Oral Answers to Questions

David Mowat Excerpts

Tuesday 11th October 2016 Commons Chamber

[Johnny Mercer (Plymouth, Moor View) (Con)]

2. If he will visit Plymouth to discuss how its city council has pooled health and social care budgets.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

Plymouth has gone further and faster in integrating health and social care than many parts of the country have done. The integrated fund that it has set up covers housing and leisure as well as health and care. I would be delighted to visit Plymouth and to learn more about how the fund is working in practice.

[Johnny Mercer]

As my hon. Friend points out, Plymouth has taken innovative steps to try to address some of the funding inequalities at play within the Northern, Eastern and Western Devon clinical commissioning group. However, between the calculated spend and the actual spend, there is a funding shortfall of £30 million. Will he agree to work with local MPs, stakeholders and those involved in the wider Devon sustainability and transformation plan to develop a written agreement to address these inequalities?

[David Mowat]

My hon. Friend refers to the time lag that can exist between target and actual funding. When I visit, I will be delighted to meet stakeholders not only to understand the allocation issues to which he refers but to congratulate the health and social care leadership on the progress they have made with their fund and on the above-average satisfaction ratings that have been achieved in Plymouth.

[Mr Ben Bradshaw (Exeter) (Lab)]

12. When the Minister is in Devon, will he meet patients’ groups and NHS staff, who are very worried about the proposals under the Government’s Orwellian Success regime, which include the closure of scores of community hospital beds, including the only community hospital beds in Exeter at Whipton hospital? Although it may make sense to integrate, and it certainly makes sense to move money from beds and buildings to better care for people in their homes, does he accept that it is simply not deliverable against a backdrop of massive cuts in social care budgets?

[David Mowat]

Yes, I am happy to meet in that context. The right hon. Gentleman is right that the Success regime is about a transfer of resources from the community hospitals to care at home and domiciliary care. That is not necessarily the wrong thing to do, but it must be done right, and I am happy to meet.

[Dr Sarah Wollaston (Totnes) (Con)]

I welcome greater integration, but the Minister will be aware that there are grave concerns about the effect of cuts to social care on the NHS. More and more patients are spending greater time in more expensive settings in hospital when they could be better looked after in their own homes or in the community, but cuts to social care make that impossible. Will the Minister set out what appraisal the Government are making of the effect and the damage to the NHS of cuts to social care?

[David Mowat]

My hon. Friend is right: social care funding is tight. It is also true to say that those parts of the country that do the best in this regard—there are some that do considerably better than others—have integrated social care and health most effectively. On the budget itself, there is some disparity among different local authorities. About a quarter of local authorities have increased their adult social care budget by 5% or more this year.

[Simon Danczuk (Rochdale) (Ind)]

3. If he will publish the full scientific evidential basis for his Department’s alcohol consumption guidelines; and what representations he has received on those guidelines.

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[Mr Steve Baker (Wycombe) (Con)]

5. If he will take steps to ensure that clinical commissioning groups publish their proposals for implementing the NHS “Five Year Forward View”.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

The “Five Year Forward View” will be delivered through sustainability and transformation plans which are currently being developed by clinical commissioning groups in collaboration with local authorities and providers. NHS England expects that all STPs will be published, although in some areas discussions are already taking place.

[Mr Baker]

I am led to understand that in Wycombe we should expect no dramatic changes and possibly no publication of a strategic plan. Does my hon. Friend agree that public confidence would be much enhanced by the clear articulation in public of a strategy for meeting the “Five Year Forward View”?

[David Mowat]

I agree with my hon. Friend, and I will try to give a clear answer. NHS England is determined that all 44 areas will publish their plans shortly. For those that have not already done so, publication will take place after the formal checkpoint review at the end of October. Areas are working to different timescales, but the plans will all be published by the end of November. For the avoidance of doubt, that includes the STP for Buckinghamshire, Oxfordshire and Berkshire West.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

The NHS “Five Year Forward View” called for a radical upgrade in prevention and public health. How does the Minister square that with the Government’s subsequent cuts to public health, including £200 million in-year cuts and further cuts expected by 2020?

