Science and Technology Committee

Dan Poulter Excerpts

Tuesday 8th 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:

I would like to inform the House, together with my right hon. Friend the Minister of State for Universities and Science (Mr David Willetts), that the Government response to the House of Lords Science and Technology Committee Inquiry into Regenerative Medicine, Cm 8713, was laid before Parliament on 1 October.

The Government welcome the Committee’s report and agree with many of its helpful findings and recommendations.

The Government remain committed to the field of regenerative medicine and we recognise the significant role that regenerative medicine has in delivering the next generation of healthcare, providing possible treatments or cures for areas of unmet medical need. Regenerative medicine is recognised as one of the UK’s eight great technologies, given its huge opportunities for technological advance and the economic benefits we believe it can bring to the UK economy.

Following the recommendations of the report we are setting up a regenerative medicine expert group to develop an NHS regenerative medicine delivery readiness strategy and action plan. This group will draw and build on existing initiatives outlined in the response to ensure the NHS is fully prepared to deliver the innovative treatments that regenerative medicine offers. In addition, this group will monitor the effect that regulation has on the progress of regenerative medicines in the UK,

“Government Response to the House of Lords Science and Technology Committee Inquiry into Regenerative Medicine” is available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. It is also available at:

https://www.gov.uk/government/publications/regenerative-medicine-inquiry-government-response.

NHS: Negligence

Dan Poulter Excerpts

Tuesday 8th October 2013 Ministerial Corrections

[Andrew Bridgen]

To ask the Secretary of State for Health what proportion of the money set aside by the NHS to compensate patients for clinical negligence claims will be paid to lawyers representing patients.

[Official Report, 5 September 2013, Vol. 567, c. 469-70W.]

Letter of correction from Daniel Poulter:

An error has been identified in the written answer given to the hon. Member for North West Leicestershire (Andrew Bridgen) on 5 September 2013.

The full answer given was as follows:

[Dr Poulter]

As at 31 March 2013 the National Health Service Litigation Authority has made provision for claimant solicitors' costs of £1.22 billion. This is against a total provision of £5.8 billion relating to all reported but unresolved clinical negligence claims, equating to a proportion of about 21% of the provision.

It should be emphasised that these sums do not represent a single year's costs, but a provision in the account for costs that may be paid out spread over a number of subsequent years.

The correct answer should have been:

[Dr Poulter]

As at 31 March 2013 the National Health Service Litigation Authority has made provision for claimant solicitors' costs of £607.8 million. This is against a total provision of £5.8 billion relating to all reported but unresolved clinical negligence claims, equating to a proportion of about 10.4% of the provision.

It should be emphasised that these sums do not represent a single year's costs, but a provision in the account for costs that may be paid out spread over a number of subsequent years.

Language Controls for Doctors

Dan Poulter Excerpts

Monday 9th September 2013 Written Statements

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

The Department of Health has been working with the General Medical Council (GMC) and other stakeholders to look at ways to ensure that the language capability of doctors working in the UK is sufficient, and earlier this year I signalled the Government’s intention to further tighten rules about overseas doctors.

Subsequently, on 7 September 2013 the Government launched their consultation “Language Controls for Doctors—Proposed Changes to the Medical Act 1983”, which consults on proposals to amend the Medical Act 1983 to give the GMC more explicit powers to take action where concerns arise about a doctor’s English language capability. The draft Medical Act (Amendment) (Knowledge of English) Order has also been published alongside the consultation document. The proposals are designed to complement and further strengthen the existing language controls imposed through the responsible officer regulations, performer’s list regulations and other checks undertaken at a local level.

The consultation will close on 2 December and the Government welcome views on the proposals and invite comments through the consultation process.

“Language Controls for Doctors—Proposed Changes to the Medical Act 1983” and the draft Medical Act (Amendment) (Knowledge of English) Order have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Managing Risk in the NHS

Dan Poulter Excerpts

Wednesday 17th July 2013 Commons Chamber

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

It is a great pleasure to rise to speak in support of the amendment tabled by my right hon. Friend the Prime Minister.

Both sides of the House believe in our NHS, the staff who work in it and the care they provide for patients. I am also sure that both sides recognise that, in the wake of the Francis inquiry and yesterday’s report from Sir Bruce Keogh, the 65th year of the NHS has been its most challenging and that we need to face up to those challenges.

This debate has had three key themes: the importance of the NHS, the staff who work in it and the care they provide for patients; the importance of making greater productivity gains in the NHS to improve care and make sure that we do more with our resources; and the importance of openness and transparency and the need to learn lessons from things that have gone wrong, so that patient care can be improved.

Back Benchers have made some high-quality contributions. It is always a pleasure to hear the hon. Member for Walsall South (Valerie Vaz) and the right hon. Member for Holborn and St Pancras (Frank Dobson). The hon. Member for Halton (Derek Twigg) made a very strong case for his local health care services. I pay particular tribute to the right hon. Member for Cynon Valley (Ann Clwyd), who has done some tremendous work in looking at how we can improve the NHS complaints procedure. She read out a number of examples of things that have gone badly wrong, from which we need to learn lessons for the future. The work she is doing at the moment is hugely important and valuable, and the Government look forward to receiving her report shortly.

My hon. Friend the Member for Bracknell (Dr Lee) highlighted some of the challenges with the existing NHS estate and the need to modernise facilities and make some of the older buildings more fit for purpose to meet the needs of patients in the modern world. My hon. Friend the Member for Bristol North West (Charlotte Leslie) made a very brave speech. She spoke at great length—and rightly so—about the importance of involving the medical royal colleges in deciding how hospital inspection processes should be implemented and about the importance of clinical leadership and involvement in those inspections to help understand what good care looks like. After all, those colleges are centres of excellence in their fields and it is right that we listen to what they have to say.

My hon. Friend the Member for Southport (John Pugh) made a particularly thoughtful speech. He called for good management and spoke of the need for good managers in the NHS. He also made the important point that, in all our debates on patients who have been let down, the regulators have often not played their part. That is why we need to ensure that the regulators continue to come to the table and that the improvements at the CQC continue. The regulators need to remain fit for purpose.

