Clevedon Community Hospital
Dan Poulter Excerpts(11 years, 5 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I congratulate my right hon. Friend the Member for North Somerset (Dr Fox) both on securing the debate and on his strong advocacy for Clevedon community hospital.
Members who represent more rural constituencies know the importance of high-quality community health care facilities, including community and cottage hospitals. They provide important close-to-home care for patients in more rural areas, particularly frail and elderly patients who have long distances to travel to receive health care.
We know the importance of such hospitals in meeting the long-term challenges of the NHS. We need to redesign services and deliver more services closer to home, and prevent inappropriate hospital admissions to big acute hospitals such as those in Bristol or Weston-super-Mare. That means ensuring that we have the right community resources properly to support local people, including those with long-term medical conditions such as asthma, diabetes and dementia. In particular, we need to ensure that we have community-based support for older people—the biggest group with long-term conditions.
We want to move the emphasis of care in this country away from acute crisis management, to which the NHS is accustomed, both to save the NHS money and to provide better care for people in their homes and communities. Community hospitals such as Clevedon are important in delivering such care. They provide invaluable beds for people with long-term conditions to give their carers respite, and important rehabilitation in a setting close to home, family and support networks for people who have broken hips, or who have had strokes or heart attacks. They provide the opportunity for step-up care for people who are not so unwell that they need to be admitted to an acute setting, but who can be better looked after temporarily in an environment that provides the additional care that people need. The Dr Foster report, which was published this week, highlights that 29% of patients did not necessarily need to be in acute hospital beds. If we are to meet the challenge of ensuring that people are better looked after and are not in hospital beds when they do not need to be, it is important that we invest properly in community resources, and Clevedon community hospital is just one of those resources.
I share with my right hon. Friend and the community he represents their frustration with the primary care trust, as I have Hartismere community hospital in my constituency. My predecessor, Lord Framlingham, had considerable struggles with the PCT about the potential closure of an important rural hospital. From what my right hon. Friend says, his constituents and local patients have been having considerable struggles and difficulties with the local PCT in Somerset.
I acknowledge the special role the League of Friends plays in the life of Clevedon community hospital, a point my right hon. Friend made in his speech. It has worked to raise a lot of money for the hospital and to ensure that it is retained as an important community health care resource. It is dismayed and disappointed, as are others in the local community, by the attitude of the PCT. I understand his disappointment, but under the PCT arrangements the provision of local NHS services remains with the local NHS. However, he is concerned that approximately £1.5 million or £1.6 million has been spent on project costs and other costs over a four-to-five-year period, in proposing to develop a new and sustainable community hospital facility in Cleveland. The money has been spent, but there is still no new facility. As physicians, we would rather the money had been spent on a new facility or on community care.
If it is any consolation to my right hon. Friend, I had a conversation with local health care representatives yesterday. They reassured me that even without the new facility at the allocated site, there are no concerns about any loss of services with the transfer from the PCT to the clinical commissioning group that will have responsibility for running community services. I hope it reassures my right hon. Friend to hear that when the new arrangements come into place in April next year services will remain as they are now.
On endoscopy services, as clinicians we know that strict evidence-based clinical standards must be achieved when delivering endoscopy services, which, for patient safety and to maintain high-quality patient care, have to be adhered to. There were concerns that facilities at Clevedon hospital were not able to maintain those high standards. For example, arrangements for the decontamination of endoscopy equipment would have to be substantially improved if the service was to achieve external accreditation by the national joint advisory group for endoscopy, and that would need to be achieved for the service to return to the hospital.
Despite my conversation yesterday with representatives from local health care commissioners, I am alarmed by what my right hon. Friend tells me about the business case to all intents and purposes being approved and then suddenly, between March and June, being disapproved—an extraordinary turn of events. It is inexcusable to raise the expectations of local patient groups, effectively giving a green light suggesting things were going ahead, and then to remove that expectation. I am happy to look into the matter further and to write to my right hon. Friend about it in more detail, because I am concerned about the issues he has raised. When something like £1.5 million has been spent on planning, and various plans and business cases have been brought forward, it is all the more concerning. It is not a satisfactory state of affairs, as far as the local management of NHS resources is concerned, and it is certainly not a satisfactory state of affairs, as far as local patients are concerned. I shall further investigate the matter and write to him on the basis of those investigations.
On future provision, I would like to reassure my right hon. Friend that, according to what local health care commissioners told me yesterday, the services currently provided at the hospital are safe and will still be provided. Even though plans do not appear to be in place, as they once were, to build a new hospital on a new site, it would be relatively easy, I understand, to maintain the buildings and the facilities on the current site in a state that would allow for the safe delivery of high-quality patient care and the ongoing provision of services for patients in the area. I understand that the older building can be improved, if required, to ensure that it can still deliver high-quality patient care.
With those reassurances, I will further investigate why the business case has gone from being approved to disapproved, as my right hon. Friend said. We have been reassured that the services currently provided at the hospital will continue to be provided for the foreseeable future.
Dr Fox
If we are to maintain clinical services on the original site, substantial investment will be required. I am sure that my hon. Friend will be sympathetic to our view. If a business case can be perfectly fine in March but dumped in July, if we, the poorest funded PCT, can give money to other less well-performing PCTs and given that the transfer is being put forward again this year, how can we have much confidence in the local management? Then, when our questions are not answered, as they continue not to be, we feel that there is not only insufficient competence but a lack of transparency. I am grateful for his reassurance that the matter will be looked into, but I would also like him to kick our local PCT in the proverbials to ensure we get the money required from the sale of the Millcross site or from additional investment, so that we can get the facilities that our taxpayers contribute towards but which seem to be getting siphoned off into other areas, whether because of a lack of adequate priorities or competence.
Dr Poulter
My right hon. Friend makes a good case. From what he has outlined, I fully agree that some of the circumstances surrounding the decision seem extraordinary and completely unacceptable. He described it as being far from competent, and I would not wish to disagree, judging from his analysis.
We are interested in delivering high-quality front-line patient care. The challenge for the NHS is delivering that care close to home and close to people’s communities. That is what Clevedon does and what it needs to continue to do. We need to ensure that PCTs, as they are at the moment, and clinical commissioning groups, as they will be in the future, invest in high-quality local health care services in order to meet the challenge of better looking after older people. That is the clear challenge that David Nicholson set for the NHS in 2009 in the quality, innovation, productivity and prevention challenge. It is about the need to redesign services in order to deliver better and more affordable care in the community.
That was also the challenge that Dr Foster outlined for the NHS earlier this week. It is about time that my right hon. Friend’s local health care commissioners acknowledged that challenge, invested in local health care services and made the argument for keeping investment locally, rather than, as he said, siphoning it off elsewhere. I will clarify the matter further by investigating with the PCT what has happened. From our discussions so far, I can reassure my right hon. Friend that the PCT and the clinical commissioning groups reassured me yesterday that they would, they thought, be able to find the investment to continue with the current older buildings, maintaining them as fit for purpose to continue with patient care, and that patient care will continue on the current site, as it does now, in April. Nevertheless, there are clearly questions for the local health care commissioners to answer.
Question put and agreed to.
Liquid Nitrogen Drinks
Dan Poulter Excerpts(11 years, 5 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I congratulate my hon. Friend the Member for Morecambe and Lunesdale (David Morris) on securing this debate and on his continuing strong advocacy for his constituents. I know that he has been a diligent and hard-working constituency MP since he was elected, and I pay tribute to his work in bringing forward this issue. As a doctor, I was sad to hear of the ordeal that Gaby Scanlon endured when she went out to celebrate her 18th birthday, and of the distress caused not only to her but to her family and friends. I acknowledge my hon. Friend’s determination, therefore, in following up on the serious injury suffered by his constituent.
As my hon. Friend rightly outlined, the incident on 2 October has attracted considerable media attention. Tonight being a Friday night, I am sure that many young people will be going out into bars and clubs in the places they live or perhaps further afield. This debate has also attracted attention in Australia and New Zealand. As we know, this is the first time that the Food Standards Agency has been made aware of a food incident involving the use of liquid nitrogen. I say “a food incident”. The FSA, a national body working in close partnership with local licensing authorities, has responsibility to ensure that food and drink in our restaurants, bars and clubs and elsewhere is served responsibly and safely. When it became aware of the incident, the FSA immediately issued a warning to raise consumers’ awareness of the dangers of consuming drinks containing liquid nitrogen. The FSA also encouraged all environmental health officers to be vigilant about the use of liquid nitrogen in food or drink when carrying out their routine inspections of food and hospitality premises.
I hope my hon. Friend will be reassured to hear about the controls that are already in place. Food law prohibits the sale of harmful foods and drinks in the UK. Manufacturers, retailers and businesses in the UK have a legal obligation to ensure that the food and drink they serve to the public is fit for human consumption. There are industry safety and handling guidelines around the use and storage of liquid nitrogen. Business owners are responsible for training their staff, making them aware of the potential risks of using liquid nitrogen and having appropriate safety measures in place to protect staff and consumers. Existing legislation prohibits the sale of food and drink that is unsafe. Enforcement of both health and safety measures and food safety legislation is the responsibility of the relevant local authority—in this case Lancaster city council. Businesses selling alcohol that are convicted of food safety offences can have their alcohol licences withdrawn by the local licensing authority.
It is worth touching on the wider point about the glamorisation of alcohol—sometimes by the food and drink industry, but particularly by wider sectors of the media. As I have said, tonight many young people will go out to bars, clubs and other settings in town centres and elsewhere, including the village and market town pubs in my constituency, to enjoy an evening out with friends. On the whole, things will pass successfully and without any adverse incident. However, we know that there has been a problem in parts of the country where certain bars and clubs have been irresponsible in their marketing of alcohol. It is the responsibility of licensing authorities to ensure good practice in the performance of their local bars and clubs and to ensure that they are run responsibly. With regard to the premises in question, that is something that I know the local council will look at seriously in the ongoing investigation in this case.
