Hospital Car Parking Charges

Dan Poulter Excerpts

Monday 1st September 2014 Commons Chamber

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

I would like to begin by congratulating my hon. Friend the Member for Harlow (Robert Halfon) on securing this debate and my hon. Friend the Member for Thurrock (Jackie Doyle-Price) on her opening speech, which outlined a number of the key issues, about which we are all concerned and to which a number of Members have referred. I understand and have listened to the concerns expressed, both in this House and by the public more generally, about car parking in our NHS, especially where the cost is high and can be considered a rip-off for patients, their families and, sometimes, NHS staff. That is why we published the new NHS patient, visitor and staff car parking principles last month, which will lead to new guidelines at the beginning of next year.

Before I address those principles and respond in more detail to some of the points raised, it is important to pick up on the key issue that has been outlined—my hon. Friend the Member for Thurrock raised it in her opening remarks—which is that, for a patient, driving to hospital is not a choice; it is essential in order to receive important and, often, life-saving treatment. It is also important for relatives and those wishing to support and look after friends and others who may be admitted to hospital through no fault of their own. It is right to say, as my hon. Friend did, that Basildon was a challenged trust, but addressing the challenges of that trust, both financial and in terms of patient care, should not come at the expense of short-changing patients. There are many other measures that trusts need to look to—such as improving their procurement practices, better managing the NHS estate and, in the long term, lowering costs by reducing their dependence on temporary staffing—to balance their books and ensure that as much money as possible is directed to front-line patient care.

My right hon. Friend the Member for Sutton and Cheam (Paul Burstow) made a number of important points, including the key one that car parking should not be a cash cow and needs to be seen in the context of the wider sustainability challenge of the NHS, and that many trusts are still paying the price for poor PFI deals that they signed up to under the previous Government. He also asked what role the CQC could play in addressing the issue if parking charges were prohibitive. Of course there is a role for the CQC. If concerns were raised about patients being prevented from accessing the NHS care they needed as a result of prohibitive car parking charges, the CQC could of course make recommendations and raise that with the trust as part of its inspection regime. The power for the CQC to do that exists at the moment, and I am sure the chief inspector of hospitals will be mindful of that as part of the inspection regime.

We had many other good and important contributions, including from my hon. Friends the Members for Harrow East (Bob Blackman) and for Harlow, who spoke very eloquently and outlined clearly the reasons for calling this debate. We also heard from my hon. Friends the Members for Peterborough (Mr Jackson), for South Derbyshire (Heather Wheeler), for Worcester (Mr Walker) and for Hexham (Guy Opperman), all of whom spoke eloquently. In the time available to me, I will do my best to pick up on some of their points in my broader remarks.

We talk about the fact that there are many examples of unacceptable practice in hospital car parking, but it is important to highlight the fact that 40% of hospitals that provide car parking do not charge and of those that do, 88% provide concessions to patients. However, I am aware that there are 40 hospital sites—which is 3.6% of hospitals in acute and mental health trusts—that have charges and do not allow concessions to patients who need to access services. As a Government, we want to see greater clarity and consistency for patients and their friends and relatives about which groups of patients and members of staff should receive concessions and get a fairer deal when it comes to car parking. It is exactly for those reasons that we published the principles that will underpin the guidance that will be published in February or March next year about how we deliver fairer car parking charges, of which all trusts will be expected to be mindful.

I want briefly to outline some of the key points in that guidance. We want to see concessions, including free or reduced charges or caps for the following groups: disabled people, frequent out-patient attenders, visitors with relatives who are gravely ill, visitors to relatives who have an extended stay in hospital, and staff working shifts that mean that public transport cannot be used. Other concessions—for example, for volunteers or staff who car share—should be considered locally. The list I have given is not exhaustive—we will return to it as part of the guidance we produce early next year—but it is important that we have much greater consistency and clarity from all hospitals about which groups should receive parking concessions and free parking when that is appropriate.

[Mr Frank Field]

It is quite clear that the Government have a model in mind of the minimum standards that hospitals should subscribe to, which is welcome. Will the next round of consultations that the Government undertake with hospital trusts outline what will happen to those that pay scant regard to what the Government are suggesting?

[Dr Poulter]

It is exactly because a small minority of hospital sites have no concessions at the moment, which is unacceptable and not fair to patients—I outlined 40 such sites that I am aware of in acute and mental health trusts—that we brought forward the principles and are refreshing the guidance. We need to see hospitals respond to that guidance. Powers are already available to the CQC and the chief inspector of hospitals for the CQC to take action, if appropriate, if there is behaviour in a hospital that makes it prohibitive for patients to receive treatment. However, we also need to look at what other measures we can introduce against trusts that still show disregard for the guidelines, to make it clear that doing so is no longer acceptable. For example, mechanisms are available to us when we give finance to trusts to ensure greater conditionality on that finance in future.

That is something we would certainly look at seriously as a mechanism for enforcing better behaviour, but I am hopeful, thanks to the fact that we will have refreshed guidance and that many patient groups are championing this issue at the local level. My right hon. Friend the Member for Sutton and Cheam made the point articulately that patient action locally meant that St Helier hospital, which was one of the worst offenders for car parking charges and disregarding the rights of patients and staff, has reformed its ways. Patient action has led to improvements. A number of mechanisms are already in place and, with the guidelines, I am sure we will get to a much better place across all trusts. However, if necessary, we have other measures, when we are giving finance to trusts, to put levers in place.

[Mr Frank Field]

Does the inspector have powers to instruct the groups that will probably pay scant attention to the guidelines to make the changes that the whole House wants?

[Dr Poulter]

If concerns are raised as part of a care quality inspection that patients are receiving substandard care or not receiving the quality of care that they should be as a result of being unable to access services, there would of course be a role for the chief inspector of hospitals and the CQC to raise that as part of their inspection report. I am sure the chief inspector will bear that in mind for the 40 hospital sites that at the moment do not have concessions for those who are very unwell or who are disabled. I am sure that those trusts, which will be listening keenly to this debate, will bear that in mind and will want to take action, hopefully before the refreshed guidance is produced.

I know that time is pressing and I do not wish to detain the House much further, but I want quickly to outline a few of the other measures that are in place as part of the principles that will underpin the guidance, which hopefully will reassure right hon. and hon. Members that the Government have taken appropriate steps to address these issues.

Staff parking is an important issue. I probably speak as the only Member—currently, at least—who, as a practising hospital doctor, has genuine, first-hand experience of this issue. It is important to look after our front-line staff. Car parking in hospitals should not be allocated according to staff seniority or because someone happens to be a senior manager; it should be allocated according to the needs of staff and the type of care and shift patterns they provide. That is made very clear in the principles underpinning the guidance to be published.

On payments for hospital parking, our principles say that trusts should consider pay-on-exit or similar schemes, whereby drivers pay only for the time they have used, and fines should be imposed only where they are reasonable and should be waived when overstaying is beyond the driver’s control. Details of charges, concessions and penalties should be well publicised, including at car park entrances, wherever payment is made, including inside the hospital. The issue has been raised of the sharp practice sometimes carried out by the management of car parks in hospitals, and we have made it clear in the principles underpinning the guidance that those practices are unacceptable.

Finally, on contracted-out car parking—another issue raised in the debate—NHS organisations remain responsible for the actions of private contractors who run car parks on their behalf. NHS organisations are expected to act against rogue contractors in line with the relevant codes of practice, where applicable. Contracts should not be let out on any basis that incentivises fines—for example, income from penalties only. This Government expect hospitals to take action against contractors who behave irresponsibly, short-change people and behave badly towards patients, their relatives and staff.

I hope that I have reassured the House, particularly those who brought this debate before us today, that this Government take the issue very seriously and believe that unacceptable behaviour by hospitals and unacceptable hospital car parking charges will become things of the past.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 15th July 2014 Commons Chamber

[Philip Davies (Shipley) (Con)]

7. What lessons his Department has learned from the Born in Bradford research study.

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

By tracking the lives of 13,500 children and their families, the Born in Bradford research study is providing information that will help us to understand the causes of common childhood illnesses, and to explore the mental and social development of a new generation.

[Philip Davies]

In the Born in Bradford study, 63% of Pakistani mothers are married to cousins, and within that group there was a doubling of the risk of a baby being born with a congenital anomaly. The report also found that “a larger number” of children born to cousins

“will have health problems that may lead to death, or long term illness for the baby.”

How much do health issues related to first-cousin marriages cost the NHS, and, given those findings, is it not time that such marriages were outlawed?

[Dr Poulter]

We do not have any financial information, but it is important to point out that the Born in Bradford study showed that there was an increase in the risk of birth defects from 3% to 6% in consanguineous marriages. However, that clearly highlights that not all babies born to couples who are related have a genetic problem, and the key issue is to help women to make an informed choice before they get pregnant and to direct them to genetic counselling where that may be required.

[Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab)]

8. What the new deadline will be for moving people with a learning disability out of assessment and treatment units and into community provision.

--- Later in debate ---

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

12. What recent advice he has received on NHS trust deficits in England.

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

We have regular conversations with the NHS Trust Development Authority and Monitor about the provider sector. For 2014-15, the TDA, NHS England and Monitor are establishing a joint package of support and financial improvement measures for some of the weakest local health economies.

[Mr Brown]

Even if the Department were able to achieve every possible efficiency saving, both Monitor and the King’s Fund are forecasting a substantial deficit in next year’s budget. What is the Department’s policy response to that? I understood that the Secretary of State ruled out charging in answer to an earlier question, so that leaves either applying more money to the problem or restricting the service.

[Dr Poulter]

The right hon. Gentleman asks a valid question about how to make efficiency savings. Under the previous Government, there was a requirement in 2009 to make £20 billion of NHS efficiency savings during this Parliament, which is being delivered at £4 billion a year. Improving procurement practice at hospitals, improving estate management, greater energy efficiency measures, ensuring more shared business services in the back office and reducing bureaucracy are all measures that will continue to ensure that the NHS meets the challenge and frees up more money for front-line patient care.

[Jeremy Lefroy (Stafford) (Con)]

Stafford hospital has struggled with deficits for many years, but it has substantially improved its care. On Friday, however, it was announced that 58 beds will be closed due to staff shortages. My constituents and others are extremely concerned that the trust special administrator’s plans, which the Secretary of State endorsed, to keep A and E, acute medicine and many other services at Stafford are at risk. Will the Minister reassure them and staff that that is absolutely not the case and that the TSA’s plans will be enacted as a minimum?

[Dr Poulter]

The most important thing in delivering local services is to ensure high-quality patient care and patient safety, so I would want the TSA’s plans to be delivered as quickly as possible to ensure that high-quality services are delivered locally and that patients’ best interests are protected.

[Jesse Norman (Hereford and South Herefordshire) (Con)]

13. What steps he is taking to improve care for people affected by stroke.

--- Later in debate ---

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

16. What assessment he has made of the adherence by NHS trusts and clinical commissioning groups to the healthy child programme (a) in general and (b) in respect of the provision of perinatal mental health services.

