Acute and Emergency Services
Dan Poulter Excerpts(12 years ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I congratulate my hon. Friend the Member for Bracknell (Dr Lee) on securing this debate and on making such an eloquent speech about the importance of modernising the NHS so that it can continue to deliver high-quality care. That often goes hand in hand with both improving efficiencies in care delivery to patients and reducing the cost of delivering care.
My hon. Friend outlined how the NHS crisis management system focuses on the acute sector. If we were designing the NHS today, it would look very different. My hon. Friend explained the importance of community-delivered care and pointed out that we need to keep people living well and healthily in their communities, rather than picking up the pieces in the hospital setting after they become unwell. He rightly made the point that the length of time of hospital stays for surgical operations has fallen. It has fallen from about nine or 10 days over the past decade or 15 years to an average of about five or six days. Increasing use of keyhole surgery and other minimally invasive procedures have also increased the quality of care we can provide, reduced the cost and, importantly, ensured that patients are treated in a more effective way. These developments also take account of the fact that people are much better off at home than in hospital, or when being treated as day cases rather than long-term admissions.
My hon. Friend rightly highlighted that there is a big challenge facing our health service in the decade ahead: we have many people with long-term medical conditions who need to be treated and we have many older people. People with diabetes, heart disease and dementia are also living longer. The way we should look after them is not to wait for them to get unwell and then pick up the pieces when they arrive at A and E, but to prevent them from getting unwell in the first place. We must deliver more care in the community and, where we can, focus on prevention rather than cure. We need to do more to ensure that proper rehabilitation is available for people after a stroke or an operation. That needs to be delivered, as much as possible, in the community and people’s homes, as it produces much better care.
We already see good examples of where that is working. In Wigan there has been a cost-saving to the NHS of £700,000 through a new service that makes sure people who have suffered a stroke spend no longer than 50 days in hospital. They are in hospital for a much shorter period and they get the vital rehabilitation and care they need to improve their outcome and improve their recovery. That care is now delivered in the community, rather than the hospital setting. That is cheaper for the NHS and better for patients. It is a good model of care that we can take elsewhere.
As my hon. Friend said, it is important that politicians are brave in how we talk about these matters. He should be commended for the way in which he has approached the issues and been very honest about the fact that medical care will need to look different in future. Sometimes the politician is the worst enemy of the physician. We are both medical doctors—we both still practise medicine—and we understand that good care will look different in the years ahead. It is important to make the case in our roles both as physicians and as politicians that what matters is delivering high-quality patient care, which will have to look different if we want more care at home and more preventive care.
My hon. Friend talked about the need for service reconfigurations that provide specialist centres and more focused centres of care. Among the many examples that he outlined, he said that the reconfiguration of stroke services in London was massively to the benefit of patients and that having fewer centres for stroke care has been saving many hundreds of lives every year; indeed, there are good clinical data to support that. Yesterday I visited hospitals in Manchester, where I saw another good example of where service reconfiguration has worked well after a case was made for reconfiguration of maternity care and neo-natal care. Having fewer obstetric-led maternity units and more midwifery-led units is saving the NHS money but also saving 30 babies’ lives every year in the Manchester area. Mike Farrar, the former head of the strategic health authority, delivered that change very effectively.
Although I take on board what my hon. Friend said about nationally led service reconfiguration, a key thing that we can derive from the changes to services in Manchester and London is that they were driven at a local level by good clinical leadership and effective engagement of local communities. There are many good examples of strong clinical leadership at a local level delivering improved patient care as well as saving money which is being ploughed back into the NHS to improve care for other patients.
Let me turn to service reconfiguration in Bracknell, my hon. Friend’s part of the world. As he is aware, this Government, like previous Governments, have set a number of tests for service reconfiguration. There are four key tests. First, while it is important that local health care services should be designed around local needs, the Government are clear that the NHS should develop and implement plans for service change in a consistent way that gives confidence to local communities. The four tests clearly outline that there should be strong local clinical leadership and ownership of how services are redesigned, as well as strong community engagement. As in the example of Manchester, where community engagement was achieved and people are buying into the change because it is saving 30 babies’ lives every year, we can not only deliver better-quality care for patients but bring the community with us in doing so.
Under the third test, the change, as well as being clinically led, should encourage choice and availability. In more rural parts of the country, focusing on bigger and better centres will often reduce choice, because due to their rural nature such areas need more service providers—more hospitals. People may therefore have to travel long distances to receive their care.
Finally, even if the proposed change involves cost savings to the NHS, the key focus should be on its ability to deliver better-quality patient care. Where all four tests for local reconfigurations can be met, we should all welcome it. My hon. Friend mentioned that the new arrangements are already working well in London, Manchester and elsewhere.
I am happy to meet my hon. Friend to talk through the service reconfigurations that he is advocating in his part of the country, if he wishes to do so. I know that he is already working with his primary care trust and strategic health authority, and with fellow MPs whose constituents and hospitals will be affected by the proposals, and I urge him to continue to engage at local level with the PCT and the SHA, and with colleagues. If he continues to advocate the case that he has outlined today, he will bring people with him.
It is important to stress, however, that the decisions will be taken at local level. As PCTs turn into local clinical commissioning groups, it will be a matter for those groups to work together to decide what health care services will look like at local level. I am sure that my hon. Friend and other parliamentary colleagues will want to continue to engage with them and to make a strong case for proposals such as these. Given the eloquence with which my hon. Friend has put forward his proposals today, I am sure that he will have some success.
Question put and agreed to.
Oral Answers to Questions
Dan Poulter Excerpts(12 years, 1 month ago)
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Mrs Mary Glindon (North Tyneside) (Lab)
3. What his policy is on upholding national pay arrangements in the NHS.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
NHS trusts and foundation trusts have the freedom to determine the terms and conditions of the staff they employ. As the hon. Lady will be aware, the “Agenda for Change” was negotiated and brought in during 2004 by the then Secretary of State, John Reid, to agree a national framework for pay in the NHS. In general, most trusts support the agreed pay framework and the “Agenda for Change”, and they are likely to continue to use national terms, provided they remain affordable and fit for purpose.
Mrs Glindon
In fairness, a truly national health service demands a national pay scheme, and the British Medical Association has warned that the move to regional pay undermines the ethos of “national” in our national health service. How does the Minister intend to act on that warning?
Dr Poulter
I remind the hon. Lady that it was the previous Government who set up the current national pay framework in 2004, and that framework has been amended 20 times to support employers over that period. The previous Government gave foundation trusts the freedom to amend those pay terms and conditions. Regional pay does exist in the NHS. On the basis of what she has said, does the hon. Lady wish to remove the London weighting for those workers who live in London? I am sure she would not want to do that because we recognise that it is more expensive to live in certain parts of the country, and workers should be rewarded for that.