We expect those who sell and promote alcohol to do so responsibly. The alcohol industry in general has made a core commitment, through the public health responsibility deal, to foster a better culture of responsible drinking. We are grateful for the national recognition of the importance of the issue by the alcohol industry, but the Government’s alcohol strategy goes further in fostering responsible drinking, aiming to cut the number of people drinking to harmful levels. It addresses both health and social harms, describing co-ordinated actions across Government, and includes a commitment to introduce a minimum unit price for alcohol to tackle the sale of heavily discounted alcohol, with further action to ensure that local authorities have the licensing powers they need to protect local communities. The strategy will deal not just with binge drinking, but with all activities to do with responsible drinking, promoting safe places for people, young or old, to go out in town centres in the evenings. On 28 November, the Government launched a consultation on a number of areas set out in the strategy, including a recommended price of 45p per unit of alcohol. We are taking that action to ensure a sensible price for drinks that cause harm.
What is the local authority doing in this case? Lancaster city council is rightly investigating the events that led to Gaby’s very serious injury. The full details of what happened in this incident are not yet publicly available, because of the ongoing review and investigation of the case by the city council. However, I can reassure my hon. Friend that once they have concluded, government departments such as the Food Standards Agency will consider whether further guidance is necessary. As I outlined earlier, initial action has been taken to warn consumers of the risks of consuming drinks containing liquid nitrogen and to ensure that local authorities are vigilant in their inspection of food businesses with regard to the sale of this product. We do not yet have all the information about what happened in the bar in Lancaster, so we need to wait for the conclusion of the investigation by the council. However, I reassure my hon. Friend that we will take the results of that investigation seriously and the FSA will consider them. We must ensure that what happened to Gaby does not happen again to other young people.
Question put and agreed to.
Oral Answers to Questions
Dan Poulter Excerpts(11 years, 5 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
The previous Labour Government gave foundation hospitals additional freedoms to set their own pay terms and conditions for staff and, as a result, the information is held locally, not centrally.
Mr Bain
I thank the Minister for that non-answer. Will he recognise that with average wages 6.8% lower for full-time workers than they were when this Government took office, people are right to be sceptical about the Government’s record in pay? Why is he sitting back and doing nothing while the national character of our health service is being destroyed through regional pay arrangements?
Dr Poulter
It is worth reminding the hon. Gentleman that, as I outlined in my first answer, it was the previous Government who gave foundation trusts additional freedoms to set their own pay terms and conditions outside national frameworks. This Government are working closely with NHS employers and the trade unions to make sure that we maintain “Agenda for Change” and national pay frameworks as fit for purpose, and we are very pleased with that. If the hon. Gentleman wants to ask why there is regional pay and freedoms for employers to set regional pay, he should ask those on his own Front Bench, some of whom were Ministers when these freedoms were set.
John Pugh (Southport) (LD)
Does the Minister recognise that the recent progress in national negotiations over greater flexibility is very encouraging and makes the efforts of the south west consortium and others both disruptive and pointless, in context?
Dr Poulter
We have had encouraging results from national pay negotiations at the recent NHS Staff Council, and unions are to consult their members on those results. There is general agreement that we need to maintain national pay frameworks, provided they are fit for purpose. I hope my hon. Friend will find that the south west pay consortium, which has been somewhat heavy-handed in the way that it has conducted its affairs, also sees the benefit of maintaining national pay frameworks. That is why we would like to see a quick resolution of the matter at a national level.
Pauline Latham (Mid Derbyshire) (Con)
6. What recent assessment he has made of the cancer drugs fund.
Kate Green (Stretford and Urmston) (Lab)
12. What steps he is taking to ensure that primary care trusts do not ration access to NHS treatments and operations.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
Rationing on the basis of cost alone is completely unacceptable. That is why the Government are increasing the NHS budget by £12.5 billion over the life of this Parliament and giving front-line health care professionals the power to decide what is in the best interests of patients.
Luciana Berger
I listened closely to the Minister’s answer. My constituent, Raymond Hickson, has been told that he has a leaking valve in his upper leg, causing varicose veins. His leg will eventually fill with blood, rendering him unable to walk and, therefore, to work, as he is currently employed in a manual job. He has been refused a simple operation on the basis that he now does not fit the PCT criteria, although he has had two similar operations in the past 15 years. What advice would the Minister give Mr Hickson and others like him, who are clearly the victims of treatment being rationed?
Dr Poulter
It is worth pointing out to the hon. Lady, who raises a legitimate point about that gentleman’s case—[Interruption.] The right hon. Member for Leigh (Andy Burnham) says “Do something”, but this type of rationing of varicose vein surgery occurred when the previous Labour Government were in power—[Interruption.] It did, and rationing of many other types of services was much worse. It is this Government who have introduced the cancer drugs fund to stop the rationing of cancer treatments to patients, which has benefited 23,000 extra patients, and many more elective procedures are taking place across the NHS every single day. On the specific case the hon. Lady raises, obviously if her constituent has a specific concern, there are safeguards in place locally for him to raise it if he thinks the decision is not based on clinical criteria.
Kate Green
Trafford primary care trust offers one cycle of in vitro fertilisation treatment to women up to age 29. The Minister will be aware that the National Institute for Health and Clinical Excellence guidance is for up to three cycles and up to age 39. Last year the all-party group on infertility pointed out that a very large majority of PCTs were not meeting the NICE guidance. Why does he think that is, and what is he going to do about it?
Dr Poulter
Of all Ministers in the House, the hon. Lady has probably asked the right one about this issue. This is a long-standing problem that goes back many years. There has been great variability in the availability of IVF in different parts of the country, and, at a national level, NICE finds that unacceptable. I will be taking the matter forward, and I assure her that we will make sure that we do all we can to iron out that variability and follow NICE guidelines so that everyone can receive the best IVF treatment.
Mr Stephen Dorrell (Charnwood) (Con)
Does my hon. Friend agree that the best way to ensure that high-quality care continues to be available to all patients, as and when they need it, is to ensure that the health and care systems are brought together into a single joined-up system so that, in the words of Mike Farrar of the NHS Confederation, we operate a care system with a health adjunct rather than a health system with care support?
Dr Poulter
My right hon. Friend has, over many years, been a very strong advocate—probably the strongest advocate in this House—for integrated care, which this Government are determined to make a reality. He is absolutely right that we need properly joined-up care that we properly deliver when we face up to the big health care challenges of how we better look after people with long-term conditions and older people. The only way to do that is to deliver more care in the community, and that has to be achieved through more joined-up and integrated care.
Mr Nick Gibb (Bognor Regis and Littlehampton) (Con)
My constituent, Jennifer Payten of Bognor Regis, needs dental implants because her temperomandibular disorder means that dentures cause pain and severe headaches. For the past 10 years, Ms Payten has been passed from NHS trust to NHS trust in a Kafkaesque nightmare that no one in modern Britain should have to tolerate. I have written to the Secretary of State about this matter. However, will the Minister personally look into Ms Payten’s case to help to unblock the logjam and ensure that my constituent receives the health care that she needs to enable her to return to a normal life?
Dr Poulter
I thank my hon. Friend for his question. He is right to raise this, because it has been a very long-standing problem. I am sure that he would welcome, with me, the fact that under the current Government over 1.1 million more people are receiving access to NHS dentistry. However, this is a difficult case, and I am happy to meet him to discuss it further and see what I can do to help to unblock the problem.
Andy Burnham (Leigh) (Lab)
Ministers have repeatedly promised to ban rationing of treatment by cost in the NHS. If the Minister is presented with evidence that this is still continuing, will he today give the House a categorical assurance that he will act immediately to stop it?
Dr Poulter
It has been very clear in all the criteria for NHS commissioners set by the previous Government and by this Government that decisions about local health care treatment have to be based on clinical need, and that those decisions are for local commissioners. The difference is that this Government will make sure that doctors, nurses and health care professionals are in charge of budgets and setting health care priorities rather than the managers the previous Government chose to favour, who did not always have experience of front-line care and did not always understand some of the challenges that patients were facing.
Andy Burnham
I will take that as a yes. The Minister is going to have a busy day, because this afternoon he will have on his desk new evidence that I will send him showing that an estimated 52,000 patients in England are being denied treatment and kept off NHS waiting lists because of new restrictions imposed under his Government on cataracts, varicose veins, carpal tunnel syndrome, and other serious treatments. Ministers boast of lower waiting lists, but that is because they have stopped people getting on to the waiting lists in the first place. Patients in pain and discomfort, unable to work, are being forced to pay for treatment. How many more people will have to suffer before he finally acts?
Dr Poulter
We have already highlighted in earlier answers the fact that under the previous Government health care rationing was far worse on varicose veins, which one of the right hon. Gentleman’s own Back Benchers mentioned, and elsewhere. This Government are very proud of our record whereby 60,000 fewer patients are waiting more than 18 weeks than under the previous Government and 16,000 fewer patients than in May 2010 are waiting longer than a year. Waiting times are coming down, infection rates in hospitals are coming down, and people are getting better care. This Government ended the worst health care rationing scandal of all—the fact that people with cancer were not getting access to the drugs they needed. Now, 23,000 people are getting access to that care. If he could not do anything about rationing, he should at least recognise that this Government have done something and have made a real difference to people’s lives, particularly patients with cancer, by reducing rationing.
Tim Farron (Westmorland and Lonsdale) (LD)
Those of us who live in rural areas such as south Cumbria have faced the rationing of acute services for years—not rationing by price, but rationing by distance. Will the Minister encourage Morecambe Bay, which will undertake its review of the allocation of services in the coming months, to allocate accident and emergency services back to Westmorland general hospital, where they would be closer to the people whose lives they could save?
Dr Poulter
As my hon. Friend is aware, from next year the NHS Commissioning Board will have responsibility for commissioning local services and for setting the funding formula. I would be happy to raise his issue with the board, because it is true that, historically, the capitation formula has not recognised the fact that there are a lot of older people in rural areas and further distances to travel. The previous Secretary of State, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), took steps towards reviewing the formula and I assure my hon. Friend that the Government will be looking into it further.
