Community Alarm Services: Social Housing

David Mowat Excerpts

Tuesday 21st February 2017 Westminster Hall

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

It is a pleasure to serve under your chairmanship today, Mr Hollobone. I start by congratulating the hon. Member for Ellesmere Port and Neston (Justin Madders) on leading the charge on this debate, which raises a number of serious issues. I thank him for the work he has done so far with the family and the progress that has been made as a consequence of that work. I will come on to talk more about that in the next few minutes.

This short debate raises a number of important questions. It is clear that we need to learn lessons. In preparing for the debate, it struck me that this industry is a growth area in our country. More and more people are in sheltered accommodation for longer and are reliant on call handling services provided by a variety of contractors. More and more people are therefore susceptible to this sort of tragedy, which is probably a consequence of a mixture of individual error and the procedures and processes not being in place to pick that up.

Before I respond in more detail, I add my condolences to the two daughters and the family of Mr Volante for what happened on 5 November 2015. I reiterate that the Government are as keen as they are that we get the lessons learned from this situation right.

I will briefly set out the issues as I see them on what happened that evening. The company Magenta was operating an outsourced service called Support Link to the sheltered housing association. It received a call from Mr Volante. All that was heard in that call was the word “help”. As per the procedure, the company tried to reach Mr Volante’s daughters, who were the next contact in the process it had. It was unable to do that, and then called an ambulance.

As the hon. Gentleman has said, although it was known to the call operators that Mr Volante had a heart condition, at that time it was not made clear to the ambulance service. As a consequence, although not necessarily entirely as a consequence of that—we will come back to that; the hon. Gentleman made some comments about how the ambulance service reacted—the call was given a lower priority than it otherwise would have been. The consequence of that was that the standard for the call was 30 minutes, and as we have heard, it took nearly two hours on 5 November, the reason given being that it was Guy Fawkes’ night.

When Magenta was informed that the ambulance was going to take longer than expected, it called back and was unable to get a reply from Mr Volante. It did not take any further action at that time, such as asking the ambulance service to expedite or convert the call to a higher priority. When the ambulance finally arrived, as we have heard, Mr Volante was found to be deceased. The coroner accepted that had procedures been carried out effectively and properly the outcome may well have been the same, but we do not know that. He made a number of recommendations at the inquest, including a regulation 28 report, which is what we are here to discuss, and made other, wider points.

The coroner made a number of observations specific to this case and a number of wider observations, and we have heard about the work that has been done on some of those points. His specific observations on the case included the point that Magenta had access to the medical records, and the ambulance service should have been made aware that Mr Volante had heart disease. The ambulance service has said that had it known that, it would have been likely to have given the call a higher priority and got an ambulance there much more quickly.

Secondly, and equally importantly, when Magenta called Mr Volante back and there was no response, which implied some kind of deterioration in his condition, it did not take any action. It did not inform the ambulance service that the call should potentially be upgraded. In two further dialogues with the ambulance service, it did not do anything proactive to expedite the situation.

Finally, the coroner suggested that Magenta’s procedures be updated and that training and supervision be updated to reflect that. My understanding is that Magenta has put the required changes in place quickly and effectively, which I believe has been accepted by everyone involved—but of course that is not the whole issue.

There are four wider issues. First, Magenta is accredited by an organisation called the TSA. It is clearly important that the measures that Magenta has implemented are implemented equally by all other members of the TSA. Organisations that declare themselves to be accredited, which brings some status in terms of procurement and all that goes with it, must put in place exactly the same procedural changes as Magenta. I will come on to talk about that.

The second issue is that that applies only to organisations that are accredited or are part of the TSA, but a number of call handling organisations are not in that category. We think, although we do not know for certain, that about 10% of call handling organisations are not accredited, which clearly leads to a loophole in making this process work.

The third issue—the hon. Gentleman talked about this—is whether the ambulance service could have done more. It is not absolutely obvious to me why the initial call was given a green coding. I accept Magenta’s story that had it been informed of the heart condition the call would not have been given that code. I have not seen the conversation, but it still does not seem right that a call for help should have resulted in a low-priority ambulance being called. Another issue is that, after the call was given a lower priority, the ambulance took nearly two hours, against a standard of 30 minutes. I will come back to what the lessons learned are.

The fourth issue to learn lessons on is the overall regulatory environment. GPs, hospitals, care homes and domiciliary care providers are regulated by the Care Quality Commission. That regulatory system is, on the whole, effective. It is not 100% effective, but it is certainly better than nothing. The interesting point, which the hon. Gentleman did not raise explicitly but is part of the learning, is that sheltered accommodation is not regulated in the same way. The reason is that, under the Health and Social Care Act 2008, which set up the system of regulation, sheltered accommodation is not considered to provide personal care and is therefore outside the regulatory environment.

That also applies to call handling organisations. We have noted that they are not regulated. I had a discussion this morning with the CQC, which is aware that they are outside the regulatory system, and we are going to monitor the issue and think about taking it forward. I do not want to be more explicit than that, and the hon. Gentleman did not raise the issue explicitly. I learned that the status of a call handling organisation is similar to that of a friend phoning 999 when an issue has arisen. There are issues there that we can learn from and think about. The very least that needs to be understood is that, when something is not regulated, people need to be clear about what that means, and we should not act under the perception that regulation exists.

We heard from the hon. Gentleman about the work that he and Mrs Cuthell have done with the Telecare Services Association. Broadly speaking, the TSA operates a framework of best practice for such conversations. The framework is audited, and I believe that the TSA has teeth in its accreditation process. Through the work of the hon. Gentleman and Mrs Cuthell, it has been made clear that the framework will be updated. The next version is to be released in the summer—in June or July—and it will be audited. I can say no more about it than that, other than that I agree with the hon. Gentleman that progress has been slow. After this debate, we will write to the chief executive of the TSA to say that the Government also regard it as very important that the framework is updated, and that we expect that to happen. The hon. Gentleman and I should perhaps meet at the back end of the summer to ensure that everybody is happy that action has taken place appropriately and that every other supplier has put in place the same level of protection as Magenta.

On the issue of non-TSA suppliers, which is a loophole, I have explained the regulatory environment. The commitment I make about that 10% or 20% of the market—the fact that we know so little about it is significant—is that we will find out which the major organisations in that category are and write to them to put to them the lessons that Magenta has learned from this case. We will say that we expect them to understand the lessons and take similar action. There is a point to be made about how such services are procured by clinical commissioning groups and local authorities. Those organisations need to understand—I think this is the case at the moment—that when someone procures call handling services of this type, there are benefits to ensuring that the organisations they buy from are accredited by the TSA. That has some value, and commissioners should be on guard in that respect.

The hon. Gentleman’s final point was about the performance of the ambulance service on that evening. I agree that the time taken for the ambulance to get there was completely unacceptable—I think the ambulance service agrees with that, albeit that it is mitigated by the fact that it was 5 November. The hon. Gentleman made a number of wider points about funding, which he cannot expect me to answer in this debate. We will write to the chief executive of the North West Ambulance Service to make the point that this incident was unsatisfactory and ask him to be absolutely certain that the initial classification as low-priority was correct following the dialogue between his call handler and the Magenta call handler. It is not absolutely clear to me, given the facts as I understand them and as the hon. Gentleman set them out today, that that was the case. I make that commitment.

At the start of the debate, the hon. Gentleman said that Mrs Cuthell’s major motivation is to ensure that what happened to her family never happens again. I cannot make a commitment that it will never happen again, but I can say that the story we have heard is completely unsatisfactory. The Government understand the failures that occurred and will put in place what is needed to try to ensure that it does not happen again. The hon. Gentleman made the point that 1.7 million people are covered by such call handling systems. That number will only increase as our population ages and as a higher proportion of people are in sheltered accommodation or are covered by call handling organisations while living at home.

I reiterate my commitment to meet the hon. Gentleman at the back end of the summer to ensure that these various things have been taken on board, that these actions, many of which he has led, have taken place, and that we are happy that what can be done has been done.

Question put and agreed to.

Oral Answers to Questions

David Mowat Excerpts

Tuesday 7th February 2017 Commons Chamber

[Rehman Chishti (Gillingham and Rainham) (Con)]

2. What steps his Department is taking to support people with post-polio syndrome.

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

My hon. Friend will be aware that polio was eradicated from the UK in the 1980s. However, between 25% and 80% of sufferers go on to development post-polio syndrome, a condition that, although not life-threatening, can be debilitating. The NHS response centres on structured self-management and pain relief and increasing referrals to both physio and occupational therapy.

[Rehman Chishti]

As parliamentary ambassador for the British Polio Fellowship, I know that 93% of people are unaware of post-polio syndrome. Low awareness among GPs, and in the NHS more generally, is leaving patients waiting for up to six years for a diagnosis. Will the Government agree to fund a PPS awareness campaign?

[David Mowat]

I congratulate my hon. Friend on his work for the British Polio Fellowship, which is a good charity that makes a real difference. He is right that the condition is difficult to diagnose; the symptoms are vague and there is no definitive test. NICE is updating its best practice, and the British Polio Fellowship has developed guidelines that we all need to use to build GP awareness of the condition.

[Jim Shannon (Strangford) (DUP)]

As the Minister said, there is no specific test for diagnosing PPS, so will he outline what information is offered to medical professionals to diagnose and treat the syndrome to ensure that the symptoms are correctly collated and not put down to other untestable issues, such as fibromyalgia?

[David Mowat]

As I said, the symptoms are vague and there is no definitive test. As my hon. Friend the Member for Gillingham and Rainham (Rehman Chishti) pointed out, awareness of the condition among GPs is not as high as it could be, so we need to do more, with the NICE guidelines and the work of the British Polio Fellowship, on GP education, training and information.

[Chris Green (Bolton West) (Con)]

3. What progress he has made on improving hospitals in special measures.

--- Later in debate ---

[Liz McInnes (Heywood and Middleton) (Lab)]

15. What assessment he has made of the effect of changes to local authority social care budgets on the provision of adequate health and social care services.

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

The relationship between health and social care budgets is complex. A recent study by the University of Kent has shown that, for every pound spent on care, hospital expenditure falls by between 30p and 35p. The hon. Lady will also be aware that there has been an increase in delayed transfers of care over the past two years, which has resulted in an increase in the number of unavailable hospital beds. Our best estimate of that increase is around 0.7% of total NHS bed capacity due to the increase in social care delays.

