Southern Health NHS Foundation Trust

Dan Poulter Excerpts

Wednesday 8th June 2016 Westminster Hall

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate my hon. Friend on securing this debate, and on her articulate explanation of the issues involved and the tragedies that have befallen a number of patients.

Clearly there has been a failing of clinical governance in the trust on a massive scale. However, I wonder whether my hon. Friend will reflect on two points. First, it is very difficult to deliver improvements in quality in a resource-poor environment, notwithstanding the clinical governance issues, and we know that child and adolescent mental health services and learning disability services have been chronically underfunded for many years nationally.

Secondly, people with learning disabilities often have complex physical healthcare needs as well as mental healthcare needs, and improved staff training needs to be put in place nationally. That needs to be properly resourced and funded if we are to make a meaningful difference and get things right for people in the future.

[Suella Fernandes]

I totally agree with my hon. Friend’s observation. There is a challenge here. This is unfamiliar territory for the NHS, and funding will be necessary to support any new attempt to make progress following debates such as this one.

Inspectors from the Care Quality Commission visited Southern Health as part of the planned inspection during January of this year. Following that inspection, the CQC announced on 6 April that it had issued a warning notice to Southern Health, telling the trust that it must make significant improvements to protect patients at risk of harm while in the care of its mental health and learning disability services. The announcement stated that the notice required the trust to improve its governance arrangements to ensure that there was robust investigation and learning from incidents and deaths, to reduce further risks to patients.

The team of inspectors also checked on improvements that had been required in some of the trust’s mental health and learning disability services following previous inspections. They found that the trust had failed to mitigate significant risks posed by some of the physical environments from which it delivered mental health and learning disability services.

On the wider issue of reporting deaths, the inspectors found that the trust did not operate effective governance arrangements to ensure robust investigation of incidents, including deaths; did not adequately ensure that it learned from incidents, so as to reduce future risk to patients; and did not effectively respond to concerns about safety that had been raised by patients, their carers and staff, or to concerns raised by trust staff about their ability to carry out their roles effectively.

All those findings, and the serious step of issuing a warning notice, reinforce the most serious of the Mazars findings. Dr Paul Lelliott, the CQC’s deputy chief inspector of hospitals and lead for mental health, was quoted as saying that the services provided by Southern Health required “significant improvement”. He said:

“We found longstanding risks to patients, arising from the physical environment, that had not been dealt with effectively. The Trust’s internal governance arrangements to learn from serious incidents or investigations were not good enough, meaning that opportunities to minimise further risks to patients were lost.

It is only now, following our latest inspection and in response to the warning notice, that the Trust has taken action and has identified further action that it will take to improve safety at Kingsley ward, Melbury Lodge in Hampshire and Evenlode in Oxfordshire. The Trust must also continue to make improvements to its governance arrangements for reporting, monitoring, investigating and learning from incidents and deaths. CQC will be monitoring this Trust very closely and will return to check on improvements and progress in the near future.”

The CQC published the full report of its January 2016 inspection at the end of April 2016. It confirmed the concerns that had been raised in the warning notice and gave further details of specific issues. The chairman of Southern Health’s board, Mike Petter, resigned the day before the report was published.

On the same day that the CQC published its warning notice, NHS Improvement issued a statement announcing that it was seeking further powers to intervene in the trust’s governance, to ensure that the trust complies with the improvements required of it. NHS Improvement said that it intended to insert an additional condition into the trust’s licence to supply NHS services, which would allow NHS Improvement to make management changes at the trust if progress was not made on addressing the concerns that had been raised.

The additional condition was imposed on 14 April, and the statutory notice contained severe criticism of the trust and its leadership. It stated that undertakings that the trust gave in April 2014 that it would comply with enforcement notices relating to breaches of its governance conditions were yet to be delivered in full. It notes that additional undertakings were made by the trust in January 2016 in response to the Mazars report and summarises the CQC’s findings from its inspection in January, saying that the warning notice had identified “longstanding risks to patients” that had not been addressed. It then said:

“In the light of these matters, and the other available evidence, Monitor”—

that is, NHS Improvement—

“is satisfied that the Board is failing to secure compliance with the Licensee’s licence conditions and failing properly to take steps to reduce the risk of non-compliance. In those circumstances, Monitor is satisfied that the governance of the Licensee is such that the Licensee is failing and will fail to comply with the conditions of its licence.”

On that basis, NHS Improvement, or Monitor, has imposed a new condition to Southern Health’s licence, requiring that it

“has in place sufficient and effective board, management and clinical leadership capacity and capability, as well as appropriate governance systems and processes, to enable it to”

address the failures in governance

“and comply with any enforcement undertakings, or discretionary requirements, imposed by Monitor in relation to these issues.”

Mental Health Taskforce Report

Dan Poulter Excerpts

Wednesday 13th April 2016 Westminster Hall

[James Morris]

My hon. Friend makes a very important point. He is right, and I will come to the need for greater accountability later in my speech.

On commissioning, the “Five Year Forward View” report states:

“The transformation we envisage will take a number of years and without clear information about what the best care pathways look like and good data on current levels of spending, access, quality and outcomes, it will be hard to assess the impact of organisational change and ensure mental health services are not disadvantaged.”

Its very first recommendation is:

“NHS England should continue to work with Health Education England…Public Health England…Government and other key partners to resource and implement Future in Mind, building on the 2015/16 Local Transformation Plans”—

which I know are in the process of being implemented—

“and going further to drive system-wide transformation of the local offer to children and young people so that we secure measurable improvements in their mental health within the next four years.”

I dwell on those recommendations because—this speaks to my hon. Friend’s point—we need more transparency on what clinical commissioning groups are spending and where. The report is clear that there is currently simply too much variability across the country. I have long been an advocate of the importance of local, decentralised decision making. It is important that clinical commissioning groups have the freedom to commission services that they think are appropriate to their local population. The report is clear that we need a more consistent approach on mental health services that focuses on collaboration and more integrated commissioning across the spectrum.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

Will my hon. Friend reflect, in the context of the devolved settlement for services, on the importance of substance misuse services and on the impact that the fragmentation of those services away from other mental health services may have had on patient care?

[James Morris]

My hon. Friend makes a powerful point. We need to deal with some of the issues to do with fragmentation in the system—he refers to substance misuse. The thrust of the recommendations in the report is about making sure we have a more integrated approach to commissioning mental health services across the piece.

The second important facet of the implementation challenges that the report throws up is research into mental health services. It mentions the need to have a proper, coherent 10-year plan for research into mental health to fill what are, as many of us would agree, big gaps in the evidence base.

--- Later in debate ---

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

It is a pleasure to serve under your chairmanship, Mr Wilson, and to speak in the debate. I pay tribute to my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) for bringing the debate, for his continued advocacy of the needs of mental health patients and for pushing continually during his time in the House on an important issue in ensuring that we hold our Government and NHS providers to account, so that genuine parity of esteem is delivered for mental health patients.

In the brief time available, I want to talk about a few points raised in the mental health taskforce’s good report, focusing on the need for more holistic care and joining up physical and mental healthcare for people with mental illness. I want to talk about access to care, recognising that some people struggle to access physical healthcare owing to their ethnicity or because English is not their first language. Such problems are compounded for those who have mental illness. I will also focus on some of the challenges in joining up what is a very fragmented health and care system, particularly for people with complex and enduring mental illness.

On holistic care, we know that somebody who is mentally unwell and has a chronic and enduring or severe and enduring mental illness can live a life up to 20 years shorter than somebody without that mental illness. That fact alone makes the point that we need to join up physical and mental healthcare better. My hon. Friend talked about a patient with diabetes. Such a patient may well develop diabetes because they are mentally unwell and do not have the right physical healthcare and support, or they may develop it as a side effect of some of the medication they are taking. We know that antipsychotic medications, for example, are linked with high cholesterol and developing diabetes.