[David Mowat]

The STP process is an attempt to upgrade our public health and mental health provision and cancer outcomes. Every STP will be expected to provide an assessment of local public health priorities and the timetable for progress towards that.

[Mr Edward Vaizey (Wantage) (Con)]

Wantage community hospital in my constituency has recently closed because of the threat of Legionnaires’ disease, and it will not reopen until we have finally concluded consultation on the sustainability and transformation plan—if it reopens at all. This consultation has been delayed, and that naturally worries my constituents. Will the Minister join me in urging Oxfordshire to get on with consulting on this very important plan, so that we can have a reasonable discussion?

[David Mowat]

I will join my right hon. Friend in doing that. I am not familiar with the specifics of the Wantage case, but it does not sound right that it is an ongoing thing that is not fixed quickly.

[Keith Vaz (Leicester East) (Lab)]

May I congratulate the Minister on his appointment to the Front Bench, as well as the Under-Secretary of State for Health, the hon. Member for Oxford West and Abingdon (Nicola Blackwood), on hers? I am sure that they will do a terrific job in their posts.

As a type 2 diabetic, I am very concerned about the fact that local clinical commissioning groups are just not providing information on preventive work against diabetes. Will the hon. Gentleman confirm that diabetes will be referred to once these plans have been published?

[David Mowat]

I will confirm that. There is a national diabetes plan, as the right hon. Gentleman will be aware. Diabetes is one of a number of long-term conditions in which these plans are charged to deliver improvements, and it would not be acceptable for a plan to be signed off or completed unless progress on diabetes had been made.

[David Tredinnick (Bosworth) (Con)]

When the Minister looks at new treatment options in the forward view, will he consider the example of Velindre NHS Trust in south-east Wales, which treats 1.5 million cancer patients every year and is now using reflexology, reiki healing, aromatherapy, and breathing and relaxation techniques to alleviate anxiety, pain, side effects and symptoms? If that was more widely spread over the health service in England, cost savings and patient satisfaction would increase.

[David Mowat]

The STP process is locally led, not led from the centre, but I would expect clinical judgments of the type mentioned to be made if they could be confirmed on the basis of scientific and trial-based evidence.

[Julie Cooper (Burnley) (Lab)]

Central to the aim of the five year forward plan for the NHS is a sustainable health service in which all patients receive the right care at the right time in the right place. With that in mind, can the Minister tell me what action he is taking to address the problem of delayed hospital discharges, which have risen by 20% so far this year? That amounts to an additional 926 people every day condemned to stay in hospital longer than is medically necessary.

[David Mowat]

First, may I welcome the hon. Lady to her post and wish her luck in the new job? There has been an increase in delayed discharges in England over the past year. Only a part of that increase is due to difficulties in the integration between social care and the NHS—a large part of it comes from within the NHS itself—but it is not uniform across local authorities. Indeed, many local authorities are improving in this regard. What is very clear is that those making the most progress the most quickly are those that have gone furthest in integrating social care and healthcare.

[Michelle Donelan (Chippenham) (Con)]

6. What the timetable is for the review of the diagnosis, treatment and transmission of Lyme disease announced on 10 May 2016.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

The Department of Health has commissioned three separate reviews on the diagnosis, treatment and transmission of Lyme disease. The work will be carried out by the epicentre of University College and be clinically driven and evidence-based, and it will be published in late 2017.

[Michelle Donelan]

Although I am delighted that the Government are looking into this serious and important disease, as the reviews progress thousands of people contract Lyme disease each year, particularly in areas such as Wiltshire, and they can receive inadequate treatment, so will the Minister look into speeding up these reviews?

[David Mowat]

It is fair challenge that this work is high priority, and we need to go as fast as possible, but we are working with research teams. The work will be trial-based and needs to be as definitive as possible. In the meantime, early diagnosis is the key way to make progress. Public Health England continues to work with GPs and the public on it.