John Pugh (Southport) (LD)
The Lib Dem conference rejected regional pay entirely, but not the London weighting, and 25 honourable colleagues endorsed a submission to the pay review body. With that in mind, is it not odd that the south-west consortium remains part of national pay bargaining?
Dr Poulter
My hon. Friend makes a good point and it is important that we support national pay bargaining where we can. There is an agreement in principle, endorsed by NHS employers, that national pay bargaining is supported throughout the NHS. It was supported throughout the NHS under the previous Government, who set up the “Agenda for Change”, and during their tenure, that agenda remained fit for purpose. Twenty changes during the previous Government’s tenure benefited employees in the NHS, and rightly so. The current Government believe that we must continue to ensure that the system is fit for purpose.
Mr Jamie Reed (Copeland) (Lab)
It is most unusual to find the ghost of Christmas past sitting next to the invisible man. The truth is that in May this year, the Deputy Prime Minister stated:
“There is going to be no regional pay system. That is not going to happen.”
Regional pay will strip millions from local NHS services; it will hit the poorest areas of the country hardest, damage front-line NHS care, and there can be no justification for it. Will the Minister categorically rule out continuing with these ruinous proposals—yes or no?
Dr Poulter
The arguments presented by the hon. Gentleman are fatuous, and the previous Government endorsed regional bandings for London workers. If today he is saying that he does not agree—[Interruption.] You might learn something if you listen. If he is saying that he does not agree with London weighting for London workers, which is a form of regional pay—[Interruption.]
Dr Poulter
If the hon. Gentleman listens, he may well learn something about what his Government did when they were in power. They endorsed the fact that in the NHS it is important to recognise that we need inducements in some parts of the country to encourage workers to work there. That is why we have central London and outer London weighting. If it was good enough under the previous Government, it should be good enough now.
Mr Speaker
Order. We are immensely grateful to the Minister, but we have a lot to get through and we really must press on with rather greater dispatch from now on.
Mr Nick Gibb (Bognor Regis and Littlehampton) (Con)
6. What assessment he has made of the role of community hospitals in the range of local health care and hospital provision.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
My hon. Friend is right to highlight the importance of community hospitals in his constituency and elsewhere. They can provide high-quality care close to home, particularly for people with long-term conditions and the frail and elderly.
Mr Gibb
I am grateful to my hon. Friend for that answer. If there is a conflict between local health officials and local people as to the desirability of a community hospital, as there is in Littlehampton in relation to the Littlehampton community hospital, which most people in the town want to see rebuilt, whose views should prevail—the NHS employees or the local residents of Littlehampton?
Dr Poulter
I thank my hon. Friend for his question. As he is well aware, it is down to local commissioners—local doctors—in Littlehampton to decide, in consultation with local communities, what is good health care. Of course, we must not get fixated on buildings in the NHS. I know there is a local campaign to support the re-establishment of Littlehampton district hospital, and although that may be a very desirable end, there may be many other ways in which high-quality health care can be provided for his constituents closer to home.
Graham Jones (Hyndburn) (Lab)
From April, my local health centre will be transferred to a national property company, a quango, in Whitehall. How can local people in Hyndburn regain some influence over this health centre and its use after April?
Dr Poulter
Part of reorganising services and delivering good health care is about clinical leadership—I hope that is supported across the House—and local doctors, nurses and health care professionals saying what is important for their patients and what local health care priorities are. Obviously, local communities need to be engaged in that process, but what really matters is what is good for patients and delivers high-quality care for them. We need to deliver more care in the community, and in doing so we have to recognise that some of the ways we have delivered care in the past—picking up the pieces in hospitals when people are broken—need to change. We have to do more to keep people well at home and in their own communities.
Sir Alan Beith (Berwick-upon-Tweed) (LD)
Given that the maternity unit at Berwick infirmary has been suspended since the beginning of August for safety reasons, with births being referred to a hospital 50 miles away, will the Minister take into account the urgent need to provide the necessary clinical support for community hospitals in remote areas so that they can provide local essential services to the highest standards?
Dr Poulter
I thank my right hon. Friend for that question. We discussed this issue in the Adjournment debate before the autumn recess. He is a strong advocate for his local maternity services. The concern was that only 13 births take place at his local maternity unit every year, and whether staff can continue to deliver high-quality care with such a low number of births. Of course, his local providers will want to consider the rurality of the area and the potential, as outlined in the Birthplace study, of rotating staff in and out of the hospital to support his local unit.
Barbara Keeley (Worsley and Eccles South) (Lab)
7. What steps he plans to take to ensure that providers of domiciliary care employ staff who are properly qualified and security checked.
Mr William Bain (Glasgow North East) (Lab)
12. What recent representations he has received on regional pay in the NHS.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I refer the hon. Gentleman to an answer I gave earlier today.
Mr Bain
Has the Minister had an opportunity to study the research done by the New Economics Foundation a few months ago, which reveals that fully regionalised public sector pay could strip up to £9.7 billion a year from local economies, put 110,000 jobs at risk and hit women twice as hard as men? Given that, what possible justification could this Government have for such a crazy policy?
Dr Poulter
Let me bring the hon. Gentleman back to planet earth for a while—[Interruption.] He should have listened to the answer I gave a little earlier about allowing for flexibility in pay frameworks. Some degree of regional pay was introduced by the previous Government in “Agenda for Change”. On principle, then, the previous Government, the hon. Gentleman and his colleagues, including the former Secretary of State, were supportive of regional pay. However, on the current negotiations and discussions, we would like to see a collaborative relationship between employers, unions and employees in the NHS at the NHS Staff Council to make sure that we maintain national pay frameworks as long as they remain fit for purpose.
Sir Tony Baldry (Banbury) (Con)
Why should there be an assumption that local pay will lead to lower pay in the public sector? In a constituency such as mine, where the unemployment rate is below 2%, local pay could quite possibly lead to higher pay in the public sector so that people are attracted to it.
Dr Poulter
My hon. Friend makes an excellent point. It was the previous Government who, through the “Agenda for Change”, gave flexibility to NHS trusts to allow some employers to pay a 30% premium in areas with workplace shortages.
Lilian Greenwood (Nottingham South) (Lab)
17. At a time when NHS budgets are under exceptional pressure, my constituents simply do not understand why the Government are so intent on pushing trusts to divert money away from patient care and into wasteful local pay bargaining. Is there not a risk that Nottingham’s excellent NHS hospitals and community services will be unable to recruit and retain the best staff if regional pay results in cuts to their salary scales? The Government are supportive of the idea, endorsed by the previous Government, that local pay flexibility allows additional rewards to be paid to staff in areas with workplace shortages, as my hon. Friend the Member for Banbury (Sir Tony Baldry) just made clear. The Government are supporting the unions, employers and employees, as the NHS Staff Council, in coming together to try to agree how we need to modify the “Agenda for Change” and other agreements to ensure that they remain fit for their purpose of protecting employees.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
We are working with the Department for Education to introduce integrated commissioning of education, health and social care for children and young people with special educational needs and disabilities. This will ensure that children with profound multiple learning difficulties can get the care they need while at school.
