GP Services

Debate between Dan Poulter and Paul Burstow

Thursday 5th February 2015 Commons Chamber

[Paul Burstow (Sutton and Cheam) (LD)]

I thank the hon. Member for Halton (Derek Twigg) for securing this debate. My name was on the application, but he was the person who made the argument that persuaded the Backbench Business Committee. I apologise to him for not being here for his opening remarks or for those of others who have contributed so far.

I was keen to contribute to the debate because it goes to the heart of how we make the NHS fit for the future and do more in the community. As the hon. Member for Brighton, Pavilion (Caroline Lucas) said in her closing remarks, the focus has moved from treating episodes of ill health and diseases of individual body parts to people living with a complex range of diseases. It is that complex co-morbidity that is driving the need to change how health care is organised and delivered in this country. If that does not happen, the system will become unsustainable. At the heart of that is the family doctor and their relationship with their patients and communities, which is a key component of building the system we need for the future.

About two months ago, I and my right hon. Friend the Member for Carshalton and Wallington (Tom Brake) met a group of GPs in my constituency to discuss some of the issues being aired today—Dr Chris Elliott, Dr Brendan Hudson, Dr Alan Froley and Dr Mark Wells—along with a practice nurse. I was pleased that a practice nurse was present, because although we are discussing the sustainability of GP practices, we need to recognise, as I am sure others have, that we are talking about the wider primary care family and the contribution made by many other professionals. We discussed the pressures on practices in our constituencies. The demands have been well documented, but I want to rehearse a couple. One frustration—it has long existed, but some of the GPs felt it had got worse—concerns the expectations around paperwork and reporting, which they feel have now got out of control. That needs to be kept under review and, where possible, streamlined. I hope the Minister will say something about that.

According to data available at CCG level on the performance of primary care and, in particular, access to GPs, in my patch, Sutton scores above average when it comes to getting an appointment, which is good news, but once someone has an appointment and arrives at the surgery, it turns out they have to wait longer than average to actually see their GP. So they can get there, but then have to wait far longer than is acceptable, and often in substandard accommodation. My constituency is a suburban part of Greater London and most of its GP practices are situated in larger houses that cannot accommodate the 21st century primary care we need. We need the investment from the infrastructure fund to flow through and allow for innovation.

[Dr Poulter]

I thank my right hon. Friend for his point about the money from the Government for GP infrastructure, but is there not also a responsibility on local authorities, when there is additional house building, to look at the contribution developers can make to support local GP and health services by developing GP and other community health care facilities?

[Paul Burstow]

Absolutely, and certainly in its local planning my local authority does exactly that—it looks at what the community facility needs are. In the southern part of my constituency, in south Sutton, there has been some controversy over plans for a new GP centre. It is planned on a piece of land that was NHS land but which does not sit within easy reach of public transport and is perceived to be in the wrong place. It is also less than a mile from a soon-to-be-unused hospital site that many of my constituents feel would be a more sensible location. It will be the basis of a new housing development in the coming years and so will be the perfect place for a consolidation of existing substandard GP surgeries currently based in houses.

In its briefing, the Royal College of General Practitioners has set out some of the pressures on GPs, including increased levels of stress and depression. In a ComRes poll it conducted, eight out of 10 GPs expressed concern that those pressures were leading to an increased risk of misdiagnosis. Yesterday was world cancer day but there are still serious issues with the number of people who do not get a cancer diagnosis until they are in an accident and emergency department, by which point it is far too late, and consequently their lives are cut short.

GPs are at the heart of delivering health care: nine out of 10 NHS consultations take place in a GP surgery, while the number of consultations has increased by 40 million since 2008 to 340 million. Interestingly, according to the 2012 GP patient survey, 1.2% of patients went to a walk-in centre or A and E department because they could not get a GP appointment at a time that worked for them, but that figure has now risen to 1.7%. I am sure the Minister will tell us that those are very low percentages and therefore not a cause for concern, but given the number of consultations—340 million—it does not take a very high percentage to have a significant impact on our A and E departments. Given that there are nearly 14.6 million A and E attendances, we can see that the gearing is such that ensuring sustainable and easily accessible GP and primary care services is critical to getting the balance in the system right.

