Budock Hospital Site

Dan Poulter Excerpts

Tuesday 11th June 2013 Commons Chamber

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

I congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on securing this debate and on her ongoing tremendous advocacy on behalf of her constituents. She talked eloquently of her own knowledge of the school—“care farm” is the expression I would use in my constituency—and the relationship between the school and the old hospital. She highlighted the importance when looking for value in NHS land of doing as much as possible to maximise the land receipt and put that money back into the NHS, but of course NHS land is community land, and it is important that, wherever possible, we work with surrounding communities to support them in local activities that benefit the population.

My hon. Friend also outlined eloquently the challenges faced by more rural parts of the country, and Cornwall in particular. We know that community resources and facilities are much scarcer in rural areas, as she highlighted in her speech. When we look at the affordability of local homes and the provision of community facilities, rurality is an important consideration and one that we always bear in mind in the NHS.

I appreciate my hon. Friend’s interest in the Budock hospital site and support her concern that best use be made of public sector land not only in releasing its monetary value, but regarding the availability of affordable homes for local people to live in. I understand that NHS Property Services has intervened to begin the process of facilitating a mutually beneficial resolution of the issues previously hindering the sale of this land to the local school. Those issues predate the transfer of ownership to NHS Property Services, and were between the former Cornwall and Isles of Scilly primary care trust and Falmouth school. Thanks to swift action since NHS Property Services took over control of the NHS estate, the issues are well on their way to being unlocked. NHS Property Services inherited a portfolio of 4,000 other properties from 161 disparate previous NHS organisations on 1 April, and a win-win resolution is now in sight.

I am sure we will have other debates on similar matters, so it is worth outlining to the House the role of NHS Property Services and some early successes that have occurred. On 1 April, NHS Property Services inherited about 4,000 NHS assets, including health centres, office accommodation, care homes and hospital buildings. It houses about 12,000 tenants and is valued at more than £3 billion. It also inherited more than 3,000 members of staff from former PCTs and strategic health authorities throughout England. This brand new organisation is already doing tremendous work in the face of this huge challenge to create efficient, fit-for-purpose facilities and services for the benefit of patients and the public. All too often in the past, there was an unacceptable variability in estates management—not just in this case, but throughout the NHS—by PCTs and SHAs. The advantage of having estate management under one central roof has already paid dividends throughout the NHS. The creation of NHS Property Services has generated an opportunity to explore options to bring together a fragmented system—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. May I just gently remind the Minister that this is a very tight debate? We are talking about one site; we should be dealing with Falmouth and nowhere else. There may be a good story to tell but we can save that for another day.

[Dr Poulter]

Indeed. Thank you, Mr Deputy Speaker, for bringing me back to the task in hand. There are many good stories to tell from other constituencies but you are quite right; we should focus on how successes in Ludlow and South Suffolk can be translated into success at the Budock hospital site.

The focus of NHS Property Services is about resolving some local planning concerns where PCTs have had difficulties in the past, which is what we are going to concentrate on. I understand that Falmouth school’s plans to purchase the Budock site pre-date the transfer of land to NHS Property Services on 1 April 2013. The school and the former Cornwall and Isles of Scilly primary care trust had previously agreed to enter into a land swap to release the school’s playing fields—which were difficult to access—for the hospital site. The NHS was then to dispose of the playing fields for housing land.

I understand that differences in the size and estimated value of the sites, and planning permission issues, had prevented both parties from reaching agreement to progress this proposal, which commenced some time ago in 2011.

The Government’s priority for easing the shortage of land for housing development is to see development take place in sustainable locations; the predominantly brownfield sites of some of the old NHS estate no longer used for clinical purposes can help bring forward land for affordable homes to be built for local families. The Budock site is brownfield land and is located in a settlement that is forecast to experience significant growth over the coming years, as my hon. Friend outlined.

The site was assessed under the Cornwall strategic housing land availability assessment and found to be suitable for approximately 100 dwellings. My hon. Friend will also be aware that Treasury guidelines on managing public money state that public sector organisations may transfer assets among themselves without placing the property on the open market, provided they do so at market prices. They also state that the organisations should work collaboratively on the transfer to agree a price, and that it is good practice to commission a single independent valuation to settle the price to be paid. My hon. Friend said that is the plan in this case.

I am pleased to report that NHS Property Services and the school have agreed that the original proposal can be revisited, with a planned joint instruction to the district valuer from both parties. NHS Property Services has agreed with Falmouth school that it will take the Budock hospital site off the market while reviewing the original land swap option. To enable both the school and NHS Property Services to deliver these proposals, support will be required from the local planning authority to ensure that a clear planning brief is available for both sites. I am sure my hon. Friend will be helpful in facilitating that accord. This will ensure that both organisations and the district valuer can understand and agree an estimated value for both sites.

This value can be demonstrated in land value and in wider community benefits such as housing, health and well-being, and education and leisure use. My hon. Friend eloquently outlined the many local sports and leisure groups that are hugely supportive of this project, and rightly so. The project will be for the sake of the local community and would be beneficial as well to the NHS through the profits from the land, which could be distributed elsewhere to support local NHS projects.

The potential outcome from this approach is a win-win situation for the local community, the school and the NHS. NHS Property Services will be able to maximise receipts from the sale of the current school playing fields for reinvestment in front-line NHS services. Falmouth school and the wider community will benefit from improved access to leisure facilities on the former hospital site, and much needed housing development in the Falmouth area will be brought one step closer. I understand that an initial report setting out the context and options for the proposed transaction can be delivered within six weeks. That will require the co-operation of the school, NHS Property Services and, importantly, the local planning authority. The report should set out a programme to include a target of three to six months for initial agreement, in the form of a contract to be reached for the transaction. This could take a number of forms, subject to the advice that both parties receive from the district valuer—contract for sale and option agreement.

This evening my hon. Friend has eloquently outlined the case for why the project should go ahead. I will of course be monitoring progress on the ground. The door is always open for her to come and see me if there are further problems or concerns. I am sure that her tremendous advocacy on behalf of her constituents will continue to unlock the potential of these proposals and make them a reality.

Question put and agreed to.

Care Bill

Dan Poulter Excerpts

Monday 20th May 2013 Written Statements

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

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

The Government, in collaboration with the Care Quality Commission, Monitor, NHS England and the NHS Trust Development Authority, are today issuing a joint policy statement to provide further information on the changes to the regulation and oversight of NHS trusts and NHS foundation trusts proposed in the Government’s initial response to the Mid Staffordshire NHS Foundation Trust public inquiry and related clauses in part 2 of the Care Bill.

The policy statement has been placed in the Library. Copies are available to hon. Members in the Vote Office and to noble Lords in the Printed Paper Office.

Regulation of Cosmetic Interventions

Dan Poulter Excerpts

Wednesday 24th April 2013 Written Statements

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

Today the review of the regulation of cosmetic interventions has been published. I wish to express my thanks to Sir Bruce Keogh, the chairman, and the other members of the review body for their report.

The Poly Implant Prothése (PIP) breast implant scandal highlighted the unacceptably poor quality of clinical practice in parts of the cosmetic surgery industry, as well as with other cosmetic interventions, including concerns about clinical safety and regulation. Sir Bruce Keogh, the NHS medical director, was asked in January 2012 by the then Secretary of State, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), to carry out a review of the regulation of cosmetic interventions. The review’s scope was broad, covering both surgical (e.g. breast implants) and non-surgical (e.g. “botox” injections) cosmetic interventions.

This review highlights how the rapid growth of the cosmetic interventions sector has outstripped the current legal framework, exposing people who undergo these procedures to a concerning lack of safeguards. It makes recommendations to improve the quality of care, to inform and empower the public and to ensure resolution and redress when things go wrong.

The review examined attempts at self-regulation to establish effective standards and found these wanting. It may be necessary, therefore, to consider new legislation or amendments to existing regulation for some of the recommendations. It may also be possible for much to be accomplished through revised professional standards and improved training.