We need to do much more to join up physical and mental healthcare. It is quite frankly scandalous and wrong that someone who is mentally unwell has a 20-year shorter life expectancy than someone who does not have that condition. That is something we must focus on and get right. We need to improve the physical and mental healthcare services for those with chronic and enduring mental illness.

We talked a little about the commissioning opportunities in that, and we must recognise that, at a local level, despite the Government’s best intentions, commissioners do not often put additional money into mental health services. Certainly in Suffolk, which I represent, the NHS funding increases—small though they may be—went largely to physical health and local CCGs failed to increase the money going to mental health conditions adequately.

The question is: how do we improve holistic care and join up physical and mental healthcare for those with long-term mental illness? We can and must learn lessons from the care in the community programme in the 1980s. The purpose of the programme—to deliver more care in the community and move away from the old asylums—was right, but the programme was not properly resourced. We must face up to that. Also, a lot of the money freed up by that was swallowed up by the physical healthcare sector and did not go into mental healthcare in the community. If we are talking about putting all the money for physical and mental healthcare in one place, we have to be careful that, by doing what sounds like a good thing, we do not effectively end up propping up the acute provider sector, which already consumes 55% of the NHS budget—that figure has risen over the last five years, as the Minister will be aware—and inadvertently further disadvantage mental healthcare, which receives only around 10% of NHS funding.

It may be appropriate—the report touches upon the importance of this—to improve liaison services on both sides of the divide between physical and mental healthcare. We could improve psychiatric liaison services for people with complex physical healthcare problems or enduring physical illnesses and, for people with long-term and enduring mental illness, we could improve medical liaison services in hospitals and properly involve and support physical healthcare in the community through GPs. I will not expand on that, as I do not have very long, but I would be grateful if the Minister responded to that point.

On access to services, we have to recognise that there is a fragmented care environment, in particular for people with chronic and enduring mental illness. Addressing that is not just about providing money for the health service, but about having appropriate housing—we know there is a shortage of appropriate housing to look after people with mental ill health in areas such as London—and dealing with the challenges in delivering proper social services care for such people. We also have to recognise that the state is often the only mechanism of support for such people. The only people caring for some of the poorest and most disadvantaged people in our society—people with long-term mental illness—work for the state; they are NHS and council workers. Unless we properly value and recognise their roles and properly fund—and increase funding—in a holistic, meaningful and long-term way, we will be unable to deliver the care that we need. There needs to be more money, more key workers and joined-up physical and mental healthcare. I endorse a lot of what the report says and I look forward to hearing the Minister’s response.

Gay Conversion Therapies

Dan Poulter Excerpts

Tuesday 3rd November 2015 Westminster Hall

[Jane Ellison]

The hon. Gentleman will see, when I propose some next steps, that I might be able to respond to his point.

Simon Stevens went on to say that he would direct NHS England to make that position—that the NHS should never fund such therapy—clear and explicit in all public statements on the issue in future. I cannot be clearer than that. If Members have examples of the NHS funding such therapy, I would be particularly interested to know about them.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

rose—

[Jane Ellison]

I will, of course, give way to my former colleague.

[Dr Poulter]

I pay tribute to my hon. Friend the Member for Finchley and Golders Green (Mike Freer) for securing the debate and to my hon. Friend the Minister for the work she does to raise awareness of the LGBT community’s needs. It is, of course, unacceptable for the NHS to sponsor these therapies. All registered medical professionals can be disciplined by their professional bodies, whether that is the Royal College of Psychiatrists or the GMC taking action against doctors in these cases for discriminating against certain patients. Is the real issue not, however, that the regulation is not there for some therapists? This is the issue that needs to be looked into: do we need to regulate more effectively some of the therapists in this field?

[Jane Ellison]

My hon. Friend speaks from a position of great knowledge. I am well aware of the challenges to the current position, which I will outline, from hon. Friends and other Members. I will try to respond to those.

I want to make this point, for the record: we are not saying that lesbians, gay men and bisexual people should not seek counselling or therapy if they are distressed about a particular aspect of their sexuality. It is important we recognise that family arguments over sexuality or hostility from other people might well be a reason for someone to seek support for that aspect of their life. That is obviously a core part of what many therapists do, so I want to be clear that there is a place for that in supporting people appropriately.

Maternity Units: Bereavement Care

Dan Poulter Excerpts

Monday 2nd November 2015 Commons Chamber

[Will Quince]

The hon. Gentleman makes a good point, and I thank him for his intervention. The chaplain at the hospital certainly gave us a huge amount of solace. They provide a really important service.

For my wife and I, our care was absolutely fantastic. I cannot praise highly enough the staff at Colchester general hospital who cared for us when we needed it most. The very positive experience that my wife and I had at Colchester represents the model I would like to see rolled out across the country. As the chance of our son being born alive was poor, we were booked into the Rosemary suite, a specialist bereavement suite at the hospital. Crucially, it was far enough away from the hustle and bustle of the maternity unit, with a room that the dad can also stay in and a lounge and kitchenette. It is as near as you can get to a home from home.

The suite gave me and my wife the chance mentally to prepare for what was to come. Importantly, it was away from the noise of crying babies and happy parents and families. It was a place to prepare but also a place to grieve in private, and somewhere that we could be with our son. Importantly, the Rosemary suite also had a cool cot, which is a piece of medical equipment that acts like a refrigerated cradle, so that babies who have died do not need to be taken straight to the mortuary. That means that parents and family members can spend as much time as they want with their baby. Sister Liz Barnes, the gynaecology nurse counsellor, gave us a huge amount of emotional support, both before and after the event. I cannot tell you what a comfort it was to have Liz with us, speaking to us and guiding us through the next steps and, of course, the funeral arrangements.

Having gone through that experience, I had assumed that every maternity unit in this country had a bereavement suite, but sadly that is far from the truth. I have heard shocking stories of a lack of compassion and care shown to parents of stillborn babies in maternity units. An article published in BMJ Open in 2013 on bereaved parents’ experience of stillbirth highlighted some of the problems in care for parents in some of our hospitals. The report carried interviews with bereaved parents and contained some very distressing responses. One mother said:

“They only left him with me for about an hour. Then they just took him away. I was begging them not to take my baby”.

Others talked of a poor experience with hospital staff. One said:

“I thought these people”—

midwives and doctors—

“knew what they were doing. I wish I hadn’t thought that now.”

Another claimed:

“The delivery was just awful from start to finish. They almost treated me like ‘the woman with the dead baby’. There was no sympathy. When I asked to see a doctor, this particular doctor came in and said, ‘We’re very busy.’ And his exact words, I’ll never forget them, “Well, with all due respect, your baby’s dead already’. Which was just the most awful thing you could say.”

Some highlighted a distressing rush to decision making. One mother said:

“I wish someone had said to me in those first few hours, ‘Even if you don’t want to see her now, you can see her in an hour or two. Or in a day or so’. I was left to believe that because I wasn’t ready to see her, that was final.”

Some of these examples are really hard to listen to, but there are also some very encouraging stories within the report. Some mothers spoke of the “very, very caring staff”. Another very movingly said:

“Even though she wasn’t breathing and she didn’t open her eyes, she”—

the midwife—

“still said you’ve got a beautiful baby girl. It just meant the world.”

I will remember until the day I die the midwife who helped me dress our son after he had sadly passed away, and she said, “You have a beautiful baby”. I will never forget that.

The report concludes that in these tragic situations, clinicians and hospital staff

“only have one chance to get it right”.