Chi Onwurah
I recently visited Hadrian school in my constituency, which caters for children with severe learning difficulties and profound and multiple learning difficulties. I saw fantastic teachers and carers doing fantastic work with fantastic children, but I also saw in the reception classes that more children with more severe health needs were entering the school. What guarantees can the Minister offer that funding will be in place for those children in five or 10 years so that Hadrian school can plan now for their needs?
Dr Poulter
The hon. Lady makes a good point. We know that the Government are putting more money into the NHS. However, this not just about putting in more money, but about how we deliver care in a more joined-up way. At the moment, education works too much in its own silo and the NHS works in another. The Government’s new commissioning arrangements will follow the more joined-up approach that we need to take properly to meet the needs of children with learning disabilities in the round. That must be a good way forward in properly joining up education and health care.
Mr Mark Spencer (Sherwood) (Con)
T1. If he will make a statement on his departmental responsibilities.
Helen Jones (Warrington North) (Lab)
T5. Before the last election, the Prime Minister promised a “bare knuckle fight” to save district general hospitals and promised that they would be enhanced. Now that we know that the board of St Helens and Knowsley hospitals is looking at a merger with Warrington and Halton to solve its problems, can the Minister give the House an unconditional assurance that no services at Warrington will be downgraded or removed, whether that merger goes ahead or not?
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
There was an option to discuss this issue at the board meeting on 29 August—not of the hon. Lady’s hospital trust but of the Halton hospital trust—because the Halton trust is looking to achieve foundation status. So I can reassure her that the services at Warrington hospital are safe.
Mr John Redwood (Wokingham) (Con)
T3. What is the administration overhead cost to the NHS and the Department this year and how does it compare with 2009-10?
Rehman Chishti (Gillingham and Rainham) (Con)
T4. Will the Secretary of State join me in welcoming the progress that has been made to reduce mixed-sex wards and improve patient privacy at Medway Maritime hospital in my constituency?
Dr Poulter
My hon. Friend is absolutely right to highlight the Government’s success in reducing mixed-sex wards not just in his hospital but throughout the NHS—we inherited a very different situation from the previous Government. Medway has been a pioneer in that area and my hon. Friend is right to commend the hospital and I put on record my thanks for all that it is doing.
Paul Goggins (Wythenshawe and Sale East) (Lab)
T8. Will the Secretary of State take a close personal interest in the proposed changes to the NHS in Trafford? Given the uncertainty about alternative accident and emergency provision, and indeed the delays in commissioning community services, will he ensure that any final decisions are deferred so that they can be considered as part of the wider review planned for NHS services across Greater Manchester?
Oral Health Services
Dan Poulter Excerpts(12 years, 1 month ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I congratulate the hon. Member for Plymouth, Moor View (Alison Seabeck) on securing the debate. I do not think that she needs to justify her pursuit of this issue to her local press, because it is an important issue, and we should all pay tribute to her long campaign. The need to improve dental health is often underestimated, and it is not discussed enough in the context of the health service. I am sure that the hon. Lady will continue to campaign strongly, as a member of the all-party group, in the Chamber and in her constituency, where she supports the medical and dental schools. I should be delighted to take her up on her invitation: I intend to go to Plymouth in the near future, and I hope to be able to visit the dental school then.
The hon. Lady rightly observed that, in health care generally, we do not talk enough about the fact that prevention is much better than cure. In many parts of the health service, payment systems have not properly rewarded staff in line with the recognition that good health care is about preventing people from becoming unwell in the first place, rather than picking up the pieces when they have developed cancer or other problems. The new dental contract makes it easier to identify key prevention issues. It focuses on the desirability of spotting early symptoms of ill health—in this instance, oral ill health—rather than spotting them much too late, when a patient’s cancer is already well advanced.
The hon. Lady also referred to important public health concerns about smoking and alcohol consumption. She was right to draw attention to the problem of binge drinking, not just among young men but nowadays increasingly among young women, and to the effects of excessive smoking and drinking on oral health. The links between high alcohol consumption and smoking and a number of cancers—particularly throat cancer and other cancers in the mouth—are well established. I am optimistic about the possibility that the new dental contract and the important focus on preventive care will enable us to identify cancers, and those who are at risk of developing them, much earlier, rather than waiting to treat people later when they are very unwell. The health service in general needs to be geared up in order to do that better, particularly in the context of oral health.
The hon. Lady also raised the issue of the European platform on oral health. I believe that the all-party group hosted a reception on that recently, praising its work. All the work we have been doing in this country has been rightly highlighted in that report, and I shall discuss that a little later. It is worth dwelling on how over the past 20 or 30 years, under consecutive Governments, we have had a record of improving oral health and improving access to dentistry, particularly in the past few years. If we are taking oral health seriously, it is important that we improve access, and we are beginning to do that well.
As the hon. Lady knows, in 1973 the average 12-year-old in England and Wales had five decayed, missing or filled teeth, but by 2003 the UK average was 0.7 fillings. So we have made great strides in the past 30 or 40 years. That improvement was partially due to the introduction of fluoride toothpaste in the 1970s—that brings me to the issues raised by the hon. Member for Strangford (Jim Shannon) in his interventions—and to the hard work of dentists up and down the country. They, along with dental hygienists, highlighted the importance of good tooth care and preventive measures through effective tooth brushing using toothpaste.
Adult oral health has improved in a similarly impressive manner. In 1968, the first adult dental health survey found that 37% of the adult population of England and Wales had no remaining natural teeth, but the 2009 survey found that the proportion had dropped to 6%. Again, that is a mark of how this country is taking this issue seriously, and we must continue to do so. Access to NHS dentistry has grown steadily, with more than 1 million more patients having been seen by NHS dentists since May 2010.
The hon. Lady rightly highlighted the European platform on oral health report and outlined some of its recommendations. I have read the report and it rightly identifies the promotion of good oral health as one of the most significant health care challenges facing EU countries. However, as she said, England’s oral health compares well with all the countries surveyed in the report, and we are especially pleased that it highlighted the “Delivering Better Oral Health” toolkit, which was a guide to prevention in practice published jointly by the Department of Health and the British Association for the Study of Community Dentistry as an example of good practice. Notwithstanding the fact that we have made good progress historically and that the European platform on oral health report highlighted the good things we do in this country, we must never be complacent. We must continue to ensure that we drive further improvements and reduce the inequalities in access and in oral health that still exist and are very real in some parts of the country.