I am supportive of the principal conclusions of the review, and the Government will make their formal written response to the recommendations before the summer recess.

“Review of the Regulation of Cosmetic Interventions—Final Report” 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.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 16th April 2013 Commons Chamber

[Christopher Pincher (Tamworth) (Con)]

4. What support his Department has given to local authorities and NHS commissioners to improve cardiovascular disease outcomes.

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

On 5 March, we published the cardiovascular disease outcomes strategy, which included 10 key actions for commissioners and providers to ensure patients and carers get the best possible support. As set out in the strategy, we will continue to make data available to local authorities to see where their areas of greatest need are and to shape their own response accordingly.

[Christopher Pincher]

Will my hon. Friend support the efforts of local clinicians, Tamworth borough council and charities such as Tamworth in the Community, which are working with parents, teachers and children to educate them about the importance of healthy eating and exercise, to deal with the health challenges we have in Tamworth and tackle the rather unfair notoriety that Tamworth gained in the press?

[Dr Poulter]

I commend the work being done locally in Tamworth to address this issue. As we know, one of the biggest public health challenges facing this country is obesity. The risk factors for cardiovascular disease include diabetes and high cholesterol. If we can tackle obesity and improve lifestyles, we will address both those risk factors directly, so I wish my hon. Friend’s local organisations every success in tackling those challenges.

[Keith Vaz (Leicester East) (Lab)]

As the Minister has said, those with diabetes are five times more likely than others to develop cardiovascular disease, which currently costs the national health service £9.8 billion a year. Will he commit to a public awareness campaign and issue guidelines for local health and wellbeing boards so that they make this a priority?

[Dr Poulter]

I commend the right hon. Gentleman’s work in raising the profile of diabetes. A lot of the Government’s work is focused on the importance of improving public health in this country and in particular on obesity, and if we are to tackle that we have to deal with diabetes. As a key part of that, we are now giving 40% of the public health money to local authorities to do exactly what he has just described: to focus money in the right places to tackle cardiovascular disease in those communities that most need it, particularly in inner-city areas.

[Greg Mulholland (Leeds North West) (LD)]

The role of local authorities in scrutinising NHS decisions is now even more important, yet the joint health overview and scrutiny committee of Yorkshire and Humber councils was consistently denied a number of important documents, which was one reason the High Court ruled that the decision taken in the Safe and Sustainable review was unlawful. This is now in tatters. Will the Minister now confirm whether he will instruct NHS England not to appeal the High Court decision?

[Dr Poulter]

Surely the validity of evidence is a matter for the court. I am sure my hon. Friend would recognise that there has to be a distinction between what we do here in Parliament and what is done in the courts. If NHS England would like to appeal the decision and if it thinks there are good grounds to do that, it must do that. The decision will then ultimately be made in the courts, on the basis of how valid that appeal is.

[Liz Kendall (Leicester West) (Lab)]

The best way to improve outcomes for heart disease patients and get the best value for public money is to help people to manage their condition at home. Will the Minister therefore explain the thinking behind the Government’s strategy of cutting one in five district nurses, so that delayed discharges from hospital due specifically to a lack of NHS community services rise by 40%, costing taxpayers £6 million a month as a result?

[Dr Poulter]

The hon. Lady and Opposition Members are fond of saying that we are cutting the NHS. It is their party that has said it will cut; they think it is irresponsible to increase funding for the NHS. We on the Government Benches have invested £12.5 billion more in the NHS. There are 6,000 more clinical staff working on the ground, focusing specifically on early intervention, early strategies and lifestyle. We now have almost 1,000 more health visitors working in the NHS and we have expanded the family nurse partnership programme. All these things will make a difference. Indeed, there is now a lot more joint commissioning between hospitals and primary care, to ensure that commissioning arrangements are in place better to support the role of community nurses and district nurses in preventive care and better look after people with long-term conditions.

[Mark Menzies (Fylde) (Con)]

6. What steps his Department plans to take to improve dementia diagnosis rates and to reduce regional variations in such diagnoses.

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[Mr Graham Allen (Nottingham North) (Lab)]

9. If his Department will make early intervention a priority for clinical commissioning groups and public health officers.

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

I commend the tremendous amount of work undertaken by the hon. Gentleman on early intervention. Yesterday, he and I attended the Early Intervention Foundation, which he has set up. We are talking a lot about legacies this week, and his legacy and the work that he has done to promote early intervention will certainly stand the test of time. The Government are committed to supporting that work, both through his foundation and through the work that we are doing to expand the family nurse partnership programme and the number of health visitors available to young families.

[Mr Allen]

I thank the Minister for those remarks, and I would like to thank those on both Front Benches for their support for the Early Intervention Foundation, which is greatly appreciated. Would the Minister accept that, in addition to having police and crime commissioners and councils promoting early intervention, the role of GPs, of directors of public health and of health and wellbeing boards will be absolutely central to getting early intervention plans and programmes to scale across the whole of England?

[Dr Poulter]

The hon. Gentleman is absolutely right. The health and wellbeing boards in particular will be well placed to bring together and join up what goes on in early interventions and to break down some of the silos that have existed in education, social services and health care. It is through the health and wellbeing boards that a lot of the work being done by health visitors and others to improve the life chances of many children, particularly those in the poorest communities, can be taken forward locally in a much stronger way.

[Andrew Bridgen (North West Leicestershire) (Con)]

What steps are being taken to encourage and help local authorities to focus on illness prevention and help people to lead healthier lives?

[Dr Poulter]

My hon. Friend will be aware that local authorities are now receiving 40% of the public health budget. That allows local authorities to have a much more nuanced approach to how and where they direct their budgets. It is of course desirable to focus on the early years to give each and every child the best start in life, to set good and healthy eating patterns and to support the work being done in the health service in expanding the health visitor programme. This also allows local authorities to address other public health challenges in the area by focusing, for example, on areas with high rates of teenage pregnancy, smoking or cardiovascular disease death.

[Mr Speaker]

I am grateful to the Minister, but we do have quite a lot to get through, so shorter answers would help.

[Mr Peter Hain (Neath) (Lab)]

What sort of early intervention have the Government ordered to prevent a contagious spread of measles from the outbreak in the Neath and Swansea area of more than 700 serious cases? Thousands of parents across Britain will have been tormented by the choice of whether to vaccinate their children for measles, mumps and rubella because of the scare. Surely the Minister should take serious action to instruct public health officials to combat this issue.

[Dr Poulter]

We are taking exactly that action to make sure that the vaccine is available and to promote the uptake of it. The right hon. Gentleman will of course be aware that the problems and concerns about the failure of some families to take up the vaccine resulted from some mis-used data in the past. That was a regrettable incident concerning the use of medical data, and is unfortunately causing great problems now. We are committed to making sure that those vaccines are available to the children who need it.

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

When it comes to early intervention with the one in 10 children in this country who have a diagnosable mental health problem, will the Minister confirm that it is the Government’s intention to ensure that those children all have access to talking therapies so that they get the right treatment at the right time, which will make a big difference for them?

[Dr Poulter]

In his time in office, my right hon. Friend did a tremendous amount to promote the cause of mental health and to get parity of treatment between mental and physical health. That is exactly what we propose to do with the money going into the talking therapies—to get in place those early interventions, not just for adults, but for children, too. We shall be taking that work forward in earnest in the years ahead.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Does the Minister agree that the most important form of early intervention is for the public to get prompt advice on their symptoms? Does he share my concern that a leaked report on the national performance of the 111 line shows that the service is in crisis with staff shortages, delays, abandoned calls, 11-hour waits for call-backs, staff being wrongly diverted to attend cats with diarrhoea and ambulance crews going without breaks for 12 or more hours? Is this not a trademark Government shambles?

[Dr Poulter]

The hon. Lady will be aware that it is important not to rush the roll-out of any service. That is why we kept in place the NHS Direct service in areas where rolling out the 111 service has been slower. A lot of good work is going on in early intervention; it focuses on giving local authorities the budget and the powers to make a difference to local communities. The Labour party should get behind that and do much more to support it. It is this Government who are making a difference in early years, and I hope that the Opposition can support us on that.