The problem with mandatory staffing ratios is that they would just provide another tick box that would not necessarily bear a relation to what good clinical care looks like. There is a clear difference between mandatory staffing ratios and appropriate staffing levels, as the Francis report indicated. We need staffing levels that reflect the needs of the patients on the ward. Those will vary from ward to ward and will change on a daily basis according to the needs of different patients. It is important that we consider the patients who are in front of the doctors and nurses on the day. It may not be nursing care that is needed, but care from other members of the multi-disciplinary team such as physiotherapists and health care assistants. That is why it is wrong to use mandatory staffing ratios as a measure of good care.

[Barbara Keeley]

The point that I keep raising with the hon. Gentleman, other Ministers and the Secretary of State is that there must be transparency in the numbers. Ratios of 2:29 have been reported to me, which nobody would be comfortable with. My excellent local hospital puts information about staffing ratios on the boards in each ward. Does he not think that we should move rapidly to provide transparency on this matter? I am asking not for mandated ratios, but transparency so that patients and their families can see what the ratio is.

[Dr Poulter]

The hon. Lady makes a very good point about the importance of having staffing levels that are appropriate to the needs of the patients. That is why NHS England is considering toolkits that will help hospitals to build the right care in the right place and at the right time for patients and to adapt care so that it is provided by the appropriate professionals, according to patient need.

The debate has rightly focused on transparency and openness. We have not got that right in the NHS since the Bristol heart inquiry, which took place under the previous Government. Both the Government and the Opposition believe that we need to support staff who feel that they need to speak out and that there needs to be greater transparency and openness. I believe that the steps that the Government are taking will make a difference. We are introducing a contractual right for staff to raise concerns and issuing guidance on good practice in supporting staff to raise concerns. We are strengthening the NHS constitution and have set up the whistleblowing hotline to support whistleblowers. We are also amending legislation to secure protection for all staff through the Public Interest Disclosure Act 1998. We are doing good work and it is right that we continue to do all that we can to support staff in raising concerns about patient care, where that is appropriate.

We must focus on improving productivity in the NHS so that we can do more with the resources that we have. As the Secretary of State outlined, that is about improving the technology in the NHS so that we can spend more money on care and free up staff time. If we use technology to better join up health and social care, staff will spend less time on paperwork and more time with patients, which will improve patient care.

It is important to consider the fact that there are higher levels of morbidity and mortality at weekends and in the evenings. There needs to be more consultant cover and out-of-hours cover at those crucial times to ensure that the service is more responsive to patients. The Government are addressing that.

In conclusion, at the beginning of this debate, the right hon. Member for Leigh (Andy Burnham) rightly highlighted the long-standing problems in our NHS. Although Labour is now talking about social care, it was the last Labour Government who cut the social care budget between 2005 and 2010. Although Labour is now talking about the risk register, the last Labour Government refused to publish it.

[Ms Rosie Winterton (Doncaster Central) (Lab)]

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

Question agreed to.

Question put accordingly (Standing Order No. 31(2)), That the original words stand part of the Question.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 16th July 2013 Commons Chamber

[Stephen Timms (East Ham) (Lab)]

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

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

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

[Stephen Timms]

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

[Dr Poulter]

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

[Mr Stephen Dorrell (Charnwood) (Con)]

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

[Dr Poulter]

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

[Julie Hilling (Bolton West) (Lab)]

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

[Dr Poulter]

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

[David Tredinnick (Bosworth) (Con)]

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

[Dr Poulter]

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

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

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

[Dr Poulter]

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

[Bob Stewart (Beckenham) (Con)]

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

--- Later in debate ---

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

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

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

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

[Mr Bellingham]

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

[Dr Poulter]

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

[Mr Jamie Reed (Copeland) (Lab)]

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

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

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

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

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

[Dr Poulter]

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

[Karen Lumley (Redditch) (Con)]

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

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

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

[Karen Lumley]

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

[Dr Poulter]

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

[Mr Philip Hollobone (Kettering) (Con)]

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

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

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

[Mr Hollobone]

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

[Dr Poulter]

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

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

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

[Dr Poulter]

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

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

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

--- Later in debate ---

[David Rutley (Macclesfield) (Con)]

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

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

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

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

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

[Dr Poulter]

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

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

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

--- Later in debate ---

[Rosie Cooper (West Lancashire) (Lab)]

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

[Dr Poulter]

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

[Andrew Stephenson (Pendle) (Con)]

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

[Dr Poulter]

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

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

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

--- Later in debate ---

[Richard Fuller (Bedford) (Con)]

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

[Dr Poulter]

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

Herbal Medicine (Regulation)

Dan Poulter Excerpts

Tuesday 9th July 2013 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Bone, for, I believe, the first time. I am sure that you were salivating, listening to the issues raised in the debate—

[Mr Peter Bone (in the Chair)]

Order. I want to make it clear to the Minister that when I sit in this Chair, I have no views on anything.

[Dr Poulter]

Indeed, Mr Bone, as you say, you have no views on anything when you are impartially chairing the debate, but I am sure you pay keen interest to the topics raised, in your position as Chair and otherwise.

I pay tribute to my hon. Friend the Member for Bosworth (David Tredinnick) for securing the debate, which I am sure is of interest to the consumers and practitioners who use herbal medicines, as well as to the many Members who attended the debate today. None of us disagree with the principles articulated here—we can all sign up to them—but good government is about working through the practicalities of proposals to ensure that they become good laws, as I will discuss later.

There have been many good and worthy contributions to the debate. The hon. Member for Strangford (Jim Shannon) showed his strong support for herbal practitioners in his constituency, and he was right to say that things in Government do not happen in a flash but have to be properly thought through. I want to reassure him that some of the products he mentioned—he talked about the benefits of vitamin E, for example—are freely available from herbal practitioners, and indeed from pharmacists and other places.

There were other strong contributions from my hon. Friend the Member for Kettering (Mr Hollobone), who is no longer in his seat, and the hon. Member for Vauxhall (Kate Hoey). The hon. Lady made her case eloquently, and I would be happy to meet with her at a later date to discuss sports therapists further, but I would not wish to intrude on Mr Bone’s patience by talking about the issue today and I hope she will forgive me for that.

I pay particular tribute to my hon. Friend the Member for Bosworth for his principled and long-standing support for herbal practitioners and his interest in alternative therapies, homeopathy and many other such issues. Today he has demonstrated his extensive knowledge of the topic under debate, and of alternative therapies in general. I am sure I am right in saying that he is the most informed Member of Parliament on many of these issues, and it is a great tribute to him that he has secured the debate today. I am sure that herbal practitioners and alternative therapists would wish to pay tribute to his great work and his advocacy on their behalf, and on behalf of his constituents.