[Richard Arkless (Dumfries and Galloway) (SNP)]

My mother recently died of motor neurone disease. In some areas of my constituency, there are 13 sufferers per 10,000 people, whereas the UK average is two per 100,000. Will the Minister please agree to meet me and representatives of the Motor Neurone Disease Association to discuss how the UK Government could lend their weight to combating this awful and debilitating disease?

[David Mowat]

Yes, I would be happy to meet the hon. Gentleman to discuss that subject.

[Mr Speaker]

I am extremely grateful to the Minister for his response on that matter.

[Jim Shannon (Strangford) (DUP)]

Bearing in mind that cases of Lyme disease have quadrupled in the past 12 years, and that some of those cases have been in my constituency of Strangford in Northern Ireland, what has been done with the devolved Assemblies in the United Kingdom of Great Britain and Northern Ireland to ensure that a UK-wide strategy is put in place to address this trend and to provide effective diagnosis and treatment?

[David Mowat]

The principal thing that we need to do with Lyme disease is to make progress on diagnosis, treatment and transmission through a definitive approach. When the results of the study that I mentioned are published, of course they will be available across all parts of the United Kingdom.

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

7. What steps his Department is taking to improve NHS procurement.

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[Mr John Baron (Basildon and Billericay) (Con)]

10. What steps his Department is taking to model the potential cost savings to the NHS budget of earlier diagnosis of cancers.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

The independent cancer taskforce highlighted the report “Saving lives, averting costs”, which identified cost savings resulting from earlier diagnosis, in particular for colon, rectal and ovary cancers. We have committed to a further £300 million for earlier diagnosis, one major product of which will be the 28-day diagnosis standard to which the Secretary of State referred earlier.

[Mr Baron]

In welcoming the Minister to his post, may I highlight evidence to show that early diagnosis, in addition to making for better survival rates, offers substantial cost savings? Colon cancer costs £3,000 per patient per year to treat at stage 1, compared with over £12,000 if it is diagnosed and treated at stage 4. We have a shortage of health economists in the NHS, so will the Minister go further and actually commission a study to look at this issue on behalf of the taxpayer, because it requires further detail?

[David Mowat]

We agree that early diagnosis saves lives and can lead to cost savings. Just as an example, we know that GP referrals are up by 91% since 2010—an additional 800,000 people are getting early diagnosis—and we are beginning to see the results of that coming through in the one-year survival figures. On my hon. Friend’s specific point about further study, Public Health England and Macmillan have commissioned recent studies on modelling, one part of which will be on the cost impact of earlier diagnosis, and we look forward to seeing the results of those studies.

[Bridget Phillipson (Houghton and Sunderland South) (Lab)]

GPs play a central role in the early diagnosis of cancer. In the 1990s, Sunderland was one of the most under-resourced areas in England in terms of the GP workforce, and we now face a similar and growing problem, even though action was taken then. Will the Minister set out how he intends to make sure not only that we train more family doctors, but that they are encouraged to work in areas where there is an acute shortage?

[David Mowat]

We are training 3,250 extra GPs every year, and we have a target of 5,000 additional doctors working in general practice by 2020. However, as well as new GPs, we must do much better with retention. That means keeping the GP population that we have, and there are a number of steps that the Government are taking to do that. On the specific point about Sunderland, there is a bursary scheme that is aimed at attracting GPs to areas where they may not necessarily have wished to work previously.

[Sir Simon Burns (Chelmsford) (Con)]

11. What estimate his Department has made of the amount accrued to the public purse from efficiency savings in the NHS since May 2010.

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[Oliver Dowden (Hertsmere) (Con)]

14. What clothing and other support the NHS provides to elderly people discharged from hospital into care homes for the first time.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

Every patient discharged from hospital into a care home should have a care plan or discharge assessment. This should include a clear assessment of their needs, covering transport, carers, GP notification, medication and, where necessary, clothing requirements.

[Oliver Dowden]

I have been approached by a number of constituents concerned about cases of elderly and vulnerable people who have been discharged from hospital straight into care homes, often without any basic personal effects or clothing because their family cannot or are not willing to supply them. Does the Minister recognise this, and what can the Government do to tackle it?

