Alexandra Hospital, Redditch

Dan Poulter Excerpts

Tuesday 12th February 2013 Westminster Hall

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

Thank you, Mr Hollobone, for calling me to respond to the debate. It is a great pleasure to serve again under your chairmanship.

I pay tribute to my hon. Friend the Member for Redditch (Karen Lumley) for her advocacy on behalf of her constituents and local patients, and indeed for paying tribute herself to the hard-working staff at her local hospital. As she rightly points out, the future of the Redditch hospital has been discussed for far too long and I hope that, during the next few months, we can come to a conclusion that will not only be of benefit to local patients but bring higher-quality care to people in Redditch and the whole of Worcestershire. Any redesign of services must be led by local commissioners and—crucially—must also consider the best interests of local patients; those redesigning services must listen to the voices of local patients.

My hon. Friend rightly outlined in her speech the fact that no hospital or trust operates within a vacuum in the NHS, and she is also right to say that private finance initiative deals in the local area have been problematic and have left a very damaging legacy; that has happened not only in her part of the world but throughout the NHS. We must learn lessons from that in the future. It is distressing and regrettable that bad PFI deals sometimes have an impact on neighbouring hospitals, and it is a position that we, as a Government, have inherited. We will continue to do what we can, by working with trusts with difficult PFI deals, to try to mitigate those difficulties.

My hon. Friend rightly highlighted the fact that decisions about her local trust have an impact on the wider health economy in Worcestershire, and that that broader impact needs to be taken into account by those making decisions about the Alex hospital. When my hon. Friend and I met my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi)—my hon. Friend the Member for Bromsgrove (Sajid Javid) was unable to attend that meeting—the point was made clearly that many hospitals in the wider health economy of Worcestershire have natural links with Birmingham. That must be taken into account when services are redesigned for the benefit of patients.

Increasingly, clinical evidence is stacking up that some specialist clinical services need to be run from specialist centres, because those centres produce much better outcomes for patients, so the link to the major population centre for the surrounding counties should be taken into account. As I say, we need specialist centres of excellence for the benefit of patients.

My hon. Friend the Member for Redditch made the point that the Alex hospital has a historical legacy of difficulties, with big, intermittent deficits at the local trust. There have been commendable attempts to deal with those difficulties, but there has been a difficult situation for a number of years. Clearly, we want to see long-term stability for Redditch, for the local trust more broadly and for the local health care economy. Key to achieving those things is having high-quality medical personnel working in the hospital, and the ability to retain and recruit high-quality consultants.

[Peter Luff]

To be clear, for the majority of Worcestershire residents Birmingham and its services are a very long way away and very inaccessible.

[Dr Poulter]

With regard to “bread and butter” day-to-day medical services, my hon. Friend is absolutely right to say that. My point was that for some services—for example, trauma or stroke—having specialist centres brings better results for patients, and there is good clinical evidence to back that up. However, day-to-day, higher-quality “bread and butter” services for patients—such as heart care or children’s services—are often best provided locally, and he is absolutely right to make that point.

[Mr Robin Walker (Worcester) (Con)]

I congratulate my hon. Friend the Member for Redditch (Karen Lumley) on securing this very important debate.

The Minister mentioned the issue of recruitment of clinical staff. One thing that the NHS in Worcestershire has worked very hard on is a cancer strategy to keep cancer care within the county and to make the Worcestershire Royal hospital a centre of excellence for cancer care. We are looking to secure a radiotherapy unit in the near future. I urge the Minister, in taking whatever decisions are necessary to ensure that the county has the strongest, most sustainable NHS, to pay attention to that work and to the importance of having a cancer service for the county.

[Dr Poulter]

My hon. Friend is absolutely right to praise the high-quality work done in Worcester to look after cancer patients. It is exactly the point that I was making in response to the intervention from my hon. Friend the Member for Mid Worcestershire (Peter Luff): the high-quality day-to-day services that patients need must be delivered locally, but more specialist operations—such as for head and neck cancer—might be carried out at a specialist site that is geared up for such operations. Day-to-day oncology care, however, is often best carried out locally, particularly when people are unwell with cancer and receiving sometimes very intensive treatment. In those situations, they need to be looked after locally.

It does not benefit patients, for medical and many other reasons, to have very long distances to travel. However, when surgical outcomes might benefit from operations being carried out at specialist centres, we must differentiate day-to-day treatment from the more specialist care that may be required as a one-off surgical intervention. We should do that when the evidence stacks up that specialist centres for such surgical interventions often deliver better results and better care for patients. Nevertheless, my hon. Friend is absolutely right to pay tribute to his local trust for the work that it does on cancer care in Worcester, which I know is very important to him personally.

I will now respond specifically to some of the points that have been made in the debate, and consider how we go forward from where we are now. Hon. Members, particularly my hon. Friend the Member for Redditch, have made us well aware, through their articulate contributions, of the challenges that are faced by the local health care economy. Such ongoing uncertainty about the future of local health care services is wrong and completely undesirable. When local commissioners bring forward proposals for the two options that are likely to be considered later in the month, I urge them to move forward as promptly as possible to bring certainty to the situation. That will allow consideration of important issues, such as the need to have high-quality professionals working in hospitals. When there is uncertainty about the future of a trust or a particular site within a trust, it can be difficult, as my hon. Friend rightly outlined, to recruit high-quality staff to work in that trust. That is not in patients’ best interests, so the sooner we can have certainty, the better. I know my hon. Friend will join me in urging local commissioners to bring things forward as expediently and quickly as possible.

As we know, the trust is committed to providing the best-quality care for patients. That is essentially about finding the best solution for the people of Worcestershire so that they receive the best care in the future. As my hon. Friend outlined, Worcestershire Acute Hospitals NHS Trust and the West Mercia cluster have jointly commissioned a strategic review of services in the area. The review is essential to secure the clinical and financial sustainability of high-quality services for local people. That is about looking not just at getting through the next couple of years, but at what will be right for the local health economy in five or 10 years’ time.

I understand my hon. Friend’s concern that there have been delays with the review, and I once again urge local commissioners to take things forward as expediently and quickly as possible. The Worcestershire joint services review started in January 2012, and it was expected to be completed by November 2012. I hope my hon. Friend is somewhat reassured that we will move forward more quickly, notwithstanding a patchy history on resolving local health care issues. There is a need for certainty locally, and we must make sure that the time line is met and that we have a firm conclusion.

Importantly, the review involves clinicians and commissioners across the area and the NHS. It engaged with local people last summer to inform the development of proposals. As we know, developing proposals for the future of local services is about clinical leadership and about clinicians saying what is important and in patients’ best interests, but it is also about local involvement and engagement. When I met my hon. Friend before Christmas, we discussed that. The local newspaper has played a tremendous role in promoting local patients’ needs. My hon. Friend and the local population should be proud of the cross-party consensus on the importance of Redditch’s future.

Through the review, local people will have made, and will continue to make, their voices and views clear. That is important for the Government and for our four tests for reconfiguration. It is also important that local health care providers, the local trust and the trust’s board listen to local people and local health commissioners to make sure that their views are informed by what local patients want and need and by what local clinicians say is in patients’ best interests.

The joint services review steering group met on 12 September 2012 and, unfortunately, decided to delay the process again until it could explore all options to allow it to maximise service provision at the Alexandra hospital, including investigating the potential to work with other NHS providers—Birmingham being a case in point.

My hon. Friend will be aware that the Redditch and Bromsgrove clinical commissioning group has started initial discussions with three NHS providers in Birmingham to explore the feasibility of providing services from the Alexandra hospital: the University Hospitals of Birmingham NHS Foundation Trust, Birmingham Women’s NHS Foundation Trust and Birmingham Children’s Hospital NHS Foundation Trust. Those discussions are still in their early stages. However, my hon. Friend is right that when proposals are brought forward—hopefully, by the end of this month—we should move things forward quickly for the benefit of local patients.

No decisions have been made, and the discussions are only about the Alexandra hospital—that needs to be clearly set on the record. The Worcestershire Acute Hospitals NHS Trust would continue to provide all other services. Given the concerns my hon. Friends have raised, it is important to note that, although the services the trust provides need to be seen holistically, the ongoing discussions are about the specific future of Alex’s site in Redditch. That is an important distinction, and I hope it gives my hon. Friends some reassurance that any proposals are unlikely to disrupt local services to the patients they care about.

Ultimately, the decision is for local determination, and it would not be appropriate for me to comment on the discussions in further detail until we have firm proposals. We will continue to meet regularly. I am visiting Redditch in the near future, and will take a keen interest to make sure I can do all I can to support the right result for local patients.

[Mark Garnier]

The Minister will no doubt know what is coming: will he visit Kidderminster when he is next in Redditch?