Chi Onwurah (Newcastle upon Tyne Central) (Lab)
8. Whether he has put in place measures to ensure that clinical commissioning groups do not become for-profit organisations.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
Since the south-west consortium’s plans were made public in May this year, Department of Health officials have been in contact with NHS employers, NHS trade unions and the south-west consortium better to understand the views of all parties. The Department of Health wants to find a resolution and supports national pay awards.
Kerry McCarthy
I thank the Minister for that response and for his acknowledgement earlier that the way in which the south-west consortium has handled the negotiations has been heavy-handed. It is appalling that staff found out about the plans only through the leaks as, it appears, did the Department. Will he go back to the director of the consortium and urge him to put everything on hold in the south-west while national pay discussions are continuing? As the Minister says, this ought to be about national pay, not regional pay.
Dr Poulter
I fully agree with the hon. Lady and I take her concerns on board. However, because of the additional freedoms introduced by the previous Government, local employers in foundation trusts throughout the NHS have additional freedoms to set their own pay, terms and conditions. Under the rules introduced by the previous Government, it is impossible for us to intervene directly in the matter, except by continuing to encourage trade unions and NHS employers to meet the national agreements. If national terms and conditions are agreed to, I am sure that they will be endorsed at a regional level by the south-west consortium.
Andrew George (St Ives) (LD)
I am very pleased that the Minister will be meeting a cross-party delegation of MPs from the south-west next week to discuss this issue. In view of his answer to the hon. Member for Bristol East (Kerry McCarthy), is he confirming that Health Ministers have no powers at all to intervene in the negotiations between employers and their staff?
Dr Poulter
It is worth putting it on the record that it was the previous Labour Government who introduced foundation trusts in 2003 and set them free from direct accountability to Ministers. That includes the ability to set their own pay, terms and conditions. It was Labour that removed the power of the Secretary of State to direct foundation trusts, and it is Labour, not the Government, that needs to decide whether it supports the legislation that it put in place in government. We endorse national pay frameworks and will do all that we can to preserve them.
Mr David Amess (Southend West) (Con)
13. What recent representations he has received on strategies to support patients with osteoporosis.
Lisa Nandy (Wigan) (Lab)
16. What assessment he has made of the possible effect on patient safety of reductions to ambulance trust budgets.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
The budgets for individual ambulance trusts are set by local health care commissioners. In 2012-13, the budgets are increasing nationally by £2.5 billion. To ensure patient safety, ambulance trusts are required to meet national performance standards in respect of their response times.
Lisa Nandy
Does the Minister share my concern that 100,000 more patients than two years ago wait more than half an hour to be transferred from ambulance to A and E? If so, how on earth can he justify making his top-down reorganisation of the NHS a priority rather than sorting out that appalling situation?
Dr Poulter
The priorities for local ambulance trusts and the funding allocations are set locally. The hon. Lady will be pleased that between 2010-11 and 2011-12, an additional £9 million was put into the front line of the ambulance service in her area to help address some of the problems she outlines. Under this Government, more money is going to the NHS than before and more money is going into local ambulance services—£2.5 billion nationally. We should contrast that with the approach taken by the right hon. Member for Leigh (Andy Burnham) on the Opposition Front Bench, who said that to increase spending to address those problems would be irresponsible.
Dr Thérèse Coffey (Suffolk Coastal) (Con)
The Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), is my constituency neighbour. He will know that, although the East of England Ambulance trust is hitting its targets for the entire region, it is not helping in Suffolk. Will he advise on what more we can do locally to ensure that it serves all rural patients?
Dr Poulter
The problem has affected both Suffolk and Norfolk—the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), also takes an active interest in it. One problem was that the managers of the local ambulance trust were not listening to front-line staff on how to design and deliver services. In a staff survey, only 4% of front-line staff in the East of England Ambulance Service said they were being properly listened to, which is completely unacceptable. This Government, in contrast to the previous one, want to put front-line professionals in charge of running services, meaning that, in future, more patients will be properly prioritised and ambulance response times will be better met.
Mr Speaker
Order. These matters could be considered further in an Adjournment debate, which might be a suitable length for the subject.
Graham Stringer (Blackley and Broughton) (Lab)
T3. What action does the Minister intend to take to reduce the number of unplanned emergency admissions to hospital by sufferers of muscular dystrophy and other neuromuscular conditions?
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I thank the hon. Gentleman for that question and for his concern about this matter. One of the key challenges for the NHS is to ensure that we deliver better care in the community, deliver more preventive care and provide better support to people with long-term conditions, such as muscular dystrophy and diabetes, in their own homes. A key part of the reforms is to make sure that a lot of services are commissioned from the community by the local commissioning groups. We have already seen that that has reduced inappropriate admissions. For example, in my part of the world in Suffolk, they have been reduced by 15% for older people.
Mr Aidan Burley (Cannock Chase) (Con)
T4. Yesterday, I received a letter from the chief executive of Monitor, which asked me and the Asset Transfer Unit to undertake feasibility work to develop a professional business case for the local community to take ownership of Cannock Chase hospital. This would be done through its transfer to a community interest company, which would then take over running the hospital estate, securing the building for the people of Cannock Chase. Will the Secretary of State welcome these proposals, which would be the first of their kind in the UK, and work with us as we develop a plan for the local community to own its hospital?
Andrew George (St Ives) (LD)
T6. There is mounting evidence that clinical care failure is as much to do with inadequate staff levels as anything else. In view of that, do Ministers agree that it is worth looking at the merits of establishing mandatory registered nurse to patient ratios across secondary and tertiary care wards?
Dr Poulter
I thank my hon. Friend for that question. This point has been raised before and although it sounds like a good idea in principle, the problem is that different aspects of care in different wards—for example, an older people’s ward compared with a ward that looks after younger people—will have differences in the intensity of nursing. Therefore, a mandated ratio would be difficult to implement. A ratio may be counter-productive to making sure that we can give more intensive nursing cover where it is needed, and could even encourage a race to the bottom.
Lilian Greenwood (Nottingham South) (Lab)
T8. A recent Schizophrenia Commission report highlighted catastrophic failings in the care of people with severe mental illness. We know that suicide rates rise during times of economic hardship and that record numbers of people are being detained under the Mental Health Act. The Government have said that mental health should have parity with physical health, so why has funding for mental health services been cut for the first time in a decade?
Steve Baker (Wycombe) (Con)
Aylesbury constituent Mrs Evans-Woodward is a young woman who has had five heart attacks. One evening her husband drove her to Wycombe’s heart attack unit with a racing pulse, but she was turned away to the minor injuries unit, which again turned her away to the accident and emergency unit in Stoke Mandeville, before suggesting that she sit outside and call an ambulance, which she duly did—all of this with a racing pulse of 180. This is not good enough. It is an appalling prioritisation of bureaucracy over simple human care and compassion. Does it not show that the NHS needs to become much more accountable to patients?
Dr Poulter
My hon. Friend is absolutely right, and I am very sorry to hear of the case he outlined. Clearly the care that his constituent received was more than substandard. If a patient needs immediate treatment, they should always receive it. This Government are quite rightly ensuring that we embed good care in everything we do. We have beefed up the role of the Care Quality Commission to improve the inspection of care quality throughout the NHS and the care sector. We are also introducing a friends and family test to pick up on examples of bad care, so that the NHS can properly learn from them locally and so that these things do not happen.
Mr Speaker
We are extremely grateful. Extreme brevity is now required from Back and Front Benchers alike.
Andy Sawford (Corby) (Lab/Co-op)
On 12 November the Secretary of State gave a categorical assurance to my constituents that there was absolutely no threat to accident and emergency and maternity services at Kettering general hospital. Does he stand by it, will he repeat it today and will he specifically confirm that obstetrics and major injury and trauma services in accident and emergency are no longer at risk at Kettering general hospital?
Dr Poulter
I thank the hon. Gentleman for his question, and I welcome him to the House and congratulate him on his victory in the recent Corby by-election. I think he has already admitted on the record that there was a lot of scaremongering during the by-election campaign about the NHS locally. One of the main reasons for concerns about the NHS is the indebtedness of many hospitals in the east of England region, because of the record of the previous Government, who signed many of them up to private finance initiative deals. I will restate for the record once again today that, as I understand it, A and E and maternity services at Kettering at the moment are safe, and there is no consultation directly on the table at the moment. He should make sure he gets his facts right before he raises questions in the House.
Mr Stewart Jackson (Peterborough) (Con)
Last week it was a great pleasure to visit Age UK Peterborough, whose No. 1 priority is dementia care, which coincides with the NHS priorities that my right hon. Friend the Secretary of State outlined earlier this week. Will he put in place procedures to make available capital moneys for the construction of dementia care facilities locally?
Duncan Hames (Chippenham) (LD)
Valued health workers in Wiltshire will appreciate the Minister’s commitment today to national pay negotiations, but they will be frustrated that he does not have the power to force them on foundation trusts. Will he at least make a direct appeal from the Dispatch Box today to the management of those trusts in the south-west consortium to participate fully in national pay negotiations?
Dr Poulter
I thank my hon. Friend for his question. He is absolutely right. I made it clear earlier that I felt there had been some heavy handedness in the way some of those trusts had behaved—although they are quite understandably exercising freedoms that the previous Government gave them. We want national pay frameworks to remain fit for purpose, which is why we endorse the national pay negotiations that are under way. I would recommend that trusts in the south-west listen to what happens in those negotiations, so that we can ensure that national pay frameworks are fit for purpose in the south-west.
NHS Trust Merger (Dorset)
Dan Poulter Excerpts(11 years, 5 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
It is a pleasure to respond to the debate. I congratulate my hon. Friend the Member for Christchurch (Mr Chope) on securing it, and on being a strong advocate for the needs of his constituents and of patients throughout his part of the world. I also pay tribute to my right hon. Friend the Member for New Forest West (Mr Swayne) and my hon. Friend the Member for New Forest East (Dr Lewis), who are also in the Chamber. They, too, are strong advocates for the patients they represent, and I know that their constituents are grateful to them for that.
