General Dental Council
Dan Poulter Excerpts(9 years, 5 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
It is a pleasure to serve under your chairmanship, Mr Hollobone, and a great pleasure to respond to my hon. Friend the Member for Mole Valley (Sir Paul Beresford). I congratulate him on securing the debate and on bringing to bear his front-line experience of working as a dentist, both in this debate and more generally. He has shown his experience today in getting to the heart of some of the issues he raised, as he has done in many debates in the House on issues relating to health care.
The General Dental Council is an important part of the health care regulatory framework that ensures the fitness to practise of health care professionals and the safety of patients. It is right that we should debate the GDC’s performance, particularly in the light of a less than complementary performance review by the Professional Standards Authority, and given the major rise in the fee that dentists will be expected to pay to their regulator.
My hon. Friend will be aware that the General Dental Council is an independent statutory body that is directly accountable to Parliament. However, as he rightly highlighted, I have no legal basis to intervene in matters such as the level of the fee, which are deemed to be part of the body’s operational running. However, in my role as Minister, I have a keen interest in the performance of the professional regulators and have regular contact with them, including the GDC, on a whole range of issues.
The background to today’s debate is that the General Dental Council recently took the decision to increase the annual registration fee for dentists by 55%, from £576 to £890, which is a significant and unprecedented increase. All professional regulators, including the GDC, are aware of the Government’s position, as set out in our 2011 Command Paper, “Enabling Excellence: Autonomy and Accountability for Health and Social Care Staff”: we do not expect registration fees to increase unless there is a clear and strong case that the increase is essential to ensure the exercise of statutory duties.
While the General Dental Council has consulted its registrants on the proposed fee rise, I am aware of, and sympathetic to, a strong body of opinion among its registrants that they are yet to be presented with compelling evidence to justify such an unprecedented fee increase. The proposed fee is more than double the £390 that the General Medical Council requires licensed doctors to pay. That is why, when I met the GDC, I raised concerns about the fee increase and reconfirmed the Government’s position on the need for a strong and transparent case for any such increase.
I have also strongly suggested to the GDC that it considers a differential rate for newly qualified dentists. Newly qualified doctors are required to pay £185 for their registration with the GMC, while newly qualified dentists pay the same as established dentists. The GDC stated to me as justification for its fee rise that there has been a 110% increase in the number of complaints from patients, employers, other registrants and the police about the dental profession, and that the cost of handling such complaints has been the key driver of the increase. However, I have not been presented with what I consider to be compelling evidence that a fee rise of that magnitude is justified by a 110% increase in the number of complaints.
It is worth noting that other health care regulators, as my hon. Friend suggested, have experienced increases in complaints but have not felt compelled to raise their fees to the same extent. I therefore understand why the British Dental Association has chosen to test this decision and issued judicial review proceedings challenging the setting of the fee. The hearing is set to take place next week, so I am sure that hon. Members will understand that it is inappropriate for me to comment further on those proceedings.
Toby Perkins (Chesterfield) (Lab)
I am grateful to the Minister for giving way, and I congratulate the hon. Member for Mole Valley (Sir Paul Beresford) on securing this debate. I have been written to by Derbyshire county local dental committee, which is concerned that the General Dental Council, under the leadership of its current chair, is investigating much more minor concerns than it did previously. That expansion in its role is one of the reasons why it is now asking dentists for more fees. Will the Minister let us know whether he thinks that the direction that the General Dental Council is taking is the wrong one, as my constituents clearly do?
Dr Poulter
As I said, under legislation, I am unfortunately powerless to intervene directly on fee setting. We recognise the independence of health care regulators and would not want them to be micro-managed by Government; that would be wrong. However, my view is very clearly, as I have outlined, that a strong evidence base is needed to justify a fee rise. Given that other health care regulators faced with similar challenges have not raised their fees to the same unprecedented degree, I have not myself been convinced that the evidence base is strong enough to justify this fee rise. I hope that that answers the hon. Gentleman’s question.
In that context, it is worth drawing attention to the section 60 order currently in progress in the House, and to the consultation process that has been taking place. The fee rise is perhaps all the more surprising as we are making good progress with the GDC on bringing in the legislative changes that will reform the way that it operates. Those changes, in the form of a section 60 order, will assist with reducing its operational costs by an estimated £2 million a year through potential efficiency savings. My hon. Friend the Member for Mole Valley made the point that all regulators need to look at better ways of working and efficiency savings in their own practice. Of course, that, as well as patient protection, is a benefit of introducing a section 60 order: it will help to reduce the running costs, potentially, of the GDC and streamline processes.
The public consultation on the GDC-related section 60 order recently closed, and the vast majority of respondents were supportive of the proposals. We therefore intend to proceed with the measures and will publish our response to the consultation in due course. My hon. Friend may be surprised to learn, as I was, that the GDC did not wait for the outcome of the section 60 order consultation before announcing the fee rise.
The changes proposed in the section 60 order will: enable the GDC to delegate the decision-making functions currently exercised by its investigating committee to officers of the GDC, known as case examiners; enable both case examiners and the investigating committee to address concerns about a registrant’s practice by agreeing undertakings with that registrant, which have the same effect as conditions on practice, without the need for a practice committee hearing; introduce a power to review cases closed following an investigation—rules to be made under that power will provide that a review can be undertaken by the registrar if she considers that the decision is materially flawed, or new information has come to light that might have altered the decision and a review is in the public interest—introduce a power to allow the registrar to decide that a complaint or information received did not amount to an allegation of impairment of fitness to practise; introduce a power to enable the investigating committee and the case examiners to review their determination to issue a warning; and ensure that registrants can be referred to the interim orders committee at any time during the fitness to practise process.
Very similar section 60 orders have been laid before Parliament in conjunction and consultation with other regulators, and a great benefit of those orders is that they are about not just protecting the public but supporting the regulators to have more streamlined processes and reducing costs. Of course, when costs are reduced, we would always expect the savings to be passed on to the people who pay the annual fee.
Sir Paul Beresford
Is there evidence that the other registering organisations have reduced their fees, or keep them down, in the light of the anticipated savings, which would be sensible?
Dr Poulter
If we look at similar organisations, we see that the GMC, for example, has similar practices and processes. The Nursing and Midwifery Council has a very small fee rise, but has seen a similar section 60 process take place. All those regulators, in my view, have taken every step possible to look at their annual fee in the context of the section 60 orders, and with the mindset that any fee rise needs to be fully evidence based and appropriately proportionate. From my conversations, and from the practice of other health care regulators, I think that there is very good evidence that that is a consistent pattern of behaviour. As I said, the GDC’s fee rise is unprecedentedly large, and its behaviour is not consistent or in keeping with that of any of the other health care regulators, from what I can see.
In addition to the GDC-related section 60 order, the Government are taking forward a number of key pieces of secondary legislation in this Parliament to address priority areas that we have identified after discussion with the regulatory bodies and other stakeholders; I mentioned other section 60 orders. We are also working on a response to the Law Commission’s valuable work on proposals for more wide-ranging reforms.
I am aware that the decision not to progress a professional regulation Bill in the current Session has come as a disappointment to interested parties. However, that decision provides an opportunity to invest time in ensuring that that important legislative change is got right, for the benefit of those who will ultimately be affected by it. My hon. Friend outlined very articulately some of the challenges that need to be considered in putting together the Bill. We are committed—I would like to put this on the record again—to bringing forward primary legislation to address wider reforms to the system of professional regulation when parliamentary time allows, but in the meantime, working with the regulators, we have put in place, or have in train, a number of section 60 orders. They are about streamlining processes, providing efficiencies to the regulators and, most important of all, protecting patients and the public.
Let me say a quick word about the GDC’s general performance. It is very important that the GDC manages its rising volumes of complaints as well as the other issues raised by the Professional Standards Authority as part of its annual performance review. In due course, the GDC will need to demonstrate what it has done to address the recommendations made.
Hon. Members may be aware that the Professional Standards Authority is also conducting an investigation of the GDC after claims were made by a whistleblower about the management and support processes of the GDC’s investigating committee. I understand that the Professional Standards Authority has concluded the evidence-gathering phase of the investigation, is in the process of compiling the investigation report, and will provide that report to the Select Committee on Health and publish it on its website in due course.
I have outlined a number of issues and concerns about the unprecedentedly high rise in the GDC fee. As we have discussed, it is out of keeping and inconsistent with the behaviour of many other health care regulators. I am not convinced, from the evidence that I have been presented with, that there is a strongly evidenced case to support that fee rise, and it goes against Government policy, which is to encourage regulators to set appropriate and proportionate fee rises, to show restraint where appropriate and to be mindful of the effects of fees on registrants.
I want to make it clear, in drawing to a conclusion, that I am not raising any doubt about the fact that the GDC continues to fulfil its statutory duties. However, it will need to make significant improvements to meet the challenges set out in the annual performance review undertaken by the Professional Standards Authority. Registrants, patients and the public need to be able to have confidence in the performance of the GDC and to see improvements in its operation, effectiveness and efficiency. I hope that I have answered all the points raised in the debate, and I again thank my hon. Friend the Member for Mole Valley for raising a very important issue that I am sure is filling many MPs’ postbags.
Mr Philip Hollobone (in the Chair)
I thank all hon. Members who took part in the debate.
Oral Answers to Questions
Dan Poulter Excerpts(9 years, 5 months ago)
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Kerry McCarthy (Bristol East) (Lab)
2. What recent assessment he has made of the adequacy of provision of student health services.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
All patients are eligible to register with local primary medical care services, and that includes students who are moving away from home and starting university.
Kerry McCarthy
I do not think that the Minister has entirely engaged with the question. Those who run the student health services at Bristol university are warning that young people’s health is very much overlooked and underfunded—particularly mental health, which accounts for a quarter of all consultations. They are being hit by the GP funding changes and by cuts in public health spending on sexual health advice, and they have had to introduce their own meningitis vaccination programme because the Government have not introduced one. What support can the Minister give specifically to student health services?
Dr Poulter
I certainly remember being actively encouraged to register with a local GP when I was a student at Bristol university, and I understand that that continues today. As for the important question of children’s and young people’s mental health, the children’s mental health and well-being taskforce is looking at the mental health and well-being of students. Student Minds is involved in the process, and that in particular will help to inform the work of the taskforce in improving access to students with mental ill health.
Duncan Hames (Chippenham) (LD)
Students do register with a practice in their university cities, but I was told recently by one of my constituents that she had experienced difficulty in gaining access to timely health care as a temporary resident when she was back at home. What options are available to ensure that students remain registered in the place where they are likely still to be spending half the year?
Dr Poulter
We recommend that all students register with university services, or with a GP in their university areas, but if patients are away from the GP with whom they are registered for more than 24 hours and less than three months—and that would include students—they can see a GP in the area where they are staying as temporary residents. GPs should be aware of that entitlement.
Keith Vaz (Leicester East) (Lab)
Students with long-term illnesses such as diabetes find it extremely difficult to manage their conditions, and there is evidence that a number of students are skipping their insulin injections. What further steps can be taken to make them aware of the necessity for them to take that important medication?
Dr Poulter
This is an incredibly important area of health care. How do we support young people through periods of transition? We know that people with long-term illnesses may struggle particularly, and diabetes and epilepsy are two of the conditions that have been identified. NHS England is currently examining transitional care tariffs to support people during the transition between children’s and adult health services, and educational support is part of that ongoing work.
Oliver Colvile (Plymouth, Sutton and Devonport) (Con)
My right hon. Friend the Minister for Universities, Science and Cities recently announced that there would be no cap on the number of students wishing to study pharmacy. Does my hon. Friend agree that Plymouth university should now press ahead with the setting up of a pharmacy school given that it is the Peninsula medical school?
Dr Poulter
My hon. Friend makes an important point. I visited the Peninsula medical school and his local university to highlight some of their excellent work in training medical and dental students. I believe that there is ample scope to expand provision to train other health care professionals in what is becoming an outstanding medical and health care training facility.
Mr Philip Hollobone (Kettering) (Con)
4. How many patient episodes there were at Kettering General Hospital in (a) 2010 and (b) the last year for which figures are available; and what assessment he has made of the reasons for the change in the number of such episodes.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
In 2012-13 there were 85,497 in-patient finished consultant episodes at Kettering General Hospital NHS Foundation Trust, compared to 84,602 in 2011-12. There has also been an increase in the number of accident and emergency attendances, from 76,099 in 2010-11 to 84,055 in 2012-13. That increase is largely attributable to a high demand for services from a growing, ageing population.
Mr Hollobone
Kettering general hospital serves one of the areas with the fastest population growth and greatest ageing in the whole country. Today’s report from the Care Quality Commission shows that, while the hospital has some of the most caring staff in the whole of the NHS, many areas of the hospital require considerable improvement. Will the Minister ensure that future NHS funding decisions are better targeted at areas such as Kettering which have such costly demographics?