My hon. Friend is right to highlight the chief medical officer’s challenge about the future of antibiotics, but we can make a clear distinction between those remarks and the subject of today’s debate. I am sure that the chief medical officer would not wish her remarks to be associated with a call for a greater use of herbal medicine—that was clearly not outlined in her paper. Although it is important that we always consider ways—via traditional medical routes or otherwise—of improving people’s health and providing the right therapies, the paper clearly laid out the long-standing challenges as being about antibiotic resistance, and it would be wrong, therefore, to allow the two issues to be confused.

By way of background, it is worth highlighting that although we support patient choice some herbal products have caused harm to consumers. There are a number of reasons why that might happen: the herb may be intrinsically toxic; the product may be accidentally or purposefully contaminated by harmful materials or heavy metals; people may choose herbal products for serious conditions when medicines with a solid evidence base would be more appropriate; and, if herbal products are taken together with conventional medicines, the interactions may be unpredictable. It is right, therefore, that we support the responsible use of medicines and have a licensing system.

Directive 2004/24/EC on traditional herbal medicinal products was introduced to harmonise the European Union internal market and remove barriers to free movement. The directive deals with products manufactured on an industrial scale, and makes all operators in the market comply with the same set of rules, facilitates free movement and ensures increased product safety, which, I am sure we agree, has a positive impact on patient safety and public health.

The question of whether herbalists and traditional Chinese medical practitioners should be statutorily regulated has been debated since the House of Lords Science and Technology Committee first reported on the matter in 2000. The hon. Member for Vauxhall and my hon. Friend the Member for Bosworth outlined in their remarks that there is a lot of background and history. The previous Government grappled with the issues, and the current Government are also considering how to address and fulfil the commitments made by the previous Health Secretary, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley). Hon. Members will be aware that on 16 February 2011 the Government announced their intention to take forward the regulation of herbal medicine practitioners and traditional Chinese medicine practitioners, specifically with regard to the use of third-party products in their practice.

Herbal products broadly fall into three categories. The first are the 310 herbal medicines that already have a marketing authorisation or a traditional herbal registration—in other words, a product licence. Those 310 medications are currently available for use and are effectively licensed. They are safe and widely used, and have undergone all relevant testing and checks. The second category, which is the one we are addressing today, covers products manufactured by a third party. Such products have been illegal since April 2011, following the implementation of the EU directive. The third category is products made up by a practitioner on their own premises following an individual consultation. Although such products are not affected by the directive, some of the herbal ingredients may be restricted by the Human Medicines Regulations 2012.

The previous Health Secretary’s concerns about the second category—products manufactured by a third party—prompted the decision to take forward statutory regulation of such products. The Government’s intention was to allow regulated herbal practitioners lawfully to source third-party manufactured herbal medicines, with appropriate safeguards in place to minimise the risks associated with the products, but since April 2011 the European directive has made it illegal for herbal practitioners in the UK to source such products for their patients.

Following the EU judgment in the case of the Commission v. Poland, which my hon. Friend the Member for Kettering mentioned, we have reassessed the risks. That case actually concerned unlicensed conventional medicines being used because they were cheaper, and although there is a clear distinction between those products and herbal remedies we had to look at what else the judgment said. It looked at the specials regime and, critically, it emphasised how strictly the regime must be applied. The judgment has a knock-on effect for what we propose for the use of herbal medicines manufactured by third parties without a licence, and it therefore needs careful consideration because there is a very high risk that we would be found to be in infraction of the European directive. We therefore need to consider further herbal products manufactured by a third party, and I will return to that point later.

The Government would, of course, like to find a way through the issue that supports responsible businesses and ensures public safety. Since the announcement in February 2011, the Department of Health has been working with officials in the devolved Administrations and with the Health and Care Professions Council to establish a statutory register for herbal practitioners. Alongside that, we have been considering a strengthened system for regulating medicinal products, to enable consumers to have access to a greater range of third-party manufactured herbal medicines. The process continues to be complex and lengthy, and it has been further complicated by the judgment in the European Union v. Poland case.

We acknowledge that there is strong support from some groups of herbal practitioners for the statutory regulation of the sector, but not all practitioners are in favour. I am sure, therefore, that hon. Members will appreciate that it would be irresponsible for the Government to undertake to alter the status of a group of workers without first ensuring that the policy and final decision offered an appropriate form of regulation and ensured that the proposals adequately addressed the risks posed to consumers of third-party manufactured herbal medicines.

As I stated earlier, complex issues are involved. We are discussing how to ensure that our proposals are fit for purpose and proportionate, and that they properly protect the public. I want to assure the hon. Member for Vauxhall that the matter has not been dropped. We absolutely support the principles outlined by my right hon. Friend the Member for South Cambridgeshire in his written ministerial statement to the House, and I fully appreciate that the delay is causing anxiety and concern to practitioners of herbal medicine and to consumers.

To ensure that we take forward the matter effectively, we want to bring together experts and interested parties from all sides of the debate to form a working group that will gather evidence and consider all the viable options in more detail, particularly because of the Polish case. I am aware of the concerns of my hon. Friend the Member for Bosworth about making timely progress, and I would therefore very much welcome his direct involvement in the working group to ensure that the interests of practitioners are properly looked after. We can meet when the House returns to work out how to take forward the proposal.

I hope that my commitment to setting up a working group will reassure my hon. Friend and all hon. Members that the Government are carefully considering this important issue. We recognise and agree with the principles, but the practicalities are such that we must have legislation that is fit for purpose—that does not trigger infraction proceedings from the European Union, but protects the public. That is vital in all health care matters, whether in relation to traditional medicines or to herbal medicines and alternative therapies. For that reason, we want to set up a working group and to work with my hon. Friend, and herbalists and others, to ensure that the legislation is fit for purpose. I look forward to discussing that with him in due course.

[David Tredinnick]

Before my hon. Friend sits down—I think that he was about to do so—may I thank him for his remarks? I am sure that knowing there is some progress is welcome, but I remind him that there have been many working groups in different guises over a long period, and the image that springs to mind is of the long grass. I am grateful to him for suggesting that I might be part of the process, but I want to be reassured that we are in the short grass. Lastly, is there general agreement with the devolved Administrations or is that a sticking point?

