this year and a lot of action has been put in place by the Secretary of State to recognise where there have been failings in the health system in the past. We know that the majority of the health service, however it is commissioned, be it through a provider of NHS services, through the voluntary sector or through private providers, provides fantastic care on a day-to-day basis. We are proud that we have a publicly funded health service that has many fantastic front-line staff—I count myself still to be one—who do a very good job of looking after patients.

We know that things sometimes go wrong: the hon. Gentleman has highlighted what went wrong in his constituency and in the wider NHS things went wrong, very tragically, at Mid Staffordshire. We need to learn from those mistakes and ensure that they are put right in future, whether they are in the commissioning process—clinically led commissioning should put us in a much better place in that regard—or in the care that is provided to patients. We need to ensure that all hospitals, as well as other health care providers and care sector providers, step up to the plate, recognise that patient safety must always be paramount and ensure that the lessons that need to be learned from the Francis report are learned. My right hon. Friend the Secretary of State will report back to the House in due course—later this month, I believe—with further recommendations that will, I hope, reassure the hon. Gentleman.

In conclusion, let me turn specifically to diagnostic services in Brent. I am aware that the hon. Gentleman has recently asked questions about referral processes for diagnostic services provided in his constituency. As he knows, the contracts for those services were originally let by the then PCT under arrangements encouraged by the policies of the previous Government and are managed by the North and East London commissioning support unit on behalf of the CCGs. The London NHS Diagnostic Service, provided by InHealth, offers GPs and other health care professionals direct access to high-quality diagnostic and imaging scans and tests throughout London delivered from a range of sites, including mobile, fixed and community-based facilities.

I hope that it reassures the hon. Gentleman to hear that between September 2010 and August 2011, 2,397,018 diagnostic tests were carried out in London but more recently, between September 2012 and August 2013, there was an increase of about 300,000 to 2,651,560. That shows that the service in London is in robust health and is being used to facilitate scans and other procedures to diagnose many more patients today than two to three years ago.

I understand that the hon. Gentleman has been in communication with local commissioners and that the relevant NHS England area team has advised him that GP practices do not receive any referral payment when patients are referred to the London NHS Diagnostic Service provided by InHealth. I know that that is an area of concern to him and he was possibly suggesting that there might be some cosy internal relationship among local health care services to the detriment of patients. I can reassure him that that is certainly not the case. GPs make clinical decisions on the basis not of financial bribes, but of what is best for their patients. I hope that he will be reassured by the answer he has received from the commissioners and I do not think that it is in any way likely that GPs or other health care professionals will act in a way that is outside the best interests of their patients. It has always been my experience that front-line health care professionals, with very few exceptions, act with openness and integrity and always advocate for their patients’ needs. I hope he will be reassured by that.

I hope that the hon. Gentleman is reassured that diagnostic services are in robust health under this Government nationally, and in Brent.

Question put and agreed to.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 22nd October 2013 Commons Chamber

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

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

[Neil Carmichael]

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

[Dr Poulter]

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

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

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

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

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

[Julian Smith]

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

[Dr Poulter]

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

[Nick Smith (Blaenau Gwent) (Lab)]

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

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

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

[Nick Smith]

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

[Dr Poulter]

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

[Mr Stephen Dorrell (Charnwood) (Con)]

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

[Dr Poulter]

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

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

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

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

He told the House:

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

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

[Dr Poulter]

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

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

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

[Dr Poulter]

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

[Liz Kendall (Leicester West) (Lab)]

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

[Dr Poulter]

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

[Martin Vickers (Cleethorpes) (Con)]

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

--- Later in debate ---

[Andrew George (St Ives) (LD)]

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

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

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

[Andrew George]

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

[Dr Poulter]

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

[Mr Ben Bradshaw (Exeter) (Lab)]

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

[Dr Poulter]

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

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

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

[Dr Poulter]

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

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

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

[Dr Poulter]

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

[Kerry McCarthy (Bristol East) (Lab)]

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

--- Later in debate ---

[Mark Pawsey (Rugby) (Con)]

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

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

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

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

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

[Dr Poulter]

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

[Andrea Leadsom (South Northamptonshire) (Con)]

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

[Dr Poulter]

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

[Alison McGovern (Wirral South) (Lab)]

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

--- Later in debate ---

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

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

[Dr Poulter]

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

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

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

Psychological Therapies

Dan Poulter Excerpts

Wednesday 16th October 2013 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Edward. I pay tribute to my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) for securing this debate, for his tremendous work on the all-party group in highlighting the importance of mental health and the need to continue to raise mental health issues, and for his supporting the Government in seeking parity between physical and mental health, to which we have been committed since the coalition came to power in 2010. I congratulate the hon. Member for Liverpool, Wavertree (Luciana Berger) on her promotion to her new role and commend her largely bipartisan approach to the debate and on recognising that some of these issues are bigger than party politics.