[Dr Poulter]

I would be delighted to visit Kidderminster hospital. It might not be on the same day I visit Redditch, but I will make sure I put it on my list of priorities to visit. I would be delighted to see the excellent work done at Kidderminster hospital and, indeed, at Worcester, at some point in the near future. In addition to the bit of clinical work I still do, I prioritise going out on a Thursday as regularly as I can to see the NHS on the ground and to see what is going on. I would be delighted to visit other local trusts, when I can fit them into the diary, later in the year.

What are the next steps? If agreement is reached on a clinically and financially sustainable solution in the interests of local people, a robust process needs to follow. The Worcestershire joint services review steering committee will meet on 26 February to set out options for consultation. We are then likely to have two options regarding the way forward. One is likely to involve Worcestershire Acute Hospitals NHS Trust continuing to operate services from the Alexandra hospital. The other is likely to involve exploring the feasibility of the Birmingham foundation trust operating services at Alexandra hospital, if that is in local people’s best interests.

The final proposals will require the support of the NHS in Worcestershire. However, the local NHS has assured me that it will continue to engage with people while proposals are finalised. Of course, I would expect any proposals to meet the four tests for service change that we have clearly outlined—principally, that any changes are clinically led and have strong patient and public engagement. The local NHS expects final proposals to be ready for public consultation later in the summer. However, it is vital, as we have stressed throughout the debate, that we hold those involved firmly to their task and reach a conclusion for the sake of staff and patient certainty and for the benefit of the local NHS.

[Karen Lumley]

One of my questions was: who actually owns the Alexandra hospital?

[Dr Poulter]

As my hon. Friend will know, the local hospital is designated as part of a trust. It is a non-foundation trust, so there is direct regard to the Secretary of State in some matters relating to the trust. I hope that gives her some reassurance. Of course, the NHS is owned by all of us, which is why it was so important when we set out our four tests for reconfiguration that we made sure they were about strong clinical leadership in the best interests of patients, as well as strong patient and public engagement, so that patients and the public can clearly see that any changes to local services are in their best interests and so that they can properly engage in the process. There has been strong local feeling and opinion on this issue, and I am sure it will be listened to carefully when decisions are taken about the future.

In conclusion, I encourage my hon. Friends and local people to participate in the consultation process to ensure their views are fully taken into account. I will maintain a keen interest. I am looking forward to visiting each site in the trust in due course. I am always available to talk through matters if Members have concerns.

Neonatal Care

Dan Poulter Excerpts

Wednesday 6th February 2013 Westminster Hall

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

It is a great pleasure to serve under your chairmanship, Mr Streeter. I congratulate my hon. Friend the Member for Daventry (Chris Heaton-Harris) on securing this important debate on neonatal services. He strongly advocates the needs of his constituents, but also raises an important issue that we are already focusing on and improving, to give every child the very best start in life.

It is also a pleasure to hear from my hon. Friend the Member for Hexham (Guy Opperman), and I am looking forward to visiting his constituency in the near future. An April visit is in the diary at the moment, and I look forward to visiting and seeing for myself some of the excellent care delivered locally. He is right to highlight that midwifery-led units play an absolutely vital part in delivering high-quality care for women and their families. The Birthplace study absolutely supports his points and suggests that midwifery-led units may well play an even more vital role in the future provision of maternity services. I am sure that we will discuss such matters in future debates.

Before we get on to the specifics of neonatal care, I want to discuss some of the more general points made by my hon. Friend the Member for Daventry. He mentioned air ambulance services, and he is quite right to say that if we want a co-ordinated and integrated emergency response, particularly in more rural and sparsely populated areas, air ambulances must play an important part. The land and air-based responses need to be co-ordinated effectively, particularly for road traffic accidents. He makes a good point and I am sure that the local commissioners in Daventry and elsewhere will take note of our discussions today.

My hon. Friend was quite right to say that the payment- by-results system has been problematic in many areas of medicine. My right hon. Friend the Leader of the House, when he was Secretary of State for Health, made strides towards changing the tariff system in many areas of care, particularly the year-of-care tariff for people with longer-term and more chronic conditions. We also have changes being implemented to the maternity tariff to encourage a normalisation of birth. We want to view birth as a normal, everyday, natural process and to move away from births that need hospitalisation, by supporting people better in the round through antenatal care and more holistically throughout pregnancy, childbirth and the post-natal period.

My hon. Friend mentioned the unacceptable variations in care that exist across the country, which was highlighted poignantly today in the debate on the NHS in mid-Staffordshire. He has also previously advocated the reduction of stillbirths and supports the excellent work that Bliss does to raise the importance of high-quality neonatal care. More work is necessary, but I want to describe some of our achievements and the progress that the Government have made over the past couple of years, which shows that we are taking such issues seriously. As my hon. Friend quite rightly outlines, there is more that we can do and we intend to do more over the months and years ahead.

As has been said throughout the debate, we cannot divorce childbirth and midwifery care from neonatal care; the two are linked in terms of service provision and the care that is provided for premature babies. We want to provide more care and support for women during pregnancy, and the latest work force figures show that midwife numbers increased by 1,117 between May 2010 and October 2012. Training places in midwifery are at a record high, and we are ensuring that commissions for future training places will remain at a record high, so that we can continue to provide personalised, one-to-one midwifery care for women. The birth rate is increasing, and that is why we are employing more midwives and keeping training commissions high.

On neonatal care, 1,376 neonatal intensive care cots were available in December 2012, of which 951 were occupied. In December 2011, only 1,295 such cots were available. So in a period of 12 months—between 2011 and 2012—we have seen an increase in the number of neonatal intensive care cots available nationally, and I am sure that my hon. Friend will agree that that is a good thing.

The number of paediatric consultants has also increased, from 1,507 in 2001 to 2,646 in 2011, and the number of paediatric registrars—or middle-grade junior doctors—has also increased by almost fourfold in the same period, with some of those registrars specialising in neonatal medicine. Consequently, I believe that we must give some credit to the previous Government for some of the work that they did in this area, but this Government have taken their work forward with renewed vigour to make this a priority.

The number of full-time paediatric nurses has also risen, from 13,300 at the beginning of the century to 15,629 in 2011. So, in general, we are seeing good progress being made in putting more resources into children’s health care, giving every child the very best start in life.

Specifically on neonatal services, my hon. Friend is right to highlight the fact that we need to do more to ensure that there is no variability in the system. We made a commitment very clearly as a Government to high-quality, safe neonatal services, founded on evidence-based good practice and good outcomes for women and their babies. Improving outcomes, rather than focusing on process measures, is what we are all interested in. We want to ensure that babies who need neonatal care are given the very best care and have the very best outcomes in terms of their future life and, indeed, the care that they receive on neonatal wards.

In our mandate to the new NHS Commissioning Board, we will be holding it accountable for all health outcomes. We want to see the NHS in England leading the way in Europe on health care outcomes. The Secretary of State for Health has made it clear that mid-table mediocrity must be a thing of the past in all areas of medicine, and I will make sure that I work closely with Bliss and other organisations and, indeed, with my hon. Friend to make sure that we hold the NHS Commissioning Board to account for delivering high-quality health outcomes everywhere, particularly in this important area of neonatal care.

It is worth highlighting, and I think that I have time to do so, the different types of neonatal facilities that are available; the different types of special care baby units, or the level 1, level 2 and level 3 units. Special care units, traditionally known as level 1 units, provide care effectively just for the local population in the local area. They provide neonatal services, in general, for singleton babies born after 31 weeks and six days gestation, provided the birth weight is above 1,000 grams. For slightly more complicated births or slightly more premature births, there are level 2 units, which provide neonatal care for their own local population and for some sicker, or more premature, babies from elsewhere. They provide neonatal services, in general, for singleton babies born after 26 weeks and six days gestation, and for multiple-birth babies born after 27 weeks and six days gestation, provided the birth weight is above 800 grams. Then we have level 3 units as they are traditionally known, which are neonatal intensive care units, and they are sited alongside highly specialist obstetric and fetomaternal medical services. For example, there is a level 3 unit across the river from here, at St Thomas’ hospital. Such units take very premature babies.

That description highlights the fact that neonatal care must be considered alongside the provision of high-quality maternal care; the two go very much hand in hand. The point that my hon. Friend made—my hon. Friend the Member for Hexham made it as well—is that when services are being redesigned or reconfigured the most important thing is to provide high-quality patient care. Reconfiguration is about delivering those high-quality patient outcomes and that high-quality care.