[Dan Jarvis (Barnsley Central) (Lab)]

10. When the Government plan to respond to the consultation on standardised packaging for tobacco products; and if he will bring forward legislative proposals on standardised packaging.

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

Following a referral from the joint Manchester and Trafford health overview and scrutiny committee, the Secretary of State requested initial advice from the independent reconfiguration panel. That was received on 27 March 2013. The Secretary of State will consider the advice and make a decision in due course.

[Kate Green]

This issue is of huge importance to my constituents, who are concerned about access to accident and emergency and acute services and about delays in discharge into the community in the absence of adequate community provision. So far, Ministers have refused to meet me so that I can make representations about my constituents’ concerns. Will the Minister give me an undertaking that no final decision will be taken until that meeting can take place so that local concerns can be properly taken into account?

[Dr Poulter]

I am sure that we would be happy to meet the hon. Lady; I am certainly happy to do so. A number of the concerns she has outlined in the House and at a local level will be taken into consideration by my right hon. Friend the Secretary of State when he considers the report.

[Mr Graham Brady (Altrincham and Sale West) (Con)]

I welcome the Minister’s undertaking to meet local Members to discuss these important matters and I endorse the comments made by the hon. Member for Stretford and Urmston (Kate Green) about the importance of a timely resolution. The longer this goes on, the greater the cost will be to local health services.

[Dr Poulter]

My hon. Friend is absolutely right, and it is important that a timely conclusion is reached. It is also right, as the hon. Member for Stretford and Urmston (Kate Green) said, that the need to improve community services and preventive care and to provide better support for people with long-term conditions in the Trafford area should be considered.

[Paul Goggins (Wythenshawe and Sale East) (Lab)]

I also welcome the Minister’s agreement to meetings. Will he and the Secretary of State carefully consider the likely impact of downgrading accident and emergency facilities at Trafford general and the implications for nearby Wythenshawe hospital? Does the Minister agree that a failure to provide proper facilities at Wythenshawe for the anticipated additional 4,500 accident and emergency patients, the additional admissions stemming from that and the extra beds required could lead to long delays and a diminution in the service?

[Dr Poulter]

My right hon. Friend the Secretary of State has visited Wythenshawe hospital and can pay testament to the high-quality care available there. All the points that the right hon. Gentleman has raised will, of course, be taken into account when a decision is made.

[Mrs Linda Riordan (Halifax) (Lab/Co-op)]

16. What steps the Government plans to take to improve public awareness of the signs and symptoms of early rheumatoid arthritis.

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[David Morris (Morecambe and Lunesdale) (Con)]

17. Whether there are plans to close the accident and emergency department at the Royal Lancaster Infirmary.

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

I would like to reassure my hon. Friend that there are no plans and never have been any plans to close the accident and emergency department at Royal Lancaster Infirmary.

[David Morris]

I thank my hon. Friend for that robust answer. Does he agree that the local Labour party fabricated the scare story that the A and E department was going to close? It was never going to close, as he has just stated. Will he assist me in taking the local Labour party’s bogus petition offline?

[Dr Poulter]

My hon. Friend is right to highlight the fact that it is wrong of any political party—in this case, the Labour party—to focus on scaremongering when there is no basis in truth. At no point have there been plans to close Royal Lancaster Infirmary.

[Mr Philip Hollobone (Kettering) (Con)]

18. What assessment he has made of (a) the pressures faced by Kettering general hospital’s accident and emergency department and (b) what can be done by Kettering general hospital to achieve national accident and emergency transition time targets.

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

Local health care commissioners have worked with the trust, Monitor and NHS England’s Hertfordshire and South Midlands local area team to ensure that robust plans are in place to improve the trust’s performance against accident and emergency waiting time performance indicators.

[Mr Hollobone]

The greatest difficulty for Kettering is that it has the sixth fastest household growth rate in the country, and A and E admissions are up 12% year on year. Will the Minister ensure that the NHS Commissioning Board makes sure that population estimates are put into its funding formula?

[Dr Poulter]

My hon. Friend makes a very good point. I will take up the matter further with the NHS Commissioning Board because it is important that when we are commissioning services we take into account future population growth.

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

Along with the hon. Members for Kettering (Mr Hollobone) and for Wellingborough (Mr Bone), I shall meet the chief executive and chair of Kettering general hospital this Friday to discuss the latest steps in the Healthier Together review. Does the Minister agree that it is important that we urge on Kettering general hospital and all the other decision makers that we must maintain our proper accident and emergency and other vital services at Kettering general hospital?

[Dr Poulter]

It certainly sounds as though there is a need for an accident and emergency department in Kettering. These are matters for the local commissioning boards to take forward, but it would be wrong for the hon. Gentleman or anyone else to say that as part of the Healthier Together programme there are any site-specific proposals that would in any way threaten Kettering accident and emergency department.

[David Rutley (Macclesfield) (Con)]

T1. If he will make a statement on his departmental responsibilities.

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

That is an absolutely extraordinary question given that it was the previous Labour Government’s decision to contract out out-of-hours services in the first place, which has led to the massive pressure on so many A and Es. The regulations in place for many of these arrangements were laid by the previous Labour Government.

[John Pugh (Southport) (LD)]

T9. What is the Department doing to deal with the difficulties presented by poor data sharing between health and social care agencies and the threat to integration that that presents?

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[Andrew George (St Ives) (LD)]

If there is a smidgeon of space in any of the Ministers’ diaries, is there a chance that they could meet me and representatives of the nursing profession to address not the issue that I think the Government are saying they are opposed to—mandatory nurse to patient ratios on wards—but that of adequate registered nurse levels on hospital wards?

[Dr Poulter]

Of course, I would be very happy to meet my hon. Friend to discuss this matter further. He can be reassured that I have regular discussions on these matters with representatives from the nursing profession, both in my clinical work and, more specifically, in my ministerial roles.

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

The Secretary of State said earlier that 1 million extra people are attending A and Es annually, but a few minutes later he said that the figure was 4 million. Which one is it?

Health Education England

Dan Poulter Excerpts

Friday 22nd March 2013 Written Statements

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

On 1 April 2013, Health Education England takes over responsibility for national leadership of health education and training and ensuring that the health work force has the right skills, behaviours and training, and is available in the right numbers, to deliver high-quality patient care. We have already announced our intention to establish Health Education England as a non-departmental public body at the earliest opportunity, as set out in the Draft Care and Support Bill.

The creation of Health Education England will bring together responsibility for education and training; the outcome of which will be a better work force planning, education and training system for health and public health, and one that is clearly focused on continually improving the health of the public and services for patients.

Given the findings of the Francis report and the importance of reflecting the changes and improvements required in the recruitment, training and education of NHS staff in the Government’s response, the full mandate for Health Education England will be published at the end of April.

Erdington Walk-in Centre

Dan Poulter Excerpts

Tuesday 5th March 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 second time, Mr Weir, and to reply to the hon. Member for Birmingham, Erdington (Jack Dromey), whom I congratulate on securing this debate. I acknowledge his hard work on behalf of his constituents in campaigning for the retention of Erdington walk-in centre, and the strength of feeling locally, which he eloquently outlined.

Before I move to the local context, it would be remiss of me not to pick up the issues of national consequence raised by the hon. Gentleman. This Government will have invested £12.5 billion more in the NHS between the last election and the one in 2015, which is providing some, albeit small, real-terms growth in the NHS budget. Even though we are in difficult economic times, the Government have made a clear commitment that the NHS is a special case that needs further investment, which we are providing. It might be worth the hon. Gentleman taking that up with one of his Front-Bench colleagues, the right hon. Member for Leigh (Andy Burnham), who in contrast said that such investment was irresponsible. Indeed, the Labour party running the NHS in Wales intends to make an 8% real-terms cut in its budget. It is worth reflecting on the reality of the situation before getting drawn into any political rhetoric.