It also stated that the experience of stillbirth can be influenced as much by staff attitude and caring behaviours as by high-quality clinical procedures. Last month, a study said that the UK provides the best end-of life care in the world, but if we want to maintain this level, we should not forget end-of-life care for stillborn babies and those with very short lives. The impact of stillbirth and post-natal death on parents should not be understated.

As it stands, maternity bereavement care in English hospitals is patchy. A major survey by the bereavement charity, Sands, from 2010 highlighted that nearly half of the maternity units in England did not have a dedicated room on the labour ward for mothers whose baby has died. That is important because these rooms are where they cannot hear other babies, jubilant parents and visiting families. It is absolutely vital that more hospitals recognise the importance of bereavement suites and their role in easing the pain and loss of bereaved families. These bereavement suites should be separate from the main maternity unit.

Even though I was absolutely aware of the likely outcome when I entered the Rosemary suite in October last year, nothing can prepare you for the shock and the numbness that comes from seeing your wife give birth to a lifeless baby. The precious hours we spent in what I can describe only as beautiful silence afterwards helped me and my wife come to terms with what had just happened. No parent should have to face being taken to a room in a maternity ward of crying babies when you have just gone through a stillbirth.

Many charities, such as Sands, Cruse and The Compassionate Friends do a fantastic job in raising awareness of the support that should be provided to bereaved parents. Many of the bereavement suites in hospitals are actually partially funded and provided by the fantastic work of these charities. I know many bereaved parents, us included, raise money after their loss, knowing how valuable these suites are. I know there has been some progress made in this area. In 2013-14, the Government invested £35 million in new maternity equipment and facilities. That helped to fund nearly 20 new bereavement suites and areas to support bereaved families. There is also a growing recognition of the role of bereavement-trained midwives, and that is really important in helping bereaved families after stillbirth or infant death. In February 2014, the NHS published a report on the support available for loss in early and late pregnancy, which stated:

“There needs to be better recognition of the bereavement midwife role. Generally, these roles are not part of the original establishment. Trusts are beginning to recognise the value in having these specialised posts and they are becoming more commonplace.”

It is great to see trusts increasingly recognise the fantastic work that these specialist bereavement suites and the staff can play in these tragic circumstances. I know that my family were very grateful for the fantastic support that we received.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

I thank my hon. Friend for making a very important and powerful speech, drawing on his own tragic experiences. I have seen such experiences in my own clinical work far too often. Does he agree that whereas we normally leave commissioning to the discretion of local commissioners, we should be pushing in the next mandate to NHS England for there to be standard commissioning for all clinical commissioning groups to ensure that all birthing units have appropriate bereavement space and facilities to look after women who have had a miscarriage or had a stillbirth?

[Will Quince]

I thank my hon. Friend for that. I could not have put it better myself. I recognise the work that he did when he was a Minister in this area, and the huge part that he played in that £35 million investment.



I wish to see the Department of Health do three things to improve maternity bereavement care in England: first, to carry out a full assessment of the state of maternity bereavement provision in England, including on the number of maternity bereavement suites in each of our maternity units; secondly, to work with NHS England and local clinical commissioning groups to raise awareness of maternity bereavement care; and, thirdly, to consider introducing guidelines that each maternity unit should have a specific maternity bereavement suite for families.

I hope that I have been able to do this matter justice in such a short period of time. Great quality maternity bereavement care had such a positive effect on my family and me. I want the great care that we received to be extended to many other bereaved families across our country. Ernest Hemingway is attributed with saying:

“For sale: baby shoes never worn”

Those words encapsulate in a brutally concise way the sadness of losing a child.

The NHS cannot take away the loss or the grief, but we can make sure that every parent has the time, space and environment in which to grieve in peace.

Cities and Local Government Devolution [Lords] Bill

Dan Poulter Excerpts

Wednesday 21st October 2015 Commons Chamber

[Karin Smyth]

I welcome the devolution of some health and care services to local areas. My hon. Friend the Member for Denton and Reddish (Andrew Gwynne) recalled our manifesto pledges for the “what” and the “how”, and I have a lot of concerns about the structural changes that might come as a result of all this. As has been mentioned, Bristol, an area of nearly half a million people surrounded by more rural areas, has two major acute hospitals, both of which offer a range of services, including highly specialised ones. I would like the Minister to say something on the issue of specialised commissioning. Patients are drawn from across the south-west; one hospital draws half its patients from Bristol and the other half from neighbouring South Gloucestershire. Two different clinical commissioning groups are involved, and a plethora of different organisations are involved in both the commissioning and the provision of services. In an earlier exchange on this type of devolution, the Minister sometimes talked about the provision of services and sometimes about the commissioning of services. It would be helpful to understand the devolution aspects: are we talking about provision in the new marketplace or about commissioning, and how will we bring those two things together? That is problematic for us in Bristol.

I am a former board member of a primary care trust and I spent many happy hours discussing the correct configuration of primary care and CCGs in Bristol—whether it should be a stand-alone Bristol or not. We started off with Bristol divided into two and we then talked about doughnuts. The Minister missed an earlier discussion involving the hon. Member for North East Somerset (Mr Rees-Mogg), who wanted to make sure that Bristol stayed Bristol and did not include other areas. [Interruption.] That was a shame, because it is always a joy. We never quite resolved that issue, and similar issues are applicable to many other cities and city regions. I fear that the approach being taken could make an already difficult situation for Bristol much more difficult.

The Minister and I were both at the King’s Fund discussion last week about devolution and health, and I think it was people from Manchester who talked about the fact that they had to bring 38 different organisations around the table to talk about some of these matters. My concerns relate to further structural reorganisation. Given the organisations involved and given the situation in Bristol, I wonder how I, as a patient on my pathway from prevention through primary care to community services, hospital care and possibly specialised services, would understand who is really accountable for that pathway. As we know, we can map a pathway but people do not always map closely to that. In general, I welcome this move, but of course we have concerns about financial stability, particularly of those hospitals and of wider community services. At last week’s King’s Fund event, as was quietly pointed out, we do not want a situation where money is moved from GP services into fixing potholes. We need to be very concerned about such things.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

It is a pleasure to serve under your chairmanship, Mrs Main. I rise to make a few brief remarks in support of this clause and the Government amendments. Clearly, the direction of travel that is outlined is desirable in health and care terms. The amendments will put in place clear safeguards to deal with national regulatory structures, which are there to protect patients and to ensure that the quality of care is universally high throughout the whole country.

The importance of devolving health and care at a local level is something that we have often talked about in this place, but we have sometimes struggled to find the legislative mechanisms to make it happen. These powers will be a desirable step forward in encouraging a more integrated model of health and care. We often talk about how we can move the focus in many parts of our health service towards delivering more services in the community and a more preventative approach to healthcare. Clearly, this Bill is a big step in that direction.

By 2018, we know that there will be 3 million people with three or more long-term health conditions. Many of those people will require support not just from the health service, but from adult social care services, local voluntary and charitable organisations and, in the case of some people with special educational needs, education services. It is vital that we properly link and join up the services that are in place to support these people. Personalised care and mechanisms of support are often found at a local level, which is exactly what this devolution is about.

Other measures have been put in place to integrate better adult health and social care, including the better care fund, which was part of the Care Act 2104. The coalition Government also introduced some strong measures to improve the provision for children with special educational needs. But these measures go further and allow more bespoke and personalised local solutions to be put in place to support people with more complex care needs. Importantly, they also recognise that parts of the country are different in terms of not just their geography, but their cultural make up and their demographics. That is particularly important when we talk about devolving health and care. We know that some city areas have high black and minority ethnic populations with specific healthcare needs. These measures will put us in a much better place to help such areas support those communities, as well as more rural areas, in dealing with the challenges of an ageing population and increasing numbers of people with complex healthcare needs.

