GP Services

Debate between Dan Poulter and Jamie Reed

Thursday 5th February 2015 Commons Chamber

[Dr Poulter]

My hon. Friend is right. I spoke to medical students and those teaching them in Cornwall on a visit earlier this year. It is important, particularly for rural areas, to encourage more placements in rural areas in general practice. Often at my hon. Friend’s medical school and other medical schools in remote rural areas, there is a good track record of recruiting more local young people so that they are being educated locally. The hope is that those people will stay and work in the local work force and contribute to the local NHS after they graduate. I hope all hon. Members will agree that that is a good thing, particularly in more deprived areas.

I must make progress as I do not want to intrude upon the House’s time for too much longer. There are two or three important points that I want to make. I mentioned that in the health education mandate in 2014 we mandated to increase the number of GP trainees from 40% to 50% of all trainee doctors. That will make 5,000 extra GPs available by 2020. It is important to note, however, that as well as having the appropriate size work force, we must plan for the future shape of the work force. The new models of care set out in the NHS England “Five Year Forward View” will require different models of staffing, and we need to plan with that in mind. That is why Health Education England has established an independent primary care work force commission, chaired by Professor Martin Roland of the university of Cambridge.

In line with the contributions to the debate from a number of hon. Members, including my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), the commission will identify models of primary care that will meet the needs of the future NHS, including a greater emphasis on community and primary services and the more integrated delivery of care, which will involve the better use of multidisciplinary teams. We have been talking about GPs today, but delivering better care in the community is also about nurses, physiotherapists, occupational therapists, pharmacists, speech and language therapists and the many other health care professionals who play a part in delivering high-quality care to patients in general practices and in the community every day through our NHS.

In response to concerns raised by hon. Members about access to services, GP services need to be available to patients in a convenient place and at a convenient time. Achieving improved access to general practice not only benefits patients, but has the potential to create more efficient ways of working, which benefits GPs, practice staff and patients. The previous Government attempted to improve access to GP services by establishing a 48-hour access target. We know now that that target did not work. From 2007 to 2010, the proportion of patients who were able to get an appointment within 48 hours when they wanted one declined by 6%.

A 48-hour target can make it more difficult for some of the more vulnerable patient groups who GPs look after, particularly people with complex medical co-morbidities, to get the important routine appointments that they need. We should bear in mind that targets can be perverse. That target did not work in its own right, and could make it more difficult for people with complex needs and the vulnerable and frail elderly to get the routine appointments that keep them well and properly supported in the community.

Many points have been made about Labour’s disastrous 2004 GP contract. I do not need to rehearse those. The single biggest barrier to access to care is not being able to see their GP when people need to, in the evenings and at weekends. We have put together the Prime Minister’s fund with £100 million to back it to improve access to GP services in the evenings and at weekends, to make sure that patients receive the better service that they deserve.

[Mr Reed]

In 1997, only half of patients could see a GP within 48 hours. By 2010 the vast majority could do so. Does the Minister agree with Maureen Baker of the Royal College of General Practitioners, who said:

“It is ludicrous to continue to blame a GP-contract that is more than ten years old for the woes currently besetting the entire NHS”?

[Dr Poulter]

It is easy for the hon. Gentleman to take quotes out of context. It is undoubtedly the case that A and E admissions rose dramatically and the pressure on A and E increased dramatically because people could not access their GP out of hours. Of course that is the case. The facts and the statistics bear that out. Also, many people work, so having access to their GP service in the evenings is increasingly important to working people, so that they can see their GP at a time that is convenient to them. We have a chronic disease burden, which all hon. Members are concerned about, so why should primary and community care services be unavailable at weekends? That is not a well structured GP contract or arrangement. It is important that we do our very best to put that right.

Mike O’Brien, who was a Health Minister in the previous Labour Government, is on the record as having criticised that GP contract and the damage it did to patient care. We want to support GPs to provide a seven-days-a-week service again, which is why we have put in place the Prime Minister’s fund. I hope that the hon. Member for Copeland, putting aside party political differences, will recognise that GP services need to be properly available to patients seven days a week.

Health and Social Care (Safety and Quality) Bill

Debate between Dan Poulter and Jamie Reed

Friday 9th January 2015 Commons Chamber

[Mr Jamie Reed]

I listened closely to the hon. Member for Stone (Sir William Cash). As I said earlier today, and on Second Reading, in Committee and throughout the passage of the Bill that became the Care Act 2014, patient safety is our guiding principle, and we are responsible for ensuring that all that we do is intended to improve it. The purpose of NHS regulation should always be to improve safety and achieve better patient outcomes. I therefore strongly sympathise with the principle of the new clauses. However, I should be grateful if the hon. Member for Stone explained why he does not agree with the hon. Member for Stafford (Jeremy Lefroy) that the duties for which they provide are already covered by the Bill and by other legislation.

A little over 12 months ago, I was a member of the Committee that scrutinised the clause in the Care Act that amended the Health and Social Care Act 2008, which new clause 2 seeks in turn to amend. The new clause adds the following words:

“The assessment of the performance of a registered service provider is to be by reference to whatever indicators of quality the Commission devises, but must include indicators of the safety of health and social care services.”

That is sound in principle, but it seems to me that it would remove from the CQC the flexibility that allows it to exercise its own judgment. Existing legislation gives the CQC a duty to describe and justify its indicators, and to consult on them before carrying out inspections. As the hon. Gentleman said, the Care Act also gives it a power to amend and revise those indicators.

Section 3 of the 2008 Act states:

“The main objective of the Commission in performing its functions is to protect and promote the health, safety and welfare of people who use health and social care services.”

Will the hon. Gentleman explain why he thinks his new clause is needed on top of that, and in combination with the CQC’s duty to consult on the indicators that it uses to assess services? If we support the principle of independent inspection, we need to guard against making unnecessary changes to legislation that could deter the CQC from performing its central role of ensuring the safety of the services that is inspects.

New clause 2 requires the CQC to

“include indicators of the safety of health and social care services.”

We all want the best and most effective legislation to be passed, but I fear that the new clause could be open to significant misinterpretation. The section of the 2008 Act to which the new clause relates concerns CQC reviews of the performance of service providers. The CQC will inspect a number of different services, including services that do not directly involve social care. The new clause, however, could require it to include indicators of safety in social care services regardless of whether the service concerned involves social care. If that is the hon. Gentleman’s intention, will he explain why he believes the provision to be necessary? Furthermore, new clause 2 refers to “social care services”, whereas new clause 3 refers to “adult social care services”. I hope that the hon. Gentleman will be able to explain what appears to be a discrepancy.

As Labour Members have made clear, we believe that patient safety is paramount in our NHS, that effective regulation is key to securing it, and that producing such regulation is our role in the House. I should be grateful if the hon. Gentleman explained why he believes that his new clause is essential to more effective regulation, given that—as the hon. Member for Stafford has pointed out—it seems merely to repeat existing provisions.