The hon. Member for Birmingham, Erdington is right to raise the specific pressures on A and E. We know that A and Es are being accessed by increasing numbers of patients, and we know from history that one key driver of that was the previous Government’s decision to contract out-of-hours GP care away from local GPs. One direct consequence of that has been additional pressures on accident and emergency departments. In many ways, that pulls against what he spoke about and what I believe in, which is the need to deliver more and higher quality care in the community. That cannot be nine-to-five or nine-to-six care in the community; it has to be all-day, 24/7 care, which is what integrated good health care looks like. I believe that the decision was bad. I saw its consequences when I worked as a casualty doctor in A and E. We have lived to regret it, and it has been badly to the detriment of patients.

The report on the Mid Staffordshire NHS Foundation Trust graphically outlined the fact that targets have often got in the way of front-line patient care. That is why this Government, when they came to power, relaxed the 98% target for the four-hour wait in A and E and set it at 95%, which doctors, nurses and my fellow health care professionals said was in the best interests of patients. Too often the four-hour target meant that a patient who perhaps had a broken toe was given priority ahead of a patient with potentially life-threatening chest pain. That was not good medicine or patient care, but showed targets getting in the way of looking after patients effectively, a lesson that was graphically depicted in the Francis report on the Mid Staffordshire trust. We must learn such lessons and acknowledge that although targets can have a place in health care, we have to trust and listen to front-line health care professionals if we are to deliver high-quality care for patients.

On the national context of urgent care and accident and emergency care, the Government are committed to developing a more coherent 24/7 urgent care service in every part of England. That will provide universal access to high-quality 24/7 urgent care services, so that whatever people’s needs or location, they will get the best care from the best person in the best place and at the right time.

The NHS has always had to respond to patients’ changing expectations and advances in medical technology. As lifestyles, society and medicine continue to change, the NHS will also need to change. The reconfiguration of urgent care services is therefore about modernising the delivery of care and facilities to improve patient outcomes, develop services closer to home and, most importantly, save lives. We are clear that, as the hon. Gentleman outlined, the reconfiguration of front-line services is a matter for the local NHS. That was the previous Government’s policy and is this Government’s policy.

Services should be tailored to meet the needs of the local population. We expect proposals for service changes to meet four tests: to demonstrate a clear clinical evidence base underpinning any proposals, focusing on improved outcomes for patients—in other words, to save lives—and to show clear support from GPs as the commissioners of local health-care services, strengthened arrangements for public engagement and support for patient choice. Even when all those tests are met, if the responsible local authority is concerned about a decision, it will have the option to refer such a decision to the Secretary of State.

Our vision for urgent care is to replace the ad hoc, unco-ordinated system that has developed over the past few years—characterised by poor quality and too much variation in care throughout the country—with a more consistent system that delivers improvements in patient care. The Government are committed to putting GPs in charge of commissioning urgent care services. We believe that empowering GPs and other health professionals will achieve better and more patient-focused services.

It would be wrong not to talk about the winter pressures faced by the NHS. In response to those pressures, we have put about £330 million of additional money into the NHS to deal with them. I am aware that local hospitals in the Birmingham area recently issued a statement advising patients to attend A and E only for matters requiring urgent attention, because of the pressures of demand experienced by emergency departments. There is always more pressure on the NHS during winter months, with more demand on urgent and emergency care services, and this year is not different. During October and November 2012, NHS Midlands and East scrutinised winter plans, escalation triggers and protocols across its health economies, and it is monitoring pressure on health services during the winter across the whole of the strategic health authority area to ensure that patients continue to have access to high quality NHS care in Birmingham and elsewhere.

I turn to the local context, which is obviously of importance to the hon. Gentleman and his constituents. He is a tremendous advocate for his constituents, and has eloquently outlined some of the local concerns, which relate to an NHS review of urgent care provision in Birmingham and Solihull. The clinical commissioning groups in the area are developing an urgent care strategy to improve access to and integration of services for people with urgent health care needs, to make the system simpler to navigate and to avoid duplication.

I understand that local commissioners have engaged stakeholders in the process, and they include clinicians, patient groups, providers and health overview and scrutiny committees. The local NHS has collected evidence from local people to understand the usage of current urgent care services, such as walk-in centres.

The hon. Gentleman will be aware that the local NHS is now developing a draft strategy outlining some initial options. However, it is important to make it clear that as yet no decisions have been made. That is for local determination, and it would not be appropriate for me to comment further on the detail of the urgent care review.

I am assured by the local NHS that engagement with local people and other stakeholders will continue over the coming months to ensure their input in the final proposals ahead of the formal consultation later in the year. Of course I expect any proposals to meet, where appropriate, the four tests for service change.

I understand that the hon. Gentleman met representatives of Birmingham CrossCity CCG in December 2012 to discuss the review, and I encourage him to continue engaging with local NHS staff on the matter.

[Jack Dromey]

It is certainly true that we had a meeting in December and that it was clear beyond any doubt that there was a real threat to both the walk-in centres. A commitment was given that by the end of January there would be a route map of the next stages of process and engagement, but here we are in the first week of March and it has yet to be produced. The suggestion now is that it might not be with us until mid-April at the earliest. Although I understand what the Minister is saying in good faith about the importance of proper engagement with the community, I have to say that those responsible in the national health service in Birmingham have been dragging their heels.

[Dr Poulter]

The hon. Gentleman is right to say that when there is talk of service change, effective engagement is important and must be dealt with in an expedient manner. There must be an awareness that the prospect of any change can lead to understandable concerns among both staff and patients. A time of change is always potentially unsettling. I know that he, like me, will want to encourage the CCGs to come to the table and address this matter more effectively than they have done. I will endeavour to ensure that there are representatives from the CCGs at the meeting that we have later in the month, as that will be an effective way of helping to facilitate matters and bring them to a more speedy resolution.

In conclusion, I encourage local people in Birmingham and Solihull and their elected representatives, including the hon. Gentleman, to participate in the engagement process and subsequent consultation to ensure that their views are taken into account. I look forward to meeting the hon. Gentleman later this month to ensure that we do all we can to facilitate a speedy resolution of the matter and to ease these times of uncertainty that are faced by his constituents.

Health Professionals: Regulation

Dan Poulter Excerpts

Monday 4th March 2013 Commons Chamber

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

I congratulate my hon. Friend the Member for North East Cambridgeshire (Stephen Barclay) on securing the debate. He made a number of serious allegations, but he was absolutely right to say that it is completely unacceptable to manipulate any patient information deliberately in order to falsify reports of a trust’s performance, and there will be serious consequences for any part of the NHS that is found to be doing so. He was right to say that if we are to have an open and accountable NHS in which patients and the public know how hospitals are doing, the hospitals must be open and honest about their performance.

My hon. Friend was also right to say that we want the NHS to have the lowest mortality rates in Europe. Sir Bruce Keogh, the NHS medical director, is currently leading an investigation into hospitals with higher mortality rates to understand why they are higher and whether they have all the support they need to improve. To pick up on the point that my hon. Friend the Member for Bristol North West (Charlotte Leslie) raised in her intervention, that will involve senior clinicians with background expertise going into those hospitals to ensure that proper scrutiny is brought to bear.

[Charlotte Leslie]

Will the Minister give way?

[Dr Poulter]

I will, very briefly, although my hon. Friend did not notify me previously that she intended to intervene.

[Charlotte Leslie]

I thank the Minister for his courtesy and apologise for not notifying him in advance. Does he have any indication of where our current mortality data lie in relation to comparable countries and, if not, will he speak with Sir Brian Jarman of the Dr Foster website, because I believe that he has some rather depressing news on that front and it is probably time to start speaking the truth about that as well?