This Bill is an important step forward, which builds on many strong measures that have already been put in place over the past few years by both the coalition Government and the previous Labour Government. We all believe in integration and in the need to bring healthcare services closer to the individual and make them more personalised. We know that there is too much duplication in the health service and in adult social care, which costs money. That money should be going to the frontline, but duplication often gets in the way of front-line professionals helping patients. This is a big step forward in allowing local health economies and local areas to put in place the right mechanisms to support the people they look after.

[Liz McInnes (Heywood and Middleton) (Lab)]

First, let me echo the words of the Minister and pay my own tribute to my colleague, Michael Meacher, who sadly died today. I was born and bred in his constituency, so he was my MP for a long number of years. He was greatly respected in the constituency and will be very, very sadly missed.

I wish to start by echoing the words of my hon. Friend the Member for Nottingham North (Mr Allen) who said that we need to get this Bill right. The proposals for health devolution raise a great number of questions, which I hope we will deal with in a constructive manner, as we need positive outcomes. Labour Members are concerned about overlapping areas, coterminosity, and cross-border responsibilities, and they have been highlighted by my hon. Friends the Members for Bassetlaw (John Mann), for Denton and Reddish (Andrew Gwynne), for Hemsworth (Jon Trickett) and for Bristol South (Karin Smyth). We need some clarity about how the devolved responsibilities will work in practice.

Kettering General Hospital

Dan Poulter Excerpts

Tuesday 24th March 2015 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Gray. I congratulate my hon. Friend the Member for Kettering (Mr Hollobone) on securing this debate. I also commend him and our colleagues in the Chamber—my hon. Friend the Member for Wellingborough (Mr Bone) and the hon. Member for Corby (Andy Sawford)—for their consensual and cross-party approach to tackling the challenges of the local health economy and addressing the needs of local patients. It is working together, as a group of MPs, that has helped to deliver success for the local hospital. That cross-party consensus is an example of what should be done. My hon. Friend the Member for Kettering is right that good health care is not political; it is about doing the right thing by patients, and that is the approach that hon. Members here today have taken in addressing local health concerns.

A number of the points raised today are ones we have talked about in meetings at the Department of Health. I have taken a keen interest in supporting Kettering in its future ambitions and in supporting my hon. Friend in his strong advocacy of the needs of local patients and his local hospital. As he rightly outlined, this is a part of the country with a growing population, due to increasing housing growth and the plans to increase housing growth in the future. As in all parts of the country, there is increased pressure on medical services from an ageing population with complex health care needs. By 2018, we will have 3 million patients with not one or two, but three long-term medical conditions—it could be diabetes, dementia, heart disease or chronic obstructive pulmonary disease.

Caring for patients with complex medical needs is a challenge for our whole country, and I know it has been one of the main drivers of increased admissions to A and E in Kettering. The acuity, which is the severity of the illness or medical admission, is a key issue that has been picked up by the A and E consultants and doctors with whom I have discussed the challenges faced locally by the trust. Supporting a better way of caring for people with long-term conditions and the frail elderly is at the heart of the proposals for the care hub that my hon. Friend outlined.

I want to take this opportunity to recognise the outstanding work done by NHS staff up and down the country. On this occasion, it is appropriate to draw attention to NHS staff working in and around Kettering—not only in the hospital, but in general practice, community mental health teams and palliative care teams. The commitment across the board in Kettering to delivering the highest-quality patient care is an example of what the NHS is all about, and it is right to recognise the dedication of front-line staff in the Kettering area.

I want to take the opportunity also to commend formally my hon. Friend for the outstanding interest that he has shown in standing up for the best interests of local patients throughout this Parliament and for his dedication in never missing an opportunity to raise questions in this Chamber and in the main Chamber during Health questions or to raise the case of his constituents in the Department of Health with me as the responsible Minister. It has been a pleasure to do all I can to support him, his constituents and Kettering hospital.

My hon. Friend is right to highlight the recent investment in the hospital. That is due in no small part to his advocacy and that of other hon. Members in consistently raising the needs of Kettering hospital and the local population. My hon. Friend will recall that when we met in January to discuss health services in his constituency and the plans that his local NHS has to deal with some of the pressures that it faces, we talked about some promising ideas. I will discuss those in more detail in a moment.

Before I do so, it would be appropriate to say a few words more generally about the pressures that the health service has faced during a difficult winter, how they have been handled and what we have done to support the health service both in Kettering and more generally. We know that parts of the NHS can and have come under pressure because of unprecedented demand, linked to the challenges of our ageing population. Compared with four years ago, every day the NHS sees 16,000 more hospital out-patients, performs 10,000 more diagnostic tests and carries out 3,500 more operations, and there are 2,000 extra ambulance journeys. Every year, 1.3 million more people visit accident and emergency departments.

Despite the extra demand, our NHS is performing well and treating the vast majority of people quickly. It is particularly important that it is dealing with the most unwell patients first. That is possible because we have taken, even in difficult economic times, the decisions that have allowed us to increase the NHS budget by £12.7 billion over this Parliament. Of course, that has allowed us to support Kettering hospital with local investment, which my hon. Friend outlined.

The NHS is also on track to deliver up to £20 billion in efficiency savings over this five-year period. That challenge was outlined by the former chief executive of the NHS, Sir David Nicholson, in 2009. Even to stand still and even with increased investment going into the NHS, it needed to make greater efficiencies. As a result of reforms and modernisation, we expect to save £4.9 billion over this Parliament and £1.5 billion a year from 2014 onwards. All of that will go directly back into front-line care in Kettering and elsewhere.

[Andy Sawford]

I thank the Minister for generously giving way, especially as the debate was secured by the hon. Member for Kettering. The Minister makes a point about efficiencies, but will he comment on the issue of geography, which we have not really touched on? We have talked about demand, but this is a critical issue for north Northamptonshire. The geography of our area is such that for people to have to rely on a hospital other than Kettering would mean considerable travel time. As someone who represents a rural area, I can say that that is an efficiency that we would not want to make. We would prefer to say, “Look, we want our local hospital. We recognise that there are challenges in sustaining a local hospital, but the geography of our area is such that we want to keep hold of it.”

[Dr Poulter]

The hon. Gentleman makes a very important and valid point. As well as improving the way our NHS buys goods and services—improving procurement practice, an issue that we discussed with members of the local health care team from Kettering when they visited me in the Department of Health—improving estate management and taking other measures of obvious efficiency, there is a need, outlined clearly in NHS England’s “Five Year Forward View”, to radically transform the way we deliver care. My hon. Friend the Member for Kettering made that point. It is now a priority to care better for frail elderly people through better integrating health services. I am talking about using the hospital potentially as a hub for vertical integration of services, particularly in more rural areas. That will mean that other health services—community health services, general practice and mental health services—can be supported and integrated with the hospital service as a hub-and-spoke model of care.

Crucial to that as well is integrating what the social care service does at the same time and having an approach that joins up what health and social care have to offer. Taking advantage of the better care fund that has been set up at local level, so that the local authority can work more collaboratively with the NHS, is very important. It is often very difficult to define where social care ends and health care begins, because staff are dealing with the same person, with the same care needs, but traditionally a silo approach has been taken to the delivery of care. We need to break down institutional silos and deliver more personalised care. That is at the heart of integrating care—at the heart of the hub-and-spoke model built around Kettering hospital. It draws on the importance of joining up what the local authority does with what the NHS does. That is particularly important in more rural areas, such as the one that the hon. Member for Corby represents.