[David Mowat]

As I said earlier, there is a national process in the form of the care plan. Where the family is not able to or will not provide support, typically the voluntary sector is asked to do so. If that does not work, local authorities can increase the personal expenses allowance to provide clothing. I am interested to hear about the cases that my hon. Friend mentions in his constituency, and I am very happy to talk to him to understand better why the process has failed there.

[Mr Speaker]

And have a cup of tea with the fella.

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[Paula Sherriff (Dewsbury) (Lab)]

T2. Last October, the then Health Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), confirmed that my constituency fell far below the national average in terms of NHS dental provision. In fact, it is one of the worst in the country. Unfortunately, nothing has changed since then. Does the Secretary of State believe it is acceptable that my constituents, including many children, are unable to get an NHS dentist?

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

It is clearly unacceptable if the situation that the hon. Lady sets out is the case. I am happy to meet her and work with her to take the action that is needed to make things better.

[Fiona Bruce (Congleton) (Con)]

T6. The Government have provided a welcome increase in funding for mental health support, yet it does not appear to be reaching my constituency effectively, particularly for children. Now there are concerns that the Millbrook unit at nearby Macclesfield hospital might close. Will the Secretary of State look into those concerns?

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[Danny Kinahan (South Antrim) (UUP)]

T3. I know that this is a devolved matter, but I look forward to the Union working together on it. In Northern Ireland, the health service is in crisis. To give cancer as an example, 6.7% of those with breast cancer are called in to be checked within 14 days—not 100%—and yet we have 392,000 people on the waiting list. Will the Secretary of State or his officials meet us to find a better way forward, so that we can all work together?

[David Mowat]

I have made it clear that we should all be working together to defeat cancer. We know that the best way of doing so is early diagnosis. We have made a lot of progress on that in England over the past few years but have a lot further to go. We are of course willing to talk to the devolved Administration about what they can learn from us—and perhaps vice versa.

[Maria Caulfield (Lewes) (Con)]

T7. Will the Secretary of State look again at the decision not to fund second stem cell transplants for adults and children with blood cancers, given the significant clinical evidence of their benefit for those who relapse? He should not just take my word for it but should take it from the Anthony Nolan Trust and the 36 specialists who have written to him asking him to review the decision.

[David Mowat]

This is a very difficult area, but decisions on priority are clinically driven and must continue to be based on peer-reviewed data. The most recent review determined that less than one third of second transplants would result in survival after five years; that is why they were not funded. There will, however, be a further review next April, and to the extent that the data have changed there will be a new evaluation at that time.

[Fiona Mactaggart (Slough) (Lab)]

T5. Deer Park medical centre in Witney faces closure, and patients will be dispersed a long way into other practices in an area where one in four already waits more than a week to see their GP. Duncan Enright, who is Labour’s candidate in the Witney by-election, is campaigning to save the centre. Will the Secretary of State reward his campaign by saving it today?

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[Mrs Emma Lewell-Buck (South Shields) (Lab)]

I heard the Minister’s response earlier. He was of course right that sustainability and transformation plans are led locally, but he failed to acknowledge that the Government have given a mandate to make cuts attached to STPs. Without consultation, my local hospital has been downgraded. What on earth will the Secretary of State say to my constituents who may lose loved ones because they have had to travel miles further to another hospital?

[David Mowat]

If I may, I will give a quote:

“To reshape services over the next 10 years, the NHS will need the freedom to collaborate, integrate and merge across organisational divides.”

That comes from the 2015 Labour manifesto. The STP process is designed to bring about better care and health, and better productivity. We should be critical friends of the process because we all want a better national health service.

[Lucy Allan (Telford) (Con)]

Local health commissioners have concluded that Telford’s brand new women and children’s centre, which serves some of the most deprived populations in the country, should be closed and moved to a more affluent area where health is better than the national average. The commissioning process has lost the confidence of local people. Will the Secretary of State intervene and ensure that local health commissioners fulfil their legal duty to reduce health inequalities?