[Dr Poulter]

I thank my hon. Friend for her intervention. We have made it clear, both in opposition and in government, and indeed in the health care mandate, that we do not find it acceptable that Britain, compared with some other European countries, is not doing well when it comes to survival rates for a number of diseases, including some types of cancer and some respiratory diseases. We all know that the NHS must achieve more in that regard. It is not necessarily an isolated issue that applies to one particular trust. That is why we made it a priority in the NHS mandate set by my right hon. Friend the Secretary of State for Health at the end of last year, but the priority should be clinical outcomes, and a key priority is improving mortality for a number of diseases, particularly those that are attributable to patients with long-term conditions.

I thought that it might be worth discussing in more detail a few of the points my hon. Friend the Member for North East Cambridgeshire raised. He talked in particular about the Francis report. For everybody who cares about the NHS and works in it, as I still do, the day the Francis report was published was a humbling one. There was failure at every level: a systemic failure, a failure of regulation, a failure of front-line professionalism, a failure of management and a failure of the trust board. There are systemic problems with the NHS that we need to focus on and address. That is what my right hon. Friend the Secretary of State will outline when we give our further response to the Francis report later this month.

My hon. Friend the Member for North East Cambridgeshire was also right to highlight that there has been too much covering up in the past and not enough transparency. If we are to put right some of the systemic failings highlighted in the Francis report, we need to be grown up enough to acknowledge that sometimes the NHS does not come up to standard and the care that we would expect to be delivered to patients is not always good enough. If we care about our NHS, and if we want an NHS we can continue to be proud of and that will continue to be the envy of the world, we must acknowledge when things go wrong and ensure that we face up to the problems in an open and transparent way. We must ensure, as many hospitals with a more transparent culture do, that good audit and proper incident reporting are in place for when things go wrong. We must ensure that, rather than having recriminations and closed doors, bad things are learned from, and that where things have gone wrong and patients have not been treated properly, hospitals and the whole the NHS make more active efforts to deal with problems and failures of care.

[Dr Julian Lewis (New Forest East) (Con)]

I thank the Minister for his courtesy in giving way. It might be helpful, Mr Speaker, if you would give us guidance on whether pre-notification is still required. What the Minister says is all well and good but why is it, after so many people died in such an unacceptable way, that nobody seems to have carried the can or taken responsibility?

[Mr Speaker]

Order. I thought, in the circumstances, that I would let the debate flow, but for clarification I ought to say that there is a requirement that a Member who wishes to make a speech in someone else’s Adjournment debate secures agreement in advance, but there is no such requirement—this point is widely misunderstood—in respect of an intervention. It is purely for the Minister to decide whether to take an intervention. No impropriety has been committed by the hon. Member for Bristol North West (Charlotte Leslie); her virtue is unassailed.

[Dr Poulter]

Indeed, and thank you, Mr Speaker. I will, of course, do my best to take as many interventions as possible, but my hon. Friend the Member for New Forest East (Dr Lewis) will be aware that I have been generous so far and that the time allotted to Adjournment debates means that it is difficult to give as full an answer as possible to interventions. For that reason, it is useful to have some notice that an hon. Member intends to intervene.

My right hon. Friend the Prime Minister made the point clearly, as did Robert Francis in his report, that it was not for the Francis report to highlight individuals or blame them for what happened; the report was about ensuring that there was a clear acknowledgement that there had been systemic failure, which I talked about earlier. It was a failure of professionalism on the front line; a failure of the trust’s board; a failure of regulation and the regulators; and a failure of management at the trust. When systemic failure occurs, it is right that we put in place systemic solutions, and that is what my right hon. Friend the Secretary of State will do later this month.

My hon. Friend the Member for North East Cambridgeshire made the key point that a real culture change was required, and that that is about having transparency and openness in the NHS. He is right to highlight those points. If we want transparency and openness, we need to look at some of the steps that have already been taken. We know that the Public Interest Disclosure Act 1998, which in theory gives protection to whistleblowers and people who want to speak out, has not been effective. Legislative approaches have not been enough to ensure that people feel free to speak out. Legislation has so far not been effective in creating that culture of openness and transparency that we all believe is necessary.

However, we have seen two things in the past six months that will make a real difference, the first of which is the contractual duty of candour, which will be introduced in the NHS for hospital trusts. It will mean that there is support for openness and transparency as part of the NHS contract. The second is the strengthening of the NHS constitution, which brings direct support to the cause of whistleblowers. Those things will be further strengthened in our further response later in the month to what happened at Mid Staffordshire.

[Stephen Barclay]

I very much welcome the Minister’s assurance that there will now be changes for whistleblowers. I repeatedly raised my concerns with Sir David Nicholson in the Public Accounts Committee, so why did he continually tell me that there was no problem with the guidance or the legislation, and that adequate protection was in place for whistleblowers? The Minister is now accepting the need for change, but why did the chief executives tell me that there was no problem?

[Dr Poulter]

I say to my hon. Friend that the Department of Health has, like everyone who works for it, made it clear that gagging clauses are not and have never been acceptable in the NHS. There is a distinction to make between confidentiality clauses, which might be part of any financial settlement with anyone who works in either the commercial sector or the public sector, and a gagging clause. It is the duty of any front-line professional, according to and as part of their registration with the General Medical Council or the Nursing and Midwifery Council, to speak out when there are issues of concern. That is a part of good professionalism. That is what being a good professional is about. It is about someone saying that they recognise that there has been unacceptably poor care in a hospital or a care setting and that they have a duty, because they are a registered doctor or nurse, to speak out to highlight where problems have occurred. The point is that at Mid Staffordshire there was clearly a failure of that professionalism not only on the front line but at every level. Gagging clauses have never been considered by the Department of Health, certainly under the current Government, to be an acceptable part of the NHS. That was made very clear in a recent letter written by my right hon. Friend the Secretary of State to NHS hospitals and chief executives.

[Dr Phillip Lee (Bracknell) (Con)]

On the subject of gagging clauses, did the settlement that formed part of the severance payment of the former chief executive of Mid Staffs include a gagging clause? If the Minister cannot tell me that today, will he put it in writing?

[Dr Poulter]

I shall endeavour to write to my hon. Friend to clarify as I do not have the information immediately to hand. That does not detract from the fact, however, that a gagging clause in any form is unacceptable to this Government, should be unacceptable to everybody in this House and is unacceptable to every doctor and nurse who works in the NHS. We will continue to do all we can through the contractual duty of candour and through strengthening the NHS constitution to make it easier for NHS staff to feel that they can speak out openly and feel supported in doing so, so that we have an open and transparent NHS of which we can be proud.

My hon. Friend the Member for North East Cambridgeshire also raised a very important point about open and transparent data on surgical outcomes. It was Professor Sir Bruce Keogh, the current NHS medical director, who put together the purple book of cardiac surgery, which has made a huge difference through greater transparency of outcomes in that specialty. That was in reply to the findings of the Bristol heart surgery inquiry, and it is regrettable that we have not seen similar advances in openness and sharing of data in other specialities in the NHS. That is not necessarily because the data do not exist, because they often do. In some specialties, such as urogynaecology, national databases are being put together to consider the long-term data on certain operations, which, to some extent, will give data on individual surgeons.

In the NHS, we often have a plethora of data and a lot of audit information that is collected at a local level, and we must ensure that those data are used in a better way in future. A lot of work can be done to add transparency and to share audit data in different trusts so that they are openly comparable to build a national picture of certain types of care and how we can improve patient care. That was a good point that was well made, and I know that Sir Bruce Keogh is continuing and will continue to develop that work in his role on the NHS Commissioning Board. I had a very encouraging meeting recently with a number of senior surgeons who recognise the importance of such work in their specialties. I am sure that the NHS will continue to develop it at a greater pace in the future, not least because of what we have heard from the Mid Staffs inquiry.

In conclusion, throughout the debate the point has been made that we have legislation in place to protect whistleblowers, but it has not been effective—[Interruption.] My hon. Friend the Member for Bracknell (Dr Lee) says from a sedentary position that it does not work. He is absolutely right—it has not been effective and that is why we are considering the Mid Staffs inquiry and the issues of culture that have existed and that have failed and let down patients. We will have a robust response to those failings to put right what has gone wrong and to ensure as best we can that another Mid Staffs will never happen again in the NHS. I am sure that we will all support what our right hon. Friend the Secretary of State says in his further response later this month.