The hon. Lady raised the issue of the new dental contract. The reforms of the contract focus on a number of things, including improving access to care. There is an important focus on preventive dentistry—preventing bad things from happening to people and on picking up things early. As she is aware, the new contract that we are introducing will be based on registration, capitation and quality, rather than a more payment-by-results system. Such an approach will allow more focus to be put on those preventive measures, rather than on the more reactive measures that a payment-by-results system tends to deliver. The new contract will replace the existing model that rewards units of dental activity rather than taking a more holistic view of what is good for the patient. We can learn from this approach as a good model of health care as we develop tariffs throughout the health care system. Such a model is already being used well in some parts of the country—in stroke care and other areas of preventive care, for example, where a more holistic, joined-up approach to what happens before hospital admission and afterwards in rehabilitation is as important as immediate treatment in a hospital setting.
Elements of that contract are being tested in 70 practices at the moment, and we are rolling them out to an additional 20 to 25 practices as part of the pilot to make sure that that contract is fit for purpose. When the further results from those are available, I will be happy to share them with the hon. Lady, so that we can ensure that we design the best contract.
Alison Seabeck
Perhaps it might be appropriate to share some of that information with the all-party group, rather than one to one.
Dr Poulter
Absolutely, and I would be very happy to do so. The hon. Lady’s commendable focus on this area of health care would, of course, lead me to wish to share that information with her, but of course I would be delighted to share it with the all-party group, too. The work done by a number of all-party groups, including hers, helps to ensure that many of these important issues are never forgotten and that they are kept at the forefront of the minds of our fellow parliamentarians.
Of course, as the hon. Lady rightly highlighted, there are some inequalities across the country and, as we know, among different socio-economic groups. Improving access to care will play an important part in addressing those health care inequalities. I draw the attention of the House to our progress in preventive care, in addition to the new contract. The number of adults being treated with fluoride varnish, which is one of the most effective preventive treatments available, rose by 43% last year. Among children the figure was 64%. By investing in preventive treatment, we are ensuring that future generations will enjoy good oral health throughout their lives. In addition to promoting the application of fluoride varnishes, we will seek to promote the learning of lessons from the best performing areas of the NHS and to work with the devolved Administrations and local and regional government to iron out inequalities across different geographical areas. It is important that in all areas of health care, including dentistry and oral health care, we learn from things that have gone well so that we can roll out that good practice elsewhere and ensure that it is learned from. We should also be open and honest when things have not gone so well, so that we can learn lessons and improve services for the benefit of patients.
The hon. Lady mentioned the Peninsula dental school and rightly stated that it was opened in 2007, under the previous Government, as a joint venture between Plymouth and Exeter universities. The school has been a great success. I know that she has been a great advocate for it and is rightly very proud of what it has achieved and of what it is doing in Plymouth. Earlier this year, the two universities announced changes in how the school is run. Exeter will now operate a medical school of its own while the teaching of both medical and dental studies will continue in Plymouth. I know that it is important that her constituents are reassured about that and that as we have a successful dental school we should recognise that and support its continuing function. Many of the changes were purely administrative, rather than to front-line services.
I acknowledge the concerns expressed by the hon. Lady tonight and elsewhere, but both universities have stated that the split will improve the administration of medical education in the south-west and we expect the changes to have no negative impact on the dental school. I know that she will ensure that the voices of the dental school and her constituents are heard loudly both locally and in Parliament, and I am happy to support her in that.
Let me finally make a few points about dentistry in the south-west of England. The hon. Lady talked about NHS dentistry in her constituency, including the case of an individual constituent who had problems accessing it. We know that we have further to go in improving access, but the Government have made good strides in that direction, as did the previous Government. We have made significant progress and the latest NHS figures show that since March 2010 the number of people who accessed an NHS dentist in the south-west over the previous 24 months has increased by almost 150,000. That is a strong step in the right direction.
In Devon, £500,000 was invested in four practices in March to provide a further 6,500 dental places, which will become available over the next 12 months. I understand that at the same time a further two practices have increased their capacity and will provide an additional 3,000 places over the next 18 months. We are continuing to ensure that we widen access to dental services in the south-west.
In the south-west, as in the rest of England, we are making vital improvements to access to NHS dentistry and putting in place the measures needed to continue the improvements in this country’s oral health. Access is rising, rates of decay have fallen and continue to fall, and we are piloting a new contract designed further to increase access and improve oral health, focusing on prevention as a key part of our efforts to improve people’s oral health and general health, and to keep them well. We are committed to ensuring that NHS dentistry is available to those who want it, and improving oral health is at the heart of what dentistry does.
Of course challenges remain. We must make sure that pilot studies are effective and that we listen to any concerns that emerge from them, so that we can improve the new contract accordingly. The fundamental focus is on moving away from a reactive service to a preventive care service. That will both improve oral health by reducing the incidence of cancer, and give children the best start in life by engendering good dental health habits through the involvement of hygienists and other practitioners. Our aim is to move dental care on to a more stable footing. This Government are committed to continuing the progress that consecutive Governments have made in widening patients’ access to dental services, particularly those patients who have had difficulty accessing such services in the past.
Question put and agreed to.
Report on Sport and Exercise Science and Medicine (Government Response)
Dan Poulter Excerpts(12 years, 1 month ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
My noble Friend Earl Howe, the Parliamentary Under-Secretary of State, Department of Health, has made the following written ministerial statement:
We have today laid before Parliament the “Government Response to the House of Lords Science and Technology Select Committee Report of Session 2012-13: Sport and exercise science and medicine—building on the Olympic legacy to improve the nation’s health” (Cm 8452).
We welcome the Committee’s report and its focus upon the quality and application of sports and exercise science and medicine. The effective translation of scientific breakthroughs in this area into health benefits for patients and the public represents a major opportunity as a legacy of the London 2012 Olympic and Paralympic games. We are therefore targeting investment to support the translation of biomedical research.
Today’s publication is in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
Nursing and Midwifery Council Grant
Dan Poulter Excerpts(12 years, 1 month ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
The Government have made an offer to the Nursing and Midwifery Council (NMC) of a one-off grant of £20 million to support it in improving its performance in dealing with fitness to practise cases.
The NMC is an important organisation with a vital role to play in protecting patients. The offer comes after a period when the NMC has experienced many years of financial and performance difficulties. This year, under new leadership, the NMC has already begun to make improvements to its operations and financial management, but much more still needs to be done.
The NMC has recently consulted on increasing its annual fee to £120. This would mean nurses and midwives would have to pay an extra £44 every year, at a time of significant pay restraint in the public sector.
The Government expect that this grant will provide the extra financial support required for the NMC to properly tackle a backlog of fitness to practise cases, as well as to allow it to reduce the effect of a fee rise for hard-working nurses and midwives.