It is right to highlight the importance of having a good working relationship between Members of Parliament and their local hospital trusts. It is never desirable for any hospital to embark on local service changes of any kind without properly engaging with the local Members of Parliament. In this case, we are talking about a merger, rather than a service reconfiguration; there is an important distinction between the two, which I will come to in a moment. Nevertheless, from what my hon. Friend the Member for Christchurch has said, it does not sound as though the local hospital trust has engaged with him in a way that we would all consider desirable, and I am sure that it will consider that in its future relations with MPs.
That point was strongly made when my hon. Friend read out the heavily redacted document. There is freedom of information, and certain issues can quite rightly be exempted from freedom of information requests under statute. However, to present a document bearing only the heading “Maternity” is not in the spirit of co-operative and collaborative working with Members of Parliament or in the spirit of being as open and transparent as we would like. I am sure that he has already raised these issues locally, but I would also like to place on record my concern at what he has told the House. It is important that MPs, as strong advocates for our constituents and the patients in our constituencies, should always be engaged at an early stage when decisions of this magnitude are being made.
My hon. Friend paid tribute to the dedicated front-line staff at the hospitals in Poole and Bournemouth. It is worth highlighting that some very good things have been happening in both trusts. At Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, a life-saving service that treats heart attack patients within 60 minutes is now available 24 hours a day, seven days a week at the Royal Bournemouth hospital. It treats heart attack patients from across Dorset, Hampshire and Wiltshire. Also, a new combined acute and rehabilitation stroke unit opened in 2012. It is designed to improve the experience and outcomes of stroke patients by providing specialist services, with a particular focus on the rehabilitation of patients, which is an important part of stroke care.
Mr Chope
I am glad that the Minister cited those examples, but are they not examples of how independent trusts can innovate and thereby create beneficial change rather than have a monolithic monopoly? Surely we would not have so much innovation if all our trusts were merged into one.
Dr Poulter
My hon. Friend is right that trusts—in their own right, or when they are merged together as they were historically over the river at Guy’s and St. Thomas’ and at the medical school of Guy’s, King’s and St. Thomas’ of which I am a graduate—can gain and improve the quality of care available to patients without losing their distinctness. Services are offered on each site, but at the same time they can add to the services they provide to patients in the totality. I believe my hon. Friend is right to say that these innovations have come from the independence and the good work of his local hospital, but I also believe there can be distinct advantages from hospitals coming together as well. The common purpose is making sure that good local service provision is maintained, while services of clinical excellence are also developed, further improving the offer to patients—not just in those towns, but throughout the area.
I want to highlight, and not leave out, some of the good things happening at Poole hospital, as it would be wrong for me, having highlighted a number of good developments at the Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, not to mention them. At Poole hospital, the standard of care for cancer patients has been rated as among the best in the country in a national survey. The 2011-12 national cancer patient experience survey found that 94% of patients rated their care as “excellent” or “very good”, giving Poole the highest score recorded among participating trusts. I know all Members, as constituency Members, would feel very proud of that hospital’s achievements.
I am sure that my hon. Friend welcomes this Government’s investment in the NHS, even in very difficult economic times, as we put an extra £12.5 billion into NHS services over the lifetime of this Parliament. I am sure we all agree that that is a good thing.
What is the current position? Let me address some of my hon. Friend’s points. As to the proposals by the foundation trusts in Bournemouth and Poole, I appreciate that when any changes to local NHS services are mooted, people can become anxious and feelings can run high. However, I must be very clear to my hon. Friend that there is no formal role for Ministers or the Department of Health in approving mergers between two foundation trusts. I fully appreciate his concern to ensure that there is appropriate engagement and consultation on any proposals for service changes that may affect his constituents. I have already put on record some of my concerns about the process and engagement so far, which I think we would all accept is not ideal.
Mr Chope
I was not asking the Minister to have a role in approving the merger or otherwise. What I asked him to do, on behalf of the Government, was to say to the Office of Fair Trading that this is an issue of sufficient significance that it should be referred to the Competition Commission.
Dr Poulter
If my hon. Friend will be patient with me for a few moments, I will address that point a little later.
In acknowledging the understandable anxiety that can be stoked when any discussions about hospital services take place, it is important to highlight the fact that, as we saw over the river at Guy’s and St. Thomas’, although there was some good preservation of the individual and distinct offers to the local populations of the two institutions in their own right, by coming together they have been better together and provided better services.
One of the big problems we face in the NHS is concern about putting more money into front-line care and about cutting back on waste and bureaucracy. Clearly, if the administration across two trusts can be shared, it will free up more money to be diverted and put into what we all care about—front-line patient care.
Let me put on record once again that the trusts have clearly stated that this is not about the reconfiguration of clinical services. That is quite distinct. My hon. Friend was quite right to mention some of the points I raised in reply to my hon. Friend the Member for Bracknell (Dr Lee) about the important and distinct challenges faced in rural constituencies, and the fact that service reconfiguration challenges are very different in rural areas where there are longer distances to travel. As I have said, however, this is not about reconfiguring services, but about trusts merging and seeking what I think we would consider to be potentially desirable results, such as economies of scale and a reduction in unnecessary administrative burdens when possible. I think that, although the process and the approach taken to engagement with my hon. Friend and other Members of Parliament have not been ideal, some very positive elements have emerged from the discussion.
As my hon. Friend said, stringent tests would be applied to reconfiguration if it were on the table. The criteria would be strong public and patient engagement, consistency with current and prospective need for patient choice, a clear clinical evidence base, and support for proposals from clinical commissioners. Clinicians should always lead reconfiguration challenges, but today we are not talking about reconfiguration; we are talking about a hospital merger. It is the first of its kind to be proposed between foundation trusts in the country, and in that respect it is new territory for the NHS. There are distinct rules, including, as my hon. Friend said, referral of the case to the Office of Fair Trading.
The OFT’s role in reviewing the merger will be to establish whether there is a realistic prospect that it will result in a substantial lessening of competition. I am sure that it will also consider the issues of rurality and the choice of services available to patients. Should it refer the matter to the Competition Commission, which it has a right to do if it has concerns, the commission’s role will be to conduct an in-depth investigation, and to decide whether the merger does indeed represent a substantial lessening of competition and choice.
Concern has been expressed about the rurality of surrounding areas, and about the fact that there are long distances between hospital trusts. That may—
Mobile Technology (Health Care)
Dan Poulter Excerpts(11 years, 5 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
It is a pleasure to serve under your chairmanship, Mr Havard.
It is also a pleasure to respond to this debate, and I congratulate the hon. Member for West Lancashire (Rosie Cooper) on securing it and on highlighting an important focus of future health care policy. She is right to highlight the Nicholson challenge: for the NHS just to stand still and to continue performing at the same level so that patients continue to receive the high-quality care that we all believe and know they deserve, it needs to make £20 billion-worth of efficiency savings and to put that money back into front-line patient care. A key part of the debate is that better IT will improve the way we communicate with patients and keep people well and better supported in their own home and community, on the basis that preventive health care is much better than curative health care, both for the patient and, financially, for the NHS. Of course, I would be delighted to meet the hon. Lady and people involved in the IT industry at a later date to discuss things further.
Although we know that simple things such as in-ear thermometers, improved hoists in hospitals and better-quality equipment in operating theatres has improved the quality of patient care over many years and driven down the cost of providing health care, the hon. Lady is right to highlight the fact that we need to harness and better utilise more modern types of technology such as telehealth and mobile technology to support people better in their own homes and to drive down the cost of care.
Last week, my right hon. Friend the Secretary of State for Health outlined the NHS mandate, in which he set out the vision for the NHS and addressed some of the key challenges that we face. In her speech, the hon. Lady rightly highlighted that we have an ageing population with many people living a lot longer with long-term medical conditions such as diabetes, cancer, heart disease and dementia. The challenge for the NHS is ensuring that we deliver care in a better way that meets people’s care needs while ensuring that, where we can, at the same time as producing high-quality care, we reduce costs so that there is more money to go around to look after more people.
My right hon. Friend the Secretary of State announced in the publication of the mandate that a real priority for the NHS is to improve the management of long-term conditions by helping people to better understand their conditions and to take control by supporting them to self-care, thereby realising the massive potential benefits offered by information technology both in supporting people to better understand and look after their conditions in the community, and in their own homes, and in supporting, better educating and better looking after the people who look after patients—the carers. That is an important part of providing high-quality health care.
We already know that there are 15 million people with long-term conditions, accounting for some 70% of all in-patient beds. We also know that many such hospital stays could be avoided through better management, including the better use of mobile technologies to prevent people from becoming so unwell in the first place that they need to be admitted to hospital. That would also help to prevent the revolving door of hospital admissions that sometimes happens when people do not necessarily have the support that they need and deserve when they are discharged from hospital, perhaps after a hip operation or similar stay.
Improving access and the quality of health care available to all patients is a key aim for the NHS, not just in meeting the Nicholson challenge but in improving day-to-day quality of care. Increasingly, technology will play a part in that: not just breakthroughs in simple day-to-day medical devices but changes in how we reach people in remote rural settings and in their homes and communities through the use of telemedicine, telehealth and mobile devices. We can and should take advantage of the deeply interconnected nature of modern society to improve people’s experience of health care and significantly increase our efficiency in delivering it.
There are infinite ways in which technology can transform how people access health and social care services. “Digital First”, a report published in July by the Department of Health, estimates that the NHS could save up to £2.9 billion by implementing just 10 simple actions to transform how people access health care. Those savings could be made almost immediately and with minimal investment by making use of existing technologies to reduce inappropriate face-to-face contacts.
There are many examples of simple things that can be done, such as having a doctor or nurse talk to a patient on the phone when they call to book an appointment or as an initial assessment. About one third of patients do not necessarily need a face-to-face GP appointment. Such conversations can reassure callers that they are okay and not that unwell, and that perhaps they should see how things go overnight or later in the day and call back if they need further help. They also help the patient access health care in the most appropriate way, as the GP triages the patient remotely.