Dr Poulter
My hon. Friend will be aware that the NHS funding formula is set independently, free from political interference. It is reviewed annually. I should like to reassure him that the Nene and Corby clinical commissioning groups have both received higher than real terms growth in their funding allocations and will do so again next year, to move them closer to their target allocations.
Andy Sawford (Corby) (Lab/Co-op)
I have been working closely with the hon. Member for Kettering (Mr Hollobone) in recent years on a campaign to support the hospital. We recognise the issues that the CQC has raised, and we support the journey that the hospital is taking towards improvement. When the hon. Gentleman and I come to see the Minister in a few months’ time, will he look favourably on our bid for £20 million of funding to improve our accident and emergency department, whose physical environment has been described by experts as being among the worst in the country?
Dr Poulter
I am looking forward to that meeting in the new year. I should like to reassure the hon. Gentleman and my hon. Friend that the Department has provided a total of £5 million of temporary public dividend capital funding and a further £1 million of emergency capital to the trust in the past three months, so support is going into the delivery of high-quality services.
Norman Baker (Lewes) (LD)
5. What recent assessment he has made of the potential medicinal benefits of cannabis.
Mr David Crausby (Bolton North East) (Lab)
10. How many (a) NHS trusts and (b) foundation trusts are forecasting a deficit.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
Thirty-three NHS trusts and 60 foundation trusts are forecasting an end-of-year financial deficit, with the remaining 65 NHS trusts and 87 foundation trusts forecasting an end-of-year surplus.
Mr Crausby
Earlier this year, Monitor announced that the number of trusts in financial breach had nearly doubled over the previous 12 months. How confident is the Minister that the number will not double again next year?
Dr Poulter
I am very confident that the measures already in place to drive efficiencies in the NHS are on course to save £20 billion during this Parliament. Many of those efficiencies are being delivered by improved procurement practice at a trust level. The Government have also invested £15 billion during this Parliament, which is a real-terms increase of £5 billion in NHS funding to support trusts.
Robert Halfon (Harlow) (Con)
The Government have invested hugely in the NHS in Harlow, including millions of pounds to our accident and emergency unit. However, for historical reasons the Princess Alexandra hospital has financial difficulties. Will my hon. Friend look at this and see what the Government can do to help?
Dr Poulter
Of course. As my hon. Friend is aware, every local health area—every clinical commissioning group—is receiving an increase in the funding available to it year on year. I would be happy to meet him to discuss the matter further, if that would be helpful.
Mr Gareth Thomas (Harrow West) (Lab/Co-op)
As the Minister knows, North West London Hospitals is one of the NHS trusts that is in deficit. It has seen the accident and emergency departments at two nearby hospitals close, and its hospital board estimates that an additional 123 beds are necessary. Will the Minister meet me to discuss the problems of its historical deficit and the need for additional funding to make sure that those 123 medical beds are provided?
Dr Poulter
I can reassure the hon. Gentleman that, in the words of the medical directors of all the hospitals affected, there is a very high level of clinical support for the programme across north-west London, and the changes will save many lives each year and significantly improve the services that are available to local patients. I hope that is reassuring to the hon. Gentleman and to local patients.
John Stevenson (Carlisle) (Con)
Running a deficit can demonstrate short-term problems which, once resolved, will allow a trust to return to balance. Does my hon. Friend agree that there must be flexibility in the system, particularly for trusts such as North Cumbria, which have been in special measures?
Dr Poulter
It is absolutely right that trusts such as North Cumbria need to face up to challenges when those affect the quality of patient care, and that the focus of Care Quality Commission inspections and special measures is to drive up standards of care. It is also important that we continue to invest and support trusts where we can. That is why we are pleased to be increasing the NHS budget by £15 billion during this Parliament.
Sir Gerald Kaufman (Manchester, Gorton) (Lab)
Is the Minister aware that the Manchester primary care trust ought not to be incurring a deficit because it does not spend sufficient of its money and resources on investigating cases referred to it and on responding to hon. Members such as myself when they write to it over a period of months? Will he look into this incompetence and examine similar behaviour, or lack of it, by the Care Quality Commission?
Dr Poulter
It is very important that the NHS faces up to the situation when things have gone wrong so that it can put them right for the benefit of patients in future. If the right hon. Gentleman has concerns about his local NHS not investigating complaints that he has raised with it on behalf of his constituents who are patients of the local trust, I am very happy to investigate those issues for him if he would like to write to me about them, and see what I can do to ensure that he gets the answers that he and his local patients deserve.
Douglas Carswell (Clacton) (UKIP)
I understand that pretty much every hospital in Essex faces a yawning deficit, including Colchester hospital. Can the Minister guarantee that we can address the deficit without having to dramatically and radically reconfigure local services in Essex?
Dr Poulter
It is important to outline that for the first time this Government have put in place, via section 42 financial agreements with trusts where there is a requirement for interim financial support, measures that will ensure that trusts are held to account for delivering efficiencies—for example, reducing agency staffing costs, improving procurement practice, more efficient estate use and land disposal, and pay restraint of very senior managers. I am therefore confident that the local NHS can continue to deliver efficiencies to direct money to front-line care.
Eric Ollerenshaw (Lancaster and Fleetwood) (Con)
11. Whether it remains the policy of the cancer drugs fund to provide drugs which NICE has rejected for general use in the NHS.
Alex Cunningham (Stockton North) (Lab)
T3. My constituent Corron Sparrow was left lying in the road for two hours with a compound fracture of his leg despite a call from a policeman to the North East Ambulance Service pleading for help. Eventually the service responded by sending an ill-equipped St John Ambulance team who then had to call for professional assistance. There are many more failures. It is now three weeks since I wrote to the chief executive, Yvonne Ormston, asking for an inquiry into this, but she has not even acknowledged my letter. Will the Minister intervene and tell the North East Ambulance Service that it cannot just ignore these matters?
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I am very sorry to hear about the difficulties experienced by the hon. Gentleman’s constituents, and of course I am happy to look into those and do what I can to help him with that. However, I would also like to make it clear on the record that because this Government have put £15 billion more into the NHS during this Parliament, we are making sure that we are keeping services running efficiently through the winter for the benefit of patients.
Sir Alan Beith (Berwick-upon-Tweed) (LD)
T9. Do Ministers agree that the patient transport guidance should be interpreted with an understanding of rural needs, rather than telling my elderly constituents to report to a hospital 60 miles away and to get three buses there and three back that do not connect with each other in order to have treatment or consultation?
Dr Poulter
It is particularly important in rural areas that patients with complex medical needs who have difficulties mobilising or who perhaps do not have access to a car are supported by the local NHS to access the services they need. There is provision for local hospitals, as well as for CCGs, to give financial assistance to support patients in accessing services and to give them lifts to hospitals, as appropriate.
Mr Ben Bradshaw (Exeter) (Lab)
T10. When I asked the Prime Minister two weeks ago about the financial crisis facing Devon NHS, he seemed completely unaware of it, so could the Health Secretary please explain why Devon NHS faces an unprecedented £430 million deficit and what he is doing to stop the rationing, cuts and total withdrawal of some services that is now being proposed?
Charlotte Leslie (Bristol North West) (Con)
One of the key challenges in improving access to GPs is improving recruitment of GPs. Will the Secretary of State work with the Royal College of General Practitioners and other medical groups to see whether there might be merit in introducing a mandatory stint of working in a GP surgery for junior doctors?
Dr Poulter
I am sure that my hon. Friend will welcome the fact that there are now just over 1,000 more GPs working in the NHS and training than when we came into government, but there is more we need to do. We have committed to delivering 5,000 more GPs for the NHS, and part of that work will be working with the Royal College of General Practitioners to ensure that we can support return-to-practice initiatives for GPs who have taken career breaks.
National Health Service (Amended Duties and Powers) Bill
Dan Poulter Excerpts(9 years, 5 months ago)
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Mark Reckless
I think that that is probably correct. I may be guilty of having believed the undertakings I was given by those on the Government Front Bench.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
It might be helpful for the hon. Gentleman to bear in mind the words of his colleague, the hon. Member for Clacton (Douglas Carswell), who said:
“Never one to slavishly support the party line, I would be quite prepared to oppose these reforms”—
the 2012 Act—
“if I felt they were a step back. But I won’t. These changes are necessary—and contrary to much of the mainstream media coverage, in my experience they are quietly supported by many doctors too.”
Does the hon. Gentleman support what his colleague said, or does he not?
Mark Reckless
I think that my hon. Friend the Member for Clacton (Douglas Carswell) was right in saying that some doctors supported the Bill that became the 2012 Act. During the early stages of that Bill, a number of representative bodies supported it, or were presented as doing so. As the Bill proceeded, however, some of what had been claimed to be support from organisations such as the British Medical Association seemed to fall away. I believe that the Bill ran to 460 pages.
The problem was the way in which legislation is made in the House. The coalition agreement promised us a House business committee, but no such committee deals with the allocation of time for legislation. We have a Committee of Selection, but it is run by the usual channels—the Whips on either side of the House—and people with expertise such as the hon. Member for Totnes (Dr Wollaston), who might actually have improved the Bill, were excluded from it.
Dr Poulter
I feel I should quote further from what was said by the hon. Member for Clacton, when much of the Committee stage of the Health and Social Care Bill had been completed. He went on to say—on 11 February 2012, on his TalkCarswell.com website—
“If these proposals were defeated, it would be a setback for all those of us who would like to see public service reform. We need to keep our nerve.”
That rather contradicts what the hon. Member for Rochester and Strood (Mark Reckless) has just said, does it not?
Mark Reckless
That is an excellent website, which I recommend to all Members. The Minister has said that my hon. Friend made those observations when most of the Committee stage of the Bill had been completed. Was that during the “pause” that had been invented as a new mechanism for Parliament? My hon. Friend is not here at the moment, but I think he would agree with me that the 2012 Act is not as it was billed to us by those on the Government Front Bench. It has led to an extraordinary degree of additional complexity in the NHS, and the introduction of competition bodies—and, in particular, European competition law—into the NHS is not welcome.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I shall begin by returning to the founding moment of our NHS, when a national health service was created which remains to this day a world-class health service where care is available to all, irrespective of ability to pay and free for all at the point of delivery. These fundamental principles of our NHS have been cherished and protected by each and every Government throughout its proud history, and were in 2012, for the first time, put on to statutory footing by this Government through the Health and Social Care Act.
Dr Poulter
If my hon. Friend will bear with me, I am going to make a little more progress and then give way later on.
Those who believe that our NHS has always been run solely through public providers are of course very wrong. From its very inception, the NHS that Nye Bevan created has comprised providers in the public and the non-public sectors. In 1948, independent GPs, community pharmacists and dental practitioners contracted with our health service to provide primary medical services to patients, and they continue to do so to this day as part of the public-private partnership. It is worth reflecting on the fact that Tony Blair’s former political secretary, John McTiernan, said only this August that
“an NHS without private providers is unimaginable. For one thing, no one—even on Labour’s extreme left—is arguing that we should nationalise general practice. But GPs are private providers, acceptable to opponents of the ‘private sector’ because most encounters with the NHS are visits to your local doctor”.
We also take for granted the key role played by charities and the voluntary sector in providing NHS care to patients across the country, notably Macmillan Cancer Support and Marie Curie Cancer Care.
In opening my contribution to this debate, I reaffirm this Government’s commitment to the founding principles of our NHS, a health service free at the point of delivery, and recognise that since its creation by Nye Bevan in 1948 our NHS has always been a public-private partnership. For public services to be equitable and free at the point of use, they did not all need to be provided on a monopoly basis within the public sector, controlled in a rigid way by local bureaucracies often deeply resistant to innovation and genuine local autonomy.
“The aim should be to change fundamentally the way the NHS was run: to break up the monolith; to introduce a new relationship with the private sector; to import concepts of choice and competition”.
Those are not my words, but those of Labour Prime Minister Tony Blair about the reforms to the NHS that he introduced under the previous Labour Government.
Angie Bray
Does my hon. Friend agree that the most damaging thing for the NHS—patients and staff alike—is a lot of misleading scaremongering? I am afraid that we have heard more of that in the Chamber today. Will he correct the record to make sure that it is very clear that the pledge made by the Secretary of State for Health that the A and Es at Ealing and Charing Cross hospitals will both remain open for the long term still stands, and that they will allow themselves to be directed by Bruce Keogh’s report such that whatever recommendations he makes on A and E, they will make sure that they meet those requirements?
Dr Poulter
I am happy to confirm and to put on the record the points that my hon. Friend has made. It is important that the NHS is not used as a political football, and that services are always designed and delivered in the right way for patients. There is often too much scaremongering in these debates. I reiterate that what she said about the local A and Es is absolutely correct.
Dr Poulter
I have just dealt with it, and I am going to make a little progress.