The best example of where service reconfiguration has really benefited patients that I can think of was in Manchester, which I visited towards the end of last year. A redesign of the maternity and neonatal provision in Manchester in a very planned, systemic way resulted in about 30 babies’ lives being saved every year. When the case for reconfiguration is made in terms of patient care and not in terms of cost, as my hon. Friend the Member for Daventry outlined, that is the right reason to reconfigure and redesign services. What we cannot have, and what has been expressly ruled out under the criteria for reconfiguration, is redesigning services purely on the basis of cost. If we are going to redesign the way that we deliver care, it must be done in the way that it was done in Manchester, where—as Mike Farrar, who is now the chief executive of the NHS Confederation, said—it is about saving babies’ lives. That service reconfiguration in Manchester was right, because it is saving 30 babies’ lives every year. That is the right reason for reconfiguration.

My hon. Friend was absolutely right to highlight that in some cases, when we look at these issues in areas where there are long distances to travel and considerable rurality, all these factors need to be taken into account when redesigning services. However, the end result must always be for the benefit of patients. It may be the case that sometimes people have to travel a little bit further to get that high-quality care, but these decisions must be considered in the round and on the basis of achieving high-quality outcomes and doing the best things for mothers and their babies.

In conclusion, it might be worth highlighting a few other specific things about neonatal care that the Government are committed to doing. We now have a toolkit for neonatal care, and we are looking to ensure that it is properly implemented across the NHS. Some parts of the country are doing very well in ensuring that the majority of their staff working as nurses in neonatal units have specialist training, but that is not the case everywhere. We have established that toolkit; that was a direct challenge that the Government have picked up and taken forward, to ensure that we drive up the standard of neonatal care everywhere.

[Guy Opperman]

Does the Minister accept that, as the health care reforms kick in, it is incumbent upon GPs to make the point when they first advise expectant mothers that they can give birth at various places and that midwife-led units provide the full spectrum of care from well before the birth to well after it?

[Dr Poulter]

My hon. Friend is absolutely right. It is vital that whenever there is a discussion with any patient—in this case, it is a discussion with an expectant woman about where she should give birth—that an informed choice is made. That should not just happen initially, but that choice should be reviewed consistently, according to what the risk factors might be throughout the pregnancy, and women should be helped and supported into choosing the most appropriate birth setting for them. And all factors, such as the woman’s safety or what care might be required immediately after the birth, are vital ingredients in that decision-making process.

What we want to promote, and what we all believe in, is patient choice in the NHS. One thing that is facilitating patient choice in maternity care is having a national set of maternity notes now, so that all women effectively have a transferrable set of notes that they can take from one unit to another. That is something that is being driven across maternity care, and I think that it will make a real difference if the location of care needs to change in the future.

I will also say something specifically about how we will ensure that we better implement the toolkit, which we agree is a good thing in driving up the quality of training available to neonatal nurses. Very shortly, I will be devising and helping to set up the Health Education England mandate, which will be responsible for training health care professionals in England; not just doctors but all health care professionals. A mandate will be established for how that body will operate and what it will prioritise as areas of training. I am very happy to give a commitment, just as we did on the mandate for the NHS Commissioning Board, to ensure that giving every mum the right support in pregnancy and every baby the very best start in life is something that we will look to incorporate in that mandate, to make sure that high-quality training is available for health care professionals involved in all aspects of pregnancy, birth and beyond, and of course neonatal care is an important part of that.

That is something that I will take away from this debate, to ensure that it is clearly an important part of the Health Education England mandate that we look very seriously at neonatal services, to help to iron out the unacceptable variability in training that we have identified. I hope that that is reassuring to my hon. Friend the Member for Daventry. I thank him for securing this debate, and I thank you, Mr Streeter, for chairing it.

Question put and agreed to.

University Hospitals of Morecambe Bay NHS Foundation Trust

Dan Poulter Excerpts

Tuesday 5th February 2013 Westminster Hall

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

It is a great pleasure to serve under your chairmanship, Mr Howarth. It is not the first time, but nevertheless it is a pleasure.

I pay tribute to the hon. Member for Barrow and Furness (John Woodcock) for his advocacy on behalf of his constituents and all those in Cumbria who are looked after by the local trust and to my hon. Friend the Member for Morecambe and Lunesdale (David Morris), whose constituency I recently had the pleasure of visiting, for his advocacy on the behalf of his constituents. I have indeed received a copy of the letter sent to him by the chief executive of the NHS trust, which says:

“Whilst it would be wrong of me to second guess the future, I personally find it hard to imagine Lancaster not having emergency services.”

I hope that that is reassuring to him and his constituents.

On the main issues raised in the debate, I have already paid tribute to the strong advocacy on behalf of his constituents by the hon. Member for Barrow and Furness. He was very kind to brand me an expert in obstetrics. I would not go quite that far, but he is right to say that I have considerable understanding of the issues involved and of the importance of ensuring that we provide safe and comfortable environments in which women can give birth. He is also right to read out the case that I advocated in a debate here in Westminster Hall some time ago, and it is important that we recognise that uncomplicated deliveries can become more complicated. We know that for women in some parts of the country, particularly those in more deprived areas, there are often higher risk rates of prematurity. These are all issues that need to be taken fully into account whenever services for the safe delivery of babies, and for the safe care of women during pregnancy, delivery and the period afterwards, are examined.

The hon. Gentleman is also right to highlight that there are geographical considerations in Cumbria, as in many rural areas, including the fact that there is only one main road and the problems that presents in respect of allowing the local trust to transfer patients effectively and safely from one site to another. It potentially creates difficulties at certain times of day if the road is busy, as he is aware. However, it also requires the availability of ambulances, and he was right to point that out.

When decisions are made about changing services, whatever the reason may be for changing them, they cannot be taken in isolation. In this case––I will discuss this further later––I believe that the decision was made in good faith, although I share some of the concerns that the hon. Gentleman raised, given that we know that there have been a lot of problems at the trust with maternity services as well as the safety concerns he outlined. Those decisions cannot be taken in isolation. They need to be taken in collaboration and after discussion with local commissioners and indeed with the ambulance service, if they are to be made correctly and for the benefit of patients.

The hon. Gentleman was also right to outline the four tests for reconfiguration. In particular, he was right that reconfiguration must be clinically led, based upon evidence and always in the best interests of patients. Reconfiguration should never happen for cost reasons alone, and he was absolutely right to highlight that. Reconfiguration also needs to have the support of local GP commissioners. However, from what he has said today it appears that there are local concerns about the proposed changes, and that there has not been an integrated, joined-up approach in relation to this decision.

We have also discussed the concerns over the need to integrate ambulance transfers into any local decisions because of the travelling distance from Barrow to Lancaster. That is one of the issues that should have been take into account when these decisions about reconfiguration were being made, and I am very concerned to hear the hon. Gentleman say that he does not believe that they were taken into account and that local commissioners also have concerns about this matter.

I am very happy to meet the hon. Gentleman again in the very near future to discuss this; that would be very desirable. It is vital to ensure, as the hon. Member for Copeland (Mr Reed) said, that we do not see service reconfiguration by stealth or via the back door. We should have an integrated, joined-up approach to local decision making, particularly in view of what can only be described as the deficiencies of the past at the trust and the very sad cases that the hon. Member for Barrow and Furness and I have corresponded about, as well as the police investigations that are going on. He is aware that it would be inappropriate for me to comment directly on those.

There is a need to ensure that in the future decisions are made in a holistic way and in the best interests of patient safety. Such decisions are not just for the trust to make alone but must be made in conjunction with the local commissioners and the ambulance service, if we want to ensure patient safety. The hon. Gentleman and I can discuss that further when we meet.

The hon. Gentleman raised another important issue: the ongoing investigations at the trust. He was right to do so. As we know, tomorrow the Mid Staffordshire report will be published, which makes these sorts of issues all the more poignant and important. The NHS has sometimes had a history of covering up bad things that have happened to patients, and that is completely unacceptable. The result of that is bad care for patients, and cultural problems in trusts and hospitals. Those sorts of things cannot go on. When there are investigations, they need to be carried out transparently and openly, so that people feel the issues have been fully aired. It is also vital that those investigations have a degree of independence, as he suggested.

[John Woodcock]

I thank the Minister for giving way, and for the excellent and considered way that he is responding to my points. He referred to the Mid Staffordshire situation. Does he accept that that started as an internal inquiry, which was found to be insufficient to get to the bottom of the issues and required a greater degree of independence to be established? We are worried that the same thing may be apparent in Furness.

[Dr Poulter]

Absolutely. There will be a full response to the Mid Staffordshire inquiry tomorrow, so I will not pre-empt it or go into detailed discussion of that issue. However, it is absolutely right that we must encourage staff who have concerns about patient care to raise those concerns and air them in an open way. Moreover, when we know that there have been long-standing failings at a trust about the quality of care provided to patients and concerns raised about those failings—although Morecambe Bay NHS Foundation Trust, for example, has made some good progress in recent months, there are some long-standing issues there—it is important that, when an investigation is carried out, it is carried out in a transparent, open and independent way; there must be a great degree of independence involved.