[Dr Poulter]

I thank my hon. Friend the Member for Stone (Sir William Cash) for tabling these new clauses and I commend him on his tireless work in taking forward the interests of his constituents around the terrible events that occurred at Mid Staffordshire NHS Foundation Trust and the subsequent steps he has been involved with all the way through to improve standards of hospital care provided to the people of Stone and the surrounding areas. He is also right to pay tribute to my hon. Friend the Member for Stafford (Jeremy Lefroy), who has worked tirelessly not just on this Bill, but as an advocate for his constituents and local patients. He is a great credit to the people of Stafford and, party politics aside, being a Member of Parliament is about public service, and he embodies the very best of that in the work he has done in bringing forward this Bill and in his advocacy of the needs of his local patients.

--- Later in debate ---

[Mr Jamie Reed]

Thank you for calling me to speak, Madam Deputy Speaker, and happy new year.

I listened closely to the hon. Member for Stone (Sir William Cash) introducing his new clause 4 and to the other hon. Members who have spoken on it. They are correct to say that good communication between professionals and patients is crucial for ensuring positive health outcomes. I would go so far as to say that it is critical. One of the issues that we need to address in this regard is the needs of patients with sensory impairments, such as deafness and blindness. That is not covered by the new clause and it has no regard for nationality or language skills.

In April 2010 the Health Committee conducted an inquiry called “The use of overseas doctors in providing out-of-hours services” following the tragic death, to which the hon. Gentleman referred, of David Gray in 2008 after receiving medical treatment from Dr Ubani from Germany, who was working his first shift as an out-of-hours doctor in the United Kingdom. The report recommended that the Government make the necessary changes

“to enable the GMC to test the clinical competence of doctors and undertake systematic testing of language skills so that everything possible is done to lessen . . . the risks of employing another unsuitably trained . . . doctor in out-of-hours services.”

Following this case, I understand that the Government have, with the support of Labour, worked to strengthen the powers of the General Medical Council in this regard. We welcome that.

Notwithstanding all this, I am unsure what the hon. Gentleman is trying to achieve. Given the existing practice of the GMC, the new clause, although agreeable in principle, is superfluous. The GMC conducts English language assessments already, and failure to undertake an assessment or failing such an assessment can result in fitness to practise hearings, which can lead to a loss of registration to practise.

These assessments can be triggered in a number of ways. A single complaint from a patient, a health professional or another party can result in an assessment, as can prescribing errors and poor record keeping. Overseas medical regulatory authorities can prompt an English language assessment if they believe that a doctor does not have sufficient knowledge to treat patients in an English-speaking context. Indeed, the GMC website tells international doctors that

“you must satisfy us you have the necessary knowledge of English to get registration with a licence to practise”.

So the GMC needs to be satisfied before a licence to practise is granted. These tests relate to all forms of communication—speaking, reading, writing and listening. It is right that the GMC continues to be vigilant in its oversight of this requirement. Good communication is central to patient safety, and the GMC does a great deal to ensure that those practising in the NHS have the skills required to do so safely.

I want to place on record an acknowledgement of the contribution made to our national health service, which I know nobody doubts, by the many overseas health care workers without whom the NHS would not be able to cope, including in my constituency. On Second Reading of the National Health Service (Amended Duties and Powers) Bill, my hon. Friend the Member for Bolsover (Mr Skinner) commented that he had received a “United Nations heart by-pass” operation, by which he meant that people from all over the world had done a great deal for the health of this country, and we should all be thankful for that.

We have touched briefly on unintended consequences. Some politicians have recently sought outside the House to manipulate and inflame the issue with a view to creating an imaginary bygone Britain in the public consciousness as part of a long-standing flight from reality based on bizarre notions such as “gay rain”, the enforced segregation of breastfeeding mothers from public spaces and the right to use racist language. We must all be careful not to legitimise this abhorrent, detached, cultish behaviour or the perverted mindset which underpins it.

[Dr Poulter]

I am grateful to my hon. Friend the Member for Stone (Sir William Cash) for tabling the new clause. We all agree that it is vital that doctors can speak and communicate effectively in English. My hon. Friends the Members for North East Somerset (Jacob Rees-Mogg) and for Shipley (Philip Davies) made a number of important points.

I hope I can bring some reassurance to hon. Members that there are already in place, thanks to changes introduced by this Government, a number of strong tests for language competency and the ability to communicate. It is not good enough for a medical professional to be able to speak English; it is important in all aspects of health care that we can communicate effectively with our patients. The ability not just of doctors from overseas when they work in and contribute to the NHS, but of doctors who have been working here for many years to communicate effectively is at the heart of good medicine. There are a number of steps that this Government have taken to strengthen the tests in place.

To echo the comments of the shadow Minister, I have worked alongside many doctors and many health care professionals from all over the world who have come here to contribute to our NHS and to the care of patients. Many of those doctors have been outstanding and continue to look after patients today as we debate the new clause. One of the strengths of our diverse NHS is that because we have a world-class health service, doctors want to come here and contribute as part of their careers, often for a short period, before they return to New Zealand, Australia or the many other countries from which they have come. The diversity of our NHS and the fact that we attract doctors—often the very best doctors—from all over the world is a great strength, but it is vital that all doctors can both speak English and communicate effectively in English. That is not controversial, and it is what good patient care is all about.

Clause 5 and the schedule will introduce a consistent overarching objective for the Professional Standards Authority and professional regulators—the General Dental Council, the General Optical Council, the General Osteopathic Council, the General Chiropractic Council, the Nursing and Midwifery Council, the Health and Care Professions Council and the General Pharmaceutical Council—to ensure that public protection is at the heart of what they do.

The clause introduces the term “well-being” into the objectives of a number of these regulators. This has been a long-standing and established feature of the legislation for the General Pharmaceutical Council, the Health and Care Professions Council and the Nursing and Midwifery Council. The term encompasses those aspects of a health care professional’s role that may have an impact on individuals but may not directly impact on their health or safety: dignity, compassion and respect are all vital aspects of delivering high-quality care. This was highlighted most starkly in the Francis inquiry report of February 2013, which put into focus the terrible and serious failings in the care provided at the former Mid Staffordshire NHS Foundation Trust, which was the basis on which my hon. Friend the Member for Stafford (Jeremy Lefroy) introduced the Bill.

One specific area where real changes in the protection of patients are being made relates to the strengthening of arrangements to ensure that all health care workers have sufficient knowledge of English and the ability to communicate effectively with patients in English before being allowed to work in the UK. The General Medical Council has always been able to check the language skills of doctors from outside the European Union who want to practise medicine in the UK. It does this through the international English language testing system, which covers all four language skills—listening, reading, writing and speaking—and it is widely accepted by employers, the other health care regulators and professional bodies as a means of assessing proficiency in English in a professional environment. The GMC continually assesses the effectiveness of this test to ensure its robustness.