I want to deal with the contribution made by the hon. Member for Rochester and Strood (Mark Reckless). He failed to address the issues that I had raised earlier about the support that the hon. Member for Clacton (Douglas Carswell), his party colleague, gave to the Health and Social Bill—now the Health and Social Care Act. In fact, as the right hon. Member for Leigh (Andy Burnham) said, the hon. Member for Clacton thought that the reforms did not go far enough. Indeed, the leader of his party is on record as talking about the need, in effect, to privatise our NHS. I would like to reaffirm the commitment that that will absolutely never happen under this Government or any Conservative Government.
Another important point needs to be made. Earlier this week, the hon. Member for Rochester and Strood expressed frankly unacceptable and distasteful views on repatriation. We must of course bear in mind that 40% of staff in our NHS come from very diverse, multicultural backgrounds. We very much value the contribution that doctors, nurses and health care staff from all over the world make to our NHS. I do not want to see those people repatriated; I want to see them continuing to deliver high-quality care for patients in our NHS—something that UKIP clearly opposes.
Mark Reckless
I have made absolutely no such remarks; I have said only that we wanted such people to be able to stay. The disgraceful remarks were actually made by the Conservative candidate, who juxtaposed the issues of unlimited immigration and fear of crime.
Dr Poulter
I think that the hon. Gentleman’s remarks are very clearly on the record, and I am sure that NHS staff, many of whom come from very diverse, multicultural backgrounds, will be very aware of them. In this Conservative-led Government, we are very proud of the contribution that people from all over the world make to our NHS, and I believe that that needs to continue in the future. As we have seen from the hon. Gentleman’s leader, his party makes it up as it goes along on things to do with the NHS. It is in favour of privatisation and does not value the contribution—[Interruption.]
Sir Tony Baldry
On a point of order, Madam Deputy Speaker. There is so much noise coming from the Opposition Bench below the Gangway that it is impossible even for someone who is as near to the Minister as me to hear what he is saying. Given that Labour Members appear to support this Bill, it would be a courtesy for them at least to listen to the Minister with some attention.
Madam Deputy Speaker (Mrs Eleanor Laing)
The right hon. Gentleman knows very well that all Members exercise their right to speak loudly, quietly, in stage whispers and in other ways in this Chamber. I am listening very carefully to the level of noise, and if it reaches much higher than it already has, I will ask Members to be more courteous to the Minister. However, I am quite sure that the Members present will wish to be courteous to the Minister and to hear what he has to say.
Dr Poulter
Thank you, Madam Deputy Speaker. I am sure that Members in all parts of the House—although perhaps not the hon. Member for Rochester and Strood—would like to reaffirm their commitment to and the value they place on all NHS staff, no matter what background or culture they come from. We want those staff to continue to practise in and work for our NHS to the benefit of patients.
Dr Poulter
I think that the hon. Gentleman has said quite enough already, and I need to make some progress.
Let me move on to the second, substantive, point in this debate, on which I hope there will be a large amount of agreement. It was articulated—
Dr Poulter
Thank you, Madam Deputy Speaker.
The point was articulated very well by my right hon. Friend the Member for Banbury (Sir Tony Baldry) in one of the best and most accurate speeches of this Parliament in an NHS debate.
Mark Reckless
On a point of order, Madam Deputy Speaker. The Minister has made a false allegation to which he has not given me the right of reply. Of course I welcome all those immigrants in the NHS. They are very welcome and we want them to stay as much as he does.
Madam Deputy Speaker
There has been much discussion this morning about who has said what about what. My concern in the Chair is that the Bill should be discussed. That is the matter before the House, and we will discuss it.
Dr Poulter
Thank you, Madam Deputy Speaker. I think the tone of that point of order made my point for me better than I could have done.
As my right hon. Friend the Member for Banbury said in what was one of the best speeches on the NHS I have heard in this Parliament, the Health and Social Care Act 2012 did not introduce competition into our NHS. To say that it did is factually incorrect, scaremongering and distracts the NHS from addressing the key issues it faces. It was the creation of a mixed health economy, implemented by the previous Labour Government, that exposed our NHS to competition law, not the introduction of the Health and Social Care Act.
Andy Burnham
That is a very important point that goes to the heart of this debate and that really needs to be cleared up for those listening and watching. The Minister said that the Act did not introduce competition. Will he confirm that it gave, for the first time, a role to the competition authorities under the Enterprise Act 2002 and that since then they have intervened, for the first time ever in the history of the NHS, in Bournemouth and Poole?
Dr Poulter
What I will confirm is that it is factually correct, as my right hon. Friend the Member for Banbury made clear, to say that it was the previous Labour Government—Tony Blair’s Government—who introduced competition into our NHS. At the end of Labour’s time in office, I believe that £6 billion a year was going to NHS providers. The right hon. Member for Leigh was quite happy to pay private sector providers 11% more than NHS providers for providing the same service. That was Labour’s commitment to the private sector, which we have cleared up and put right in the 2012 Act.
Let us remember what the Labour party said in its last general election manifesto. I am sure Labour Members will remember it well—the right hon. Gentleman may well have written it. It said:
“All hospitals will become Foundation Trusts…Foundation Trusts will be given the freedom to expand their provision…and community care, and to increase their private services”.
That is from the manifesto that every Labour Member stood on at the last election. The facts are clear: competition in our NHS was introduced well before this Parliament and well before this Government came into power. It was introduced by policies made by Members who now sit on the Opposition Benches—the policies of the previous Labour Government.
As my right hon. Friend the Member for Banbury reminded us, it was Labour that introduced the use of independent treatment centres in 2003, the “any willing provider” policy and the advent of patient choice in 2006, and it was Labour’s policies when in government that brought NHS commissioning under the scope of European competition law through the Public Contract Regulations 2006.
Mr Mike Weir (Angus) (SNP)
There is an interesting argument taking place between the two Front Benchers about who is responsible for bringing competition into the health service, but the fact is that, no matter who is responsible, the health service could now come under the transatlantic trade and investment partnership. Why will the Government not specifically exclude health services from TTIP before it is negotiated?
Dr Poulter
I will come on to TTIP later, and I hope I will be able to reassure the hon. Gentleman.
The previous Labour Government attempted to make commissioners compliant with the law by publishing the “Principles and rules for cooperation and competition” in 2007 and establishing the competition and co-operation panel in 2009, to oversee Labour’s NHS marketplace. Let us be clear: it was the previous Labour Government who chose to introduce private providers into our NHS and it was the previous Labour Government who set up the legal framework to support private providers in the health service.
It has been said that
“the private sector puts its capacity into the NHS for the benefit of NHS patients, which I think most people in this country would celebrate.”—[Official Report, 15 May 2007; Vol. 460, c. 251WH.]
Once again, those are not my words, but those of the right hon. Member for Leigh when he was a Minister in the previous Government. That is a fitting memory of the previous Labour Government’s expansion of private providers in the NHS. Let us remind ourselves of the right hon. Gentleman’s words again: he said that most people in this country would celebrate the private sector in the NHS.
Mr Ronnie Campbell
The Minister talks about Labour privatisation, but why is it that so many Conservative Members are being paid by private companies? What are you getting money off them for? What are you doing?
Dr Poulter
I am just a doctor who still works in the health service and I practise medicine for free. Of course, we could go into the fact that I am the only Front Bencher present who has front-line experience of looking after patients. Professional politicians on the Opposition Benches are outlining a case that is incoherent with their record in government. We could also talk about the huge union funding that goes towards many Labour policies, but time would forbid us from doing so and I am sure that the Deputy Speaker would not want me to digress from the subject of this debate.
Let us come on to what the Health and Social Care Act actually did. First, it stripped out an entire layer of management from what was at the time an overly bureaucratic NHS. This is an important point that hon. Members would do well to listen to. The reforms will save our NHS £5.5 billion in this Parliament alone, and £1.5 billion every following year. That money is being put back into front-line patient care. In addition, as I notified the House in an answer to a recent written question, spending on administration as a proportion of the total NHS budget has fallen under this Government from 4.3% in 2010-11 to 2.9% in 2013. More money is going into front-line patient care because we have stripped out bureaucracy and administration and freed up that money to look after patients.
Between 2010 and July 2014, the number of infrastructure and administration support staff in the NHS has reduced by 10.3%, which is about 21,000. That includes a 17.7% decrease in managers and senior managers combined. Savings from reducing bureaucracy in this manner are being ploughed back into front-line patient care. For instance, we now employ 8,000 more doctors and 5,600 more nurses on our wards than in May 2010, and our NHS can do nearly 1 million more operations every year.
Clive Efford
The hon. Gentleman is taking us through a very detailed list of bureaucratic costs. Obviously, the Government are paying close attention to that, but why is it that when I asked them about the cost of overseeing the tendering process—the cost of lawyers, accountants and other advisers—they said that they do not collect that information?
Dr Poulter
I will come on later to the costs that the hon. Gentleman’s Bill would directly create. The point is that we should be proud—the Labour party should be supporting the Government—that we are reducing administration and bureaucratic costs, because that money is now being spent on patients. Why cannot Labour for once accept that a good thing has happened and that more money is now going into front-line patient care?
The second effect of the 2012 Act is that it empowered local doctors and nurses, as those closest to and most able to determine the needs of their patients, to design and lead the delivery of services around the needs of those patients. Thirdly, the Act placed great importance on and sought to drive increased integration across our NHS, a point clearly articulated by my hon. Friend the Member for Bosworth (David Tredinnick). Commissioners had duties placed on them by the Act to consider how services could be provided in a more integrated way, and we have since built on the Act by supporting a number of integration pioneer sites, which will trail-blaze new ideas to bring care closer together, particularly for frail elderly people and people with complex care needs. They will be leaders of change—a change we have to see in the health system, if we want to offer the very best quality of care to patients.
We are also supporting the health and care system through the £5.3 billion better care fund, with commissioners working in partnership with local authorities to deliver more integrated person-centred care. Offering seven-day services and delivering care that is centred on patients’ needs will encourage organisations to act earlier to prevent people from reaching crisis point. That is the sort of clinical leadership that the Act has fostered. It will refocus the point of care towards more proactive community-based care, for the benefit of so many patients.
Grahame M. Morris
The Minister is defending fragmentation, but may I, as a former member of the Health Committee, remind him that Sir David Nicholson, the former chief exec of the NHS, summed up the situation last year by saying:
“You’ve got competition lawyers all over the place, causing enormous difficulty. We are getting, in my view, bogged down in a morass of competition law which is causing significant cost in the system”.
Is the Minister saying that the chief exec is wrong in his assessment?
Dr Poulter
The chief executive makes exactly the point. It was of course the Labour Government who introduced competition into the NHS. If the hon. Gentleman has a problem, he should take it up with his colleagues further along the Front Bench who they introduced competition into the NHS. Monitor, as the sector regulator, must now have regard to having better integrated services, reducing fragmentation and putting more emphasis on the best interests of patients.
The fourth effect of the Health and Social Care Act has been to provide clarity about existing NHS practices on patient choice and competition that were introduced by the previous Government. Under the Act, nothing changed from the rules laid down under Labour on how commissioners should behave when they procure services. That has been borne out, despite the myths and scare stories surrounding the Act. Simon Stevens, a former Labour special adviser under Tony Blair and now head of NHS England, said to the Health Committee that
“if the claim was that CCGs have to start putting all of their health service purchases out to public procurement, that is clearly not true and it isn’t happening”.
That was the current head of the NHS making it clear and putting the record straight on the Opposition’s scaremongering. The NHS agrees: the NHS Confederation stated in its briefing on the Bill:
“The current rules are clear that no-one can pursue competition in the NHS if it is not in the interests of patients.”
Our NHS finances bear that out. In the last financial year, spending on independent health care provision by commissioners was shown to be about 6%, compared with 5% under Labour in 2010. That is hardly evidence of the sweeping privatisation of NHS services, but it is evidence of clinical commissioners making informed, clinically led choices for the benefit of patients.
Dr Steve Kell, chair of the NHS Clinical Commissioners, has made it clear that there is not a clinical commissioning group in the land that has any kind of “privatisation agenda”. What CCGs all share is clinical expertise and an unflinching desire to improve local health services for their patients. This Government will not stand in their way or play party politics with the judgments of doctors and nurses who are making the right choices in the best interests of their patients. Indeed, Dr Michael Dixon, chair of the NHS Alliance, and others wrote in The Daily Telegraph this morning:
“As NHS doctors, we are deeply concerned about the misguided and potentially disruptive National Health Service Bill being debated today.”
Working with other key health care organisations, NHS England—I hope that Labour Members will agree with this uncontroversial point—has set out how the health system must change over the next five years, looking at new models of care delivery and taking a more integrated approach to the delivery of health and care. Earlier in the year, the head of NHS England, Simon Stevens, made it clear that if the procurement, patient choice and competition rules stood in the way of delivering the required changes, he would say so. Clearly, he has not done so.