Before I deal with some important issues raised by my hon. Friend the Member for Halesowen and Rowley Regis, I want to touch on the contributions of other hon. Members and talk about the context in which we are operating. We recognise, as a Government—I think that all hon. Members in this debate have recognised—that for far too long we focused on crisis management in health care generally, particularly in mental health, rather than on upstream interventions, which is where IAPT plays such an important role to keep people well in their own homes and communities, instead of picking up the pieces when they become so unwell at the other end. There is a good economic argument for that, but it also provides much better care for the patients and the people we all care about as Members of Parliament, and whom I care about as a doctor.

The hon. Member for Strangford (Jim Shannon) raised some important issues about veterans’ health. He knows that I have personally committed to improving the provision of physical and mental health care for our armed forces veterans. There are now 10 dedicated teams in England, focusing on supporting our veterans who have post-traumatic stress disorder and other mental health problems, post-discharge. A lot of work is going on—much more collaborative work—between the NHS and the armed forces, to ensure that general practitioners and health care professionals in England are much more aware of armed forces personnel coming back into their care, after serving in the armed forces, that a more holistic approach is taken, that people do not present too late in crisis and that GPs can be much more proactive in offering reassurance and support to veterans who may be running into the early signs of difficulties. My counterpart in Northern Ireland has been working hard on that and he should be commended for it.

My hon. Friends the Members for South West Bedfordshire (Andrew Selous) and for Eastleigh (Mike Thornton) made important contributions about the holistic approach to health care in general, about how mental health needs to be considered holistically and about the benefits to wider society of upstream interventions. Getting health care right can also provide additional benefits for the economy; for example, by supporting families to stay together and bring up their children. All these things are beneficial and at the heart of my work on early interventions projects. My hon. Friend the Member for Hornchurch and Upminster (Dame Angela Watkinson), who is no longer in this Chamber, and I are working closely on that.

[Huw Irranca-Davies (Ogmore) (Lab)]

I apologise for being late. I was at another meeting. I, too, congratulate the hon. Member for Halesowen and Rowley Regis (James Morris) on securing the debate. Has the Minister already secured a meeting with Welsh Government Ministers, or will he do so in future, to discuss the approach towards veterans that he outlined? That issue is close to my heart, because I am aware of emergency rescue situations in which things have gone too far, when services, including mental health services, have been stretched way beyond their means in dealing with them. There would be benefits from sharing best practice across all the regions and nations.

[Dr Poulter]

The hon. Gentleman is right. We UK Health Ministers work collaboratively on many issues. However, on veterans, we have to recognise that, although we have UK-wide armed forces, health is a devolved responsibility. We need to share different initiatives better between the devolved Administrations. Some remote areas of Wales, in particular, could learn from best practice in the NHS about how we are using, to good effect, specialist mental health teams for veterans. I should be happy to share that and meet my counterpart in Wales to talk that through in greater detail.

I will focus in particular on the important contribution of my hon. Friend the Member for Halesowen and Rowley Regis. He addressed a number of issues that are central to the provision of good mental health care, and he threw down some challenges on how we could make things better. In particular, he praised the scale of the Government’s ambition to have genuine parity between physical and mental health, which has to be right; it is at the centre of everything that we are looking towards in the good commissioning of services locally.

I reassure the hon. Member for Liverpool, Wavertree that, with the addition of IAPT, there has been a substantial increase in the NHS’s total investment in psychological therapies. As she will be aware, however, it is down to local commissioners to prioritise their resources to meet local need, based on the local population that they serve. In the past, the challenge has been that good commissioning has too often been seen purely through the framework of physical health. Through the NHS Commissioning Board’s mandate, we are now ensuring that there is parity between mental and physical health. That journey is already well under way to ensure that good commissioning is no longer just about commissioning for acute services, such as stroke and heart attack, but about looking at the whole patient and considering the importance of upstream interventions, which are central to IAPT’s role in looking after patients.

My hon. Friend the Member for Halesowen and Rowley Regis also talked about the need to consider CBT and its evidence base. As he knows, it is not the role of Ministers to question the integrity of NICE, but NICE keeps its criteria under review, and there is a very strong evidence base to support CBT. The evidence base for IAPT is continually being developed and adapted, and a number of pilots are already in place to consider the potential to extend the scope of therapies, including to older people. I hope that that is reassuring. NICE will be listening to this debate, and it continues to evaluate the evidence. With mental health, there has always been controversy on how evidence is collated, because mental health is different from physical health, and NICE will keep that under review when it adapts and introduces future guidelines.

The debate has been called because all hon. Members in the room believe that, for too long, there has been too much focus on crisis management and acute response when patients with mental health conditions become very unwell. We would all like to see much more focus on upstream intervention, which is what IAPT is all about. We need to move the focus away from SSRIs—selective serotonin reuptake inhibitors—and drug-based therapy towards upstream, proactive intervention for what is sometimes a very vulnerable patient group.

The benefits of early intervention have been outlined by many hon. Members. There are clear health benefits, but there are also economic benefits, benefits to the family and benefits from getting people back to work, education and training, and from supporting people to have more productive and happier lives. That is why we will continue to ensure parity of esteem in commissioning for physical and mental health, and it is why we will continue to support upstream interventions in the early years—I will address early-years IAPT later. We will also ensure that we continually drive good commissioning to encompass mental health as well as physical health. That holistic approach to health care, by prioritising mental health, is good for people’s health care, good for families and good for the economy. That is why we will ensure that it remains a priority.