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

NHS England commissions the healthy child programme and the NHS England mandate includes an objective to reduce the incidence and impact of post-natal depression. NHS England is held to account through its regular assurance processes and we are well on track to deliver an additional 4,200 health visitors by 2015 who will provide individual one-to-one support for women in the post-natal period.

[Mrs Hodgson]

The National Childbirth Trust found that just 3% of clinical commissioning groups have strategies to provide these services and 60% have no plans to put them in place at all. The Minister might be aware that the all-party group on conception to age two, superbly chaired by the hon. Member for East Worthing and Shoreham (Tim Loughton), has recently announced an inquiry into factors affecting child development, with the first session last week considering this very issue. In advance of its conclusions, will the Minister give a pre-emptive guarantee that all expectant mothers will have access to perinatal mental health services and that it will not just depend on where they live?

[Dr Poulter]

The hon. Lady makes a very important point. We know the importance of good perinatal mental health not just for the mother but for the life chances of the child. That is very important if we are to ensure that we get the commissioning of maternity services right in the future. There is a commitment in the Health Education England mandate that by 2017 all maternity units will have specialist perinatal mental health staff available to support mums with perinatal mental health problems.

[James Duddridge (Rochford and Southend East) (Con)]

T1. If he will make a statement on his departmental responsibilities.

--- Later in debate ---

[Andrew Selous (South West Bedfordshire) (Con)]

T5. The Chavasse report on improving care for members of the armed services and veterans builds on the improvements that we have already made and has been welcomed by the Department of Health and indeed the Ministry of Defence. We owe it to our armed services to carry on making improvements to their care, so will the Minister encourage NHS England to look favourably on its recommendations?

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

My hon. Friend is right to highlight the importance of the Chavasse report. Its focus on improving care for veterans is warmly welcomed. There is a lot that we can work with to deliver better care and build on the specialist care centres already in place for veterans who have lost limbs and need prosthetic services and to provide additional support for veterans with mental health problems.

[Mr Speaker]

Mr George Mudie. Not here.

--- Later in debate ---

[Chris Bryant (Rhondda) (Lab)]

There is lots of evidence to show that chronic traumatic encephalopathy is now a major cause of depression, dementia and in many cases suicide, but the World cup showed that many sporting bodies are still not taking concussion seriously enough. Will the Minister, perhaps with colleagues in other Departments, bring in all the sporting bodies, the doctors and the teachers so that we can take concussion in sport seriously?

[Dr Poulter]

The hon. Gentleman makes a very good point. As we commission NHS services, it is increasingly important that there is more focus on sports injury and rehabilitation, not just in relation to our elite sports people, but in relation to those people who play sport regularly at weekends, to ensure that they are properly looked after. If it would be helpful, I am happy to meet the hon. Gentleman to discuss the matter further and see how we can take it forward.



BILLS PRESENTED

Protective Headgear for Cyclists Aged Fourteen Years and Under (Research) Bill





Presentation and First Reading (Standing Order No. 57)

Annette Brooke presented a Bill to require the Secretary of State to commission research into the merits of requiring cyclists aged fourteen years and under to wear protective headgear; to report to Parliament within six months of the research being completed; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 12 September, and to be printed (Bill 74).

Amenity Land (Adoption by Local Authorities) Bill

Presentation and First Reading (Standing Order No. 57)

Annette Brooke presented a Bill to amend section 215 of the Town and Country Planning Act 1990 to allow local authorities to adopt areas of amenity land which are unregistered or vested in the Crown, for the purposes of maintenance; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 12 September, and to be printed (Bill 75).

Sugar in Food and Drinks Bill



Presentation and First Reading (Standing Order No. 57)

Geraint Davies, supported by Jeremy Lefroy, Mr Mark Williams, Mrs Madeleine Moon, Mrs Linda Riordan and Dr Julian Lewis, presented a Bill to require the Secretary of State to set targets for sugar content in food and drinks; to provide that sugar content on food and drink labelling be represented in terms of the number of teaspoonfuls of sugar; to provide for standards of information provision in advertising of food and drinks; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 7 November, and to be printed (Bill 76).

Severe Eating Disorders (North-East England)

Dan Poulter Excerpts

Monday 23rd June 2014 Commons Chamber

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

I congratulate the hon. Member for Newcastle upon Tyne Central (Chi Onwurah) on securing the debate and not only raising important issues about the provision of services for people with eating disorders in her constituency, but doing so in the context of an important national debate, because many of us are aware that there has not always been a genuine parity of esteem between mental and physical health. If we are to have a holistic health service that focuses on better supporting people in their own communities, mental health will play an important part. In the north-east and elsewhere, it is vital that we try, in the first instance, to prevent people who have anorexia or other eating disorders from becoming so unwell that they need to be admitted as in-patients. That clear priority is not mutually exclusive to this debate, because it is clearly what good medicine and health care—whether for physical or mental health—is all about.

Eating disorders mainly affect young people, and I shall say a little about that as I address the specific concerns in the north-east that the hon. Lady outlined. Anorexia particularly affects women under the age of 25, from the early teens onwards. Research tells us that there might be more than 1 million people in the UK who are directly affected by an eating disorder.

Worse still, as the hon. Lady highlighted, anorexia kills more people than any other mental health condition, and the longer a patient is unwell with anorexia, the more likely the condition is to be fatal. Even before people begin to lose weight, they are failing to put on the bone mass that will sustain them as adults, and the disease is linked to osteoporosis and other conditions in later life associated with bone fracture. As the disease progresses, it becomes life threatening, particularly due to the muscle wasting that occurs to the internal organs, especially the heart. There can come a point, sometimes quite quickly, when as muscle mass deteriorates, it is lost preferentially from the heart. That increases the risk of heart attacks, which can often, tragically, be the cause of death in such cases.

We are also aware that eating disorders afflict young women at perhaps the most formative period of their lives. The peak age of onset of anorexia is 15. For bulimia it is two or three years later. On average, people with anorexia will recover, if they recover at all, after about six years of care. That highlights the importance of good out-patient services in delivering better care. If we can stop people getting to the stage where they become so unwell with anorexia, with better support through talking therapies and other interventions as part of good community-based care, that is a clear priority for mental health services and one that commissioners are taking very seriously in the hon. Lady’s part of the country, as she outlined.

Eating disorders span the transition between child and adolescent and adult services. This has sometimes led to unacceptable variations in care and fragmented services, as we heard. So how do we deal with this? Early diagnosis is key. We have to make sure that treatment is available to minimise the effect of these distressing conditions. But alongside this, and perhaps before this, we need to attack the causes as well. Eating disorders are often blamed on the social pressure to be thin, as young people in particular feel they should look a certain way. In reality, the causes are much more complex than that.

There are several risk factors—having a family history of eating disorders; depression or substance misuse; being criticised for eating habits, body shape or weight; being overly concerned with being slim, particularly if combined with pressure to be slim from society or for a job; and having an obsessive personality or an anxiety disorder. Other key causes of eating disorders are sexual or emotional abuse, the death of people who are close and other stressful situations. There are also issues specific to particular eating disorders, which I will not go into today. There are clear differences between anorexia, bulimia and binge eating disorder. Binge eating disorder has the added complication of the binge eating cycle, leading to increased blood sugar and potential links to diabetes.

It is important that such disorders are not looked at in the context of the mental health service in isolation. When we know that the cause of death may often be due to cardiac arrest in the case of anorexia, and when we know that there may be links between binge eating disorder and diabetes, it is important that an holistic approach is taken to the care of people who become very unwell. There is a link between the physical and the mental health services that are available to patients, and I know from conversations that local commissioners are looking at that in the way they deliver care.

Last year, the Home Office launched a report of its body image campaign, which highlighted the need to ensure that young people have healthier and happier futures where a wider spectrum of healthy male and female body shapes is represented. I am sure we would all support that.

I assure the hon. Lady that children and young people’s mental health, particularly in the north-east, is a priority for the Government. That is why we have invested £54 million in the four-year period from 2011 to 2015 in the children and young people’s improving access to psychological therapies programme, or children and young people’s IAPT services. This provides training in a number of evidence-based psychological therapies, not just the more common cognitive behavioural therapy or CBT, but systemic family therapy and interpersonal psychotherapy.

Given the complexity of the causes of eating disorders, that more holistic basis to the way that children and young people’s IAPT services work to get early intervention in place, and the £54 million supporting that deployment in the north-east and elsewhere, will, we hope, make a difference in the years ahead. We must recognise that we are coming from a baseline where there was no parity of esteem in terms of how the NHS prioritised eating disorders or how the NHS commissioned services for eating disorders. This investment in that early intervention will bring real improvements to the quality of care of people with eating disorders in the north-east and elsewhere. We know that early intervention is key. It is also important that we get a firmer understanding of the scientific basis and the research that underpins good treatment. The South London and Maudsley NHS Foundation Trust has conducted a £2 million programme of research specifically on the treatment of anorexia, which will improve treatment and care throughout the country.

In the north-east, child and adolescent mental health services have been transformed by the introduction of the children and young people’s IAPT services, which I outlined earlier, in the areas covered by three CCGs, namely Teesside, Newcastle, Hartlepool, Middlesbrough and Easington. Between them, they commission CAMH services for 61% of young people in the region already under other CCGs, and the other CCGs have agreed to follow them. Steps are being made in early intervention, in providing better support for people with eating disorders in the north-east.

[Tessa Munt (Wells) (LD)]

I recognise the similarities between what is happening in the north-east and in the south-west. We have young people being discharged from services when they reach the 18-week threshold or because they have reached a body mass index of 18, yet the Minister has accepted that this is a complex condition which sometimes takes five or six years to recover from.

[Dr Poulter]

That is absolutely right, and it is important that there is a strong link between what happens in the community and what happens at the specialist centre. We know that there are advantages to commissioning specialist beds for eating disorders. We know that there is good evidence supporting the fact that that delivers better care for patients. But it is important that there is a strong link between that and what happens to the patient and the young person when they are discharged from that care, and that there is proper support in the community for those people afterwards. That is what will be supplied in this context by the newly commissioned services at Benfield House, which specifically focuses on providing high-quality day services and real support for young people and their families.

[Chi Onwurah]

I considered the importance of continuity of care and the unique nature of in-patient care requirements, and the Richardson unit had both out-patients and in-patients, and that continuity of care was very important. Please will the Minister address the issue of the Richardson unit?

[Dr Poulter]

In the brief time available to me now, I will come on to the Richardson unit specifically. The hon. Lady outlined the decisions made in 2010 and why they were made. We must recognise that under the criteria brought in by this Government, there are now strengthened criteria for public engagement in future decisions about commissioning. In future, they will have to be clinically led by local clinicians and made on the basis of strong public engagement. I would hope that those decisions would not necessarily have been taken in the same way had they been made under the criteria introduced by this Government.