Let me be absolutely clear: the NHS England “Five Year Forward View” did not call for further legislative change—that is what the Bill proposes—or for structural upheaval or a return to Whitehall control of our NHS. I am sure that we can all agree that NHS England’s “Five Year Forward View” was an important piece of work that deserves to have broad cross-party consensus.
Politicians now need to leave the NHS to get on with the job: let the doctors and nurses run the NHS as we have freed them up to do. We can support leaders in the system, and help to free more money for front-line care through improved NHS procurement, better estate management and reduced spending on temporary staff. However, making top-down legislative change to the system, as the hon. Member for Eltham proposes, would be disastrous at a time when we should focus on supporting our NHS to deliver better care for patients.
It is important to look at what the Bill would do. It is quite simply wrong to believe that removing the parts of the 2012 Act that relate to the competition will stop competition law applying to our NHS.
Mr Anderson
Is the Minister happy that, because of competition, groups such as Care UK have cut professional health workers’ pay by between 35% and 40%? How does he expect those people to feel motivated to go to work every day when they cannot afford to pay their mortgage or to look after their kids properly? Is that really what we should expect in this day and age?
Dr Poulter
The hon. Gentleman will be aware that Care UK provides a lot of the care in the social care sphere. I understand that much of the social care commissioned by local authorities is already provided by the private sector. The big idea of the right hon. Member for Leigh is about driving further integration. Under the integration plans that he has outlined, more power would of course be given to companies such as Care UK. We support integration, but it must be done in a way that always meets the best needs of local patients, and it must be evolutionary change rather than revolutionary change, working with front-line professionals to do the best for their patients.
Dr Poulter
Let me make a little progress on the damage that the Bill might do. As I have said, the belief that removing the parts of the 2012 Act that relate to competition will stop competition law applying to our NHS is simply wrong. That important point goes to the heart of what the right hon. Member for Leigh has said.
Dr Poulter
If the hon. Lady will let me make some progress, I will come to her shortly.
The fact that such a belief is wrong was recently made clear in correspondence from Simon Stevens to the right hon. Gentleman—from one former Labour special adviser to another—which stated:
“We are, as appropriate, required to observe European procurement regulations, originally introduced in 2006, and related UK law. In everything we do we are also required to exercise our functions effectively, efficiently and economically. As a result we are advised that a blanket contracting ban would not be permissible.”
It would not be permissible because of regulations introduced by the previous Labour Government. That is another reminder that Labour introduced competition into the NHS.
As I explained earlier, under changes introduced by the previous Labour Government, health commissioners were subject to EU competition law for several years prior to the Act, and they would continue to be subject to it even if the Act was repealed.
Dr Whiteford
The points the Minister is making about competition take us back to the transatlantic trade and investment partnership. He must be aware that the NHS across these islands is developing in very different directions, and competition has not been at the heart of what has happened in other parts of the UK. I want him to give us cast-iron guarantees today that there will be no obligation on the NHS in Scotland to open up because of that trade agreement, even if the UK decides in its favour. What opportunities are there, if the treaty exposes the Scottish Government to—
Dr Poulter
I will come to TTIP shortly, and I think that I will be able to reassure the hon. Lady and the hon. Member for Angus (Mr Weir).
The Health and Social Care Act put in place an alternative route to the courts, through Monitor, to address abuses of the rules around procurement. The Bill would remove that alternative route, meaning that future complaints under the law would result in hugely costly legal processes for health care commissioners, and complaints would be considered by the courts, rather than by Monitor, a health expert regulator. That cannot be good for patients. The Bill would result in more money for the lawyers, and much less money for our NHS and the patients that it looks after.
Another important point is that by favouring NHS over non-NHS providers, the Bill would be a move against the voluntary and charity sector providers, such as Macmillan and Marie Curie, who have done so much to help care for patients for many years.
Jeremy Lefroy
I am glad that my hon. Friend has mentioned Macmillan. At the moment, Macmillan is in the middle of tendering for end-of-life and cancer care in Staffordshire, which hon. Members have mentioned. Although the integration that the tender requires is absolutely vital—I think that it is supported by all Members, including the hon. Member for Stoke-on-Trent Central (Tristram Hunt) in a recent article—one of the real problems involves the mechanism. The fact is that the integration seems to require the tender to be for the entire service, rather than for just a small contract, say, to help with integration. Will my hon. Friend comment on that, because this is one of the problems at the heart of the matter? We do not want large private companies to run our cancer and end-of-life services.
Dr Poulter
In a moment I will address in a little more detail a couple of the points that were raised. I reassure my hon. Friend that the section 75 regulations that underpin the 2012 Act, which are almost identical to regulations that the previous Government were involved with, outline very clearly, under regulation 10, that integrated service, or encouraging co-operation between providers in the interests of patients should not be seen as anti-competitive. Regulation 15 makes it clear that Monitor cannot direct a commissioner to hold a competitive tender. There is strong support throughout those regulations, as there is throughout the 2012 Act, for integrated service delivery in the best interests of patients, where that is appropriate.
Dr Poulter
I am going to make some progress—I hope the hon. Lady will forgive me—because Mr Deputy Speaker is looking at me.
Dr Poulter
Points were made about the voluntary and charitable sector supporting innovative new models of care. Through the Newquay pathfinder project Age UK has provided volunteer support to vulnerable older people considered at risk. Under the home scheme the British Red Cross provides volunteer support to patients in their homes, which is aimed at preventing admission to, or facilitating discharge from, hospital. The charity has care in the home contracts with more than 30 NHS trusts and social services departments, and the scheme enables reduced admissions, increased convenience to patients, and many other associated benefits.
My hon. Friend the Member for Stafford (Jeremy Lefroy) mentioned Macmillan. I like to talk about Macmillan, which has long provided vital support to patients right across the UK. It is collaborating with doctors in Staffordshire to transform cancer care and end-of-life care, and together they aim to commission care right across the patient journey. In cancer, that means commissioning prevention and health promotion, ensuring early diagnosis and prompt treatment through survivorship and improving end-of-life care.
In reality, the only route proposed in the Bill for recourse against unfair treatment by commissioners is to take us back to the previous Labour Government’s competition laws in 2006 and open up legal challenge through the courts. Only private providers with enough resource behind them are likely to be able to afford to exist in that court-based system, to pay high legal fees, and to invest in providing NHS care to patients, and smaller providers, especially charities, will lose out. Surely we do not want to see that in our NHS—an NHS in which, I hope we all agree, charitable and small local health care organisations have something important to contribute for the benefit of patients.
Before I conclude, I must briefly address some of the misleading commentary that has surrounded TTIP, which is serving only to distract from the real debate about our NHS. First, may I state that there is absolutely no agenda whatsoever to privatise our NHS through the back door? TTIP cannot force the privatisation of public services by EU member states. This position has been made explicitly clear by us and by the relevant negotiating parties. To suggest otherwise would be disingenuous and, frankly, wrong. I encourage Members to look at the recent negotiating mandate published by the European Commission, where this position is made absolutely clear. I note the comments of Ignacio Garcia Bercero, EU chief negotiator, on the record at the end of round 7 negotiations—
Dr Poulter
I am addressing the hon. Lady’s point, so I hope she will let me do so. Ignacio Garcia Bercero said:
“I wish…to stress that our approach to services negotiations excludes any commitment on public services, and the governments remain at any time free to decide that certain services should be provided by the public sector.”
That is a very clear reassurance, and I hope it will be accepted by all hon. Members. I will give way just once more, because I do not want to test Mr Deputy Speaker’s patience as I come to a conclusion.
Dr Whiteford
I am grateful to the Minister, but my understanding is that the Commission has said that if one part of the UK market is opened up through privatisation—perfectly democratically, as it could be—then all parts will be opened up. I want his assurances that Scotland will not be forced, by the back door, to privatise its NHS on the coattails of this House.
Dr Poulter
The Government’s health care reforms ensured that, as under the last Labour Government, day-to-day decisions of care delivery became the responsibility of clinically led NHS commissioners. It is for the local NHS to decide which providers, whether from the public, private or voluntary sectors, can best meet the needs of their patients and deliver high-quality care.
Dr Poulter
I will give way one more time in a moment, and then that really will, I am afraid, be the lot, because I know that Mr Deputy Speaker would like me to come to a conclusion.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
On a point of order, Mr Deputy Speaker. I do not know what is going on with this speech. I know that the Minister is a distinguished medical person, but he is presenting the speech with so much jargon and such technical terms that very few people out there will understand the main thrust of it. The only thing many people have understood in the last few minutes is the back-door privatisation.
Mr Deputy Speaker (Mr Lindsay Hoyle)
That is absolutely not a point of order, but we will hear from some other speakers if we can get to the end of this speech. We might then hear some other parts of the debate.
Dr Poulter
Thank you, Mr Deputy Speaker.
I have mentioned the benefit to patients many times in my speech, because that is, after all, what I care about as a doctor and what I care about as a Health Minister, and what I hope all hon. Members care about; I know that the hon. Member for Huddersfield (Mr Sheerman) does so.
Additionally, and contrary to claims made by some, TTIP will not prevent any future Government from changing the legal framework for the provision of NHS services. Neither will it prevent the termination of the private provision of such a service in accordance with the law or contracts entered into, as is already the case today. The reassurances that we and the European Commission offered were sufficient for the right hon. Member for Wentworth and Dearne (John Healey), a previous shadow Health Secretary, when he stated:
“On the NHS....my direct discussions with the EU’s chief negotiator have helped produce an EU promise to fully protect our health service including, as the chief negotiator says in a letter to me, so that: ‘any ISDS provisions in TTIP could have no impact on the UK’s sovereign right to make changes to the NHS.”
If it was good enough for the right hon. Gentleman—
Clive Efford
That really will not wash. The Minister is saying that we must trust the Government and that they will not allow TTIP to apply to the national health service. The Bill says that this House will be sovereign; this House will decide whether TTIP applies to our national health service. Does he support that?
Dr Poulter
I was simply quoting the reassurances that his right hon. Friend had given to all hon. Members, which was that
“any ISDS provisions in TTIP could have no impact on the UK’s sovereign right to make changes to the NHS”.
If TTIP is good enough for the right hon. Member for Wentworth and Dearne , it should be good enough for everyone in the Labour party.
John Healey
Would the Minister be good enough to concede that that has absolutely nothing to do with what the Government have been arguing; that is to do with the EU and their negotiation. The Trade Minister in charge has said that he does not want the NHS to be excluded in the way that we want.
Dr Poulter
No; I am simply quoting what the right hon. Gentleman has already put on the record about reassurances that he has received from the EU about an EU trade settlement. Surely, if the reassurances were good enough for him when he wanted to communicate them more broadly to his colleagues, and more broadly to members of the public, they are good enough now. It is very difficult to climb down from those reassurances, which he has previously given, and in the remarks I have made I have further reassured the House about the protection that this Government have made for the NHS in TTIP.
I am immensely proud of the way our NHS has already responded to the challenges of a growing and ageing population, meeting increased demand through a purpose and drive to improve the quality of patient care. That is why our NHS was recently ranked No. 1 in the Commonwealth Fund’s assessment of 11 global health care systems. This is at a time of unprecedented challenge to public finances across the globe, and testifies to the incredibly hard work of NHS staff and a very tough choice by this Government to protect our NHS budget and increase it by £12.7 billion between 2010 and 2015—a decision that the right hon. Member for Leigh called irresponsible but one of which we are very proud.
I remind the House of the words of the right hon. Member for Leigh when he was a Health Minister defending Labour’s record on introducing private providers into our NHS:
“I think the NHS can finally move beyond the polarising debates of the last decade over private or public sector provision”.
I agree: it is definitely time to move on. Our NHS focus needs to be on delivering for patients, so let us put distractions aside and let our hard-working doctors, nurses and health professionals get on with the job.
Language Controls (Healthcare Professionals)
Dan Poulter Excerpts(9 years, 6 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
The Department of Health has been working with the General Dental Council (GDC), the Nursing and Midwifery Council (NMC), the General Pharmaceutical Council (GPhC) and the Pharmaceutical Society of Northern Ireland (PSNI), along with other stakeholders to look at ways to ensure that the English language capability of nurses, midwives, dentists, dental care professionals, pharmacists and pharmacy technicians working in the UK is sufficient. We greatly value the contributions that health care professionals from all over the world have contributed, and continue to contribute to our NHS, but it is essential that they have a sufficient knowledge of the English language, in order to provide safe patient care. Earlier this year, changes were introduced to strengthen the law around language controls for doctors, by introducing language controls for European economic area (EEA) doctors wishing to practise in the UK. Ministers from the four UK Health Departments are firmly committed to improving public protection by preventing health care professionals who do not have sufficient knowledge of English from working in the UK.
