GP Services
Dan Poulter Excerpts(9 years, 3 months ago)
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Derek Twigg
The right hon. Gentleman makes an important point. Clearly, if there is a large housing development or one that results in a large population increase in an area of the country, planning for that should include the need for proper GP services. Of course to do that we need more GPs—that is a crucial part of it. The other point to make, which other Members may want to raise in the debate, is that we also need good facilities and buildings, because unless we have those we are not going to attract as many people into general practice. Some facilities and buildings around the country, including some I have had in my constituency, are just not up to the job. Trying then to get new facilities or new buildings built, or passed through the NHS system, is remarkably difficult and takes years. I can give examples of that in my constituency. The right hon. Gentleman raises an important point, but we need to have more GPs to do what he suggests.
I am conscious that other Members wish to speak, but I want briefly to discuss the Government’s record. Like others, I believe strongly that the Government made a major mistake in embarking on a massive reorganisation of the NHS, despite saying that they would not do so, which according to different estimates has cost between £2 billion and £3 billion. Whatever my political differences, why do I think that was such a major mistake? Well, it distracted the health service at a time when it was under massive pressure, and used up crucial resources. The massive increase in financial pressure was also building.
As a result of the creation of the clinical commissioning groups, many GPs have had to spend more time away from their surgeries. Let me just add that the CCG in Halton works very well; it is very progressive and forward thinking. It is determined to try to improve health and has worked very well in partnership with the local borough council. But the health service was distracted by the change, which cost a lot of money and took away vital time and resources that should have been put into ensuring that we had the right number of GPs and the organisation that we needed.
This Government have not done nearly enough to prevent the shortage of GPs. We are still waiting to see whether their plans will add up and create the number of new GPs that we need. I was shocked by one revelation. I would have thought that if someone wanted to decide on the number of GPs that are needed, they would have to know how many vacancies there were, but when I tabled a parliamentary question recently, I found out that the Government no longer kept a record of GP vacancies. I then asked the House of Commons Library how that could be. It told me that the survey suspension coincided with a fundamental review of data returns, which was initiated by the present Government in September 2010 in response to a commitment in the White Paper, “Equity and Excellence: Liberating the NHS” to
“initiate a fundamental review of data returns, with the aim of culling returns of limited value.”
How such information on GP vacancies could be deemed as being of “limited value” is a mystery to me.
The Library has also told me that Health Education England’s work force plan indicates an estimated gap of around 3,000 full-time equivalent GPs between the number of staff in post and the forecast demand. I understand that the Government are saying that the supply and demand gap is expected to close by 2020 if an additional 3,100 new GP trainees can be found every year, but we have already heard about the problem of recruiting trainees to work in general practice.
Dr Maureen Baker, chair of the Royal College of General Practitioners, said that the threat was one element of a “shocking” wider crisis in front-line community care, with more than 1,000 GPs expected to leave the profession every year by 2022. The number of unfilled GP posts has nearly quadrupled in the past three years to 7.9% in 2013. The RCGP has estimated that we need some 8,000 more GPs in England, and 10,000 across the UK, by the end of the next Parliament in order to meet growing demand from patients.
The Government’s decision to get rid of NHS Direct and replace it with NHS 111 was short-sighted. Members do not have to take my word on that. They can just listen to the words of a GP in my constituency, who said:
“NHS 111 has been a complete disaster. Lay people/call centre staff working from a crib sheet/flow chart are creating huge demand in both primary care and A and E. Quite a bit of controversy about this in the last few days. They call for ambulances at the drop of a hat and seldom advise the patient to self-care. The callers not admitted are advised to see their GP within a few hours. The contact summaries are unintelligible.”
Those words are not mine but those of a GP: NHS 111 has caused some real concerns.
The Government have also cut GP training. The shortage of GPs is, without doubt, one reason why we are finding it harder to see a GP. It is also holding back the NHS from meeting the challenges of the future, such as providing better care outside hospital to support an ageing population. Of course the right hon. Member for Chelmsford (Mr Burns) will remember that that was one of the key reasons why the Government introduced the Bill they did.
My right hon. Friend the Member for Leigh (Andy Burnham) has stated that a future Government will raise something like £2.5 billion for a time to care fund from a mansion tax on properties worth more than £2 million, cracking down on tax avoidance and a new levy on tobacco firms. Such investment will enable a Labour Government, by the end of the next Parliament, to provide 20,000 more nurses and 8,000 more GPs to help people stay healthy outside hospital and to tackle GP access problems.
In 1997, only half of patients could see a GP within 48 hours. The previous Labour Government rescued the NHS after years of Tory neglect. By the time we left office, 98% of patients were being seen within four hours at A and E and the vast majority of patients—80%—could get a GP appointment within 48 hours.
One of the Prime Minister’s first acts was to scrap Labour’s guarantee of getting a GP appointment in 48 hours and to cut the funding for extended opening hours.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
The hon. Gentleman is making some important points, but does he recognise the fact that it takes a number of years to train any medical specialist, including a GP? While he is talking about the previous Government’s investment in the NHS, would he like to explain why that forward work force planning was not done and how such planning may have helped with some of the issues that he is raising today?
Derek Twigg
The Minister makes an interesting point. At Prime Minister’s Question Time, we keep hearing the Prime Minister say, “Look how many extra GPs and nurses we have recruited,” but how long does it take to train them? I suggest that the Minister look at the figures on the number of additional GPs and nurses recruited between 2003 and 2009.
Derek Twigg
Again, that is an interesting point. There is a perception that every GP practice provided out-of-hours cover with the GPs themselves going out to see their patients. Of course, some of them did that, but many did not. Many of them were already using locums. During my childhood, I was a particularly bad asthmatic, and most of the doctors who came out to see me were locums, not my GP. We must look at how we organise out-of-hours services, but the key thing to focus on today is that we have not got enough GPs.
Dr Poulter
On long-term work force planning, the hon. Gentleman suggests that there is suddenly a crisis in GP recruitment—which I do not think is necessarily correct—but if the previous Government were serious about investing in general practice, they should have trained a lot more GPs than they did.
Derek Twigg
I know the Minister’s background, but he should read the figures on the number of GPs recruited by Labour when we were in power. Between 2000 and 2009, there were thousands of extra GPs, compared with the additional recruitment since this Government came to power. He should compare the two records.
I will not take any more interventions, Mr Speaker, because other Members want to speak.
Many local initiatives are trying to deal with the crisis in general practice and gaining access to GPs, or certainly to mitigate the effect. Clinical commissioning groups, such as Halton CCG, are working closely with partners to develop a strategy within the financial constraints. Halton CCG has told me:
“Delivery may be across the whole CCG on a Halton-wide footprint; by bringing more than one GP practice together to service distinct communities through a ‘hub’ based approach; by sustaining individual practices wherever appropriate and by giving local people and communities more opportunities to self-care and create resilience”.
It is working with partners to try to improve the situation, despite the financial constraints and the shortage of GPs, but we must attract more GPs.
The Royal College of GPs has told me that, in its view, it is vital that we increase the share of the NHS budget spent on general practice in England from 8.3% to 11%. That is one of the key parts of its campaign. That increase would help to reduce pressure on other parts of the NHS by supporting the delivery of more patient care in the community and keeping people out of hospital wherever possible.
The fact is that general practice cannot go on in this state. We need a sustainable, funded plan to ensure we have enough GPs to meet the population’s needs and to provide better care outside hospital. Clearly, patients should not have to wait days and sometimes weeks to see a GP or be constantly denied the opportunity to see the GP of their choice. We need to relieve the pressure on hard-pressed GPs, by ensuring that general practice is where more young doctors want a career, and in doing so we would have much better integrated care. We need better buildings to make general practice a more attractive place. We must of course constantly challenge the medical profession on how they can work better and deliver better services to patients within available resources. In the end, both politicians and clinicians must put the interests of patients first, while getting the best value for the taxpayer.
Sarah Newton
My right hon. Friend makes a good point. The plan that NHS England has put forward is about shifting resources from the acute emergency care sector into primary care sectors, especially GP practices. The point that he makes about flexible working fits well with my point about enabling more women to stay in the NHS or to return to it. Many walks of life are addressing the issue of enabling women to combine their caring responsibilities with their desire to play a full part in society, whether that is in public service as a GP, as a Member of Parliament or in business. Much more work needs to be done by the NHS to look at ways to enable women to combine caring for children or elderly parents with being a GP or fulfilling other roles in the NHS.
Women often take a break to look after their families—it is something that I did myself—and it can be difficult for women in their late 30s or 40s to find the ladder back into their previous careers and occupations. I note that many former GPs could make excellent GPs again if they were given the opportunities to retrain and reskill. They could contribute enormously, through working flexibly, to enable GP practices to open more hours.
Dr Poulter
My hon. Friend makes an important point. I hope that she will welcome the opportunity we may have to revisit the issue of the annual performers list. At the moment that means that if a GP is out of practice for a year, it is very difficult to return. That is something that we need to address, and I hope that she will be supportive of the Government’s efforts to address it with NHS England.
Sarah Newton
I welcome the Minister’s intervention. That sounds like an excellent initiative and I am sure that more will follow, because we need to use the talents of everyone in our nation to address the challenges that we face. Women can play an enormously important role in the NHS, as they can in all other walks of life.
Caroline Lucas (Brighton, Pavilion) (Green)
I add my congratulations to the hon. Member for Halton (Derek Twigg) on securing the debate. I am very pleased to have worked with him to have this opportunity today to discuss the vital issue of building sustainable GP services.
Proper funding for our GP services is vital for good patient care, easing pressure on hospitals and ongoing sustainability. The question we need to ask is this: why have Ministers allowed a trend of consistently falling GP funding? The Royal College of General Practitioners made its own concern clear back in June 2013 with an urgent call for an increase in GPs’ share of the NHS budget, so that 10,000 more GPs could be hired. However, recent figures reveal funding to be at an all-time low of 8.3%, something which shows a worrying complacency. In response, more than 300,000 people, including many in my constituency, have signed the RCGP’s petition, “Put patients first: back general practice”. The petition calls for more money to be allocated to GP services. Alongside the campaign, the BMA has conducted clear analysis of the serious work load pressure facing GPs, an issue so many hon. Members have raised today.
As the Minister well knows, the drop in share of the NHS budget for our doctors’ surgeries comes at a time when GPs are under increasing pressure and are having to see more and more patients. A situation in which they are seeing 40 to 60 patients a day is simply unsustainable for both patients and doctors. It is horrifying that 80% of GPs say that they do not have sufficient resources to provide high-quality patient care.
GPs in my constituency are telling me that good patient care is being destroyed because of what they see as impossible demands, including as a result of privatisation and a lack of funding for primary care services. For example, in a joint letter to me, seven local GPs said:
“There is no doubt that general practice is really suffering from the lack of investment, impossible demands and never ending re-organisations. If we could stop having administrative battles and spend our precious hours on patient care we would all be much happier, and the service would be better and significantly cheaper to run.”
Dr Poulter
I commend the hon. Lady for making points on behalf of her local GPs. She talked about privatisation. Would she not accept that the funding model for GPs as small businesses in their own right has existed since 1948, when Nye Bevan created the NHS?
Caroline Lucas
I accept that, of course. When I talk about privatisation, I guess what I am referring to is constant fragmentation: the way in which NHS England, CCGs and others are still struggling to get a streamlined process, which makes it more difficult for patients to be seen when they need to be seen and by the person who needs to see them.
Paul Burstow (Sutton and Cheam) (LD)
I thank the hon. Member for Halton (Derek Twigg) for securing this debate. My name was on the application, but he was the person who made the argument that persuaded the Backbench Business Committee. I apologise to him for not being here for his opening remarks or for those of others who have contributed so far.
I was keen to contribute to the debate because it goes to the heart of how we make the NHS fit for the future and do more in the community. As the hon. Member for Brighton, Pavilion (Caroline Lucas) said in her closing remarks, the focus has moved from treating episodes of ill health and diseases of individual body parts to people living with a complex range of diseases. It is that complex co-morbidity that is driving the need to change how health care is organised and delivered in this country. If that does not happen, the system will become unsustainable. At the heart of that is the family doctor and their relationship with their patients and communities, which is a key component of building the system we need for the future.
About two months ago, I and my right hon. Friend the Member for Carshalton and Wallington (Tom Brake) met a group of GPs in my constituency to discuss some of the issues being aired today—Dr Chris Elliott, Dr Brendan Hudson, Dr Alan Froley and Dr Mark Wells—along with a practice nurse. I was pleased that a practice nurse was present, because although we are discussing the sustainability of GP practices, we need to recognise, as I am sure others have, that we are talking about the wider primary care family and the contribution made by many other professionals. We discussed the pressures on practices in our constituencies. The demands have been well documented, but I want to rehearse a couple. One frustration—it has long existed, but some of the GPs felt it had got worse—concerns the expectations around paperwork and reporting, which they feel have now got out of control. That needs to be kept under review and, where possible, streamlined. I hope the Minister will say something about that.
According to data available at CCG level on the performance of primary care and, in particular, access to GPs, in my patch, Sutton scores above average when it comes to getting an appointment, which is good news, but once someone has an appointment and arrives at the surgery, it turns out they have to wait longer than average to actually see their GP. So they can get there, but then have to wait far longer than is acceptable, and often in substandard accommodation. My constituency is a suburban part of Greater London and most of its GP practices are situated in larger houses that cannot accommodate the 21st century primary care we need. We need the investment from the infrastructure fund to flow through and allow for innovation.
Dr Poulter
I thank my right hon. Friend for his point about the money from the Government for GP infrastructure, but is there not also a responsibility on local authorities, when there is additional house building, to look at the contribution developers can make to support local GP and health services by developing GP and other community health care facilities?
Paul Burstow
Absolutely, and certainly in its local planning my local authority does exactly that—it looks at what the community facility needs are. In the southern part of my constituency, in south Sutton, there has been some controversy over plans for a new GP centre. It is planned on a piece of land that was NHS land but which does not sit within easy reach of public transport and is perceived to be in the wrong place. It is also less than a mile from a soon-to-be-unused hospital site that many of my constituents feel would be a more sensible location. It will be the basis of a new housing development in the coming years and so will be the perfect place for a consolidation of existing substandard GP surgeries currently based in houses.
In its briefing, the Royal College of General Practitioners has set out some of the pressures on GPs, including increased levels of stress and depression. In a ComRes poll it conducted, eight out of 10 GPs expressed concern that those pressures were leading to an increased risk of misdiagnosis. Yesterday was world cancer day but there are still serious issues with the number of people who do not get a cancer diagnosis until they are in an accident and emergency department, by which point it is far too late, and consequently their lives are cut short.
GPs are at the heart of delivering health care: nine out of 10 NHS consultations take place in a GP surgery, while the number of consultations has increased by 40 million since 2008 to 340 million. Interestingly, according to the 2012 GP patient survey, 1.2% of patients went to a walk-in centre or A and E department because they could not get a GP appointment at a time that worked for them, but that figure has now risen to 1.7%. I am sure the Minister will tell us that those are very low percentages and therefore not a cause for concern, but given the number of consultations—340 million—it does not take a very high percentage to have a significant impact on our A and E departments. Given that there are nearly 14.6 million A and E attendances, we can see that the gearing is such that ensuring sustainable and easily accessible GP and primary care services is critical to getting the balance in the system right.
I hope the Minister will say something about the piloting of 24/7 access to GPs and ensuring we have the right data to better understand which areas are under-doctored so that we do not have to rely on anecdotal evidence. There is clearly a concern about deprived and rural areas not having sufficient doctor cover, but at the moment we cannot map that accurately. I hope he can tell us what is being done to target resources to support areas crying out for better GP coverage. In addition, I hope he can say what will be done to address the fact that, despite the Government’s having identified the need to train more GPs and despite the number of places having increased significantly under this Administration, not enough places are being filled. What is being done to get up to the right number?