It is a decision for the NMC Council whether or not to accept the Government’s offer of a grant.
health
Dan Poulter Excerpts(12 years, 2 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I thank hon. Members for their kind comments. A lot of ground has been covered in this debate and many good points have been raised about local NHS services. I hope that hon. Members will forgive me if I cannot give comprehensive answers about everything that has been raised, but I will do my best in the time that is available.
It was clear from all the points that were made in the debate that every hon. Member sees the NHS through the prism of the patient. That is the right way to regard how NHS services are delivered. Patients are the priority for our NHS services and for the Government, and they were the priority for the former Secretary of State, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), in his decision to push ahead with the NHS reforms. The basis of the “No decision about me without me” policy is that patients are the most important thing. They are why doctors and nurses do their work and why all Governments endeavour to fight for a better NHS.
I turn now to the concerns of individual Members. I believe that I am right to wish my hon. Friend the Member for Milton Keynes South (Iain Stewart) a happy birthday. A number of hon. Members have concerns about the competitive procurement processes for community health services in Milton Keynes. He mentioned the concerns of my hon. Friend the Member for Milton Keynes North (Mark Lancaster). Our policy is clear that it is for the local NHS, and the primary care trust in particular, to look at the options for different procurement procedures and to decide what is best for local people. The local strategic health authority has played an important role in assuring the PCT’s decisions. Whichever option is chosen, it must be possible to put it in place before 31 March 2013, to avoid the continuing and damaging uncertainty for staff. I am happy to meet my hon. Friend the Member for Milton Keynes South and other hon. Friends to discuss the matter further.
My right hon. Friend the Member for Berwick-upon-Tweed (Sir Alan Beith) talked about maternity services, which is a matter close to my heart. This morning, I visited Newham university hospital, which faces different challenges in maternity care. I looked at the fantastic new unit that has been opened at Newham, which will meet those challenges and provide high-quality maternity care to that part of London.
My right hon. Friend was right to point out that the challenges for maternity services—indeed, for all health care services—in more rural areas such as Berwick-upon-Tweed are different from those in more urban parts of the country, such as London. Women and families in Berwick, like women and families everywhere, deserve maternity services that focus on improving the delivering of high-quality health care for women and babies, and on improving women’s experience of care.
The decision temporarily to close the midwifery-led maternity unit and in-patient post-natal services at the Berwick infirmary, to which my right hon. Friend alluded, was difficult for the local trust to make. He is right to say that in making such decisions there should be regard to the rurality of the area. He made good suggestions about the potential for rotating staff to support rural maternity units. I understand that the decision was made to protect the quality and safety of maternity services in the area and, in particular, to protect the quality of care and safety of women in labour.
I have been assured that the trust is working closely with commissioners to look at the future of maternity services in Berwick. The review will be completed in the coming months. My right hon. Friend may be aware of the recent birthplace study, which discusses good and bad practice in supporting smaller maternity units. I am sure that the commissioners will have regard to that study in making decisions about the future of the unit in his area. He should be assured that I will take a close interest in the matter and support his advocacy on behalf of his constituents.
My hon. Friend the Member for Ealing Central and Acton (Angie Bray) made some points about the service reconfiguration of health care services in London. The hon. Member for Mitcham and Morden (Siobhain McDonagh) also mentioned that issue, and I am sure she would like to pay tribute—as I do—to my right hon. Friends the Members for Carshalton and Wallington (Tom Brake) and for Sutton and Cheam (Paul Burstow), for their work over the years campaigning for services at St Helier hospital.
Key tests must be passed to ensure that clinical services are suitable for reconfiguration. First, there must be support from local clinicians, and, secondly, arrangements for public and patient engagement and consultation—including with local authorities—must be strengthened and put in place. Thirdly, we need greater clarity on the clinical evidence bases underpinning proposals, and, finally, any proposals should take into account the need to develop and support patient choice.
The reconfiguration of front-line health services is up to the local NHS, and no decisions will be taken until there has been a full public consultation. St Helier hospital is part of the south-west London reconfiguration scheme “Better Services, Better Value”, which is in its pre-consultation stage and is led by local GPs, nurses, acute clinicians, other health care professionals and patient representatives. Under “Better Services, Better Value”, the number of accident and emergency and maternity units will be reduced from four to three, and the likely recommendation is for St Helier to become a local hospital with an urgent care centre.
Ealing hospital is part of the “Shaping a healthier future” scheme in north-west London. Proposals for that scheme include centralising A and E units, and having maternity facilities on fewer sites. However, I reassure my hon. Friend the Member for Ealing Central and Acton that there are no plans to close any hospitals, and certainly not Ealing hospital. As she said, a full public consultation began on 2 July this year and will finish no earlier than 8 October, and I encourage my hon. Friend and her constituents to continue engaging with that process. She outlined the good campaign that she has been running to encourage local engagement, and I am sure she will continue with that so that local voices can be heard when health care decisions are made in the area.
The issue of children’s congenital heart surgery was raised by a number of hon. Members, including my hon. Friends the Members for Leeds North West (Greg Mulholland) and for Pudsey (Stuart Andrew). My hon. Friend the Member for Sittingbourne and Sheppey (Gordon Henderson) spoke passionately about Jacob, the son of one of his constituents.
A number of hon. Members are concerned about the “Safe and Sustainable” review of specialist paediatric services, and particularly its focus on the reconfiguration of heart surgery services. However, as was made clear in a number of contributions, its findings were based on Professor Kennedy’s review of paediatric heart services at Bristol after the heart scandal there, and the “Safe and Sustainable” review is independent of the Government, as it should be. In those circumstances, and given the notice of legal proceedings and referrals to the Secretary of State, it is not appropriate for me to comment further on that review or its outcome, and that stands for my statement on the Floor of the House as well as for my correspondence with constituents. I know that my hon. Friend the Member for Leeds North West has written to the Department on this matter, and the Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry), replied with details of how anyone who wishes to raise concerns about the review can get their voices heard.
Greg Mulholland
I commend the Minister for his professionalism in both his previous career and his current role. Although I accept what he says, does he agree that our statutory process must be allowed to look at whether this review is, as we believe, a dodgy decision, or, as the Joint Committee of Primary Care Trusts contends, a fair one? Does the Minister at least agree that such scrutiny should take place, and that the fact that it is being prevented because documents have not been released is wrong and must be rectified? That is all I ask him to say today.
Dr Poulter
As my hon. Friend is aware, there is a process for scrutinising all decisions and, as I have outlined, if the correct procedure has not been followed, decisions are open to judicial review. To reassure hon. Members, we have accepted, from a medical perspective, the principle that fewer units deliver better care for patients and better surgical results for children. Therefore, this review is not about closing units in any particular hospital, but about specialist surgical services. Day-to-day care of patients and paediatric care for those who have had surgery will continue locally even after this review, and that should reassure local patients.