[Marie Rimmer]

It is quite amazing that the Minister is prepared to stand up and accept that there is a crisis in the NHS caused by the lack of social care provision. The crisis in social care means that more and more local authorities are reduced to just washing, feeding and toileting our elderly people. The crisis in residential care means that people from homes are going into the hospitals and choosing to leave the patients with the most complex needs, because they cannot afford the staff to look after them—

--- Later in debate ---

[Mr Speaker]

Order. I am sorry. I say to the hon. Lady without fear of contradiction that we must spread things out evenly.

[David Mowat]

I agree that budgets make a difference, which is why we are increasing spending by £7.6 billion over this Parliament, but so do leadership, grip and best practice. Some 50% of all delayed transfers that are due to social care delays occur in 24 local authorities. Many other local authorities have virtually no delays. I recently visited the IASH team—Integrated Access St Helens—in the hon. Lady’s own constituency, which, working with Whiston hospital, has achieved spectacular results and some of the best outcomes in the country. I am sure that she will want to join me in congratulating those responsible.

[Liz McInnes]

My local council of Rochdale has had to make cuts of £200 million in the past six years. It has a further £40 million of cuts to implement, which will pile the pressure on our social care budgets. The 2% precept will raise only £1.4 million, which is a drop in the ocean when our total adult social care budget is £80 million. With our hospitals reporting a 70% increase in delayed discharges, I call on the Minister to bring forward the better care fund scheduled for the end of this Parliament so that our social care services can cope now.

[David Mowat]

As a direct answer to the hon. Lady’s question on the improved better care fund, let me tell her that it will be allocated in such a way that the combination of the fund and the precept will address real need. That is what we will be doing during the remainder of this Parliament, starting from April. We spend more on adult social care in this country than Germany, Canada and Italy, but it is very important that we spend it well.

[Helen Whately (Faversham and Mid Kent) (Con)]

It was good to hear my hon. Friend referring to the University of Kent’s research.

Under the guidance of the vanguards and the sustainability and transformation plan, NHS and social services in Kent are working closer together than ever before, although there is still further to go. Does my hon. Friend agree that it is vital that we overcome the barriers between social services and the NHS so that they operate more as one system, meaning that patients can get the sort of care they need in the right place, preferably at home?

[David Mowat]

My hon. Friend makes a good point about the success of the vanguard in Kent. Last week I visited the care home vanguard in Sutton, which has achieved a 20% reduction in A&E admissions due to better integration and the sort of things that she mentions as being successful in Kent.

[Andrew Stephenson (Pendle) (Con)]

If the Minister watched BBC News last night, he might have seen footage showing the extreme demand for treament in Royal Blackburn hospital’s A&E department and the pressure that it is under. We could point to social care changes but, in reality, the situation is down to the closure of Burnley general hospital’s A&E department in 2008 under the previous Labour Government. What more can we do to support and reduce pressure on A&E departments?

[David Mowat]

My hon. Friend is correct in so far as two thirds of all delayed transfers of care are a consequence of internal NHS issues, not issues between the NHS and councils. The issue regarding Blackburn and Burnley is part of that.

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

Recent figures on delayed transfers of care ranked Salford 105th out of 154, with 533 delayed days in November 2016. Sir David Dalton has said that overcrowding at Salford Royal hospital is due to its

“inability to transfer patients safely to an alternative care setting”,

and that changes to social care funding are “urgently required”. Salford Council’s budget has been cut by 40% since 2010, leading to the loss of £18 million from social care budgets. Salford royal hospital, rather than the council, is now providing social care. I know that the Health Secretary respects Sir David. Does Minister accept Sir David’s view about the need for funding changes, or will he continue to find people to blame for cuts inflicted by his Government?

[David Mowat]

Conservative Members very much respect Sir David Dalton. I remind the hon. Lady that she stood for election on a slogan of not a penny more for local government, so it is entirely inappropriate for her to say different things now. There is now an opportunity in Manchester, through the devolution deal, to integrate care and the NHS more effectively, and I expect that to happen.

[Paul Blomfield (Sheffield Central) (Lab)]

8. What assessment he has made of trends in the availability of GP appointments.

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

Best trend data come from the GP patient survey, which collates feedback from more than 2 million patients biannually. The most recent results show that 92% of patients found their appointment to be convenient—a slight increase on previous results—and that 86% of respondents rated their overall experience of their GP’s surgery as good.

[Paul Blomfield]

The Minister knows that there was a 30% rise in waiting times in 2016—that is one of the key concerns that constituents raise with me. Local GPs tell me that one of the main pressures they face is the failing social care system. The Minister knows that the answers he gave a moment ago do not address the problem, so will he commit to doing something meaningful?

[David Mowat]

The answer I gave a moment ago was the results of the GP patient survey. The Government and I accept that the country needs more GPs. GPs are the fulcrum of the NHS, and we have plans for a further 5,000 doctors working in primary care by 2020. We intend to add pharmacists, clinical pharmacists and mental health therapists as part of the solution.

[John Howell (Henley) (Con)]

14. It is not just the need for GPs that is relevant. Surely there is a requirement for GPs to work at weekends, and that should be included in the assessment of demand for their services. GPs should also work with better technologies and work together as groups.

[David Mowat]

The Government are committed to GPs offering appointments seven days a week, 8 am until 8 pm, by 2020. By 2018, we will have rolled that out in London. Part of this is about GPs working smarter in integrated hubs of between 30,000 and 40,000 patients, thus enabling them to spread out and to offer services such as pharmacy, physio and social care.

[Joan Ryan (Enfield North) (Lab)]

In a survey of Enfield North residents that I conducted, 58% agreed that it is difficult to get a GP appointment. The Royal College of General Practitioners has calculated that Enfield needs 84 more GPs by 2020, but between 2010 and 2014, we lost 12 practices and had only one opened. If the 5,000 GPs appear by 2020, what will the Minister do to ensure that Enfield gets those it needs?

[David Mowat]

As I said earlier, we will have 5,000 further doctors working in general practice by 2020. A chunk of those will be available for every part of the country, and Enfield is included in that. I do accept that the GP system is under stress and that we need more GPs, and the points that the right hon. Lady makes are right.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

Employing more GPs is, of course, important, but the Minister is right to say that so is collaboration. How far have we got with spending the £1 billion earmarked by the Chancellor in 2014 for improving GP surgeries? Does the Minister share Ara Darzi’s vision of more polyclinics, which will enable GPs to work more closely together?

[David Mowat]

The vision set out in the GP five year forward view is of substantially more spend in the community and of an increase, as a proportion, in the amount of money in the NHS going to people in primary care. Part of that will be in polyclinics and the estate generally. As I say, one of the most innovative things we have found in the GP vanguards is that when they start to put together groups of 30,000, 40,000 and 50,000 patients in a GP hub, the quality of care increases dramatically. We are going to accelerate that.

[Andrew Rosindell (Romford) (Con)]

9. What plans the Government have to increase access for patients to innovative drugs and medical devices.

--- Later in debate ---

[Rob Marris (Wolverhampton South West) (Lab)]

13. What proportion of prostate cancer patients wait for more than two months to begin cancer treatment after the hospital has received an urgent GP referral.

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

The national standard is that we expect 85% of all cancer patients to receive initial treatment within two months of an urgent referral. For cancer overall, the most recent data indicate that we achieve 82%, and for prostate cancer around 78%, against that standard. The lower figure for prostate is due to the fact that the pathways are more complex than average.

[Rob Marris]

I am disappointed by the figures, but at least they are available. When I asked this as a written question last month, the information was not available, nor was information available about the number of vacancies for prostate cancer surgeons, their training or the equipment that they use, because that information, I am told, is not collected centrally. When will the Department collect adequate information to run the health service properly?

[David Mowat]

More information was published on cancer by clinical commissioning groups since the back end of last year than at any time in the history of the NHS. [Interruption.] The hon. Gentleman is right to say that prostate is grouped with neurological cancers in general, and that is the type of surgeon being employed. But the fact is that the Government have been incredibly transparent in terms of information published on cancers.

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

Last Saturday was World Cancer Day. The theme was unity, and I am still wearing my unity band with pride. We must do all we can to beat cancer, yet the Government are coming to their three-year anniversary of not meeting the 62-day wait target. Treatment quickly after diagnosis is crucial for tackling all cancers. Will the Minister outline what he is doing to ensure that that target is once again met so that patients receive timely treatment?

[David Mowat]

The volume has increased greatly, and there are something like 2,000 more people being diagnosed every day. The hon. Lady is right: of the eight cancer standards against which we judge ourselves, we meet seven, and the 62-day one has not been met. We need to do more to achieve that, and the cancer strategy set out a pathway for doing so. We have particularly invested in the early diagnosis component; we have invested £200 million in early diagnosis and getting a 31-day all-clear or referral for treatment. That is the pathway to meeting the 62-day target. She is right to raise this, because it is an important indicator and we need to do better.

[Pauline Latham (Mid Derbyshire) (Con)]

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

--- Later in debate ---

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

T2. The recently introduced one-year cancer survival rate indicator is a beacon of light in a system still too focused on process targets. What more can the Government do to hold underperforming clinical commissioning groups to account for that outcome indicator, given that we are still failing to catch up with international averages when it comes to our survival rates?

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

My hon. Friend is right to say that we now publish one-year survival rates for every CCG in the country, and I agree that that is a beacon of light and a transformative step. It also shows differences of more than 10% between the best and the worst, which is unacceptable. The transparency itself will bring improvement, but we have also recently established 16 cancer alliances, whose sole job is to roll out best practice and investigate and bear down on poor performance.

[John Pugh (Southport) (LD)]

T4. Will the Minister update the House about NHS litigations, which rocketed to £1.4 billion last year? Are they anything like under control?

[Derek Thomas (St Ives) (Con)]

T3. If someone in St Ives suffers a severe stroke, they will have a far better chance of a full recovery if they get quick treatment and then proper therapy and rehabilitation in the community. That does not happen for everybody. What is the Department going to do to ensure that there will be a national stroke strategy?

[David Mowat]

The current stroke strategy was produced in 2007 and our priority is to implement it fully. Frankly, in my time as a Minister, I would prefer to have detailed implementation plans and not more strategies. My hon. Friend refers to the great differences in performance across the country, in particular in access to speech and language therapy, and we need to achieve better on that.