[Dr Poulter]

I reassure my hon. Friend that I am not aware of any points of disagreement with the devolved Administrations, but I will write to him and provide reassurance if there are any issues of which I am unaware. My understanding is that there is a unified position across all of the different health Departments.

[Jim Shannon]

On the devolved Administrations, I speak with some knowledge of the Northern Ireland Assembly, where my colleague Edwin Poots is the Minister of the Department of Health, Social Services and Public Safety. We and the Minister in the Northern Ireland Assembly are keen to have a focus of attention and a continuity of thought among all the regions of the United Kingdom to ensure that we can support the Under-Secretary of State for Health. The quicker he and the Government move that on, the gladder the regions—especially Northern Ireland—will be to jump in behind and support them.

[Dr Poulter]

The hon. Gentleman is absolutely right to highlight the strong working relationships, particularly with his colleague in Northern Ireland. We are grateful for that continuing strong working relationship on both this and other issues, and I look forward to working with him.

I reassure my hon. Friend the Member for Bosworth, who was concerned about the short and the long grass, that the intention behind his involvement in the working party is to keep it firm to its task. I am sure that he will want, as part of his involvement, to ensure that that happens. When we meet to discuss this further after the House returns in September, we can ensure that the proposals are proportionate and fit for purpose, and that they protect the public, including through giving people an informed choice about the use of herbal products.

[Kate Hoey]

Will the Minister give way?

[Dr Poulter]

I will give way for the last time.

[Kate Hoey]

I tend to agree about the long grass: officials are always coming up with another working party, because it is a nice way to postpone things. Will the Minister give us some idea of the time scale?

[Dr Poulter]

We need to sit down together. I very much want to involve my hon. Friend the Member for Bosworth, and the hon. Lady would be very welcome to join that discussion when the House returns. The idea is to get a working party up and running in the early autumn to ensure that we progress matters. We obviously need to discuss issues raised today about statutory regulation and third-party manufactured products, and to look at such products in detail to see which might be classified as more akin to food additives or vitamin and mineral supplements and which as more akin to medications, because there is a spectrum. We need to work through such issues to make sure that we get to the right place.

It is important that any legislation not only passes the test of principle—we are all signed up to it—but is practical and fit for purpose. Particularly in light of the judgment in the case of the EU Commission v. Poland, we have other issues to consider that make the matter a little more complex. I reassure my hon. Friend the Member for Bosworth and the hon. Member for Vauxhall that we are committed to making timely progress, and when we meet on our return in September, we can progress things. I am sure that my hon. Friend’s involvement will keep the Government keen to their task.

[Mr Peter Bone (in the Chair)]

I thank hon. Members for taking the time for an absolutely splendid debate.

Stafford Hospital

Dan Poulter Excerpts

Thursday 4th July 2013 Commons Chamber

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

It is a great pleasure to reply to the debate. Let me begin by congratulating my hon. Friend the Member for Stafford (Jeremy Lefroy), and expressing my great admiration for the work that he has done so tirelessly during his time in the House. He has been a tremendous advocate for all his constituents, for the hard-working staff at the trust who are doing their best in very difficult circumstances, for all the people who have rightly spoken out about earlier problems at the trust, and for the patients. He is an example to us all of what a hard-working and dedicated constituency Member should be.

I also congratulate my hon. Friend the Member for Stone (Mr Cash), who has been raising this matter tirelessly for many years. It is a tribute to the efforts of both my hon. Friends that we have got to where we are today.

I can reassure my hon. Friend the Member for Stone that the findings of the Mid Staffordshire inquiry are at the forefront of the Government’s mind. As he will recall, our response to the Francis report set in train a number of important pieces of work. First, we asked Sir Bruce Keogh, medical director of NHS England, to look into 14 hospitals where there had been two years of higher than standardised mortality ratio indicators. That work is now reaching fruition. Following a report as damning as the Francis report, which looked into the culture of the NHS, we thought it right to investigate other hospitals that could give rise to concern, and we now think it right to examine the findings of Sir Bruce Keogh’s report before we report back to the House. We also set in train Camilla Cavendish’s review of nursing and Don Berwick’s inquiry into a minimum-harm and no-harm culture in the NHS. All those inquiries have formed part of our response to the Francis inquiry, and they have all been independent of Government. We shall have the reports in the next few weeks, and we shall then be able to arrange the more considered debate on the Floor of the House for which my hon. Friend has rightly called.

My hon. Friend the Member for Stafford was right to highlight the fact that the health care challenges in more rural areas, where travelling distances are longer, are by definition different from the health care challenges in urban areas. He was also right to highlight the fact that, throughout the NHS, in Stafford and elsewhere, we face the challenge, in both human and financial terms, of better looking after an ageing population and better providing dignity in elderly care.

My hon. Friend was right to highlight the fact that we need to support people such as Julie Bailey, who was treated appallingly in the light of her great courage and conviction. We must support people inside and outside the NHS who have the courage to speak up when there are concerns. We have made that clear in our initial response to the Francis inquiry report. That is why we have set up a whistleblowing hotline and are tackling the cultural issues in the NHS. We will support staff who want to raise concerns, so they can do so free of fear and intimidation. That is absolutely the right thing to do.

It is admirable that local people have continued to come out in full support of their hospital through the Support Stafford Hospital campaign. That was demonstrated by the 50,000 people who marched through Stafford with my hon. Friend in April and by other local events such as the Night of Light event in May. I am sure that we all agree that it is vital that the trust special administrator, currently in place at the trust, develops the right proposals for the future of services at the hospital to provide high-quality, affordable and sustainable services. I will return to that later.

The NHS is about to celebrate its 65th anniversary and its 65th year has perhaps been its most challenging. In that year, we have perhaps questioned some of the things that we held dear. I work in the NHS, I believe in it and I believe that our NHS should be and is one of the very best health services in the world, but when things have gone so badly wrong it is right that we learn lessons from what has happened, that we ensure that we put them right and that we support staff when they raise concerns. It is right that we drill into how to ensure that we listen to staff in learning how to put things right in local hospitals. We must also ensure that we create a culture in which trust managers always listen to what front-line staff tell them. In my experience, when things go wrong in front-line patient care, it is often because there is a disconnect between management and front-line staff. That is why the Government, through the Health and Social Care Act 2012, are embedding in the NHS a culture of clinical leadership, which will benefit patients massively.