In addition to this test of their language skills, the GMC conducts a professional and linguistic assessments board exam—often called the PLAB exam—for doctors from outside Europe. This tests their reactions to a number of clinical scenarios and their ability to apply their clinical knowledge to the treatment of patients and is the main route by which international medical graduates demonstrate that they have the necessary skills and knowledge to practise medicine in the UK.

However, following the death of a patient, David Gray, and the tragic circumstances surrounding that death in 2008 after he received medical treatment by Dr Ubani, a German national, where language skills were a strong component in the incident, a House of Commons Health Committee report recommended that the Government change the law to allow the GMC to extend language tests to doctors within the European economic area, providing consistency in how doctors from both within and outside the EEA are treated with regard to assessing their language skills, before being allowed to practise medicine in the UK.

The Government made a commitment in the 2010 coalition agreement, which the shadow Minister has mentioned, to stop foreign health care professionals working in the NHS unless they have passed robust language tests. We have fulfilled that commitment in respect of doctors, and we are now putting in place additional measures, through section 60 orders, to introduce language testing for other health care workers.

West Cumberland Hospital

Debate between Dan Poulter and Jamie Reed

Monday 20th October 2014 Commons Chamber

[Dr Poulter]

This has been a long-standing shortage; the trust has not been an attractive place for junior doctors to work for many years—probably for the past decade. However, the trust is now looking at ways in which it can better incentivise doctors to work there. That is an important step forward. If we want junior doctors to return to the trust—given that they have been removed from it because they were not getting the high-quality training they needed in order to become consultants—we must ensure that we incentivise the recruitment of more senior doctors to the trust. The hospital is now looking much more seriously at that than it has done in the past.

As I just outlined, recent measures have resulted in the consultant medical staff being increased by 17%, which is a positive step forward. Measures are also being put in place to ensure that nurse practitioners will be better used, where appropriate, to treat patients. The trust can be proud and pleased with the progress that it is making in that respect. An important aspect of looking after patients is to ensure that there is a full rota of junior doctors on site, and I am sure that if the progress in increasing the amount of consultant cover is maintained, that will become available again in the future.

On performance, the trust has put in place a recovery plan to meet waiting time targets from the end of 2014. It is currently working to reduce its backlog of patients who have been waiting for more than 18 weeks from referral to treatment, and it has received additional funding to support that. As hon. Members have pointed out, however, the trust has been financially challenged for some time. Last year, it reported a deficit of £27.1 million. The Department of Health provided significant financial support to the trust in 2013-14, as it has in previous years. The trust received £11.5 million from the Department, alongside support from the trust development authority and the clinical commissioning group, and £6.3 million in private finance initiative funding support. As we have discussed, however, that position is not sustainable in the long term. That is why further discussions about foundation trust status are being held.

Other critical challenges remain. Most significantly, some services at West Cumberland hospital remain fragile due to difficulties recruiting specialists and consultants and to the current heavy reliance on locums. However, I hope that that issue will be addressed in the near future if the trust can continue to recruit more consultants.

The Care Quality Commission inspection report published in July 2014 rated the safety of acute medical and outpatients services at the West Cumberland hospital “inadequate”. That reflects the difficulties that the hospital has faced for many years, and continues to face, in recruiting adequate staff to run some of its services safely and effectively. However, the trust has made significant progress in addressing the many challenges it faces. The CQC inspection acknowledged that, giving it an overall rating of “good” for providing a caring service to patients.

Another CQC inspection is expected to take place in early 2015, and I understand that the trust is working hard to make improvements ahead of that. For example, the outpatients service has greatly improved the availability of patient notes, an issue highlighted at the previous inspection. As I understand it, patients’ notes were not available when they came for an appointment. That is not helpful in providing an understanding of their previous history, which disadvantages the staff who are looking after the patient and trying to provide the best possible care. The trust has taken that issue on board and I understand that it is making good progress to address it.

The trust has made significant progress in other respects, most notably, and perhaps most importantly, in reducing high mortality rates. That means that patients in Cumbria who would have died had these changes not been introduced are alive today. Having been one of the highest in the country, the trust’s mortality rates are now within national confidence limits, and the trust and its staff must be commended for that turnaround. Further progress has also been made in, for instance, the meeting of the four-hour A and E standard, the implementation of a new patient experience programme, and a reduction in clostridium difficile infection rates. However, changes must continue to be made to secure a sustainable future, and to enable the trust to keep building on the good progress that it has made so far. It is important for the local NHS to be supported in that work to secure safe, high-quality patient care.

[Mr Reed]

Will the Minister explain why mortality rates increased sharply immediately after the summer of 2010?

[Dr Poulter]

I do not have the local knowledge that would enable me to understand why that happened, but what is important is the need for action to be taken in cases in which there is a history of higher than expected standardised mortality rates—cases in which patients have died when they should not have died. That is why the Government asked Sir Bruce Keogh to investigate this trust, and, indeed, many other trusts, as a result of which some were put into special measures.

Although a number of challenges remain, and the trust must address them, it appears to be making good progress in terms of standardised mortality rates, which means that—as I said earlier—patients who might have died in the past are now surviving. That is testimony to the hard work of the trust’s front-line staff. I know that Members will be pleased, and that, more importantly, local patients and their families will be very grateful.

The subject of reconfiguration was raised. The issues affecting west Cumbria were discussed during a debate secured in 2012 by the hon. Member for Copeland (Mr Reed), and I know that the future of services at the hospital is a matter of continuing concern to both him and the hon. Member for Workington. As I said earlier, the local NHS is committed to ensuring that West Cumberland hospital has a viable and successful future, and that west Cumbrian patients continue to receive treatment there. That is why £95 million—£70 million of it from the Government—is being made available to improve its facilities. The money will allow it to offer 21st-century facilities, including seven new operating theatres, four of which will have full laminar flow, which will make them suitable for use in any operation. That will allow the hospital to offer a wide range of surgical services, and to become a centre of excellence for elective surgical procedures.

The hon. Member for Workington asked what excellence would be provided at the hospital. I can tell him that the investment in new facilities will allow patients to receive elective surgical procedures of a much higher quality, which will hugely benefit the local population. That investment is supported by additional investment in other local health care facilities, including, not far away, the new £11 million Cockermouth community hospital—which was officially opened in August 2014—and the new health centre at Cleator Moor.

Alongside the financial investment in the hospital, there are continuing efforts to attract and recruit new clinicians to North Cumbria University Hospitals NHS Trust. International recruitment campaigns have already taken place, and financial incentives are now available to support recruitment to the posts that are the most difficult to fill. That point arose earlier in the debate. Hospitals often have the flexibility to offer incentives in the event of recruitment challenges and difficulties, and I am pleased that the local trust is taking advantage of the opportunity to offer such incentives to attract new consultants and permanent staff.