As I said, I have followed developments in Kettering with keen interest. It is worth saying that since October 2012, when Monitor found the trust to be in breach of its licence in relation to consistently poor A and E performance, considerable progress has been made. That is in no small part down to the work of the local NHS and the local health care teams. To date, in 2014-15—I am now bringing the House up to date—the Department has provided £7.4 million of revenue support and £5 million of emergency capital to the trust. Over the winter, the trust fully activated its winter plans, building on initiatives that proved successful in previous years.

That work included an enhanced weekend discharge team, detailed plans allowing escalation when there was a busy period, and appropriate use of short-stay facilities, including an observation unit and ambulatory care unit. Those short term measures are designed to ensure that services continue in times of pressure, but the intention, quite rightly—building on the point about better integrating health and social care and what happens in the community with what happens at the hospital—is to move to a position whereby there is the ability to cope with pressure all year round and not just during the winter. The urgent care hub has that integrated delivery model at its heart.

The hub, as my hon. Friend the Member for Kettering outlined, would incorporate existing A and E services and facilities, but also include, for example, GP services and out-of-hours care, an on-site pharmacy, a minor injuries unit, facilities for social services, facilities for mental health care—that is particularly important and sometimes overlooked, but not in this case—and access to community care services for the frail elderly. Those services would facilitate rapid assessment, diagnosis and treatment by appropriate health and social care professionals. Patients would be streamed into appropriate treatment areas to minimise delays and reduce the need for admissions.

The hub’s location is, I am told, still being finalised, but options include clearing and redeveloping existing areas of the hospital or developing a new build on the site. The local NHS envisages that a capital investment of approximately £30 million, as my hon. Friend outlined, will be required. However, that figure will be subject to further detailed assessment as part of the business planning process.

The principle of the hub is absolutely the right way forward for the local NHS. It is the type of integrated care model that we need elsewhere in the country, particularly where the NHS is servicing a broad population. In this case, it is servicing not just Kettering, but a partially rural county and rural area. This is a model that I am sure hon. Members will continue to support and that I will continue to have a keen interest in supporting. I hope the plans will be successful at making the improvements that patients in my hon. Friend’s constituency and the area surrounding Kettering want. There are encouraging signs. The improvements envisaged are significant and would ensure that the local area had a resilient and high-quality health care system to deliver the highest-quality patient care. I again thank my hon. Friend the Member for Kettering for securing the debate.

Non-Departmental Public Bodies (Triennial Reviews)

Dan Poulter Excerpts

Thursday 12th March 2015 Written Statements

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

I am today announcing the start of the triennial reviews of the NHS Pay Review Body (NHSPRB) and the Review Body on Doctors’ and Dentists’ Remuneration (DDRB).

All Government Departments are required to review their non-departmental public bodies (NDPBs) at least once every three years. In order to ensure that the Department is an effective system steward and can be assured of all the bodies it is responsible for, the Department has extended the programme of reviews over the next three years to all its arm’s length bodies and Executive agencies.

The reviews of the NHSPRB and DDRB have been selected to commence during the first year of the programme (2014-15). The reviews will consider the two pay review bodies’ functions and corporate form, as well as performance and capability, governance and opportunities for greater efficiencies. The Department will be working with a wide range of stakeholders throughout the reviews.

[HCWS408]

NHS Charges

Dan Poulter Excerpts

Wednesday 11th March 2015 Written Statements

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

My right hon. Friend the Under-Secretary of State, Department of Health, Earl Howe, has made the following written ministerial statement.

Regulations have been laid before Parliament to increase certain national health service charges in England from 1 April 2015.

This Government have made tough decisions to protect the NHS budget and increase it in real terms, but health charges remain an important source of revenue to support the delivery of high-quality NHS services. This is particularly important given the increasing demands on the NHS, with spending on medicines alone doubling since 2000. It is therefore crucial that these charges increase to keep up with rising costs.

This year, we have increased the prescription charge by 15p from £8.05 to £8.20 for each medicine or appliance dispensed.

Ninety per cent of prescription items are already provided free of charge.

To ensure that people with the greatest need are protected, such as those who are not eligible for free prescriptions but who have long-term conditions, we have again frozen the costs of a prescription prepayment certificate (PPC). The three month certificate remains at £29.10, and the cost of the annual certificate will remain at £104. An annual certificate means that a person can have all the prescribed items they require during the year dispensed for £2 per week.

Regulations have also been laid to increase NHS dental charges from 1 April 2015. The dental charge payable for a band one course of treatment will increase by 30p from £18.50 to £18.80. The dental charge for a band 2 course of treatment will increase by 80p from £50.50 to £51.30. The charge for a band 3 course of treatment will increase by £3.50 from £219 to £222.50. The small increases this year are lower than in recent years.

Dental charges represent an important contribution to the overall cost of dental services. The exact amount raised will be dependent upon the level and type of primary dental care services commissioned by NHS England and the proportion of charge paying patients who attend dentists and the level of treatment they require.

Charges will also be increased, by an overall 1.6%, for wigs and fabric supports.

The range of NHS optical vouchers available to children, people on low incomes and individuals with complex sight problems are also being increased in value. In order to continue to provide help with the cost of spectacles and contact lenses, optical voucher values will rise by an overall 1%.

Details of the revised charges are in the following tables.

Royal National Orthopaedic Hospital (Stanmore)

Dan Poulter Excerpts

Wednesday 4th March 2015 Westminster Hall

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

I will of course pass that message on, Sir Alan. It is a pleasure to serve under your chairmanship for, I think, the first time in the almost three years I have been a Minister. I heed and take note of your comments. I congratulate my hon. Friend the Member for Harrow East (Bob Blackman) on securing this debate on an issue that is important to him and his constituents—and, more broadly, to many others. As he rightly outlined, Stanmore is a centre of national excellence in orthopaedic care. It has an international reputation. With the care it provides to its patients, it is one of the best centres in the world.

Before I address the issues my hon. Friend raised, I pay tribute to all those who work in our NHS—not just in his constituency, but right across the country—for their dedication, determination and commitment in providing first-class services to all whom they care for. I know that he made his remarks in that spirit. First-class, dedicated NHS staff need to be supported with the right facilities to provide that level of care. That is exactly why he raised the issue today, and I hope my remarks will bring him some reassurance.

One issue I wanted to pick up on was consultancy spend. I agree with my hon. Friend that hospitals spending money hand over fist in that way on consultants is completely unacceptable. I hope he will be pleased to know that the consultancy spend in the NHS has been reduced by £200 million since the previous Labour Government were in power, which is a strong step in the right direction. Many of the issues that he raised on that are historical. We have introduced new section 42 guidance for trusts that are in deficit to ensure that they are much more rigorous in how they spend their money when they want to receive additional Government cash. Looking at consultancy spend and ensuring that money is not wasted in the way that he outlined are important parts of the new criteria.

As we have heard, the RNOH is the largest orthopaedic hospital in the UK and is regarded as a leader in the field of orthopaedics in the UK and worldwide. It provides a comprehensive range of neuromusculoskeletal health care, ranging from treatment for acute spinal injuries to orthopaedic medicine and specialist rehabilitation for those who suffer from chronic back pain. The range of specialist treatments provided by the trust includes: the rehabilitation of people with life-threatening conditions, including spinal cord injuries; the innovation of new treatments, which is increasingly important, particularly in the areas of care provided by the hospital; leading-edge research and development; the manufacture of state-of-the-art prosthetics; and the training of future orthopaedic specialists. The trust is a national provider of health care: 45% of the trust’s patients live in London, a further 22% are from the remainder of the south-east, 31% are from further afield in the UK and 2% are international, which shows the hospital’s outstanding reputation.