If a trust sees fit to launch an investigation and a review of what has happened, it is important that the investigation and review pass the test of transparency. There may well be a role for local MPs and other interested parties in that process, and when the hon. Member for Barrow and Furness and I meet, that is an issue that I will be very keen to discuss further, to ensure that we can discuss with the local trust ways in which we can ensure that there is that transparency and independence in the process. That is very important to ensure that those patients, and their families who have had problems in the past—in some cases, there have been deaths at the trust—feel that the investigation addresses their allegations.

Obviously, this debate is not just about maternity services at the Morecambe Bay NHS Foundation Trust; there have been other issues around the trust, and any investigation will need to take account of all those issues. I understand that that is what will happen.

[Mr Jamie Reed]

I am very grateful to the Minister for his considered and thoughtful response to the debate. I agree with him wholeheartedly on the importance of transparency and openness. However, where there are different clinical groups commissioning services from a single trust that operates a number of different hospitals, who actually holds the ring and decides which services are commissioned where?

[Dr Poulter]

The hon. Gentleman asks a very good and thoughtful question. It is the duty of the commissioning groups to work collaboratively for the best interests of patients. They obviously have responsibility for their own budgets and, as I say, they all ought to work collaboratively for the benefit of patients. However, if there are concerns about that, there is also a role in this process for the commissioning board, which will have some oversight over the process, to help to ease it through. In many parts of the country, there is already good evidence that the emerging local commissioning groups are working together collaboratively in just the way that I have described. I hope that that is reassuring for the hon. Gentleman.

We know that the Morecambe Bay NHS Foundation Trust has had a very long and troubled history. We also know that it serves a very important purpose in looking after people throughout north Lancashire and Cumbria. My hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) made clearly the good point that the configuration of the trust geographically is challenging. We, as a group, are going to meet together to talk through some of these issues and the troubled history of the trust, to ensure that we can do our best to work through these issues.

There have been problems in the past with the trust and local patients have not been treated properly, and they and their families have suffered. There have been long-standing concerns over local care quality issues. That may mean that we have to redesign the way that services are delivered; that may be an inevitable consequence of improving patient care in the long run. Nevertheless, the driver of this process must be delivering high-quality local health care within the envelope of providing improved patient care with better outcomes and safer care for patients. However, the only way that we will achieve that is if all the commissioners are working collaboratively with the trust in a more integrated approach to care. The failure to do that is where things have gone wrong in the past, and that is what needs to change in the future.

Plasma Resources UK Limited

Dan Poulter Excerpts

Thursday 17th January 2013 Written Statements

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

Further to the written ministerial statement made on 13 July 2012, Official Report, columns 84-85WS, I am announcing today that the Government have decided to seek private sector investment in the Government-owned limited company, Plasma Resources UK Ltd (PRUK) through the sale of the majority or all of the shares in the company. We are taking this action to support the company and its employees in the next phase of the company’s development.

We have carefully examined the strategic options that will best allow the company—which includes the UK-based fractionation facility Bio Products Laboratory Limited (BPL) and the US-based plasma supply company, DCI Biologicals Inc—to grow and be successful in an established and highly competitive global industry. It should fulfil its potential as part of the strategically important bioscience sector of the UK economy. Our conclusion is that this route will best meet those requirements.

Patients will also benefit, as investment will not only allow continued improvements to the existing products but also the potential development of new treatments to create a better product portfolio. Resources will also be used to ensure that the facilities keep pace with the latest technology so the company can achieve its full potential. Overall, the investment will play a key part in ensuring the continued supply of high-quality products to patients.

Potential investors will need to show not just the level of resources they are willing to make available but also set out a credible plan as to how the operations will be grown and how products will be developed.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 15th January 2013 Commons Chamber

[David T. C. Davies (Monmouth) (Con)]

2. What recent steps he has taken to reduce hospital waiting times in England.

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

Latest figures for October 2012 show that 70,000 fewer patients are waiting longer than 18 weeks than at the last election. The Government’s mandate to the NHS Commissioning Board makes timely access to services a priority.

[David T. C. Davies]

Those figures compare extremely well with those in Wales, where most patients are waiting for 26 weeks, and many for 36 weeks. Would the Minister be willing to share some advice on how to get waiting lists down with his counterparts in Wales, and perhaps discuss with them why patients wait so much less time in the Conservative NHS in England than in the socialist NHS in Wales?

[Dr Poulter]

My hon. Friend is right to highlight key differences between the NHS in England and in Wales. The Labour-run Assembly in Wales is cutting funding by around 8%, which will—of course—impact on the quality of care available to patients and other front-line services. At the same time, in England we are ensuring that we continue to invest, with £12.5 billion in the NHS during the lifetime of this Parliament. I would be happy to point that out to colleagues in Wales and the Welsh Assembly, and to make the point that it is the Conservatives and the coalition Government who deliver better patient care through investing in the NHS.

[Julie Hilling (Bolton West) (Lab)]

Will the Minister tell the House how many NHS trusts failed to meet the accident and emergency target of 95% of people being seen within four hours last week? When was the last time that target was met nationally?

[Dr Poulter]

I am happy to inform the hon. Lady that we are meeting the 95% target nationally for the A and E wait. On the most recent figures available, 96% of patients were seen within that period—96 out of every 100 patients are seen within four hours in A and E. The key difference between this Government and the last Labour Government is that we trust clinicians to ensure that they prioritise those patients in greatest need ahead of purely meeting targets and ticking boxes.

[Andy Burnham (Leigh) (Lab)]

As winter bites, the NHS faces its toughest time of year, but there is mounting evidence that the Secretary of State has left it unprepared. For 105 of his 133 days in office, the Government have missed their own A and E target for major A and Es. Last week, for the first time, the figure fell below 90%. Right now in A and Es up and down England, ambulances are stuck in queues outside, patients are on trolleys in corridors, and people are waiting to be seen for hours on end. Does the Minister accept that there is a growing crisis in our A and Es, and if he does, what is he doing about it?

[Dr Poulter]

The right hon. Gentleman is good at putting across figures based on brief snapshots in the year. We know that on an annual basis we are meeting the target, and that 96% of patients are being seen on time in A and Es. We have made allowances for winter pressures, which we know are always difficult during the flu season every year, and we have put aside £330 million to ensure that we support the NHS during those winter pressures. Let me make it clear to the right hon. Gentleman that it is wrong to try and distort figures based on outcomes from a snapshot of just a few days or a week. It is important to put across the clear picture, which is that the Government are meeting targets in the NHS and patients are being treated in a much more timely manner than under the previous Government.

[Andy Burnham]

I suggest to the Minister that he needs to get out on the ground in the NHS a bit more. The figures I gave him were for major A and Es. If he got out more, he would realise that his complacency, which we have just seen at the Dispatch Box, is not justified. Let us look at Milton Keynes, which was identified by the Care Quality Commission as one of the 17 understaffed hospitals, and where last week just 72% of patients were seen within four hours. Milton Keynes is one of 15 trusts in England where A and E performance plummeted below 80%. These are the kind of figures that we have not seen in the NHS since the bad old days of the mid-1990s. Ministers like to blame nurses, but it is time they started accepting some responsibility. Will the Minister today ensure that all A and Es in England have enough staff to get safely through the winter?

[Dr Poulter]

I reassure hon. Members that, unlike any Member on the Opposition Front Bench, I still work in the NHS every week and I ensure that I see what happens on the ground. That cannot be said of any Front-Bench Opposition Member. The coalition has Ministers who are in touch with what is happening in the NHS on the ground. On A and E waits, we are trusting clinicians to exercise their judgment, which is why we now have a 95% target. We are ensuring—and the statistics show—that we are meeting that target on an annual basis. Patients are being treated in a timely manner. Furthermore, we have put in £330 million to deal with winter pressures. It is wrong of the right hon. Gentleman to try and mislead the House in this way—[Hon. Members: “Oh!”]—and use figures from a snapshot in time, rather than in a generality, which would indicate—

[Mr Speaker]

Order. Sorry, the Minister needs to withdraw the suggestion that anybody tried to mislead the House. That simply needs to be withdrawn; that is all.

[Dr Poulter]

Indeed. I do withdraw that comment, Mr Speaker, and I apologise for saying that there was any deliberate attempt to mislead the House at all. I was simply pointing out the fact that the right hon. Gentleman is highlighting a snapshot in time—

[Mr Speaker]

No, no. Order. I must say to the Minister that when a retraction is required, that is what is required and that is all that is required. We move on.

--- Later in debate ---

[Rehman Chishti (Gillingham and Rainham) (Con)]

4. What steps he is taking to support the recruitment and training of midwives.

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

The Government are committed to ensuring that the number of midwives in training matches the needs of the birth rate. There are now over 800 more midwives working in the NHS than there were in May 2010, and a record 5,000 currently in training.