To build on the progress that is already being made, clinicians are working towards changes that offer the best opportunities for better outcomes to be given to patients suffering from the most serious illnesses. No changes will take place unless there is clear clinical evidence that they will result in better outcomes.

Understandably, people have concerns when any change to local health care services is being discussed, but it is important that such concerns are not exploited for any political or other purpose, and that all changes that take place are in the best interests of local patients. The five-year plan for the local health service being developed by local doctors and clinical commissioners is looking at how services can be delivered safely and sustainably in the future. In developing the plan, I expect the local NHS to give important consideration to the distance patients need to travel to access services, particularly emergency services. As we have discussed, rural areas are very different from urban areas, and the distance patients may have to travel to access services is an important factor in determining what is safe for patients. Local commissioners need to take note of that.

[Mr Reed]

The Minister represents a rural constituency. Notwithstanding his medical expertise and knowledge, would he be happy for constituents of his who were in labour and showing complications to have to travel for more than 90 minutes, bed to bed?

--- Later in debate ---

[Dr Poulter]

That actually may have to happen in my constituency, for example, in cases where my local hospital does not have the right support for a very premature baby in utero once it is born. Neonatal services are not always as well developed at every hospital, and some areas tend to have a regional centre of excellence for neonatal care. As the hon. Gentleman said, there may be a regional centre of excellence for cardiovascular services, heart surgery or other specialist services. We want to ensure that bread and butter, day-to-day medical services are always provided by local hospitals—that is particularly important in rural areas—but we have to ensure when taking these decisions that where there is a clinical case for better patient care to be delivered at a centre of excellence, that case is made and communicated effectively. So, for example, although I would want to ensure, as I have done, that in Suffolk patients are able to receive the best possible care from the local NHS, if they needed super-specialist services and other services that are better provided at a specialist centre, they receive that care from those centres. I have always advocated that important case on clinical grounds.

This is about seeking to provide high-quality day-to-day services, while recognising that some services have to be provided at specialist locations. So when dealing with the potential birth of a very premature baby, it is important that the right support after birth is available, and that is provided by more specialist neonatal intensive care units—for example, Brighton is a regional centre for the south of England for some of those services. It is also important that, where possible, an intrauterine transfer takes place to make sure that the right care is available upon birth and after delivery.

It is also important to stress that in designing and working through what the right patient services are, and in putting together the local five-year plan in Cumbria, certain guarantees and reassurances have been made to the local population. I spoke just now about important day-to-day medical services, and a commitment has been given that there will continue to be an accident and emergency department at West Cumberland hospital. That is part of what I was just speaking about: high-quality, immediate services available for patients in more rural and remote areas. An independent review is looking at maternity services across Cumbria and will feed into work locally to find the best possible solution to providing safe and sustainable maternity care in the future.

While the five-year plan outlines the direction of travel for the local health service, no definite proposals have yet been put forward, and work remains at an early stage. In developing its proposals, I expect the local NHS to ensure that patient safety is a key focus, and that any movement or change of services is based on clear clinical evidence of better outcomes for patients.

I wish to make some important points about public engagement, which was raised by both hon. Gentlemen. It is important that people who use NHS services get a say in any changes to those services. We are very clearly committed to that as a Government, and it is important that local clinical commissioning groups, and the doctors and nurses who run them, properly engage with the public when they are making the case for the future shape of local health care services. I encourage local patients to continue to engage with the NHS as plans for west Cumbria are developed.

I understand that Cumbria CCG has met local MPs and the local campaign group to discuss their concerns and is happy to maintain that dialogue and continue to meet to discuss issues of concern in the weeks and months ahead.

The local NHS held a period of engagement to inform the development of the five-year plan. Both the CCG and the trust are committed to undertaking more engagement and communication with local people in the coming months.

Any proposals put forward for significant changes to local health services will be subject to a full public consultation in which patient and public views can be fully engaged in helping to shape future health care services. That is an important reassurance to give Members. No decisions will be made without that full public consultation if and when any changes to services are proposed.

In conclusion, I know that local people care deeply about the future of West Cumberland hospital—that has come across clearly from the contributions this evening. The provision of health care services affects all members of the community. We have only to look at the example of 10-year-old Maddy Snell who last week received a reply from the Prime Minister to her letter about potential changes to local health care services to see how the whole community in west Cumbria wants to be involved in the future of its hospital.

Patients should keep up that engagement with the local NHS and make their opinions known to those developing proposals for the future of local health care services. I also want to encourage the people of Whitehaven to listen to the reasoning behind any proposals that their local doctors bring forward for improvements in the way in which people are cared for in the local area.

I should like to reiterate that local health services in west Cumbria have a strong future. There is a commitment from the local CCG, led by doctors and nurses, for a continuing accident and emergency service, and the Government support a £95 million investment in health care facilities at West Cumberland hospital.

[Mr Reed]

The Keogh report makes it very clear that meaningful engagement with the staff both at the Cumberland infirmary, Carlisle, and the West Cumberland hospital is nothing like it should be. That is one of the key reasons the trust entered special measures. All of us from all parts of the House want to see the hospital trust emerge from special measures as quickly as possible. However, latterly, that engagement internally has demonstrably worsened. How can we get out of special measures if these behaviours persist?

[Dr Poulter]

Part of the challenge may well be challenging some of the existing work practices at the hospital. I accept what the hon. Gentleman has said about the quality and commitment of local NHS staff. In my experience, I have never found a member of the NHS who has been engaged in health care with anything but the best intentions and the wish to help people. That is why I am a doctor and why many people go into health care; they want to provide compassionate care for people and to improve the human condition. I know that that is what drives local staff in Cumbria. Sometimes when profound issues have to be faced, such as higher than expected local mortality rates, challenging conversations have to take place. Such issues are the result of not a lack of commitment or dedication from the staff, but the fact that some working practices need to be improved. Additional training and support may need to be put in place to improve those working practices. It is important that that is done in a way that brings staff along in a collaborative working environment.

When things go wrong in health care, it is rare that there is one single causal factor, although sometimes there is; sometimes it is the negligent act of one person. Often, however, it is the system in a hospital that has let someone fall through the gaps. This is about challenging working practices, and as far as possible, that has to be done collaboratively. Clearly, there have been huge improvements in the way health care is delivered locally. Mortality rates have fallen, and patients are being looked after in the way we would all expect. That is down to the hard work of the staff who are facing up to some of the challenges, and making sure that they put right what may have been wrong.

It is important that when there are discussions about reconfiguring, changing or developing health care services, local clinical commissioners engage effectively with the hospital and properly with hospital staff. Part of the broader consultation and engagement exercise needs to be focused on proper engagement between the clinical commissioning group and the clinicians and other dedicated staff who work at the trust. From what hon. Members are saying, there may be more work to do in that area. I urge the clinical commissioning group to put right any issues, because it is important that everybody signs up to dealing with future challenges.