I invite the hon. Lady to have a further meeting with the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), when she will be able to raise more of those concerns with him directly, but it is important to recognise that there is now a change in the way in which consultations are carried out. That was not there at the time, and that is part of the reason why there was not the transparency that the hon. Lady wanted and desired; transparency that we would all find desirable, but unfortunately the criteria were laid down by the previous Government. People often felt done to, rather than done for and cared for. That is why we have changed and improved the criteria.

As well as offering that meeting with my hon. Friend, I want to say that it is completely unacceptable for patients to be travelling long distances for their treatment and care at specialist centres and units. That is not good health care. We know that part of the recovery for people with eating disorders is having a community-based package where there is a strong link with family support. On the basis of that, my hon. Friend and I will raise with NHS England the specific issues arising from this debate, and I would also like the hon. Lady to meet my hon. Friend to discuss this further. I hope she finds that reassuring, and that she also finds reassuring the important early intervention measures that have been put in place in her constituency.

Question put and agreed to.

Localised Health Care

Dan Poulter Excerpts

Wednesday 11th June 2014 Commons Chamber

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

I pay tribute to my hon. Friend the Member for North East Cambridgeshire (Stephen Barclay) for securing the debate and for his strong advocacy on behalf of his constituents and local patients. As he has continually reminded the House since his arrival here—I arrived at the same time—we, as a coalition Government, understand the importance of spending public money wisely and investing every possible penny in front-line patient care.

My hon. Friend raised a number of points, and I did not disagree with a word of what he said. In particular, he was right to emphasise the need for a radical transformation of the way in which we deliver care over the next five to 10 years. We need to deliver more care in the community, closer to people’s homes. It is a question not just of good health care economics, but of good patient care. It is right for people with complex care needs—people with diabetes, dementia and cancer—to be cared for as close to home as possible. That requirement is all the more acute and important in some of our more rural communities, such as my hon. Friend’s constituency in the fens.

We should bear in mind the challenge laid down by the former chief executive of the NHS and echoed by the current chief executive, Simon Stevens. We must ensure that we spend the NHS budget more wisely, and direct more money to front-line patient care. There have been real-terms increases in the budget, and, as a coalition, we are all proud of the fact that we are investing more money in the NHS even in difficult economic times. Nevertheless, we must ensure that that money is spent more wisely, and that the way in which care is delivered continues to become more efficient. We have an ageing demographic, and the effects of that are often experienced more acutely in rural areas. Our technology is continually improving, and patients rightly have rising expectations of the quality of care that they will receive. We must therefore ensure that we deliver care more effectively, and in a more patient-centred way.

To meet that challenge, more needs to be done on NHS procurement at local and national levels, as my hon. Friend highlighted. The Government support that. We need to do more in the health service to ensure that we reduce unnecessary administration and bureaucratic costs and back-office services. He highlighted that as a challenge for his local health economy.

It is crucial that we transform the way we deliver care. That means breaking down silos in Cambridgeshire and elsewhere, particularly between the hospital sector—Addenbrooke’s and Peterborough city hospital, for example—and the health care that is commissioned and delivered in the community by CCGs. That also applies to the social care sector run by the local authority. It is important that Cambridgeshire county council—my hon. Friend outlined the challenges—plays a key role in helping to transform the ways in which services are delivered. Sometimes, it will not be possible to decide whether an elderly and frail person in Cambridgeshire should receive care that is provided by social services or by the NHS. It is the same person; it is the same patient, and it is time that local authorities and the NHS dropped the silo working mentality, worked together and focused the money and attention on the patient. The better care fund that the Government are setting up will come into force next year. That will provide about £3.8 billion specifically to promote better integration of health and social care. I am sure that will be of great benefit in Cambridgeshire, including in the rural communities that my hon. Friend represents.

From an NHS perspective, there are three components to transforming the way services are delivered and to breaking down those silos. It is important we have the right leadership on the ground to deliver improvements. I know as a fellow east of England MP that we have had challenges sometimes in that regard. We need the right leaders to drive change. My hon. Friend was right to highlight that the changes under the Health and Social Care Act mean that we have clinical leadership through CCGs. That will bring benefits because decisions and resource allocations are being made by clinicians who understand where the money is best spent to improve patient care.

We also need the leadership from NHS England teams at an area level to be effective. I hope that my hon. Friend will agree that all MPs in Cambridgeshire and elsewhere need to hold those local area teams to account. We need to ensure that they are working to do their bit to support the clinical leadership on the ground at CCG level.

Hospital providers at Addenbrooke’s, Peterborough city hospital and elsewhere need to come together and work with the CCGs to deliver care. When we talk about delivering care in the community, one of the key aspects is having a work force who work across hospitals and the community—across both primary and secondary care. Far too often, a work force who work in, say, cancer services are based just in the hospital. In commissioning services, we need to recognise that the work force need to be commissioned across primary and secondary care. One example would be to have more specialist nurses in diabetes who not only work at the hospital base but are commissioned across the community. It is important to ensure that my hon. Friend’s CCGs work with the hospital provider, particularly Addenbrooke’s, a centre of international excellence, to deliver more holistic care for people with long-term conditions, and that the work force are not just based in the hospital but go out to where the patients are in the community. That is key to delivering improvements in care.

I want to highlight some of the important local issues that my hon. Friend has raised. I was pleased to hear him make the point about the St George’s surgery and that chemotherapy services are being delivered in the community. His constituents should be proud that they have a GP surgery that is delivering that sort of care in the community. Some of the sickest people, who often struggle to travel to hospitals, are being looked after close to home and receiving high-quality care in the local GP surgery. That sort of care needs to be regularly offered in the next five to 10 years in many more GP surgeries—not as an exemplar, but as a regular example of what good practice and good health care looks like. That is transforming services and delivering more care in the community. My hon. Friend should be very proud of the part he has played in helping to make that a reality, and proud of the fact that his constituents have a service many other people will be looking forward to having in the future.

We must also have the right preventive care so that people who do not need to go to hospital do not go there. My hon. Friend talked about intravenous therapy. Someone with an infection from a leg ulcer, for instance, who will need IV antibiotics could be given them in the community. Traditionally those patients have ended up in hospital not because that is the right place for them to be, but because the care in the community to provide IV antibiotic therapy was not available. That is not good for patients, nor is it good health care economics—it is expensive for the NHS. That is exactly the sort of service older people with complex care needs require, particularly in rural communities. I know my hon. Friend’s CCGs will want to prioritise that in the months ahead.

My hon. Friend highlighted the importance of having close-to-home blood testing facilities. Many older people may be on warfarin for atrial fibrillation or other medical conditions. It is important that for that, and other simple blood tests, the person is treated and looked after close to home by their general practice. In rural areas, particularly in Cambridgeshire and Suffolk, where my constituency is, the GP surgery is often the hub of care, so the more we can do to provide care in those environments and close to home, the better it will be for patients.

We will also find that more patients will turn up for their appointments. One of the major causes of non-attendance at appointments in rural areas is that frail older people struggle to get to where the care is. If that care is delivered by their GP much closer to home, that saves the health service money and makes those services much more accessible. Every general practice should be offering simple services such as blood testing and supporting patients with the management of warfarin. I am pleased my hon. Friend will be championing a campaign to make this a reality throughout Cambridgeshire.

If we are to deliver better services in the community, we must have the right training in place for our work force. We need to have a work force who have the right skills to look after people with complex care needs. Under our health care reforms, we now have Health Education England, with a £5 billion budget. At a local level there are now local education and training boards, which are responsible for delivering the right sort of training to staff in each locality. A particular priority for the local education training board in the east of England is recognising the rurality of places such as Cambridgeshire and making sure there is specialist training in dementia and other care areas that addresses the needs of rural communities and ensures that people can be treated close to home. We must have the staff with the right skills to make sure that that happens.

In that respect, there will be more specialist training for GPs in mental health and children’s health care. Much of GPs’ work load is in those areas, and it is extraordinary that in the past not all GPs have had the right training. Thanks to the changes we have made through the mandate to HEE, in future we will ensure not only that there are bespoke courses for GPs to specialise in these areas, but that the whole skill set of all GPs going through training is improved to provide better community-based care. That will bring benefits to my hon. Friend’s constituents.

My hon. Friend is right that the NHS has received real-terms increases in funding in this Parliament, and we are proud to have delivered that. Every CCG, including in Cambridgeshire, will be receiving increased funding. I can understand the frustration that perhaps the progress on changing the funding formula in accordance with the independent review findings has not been as quick as some of us representing more rural communities would have liked, but that is moving in the right direction. The funding formula is now set independently, away from political interference, and according much more to health care need rather than political drivers Ministers or others may set. We will see a funding formula that will be allocated much more in line with local health care needs, but NHS England will have an opportunity again this year to examine rurality as a factor in allocating the funding formula.

I hope my hon. Friend is reassured by some of the points I have made. More importantly, what has come from this debate is that we have seen that he is a champion for the local NHS and for local patients. In his work on the Public Accounts Committee, not only does he recognise the importance of spending taxpayers’ money wisely and putting money into front-line patient care, but he understands the long-term challenges involved in transforming care. We need much more collaboration between different GP surgeries. Local commissioners need to lead that, we need more back-office sharing to reduce costs in GP surgeries, and we need better management of estates. We recognise that many GPs are small businesses in their own right, but small businesses may need to work together in a publicly funded health service to realise economies and free up more money to deliver better patient care; and we need to invest in telehealth, telemedicine and the right technology to support people with long-term conditions at home.

We also need to ensure that the better care fund that comes into effect next year is used effectively to join up what social services do with the NHS, to focus more attention on the patient and to break down the historical silos between the NHS and social care. We also need to ensure that commissioners, involved in clinically led commissioning, drive this process. They need to challenge other commissioners to do the right thing and make sure that patients are always at the centre of what happens. That is the objective, it is what needs to happen, and I know that my hon. Friend will be championing the cause locally. The goal is there and I know that he will be at the heart of the debate locally to break down those silos and to transform radically the way care is delivered, because he cares about his local patients, and I know that his local clinical commissioning groups do too.

There will be different ways of doing things in future, but they will of course be to the benefit of patients. I am delighted that he is championing this agenda, and he can count on my full support and the support of the Government in taking it forward. Once again, I congratulate him on securing this debate and on the leadership he is showing to support his local NHS in delivering better care for patients.

Question put and agreed to.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 10th June 2014 Commons Chamber

[Graeme Morrice (Livingston) (Lab)]

2. If he will commission a review of the safety of polypropylene transvaginal mesh implants.

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

The Department of Health, NHS England and the Medicines and Healthcare Products Regulatory Agency—the MHRA—have been working collaboratively with the clinical community to address the serious concerns that have been raised about transvaginal mesh implants. A working group, chaired by NHS England, has been set up to identify ways to address them. The group will also have patient representation.