[John Mc Nally (Falkirk) (SNP)]

T5. My Falkirk constituents, Michelle and Justin Young, have been through the lengthy treatment approval process for their son, Michael, to access the Duchenne muscular dystrophy treatment Translarna. Thankfully, Michael is now receiving it. With a growing number of emerging treatments for rare diseases expected in the forthcoming years, what action are the Government taking to increase the capacity of the Medicines and Healthcare Products Regulatory Agency when the UK leaves the EU? Most importantly, will the Secretary of State or the Minister agree to meet Muscular Dystrophy UK—

Colostomy Irrigation

David Mowat Excerpts

Thursday 2nd February 2017 Commons Chamber

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

I congratulate my hon. Friend the Member for Montgomeryshire (Glyn Davies) on his excellent speech. I want to congratulate him on three more things: first, on securing the debate two days before World Cancer Day; secondly, on rightly saying that this is the first time that we have had a debate on the subject in this place—it is good that we are doing so—and, thirdly, on talking so passionately about his personal story in such a matter of fact way, if I may use that term. He spoke candidly and clearly about a subject that sometimes carries with it a stigma, or that is a taboo.

I have been looking after the whole area of cancer for the past six months. It strikes me that when people come into the system, we are as good as anywhere in the world at treating them and dealing with the illness. Unfortunately, one problem we have is that too many people come into our system too late. As a result, first or second-stage diagnosis is not possible and their outcomes are worse. One of the reasons for that is awareness—my hon. Friend used that word—and such debates can only increase awareness, so it is good that we have them.

My hon. Friend rightly said that uptake of colostomy irrigation is low. We think that some 5% of all those who could do so use the technique, rather than an alternative. I will talk a little about why that is and what we might be able to do about it. We think that there are some 6 million people in this country with bowel incontinence issues. Of course, the majority of them are nothing like as serious as the story we heard this afternoon. Similar stories may result from bowel cancer, and perhaps also from other types, such as cervical cancer. The choice of whether to use irrigation or another technique is a personal one. There are pros and cons to each, and I will try to set them out. Before I do, perhaps I should talk a little bit about what the Government need to do, and what they are doing, regarding the prevention, screening and treatment of bowel cancer. Obviously, if we were more successful at those, we would reduce the incidence of the disease and the need for the techniques that we have heard about.

The Government’s approach is informed by the cancer strategy, which came out about 18 months ago. It included 96 recommendations, all of which were accepted. It has been fully funded, and its implementation is now being led by Cally Palmer and Bruce Keogh from NHS England. We are finding that survival rates are increasing —we know that they are increasing quite sharply for most cancer types—but there is probably still a gap between us and the best in the EU. We are determined to close that gap, and although we are doing so, there is still work to do.

Of the parts of the cancer strategy that relate most to this debate, I want to talk about screening and about living with cancer and beyond—we have heard a story about doing so over the past 14 years. I also want to talk about one of the things that I think will be most important in improving cancer awareness and outcomes: the whole area of transparency.

One of my hon. Friend’s points was that there are staffing issues in this area, particularly in relation to bowel cancer. He said that we do not have enough endoscopists—that is true. The Government are committed to training a further 200 by 2020. Indeed, we have not been able to do some of the things on screening that we want because of those staff shortages, but we are addressing that problem very firmly.

The current screening test is an FOB, or faecal occult blood test, which is in the process of being replaced by the FIT—faecal immunochemical test—from 2018. A contractor/supplier has been appointed. The expectation is that that will lead to a sharp increase in the incidence of screening, the numbers of people coming forward for screening and the efficacy of that screening, which is very important.

In parallel, we have introduced a bowel scope screening process for males and females at or around their 55th birthday. This one-off test involves a full endoscopy, as a consequence of which polyps are removed. Whether or not they are benign, that process sharply reduces the incidence and risk of future bowel cancer, which is also very important. In the interests of full disclosure, let me say that I have also gone through the procedure. It was not anything like my hon. Friend’s, but I nevertheless went through it successfully. The process is a very important part of this fight.

The second aspect of the strategy is living with and beyond cancer. When I gave a presentation to the all-party group on ovarian cancer, I was struck that a lady whom I met afterwards said that she had received a terminal diagnosis for that type of cancer, but was not receiving support. That is obviously not where we want to be. The Government’s intention is that, by 2020, everybody who has a cancer diagnosis will have an individually designed package, with a cancer nurse specialist assigned to them. We are undertaking that programme in conjunction with Macmillan. It is important because cancer is increasingly curable, so we must increasingly put in place softer packages, as it were, to help people afterwards.

The final area I want to touch on is transparency. One of the frustrations is something that I often reflect on after talking to colleagues about the NHS and its effectiveness. Many of them are very concerned—almost certainly rightly—about the bricks and mortar of their NHS establishments, because they are very visible. Changes in configuration also concern them and their electors. I have fewer conversations with colleagues who are concerned about cancer outcomes in their areas. Those statistics are now published, so we know which are the best clinical commissioning groups, which are the worst and which are average.

One way in which we will increase the overall standard and quality of outcomes is through dialogue—with Members and the public more generally to act on the pressure points—about the performance of CCGs. I would argue that whether a Member’s CCG is doing one of the best or one of the worst jobs in the country might be more important to their community than whether the accident and emergency department is open for 24 or 18 hours. However, we do not always have such dialogues in this place.

On innovations in treatment for bowel cancer, keyhole surgery is making a big difference to outcomes. There are very clever people doing very clever things, which are leading to better outcomes and successful operations.

For many, however, a colostomy is needed. Broadly speaking, there is a choice of techniques: the irrigation technique that we have heard about this afternoon; or an appliance, which is typically a bag. There are pros and cons of each but, as my hon. Friend said, the appliance route is chosen 20 times more frequently than irrigation. This must be a personal choice, and NICE guidelines state that choices should be explained, but that is an extreme difference. As my hon. Friend said, the difference is far greater than that in the United States. It might well be that there is not enough awareness, so this debate has been one way to address that.

A recent paper by Sir Norman Williams, the senior clinical adviser to the Secretary of State for Health, set out the benefits of irrigation: there is no need for an appliance; the individual has control over timing; there is some evidence that fewer drugs are required, with a consequent increase in general wellbeing; and an individual is able to have a more varied diet. Those benefits suit many people. The technique might not be suitable for people with heart or kidney diseases or Crohn’s disease, and some might find that the 45 to 60-minute process is too onerous. In addition, I think I am right to say that the best results from this technique tend to come if the process is carried out at roughly the same time every day, which might not suit everybody.

The NICE guidelines are very clear: both techniques should be offered by the clinician or stoma nurse. The choice should be based on facts and personal preference. Whichever technique is selected by the patient, the nurse is responsible for teaching the process and supporting the patient until they are up and running, because it is extremely important to get it right.

I again congratulate my hon. Friend on securing the debate and raising awareness of the issue. He has talked frankly about a process that has been a massive help for many people in their day-to-day lives.

Question put and agreed to.

Draft National Health Service Commissioning Board (Additional Functions) Regulations 2017

David Mowat Excerpts

Wednesday 1st February 2017 General Committees

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

I beg to move,

That the Committee has considered the Draft National Health Service Commissioning Board (Additional Functions) Regulations 2017.

It is, as ever, a pleasure to serve under your chairmanship, Mr Davies. These regulations deal with the transfer of a business unit, the Commercial Medicines Unit, from the Department of Health into the NHS Commissioning Board, usually referred to as NHS England. The details are set out in the explanatory note, in particular paragraph 7, but I will tell the Committee in broad terms what the Commercial Medicines Unit does and why we feel it is time to transfer it from the Department of Health to NHS England.

There are 35 to 40 staff in the unit, principally at Runcorn and Reading, and their role is to procure, conclude and manage a set of framework agreements that are used within NHS England to purchase medicines in the hospital sector. About £8 billion total throughput is involved, of which £2.6 billion relates to framework agreements. There is an estimated saving in excess of £100 million a year from having the framework agreements, which cover drugs, medicines and services.

The process is that typically NHS organisations—either the specialised commissioning function or hospital pharmacists—identify areas where it would be of benefit to have framework agreements: perhaps there is going to be a drugs increase or an increase in volume of a particular item. This group sets up those agreements; they negotiate them with the suppliers, put them into place, and make them available for use in hospitals throughout the country. When the drugs are used they are paid for by the NHS. There is clearly a bit of a divide in that the NHS initiates and then the frameworks in the Department of Health and then the NHS do the back end in terms of specialised commissioning and paying for them.

The Carter review, which looked at efficiency across the hospital sector, identified this as an area that we should consider putting back from the Department of Health into NHS England. The view is that that is a logical thing to do at this stage. The regulation would regularise the way that business is carried out.

[Michael Fabricant (Lichfield) (Con)]

Concern was expressed at Prime Minister’s Question Time a couple of hours ago that various parts of the NHS might be sold off in any future agreement between the United States and the UK. Will my hon. Friend confirm that the transfer of this unit to NHS England does not make it any more vulnerable? Perhaps he might like to comment on the Prime Minister’s view regarding any such sell-off.

[The Chair]

Order. Despite Mr Fabricant’s attempt to try to widen the debate to the privatisation of the NHS and trade deals with America, I would be grateful if the Minister ignored his advances and stuck to the subject that we are debating.

[David Mowat]

Thank you, Mr Davies. On this occasion, I will ignore my hon. Friend’s advances. I will make the point that what we are doing with the regulations is nothing to do with privatisation or any such decision. This is an operational function carried out in the public sector that is being moved from one part of the public sector to another part of the public sector. The rationale is to consolidate the procurement expertise in the health system in one place and it is felt that that would provide business benefits.

The National Health Service Act 2006 does not permit this fairly routine transfer of a business function, so these regulations are necessary. In essence, there are three things in the regulations. There is one power that we seek to give to NHS England and two duties in respect of the transfer. The power is for NHS England to take over the business function currently being done within the Department of Health—in other words, to negotiate, procure and manage those framework agreements. That is the first part of the regulations.

The second part imposes a duty on NHS England to replicate the advice that the unit gives the Secretary of State from time to time in the discharge of his duties more generally in the health system, be it on medicines pricing, benchmarking or issues of that sort. We are formalising that duty. The rationale is that the new group within NHS England will have a duty to talk to hospital pharmacists—the people who make the purchases and are responsible for the drugs. The duty to consult, which is currently undertaken by the Department of Health, will continue in NHS England.