[Rehman Chishti]

The Oliver Fisher neonatal intensive care unit at Medway Maritime hospital in my constituency is an excellent charity that looks after approximately 900 premature and sick new-borns each year. What further midwife support will the Government give to such care units?

[Dr Poulter]

My hon. Friend is absolutely right to point out the excellent work done at his local unit, which receives funding from the NHS and from charitable sources. We are investing more money into training midwives, and there are now more midwives working in the NHS. It is for local commissioners to capitalise on that, and to invest in support for neonatal units.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

With births per midwife rising, maternity services being cut and newly qualified midwives unable to find a job, what on earth happened to the famous boast of the Prime Minister that he would recruit 3,000 more midwives and make their lives a lot easier?

[Dr Poulter]

With respect, perhaps the hon. Gentleman should listen to my answers before he pre-prepares a statement. I just outlined clearly that in the past two years there have already been 800 more midwives working in the NHS, and there are record numbers in training thanks to the investment being made by the Government. We are delivering on making sure that we are investing in maternity and investing in high-quality care for women. We are proud to be doing that—something the previous Government failed to do.

[Nigel Adams (Selby and Ainsty) (Con)]

5. What assessment he has made of the effect of the current NHS funding formula on rural areas with a large elderly population.

--- Later in debate ---

[Kate Green (Stretford and Urmston) (Lab)]

10. What estimate he has made of the number of patients who waited longer than four hours for treatment in accident and emergency departments in 2012; and if he will make a statement.

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

In 2012, the NHS saw nearly 22 million people in A and E across the country, with 96% seen within four hours, which I am sure the hon. Lady will agree is a great achievement. That means that the A and E clinical quality indicators for high-quality patient care are being met in the NHS.

[Kate Green]

Last week, the Manchester Evening News reported that more than 1,000 patients had waited more than four hours at A and Es across Greater Manchester in December. I am sure the Minister is well aware of the planned downgrading of services at Trafford general hospital, and I understand that last night the joint health scrutiny committees of Trafford and Manchester agreed that the proposals should be referred to the Secretary of State for decision. Given last month’s alarming figures, will Ministers assure me that in reaching a decision about the future of Trafford general hospital, full account will be taken of capacity across Greater Manchester?

[Dr Poulter]

I thank the hon. Lady for her question. I recognise her concerns for her constituents. As has been outlined, there are seasonal variations, and I am sure that local commissioners will want to take such issues into account when they make decisions, and they must meet the reconfiguration tests set out by the previous Secretary of State for Health, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley).

[Gavin Barwell (Croydon Central) (Con)]

The Better Services Better Value review of NHS services in south-west London identified that Croydon university hospital does not have sufficient senior doctors in its A and E, and nor did it under the previous Government. The review has been put on hold because Surrey has asked to be included. Will the Minister reassure my constituents that there will be a rapid solution to ensure that we have the A and E care that we deserve?

[Dr Poulter]

My hon. Friend is right to highlight a long-standing problem—it has not happened just recently —of a lack of particularly middle-grade doctors in A and Es. Although the number of consultants has increased by about 50%, as A and Es move rightly towards becoming a 24/7 consultant-led service, attracting middle grades to the specialty has been a problem. We set up a task force to consider that, as well as making better use of a multidisciplinary work force and emergency nurse practitioners to meet some of the staff shortages.

[Mr Jamie Reed (Copeland) (Lab)]

The performance of A and E services has an obvious and acute effect on the performance of ambulance services. In London, freedom of information requests show that the number of ambulances waiting more than 30 minutes from arriving at hospital to handing over their patients has gone up by two thirds over the last year, that ambulances are missing their targets in responding to the most serious life-threatening callouts, and that the average length of time that patients wait in ambulances before accessing A and E is going up, and in some cases patients are waiting almost three hours. The Care Quality Commission says that London Ambulance Service NHS Trust does

“not have sufficient staff to keep people safe”.

The question for the Secretary of State is simple: what is he going to do about it?

[Dr Poulter]

The hon. Gentleman is right to highlight the unacceptable variations in the quality of triage and handover between ambulance services and hospitals, not just in London but in other parts of the country. Many hospitals, however, do that well, and it is important that local MPs highlight the issue, champion good practice on handovers and ensure that that good practice is carried out at other A and Es. It is unacceptable that patients should wait for handover.

[John Pugh (Southport) (LD)]

Can the Minister update the House on the roll-out of the 111 service and its effect on A and E admissions and 999 calls?

[Dr Poulter]

As my hon. Friend knows, we are developing the 111 service further to improve triage and take pressure off accident and emergency services when that is appropriate. I am sure all Members agree that when patients do not need to go to A and E, it is best for them to be treated in the community or properly triaged.

[Eric Ollerenshaw (Lancaster and Fleetwood) (Con)]

11. What steps he is taking to improve the recruitment and retention of specialist accident and emergency doctors.

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

That is a long-standing problem. Recognising that emergency medicine is moving towards becoming a 24-hours-a-day, seven-days-a-week service, the Government have set up an emergency medicine task force to tackle the problem and encourage more recruitment of middle-grade doctors to A and E specialties.

[Eric Ollerenshaw]

Might it be time for us to take a leaf out of the Department for Education’s book, and consider offering scholarships or bursaries tied to doing the job for a certain number of years in order to improve recruitment and retention in this difficult area?

[Dr Poulter]

Bursaries are already available to medical students to encourage recruitment to the medical profession. As for the specific question of A and E recruitment, at the end of last year I published—alongside the report from the Doctors and Dentists Review Body on the consultant contracts and clinical excellence awards—a report on junior doctors in training. That has given us an excellent opportunity to consider what rewards and inducements may be available to encourage junior doctors to move into A and E and other specialties in which the work is particularly intensive and the meeting of staffing requirements has posed a long-standing challenge.

[Liz Kendall (Leicester West) (Lab)]

The Government say that the number of doctors in the NHS has increased by 5,000 since they came to power. When did those doctors start their training?

[Dr Poulter]

We know that it takes five or sometimes six years for doctors to complete their medical training. The key difference is that under the plans left by the last Government not all doctors were guaranteed places of work in the NHS after completing their training, whereas the present Government are ensuring that they find NHS jobs. That is why we have 5,000 more doctors in the NHS. The same applies to midwives: under the last Government they were not finding places after completing their training, but under this Government they are, and there are 800 more of them.

[Kelvin Hopkins (Luton North) (Lab)]

12. What steps he plans to take to address damage to health caused by alcohol consumption.

--- Later in debate ---

[Lorely Burt (Solihull) (LD)]

13. What plans he has to review urgent care services.

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

The configuration of urgent care services is a matter for the local NHS, and commissioners should ensure that there is provision of appropriate urgent care services locally to provide safe and effective care for patients.

[Lorely Burt]

A review of urgent care services by the new GP-led clinical commissioning group for Solihull is causing consternation as it is throwing the future of our highly regarded walk-in centre into doubt. Does the Minister agree that users must be properly consulted, as services must be designed around patients, and that allocation to cost centres must come second to delivering services?

[Dr Poulter]

I agree with my hon. Friend. Where there are well-functioning local services that have local support, commissioners should recognise that in their decisions, but it is also important to highlight that any reconfiguration of local services has to meet the four tests laid down by the previous Secretary of State: support from GP commissioners; strengthened public and patient engagement; clarity on the clinical evidence base; and support for patient choice. I hope that reassures my hon. Friend.

[Fiona Mactaggart (Slough) (Lab)]

One of the ways in which the Government are trying to prevent urgent care and A and E admissions is by holding down the funding for unplanned admissions to 30% above 2009 levels. That is proving very hard in places where many people who arrive for A and E or urgent care are not registered with a GP. What can the Minister do to help with the funding of services in communities where it has proved impossible to reduce A and E admissions?

[Dr Poulter]

The hon. Lady rightly highlights that there are challenges ensuring registration with GPs, particularly in areas with large migrant population groups. In some parts of London, each year as many as one third of patients move and change GP surgeries. This is a big challenge and we are encouraging local hospitals to make sure that people who turn up at A and Es inappropriately subsequently register with a GP.

[Miss Anne McIntosh (Thirsk and Malton) (Con)]

14. What his policy is on community hospitals.

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

The Government are committed to supporting the NHS to work better by extending best practice on improving discharge from acute hospitals and increasing access to care and treatment in the community. Community hospitals play a valuable role in this process.

[Miss McIntosh]

I welcome my hon. Friend’s reply. Will he give an assurance that going forward there will always be a place for community hospitals in respect of palliative and rehab care, which can be more easily delivered in one place?

[Dr Poulter]

My hon. Friend makes an excellent point. Community hospitals can provide a good focus for palliative care, respite care, intermediate care and step-up and step-down care close to home, particularly for people in rural communities who may otherwise have to travel very long distances to attend hospitals. I hope the community hospitals in my hon. Friend’s constituency will have a long and vibrant future.