[Graeme Morrice]

Last week, I attended the Scottish Parliament’s Public Petitions Committee to hear from and support women who have suffered from the horrific adverse effects of mesh implants. Women spoke from wheelchairs or on crutches and were in constant pain. They could not possibly have been told about the risks of TVM implants because there are simply no accurate data available. Will the Minister or the Secretary of State meet me and mesh campaigners from across the country, so that they can fully understand the urgency of the situation and the kind of action that is required to end this scandal once and for all?

[Dr Poulter]

I would be very happy to meet the hon. Gentleman. It is important to note that work is under way to collect better data on urogynaecological procedures generally and on mesh implants, because the complications that occur post-surgery are often multifactorial. An NHS England-funded audit on urogynaecological procedures for stress urinary incontinence is currently taking place, which covers all procedures, not just mesh implants. I am sure that we can discuss that and what the working group will do to review the procedures when we meet.

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

3. What progress his Department has made in introducing a cap on care costs.

--- Later in debate ---

[Jason McCartney (Colne Valley) (Con)]

8. What steps his Department is taking to improve access to and standards of dental care.

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

Between May 2010 and December 2013, 1.5 million more patients were able to see an NHS dentist. We are committed to reforming the current contractual arrangements to promote improvement in oral health and to increase access to dentistry services.

[Jason McCartney]

What specific advice would the Minister give to my constituents who are trying really hard to access good quality, local dental care on the NHS?

[Dr Poulter]

A recent HealthWatch report highlighted this issue in west Yorkshire, where access to dental services has been a long-standing challenge. NHS England is looking at the financial arrangements in west Yorkshire and will report back soon. I am happy to meet my hon. Friend and representatives from the local NHS to take this issue further forward and ensure that local patients get the service they deserve.

[Michael Fabricant (Lichfield) (Con)]

9. What steps he is taking to ensure that whistleblowers in the NHS are protected from (a) dismissal and (b) other punitive measures by their employers.

--- Later in debate ---

[Paul Blomfield (Sheffield Central) (Lab)]

11. What assessment he has made of the potential effect on health outcomes of phasing out minimum practice income guarantee funding from GP practices in England.

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

The minimum practice income guarantee payment is unfair because practices serving very similar populations are paid very different amounts per patient. The payments are being phased out over a seven-year period to allow practices time to adjust. The money released by doing this will be reinvested in the basic payments made to all general medical services practices, which are based on numbers of patients and key determinants of practice workload, such as the age and health needs of patients.

[Paul Blomfield]

The minimum practice income guarantee was introduced to meet the specific needs of specific practices. Those needs have not changed. NHS England has drawn up a list of 100 practices across the country that will be threatened by its withdrawal. Five are in Sheffield and two are in my constituency. Will the Minister give a guarantee that no practice will close as a result of the withdrawal of the minimum practice income guarantee, and will he provide the funding to achieve that?

[Dr Poulter]

The point is this: the funding system set up by the previous Government was based on historical funding and did not necessarily recognise the needs of patients. One practice might have been paid more for historical reasons than another practice next door that might have been treating more patients. That was unfair; we have changed it. NHS England is working at local level with practices that are, for whatever reason, in financial difficulties to make sure that it can help them get to the right place.

[George Freeman (Mid Norfolk) (Con)]

The GP practice in Watton in my constituency is struggling with the recruitment of GPs and is now two short, which is putting pressure on services. Today I heard of the proposal from NHS England to deregister 1,500 patients and transfer them to neighbouring practices in the constituency, raising a whole series of issues. Will the Minister agree to meet me to talk about what should happen, including whether NHS England could fund some sort of locum service?

[Dr Poulter]

Yes, I would be delighted to meet my hon. Friend. It is important to see, where possible, collaboration between GP practices on back-office services and other savings that could be made—something the public sector needs to do more generally so that more money can be invested in patients. The Government are training more GPs; in future, we will see 50% of postgraduate medical training taking place in general practice, leading to a big increase in the number of GPs.

[Mr Andy Slaughter (Hammersmith) (Lab)]

Will the Minister look at the decision by clinical commissioning groups in north-west London to move funding away—contrary to what NHS England has proposed—from GP practices and primary care in deprived areas such as Hammersmith to areas that have much better health outcomes?

[Dr Poulter]

I do not believe that that is the case. In looking at the changes, we need to factor in the point that the minimum practice income guarantee, which was a historical payment and not based on patient need or patient demand, is being phased out in order to achieve a more equitable solution. As a result, we can see that the global sum payments to GPs have risen from £66.25 per patient in 2013-14 to £73.56 per patient in 2014-15. Clearly, the global sum payment to GPs per patient has increased, which is a good thing for patients and the equitability of services.

[Miss Anne McIntosh (Thirsk and Malton) (Con)]

Historically, there used to be a payment for the distance GPs or their patients travelled. The removal of minimum practice income guarantee funding may make certain rural practices unviable. Will the Government address that issue, and will the Minister look particularly at rurality and sparsity in order to address what is a very real issue for rural GPs?

[Dr Poulter]

My hon. Friend makes a very good point, and we know that rural practices have unique challenges. The point is that because the money from the minimum practice income guarantee is going to be reinvested in a global sum payment, and because the global sum payment per practice is increasing, one of the key determinants of that payment is, in fact, rurality, so that should be of benefit to many rural practices.

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

The situation is far more urgent than the Minister’s complacent answer suggests. One practice in a deprived part of London has said that it is weeks away from laying off staff and just months away from closure. The Royal College of General Practitioners says that 1,700 practices could be affected, with over 12 million patients potentially facing even longer waits for appointments. Is it not the case that until we have a Labour Government, GP services are going to be marginalised and patients are going to face ever-longer waits?

[Dr Poulter]

I am afraid that the distance between the real world out there for patients and the Labour Government’s record is very clear. Under the Labour Government’s record on general practice, 20% of patients were routinely unable to get a GP appointment within 48 hours, and a quarter of patients who wanted to book an appointment more than 48 hours in advance could not get one. That was what happened under Labour; that is Labour’s commitment to general practice and GP patients. Under this Government, we are making sure that there is equality of finance per patient according to patient need, and that is how health care decisions should be made.

[Mr Speaker]

Order. I encourage the Minister to learn to provide more succinct answers. They are always too long.

--- Later in debate ---

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

T2. A Birmingham trust has recently announced that it will be possible to cut 1,000 beds across the city by setting a maximum stay of seven days for most patients. Not surprisingly, this has caused some alarm. Are Ministers aware of that proposal? What guidance, if any, can they offer in regard to such proposals?

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

As the hon. Gentleman will be aware, patients need to be treated according to clinical need, and bed stays should not be determined by anything other than that. So if what he describes is actually the case, it would be very disturbing. If he would like to raise the issue further with me, I would be happy to look into it for him.

[Jesse Norman (Hereford and South Herefordshire) (Con)]

T5. Like other rural communities, Herefordshire has long suffered from chronic underfunding in health care. Does the Secretary of State share my view that setting clinical commissioning group allocations should be an evidence-based process that takes into account factors including sparsity and old age? Also, will he ignore the calls from the shadow Health Secretary, who was seeking to cut the previous NHS allocations in areas such as Herefordshire?

--- Later in debate ---

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

T7. The Government can be rightly proud that there are fewer managers and more doctors in the NHS than in 2010. However, recent research by the TaxPayers Alliance shows that in the Greater East Midlands commissioning support unit more than £1 million a year is being spent on 26 administrative jobs of dubious value such as communications managers, communications officers, three communications and engagement leads, and two equality and diversity managers. The list goes on, Mr Speaker, but I will not. What further steps can my right hon. Friend take to ensure that the NHS budget is spent on front-line medical services?

[Dr Poulter]

My hon. Friend is right to highlight the fact that as much money as possible always needs to be put into front-line patient care. Under the previous Government, spending on managers and administrators more than doubled from £3 billion to £7 billion, and we have seen the number of administrators fall by 20,000. There is clearly work to do in his area, because as much money needs to go on front-line patient care as possible, and I hope that local commissioners will be looking to share back-office services as much as possible with other commissioning groups to reduce costs and put money into front-line patient care.

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

Earlier the Secretary of State and his Minister said that the minimum practice income guarantee was unfair. What is unfair is that so many practices in Hackney and east London are set to close, in an area where there is great deprivation. What are they going to do to make sure that patients still have practices to go to?

[Dr Poulter]

We have had this discussion. A payments system that is almost 20 years out of date and is not funding patients according to clinical need or is not per head of population will not deliver good care. The payments system needs to be changed and NHS England is working with practices that are facing challenges to address those challenges and ensure that high-quality patient care can still be delivered locally.

[David Rutley (Macclesfield) (Con)]

T8. Following the recent speech by the new NHS England chief executive Simon Stevens about the important role of local hospitals, can my right hon. Friend confirm that district general hospitals such as Macclesfield will continue to play a vital role in delivering local health services in the years to come?

--- Later in debate ---

[Ian Swales (Redcar) (LD)]

T9. My constituent, Beth Charlton, recently lost her father to pancreatic cancer and notes that patients have only a 3% chance of surviving five years. That is much lower than the survival rates for other cancers and has not improved in 40 years. Will the Minister invest more in early detection and diagnosis of this silent killer?

[Dr Poulter]

Spending on health care research, including cancer research, has considerably increased under this Government, and much of that funding is allocated independently. It is important to note that pancreatic cancer is, as the hon. Gentleman says, a silent killer, because presentation is often very late in the disease process. Patients can present suddenly with painless jaundice and are often only three months away from death. It is therefore important that we look at the causes of pancreatic cancer and focus on primary prevention and on helping people to develop a healthy attitude to alcohol.

[Mr Dennis Skinner (Bolsover) (Lab)]

In the last hour I have heard the Secretary of State and his Ministers complain about the problems with A and Es; I have heard them talk about the problems with GPs; now we hear that they have lost control of care of the elderly. Instead of continuing to blame the last Labour Government of four years ago, why does the right hon. Gentleman not admit that the NHS is not safe in his hands? Let us have an election and get a Labour Government.

--- Later in debate ---

[Kerry McCarthy (Bristol East) (Lab)]

The Stitch project in Bristol has contacted me with concerns about the number of overdoses by people on prescription medication and suggested that allowing medication to be dispensed in instalments would be a better way of handling those vulnerable patients. I was disappointed in the response that I got from the Department, and I urge the Minister to think again on this issue.

[Dr Poulter]

I am very happy to meet the hon. Lady to discuss this further and see what we can do because it is important that the vulnerable patient groups she highlighted are looked after in the right way.

[Charlotte Leslie (Bristol North West) (Con)]

As he heralds an era of transparency, can the Secretary of State update us on what steps he has taken to ensure that private providers in the NHS are every bit as transparent and accountable as public ones?

GP Services (Tower Hamlets)

Dan Poulter Excerpts

Tuesday 13th May 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Streeter, for what I believe is now the third time, and to respond to this debate. I congratulate the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) not only on securing the debate but on his advocacy on behalf of local patients. We have discussed that before during meetings in my office in the Department on other issues. I am sure that my noble Friend Earl Howe will be happy to meet him, and I extend that invitation on my noble Friend’s behalf.