Texting and e-mailing people to remind them of appointments has already been shown throughout the NHS to reduce the number of people who fail to turn up to their medical appointments. One big challenge in health care is getting patients to attend and comply with treatment, particularly those with longer-term conditions who must make multiple trips to a hospital or care setting. E-mails and texts are an effective way to remind people about their appointments and help educate them, removing the burden from the acute setting by ensuring that they understand how better to manage their conditions.
Those are simple changes, using the technologies that people use every day and are already familiar with, that can free hundreds of millions of pounds and provide more convenient access to NHS services, particularly for patients who live in more remote and rural parts of the country.
Technology can also improve the working lives of professionals. The funds that we are making available to nursing staff will enable them to access information faster so that they can spend more face-to-face time with patients, an important point that the hon. Lady made in her speech. Doctors, nurses and all health care professionals want to spend time looking after their patients. They do not want to be bogged down in paperwork. Technology, whether used on the ward or to access and look after patients remotely via telehealth or mobile technology, is a good way to ensure that front-line health care professionals have more time to do what they want to do and what they are trained to do: care for and look after the sick and patients.
I have seen at first hand the potential of telehealth and telemedicine to transform and save people’s lives. Earlier this month, I visited the telehealth hub at Airedale NHS Foundation Trust, which I know is on the other side of the Pennines from the hon. Lady’s constituency, but I am sure she will not mind my using it as an example. The hub is staffed 24 hours a day, seven days a week, by skilled nurses specialising in acute care. A consultant is also on hand if needed.
The aim of the service is to care for patients closer to home and keep them there whenever it is safe to do so. In other words, it ensures that people are properly supported and well advised in their own homes and other care settings, such as residential homes, so they do not become as unwell as they might otherwise. They are given appropriate health care advice, guidance and support in their homes and care settings, which helps reduce the burden on acute services in the area. It is particularly important in more rural areas, where the distances that professionals must travel to look after patients are so great that the only effective way to get around to as many patients as possible, in both financial and human care terms, is to use the benefits that telehealth brings to Airedale and the surrounding areas.
Evidence suggests that many patients are admitted into hospital when, as we have discussed, that is not always the best environment or the most appropriate place for them. Using telemedicine allows patients to manage their conditions with the hospital’s support. It can prevent time-consuming, costly trips to hospital for outpatient appointments. The patient’s GP is instantly informed and kept up-to-date about any consultations that occur via the telehealth care hub.
Importantly, the Government do not want such initiatives to take place in isolation. We believe, as I know the hon. Lady does, that we must ensure that they become day-to-day occurrences in the NHS as the years go on. Technology and the better use of information provide immense opportunities for improving the quality and accessibility of NHS care, not just in remote rural settings but in every care setting that we can think of.
The Government’s information strategy for health and social care, “The Power of Information”, is another example that highlights the importance of harnessing innovative new technology and delivering better health for patients. The strategy, of which I know the hon. Lady will be aware, was published in May, setting out ambitions for people to be offered online and mobile access to records, electronic communication with professional teams, online health and care transactions and the ability to rate services and provide feedback about how effective and convenient they were for the patient.
A small number of actions will need to be led nationally, such as setting common standards to allow information to flow effectively around the system. More detailed implementation planning will be led by organisations including the NHS Commissioning Board to ensure that current good localised initiatives in different parts of the country are rolled out nationally. We learn from areas such as Airedale, where looking after people in their own homes through the better use of technology is going well. Those examples should be rolled out to become the norm in the NHS. I know that the NHS Commissioning Board will be central to driving that through, which is why improving information technology was at the heart of the NHS mandate launched last week.
Mainstreaming assistive technology across the NHS is particularly important. As we have discussed, it is not good enough to have high-quality localised initiatives; we need a systematic, NHS-wide approach that embraces technology. My right hon. Friend the Secretary of State for Health announced at the Age UK conference last week that plans have been agreed that will ensure a further 100,000 people will be supported by telehealth in 2013, a sixteenfold increase in the number of people being helped by telehealth and telecare. It will make Britain the largest market in the world behind the USA, which is something that we can all be proud of.
The recently published results from the whole system demonstrator programme are potentially game-changing. We now have robust academic and scientific evidence that such technology can drive improvements not only in quality and value in the NHS but in patient satisfaction levels and outcomes. We all know that the most important people in all these discussions are the patients whom the clinician looks after and the telehealth provider wants to look after. Importantly, when we are designing telehealth services, like all other NHS services, we need feedback from patients in order to ensure that where services are working well, they can be rolled out elsewhere in the NHS, and that where improvements could be made and things are not going so well for patients, the NHS can learn from that and adapt technology to improve care in future.
At the Age UK conference last week, my right hon. Friend the Secretary of State announced some significant steps on the road to supporting the 3 million people who stand to benefit from telehealth and telecare by 2017. As the hon. Lady said, the key is improving care for older people. They are the biggest users of NHS services, so they will see the most immediate changes and feel the most immediate benefits from telehealth. We have a growing elderly population and growing numbers of people with multiple long-term conditions. In order to meet the challenge of looking after them properly and providing dignity in elderly care, we must ensure that we keep them well at home and in their communities. One significant part of the answer is doing more for telehealth. The Government are well on the road to doing so. I welcome further discussions with the hon. Lady about what more we can do to look after people, particularly the frail elderly, in their own homes.
Mr Dai Havard (in the Chair)
Thank you, Minister. I am sure that you will have interesting discussions with your colleagues in the devolved Administrations about interconnectivity as well.
Question put and agreed to.
Birth Environment (Improvements)
Dan Poulter Excerpts(11 years, 6 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I am announcing a £25 million capital funding in 2012-13 for the NHS to improve the birthing environment in the maternity units that need it most, so both mothers and fathers, and the staff who work in the units, can benefit from a more pleasant and appropriate environment.
Women should receive excellent maternity services that focus on the best outcomes both for them and their babies, based on women’s experience of care. It is important for all women to be able to give birth in a safe, high quality environment that is best suited for them. Birthing environments should be designed so to provide for the safe care of mothers, fathers and baby in a comfortable, relaxing environment that facilitates what is a normal physiological process, enabling one-to-one midwife care during labour and birth in privacy whenever possible, while enhancing the family’s enjoyment of an important life event.
This builds on the Government’s pledge to improve maternity care by making sure:
women will have one named midwife who will oversee their care during pregnancy and after they have had their baby;
every woman has one-to-one midwife care during labour and birth; and
parents-to-be will get the best choice about where and how they give birth.
Providers will be able to bid for central funding in the current financial year to support the refurbishment of wards, for example, by adding ensuite facilities, providing new facilities to allow fathers to stay overnight at the birth and new equipment such as birthing pools. Bids will need to meet the criteria set out in “Maternity care facilities: Planning and design manual, Version:0.8:England (2011)”.
The criteria for applying for funding and the deadline for receipt of applications will be announced shortly. It is important that the views and experiences of women and their families locally inform the development and design of birthing environments. The successful projects will have demonstrated involvement and support from service users and the ability to deliver the project in the current financial year.
Kettering General Hospital
Dan Poulter Excerpts(11 years, 6 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
It is a pleasure to respond to this debate and I congratulate my hon. Friend the Member for Kettering (Mr Hollobone) on showing great concern for his local hospital, and on expressing so eloquently his support for local NHS services and staff in Kettering and throughout his region. I recognise his long-standing dedication to ensuring that the health needs of all his constituents are met and, throughout his time in the House, he has been a strong advocate for his constituency, not just in today’s debate. He has consistently raised issues on how to improve the quality of health care and outcomes for the people of Kettering, and I congratulate him on that.
It is worth providing a little background to today’s debate. As my hon. Friend eloquently outlined, Kettering hospital had just under 370,000 patient contacts in 2011-12, including more than 85,000 attendances at A and E. That is more than ever before which, as he pointed out, is due to rising population pressures in Kettering and increased population growth. Indeed, the fact that people are living longer presents new and different challenges to the way we deliver health care throughout the NHS.
Let me take this opportunity to recognise, as my hon. Friend did, the hard work and dedication shown by NHS staff in his constituency. There are more than 3,200 staff at the trust, in addition to those who work hard to look after patients in primary care. The dedication and commitment they show to improving the health and well-being of my hon. Friend’s constituents, and those of other hon. Members, makes us all proud of our NHS and the dedicated front-line staff who work tirelessly on a day-to-day basis, often going above and beyond the call of duty to deliver high-quality patient care.
I reassure my hon. Friend that A and E and maternity services at Kettering hospital are safe. The Prime Minister has put that clearly on the record, and I confirm it again today.
Dr Poulter
It is interesting to find a Member from Nottingham, who I hoped would be in her constituency on a Friday looking after her constituents, taking such an active interest in this debate. However, I am happy to give way once on this issue.
Lilian Greenwood
I am attending this debate because I was here earlier to deal with a private Member’s Bill on behalf of the shadow transport team. Whatever the Minister says, is it not a fact that in the official documents, the “best” option is downgrading Kettering general hospital’s accident and emergency, maternity, children’s and acute services, and cutting a significant number of beds? How can he say that those services are safe?
Dr Poulter
The hon. Lady is turning this into a political debate, which is exactly what the Labour candidate in the Corby by-election has done. That is completely wrong and what she says is not true—it is scaremongering. There are no official documents at the moment because there is no consultation of that nature at the moment. There is no NHS consultation. Perhaps she should focus more on Nottingham, which is where her constituency is. I am sure her constituents would rather she were on the train back to hold a constituency surgery, which is what I will be doing after this debate, rather than making silly, ill-founded and mistaken political points about matters that bear no resemblance to her constituents’ concerns. I hope she will draw a lesson from this. I know she has been put up to making that point, but this is not the time.
The hon. Lady’s point was ill-founded. There is no consultation active in Kettering at the moment. There were some leaked documents about a range of options, which incorrectly set a number of hares running. The Labour candidate in the Corby by-election has already retracted his position. My hon. Friend has held the debate today because of that scaremongering, and because he is such a strong advocate for the needs of his patients in Kettering and his hospital. He wants to reassure them that Kettering hospital has a viable future.