I hope the Minister will say something about the piloting of 24/7 access to GPs and ensuring we have the right data to better understand which areas are under-doctored so that we do not have to rely on anecdotal evidence. There is clearly a concern about deprived and rural areas not having sufficient doctor cover, but at the moment we cannot map that accurately. I hope he can tell us what is being done to target resources to support areas crying out for better GP coverage. In addition, I hope he can say what will be done to address the fact that, despite the Government’s having identified the need to train more GPs and despite the number of places having increased significantly under this Administration, not enough places are being filled. What is being done to get up to the right number?

Care Bill [Lords]

Debate between Dan Poulter and Paul Burstow

Tuesday 11th March 2014 Commons Chamber

[Dr Poulter]

The spirit of the previous Government’s legislation was to look at the wider health economy when a trust is in extremis and has reached the point at which it is failing patients, either because of its financial failure or the direct effect that has on the quality of patient care. There then needs to be a wider look at the whole health economy. I know the Princess Royal university hospital in my hon. Friend’s constituency very well. I also know Lewisham hospital very well, having done some of my medical training there. They cannot be seen in isolation from King’s college hospital, Woolwich, Sidcup and all the other hospitals in the area, because they look after patients in that part of London as part of an integrated health and care service. When a hospital fails in that way, it has to be looked at holistically. It is a power of last resort, to be used when a trust is in extremis, not a routine power, which is why we have the TSA process set up by the previous Government.

[Paul Burstow]

I am grateful to the Minister for some of the clarifications he has given so far. When he concludes his comments on new clause 16, will he confirm that the review of the guidance that he has invited me to chair will also consider the issue of consultation to ensure that it is genuinely pervious to public opinion and other clinical opinions in the area?

[Dr Poulter]

I am happy to give my right hon. Friend that assurance. It will be for him to lead the review, and we look forward to the work he does.

New clause 16 would make a second key change: to prevent the Secretary of State or Monitor from making decisions about recommendations affecting other trusts. Instead, local commissioners would have to undertake a further process of consultation and make their own decision. The effect would be to completely undo the changes that clause 119 is seeking to make—

[Dr Poulter]

It would take outside the administration process and the timetable recommendations that affect other trusts. It could mean that a complete solution for the trust in administration and local patients could not be found. As before, my right hon. Friend the Member for Sutton and Cheam said that examining in isolation a trust that is failing significantly would be like throwing it to the wolves on its own. New clause 16 would render the strict legal timetable for the regime ineffective by significantly delaying resolution. I know that it is not his intention, but the new clause would undo the core purpose of clause 119 and the very aims of the regime, which are to put in place sustainable and safe health care services for patients when a trust has significantly failed.

[Paul Burstow]

I think I have heard the Minister tell us that there will be an equivalency between commissioners whereby they will all have to agree to changes being led by a trust special administrator, that there will be further examination of the consultation issues, and that we will make sure that the process is used rarely and exceptionally. Given his confirmation of those things, I want him to know that I am satisfied that my concerns are being addressed. On that basis, I do not intend to press my new clause, and I urge colleagues to do likewise.

[Dr Poulter]

I am very pleased that my right hon. Friend is reassured. I pay tribute to the tremendous work that he has done throughout the passage of the Bill in scrutinising and pushing the Government to ensure that we produce better, and good, legislation. I commend him for the work he has done on that.

It is important to point out that clause 119 makes a number of changes to strengthen patient, public and commissioner involvement in the process. In concluding, I shall draw out its important aspects. First, the clause would extend the public consultation period from six to eight weeks so that the public and others in the wider health economy can give their views and improve the recommendations. It would also give the administrator more time than the previous Labour Government did to produce draft recommendations, extending the period from 45 to 65 working days.