On the future of Stafford hospital and the issues raised in the debate, the events that took place led Monitor to intervene and, over the past few years, there has been a whole health economy approach to improving services at the trust. That has led us to where we are today. Monitor, as the regulator of foundation trusts, appointed a TSA at the trust in April 2013 to determine the future provision of services at the trust. As we know, that process is ongoing.

I should be clear that, while the TSA is developing its proposals, I cannot discuss that in much detail. Nor is it known what the TSA is likely to propose. It is right that that process is free of political interference. However, what I would expect, and I am sure that my hon. Friend would agree, is that the TSA fully engages with key stakeholders during that process, including clinical commissioning groups, local health care providers, local authorities and local MPs, which I have been assured is the case. The TSA is legally bound to consult on its proposals and I would expect that any proposals meet the four tests for any service change and reconfiguration, which were set by the former Secretary of State for Health, now the Leader of the House of Commons.

[Joan Walley]

Can the Minister assure me that, following publication of the report by the trust special administrator, as well as the people and communities in Stafford, the people and communities in North Staffordshire will be consulted? There are wider concerns about how any further collaboration will affect health care, which has to be improved in North Staffordshire as well as in Stafford.

[Dr Poulter]

I thank the hon. Lady for her question. As I highlighted earlier, it is absolutely right that the TSA will look at the whole health and care sector in Staffordshire, and of course the implications of any potential change for neighbouring hospitals. That is implicit in the work that the TSA is doing. This is, of course, not an issue I can dictate from the Dispatch Box or the Secretary of State determines. It is for the TSA to decide what its own work is, and it is important that that is done without political interference, so the right decision for local patients in Stafford and surrounding areas can be reached. I am sure the hon. Lady will agree about that.

I appreciate the concerns of my hon. Friend the Member for Stafford that acute services should remain at Stafford hospital. However, the TSA is independent of Monitor and therefore it would not be appropriate for Monitor—or, indeed, Ministers or the Department of Health—to seek to influence this process. My hon. Friend is aware that, at the request of the TSA, Monitor granted an extension to the period in which it can develop its proposals and the consultation period. I understand that the TSA is expected to consult on its proposals between August and October 2013, and I am sure my hon. Friend and his constituents will play an active role in that, and that the views expressed in the House today will be listened to as a part of the deliberations of the TSA and in the consultation process that follows.

I appreciate my hon. Friend and his constituents will experience uncertainty while the TSA develops its proposals. However, the TSA is engaging widely with the broader health economy as these proposals are developed and I understand that includes speaking with my hon. Friend and the Stafford Hospital Working Group. I would, therefore, encourage my hon. Friend to continue this dialogue with the TSA to ensure that his views and those of his constituents are fully taken into account as proposals for the future of Stafford hospital emerge.

I pay tribute to the work of my hon. Friend and my hon. Friend the Member for Stone, because if it were not for their work, we would not be where we are today and the people of Stafford and Staffordshire would be much more poorly represented. Their record speaks for itself and they have our full support in the work they are doing as advocates for their constituents. I look forward to continuing to support them in my role as a Minister, and the Government stand ready to support Stafford hospital.

Question put and agreed to.

Health and Care Services

Dan Poulter Excerpts

Wednesday 3rd July 2013 Commons Chamber

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

It is a pleasure to close this debate and to respond to my right hon. Friend the Member for Charnwood (Mr Dorrell) and to his Committee’s report. I had the great privilege of serving under his chairmanship before I was appointed as a Minister, and he has been perhaps the greatest advocate of joined-up and integrated care, both as a distinguished member of previous Governments as Secretary of State for Health, and in all the work he has done as Chair of the Health Committee. His work has helped to lead to the great emphasis that the Government are placing on integrated and joined-up care, both through the Health and Social Care Act 2012 and in the statement by the Chancellor last week.

Friday marks the 65th anniversary of the NHS. I am proud to work in the NHS and to look after its patients. I think every Member in this House wants to see a health service of which we can all be proud. We are proud of our health service, but this 65th year of the NHS has also been marked by many challenges, which were outlined in the Mid Staffs report, the response to Morecambe Bay and in the comments on Tameside hospital made by the hon. Member for Denton and Reddish (Andrew Gwynne). We have to respond to those challenges, and the Government are taking strong steps to ensure that we deliver and stamp out the small pockets of poor care in the care system.

If we are to deliver a health service that is fit for the future, it has to be a joined-up health and care service. We can no longer afford to see the NHS and the social care sector as silos in their own right: we have to have a joined-up integrated approach. It is for that reason that we are proud to have increased the NHS budget by £12.7 billion. We are driving integration with that budget increase. We are encouraging local authorities and the NHS to collaborate in treating the needs of patients, and to address the problem highlighted by the Select Committee of people being passed, like pass the parcel, from one part of the system to another without any joined-up thinking or integrated care. I know that Members on both sides of the House want an end to that. In the spirit of consensus, we all want a health and care system that truly looks after the needs of individuals and is not run by the different financial and cultural silos of the whole.

We have heard strong contributions from hon. Members on both sides of the House in what has been a consensual debate. If we are to tackle the challenge outlined by Sir David Nicholson in 2009, when the previous Government were in power, to make 4% efficiency savings year on year just to stand still and to meet the increasing demand of an ageing population and the increasing health care expectations of patients, then we need consensus. To meet the challenge, we have to see a fundamental service transformation and redesign. We also have to see a far more productive NHS. Productivity gains and efficiency savings have to be made, while the challenges outlined by the Mid Staffs case and others are just as true today.

My hon. Friend the Member for Witham (Priti Patel) outlined clearly the importance of cutting back on bureaucracy and waste in the NHS where possible. Under the Health and Social Care Act 2012, £1.5 billion of bureaucratic savings will be put back into front-line care on an annual basis. She was right to highlight the importance of clinical leadership in delivering better services. There is good evidence that clinical leadership is not just about improving patient care. We can improve productivity through clinical leadership by improving the procurement of services and goods in the NHS. Procurement of services and goods makes up £20 billion of the NHS budget. There is good evidence that strong clinical engagement and leadership will help us to deliver greater productivity.