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I thank the hon. Members for Halton (Derek Twigg) and for Brighton, Pavilion (Caroline Lucas) for securing this debate today. I commend them for raising important issues about the resourcing of general practice, access to GP services and the future shape of general practice and how it will continue to deliver high-quality care to patients. In particular, I should like to praise the many GPs who work exceptionally hard every day for our NHS and deliver high-quality care to patients.
The hon. Member for Halton made some other important points about mental health training for GPs. Historically, GPs have not always received training in mental health. That must change. The Royal College of General Practitioners and the Royal College of Psychiatrists support that change, and that is why we have stipulated in Health Education England’s mandate that GPs should receive compulsory training in mental health in future. Health Education England is now working with the royal colleges to put that in place. That important step forward will benefit many patients throughout the country.
I will ask my right hon. and noble Friend Lord Howe to look into the issues raised by the right hon. Member for Knowsley (Mr Howarth) and the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) and to get back to them in due course. Although the hon. Member for Halton raised some important issues, some of which were echoed by the shadow Minister, the hon. Member for Copeland (Mr Reed), it is frankly not good enough to complain now about a GP work force crisis when they were in power for 13 years. It takes three years from the end of foundation training to train a GP, and training a part-time GP takes longer. If there is a work force crisis in general practice, it is because the previous Labour Government did not have the foresight to train enough GPs when they were in power.
Dr Poulter
I will give way in a moment.
Under this Government, 1,000 more GPs are working in the NHS or training. That is a move in the right direction. We have put in place long-term work force plans to ensure that there are 5,000 more by 2020. We have recognised the pressure that GPs are under, and we have trained and are training more. I hope that the hon. Gentleman will do better than he did in his speech and at least acknowledge the point I have made.
Derek Twigg
With respect to the Minister, I am not suggesting that everything that the Labour Government did was perfect or that we met every demand on us. I tried to make it clear, although he does not want to recognise this, that there were massive improvements in the number of GPs. The Library’s figures for 2003 to 2009 show an extra 5,000 GPs. Many of the GPs now coming into place were trained under the Labour Government.
Dr Poulter
Indeed, there was an increase in the number of GPs, as there has been under this Government, but it is not good enough to lay the blame for a lack of GPs at this Government’s door, as the hon. Gentleman and the shadow Minister tried to do, when it takes a long time to train more GPs. What may have been a better decision for the previous Government in the advanced work force planning would have been to follow this Government’s example, by saying that 50% of medical graduates should become GPs. Currently, the rate is 40%. That needs to rise to 50%, and we need to encourage more people to become GPs. If we had more equality in where medical graduates end up practising medicine, that would be a big step in the right direction in training the extra GPs needed. If that had been done 10 years ago, we might not have some of the problems that the hon. Gentleman outlined. Indeed, he said that only 27% of GPs were under the age of 40. That reinforces my point about medical graduates.
Duncan Hames
I agree with the Minister that there is no substitute for persuading more medical graduates to train as GPs, but will he look at what can be done to attract women who were GPs back into general practice after they have started a family if that was the reason why they left? Will he also look at the working practices that we require of GPs to find out how that can be a more reliable way to make the most of the GP training that we have committed to?
Dr Poulter
Indeed. My hon. Friend makes an important point and echoes that made earlier by my hon. Friend the Member for Truro and Falmouth (Sarah Newton). At the moment, a valuable part of our general practice work force, perhaps due to life circumstances or the fact that they have started a family and have had two children quickly one after another, face difficulties in going back into practice. Issues to do with the operation of what is called the performers list need to be looked at, and I will ensure that NHS England does so and considers how we can better support GPs to get back into practice when they have had career breaks for legitimate family and other reasons.
Dr Poulter
I hope that the hon. Gentleman will forgive me. I may give way later, but I want to make some progress because this is a debate for Back Benchers. I will address the points that he made a little later on.
General practice funding is, of course, important. We must have regard to the primary care work force, how patients access their GP and how we structure primary care to get the best results for patients. It is only by looking at all these together that we can properly ensure the sustainability of the general practice services, which we are all so rightly proud of in each of our constituencies. Some excellent points on local sustainability were made by my right hon. Friend the Member for Chelmsford (Mr Burns) in an intervention, and by my hon. Friend the Member for Henley (John Howell). They spoke about the importance of co-ordinating local planning processes with the local NHS to better support GPs to develop practices in areas of housing growth. I am sure all local authorities will want to look at that in more detail.
On work force issues, being a GP is still a rewarding and well-paid career, with the average salary for a GP close to £110,000 per year. GPs are often the first point of contact for patients when they use our national health service. We should not lose sight of that in this debate. We have already delivered an increase of 1,051 full-time equivalent GPs who are working and training in our NHS since September 2010. This brings the total number of full-time equivalent GPs to 36,294, which represents a real increase in capacity under this Government. However, we know that there is still more to do. A report undertaken by the Centre for Workforce Intelligence last year warned of a demand-supply imbalance emerging by 2020 unless there is a significant boost to GP training numbers.
Before the report came out we had already made plans through work that Health Education England was undertaking to increase the number of GPs. NHS England has been working closely with Health Education England, the Royal College of General Practitioners and the British Medical Association to produce a 10-point action plan to increase the size and capacity of the general practice work force, which we have backed with £10 million of funding. This plan covers a wide range of measures to recruit more young, aspiring medical students to take up a career in general practice, retain those doctors already working there, and provide support for those GPs who have taken a career break and help them to get back into work—an issue that a number of Members raised in the debate.
Grahame M. Morris
Will the Minister address the point that I raised about under-doctored areas, particularly deprived areas, where we find it difficult to attract GPs? Would he consider writing off the student loans of those individuals in order to make it attractive to work there?
Dr Poulter
The hon. Gentleman and I do not often agree, but I agree with him on this. We have to do more to support medical students and to encourage people from all backgrounds to become medical students. It was a sad indictment of the previous Government that social mobility into many degree courses was falling, and that was particularly the case in medicine. We have been working with the medical schools to look at the importance of early engagement, supporting people from a much younger age, and universities engaging with local communities, as is the case at my medical school, Guy’s, King’s and St Thomas’, where people from more deprived backgrounds are supported and encouraged into medicine by the medical school’s engagement with schools and with pupils from an early age. That is the sort of approach that works.
One of the challenges is the distribution of medical schools and medical places often around our larger cities. The challenge is to support smaller and important medical schools, such as Lancaster, which does a great job of supporting local young people to become medical students and then into medical careers. We need to support those universities to expand where that is appropriate. Many of our traditional models of medical training at medical schools tend to focus from day one on encouraging people to become surgeons. We know that we need to support more people to become general practitioners. What works well and what Lancaster and Keele universities in particular do through their syllabus is to encourage more young people to undertake more placements in general practice. That has a good effect in encouraging those medical students to want to become GPs in their later medical careers.
Sarah Newton
Does my hon. Friend agree that the university of Exeter medical school at the Royal Cornwall hospital is an important medical school because it enables people to see general practice in remote rural communities? We know from previous contributions to the debate that that is important in attracting people into remote rural areas.
Dr Poulter
My hon. Friend is right. I spoke to medical students and those teaching them in Cornwall on a visit earlier this year. It is important, particularly for rural areas, to encourage more placements in rural areas in general practice. Often at my hon. Friend’s medical school and other medical schools in remote rural areas, there is a good track record of recruiting more local young people so that they are being educated locally. The hope is that those people will stay and work in the local work force and contribute to the local NHS after they graduate. I hope all hon. Members will agree that that is a good thing, particularly in more deprived areas.
I must make progress as I do not want to intrude upon the House’s time for too much longer. There are two or three important points that I want to make. I mentioned that in the health education mandate in 2014 we mandated to increase the number of GP trainees from 40% to 50% of all trainee doctors. That will make 5,000 extra GPs available by 2020. It is important to note, however, that as well as having the appropriate size work force, we must plan for the future shape of the work force. The new models of care set out in the NHS England “Five Year Forward View” will require different models of staffing, and we need to plan with that in mind. That is why Health Education England has established an independent primary care work force commission, chaired by Professor Martin Roland of the university of Cambridge.
In line with the contributions to the debate from a number of hon. Members, including my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), the commission will identify models of primary care that will meet the needs of the future NHS, including a greater emphasis on community and primary services and the more integrated delivery of care, which will involve the better use of multidisciplinary teams. We have been talking about GPs today, but delivering better care in the community is also about nurses, physiotherapists, occupational therapists, pharmacists, speech and language therapists and the many other health care professionals who play a part in delivering high-quality care to patients in general practices and in the community every day through our NHS.
In response to concerns raised by hon. Members about access to services, GP services need to be available to patients in a convenient place and at a convenient time. Achieving improved access to general practice not only benefits patients, but has the potential to create more efficient ways of working, which benefits GPs, practice staff and patients. The previous Government attempted to improve access to GP services by establishing a 48-hour access target. We know now that that target did not work. From 2007 to 2010, the proportion of patients who were able to get an appointment within 48 hours when they wanted one declined by 6%.
A 48-hour target can make it more difficult for some of the more vulnerable patient groups who GPs look after, particularly people with complex medical co-morbidities, to get the important routine appointments that they need. We should bear in mind that targets can be perverse. That target did not work in its own right, and could make it more difficult for people with complex needs and the vulnerable and frail elderly to get the routine appointments that keep them well and properly supported in the community.
Many points have been made about Labour’s disastrous 2004 GP contract. I do not need to rehearse those. The single biggest barrier to access to care is not being able to see their GP when people need to, in the evenings and at weekends. We have put together the Prime Minister’s fund with £100 million to back it to improve access to GP services in the evenings and at weekends, to make sure that patients receive the better service that they deserve.
Mr Reed
In 1997, only half of patients could see a GP within 48 hours. By 2010 the vast majority could do so. Does the Minister agree with Maureen Baker of the Royal College of General Practitioners, who said:
“It is ludicrous to continue to blame a GP-contract that is more than ten years old for the woes currently besetting the entire NHS”?
Dr Poulter
It is easy for the hon. Gentleman to take quotes out of context. It is undoubtedly the case that A and E admissions rose dramatically and the pressure on A and E increased dramatically because people could not access their GP out of hours. Of course that is the case. The facts and the statistics bear that out. Also, many people work, so having access to their GP service in the evenings is increasingly important to working people, so that they can see their GP at a time that is convenient to them. We have a chronic disease burden, which all hon. Members are concerned about, so why should primary and community care services be unavailable at weekends? That is not a well structured GP contract or arrangement. It is important that we do our very best to put that right.
Mike O’Brien, who was a Health Minister in the previous Labour Government, is on the record as having criticised that GP contract and the damage it did to patient care. We want to support GPs to provide a seven-days-a-week service again, which is why we have put in place the Prime Minister’s fund. I hope that the hon. Member for Copeland, putting aside party political differences, will recognise that GP services need to be properly available to patients seven days a week.
Mr John Baron (Basildon and Billericay) (Con)
Will my hon. Friend give way?
Dr Poulter
I am encroaching on the House’s time and have been generous in giving way, so I will bring my remarks to a conclusion.
As the Prime Minister has said, a strong NHS needs a strong economy. As a result of this Government’s prudent economic policies and long-term economic plan, we have been able to proceed with several major investments in general practice and primary care more broadly. Between 2012-13 and 2013-14, the total spend on general practice increased in cash terms by £229 million. Many hon. Members, and the hon. Member for Walthamstow (Stella Creasy) in particular, raised concerns about the quality of GP premises. On top of the increased funding, therefore, we recently announced a £1 billion investment in primary and community care infrastructure over the next four years. It aims to improve premises, help practices to harness technology, give them the space they need to offer more appointments and lay the foundations for more integrated care to be delivered in community settings.
Stella Creasy
In my contribution I specifically asked the Minister whether he would commit to a review of GP access in Walthamstow because of the combination of problems—the two-week wait for appointments, the poor quality of surgeries and the single-practice GPs. Will he make that commitment today to the people of Walthamstow?
Dr Poulter
I hope that I have given the hon. Lady some reassurance about the Government’s commitment to invest £1 billion in primary and community care infrastructure over the next four years, which will help many local GPs. I also gave a reassurance to her hon. Friends earlier in the debate. I will certainly ask my noble Friend Earl Howe to look into the matter and write to her. He might also be available for a meeting, if time permits, before the end of this Parliament.
Integrating care is of course a priority for the Government. The better care fund has already made headway by combining £5.3 billion of existing funding into local authorities and the NHS—combining health and social care pots, which will be of great benefit to the frail elderly and people with long-term conditions such as dementia and heart disease. In addition, we have backed the new models of care set out in NHS England’s “Five Year Forward View”, with a £200 million transformation fund. That will allow the NHS to pilot new models, such as multi-speciality community providers, which aim to provide more proactive, person-centred and joined-up care.
In conclusion, the initiatives that I have described are geared around not only increasing the cash and resources available for general practice in the short term, but radically transforming the way we deliver care, which will ensure that we have GP services fit for the future.
Sir Gerald Howarth
I am extremely grateful to my hon. Friend and to the House, because I have been following this important debate not only occasionally in the Chamber, but on the screens. In the area around Aldershot and Camberley, GPs have got together to provide out-of-hours services run by them, and it works, so there are good practices providing accessible out-of-hours services, where GPs have come together to provide that cover for their patients, not for other surgeries’ patients.
Dr Poulter
My hon. Friend makes an important point. We talked earlier about the GP contract changes in 2004. Many local GPs have recognised the barriers that can be put in the way of delivering high-quality, local patient care and have worked together to provide local solutions. My right hon. Friend the Prime Minister has provided £100 million to support the return to seven-days-a-week services, and I think that rural practices will increasingly want to bid for that fund. Initial funding has predominantly gone to urban areas, but areas such as Suffolk are now looking to bid, because local GPs recognise that it is in the best interests of patients to provide locally run, seven-days-a-week services. I commend my hon. Friend’s local GPs for what they are doing to deliver that care in Aldershot.
Under this Government, more money is going to general practice. We have returned to having a dedicated GP for every patient. There are over 1,000 more GPs, and we plan to train 5,000 more. If we have a Conservative-led Government after May, we will return to seven-days-a-week GP care for all by 2020. This Government are backing GPs and delivering the care that patients deserve.
Law Commission: Government Response
Dan Poulter Excerpts(9 years, 3 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
The Government are today publishing, on behalf of all four countries, “Regulation of Health Care Professionals: Regulation of Social Care Professionals in England—the Government’s response to Law Commission report 345, Scottish Law Commission report 237 and Northern Ireland Law Commission report 18 (2014) Cm 8839.” The response has been laid before Parliament and is available in the Library of the House.
In accordance with the protocol between the Lord Chancellor and the Law Commission I am providing a full response to the Commissions.
I would like to thank the Law Commission, the Scottish Law Commission and the Northern Ireland Law Commission for their report, published in April 2014, and for their hugely helpful work reviewing complex professional regulation legislation.
The Government are grateful for this thorough and considered review of complex legislative framework governing regulation of health care professionals and in England, social care professionals. We have accepted the large majority of the Law Commissions’ recommendations in full, and others in part.
There are a small number of areas where we disagree with the Law Commissions’ recommendations—where we wish to take a different approach, or where further work needs to be done. However, we overwhelmingly support the Commissions’ ambition for improvements and where appropriate, greater consistency across the regulation of health professionals including robust governance structures for regulatory bodies, enabling innovation in education and leaner processes to enable the regulatory bodies to take swifter action to ensure public protection.
We are now taking the opportunity to consider the Law Commissions’ report and draft Bill, and to work closely with the regulatory bodies to build on the good work the Law Commissions have done. The Government remain committed to legislative change and we are seeking to make changes to enhance public protection through secondary legislation to address a number of priority areas that we have identified in discussion with the regulatory bodies.