Dr Poulter
I will not give way again. This is an Adjournment debate, not a general debate on the Floor of the House. The hon. Lady did not contact me before the debate to say that she would make a point—no Labour Member did. This is not a time to raise those points. The debate is about reassuring my hon. Friend that Kettering hospital has a viable future, which it does. That is confirmed clearly by Healthier Together, which has also confirmed that no active consultation is taking place; that, at the moment, we have only potential options appraisals; that A and E and maternity are safe; and that Kettering hospital has a viable future. I hope that the hon. Lady will put as much dedication into standing up for her hospital services in Nottingham as she has to making cheap party political points in a debate about a different part of the country.
I should now like to address some of the points, questions and legitimate concerns that have been raised, mostly as a result of the outrageous scaremongering by the Labour party. The Healthier Together programme has been put together, but, as I have said, there is no formal consultation at the moment. I am sure the concerns my hon. Friend so eloquently raised will be fed into it, and that the debate, and the comments of the Prime Minister and Health Ministers, will be part of it.
We recognise, as my hon. Friend has outlined, the importance of proper public engagement throughout any consultation process—as and when it comes. He will be aware that there has already been significant public and stakeholder engagement on how services in the midlands might need to look in future. As he rightly said, there are new demographic challenges—more people are moving into that part of the country—and the process of engagement must continue. If a formal consultation is opened in future, it is important that it meets the clear clinical tests for service reconfiguration. However, I should repeat that no formal consultation has been opened and it would be incorrect to allow any further Labour party scaremongering on that point.
It is worth bearing in mind that part of the reason for the concerns about services in my hon. Friend’s part of the world is the massive private finance initiative debt signed off by the previous Government to Milton Keynes hospital, which has struggled ever since the PFI was signed. That has led to significant pressures on Milton Keynes and other hospitals in the region. As we know, some services are specialist centres. It might be worth reflecting, before any further cheap political points are made, that one reason why there was a discussion about a consultation on services was the big PFI legacy of debt, which is stopping the delivery of high-quality front-line care. That is a direct legacy of the previous Government signing off bad PFI deals in health care. It is worth reflecting on that before any more scaremongering takes place.
When reconfiguration of health care takes place, the previous Government—and this Government—have laid down some key tests of what makes a good reconfiguration. It has to be led locally by local commissioners and decision makers, and my hon. Friend made that point very clearly. Any significant proposed changes to services would be subject to four reconfiguration tests set out by the previous Secretary of State for Health. They are local support for the changes from GP commissioners and clinical leaderships; robust arrangements for public and patient engagement, including local authorities; greater clarity about the clinical evidence basis underpinning proposals; and the need to take into account the development and support of patient choice.
In my hon. Friend’s region there are considerable distances between the hospitals involved and, if at some point in the future a consultation opened up, those greater travelling distances between hospitals would be taken into account as it may impinge on patient choice. I hope that restating those configuration tests is helpful. If there is concern that those tests have not been met, an independent review can be carried out by the independent reconfiguration panel, at the discretion of the Secretary of State. I hope that my hon. Friend finds that reassuring. I reiterate that at the moment there is no consultation formally on the table in Kettering, and its accident and emergency and maternity services are safe.
There are other significant challenges facing Kettering hospital and the local NHS, as my hon. Friend outlined. They are the same as those faced by the NHS everywhere— ensuring that we have services that are fit for purpose for the future to better look after the many older people—people are living longer—and the need to provide more dignity in elderly care. Part of that is having local bread-and-butter services. My hon. Friend rightly made the point that some health care services have to be regionalised, such as specialist trauma centres. The clinical evidence is that such centres save lives and, in my part of the world, we have one in Addenbrooke’s. Dedicated centres for stroke care also improve care for patients and the quality of outcomes for people with stroke, so that they can resume their daily activities much more quickly. Those day-to-day, bread-and-butter health care services that are so important, such as maternity and accident and emergency—and the cardiac services that Kettering is rightly proud of—are needed at a local level, and I am sure that any test of reconfiguration would confirm that they should remain accessible locally. We are very aware that many parts of the country are not urban. Many people face the challenges of rural life and the distances to travel between centres. Whenever services are redesigned in the future, it is important that those bread-and-butter services are available for local patients.
I reiterate the fact that there is no formal consultation proposal, and there is no place for scaremongering in these debates. I am sure that the future of Kettering hospital is a vibrant and successful one. I know that my hon. Friend has strongly advocated the dedication of local staff and I hope that he will take my reassurance back to them—so that they do not listen to the scaremongering—that Kettering hospital will still have a viable A and E and viable maternity services, and a very strong future.
Question put and agreed to.
Regional Pay (NHS)
Dan Poulter Excerpts(11 years, 6 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
It is a great pleasure to respond to today’s debate. I am pleased to start on a consensual note, in that we have heard some genuine concerns expressed by Members on both sides of the House on behalf of our NHS staff. All hon. Members very much value the dedication and hard work of all staff who work in the NHS on a daily basis. They often go above and beyond the call of duty to look after patients, and I would like to echo the comments made in that regard.
We have heard good contributions from the hon. Members for Blaydon (Mr Anderson), for South Down (Ms Ritchie), for Bristol East (Kerry McCarthy), for Hartlepool (Mr Wright), for Plymouth, Moor View (Alison Seabeck), for York Central (Hugh Bayley), for Worsley and Eccles South (Barbara Keeley) and for Stockton North (Alex Cunningham); my hon. Friends the Members for Kingswood (Chris Skidmore), for Southport (John Pugh), for Aberconwy (Guto Bebb) and for North Cornwall (Dan Rogerson); my hon. and learned Friend the Member for Torridge and West Devon (Mr Cox); and my hon. Friends the Members for North Devon (Sir Nick Harvey) and for St Ives (Andrew George). The contributions from the hon. Member for York Central and my hon. and learned Friend the Member for Torridge and West Devon were particularly thoughtful, putting on the record their genuine concerns for the NHS staff who work in their constituencies. Those contributions encapsulated the support that all Members of this House wish to show for the hard work that NHS staff do every day.
However, I was disappointed by the intervention from the right hon. Member for Exeter (Mr Bradshaw). I have looked at the Hansard record, and it is worth picking up on this. I have here the details of the exchange involving the hon. Member for Bristol East (Kerry McCarthy), and I want to set the record straight for the House now. She asked:
“When did the Department of Health first find out about the formation of the consortium?”
The Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry), replied that she was not aware—the Department was not aware—but that she would
“make further inquiries of …officials…and write to the hon. Lady”
to clarify that. It is clear that my hon. Friend has been misrepresented in this debate. That is in Hansard, it is on the record clearly, and I hope that hon. Members will accept the correction and withdraw their remarks. I wish to make it very clear, for the record, that we were made aware of the south-west consortium’s plans when its project document was leaked. That is when the Department became aware of the plans. We did not encourage the consortium in any way and it has the freedoms in respect of its own employment conditions that were given to it by the previous Government under their legislation.
It is worth stressing that Opposition Members, particularly those on the Front Bench, have made many attempts to rewrite history. The speech made by the hon. Member for Copeland (Mr Reed) bore little resemblance to reality when he talked about the involvement of the private sector. The right hon. Member for Leigh (Andy Burnham) said that breaking national pay frameworks is the first step towards the marketisation of the NHS. Yet, as one of his colleagues said later, it was the previous Labour Government who introduced the private sector into the NHS in the first place, who paid the private sector more than NHS providers for providing the same services, and who allowed those private sector providers to cherry-pick the best services from the NHS, to the detriment of NHS patients. Through the Health and Social Care Act 2012, this Government will be stopping that by having more of an emphasis on joined-up and integrated care for all health care providers.
It was the Labour Government who introduced the pay structure about which Opposition Members are so concerned into the NHS. It was the Labour Government who introduced regional pay into the NHS through incentives and London weighting. It was the previous Labour Government who endorsed the flexibility of local employers to set their own terms and conditions. It was the Labour Government—the Government of the right hon. Member for Leigh—who gave greater freedoms to employers to set their own terms and conditions when they created foundation trusts.
Let me set the record straight and make things perfectly clear. We cannot rewrite history. The right hon. Member for Leigh wants a change of direction, but does he mean a change of direction from the pay flexibility that he and his Government gave to the NHS when they were in power? The Government recognise that in some parts of the country it is important to have pay flexibility in the NHS. We believe that it is right to reward London workers with a £6,000 London weighting because the cost of living is much higher. Does he want to withdraw that flexibility?
Andy Burnham
On our watch, no trust opted out of the national pay agreement in the NHS, but on the Government’s watch, 32 trusts are trying to undercut it. The hon. Gentleman is in the Government—what is he going to do about it?
Dr Poulter
The right hon. Gentleman cannot rewrite history. He cannot stand at the Dispatch Box and say that he no longer agrees with the pay flexibilities he gave local NHS employers or with the “Agenda for Change” document that his Government put in place. That document recognises that in parts of this country premiums of up to 30% need to be paid to employees. It also recognises that the cost of living in London is much higher and gives a £6,000 premium to NHS workers who work in the centre of London.
In our amendment, the Government are pleased to support the comments made to the GMB by my right hon. Friend the Chief Secretary to the Treasury. That highlights the Government’s support for NHS and public sector staff and recognises implicitly that in some parts of the country—as the previous Government’s “Agenda for Change” makes clear—we need pay flexibility to recognise when the cost of living is greater.
Importantly, the Government have also made clear our intention to retain national pay frameworks and national collective bargaining while they remain fit for purpose. That is why we are encouraging NHS employers and the trade unions to come together at the NHS Staff Council to negotiate a settlement that remains fit for purpose so that we can continue to endorse national pay frameworks. That is the stated position of the Government and it is a shame that the Opposition are attempting to politicise an issue of their own making.
It is worth putting it on record that despite the financial challenge faced by the whole public sector, we have put an extra £12.5 billion into the NHS during the life of this Parliament. That is not to say, however, that there is no financial pressure, and the Opposition were right to highlight the Nicholson challenge and the need to cut away bureaucracy and waste in the NHS in order to put more money into the front line. We endorse that. The Government are meeting the Nicholson challenge, and the NHS reforms we have put in place will put the NHS in a much better place to do that in the future.