My hon. Friend the Member for Bosworth (David Tredinnick) talked about a number of other opportunities that the Health and Social Care Act offers to drive integrated care. I am pleased, as late converts, that the Opposition are now supporting the arguments we outlined during the passage of the Act about the importance of integrated health and social care. He also looked forward to the debate, which I will not enter into today—I hope he will forgive me—about the importance of complementary and alternative therapies. I look forward to furthering that debate with him next week.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for giving way—I asked to make an intervention beforehand, so he knows the subject matter. In the last year health tourism cost the NHS some £24 million, ranging from £100,000 in some trusts to £3.5 million in others. The Secretary of State made an important statement this morning about addressing that issue. Is the Minister in a position to set out the time scale for saving the NHS that £24 million a year?

[Dr Poulter]

The hon. Gentleman is absolutely right to highlight the fact that health tourism presents challenges. We need to look at them, which is why we have launched a consultation on exactly how to do so. We should recognise that we hugely value the fact—it is very beneficial to the British economy—that students come here from overseas to train and, sometimes, to work. Part of ensuring that they do so in a responsible manner and do not short-change British taxpayers and British patients means making provision for their health care needs, if necessary, and ensuring that the NHS does not pick up the tab. That is something we have opened a consultation on. It will report back later this year, and I am happy to discuss the matter further with the hon. Gentleman away from this debate.

In opening the debate, my right hon. Friend the Member for Charnwood was absolutely right to ask how we would deliver greater productivity in the NHS and to say that pay plays a part. Improving procurement, driving greater productivity and, crucially, service reconfiguration all play their parts too. It is worth highlighting the fact that the NHS needs to become more efficient at how it manages its estates, with £3.1 billion or so spent on NHS estates annually. There is much that can be done to improve the energy efficiency of those estates, which is why the Government launched a £50 million fund to support that work. A lot also needs to be done to reduce the £2.4 billion temporary staffing bill. That is something we will be talking about when we launch a paper later in the summer. There also needs to be greater focus on good leadership at board level—something we have touched on before—and engaging clinical leaders in helping to drive productivity and improvements in patient care.

It is also worth outlining the role of tariffs, which were touched on in the Committee’s report and in today’s debate, in driving more joined-up care. It is true that tariff change in itself is not good enough to drive improvements in patient care. Tariff change must drive service change and transformation at the same time, driving the more integrated care model that we all believe in. When my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) was Secretary of State, he initiated a review of the tariff system and looked specifically at best practice tariffs. We are now seeing the emergence of tariff change in a way that not only reduces costs, but drives service transformation. In the case of fragile hip fractures, day case procedures—such as cholecystectomies and similar procedures—and major trauma, we are seeing service change and transformation being driven by improved tariffs, which often cut across primary and secondary care.

If we are to deliver an NHS that is fit for the future, both financially and in human terms, that will be down to major service transformation and moving towards a system that provides integrated health and care. That is why last week my right hon. Friend the Chancellor outlined in his statement a £3.8 billion fund that will be shared between the NHS and local authorities to deliver integrated services more efficiently for older people and disabled people, ensuring that health and social care work together to improve outcomes for local people. Importantly, the Health Committee’s calls for health and wellbeing boards to play a vital role in overseeing the fund is something that we envisage becoming a reality.

In conclusion, we know that there are big challenges to the NHS in driving up productivity, and we know that we have already met some of them by cutting out, through our reforms, £1.5 billion of bureaucracy in the NHS—money much better spent on patient care. Crucially, in the years ahead, we will focus on the service transformation that is required to deliver a more integrated health service, continuing to develop those best practice tariffs that drive integration and bring together health and social care. It is not just about finances, because it is also about good care, which is why it is important to deliver the integrated system that patients deserve.

[Mr Dorrell]

rose—

NHS Funding (York and North Yorkshire)

Dan Poulter Excerpts

Tuesday 18th June 2013 Westminster Hall

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

It is a pleasure to serve under your chairmanship, I believe for the first time, Mr Streeter.

I pay tribute to the hon. Member for York Central (Hugh Bayley) for introducing the debate and raising the important issue of health care funding. He, like all Yorkshire Members in the Chamber, is a great advocate for his constituents. It is important to debate such issues and, in particular, to look at perhaps the greatest determinant of need in the NHS, which is that many older people have very expensive multiple care needs—dementia, diabetes, heart disease—and to look at the very big human need, which is how better to provide dignity in elderly care. That is exactly why my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) adjusted the formula, slightly changing the weighting for deprivation, to reflect such demographic challenges.

My hon. Friends and the hon. Member for York Central will be aware that the responsibility for health care funding now falls to NHS England. I have committed NHS England to reviewing the funding formula, and I am sure that it will listen carefully to today’s debate on north Yorkshire and elsewhere.

It is important to highlight how funding flows work in the NHS, and it may be helpful to say a few words about how the new arrangements have changed the way in which funding is allocated. As Members have pointed out, the NHS is paid for by taxpayers, and the money is allocated to the Department of Health by the Treasury. For 2013-14, the Department has set key priorities for NHS England through the mandate. I will outline the priorities that will help NHS England to prioritise funding within the NHS, and aid in the interpretation and use of the independent data given to it by the Advisory Committee on Resource Allocation.

The first priority in the mandate is the focus on preventing people from dying prematurely by improving mortality rates for the big killer diseases to be the best in Europe, through improving prevention, diagnosis and treatment. There is a clear priority to improve the standard of care throughout the system, so that the quality of care is considered as important as the quality of treatment or the clinical outcome. That will be done through greater accountability, better training, tougher inspections and paying more attention to what patients say, so that we have a truly patient-centred NHS, which is as important as providing care and dignity of care for older people.

There is a clear priority to improve treatment and care of people with dementia, and to focus on the important role played by technology—particularly in rural areas, through telehealth and telemedicine—in delivering better care in the community for older people. A key focus is on improving productivity and ensuring value for money to make sure that our health care system stimulates and supports the local economy in relation to not only the obvious importance of keeping local populations well and at work, but the benefits that can be gained from synergies with the life sciences and the supportive and stimulating research from such important places as Cambridge.

The Department of Health has set the mandate and a clear sense of direction for the NHS, with the priorities that are clearly there. The Department then makes allocations to several health bodies, including Public Health England, Health Education England, the NHS Trust Development Authority and NHS England. For 2013-14, NHS England received £95.6 billion, and some of that money will then, in turn, be allocated to clinical commissioning groups, but allocations to individual CCGs and the formula used to decide them are now the responsibility of NHS England, which has the key role.