The RNOH plays a major role in teaching. More than 20% of all UK orthopaedic surgeons receive training there, which is testament to the desire of the surgeons of tomorrow to ensure that they train and have experience of providing care at an outstanding centre of excellence. Patients benefit from a team of highly specialised consultants, many of whom are recognised for their expertise both in the UK and abroad. As my hon. Friend outlined, according to the friends and family test, Care Quality Commission inspections and many patient indicators, Stanmore is a centre of excellence and produces the very best possible care and results for patients.

The RNOH’s proposed redevelopment of the Stanmore site is key to ensuring that it can continue to improve the care it provides. I am aware that most of the buildings at Stanmore date from the 1940s, and many are no longer appropriate or fit for purpose for the high-quality care and excellent clinical outcomes that the RNOH provides for its patients. The plan is to rebuild the hospital so that it can continue to provide its specialist orthopaedic care to thousands of patients, young and old, with conditions too complicated for other larger general hospitals to handle. The new hospital will be a state-of-the-art facility that reflects and enhances the medical excellence that already exists at the RNOH. It will provide 124 beds, the majority of which will be in single rooms, thereby greatly enhancing patient privacy and dignity and helping to reduce the transference of infection, the incidence of which, as my hon. Friend outlined, is remarkably low at the trust.

Patient experience will be enhanced through a number of en-suite single rooms and modern, spacious and well-equipped communal areas. Improved facilities for staff will give them a better environment in which to work, enabling them to provide the best possible care. The RNOH is renowned worldwide for its clinical excellence, and manages to maintain high standards of outcomes despite the condition of the estate. The trust looks forward to continuing that high standard of care in the new hospital, which will provide an enhanced setting both for patients, and for support staff delivering the highest possible quality of care.

I appreciate the concerns that have been expressed. My hon. Friend called some of the challenges Kafkaesque, and I share his frustration at the difficulties experienced in developing and improving the facilities at the trust. It has taken a long time to get the proposed redevelopment to this point. Nevertheless, it is important that the business case is affordable. We know some of the historical dangers and challenges of unaffordable private finance initiative deals. In fact, a PFI deal crippled the South London Healthcare NHS Trust; that serves as a reminder to us all of the challenges that hospitals will face in achieving sustainability and delivering high-quality patient care if they take on unsustainable and unaffordable PFI deals.

I know that it has been frustrating, but we must ensure that the financial arrangements for the loan, as well as those underpinning the new development package, are sustainable, in order to ensure that the future provision of services is not jeopardised by a rush into an imprudent financial arrangement. It is in that spirit that there has been a lot of due diligence, although I accept that it has been frustrating.

In April 2013, the NHS Trust Development Authority took over responsibility for approving business cases for estate redevelopment. Between April and December 2013, the TDA worked with the trust to address the additional assurances required on the draft appointment business case. Both the trust and the TDA are clear that the right solution must enable the provision of excellent services to patients, be affordable, and offer value for money.

In December 2013, the RNOH trust board determined that it was unable to give its continued support for the draft appointment business case, because the trust concluded that the risks to affordability and flexibility associated with continuing with the scheme as then proposed were not sustainable. At that point, recognising the importance of the proposed redevelopment, the TDA committed to supporting the trust in working up alternative options for funding. The TDA has been supporting the RNOH to develop a business case that offers value for money and stands a good chance of securing the necessary funding to enable important improvements to be made for the benefit of patients. Serious consideration must also be given to the impact on the long-term sustainability of the trust.

In January 2014, when the financial modelling was complete, the trust concluded that a PFI scheme was unaffordable and that it wished to pursue an alternative scheme. In May 2014, the trust presented to the TDA an outline of its new preferred option for the redevelopment of the Stanmore site. It is a smaller-scale capital redevelopment, costed at around £40 million, as my hon. Friend said. The cost is to be met jointly through public funds and the proceeds from land sales.

Hospitals and trusts sometimes have surplus land that is not used for patient care, and that it costs them money to maintain—money that does not go to front-line patient care. It is of course right that, if they would like to redevelop facilities for the benefit of patients, they should use some of the capital receipts from the sale of that land to contribute to any planned redevelopment. It is in that spirit that the new package was put together. Indeed, it is in that spirit that the section 42 guidance for trusts in deficit that require finance, which I outlined earlier, was drawn up. Where trusts have surplus land that they could release because it is not required for patient care, that land can be freed up in order to provide affordable homes for local people, support the construction industry and, of course, reduce the overall cost of running a trust’s estate. That is a win-win situation for the NHS, as well as for the local economy and, often, young families in the area. I am sure that that will be a benefit of the proposed new scheme, as my hon. Friend said.

The TDA supports the approach that has been put together as part of the £40 million package, and will advise and support the trust on the development and submission of its application for public funding and its business case for the sale of land.

Looking to the future, I understand that the TDA received the trust’s revised outline business case on 29 January. The TDA is now assessing the business case with the aim of making a decision at the earliest opportunity; its board meeting will be held on 19 March—in less than three weeks’ time. This morning, I spoke positively to the TDA about the business case. I have every hope that the outline business case will be strongly supported. We must obviously wait for the outcome of the meeting, but I hope that my hon. Friend and his constituents will hear good news later this month.

The TDA recognises the unarguably poor quality of the Stanmore estate, and the great challenges that that presents to the delivery of high-quality health care and a positive patient experience in the months and years ahead. It is mindful of the need to make a swift decision, so it is committed to working alongside the trust to agree a business case for clinical quality reasons. It is vital that that is done in a way that safeguards important services for patients. Now that the TDA has received a formal business case to review, the process will continue at pace. Once the business case is approved, the TDA will support the trust in developing a full business case and finalising any outstanding assurances that might be required, in the shortest time possible.

I hope that my hon. Friend is reassured that a very active process is now in play, with the Trust Development Authority proactively supporting the trust to progress its business case, which I am optimistic will be approved in its outline form later this month. I hope that my hon. Friend’s constituents will then receive some very good news that will be welcomed not only at Stanmore and by his constituents, but by orthopaedic patients in this country and elsewhere in the world who receive the best possible care from the trust.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 24th February 2015 Commons Chamber

[Graeme Morrice (Livingston) (Lab)]

9. How many NHS staff have been made redundant and subsequently re-employed by the NHS since May 2010.

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

Over the four and a half years between May 2010 and October 2014, 5,210 people—equivalent to, annually, less than 0.1% of the NHS work force—have been made redundant and then returned to work elsewhere in the NHS.

[Julie Hilling]

But at a time when A and E is in crisis and there are not enough nurses, how on earth can the Minister possibly justify firing and rehiring thousands of NHS staff? What greater sign could there be of a Government with their priorities totally wrong?

[Dr Poulter]

I am not sure I recognise that picture of the NHS. We know that there are between 6,000 and 8,000 extra nurses, midwives and health visitors working in our NHS than there were under the previous Government. Also, in respect of A and E, the average length of stay in hospital has steadily come down from about eight days in 2000 to about five days now. So our NHS is getting better and improving under the current Government.

[Graeme Morrice]

Last year the Prime Minister promised to recover redundancy payments from people who have been rehired. Can the Minister tell us how many payments have been recovered and at what cost?

[Dr Poulter]

The hon. Gentleman will be aware that it was the previous Labour Government who in 2006 set these eye-watering redundancy payments for the NHS, and we have committed to making sure we reform and change that. Therefore, as part of our negotiations and pay offer to NHS staff we want to introduce a redundancy cap of £80,000. Since many Opposition Members are supported by trade unions, I hope they will encourage union members to back that pay and redundancy cap.