Mr Reed
Does the Minister agree that everyone in this House should pay close attention to the fact that another set of terms and conditions for public servants is being negotiated now, and that if Members of Parliament vote for regional pay in the national health service they should accept regional pay for Members of Parliament?
Dr Poulter
The hon. Gentleman needs to be brought back to reality for a second. His Government introduced regional pay in the NHS through “Agenda for Change”, so he cannot stand at the Dispatch Box and rewrite history, saying that he is desperately concerned for the workers. “Agenda for Change” needs to remain fit for purpose, and it is the Government who are standing up for NHS workers. We will protect not just patients but jobs and workers in the NHS by ensuring that we support NHS employers and the trade unions as they come together to protect jobs and ensure that “Agenda for Change” remains fit for purpose in the future.
In conclusion, it is clear that the Opposition want to rewrite history, but it is time to cut the propaganda and get real about the debate. We all want to see individual employers given autonomy based on agreed national frameworks, but we want to make sure that “Agenda for Change” stays fit for purpose. In the end we must deliver high quality care for patients, and we understand that that also means looking after staff. That is why it is so important that the national pay frameworks remain fit for purpose, and that on both sides of the House we encourage NHS employers and the trade unions to negotiate a settlement within those frameworks.
The Opposition must stop attempting to play politics. They must support the NHS staff, as we on the Government Benches are doing. The Government are standing up for the NHS, its staff and its patients. That is why I urge all hon. Members to support the amendment and reject the motion.
Question put (Standing Order No. 31(2)), That the original words stand part of the Question.
Nursery Milk Scheme
Dan Poulter Excerpts(11 years, 6 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I congratulate my hon. Friend the Member for Mid Dorset and North Poole (Annette Brooke) on securing this debate. During her years in the House she has not only shown a keen interest in the nursery milk scheme but has been a strong parliamentary ambassador for the National Society for the Prevention of Cruelty to Children and, since 2006, a champion of Save the Children. That is a long track record of supporting and standing up for issues that matter to children—in this case, the nursery milk scheme. She rightly outlined the tremendous health benefits not only of the nursery milk scheme but of a healthy diet in young children, and highlighted the benefits of drinking milk, given the proteins, minerals and vitamins that it contains. I want to confirm to the House again that the nursery milk scheme is here to stay.
Before I address the points that my hon. Friend raised, it is worth highlighting a few of the issues. While we fully endorse the provision of nursery milk, she is absolutely right to point out that the cost of the scheme has gone up considerably over the past few years. In an average supermarket, a pint of milk costs about 50p to 55p. According to the most recent figures of June 2011, within the scheme there are 23,000 claims—well over 50% of the total—where milk costs 70p to 79p per pint, and almost 9,000 claims where it costs over 90p per pint, which is almost double the cost in the supermarket.
Many hon. Members representing rural constituencies will be concerned that dairy farmers across the country are struggling, and that the increased cost of milk is not rewarding those farmers in the farm-gate price. We must reflect on the cost of the scheme. Since the scheme costs a lot of money, it would be nice if those companies that profit from it also recognised that some of that profit could be passed back to famers in the farm-gate price. The Government and the National Farmers Union do not see that happening as part of the scheme, and although the NFU and the Department for Environment, Food and Rural Affairs support the nursery milk scheme as a way of supporting dairy farmers, it is nevertheless disappointing that companies that supply nursery milk are not supporting our farmers in the way we would like.
As my hon. Friend rightly said, the nursery milk scheme is of long standing and has been running throughout Great Britain since the 1940s. The devolved Administrations in Scotland and Wales fund milk supplied through the scheme to children in their countries, and Northern Ireland has its own, similar scheme—I am pleased to see the hon. Member for Strangford (Jim Shannon) in his seat as usual.
As we know, the scheme funds free milk for around 1.5 million children under five years of age at 55,000 child-care providers throughout Great Britain. Nursery milk is a universal benefit, meaning that child-care providers can claim the cost of milk provided to any child, regardless of the child’s home circumstances. The scheme is valued by parents and pre-school staff, and its health care benefits were thoroughly outlined earlier in the debate.
The Government recognise, however, that the nursery milk scheme is expensive, and the consultation was about improving its operation and ensuring that it remained fit for purpose. The scheme remains largely unchanged since it was first introduced as a wartime measure, and in recent years prices claimed for milk purchased under the scheme have risen significantly, owing largely to third-party agents who seek to make considerable profits by delivering milk to child-care providers. As I said earlier, unfortunately those profits are rarely paid back to farmers in the farm-gate price.
The prices claimed for milk supplied under the scheme have risen significantly, with some claims reaching almost £1 a pint. That has led to a corresponding increase in the overall cost of the scheme. In 2007 and 2008, the scheme cost £27 million, but by 2010-11 that had risen to £53 million—it almost doubled in only four years. If we do nothing, that trend looks likely to continue, with costs potentially rising to £76 million by 2016.
Under the current system, there is no limit on the price at which child-care providers may purchase milk, or even a requirement for each provider to review their milk expenses. In many cases, agents supplying milk handle the claims themselves, rendering child care providers unaware of the price paid. For those reasons, the total cost of the scheme has risen dramatically over the past few years, and although the amount of milk supplied has risen by 25% since 2009-10, the total cost of the scheme has risen by 45%.
Tessa Munt (Wells) (LD)
Does the Department of Health have a grip on the procurement process involved in this scheme? When providing milk across the nation, surely we should be able to supply from local sources or distributors. The costs that the Minister mentions seem to have escalated greatly, but farm-gate prices have not changed much. It seems extraordinary that someone has not got a grip on procurement.
Dr Poulter
My hon. Friend is absolutely right, and that is why the Government launched the consultation in the first place. The scheme was devised in the second world war, and its provisions mean that the Department of Health currently has no role in active procurement. The Government embarked on the consultation in view of the rising costs, and my hon. Friend will rightly feel concern for dairy farmers in her area of Somerset. Profits from this scheme are going to intermediate companies, and the cost has recently escalated out of control. My hon. Friend also highlights the fact that farm-gate prices have not improved as a result of those increased prices and profits for intermediate suppliers of milk.
It is worth pointing out that an important factor contributing significantly to the scheme’s accelerating costs seems be embedded in its design. No mechanism exists to incentivise child-care providers to economise and search for the highest attainable value for money in their local markets, to support their local farmers or to source their milk from a certain provider. Over the last three years, the average price paid for a pint of milk in a supermarket has been 50p, but the average charged by agents is 78p, which is well over 50% higher. That shows that the scheme is rapidly becoming unfit for purpose, which is exactly why the Department embarked on the consultation.
Annette Brooke
Until recently, at least one school was not registered in the scheme because it feared the bureaucracy would be too great. A balance must therefore be struck to ensure that schools and child-care providers participate in the scheme.
Dr Poulter
My hon. Friend makes a good point. As part of our consultation, we are looking at a number of options as to how we can maintain an effective scheme and ensure that the one we offer and deliver is better value for money.
It is worth looking at the three options in the consultation. The first option was to cap the price that can be claimed for milk. Under that option, an upper limit on the price that could be claimed for milk would be introduced and increased each year in line with inflation in the retail price of milk. In special circumstances, arrangements would be put in place to vary the cap for child-care providers that, perhaps because of geographical isolation and rurality, to which hon. Members have alluded, do not have access to milk priced at the normal market rate.
The second option was to issue e-voucher cards with or without devolved incentives for child-care providers to buy milk economically. Under that option, child-care providers would no longer have to pay for milk and then claim reimbursement from the nursery milk reimbursement unit. On joining the scheme, child-care providers would indicate how many children would normally be attending for two hours or more per day. They would then be credited with a prospective monthly payment equal to the number of pints required, multiplied by a fixed reimbursement rate, which would be set at an average market price per pint.
The final and third option was to contract a company or consortium of companies for the direct supply and delivery of milk to all child-care providers. Under that option, the Department of Health would take a much more active role in procurement. It would contract a company, or a consortium of companies, for the direct supply of milk to all child-care providers registered with the scheme at an agreed price per pint supplied. That is one way to avoid the bureaucratic burden to which my hon. Friend has referred.
Jim Shannon
The debate so far has been about the price of a pint of milk. My recollection, like that of the hon. Member for Mid Dorset and North Poole (Annette Brooke), is of a third of a pint of milk. If we reduce the quantity of milk for a small child, would that not reduce the price? Is that too simplistic?
Dr Poulter
We will see what the consultation says. One option, which I have outlined, takes into account the bureaucratic burden of the cost on schools. We value the scheme and want to keep it—that is implicit—but at the same time, we recognise that going through a bureaucratic process to claim for milk could increase the cost to nurseries and other child care settings. The third option in the consultation is therefore for direct procurement from the Department of Health. That would help to reduce the bureaucracy in the scheme, although the hon. Gentleman will be aware that there is an allied, parallel scheme in Northern Ireland that operates in a similar way to the schemes in England, Scotland and Wales.
The National Farmers Union values the nursery milk scheme as a well established and highly regarded programme that plays an intrinsic role in society, supporting our dairy farmers as a key part of the supply chain. At the same time, the NFU believes that every attempt must be made to ensure a fair return to the whole dairy supply chain, including the primary dairy farmer. We must not lose sight of that. When the intermediaries are making huge profits, the farm-gate price—the price paid to farmers, who we value, particularly in rural communities—must be recognised in how the scheme operates. For the NFU and all those concerned about the impact of the proposed changes on the dairy market, let me explain that, according to Dairy UK estimates, milk supplied under the nursery milk scheme represents less than 1% of the total value of the UK dairy market; nevertheless, it is an important part of that market.
We are consulting on the scheme. The consultation closed at the end of last month, and we will be considering the representations made. To conclude, I repeat that the nursery milk scheme will continue as a universal benefit. It has huge health benefits for young children, and all eligible children in the care of child-care providers will continue to receive their free milk. We need to establish a system, however, that makes the nursery milk scheme fit for purpose and makes it adapt to recognise the important role that farmers play in the supply of milk—
Stillbirth Certification
Dan Poulter Excerpts(11 years, 6 months ago)
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Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
Thank you, Mr Owen, for calling me to speak. It is a great pleasure to serve under your chairmanship; like my hon. Friend the Member for Daventry (Chris Heaton-Harris), it is the first time that I have done so.