Question put and agreed to.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 26th February 2013 Commons Chamber

[Jeremy Corbyn (Islington North) (Lab)]

5. What recent discussions he has had with the Whittington hospital on the proposed disposal of its assets and reductions in medical and non-medical staff.

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

This is a matter for the local NHS, in particular the Whittington Hospital NHS Trust. Neither the Secretary of State nor the ministerial team have met with the trust recently on this subject.

[Jeremy Corbyn]

That is a disappointing reply from the Minister. Is he aware that the Whittington is a successful, popular, local district general hospital, yet, as part of its application to become a foundation trust, it is proposing to: sell off a quarter of its land; make 500 of its staff, including many nurses, redundant; and reduce the number of beds to 177, roughly half the current figure? This is, apparently, to provide a better service to the community, a point totally lost on the thousands of local people who are angry at the reduction in their hospital services. They see it as a prelude to its ultimate closure as a district general hospital with an A and E department. Will the Minister take an interest and perhaps intervene to protect a very good local hospital from this not very sensible plan?

[Dr Poulter]

The hon. Gentleman is right to highlight the fact that the trust has handled this issue badly at a local level, but, as he will know, decisions about local health care reside with local trusts. The point is this: if we look at the plans, the trust is talking about selling off land that is mostly not used for clinical purposes and reinvesting that money in front-line patient care: investing £10 million in improving the maternity department, which has already benefited from £750,000 from the Government only this year; £2.9 million in the same-day treatment centre to support A and E and treat patients faster; and £1.9 million for a new undergraduate education centre and library. Those assets are being sold off to directly influence and improve patient care, which has to be a good thing.

[Ms Diane Abbott Hackney North and Stoke Newington) (Lab)]

Is the Minister aware of how angry and concerned Londoners are about the threats to their health service—not just about the £17 million property sales at the Whittington and the drop in bed numbers, but about the threat to four A and Es in north-west London and, of course, the A and E in Lewisham? Ministers have accused campaigners of overstating the case. Is that not a complacent attitude? Surely doctors and residents on the ground know the value of these services better than Ministers in Whitehall. Is he aware that Londoners came out in unprecedented numbers to fight for Lewisham hospital and will continue to fight for the best possible NHS services in our region?

[Dr Poulter]

The hon. Lady is absolutely right to highlight the fact that service changes have to be clinically led, meet the tests we have outlined and engage with communities effectively, but the point is that the previous Government also redesigned and changed services, very often for the benefit of patients. When the redesign of services is clinically led and services are better delivered for patients, that has to be a good thing so let us look at these proposals. If they are clinically led, let us see whether they deliver improved care for patients, and if they do, it is the right thing to do.

[Kelvin Hopkins (Luton North) (Lab)]

6. What assessment his Department has made of harm caused to babies by alcohol consumed during pregnancy; and if he will make a statement.

--- Later in debate ---

[Karl MᶜCartney (Lincoln) (Con)]

9. What recent discussions he has had with officials in his Department on the forthcoming NHS investigation into mortality indicators.

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

Ministers have discussed the terms of reference for the review of hospitals that have been highlighted as outliers for the last two consecutive years using nationally published mortality indicators. The terms of reference were published by Professor Sir Bruce Keogh on Friday 15 February.

[Karl MᶜCartney]

Just over a year ago, I asked the previous Secretary of State a question about gagging orders and the specific case of Mr Gary Walker, the former chief executive of United Lincolnshire Hospitals NHS Trust. In the light of the recent news that our local health trust is now being investigated amid concerns over patient safety, what assurances can the Minister give the House that such Stalinist gagging orders, which have cost the taxpayer £15 million in the past few years, will be outlawed as soon as possible, to ensure that, under this Government, it will not take 81 requests to ensure that patient safety is paramount?

[Dr Poulter]

My hon. Friend is absolutely right to highlight the fact that all staff in the NHS should feel able to speak up and raise concerns about patient safety, so that the organisations for which they work can take up their concerns and investigate them. He will be aware that the people who raise such concerns are protected under the Public Interest Disclosure Act 1998.

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

Last week I visited Salford Royal hospital, which has the lowest death and weekend mortality rates in the north-west, and the seventh lowest in the country. It is interesting to note that Salford also has higher ratios of nurses per in-patient bed, and that individual wards in the hospital publish data on their rates of MRSA, ulcers and falls. Does the Minister accept that good practice at hospitals such as Salford Royal should be investigated alongside the poor practice and high mortality rates in other hospitals?

[Dr Poulter]

The hon. Lady is absolutely right. That is exactly what the review is about. It is going into the 14 hospitals in which concern has arisen over mortality data, looking at the practices there and commissioning a peer review of them from leading clinicians and patient groups. That will help to raise standards of practice where required.

[Sir Peter Tapsell (Louth and Horncastle) (Con)]

In supporting the points that have just been made by my hon. Friend the Member for Lincoln (Karl MᶜCartney), may I tell the Minister that, as he might expect, there is considerable anxiety among my Lincolnshire constituents over the fact that the United Lincolnshire Hospitals NHS Trust has a higher than average mortality rate? Will he tell us when the promised review of the situation will begin, and who will be conducting it?

[Dr Poulter]

To reassure my right hon. Friend, the review is being carried out and led by Sir Bruce Keogh, the NHS medical director. We are already well under way in implementing the review. It should be in place by the very early summer to inform Members of this House and to make improvements to patient care at the local trust level.

[Ian Austin (Dudley North) (Lab)]

People in Dudley were concerned to discover that higher than average mortality rates have led to Russells Hall hospital in my constituency being investigated. I have written to Sir Bruce Keogh to ask whether he or a member of his team will meet me to discuss the inquiry, so that we can find out exactly what has been going on and local people can provide information to it. How does the Minister think that things at the hospital will be improved when nurse numbers in the NHS are being reduced, waiting lists at the hospital have gone up by 177% and the NHS in Dudley has had to spend £20 million on a costly and bureaucratic reorganisation instead of on improving front-line care?

[Dr Poulter]

I had thought that the hon. Gentleman had risen on a consensual note, raising his constituents’ concerns—and he was right to do that. The review is about making sure that any failings in care in local trusts are picked up and improved. The fact of the matter is that waiting times are down under this Government in comparison with the previous Government and many more additional clinical staff are working in the NHS—about 2,000 more than under the previous Government. At the same time, we have cut 18,000 administrative and management posts, and the money from that is being reinvested in front-line patient care.

[Mr Speaker]

If the hon. Member for Crawley (Henry Smith) wishes to come in on this question, he may, but he is not obliged to do so.

--- Later in debate ---

[David Mowat (Warrington South) (Con)]

10. What assessment his Department has made of the effect of hospitals built under the private finance initiative on the work of neighbouring hospitals.

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

This Government recognise that no hospital operates in isolation. We are providing seven NHS trusts that are facing difficulties as a result of PFI agreements with access to a £1.5 billion support fund to pay for extra costs accrued as a result of those damaging PFI schemes.

[David Mowat]

I apologise for my voice—perhaps I shall soon be interacting more directly with the NHS.

The Warrington and Halton hospital has independent trust status. It is busy and getting busier. The previous Government built a huge PFI hospital about 10 miles away at Whiston, which does not have the patient volumes to sustain the demands of the botched PFI deal. It is heavily loss-making. Will the Minister provide assurance that there will be no forced merger and that my constituents will not pay for a bad decision made a decade ago?

[Dr Poulter]

I thank my hon. Friend for his question. He is right to highlight the very damaging PFI scheme signed by the previous Government for the St Helens and Knowsley NHS Trust. The percentage of annual turnover going on PFI payments at the moment is 14.2%. That is unsustainable, which is why this Government are trying to sort out the mess created by the previous Government’s signing up to too many PFI agreements.