As I have said, I am confident in the local clinical commissioning group’s commitment to supporting a viable A and E at the hospital. The Government have provided investment to develop facilities further, particularly facilities for surgical procedures, in the hospital and the local area. With that investment, there is a strong future for local hospital services. It is important that local clinical commissioners continue to engage with staff at the trust, and particularly with local patients. After all, if we want a health service that is fit for purpose in Cumbria and elsewhere, it has to be based on the needs of local patients. It is to them, more than anybody else, that local commissioners need to listen.

Question put and agreed to.

Type 1 Diabetes (Young People)

Debate between Dan Poulter and Jamie Reed

Wednesday 30th April 2014 Westminster Hall

[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.

Care Bill [Lords]

Debate between Dan Poulter and Jamie Reed

Tuesday 11th March 2014 Commons Chamber

[Mr Reed]

I absolutely share those concerns. We did not hear anything last night that reassured anybody who understands the Bill. Certainly, Government new clause 34 is not worth the paper that it was hastily written on, and I want to move on to that right now.

Surely it is not too much to expect the democratically elected politician who sits in Cabinet and is responsible for the national health service to be accountable for how the medical data that that service captures is used. Crucially, the Secretary of State for Health is accountable not only to this House but to the people of this country in a way that a quango cannot be and has never been. Such accountability can begin the process of building the trust necessary to ensure the success of projects such as care.data. Without that, QED, the Secretary of State is asking Parliament and the people of this country for permission to remove democratic accountability from how their confidential medical data are used. The implications for the use of patient data in any project are utterly toxic.

I said earlier that it would be tragic if the Government’s failings were to continue to contribute towards the erosion of trust in care.data. Sadly, the Bill provides scope for other regrets. Part 1 seeks to make worthwhile but modest improvements to our care system, falling a long way short of the concept of whole-person care articulated by Labour. The Government new clauses and amendments that we are now discussing, however, and clause 119—the hospital closure clause that we will discuss later—fundamentally disfigure what is without doubt a worthwhile Bill. Perhaps that shows us the two sides of the coalition in the ministerial team. We shall see. None the less, it is a cause for regret.

Trust is at the heart of Government new clause 34. Yesterday, the Minister tried to reassure the House that the new clause would provide the safeguards that people require for the protection of their confidential medical data. He demonstrably failed to do that. Challenged time and again to illustrate how his new clause would facilitate the claims he has made for it, or improve safeguards for patients, he could not do so. Next time, it might be a good idea if the Secretary of State could get the same person to write both the Government amendments and the Government press release, because the amendments and the new clause do not provide what the Government claim they will. Sadly, that erodes trust yet further.

New clause 34 has been made necessary due to the appalling handling of the care.data project by the Government and the resulting erosion of public trust. The truth is that the new clause was hastily tabled again just before the deadline for amendments because the original, botched new clause 14 did not do what the Government said it would. Guess what? New clause 34 does not do what they say it will either. Subsection (3) would amend section 261 of the Health and Social Care Act 2012 to read:

“The Information Centre may disseminate (other than by way of publication), to any such persons and in such form and manner and at such times as it considers appropriate.

But the Information Centre may do so only if it considers that disseminating the information would be for the purposes of—

(a) the provision of health care or adult social care;

(b) the promotion of health.”

Yesterday, the Minister was given numerous opportunities to explain how this provision would prohibit private health insurance companies from gaining access to our data—he could not do so. The new clause provides for entirely elastic definitions that, in practice, will have a limitless application.

What happens when a private health insurance company requests information from the HSCIC on the basis that it was going to conduct specific controlled, randomised assessments of the impact of physical activity on various age groups in order to promote and recommend appropriate physical activity to its policyholders— perhaps with a view to reducing their premiums? That is clearly being used to promote health and well-being, so how would new clause 34 stop it? It would not—under the proposed wording, it would be facilitated. Once such a company has the data, what prevents it from using them for other means? Under our new clause 25, such use would be a clear offence, but sadly the Government have offered no such safeguards.

It is no wonder the public cannot trust Ministers. Just a few weeks ago, in Committee room 9, the Minister assured me and the rest of the Public Bill Committee:

“There are strict controls about the release of potentially identifiable information; for example, that type of information would only ever be released to approved organisations for approved purposes”.––[Official Report, Care Public Bill Committee, 30 January 2014; c. 516.]

Yet these strict controls fail to appear time and again. The only comfort offered to the public is that those issues will be resolved by regulations drafted by Ministers in whom confidence and trust has been lost—that is not good enough. With that in mind, can the Minister explain who signed off the release of data covering 47 million patients that were obtained by the Institute and Faculty of Actuaries? Such issues must be addressed, and it seems likely that when he eventually responds to the Chair of the Health Committee, the Secretary of State will give cause for yet further concern about how patient data are being used.

In responding to the news about that massive data breach, a Department of Health source stated:

“The rules changed last year so this would no longer be allowed. Information like this can only be accessed now if there is a clear benefit to improving health or health systems.”

It is chaos: if the rules have already been changed, the new clause tabled in haste by the Minister is full of superfluous subsections. Why does he need to change the rules again if they have already been changed?

We have a golden opportunity to get this right. The more that patients allow their data to be used, the greater the positive effects of care.data. These issues will not be resolved today and they will not be resolved by any of the Government proposals before us. If we want care.data and schemes like it to work in the future, we need to establish trust. Getting this right will save lives. Accountability is critical when accessing and using the most sensitive personal data, and the whole House can send a message to the people of this country—that we understand their concerns, that we are serious about safeguarding their most private data and that we are determined to continue to improve our health services—by voting for new clause 25 and amendment 29.

[Dr Poulter]

I thank hon. Members for the many comments and pertinent points made during the debate, both last night and today, and I will do my best to respond to the main issues raised. In particular, I wish briefly to respond to a couple of points raised by the shadow Minister. He talked about rank incompetence, but let us remember that the previous Government wasted £10 billion on an NHS IT project that was not fit for purpose and did not work. So Government Members will take no lessons about information services in the NHS from Labour Members, given that their Government wasted £10 billion, which I would have rather seen spent on front-line patient care. Furthermore, Labour Members repeatedly raise the issue of the lack of safeguards, but they failed to put them in place when they were in government. Only this Government have put in place safeguards, doing so through the 2012 Act, which I outlined clearly in my contribution last night, and through the further reassurances provided by the proposals we are making today.

--- Later in debate ---

[Dr Poulter]

It was very clear, as NHS England has acknowledged, that the communication exercise put forward was not ideal. That is part of the reason why we are debating the issue today. I hope I have brought further reassurance to hon. Members about the fact that the 2012 Act does put in place robust safeguards, which were not in place under the previous Labour Government. We have put in place the safeguards through that Act and through the Government amendments we have tabled.