Today the Government launched their consultation “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 1976”. The consultation document consults on proposals to amend the legislation governing the GDC, NMC, GPhC and PSNI so as to give them more explicit powers to satisfy themselves about the English language capability of EEA applicants for registration, as well as to take action where concerns arise about a registered professional’s ability to communicate adequately in English. The draft Health Care and Associated Professions (Knowledge of English) Order 2015 has also been published alongside the consultation document.
The consultation will close on 15 December 2014 and the Government welcome views on the proposals and invite comments through the consultation process.
“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 1976” and the draft Health Care and Associated Professions (Knowledge of English) Order 2015 have been placed in the Library of the House. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
General Practices (Coventry)
Dan Poulter Excerpts(9 years, 6 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
Thank you, Madam Deputy Speaker, and I thank the hon. Member for Coventry South (Mr Cunningham) for his kind regards in that respect.
I congratulate the hon. Member for Coventry North West (Mr Robinson) on securing this debate. Like his hon. Friend, he raised a number of important broader points about the future of general practice and the work force—I hope to provide some reassurance in that regard—and some important local issues, which I also intend to address.
I commend both hon. Members for their interest in local health care matters as they affect their constituents, and I pay tribute to the dedication and professionalism of all the GPs and other staff working in primary care in Coventry and surrounding areas. The House will agree, I am sure, that good quality patient care is expected, regardless of which part of the country we live in. GPs are the bedrock of our NHS, with an estimated 340 million consultations taking place in general practice every year. We want to ensure that we always give GPs the right support so that they can deliver the best possible care for patients.
I am aware that the Coventry and Rugby local medical committee of the British Medical Association issued an open letter on 26 September, giving its views on national and local issues in general practice.
Let me turn first to one of the important points raised in the debate, which was that there has quite rightly often been a focus on the NHS as viewed through the prism of secondary care, yet the majority of engagements with patients is in primary care and in the community. We need to recognise the role of pharmacy, too, as many people’s first point of contact will be with the pharmacist and, in the NHS, with their GP or another element of primary and community health care. It is therefore important to challenge that traditional prism through which the NHS tends to be regarded. We know that it is not just about hospitals; it is about primary care, too, and about ensuring that we invest to support GPs and deliver other high-quality community health care services.
Mr Robinson
We are greatly reassured by the Minister and agree with what he said. Will he confirm the figure—I was quite surprised to discover it—that at least 90% of all initial contacts with the NHS are through primary services? As he rightly says, it is mainly GPs, but chemists and others, too. Is the 90% figure correct?
Dr Poulter
I believe that that estimate is correct, although it is impossible to give a totally accurate figure, because some of the consultations, particularly with a pharmacist, might be informal rather than registered as an official consultation. For many people, it is important to get advice from their local pharmacist about how better to manage their medication regime or just to seek simple advice about what to take for an upset stomach. Those informal consultations are not usually registered in the same way as GP consultations, even though they happen every single minute of every day in our health service. Those points of contact are in the community, not in secondary care. This is how most people will come into contact with the health service, although in this place we sometimes talk about the NHS through the prism of secondary care. It is a legitimate challenge for all us of to recognise the importance of primary and community care and to continue to invest in and support those people who deliver that when we design health care services in the years ahead.
As a doctor myself, I particularly recognise the work of GPs and the vital role that they play. Shortly after the local medical committee issued its letter, as highlighted in the remarks of the hon. Member for Coventry North West, the Government were pleased to see that NHS employers, on behalf of NHS England and the BMA, reached agreement on changes to the GP contract. The BMA made the point that these changes will provide much needed breathing space for general practice and greater stability for patients. However, we accept there is much more that we need to do in the longer term to support general practice, such as recruiting more GPs to help tackle GP burn-out. I shall say more about that later.
We are of course pleased to have reached agreement with the BMA, and I think it is useful to set out a few points about what we have done nationally and what we want to do in the coming years, as this will help to address some of the concerns raised by the hon. Gentleman.
First, it is worth highlighting some of the investment in general practice that has taken place. We recognise the need for a reversal of the shift that the hon. Gentleman described so articulately—the shift that has taken place, over decades of investment, away from community care and towards hospital care. I hope the hon. Gentleman will be reassured by the latest figures, which show that the total investment in general practice increased in cash terms by 2.92% between 2012-13 and 2013-14, from £7,863.8 million to £8,093.4 million. I shall write to him to confirm those figures, but I think we should all welcome the reversal of the traditional shift in favour of secondary care, towards general practice and other primary care. The hon. Gentleman may be aware that NHS England published its “Five Year Forward View” last week. In that report, it committed itself to more investment in primary care over the next five years, including investment in infrastructure.
I know that the hon. Gentleman is rightly concerned about GP numbers. Although the headcount figure in this year’s annual work force census shows a very small decrease of 29, the full-time equivalent figure has increased by 423, or 1.2%, which represents a real increase in capacity in the system. There are now 36,294 full-time equivalent GPs working in the NHS, including registrars and retainers. That is an increase of 423 since 2012, and an increase of more than 1,000 since 2010. There are 329 full-time equivalent GPs working in the Coventry and Rugby clinical commissioning group area, compared with 305 in 2010, so numbers are beginning to increase locally. I hope that that, too, is reassuring.
I understand that the NHS England Arden, Herefordshire and Worcestershire area team is working with the deanery, examining work force development issues and, specifically, ways of improving the process for GPs who want to return to general practice after a career break. The hon. Gentleman made the important point that the work force now includes many women GPs. That is one of the great strengths of the profession, but we must bear in mind the need to enable women who take career breaks in order to start a family to return to general practice. I know that a great deal of work is being done in that regard, not just locally but nationally, involving the Royal College of General Practitioners and the General Medical Practice.
We accept that the work force must grow to meet rising demand from an ageing population. That is why our mandate to Health Education England requires 50% of trainee doctors, after graduation—3,250, on the basis of current forecasts—to enter GP training programmes by 2016; the current figure is about 40%. That will enable further increases to be made in the GP work force: we expect an increase of about 5,000 by 2020. Although numbers are rising, we know that GPs need more resources.
Mr Robinson
My hon. Friend and I are very reassured by what the Minister has said. As for the numbers—which, of course, we always have to plan for—does the increase of 5,000 by 2020 mean an increase in the total number of doctors, or an increase in the number of GPs? Will that be enough, given that 10,000 doctors will retire from general practice alone in the next five years? Does the 5,000 figure relate to the position after those GPs have retired? How does the calculation work?
Dr Poulter
The figures that I gave are based on what we assume will be the attrition rate over the next five years. The total number of doctors has increased by, I believe, about 7,000 over the last four years, but the 2020 figure relates specifically to GPs.
The hon. Gentleman has made a good point. The same consideration has historically applied to health visitors. When a large proportion of that work force has been close to retirement over a five or 10-year period, it has meant the loss of a great deal of experience, but that is not the only issue: there is also the need to plan for those retirements in advance. The figures that we worked out with Health Education England take account of attrition rates.
Part of that is about ensuring that half those medical students become GPs on graduation; currently, only 40% do so. That is where the extra increase in capacity will come from. That will also address the fundamental issue that we have been discussing today—namely, that we need more people working in the community and in primary care. We need to move the prism of the discussion about what good health care looks like away from it being just about delivering good health care in hospitals.
The work being undertaken by Health Education England will improve the applications and fill-rate for GP training. The work includes: a review of the GP recruitment process; development of a returner and refresher scheme; development of a pre-GP year to give prospective GP applicants exposure to the specialty; and careers advice for foundation doctors and medical students. That careers advice is important. When I was at medical school, everyone in my year wanted to be a hospital doctor. I entered a hospital specialty. It is therefore important that, from day one at medical school, students are encouraged and supported to recognise the tremendous opportunities that a career in general practice could offer.
Part of the challenge is to set the aspirations of medical students appropriately and to recognise that the work of a general practitioner is as important as—if not sometimes more important than—the work of a hospital specialist. We need to encourage greater recognition of that fact in medical schools, given that we want to deliver more care in the community. I believe that it is Lancaster medical school that has done a very good job of placing a greater emphasis on prospective GPs doing more community-based and primary care placements during medical school training. That has encouraged more students to enter general practice afterwards. I think I am right in saying that it is Lancaster medical school, but I will write to the hon. Member for Coventry North West after the debate to outline exactly where that kind of initiative has been effective. When looking at how we should train our future work force, it is vital to ensure that more medical students focus on a career in general practice from an early stage of their development if we are to encourage more of them to choose that route. We know that that has worked in the past.
I shall not detain the House by describing the work that Health Education England is doing nationally. Instead, I want to respond to the hon. Gentleman’s questions by talking about what we are doing now to support GPs through technology to enable them to provide a better service to patients. This applies not only to the service available during the current opening hours but to how we might facilitate community and primary care services on a more seven-days-a-week basis.
Last autumn, the Prime Minister announced a challenge fund of £50 million to support innovative GP practices in improving services and access for their patients. As well as offering seven-days-a-week access and evening opening hours, pioneer GP groups will test a variety of forward-thinking services to suit modern lifestyles, including Skype, e-mail and phone consultations. We need to recognise that this is about engaging with people on their own terms. Someone who is working might want to engage with their GP in a different way from someone who is retired, for example. The challenge fund will help to address those questions.
The challenge fund is now supporting more than 1,000 practices covering every region. The pilots will draw best and innovative practice from GPs on the ground to determine what is needed and works locally. We recently announced a second wave of access pilots, with further funding of £100 million for 2015-16. Yesterday, NHS England published details of how to apply to become a wave 2 pilot site, including the application criteria, process and time scales. I hope that practices in Coventry will take advantage of that fund and make applications to support local patients.
The £3.8 billion Better Care Fund combines existing funding in a single health and care pot, promoting integrated care and joint working between health and care services. It aims to ease pressure on services by encouraging greater prevention and by supporting people to stay independent for as long as possible. I have been informed that, in 2015-16, the Coventry clinical commissioning group will receive £9 million to improve services in the local area. Demand continues to grow nationally, and Coventry is no exception to that trend. However, I am told that significant work has been done over the past few years to increase access and to support local initiatives. Significant investment has been made in premises to improve better access to services and an improved patient experience. Four practices co-located to the City of Coventry health centre in 2012 and three practices moved to the new centre at Clay lane in 2013. The hon. Gentlemen raised some issues about practice closures—
Madam Deputy Speaker
I am grateful to the hon. Gentleman for his attempt to be helpful, but I will invite the Minister to move that the House do now adjourn, after which he may recommence his speech.
Motion made, and Question proposed, That this House do now adjourn.—(Dr Poulter.)
Dr Poulter
Thank you, Madam Deputy Speaker. I apologise for the lack of the usual accompanying member of the Treasury Bench team to conclude proceedings, but I am pleased to continue the informative debate we have been having.
I was addressing the point about practice closures. The way the information is collected sometimes leads to a headline of “practice closures”, but it may well be that practices have merged, and it is important to recognise that when we have a debate, even an informed one such as this. When a number of practices have co-located locally to improve premises and there has been improved investment, that is an enhancement of services; it in no way diminishes the services available to patients. I do not know the details of each and every surgery in Coventry, but clearly collaboration has taken place, along the lines of the Darzi model outlined by the hon. Member for Coventry North West, whereby surgeries can pool their resources and work together. That can bring benefits to all their patients and mean an additional freeing up of money to invest in other community-based health services, for example, physiotherapy or speech and language therapy. That approach has worked well in many parts of the country, including in the examples I gave in Coventry.
I understand that NHS England has also given approval for new premises for the Prior Deram Walk practice in Canley, Coventry, with the new facility expected to be completed next summer. Ongoing investment is taking place locally. Practices in Coventry have a good provision of extended hours, through the enhanced service for extended hours, and have adopted online booking for appointments and repeat prescriptions. NHS England’s area team monitors complaints from patients and is currently receiving no complaints about access or difficulty in registering with a practice in the Coventry area, although if there are concerns, I would be happy to take an intervention.
Mr Jim Cunningham
I thank the Minister for his announcement about a new practice in Prior Deram Walk, which is badly needed and which we would welcome.
Dr Poulter
I am pleased to have brought some good news about future planning to the debate. As I will be writing to the hon. Member for Coventry North West in detail about some of the initiatives with medical students, I am happy to outline further the future plans for that practice in the letter.
GP patient survey results from 2014 indicate that 85% of people who responded in the Coventry and Rugby clinical commissioning group area rated their GP surgery as “very good” or “fairly good”. Although this is a high proportion, it could of course be improved further. The figure is, however, testament to the work of local GPs and the quality of care they provide, alongside everybody who works in those practices. I am also aware that Coventry local medical committee had concerns that Coventry and Rugby CCG was not following NHS England planning guidance and investing more in general practice to support it in transforming the care of patients aged 75 and older. I understand the LMC has now reached agreement with the CCG on that, which is good progress. Our plans for personalised care for the most vulnerable patients included NHS England asking CCGs to set aside £250 million from existing funds. However, as has always been the case, CCGs are not restricted to using this funding on general practice only. For example, in some areas, CCGs have used the funding to employ extra district nurses for local practices.