[Mr Nick Raynsford (Greenwich and Woolwich) (Lab)]

The Minister will be aware that support for excess PFI costs was an important element in the report of the trust special administrator in south-east London, to which the Secretary of State referred in an earlier exchange. That recommendation was widely welcomed. However, as I highlighted in questions a month ago, the Government have not accepted the financial recommendations of the trust special administrator for the capital costs and the transitional costs inherent in his recommendations. If the Government wish to proceed with these changes, will the Government agree to meet those costs as well?

[Dr Poulter]

The right hon. Gentleman is in dangerous territory talking about PFI schemes to which the previous Government signed up. No hospital operates in isolation. The South London Healthcare NHS Trust was paying out 13.9% of its turnover on the PFI. That was unsustainable. It has caused huge difficulties in the local health care economy and affected patient care, which was a very bad thing to do. The right hon. Gentleman needs to recognise that this Government are providing £1.5 billion-worth of support to many trusts that have struggled under these PFI agreements—

[Mr Speaker]

Order. I am grateful to the Minister, but we have many questions to get through and the answers are sometimes just too long.

--- Later in debate ---

[Nick Smith (Blaenau Gwent) (Lab)]

On performance data, what plans does the Minister have to expand the friends and family test so that it provides the reasons for patients’ views and real-time feedback on their experience of services?

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

I thank the hon. Gentleman for his question. The friends and family test will give real-time feedback about patient services, but we need to ensure that the data from the test are used effectively by local trusts and scrutinised by the Care Quality Commission and other organisations so that they can go in if there are problems to ensure that they stand up for the rights of patients.

[Alun Cairns (Vale of Glamorgan) (Con)]

T7. Kevin Davies, a constituent from Cowbridge, visited my surgery yesterday. He is a prostate cancer patient and robotic surgery was deemed to be the most appropriate form of care. Unfortunately, robotic surgery for prostate cancer is not available in Wales and he was forced to travel to Bristol and pay £15,000 for the treatment. Will my hon. Friend agree to work with the Welsh NHS either to come up with a formal agreement whereby facilities are available to Welsh NHS patients or to press it to invest in its own facilities?

[Helen Jones (Warrington North) (Lab)]

The Prime Minister promised a fight to save district general hospitals, yet the Secretary of State’s recent decision on Lewisham suggests something completely different. Will the Secretary of State therefore give the House an assurance that the north Cheshire hospitals trust will not be forced into a merger or to downgrade its services because of financial problems elsewhere?

[Dr Poulter]

I know that the hon. Lady had tabled a question on this matter. The point is that a foundation trust has autonomy and cannot be coerced or forced into a merger. It is for the board of that trust to make decisions for the benefit of patients.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

T8. Patients in Suffolk are very worried about the performance of the ambulance service. In the past two months, less than 60% of ambulances have hit the target for reaching emergency cases. The strategic health authority and others, including all the MPs in the region, are not happy about that. Will the Government intervene, too?

--- Later in debate ---

[David Tredinnick (Bosworth) (Con)]

May I alert my right hon. and hon. Friends to the recently published road map for complementary and alternative medicine in Europe, which cost the European Commission £1.5 million? Will they look at it carefully to see where services can be extended in our own national health service?

[Dr Poulter]

I assure my hon. Friend that we will look carefully at anything that he wants to put forward, but any treatment on the NHS needs, of course, to be evidence-based.

[Helen Goodman (Bishop Auckland) (Lab)]

Every year 18,000 epileptic fits are triggered by video games and screen-based activity. Can the ministerial team tell us what research is being done on that and what discussions they have had with the industry to make video games safer and improve the labelling?

Health Committee's Report on the General Medical Council (Government Response)

Dan Poulter Excerpts

Monday 25th February 2013 Written Statements

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

We have today laid before Parliament the “Government response to the House of Commons Health Select Committee’s report of Session 2012-13: 2012 accountability hearing with the General Medical Council” (Cm 8520).

This Government welcome the Health Select Committee recommendations contained in this report, and would like to thank the Committee for its work.

The Government’s Command Paper, “Enabling Excellence” (Cm 8008), published in February 2011, sets out a comprehensive strategy for ensuring that professional regulation systems are robust and made it clear that the Government would like to see more effective accountability for the health professions regulatory bodies. We have taken forward the recommendations made in this report and its predecessor and the changes to the Responsible Officer regulations, subject to parliamentary approval, will be introduced in April 2013. The Government plan to consult on giving new powers to the General Medical Council to check the language skills of all doctors, through amendment to the Medical Act.

It is right that the independent bodies responsible for ensuring public protection through the regulation of healthcare professionals are held to account effectively by Parliament.



Copies of the Government’s response are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office. The report is also available at: www.dh.gov.uk/health/2013/02/hsc-response/.

Accident and Emergency Provision (North-East)

Dan Poulter Excerpts

Wednesday 13th February 2013 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Crausby. I congratulate the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) on securing the debate and I thank all hon. Members who have come to advocate their constituents’ needs. The hon. Gentleman and I met earlier this year to talk through some of the problems and challenges in his local area. We discussed some of the individual cases that he has highlighted today, which we all agree to be unacceptable, in particular the case of one of his constituents who experienced a completely unacceptable 11-hour delay as a result of problems with getting the high-quality care they deserved.

There are several interacting issues: the ambulance service, the local A and E response, and the services provided at local A and Es. One key theme, as the hon. Gentleman and I discussed when we met, and as his speech made apparent, is the need to fundamentally change and improve how the NHS looks after older people. That point was brought home vividly last week by the report on the Mid Staffordshire NHS Foundation Trust. In addition, at the end of last year the Dr Foster hospital guide found that 30% of older people in hospital should not be treated there, and that more community-based support was needed. When we met, the hon. Gentleman rightly stressed the important role that local, smaller health care providers, in Guisborough and East Cleveland and elsewhere, can play in providing better community-based care. When people do not need to be in A and E in the first place, it is better for them to be looked after in their homes and communities, and it also brings financial benefits to the NHS. For older people, being admitted to hospital when they do not need to be there is distressing, and their length of stay tends to be much longer.

The hon. Gentleman threw down this challenge: will the changes being made to the health care system nationally put us in a better place to deal with the long-term challenge? The answer to that is yes, and I will briefly deal with that point before I come on to the local challenges that he has outlined.

Why do we need to change what we are doing in the NHS? I have set out clearly that we must do better, by keeping people well in the community. Before I came to the debate, I was talking, over the river at St Thomas’ hospital, about how we must improve children’s health, better look after children with long-term conditions, ensure that children with asthma and diabetes who do not need to be in hospital are not there in the first place, and provide better community-based care. Such improvements are particularly important for the care of the elderly. From April, we will put 80% of the NHS budget into the community, with clinical leadership through doctors and nurses. That is a strong step in the right direction of focusing on community-based and preventive care. I believe that we should all regard that as a good way forward.

[Pat Glass]

My recent experience reflects what the Minister has said. Older people who stay in hospital for long periods of time come out able to do less for themselves because things are done for them in hospital. When my father came out of hospital after five weeks, he was able to do far less. Will the transfer of funding into the community prevent that from happening? Will it allow people like him to be supported at home so that they do not have to spend long periods of time in hospital and come home with less mobility?

[Dr Poulter]

The hon. Lady makes a good point. A prolonged period of bed rest can have a huge impact on an older person’s mobility and their ability to look after themselves. The challenge, as she rightly outlines, is to get more support in the community. Putting the budget in the community is a step towards the provision of more preventive care, more community-based care and more care that keeps people, particularly older people, better supported and looked after in their homes.

The other challenge is to achieve a more joined-up approach between secondary care in an acute hospital—such as James Cook hospital—and care in the community. There is sometimes too much silo working, and we need to break that down and develop a more joined-up approach to care. That might be done, for example, through intermediate care teams that operate out of a hospital, who will help through physiotherapy and occupational therapy. When an older person arrives in A and E, we need immediately to gear up the right support in the short and longer term to enable them to go home more quickly. That is an important part of a more integrated and joined-up approach to ensure that an older person can be effectively supported and looked after at home if that is right for them. It is important that we get that more integrated approach across the whole country.