[Andrew Stephenson (Pendle) (Con)]

Can the Minister confirm that according to the latest figures there are more nurses working in the NHS now than there were in 2010, including an additional 391 at East Lancashire Hospitals NHS Trust and an additional 59 at Airedale NHS Foundation Trust, the two trusts that serve my constituency?

[Dr Poulter]

I am delighted to confirm that, and we have made a conscious decision to reduce NHS waste and bureaucracy. NHS administration spending is down from 4.27% under the previous Government to only 2.77% now, which has resulted in £5 billion of efficiency savings and meant we can invest in about 6,000 more nurses, midwives and health visitors.

[Maria Miller (Basingstoke) (Con)]

The extra NHS staff my hon. Friend talks about are welcome, but my constituents want to know that standards of care are the best as well. What progress is he making to ensure that hospital patients get the best possible care?

[Dr Poulter]

The most important thing we have done is support our front-line staff with additional investment in the NHS, which Labour called irresponsible, and there is about £13 billion more going into the NHS during this Parliament. We have also increased transparency to make sure that where there are isolated pockets of poor care, the Care Quality Commission can intervene and make recommendations to improve the quality of care for patients in those hospitals.

[Nic Dakin (Scunthorpe) (Lab)]

20. Given the significant challenges facing the NHS and the fact that this top-down reorganisation has led to this hiring and firing and therefore a distraction of energy and attention at crucial times, do not the Government now regret their top-down reorganisation?

[Dr Poulter]

A reorganisation of NHS services that results in administration spending being reduced from 4.27% under the previous Government to 2.77% under this Government, meaning that there is £5 billion more money for front-line patient care, is a good thing. That is something the Opposition should support, because it means that patients are getting a better service.

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

Can the Minister remind the House of the number of extra specialist A and E doctors working in the NHS in England now compared with 2010?

[Dr Poulter]

My hon. Friend is right to raise this important point. As part of our commitment to investing more money in the front line, we have been able to ensure that there are between 800 and 1,000 more doctors now working in A and E than there were under the Labour Government.

[Several hon. Members]

rose—

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

Those of us on the Public Accounts Committee have heard about the industrial scale of this revolving door of people going out of one job and into another with a fat redundancy payment. Does this not show that the Government have lost their grip on what is truly important in the NHS, which is paying front-line clinicians to serve patients?

[Dr Poulter]

That is extraordinary. The Public Accounts Committee will be aware that these redundancy terms were introduced by the previous Labour Government in 2006. We are committed to changing them and I hope that the hon. Lady’s party will support us in exerting pressure on the unions to support the pay deals on the table that will introduce an £80,000 redundancy cap.

[Mr Speaker]

Ms Johnson, do you have a similar question?

[Diana Johnson (Kingston upon Hull North) (Lab)]

21. Yes, Mr Speaker; I am grateful. I want to ask about the number of nurses who have been made redundant. Lots of hospitals in my area are now recruiting from Spain, and I wonder whether an assessment has been made of the cost to the NHS of using nurses from abroad after making other nurses redundant.

[Dr Poulter]

Our NHS has always benefited from overseas staff bringing their skills and coming to work here, and we can all welcome that as long as they have a good standard of spoken English, which is something that we are putting right through the legislation that we are introducing. As I outlined earlier, there are now around 7,500 more nurses, midwives and health visitors working in the NHS than there were under the previous Government.

[Douglas Carswell (Clacton) (UKIP)]

2. What contingency plans his Department has formulated to cope with the expected increase in the number of GPs retiring before 2020.

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

In addition to the extra 1,000 GPs working in our NHS since 2010, our mandate to Health Education England will ensure that 50% of trainee doctors enter GP training programmes by 2016. This will enable the delivery of 5,000 additional newly qualified GPs by 2020.

[Douglas Carswell]

I am told that many young doctors are choosing not to go into general practice. That, coupled with the number of retiring GPs, is leading to real shortages in places such as Clacton. What more can be done to make general practice more attractive to young doctors, in order to offset the number of GPs who are retiring?

[Dr Poulter]

There have always been parts of our health service where it has been difficult to attract GPs to work; that is a long-standing problem. A new £10 million investment fund has been put in place, and a new 10-point plan is being delivered by NHS England to look at how we can better incentivise younger doctors to work in areas in which it has traditionally been difficult to recruit. I am sure that that will bring benefits to the hon. Gentleman’s constituency and elsewhere in the NHS.

[Sir Tony Baldry (Banbury) (Con)]

Does my hon. Friend agree that this is not just a matter of the total number of GPs? Quite a lot of GPs now want to work part time, and quite a lot now want to be salaried rather than being partners. Is he confident that the model that was set up in 1948, which effectively means that each GP practice is its own separate, private business, is still suitable in the 21st century?

[Dr Poulter]

My right hon. Friend asks an important question. We can of course support the existing model, and the innovation that comes with GPs being small businesses, and that is exactly what we are doing with the £1 billion investment fund for GP infrastructure and technology. We are supporting those GPs as small businesses to develop better patient services.

[Valerie Vaz (Walsall South) (Lab)]

On what is his last outing, will the Minister tell us how many GPs, in addition to those who have retired, have left the profession and how many have gone to work abroad?

[Dr Poulter]

It has always been the case—it was certainly the case among many of my medical contemporaries—that many people from our NHS go and work overseas for some time. They often come back to the NHS, bringing broader experience and skills. As I outlined earlier, there are now 1,000 more GPs working and training in our NHS than there were five years ago.

[Mr Philip Hollobone (Kettering) (Con)]

Following the retirement of a senior partner whom it has been impossible to replace, Dr Hadrian Moss of the Dryland GP surgery in Kettering has followed the advice of the British Medical Association and informally closed his expanded list of 2,500 patients on the ground of patient safety. He has now been taken to task by NHS England for a potential breach of contract. What is the Minister’s opinion on reconciling the views of the BMA on patient safety guidelines and those of NHS England on a potential breach of contract?

[Dr Poulter]

I am sure that my hon. Friend will understand that it is difficult for me to comment on an individual case, but I am very happy to look into the matter and get back to him about it.

[Ms Margaret Ritchie (South Down) (SDLP)]

Given that the needs of patients must come first and that young people are not choosing to pursue GP training as much as they used to, what discussions will the Secretary of State hold directly with the British Medical Association, the Royal Colleges, the training councils and his colleagues in the devolved Administrations throughout the UK to address this issue, to prevent further congestion in accident and emergency departments?

[Dr Poulter]

There is a lot of work going on in this area. First, we are encouraging and supporting GPs who have had career breaks, perhaps because they have started a family, to get back into the profession more easily than they have been able to do in the past. Secondly, we also have the commitment that 50% of medical students and doctors leaving foundation training will become GPs in future. That will make sure that we have 5,000 more GPs by 2020.

[Andrew Gwynne (Denton and Reddish) (Lab)]

But the Government’s reorganisation took billions of pounds away from the NHS front line. Figures released last week show that fewer than a quarter of medical students now enter general practice, because they can see the pressure that Ministers have put on it, while GP morale has collapsed. Should the Minister not now admit that the reorganisation was a mistake and instead match Labour’s pledge to invest an extra £2.5 billion a year to recruit 8,000 more GPs and guarantee appointments within 48 hours?

[Dr Poulter]

I know that the Labour party is full of professional politicians, but medical students do not just leave medical school and straight away become GPs; they become foundation doctors. As I have outlined, 50% of the people leaving their foundation training will become GPs in future, which will increase the number of GPs by 5,000. Under this Government the number of GPs in education, training and working in the NHS has increased by 1,000, which is a move in the right direction.