[Mr Jamie Reed]

Does the Minister accept any responsibility for this near disastrous collapse of the care.data scheme, or is it all NHS England’s fault?

[Dr Poulter]

As the hon. Gentleman will be aware, under the 2012 Act, NHS England has responsibility for much of the operational day-to-day performance of the NHS, and NHS England has accepted responsibility for the fact that it did not communicate some of the information about care.data in the best way. But I hope that by referring the House to the safeguards we have in the 2012 Act and the additional safeguards we are putting in place through our Government amendments, we can reassure hon. Members that data will be used for the benefit of the health and care system, and for the promotion of health.

I wish now to deal with some of the good points raised in the debate and I hope to bring further reassurance to hon. Members. My hon. Friend the Member for Totnes (Dr Wollaston) rightly asked about an issue that came up recently in the Health Committee: whether data would be allowed to be passed on to the Department for Work and Pensions. The overriding purpose of any release to the DWP could not conceivably be the provision of health care or adult social care in England or the promotion of health so, no, that could not happen under the 2012 Act or under the provisions we have introduced today.

My hon. Friend also raised issues relating to the HSCIC and free text. As the hon. Member for Worsley and Eccles South (Barbara Keeley) said, it was outlined in the Health Committee evidence sessions that the use of free text had been examined and had, in effect, been ruled out—I hope that my recollection is correct on that. To give further reassurance, may I say that the HSCIC made it clear that the General Practice Extraction Service that we have in place to support the extraction of the data from those GP systems for care.data has taken great care to ensure that we extract only the coded information in those records, not the free text notes, which patients may well have shared during consultations with their GPs? In addition, a number of explicit conditions were excluded from those extractions, including issues relating to HIV/AIDS; sexually transmitted infections; termination of pregnancy; in vitro fertilisation treatment; complaints; convictions; imprisonment; and abuse by others. Clear safeguards and reassurances have been established on those issues, and I hope that reassures my hon. Friend further.

Oral Answers to Questions

Debate between Dan Poulter and Jamie Reed

Tuesday 14th January 2014 Commons Chamber

[Dr Poulter]

It is true that many parts of the medical and health care work force can contribute to the delivery of high-quality care, and paramedics have an opportunity to do that. As part of our “Refreshing the mandate for Health Education England” initiative, we will be considering how we can make progress in that regard during the coming months and years.

[Mr Jamie Reed (Copeland) (Lab)]

I wish you and Ministers a happy new year, Mr Speaker. We certainly hope that it is a much happier new year for NHS patients.

In the last 52 weeks, almost two in 10 patients who arrived in accident and emergency units at the University Hospitals of Leicester NHS Trust waited for more than four hours. In 2011, the local risk register for Leicester, Leicestershire and Rutland primary care trust cluster warned that the Government’s reorganisation of urgent care services would lead to the

“risk of…inability to develop a resilient, predictive, high quality, Urgent and Emergency Care System.”

Given warnings from local risk registers about the disastrous impact of the Government’s reorganisation, and following the worst week of the winter so far for accident and emergency services, will the Secretary of State come clean, act transparently, and publish the warnings contained in the national risk register?

[Dr Poulter]

I remind the hon. Gentleman that the last Government never published risk registers. The policy that we have adopted is therefore entirely consistent with theirs. However, as the hon. Gentleman will recognise, it is not for Whitehall to micro-manage local commissioners and health care services. Decisions of that kind need to be made locally, by local commissioners working with patient groups in the best interests of patients and local communities.

Pharmacies and the NHS

Debate between Dan Poulter and Jamie Reed

Wednesday 20th November 2013 Westminster Hall

[Dr Poulter]

On how drugs are accessed, one of the problems—this was why the cancer drugs fund was set up—was that some people, as the hon. Gentleman rightly outlined, had been receiving drugs in other countries for many years, but we in this country were a little slower to respond to some of those innovations. But of course we need to ensure that, whatever fund we set up for providing medications, those medications are shown to be effective and there is an evidence base for them. However we do things, there will always be new treatments on the horizon that we would like to get through to people more quickly, and we need to ensure that those treatments are always evidence-based. I think that we can be pleased that the cancer drugs fund has made a significant difference by providing treatments in a more effective and much quicker manner, but if the hon. Gentleman would like to discus the matter further, I would be very happy to see him and talk it through in more detail.

I think that it would be useful for me, picking up on the points raised early in the debate, to outline the processes involved in opening a pharmacy. Anyone can open a pharmacy anywhere, subject to the premises being registered with the General Pharmaceutical Council, when the owner’s service model includes the sale or supply of pharmacy medicines or prescription-only medicines against prescriptions from that pharmacy. However, there are extra criteria for providing NHS pharmaceutical services. Anyone wanting to provide NHS pharmaceutical services is required to apply to the NHS to be included on a pharmaceutical list.

Before September 2012, there were control of entry requirements. The NHS (Pharmaceutical Services) Regulations 2005 determined whether a pharmaceutical contractor could provide NHS pharmaceutical services. In England, no new contractor could be entered on to a PCT pharmaceutical list unless it was “necessary or expedient” to secure the adequate provision of pharmaceutical services locally. That was the control of entry test. If a new service provider was judged neither necessary nor expedient, the NHS, or the PCT in question, had to refuse the application. There were rights of appeal to the family health services appeal unit, which is run by the NHS Litigation Authority. That was available if there was a concern.

Part of the reason for the strict criteria relates to the pricing mechanism and how pharmacists are paid, which I will come to later. Obviously, the local health economy is an issue, and pharmacists are not paid just for the number of prescriptions that they provide; they are also given a baseline fee. When we have a publicly funded health service and we need to ensure that need and demand are aligned, it is important that we look at this in the round. I sympathise very strongly with the points about the need to de-bureaucratise the NHS where possible—those were good points well made—but we also have to recognise that this is not just about arbitrary mapping; it is about aligning need and demand for a service within the pricing framework in place. That is not just about the number of prescriptions that are provided; it is a much more complex mechanism. I will come to those points later.

[Mr Jamie Reed]

I am grateful to the Minister for giving way; he is being typically generous. On pharmacy numbers, does he think that we have too few or too many, or is the number about right?

[Dr Poulter]

The hon. Gentleman will be aware that under the previous Government, the Office of Fair Trading did a review and recommended total deregulation of the pharmacy industry. That was in 2003. The previous Government put in place a strong package of reforms to recognise that we need some degree of what my hon. Friend the Member for Ipswich would call market forces but I would probably refer to more as patient choice. We need to support patient choice as much as we can, but within the context in which we have a publicly funded service that needs to be regulated. It is a health care service; it is treating and looking after patients. We need not only to secure good value for the taxpayer, as part of how we fund that service, but to ensure that there is independent regulation and some regulation by Government as well. That is about ensuring that we have the highest-quality services available.