[Jim Fitzpatrick]

I apologise for intervening so early, but I do not remember having any meetings with the Minister in his office on any subject. I would not want to mislead the House, or for people to think that we had held meetings in which I had not raised this issue.

[Dr Poulter]

A congregation of MPs from London came to see me and I believed that the hon. Gentleman had been there, but I am obviously mistaken. I apologise for that mistake, but I can recall similar conversations in the past during meetings with other MPs from other parts of the country, in which we talked about not just GP services but other local health care services of a similar nature. During those meetings there was advocacy of similar strength to that which we have heard today.

Indeed, a previous debate in Westminster Hall, led by my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron), focused on the impact of the minimum practice income guarantee changes on more rural practices in his constituency. The topic has come to the fore for many hon. Members, who I know will wish to discuss it further with the relevant Minister. I therefore want to put on record a formal invitation to come and see my noble Friend Earl Howe to discuss the subject further at some point after this debate.

It may be helpful if I outline why the minimum practice income guarantee was set up in the first place and why it is important to change the payment structure for general practice. The minimum practice income guarantee is a top-up payment to some general medical services—GMS—practices. It was introduced as part of the 2004 GP contract to smooth transition to what were then new funding arrangements, so it is now 10 years out of date. Last year, we announced that the minimum practice income guarantee will start to be phased out from April 2014. We consider minimum practice income guarantee payments to be inequitable because under the system, two surgeries in the same area serving similar populations may be paid different amounts of money per registered patient.

The MPIG will be phased out over a seven-year period, as the hon. Member for Poplar and Limehouse will know. We are phasing it out to make sure that there is more equity between what different practices in comparable areas receive per patient, and that funding follows the patient more accurately, rather than the practice. I am sure we can all sign up to that in principle. The payments will be phased out gradually with the overall intention that the funding for GP practices will be properly matched to the number of patients they serve and the health needs of the local population.

The money released by phasing out the MPIG will be reinvested in the basic payments made to all general medical services practices. Those payments are based on numbers of patients and key determinants of practice work load such as patients’ ages and health needs—deprivation is of course a driver of patients’ health needs. We are committed to making sure that patients have access to high-quality GP services wherever they live and ensuring that in the same geographical area similar practices receive effectively the same amount of funding for each patient they look after.

It is also worth highlighting the overall impact for practices, both in the country more generally and in London in particular. NHS England has undertaken analysis regarding the withdrawal of the MPIG. Inevitably, a small number of practices will lose funding, and NHS England has considered the very small number of significant outlier practices for which alternative arrangements may need to be made to ensure appropriate services are maintained for local people.

We appreciate that this is a matter of concern for some practices, including some in the hon. Gentleman’s constituency that he has mentioned today. That is why we have decided to use the next seven years to implement the changes to the MPIG, introducing them gradually through a phased transition to a new funding arrangement, rather than taking a big bang approach. Phasing the changes in over that seven-year period will allow the minority of practices that lose funding to adjust more gradually to the reduction in payments.

As the hon. Gentleman highlighted in his remarks, the changes cannot be seen in isolation but should be looked at together with the changes to the quality and outcomes framework payments for GP practices; those changes need to be set alongside the global sum paid to GMS practices. When all those factors are put together, I understand that practices in London with a GMS contract, of which there are 721, will see an overall funding increase of £731,000 resulting from the net effect of all the changes. I will write to the hon. Gentleman to outline that in detail ahead of his meeting with my noble Friend Earl Howe.

[Jim Fitzpatrick]

When we have that meeting with Lord Howe, it would be useful if NHS England could provide the Minister and his officials with an accurate breakdown of figures for the practices in Tower Hamlets. Given the order of deprivation, the chronic ailments and conditions, the age profiles of very elderly and very young people, and the language problems, even NHS England, as I quoted, is saying that the combination of changes to the minimum practice income guarantee and the quality and outcomes framework reductions is creating specific difficulties in Tower Hamlets that are not generally replicated across the rest of London.

[Dr Poulter]

I am happy to write to the hon. Gentleman after the debate to outline the more general points, and I am sure that we can ensure that more specific details are available for him to discuss in his meeting with my noble Friend Earl Howe. NHS England has made it clear that it has been looking carefully at how it can support the practices that are most affected, through its area teams, and I am sure that it will be happy to continue a dialogue with local practices and with the hon. Gentleman to work out how further local support could be given if some practices are struggling as a result of the changes. That offer has been made to those practices that have already been identified as most affected, but NHS England is continually reviewing the matter as a pathway process for phasing in the changes.

NHS England has also suggested that those practices with very small lists, which may be particularly affected, could collaborate through federating, networking or merging with other practices nearby to provide more cost-effective services. It also suggested that it would be possible to identify other ways in which practices might improve cost efficiency, such as reviewing staffing structures and other commissioning or contracting options—for example, how some patient care services are offered in the area by collaboration. Sometimes, back office costs and inefficiencies can be reduced to free up more money for patient care. We must remember that, on the whole, GP practices are small businesses in their own right. We expect NHS England to work with GPs to support best practice and technology, and to encourage general practices to collaborate and work together, and it is happy to do so. It is expected that general practices will do what they can to help themselves, and that NHS England will work with them to facilitate that for them as small business owners.

[Jim Fitzpatrick]

I recognise that there is some logic in the Minister’s suggestion about smaller practices. The Jubilee Street practice has 13,000 patients. It is a big practice and is multi-handed with clinicians and staffing, and is considered to be extremely efficiently run.

[Dr Poulter]

Indeed. I will talk in more detail about Tower Hamlets, but the hon. Gentleman is right to say that it has a long history of collaboration, efficiently run practices and good working between GPs and other community health services to support some of the most vulnerable people in our society and to address specific issues of health care and equality. The hon. Gentleman outlined that in his speech and local GPs should be proud of what they have done and their work and efforts in many cases to help deliver greater efficiencies. Nevertheless, the offer is there from NHS England to engage with area teams to see what more support can be provided. It is keen to ensure that if particular practices believe they are disadvantaged, the teams will do what they can to work with the practices to mitigate that.

It is worth talking briefly about the changes in the quality and outcomes framework. In addition to the minimum practice income guarantee from April this year, we have also made changes to QOF and reduced it by more than a third to free up space and time for GPs to provide more proactive and personalised care for their patients, particularly the frail elderly. One of the great frustrations that we are all aware of—medical staff, health care staff and particularly GPs—has been the amount of bureaucracy that GPs are sometimes required to undertake, which has got in the way of their being able to deliver front-line patient care and spend time with patients. The changes to QOF were welcomed by the British Medical Association and GPs because they will help reduce the bureaucratic burden and allow GPs to spend more time with patients and focus more on personalised care and more vulnerable patient groups. I think we all believe that to be a good thing and a great achievement from those GP contract negotiations.

As part of the QOF changes, we have retired indicators when they were either duplicating other incentives in the health care system, or were of low clinical value and use—for example, if they were just process measures rather than measures linked directly to patient care. We are ensuring that the payment system is strongly linked to delivering better care and improving care for patients rather than to process measures. That has sometimes been a criticism of QOF payments in the past, not least by GPs. Removal of these indicators will help to reduce bureaucracy, unnecessary patient testing and unnecessary frequency of patient recall and recording.

The money released from the changes to QOF will be reinvested in the basic payments made to all general medical services practices, to which I alluded earlier. The global sum will be reinvested through the GP contract and I understand that practices in London with a general medical services contract will overall be net beneficiaries to the tune of roughly £700,000. We welcome that, and I will give the exact figures in my letter to the hon. Gentleman, but I believe that what I have said in this debate is an accurate reflection of the situation.

I turn to Tower Hamlets and will address some of the concerns that have been raised in the debate today. We understand that some practices have particular concerns about the changes to the minimum practice income guarantee and to QOF funding. I assure the hon. Gentleman and his constituents that the Government and NHS England are committed to ensuring that good, high quality primary care for local people, such as his constituents, is a priority. I understand that despite being one of the most deprived boroughs in London, Tower Hamlets has developed some outstanding general practices often as a result of the hard work and dedication of the GPs who want to address health care needs, to look after vulnerable people in society, and to ensure that the health care inequalities that we have discussed are properly addressed. His local GPs and all health care staff delivering care on the ground should be proud of that.

As the hon. Gentleman outlined, Tower Hamlets is top in the country for blood pressure and cholesterol control for patients with diabetes, resulting in reduced complications of diabetes and reduced admissions for heart attacks. It is also top in London for MMR vaccination and for flu vaccination for the over 65s. That is an example of how, even in one of the most deprived areas with some of the greatest health care needs, local GPs, local primary care and local community care are delivering very good results for patients. It is also one of the 14 national pioneers for integrated care, a programme in which primary care will play an increasingly important role. We want to keep people out of hospital and it is vital that they are supported in their own homes and communities. Integrating primary care with community care and effective adult social services care from the local authority will be key in delivering that.

I understand that NHS England’s area team has set up a task and finish group to look at the support that might be offered to practices with membership drawn from local medical committees and the London office of the clinical commissioning group’s chief officers and the local area primary care commissioning team. I understand that NHS England’s area team in London has been in regular contact with individual practices in Tower Hamlets to offer them ongoing support regarding these changes. I am sure that after this debate, that important input and dialogue will intensify to recognise some of the issues that the hon. Gentleman raised.

We also recognise some of the challenges facing small practices in delivering the increasingly wide range of primary care services as more services move from hospital settings into the community. All health services, hospital trusts, community and mental health care providers, as well as GPs, are facing the challenge of meeting increasing demand with small increases in funding. That demand is coming from an ageing population with increasing levels of long-term conditions as well as the costs of new drugs, and patients’ expectations. Those issues are faced throughout the health service, but they are acute in Tower Hamlets. Local GPs recognise the need for flexibility in the way in which future services are provided and we need to support practices to work together to demonstrate how best to use their resources for the benefit of all their patients.

We have announced that NHS England is supporting practices as they phase in the changes to the minimum practice income guarantee and to QOF payments. There is an offer to meet my noble Friend Lord Howe and I know that NHS England will continue to do what it can to support local practices in Tower Hamlets.

Again, I put on the record my congratulations to the hon. Gentleman on securing this debate and to the local GPs who deliver some of the best health care outcomes in England for the patients they look after.

Question put and agreed to.

Health Education England (Mandate)

Dan Poulter Excerpts

Thursday 1st May 2014 Written Statements

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

Today the Government have published the Health Education England(HEE) mandate for 2014-15. This will come into effect immediately and was developed following consultation with stakeholders.

The mandate is published every year and sets out what HEE will need to deliver with its nearly £5 billion budget in the coming year, on the areas of:

Work force planning;

health education; and

training and development.