In making those allocations, NHS England relies on advice from the Advisory Committee on Resource Allocation, as Members have said. ACRA provides detailed advice on the share of available resources available to each CCG to support equal access for equal need, as specified in the priorities set out in the mandate.

NHS England does not, therefore set income on an equal cost per head basis across the whole country; allocations instead follow an assessment of the expected need for health services in an area, and funds are distributed in line with that, which means that areas with a high health need receive more money per head. Under the formula, the 10% most deprived areas received more than 30% more per capita compared with the 10% least deprived, as the hon. Member for York Central outlined in his comments about Barnsley.

The calculation is based on several factors. In particular, it is increasingly based on the age of the population, the relative morbidity and unavoidable variations in cost. The objective is to ensure a consistent supply of health services across the country: the greater the health need, the more money that will be received. I am sure that we all support that.

The shift from a PCT funding formula to a CCG funding formula resulted in changes to the allocation for each particular area in 2013-14, as the hon. Gentleman commented. Funding now often takes place at a more local level—at the CCG rather than the PCT level—which we hope will ensure better prioritisation for local health care funding, with the funding formula being more sensitive to local health care needs.

The CCG model covers only non-specialised hospital and community care, as well as primary care prescribing, but the older PCT model also covered the whole of primary care, specialised services and public health, the costs of which were transferred to NHS England. There is, therefore, no direct comparability between the old PCT funding formula and the new CCG formula, for the reasons that I have outlined.

[Nigel Adams]

Whenever there are historical funding problems, such as those we experienced in north Yorkshire, there are inevitably leaks or stories about potential rationing and cuts to services. In my constituency in north Yorkshire, there has been lots of media speculation that a hospital opened by the Duke of Gloucester less than two years ago might close or lose its minor injuries unit. I have an awful lot of respect for the Minister, because he has done the job professionally, but I urge him to press NHS England to consider the funding case for north Yorkshire and other rural areas, and to consider the special circumstances that we have to deal with.

[Dr Poulter]

I will of course continue to press NHS England and raise concerns, as we have with representatives from the area, about the funding challenges being faced in north Yorkshire. It is also important to be aware that, because of how the new system works, with a mandate that sets clear priorities, NHS England recognises the need for a review of the funding formula for not only north Yorkshire, but nationally.

I agree with the remarks of my hon. Friend the Member for York Outer (Julian Sturdy) and the hon. Member for York Central about ensuring that funding goes to areas of greatest health care need. NHS England will obviously want to take account of rurality, age, the needs of older people and the complexity of care when it reviews the funding formula.

[Hugh Bayley]

The Minister says that Barnsley gets more money than north Yorkshire because of its higher level of deprivation, which I acknowledge, but why has the new formula given York less money than leafy Richmondshire and Hambleton, when York has higher levels of teenage pregnancy, drug addiction and deaths from asbestos-related diseases among people who had a career in industry. We have higher levels of deprivation than other parts of north Yorkshire, and yet we get less money. That cannot be right.

[Dr Poulter]

The hon. Gentleman makes a good case on his constituents’ behalf, but he should recognise that the Vale of York CCG—it serves not only his constituency, but others in the surrounding area—has received £357,891,000 which is the highest allocation in the area. He is right that its allocation is relatively lower per head than, say, that of Scarborough and Ryedale CCG, but I have outlined the factors that inform the capitation formula for funding, including density of population, and the obvious advantages of delivering health care in an urban environment.

I would be very happy to talk through such issues with the hon. Gentleman and my hon. Friends who are here today, and I am sure that we can arrange a meeting to do so in more detail than this debate allows. I also point out that NHS England will fundamentally review the funding formula to take account of demographics, age and rurality, which I am sure we all welcome. I look forward to meeting hon. Members in due course for further discussions and to see how I can assist them with the matters that they have raised.

Question put and agreed to.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 11th June 2013 Commons Chamber

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

2. What steps his Department is taking to ensure consistent and continuous provision of pre-natal and post-natal care.

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

The Government are committed to improving continuity of care during pregnancy and the post-natal period. To give women the personalised care that they deserve, we have increased the number of midwives by nearly 1,400 and the number of health visitors by more than 1,000 since May 2010. In addition, there are a record 5,000 midwives in training.

[Mr Amess]

Will my hon. Friend visit Southend university hospital, and tell residents at first hand what steps the Government are taking to ensure that post-natal care meets clinical guidance and the Government’s aspirations to ensure that the maternity experience is continuous, with patients having one dedicated midwife?

[Dr Poulter]

I would be delighted to visit my hon. Friend’s constituency. He has been a tremendous advocate for maternity services, both nationally and in his constituency, in his time in the House. As I am sure that he has realised, if we want a genuinely personalised maternity service, we need to ask women about their experiences of care. That is why the Government are introducing a friends and family test in maternity from October this year.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

The Minister knows full well that post-natal depression is the thing that is most likely to kill a healthy young woman, and we know how to deal with it, but in many areas across the country we are cutting the number of visits from midwives after births, and the support given. We know how to tackle post-natal depression. Why should it be that in some parts of the country the support is wonderful, and in others, it is non-existent?

[Dr Poulter]

The hon. Gentleman is absolutely right to highlight that there has, in the past, sometimes been unacceptable variation in the quality of post-natal care. That is why we are increasing the number of midwives and have done so by nearly 1,400, and why we are putting money and effort into increasing the number of health visitors, who play a vital role in supporting mums, babies and families in securing that important bond, and in supporting mums so that they get the right help when they suffer from post-natal depression.

[Stuart Andrew (Pudsey) (Con)]

3. What plans he has for the future of children’s heart surgery provision in Yorkshire and the Humber.

--- Later in debate ---

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

5. What estimate he has made of the optimal level of bed occupancy in NHS hospitals.

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

Average annual bed occupancy rates for all NHS beds open overnight have remained stable between 84% and 87% since 2000. The Government do not set optimal bed occupancy rates for the NHS. NHS hospitals need to manage their beds effectively in order to cope with peaks in both routine and emergency clinical demand.

[Luciana Berger]

I listened carefully to what the Minister said, but the Royal College of Physicians has warned that this winter there were more black alerts—when a hospital has no beds available—than there were over the previous 10 years combined. What urgent action are the Government taking to reduce bed occupancy levels and prevent next winter being even worse?