On the important point about the wider community work force, it is increasingly the case that although a nurse may be counted as a member of hospital staff, their role goes across not just the hospital, but the community. That is particularly the case for nurses who support patients with long-term conditions such as multiple sclerosis and diabetes. Although that nurse is officially counted as a hospital employee, they play an increasingly important role in supporting the patient in the community. Having visited the local hospital in Coventry, I know that there is a great emphasis on the hospital working much more collaboratively with the community. The role of the hospital is about not just picking up the pieces when things go wrong but proactively supporting patients, especially those with long-term conditions, when they are at home.
Jim Fitzpatrick
I apologise to the Minister for intervening on him while he is replying to a debate on Coventry. He just mentioned collaborative service. The Barkantine practice in my constituency combines a 10-handed GP practice with a walk-in centre. It is able to offer appointments from 8 o’clock in the morning to 8 o’clock at night seven days a week, which is what the Prime Minister made a big point about in his conference speech. However, because of restructuring, the practice is having to hand over its walk-in centre finances to the local CCG, which means that the critical mass for providing the 8 am to 8 pm service seven days a week is no longer appropriate. Will the Minister look at that with regard to collaborative working, as we are talking about breaking down a system that the Prime Minister wants to see replicated across the country?
Dr Poulter
I hope the hon. Gentleman will excuse me if I do not detain the House in addressing that specific point today, but I will look into it and write to him separately about it. We have discussed local issues in his constituency before. I will take away what he says and get back to him, hopefully with some reassurance on the points that he has raised.
The CCG is developing a pre-hospital model to help manage urgent care and reduce attendance and admission to hospital. The development includes operational and clinical staff from a number of organisations including patient champions, primary care, local trusts and authorities, and unscheduled care providers.
The model being considered at the moment describes a community urgent care system designed around the patient, ensuring easy and timely access at a convenient location without blocks or diversions. The CCG and its partners at the Coventry urgent care board have developed and agreed a winter capacity and resilience plan. NHS England has made £2.8 million available to support the plan, and a number of specific winter schemes are already being put in place. They include: additional home care capacity for both planned and unplanned support; additional social worker capacity to support A and E and ward board rounds; GP responders; and hospital at home.
The plan sets out a clear mechanism for engaging and developing leaders and staff to enable the cultural changes required to support clinical commissioning activities, performance improvements and services changes necessary in the changing NHS environment at a local level. As we have said, this is about ensuring that the emphasis is moved away from a reactive care model in the hospital—having met the staff in Coventry I know that it is a very good reactive care model—and giving people better support and care at home. That is what investment in local GP practices and increasing GP numbers is about. It is also about ensuring that the right relationships are engaged at a local level to support the right type of care being delivered to patients in Coventry. Its focus is on developing internal capacity and capability to ensure that the emphasis is on upstream interventions, preventing people from becoming so unwell that they need to go into hospital, and making sure that people with long-term conditions and disabilities get the proper community-based support that they need.
I hope that I have brought some reassurance to the hon. Members for Coventry North West and for Coventry South, and I have a couple of points on which I will write to both of them. Once again, I convey my gratitude to the front-line staff working in Coventry. I have seen the local hospital for myself and know how hard local staff work. It is clear that investment is going into GP premises locally and that there is a commitment to continuing to support general practice in Coventry and the development of improved community services to ensure that the big challenge that faces the NHS, which is to support people with long-term conditions, is met, not just nationally, but in particular for those patients who need services from the NHS in Coventry.
Jim Fitzpatrick
On a point of order, Madam Deputy Speaker. On 16 October, during the Backbench Business Committee debate on cycling, I said that
“the proportion of cars on that stretch of road is already less than 9%”.—[Official Report, 16 October 2014; Vol. 586, c. 502.]
Further research has clarified that the 9% figure refers to an assessment of the percentage of private cars using the A3211 route at certain times of the day. This is based on counts carried out by transport consultants Steer Davies Gleave for Canary Wharf Group. It would have been more accurate for me to have said, “the proportion of private cars on that stretch of road is already less than 9% at some times of the day.”
I am grateful to be able to set the record straight. I apologise for not accurately reflecting the position. I am not sure whether this qualifies technically as misleading the House as it was an incomplete picture, but I apologise unreservedly for doing so, as that was clearly not my intention.
Oral Answers to Questions
Dan Poulter Excerpts(9 years, 6 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Tim Loughton (East Worthing and Shoreham) (Con)
2. What safeguards are in place for the sustainability of NHS facilities when clinical commissioning groups contract out local services.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
The previous Government introduced greater competition to the NHS. This Government have ensured that it is for local doctors and nurses through clinical commissioning groups, rather than bureaucrats, to decide how best to procure NHS services in the interests of their patients.
Tim Loughton
As the Minister is aware, Coastal West Sussex CCG is controversially proposing to award a major contract for musculo-skeletal services to a social enterprise consortium rather than Worthing hospital. While I welcome new ways of working in the NHS, as long as the quality of care for patients remains key, what safeguards are in place to ensure that existing NHS services such as trauma and accident and emergency, which we campaigned so hard to protect at Worthing hospital, are not compromised?
Dr Poulter
The Health and Social Care Act 2012 ensures that commissioners must also have regard to delivering integrated health care services. I reassure my hon. Friend that the West Sussex CCG has clearly stated:
“The…CCG will continue to commission MSK related trauma from the current providers and the intention is for this to continue for the duration of this MSK…contract”.
Mr Jim Cunningham (Coventry South) (Lab)
23. What is the Minister doing to retain GPs as there is considerable concern in Coventry about the number who are leaving practice?
Dr Poulter
I hope that I can reassure the hon. Gentleman that there are now 1,000 more GPs in training and working in the NHS under this Government than when we came to power in 2010. We are committed to training even more GPs to ensure that we can widen access to general practice services.
Andrew George (St Ives) (LD)
In what circumstances can clinical commissioning groups treat the NHS as a preferred provider, and in what circumstances are they forced to contract out services?
Dr Poulter
As my hon. Friend will be aware, when commissioning services, it is important that regard is given not only to competition because, under the 2012 Act, we have ensured that there must be regard to delivering an integrated and joined-up approach for local services. That is an issue for local commissioners to decide in the best interests of the patients they look after.
John Cryer (Leyton and Wanstead) (Lab)
Are not certain CCGs starting to merge decision-making processes, meaning that some important strategic decisions are removed even further from local communities and there is therefore a complete lack of accountability?
Dr Poulter
For some more specialist services, collaboration between various parts of the local NHS will always be needed. That is about good health care commissioning and ensuring that services are joined up in a collaborative way. Whereas day-to-day, bread-and-butter services will be commissioned by a local CCG, for more specialist services, clinical commissioners will of course need to work together to ensure that local centres of excellence are commissioned.
Steve Baker (Wycombe) (Con)
The sustainability of NHS facilities is often prejudiced by the millstone of Labour’s private finance initiative deals. What is the Government’s expectation of how CCGs should make the best of the hand that they have been dealt?
Dr Poulter
My hon. Friend is absolutely right that PFI deals signed by the previous Government have crippled the finances of many hospital trusts, meaning that many of them are unable to invest as much in front-line patient care as they would like. It is important that the Government support the mitigation of PFI deals, when possible, and we have a group that is doing exactly that and supporting local commissioners to deal with the worst excesses of the previous Government’s mismanagement of the NHS finances.
Mr Gareth Thomas (Harrow West) (Lab/Co-op)
3. How many patients waited longer than four hours in A and E departments in 2013-14.
Jesse Norman (Hereford and South Herefordshire) (Con)
5. What steps he is taking to encourage hospital trusts to manage their PFI costs more effectively.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
PFI schemes have had their contracts reviewed for potential cost savings. A major data collection on the results is currently under way. In 2013, the Treasury launched a code of conduct for operational PFI contracts which contained a number of new guidelines for better working relations between the public and private sector parties.
Jesse Norman
Thanks to determined work with which I have been closely associated and with outside experts’ advice, Hereford hospital has managed to save several million pounds on its exorbitant PFI contract—money that is already being ploughed back into medicine and services for local people. My studies make it clear that there are hundreds of millions, if not billions, of pounds still to be saved on the PFI across other NHS hospital trusts. Will my hon. Friend press Monitor and the NHS Trust Development Authority to do everything they can to encourage hospitals to take on specialist PFI contract advisers to help them make these savings?
Mr Speaker
Order. Questions must be shorter. I say with the greatest courtesy to the hon. Member for Hereford and South Herefordshire (Jesse Norman) that to read out a prepared script and be too long is doubly bad, and it really is not excusable.
Dr Poulter
My hon. Friend is right to highlight the fact that the annual cost of PFI left by the previous Administration is £1.79 billion, which will rise to £2.7 billion. It is right that we do all we can to support hospitals to reduce the costs of PFI that have been inflicted upon them, and we will continue to do that and work with the Treasury to make sure that that specialist advice is available for the NHS to reduce the cost.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
I am worried that the members of the ministerial team are living in some sort of parallel universe. At the Calderdale and Huddersfield Trust we had a PFI. A hospital that has a long history of success is now struggling because it cannot get a management that works between the clinical commissioning groups and the trust. That is the truth—it is chaos.
Dr Poulter
There is nothing wrong with PFI schemes in principle; the point is the way in which they were put together by the previous Government. In 2011, the right hon. Member for Leigh (Andy Burnham) said:
“We made mistakes. I’m not defending every pen stroke of the PFI deals we signed”.
Those PFI contracts have damaged local hospitals and damaged local health care provision—
Mr Speaker
Order. I just said to a Back Bencher that his question was too long. I have said to the Minister several times that his answers are not just too long, but far too long, and if they do not get shorter I will have to ask him to resume his seat—which frankly, for a Minister, is a bit feeble.
Nick de Bois (Enfield North) (Con)
Will the Minister confirm that unlike the PFI agreements for my neighbouring hospitals in north Middlesex and Barnet, which were negotiated badly and ineffectively, the rebuild of Chase Farm hospital will be funded by proceeds from its own land sale and Treasury money, not PFI?
Dr Poulter
My hon. Friend makes an important point. Hospitals should always look to their own efficiencies first by improving procurement practices and freeing up surplus land to fund local schemes. His hospital has done that very effectively, and it has not pursued the policies of the previous Government, which have put so many trusts into difficulty.
Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)
Given the total forecast deficit across English hospital trusts, including PFI schemes, is it still the Government’s position that the situation can be dealt with by efficiency savings alone?
Dr Poulter
During this Parliament we are set to improve efficiency in the NHS and make £20 billion-worth of efficiency savings. There is much more that we can continue to do on improving hospital procurement practices, sharing business services across the NHS, and freeing up surplus land—which, as my hon. Friend the Member for Enfield North (Nick de Bois) outlined, is happening at his hospital. That is what we need to focus on in freeing up money for the front line.
Guy Opperman (Hexham) (Con)
Hexham hospital is outstanding but was built under a very expensive Tony Blair PFI. Does the Minister welcome the fact that Northumbria NHS trust is the first in the country to buy out the PFI and put it into public ownership, thereby putting millions more into front-line care?
Dr Poulter
My hon. Friend makes an important point. The PFI schemes negotiated by the previous Government were, quite frankly, disastrous for many hospitals. His hospital has seen that the way forward is to buy out the PFI and free up more money for front-line patient care. We will support as many more hospitals in doing that as can be achieved, because this is about making sure that we deliver more money for NHS patients.
Kelvin Hopkins (Luton North) (Lab)
I was fascinated by the question from the hon. Member for Hexham (Guy Opperman). Would not the simple solution be to take all PFI assets back into public ownership, reintegrate them with hospitals’ existing assets, and save millions of pounds for hospitals every year and billions of pounds for the public purse over time?
Dr Poulter
I understand that the hon. Gentleman is unhappy with the way in which the previous Government negotiated PFI contracts. We are unhappy with it as well, because it is costing the NHS almost £2 billion on current forecasts. We are making sure that we can put in place measures to support hospitals in mitigating the worst excesses of these poorly signed PFI deals.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
Between 2010 and 2013, 52,528 new pre-registration nurse training places were filled, and this year Health Education England has made 19,206 new places available.
Barbara Keeley
It is interesting that the Secretary of State cannot follow his own advice about not making operational matters in the NHS political footballs. Perhaps we can try again. The number of nurse training places has been cut by thousands since 2010—a key issue given the need of hospitals to reach safe staffing levels. The Royal College of Nursing has said that Labour’s plans for 20,000 more nurses are absolutely necessary. Does the Minister agree?
Dr Poulter
It is right that hospitals respond when there are not enough staff working there, if that is affecting patient care. That is why under this Government 2,500 more nursing staff are working now than in 2010. That is progress to ensure that we are facing up to challenges in care where they exist at local hospitals.