In addition, the Health and Social Care (Safety and Quality) Bill, presented by my hon. Friend, the Member for Stafford (Jeremy Lefroy) is also seeking, with Government support, to introduce consistent objectives for the PSA and for some of the regulatory bodies, and a requirement for those regulators’ panels and committees to have regard to the objectives when determining whether a practitioner is fit to practise and when determining what sanctions might be appropriate. This builds on the Law Commissions’ recommendations 13 and 85.
We consider the Law Commissions’ report and draft Bill are a significant advance towards making sure that our professional regulation system is fit for the future, and the Government are committed to legislate further on this matter in due course. As the Government move forward on professional regulation legislation, we will make sure it is right, not only for the regulatory bodies, but also for the public, patients, and registrants. The Government’s response can be viewed online at: http://www.parliament.uk/writtenstatements
[HCWS235]
Language Controls: Health Professionals
Dan Poulter Excerpts(9 years, 3 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
We greatly value the contributions that health care professionals from all over the world have made, and continue to make to our NHS, but it is essential that they have sufficient knowledge of the English language to provide safe patient care. In 2014, changes were introduced to strengthen the law in this area for doctors, by introducing language controls for European economic area (EEA) doctors wishing to practise in the UK.
The Department of Health has since been working with the Nursing and Midwifery Council (NMC), the General Dental Council (GDC), the General Pharmaceutical Council (GPhC) the Pharmaceutical Society of Northern Ireland (PSNI), and with other stakeholders, to look at ways to ensure more rigorous language competency tests can be applied for nurses, pharmacists and dentists from within the EEA. This would bring language controls for EEA health care professionals in line with the language tests and controls applied to non-European applicants who wish to treat patients in the UK.
For this reason, on 3 November 2014 the Department went out to consult on proposals to allow these regulatory bodies to apply language controls to healthcare professionals seeking entry to their registers, to ensure they have a sufficient knowledge of the English language to enable them to practise safely in the UK.
The Department has today published a consultation report, “Language controls for nurses, midwives, dentists, dental care professionals, pharmacists and pharmacy technicians—proposed changes to the Dentists Act 1984, the Nursing and Midwifery Order 2001, the Pharmacy Order 2010 and the Pharmacy (Northern Ireland) Order 197—A four country consultation report” which sets out our findings has been placed in the Library of the House. It is also available online at:
http://www.parliament.uk/writtenstatements
The proposed legislative changes to strengthen language testing of health care professionals will be an effective way of ensuring the language competence of all overseas nurses, midwives, dentists, dental care professionals, pharmacists and pharmacy technicians. This change in the law will mark an important milestone in improving patient safety and care.
The Health Care and Associated Professions (Knowledge of English) Order 2015 will be laid in Parliament shortly.
[HCWS233]
NHS (Government Spending)
Dan Poulter Excerpts(9 years, 3 months ago)
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Chris Leslie
We have to do far more to create a joined-up health service and social care system. That is very much part of the 10-year plan for the NHS that we announced yesterday. Yes, this is a debate about resources and getting the investment in, but we have to do more than that.
I question why the Conservatives are not putting their plans for funding the NHS on the record. Is it that they do not have any plans to pay for it or, which is more likely, that they are committed to shrinking public service investment in this country? The Conservatives and the Liberal Democrats have signed off on projections that would shrink public services to just 35% of GDP by the end of the coming Parliament. [Interruption.] I say to the hon. Member for Daventry (Chris Heaton-Harris) that there was nothing in the charter for budget responsibility about shrinking the state to 35% of GDP. That is his plan. Public services have not been at that level since the late 1930s—before the NHS even existed.
That is the Conservatives’ vision, but what would it mean for the NHS? We are fortunate in this country that charging makes up just 10% of a patient’s out-of-pocket expenses. That includes prescriptions, optical services and dental services. Let us just look at how it works in those countries where public services form just 35% or less of GDP. There are four such countries across the OECD. In Switzerland, where public services make up 32.8% of GDP, more than a quarter of a patient’s income goes towards the cost of treatments. It has an insurance system in which the patient effectively pays an excess: as with a car insurance system, the patient has to pay the first amount and it is deducted from the total bill. Patients in Switzerland typically pay £1,800 out of their own pockets. In Mexico, charging makes up 44% of out-of-pocket expenses, in Chile it is 32% and in Korea it is 36%. Korea has a co-payment system, which means that up to half the hospital costs have to be borne by the patient.
Such things happen in every country where less than 35% of GDP goes towards public services. The Conservatives want to head us in the direction of such pressures. An NHS free at the point of use is not sustainable under the Conservative plans, and the risk that charges will be introduced is great.
The Conservatives have form on this issue, because their 2005 manifesto, which the Prime Minister and the Chancellor authored, encouraged people to go private. They wanted a patient passport that would have introduced charges for people who wanted to jump the queue. I wonder whether my hon. Friends recall that. The Prime Minister and the Chancellor wanted such charges for basic medical treatments. I have another question for the Minister and, again, I will give way to him. Would the Conservative party still introduce those plans in the dreadful event that they won the next general election? I will give way to the Minister if he wants to say that that is categorically not part of his party’s plans.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I am sure that the hon. Gentleman can be patient. I will reply to him in a few moments when he finishes his speech.
Chris Leslie
It was quite a simple question. The Minister could have dealt with it there and then, and pushed the matter to one side. I half expected him to do so. But no, that is not the answer he gave. Perhaps we are seeing the return of Michael Howard. The patient passport rears its head again.
What else can we expect from the Conservatives? More privatisation and more market-based changes.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I welcome this opportunity to discuss the NHS. In answer to the question from the hon. Member for Nottingham East (Chris Leslie), I reconfirm the Government’s commitment to an NHS free at the point of need and free at the point of delivery. Only with a strong economy can we afford to pay for our NHS.
It would be wrong to open my remarks without commenting on the Labour party’s increasingly regrettable approach of weaponising the NHS. I still work as an NHS hospital doctor. There are a lot of professional politicians on the Opposition Front Bench. In my capacity as a local MP, I have been out on the front line with the East of England ambulance service during night shifts over this busy winter period. Front-line NHS staff do not appreciate the way in which the Labour party is trying to run down our NHS. There are a lot of staff working incredibly hard over this busy winter period and they should be congratulated on the effort and dedication that they put into front-line patient care. I hope that the hon. Member for Nottingham East and the Leader of the Opposition will reflect on that.
As this is an economic motion, it is appropriate in my opening remarks to address the economic situation our country was in when we came into government. We inherited the worst economic record of any new Government since the 1930s. Labour’s record of economic incompetence and profligate spending meant that the annual deficit was £134 billion and that we were paying back £367 million each and every day in debt interest alone. I believe that the hon. Member for Nottingham East was a special adviser who advised on that profligacy and incompetence. Labour left Britain with its largest deficit since the second world war. One pound in every four that was spent by the Government came from borrowing. Labour’s outgoing Chief Secretary to the Treasury, the right hon. Member for Birmingham, Hodge Hill (Mr Byrne), summed it up in his note to his successor with the words, “Good luck. There’s no money left.” There we have it—Labour’s record of economic incompetence. Britain was bankrupted by the last Labour Government, but thanks to our long-term economic plan things have changed for the better and Britain is back on track. There are now 2.16 million more private sector jobs since the coalition came to power, and 2 million more people have started an apprenticeship. The Government are giving more young people a chance in life and the opportunity to take home a pay packet.
Grahame M. Morris
May I just point out one of the lessons from history? When the NHS was established after the second world war, the country was tasked with rebuilding and its debt and deficit were considerable. But the Labour politicians of the day had the strength of character and the will to make that investment in the interests of the health of the nation. Should we not do that now?
Dr Poulter
To take the intervention in the spirit in which it was intended, I recognise that the hon. Gentleman is committed to our NHS, as are Members on this side of the House. That commitment to and investment in the NHS has been made clear by the fact that we have increased NHS spending by £12.7 billion during this Parliament.
Opposition Members have also incorrectly asserted that our long-term economic plan is taking Britain back to the 1930s, but the latest forecast from the independent Office for Budget Responsibility shows that our plans would reduce total Government spending as a share of GDP from some 40% today to 35.2% by the end of the next Parliament in 2020—the same levels of public spending as were proposed under Labour in 2002, when the right hon. Members for Doncaster North (Edward Miliband) and for Morley and Outwood (Ed Balls) were in the Treasury. If it was appropriate to set public spending at that level under Labour when they were in government, they need to explain why it is somehow wrong for a Conservative-led or coalition Government to plan for a similar level of public expenditure in the future—something that the Labour party has completely failed to do to date.
Rosie Cooper (West Lancashire) (Lab)
The Minister referred to the goodbye note from my right hon. Friend the Member for Birmingham, Hodge Hill (Mr Byrne). Would the Minister’s goodbye note say, “Good luck, there’s no NHS”?
Dr Poulter
Such drivel, frankly, is beneath the hon. Lady. We have made considerable additional investment in the NHS. Comparisons between an NHS run by a coalition Government in England and the NHS in Wales bear up very well for the NHS in England.
Caroline Lucas
Just before I came into this debate I met a 10-year-old constituent, Margot, and her mother, who works for the NHS. She works all hours and still struggles to put enough food on the table. Can the Minister explain why the Prime Minister does not care about NHS workers? That is what Margot wants to know and that is what the rest of the country want to know.
Dr Poulter
I am familiar with the hon. Lady’s constituency, having worked as a doctor at a hospital in the area. Her question is very disingenuous when we have increased the number of front-line clinical staff working in our NHS, investing in more staff to treat patients. We have also recently agreed with the unions a pay deal that will see the majority of NHS staff receiving a substantial increase in pay, thanks largely to their increments. Other staff will receive 1%.
Mr Mark Spencer (Sherwood) (Con)
The Opposition appear to struggle with the concept that we can fund public services only if the economy is moving forward. The interest alone on the debts that the previous Government amassed would have been enough to build a hospital ward every 30 minutes.
Dr Poulter
My hon. Friend makes a very good point. On this side of the House we believe that when we spend public money we should do so efficiently and effectively. We have also made Government spending much more efficient—[Interruption.] Rather than heckling, the hon. Member for Liverpool, Wavertree (Luciana Berger) might do well to listen to what I am about to say, because efficient public spending should be a priority for any Government, although it certainly was not for the previous Government. Cabinet Office figures, endorsed by the National Audit Office, show that £14.3 billion of savings, relative to 2009-10, have been made across many areas of expenditure, including procurement, work force, major projects and transformation. That is £850 for every working household saved by this Government, and clearly shows that we are spending public money much more efficiently and wisely than Labour ever did when in office.
Stephen Gilbert (St Austell and Newquay) (LD)
Does the Minister agree that money can be spent only once? Labours say it wants to invest £2.5 billion from the mansion tax in the NHS, but it has already promised that to deficit reduction and introducing a 10p tax rate. That is nonsense.
Dr Poulter
My hon. Friend makes a very good point. The mansion tax, which is alluded to as a major plank of the Opposition’s funding plans for the NHS, has already been spent three times—that is economic incompetence if nothing else.
Chris Leslie
The Minister claims to be spending NHS resources effectively. Let us put to one side the £3 billion that he wasted on the NHS reorganisation—difficult though that is to do—and address the issue of clinical negligence in the NHS. My understanding is that it was at about 0.8% of NHS expenditure, but it has now gone up to an astonishing 1.1%. More than £20 billion has been set aside for clinical negligence provision because clinicians do not have the time they need to do the job and stop problems occurring. Should not the Minister apologise for that?
Dr Poulter
That is frankly not true and a misrepresentation of the facts. We have a very safe health service, and that was recognised by the Commonwealth Fund. We also know that even in a very safe health service bad things sometimes happen. This is not a controversial point: it is a sensible and important point. In some areas, such as obstetrics, we have very safe care in the main, but sometimes there can be a very high quantum of claims, such as £7 million for a lifetime of care in one case. We have to make sure that in the rare cases when things go wrong we look after people properly. That is uncontroversial.
The projected future trajectory for the litigation bill spend was exactly the same under the previous Government as it is now, and we are looking at dealing with lower value claims to save money on litigation in the future and removing the sometimes adversarial nature of litigation, which is much more beneficial for patients and their families.
Chris Leslie
To focus on the detail and take the politics out of this issue, I think that the Minister said that the clinical negligence bills have not gone up under this Government compared with those under the previous Administration. If he wishes to repeat those words, I am sure that his officials and others will correct him. Does he really think that there are no further clinical negligence liabilities under his watch?
Dr Poulter
The point is that the figures for the expected trajectory of clinical negligence were the same under the previous Government as under this Government. We know that even though the NHS and its front-line staff deliver safe and effective care in the main, the costs of looking after people—who may not previously have survived into adulthood, but do so now because care has improved—are now much greater. As a result, the quantum of settlements is sometimes greater than it used to be because our NHS is doing better at helping people, who previously might have died in childhood, to live longer. That means a greater lifetime of care costs, which the previous Government would have been familiar with when they looked at future litigation spending. We are, rightly, asking where we can save money on NHS litigation and we will announce soon the results of work on reducing the adversarial nature of low quantum claims, which will also benefit NHS finances.
As senior figures in the Labour party made clear this week, if the previous Labour Government had delivered efficiencies on the scale that we have delivered in our NHS, £40 billion more would have been available for front-line patient care. Let us remember that it was under Labour that £10 billion was wasted on a failed NHS IT contract; that hospitals were crippled by eye-watering PFI repayments, which currently total £2 billion a year; and that the pay bill for NHS managers doubled. Indeed, in the last year under the right hon. Member for Leigh (Andy Burnham), the number of managers in the NHS went up six times as fast as the number of nurses.
Andy Burnham (Leigh) (Lab)
I am grateful to the Minister, because I was going to mention my last year in office. Would he care to inform the House what the bill for management consultancy in the NHS was in 2010 and what it is now?
Dr Poulter
I have just told the right hon. Gentleman very clearly that the cost of NHS managers doubled under the previous Labour Government, a profligate record of spending that has taken money away from front-line patient care.
Stephen Gilbert
The Minister missed one thing from the list. A written parliamentary question revealed to me in 2010 that the Labour party spent £250 million paying private providers to do precisely nothing.
Dr Poulter
My hon. Friend makes a very important point. We could stand here all day talking about the inefficiencies and profligacy in running the NHS finances by the previous Labour Government. He is also right to highlight—
Dr Poulter
I am going to make some progress. I will give way to the right hon. Gentleman later. I have been very generous and I need to make some progress. I remind him that under the previous Labour Government, as my hon. Friend the Member for St Austell and Newquay (Stephen Gilbert) highlighted quite rightly, NHS providers were paid less than private sector providers. The right hon. Gentleman and the previous Labour Government paid the private sector 11% more than the NHS for performing the same NHS operations—something we have clearly outlawed under our legislation.
If we needed a further reminder of what Labour does when it runs the health service we need only look at Wales today, where almost every indicator of NHS performance shows that the Welsh NHS, run by Labour, is performing poorly when compared with the NHS in England. While we protected and increased our NHS budget in England, Labour in Wales has cut the NHS budget and patients are paying the price. Thanks to Labour in Wales, people have to wait about 100 days longer than patients in England for knee and hip operations. On finances and on care, Labour has let down our hard-working NHS staff and patients in Wales by its lack of investment in front-line services.
Charlie Elphicke
I am sure the Minister would agree that the shadow Health Secretary could have opened this debate, rather than trying to intervene now in a desperate way. Does my hon. Friend also recall the shadow Secretary of State, when he was Health Secretary in 2009, saying that we can
“move beyond the polarising debates of the last decade over private or public sector provision”?
That is what he said then. What does he say these days?
Dr Poulter
My hon. Friend is absolutely right. The fact that the shadow Health Secretary’s colleague, the hon. Member for Nottingham East, opened the debate perhaps shows a lack of confidence. The shadow Health Secretary’s record is very difficult to defend.