Mr Cash
On that point, and in the light of the way this legislation has been redressed over the past year and half, does the Minister accept that before the legislation was introduced, and now, ultimate responsibility and accountability for all matters affecting the health service turned on the duties, accountability and statutory responsibilities of the Secretary of State? That is why the Minister is now at the Dispatch Box, just as the Secretary of State would be in other circumstances.
Dr Poulter
I accept that the Secretary of State has always had responsibility for the health service, and that was implicitly made clear in the Health and Social Care Act 2012. It is, however, important that we no longer have a system in this country that micro-manages the delivery of local health care services. We must listen to local doctors and nurses, and put them in charge of the configuration of local services because they are often the best advocates for the needs of local patients. Reconfiguring local services should be led—as per the four tests I outlined previously—on good clinical grounds where there is a clinical case for reconfiguration and where local communities have been consulted. That is something we should listen to and we must move away from the Whitehall micro-management of local health care delivery.
Gordon Henderson
Does the Minister accept that local people wanted Royal Brompton hospital to be kept open, and that the decision to remove the intensive care unit was not taken by local people? The Minister is arguing against himself.
Dr Poulter
The initial process for the reconfiguration was started, I believe, by John Reid when he was Secretary of State in 2002, after listening to evidence at the time. We should remind ourselves why we are discussing congenital heart services. All speakers have accepted the principle that there is good clinical evidence—acknowledged by doctors and specialists—that having fewer units actually delivers better care for patients. That was accepted by my hon. Friend the Member for Pudsey. I am not going to go into the rights and wrongs of individual units as that is under judicial review and I will not be drawn further on that point today.
Dr Poulter
I have been very generous and indulgent but I must make some progress. The process was led by doctors and nurses, and there is an ongoing consultation to engage with, review and reflect on decisions at a local level. That came out clearly in comments by my hon. Friend the Member for Leeds North West, but some of those processes are under judicial review and I will not, therefore, be able to comment further. I hope that my hon. Friend the Member for Sittingbourne and Sheppey will accept my reassurance that these reviews are carried out on good clinical grounds that take into account local factors such as whether local health care services are well designed. The important thing is that they are being led and developed by local doctors and nurses. We need such clinical leaders in the NHS, because they are the best advocates of patients’ needs.
My hon. Friend the Member for Stafford (Jeremy Lefroy) has been a strong advocate of the needs of his constituents and the staff of Mid Staffordshire NHS Foundation Trust. I know that we will be meeting tomorrow to discuss his concerns further, and I will also meet my hon. Friend the Member for Stone (Mr Cash), who has sadly now left the Chamber. We will talk about a number of issues, and I reassure my hon. Friend the Member for Stafford in advance of that meeting that I and other Ministers will continue to do all that we can, as our predecessors did. He rightly paid a full tribute to my right hon. Friend the Leader of the House for all the work that he did as Secretary of State for Health to support staff of that trust and ensure that there are good outcomes for patients. On behalf of all members of the Health team, I commend my hon. Friend the Member for Stafford for his work as a strong advocate of the needs of local patients, and I look forward to meeting him tomorrow.
My hon. Friend the Member for Pendle (Andrew Stephenson) rightly raised the issue of paramedic prescribing. He talked about the need for more flexibility in urgent and emergency care services, on the basis that it is better to have prevention than cure. We know that paramedics do a great job every day of looking after people and providing essential care on the spot and in the ambulance that saves lives before people get to hospital. The more we can do to support paramedics in providing preventive care in the community, the better for patients.
As well as allowing flexibility in urgent care services, paramedic prescribing would allow eligible paramedics to deliver more treatment in the home and the community where appropriate. That should prevent hospital admissions and reduce demand on the system. At the moment, paramedics can administer a range of medicines, but they cannot write prescriptions for patients. A new system of paramedic prescribing should benefit both patients and the NHS. Due to resource and capacity issues it has not been possible to take forward that work yet, but it will be considered within the new architecture of the NHS Commissioning Board along with other work programmes on resources and capacity. I shall certainly raise the matter, and the good points that my hon. Friend made, with ministerial colleagues.
My hon. Friend the Member for Mid Derbyshire (Pauline Latham) talked about diabetes care, particularly for type 1 diabetes. It is commendable that a lot of her focus was on younger people with diabetes. The number of patients with type 1 diabetes and known to be on insulin pumps has increased. At the moment, at least 3,700 children and more than 10,000 adults are on insulin pumps, and they are particularly important for younger people who may find it more difficult to control their diabetes. However, they are important for all people who have difficulty with their insulin and their diabetes control.
We want people to lead more independent lives, and we want to support people with long-term conditions to enjoy the same life as anybody else, so it is right that we do more to support people with type 1 diabetes. Those with difficult diabetes control have to be mindful of their disease on a daily basis, and if we can do more to ensure that their diabetes is not a factor in how they live their lives, that has to be a good thing.
The NHS operating framework for 2011-12 highlights the need to do more to make insulin pumps available. The NHS Diabetes insulin pump network is promoting good practice, but as we have discussed, pump therapy is not suitable for everybody. We are waiting for the conclusion of the first ever national insulin pump audit early next year, which will give us a clearer picture of the number of pumps provided and the services that are available. Importantly, it will also include the first investigation of how services are provided compared with the guidance issued by NICE in 2008 and updated in 2011, which my hon. Friend outlined.
My hon. Friend also raised the issue of artificial pancreases. There is small-scale use of them in children, but the clinical trials are not yet conclusive as to their effectiveness and ease of use and there are currently no NICE guidelines on the subject. We need to use the commissioning process to address the disparities in NHS care and better reflect good medical practice, and nowhere is that more true than in diabetes care. We need to ensure that where there are NICE guidelines on good practice, that practice is carried out.
Finally, I wish to reflect on service reconfiguration and social care, which my hon. Friends the Members for Pudsey and for Milton Keynes South raised. Social care reform is important, and we need an integrated approach to health and social care. We must ensure that we reflect the health care needs of local populations and do more to support people with long-term conditions. That is a key driving force behind the vision for the NHS that my right hon. Friend the Leader of the House outlined in 2010 when he was Secretary of State for Health. It drives what should happen, and what does happen, at local level every day as doctors and nurses look after their patients.
Decisions about integration and what it means to have good joined-up care, particularly for older people and those with diabetes, chronic obstructive pulmonary disease, asthma, dementia and other long-term conditions, need to be made at local level, drawing on the best of local health care provision. The Government will ensure that the NHS Commissioning Board’s mandate includes guidance on what is good commissioning. I am sure that from 2013, when the Government’s reforms have gone through and we have an NHS that is truly locally led, there will be properly joined-up and integrated care that better looks after people with long-term conditions, focuses on prevention rather than cure and particularly focuses on looking after older people better.