In summary, we are moving an operational function from the Department of Health, which really should be concerned with strategy, not operations, into NHS England to achieve better procurement results over time. Staff who will be transferred will suffer no detriment whatsoever. For example, they will move from one pension scheme to another. It would be a TUPE process if this were the private sector; it is a public sector version of that. Either on terms or locations, there will be no staff impact. I commend the regulations to the Committee.

--- Later in debate ---

[David Mowat]

I thank the shadow Minister for her comments. We all want to see value for money for the NHS. The NHS spends £16 billion a year on drugs and the unit is one of the mechanisms by which that spend is kept as low as possible. We have reason to believe that the unit does a good job. We believe it will do an even better job when it is formally moved into the NHS in the way set out in the regulations.

On the move to the provinces that was mentioned earlier, I am with my hon. Friend the Member for Lichfield on that, but perhaps I can put his mind at ease. The majority of the people affected by the new functions are located in Runcorn, which is in the provinces and close to my constituency. I can confirm that they will not be moving from Runcorn, although I agree with his direction of travel on these things.

I thank members of the Committee for their attendance this afternoon. The unit performs a key role that is better done in NHS England than in the Department of Health, because it is an operational role. We wish that to continue and I am sure everyone in Committee wishes the people responsible for procurement in the NHS all the best in the very important job they do.

Question put and agreed to.

Duodopa

David Mowat Excerpts

Tuesday 31st January 2017 Westminster Hall

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

It is a pleasure to serve under your chairmanship this afternoon, Sir Edward. I add my congratulations to those of my hon. Friend the Member for Montgomeryshire (Glyn Davies) to the hon. Member for Ealing, Southall (Mr Sharma) on securing the debate. It is right that we use the opportunity to discuss matters such as this one in Parliament and to ensure that we, whether that be NICE or the Department, get this right.

May I start by agreeing with the hon. Member for Ealing, Southall? He made the point that it would be completely wrong for NICE to make an evaluation based on flawed data, flawed information and a flawed methodology. If that were the case—we will talk about that during the next few minutes—it would require action. He also made the point that it is right that we have a body such as NICE that attempts to validate the treatments that are available in a coherent and consistent way.

The hon. Gentleman mentioned the quality-adjusted life year issue. There has to be a method of comparing drugs that are available, for example, for Parkinson’s with those available for cerebral palsy or muscular dystrophy, and we have to be fair to the community as a whole. That is what the NICE process is intended to do. It is also important to make the point that at the moment, the drug is available in NHS England. It has been commissioned since 2015 by the specialised commissioning team. That will continue—the updated NICE guidance will not change it—until NHS England’s specialised commissioning group makes a different decision, if that is what happens.

I will make a few points about Parkinson’s first of all. We know that it is a terrible, progressive disease and that there is no real understanding of what causes it. The occurrences of it are rising. Some 130,000 people in England have been diagnosed with Parkinson’s disease, which is caused by the death of a type of cell—those containing dopamine—in our brains. As the hon. Gentleman said, the disease causes tremors, stillness, slow movement, speech impediment and so on. Of those 130,000 people who are suffering from Parkinson’s disease, something like one in 1,500 are given Duodopa. There are currently 75 people in England who receive it, and the cost is roughly £28,000 for each of them.

The process is that when a diagnosis of Parkinson’s is made, NHS England typically refers the patient to a specialist centre for neurological care and an evaluation. A set of processes are carried out by the neurosurgeons in an attempt to remedy the dopamine issue that will have caused the Parkinson’s. The typical and main treatment is a drug called levodopa, but for a number of people there are side effects and it eventually stops working. As a follow-up remedy, as the hon. Gentleman said, either apomorphine, brain stimulation or Duodopa is prescribed, or a combination of those three things. How they interact with one another is quite complex, but those are the typical prescriptions if the main treatment is not successful.

As I said, the cost of Duodopa is something like £28,000 per patient per year, and 75 people are receiving it, so that is around £2 million a year, which is not massive in the great context of NHS spend. Nevertheless, it is important that we compare it with other treatments and make sure that it is the most effective for patients. That is what NICE has done. It had previous guidance on the treatment of Parkinson’s from 2006 and over the past year or so has produced draft guidelines, which the hon. Gentleman referred to, on the use of the drug. Those guidelines were put out to consultation, which closed in November. It is true, as the hon. Gentleman said, that those draft guidelines said that in NICE’s view, at no stage in the treatment is Duodopa to be recommended. The reason given was that, under NICE’s evaluation criteria, the cost of the drug is too high.

I have the NICE report in front of me, and the actual analysis is quite complex. The hon. Gentleman said that the report talks about the figure of £500,000—or alternatively £80,000, as I think I heard him say—per quality-assisted life year. I think it also comes up with lower numbers, but the truth is that it does not come up with a number that is anything close to the normal threshold at which a drug is approved for use, which is typically £20,000 to £25,000 per quality-assisted life year. The hon. Gentleman mentioned the methodology that was used. The consultation process drew in points from members of the public, from the profession and indeed from the company that markets the drug, which did say that there were methodology issues—I think it used the phrase “issues with the mathematics”. Those points will all be referred to the NICE committee and will be taken into account if and when the final analysis is confirmed or changed.

However, I will say that a quality-assisted life year figure in the order of £80,000 is quite a long way away from where it needs to be. There are various remedies for that. In similar debates I have made the point that one option is for the drugs companies involved to review their pricing. These things are not necessarily set in concrete. When they price a drug they are doing two things, and the cost of actually manufacturing the drug is often quite small compared with the invested intellectual capital that they are trying to recover. There is a choice, because if the drug is not prescribed they are not recovering either of those costs. I simply make the point that there is an opportunity for the company to do that.

As the hon. Gentleman said, it is true that NICE’s recommendation is that a combination of apomorphine and deep brain stimulation is more effective as a treatment and in terms of cost. We are having this debate on the draft guidance, and even if that guidance is confirmed, it will then have to go to the NHS England specialised commissioning group, which will have another opportunity to look at it in the round. As he said, Duodopa is a little unusual in that it is currently being prescribed. It is not as though it is a new treatment—it was prescribed in advance of the NICE recommendation.

I will say a little bit about NICE. It is very easy to knock it and say, “These guys don’t know what they’re doing. They don’t understand what is going on. It is obvious that if they were a bit more diligent or a bit better trained they would not have given this answer.” I looked at who was on the committee for the Parkinson’s guidelines. There were 18 people; it comprised consultant neurosurgeons, neurology pharmacists, people from patient groups and physiotherapists, so there were a number of people with a great deal of experience in managing Parkinson’s disease. It is important that the decisions on how we make drugs available are made by scientists, based on rigorous criteria and an attempt to look at the science rigorously, and not by Members of Parliament, as I think everybody in the Chamber would agree.

[Glyn Davies]

I intervene only to reinforce the Minister’s point. I remember being involved in campaigning against NICE and calling it out for everything I could when bowel cancer drugs were not available. That was driven by my personal interest, but in time I have come to realise—partly because my son who works for a drug company lectures me about this—that the principles behind NICE are absolutely vital. If we ever move away from that, we will finish up in a complete free-for-all, with all sorts of pressure and inducements from Members of Parliament not to follow proper procedure.

[David Mowat]

I can only concur that many of us benefit from lectures from our children, and it is nice to know that my hon. Friend does. I agree with the point made by the hon. Member for Ealing, Southall. If NICE has made a mistake, if something has been wrong in its analysis—this is why draft guidelines are published—and if things are brought to its attention that are not adequately reflected in its work, it has the opportunity to change that and will do so. Given the points that we have just heard, that is the right process.

When the finalised position is established, NHS England will consider whether to accept the NICE guidance. It will make a decision on what it does regarding the cohort that receive the drug and new patients, for whom there is potentially a difference in treatment. That process is many months away, frankly. It will not occur until NICE has finalised its guidance and published the complete position.

I finish by agreeing with the intervention made by my hon. Friend the Member for Montgomeryshire. These decisions are very difficult. Only 75 people receive the drug, but for them it is potentially life-changing, as it would be for the people who will need it in future, and I do not want to underestimate that. I can only repeat the points made in the NICE guidance; it believes that there are other equally effective treatments, such as a combination of apomorphine and brain stimulation. I am not a clinician, so it is not possible—and not right—for me to have a view on that, other than to say that until we are able to show that NICE has somehow been wrong in what it has done, it is right that we as a Parliament and as a group of MPs accept and respect that process, because we know that diligent scientists and clinicians have tried to get it right.

I thank the hon. Member for Ealing, Southall for raising this important subject; it is good that we have had the chance to talk about it today.

Question put and agreed to.

Provision of Cervical Screening

David Mowat Excerpts

Friday 27th January 2017 Commons Chamber

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

Thank you for those comments, Madam Deputy Speaker. I thank the hon. Member for Dewsbury (Paula Sherriff) for her constructive speech, which was challenging towards the end. She raised four important points, which I will try to address in my remarks.

I also thank the hon. Lady for her work with the all-party parliamentary group on women’s health to lead the charge on cervical screening. On Jo’s Cervical Cancer Trust and the #SmearForSmear campaign, during her remarks I was able to check with both my Parliamentary Private Secretary, my hon. Friend the Member for Kingston and Surbiton (James Berry), and the Whip, my hon. Friend the Member for Daventry (Chris Heaton-Harris), and we will be delighted to take a selfie with her that we can use for #SmearForSmear. This debate is about asking challenging questions, but it is also about awareness. We will do anything we can to help a charity such as Jo’s Cervical Cancer Trust do its job better. Perhaps we can take the selfie together after we finish.

As the hon. Member for Dewsbury said, nine women a day are being diagnosed with cervical cancer and two to three women a day are dying. It is a cancer that is almost entirely preventable through screening although, as she said, the symptoms are hard to detect, which I will cover. She said that the cancer strategy, which is being led by Cally Palmer, covers screening in some detail, including how we will proceed, and addresses the need right across the cancers for clinical commissioning groups to take a consistent approach to survival rates, early diagnosis, 62 day referral-to-treatment times and the whole cancer experience.