Dr Poulter
If the right hon. Gentleman wanted to contribute to the debate in such a meaningful way, why did he not have the courage to stand here and speak in this debate? I have been very generous in giving way. I know he does not like to be reminded of his record in office. Frankly, on NHS finances his record is abysmal, just like the previous Labour Government’s record of running our economy. If he wants to contribute he should speak in the debate. I will give way generously again later, but I want to make some progress.
On the Government Benches, we know that we cannot have a strong NHS without a strong economy. In spite of the profoundly challenging financial position we inherited from Labour, I am proud that this Government have increased NHS funding in each year of this Parliament. As a result of the additional funding announced in the autumn statement for 2015-16, funding will be £16 billion higher in cash terms in 2015-16 than it was in 2010-11. That equates to an increase of £6.8 billion in real terms for our national health service under this Government.
Our NHS is also on track to deliver up to £20 billion of efficiency savings this Parliament, having reported about £15 billion of efficiencies in the first three years. All of that has, or will be, reinvested into front-line patient care. Our commitment to our NHS has meant that, since the last election in 2010, there are now more than 17,200 more professionally qualified clinical staff, including over 9,000 more doctors, enabling 850,000 more people to have operations than in 2010, and over 3,300 more nurses, midwives and health visitors. Fewer patients are waiting to start treatment, and hospital infections have virtually halved. Mixed-sex wards, a great scandal of the previous Government, have largely become a thing of the past. I could, and will, go on in a moment.
Alison Seabeck (Plymouth, Moor View) (Lab)
The Minister talks about more nurses. Derriford hospital in Plymouth has had to fill more than 60 vacancies with nurses from overseas. Morale is so low among nurses in the UK—plus we are not training them—it cannot fill those vacancies. He spoke earlier about a substantial pay rise. Would he like to explain to the nurses in my constituency exactly how substantial that pay rise is, because they do not think they have had a substantial pay rise?
Dr Poulter
Through the “Agenda for Change” settlement, many nurses will receive an incremental pay rise worth an average, I think, of between 3.2% and 3.4%. On top of that, we have come to an agreement with the unions to give a 1% rise, particularly to the lower paid NHS staff. That is something I hope the hon. Lady welcomes. It is worth highlighting that one of the biggest things that supports front-line staff is increasing numbers. In Plymouth Hospitals NHS Trust, the number of hospital doctors since 2010 has increased by 25 and the number of nurses by 62. That shows that the investment we are making at national level is paying dividends at local level in her trust.
Dr Poulter
I am going to make some progress and I am sure I will give way to the hon. Lady later on.
The investment we are making in the NHS also means that our NHS is caring for more patients than it has ever done before. Last year, compared with Labour’s last year in office, there were 1.2 million more episodes of in-patient care, including 850,000 more operations, 6.1 million more out-patient appointments, 3.6 million more diagnostic tests and almost 460,000 more GP referrals seen by a specialist for suspected cancer, meaning that under this Government more patients are receiving early referral for important care. We have also reduced the number of administrators in our NHS by 20,000. That is freeing up more cash to be reinvested in the front line of patient care.
James Morris (Halesowen and Rowley Regis) (Con)
While we are talking about future resources for the NHS, may I commend the Government for what they have done to move towards parity of esteem in mental health and investment in talking therapies? Is it not important, when we consider future NHS resources, to consider the balance of the £14 billion that we currently spend on mental health services and how we can further invest in mental health services over the next Parliament?
Dr Poulter
My hon. Friend makes an important point. We have made considerable progress under this Government in improving the funding in the past year—£302 million more for mental health services—and in making sure that from this year, for the first time, there will be genuine parity between mental and physical health when we introduce access targets. They will ensure that patients are seen in a more timely manner when they suffer from mental illness and need specialist care and referral. Our record in office on mental health is something I think we can be very proud of. We have for the first time in many years reset the debate. There is now becoming a genuine parity of esteem between mental and physical health.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
It is always important to hear the Government talk about parity of esteem. In practice, however, we have seen many examples in the past year where that has not actually applied, whether that is NHS England’s decision to apply a cut to a mental health trust that is 20% higher than for all other trusts, or the figures we saw this year showing that child and adolescent mental health services have been cut by £15 million. Is it not just warm words to talk about parity of esteem, when in reality people have to travel hundreds of miles to access in-patient care or not get any treatment at all?
Dr Poulter
Frankly, the previous Government’s record on investing in mental health was woeful. To reassure the hon. Lady—I think it would perhaps be worth her noting the points I have raised—we have increased the mental health budget this year by £302 million. I will talk a little more about support for children with mental ill health later in my remarks.
We have also put a lot of investment and support into tackling perinatal mental health. By 2017, for the first time, mums will have specially qualified and trained staff in every birthing unit to provide support for perinatal mental health. [Interruption.] The hon. Lady says that is not treatment. I am a doctor. I work in maternity. It is absolutely right that we put in place the right support for perinatal mental health. I am sorry, but frankly that is misunderstanding the clinical reality of what it is like to look after patients. It does the hon. Lady—and those on the Opposition Front Bench—a great disservice.
At a time of continued pressure on the public finances, the additional funding announced by the Chancellor in the autumn statement further highlights the priority the Government place on our NHS. The extra money we have provided will enable our NHS to continue to meet significant and rapidly rising patient expectations and demands in the short term, while allowing us to make important investment in new models of community-based care in order to realise the vision set out in NHS England’s “Five Year Forward View”.
The Government’s commitment to our NHS is clear. By ensuring a strong economy, we will also ensure that our NHS remains sustainable in the long term as a health service that is free at the point of need and of use—the health service we all believe in.
Dr Poulter
Well, I am a doctor. It is a pity there are so many professional politicians in the Labour party. Had they experience of real life, they might be able to make a more valuable contribution to debates in this place.
In 2015-16, funding for front-line NHS services in England will be £2 billion higher. Of this additional funding, £1.5 billion will go to local NHS services to meet the ever-growing demand for services and to provide better care for the frail elderly and people with long-term medical conditions, such as heart disease and dementia. In addition, £200 million will go towards piloting new care models set out in NHS England’s “Five Year Forward View”; £250 million will provide the first tranche of the new £1 billion fund, spread over the next four years, for investment in new primary and community care facilities; and about £30 million will go to the NHS to develop the best approaches to caring for young people with eating disorders in both in-patient and community settings—which further answers the question from the hon. Member for Liverpool, Wavertree by confirming this Government’s commitment to providing better care for people with mental illnesses.
Dr Poulter
I will give way one more time, but after that I will not give way for a while, as I want to make some progress.
Barbara Keeley
I thank the Minister for giving way, particularly as he is a doctor. He never took into account my real-life experience in IT when we debated care.data, so he wants to be careful about saying that people do not have real-life experience—several of us have real-life experience in different industries, but he does not take that into account.
Barbara Keeley
Will the Minister address the issue of delayed discharges and the impact of cutting community resources? We have touched on social care in general practice, funding for which has really been cut, but the big issue that comes up again and again before the Health Select Committee concerns the loss of thousands of district nurses. I heard yesterday that in the north-west agencies do not even have supply district nurses. Will he address the matter of those community resources? He is talking about community care for the elderly and vulnerable. What will be done about district nurses?
Dr Poulter
As the hon. Lady will be aware, front-line staff use IT and understand the importance of joining it up to benefit patient care while also protecting confidentiality. On the point about district nurses, she is right that we need to transform the model of care, which is why the Government set up the £5.2 billion better care fund—to ensure we join up more effectively what happens between our acute hospitals, the wider NHS and adult social care. This approach will be transformative, delivering better care for the frail elderly and providing more care in people’s homes.
Of course, part of that is about changing work force models and ensuring that staff who have traditionally worked only in hospitals, supporting people with long-term conditions such as multiple sclerosis, can also work in the community. [Interruption.] The hon. Lady is chuntering away, but I have answered her question in an informed and sensible way, having spoken about how our work force models need to change as part of our investment in integrating and joining up care so that patients looked after now in a purely hospital environment can have access to staff across both community and hospital care, which is important for people with long-term conditions such as diabetes, multiple sclerosis and dementia. I hope she can support that.
It is also important to consider some of the equally important funding decisions we have made in maternity care. In 2013-14, we provided £35 million of capital funding for the NHS to improve birthing environments, which represents the single biggest capital investment in maternity care for decades. That has benefited more than 100 maternity units, including through the establishment of nine new midwifery-led birthing centres in eight areas, and transformed many local maternity services across the country. Improvements delivered by our maternity investment fund include: more en-suite bathroom facilities in more than 40 maternity units, providing more dignity and privacy for women; more equipment such as beds and family rooms in almost 50 birthing units, allowing dads and families to stay overnight and support women while in labour or if their baby needs neonatal care; and bereavement rooms and quiet areas at nearly 20 hospitals to support bereaved families after the thankfully rare but always tragic loss of a baby.
Our £35 million maternity investment has made a big difference to the experience mums and families have of NHS maternity services.
Dr Poulter
I have been very generous in giving way, but I must now make some progress.
Dr Poulter
No, on this occasion, the hon. Gentleman will have to forgive me.
Our capital investment in maternity services, which, as I said, is the biggest for decades, is making a big difference to mums, dads and new families. Thanks to our investment in the midwifery work force, we now have the highest ever number of midwives working in our NHS—about 2,000 more than in 2010—providing more personalised care and support for women and new mums. However, we must all recognise the challenges facing our health and care system in the months and years ahead. NHS England’s “Five Year Forward View” argued that we needed to do more to tackle the root causes of ill health through a radical upgrade in prevention and public health; to give patients more control over their own care, including through the option of combining health and social care, and new support for carers and volunteers; to ensure the NHS changes to meet the needs of a population that lives longer; and to develop and deliver new models of care, local flexibility and more investment in our work force, technology and innovation, some of which I have already outlined.
That is why the Government have provided additional funding for NHS front-line services in 2015-16, including £200 million to pilot new care models and £250 million for the first tranche of the new £1 billion fund, spread over the next four years, for investment in new primary and community care facilities to support our GPs and primary and community care work force in the important work they do. In community care, we are committed to undoing the terrible mistake that was Labour’s 2004 GP contract, which left so many people, particularly the frail elderly, without the GP care they needed at evenings and weekends. Our investment will support GPs to provide care for patients seven days a week so that patients will once more be properly supported during evenings and weekends. We are also training an extra 5,000 GPs, in addition to the 5,000 extra we have already seen under this Government, to provide that care.
We are clear, however, that if the NHS is to meet the challenge of increasing patient demand and expectations, it cannot stand still. By 2018, 3 million people in our country will have three or more long-term conditions, so we must continually adapt and change how we deliver care to support patients, families and carers, and deliver more care in people’s homes and communities. For our part, and as part of our plan for our NHS, not only are we delivering a strong economy so that we can protect our NHS budget, but we will continue to be ruthless in delivering greater efficiencies in estate management and procurement and in reducing back-office costs so that we can reinvest that money in front-line patient care. Furthermore, we will continue to back front-line staff with the training, equipment and new technology they need to do their job and provide high-quality patient care, which is why we have already made available an additional £2 billion down payment to deliver NHS England’s “Five Year Forward View” and why the Prime Minister has committed to continuing to protect our NHS and ensuring that it has the additional money it needs to deliver first-class patient care in the months and years ahead.
In conclusion, I would like to thank the dedicated NHS staff working incredibly hard to keep us well looked after and safe in this busy winter period. As a practising doctor—I know Labour does not like it, given its dearth of real-life experience and the number of former special advisers on its Front Bench—I know how hard our NHS staff work and how dedicated they are to delivering the highest-quality patient care. I remind the House that we have been able to increase the money available to our NHS only because we have the growing economy to pay for it; because our long-term economic plan is working; and because, under this Conservative-led Government, there are more people in work than there were under Labour. Anybody who does not have an economic plan for the economy—and Labour has no plan for our economy, as has certainly been clear in today’s debate—does not have a plan for the future of our NHS. Through economic policies and by creating growth and jobs, we have been able to announce additional NHS funding for 2015-16 without having to raise taxes, including on people’s homes, as Labour would like to. This gives our NHS the funding it needs to begin implementing the plan set out in NHS England’s “Five Year Forward View”, so that it can continue to be a world-class, sustainable health service, delivered free at the point of need.
When we came into power, we took two big strategic decisions with our NHS: to increase funding and to cut bureaucracy and waste, and to reinvest that money in more doctors, nurses and front-line staff and to improve front-line patient care. That is exactly what we have done, so the choice on 7 May will be clear: between a Labour party that bankrupted Britain and would do so again, at the same time bankrupting our NHS, and a Conservative Government, committed to securing our NHS by delivering a strong, stable and growing economy.
Emily Thornberry (Islington South and Finsbury) (Lab)
Let me begin by thanking the Minister for his contribution today—particularly as he is a doctor. I also thank him for helping those of us with our Tory NHS debate bingo cards to show that he has used all the words we were expecting—“weaponise”, “Wales”, “long-term economic plan”—and for the additional benefit of sharing his understanding of the international banking crash, which is that it was Mr Brown shovelling money out of the back windows at Lehman Brothers that caused the entire world economy to crash.
Let me move on to perhaps a much more important point. How are we going to fund the national health service in the future? What the Minister did not address—which is a grave disappointment—were some of the matters in the motion that we are supposed to be debating. My constituents prioritise the NHS probably over everything else. For them, it is all about our working together as one community and looking after everyone: no one is more important than anyone else; we all stick together; we pay our taxes and support the weakest; and all of us should be able to get world-class health care. We are very proud of the national health service, which has delivered that. However, my constituents are profoundly concerned about what is going to happen in the future. Can the national health service survive another five years of a Tory Government? The answer they come to very rapidly is no.
The question is a simple one. How can the Prime Minister stand up at the Tory party conference and say, “We’re going to make £7 billion worth of tax cuts,” and not tell us where the money is coming from? How can the Prime Minister or the Chancellor of the Exchequer say that state spending is going to decline to the level it was in the 1930s, when in the 1930s we did not have a national health service? How does that work? How do we square that circle? Without answers to profoundly important questions such as those, the public simply say, “We don’t trust you with the most precious thing we have as part of our British identity. We want to be able to have a national health service that will hold us together.” How can the NHS be safe in the hands of this Government?
Dr Poulter
The hon. Lady will of course be aware that our plans for public spending will only put it back to the level it was in 2002, under the previous Labour Government, which is hardly the bleak picture she paints. At the same time, we will be able to invest money in our NHS.
Emily Thornberry
I still do not understand why, therefore, the Office for Budget Responsibility says that the percentage of state spending will be at the level it was in the 1930s. In the end, although the Minister is a doctor, I would prefer to take the word of the Office for Budget Responsibility. Indeed, I urge the Minister to speak again to his party leader and say to him, “When we come to make manifesto commitments, let’s run them past the Office for Budget Responsibility,” so that the public know whom they can trust on money and particularly on the NHS.
I remember serving on the Health and Social Care Bill Committee for many, many weeks—months, in fact; indeed, I believe it was almost a year of my life. I remember my hon. Friend the Member for Leicester West (Liz Kendall) and I pleading with the Government not to go ahead—not to waste time and money on a top-down reorganisation; not to waste people’s heart and soul on a reorganisation of the national health service in a way that was unnecessary. We said, “All you’re doing is opening the door to privatisation. What you are doing is wrong for the national health service. You must stop. You must think again.” And there was indeed a pause—a pause for an awful lot of spinning—but the Government still forced through a profound reorganisation of the national health service that has allowed the market to come into the NHS and wasted £3 billion.