It complements the work set out in the Government’s mandate to NHS England and the Government’s response to the Francis report, focusing on how we can support the health care work force through excellent education and training so that they can continue to deliver the very best care to patients.

The mandate will make sure that HEE delivers the right health care work force with the right skills, values and competencies. The Government’s priority in developing the mandate is to train and retain a health care work force equipped with the skills to deliver much more proactive care and support for patients in the community, and with the right skills to support people with long-term medical conditions to live with dignity in their own homes.

Specifically, the mandate will:

support families through pregnancy by creating a work force that can deliver personalised maternity care, improving the specialist skills needed to provide care to mothers with mental health and substance misuse issues so that specialist perinatal mental health support is available for every woman who needs it by 2017;

allow care assistants and health care support workers to break through the NHS careers glass ceiling and progress into careers in nursing and midwifery by improving the access to fully funded part-time degree courses for health care assistants and maternity support workers in order to ensure that staff with strong caring experience can access higher education;

place greater emphasis on children’s health by:

a) ensuring the training is available to enable more GPs to develop a specialist interest in children’s health;

b) improving training in child health for all GP trainees through new courses; and

c) further expanding health visitor capacity and equipping them with the skills they need to carry out the important work they do;

make sure mental health is given the importance it deserves by:

a) ensuring the training is available to for more GPs and nurses to pursue a specialist interest in mental health;

b) ensuring post-registration training in perinatal mental health to ensure that trained specialist mental health staff are available to support mothers in every birthing unit by 2017; and

c) developing training programmes that will allow all staff to have an awareness of mental health problems and how they may affect their patients by January 2015;

improve training available to GPs on the psychological and physical needs of veterans and their families by making a specially trained GP available to every clinical commissioning group (CCG);

roll out specialist dementia training to an additional 250,000 staff by March 2015, and make these opportunities available to all staff by the end of 2018 to improve the care of people with dementia;

train and develop a work force with skills that are transferable between different care settings by working with partners across the health and care system to review current curricula and training pathways, and develop common standards and portable qualifications. This will support the delivery of integrated health care and ensure staff can more readily work across different care settings as increasingly more health and care is delivered in the community and via primary care services;

contribute to improvements in public health outcomes by continuing to develop public health specialists and improving the public health skills of all health care staff supporting important priorities such as antimicrobial resistance and immunisation; and

ensure all recruitment into NHS funded training posts incorporates testing of compassionate values and behaviours, in addition to technical and academic skills, by March 2015.

The mandate also tasks HEE to deliver value for money, transparency and the reform of education and training funding.

“Delivering high quality, effective, compassionate care: Developing the right people with the right skills and the right values: A mandate from the Government to Health Education England: April 2014 to March 2015” has been placed in the Library.

Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

Type 1 Diabetes (Young People)

Dan Poulter Excerpts

Wednesday 30th April 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship for the second time this week, the first time being during the Defence Committee sitting yesterday.

I pay tribute to the right hon. Member for Knowsley (Mr Howarth) for securing the debate and for his articulate and reasoned contribution to it, and for his passionate advocacy of the needs of people with type 1 diabetes. He has family experience of these issues that will have strongly informed his understanding of them. The balanced, perceptive way that he approached the debate, raising important issues, particularly about tariff-setting, which is in my view the strongest and best way to drive up the quality of care available for patients with type 1 diabetes, is of great credit to him and helped set the tone for a consensual debate. It is also a pleasure to respond to the right hon. Gentleman formally, because he responded to my maiden speech when I was first accepted into the House. He was kind to me then and I hope that my response will do this debate justice and will bring some comfort to hon. Members who have raised concerns.

I also pay tribute to hon. Members’ contributions to the debate. As always, the hon. Member for Strangford (Jim Shannon) makes important points about how, although we have devolved health systems, we need to learn lessons from best practice throughout England and Northern Ireland. It is important, even in a devolved health system, that we work collaboratively together to improve standards of care. I will try to deal with points raised in the contributions from the right hon. Member for Tynemouth (Mr Campbell) and the hon. Member for Brighton, Pavilion (Caroline Lucas).

My hon. Friend the Member for Cities of London and Westminster (Mark Field) eloquently outlined for all of us what this means on a day-to-day basis for a young person with type 1 diabetes. In many respects, that sets out the challenge for our health service: working together with the education sector and with other parts of our health and care system, it needs to help improve the day-to-day quality of life for people with type 1 diabetes. My hon. Friend the Member for Torbay (Mr Sanders) made a similar point. My hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) raised the importance of research funding. I will address those points later in my remarks.

As we have heard, type 1 diabetes has a potentially devastating effect on children’s health. Poor diabetic control for children increases their risk of developing long-term complications over the course of their lives—we have heard about renal complications, diabetic retinopathy and the consequences of diabetes-related peripheral neuropathy. Such consequences are potentially life changing, and so it is important that we do all that we can to address them and to support people with type 1 diabetes. It is a question not just of early diagnosis but of the right care and support in the secondary care setting, in primary care and in the community, to give better support to people with the condition so that they can stay well and be properly looked after. That is a challenge that we face in all aspects of the care that we provide to young people.

The children and young people’s health outcomes forum, which was set up by my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), highlighted a number of challenges faced by children with long-term conditions such as diabetes and by their families. It is worth highlighting two or three. The first was that there are poor arrangements for transition to adulthood—that has been highlighted throughout our debate. Secondly, there is a need for better integration of care, with co-ordination around the patient—the child or young person. We need a comprehensive, multidisciplinary team approach to care, with a much greater emphasis on better support for young people in the community and in their own homes. There also needs to be much speedier diagnosis of long-term conditions in young people, including asthma, diabetes and epilepsy.

The NHS atlas of variation has identified an unacceptable variation between different areas, a point raised by the shadow Minister. That is clearly unacceptable to us all. There is variation in the quality of management of children’s diabetes, and in the number of children with previously diagnosed diabetes admitted to hospital for diabetic ketoacidosis. We all know, then, that we have some way to go on improving the care of children and young people with diabetes. I hope my remarks will be able to give some reassurance that we are now firmly on the right track, particularly with our best practice tariff.

[Jim Shannon]

In my contribution I outlined the diabetes strategy that was in place for the 10 years up to 2013. I have asked Ministers about that issue a number of times and am keen to see a continuing initiative for a UK-wide strategy. Will the Minister give us an idea of his intentions in that regard? That strategy could address regional variations.

[Dr Poulter]

As I mentioned earlier, it is important that we learn from good practice, not just in the UK but elsewhere. A key driver of improving practice is clinical audit of the quality of services delivered. Outcomes for people with diabetes in England will also be assessed by the national diabetes audit, which includes a core audit, the national in-patient diabetes audit, a diabetes pregnancy audit, the national patient experience of diabetes services survey and the national diabetes foot audit, which is due to be launched this summer. Having that high quality comparative data, gathered through clinical audit from different care settings across the UK, will help us to understand where services are and are not delivered well. Audits in particular care settings always make recommendations for improvement, and the following year there is another audit. Exposing where care is good or not so good and putting in place plans for improvement on the ground will be a big step forward. At a national level, we can then look at which improvement plans have worked and which have been less successful. That learning is a good way of driving up standards and can be shared with Northern Ireland and other devolved parts of the United Kingdom, and indeed on an international basis. I believe that in this country we are historically good at collecting data. The purpose of national audits is to drive up standards of care, which is why NHS England is putting many more national audits in place throughout the health service. We will be able to compare what is done in different care settings, learn where care needs to be better and drive up standards throughout our health service.

We all understand the importance of the integration of mental health care and diabetes care for the young people who have serious health issues resulting from that combination of issues, which puts them at high risk of complications and premature death. The Government are investing £54 million over four years to enhance the children and young people’s improving access to psychological therapies—CYP IAPT—programme. That programme is helping to transform services through training in evidence-based therapies to support children and young people with a range of mental health issues. I am sure we all support that programme and want to see it expanded further.

I am glad to say that investment in type 1 diabetes research by the Medical Research Council and the National Institute for Health Research has risen from more than £5.8 million in 2011-12 to more than £6.5 million in 2012-13. The National Institute for Health Research is funding a £1.5 million trial focusing on children and young people with type 1 diabetes, which is comparing outcomes for patients treated with multiple daily insulin injections to outcomes for those using pumps, one year and five years after diagnosis. The report of the trial is due to be published in a few months. When we are looking at how best to support people with type 1 diabetes in leading as normal a life as possible, whether that be in education or in the workplace, it is important that we understand which interventions and methods of support work best. I am sure that that research will put us in a much better place on that.

[Mr Jamie Reed]

Is the Minister aware of the JDRF’s “#CountMeIn” campaign? It is calling for an investment of £12 million per annum by the MRC and NIHR to bring the UK in line with recent per capita spending by Governments internationally. Has he given any thought to that and if so will he comment on it?

[Dr Poulter]

With research funding there is often a bidding process, and it is up to organisations to bid for funding. I am pleased that the amount of money going into diabetes research is improving and that there is a now a project specifically on type 1 diabetes that is looking at the impact of different interventions and support—such as the use of pumps—on young people’s lives to see which methods work better. The emphasis is not just on clinical outcomes but on how young people’s experience and quality of life is affected, so that that is taken into account in how we look at diabetes. Health care research funding is moving in the right direction, and not just for diabetes—research funding has increased considerably over the past few years in a number of areas of health care, something that we should welcome.

As we know, NICE has national standards, but in the few minutes left I want to discuss the best practice tariff. The way that we set up commissioning arrangements and the best practice tariff will help us make a difference in the future. The tariff ensures that payment is linked to the quality of care provided, an important driver of how services are delivered to patients.

I will briefly set out aspects of the diabetes best practice tariff. A young person’s diagnosis is to be discussed with a senior member of paediatric diabetes team within 24 hours of presentation, to get early specialist support in place. All new patients are to be seen by a member of the specialist paediatric diabetes team on the same or the next working day, and each patient is to have a structured education programme, tailored to their needs and the needs of their family, to support them and help them understand how they can better cope with their condition and manage it themselves as best as they can. The tariff places a strong emphasis on multidisciplinary team work, including support from dieticians—we have heard about issues connected to eating disorders, and dieticians will have a key role on that. Many other aspects of the tariff focus on multidisciplinary working to put things on a better basis for young people with diabetes.

The right hon. Member for Knowsley raised a number of other issues in the debate; I will write to him about those matters. The issue is complex and important, but I hope that I have been able to offer some reassurance. The tariff and the increased spending on research mean that we are moving to a better place with our support for people with type 1 diabetes.

Sir Robert Peel Hospital

Dan Poulter Excerpts

Tuesday 1st April 2014 Commons Chamber

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

I congratulate my hon. Friend the Member for Tamworth (Christopher Pincher) on securing the debate. I am well aware of his long-standing interest in matters affecting his constituency, including his well-documented support for the Sharon Fox cancer centre. I fully understand why he has raised the matter of the Sir Robert Peel hospital today. I hope that the discussion about the future of services in Tamworth and the surrounding area will move forward constructively following this debate—certainly more constructively than it might have done recently.