As hon. Members will be aware, the mandate set by the Government for NHS England last year establishes a holistic approach as a priority for the whole NHS for the first time. Improving access to psychological therapies is fundamental to the success of improving mental health. The mandate makes it clear that everyone who needs them should have timely access to evidence-based services. That is particularly important for mental health. By the end of March 2015, IAPT services will be available to at least 15% of those who could benefit—an estimated 900,000 people a year. We are also increasing the availability of services to cover children and young people with long-term physical health problems and those with severe mental illness to ensure that everyone can access therapies. There is an emphasis on those who are out of work, the black and minority ethnic populations and older people and their carers.

IAPT is being made available throughout the country. The programme was started by the previous Government in 2008, and we now have an IAPT service in every clinical commissioning group. There are more than 4,000 trained practitioners, and more than 1 million people are entering and completing treatment. Recovery rates have consistently been in excess of 45%, and they are much greater in many areas. The programme already has a clear track record of evidence-based success, and it is helping to reach some of the most disadvantaged and marginalised people in our society, which we would all say is a good thing.

[Andrew Selous]

My hon. Friend is absolutely right about the evidence. Although this is a little premature, he might be aware that the Department for Education has just commissioned evidence on the efficacy and cost-benefits of couple counselling. I have sometimes heard it said that there is no evidence for anything other than CBT, so will he say a little about the range of provision available under IAPT, specifically in relation to couple counselling?

[Dr Poulter]

My hon. Friend is absolutely right. I will address children’s IAPT in a moment, because the hon. Member for Upper Bann (David Simpson) made an important point on that.

My hon. Friend is right that, through not only IAPT but other programmes that consider health care more holistically—particularly the family nurse programme, which is aimed at vulnerable teenage mums—upstream intervention supporting those vulnerable groups helps to keep couples together and helps reduce rates of domestic violence. The programmes also support a stronger bond between mum and baby, so the child does better at school and mum and dad are supported to get back into education, training and work. So it is a win-win situation for the economy, and it helps vulnerable younger parents to have a better start in their own lives and provides a better start in life for their children. That is not exclusive to family nurses; we are also considering how the approach may be developed with IAPT, so that we can have a more joined-up approach both to children’s health generally and to families.

Earlier this year, I launched a system-wide pledge across education, local authorities, the voluntary sector and the NHS to do everything we can to give each and every child the best start in life. Part of the pledge is to do exactly what my hon. Friend outlines, which is to focus on getting early and upstream interventions right to support children in having the best start in life. We are also seeing the benefits of supporting families and reducing rates of domestic violence. I hope that is reassuring, and we will continue to develop and press those policies.

Briefly, our children’s IAPT programme is no less ambitious in its aim to transform services. In 2011, we announced funding for children and young people’s IAPT of £8 million a year for four years, and in 2012, we agreed significant additional investment of up to £22 million over the next three years, which is a total of £54 million up to 2015. That additional funding will be used to extend the range of evidence-based therapies to include systematic family therapies and interpersonal psychotherapy, to extend the range, reach and number of collaborators within the project and to develop interactive e-learning programmes to extend the skills and knowledge of professionals such as teachers, social workers and counsellors. Again, there is a multi-agency approach to improving the support and care available to children, because this is not just about the NHS, but about local authorities and education working together to get it right for young people. Behind those facts and figures are the people whose lives and services have been transformed by IAPT.

To conclude, it might be worth outlining a recent conversation that I had with a GP. When talking about IAPTs in West Sussex, he said, “I hear from GP colleagues that this is the single most positive change to their medical practice in the last 20 years, and I echo this. Our local service reaches out to the community, and it is always looking at ways to improve. It is continually developing new evidence-based interventions for people with anxiety and depression, delivered one-on-one and in groups in a flexible way that means patients have real choice. They have filled a huge gap in need and are a force for good.” That is absolutely right, and it is why we will continue to develop parity between mental and physical health and continue to expand the IAPT programme.

Urgent and Emergency Services

Dan Poulter Excerpts

Thursday 10th October 2013 Written Statements

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

My noble Friend the Parliamentary Under-Secretary of State, Department of Health, Earl Howe, has made the following written ministerial statement:

We have today laid before Parliament “Government Response to the House of Commons Health Select Committee report into Urgent and Emergency Services: Second Report of Session 2013-2014”, Cm 8708.

We believe the NHS is world class when it comes to the quality and ease of access to urgent and emergency care. However, as the Committee has identified, the system faces increasing pressure. We welcome the Committee’s recommendations and the opportunity to explore and discuss the issues highlighted by the report.

This response describes the comprehensive initiatives, both short-term and long-term, the Government have put in place to assist the NHS in meeting ever-growing demand for urgent and emergency services. These range from the provision of an additional £500 million for this winter and the next, to the NHS England review of the urgent and emergency care framework.

Copies of the Government response are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.