One of the things that I always say when we in this place have a debate about cancer is that we spend too much time—I am as guilty, or have been in the past, as any other Member—discussing the bricks and mortar of the health service and not enough thinking about some things that probably matter more to our constituents, such as one-year survival rates for cancer. We should be evaluating and holding our CCGs to account much more often over differential one-year survival rates, because, in the end, they probably matter to more people and have more impact on their lives than perhaps some of the accident and emergency reconfigurations that we discuss.

There is a cervical cancer screening programme, and the hon. Lady made some good points about take-up. She did not talk about the campaign that has been waged in some areas on screening under the age of 25. I do not think that that is something that Jo’s Cervical Cancer Trust wants, but I will cover it and the reasons we do not do it.

The hon. Lady mentioned the importance of the enhanced HPV screen that is coming in, asking a question about the IT systems to support that. We are planning that that will be in place—I have confirmed that; I think written questions have been tabled on the issue—by April 2019, when it will be rolled out. That will be in place. I can give her that assurance.

I want to talk a little about the point the hon. Lady made about GP awareness and clinical practice, because, as she said, there is not enough awareness of the symptoms of cervical cancer. It is hard to detect the symptoms, such as abdominal bleeding and its many causes. I will also cover the fact, which she rightly referred to, that the UK is doing a lot in the area of vaccination, which is probably what will achieve the most progress in the future and make the biggest difference in getting rid of this disease, which is, as you said, Madam Deputy Speaker, quite preventable.

On screening, I will start with the good news: we have screened 3 million women a year between the ages of 25 and 49. Every three years, a screening is available. After that, to the age of 64, it is every five years. The view is that, if that screening were not being done, there would be about 5,000 more deaths a year, rather than the 700 to 800 that are happening now.

Although there are few areas of cancer treatment, performance and survival rates on which the UK could say that it is a world leader, the screening figures from the OECD show that we are No. 4 of the 30 OECD countries. We do more screening than countries such as Germany, Denmark and Austria. However, the hon. Lady raised the point, and she is right, that screening rates are going down. They are going down across the world and we do not wholly understand why. We need to do more to get them up, as about 25% of women who are entitled to be screened are not being screened, and that percentage increases for women coming for their first screen at the age of 25 to 29. That is arguably the most important one, but the percentage of those not coming is about 33%.

As the hon. Lady said, the incidence of that is higher among ethnic minority women and among women with learning disabilities. There is a correlation with social deprivation as well. Perhaps that is predictable, but it is nevertheless true.

On the reasons for that, the hon. Lady talked about, perhaps, embarrassment. I think Jo’s Cervical Cancer Trust has done some work on that. Some people say that they have no time to go to their GP, or they are scared about what the procedure involves or they think it is not important. We need to do what we can to improve that.

The hon. Lady raised some interesting points about the letter people receive, and she quoted from it. I am told that that correspondence is being reviewed, but it strikes me—she made the point in her speech—that we are all on the same side in this regard. One way forward might be for her and Jo’s Cervical Cancer Trust to come and speak to me about some of those suggestions, because they would be pushing at an open door. We can do that in the next few weeks.

We are trying to make the information more accessible, particularly for women with learning difficulties, because there are specific issues there—there are specific issues with their health in general, but particularly with regard to this issue. As the hon. Lady said, a lot of work is going on to target those GP practice areas and understand why they have such high incidence of no-shows. It is somewhat correlated with ethnic minorities, and it might involve some behavioural norms, for the reasons that were mentioned. I should say at this point that the Chancellor gave £650,000 from the tampon tax to Jo’s Cervical Cancer Trust, which has used that money to try to understand, behaviourally, why a quarter of women are still not coming forward for screening in spite of a second reminder, and to increase awareness. None of that is to say, though, that there is not more to do. I am happy to speak to her and Jo’s Cervical Cancer Trust about it.

From time to time there have been petitions and discussions about lowering the age limit for screening. I was pleased that the hon. Lady did not mention that, because it has been looked at again by the UK National Screening Committee, the World Health Organisation and, indeed, Jo’s Cervical Cancer Trust, and there is agreement that earlier screening would do more harm than good because it is particularly likely to lead to false positives, which would create a pressure for biopsies that are not necessary. Notwithstanding the tragic case of Amber Cliff, the view is that screening that cohort of women earlier not only would not be beneficial—it is not a question of it not being cost-effective—but would actually make things worse. In that cohort of women, about five a year die, so it is particularly important that they understand the symptoms and go to their GP as quickly as possible. I should emphasise that there is no EU or other UK country that screens women under the age of 25. I shall discuss vaccination in more detail in a moment, but it is one of the things that will make a difference to women in that age group, and it will help with the screening no-shows, because we are getting much better uptake numbers for vaccination.

The hon. Lady talked about HPV as a significant indicator of risk. One thing that is being introduced on the back of the normal, historical screening is screening for the virus on the first occasion. If it is present, the woman will be monitored much more closely going forward, because it is a very good indicator of the likelihood of cervical cancer developing. As I said, that programme will be rolled out nationally from April 2019. We are at the forefront of countries that are doing that around the world. I used to work with IT systems, and the hon. Lady is right to continue to ask about this one. The referral system and database will be ready to make that roll-out happen.

The hon. Lady rightly discussed the need for a GP outcomes framework. NHS England has done work to ensure that GP awareness is as high as it should be and that women, particularly those with mid-period bleeding, understand that it is serious and should be investigated and, if necessary, that they should be sent to a gynaecologist.

HPV, which is the indicator of this and other cancers, lends itself to vaccination, and we are one of the first countries in the world to bring in a very high volume of vaccinations of girls aged between 12 and 13. I am pleased to say that, last year, 85% of year 9 girls received the vaccination, which almost entirely takes away the likelihood of cervical cancer developing. That 85% is a higher number than the screening number, and it will help us to catch the people and the areas that have traditionally been hard to reach. Indeed, it is one means that we will use to address the issue of those hard-to-reach groups.

As HPV leads to other cancers, it has been suggested that the vaccination should also be given to boys. That is under discussion now, and we will be making a decision in the next few months. At the moment, only girls are vaccinated.

Let me finish by thanking again the hon. Member for Dewsbury for the points she raised, and for the way in which she did so. This is not a party issue—all of us are against cervical cancer. However, it is right that we challenge the postcode lottery that she mentioned and discuss ways to improve the take up of screening. If the five of us who are in the Chamber can do a selfie at the end of this debate and give it to Jo’s Cervical Cancer Trust it will perhaps show that, at least, the awareness part has been achieved.

Question put and agreed to.

Defibrillators in Public Areas

David Mowat Excerpts

Monday 16th January 2017 Commons Chamber

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

The hon. Member for Garston and Halewood (Maria Eagle) started her excellent speech by saying that defibrillators save lives. We accept that; there is no question but that that is the case. Before I respond to the points that she and my hon. Friend the Member for Twickenham (Dr Mathias) made, I want to add my congratulations to the Oliver King Foundation on its work, and to the family on turning a terrible tragedy into something positive. We have heard about what has been achieved in Liverpool, as well as more widely.

One of the asks of the hon. Member for Garston and Halewood was that I meet her and the family to talk about how to take this matter forward. I confirm that I would be very happy to do so. Indeed, the sports Minister, my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch), who is with me on the Front Bench today, also feels passionately about this matter, which was in the sport strategy that was published about a year ago. I am happy to set up such a meeting. I am not in a position to set out tonight the Government’s view if the private Member’s Bill does not go through, but if the hon. Member for Garston and Halewood organises the meeting, I would be happy for it to be more widely attended by interested Members.

[Mr George Howarth]

I think the hon. Member for Lewes (Maria Caulfield) accepts, as I certainly do, that although a ten-minute rule Bill might have been a good way to raise the issue, it is not a suitable vehicle for taking this forward. The request is that the Minister and the Department look at the Bill as it stands, and that, if it needs to be amended or redrafted, they suggest ways of doing so, or even take it on themselves. The Government should bring a measure forward, rather than leaving this to a legislative vehicle that simply will not work.

[David Mowat]

As I have said, I am not in a position to say tonight what the Government will do in respect of the Bill. I am willing to say that we will meet and talk about it after this debate. As I will come on to say, there is a question about the extent to which defibrillators should be mandatory, as was raised in relation to schools, versus dealing with this through guidelines and other forms of help. I will try to make some of those points later.

The hon. Member for Garston and Halewood made the point that the survival rate of people who have an out-of-hospital cardiac arrest is in the order of about 10%. It varies a little by ambulance service—it can be between 7% and 12%—and if we could get all ambulance services up to 12%, that in itself would save many lives. There is no question but that if defibrillators were available in time, the figure would be at least doubled and perhaps increased by more than that. We also accept the figure from the British Heart Foundation, which I think she cited, that every minute of delay reduces the probability of success by something like 10%.

We need to achieve two things: we need to create more access to defibrillators; and, as my hon. Friend the Member for Calder Valley (Craig Whittaker), who is not now in the Chamber, said in relation to the incident in his family, we also need to increase training and CPR awareness. I recall doing CPR training and being taken through all this two years ago in a church hall in Warrington. It really did not take very long, and I hope I can still remember how to do it. Using these things must be done in parallel with other training. I understand that some defibrillators work fairly easily without too much training, but experience of and ability in CPR buys time, which is what we need to achieve.

I will talk about what the Government are doing in relation to public places, schools, the workplace more generally and, as I have mentioned, sports. I will also take a few minutes at the end of my speech—I do not think that we will be here until 10 o’clock—to talk about screening, which was mentioned as something we ought to consider.

Since 2007, ambulance trusts have had responsibility for the defibrillators around the country. That is because they are where 999 calls go, and they ought to know where the nearest defibrillator is when they get one. If there is a code or the defibrillator is locked, they are responsible for that. In addition, the British Heart Foundation in England—this is also happening in Scotland—is trying to create a database of the defibrillators that we believe are out there. The BHF thinks that there are something like 14,000 defibrillators. Unfortunately, for historical reasons that have grown up over time, there could be maintenance issues with some of them. We need to bring all that up to date, and the BHF is leading the charge on that.

In the past two years, the Government have allocated £1 million per annum for defibrillators in public places. That money is for England only and has led to some success. We had 700 new defibrillators last year as well as the cabinets that go with them, in addition to a range of CPR training, and we expect the same thing to happen this year. That represents an appreciable increase in the number of defibrillators. As I have said, we are doing that because we believe that defibrillators save lives, as does the training around them.