Nursery Milk
Dan Poulter Excerpts(12 years, 2 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
The Government’s consultation on the “Next Steps for Nursery Milk” is currently under way. We have received a large number of responses from a range of organisations including child care settings, specialist milk suppliers, and milk industry.
Due to the summer break, we have been asked to provide extra time to schools and nurseries to respond to the consultation. The Government are therefore extending the consultation period for an extra six weeks, to ensure that anyone who wants to contribute can do so. The new closing date of the consultation is Tuesday 23 October 2012.
The Government are committed to continuing the nursery milk scheme. Through this consultation, we are exploring three different options for improving the operation of the scheme.
We will publish a formal response to the consultation on the future operation of the nursery milk scheme taking full account of all the consultation responses.
“Next Steps for Nursery Milk” has already been placed in the Library.
National Health Service
Dan Poulter Excerpts(12 years, 4 months ago)
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Andrew Gwynne
We set out the Nicholson challenge, but I notice that the hon. Gentleman does not defend the decisions being taken by his Government to restrict or stop these treatments.
It is becoming increasingly clear that there is a gap between Ministers’ statements on the NHS and people’s real experience of it on the ground. In opening, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) incorrectly said that GP referrals have gone down. Figures published by the Department of Health on 13 July 2012 show that GP referrals are up by 1.9% year on year. Those are statistics from the Minister’s own Department’s. He is out of touch. Furthermore, the Minister said that NHS Hull is not restricting procedures on ganglia, but a freedom of information request we received says:
“NHS Hull will not routinely commission excision of ganglia”.
That was in April 2012, and it is a fact, again showing that Ministers are out of touch. The Secretary of State claimed that there is no such evidence of treatments being restricted or decommissioned.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
Will the hon. Gentleman give way?
Andrew Gwynne
I will not, as I do not have time now.
In the Secretary of State’s annual report to Parliament, he dismissed restrictions on bariatric surgery as “meaningless” and continued to say:
“Time and again, he says”—
that is my right hon. Friend the Member for Leigh (Andy Burnham)—
‘“Oh, they are rationing.’ They are not”.—[Official Report, 4 July 2012; Vol. 547, c. 923.]
But Opposition Members all know the truth. Aside from the evidence presented by the Labour party and the GP magazine, verified by Full Fact, primary care trusts acknowledge that they are restricting access to bariatric surgery. The National Institute for Health and Clinical Excellence recommends surgery for anyone with a body mass index of 40 or a BMI of 35 and co-morbidity. Many PCTs, including NHS Stockport in my own constituency of Denton and Reddish, impose additional restrictions.
Recent freedom of information requests of PCTs and shadow clinical commissioning groups across England have revealed that 149 separate treatments, previously provided for free by the NHS, have been either restricted or stopped altogether in the last two years, with 41 of those being entirely stopped in some parts of the country. This provides the clearest evidence yet of random rationing across the NHS and of an accelerating postcode lottery, which appears to be part of a co-ordinated drive to shrink the level of NHS free provision. From our study, it is clear that many patients are facing difficulties in accessing routine treatments that were previously readily available, and there is evidence that some patients are being forced to consider private services in areas where the NHS has entirely stopped providing the treatment.
Of course, there has been a real reduction in the number of nurses working in the NHS. The Government have claimed that there are only 450 fewer nurses, and at Health questions last month, the Minister, the right hon. Member for Chelmsford said that the figure was “nowhere near 4,000”. But now we all know the truth: figures for the NHS work force in March 2012 showed clearly that there are 3,904 fewer nurses than in May 2010. We have seen broken promise after broken promise, including on reconfigurations.
It was this Government who, when in opposition, spent millions of pounds during the general election putting up posters throughout the country reassuring the electorate that under the Conservatives there would be a moratorium on hospital and A and E closures. Indeed, in opposition, they pledged to overturn some very difficult reconfiguration decisions taken by the previous Labour Government. Yet, as we have seen, the moratorium has not materialised, and there is now evidence of major changes to hospital services across the country.
It is worth remembering that the Prime Minister gave a firm pledge not to close services at Chase Farm hospital, but in September 2011, this Secretary of State accepted the recommendations and approved the downgrading and closure of services at Chase Farm. And there are several others, such as the Hartlepool, the King George hospital in Ilford, the East London, the Trafford General, the North London, the St Cross in Rugby and, as we have heard today, the West London, too, that have either closed or are set to close. What is becoming clear is that when it comes to reconfiguration, Ministers are hiding behind their new localism and are happy to blame the soon-to-be-abolished structures for the forthcoming closures.
In the brief time remaining, I want to deal with Government spending on the health service. As we have learned, actual Government spending on the NHS in 2011-12 fell by £26 million.
Adult Social Care
Dan Poulter Excerpts(12 years, 4 months ago)
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Liz Kendall
We remain serious about trying to achieve cross-party consensus. If one party comes forward on its own and proposes a controversial and difficult decision, that always leads to a political fight; we saw that only too clearly before the last general election. However, we need cross-party consensus because this is a long-term challenge. We have to try to get agreement so that, whichever party is in power, people know there is a system that they can understand and pay for in future.
Government Members have criticised Labour’s record in government, but we are proud of our achievements on social care. We increased spending by 53% when we were in government. We helped drive up quality through national performance assessment of local councils and independent inspection of care services. We championed integration, with new legal powers for the NHS and local councils to pool budgets, and new care trusts jointly to commission care. Those care trusts will be swept away under the Health and Social Care Act 2012. We supported carers through the carers grant and new rights for carers. We introduced the first ever national dementia strategy, and we backed improvements in housing through the Supporting People programme and extra care housing. [Interruption.] The hon. Member for Reading East (Mr Wilson) mutters from a sedentary position that that is not real action. He should try telling that to the carers we supported through breaks that are now under threat, and the people who have benefited from extra care housing and the Supporting People programme, which his Government have cut by 12%.
We understood that we had much further to go, however. That is why before the last general election we published plans for fundamental reform, including difficult decisions on how care should be funded. We tried to get cross-party agreement. We did not succeed, but we are determined to try again now.
A year ago, my right hon. Friend the Leader of the Opposition made an open and sincere offer of cross-party talks, and it is a matter of genuine regret that the Government unilaterally decided to publish their own progress report on funding, rather than the joint report we had wanted to agree. Labour remains committed to serious and meaningful cross-party talks.
I hope that the Minister will tell the House whether the Government will commit to addressing the current funding gap as well as future reform. Andrew Dilnot says that that is vital. Will they also set a clear timetable for reform, with legislation on funding reform in this Parliament, as Labour has called for? Will they agree to include their Treasury team in the talks, which Labour has offered from the start?