I pay particular tribute to my hon. Friend for raising this matter in Westminster Hall today. He and I have worked together in the past to raise awareness of the need to do more to support those families who have had the terrible experience of stillbirth. We have also worked together in the past to discuss the need for greater research in this area. He is absolutely right to highlight a number of the issues that he has raised today, and I will deal with the issues that he has raised in turn.
In my own medical career as a doctor, I have never seen anything more tragic than either a very badly injured or ill child, or a dead baby. The death of a baby is probably the worst situation that I came across, and losing a child is the worst experience for family and friends; it lives with people for ever. For some families, there is no coming to terms with the death of a child. It is a very difficult thing to live with and we must continue to do all we can to support those families, working with Sands and the other organisations that do a very good job in supporting those families; we must continue to do more.
My hon. Friend quite rightly highlighted the unacceptable regional variation in stillbirths. From the figures for 2011, we know that the strategic health authority for the north-east of England reported 5.8 stillbirths per 1,000 live births, whereas the SHAs for the east of England and the south-west of England reported 4.7 stillbirths per 1,000 live births. As I say, that is an unacceptable variation. There is an acknowledgment by the Royal College of Obstetricians and Gynaecologists, by the Royal College of Midwives and by Sands and many organisations that we need to do more to reduce the rate of stillbirths in this country. We must continue to do more to research the factors that cause stillbirth. As my hon. Friend said, in many cases the cause of a stillbirth is still unclear. We also need to continue to crack down on this unacceptable regional variation, and learn where there is good practice in combating and reducing stillbirth rates and where the NHS is doing things better, so that that good practice can be rolled out across the country.
As I said, the death of a baby, whether during pregnancy or following birth, is probably the worst tragedy that anybody can face, and that is true both from the point of view of a health care professional and from a family’s perspective. Stillbirth is not only the loss of a child, but the loss of all the hopes and dreams that the family would have had about what that baby would have become and what it would have meant to them in the years ahead. That is why it is particularly important that this is an area that we continue to focus on, to reduce stillbirth rates and so that both the Department of Health and medical professionals take this issue increasingly seriously. As my hon. Friend rightly highlighted, our stillbirth rates are 33rd out of 35 high-income nations and as a country we need to do better than that and improve on those rates.
Jonathan Lord
I am glad to hear my hon. Friend the Minister and my hon. Friend the Member for Daventry (Chris Heaton-Harris) talk about the work of Sands. I myself have had constituents come to me with the help of Sands, and my hon. Friend the Minister speaks very well about that organisation and about the real hurt of those families who have suffered a stillbirth.
However, could my hon. Friend the Minister just give us a little bit more information as to why he thinks the stillbirth rates in this country are higher than they should be, and why they are higher than the rates in many other western countries? What are the reasons behind that? That is the crucial thing—to stop this terrible tragedy happening to other families.
Dr Poulter
I thank my hon. Friend for that question, and he makes a very good point. As we have said today, we have high stillbirth rates in this country. One factor that the Royal College of Obstetricians and Gynaecologists has picked up on is the fact that there are sometimes variations in clinical practice, including in picking up on early warning signs that we know are associated with stillbirth, for example reduced foetal movements during pregnancy. That sort of thing always concerned me as a front-line professional and it concerns many midwives.
However, we need to have in place across the NHS better systems so that professionals can work with women to identify those early warning signs that something may be wrong in a pregnancy and to ensure that women come in quickly and seek help, or hopefully, rather than seeking help because something is going wrong, in many cases they can seek reassurance. However, where things are not right for a baby, we must ensure that the medical help is on hand to intervene quickly and to support the pregnant woman and hopefully mum-to-be.
There are parallels that can be drawn between where we are now with stillbirths and the situation with cot deaths a number of years ago. Back in the 1980s, the cot death rate was very high, peaking at 2.3 deaths per 1,000 live births in 1988. Following the launch of the “Back to Sleep” campaign in the early 1990s, the rate declined dramatically, falling to 0.6 deaths per 1,000 live births in 1995. This reduction has continued as awareness of the key messages on reducing the risk of cot death has increased. By 2010, the rate was 0.22 per 1,000 live births. To put that in real life rather than statistical terms, we are actually talking about a reduction from some 3,000 cot deaths a year to 300 or 400, which is not perfect, because we still have babies dying of cot death, but raising awareness and targeting cot death has proved to be an effective way of reducing rates. That is something we can learn from in the discussion we are having today about stillbirth.
The point that all hon. Members have made today is that the decline in stillbirths in the United Kingdom has not kept pace with that of comparable countries. According to The Lancet, we rank 33rd in the world for stillbirths. We need to ensure that we do better and take this issue seriously.
Both my hon. Friends have spoken about Sands. It is worth highlighting what that organisation has done. It provides tremendous support for families who find themselves in very difficult situations. It has highlighted the vital importance of the Government and the medical profession—midwives are taking this issue on board and are taking it more seriously—supporting families to make sure that in future pregnant women and families do not have to suffer the problems associated with stillbirth.
Sands has raised a number of issues, including research, which we have talked about and which I will come on to in a moment, and the fact that action is required to raise awareness, as we saw with cot death in the past, of the known risk factors for stillbirth so that prospective parents can make better choices and understand what could go wrong in pregnancy and what the warning signs may be—for example, reduced foetal movements. We need to ensure that parents are informed and that health care professionals know how to support parents and pregnant mums to help them to recognise the warning signs. They need to provide reassurance and care where appropriate and need to intervene when very serious concerns are raised.
We have said that it is not acceptable that the UK has one of the worst stillbirth rates in the developed world. We have developed a stillbirth prevention work programme, which my hon. Friend the Member for Daventry alluded to earlier. The Government are taking this piece of work very seriously, in conjunction with the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists, and the NHS to help to iron out the unacceptable variations in practice and the unacceptable regional variations that we have talked about.
The development of this work programme has been informed by a workshop jointly hosted by Sands and the Department of Health, which took place on 1 March this year. Discussions focused on key areas such as raising awareness and improving identification of babies at risk and improving perinatal reviews. We are continuing with this work to ensure that we can put that into practice throughout the NHS so that we provide pregnant mums with the support that they deserve.
My hon. Friend rightly raised the issue of research. It is important that we fully understand stillbirths. We do not always know what the cause of a stillbirth was. It is important that we do research and look into what the unknown causes and reasons might be. What are the factors that cause stillbirths? We know some of the causes; we do not know all of them. Continuing to research and focus on that is important.
The Government have funded a number of research programmes. Most recently, the Department has funded research through the National Institute for Health Research and the policy research programme. An estimated spend relating to maternal and foetal health has increased from £4.4 million in 2006-07 to £12.7 million in 2010-11. The issue of improving foetal health, babies’ health and maternal health is something that we take very seriously.
Working with Sands, the Department’s policy research programme has funded a policy research unit in maternal health and care at the national perinatal epidemiology unit at Oxford university. Research themes focus particularly on pregnancy loss, perinatal morbidity, maternal morbidity and maternal mortality.
The National Institute for Health Research in Cambridge has an ongoing programme of research on women’s health. A major focus of that research is understanding the determinants of stillbirth risk and using that understanding to improve clinical care of pregnant women. Indeed, last week I visited Manchester where there is a very high quality of care for pregnant women and for newborn babies. The university of Manchester’s maternal and foetal health research centre is currently leading projects in understanding the reasons for stillbirth. I know it will be looking to feed that in nationally so that we can continue to reduce stillbirth rates.
Research on its own is not enough. When we have the research, we have to ensure that we get it out there to the professionals, sharing it and the information from that with parents, to help them to make informed choices about their care and to be aware of the risks and the possible warning signs of stillbirth. Raising awareness is so important. It is an issue highlighted in particular by the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists. They have said that there is unacceptable variation, as we have accepted in this Chamber, in the rate of stillbirth and in how some health care professionals interact with families and pregnant women during pregnancy. Working up national guidelines that focus on professionals supporting families, as well as being aware of the other factors, is an important part of reducing stillbirth.
Another point made by my hon. Friend is that families who have suffered a stillbirth have not always received good bereavement support. We know that a lot of care and attention has been paid to ensure that more support and care is given to families—the royal colleges have taken that on board—and we are looking seriously at how we can provide more support. Many hospitals and trusts have invested in bereavement rooms and quiet areas for families when they have had early pregnancy loss or a stillbirth. That is right, because although maternity things generally go well and we have a good outcome, when things go badly we need to ensure that we are prepared and have a supportive environment to look after families in such circumstances.
Finally, it is important to focus on certification, an issue raised by my hon. Friend. I will look into the matter in more detail and get back to him in writing as well, rather than try to put together an answer in the two or three minutes available to me. He made the point that some mums who give birth have to go through the whole birthing process—they actually give birth to a dead baby—and that is an incredibly traumatic and difficult thing to do, because they know that their baby is not alive. Some mums, however, have to do that. In such situations, although the law, with such things as birth and death certificates, is there for good reason, the human reality is sometimes not recognised in the law as effectively as we might like. There will, though, sometimes be difficulties with law, however we have it. As best we can, we have tried to mitigate such situations by beginning to provide more supportive environments for parents after a stillbirth and by providing certificates recognising that there has been a stillbirth after 24 weeks. That goes some way towards recognising the difficult and tragic event—we recognise that a baby has been born, although the baby was not born alive. I will write to my hon. Friend in more detail in the next few weeks, because the issue deserves more than a few sentences at the end of the debate.
I thank my hon. Friend and pay tribute to his work on raising awareness of such an important issue. The Government are very much committed to taking forward our work with Sands and ensuring that we reduce stillbirth rates in this country, as well as providing more research to investigate the causes of stillbirth and better support for bereaved parents in what is perhaps the most difficult thing I have ever seen in my medical career.
Question put and agreed to.