Given that I am running short of time, I will write to my hon. Friend or I would be happy to meet him—whichever he prefers—to talk through the specifics of the context of mapping out a local needs assessment, which is now carried out by health and wellbeing boards. That is a pharmaceutical needs assessment. I am happy to talk through with him in detail how that interrelates with the pricing mechanism and how we need to ensure that the two are kept in balance in the context of the conversation that the hon. Member for Copeland and I have just had.

It is worth highlighting the fact that pharmacists and pharmacies play an increasingly important role in our NHS. Many pharmacies now provide additional services. They are contracted to do so outside those pricing frameworks. That is done locally by clinical commissioning groups. Health and wellbeing boards or local authorities can also contract pharmacists to provide services. As my hon. Friend will be aware, responsibility for public health—40% of that budget—has now passed to local authorities. Given that public health responsibility, there is a strong role for local authorities in commissioning local health care services if they feel that that would be in the interests of the local population.

Under the Health and Social Care Act 2012, other providers of health care services, outside the traditional framework of GP and community services and secondary care, were given more of an opportunity to put themselves forward and offer to provide valuable services. This is a real opportunity for pharmacists to bring forward to CCGs what they do and to make the case that they can provide many services in a way that will be focused on primary prevention and that will save the local health economy money but also deliver better care. The track record of pharmacies and pharmacists is very good in delivering community care—whether looking after people with diabetes or providing simple services for other patient groups. Under the 2012 Act, there is now a much greater opportunity for pharmacists to come forward and put in offers, within an integrated health service, and make the case about how they can provide services. They may be able to do that in a much better way, as they are often embedded in their communities, than some of the traditional mechanisms in the NHS.

I hope that my hon. Friend will be reassured by the fact that the legislation that we have put in place as a Government has given pharmacists a much greater opportunity to contribute to their local health economy, not just in economic terms and in terms of the economic benefits that that will bring for pharmacists, but by delivering the very good care that we know they can deliver.

We have had a wide-ranging debate. I think that we can be sure that there is in place a robust pricing mechanism, which on the whole works very well and secures good value for the taxpayer and for local patients, but there are issues about certain items that pharmacists can prescribe, and we do need to look into them. There is a role for NHS Protect in doing that. We value the innovation that pharmacists provide locally in delivering better—higher-quality—patient-centred care, and the 2012 Act has put us in a better place to support local pharmacists in delivering the kind of patient care that we all want to see in our local communities.

Oral Answers to Questions

Debate between Dan Poulter and Jamie Reed

Tuesday 16th July 2013 Commons Chamber

[Dr Poulter]

I thank my hon. Friend for that question and his diligent local campaigning on the issue. He is absolutely right that the Marsh review highlighted a failure of leadership at the trust and in the trust board as well as a disconnect between the front-line staff, who work effectively and well, and that leadership. We now have a new team at the top and we must give it time to respond to the Marsh report and put in place the right measures. I believe that efficiencies can be made at a back office and regional level, but there is a good case for ensuring that more localised data are presented about ambulance response times countywide.

[Mr Jamie Reed (Copeland) (Lab)]

The East of England ambulance service is failing to meet the needs of patients on the Secretary of State’s watch. The hon. Member for Waveney (Peter Aldous) has said:

“This did not used to happen.”—[Official Report, 25 June 2013; Vol. 565, c. 19WH.]

The hon. Member for Witham (Priti Patel) has said:

“Lives are put at risk.”—[Official Report, 25 June 2013; Vol. 565, c. 2WH.]

Does the Minister agree with those Members, and does he believe that clinical outcomes for patients in the east of England have been affected by the collapsing service over which he has presided?

[Dr Poulter]

The hon. Gentleman would do well to heed the Marsh review before asking his questions, because it highlights a fundamental, systemic failure of leadership at the ambulance trust which dates back to the last Government’s time in office. As we know, the number of NHS managers in the east of England rose by 86.4% under the last Government, but there was a lack of connection between the managers of the trust and front-line staff. Government Members are promoting clinical leadership, and trusting clinicians and front-line paramedics to deliver a much better ambulance service. I suggest that the hon. Gentleman should prepare his questions more thoroughly in future, and should read the Marsh review before he asks them.

University Hospitals of Morecambe Bay NHS Foundation Trust

Debate between Dan Poulter and Jamie Reed

Tuesday 5th February 2013 Westminster Hall

[Dr Poulter]

Absolutely. There will be a full response to the Mid Staffordshire inquiry tomorrow, so I will not pre-empt it or go into detailed discussion of that issue. However, it is absolutely right that we must encourage staff who have concerns about patient care to raise those concerns and air them in an open way. Moreover, when we know that there have been long-standing failings at a trust about the quality of care provided to patients and concerns raised about those failings—although Morecambe Bay NHS Foundation Trust, for example, has made some good progress in recent months, there are some long-standing issues there—it is important that, when an investigation is carried out, it is carried out in a transparent, open and independent way; there must be a great degree of independence involved.

If a trust sees fit to launch an investigation and a review of what has happened, it is important that the investigation and review pass the test of transparency. There may well be a role for local MPs and other interested parties in that process, and when the hon. Member for Barrow and Furness and I meet, that is an issue that I will be very keen to discuss further, to ensure that we can discuss with the local trust ways in which we can ensure that there is that transparency and independence in the process. That is very important to ensure that those patients, and their families who have had problems in the past—in some cases, there have been deaths at the trust—feel that the investigation addresses their allegations.

Obviously, this debate is not just about maternity services at the Morecambe Bay NHS Foundation Trust; there have been other issues around the trust, and any investigation will need to take account of all those issues. I understand that that is what will happen.

[Mr Jamie Reed]

I am very grateful to the Minister for his considered and thoughtful response to the debate. I agree with him wholeheartedly on the importance of transparency and openness. However, where there are different clinical groups commissioning services from a single trust that operates a number of different hospitals, who actually holds the ring and decides which services are commissioned where?

[Dr Poulter]

The hon. Gentleman asks a very good and thoughtful question. It is the duty of the commissioning groups to work collaboratively for the best interests of patients. They obviously have responsibility for their own budgets and, as I say, they all ought to work collaboratively for the benefit of patients. However, if there are concerns about that, there is also a role in this process for the commissioning board, which will have some oversight over the process, to help to ease it through. In many parts of the country, there is already good evidence that the emerging local commissioning groups are working together collaboratively in just the way that I have described. I hope that that is reassuring for the hon. Gentleman.

We know that the Morecambe Bay NHS Foundation Trust has had a very long and troubled history. We also know that it serves a very important purpose in looking after people throughout north Lancashire and Cumbria. My hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) made clearly the good point that the configuration of the trust geographically is challenging. We, as a group, are going to meet together to talk through some of these issues and the troubled history of the trust, to ensure that we can do our best to work through these issues.