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
One of the authors of the Dilnot report was Lord Warner, who was a member of the previous Labour Government. He made the point that one of the reasons for the funding crisis is that the previous Government failed to invest adequately in social care; it received only 70% of the funding compared with the NHS. That was one of the major failings of the previous Government. They should have invested more in social care when the sun was shining and the country had the finances to do that.
Liz Kendall
I politely say to the hon. Gentleman that we did not cut local council budgets by a third. I have always said that social care budgets have been under increasing pressure for many years, which is why we desperately need funding reform. I know that he supports that reform and will work with us in the years ahead.
The Government’s decision to kick the issue of long-term care funding into the long grass is a bitter blow for older and disabled people and their families. It is a huge disappointment for local councils, which are desperate for a new social care settlement, and it is a disaster for our NHS, which will face intolerable pressure as our care system crumbles further still. This issue will not go away, because our population is ageing. Our care system needs fundamental reform—reform this Government have so far failed to deliver. I commend the motion to the House.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
It is a great pleasure to follow the hon. Member for Luton North (Kelvin Hopkins). I commend him for his ability to get Europe into almost every debate we have in this House. I am not sure whether his sums quite added up at the end of his speech, but it is commendable that we have seen a commitment across the House this evening to improving the dignity and quality of elderly care, which is something I am sure we would all like to see.
All previous Governments have taken steps in that direction, but I believe that the White Paper and the draft Bill that this Government have brought forward represent the most significant steps towards improving dignity in elderly care for a generation. The “in-principle” support for Dilnot and the Dilnot proposals is a good recommendation, and it needs to be considered in the context of whole-government spending at the next spending review. However, for the first time there has been an in-principle agreement by a Government that social care is one of the most important issues and challenges facing our country. How we are going to provide dignity in elderly care—high-quality care in the community—is a clear priority for this Government, and that should be commended.
I want to outline some of the real challenges that face people who are in receipt of social care, particularly the frail elderly. The hon. Member for Blaydon (Mr Anderson) pointed out that it can be difficult to distinguish between NHS care and social care, because they often involve exactly the same things. They include supporting the activities of daily life that we all take for granted, such as washing, dressing, getting in and out of bed or the bath and going up and down stairs. Those are the kinds of things that we mean when we talk about providing high-quality social care, and this Government have put forward strong measures that will make it much easier to provide such care for the people who most need it.
The White Paper and the draft Bill provide for support for carers, and for improving the personalisation of care, which is particularly important for younger people in receipt of social care, as the hon. Member for Scunthorpe (Nic Dakin) said. Respite care is also recognised as an important means of better supporting carers, giving them a break from the hard work of looking after people and ensuring that the role of carers is properly supported. The proposals also include a commitment to portability of care, and to a universal care assessment.
Glyn Davies (Montgomeryshire) (Con)
I raised the issue of portability with the Secretary of State last week. It is crucial that a debate should take place about what we are doing here and what is happening in Wales, as this is a devolved matter. There must be close liaison between us. I understand that the initiative must come from the Welsh Government but, without that liaison, people will fall between the two countries.
Dr Poulter
My hon. Friend makes an important point. Social care and NHS care do not recognise county borders, which is why portability is so important. They certainly do not recognise the boundaries between England and Wales or between any other parts of the United Kingdom. We have devolved responsibility for the NHS, and the fact that there are different funding priorities in the different parts of the UK, with the Government in England supporting investment in the NHS and the Labour Administration in Wales cutting NHS spending, highlights the importance of my hon. Friend’s point. I am sure that the Minister will be able to reassure us that the coalition Government are taking steps to ensure that portability can take place across those borders wherever possible.
The White Paper also contains a commendable commitment to improving integrated care and ensuring that more joined-up working takes place between the NHS and social care.
Sarah Newton
Would my hon. Friend like to comment on some of the Opposition’s assertions that the efficiency savings from reductions in management levels in NHS are not being put back into front-line services to enable integration, and that they are somehow being siphoned off to the Treasury? I do not believe that—
Dr Poulter
I thank my hon. Friend for her intervention, and I agree with her. The Government are making a clear commitment to encouraging integrated care and to putting savings made in the back office back into the front line of NHS care. Many billions of pounds have already been committed, and there is more money in the draft Bill to encourage better integration between the NHS and social care services.
As the Minister of State said, it is important to shift the emphasis away from crisis management and towards preventive care. The focus on housing as part of the integrated care system is important. My hon. Friend the Member for Congleton (Fiona Bruce) made the point that, far too often, older people fall over and injure themselves as a result of poor lighting or a lack of handrails in their homes, ending up in the accident and emergency department, when better lighting and preventive care in the home would have provided a much more effective way of looking after them properly, as well as saving the NHS and social care a lot of money. That key commitment to more integration between the NHS, providers of housing and social services providers is a fundamental ingredient of the way in which we can improve the day-to-day quality of adult social care, while also saving a great deal of money, which can be spent on improving care for everyone else.
Finally, let me talk a little about funding. The Dilnot proposals have been agreed to in principle, and I hope that the Opposition will at least give the Government some credit for the fact that there has been a once-in-a-generation attempt to deal with this issue. It is not good enough to say, 13 years into an Administration, “Three weeks before the general election, we will publish a White Paper.” No one could consider that a serious commitment to tackling the challenges that we face.
The way forward now must be the cross-party working that we all believe is desirable. That means that all parties must work together and support the Government’s White Paper, support day-to-day improvements in care for older people, and support the agreement in principle to the Dilnot proposals that the Government have presented.
Care and Support
Dan Poulter Excerpts(12 years, 4 months ago)
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Mr Lansley
I am not attempting to hoodwink anybody. I have made the point very clearly that in this financial year the Association of Directors of Adult Social Services is making total savings of £891 million, of which only 13%, some £113 million, is being achieved through reductions in services. We are investing in and supporting such services. In 2012-13, £930 million of extra funding will go to local authorities through formula grant to support social care. The NHS is transferring £622 million and we are doubling last year’s figure so that £300 million will be available through the NHS for re-ablement. Those are major additions to the support for care.
On the other point that the hon. Gentleman made, even the right hon. Member for Leigh did not try to return to the debate that we had before the election, and rightly so. The right hon. Gentleman eschewed party political point scoring; the hon. Member for Easington (Grahame M. Morris) did not. I think he should have done.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
I warmly welcome the statement. There is clear commitment in a number of good areas, including improving the portability of services, providing greater support for carers, improving respite care and having more joined-up working between the NHS and adult social services, which will save social services and the NHS money, and improve the care that is delivered to patients. Does the Secretary of State agree that when local government commissions services, it should do so with a view to improving the quality of care and moving away from the care-by-the-minute mentality to which many local care providers seem to adhere?
Mr Lansley
My hon. Friend is absolutely right in all respects. I know that local government will welcome the philosophy of commissioning for quality, rather than commissioning simply on the basis of watching the clock. That will also be welcomed by older people who are in receipt of care.