The Member for Garston and Halewood talked about schools. She rightly said that schools have been issued with guidance saying that we expect them to consider the installation of defibrillators, but it is also true to say that not every school has a defibrillator. The hon. Lady also talked about defibrillators costing in excess of £1,000. The scheme that we have put in place for schools uses NHS Supply Chain, which means that they can source a defibrillator for something like £435, which is clearly better than £1,000. I accept that that still comes out of a school’s budget, but nevertheless a great number of schools are taking that up. Schools can also apply to the British Heart Foundation scheme that we talked about earlier, provided that the defibrillator is publicly accessible, which in many cases it would be. However, I accept that we have not mandated such provision, as the Bill asks us to—I will talk about that a little later.

There are workplace health and safety aspects that every employer must consider. We have put in place a requirement that, from 1 January this year, everybody in a workplace who is first aid-accredited—obviously health and safety regulations require that there are such people—must have defibrillation training and be in a position to use those facilities. That is now happening, and it includes everybody who will have to do a first aid refresher course.

As I mentioned, sport is a priority area. Sports governing bodies will have formal responsibility, and many sports are taking this forward. We know of the incidents that have occurred. I think it was Fabrice Muamba during a Tottenham game who was saved by a combination of a defibrillator and a doctor in the crowd who knew CPR, and rugby league and rugby union are also involved. The Football Association has made available a £1.2 million grant to buy 1,300 defibrillators for use at football grounds up and down the country—and not just at the very large grounds. I am involved at Warrington Town football club, and we will be getting a defibrillator under that scheme as well. All FA-accredited coaches will also have to be CPR trained.

I know from the sports Minister that the sport strategy has made defibrillators in sports a priority. She has nominated Baroness Grey-Thompson to take this forward, in terms of putting a duty of care on the various governing bodies. It is an area of priority.

It is also important to understand more about sudden cardiac arrest and to make progress through research. The Government have provided funds through the National Institute of Health Research particularly to deal with the genetic aspects of the condition, given that it has a generic element. Work on gene discovery is also going on at the Oxford Biomedical Research Centre. I am not saying that we are close to a solution or a clear way forward, but this is a research priority. If we understood the genetics better, it would help us to do screening better, so let me move on to screening.

There is a school of thought that screening for children’s genetic predisposition to heart problems could make a difference. In 2015, the UK’s screening authority, the screening committee, considered screening people between the ages of 12 and 39. It did not support that, however, and I believe that that position is consistent with that of every other country in Europe. We have looked into this, and my understanding is that no other country carries out such screening. A number of reasons have been given: it is difficult to get clarity about the numbers of people who would be affected; there is concern that even if screening were to identify people with a potential weakness, there is no consensus on how that should be managed; and, finally, there is a significant concern about the efficacy of a test, especially regarding the number of false negatives and false positives, which it was felt could do more harm than good. If peer-reviewed evidence came forward, based on the findings of places that had conducted screening work, the matter would be reconsidered, but without that, it will not be looked at again until 2018. That leaves us with the issue of how to make more progress on the number of defibrillators available. Perhaps the difference between the hon. Lady’s remarks and my response is not whether it is a good thing to make progress on defibrillators, but whether the Government should mandate putting defibrillators in every school and sports facility.

[Maria Caulfield]

I understand the Minister’s concern about whether this should be mandated. However, these days we would never operate a school without a smoke alarm or fire extinguishers, and we would not put children on a school bus without seat belts. For me, defibrillators are as essential a piece of safety equipment as any of those things.

[David Mowat]

I accept that. As I say, the guidelines are clear: any school can make use of the NHS Supply Chain facility to put in a defibrillator for £400 or so.

[Mr George Howarth]

The Minister talked about screening, which my hon. Friend the Member for Garston and Halewood (Maria Eagle) also mentioned. Although I understand the conclusions and the advice that has already been given, to ensure that there is no confusion, is it not appropriate that if somebody has already been affected, screening should be available to their family, particularly their siblings?

[David Mowat]

I accept that. Also, a number of sports governing bodies offer screening for people who participate in their sports, but of course that is not the national screening of all 12 to 39-year-olds, which was the issue that was looked at.

Let me finish by reiterating my willingness to meet the hon. Member for Garston and Halewood, other Members and people from the Oliver King Foundation.

[Maria Eagle]

I conveyed a request for the Prime Minister to meet the Oliver King Foundation and Oliver’s parents. Could the Minister help me to facilitate that?

[David Mowat]

I can do many things, but I cannot answer for the Prime Minister. I think I am right in saying that those people met the Secretary of State a couple of years ago. Perhaps when we meet, however, they can start at the bottom end of the food chain before working their way upwards.

When the Government invest in any aspect of health, whether it be cancer drugs or access to GPs, efficacy and cost-effectiveness must be evaluated. The National Institute for Health and Care Excellence uses the criterion “quality-adjusted life years”. Investment in defibrillators must be judged against investment in other necessities, such as cancer drugs, but it is clear from what has been said in a debate that has attracted interest on both sides of the House and the border that defibrillators save money as we start to save lives. The Government accept that, and I want us to make progress in this regard.

Question put and agreed to.

Pharmacies and Integrated Healthcare: England

David Mowat Excerpts

Wednesday 11th January 2017 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate my hon. Friend the Member for St Albans (Mrs Main) on leading the charge on what we all agree is an important subject. We have heard some very useful speeches, although I would make the point in passing that the subject is apparently so important to the Opposition that there have been no speeches from their Back Benchers on any aspect of the reforms during the last hour and a half.

My hon. Friend used an important word in introducing the debate: integration. I will talk about that, because if we are to fulfil the potential of the sector, which we need to do, it needs to be integrated. We have heard other important words too. We have heard about “pharmacy first” and also the phrase “wellbeing hub”, which I think sums up where we want to be in time. I will try to address many of the points made in all parts of the Chamber, but I will also set out what the Government are planning. When we boil it down, however, there is a huge amount of agreement about where we need to get to and the direction of travel. We also heard about Scotland, which is not perfect—the Murray review made some points about IT integration in Scotland, which is not yet working as well as it might—but as I have said in the past, I think we have things to learn from Scotland.

Everyone in the Chamber, Government or Opposition, can agree on three things. First, we need to move funding and the profession from a model based principally on dispensing to one based much more on services. Of course it is true that, to an extent, we are already going in that direction, but the funding model is not facilitating that, and it needs to. The Government must address that and take it forward.

Secondly, we all agree that services are a good thing per se, but that they are better if integrated with the primary care pathway much more than has been the case historically, and that is about working much more closely with GPs. I do not agree that employing more clinical pharmacists in GP practices is a “red herring”; it is part of how we bring the professions together, although I accept historically there have been difficulties doing that.

The third thing we all agree on—this must apply to the Opposition as well—is that we need to get value for money for the £2.8 billion that we spend on dispensing around £8 billion-worth of drugs. It is right to look at doing that as efficiently and effectively as possible. For example, the existing funding model encourages clusters to develop. I note that the establishment payment in Scotland is £1,700 per annum—I think I heard that right—while ours is £25,000, which has encouraged clustering, so that NHS money is not being spent on frontline services.

It is worth reminding the House that none of the efficiency changes that we announced before Christmas represents a cut of money going back to Treasury; the money is being reallocated to other areas of the NHS. The impact analysis talks in some detail about how money can potentially be spent more efficiently. In parallel with that, we need to make progress on services. I completely agree with that, and I will talk about the pharmacy integration fund and the Murray report, an important piece of work which my hon. Friend the Member for St Albans talked about and which will inform our policy.

We all agree not only on those three things, but on others. For example, there is a big benefit in diverting activity away from GPs. Various reports have been produced by the sector itself, and the Government accept that up to 30% or 40% of GP appointments could possibly be handled by pharmacists. That is a massive number. If we can achieve that, it will be of great benefit to us all. More can be done in pharmacies, such as medicine reviews and medicine optimisation, let alone how they can help us with the public health agenda, which we have not covered in particular today. A lot could be done with smoking cessation, obesity and sexual health programmes.

[Julie Cooper]

The Minister is contradicting himself. Pharmacists are already planning to reduce the hours that they are available to provide these services—the very services that he tells us he values and wants to see more of. Does he accept that if he persists with the cuts, there will be less of them? Some pharmacies will close, while others will reduce services, and are already planning to cut opening hours and reduce staff.

[David Mowat]

What we are not reducing is the amount of money available for services, as opposed to dispensing. Some pharmacies use part of their dispensing money to provide services on a discretionary and ad hoc basis, but I make this point again: overpaying for dispensing is not a good vehicle for getting more and better services.

I want to talk about some of what is already happening. We have heard about flu jabs this morning—I, too, had a flu jab at a pharmacy—and at the end of last year, we had had more flu jabs in pharmacies by October than we had in all of the previous year. The money available for that and similar service-based allocations has not been affected by the changes we announced. The community pharmacy sector has received £10 million for flu jabs up to the end of October. We want to see more of that happening, and that direction of travel is important.

A number of hon. Members made the point, which I agree with, that the public need to understand that pharmacies represent an important first port of call—it should not always be GPs. The Government can do more to make that clear. When I was preparing for this debate last night, I saw a television advert from NHS England for its “Stay well this winter” campaign. The campaign is running TV and newspaper adverts, and its theme is for people to visit their pharmacy as soon as they feel unwell. The people running the campaign have told us they think the advertising campaign has generated about 1.2 million additional pharmacy visits that would not have happened otherwise. That was a good challenge and we need to do more of that.

We also need to go further with services. There are two approaches. I recommend that anyone interested in this subject—as everyone present clearly is—reads the Murray review, which was produced by the King’s Fund. NHS England commissioned the review to inform it and us on how to spend the integration fund, the budget available to drive services more deeply into the system. I will talk about some aspects of that and about some announcements that I made in October as part of the package we are discussing.

One of the announcements was about urgent or repeat prescriptions. At the moment, NHS 111 gets about 200,000 phone calls a year asking for a further prescription, and those callers are told to see an out-of-hours GP to issue a prescription, which in due course goes to the pharmacy. We are changing that so that people will be directed to a pharmacy immediately. That is a stream of revenue for the pharmacy, which will provide both a consultation, for which it will be paid, and then the drug or prescription, as necessary.