We also said that if we needed to look again—and we did—at making our national health service appropriate for the 21st century, we should look at how to bring social care and health together. It is difficult, because social care is largely provided by local authorities. Very often it is means-tested and provided locally, with local accountability, whereas the national health service was much more nationally accountable, had much better funds and was not means-tested. However, without those two things moving and working together, we cannot have proper health care in our country, because—and we all know this—most people who use the national health service are elderly. They come to A and E in crisis, and once they are in they are unable to get out again. It is demeaning. It is humiliating. It is something that all of us in the Chamber will face unless something is done.
People must be supported in the community so that they are able to live their lives as healthily as possible—yes, fighting off three or four long-term conditions, but still as healthily as possible. However, while this Government have been cutting the money to local authorities—it is being shovelled out the back door by Eric Pickles—the Health team have been saying, “Oh, it’s all right: we’re giving more money to social care.” But the Government know—and all of us who have friends, relatives or constituents who are using social care know—that there is not enough of it around. Old ladies are getting up and being taken out of bed and are sitting in their chair three hours later than they were before. They are getting visits of 15 minutes. They are not being looked after properly. They have the choice between having a bath and having a meal. In the 21st century, in one of the richest countries in the world, that is a disgrace. How can we really be looking properly at the future of the health service and allowing that to happen? Of course, if people are kept in bed until 11 o’clock in the morning and then being put back to bed at 5 o’clock in the evening, they will become unhealthy. They will end up in A and E in crisis and they will not be able to get out again.
More and more local authorities are cutting back on social care and are giving social care only to those in the most acute need. In the time I have left—I do not have very long, so I am going to rattle through—I want to say what Islington does. Despite having the sixth-worst levels of child poverty in the entire country and one of the worst mental health records in the country, Islington provides social care on a level of which we should be proud. It provides social care at moderate levels. It is working with Whittington Health. The hospital in my constituency is working with the local authority, providing health in the community. The hospital sends people out; we have GPs working in the hospital. It is a model on which I hope the next Government’s—ours—model for proper health and social care will be based: the idea of people working together, looking at the whole person, giving the health service time to care and look after people properly, and giving people the right to die at home with dignity and support.
I want to use the 30 seconds I have left to give due credit to Camden health services for allowing my father-in-law to die at home with true dignity and proper palliative care. It gave him the choice to die in his bed, next to his wife, for which I am profoundly grateful. I know that he was very privileged in being allowed to do that, because up and down the country that is not being allowed. It saved money, gave him what he wanted and gave him pride. Why are we not dealing with problems like that, instead of introducing the private market into our precious national health service?
Hormone Replacement Therapy Implant
Dan Poulter Excerpts(9 years, 3 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I congratulate my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) on securing this debate on the funding of hormone replacement therapy implants. She gives me the opportunity to discuss the issues she has raised on behalf of her constituent, Sarah, and others more generally.
Hormone replacement therapy is effective for treating women who are entering the menopause and experiencing hot flushes and night sweats as well as sleep and mood disturbances. There are a number of different types of hormone replacement therapies available, including an oral tablet taken daily, or a transdermal patch applied once or twice weekly.
We should acknowledge that there are risks for those who are prescribed hormone replacement therapy, and the guidance of the National Institute for Health and Care Excellence suggests that, among other risks, there is a small increased risk of breast cancer, stroke and gallbladder disease.
Turning to the issues raised today concerning hormone replacement therapy implants, I have been advised by the Health and Social Care Information Centre that the number of items prescribed and dispensed for hormone replacement therapy implants has been declining since 1996, from around 36,700 prescription items per year to around 5,300 in 2010, the year prior to the licence being withdrawn. HRT implant prescriptions are now down to negligible levels.
HRT implants are no longer routinely offered as a treatment for menopausal symptoms, as my hon. Friend said, and that has been the case since 2011 when the manufacturer of the licensed product, the pharmaceutical company MSD, stopped making the implants. The decision to cease manufacture was based on two main factors. First, therapeutic alternatives are available in the UK, including tablets taken by mouth, patches and gels. Secondly, cost-effective manufacturing processes are unsustainable because few countries use the implant formulation.
GPs and prescribers were advised in 2011 that treatment should be continued until a discussion could take place between the patient and their prescriber. I understand that most GPs and prescribers reviewed their patients at that time and agreed suitable alternative treatments to switch to. The Medicines and Healthcare Products Regulatory Agency advises me that the only HRT implant preparations now available are not licensed for use in England, as my hon. Friend pointed out.
There has been a change in the prescribing culture surrounding HRT implants. In the past, they were popular as they gave a steady amount of oestrogen over a period of time and women did not experience fluctuating hormone levels. However, the insertion of HRT implants requires a small surgical procedure, and that can only be done by certain clinicians. Some women increased their tolerance to HRT as a result of having an implant, and returned for higher and higher doses at reducing intervals.
Newer hormone replacement therapy patches now provide steady amounts of oestrogen hormone without the disadvantages of the implant, and this phenomenon of HRT tolerance occurs less frequently.
Tracey Crouch
I understand what the Minister is saying, but does he recognise that some women have allergic reactions to the patches? Certainly, my constituents who came to see me found that neither the patches nor the gel offered a suitable alternative to the implant, not least because the patches often fall off or there is some kind of reaction to them.
Dr Poulter
Indeed. My hon. Friend makes a fair point, and I shall make some reassuring comments in that regard in a moment. It is possible to have a reaction to a device or implant, and one would hope that if people have an allergy or reaction to any product, that would be taken into account before it is used. If it causes discomfort, irritation or any adverse reaction, its use should be discontinued and alternative therapies considered.
Clinical commissioning groups are responsible at local level for commissioning the majority of NHS services, and decisions about those services should be made, we would all agree, as close to patients as possible by those who are best placed to work with the patients and the public to understand their needs. Local NHS commissioners now have the freedom and autonomy to take responsibility for meeting the needs of patients in their area, and other health care professionals can work with the CCG, including in secondary care, to help to integrate and join up services more effectively. While clinical commissioning groups are led by primary care professionals, they are also guided by the expertise of other local clinicians.
I understand that my hon. Friend’s local CCG—Medway CCG—released new guidance on HRT implants in 2014. The guidance states that from April 2014, patients will no longer be able routinely to receive hormone replacement therapy implants from their GP. Medway CCG has advised me that the guidance was developed for HRT treatment following clinical input and review through a clear governance process. Because HRT implants are no longer licensed and more suitable alternatives are generally available, the CCG decided that it would no longer pay GPs for inserting such implants from 1 April 2014. The CCG’s policy is in accordance with General Medical Council guidance on prescribing unlicensed medicines, and my hon. Friend will appreciate that medical professionals and doctors have to have regard to those requirements under the licence that they hold, and because they are regulated by the GMC. The CCG has assured me that it does not prevent doctors from inserting an HRT implant if they think it is clinically necessary for an individual patient, having assessed their needs and tried alternatives, and providing that they have sufficient evidence to demonstrate the treatment’s safety and effectiveness.
In exceptional circumstances, where a licensed medicine is considered unsuitable or ineffective for an individual, I would expect those patients to be referred for expert opinion. I am pleased that that is exactly what happened in Sarah’s case, and that Chelsea and Westminster hospital provided her with excellent care and support. We would expect a similar process to be in place in other CCGs. If someone needs more expert support and care, perhaps because they are suffering from the menopause and their GP finds their symptoms and presentation complicated, there should always be a facility for referral to specialist care and support. What happened in Sarah’s case—thankfully, it has resulted in a positive outcome for her—is available at other centres of excellence. Expert care and advice is there, and available for patients.
Medway CCG has written to GPs locally to issue information that they can share with all patients who are still using HRT implants, and to ask them to discuss alternative forms of HRT with them at their next routine appointment.
The CCG advises me that patients should be referred to a gynaecologist for expert opinion if the GP and their patient consider that there is no suitable alternative to the HRT implant. I hope that that is reassuring to my hon. Friend. At a local level the CCG has taken the issue seriously and has written to local GPs and reminded them of the importance of reviewing the current treatment plan for women who have the implant, but if they need more specialist support and advice, to make sure that a referral is made to a specialist centre of care. That process should be available to patients throughout the country. Where specialist support is required, CCGs should routinely refer those patients on. That is part and parcel of good medical practice.
Most of the time, HRT therapy and the expertise of GPs in supporting patients through menopause is enough for the majority of patients, as my hon. Friend outlined, but sometimes there is a need for more specialist support. Centres of excellence such as the Chelsea and Westminster can provide that and consider alternative treatments and therapies where they may be appropriate.
I hope my hon. Friend finds that reassuring. I thank her once again for bringing the issue to the attention of the House. I hope I have been able to provide some reassurance to her on the issues she raised regarding support for women in Medway who need HRT therapy and potentially implants, and more generally on the process that is in place to ensure that women who need specialist care and support can receive it, and that all CCGs and all doctors would always be mindful to take the right action for the patients they look after.
Question put and agreed to.
Advisory Committee on Clinical Excellence Awards
Dan Poulter Excerpts(9 years, 3 months ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I am today announcing the start of the triennial review of the Advisory Committee on Clinical Excellence Awards (ACCEA).
All Government Departments are required to review their non-departmental public bodies (NDPBs) at least once every three years. Due to the wide-ranging reforms made by the Health and Social Care Act 2012, the Department was exempt from the first round of reviews in 2011-14. In order to ensure that the Department is an effective system steward and can be assured of all the bodies it is responsible for, we have extended the programme of reviews over the next three years to all its arm’s length bodies and Executive agencies.
The review of the ACCEA has been selected to commence during the first year of the programme (2014-15). The review will consider the committee’s 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 review.
[HCWS192]
Oral Answers to Questions
Dan Poulter Excerpts(9 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Stewart Jackson (Peterborough) (Con)
1. What steps he is taking to improve mental health care for pregnant women and new mothers in (a) Peterborough and (b) England; and if he will make a statement.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
The Government have prioritised improving mental health care and support for pregnant women and new mothers in its mandate to NHS England, with a clear objective to reduce the incidence and impact of post-natal depression. In order to implement the Government’s priority to improve perinatal mental health services, Cambridgeshire and Peterborough NHS Foundation Trust is working closely with local authority commissioners in Peterborough to develop a joint perinatal mental health strategy to improve care for women.
Mr Jackson
The Maternal Mental Health Alliance has estimated that the long-term cost of mental health care for new mothers is £8 billion, which is perhaps not unconnected to the fact that only 3% of clinical commissioning groups have a perinatal mental health strategy. Does the Minister think that this is a very serious issue and needs immediate action?
Dr Poulter
My hon. Friend is absolutely right to highlight the challenges posed by perinatal mental illness. The damage it does to women’s lives, and indeed to the wider family, was highlighted in the recent independent inquiry into maternal deaths. It is therefore important for the Government to invest, as we are doing, in improved care for the perinatal mental health of women. That is why we have made it a priority for each and every maternity unit to have staff specially trained in perinatal mental health skills by 2017.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
The Minister will know that I have been part of an all-party group campaigning on post-natal depression, which is the most likely thing to kill a healthy young woman. Is he aware that this area of mental health is under-resourced, and that mental health facilities for children and young people are desperately under-resourced? That is partly because clinical commissioning groups have been commissioning in the wrong way, which has disturbed existing arrangements and demoralised staff.
Dr Poulter
The hon. Gentleman makes the important point that there has been an historical disparity between the priorities given to mental health and physical health conditions. That is why we have legislated for parity of esteem between mental and physical health, why we are introducing access targets for patients using mental health services for the first time—that is a big step forward—and why we have increased funding for mental health services by £300 million this year.
Maria Miller (Basingstoke) (Con)
In the first few weeks of a child’s life, the mother often visits their general practitioner regularly, so I applaud the Government’s work on recruiting more health visitors and midwives. Does the Minister agree that GPs need to be sharper at identifying post-natal depression in mothers, because it can be so destructive to the lives of both the mother and the child?
Dr Poulter
My right hon. Friend is absolutely right. A lot of work is going on with the Royal College of General Practitioners and the Royal College of Psychiatrists to improve GP training and skills in mental health more generally. The specific key to this is providing the right early years work force, which is why it is so important that this Government have invested in additional health visitors to give each and every child the best start in life. The latest figures from NHS England show that the number of health visitors has increased by more than 3,000 under this Government.
Seema Malhotra (Feltham and Heston) (Lab/Co-op)
What steps is the Minister taking to make sure that awareness of domestic violence is incorporated in guidance for mental health care? We know that pregnancy can sometimes be the first time there is violence in the home, and we obviously need a strategy to address that.
Dr Poulter
The hon. Lady makes very important points. I have certainly seen in my clinical practice that some women present when there are domestic violence issues or other issues in the home, and such issues can be heightened and exacerbated during pregnancy. A lot of work is now going on to improve the awareness of all NHS staff of domestic violence and, more broadly across training, of mental health issues.
Nicola Blackwood (Oxford West and Abingdon) (Con)
For many people with mental health problems, the first emergency service with which they come into contact at a point of crisis is the police. What steps are the Government taking to ensure that such a crisis is treated as a health crisis, not a criminal incident, and will the Minister undertake to do whatever he can to ensure that no children end up in a police cell as a place of safety?
Dr Poulter
My hon. Friend makes an important point. It is absolutely right that we do not want people with mental health problems to be looked after in police cells. A lot of work has been going on. The Government have set up the crisis care concordat to look at exactly that issue, and as a result the number of people with mental illness going to police cells is now falling rapidly.
Bridget Phillipson (Houghton and Sunderland South) (Lab)
2. What steps he is taking to improve ambulance response times.
Bill Esterson (Sefton Central) (Lab)
3. What the average waiting time was for a GP appointment in the most recent period for which figures are available.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
The latest GP survey results suggest that the majority of patients can get GP appointments at a time convenient to them, but we want to do more. We are offering 7.5 million more people evening and weekend appointments through the Prime Minister’s £100 million challenge fund. NHS England does not directly collect data for GP waiting times.
Bill Esterson
I think many people up and down the country will be surprised by the Minister’s answer, including my constituent Lynne Taylor who had a chest infection but was sent to A and E by a locum because of a lack of appointments at her GP surgery. That was done on the phone without seeing her. The A and E doctors told her that she certainly should not have been sent to A and E. Will the guarantee of a GP appointment within 48 hours help patients like Ms Taylor who need to see their own doctor? Would that not also be a big step in reducing the huge pressure on A and Es?
Dr Poulter
I hope the hon. Gentleman will be reassured to hear that, according to the latest GP survey, 87% of patients in Southport and Formby clinical commissioning group were able to get an appointment or to see somebody they wanted to see at an appropriate and convenient time. It is important to note that Labour’s 48-hour target did not work. From 2007 to 2010, the percentage of patients who were able to get an appointment within the 48-hour target actually fell.
Mr Speaker
Order. Let me explain to the Minister, which I have done several times, that we have a lot of business to get through. We need answers to questions and no more than that.
Mrs Cheryl Gillan (Chesham and Amersham) (Con)
Last month, I contacted one of my excellent GPs in Chesham concerning the waiting time for one of my constituents. In his response, he reminded me that Buckinghamshire patients receive less funding per head than almost anywhere in the country. What can be done to address that inequality, so that my constituents can benefit from the same level of funding for services and treatment enjoyed by other parts of the country?
Dr Poulter
As my right hon. Friend will be aware, the funding formula is now reviewed regularly. That is done independently and is free from political interference. Looking at areas such as hers, where there are a lot of frail and elderly patients, is now more paramount in the funding formula. In the future, I am sure that the funding formula will better reflect local health care needs.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
One in four patients now wait a week or longer to see a GP. Last week’s official NHS survey revealed that almost 1 million people had to turn to A and E because they could not get a GP appointment. Will the Minister accept that his Government have made it harder to see a GP, and have caused the A and E crisis in the process? Will he respond to Labour’s call for GPs to be placed in major A and Es to help ease the pressure?