Margot James (Stourbridge) (Con)
Russells Hall hospital in the borough of Dudley has appointed 56 new nurses from overseas since the Keogh review last year. Will my hon. Friend join me in welcoming the graduate trainee programme for nursing that Russells Hall has put in place, which will provide for 100 trained nurses over future years?
Dr Poulter
That sounds like a commendable programme. It is good to hear that my hon. Friend’s local trust, where there was a shortage of nurses, is facing up to that and employing more nurses to ensure that patient care is as good as it can be.
Mr Stephen Hepburn (Jarrow) (Lab)
16. What recent representations he has received on hospital walk-in centres.
Mr David Anderson (Blaydon) (Lab)
The good people who work in the NHS have faced six years of pay restraint. How much longer must they carry the can for the failures of the people who got us into this mess—the moneylenders, the LIBOR fixers, the people who mis-sold mortgages? How much longer must front-line staff pay for the mistakes of capitalism?
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
Even in very difficult times this year, all NHS staff, either through their increments or through the 1% increase, will be getting a pay rise. Of course, we would like to do more, but the NHS finances are under pressure, and our priority is to ensure that we employ as many front-line staff as we can. We now have more than 13,000 more front-line staff working in the NHS than we did when we came into government.
Charlie Elphicke (Dover) (Con)
T6. Can the Secretary of State confirm to the House whether there are any plans to sell off the NHS and will the NHS remain free at the point of delivery?
Kate Green (Stretford and Urmston) (Lab)
The NHS Litigation Authority is piloting a new approach to improve feedback and learning in response to allegations of negligence. Will the Secretary of State say how patients can find out what feedback the NHSLA has given to individual trusts and how the trusts have responded?
Dr Poulter
The hon. Lady raises an important issue, which is that the NHS Litigation Authority often picks up on things when they do not go well and when the communication between patients and trusts has broken down. That is one of the things that need to be put right. I will look into the matter and write to her, because it is important that when things go wrong patients are supported in the right way and the lessons are learned.
Annette Brooke (Mid Dorset and North Poole) (LD)
T9. Currently, there are no psychiatric intensive care unit beds for women in Dorset. One of my constituents was recently sent to a unit in Bradford. Will additional funding be available to address this appalling situation?
West Cumberland Hospital
Dan Poulter Excerpts(9 years, 6 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 the hon. Member for Workington (Sir Tony Cunningham) on securing this evening’s debate, and I commend him for his interest in local health matters affecting his constituents, and for his clear advocacy of the needs of local patients.
We all understand that the configuration of local health services is an important issue for many Members—and for many of our constituents—particularly those who represent the more rural parts of the country such as Cumbria. We all agree that patients should receive high-quality care, regardless of where they live.
These are challenging times for the West Cumberland hospital. There have been difficult decisions to face up to, following the Keogh review, and the hospital has been put on special measures, following concerns about some aspects of patient care. I will say a little more later about that and about the importance of patient and public engagement in all decisions affecting the reconfiguration of local health care services.
First, I want to provide hon. Members with some reassurance about the future of local health services. It is important to note that for the first time in more than 50 years significant investment is being made under this Government in health care facilities in west Cumbria. The West Cumberland hospital is being redeveloped at a cost of £95 million, with this Government providing £70 million of that funding. The improved hospital will offer high-quality services and facilities fit for the 21st century, including significant local elective surgical services for the benefit of local patients.
The local doctors in the Cumbria clinical commissioning group are committed to keeping West Cumberland hospital clinically and financially viable, with the majority of Whitehaven patients continuing to access services, including A and E, at that hospital. I would also like to reassure the hon. Gentleman that it is the local doctors and nurses who run the clinical commissioning group—not me or anyone in Whitehall—who will make the decisions about health care in Whitehaven and Cumbria.
Before I move on to the specifics of the issues raised by the hon. Gentleman, it is worth noting the long-running issues at North Cumbria University Hospitals NHS Trust and the progress that has been made towards addressing them. Because of a history of high mortality rates—which means that more people were dying at the trust than should have been the case—the trust was placed into special measures in July 2013 as a result of Sir Bruce Keogh’s review. The trust is now working towards a merger with Northumbria Healthcare NHS Foundation Trust, which will further ensure that it can offer safe, high quality and sustainable patient services.
The trust has continued to work hard to tackle its long-running problems with recruitment of medical staff. It has recently implemented a nurse practitioner work force model to replace trainee doctors, who are currently not being placed at the trust due to long-standing difficulties in ensuring the necessary levels of senior medical training support. A recent positive development is that the trust has increased its consultant medical staff by 17%, as well as introducing a new nursing structure, which is helping to ensure safe nurse staffing levels on every ward.
Sir Tony Cunningham
Why does the Minister think there is such a shortage of doctors?
Dr Poulter
This has been a long-standing shortage; the trust has not been an attractive place for junior doctors to work for many years—probably for the past decade. However, the trust is now looking at ways in which it can better incentivise doctors to work there. That is an important step forward. If we want junior doctors to return to the trust—given that they have been removed from it because they were not getting the high-quality training they needed in order to become consultants—we must ensure that we incentivise the recruitment of more senior doctors to the trust. The hospital is now looking much more seriously at that than it has done in the past.
As I just outlined, recent measures have resulted in the consultant medical staff being increased by 17%, which is a positive step forward. Measures are also being put in place to ensure that nurse practitioners will be better used, where appropriate, to treat patients. The trust can be proud and pleased with the progress that it is making in that respect. An important aspect of looking after patients is to ensure that there is a full rota of junior doctors on site, and I am sure that if the progress in increasing the amount of consultant cover is maintained, that will become available again in the future.
On performance, the trust has put in place a recovery plan to meet waiting time targets from the end of 2014. It is currently working to reduce its backlog of patients who have been waiting for more than 18 weeks from referral to treatment, and it has received additional funding to support that. As hon. Members have pointed out, however, the trust has been financially challenged for some time. Last year, it reported a deficit of £27.1 million. The Department of Health provided significant financial support to the trust in 2013-14, as it has in previous years. The trust received £11.5 million from the Department, alongside support from the trust development authority and the clinical commissioning group, and £6.3 million in private finance initiative funding support. As we have discussed, however, that position is not sustainable in the long term. That is why further discussions about foundation trust status are being held.
Other critical challenges remain. Most significantly, some services at West Cumberland hospital remain fragile due to difficulties recruiting specialists and consultants and to the current heavy reliance on locums. However, I hope that that issue will be addressed in the near future if the trust can continue to recruit more consultants.
The Care Quality Commission inspection report published in July 2014 rated the safety of acute medical and outpatients services at the West Cumberland hospital “inadequate”. That reflects the difficulties that the hospital has faced for many years, and continues to face, in recruiting adequate staff to run some of its services safely and effectively. However, the trust has made significant progress in addressing the many challenges it faces. The CQC inspection acknowledged that, giving it an overall rating of “good” for providing a caring service to patients.
Another CQC inspection is expected to take place in early 2015, and I understand that the trust is working hard to make improvements ahead of that. For example, the outpatients service has greatly improved the availability of patient notes, an issue highlighted at the previous inspection. As I understand it, patients’ notes were not available when they came for an appointment. That is not helpful in providing an understanding of their previous history, which disadvantages the staff who are looking after the patient and trying to provide the best possible care. The trust has taken that issue on board and I understand that it is making good progress to address it.
The trust has made significant progress in other respects, most notably, and perhaps most importantly, in reducing high mortality rates. That means that patients in Cumbria who would have died had these changes not been introduced are alive today. Having been one of the highest in the country, the trust’s mortality rates are now within national confidence limits, and the trust and its staff must be commended for that turnaround. Further progress has also been made in, for instance, the meeting of the four-hour A and E standard, the implementation of a new patient experience programme, and a reduction in clostridium difficile infection rates. However, changes must continue to be made to secure a sustainable future, and to enable the trust to keep building on the good progress that it has made so far. It is important for the local NHS to be supported in that work to secure safe, high-quality patient care.
Dr Poulter
I do not have the local knowledge that would enable me to understand why that happened, but what is important is the need for action to be taken in cases in which there is a history of higher than expected standardised mortality rates—cases in which patients have died when they should not have died. That is why the Government asked Sir Bruce Keogh to investigate this trust, and, indeed, many other trusts, as a result of which some were put into special measures.
Although a number of challenges remain, and the trust must address them, it appears to be making good progress in terms of standardised mortality rates, which means that—as I said earlier—patients who might have died in the past are now surviving. That is testimony to the hard work of the trust’s front-line staff. I know that Members will be pleased, and that, more importantly, local patients and their families will be very grateful.
The subject of reconfiguration was raised. The issues affecting west Cumbria were discussed during a debate secured in 2012 by the hon. Member for Copeland (Mr Reed), and I know that the future of services at the hospital is a matter of continuing concern to both him and the hon. Member for Workington. As I said earlier, the local NHS is committed to ensuring that West Cumberland hospital has a viable and successful future, and that west Cumbrian patients continue to receive treatment there. That is why £95 million—£70 million of it from the Government—is being made available to improve its facilities. The money will allow it to offer 21st-century facilities, including seven new operating theatres, four of which will have full laminar flow, which will make them suitable for use in any operation. That will allow the hospital to offer a wide range of surgical services, and to become a centre of excellence for elective surgical procedures.
The hon. Member for Workington asked what excellence would be provided at the hospital. I can tell him that the investment in new facilities will allow patients to receive elective surgical procedures of a much higher quality, which will hugely benefit the local population. That investment is supported by additional investment in other local health care facilities, including, not far away, the new £11 million Cockermouth community hospital—which was officially opened in August 2014—and the new health centre at Cleator Moor.
Alongside the financial investment in the hospital, there are continuing efforts to attract and recruit new clinicians to North Cumbria University Hospitals NHS Trust. International recruitment campaigns have already taken place, and financial incentives are now available to support recruitment to the posts that are the most difficult to fill. That point arose earlier in the debate. Hospitals often have the flexibility to offer incentives in the event of recruitment challenges and difficulties, and I am pleased that the local trust is taking advantage of the opportunity to offer such incentives to attract new consultants and permanent staff.
To build on the progress that is already being made, clinicians are working towards changes that offer the best opportunities for better outcomes to be given to patients suffering from the most serious illnesses. No changes will take place unless there is clear clinical evidence that they will result in better outcomes.
Understandably, people have concerns when any change to local health care services is being discussed, but it is important that such concerns are not exploited for any political or other purpose, and that all changes that take place are in the best interests of local patients. The five-year plan for the local health service being developed by local doctors and clinical commissioners is looking at how services can be delivered safely and sustainably in the future. In developing the plan, I expect the local NHS to give important consideration to the distance patients need to travel to access services, particularly emergency services. As we have discussed, rural areas are very different from urban areas, and the distance patients may have to travel to access services is an important factor in determining what is safe for patients. Local commissioners need to take note of that.
Dr Poulter
That actually may have to happen in my constituency, for example, in cases where my local hospital does not have the right support for a very premature baby in utero once it is born. Neonatal services are not always as well developed at every hospital, and some areas tend to have a regional centre of excellence for neonatal care. As the hon. Gentleman said, there may be a regional centre of excellence for cardiovascular services, heart surgery or other specialist services. We want to ensure that bread and butter, day-to-day medical services are always provided by local hospitals—that is particularly important in rural areas—but we have to ensure when taking these decisions that where there is a clinical case for better patient care to be delivered at a centre of excellence, that case is made and communicated effectively. So, for example, although I would want to ensure, as I have done, that in Suffolk patients are able to receive the best possible care from the local NHS, if they needed super-specialist services and other services that are better provided at a specialist centre, they receive that care from those centres. I have always advocated that important case on clinical grounds.
This is about seeking to provide high-quality day-to-day services, while recognising that some services have to be provided at specialist locations. So when dealing with the potential birth of a very premature baby, it is important that the right support after birth is available, and that is provided by more specialist neonatal intensive care units—for example, Brighton is a regional centre for the south of England for some of those services. It is also important that, where possible, an intrauterine transfer takes place to make sure that the right care is available upon birth and after delivery.
It is also important to stress that in designing and working through what the right patient services are, and in putting together the local five-year plan in Cumbria, certain guarantees and reassurances have been made to the local population. I spoke just now about important day-to-day medical services, and a commitment has been given that there will continue to be an accident and emergency department at West Cumberland hospital. That is part of what I was just speaking about: high-quality, immediate services available for patients in more rural and remote areas. An independent review is looking at maternity services across Cumbria and will feed into work locally to find the best possible solution to providing safe and sustainable maternity care in the future.
While the five-year plan outlines the direction of travel for the local health service, no definite proposals have yet been put forward, and work remains at an early stage. In developing its proposals, I expect the local NHS to ensure that patient safety is a key focus, and that any movement or change of services is based on clear clinical evidence of better outcomes for patients.