There have been problems in the past with the trust and local patients have not been treated properly, and they and their families have suffered. There have been long-standing concerns over local care quality issues. That may mean that we have to redesign the way that services are delivered; that may be an inevitable consequence of improving patient care in the long run. Nevertheless, the driver of this process must be delivering high-quality local health care within the envelope of providing improved patient care with better outcomes and safer care for patients. However, the only way that we will achieve that is if all the commissioners are working collaboratively with the trust in a more integrated approach to care. The failure to do that is where things have gone wrong in the past, and that is what needs to change in the future.

Oral Answers to Questions

Debate between Dan Poulter and Jamie Reed

Tuesday 15th January 2013 Commons Chamber

[Dr Poulter]

My hon. Friend is right to highlight a long-standing problem—it has not happened just recently —of a lack of particularly middle-grade doctors in A and Es. Although the number of consultants has increased by about 50%, as A and Es move rightly towards becoming a 24/7 consultant-led service, attracting middle grades to the specialty has been a problem. We set up a task force to consider that, as well as making better use of a multidisciplinary work force and emergency nurse practitioners to meet some of the staff shortages.

[Mr Jamie Reed (Copeland) (Lab)]

The performance of A and E services has an obvious and acute effect on the performance of ambulance services. In London, freedom of information requests show that the number of ambulances waiting more than 30 minutes from arriving at hospital to handing over their patients has gone up by two thirds over the last year, that ambulances are missing their targets in responding to the most serious life-threatening callouts, and that the average length of time that patients wait in ambulances before accessing A and E is going up, and in some cases patients are waiting almost three hours. The Care Quality Commission says that London Ambulance Service NHS Trust does

“not have sufficient staff to keep people safe”.

The question for the Secretary of State is simple: what is he going to do about it?

[Dr Poulter]

The hon. Gentleman is right to highlight the unacceptable variations in the quality of triage and handover between ambulance services and hospitals, not just in London but in other parts of the country. Many hospitals, however, do that well, and it is important that local MPs highlight the issue, champion good practice on handovers and ensure that that good practice is carried out at other A and Es. It is unacceptable that patients should wait for handover.

Regional Pay (NHS)

Debate between Dan Poulter and Jamie Reed

Wednesday 7th November 2012 Commons Chamber

[Dr Poulter]

The right hon. Gentleman cannot rewrite history. He cannot stand at the Dispatch Box and say that he no longer agrees with the pay flexibilities he gave local NHS employers or with the “Agenda for Change” document that his Government put in place. That document recognises that in parts of this country premiums of up to 30% need to be paid to employees. It also recognises that the cost of living in London is much higher and gives a £6,000 premium to NHS workers who work in the centre of London.

In our amendment, the Government are pleased to support the comments made to the GMB by my right hon. Friend the Chief Secretary to the Treasury. That highlights the Government’s support for NHS and public sector staff and recognises implicitly that in some parts of the country—as the previous Government’s “Agenda for Change” makes clear—we need pay flexibility to recognise when the cost of living is greater.

Importantly, the Government have also made clear our intention to retain national pay frameworks and national collective bargaining while they remain fit for purpose. That is why we are encouraging NHS employers and the trade unions to come together at the NHS Staff Council to negotiate a settlement that remains fit for purpose so that we can continue to endorse national pay frameworks. That is the stated position of the Government and it is a shame that the Opposition are attempting to politicise an issue of their own making.

It is worth putting it on record that despite the financial challenge faced by the whole public sector, we have put an extra £12.5 billion into the NHS during the life of this Parliament. That is not to say, however, that there is no financial pressure, and the Opposition were right to highlight the Nicholson challenge and the need to cut away bureaucracy and waste in the NHS in order to put more money into the front line. We endorse that. The Government are meeting the Nicholson challenge, and the NHS reforms we have put in place will put the NHS in a much better place to do that in the future.

[Mr Reed]

Does the Minister agree that everyone in this House should pay close attention to the fact that another set of terms and conditions for public servants is being negotiated now, and that if Members of Parliament vote for regional pay in the national health service they should accept regional pay for Members of Parliament?

[Dr Poulter]

The hon. Gentleman needs to be brought back to reality for a second. His Government introduced regional pay in the NHS through “Agenda for Change”, so he cannot stand at the Dispatch Box and rewrite history, saying that he is desperately concerned for the workers. “Agenda for Change” needs to remain fit for purpose, and it is the Government who are standing up for NHS workers. We will protect not just patients but jobs and workers in the NHS by ensuring that we support NHS employers and the trade unions as they come together to protect jobs and ensure that “Agenda for Change” remains fit for purpose in the future.

In conclusion, it is clear that the Opposition want to rewrite history, but it is time to cut the propaganda and get real about the debate. We all want to see individual employers given autonomy based on agreed national frameworks, but we want to make sure that “Agenda for Change” stays fit for purpose. In the end we must deliver high quality care for patients, and we understand that that also means looking after staff. That is why it is so important that the national pay frameworks remain fit for purpose, and that on both sides of the House we encourage NHS employers and the trade unions to negotiate a settlement within those frameworks.

The Opposition must stop attempting to play politics. They must support the NHS staff, as we on the Government Benches are doing. The Government are standing up for the NHS, its staff and its patients. That is why I urge all hon. Members to support the amendment and reject the motion.

Question put (Standing Order No. 31(2)), That the original words stand part of the Question.

Oral Answers to Questions

Debate between Dan Poulter and Jamie Reed

Tuesday 23rd October 2012 Commons Chamber

[Dr Poulter]

My hon. Friend makes a good point and it is important that we support national pay bargaining where we can. There is an agreement in principle, endorsed by NHS employers, that national pay bargaining is supported throughout the NHS. It was supported throughout the NHS under the previous Government, who set up the “Agenda for Change”, and during their tenure, that agenda remained fit for purpose. Twenty changes during the previous Government’s tenure benefited employees in the NHS, and rightly so. The current Government believe that we must continue to ensure that the system is fit for purpose.

[Mr Jamie Reed (Copeland) (Lab)]

It is most unusual to find the ghost of Christmas past sitting next to the invisible man. The truth is that in May this year, the Deputy Prime Minister stated:

“There is going to be no regional pay system. That is not going to happen.”

Regional pay will strip millions from local NHS services; it will hit the poorest areas of the country hardest, damage front-line NHS care, and there can be no justification for it. Will the Minister categorically rule out continuing with these ruinous proposals—yes or no?

[Dr Poulter]

The arguments presented by the hon. Gentleman are fatuous, and the previous Government endorsed regional bandings for London workers. If today he is saying that he does not agree—[Interruption.] You might learn something if you listen. If he is saying that he does not agree with London weighting for London workers, which is a form of regional pay—[Interruption.]