Dr Poulter
I do not think that people wanting to see their GP was at all helped by the previous Labour Government’s disastrous decision to contract out the GP out-of-hours service. Many patients are now struggling to receive appointments in the evenings and at weekends. The previous Government also broke the link with family doctors. To reassure the hon. Lady, the latest GP patient survey results suggest that less than 2% of patients who want GP appointments have to resort to walk-in centres or A and E departments. Under this Government, we have put in place an extra 1,000 GPs.
Caroline Nokes (Romsey and Southampton North) (Con)
4. What progress his Department has made on its long-term plans for easing pressures on A and E departments and preparing the NHS for the future.
Robert Halfon (Harlow) (Con)
5. What steps have been taken to help Princess Alexandra hospital in Harlow to deal with extra pressure over the winter.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
The West Essex system, which includes Princess Alexandra hospital, has received an additional £4 million in winter resilience funding. Of that, £842,000 has been spent on additional community beds, £211,000 on putting GPs into A and E departments, and £205,000 on reducing delays in the discharge of medically fit patients.
Robert Halfon
Harlow’s A and E has seen more attendances per bed than some of the biggest hospitals in the country. Although the staff at Princess Alexandra hospital are outstanding, they are still more than 40 nurses short. The chief executive says that recruitment is difficult because pay is better in the neighbouring London hospitals, although they are not far away. I welcome the 6,000 extra nurses, but will the Secretary of State consider what more can be done to help recruitment in Harlow and ease pressure on my local hospital?
Dr Poulter
I expect the additional £4 million for winter resilience to be directed towards the recruitment of additional front-line staff when that is appropriate, but there is flexibility in the current “Agenda for Change” pay scales to allow for the provision of recruitment and retention premiums if there are problems with recruitment.
Jeremy Lefroy (Stafford) (Con)
T5. The recent extraordinary pressures on A and E in the north midlands underlined for me and my constituents the importance of returning the A and E at Stafford County hospital from 14 to 24-hour opening. Given that consultant-led maternity is due to transfer from Stafford to Stoke this week and the remaining serious emergency surgery next month, will my right hon. Friend set out what steps have been taken to ensure that the safety of my constituents and other users of the services is the top priority, and advise me whether he is confident in them?
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I have been in contact with the NHS Trust Development Authority. I have been reassured that the safety of patients in Stafford is the primary concern and that the transfer of services should help to ease pressure on local services and improve patient care.
Mr Jim Cunningham (Coventry South) (Lab)
T7. Government-inflicted cuts on local government funding and subsequent reductions in adult social care services have increased the pressures of bed-blocking at University hospital Coventry, with a number of patients unable to be discharged as they wait for a nursing home place or a package of care in their own home. Does the Minister agree that this is a problem, and what steps has his Department taken to remedy it? Will he not do the Pontius Pilate act but take responsibility for his actions?
Greg Mulholland (Leeds North West) (LD)
All the talk about appointments concentrates on GPs and A and E, but does not seem to focus on pharmacies, which have a hugely important role to play, considering how many years pharmacists train for. My constituent Mr. Dhand of the Headingley pharmacy is undertaking a pilot to see how many people could and should have gone to a pharmacy rather than to a GP. Would Ministers support that?
Dr Poulter
I very much welcome what the hon. Gentleman’s constituent is doing locally. For many patients the pharmacy is often the first point of contact with the NHS, so the more we can do as a Government to support local pharmacists in delivering community services, the better.
Mr David Anderson (Blaydon) (Lab)
Despite all the warm words we hear every week from the Government about their support for the staff of the NHS, which I welcome, the Government still refuse to pay the award recommended by the independent review body. At the same time the chief executive of the trust in my part of the world has had a 78% salary increase and the people who set the allowances, the board of governors, have had an 88% increase in their allowances. Is this what is meant by “we are all in this together”?
Health and Social Care (Safety and Quality) Bill
Dan Poulter Excerpts(9 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Jeremy Lefroy (Stafford) (Con)
I thank the hon. Member for Copeland (Mr Reed) for tabling new clause 1, which allows us to debate the issue. I am most grateful to him for his full and constructive engagement with the Bill. A consultation on making the role of the national data guardian statutory is extremely important, and I fully appreciate the reasons why he has tabled the new clause.
I welcome the appointment last November of Dame Fiona Caldicott as the first national data guardian. Her extensive knowledge and experience in this area will ensure strong and visible leadership. She, together with her panel, will act as a source of clear authoritative advice and guidance across the health and care system. The Secretary of State said at the time of her appointment:
“We need to be as determined to guarantee personal data is protected as we are enthusiastic to reap the benefits of sharing it. Dame Fiona will oversee the safe use of people’s personal health and care information and hold organisations to account if there is any cause for concern, ensuring public confidence.”
Let me make it quite clear that the clauses on the duty to share information are not about care.data, which is another issue for another time. My Bill is about data being shared only with those who are directly responsible for an individual’s care for the purposes of that care. Its remit is very restrictive.
A consultation should, as the new clause provides, include reference to
“oversight of data sharing as set out in”
the Bill. Understandably, concerns have been raised that a duty to share information might somehow dilute the vital principle of patient confidentiality, which is protected by statute and common law. As I have explained before, I do not believe it will do so.
The seventh of the revised Caldicott principles, as set out in “The Information Governance Review”, is that
“The duty to share information can be as important as the duty to protect patient confidentiality. Health and social care professionals should have the confidence to share information in the best interests of their patients within the framework set out by these principles.”
As was set out on Second Reading and in Committee, clause 3 introduces a duty to share information. That must be done when it is in the person’s best interests and it is
“likely to facilitate the provision to the individual of health services or adult social care”.
Having a statutory duty to share information for the benefit of a person’s care, within the clear limits set out in the Bill, would, alongside the existing strong statutory protection for confidentiality, provide health and social care professionals with the confidence to which Dame Fiona’s report refers.
The consultation on the national data guardian will provide the opportunity to set out how oversight would work for the duty introduced by the Bill, should it become law, under the legislation that will make the role of the NDG statutory. If the consultation cannot be established through a clause in the Bill, which I understand may be the case due to the timing of the general election—the Minister will go into that, I believe—it needs to happen at the earliest possible opportunity.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
The new clause relates to clauses 2, 3 and 4. Clause 2 will place a duty on providers and commissioners of publicly funded health and adult social care to use a consistent identifier in a person’s health and care records and correspondence. The consistent identifier must be specified in regulations, and the Government’s intention is that the NHS number will be specified. It is important to note, as my hon. Friend the Member for Stafford (Jeremy Lefroy) outlined, that the duty to use the NHS number would apply only in the direct provision of care and when it was in the individual’s best interests. As he articulately said, this matter is very different from the issues with care.data that we have discussed. There is a duty on professionals to share information in the best interests of patients in respect of the provision of direct care.
Clause 3 will introduce a duty to share information that is held by providers and commissioners when it is in an individual’s best interests and will support their direct care and treatment. As we discussed in Committee, that is an essential part of the delivery of safe, effective and high-quality care.
Clause 4 defines health or adult social care commissioners or providers. Its effect will be that the duties imposed by clauses 2 and 3 will apply only to relevant health or adult social care commissioners or providers. They are defined as public bodies exercising health or adult social care in England and any person, other than an employee, who provides such services or care under arrangements within a public body.
I welcome the constructive support of the shadow Minister, the hon. Member for Copeland (Mr Reed), throughout the passage of the Bill. There has been a great deal of consensus, and rightly so. I am grateful for his support for the role of the national data guardian. As was discussed in Committee, the Government are committed to consulting on the role of the national data guardian and the Secretary of State has given his unequivocal support to the consultation. We believe that having a data guardian is an important additional safeguard in the system.
As the House will be aware, Dame Fiona Caldicott has been appointed as the first national data guardian and has already built up significant credibility in her role of challenging and scrutinising the way in which information is shared across the health and social care system. Strengthening and broadening the role of the national data guardian will further enhance the confidence of patients and the public that there is a strong voice for their rights and protections in this area.
Even without a legislative basis, Dame Fiona’s panel, which was previously known as the independent information governance oversight panel, has built its reputation as an effective and authoritative voice. It has helped to ensure that data and information are shared in a way that allows the health and care system to access what it needs to improve outcomes for patients, while protecting against their inappropriate use. Having made significant progress, there is now clear agreement across the House that it is important to embed the national data guardian in the health and care system as a powerful independent voice, and to put that role on a statutory footing.
Mr Jamie Reed
I listened closely to the hon. Member for Stone (Sir William Cash). As I said earlier today, and on Second Reading, in Committee and throughout the passage of the Bill that became the Care Act 2014, patient safety is our guiding principle, and we are responsible for ensuring that all that we do is intended to improve it. The purpose of NHS regulation should always be to improve safety and achieve better patient outcomes. I therefore strongly sympathise with the principle of the new clauses. However, I should be grateful if the hon. Member for Stone explained why he does not agree with the hon. Member for Stafford (Jeremy Lefroy) that the duties for which they provide are already covered by the Bill and by other legislation.
A little over 12 months ago, I was a member of the Committee that scrutinised the clause in the Care Act that amended the Health and Social Care Act 2008, which new clause 2 seeks in turn to amend. The new clause adds the following words:
“The assessment of the performance of a registered service provider is to be by reference to whatever indicators of quality the Commission devises, but must include indicators of the safety of health and social care services.”
That is sound in principle, but it seems to me that it would remove from the CQC the flexibility that allows it to exercise its own judgment. Existing legislation gives the CQC a duty to describe and justify its indicators, and to consult on them before carrying out inspections. As the hon. Gentleman said, the Care Act also gives it a power to amend and revise those indicators.
Section 3 of the 2008 Act states:
“The main objective of the Commission in performing its functions is to protect and promote the health, safety and welfare of people who use health and social care services.”
Will the hon. Gentleman explain why he thinks his new clause is needed on top of that, and in combination with the CQC’s duty to consult on the indicators that it uses to assess services? If we support the principle of independent inspection, we need to guard against making unnecessary changes to legislation that could deter the CQC from performing its central role of ensuring the safety of the services that is inspects.
New clause 2 requires the CQC to
“include indicators of the safety of health and social care services.”
We all want the best and most effective legislation to be passed, but I fear that the new clause could be open to significant misinterpretation. The section of the 2008 Act to which the new clause relates concerns CQC reviews of the performance of service providers. The CQC will inspect a number of different services, including services that do not directly involve social care. The new clause, however, could require it to include indicators of safety in social care services regardless of whether the service concerned involves social care. If that is the hon. Gentleman’s intention, will he explain why he believes the provision to be necessary? Furthermore, new clause 2 refers to “social care services”, whereas new clause 3 refers to “adult social care services”. I hope that the hon. Gentleman will be able to explain what appears to be a discrepancy.
As Labour Members have made clear, we believe that patient safety is paramount in our NHS, that effective regulation is key to securing it, and that producing such regulation is our role in the House. I should be grateful if the hon. Gentleman explained why he believes that his new clause is essential to more effective regulation, given that—as the hon. Member for Stafford has pointed out—it seems merely to repeat existing provisions.
Dr Poulter
I thank my hon. Friend the Member for Stone (Sir William Cash) for tabling these new clauses and I commend him on his tireless work in taking forward the interests of his constituents around the terrible events that occurred at Mid Staffordshire NHS Foundation Trust and the subsequent steps he has been involved with all the way through to improve standards of hospital care provided to the people of Stone and the surrounding areas. He is also right to pay tribute to my hon. Friend the Member for Stafford (Jeremy Lefroy), who has worked tirelessly not just on this Bill, but as an advocate for his constituents and local patients. He is a great credit to the people of Stafford and, party politics aside, being a Member of Parliament is about public service, and he embodies the very best of that in the work he has done in bringing forward this Bill and in his advocacy of the needs of his local patients.
Mr Jamie Reed
Thank you for calling me to speak, Madam Deputy Speaker, and happy new year.
I listened closely to the hon. Member for Stone (Sir William Cash) introducing his new clause 4 and to the other hon. Members who have spoken on it. They are correct to say that good communication between professionals and patients is crucial for ensuring positive health outcomes. I would go so far as to say that it is critical. One of the issues that we need to address in this regard is the needs of patients with sensory impairments, such as deafness and blindness. That is not covered by the new clause and it has no regard for nationality or language skills.
In April 2010 the Health Committee conducted an inquiry called “The use of overseas doctors in providing out-of-hours services” following the tragic death, to which the hon. Gentleman referred, of David Gray in 2008 after receiving medical treatment from Dr Ubani from Germany, who was working his first shift as an out-of-hours doctor in the United Kingdom. The report recommended that the Government make the necessary changes
“to enable the GMC to test the clinical competence of doctors and undertake systematic testing of language skills so that everything possible is done to lessen . . . the risks of employing another unsuitably trained . . . doctor in out-of-hours services.”
Following this case, I understand that the Government have, with the support of Labour, worked to strengthen the powers of the General Medical Council in this regard. We welcome that.
Notwithstanding all this, I am unsure what the hon. Gentleman is trying to achieve. Given the existing practice of the GMC, the new clause, although agreeable in principle, is superfluous. The GMC conducts English language assessments already, and failure to undertake an assessment or failing such an assessment can result in fitness to practise hearings, which can lead to a loss of registration to practise.
These assessments can be triggered in a number of ways. A single complaint from a patient, a health professional or another party can result in an assessment, as can prescribing errors and poor record keeping. Overseas medical regulatory authorities can prompt an English language assessment if they believe that a doctor does not have sufficient knowledge to treat patients in an English-speaking context. Indeed, the GMC website tells international doctors that
“you must satisfy us you have the necessary knowledge of English to get registration with a licence to practise”.
So the GMC needs to be satisfied before a licence to practise is granted. These tests relate to all forms of communication—speaking, reading, writing and listening. It is right that the GMC continues to be vigilant in its oversight of this requirement. Good communication is central to patient safety, and the GMC does a great deal to ensure that those practising in the NHS have the skills required to do so safely.
I want to place on record an acknowledgement of the contribution made to our national health service, which I know nobody doubts, by the many overseas health care workers without whom the NHS would not be able to cope, including in my constituency. On Second Reading of the National Health Service (Amended Duties and Powers) Bill, my hon. Friend the Member for Bolsover (Mr Skinner) commented that he had received a “United Nations heart by-pass” operation, by which he meant that people from all over the world had done a great deal for the health of this country, and we should all be thankful for that.
We have touched briefly on unintended consequences. Some politicians have recently sought outside the House to manipulate and inflame the issue with a view to creating an imaginary bygone Britain in the public consciousness as part of a long-standing flight from reality based on bizarre notions such as “gay rain”, the enforced segregation of breastfeeding mothers from public spaces and the right to use racist language. We must all be careful not to legitimise this abhorrent, detached, cultish behaviour or the perverted mindset which underpins it.
Dr Poulter
I am grateful to my hon. Friend the Member for Stone (Sir William Cash) for tabling the new clause. We all agree that it is vital that doctors can speak and communicate effectively in English. My hon. Friends the Members for North East Somerset (Jacob Rees-Mogg) and for Shipley (Philip Davies) made a number of important points.
I hope I can bring some reassurance to hon. Members that there are already in place, thanks to changes introduced by this Government, a number of strong tests for language competency and the ability to communicate. It is not good enough for a medical professional to be able to speak English; it is important in all aspects of health care that we can communicate effectively with our patients. The ability not just of doctors from overseas when they work in and contribute to the NHS, but of doctors who have been working here for many years to communicate effectively is at the heart of good medicine. There are a number of steps that this Government have taken to strengthen the tests in place.