I wish to make some important points about public engagement, which was raised by both hon. Gentlemen. It is important that people who use NHS services get a say in any changes to those services. We are very clearly committed to that as a Government, and it is important that local clinical commissioning groups, and the doctors and nurses who run them, properly engage with the public when they are making the case for the future shape of local health care services. I encourage local patients to continue to engage with the NHS as plans for west Cumbria are developed.
I understand that Cumbria CCG has met local MPs and the local campaign group to discuss their concerns and is happy to maintain that dialogue and continue to meet to discuss issues of concern in the weeks and months ahead.
The local NHS held a period of engagement to inform the development of the five-year plan. Both the CCG and the trust are committed to undertaking more engagement and communication with local people in the coming months.
Any proposals put forward for significant changes to local health services will be subject to a full public consultation in which patient and public views can be fully engaged in helping to shape future health care services. That is an important reassurance to give Members. No decisions will be made without that full public consultation if and when any changes to services are proposed.
In conclusion, I know that local people care deeply about the future of West Cumberland hospital—that has come across clearly from the contributions this evening. The provision of health care services affects all members of the community. We have only to look at the example of 10-year-old Maddy Snell who last week received a reply from the Prime Minister to her letter about potential changes to local health care services to see how the whole community in west Cumbria wants to be involved in the future of its hospital.
Patients should keep up that engagement with the local NHS and make their opinions known to those developing proposals for the future of local health care services. I also want to encourage the people of Whitehaven to listen to the reasoning behind any proposals that their local doctors bring forward for improvements in the way in which people are cared for in the local area.
I should like to reiterate that local health services in west Cumbria have a strong future. There is a commitment from the local CCG, led by doctors and nurses, for a continuing accident and emergency service, and the Government support a £95 million investment in health care facilities at West Cumberland hospital.
Mr Reed
The Keogh report makes it very clear that meaningful engagement with the staff both at the Cumberland infirmary, Carlisle, and the West Cumberland hospital is nothing like it should be. That is one of the key reasons the trust entered special measures. All of us from all parts of the House want to see the hospital trust emerge from special measures as quickly as possible. However, latterly, that engagement internally has demonstrably worsened. How can we get out of special measures if these behaviours persist?
Dr Poulter
Part of the challenge may well be challenging some of the existing work practices at the hospital. I accept what the hon. Gentleman has said about the quality and commitment of local NHS staff. In my experience, I have never found a member of the NHS who has been engaged in health care with anything but the best intentions and the wish to help people. That is why I am a doctor and why many people go into health care; they want to provide compassionate care for people and to improve the human condition. I know that that is what drives local staff in Cumbria. Sometimes when profound issues have to be faced, such as higher than expected local mortality rates, challenging conversations have to take place. Such issues are the result of not a lack of commitment or dedication from the staff, but the fact that some working practices need to be improved. Additional training and support may need to be put in place to improve those working practices. It is important that that is done in a way that brings staff along in a collaborative working environment.
When things go wrong in health care, it is rare that there is one single causal factor, although sometimes there is; sometimes it is the negligent act of one person. Often, however, it is the system in a hospital that has let someone fall through the gaps. This is about challenging working practices, and as far as possible, that has to be done collaboratively. Clearly, there have been huge improvements in the way health care is delivered locally. Mortality rates have fallen, and patients are being looked after in the way we would all expect. That is down to the hard work of the staff who are facing up to some of the challenges, and making sure that they put right what may have been wrong.
It is important that when there are discussions about reconfiguring, changing or developing health care services, local clinical commissioners engage effectively with the hospital and properly with hospital staff. Part of the broader consultation and engagement exercise needs to be focused on proper engagement between the clinical commissioning group and the clinicians and other dedicated staff who work at the trust. From what hon. Members are saying, there may be more work to do in that area. I urge the clinical commissioning group to put right any issues, because it is important that everybody signs up to dealing with future challenges.
As I have said, I am confident in the local clinical commissioning group’s commitment to supporting a viable A and E at the hospital. The Government have provided investment to develop facilities further, particularly facilities for surgical procedures, in the hospital and the local area. With that investment, there is a strong future for local hospital services. It is important that local clinical commissioners continue to engage with staff at the trust, and particularly with local patients. After all, if we want a health service that is fit for purpose in Cumbria and elsewhere, it has to be based on the needs of local patients. It is to them, more than anybody else, that local commissioners need to listen.
Question put and agreed to.
NHS Litigation Authority (Triennial Review)
Dan Poulter Excerpts(9 years, 6 months ago)
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The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I am today announcing that the Department of Health is commencing a triennial review of the NHS Litigation Authority. This review forms part of the first tranche of reviews to be announced this Session.
Triennial reviews of arms-length bodies are a key part of the Department’s stewardship and assurance of the health and care system, they also contribute to the Government’s wider programme of work on public bodies reform.
The review will consider the body’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.
I will announce the findings of the review later this year.
NHS Services (Access)
Dan Poulter Excerpts(9 years, 6 months ago)
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Andy Burnham
All the evidence from around the world tells us that more market-based health systems cost more than systems such as the NHS, and are more complex and fragmented. The clear conclusion I draw is that the market is not the answer to 21st-century health and care. The Government believe it is, which is why they must be defeated if we are to protect our national health service.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
I hear what the right hon. Gentleman is saying. If he is concerned about other providers in the health service, will he explain why the previous Labour Government were happy to pay private sector providers 11% more than NHS providers for providing NHS services?
Andy Burnham (Leigh) (Lab)
We brought in other providers in a supporting role to add capacity to bring down NHS waiting lists to the lowest ever level. That is what the previous Government did. By contrast, this Government are doing something different. It is mandating tendering on GP commissioners, requiring people to compete, wasting money on running tenders and privatising the national health service, which is why they must be stopped.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
It is a pleasure to conclude this debate and to speak to the contributions of hon. Friends and hon. Members. It is a pity that when we have NHS debates, they sometimes become unnecessarily tribal and partisan. Some Labour Members often seek to talk down the local NHS rather than to stand up for their hard-working NHS staff who deliver high-quality services on the ground.
I want to talk about some of the successes this Government have delivered for our NHS and then I shall address some of the points raised in the debate. We know that even in these difficult economic times, this Government have protected our NHS budget with £12.7 billion more during this Parliament. That was something that the shadow Secretary of State, the right hon. Member for Leigh (Andy Burnham) called “irresponsible”, but it is not irresponsible to make sure that we continue to support and protect the NHS front line. We have stripped out over £5 billion-worth of bureaucracy and reinvested that money into front-line patient care. That has been audited by the National Audit Office, but the hon. Member for Leicester West (Liz Kendall) did not choose to highlight that point in her remarks. It has been confirmed and we know it is true.
I make no apology for the fact that we as a Government have focused ruthlessly on having a more efficient health service that frees up as much money as possible for front-line patient care. We have reduced the number of administrative staff by around 20,000, increased front-line clinical staff by over 12,500 and set up a cancer drugs fund that has helped 55,000 people who would not have received cancer drugs to receive them. There has been an unrelenting focus on promoting a more joined-up approach to care, to help deliver more care in the community for people with long-term medical conditions, particularly the frail elderly.
Let me deal with some of the comments and contributions to the debate. I would like to reassure my hon. Friend the Member for Morecambe and Lunesdale (David Morris) that the hospital in his constituency is, of course, not going to close and that any local scaremongering by the Labour party is wrong and misplaced. I would also like to reassure the hon. Member for North Durham (Mr Jones), who raised concerns about the north-east ambulance service, that the service has generally been performing well. In 2013-14, it met all its national targets. I urge the hon. Gentleman to write to me if he has any further concerns on behalf of local patients.
We heard strong contributions from my hon. Friend the Member for Norwich North (Chloe Smith), who made important remarks about the services delivered at the Norfolk and Norwich hospital, and I look forward to accepting her invitation to visit that hospital once again in the near future, and from my hon. Friend the Member for Bosworth (David Tredinnick) who made one of his regular pleas for more alternative medicine in the NHS. Importantly, he talked about the benefits of clinically driven commissioning. Under this Government, we have put doctors and nurses in charge of our NHS to make sure that services are delivered at local level. Patient services are run by doctors and nurses, not by bureaucrats, which has been a tremendous step forward. My hon. Friend the Member for St Ives (Andrew George) made a considered contribution about the previous Government’s record on encouraging private sector providers in the NHS—a point to which I shall return.
Lilian Greenwood
What does the Minister think about what happened to the clinical commissioning group in North Staffordshire, which decided not to allow people with mild to moderate hearing loss to have hearing aids, even though that was clearly not the view of the local health scrutiny committees or local patients? Is that not precisely putting in jeopardy preventive services, which would keep people in work and keep them active in the community rather than being isolated? It is stopping those people from participating.
Dr Poulter
If the hon. Lady has concerns about local commissioning decisions, she should take them up with local commissioners. Time forbids me from going into the rationing of services by the previous Labour Government. It is important that clinical services are now designed and delivered by front-line health care professionals, and if she is concerned about them, I am sure she will take that up with her local CCG.
The right hon. Member for Leigh (Andy Burnham) referred to a work force crisis in GP training. It is clear that under this Government 1,000 more GPs are now in training and working in the NHS than in 2010 when we came into government. If it is not accepted that that is good start, we have committed to training an extra 5,000 because we want more people working in general practice.
We have ensured that 1.3 million more people are being treated in A and E compared with the number in 2009-10. We have halved the time that people must wait to be assessed, and every day we are treating nearly 2,000 more people within the four-hour target compared with the number in 2010.
Competition was introduced into the NHS not by the Health and Social Care Act 2012 but by the previous Labour Government, of whom the right hon. Member for Leigh was a Minister. The Labour Government opened the door to private sector providers when they opened the first independent sector treatment centres in 2003. The Labour Government gave £250 million to private companies and independent sector treatment centres, regardless of whether they delivered that care. Labour was more concerned about giving money to the private centres than about ensuring that quality care was delivered. Labour paid independent private sector providers 11% more to provide the same care as NHS providers. That is Labour’s record on the private sector in the NHS—a record that shows that it is more committed to the private sector than any previous Conservative Government.
Kevin Barron
If that is the case, will the Minister—as a Back Bencher, he sat on the Health Committee—tell us why there were so many clauses in the Bill that introduced the Competition Commission and the Office of Fair Trading into our national health service?
Dr Poulter
The right hon. Member will be aware that Labour’s legislation, which gave the private sector the opportunity to tender for contracts, saw 5% of NHS activity—I believe that figure is correct—provided by the private sector at the end of the last Labour Government. In the Health and Social Care Bill, we wanted to stop the unregulated approach. We wanted greater emphasis on integration of health care services. It was not just about the private sector provider fixing someone’s hip and forgetting what sort of care was available when their hip had been repaired and they had gone home. It was about ensuring greater emphasis not just on competition and what was best for patients, but on integrated and joined-up services to ensure that people were properly looked after when they left a treatment centre. We stopped the cherry-picking of services that happened under Labour, and we are proud of that.
We will take no lessons from the Labour party on NHS finances. Labour was the party that crippled the finances of so many NHS trusts with PFI deals, and it was the party that during its final year in government saw the number of managers rise six times as fast as the number of nurses.
I am proud of this Government’s record on the NHS and I am proud of our record on integration. There will be a clear choice at the general election next year: a Conservative-led Government who have delivered for patients, a Conservative-led Government who have delivered on cancer services and a cancer drugs fund, and a Conservative-led Government who will continue to ensure better care for people with long-term medical conditions. We have a proud record on the NHS and I urge my right hon. and hon. Friends to oppose the motion.
Question put.
Health
Dan Poulter Excerpts(9 years, 7 months ago)
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Gloria De Piero
To ask the Secretary of State for Health how many training posts for nurses were commissioned in England in each of the last five years.
[Official Report, 7 May 2014, Vol. 580, c. 241-43W.]
Letter of correction from Dr Poulter:
An error has been identified in the written answer given to the hon. Member for Ashfield (Gloria De Piero) on 7 May 2014.
The full answer given was as follows:
Dr Poulter
The following table shows the number of new pre-registration nursing places that were filled in the last five years. The table includes the students enrolled on the degree and diploma courses.
Nursing total | |
Number | |
2009-10 | 20,829 |
2010-11 | 20,092 |
2011-12 | 17,741 |
2012-13 | 17,219 |
2013-14 | 18,009 |
Source: Multi professional education and training budget monitoring returns. |
The correct answer should have been:
Dr Poulter
The following table shows the number of new pre-registration nursing places that were filled in the last five years. The table includes the students enrolled on the degree and diploma courses.
Number | |
|---|---|
2009-10 | 20,829 |
2010-11 | 20,092 |
2011-12 | 17,741 |
2012-13 | 17,219 |
2013-14 | 17,568 |
Source: Multi professional education and training budget monitoring returns. |