Secondly, the clause would allow a more holistic view to be taken of the wider local health system by allowing an administrator to make wider recommendations, but only as long as those recommendations are necessary for, and consequential on, primary recommendations about the failing trust.

Thirdly, the clause would widen consultation to affected trusts, their staff and commissioners. In addition—I thank my right hon. Friend the Member for Sutton and Cheam for suggesting this—we are providing in amendments 11 and 12 greater public and patient representation in the regime by requiring the administrator to consult local authorities and healthwatch organisations. That will ensure that the voice of local communities is at the front and centre of the administrator’s final recommendations. This important clause makes sure that patients and local commissioners are properly consulted. Indeed, we make sure that Healthwatch is put at the heart of everything that happens. The clause also improves arrangements for the administrator in seeking the support of commissioners affected by their recommendations, as we have discussed. That means that an administrator could develop recommendations that provide a solution for the future of failing trust services, ensuring that all those affected are fully involved. That has to be the right action.

We have heard a lot from Labour Members about the trust special administrator regime. Let us remember that this was their provision and their regime. We are putting in place measures that are true to their intentions when they put this in place, so that a trust is not thrown to the wolves when it meets their circumstances of severe failure. We will make sure that we always act in the best interests of patients. The right hon. Member for Leigh (Andy Burnham) is good at playing politics and good at spin. I am a doctor. I will always do what I believe is in the best interests of patients, and that is exactly what clause 119 will achieve.

Francis Report

Debate between Dan Poulter and Paul Burstow

Wednesday 5th March 2014 Commons Chamber

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

The publication of the Francis report was an incredibly humbling day for our national health service. It was humbling not just for those of us in this place who care about our NHS, but for the many staff who work tirelessly to look after patients and for everybody involved in looking after people as part of our health and care system.

The central plank of the report highlighted the fact that a culture had developed at Mid Staffordshire that was not in the best interests of patients. Targets and bureaucracy had got in the way of delivering high-quality care, and far too often the management of the trust did not listen to the concerns of patients or to the sometimes valid concerns of front-line members of staff.

Robert Francis made a number of recommendations in his report. The Government accepted the principles of the report and we have made great progress in implementing many of the proposals, which I will come on to later.

It is important that all parts of our health and care system learn lessons from things that have gone wrong in our health service. Front-line staff need to learn lessons where appropriate and managers need to learn to listen and respond to the concerns of front-line staff. We need to create a culture that is open and learn how to put things right in the future in order to improve patient care. That is what good health care is about, whether someone works on the front line of the service or whether they are involved as a commissioner, a manager or a Minister.

There have been many good contributions to the debate and I will do my best to touch on as many of them as I can in the time available. In particular, there has been strong advocacy for the local NHS. I pay particular tribute to my hon. Friend the Member for Stafford (Jeremy Lefroy) for his work and tireless advocacy over many years—including before he became an MP and certainly during his time in this place—on behalf of his local patients and the local hospital and staff who look after them in Mid Staffordshire. Without his long-standing efforts and those of my hon. Friend the Member for Stone (Mr Cash), we would not be where we are today and that part of the world would be less better represented. Importantly, they are the people who have asked consistently the difficult questions and allowed us to get to our current position of not just tackling poor care at Mid Staffordshire and putting right the challenges that that has thrown up, but looking at how we can improve pockets of bad care elsewhere in our health and care system.

Most hon. Members have focused on two particular themes, the first of which is the need to learn lessons from the Francis inquiry into what happened at Mid Staffs, for the benefit of the wider health and care system. We heard some very good speeches, particularly from the right hon. Member for Rother Valley (Kevin Barron), my right hon. Friend the Member for Banbury (Sir Tony Baldry) and my hon. Friend the Member for Worthing West (Sir Peter Bottomley). They discussed the broader lessons that can be learned and the importance of an open culture, of supporting clinical leadership and of recognising that perhaps staff are the best advocates of what good-quality patient care looks like in our health system.