[Dr Poulter]

We had this debate last week. The long-term pressures on the NHS, as we know, are the result of an aging population, with increasing numbers of older people arriving in A and E with complex needs, so the challenge is to ensure that they are better treated in the community. That is why my hon. Friend the Minister of State launched the integrated care pilots last month. We are also seeing more patients treated as day cases than ever before. About 80% of elective admissions are now treated as day cases, which shows a massive improvement in the speed and quality of care in the NHS.

[Mr Philip Hollobone (Kettering) (Con)]

Kettering general hospital is located in an area that has one of the fastest growing populations in the country and above-average growth in the number of patients aged 80 or over. What more can be done to send the correct signals to local authorities that they need to act quicker to get elderly patients out of hospital once they have been treated so that they can have the care they need in the community, thus freeing up hospital beds?

[Dr Poulter]

My hon. Friend is absolutely right that local authorities have a key role to play in integrated care. That is why in April this year the Government set up local health and wellbeing boards, which will bring about greater integration of care between the NHS, housing providers and social care locally. That will hopefully ensure that across the country we have a much greater focus on local health care needs and, in particular, on better supporting older people and people with long-term disabilities at home and keeping them out of hospital.

[Andy Burnham (Leigh) (Lab)]

A moment ago the Minister mentioned more elderly people coming in through A and E, and I want to present the House with new, deeply troubling evidence of that. Nobody wants to think of a very frail elderly person with no other support at home having to come to A and E by ambulance, but that is what increasing numbers of elderly people are having to do. Buried in the general A and E figures is an appalling increase in people aged over 90 coming to A and E by blue-light ambulance, which is up by 66%, equivalent to more than 100,000 of the most vulnerable people in our society. That is an appalling failure and a sign of something seriously wrong in the way we care for older people, and it is set to get worse as home care is cut further this year. Will he investigate that increase urgently and act now to prevent the collapse of social care?

[Dr Poulter]

The right hon. Gentleman is absolutely right—there is almost an outbreak of consensus across the Dispatch Boxes on this issue. We both recognise, rightly, that there is a long-term challenge in providing more integrated, joined-up care to better look after older people. However, it is ironic that he should raise that concern, because a previous Minister in the other place, the noble Lord Warner, has made the case very clearly that the previous Government failed to invest adequately in elderly care throughout their time in office. That is why this Government—I hope that we can count on the right hon. Gentleman’s support for this—are investing in health and social care, more integrated services at a local level through health and wellbeing boards and—

[Mr Speaker]

Order. The answers are too long. They need to get shorter, because we have a lot to get through. It is very simple and very clear.

[Dr Poulter]

The hon. Gentleman is right to point out that historically there have been challenges with intensive care beds. We are now seeing increases in some areas of intensive care, particularly paediatric intensive care and paediatric cots, to ensure that there is greater support in that service, but he is absolutely right that we need a greater emphasis on specialist centres focused on intensive care. That is something that the NHS Commissioning Board, NHS England, is focused on delivering. We need to ensure that across each region of the country there is more focused care and more specialist intensive care.

[Stephen McPartland (Stevenage) (Con)]

6. What progress he has made on improving cancer waiting times and diagnosis.

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[Chris Heaton-Harris (Daventry) (Con)]

13. What recent representations he has received expressing concern about the service provided by the East Midlands Ambulance Service.

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

Over the past year we have received more than 40 letters from MPs in the east midlands, including my hon. Friend the Member for Daventry (Chris Heaton-Harris), local authorities and members of the public, about the service provided by the East Midlands Ambulance Service NHS Trust and its being the best programme. My hon. Friend will also be aware that there was an Adjournment on the matter earlier this year.

[Chris Heaton-Harris]

The Minister will recall that I have raised a number of constituency cases with his Department and the Care Quality Commission about the standard of services provided by EMAS to my constituents, and how it treats its staff. Will he assure me that the Department will continue to monitor EMAS’s performance in the coming months?

[Dr Poulter]

My hon. Friend can be reassured that the trust development authority and the local chief commissioner for Erewash CCGs are closely monitoring the situation. Today, the Marsh review into the east of England ambulance service has been published, and lessons from that review about how management processes can improve front-line care for patients can be learned and applied across other ambulance services.

[Martin Vickers (Cleethorpes) (Con)]

My constituency is also served by EMAS and it is evident that my constituents have cause for concern. Coupled with uncertainty about the future of the Leeds children’s heart unit and higher than average mortality rates in local hospitals, the situation is causing considerable concern. Will the Minister agree to meet me and neighbouring MPs to discuss those problems?

[Dr Poulter]

I would be delighted to do so.

[Pauline Latham (Mid Derbyshire) (Con)]

14. What recent assessment he has made of the national cancer drugs fund list.

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[Zac Goldsmith (Richmond Park) (Con)]

T8. More than 5,000 schools across the UK now serve good-quality, sustainable meals with the Food for Life catering mark, but only three hospitals have achieved the same. It is often said that hospitals cannot do so because of the cost implications, but the three that have done so not only have incurred no extra costs, but, in the case of Nottingham hospital, have actually saved significant amounts. May I urge my hon. Friend actively to encourage take-up of the Food for Life catering mark as a model of best practice?

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

We will certainly look into the issue that my hon. Friend raises, but he will be aware that there are campaigns throughout the NHS focused on supporting local food producers, which is important in many constituencies, particularly rural ones, and developing best practice and encouraging nutrition. Chefs such as James Martin have been involved in helping to drive up standards of care, particularly in Yorkshire and other parts of the country.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

T5. I listened carefully to the Public Health Minister’s answer just three questions ago, but the Government have disproportionately cut funding to the most deprived local authorities, including Liverpool, and these local authorities have today been shown to have higher mortality rates. How does the Secretary of State expect to close, rather than widen, health inequalities?

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[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

T10. With the Department of Health having awarded Cleveland fire brigade £198,000 from its social enterprise investment fund, will the Minister confirm, pursuant to concerns raised by the Fire Industry Association, that his Department undertook an assessment as to the compliance with the European state aid regulations of the state’s funding of community interest companies that compete to take business away from the private sector?

[Dr Poulter]

I would be very happy to look further into the issue and to meet the hon. Gentleman to discuss it.