[Annette Brooke (Mid Dorset and North Poole) (LD)]

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

--- Later in debate ---

[Miss Anne McIntosh (Thirsk and Malton) (Con)]

T5. The NHS has confirmed that North Yorkshire is the only part of the country that will inherit a £19 million debt, which has to be carried by the new clinical commissioning groups. That was the situation we were promised we would never be in. What is the Secretary of State going to do to urgently address the chronic underfunding of rural areas for the NHS in North Yorkshire?

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

My hon. Friend and I have previously discussed this matter, and she is right to highlight that there are particular challenges to address in rural areas, in terms of both distances to travel and an ageing population requiring considerable health care resources. That will of course be a matter for the NHS Commissioning Board to examine when it considers future funding allocations.

[Mrs Mary Glindon (North Tyneside) (Lab)]

T6. As one in three women who get cancer are over the age of 70, can the Minister say when the newly launched Be Clear on Cancer campaign will be rolled out nationally?

--- Later in debate ---

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

T10. In the light of widespread representations from constituents about the proposals for the centralisation of pathology services, will my right hon. Friend the Secretary of State consider the clinical concerns very carefully before any such changes are sanctioned?

[Dr Poulter]

I thank my hon. Friend for that question and he is right to highlight the fact that any decisions about service reconfigurations must be clinically led, as was outlined in the Government’s tests for any service reconfiguration.

[Heidi Alexander (Lewisham East) (Lab)]

T8. Last week, the Secretary of State refused my request to meet a small group of local GPs, hospital doctors and residents who are opposed to the closure of accident and emergency and maternity at Lewisham hospital, yet in his former role he seemed very happy to trade hundreds of texts with Rupert Murdoch’s lobbyists about the purchase of BSkyB by News Corp. Why is it one rule for Rupert Murdoch’s lobbyists and another for doctors in Lewisham?

--- Later in debate ---

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

Penalties on readmission rates were introduced to improve clinical practice, but patients suffering from sickle cell and thalassaemia in my constituency and elsewhere cause hospitals to be fined for readmission, even though it is often in the patient’s best clinical interest. Will the Minister once again reconsider exempting sickle cell and thalassaemia from the penalty?

[Dr Poulter]

The hon. Lady is right to raise concerns about specific groups. The direction of travel in reducing readmission rates has to be the right thing; far too many patients were bouncing back to hospital when they would have been better looked after in the community. The longer term answer for some conditions, such as heart disease and possibly sickle cell and thalassaemia, may be year-of-care tariffs, which we are looking at very closely, as is the NHS Commissioning Board.

[Sir Nick Harvey (North Devon) (LD)]

The Secretary of State just referred to the new strategic clinical networks. As the cancer networks are merged with them, what safeguards are there to stem the loss of expertise in cancer and what specialist support will be available to CCGs trying to achieve the targets we have heard about?

--- Later in debate ---

[Natascha Engel (North East Derbyshire) (Lab)]

My 92-year-old constituent, Ron Lewin, was referred for minor oral surgery. He was eventually written to by the specialist, who said that waiting lists were very long and that assessment appointments were available in 18 weeks, but that they did offer an independent service if he wished to be seen earlier. Independent obviously means paying to jump the queue. Is that how the Government propose to cut waiting lists?

[Dr Poulter]

It is a decision for front-line medical professionals to outline when treatment should or should not be given. Treatment must always be given on the basis of clinical need, so I am sure the hon. Lady will be feeding that message back to local commissioners. There is an opportunity for people to appeal against decisions when they are not made on the basis of clinical need, as that is clearly not the right thing and not in the interests of patients.

[Zac Goldsmith (Richmond Park) (Con)]

Will my right hon. Friend’s Department make an assessment of the effects on local air quality and public health of a potential third runway at Heathrow, and will he submit those findings to the Davies commission on airport capacity?

Vascular Services (Wycombe Hospital)

Dan Poulter Excerpts

Monday 14th January 2013 Commons Chamber

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

I congratulate my hon. Friend the Member for Wycombe (Steve Baker) on securing the debate and raising issues that are pertinent not only to his constituents but to those of my right hon. and learned Friend the Attorney-General, who has been sitting next to me on the Front Bench listening to the debate and who shares a number of my hon. Friend’s concerns.

Before I discuss the substantive points about Wycombe, I should address my hon. Friend’s point about failing management in the NHS. He is right that there is a tendency to recycle failing managers in the NHS, and I am sure that the House will return to that point when my right hon. Friend the Secretary of State responds to the concerns raised in the Mid Staffordshire inquiry, following the Department’s receipt of the report.

It is worth paying tribute to the dedicated health care workers in Wycombe and the surrounding areas of Buckinghamshire, because my hon. Friend has a number of excellent clinicians. He highlighted several local successes in delivering high-quality care through vascular surgery, and I know that there are good outcomes locally in specialties such as carotid endarterectomy. He has many excellent doctors and nurses and other front-line health care professionals, and also some very good managers, who have the best interests of their patients at heart and deliver high-quality health care outcomes for local patients on a daily basis, 365 days a year.

My hon. Friend rightly highlighted some local concerns about the ongoing loss of services at Wycombe hospital, and it is worth reiterating some of his words. He said that the hospital had lost A and E, consultant-led maternity—retaining a midwifery-led unit as a concession —and paediatrics, and this year the emergency medical centre was downgraded to a minor injuries unit, resulting in a repeat of much of the local outcry at the loss of A and E, and now he has highlighted eloquently the concerns over the potential loss of some of the vascular services at the hospital.

It is worth pointing out that I was reassured today before coming to the debate by local health care commissioners in the Wycombe area that there is a strong future for Wycombe hospital. There is no threat of the hospital being downgraded to the point of closure. Commissioners today reassured me—and I hope that this reassures my hon. Friend—that in many areas Wycombe provides a very good site further to develop health care services the better to meet the needs of the local population. It is an excellent satellite site, combined with Stoke Mandeville, for providing high-quality, close-to-home health care. From discussions that I have had, I believe that there may be the possibility of improving further some of the cardiac care that is offered.

I come specifically to the issues that my hon. Friend raised about vascular services, which are particularly important in Wycombe, which has a large Asian population, among whom, as we all know, there is a higher rate of cardiovascular disease. It has a higher rate of diabetes and many cardiovascular illnesses. My hon. Friend highlighted eloquently the number of local vascular services provided, and particularly referred to amputation services. We know that one of the complications of vascular disease and diabetes is the higher rates of amputation among some patients. It is quite right that he wants to make sure that high-quality services are provided locally to meet the established need for patients who require vascular services, and that those patients have a holistic service that looks not just at their immediate medical needs but provides high-quality surgical care.

We know that as lifestyles, society and medicine change, the NHS must continually adapt. The NHS has always had to respond to patients’ changing expectations and to advances in technology. When we do change and reconfigure services, it must be about modernising facilities and improving the delivery of high-quality patient care. In that context, it is also important that while we have to recognise that some services are better provided in larger centres of care— for example, the John Radcliffe centre, which can offer super-specialist services—where the clinical outcomes for patients are better, we must also provide high-quality local services, particularly for older people. We know that the majority of vascular patients often fall into an older age demographic, and it is important that when there is any service reconfiguration, those day-to-day outpatient clinics for vascular patients are maintained locally. I am reassured that in the potential reconfiguration, bread-and-butter outpatient clinics and continuity of care for vascular patients will be maintained.

The Government are also clear that the reconfiguration of front-line health services is a matter for the local NHS. Services should be tailored to meet the needs of local people, and the four tests laid down in 2010 by the previous Secretary of State for Health, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), require that local reconfiguration plans demonstrate support from GP commissioners, strengthened public and patient engagement, clarity on the clinical evidence base and support for patient choice. If my hon. Friend is worried that these tests have not been met in the local reconfiguration, he has the opportunity directly to challenge them or to ask the local health scrutiny committee to refer them to the Secretary of State for review.

[Tim Farron]

The Minister rightly says that the NHS reforms allow local councillors to vote to refer such matters to Ministers. In my area of Morecambe bay, that opportunity comes on 22 January. Will he assure councillors that Ministers will take such referrals very seriously and look into them with great rigour?

[Dr Poulter]

Yes. I assure my hon. Friend that when a referral is made by a local overview and scrutiny panel the Secretary of State will look at it and decide whether to refer it to the independent reconfiguration panel. That is often the decision that is made in these cases, but it lies initially with the Secretary of State, who will then have to consider whether to refer it. I am happy to write to my hon. Friend further to outline these steps if that would be helpful.