In his constructive contribution, my hon. Friend the Member for Cannock Chase (Mr Burley) noted that the challenges and difficulties faced in Mid Staffordshire arose because the management in particular were blinded by targets, financial incentives and drivers, and lost sight completely of what matters most in a hospital at all times, which is delivering high-quality, good patient care. The biggest lesson we can learn, as my hon. Friend made clear, is that we need always to make sure that the delivery of high-quality care is the first and only driver of what happens on the ward. It should never be about meeting a financial target. Of course, the two are not always mutually exclusive, but in this case it is very clear that things went very badly wrong at that trust.

As was pointed out by the shadow Minister, the hon. Member for Leicester West (Liz Kendall), a significant speech was made by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), who talked about the importance of parity of esteem between mental health and physical health. He did a lot in his time in government, and he has always been a keen advocate of that. I know that he is very proud, as the Government are, that the 2012 Act has for the first time enshrined in law genuine parity of esteem between physical health and mental health. That was touched on by the Francis report, and the Government can be proud of doing that. As he will know, we have also invested £450 million in improving access to treatment in mental health services. I know that he took that forward in government, and he can be very proud of that record.

[Paul Burstow]

Through the Minister, may I pose a question to my hon. Friend the Minister of State who has responsibility for care services? He told us that Sir David Nicholson had issued a clarification about area teams not doing enough to deliver parity of esteem, but that has not materially changed how the finances are arranged, with money being taken away from mental health to pay for Francis delivery in acute care. Will that be addressed?

[Dr Poulter]

My right hon. Friend is absolutely right to say that the first step in addressing financial disincentives for mental health, which have been in the system for many years—in fact, for decades—was to establish parity of esteem in law. He helped to achieve what for the first time has been done under this Government. The next step is of course to make sure that other measures are in place to encourage and incentivise the system to spend money appropriately. Members on both sides of the House agree that we should take pressure off acute services, and nowhere is that more important than in mental health. It is important to invest in improving access to psychological therapies and talking therapies to support people, and to put in place early intervention for those with mental health problems. That is quite important, so the Government are investing money in it.

It is also important to collect proper data on mental health for the first time. For many years, data have not been collected effectively to ensure that we know what good mental services look like, but the Government will make sure that we can deliver that.

Oral Answers to Questions

Debate between Dan Poulter and Paul Burstow

Tuesday 26th November 2013 Commons Chamber

[Paul Burstow (Sutton and Cheam) (LD)]

14. What steps he has taken in response to the findings of the report by the Chief Medical Officer, “Our Children Deserve Better: Prevention Pays”, published in October 2013.

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

The chief medical officer’s report warmly welcomes the Government’s commitment to increasing health visitor numbers and support in the early years, and I shall be working with the children and young people’s outcomes forum to inform future improvements in children’s health.

[Paul Burstow]

My hon. Friend the Minister will know that about half the burden of mental health disease can first be identified during the teenage years. In her report, the CMO says that our information about the prevalence of childhood mental health problems and the level of under-diagnosis of mental health problems among that population is out of date. When will the Government commission the next survey? The last one was done in 2004. Is it not time to do another?

[Dr Poulter]

My right hon. Friend raises important issues. I should like to pay tribute to the work that he did in expanding children’s talking therapies and IAPT—improving access to psychological therapies—services to make better provision for mental health support. He is right to highlight, as the CMO did, the fact that we do not have enough data on children’s mental health. That has been a historical problem, and we are looking at ways to improve the data so that we can use them to improve health outcomes in mental as well as physical health.