To echo the comments of the shadow Minister, I have worked alongside many doctors and many health care professionals from all over the world who have come here to contribute to our NHS and to the care of patients. Many of those doctors have been outstanding and continue to look after patients today as we debate the new clause. One of the strengths of our diverse NHS is that because we have a world-class health service, doctors want to come here and contribute as part of their careers, often for a short period, before they return to New Zealand, Australia or the many other countries from which they have come. The diversity of our NHS and the fact that we attract doctors—often the very best doctors—from all over the world is a great strength, but it is vital that all doctors can both speak English and communicate effectively in English. That is not controversial, and it is what good patient care is all about.
Clause 5 and the schedule will introduce a consistent overarching objective for the Professional Standards Authority and professional regulators—the General Dental Council, the General Optical Council, the General Osteopathic Council, the General Chiropractic Council, the Nursing and Midwifery Council, the Health and Care Professions Council and the General Pharmaceutical Council—to ensure that public protection is at the heart of what they do.
The clause introduces the term “well-being” into the objectives of a number of these regulators. This has been a long-standing and established feature of the legislation for the General Pharmaceutical Council, the Health and Care Professions Council and the Nursing and Midwifery Council. The term encompasses those aspects of a health care professional’s role that may have an impact on individuals but may not directly impact on their health or safety: dignity, compassion and respect are all vital aspects of delivering high-quality care. This was highlighted most starkly in the Francis inquiry report of February 2013, which put into focus the terrible and serious failings in the care provided at the former Mid Staffordshire NHS Foundation Trust, which was the basis on which my hon. Friend the Member for Stafford (Jeremy Lefroy) introduced the Bill.
One specific area where real changes in the protection of patients are being made relates to the strengthening of arrangements to ensure that all health care workers have sufficient knowledge of English and the ability to communicate effectively with patients in English before being allowed to work in the UK. The General Medical Council has always been able to check the language skills of doctors from outside the European Union who want to practise medicine in the UK. It does this through the international English language testing system, which covers all four language skills—listening, reading, writing and speaking—and it is widely accepted by employers, the other health care regulators and professional bodies as a means of assessing proficiency in English in a professional environment. The GMC continually assesses the effectiveness of this test to ensure its robustness.
In addition to this test of their language skills, the GMC conducts a professional and linguistic assessments board exam—often called the PLAB exam—for doctors from outside Europe. This tests their reactions to a number of clinical scenarios and their ability to apply their clinical knowledge to the treatment of patients and is the main route by which international medical graduates demonstrate that they have the necessary skills and knowledge to practise medicine in the UK.
However, following the death of a patient, David Gray, and the tragic circumstances surrounding that death in 2008 after he received medical treatment by Dr Ubani, a German national, where language skills were a strong component in the incident, a House of Commons Health Committee report recommended that the Government change the law to allow the GMC to extend language tests to doctors within the European economic area, providing consistency in how doctors from both within and outside the EEA are treated with regard to assessing their language skills, before being allowed to practise medicine in the UK.
The Government made a commitment in the 2010 coalition agreement, which the shadow Minister has mentioned, to stop foreign health care professionals working in the NHS unless they have passed robust language tests. We have fulfilled that commitment in respect of doctors, and we are now putting in place additional measures, through section 60 orders, to introduce language testing for other health care workers.
Sir William Cash
Is the Minister satisfied that the measure complies with European law and that we do not need a notwithstanding arrangement? He may hope that it will not fall foul of the European Court of Justice, but has he taken advice on that? If not, will he do so after we have finished our proceedings?
Dr Poulter
I hope I can reassure my hon. Friend on that. I am absolutely sure that our measures are consistent with European law and I took advice consistently on that, although there was a difference of opinion in how the previous Government and this Government interpreted advice. I work very closely with the General Medical Council, which receives its own independent advice, and I worked with its former chair, Sir Peter Rubin, who has been a tireless campaigner for the measure. Together with the GMC, we introduced measures that are consistent with European law and mean that we are able to test the language competency of EU doctors. I am sure that there is consistency: a similar process is in place in Bavaria in Germany. Although there can be free movement of qualified health care professionals to different member states—their skills can benefit our NHS—it is also important that they can perform a doctor’s functions properly, and it is not possible for them to do that if they cannot speak English and communicate effectively with patients. Our measures are consistent with the advice I have received and, indeed, with the views of the GMC. This is the right thing to do and I am pleased that the coalition Government have put in place language tests.
Last April, I led through this House changes to the Medical Act 1983 to strengthen the arrangements to ensure that all doctors, including those from within the European economic area, must have sufficient knowledge of English before being able to work and look after patients in the UK.
I hope my hon. Friend will agree that patients are much better protected by the new powers the Government have given to the GMC. When the GMC implemented language checks for European doctors in June 2014, it also raised the pass mark for its language tests. The GMC has vigorously used the powers given to it by the Government. Since the Government changed the legislation last April to strengthen the language test arrangements, 128 EEA doctors have been refused a licence to practise medicine in the UK owing to inadequate language skills. That shows that the measure is working to protect patients in the UK from EU doctors who cannot speak English effectively. It is having an effect—it is biting—and making sure that patients are being properly protected. I will write to hon. Members to outline the measure further, and I will perhaps ask the GMC to contribute to that letter. The measure was long overdue and I am proud that we introduced it. It is protecting patients in the UK from doctors who cannot communicate effectively.
As part of a belt-and-braces approach to ensure that all doctors looking after patients can speak a good standard of English and communicate effectively with them, in 2013 responsible officers in England—senior doctors in health care organisations who oversee the employment of other doctors—were given additional statutory responsibility for ensuring that doctors
“have sufficient knowledge of English language necessary for the work to be performed in a safe and competent manner”.
In addition, on medical revalidation, which was raised by my hon. Friend the Member for Shipley, the Government have taken the important step of ensuring that all doctors must show evidence of competency on a maximum of a five-yearly basis in order to maintain their medical licence. That has improved checks on all aspects of a doctor’s work, including how well they work as part of a multidisciplinary team, how well they communicate with their patients and whether they are keeping up to date with medical practice.
Philip Davies
I welcome what the Minister has said and commend him for that initiative. In order for us to be able to see how robust the revalidation process is, can he tell us how many people have been through it and how many have failed as a result?
Dr Poulter
The revalidation process is ongoing and is reviewing everybody on the medical register. It is very easy to revalidate someone who is training to be a specialist as a surgeon or in some other hospital position, because they are assessed annually as part of their specialist training. The revalidation process for the consultant and general practice work force—which kicked off as a five-year programme—is ongoing. Some people have volunteered to come off the medical register, including retired doctors who have not practised for some time. I would be happy to write to my hon. Friend to update him on the revalidation process. It will not be completed for another couple of years, but once we have gone through the first cycle of revalidation the process will be easily repeated. I stress that doctors will be revalidated on a maximum of a five-yearly basis. It is possible for the GMC to seek reassurance with regard to certain specialties by requesting more regular competency tests as part of the annual appraisals.
The revalidation process is an important new power that is being implemented effectively. We need to keep it under review because it is important that all doctors, regardless of the proposed new clause on language testing, are competent, keep up to date with medical practice, able to communicate effectively and empathetically with their patients, and work as part of a multidisciplinary team for the benefit of patients. That applies to general practitioners, hospital specialists and those working in mental and physical health. It is an important step for which the GMC has been asking for many years and in which other health care professions are taking an interest. The Nursing and Midwifery Council is considering revalidating nurses in a similar way in future. It is a welcome measure that will help protect patients and the public. It is making good progress and I will write to my hon. Friend with further details in due course.
Medical revalidation is the process by which the GMC evaluates whether doctors can keep their licence to practise in the UK. In addition, a doctor wanting to work in general practice in the UK must also be on the national medical performers list, which is managed by NHS England. To be included on the list, the doctor must hold a licence to practise from the GMC and, as a consequence of the revalidation programme, he or she must have effective communication skills.
As I outlined earlier, the key step to improving checks on language competency for EEA doctors was the Medical Act 1983 (Amendment) (Knowledge of English) Order 2014, which made changes to the Medical Act 1983. My hon. Friend the Member for Shipley will be pleased to hear that the title of the order refers to English. After all, the General Medical Council regulates doctors on their ability to speak primarily that language, and I hope that that reassures him.
The order gave the General Medical Council the power to refuse a licence to practise to a medical practitioner from within the EU who is unable to demonstrate the necessary knowledge of English. It created a new fitness to practise category of impairment relating to language competence to strengthen the General Medical Council’s ability to take fitness to practise action where concerns are identified.
For example, if I, as a doctor, worked with a doctor about whose language competency I had concerns, or if a doctor was not able to communicate effectively in their day-to-day work, I, fellow health care workers and patients could report the doctor to the GMC, which—in addition to the existing initial point-of-entry language testing powers and the revalidation process—now has new powers to take action specifically in relation to such language concerns. That is another important measure that the Government have introduced to strengthen the GMC’s powers on language testing.
The change enables the GMC to require evidence of English language capability as part of the licensing process in cases where language concerns are identified during registration. Just as doctors from outside the European economic area can be tested on their language competency, the same competency tests now apply to doctors coming to work in the UK from within the European economic area, thanks to the new regulations. We hope that the wrongs identified following the dreadful Daniel Ubani case and the tragic death of David Gray have now been righted through very strong legislation to ensure the competency and ability to communicate in English of all doctors coming to work in the United Kingdom. As I have outlined, additional measures are now in place to enable the GMC to take action if concerns are raised during the ongoing medical practice of any doctor about their ability to speak English and to communicate effectively with their patients.
The process for determining whether a person has the necessary knowledge of English is set out in the General Medical Council (Licence to Practise and Revalidation) Regulations Order of Council 2012. The GMC has published guidance setting out the evidence required to demonstrate that a person has the necessary knowledge of English. With regard to the fitness to practise changes that have been introduced, a new category of impairment relating to English language capability has been created, which allows the General Medical Council to request that a doctor about whom concerns have been raised undertakes an assessment of their knowledge of English during a fitness to practise investigation.
The changes have hugely strengthened the General Medical Council’s ability to take fitness to practise action where concerns about language competence are identified in relation to doctors already practising in the UK. We are in the process of bringing in similar powers for the Nursing and Midwifery Council, the Pharmaceutical Society of Northern Ireland, the General Pharmaceutical Council and the General Dental Council to ensure that the health care professionals they regulate—nurses, midwives, pharmacists, pharmacy technicians, dentists and dental care professionals—will also have appropriate language skills for the roles that they perform. The consultation on our proposed legislative changes for those four regulators closed on 15 December, and we will publish the outcome shortly with a view to immediate legislation.
I want to pick up the good point made by my hon. Friend the Member for North East Somerset about the need for primary legislation. I hope that he is reassured that the existing legislation, and the ability to bring in regulations underpinning that through section 60 orders underpinning the Medical Act 1983 and other Acts, provides the ability to bring in strong regulations to protect patients and the public in respect of language competency. The Government have done exactly that. There will be future opportunities to legislate in the form of a Law Commission Bill, which would make it possible to neaten up the already very robust and strong regulation on language testing that we have introduced. I am sure that we will consider doing so at the first opportunity.
I hope that such measures will reassure my hon. Friend the Member for Stone. Thanks to this Government, strong laws have been passed, and very strict new rules are now in place to ensure that doctors practising medicine in the UK can do so only if they can communicate with patients using a high standard of written and spoken English. With that reassurance, I hope that he will withdraw his new clause.
Sir William Cash
I have listened to the Minister with great care and interest on the question of language skills. Despite his comprehensive description of the measures brought in, I feel that one or two areas might yet be usefully considered in the other place. I would be extremely glad if somebody raised them, just to test those measures further. This is the first time that we have heard such an excellent and comprehensive analysis on the Floor of the House in relation to a Bill of such importance. We are talking about situations in which there should be zero harm, so we do not want any doubts on the question of English language skills. In practice, I am prepared to withdraw the new clause, with the proviso that the matter should be looked at again in the other place at a future date. I beg to ask leave to withdraw the clause.
Clause, by leave, withdrawn.
Third Reading
Dr Poulter
We have had a productive debate, and I thank hon. Members on both sides of the House for their contributions. I put on record my appreciation for the consensual way that the Bill has been approached by all parties, and I thank the hon. Member for Copeland (Mr Reed) for his constructive attitude. Few private Members’ Bills make it beyond Second Reading, and there is determination across the House to improve patient safety. I hope we can get the Bill on to the statute book as soon as possible.
I commend my hon. Friend the Member for Stafford (Jeremy Lefroy) who, with tireless effort, is doing his best to ensure that the terrible experiences at his local hospital never happen again. The Government have thrown their full support behind this important Bill, which will do much to improve the safety of patients and protect the public. I also commend my hon. Friend the Member for Stone (Sir William Cash) on his dedication to raising some of the issues that led to the Francis inquiry and to this Bill, and for his tireless advocacy on behalf of his constituents in Stone and its surrounding areas.
We would not be where we are with this Bill without my hon. Friend the Member for Stafford. All MPs can learn from his example of outstanding public service and putting the interests of his constituents and local patients first. I congratulate him on his dedication and hard work on the Bill. I also thank my officials in the Department of Health, the Clerks of the House, and everybody who has contributed and put a lot of work into the Bill. It is rare for a Bill to get past Second Reading, and a lot of work has been done. I thank everyone who has supported my hon. Friend’s efforts to make these important changes.
I will not dwell on the importance of the Bill because we had that debate on Second Reading, in Committee and on Report. I am sure we all agree that ensuring that the CQC is operationally independent from the Secretary of State and free from political interference is vital. Not Whitehall nor the Secretary of State, but independent, professional inspectors on the ground who understand what good care looks like must carry out hospital inspections, and the Bill will further support the independence of the CQC.
The Bill will also ensure that we improve the use of information for the purposes of direct care. In Committee we discussed the importance of joined-up care, so that a doctor who receives a vulnerable patient with dementia from a care home is better able to care for them because they have access to care records for the immediate purpose of delivering care to that patient. That saves doctors and nurses time and means they can understand their patient better, and the patient will therefore be cared for in a better way. These important measures will help health care professionals to look after their patients more effectively. As Fiona Caldicott said, there is a duty on professionals to share information for the provision of direct care. That is what the Bill is about and it will hugely benefit patients. I reiterate the Government’s commitment to consulting on the role of the national data guardian in the future.
In conclusion, the Bill is about patient care and safety, which should be at the heart of everything our NHS does. This is what everyone engaged in the delivery of health care is primarily concerned about, and that is why many people—including myself—became health care professionals. We care about patients and want to do our best for them. The Bill will do much to improve the safety of patients and protect the public. It is a welcome Bill, and patients in Stafford and across the country will be grateful to the hon. Member for Stafford for introducing it. I thank him for that and urge hon. Members across the House to give the Bill their full support.
Question put and agreed to.
Bill accordingly read the Third time and passed.
Health Services (Lewes)
Dan Poulter Excerpts(9 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
My right hon. Friend the Member for Lewes (Norman Baker) has raised a number of issues and I will do my best to address them in the limited time available. I will, of course, write to him about any issues I am unable to get on to today.
I congratulate my right hon. Friend on securing the debate. A number of the points he has made are of great importance to both him and his constituents. Before I continue, I want to highlight the extra work carried out every day by all those who work in the NHS in his constituency, including staff alongside whom I have worked during my time in the NHS. During a busy time in winter, we should be proud of our front-line staff and the hard work they continue to do, even with the increased demand caused by winter pressure on our health service.
My right hon. Friend was right to say that there is now less bureaucracy in our health service and more money for the front line. Thanks to our having stripped out some of the bureaucracy, we will have £6.5 billion more for front-line care over this Parliament than we would otherwise have had. That has been independently audited, and I am sure that all patients in Lewes and elsewhere are very pleased with that.
Primary care trusts have been replaced with clinical commissioning groups. My right hon. Friend talked about some of the historical frustrations with PCTs in his constituency. I hope that the changes made on the introduction of CCGs—their clinical leadership is provided by clinicians who have actually looked after patients and understand their needs—will already have led to improvements in care in his constituency. The fact that some of the reviews now taking place are led by clinicians who run the process of allocating local health care funding will ensure that the right decisions are made about local health care priorities and about meeting the needs of patients.