[Stephen Mosley (City of Chester) (Con)]

3. How many CT scans were performed at the Countess of Chester hospital in (a) 2010 and (b) 2014.

--- Later in debate ---

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

11. How many nurses per million population were working in the NHS in each of the last five years.

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

The full-time equivalent number of nurses, midwives and health visitors working in the hospital and community health services in England per million population from September 2010 to September 2014 inclusive has remained broadly constant at 5,872, 5,768, 5,703, 5,712 and 5,781 respectively.

[Steve McCabe]

In response to 11 parliamentary questions that I submitted in the past year, the Minister has admitted that he does not know how many part-time, agency and locum GPs are in the health service, the number of agency and part-time nurses, the number of part-time doctors in our hospitals, or how many working nurses and midwives are also drawing their pensions. Given that he has so little detail on staffing, where did today’s figures come from, and what faith can anyone have in them?

[Dr Poulter]

They are in the monthly staff statistics survey. As the hon. Gentleman would like some detailed information, I am sure he will be pleased to hear that in his constituency there are now 386 more nurses than there were in 2010 under the previous Government, and nationally there are 7,500 more nurses, midwives and health visitors working in the NHS.

[Andrew George (St Ives) (LD)]

Does my hon. Friend agree with me and with the nursing profession that if nurse staffing levels on acute hospital wards fall below one registered nurse to seven acutely ill patients, excluding the registered nurse in charge, it will significantly increase the risk to patient care and result in avoidable excess deaths?

[Dr Poulter]

My hon. Friend and I have discussed this many times and I do not agree with him, as he knows. What is important is that patients are assessed on their clinical needs. A rehabilitation ward will need a different number of nurses—indeed, it may need physiotherapists and occupational therapists—from intensive care nursing, which often requires one-to-one care, so setting arbitrary staffing ratios is not in the best interests of patients.

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

Does the Minister accept that the issue is not just broad numbers, but the shortage of specialised nurses in many departments, certainly in Calderdale and Huddersfield, where we are finding it difficult to recruit the right qualified nurses for very specialist tasks, as well as the doctors to go with them?

[Dr Poulter]

In many parts of the country we are seeing more specialist nurses working, particularly in areas such as diabetes, and supporting patients with complex care needs. As we need better to support people with those complex care needs at home in their own communities, the Government will continue to invest in specialist nurses not just to provide care in hospital, but to work in the community at the same time.

[Ian Austin (Dudley North) (Lab)]

Russells Hall hospital is being forced to lose one in 10 staff, which could include midwives, to deal with Government efficiency savings of £12 million every year. This morning the hospital’s chief executive has written to me and says that these

“excessive efficiency requirements place care at risk”.

She goes on to say that

“the financial challenge has reached unviable levels”

and that NHS providers

“can no longer guarantee sustainable and safe care”.

What will it take for Ministers to listen not just to us, but to NHS staff, and ensure that hospitals such as Russells Hall have the resources they need to provide care for local people?

[Dr Poulter]

I am sure the hon. Gentleman will be pleased that, as part of our winter pressures funding, Dudley received £3.5 million to support the hospital during a difficult winter period. There are now 69 more doctors and 324 more nurses, of whom 29 are extra midwives, working in the area than in 2010.

[Mr Bernard Jenkin (Harwich and North Essex) (Con)]

12. What discussions he has had with (a) the Haven project in Colchester and (b) NHS bodies in north Essex on the need for continuing funding for support for people with moderate to severe personality disorder.

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[Glyn Davies (Montgomeryshire) (Con)]

T3. Not enough GPs want to practise in rural Wales. I am told that one of the reasons is that GPs registered in England have to go through a bureaucratic process to be able to work in Wales. Will my hon. Friend the Minister work with the Welsh Government to ensure that we have a common registration process so that GPs can move between England and Wales without having lengthy, time-wasting new bureaucracy?

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

I am very happy to look into that issue and to do what we can to support our NHS work force to move as freely as possible between England, Scotland, Wales and Northern Ireland. GP numbers in England have increased because we have protected the NHS budget, unlike in Wales, where it has been cut by the Labour Administration.

[Karl Turner (Kingston upon Hull East) (Lab)]

T2. A recent Ashcroft poll shows that only 15% of the public think that this Government have the best approach to running the NHS. Will the Secretary of State stand up at the Dispatch Box and apologise for his top-down reorganisation of the NHS and his Tory privatising Health and Social Care Act, and accept that the public will never trust the Tories with the NHS?

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[Paul Blomfield (Sheffield Central) (Lab)]

T8. When I asked the Minister last June what guarantees he would give to GP practices at risk because of the withdrawal of the minimum practice income guarantee, I was told that NHS England would ensure threatened practices “get to the right place.”—[Official Report, 10 June 2014; Vol. 582, c. 400.]Over the past seven months, those discussions have not alleviated the threat to two highly regarded practices in my constituency that face closure. Will the Minister agree to meet me and representatives of the practices to discuss what is really happening, and to consider what can be done to save them?

[Dr Poulter]

I am very happy to meet the hon. Gentleman, but he will be aware that the move away from the historical funding formula towards a per head or capitation formula is a move in the right direction. If there are certain local concerns, I am very happy to meet him to discuss them.

[Robert Jenrick (Newark) (Con)]

May I commend the Government on raising the priority for dementia in their announcement last week? Will the Secretary of State and the Department of Health put all their resources behind towns such as Newark, which are trying to establish themselves as dementia-friendly towns and are working with shopkeepers, banks and the business community to make it easier for older people with dementia to lead fulfilling lives?

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[Mark Reckless (Rochester and Strood) (UKIP)]

Medway clinical commissioning group is looking at putting GPs at the front of our accident and emergency department to help relieve pressures on emergency doctors. Do Ministers believe that that is a promising way forward?

[Dr Poulter]

There is certainly a lot of benefit from having general practice co-located alongside A and E so that people with more minor ailments or concerns can be seen by GPs. That can often take the pressure off A and E services, but more senior expertise is also on hand when required.

[Sarah Newton (Truro and Falmouth) (Con)]

Will my right hon. Friend update the House on what steps he is taking to prevent avoidable deaths from sepsis?

[Bridget Phillipson (Houghton and Sunderland South) (Lab)]

GPs across the north-east say that they are facing a work force crisis, with falling numbers of family doctors. Does the Secretary of State not recognise the connection between people being unable to get an appointment to see their GP and the rising and major pressure on our A and E department?

[Dr Poulter]

I am sure that the hon. Lady would like to support the plans we have put in place to ensure that we increase the number of GPs by 2020, and to ensure that 50% of doctors leaving foundation training go into careers in general practice.

[Mr Adrian Sanders (Torbay) (LD)]

In order to combat fraud, the previous Government quite rightly introduced five-year prescription charge exemption certificates. Now that the certificates are coming up for renewal, people are finding that they have to pay for their medicines once their certificate has expired, and they have even been fined. Unlike for a TV licence, there is no renewal reminder. Will the Government look at how to ensure that people are told they need to renew their prescription exemption certificates?

[Dr Poulter]

As my hon. Friend will be aware, 90% of patients receive free prescriptions either because they are older—over the age of 60—or because of long-standing or other factors. If his constituents are running into difficulties and have problems with renewing their certificate, I am very happy to look into that and to meet him to discuss it further.

[Mr David Anderson (Blaydon) (Lab)]

Despite assurance from the Prime Minister, it is now clear that the drug Translarna will not be available until after NHS England has concluded its internal consultations. The Secretary of State and others have told me repeatedly that they have no control over the issue, but can the Minister give the House any idea when the drug will be available for young boys suffering from Duchenne muscular dystrophy in this country, in the same way as it is across Europe? The drug is saving young boys from going into wheelchairs earlier. Does the Minister have any idea when it will be available?