Oral Answers to Questions

Debate between Dan Poulter and Paul Burstow

Tuesday 16th April 2013 Commons Chamber

[Paul Burstow (Sutton and Cheam) (LD)]

When it comes to early intervention with the one in 10 children in this country who have a diagnosable mental health problem, will the Minister confirm that it is the Government’s intention to ensure that those children all have access to talking therapies so that they get the right treatment at the right time, which will make a big difference for them?

[Dr Poulter]

In his time in office, my right hon. Friend did a tremendous amount to promote the cause of mental health and to get parity of treatment between mental and physical health. That is exactly what we propose to do with the money going into the talking therapies—to get in place those early interventions, not just for adults, but for children, too. We shall be taking that work forward in earnest in the years ahead.

Organ Donation

Debate between Dan Poulter and Paul Burstow

Wednesday 9th November 2011 Westminster Hall

[The Minister of State, Department of Health (Paul Burstow)]

I congratulate the hon. Member for Wolverhampton South West (Paul Uppal) on securing this debate, and on squeezing so much in. There were so many interventions that it felt almost as if a 90-minute debate had been fast-forwarded to include everything. I appreciate his approach, and the substantive contributions that we have heard during the short time in which we have debated this important issue. Transplantation is one of medicine’s great success stories, and I know that the hon. Gentleman has taken a keen interest in the subject for a considerable time. He is right to hold the Government’s feet to the fire when it comes to ensuring that we maintain progress in such an important area.

The coalition Government are absolutely committed to increasing the number of organs available for transplantation, and we believe that as many people as possible who need a replacement organ should be given the opportunity to benefit from a transplant. In many ways, the success of transplantation surgery and advances in technology have led to the current challenges of unmet need that have been described so powerfully and with personal examples.

Some 10,000 individuals now require a transplant, and tragically about three adults or children die every day either waiting for a transplant or after being taken off the list because they have become too ill. The hon. Member for Newport West (Paul Flynn) mentioned a blog that details the suffering and misery endured by families while they wait for a transplant, and that speaks volumes about why we must do more work in that area.

The Organ Donation Taskforce’s recommendations, published in its first report, “Organs for transplants”, in January 2008, were broadly based around the need for investment in the donation infrastructure. That is to ensure that the UK maximises its potential for donation rates, and makes organ donation a usual part of health care.

The Welsh Government’s recently published White Paper on organ donation has been referred to, and we will study their proposals carefully. In 2008, however, the independent Organ Donation Taskforce also examined the case for moving to an opt-out system but recommended against it, concluding that, although such a system might have the potential to deliver benefits, it would also present significant difficulties.

My hon. Friend the Member for Montgomeryshire (Glyn Davies) rightly drew attention to Spain, and the fact that, despite the enactment of a similar opt-out scheme in 1979, a significant transformation in the level of performance took place only after investment in infrastructure in 1989. The taskforce has drawn lessons from the Spanish experience, and it is right that we are guided by evidence.

I was asked about the taskforce’s intention that we achieve a rate of organ donation of at least 50% by 2013. That is certainly our aim, and we are on track to deliver it. Significant resources have been made available to implement the taskforce’s recommendations—largely through NHS Blood and Transplant—to increase the number of specialist nurses, who are a critical part of the system, and to appoint clinical leads, donation committees and donation chairs in acute trusts to drive improvement locally.

[Dr Poulter]

As the Minister will be aware, in 1994, there were 2,500 people on the organ donor waiting list, and last year there were over 7,500. Only 29% of the UK population are signed up to organ donation, which is woefully inadequate given that 552 people died last year while waiting for an organ transplant, excluding those who were taken off the list because they had become too unwell. It is a big problem; people are living longer, sometimes with multiple medical co-morbidities, which means that more people will need transplants. The problem will become an increasing challenge for health care providers and the Government.

Philosophically, I agree with the Minister and I am not in favour of compulsion. Does he agree, however, that we need a more targeted community-focused approach and, as with the cot death campaign that reduced cot deaths from 2,000 to about 300—