Before looking at the local situation in detail, it is important to say a few words about the importance of high-quality engagement between the NHS—in this case the trust—and local patients and commissioners. Decisions about patient care and NHS services should, where possible, be taken in as open and transparent a way as possible. It is important that patient groups and the wider public are properly consulted in decisions about local NHS services. That is clearly outlined in the tests for reconfiguration laid down by my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) when he was Health Secretary earlier in this Parliament. My hon. Friend was right to highlight the importance of public and patient engagement in the design of local NHS services, in this case for the benefit of his constituents in Tamworth.

The situation at the Sir Robert Peel hospital is of course complicated by events that have taken place with the Keogh review, to which I will return in a moment. The hospital is part of the Burton Hospitals NHS Foundation Trust. It might help the House to understand the situation better if I briefly describe the foundation trust and some of the issues relating to the way the Keogh review is affecting services. The foundation trust provides hospital-based services from four main sites: Burton Hospitals NHS Foundation Trust in Burton-on-Trent, with acute hospital services including an emergency department; the treatment centre on the Burton Hospitals site, a dedicated centre for day case surgery and treatments; the Samuel Johnson community hospital in Lichfield, with local services, including a midwifery-led maternity unit and a 24/7 minor injuries unit; and the Sir Robert Peel community hospital in Tamworth. I will say a little more about those services in a moment.

The foundation trust provides a wide range of services to a population of around 360,000 across south Staffordshire, south Derbyshire and north-west Leicestershire. Over 47,000 planned and emergency admissions, more than 70,000 A and E attendances and around 13,000 day case procedures take place each year in the foundation trust hospitals across all the hospital sites. The Samuel Johnson hospital in Lichfield, as a community hospital, provides services that are similar to those provided by the Sir Robert Peel hospital in Tamworth. Both community hospitals had previously been run by the South Staffordshire primary care trust. The issue for the foundation trust is therefore much wider than the Sir Robert Peel hospital, because it is required to look across the entire population it serves and, on the basis of the services commissioned, provide a safe and high-quality service for the benefit of patients. The trust has only comparatively recently become responsible for the two community hospitals it operates, both of which it took over in 2011.

[Andrew Griffiths]

The Minister mentioned that Queen’s hospital is a Keogh hospital. The staff there are working incredibly hard to improve standards and are taking big strides forward. The Minister will have heard about the precarious situation in relation to Queen’s and the East Staffordshire clinical commissioning group. My hon. Friend the Member for Tamworth (Christopher Pincher) requested a meeting. Will the Minister agree to meet me, other colleagues and the team from Queen’s hospital and the CCG in order to discuss our concerns and find a solution that improves services locally.

[Dr Poulter]

I will be delighted to meet my hon. Friends to talk further about local issues. There are long-standing concerns, not least the processes triggered by the Keogh review in the trust and the wider health economy.

I turn to the local reconfiguration process. To ensure that the foundation trust would continue to provide the best level of service to the local population, the trust commissioned a report from Deloitte in December 2012. The intention was to address the long-term challenges faced by the trust by refocusing community services, such as those provided at the Sir Robert Peel community hospital, and concentrating on the most vulnerable patient groups.

The Deloitte report set out a number of options. However, as we are all aware, in 2013 the trust was inspected under the Keogh review, which we took forward following the Francis report on Mid Staffordshire foundation trust. Burton was inspected because it had higher than expected mortality rates. The Keogh review was not reassured by what it found. As a result of the inspection, the foundation trust was placed in special measures by Monitor, the regulator of foundation trusts. Monitor continues to work with foundation trusts in special measures to ensure that they return to safe and efficient services as soon as possible. The Keogh review made six urgent recommendations for Burton. Those recommendations have been the drivers for the changes at Burton and at the Sir Robert Peel community hospital.

Sir Bruce Keogh challenged the foundation trust on what its long-term plans would be for the community hospitals. For example, patient activity at both sites in Lichfield and Tamworth has been decreasing across minor injuries, in-patient and out-patient services for a number of years, and is, I understand, on a steadily decreasing trend. There is a need to make changes because, as well as the higher than expected mortality rates, the trust and its local commissioners believe that the health needs of the population they serve are changing.

As a nation, we face changing challenges in health care—for example, the demographic pressures imposed by an ageing population. As the health needs of the population change, it is right that the services provided at local hospitals and in the local health economy also change and that a more integrated approach is taken between local authorities and the NHS in delivering more personalised care, particularly for the frail elderly, and more care in people’s homes and communities.

The foundation trust has already responded to the Keogh review challenge, although much is still to be done. I understand that the reconfiguration to which my hon. Friend the Member for Tamworth refers follows on from and continues the response to the Keogh review. Certainly, the aims are the same—to ensure that health care services are of high quality and meet the needs of local patients.

The Keogh review has affected the Sir Robert Peel community hospital, which currently offers local services for people living in and around Tamworth—including, for example, a 24/7 minor injuries unit, in-patient, X-ray and ultrasound department, and an out-patient service. There is one ward providing rehabilitation, care of older people, general medical care and palliative care. Consultant and nurse-led clinics accommodate consultations, investigations, minor procedures, post-treatment follow-up and health promotion.

That is not the full range of services that one would expect at larger NHS hospitals. However, having close-to-home community-based facilities is an important part of meeting the challenge of looking after older people in their own homes. Some such facilities are found at Sir Robert Peel community hospital. I am sure that the local population welcome that and believe it important in delivering high-quality health care in the months and years ahead.

There are currently discussions about the relocation of day case surgery and there is a review of endoscopy. I understand that that would affect about 30 patients a week, with services moving to local GP surgeries, Good Hope hospital at Sutton Coldfield about eight miles away, or the main trust site at Burton.

I understand that further changes are being considered in response to Keogh. However, planning is at a very early stage. I understand that the trust board will be receiving an outline paper this coming Thursday and that no decisions have yet been taken. I am sure that my hon. Friend will agree that it would be highly inappropriate for me to speculate about what option or options might be considered or chosen by the local NHS. I would certainly not want to suggest that there is a Government-preferred option that should be followed; I am not in a position to do that. Whitehall micro-management of the local NHS invariably leads to bad things happening; that is what we have tried to avoid through the health reforms that we instigated in 2012. As I said a few minutes ago, such decisions are local decisions and must be seen to be taken by the local NHS and local commissioners, in consultation with local patients.

[Christopher Pincher]

Of course my hon. Friend is absolutely right. These are local decisions for local communities and their local NHS. It is not for Ministers to dictate what services should or should not be provided for any particular hospital; it is for the local community to determine that, based on need. Does he agree, however, that when the local community decides, it should be based on proper consultation, and that listening exercises should be based on what people want and not what the clinical professionals and managers want?

[Dr Poulter]

My hon. Friend makes an important point. Of course clinical leadership in the NHS is important in designing services, but he is absolutely right that it is important that patients and the public locally are properly consulted in decisions about health care services. That is something that we believe in. Far too often in the past, patients have felt that decision making is done to them rather than their being involved in it. That is exactly why we introduced new tests for the reconfiguration of services that put patient and public consultation at the very heart of designing how medical and health care needs are addressed in the future.

As I am sure my hon. Friend agrees, the heart of the matter—this is certainly my reading of the situation from what he has said—is that there is a need for good communication from the foundation trust. That means proper engagement by the trust with local communities, patients and the public and local commissioners in all decisions. It is understandable that people will respond negatively to speculation in the media, and sometimes by word of mouth, about any change or improvement to services unless there is proper communication. It seems that in this case that communication has not been of the highest standard, and that has led to some of the concerns raised by my hon. Friend. I know that he has recently met the chair and chief executive of the trust, and I encourage him to build on that contact. I am sure that the local NHS would welcome the opportunity further to share its thinking with him. That would be very desirable for all hon. Members, including my hon. Friend the Member for Burton (Andrew Griffiths).

I hope that the trust and local GP commissioners will continue to work together to explain clearly what they are doing and why. Elected representatives also play a strong leadership role in helping to work with trusts. It is in the interests of trusts to work with local MPs to ensure that there is a proper understanding of what they are trying to achieve in the way that they deliver health care to the local community.

I was pleased to hear that my hon. Friend has received reassurances from the trust about a strong future for Sir Robert Peel hospital; that is good news. However, there is clearly a need for the trust to focus on improving its communications in future to ensure that the people of Tamworth and surrounding areas fully understand that delivering high-quality health care is about listening to the public. The public must feel that their views are being listened to and properly responded to when health care services are designed. To be absolutely clear, as my hon. Friend said, this is about making sure that patients and public in Tamworth do not feel that decisions are being done to them but that they are making decisions on their own behalf and are fully engaged in the process with local commissioners in deciding on the future health care needs of the local area. Hospital reconfiguration and good health care means listening to patients and the public and making sure that hospital services are improved and delivered in a better way.

That is all the more important in this case because of the consequences of the Keogh review. I know that my hon. Friend will go back from this debate and further engage with the local trust. As I said, I am very happy to meet him and my hon. Friend the Member for Burton to ensure that we can help to achieve better engagement with local health care commissioners and the trust.

I am glad to have had the opportunity to place on record this Government’s support for the local NHS in taking forward the difficult challenge of responding to the Keogh review. We would also like to put on record our gratitude to the local front-line staff who work very hard at the Burton trust. I am sure that as a result of their work and this debate, we will be in a much better position to make sure that the trust engages more fully with the public in Tamworth and surrounding areas when it comes to making decisions about future health care services.

Question put and agreed to.

Oral Answers to Questions

Dan Poulter Excerpts

Tuesday 1st April 2014 Commons Chamber

[Pat Glass (North West Durham) (Lab)]

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

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

Since May 2010 and up to December 2013, 4,050 staff across the whole NHS have been re-employed in the NHS following redundancy. This covers all staff grades, not just managers, and is a tiny proportion of the total NHS work force of currently around 1.2 million.

[Mr Spellar]

May I thank the Minister for that utterly complacent answer? Is it not outrageous that, while front-line health service staff are having their salaries frozen, the fat cats at the top are getting monstrous pay-outs and then being re-employed straight away elsewhere in the NHS?

[Dr Poulter]

The Opposition will have to do better than these prepared questions. We have been lumbered with their redundancy terms, which were negotiated when the right hon. Member for Leigh (Andy Burnham) was a Minister in the Department of Health.

On NHS pay, we believe in having enough front-line staff to care for patients. That is the lesson of Mid Staffs. What the previous Government would have done—and the Opposition would have us do—is give some staff in the NHS two pay rises, not just one. That is unacceptable. We need to have enough staff to ensure that we can look after patients. All staff in the NHS will receive a pay rise of at least 1%, but unfortunately, because of the terms that the previous Government set, some managers are still treated better than patients. We will change that.

[Pat Glass]

Some time ago, the Prime Minister promised to stop the revolving door in the NHS and recover payments from those staff who had got huge payments and come back, sometimes to the same job. How is that going? How many people and how much money?