My hon. Friend the Member for St Albans asked whether that scheme would somehow affect a good local scheme in her area. There is no reason why that should be the case. The new scheme is supplementary to anything that might have been commissioned already. It sounds as if her scheme was commissioned by the CCG, and that is good, although it takes us to the fact that things are patchy—different CCGs do different things in different areas, which I will come to. However, that is an example of where we need to be.

Another example is the minor ailments scheme. As I have said, 30% to 40% of GP appointments could be dealt with in pharmacies. Parts of England already have minor ailments schemes, but the service is very patchy and it need not be. It is true that different CCGs and indeed different GPs have different attitudes to such schemes, but NHS England has made a commitment that by March 2018 it will have encouraged all CCGs to be commissioning minor ailment schemes in pharmacies across their patch.

[Oliver Colvile]

Is the Minister aware that in Devon about £5 million a year is apparently being wasted on unused medicines? Something needs to happen with that to ensure that the NHS has enough money with which to do things.

[David Mowat]

Yes. Throughout the country, the number is far more than £5 million—

[Julie Cooper]

Will the Minister give way?

[David Mowat]

If I may answer the previous intervention, I will certainly give way again. I have talked about medicine optimisation and pharmacies doing reviews, in particular in people’s homes, for example, and they are part of that solution. Pharmacists in GP surgeries are part of the solution too, and a way of achieving that—as I said earlier, I do not agree that that is an irrelevancy.

[Julie Cooper]

I thank the Minister for giving way. A highly trained pharmacist, who often has a trusted relationship with his patients in the community, is better placed than any other health professional to lead on saving money on wasted drugs. Patients quite often say in a close conversation when they collect their prescription, “Actually, I’ve not been taking that,” but they quite often do not say that to their GP. The pharmacist will then take it upon themselves to say either, “Actually, do you realise you should be taking this?” or, “Let’s speak to your GP and, effectively, avoid waste.” The pharmacist is best placed to do that.

[David Mowat]

I completely agree. Pharmacists have a big role to play in saving money, and medicines optimisation is very important in that. NHS England has established an integration fund, which will provide £42 million—a significant amount, even in the context of the rebalancing that has occurred—of seed money between now and the end of the next financial year to address just those sorts of things and take that work further.

The Murray review, which was commissioned by Dr Ridge, the chief pharmaceutical officer at NHS England, and published in December, sets out in some detail what we believe the direction of travel should be. Someone asked earlier when the Government will respond to that review. I expect NHS England to respond this month—if I may put that on the record in that way. NHS England will respond, not me, but there is not a lot in the review that is controversial. There are a lot of very good points, many of them about IT integration and the care record. I agree completely that some of the progress we need to make with services involves the ability to both read and write to the summary care record. That will be part of where we have to get to. Frankly, technology is an area in which the NHS could improve. That is true in Scotland—it is true everywhere. I will not spend a lot of time talking about what we need to do, but we could facilitate an awful lot of progress on integration between pharmacy and primary care, and primary care and secondary care, if we had stronger technological and IT solutions.

Colleagues have talked about the need to have more pharmacy involvement in medicines optimisation, and care homes are part of that. Pharmacists could do an awful lot with a more structured approach to care homes. One strand of work that has come out of the integration fund is a care homes taskforce, which is chaired jointly by the Royal Pharmaceutical Society and NHS England and is setting out a direction of travel for doing the sorts of things we have talked about, such as medicines optimisation, in a more structured way in care homes right across the country. There are more than 50,000 qualified pharmacists across our country. There are also 23,000 qualified pharmacy technicians, who are part of this too. The pharmacist profession is not as short as some, and it can and needs to do more to make progress in this area.

One part of the Government’s approach to this whole area that has been mentioned and I do not think enough is made of is the GP forward view. Everyone understands how much pressure GPs are under. There are something like 400 clinical pharmacists working in GP practices. We have committed and budgeted £112 million to increase that to 2,000 clinical pharmacists, many of them dispensing pharmacists. Parts of the community pharmacy network, which we have heard a little about, regard that as potentially in conflict with what they do. I think that is wrong. It is not in conflict; it is a way of breaking down the barriers that I accept there have occasionally been between CCGs and GPs and the pharmacy profession. Those are not in anyone’s interests, and we need to get over them.

[Mrs Main]

The only concern I have about too much of a drift towards putting pharmacists in GP surgeries is that GP surgeries have limited opening hours. Many pharmacies have a drop-in service. My hon. Friend the Member for St Austell and Newquay (Steve Double) mentioned the average waiting time of eight minutes. Having a link between booking a GP appointment and going to the pharmacy would start to bring people back into GP services rather than keeping them outside those services. That is the only concern I have about that matter.

[David Mowat]

That is of course a valid concern. We are trying to make progress on having GP services open for much longer than they have been historically, including weekend opening. Several colleagues have made the point—the Murray review also addressed this—that there is occasionally a barrier between the attitudes of some GPs and what can be done by pharmacists. That is true. We must be conscious that it behoves us to try to encourage the breaking down of that barrier, and misplaced professional pride must not prevent us from doing things to the best extent. Putting some pharmacists in GP practices—particularly with new models of working in which more disciplines tend to work together and a GP does not just work on his own—is an important part of that.

[Jo Churchill]

There is a barrier, but again, those services are used in different ways. My independent community pharmacist in Bury St Edmunds dispenses around 18,000 or 19,000 prescriptions in the town and provides all these ancillary services. He also has a dispensing practice in a GP surgery, which he is looking to automate, to make it more streamlined and cost-effective. Those services are two slightly different things, and I would worry if there were too much of an idea that they service the same thing.

[David Mowat]

They are different, but my point was somewhat different: optimising the use of the pharmacist profession could facilitate the breaking down of barriers and some of the care home activities that have to happen.

I will leave a couple of minutes for my hon. Friend the Member for St Albans to respond, so I will not talk in detail about the value for money aspect, other than to repeat the point—Opposition Members made a couple of interventions about this—that overpaying for a dispensing service is not the way to facilitate a much more clinically-based and service-based approach. The way to facilitate that is to get the appropriate remuneration models and revenue streams in place, and that is what we are determined to do. In the end, that is what we expect to be judged on, and I hope that we will be judged on it. With that, I will let my hon. Friend summarise.

A&E Provision: Shropshire and Mid-Wales

David Mowat Excerpts

Wednesday 11th January 2017 Commons Chamber

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

In the few minutes available I shall give the House a recap, describing the process that we have undergone, the impasse that we have reached, and what it has been suggested we do to bring about a decision. I agree with my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) that it is important for us to make that decision and to get it right. The provision of better A&E services for the whole county in a way that works for everyone should not be the divisive issue that it has become.

First, however, I think it appropriate to reflect on the 2.7 million people who work in the NHS and the care system and to acknowledge and congratulate them on the work that they do. Today, as every day, some 2 million people have used A&E services across the country. Let me also say that my hon. Friend the Member for Shrewsbury and Atcham has worked diligently on this issue, as have other Members, including my hon. Friend the Member for Telford (Lucy Allan). I know that it is difficult for them to get this right for their constituents.

At the beginning of his speech, my hon. Friend the Member for Shrewsbury and Atcham made the important point that, ultimately, this must be a local decision. It is not a decision for Ministers, and it will not be imposed. It will be made by the local governance bodies that have been established, notwithstanding the present impasse.

Let me summarise what has been happening. This is a tale of two CCGs and a hospital trust providing services across Shropshire—in Ludlow, Bridgnorth, Oswestry and Shrewsbury—and, indeed, in mid-Wales, including Powys. I agree with my hon. Friend the Member for Montgomeryshire (Glyn Davies) that we need to get this right for the people of Wales as well. The process has been going on for a long time, but the driver for change is not financial. We are finding it increasingly difficult to staff the two A&E centres in Telford and Shrewsbury. Rotas are not being filled, and it is feared that unless we find a robust solution, there will be safety issues and it will not be possible to keep the centres open for as long as we want.

My hon. Friend the Member for Shrewsbury and Atcham observed that this was not a new issue, and that is certainly true. I understand that it is being discussed locally and that projects have been reviewing it since about 2005 without a solution being found. The Future Fit project was set up in 2013. As has been said, the process ended at the end of last year with a preferred option, which was, in broad terms, that emergency care should be centralised in Shrewsbury, with urgent care continuing to be in both locations. I heard it said in the debate earlier that that would mean most patients would continue to be served closer to where they are, either at Telford or Shrewsbury.

On the governance issue, the report of the Future Fit process was voted on by members of the two CCGs, who have broadly a 50% share in that decision, and the result was a tie. Indeed, Telford CCG raised concerns about the methodology of the process and the appraisal techniques used and whether it was robust and fair. As a consequence, there has been no agreement and we have reached our current impasse.

I understand that at the end of December an editorial in the Shrewsbury Star—

[Daniel Kawczynski]

Shropshire Star.

[David Mowat]

Sorry, an editorial in the Shropshire Star—it is not a newspaper I read—made the point that we now need to get this right; we need to make a decision and to stick by it. I think everybody in the Chamber would agree with that, with the caveat that in the end it has to be a local decision. There are very real battle lines here; I think my hon. Friend the Member for Telford met the Secretary of State yesterday on this with other Members and council leaders.

What is the proposed way forward? My briefing from the CCGs is that a week today there will be a meeting at which the intention is that two things happen. The joint committee will be reconstituted and an independent chair appointed who will have a casting vote. In parallel with that, there will be an appraisal, or review of the appraisal process, that Future Fit takes, with the intent to address the concerns raised by Telford about whether it was robust. At the end of the review—depending on the outcome, I guess—there will be a new vote with a view to potentially having a majority on one side or the other and therefore there will be a local direction. That is my understanding of the way forward.

[Mr Paterson]

It is tremendous news that there will be a mechanism that will give us the ability to come up with a clear answer. Does the Minister have any idea of the timescale for this new process?

[David Mowat]

I have been advised that the timescale is in the order of eight to 12 weeks, but it remains a local decision. That is what we hope and expect to be the case.

In finalising my comments, I want to make a couple of observations.

[Daniel Kawczynski]

I am pleased with the Minister’s announcement; hopefully we will see a conclusion to this. May I appeal to him to take an active interest in the process in these eight to 12 weeks because the integrity of this devolution of power is at stake unless we empower the clinicians to take the decisions we have ultimately empowered them to take?