Health and wellbeing boards now ensure that health and social care services are better joined up, which is important for looking after vulnerable patients, the disabled and the frail elderly. Health and wellbeing boards provide an opportunity to integrate services further, which is particularly important in a very diverse county, such as East Sussex, with rural as well as urban areas. East Sussex health and wellbeing board is grasping the opportunity to join up the local provision of primary community care, the acute sector and social services care.
An important part of meeting some of the challenges faced by the local NHS—my right hon. Friend mentioned the issue of the throughput of patients at Brighton—is to join up adult social care with NHS services better to ensure that acute beds can be freed as quickly as possible for those who are the most sick, with others being transferred into the most appropriate care setting. I know that the local health and wellbeing board takes an active interest in that issue.
My right hon. Friend raised issues about health services in Seaford and Polegate. As he rightly outlined, high-quality premises are an important part of ensuring high-quality primary care services. I understand that NHS England’s Surrey and Sussex area team is working with the Old School surgery in Seaford to explore options for the improvement of its facilities. The capital funding to create new consultation rooms for the Downlands surgery in Polegate has been agreed, and the work is intended to be completed by April 2015. That will bring improvements to patients who attend that surgery. I understand that there have been some quality issues with the premises of another practice in Polegate, the Manor Park medical centre. From memory, it is on a crossroads in the town centre. That issue is in the forefront of the mind of the Surrey and Sussex area team, which reassured me yesterday that it is looking at how to improve the situation.
Such issues are not just for the local clinical commission group; there might be a role for the local authority—perhaps with contributions from developers, where available—to support the local NHS by building new facilities. In areas of housing growth, such as around Eastbourne, the local authority could work collaboratively to collect developers’ contributions to put in place local infrastructure for schools and the local NHS. I am sure that that will be considered as a result of this debate. There is also an opportunity for the local NHS to work more collaboratively with the local authority to address some of the premises issues and to improve the quality, size and capacity of places in which local patients are treated.
As I have said, local clinicians and local authorities have been empowered through the creation of clinical commissioning groups and health and wellbeing boards to bring together health and social care. That is particularly important in the context of the issues relating to Seaford that were raised by my right hon. Friend. I am aware of the changes made at Seaford day hospital, and he outlined some long-standing frustrations with earlier decisions made by the PCT. I understand, however, that Horder Healthcare has taken over the hospital to run services, and that physiotherapy services are being provided there, which is at least a step in the right direction.
As part of the East Sussex Better Together programme, plans are being developed to bring as many services as possible, such as out-patient and diagnostic services, closer to people’s homes and communities. It is particularly important to minimise the travel that frail and elderly patients have to undertake when they need access to local health care services. Seaford is one of the key local communities that is under consideration as part of the Better Together programme. More generally, the Better Together programme is about the three local CCGs in East Sussex and the county council working together to ensure that there is a more integrated approach to delivering more community-based care across the county. That is a welcome step forward.
I am sure that the important addition of clinical input now that clinicians are leading CCGs will ensure that there is more joined-up working. The Better Together programme will look at where it is possible to join up primary and community health services, as well as at where out-patient clinics can appropriately be provided in a primary care setting. As far as is possible, we should have a one-stop shop for patients, particularly older patients. There could be blood testing for warfarin control, diagnostic services, GP services and other high-quality local community health care services in one location. Where that can be offered, it is of huge benefit to patients. In my conversations with the CCG yesterday, I was very pleased to hear that the Better Together programme is looking at exactly how to achieve that in the Seaford area. I have asked it to discuss further with my right hon. Friend how it intends to take that forward over the next few months.
It is important to talk briefly about the issues that my right hon. Friend raised about the future of Lewes Victoria hospital, which I know well, having performed some day operations there in the past with my then consultant. I understand that in October 2014, High Weald Lewes Havens CCG initiated a formal procurement process to enhance and improve the community services contract. As part of the general review of services, community services will clearly play a key part in delivering services closer to home. Lewes Victoria hospital has a track record of delivering high-quality community-based care.
A new contract for the hospital is expected to be awarded in spring 2015. That will be followed by a period of transition planning, with a view to having the new community services contract in place by the autumn. The CCG has confirmed that it plans to continue providing community health services from Lewes Victoria hospital and it is keen to ensure that the skills and expertise of the existing community services staff and the three community hospitals in the area are at the heart of plans to improve patient care and experience. I am very reassured by my conversations with the CCG that the future of Lewes Victoria hospital as a centre for delivering community-based care, day case operations and other high-quality care for people in Lewes and the surrounding areas is very secure. I am sure that that will be welcomed by the people of Lewes and the surrounding areas.
In the time that is left, I turn to the services at Eastbourne district general hospital. The hospital continues to offer a wide range of services, including emergency, out-patient, medical, surgical, diagnostic and day surgery services. I am aware that some of the services provided by East Sussex Healthcare NHS Trust have been relocated since 2013 and that improvements in patient safety have been achieved through that. I will come back to that a little later.
Although consultant-led maternity services, overnight paediatrics, orthopaedics and emergency general surgery have been sited at the Conquest in Hastings, other services, such as acute stroke care and ear, nose and throat services, have been centralised at Eastbourne, so it would not be fair to say that Eastbourne district general hospital has been the loser in the redistribution of services. It has gained from the addition of acute stroke care and ear, nose and throat services. I will turn to maternity services in a moment.
Health care commissioners are assured that there have been significant improvements in patient outcomes since stroke services have been centralised at Eastbourne. Better care is being delivered to patients as a result, which is something that both my right hon. Friend and I welcome. The trust is performing above the national average against a number of standards for stroke care.
Maternity care has been a challenge for the trust, and an emotive and controversial issue locally. One historical issue concerned safe staffing levels for maternity units, because I believe that the Conquest and district general hospitals both managed fewer than 2,000 births a year. There was a particular challenge with a lack of consultant senior cover out of hours—that is important to protect patient safety—and a challenge in encouraging and recruiting junior doctors to staff the middle-grade rotas at those trusts. Although I understand that the changes are emotive and controversial, they were about ensuring that the highest quality of care could be delivered for women, and a midwifery-led unit at the DGH now promotes choice. There are ongoing enhancements to the midwifery-led unit in Crowborough, and acute obstetric services are being centralised at the Conquest.
Perhaps it will reassure my right hon. Friend to know that following the changes, the number of serious incidents at the trust decreased from 17 between June 2012 and May 2013, to six for the same period in 2013-14. Clinical evidence points to a safer and better service for women, although I understand that these are emotive issues. East Sussex county council’s health, overview and scrutiny committee continues to provide rigorous scrutiny of those services, and has agreed that the decision to single-site consultant level maternity and in-patient paediatric services was in the best interests of the health service and the residents of East Sussex.
I am running out of time so I will wrote to my right hon. Friend about the issues he raised about St George’s park and ambulance response times, but I congratulate him again on securing this debate on an issue that I know is of great importance to him and his constituents. I encourage him to liaise directly with the local NHS and to continue championing these important issues.
Question put and agreed to.
Autism: Diagnosis of Children, Hull
Dan Poulter Excerpts(9 years, 4 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I congratulate the hon. Member for Kingston upon Hull North (Diana Johnson) on securing this debate on what is an important issue for her constituents and for many families, both in Hull and across the country. She made a strong advocacy for the needs of Thomas and many of her other constituents, and discussed some of the challenges locally as well as the flooding of facilities in Walker street, which has affected services. I think she would agree that the situation that has developed locally over time is unacceptable. I hope I will be able to reassure her that improvements in access to services are taking place and that improvements have been made over the past 18 months or so.
The National Autistic Society estimates that there are about 700,000 people in the UK with autism. We know that the right support from an early age, as the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) said, can make a huge difference to the quality of life for children and adults with autism and for their families.
Before I address some of the specifics of the local issues in Hull, I think it is worth talking about some of changes this Government have made to improve lifelong support for people with special educational needs such as autism. I hope that will address the questions the hon. Member for Kingston upon Hull North asked in her closing remarks about improving services for people in Hull with autism.
The Children and Families Act 2014 introduced, from September, new joint arrangements for assessing, planning and commissioning services for children and young people with special educational needs and disabilities. In the past, many children and their families have encountered a disconnected and fragmented system. Families, particularly those with a child with complex needs, have often faced a battle to secure all the necessary support services, finding themselves repeating the same story over and over again to different providers who are not integrated or working together properly.
The new framework will change that. It is designed greatly to improve integrated working across health, education and social care, and to deliver improved outcomes for children and their families. CCGs and local authorities will work together to agree a local package of support services for children with special educational needs and to develop personalised education, health and care plans for each child who needs one, focusing on the outcomes that will make a real difference to the individual child and their family and friends.
Each child, and each young person up to the age of 25, who needs an individual education, health and care plan will have one tailored to their individual needs, including their options for future employment and independent living. Involving the child and the family at every stage of the process is, of course, essential. The plan must be developed in collaboration with the child and the family, and should cover the range of services that the child will receive and the specific outcomes each service will deliver. The plans will also have a section for the child and the family to talk about themselves, their wishes and their aspirations, to set the context for the assessment of need. I am confident that this new approach will be a powerful tool to better join up and integrate services across the local NHS, education services and local authorities for the benefit of both children and adults with autism.
On the specific issue of waiting times for diagnosis in Hull, we know that children with autism can benefit from receiving specialist services as early as possible. The hon. Lady made that important point. The new education, health and care plans will help to ensure that children receive all the support they need, but a diagnosis is of course crucial in identifying from which services a child might benefit.
Hull CCG has committed to commissioning services with the aim of providing autism assessments and diagnoses within 20 weeks of referral, as the hon. Lady said. The CCG acknowledges that it is currently far from meeting that target. I agree with her that the situation at the moment is unacceptable. The current longest wait is almost 64 weeks, which is not appropriate or good for families. It is not right that anyone should have to wait that long, and it adds stress to what is often already a difficult time for families and children.
It is vital to recognise that NICE has guidelines on the importance of early and timely access to autism services for a diagnosis, but we must also accept that when the CCG took over commissioning from the primary care trust in April 2013, it inherited an even worse position than the one we have now. The hon. Lady was disparaging about CCGs, but I hope that will give her some reassurance that the clinical leadership of the CCG—together with the changes put in place as a result of the local education, health and care plans—are improving the quality of services.
Although only 52 children were waiting when the PCT transferred its responsibility to the CCG in April 2013, the longest wait at that point was 129 weeks, which is two and a half years. Hull CCG is working hard to address the issue of long waiting times for the assessments, and it has made substantial progress. The longest wait is now less than half the figure of 129 weeks. That reduction has been achieved while demand for autism services has been rising rapidly. The number of children requiring an assessment has increased sixfold, from 52 in April 2013 to 299 in December 2014. However, the long wait for services has halved, so some progress has been made.
Like many areas across the country, Hull has seen a large increase in the number of children referred for autism assessments and diagnoses. If the growth in the number of referrals means that more children with autism are receiving a diagnosis and therefore access to the services that they need to succeed in life, then the trend is obviously positive. However, it does of course put pressure on the multidisciplinary teams working to provide the assessments needed for autism diagnoses.
The hon. Lady drew attention to the fact that, in accordance with NICE clinical guidelines, Hull CCG commissioned an autism team made up of staff from a range of specialties and working for various providers. In response to the increase in demand for assessments, the CCG has been working with local providers to recruit additional staff to the autism team. However, it has found that recruiting to some specialties in the Hull area, particularly speech and language therapy, has been a challenge.
The CCG is continuing to work with local health and care providers. I had a conversation with the CCG area team earlier today, and I was reassured that it is now looking with greater vigour to recruit more permanent staff where there are challenges. In the meantime, there is an agreement with current staff for them to put in additional hours to support better access to services. That is only part of a short-term solution, however; the long-term one has to be to recruit more staff, particularly in vital services such as speech and language therapy. I was encouraged to learn, during my conversation earlier today, that greater emphasis will be put on long-term recruitment in the Hull area.
The CCG has also improved working practices in the autism team, which has freed up time to allow more assessments to take place. However, it is important to remember that, as the hon. Lady mentioned, Hull CCG lost an important clinical space when the Walker street children’s centre, a critical area for the service, was flooded during a tidal surge in December 2013. The centre allowed complex, multi-therapist diagnoses to be made, and its loss has had serious repercussions for the local service, which is not good for the delivery of timely access to diagnostic and other care services for people with autism. However, the CCG plans to reopen the centre early this year, which will go some way to reducing the waiting times for assessment. I hope that that reassures the hon. Lady and her constituents.
In the meantime, while the local NHS continues to work towards its commissioned target of a 20-week waiting time for autism assessments and diagnoses, it is also working to assist parents who are facing the current long waits for such assessments. The CCG is ensuring that while families are on the waiting list, they are able to contact the autism team. That enables them to access appropriate information and support services pending a formal diagnosis, which I believe is available from both voluntary and private providers in the area. That does not, of course, make the long wait for assessment and diagnostic services acceptable, but it means that families are not left completely unsupported and alone at what can be a difficult time.
Diana Johnson
I am listening carefully to the Minister and I am grateful that the CCG has been willing to brief him in a way that it was not willing to brief the local Member of Parliament. Does he find it acceptable that families are being told there is a 20-week wait for a diagnosis when clearly that is not the case? The wait is much longer, yet parents and families are still being given that false information.
Dr Poulter
I agree that the current situation is not acceptable, but the CCG inherited a much worse position from the primary care trust, and it has made progress in addressing the needs of those who have been waiting the longest. As I described earlier, in April 2013 when the CCG came into existence, the longest wait was 129 weeks. In October 2014 that had fallen to 81 weeks, and by December 2014 to 63 weeks. Progress is being made to deal with those unacceptably long waits, but ensuring that all families receive timely access to services must be the next priority. I am sure that the reopening of the Walker street service will be helpful in that respect, and that the hon. Lady will hold the CCG to account and bring the matter back to the House if it does not deliver improved services in the near future. Progress has been made in dealing with those long waits, but there is a much greater need to ensure that all patients receive timely access to a service. While a 20-week waiting time is a strong move in the right direction, in future patients should expect the service to move towards NICE guidelines.
Let me talk briefly about the broader issues that were raised in some of the interventions, such as training for staff. It is important that all NHS staff have a greater awareness of autism. The mandate for Health Education England was set by the Government and includes a requirement to develop a bespoke training course to allow GPs, who are often the first point of contact for many families, to develop a specialist interest in the care of young people with long-term conditions—including autism—by September 2015. Hon. Members may also have seen this week’s announcement by the Royal College of General Practitioners, which has launched a training programme for its members to improve the diagnosis of autism and support. I welcome that because when primary care is the initial point of contact for so many families, it is important that general practitioners have greater awareness and training in the challenges facing families with autism, and in how to recognise a child that may have autism.
The Government have provided grant funding to the Royal College of Paediatrics and Child Health to lead a consortium of voluntary sector partners and medical bodies to develop an extensive programme of resources—Disability Matters—to be launched in early 2015. It is designed not only for health professionals but for the wider work force that engages with children, and will help to raise understanding in the NHS about how to support families and young people with disabilities, including autism. Importantly, the more we do to educate not just the health work force but those who work with children with autism more generally, the more we will encourage early access to the support that those children and families need.
I commend the hon. Lady for her important and well-made case on behalf of her constituents with autism, and for raising an important matter about what has been unacceptably poor access to autism services in Hull for a number of years. I hope she is reassured that the CCG is beginning to make some progress, and I know that she and the right hon. Member for Kingston upon Hull West and Hessle, who is sitting next to her, will do all they can to hold the CCG to account. I know they will not hesitate to bring this matter back to the House if improvements are not made in the months ahead.
Question put and agreed to.