It is worth highlighting the national parameters that are being set for the delivery of good vascular surgery by the NHS Commissioning Board, which takes over full responsibility for commissioning from April this year. The board published a draft national service specification for vascular surgery for consultation. The consultation commenced in December 2012 and will conclude on 25 January 2013. It identifies the service model, work force and infrastructure required of a vascular centre. It says:

“There are two service models emerging which enable sustainable delivery of the required infrastructure, patient volumes, and improved clinical outcomes. Both models are based on the concept of a network of providers working together to deliver comprehensive patient care pathways centralising where necessary and continuing to provide some services in local settings…One provider network model has only two levels of care: all elective and emergency arterial vascular care centralised in a single centre with outpatient assessment, diagnostics and vascular consultations undertaken in the centre and local hospitals.

The alternative network model has three levels of care: all elective and emergency arterial care provided in a single centre linked to some neighbouring hospitals which would provide non arterial vascular care and with outpatient assessment, diagnostics and vascular consultations undertaken in these and other local hospitals. All Trusts that provide a vascular service must belong to a vascular provider network.”

In essence, this is about making sure that we deliver high-quality vascular care. There are two or three circumstances in which someone would require vascular care. First, there is emergency care—for example, when there is a road traffic accident, or when someone has a leaking aortic aneurysm, which is a very severe and potentially life-threatening emergency. We know from medical data that such service provided in an emergency is much better provided in a specialist centre—an acute setting such as the John Radcliffe, which would be the hub and the central focus. There is also good evidence that trauma care in any setting, including the requirement for neurological specialists potentially to be involved, is better served in a specialist trauma centre. A specialist centre provides better care in emergencies.

At the same time, it is clear from those models that there can also be a strong role for other hospitals as satellites of the central hub at the John Radcliffe. My hon. Friend clearly made the case for the high-quality outcomes at Wycombe hospital for carotid endarterectomies and other vascular services. I would suggest that there is a role for challenging local commissioners if they wished to remove some elective procedures from Wycombe when there is a case that they can still be delivered in a high-quality manner and to a good standard for patients.

[Steve Baker]

I apologise for intervening on the Minister when there is so little time left, but I can see the campaigners leaping up and down and saying that the clinical evidence in this case is that Wycombe is doing better than Oxford on aneuryism repair.

[Dr Poulter]

The evidence on the outcomes of patients from many trials does stack up over a period of time. Generally speaking, all surgeons need to do a minimum number of procedures in order to maintain regular competency, and to maintain continually high and good outcomes for patients when carrying out aneuryism repair. That is the reason for the service reconfiguration. The argument can be made, as my hon. Friend has done, that Wycombe should continue to provide those services, but we know that the national data and best evidence point to the fact that the services are best provided at specialist centres.

However, there is a good case for my hon. Friend to take forward to the local commissioners about ensuring that more of those elective procedures and elective amputations remain local, and I am sure that he will do that. I am sure that he will also want to talk to his local health scrutiny committee to ensure that it refers cases to the Secretary of State for review, if required. I thank him once again for raising the matter in the debate.

Question put and agreed to.

Newark Hospital

Dan Poulter Excerpts

Monday 7th January 2013 Commons Chamber

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

I congratulate my hon. Friend the Member for Newark (Patrick Mercer) on securing this debate and on his continued, long-standing dedication to and strong advocacy for his constituents, and his local health care services and all the patients who use them. It was good to hear interventions from hon. Members on both sides of the House; we heard from my hon. Friends the Members for Sherwood (Mr Spencer) and for Lincoln (Karl MᶜCartney), and the hon. Member for Mansfield (Sir Alan Meale). That shows that on important issues such as local hospitals we can put party differences aside to come together for the benefit of the people who matter most in the NHS—local patients. I was pleased to hear that party politics had been put aside today and I was glad to hear the hon. Member for Mansfield say that he will continue to do so in the future for the benefit of patients in Nottinghamshire.

As has been articulately outlined by my hon. Friend the Member for Newark, Newark hospital provides an extensive range of consultant-led out-patient services and does so with short waiting times. It provides many high-quality day-case procedures, and diagnostic and other services. It also has a high-quality minor injuries unit and urgent care centre. Some 35 beds are available across two medical wards, with 21 more beds in the surgical ward. As my hon. Friend rightly outlined, one challenge that faces the NHS as a whole and patient provision in Newark is the fact that many people are now living longer and need high-quality, close-to-home community health care services. That is exactly what is provided at his hospital.

We also know that a new 12-bed facility is to open in Newark hospital in February 2013. The Fernwood community unit will be a specialist unit of single-sex bays and private rooms that will meet the needs of the growing number of elderly patients we have discussed, ensuring that people have the right to recuperation and recovery in an appropriate intermediate care setting before they return to their own homes.

The hospital receives full back-up from the teams at King’s Mill and the services provided by the two hospitals are compatible and work well in synergy. I want to put on record my congratulations on and gratitude for the dedication and hard work of all the NHS staff who work on the King’s Mill site and at Newark and who do excellent work to look after patients to a very high standard. I will be happy to take up my hon. Friend’s offer of a visit to Newark hospital when time permits later in the year, so that I can meet the staff and see first hand the excellent care provided there.

It is worth highlighting that there was a local agreement on Newark services, which was signed off on 18 December. Newark and Sherwood district council agreed across party lines to work with the Newark and Sherwood clinical commissioning group and the Sherwood Forest Hospitals NHS Foundation Trust to maintain what they see as essential elements for local services. When looking after older people, it is good to have cross-agency integrated care and working and a commitment to those principles from not only the NHS but local authorities, which play such an important part in the care of older people through housing and social services.

The commitments made in the agreement were that there should be high-quality primary and secondary health care for the people of Newark and Sherwood; a strong and positive future for Newark hospital within Sherwood Forest Hospitals NHS Foundation Trust; and accessible and safe health care services for patients across Newark and Sherwood district that are as close to people’s homes as possible. As has been outlined throughout the debate, it is important that we ensure that older people do not have to travel many miles to receive high-quality care and that they receive that care, if not in their own homes, as close to their homes as possible. That is why I am confident that Newark hospital will always have a strong and viable future as a setting for the provision of high-quality care for many older people and for all the other patients it looks after so well.

My hon. Friend also raised the question of the PFI debt at the hospital trust and he was right to do so. Monitor, the independent regulator of foundation trusts, recently expressed concern about the financial situation at Sherwood Forest Hospitals NHS Foundation Trust. The trust signed its £320 million PFI deal in November 2005 for the redevelopment of King’s Mill, and in 2012-13 the trust’s PFI cash outflow is £42.5 million, which equates to 17% of the trust’s income—a very large PFI debt, with 17% of the income spent on PFI repayments. If we were not already aware of the great damage inflicted on our NHS by PFI agreements, which were sometimes signed in haste and which we have often lived to regret, that agreement would make the case very clearly.

On 21 September, Monitor published a breach of compliance report which referenced a McKinsey’s report it had commissioned. The report concluded that the trust’s PFI commitments were affordable only with additional activity from the local health economy. That means it does not qualify for Department of Health national PFI support. The report outlined the fact that the trust has potential for additional health care activity, which would benefit it financially and put it on a more stable financial footing. The emphasis on additional activity in the report seems to suggest that more can be done potentially at Newark to develop services for the benefit of local patients. That could bring revenue and income into the trust and would do more better to serve the needs of a growing population and its future health care demand.

To answer one of the points my hon. Friend raised, enhancing facilities in the minor injuries unit could play a part in putting the trust on to a more stable financial footing. The new chief executive is keen to look into the issues, as my hon. Friend said, and he is right to highlight the fact that good, dynamic leadership can turn around the trust’s financial fortunes, notwithstanding the massive PFI debt repayments. There are clearly further opportunities to develop what the hospital can do to put itself on a stable financial footing while doing more to look after local patients better. I know that the chief executive and the team at the trust are listening to the debate, and that they will take on board what I have said and the concerns that my hon. Friend raised.

My hon. Friend talked about ambulance services in the Newark area. It is worth pointing out the distances that some patients have to travel to reach a fully functioning, 24-hour A and E service. King’s Mill hospital, one of the acute settings, is 23 miles away, which is about 42 minutes by road. The Queen’s Medical Centre in Nottingham is 22 miles away, a 50-minute road journey, and Lincoln county hospital is 20 miles away, which is 45 minutes from Newark by car. Those are average journey times; there may be busy times and road congestion.

There are particular challenges in making sure that in an emergency patients can get to an appropriate A and E care setting in a timely manner. My hon. Friend pointed out that according to East Midlands Ambulance Service NHS Trust figures, in the years 2009-10 and 2010-11 and in the first quarter of 2012-13, Nottinghamshire did not reach its A8 response targets. Sometimes, those targets are skewed: they can be better in urban areas, such as Nottingham, but worse in more rural settings. I am sure my hon. Friend will want to take things further with the ambulance service and drill into the data for Newark by postcode, to compare response times in a more rural area, where there is a long distance to travel to an A and E, with those in some of the more urban settings in Nottinghamshire. It is obviously unacceptable to all of us if patients in rural communities have to wait a long time for an ambulance and life-saving treatment.