[David Mowat]

I am happy to agree to that, although I should have said at the start of my remarks that in the normal course of events this debate would have been answered by my ministerial colleague, my hon. Friend the Member for Ludlow (Mr Dunne), as he is the Minister with this responsibility, although he is not independent on this, so it is appropriate that I answer for the Government.

Once the decision has been taken and a consultation occurs, a component of the proposal will require capital. Various numbers have been floated around, one of which is £300 million. I do not believe that NHS England has yet confirmed that that capital is available, so there is a hurdle to be overcome once a local decision has been taken. I do not want to raise expectations that the process will necessarily be straightforward. This is the way in which the process will occur, as I am sure colleagues would expect. If, as a result of that stage, capital is awarded, there is the potential for those on either side of this discussion to take the configuration proposal to the independent reconfiguration panel. That is always the case in such processes, and the panel can accept or not accept what has been suggested. That is the normal process in the NHS.

I want to make one final point to all my colleagues, who are so keen to get this right for their constituents in Telford and in Shrewsbury. I ask them to remember that the NHS is not just about bricks and mortar. We often have discussions about the bricks and mortar, but I want gently to point out to right hon. and hon. Members that there are other things that they should be holding their clinical commissioning groups to account for. They should be looking at cancer performance, cancer survival rates and maternity performance, for example. There are many aspects of the NHS that are not about bricks and mortar, and it is important that Members should recognise that when we debate these matters.

Question put and agreed to.

Oral Answers to Questions

David Mowat Excerpts

Tuesday 20th December 2016 Commons Chamber

[Lyn Brown (West Ham) (Lab)]

7. What steps his Department is taking to work with community pharmacies to reduce (a) waste and (b) the cost of medicines.

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

NHS England has a range of initiatives for waste and medicine cost reduction. We estimate that there is a prize of up £150 million a year to be realised across the system on waste. Community pharmacies have a significant role to play in that, partly through their existing duty to review prescriptions when repeat dispensing and partly through the separately commissioned medicine use reviews.

[Lyn Brown]

The Minister is absolutely right to say that community pharmacies have an important role to play. On 17 October, he told the House:

“We do not believe that any community pharmacies will necessarily close as a result of these cuts.”—[Official Report, 17 October 2016; Vol. 615, c. 597.]

However, the impact assessment published by his Department just two days later described a possible scenario in which 1,000 pharmacies close. Will the Minister confirm that nobody in Britain will have to travel further to get to a chemist as a result of his cuts?

[David Mowat]

The impact assessment set out an upper range, which we do not believe represents an accurate reflection of what will happen. The facts of the matter are that we need our community pharmacy network to move towards services and away from dispensing. Paying every community pharmacy in the country, or 91% of them, £25,000 just for having an establishment does not achieve—[Interruption.]

[Mr Speaker]

Order. The hon. Member for West Ham (Lyn Brown) should not chunter from a sedentary position in an attempt to hector the Minister, who should glide seamlessly above the attempted provocation. Minister, continue.

[David Mowat]

The Minister has finished.

[Mr Speaker]

He has finished his answer. Very well; I call Alistair Burt.

[Alistair Burt (North East Bedfordshire) (Con)]

To ensure not only that unnecessary costs are reduced, but that the best community pharmacy services are provided, will the Minister do all that he can to make sure that clinical commissioning groups engage as effectively as possible with pharmacies? Preferably, that would be by getting more people on CCG boards to ensure that the crucial connection between the provision of health services and pharmacy is absolutely at the heart of what we do.

[David Mowat]

My right hon. Friend is right; CCGs are variable in the extent to which they commission pharmacy services. However, we have set out the minor ailments scheme, it will be rolled out nationally by April 2018 and we expect every CCG to take a part in it.

[Sir Kevin Barron (Rother Valley) (Lab)]

As chair of the all-party group on pharmacy, I have seen many examples of drugs that have been prescribed and not used, as I am sure we all have. Should we not renegotiate the national contract, which currently pays community pharmacies more than 90% of their income through prescribing? Surely we can do things differently.

[David Mowat]

The right hon. Gentleman rightly says that we must change the contract to move away from 90% of the income coming from dispensing. Far more must come from services, which are separately commissioned by CCGs and others. The Murray review, which he will be aware of from his work on the all-party group, sets out a road map for that, and NHS England is determined to implement it.

[Mr Stewart Jackson (Peterborough) (Con)]

May I pay tribute to the excellent work of pharmacies in my constituency? Last night, “Look East” demonstrated the pressure that urgent care centres in the east are under because of extra patient footfall. Will the Minister give me an undertaking that he will put in place guidelines to CCGs to encourage them to work much more closely with pharmacies to reduce that footfall?

[David Mowat]

My hon. Friend raises an important point, and he is right to say that we must move the community pharmacy network away from just dispensing and into services, which will include minor ailments and repeat prescriptions. I will be encouraging CCGs to do that.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

Community pharmacies, which were developed in Scotland 10 years ago, are there for minor ailment, chronic medication and public health services. Although the Minister has expressed admiration for the Scottish system, does he not recognise the need to work with the pharmacy profession to develop the full potential within community services?

[David Mowat]

I have mentioned on previous occasions that Scotland has, in some respects, gone further and faster than we have in England so far on community pharmacies. The £300 million that we have set aside in the integration fund for the rest of this Parliament is going to be used to do just the things that the hon. Gentleman has mentioned, in terms of minor ailments and repeat prescriptions. We are determined to make that happen.

[Julie Cooper (Burnley) (Lab)]

Over the festive period, in every town and city in the UK, community pharmacies will be open to dispense emergency prescriptions, and to provide specialist services and professional advice. Does the Minister appreciate that service, which not only helps the public, but takes pressure off other parts of the NHS? Will he join me in thanking community pharmacies and their staff for the work they do? Will he commit to reconsider budget cuts that will lead to a reduction of this valuable service, and instead meet the Royal Pharmaceutical Society and the National Pharmacy Association to discuss extending the role of community pharmacies, to deliver savings for the NHS?

[David Mowat]

I have met the royal college of pharmacies on a number of occasions, and indeed it has worked with us on the Murray review, which is an essential road map that sets out how we are going to move the community pharmacy network away from a remuneration model based just on dispensing and on to services as well. I agree with the hon. Lady that the 11,000 community pharmacies across the country all provide excellent services, and we expect that to continue.

[Conor McGinn (St Helens North) (Lab)]

8. What plans his Department has to help the NHS deal with pressures on services in winter 2016-17.

--- Later in debate ---

[Rob Marris (Wolverhampton South West) (Lab)]

13. How many patient days of delayed discharge attributable to the levels of suitable social care available at the Royal Wolverhampton NHS Trust there were in (a) 2010 and (b) 2016.

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

Directly comparable figures are not available, but it is clear that in the past two years there has been a substantial increase in delayed discharge figures attributable to social care at the trust, which this year were among the worst currently being recorded across the NHS.

[Rob Marris]

Sadly, those figures are no surprise, despite the well-managed New Cross hospital, because central Government have cut Wolverhampton City Council’s total income by almost 50% in the past six years. The primary care vertical integration pilot in Wolverhampton is a redesign of services so that a single organisation—the hospital trust—deals with patients from initial contact to ongoing management and end-of-life care. What steps is the Department of Health taking to support vertical integration as one potential way to improve care and lessen hospital admissions and delayed discharges?

[David Mowat]

The hon. Gentleman is right that budgets are part of the issue, which is why last week’s announcement about increased funding is important. However, funding alone does not explain the delayed transfers in Wolverhampton, which are five times worse than those of Telford, which is just down the road; twice as bad as Sandwell, which is very close; and, indeed, 30 times worse than the best performing councils, such as Newcastle, Knowsley and St Helens. With regard to his specific point about the vertically integrated pilot, this is a very exciting project and I commend the people of Wolverhampton for doing it. It is based on a model from Spain that has produced big results. We are watching it carefully and will support it as required.

[Natalie McGarry (Glasgow East) (Ind)]

15. What assessment he has made of the potential effectiveness of introducing (a) a ban on price-cutting promotions on unhealthy food in supermarkets and (b) restrictions on advertising of unhealthy food during family television programmes in reducing childhood obesity.

--- Later in debate ---

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

T7. As my hon. Friend is aware, last week the Murray report was published. When is he likely to consider it, and when will he make a statement?

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

I thank my hon. Friend for that question and commend him for his work as a pharmacy champion. The Murray review was indeed published last week, and NHS England will respond to it in detail early in the new year. It is a very important document because it sets out in some detail how we intend to transform the community pharmacy network into a service-based profession along the lines that my hon. Friend likes.

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

T3. Last week, a 76-year-old man with diabetes in my constituency took a fall and had to wait almost two hours for an ambulance. I then wrote to the Health Secretary after it emerged that not a single ambulance trust in England met its response time targets in October, including for the most critical of cases. Will he explain the reasons for these unacceptable ambulance delays and what he intends to do as we approach Christmas?

--- Later in debate ---

[Mark Pawsey (Rugby) (Con)]

My constituent Marie Bingham administers a drug at home using pre-filled syringes, but she is unable to dispose of the used needles, partly because they are in 2.5 litre sharps tubs rather than 1 litre sharps tubs. It is a ludicrous situation. Is the Minister aware of the problem, and are there any steps he can take to deal with it?

[David Mowat]

As my hon. Friend says, pharmacies are commissioned, on such occasions, to dispose of these needles. I was not aware of the particular issue about the 2.5 litre tubs that seems to exist in Rugby. I will investigate that and revert to him.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

TB rates are currently higher in bits of Ealing than in Rwanda. Could the Government better the bilateral innovation fund to which they have committed with China and go for the O’Neill report recommendation to work towards a truly global fund, in conjunction with other nations, to fight antimicrobial resistance?

[Tom Pursglove (Corby) (Con)]

A fortnight ago, I visited the pharmacy at the Corby urgent care centre to thank the dedicated staff for all that they do all year round, and to have a flu jab as part of the ongoing campaign. Does the Minister agree that exactly that sort of proactive working is crucial in trying to tackle winter pressures?

[David Mowat]

I do agree with my hon. Friend. I am particularly pleased that this year, the pharmacy network has done more flu jabs so far than in the entire period last year. I had my flu jab, and it is holding up well.

[Mr Speaker]

It is always useful to have a bit of additional information. We are greatly indebted to the Minister.