[Dr Poulter]

I think this is an own goal from the Opposition. They set the redundancy terms in 2006, when the shadow Secretary of State was a Minister in the Department, which have allowed extraordinary, eye-watering redundancy payments to be made, particularly to managers. That is to the disadvantage of front-line staff and patients. It is why we are currently in negotiations with the unions to ensure that we improve redundancy terms, stop those eye-watering payments and have more money to care for front-line patients.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

21. Talking of eye-watering payments, may I refer to the six-figure pay-off of £300,000 reportedly paid to Jo-Anne Wass, one of the 10 highest earners in the NHS? Despite the fact that she is leaving this month, the NHS is said to be paying for a two-year secondment for her, even though she will not return. How many 1% pay rises for nurses could be found out of that £300,000?

[Dr Poulter]

These are questions that the Opposition should have thought about—the hon. Lady was a Minister in the previous Government—when they negotiated the redundancy terms. They are Labour’s redundancy terms, which we are changing. When we look at the figures, under the previous Government’s NHS reorganisation in 2006 to 2008, we see that the NHS spent more than £360 million on redundancy and early retirement alone, which compares with only half that—£178 million from 2011 to 2013—under the current Government. How much more money would have been available for staff pay had the previous Government got that right?

[Ann Coffey (Stockport) (Lab)]

4. What representations he has received on community pharmacies.

--- Later in debate ---

[John Howell (Henley) (Con)]

14. What recent steps he has taken to improve maternity care.

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

We have made improving maternity services so that women have a named midwife responsible for ensuring personalised maternity care the key objective in our mandate to NHS England. Since May 2010 the number of full-time equivalent midwives increased by more than 1,500, and over the past two years I have set up a £35 million capital investment fund, which has already seen improvements to more than 100 maternity units.

[Stephen McPartland]

The Diamond Jubilee maternity unit at the Lister hospital in Stevenage is doing an amazing job for young mums, and the neonatal unit has just won a national award. I will be visiting the staff on Friday to thank them for their hard work. Would the Minister like to record his support for the staff who do such a great job?

[Dr Poulter]

I would be happy to do so. I am aware of the positive difference that the Diamond Jubilee unit has made to local maternity services. My hon. Friend will be aware that the East and North Hertfordshire NHS Trust and the unit have received £314,000 of this Government’s capital funding to support the hard-working staff on that unit delivering high-quality care to women.

[Henry Smith]

In 2001 the then Labour Government closed the maternity unit at Crawley hospital, despite a growing birth rate since then in my constituency. The local clinical commissioning group proposes to reintroduce a midwife-led maternity unit. Will my hon. Friend meet me and the CCG to discuss those plans further?

[Dr Poulter]

I would be delighted to do so. As my hon. Friend knows, I have a particular knowledge of his local hospital trust. It was a very short-sighted decision by the previous Government to downgrade and effectively close Crawley hospital, given the demographic pressures there. There is a good case for a midwifery-led maternity unit. Under this Government we are seeing the numbers of those increase. I would be happy to meet him to discuss these matters further.

[John Howell]

I welcome the increased number of midwives, but what are the Government doing to support women who suffer from post-natal depression?

[Dr Poulter]

My hon. Friend makes an important point. We were talking earlier about improving parity of esteem between mental and physical health. When we came to power, only 50% of maternity units had specialist perinatal mental health support, and we will make sure, through the mandate to Health Education England, that by 2017 all maternity units have specialist perinatal mental health support. That is something that this Government will be very proud of.

[Kate Green (Stretford and Urmston) (Lab)]

Last December the UK national screening committee advised against offering all pregnant women a routine test for group B streptococcus. The Minister will recall that I asked about this matter in Health questions last time. The issue is not to screen in all cases, but to ensure that the enriched culture medium test is available where clinicians deem it appropriate. Will the Minister look at how that test can be made available whenever it is clinically necessary?

[Dr Poulter]

That is a good point. On screening, we have to listen to the advice of the national screening committee, as I am sure hon. Members on both sides of the House would agree, but on the enriched culture medium test, I have had further meetings with Group B Strep Support and with the former editor of the obstetricians and gynaecologists journal, the BJOG. On the back of that meeting I have written to the Royal College of Obstetricians and Gynaecologists to ask it to look at the clinical evidence on that test, and it will take the matter forward.

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

I thought that answers to questions were improving after 12 noon, but the last answer on post-natal depression was not as good as I expected. We have a campaign on post-natal depression, which is the biggest killer of healthy young women through suicide. The Minister is being complacent. Early diagnosis and good GPs are essential. What is he really doing about that?

[Dr Poulter]

The hon. Gentleman is absolutely right. I thought it was disgraceful, when we came to power and inherited the legacy of the previous Government on post-natal depression, that only 50% of maternity units had perinatal mental health support. That was not good enough, and that is why I have ensured that in the mandate to Health Education England, and working with NHS commissioners, all maternity units will have specialist perinatal support by 2017. There is more training going in for the work of the Royal College of General Practitioners on mental health support for GPs in helping women, and we are now increasing the number of health visitors by almost 2,000, and health visitors do a fantastic job in providing perinatal mental health support to so many women.

[Mr David Nuttall (Bury North) (Con)]

17. Following the closure of the special care baby unit at Fairfield general hospital in my constituency, new mothers and families are now faced with travelling to either Bolton or north Manchester. In the light of the recent report from the charity Bliss on the costs of having a premature or sick baby, will my hon. Friend ensure that appropriate support is in place for Bury families who are struggling with a baby who needs specialist hospital care?

[Dr Poulter]

My hon. Friend makes an important point, and he has been a strong advocate for local mothers and families in his constituency. But he will also be aware that there was a review of maternity services in the Greater Manchester area that recognised that, by changing the way in which services were delivered, there could be improvements and 25 young children’s and babies’ lives could be saved each year. There has been a review, and that review is saving lives, so I commend any similar service reconfiguration that delivers similar benefits to women and patients.

[Nick Smith (Blaenau Gwent) (Lab)]

13. What steps the Government is taking to reduce the amount of sugar in children’s diet.

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

The hon. Lady will be aware, of course, that it was the right hon. Member for Leigh (Andy Burnham) who had the most to do with introducing the private sector and agreeing ambulance service contracts in the Greater Manchester area. I think that Opposition Members need to remember their record on private sector involvement. If she has concerns, we will of course look into them.

[Mr Speaker]

The Minister’s answers are too long. He really has to get that into his head. I do not know how hard I have to try. I try to help the hon. Gentleman, but he is not very good at helping himself.

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[Mr Dave Watts (St Helens North) (Lab)]

T7. How is the Government’s pledge to get hospitals operating on a seven-day basis going? Many GP commissioners are refusing to provide the funding for hospitals to provide that service.

[Dr Poulter]

As the hon. Gentleman will be aware, we are in negotiations with the British Medical Association and other health care unions about the future shape of the NHS consultant contract and junior doctors contract. We are determined to have a contract that remains fit for purpose in future and to reform the contract that we inherited from the previous Government, which was not fit for purpose. We will continue to work with the BMA to make sure that we protect the interests of patients and deliver better care.

[Charlotte Leslie (Bristol North West) (Con)]

I very much welcome the taskforce reviewing the effects of the working time directive; as my hon. Friend knows, I have campaigned long on the issue. Given the severity of the evidence, which shows that more than a quarter of a million hours of surgical time are lost per month because of the directive, will my hon. Friend assure me that he will not only listen to, but act bravely and robustly on, any recommendations to rid the NHS of this very dangerous directive?

[Dr Poulter]

My hon. Friend has campaigned with great vigour on the issue, and rightly so. The European working time directive, to which the previous Government signed up in a headlong and reckless way, has damaged continuity of patient care and the training of the consultants of tomorrow. That is why we set up the independent review. We look forward to its recommendations and we will make sure that we respond to those appropriately in due course.

[Andy McDonald (Middlesbrough) (Lab)]

T8. The Health Secretary talks about Welsh patients flocking to the English NHS, but is he aware that the number of English patients going to Welsh hospitals has increased by more than 10% since 2010? Does that mean that the English NHS is in crisis?

[Mr Douglas Carswell (Clacton) (Con)]

There is due to be a consultation on the future of maternity units at Clacton and Harwich hospitals. Last week, however, the management team at the already troubled Colchester trust decided to shut the units anyway. That has caused great anger and concern locally. Will my hon. Friend write to the board to ensure that it does not prejudice the outcome of the consultation and that decisions are made on the basis of fact, not muddled management?

[Dr Poulter]

I will certainly be happy to look into the issue. My hon. Friend will be aware that the closure decisions were made on clinical safety grounds, for the safety of women. It is a temporary issue. One of the outstanding problems in my hon. Friend’s part of the world and elsewhere when we came into government was a historical shortage of midwives. That is why we are investing in more midwives. There are already 1,500 more in the NHS and I believe that six more will be recruited to the local NHS in his area.

[David Wright (Telford) (Lab)]

T9. Mental health services in Telford are under review and the Castle Lodge facility has been closed for a considerable time. It has been heavily used by people in the community who do not have to be admitted into Shrewsbury. Will the Minister confirm that if local people want to retain Castle Lodge, as I believe they do, it will be retained?

[Tim Farron (Westmorland and Lonsdale) (LD)]

Rural surgeries such as Ambleside, Coniston and Hawkshead in my constituency are under threat because of a combination of historical funding difficulties and the removal of the minimum practice income guarantee. Will the Minister agree to look into the setting up of a strategic small surgeries fund, so that rural surgeries have a confident future?

[Dr Poulter]

My hon. Friend and I have discussed the issue before. As he is aware, price premiums are already built into the funding formula to support rural practices. NHS England has already identified about 100 practices that may need additional and special support. Commissioners will be looking to provide that and work with those rural practices and others that may have challenges.

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[Mr Philip Hollobone (Kettering) (Con)]

Ten babies a day are born at Kettering general hospital. May I welcome the recent award of £400,000 of NHS modernisation funds to the hospital’s 33-bed maternity unit and urge the Minister to encourage NHS England to prioritise areas of high population growth such as Kettering for future funding?

[Dr Poulter]

I know that the staff at my hon. Friend’s maternity unit work tremendously hard to look after patients, and it is important that we gave them the right facilities in order to do so. I am delighted that, like over 100 other birthing units in the country, they have received money to make sure that women are treated with greater dignity and that the quality of care is as high as it can be.

[Bill Esterson (Sefton Central) (Lab)]

I cannot speak highly enough of the staff at Southport hospital who cared for me when I spent three days there as a patient last month. They told me that GPs now routinely send older patients straight to A and E because their funding has been cut and that community services are no longer in place to support people in their own homes, which is all leading to a crisis at A and E. Is not the sad reality that what is happening at Southport is being repeated up and down the country as a result of the Government’s disastrous reorganisation and cuts to front-line services?