In the ambulance service review and the consultation on its proposals, it is vital that rurality and travel distances to A and Es and other urgent care settings are taken into account in any changes to the service. From the figures I referred to, we already know about the challenge the ambulance service in Nottinghamshire faces, because it is not meeting response targets. If we break down those targets by postcode and by area, we may find that rural areas are even further behind. When the review takes place, it is important that the rurality of Newark is properly taken into account so that patients in rural areas have the same quality of ambulance response as those in more urban settings.

In conclusion, I am pleased to confirm that there is a strong and viable future for services for local patients at Newark hospital. I very much look forward to taking the discussions further with my hon. Friend in early February, and to visiting the hospital later in the year.

Question put and agreed to.

Parliamentary Written Questions (Correction)

Dan Poulter Excerpts

Thursday 20th December 2012 Written Statements

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

I regret that the written answers given to the hon. Member for Hartlepool (lain Wright) on 6 November 2012, Official Report, column 584W, the right hon. Member for Warley (John Spellar) on 22 October 2012, Official Report, column 711W, the right hon. Member for Leigh (Andy Burnham) on 20 February 2012, Official Report, column 713W and the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) on 10 January 2012, Official Report, column 120W, contained some incorrect information.

The written answers pertained to the cost of exit packages incurred by primary care trusts (PCTs) and the information provided in the original answers incorrectly included a negative figure for one PCT, due to an error in compiling the figures for the annual report and accounts within the Department.

In respect of the answer given to the hon. Member for Hartlepool (lain Wright), a table showing the corrected figures is given below.

NHS Funding

Dan Poulter Excerpts

Wednesday 12th December 2012 Commons Chamber

[Andy Sawford]

I want to keep my remarks to Kettering general hospital, and I do not think that PFI is the issue there.

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

The hon. Gentleman mentioned the Healthier Together programme; it is clear that many of the hospitals in that programme have very high PFI debts. We will get the figures for him, to clarify that, in the closing remarks.

[Andy Sawford]

A few weeks ago, the hon. Gentleman—I am sure that he had no intention of misleading the House—talked about the funding issues at Kettering general hospital being driven by PFI deals in Anglian hospitals, which are not really part of the group that I am talking about.

[Dr Poulter]

rose—

[Andy Sawford]

I will not give way; I want to make important points for my constituents. It is important that these things are put on record, so I shall not be giving way to the hon. Gentleman again. He has not done a great service to people in my constituency in the way that he has addressed these issues.

Hospital Food (Animal Welfare Standards)

Dan Poulter Excerpts

Wednesday 12th December 2012 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Turner. I pay tribute to my hon. Friend the Member for Tiverton and Honiton (Neil Parish) for securing the debate and for his ongoing keen interest in ensuring the highest standards of animal welfare in farming and food production. We know how important that is because we both represent rural parts of the country, although I have a slightly more mixed constituency than he does, with a strong urban component. It is always in consumers’ interests for the quality of production to be high, and we do what we can to protect and support our food producers and farmers. We know that to be true, and it is something the Government take seriously.

My hon. Friend will be pleased to hear that, earlier this week, I met and discussed this matter with James Martin, a fairly well known—I recognised him—television chef. I am encouraged by the fantastic work that he is doing to raise the quality of food in hospitals throughout the United Kingdom, but particularly in parts of the north of our country. As a doctor as well as a Minister, I know how important it is that we always provide patients with high-quality nutritious food; it is especially important when looking after older patients, who need to receive high-quality nutrition as part of their recovery. That is precisely why my right hon. Friend the Secretary of State for Health has been so keen, early in his tenure, to support both high quality and dignity in care for older people, and to make sure that as a Government we actively promote greater consistency among hospitals in the provision of high-quality nutritious food and good buying standards.

It is worth outlining what the improving hospital food project is about. Good food is an essential part of hospital care, improving both patients’ health and their overall experience of their stay. Clinicians have a duty to ensure that patients get the right treatment for their condition, but it is also important that patients receive the right supportive care to enable a good recovery, and nutritious food is essential. Catering to everyone’s taste can be a challenge, and there are many ways to produce good food in hospital. It is right that local hospitals have the flexibility to decide which method is best for them in the context of the needs and preferences of their local population. People in Bradford or Liverpool will obviously have different preferences from people in more rural areas—demographic mixes and tastes differ. I am sure that my hon. Friend agrees.

Our improving hospital food project highlights eight fundamental principles that patients should expect hospital food to meet. One is that Government buying standards for food and catering services should be adopted where practical and supported by procurement practices. The standards cover nutrition, sustainability and animal welfare—the issue my hon. Friend rightly raised in today’s debate. They apply to all food procured by Departments and their agencies and came into force for all new catering contracts from September 2011. They are not mandatory for the NHS, as he said, but via the improving hospital food project, we are strongly encouraging hospitals to adopt them.

[Neil Parish]

I can understand that the Government are slightly reticent to bring in mandatory controls, but are they going to monitor the provision of good food in hospitals? Will they keep an active eye on whether the situation is improving with contracts and whether the higher welfare standards for meat and eggs are being used? They need to monitor the situation, not just bring in a system.

[Dr Poulter]

Indeed. We are looking into that at the moment, with a committee and working party looking at how to roll out good practice.

If we have a mandatory system, we may stifle the potential of what we are seeing locally under the current system. My hon. Friend has highlighted many examples of good practice, and I could add to them: in Sussex, there is a good programme, from plough to plate, which is managed by the head of catering there, William McCartney; and there are other good examples in Nottingham and Scarborough. Local innovation is driving up standards, and that happens in different ways in different parts of the NHS. One of the fundamental principles in which we believe, and it has always been thus, is that hospitals are able to determine how they respond to local conditions. Only this Government have taken seriously the need to support and encourage local innovation better. Through the approach that we have adopted and my right hon. Friend the Secretary of State’s interest in promoting good food in hospitals, we are now seeing many examples of local innovation driving up standards in local hospitals, and through such innovation we can identify and spread across the NHS better and good practice. The problem with a rigid framework or set of criteria is that it might stifle local innovation that can improve standards, as we have seen elsewhere in the NHS.

Our approach is for central Government to take an active interest in good hospital food for the benefit of patients, working through commissioning for quality and innovation payments. To promote good practice, the project is developing an exemplar pay framework within the CQUIN scheme, which enables health care commissioners to reward excellence by linking a proportion of providers’ income to the achievement of local quality improvement gains. We are developing two new CQUIN exemplars related directly to hospital food, one linked to the adoption of Government buying standards for food and one to excellence in food service. I hope that my hon. Friend is reassured by the fact that animal welfare is part of those standards. We are looking at linking CQUIN payments in the NHS to good, ethical Government procurement. We recognise and value the local innovation of various hospital food schemes, which have benefited patients from Scarborough to Sussex. That is better than a rigid framework and enables the NHS to learn from examples of good practice.

[Mr Andrew Smith]

The Minister referred to the more general application of Government buying standards. What is his response to the argument from the National Farmers Union that the standards would operate better if the red tractor standard of production was generally adopted as part of them?

[Dr Poulter]

Many of us are great fans of the NFU work to support the red tractor standard. Many great benefits can be obtained from British farmers, who often operate to higher standards of animal welfare and traceability. That is something that we are proud of, and there are great benefits for consumers in supporting such farmers. The Government therefore have an ethical framework for how food should be procured.

We are looking, through the CQUIN payments, at how to support and reward good practice in hospitals, taking into account the Government framework for welfare. When the NFU and other organisations highlight good local practice and support British farmers to lead the way in animal welfare through the red tractor standard, we want to ensure that we do not set up rigid frameworks that might prevent local hospitals from supporting such good ethical standards. Through local flexibilities that hospitals currently have, we are enabling the bar to be raised for animal welfare and the quality of hospital food.

Time forbids my going into greater detail, but we are encouraging friends-and-family testing in the NHS, putting patients and their relatives in charge of inspecting the quality of care and health care. That can be no more important than for hospital food. Recently, I visited Darlington hospital, which had had a patient-led inspection of hospital care, a key part of which was to look at hospital food, to ensure that every patient was served with nutritious food, cooked locally and on site.

A number of the issues raised in the debate cut across the responsibilities of Ministers in the Department for Environment, Food and Rural Affairs, so I will write to them and highlight the concerns expressed by my hon. Friend the Member for Tiverton and Honiton today. In my Department, however, we encourage hospitals to use and maintain ethical standards in the buying of their food, but we also enjoy and support local flexibilities that benefit patients and raise standards throughout the NHS.