On local issues, the hon. Gentleman highlighted two-hour handover delays, which are clearly completely unacceptable. In my experience, the fault for handover delays might lie in two areas. First, the triaging system in a hospital might need to be reviewed to ensure that ambulance handovers are dealt with more promptly and quickly. Secondly, a delay in ambulance handover results in ambulance crews and ambulances being pinned down in A and E when they need to be back out on the road elsewhere. I know that the hospital will want to look at that closely.

In relation to having more community-based care, sufficient community-based resources must be available to better support people with day-to-day health care needs in the community, so that they are not forced to pitch up at a hospital’s main A and E department. At our meeting, the hon. Gentleman and I discussed the fact that the opening hours of the urgent care centres at Guisborough and East Cleveland hospitals are now 9 am to 5 pm during the week and 8 am to 8 pm at weekends, which has made it difficult for local people to access local health care service and created pressure on A and E departments. Having spoken to the trust, I am pleased to report that job interviews will be held on, I believe, 25 February for specialist nurse and other posts at those hospitals, with a view to extending the opening hours again in the future.

[Pat Glass]

I make a special plea on that issue. Weardale, in my constituency, is in one of the remotest parts of the country, but 5,000 people live there. Their out-of-hours GP service is at Bishop Auckland hospital, which for some of them is 20 miles away across roads that are among the most remote in the country, and particularly difficult to use in winter. Will the Minister look at that?

[Dr Poulter]

Absolutely. Sir Bruce Keogh will be conducting a review of emergency and other urgent care services, in which A and E services will not be lumped into one category but will be considered in a more nuanced way, reflecting the fact that rural communities face particular challenges. The review will consider how out-of-hours care, urgent care and emergency care should be delivered in such areas to take into account the rural nature and the distances that people have to travel. In some cities, there is a lot of A and E provision, but in other, more rural parts of the country where people have to travel further that is not the case. I am pleased that Sir Bruce will take that into account in his review.

[Pat Glass]

Will that review also cover services such as ambulance services? There are real concerns in Weardale, where I am involved in a campaign, that lives will be put at risk if ambulance services are not improved.

[Dr Poulter]

It is absolutely right to say that any review of A and E provision, and urgent care provision, must take into account travelling distances and transfer times to hospitals and between hospitals. Those issues will be part of the discussion and the review, although they are not the major thrust of what Sir Bruce is doing. However, a number of hon. Members have arranged to meet my ministerial colleague Earl Howe, who is currently examining several issues related to ambulances, and I am sure that he would also be pleased to see the hon. Lady to talk through some of the local issues in more detail.

Increased pressure on hospital services is not necessarily unusual for this time of year, notwithstanding the fact that it is completely unacceptable for there to be long handover delays or for people not to receive prompt and high-quality treatment. There are winter pressures that occur every year, and the Government will always do all we can—the previous Government did what they could as well—to ensure that the NHS is robustly funded and supported to meet such fluctuations in demand.

The Department of Health conducts daily monitoring of the winter pressures for all acute hospital providers. I am aware that South Tees Hospitals NHS Foundation Trust has James Cook University hospital as its main acute site—of course, it is also the local hospital that most of the hon. Gentleman’s constituents will attend—and the trust, like other organisations, has experienced some additional pressures in recent months. However, under the trust’s own internal criteria, the pressures that it experienced during late December and early January were identified as level three on a scale of one to six, which demonstrates that the trust has been busy. It is important to highlight, however, that it has been coping with those additional pressures, notwithstanding the issues raised in the debate, including the need to upscale the community-based response to prevent patients who would be better looked after in the community from being in an acute hospital setting in the first place.

It is also important to say that we expect all NHS commissioners and providers to ensure that appropriate measures are in place to manage any increases in demand, particularly during the winter. The delays in patient care that have been outlined eloquently by hon. Members are simply unacceptable, be they in A and E departments or in ambulance journeys to hospital. Delays are of concern, and the local NHS trusts and their partners must ensure that they step up their local strategies to cope with unexpected increases in demand.

We always needs to be aware of such seasonal variations in the NHS. That is why the Department of Health has given more than £300 million to the NHS specifically to deal with winter pressures. However, it is for local NHS providers to recognise that that extra investment has been made and to co-ordinate their response with the community, particularly through highly skilled community intermediate care teams, which help to get older people back home from hospital as quickly as possible so that they can be better looked after in their own homes.

The other main concern expressed by the hon. Gentleman was about ambulance performance. Delaying ambulances outside A and E departments, as a result of a temporary mismatch between A and E and hospital capacity and the numbers of elective emergency patients arriving, is simply not acceptable. There is a need for the local ambulance trust and the local hospital to work more constructively together, to ensure that such delays do not happen. That might be about having better triage, or the local ambulance trust might need to put more resources into the front line in the local area.

I also take this opportunity to say that the Government have provided £330 million of additional funding specifically to help the NHS cope with the winter pressures this year, so that patients receive the treatment they deserve. I understand that South Tees Hospitals NHS Foundation Trust received more than £1 million from that additional funding, and Middlesbrough primary care trust has received a further £264,000. Investment in social care services will also benefit the broader health system, but that requires the local trust to ensure that it uses the money wisely to address the concerns raised in the debate.

In January, the hon. Gentleman and I had what I thought was a constructive meeting with the trust, and I hope that will be the foundation for him and other local MPs to engage constructively with the trust to encourage a quick solution to the problems that have been outlined. One good thing that came out of the meeting, as the hon. Gentleman already knows, is that there is now an active process going on for the recruitment of specialist nurses to the smaller hospitals—the community hospitals —in the local area. When those nurses are in place, that will be a big step forward; I hope those hospitals will be open for additional hours, which will help to take pressure off acute settings.

In response to growing demand, an overall increase in ambulance activity and longer stays in hospital owing to more complicated medical conditions, I understand that the trust has already taken some specific measures, with £650,000 of investment being put into extra nurses and consultants. To deal with times of acute winter pressure, a bed winter ward will also open. The trust is also now working actively with its partners to redesign patient services, along the lines of the rapid response teams and intermediate care teams that I described earlier, to prevent inappropriate hospital admissions in the first place. In addition, it is exploring the development of a separate paediatric A and E department to create extra space for patients.

I am sure that the hon. Gentleman would have hoped that some of those measures would have been in train earlier, but following our meeting, and after the trust has listened to this debate, I am sure it will be all the more determined to do what it can to put things right in the future. As he knows, through our engagement I am taking an active interest in these issues and I will welcome further discussions if there are more problems in the future, because the delays that have been described today are unacceptable.

[Tom Blenkinsop]

The Minister has been very constructive in previous meetings and the response that he has given today has been very constructive as well. On specialist care staff for Guisborough hospital and East Cleveland hospital, he knows from our meeting that the trust has advertised those positions four times already. Would he be willing to meet me again if the fifth attempt also proves unsuccessful?

[Dr Poulter]

I have already made the offer, and I do so again now, that I am very happy to meet again. The trust is now taking the issue very seriously and is putting in place robust measures to deal with the concerns raised during this debate and when the hon. Gentleman and I met the trust. I understand that there are 16 applicants for the posts, so a good number of people have applied. I am hopeful that after the interviews on 25 February there will be additional nursing capacity in those local health care settings, to ensure that the scope of the community health care response is improved. Also, I hope that the number of hours that the services are available will be increased, because as the hon. Gentleman knows community health care is about taking pressure off acute A and E services wherever possible, and ensuring that people who can be treated locally are treated locally. That is why those two hospitals—Guisborough hospital and East Cleveland hospital—are such important care settings.

I hope that we are now in a better position, after this debate and through the actions that the trust is already taking—following our meeting earlier in the year—to deal with some of the challenges. I again congratulate the hon. Gentleman on securing the debate, which has been constructive, and I know that he and I will be meeting again if the situation in his area does not improve.

Thank you, Mr Crausby, for chairing the debate.