(8 years, 10 months ago)
Commons ChamberI thank the hon. Lady for her excellent question. I know that the whole House is thinking of Pauline Cafferkey and her family and that it is proud that, under Dr Mike Jacobs and his team, she is getting the most outstanding care that it is possible to get anywhere in the world. We all wish her a speedy recovery. With respect to winter pressures, I know that the Royal Free had a difficult winter but I also know that it has a very good management team and made heroic efforts. I know that the whole team of doctors and nurses will do an excellent job, and we will want to support them in any way we can.
As part of my right hon. Friend’s plans for dealing with winter pressures, will he look at making greater use of the 63,000 practitioners on the Professional Standards Authority’s 17 accredited registers covering 25 occupations? Has he found time yet to read the authority’s report, “Accredited Registers—Ensuring that health and care practitioners are competent and safe”?
(8 years, 10 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
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The hon. Gentleman is right that, in the past, the NHS has not had the funding that it requires. That is exactly why the Government have committed £10 billion to the NHS at a time when efficiency savings are being made across all other Departments. That is the mark of a party that believes in the NHS and the reason why only this party can fairly claim to be the party of the NHS.
I suggest to my hon. Friend that one way to reduce the pressures on the service would be to make greater use of health professionals who are regulated by the Professional Standards Authority, which covers 13 mental health and wellbeing professions. What is the point of people getting statutory oversight, regulation and registration if the health service does not employ them to reduce the demand for its services?
My hon. Friend is right to point to this area of health policy as one that is of interest. That is why the Law Commission reported on professional regulation before the last election. It is being kept under close review within the Department.
(9 years, 1 month ago)
Commons ChamberHas my right hon. Friend had a chance to read the report by the Professional Standards Authority for Health and Social Care, which says that pressure would be taken off doctors and nurses if greater use were made of the 63,000 practitioners that it regulates on 17 separate registers covering 25 occupations? Will he look at the report and write to me?
I am very happy to do that. My hon. Friend is right to point out that the solution to the problem is not just about expanding the number of appointments offered by GPs, although we are doing that; it is also about looking at the very important role that pharmacists and other allied health professionals have to play in out-of-hospital care.
(9 years, 2 months ago)
Commons ChamberWe do need to make important changes to the training of medical staff, and I shall give the hon. Gentleman one example of where that matters: creating the right culture in the NHS so that doctors and nurses feel able to speak out if they see poor care. In a lot of hospitals they find that very difficult, because they are working for someone directly responsible for their own career progress, and they worry that if they speak out, that will inhibit their own careers. We do not have that culture of openness. The royal colleges have been very supportive in helping us make that change, but yes, medical training is extremely important.
To build on the point made by the hon. Member for Huddersfield (Mr Sheerman), is not a critical aspect—something that the Health Committee has looked at—what doctors are learning now? More needs to be done about prevention. Has my right hon. Friend seen early-day motion 1 about reducing levels of obesity, and is not reducing the amount of sugar in fizzy drinks a key challenge for him?
My hon. Friend is absolutely right. The big change we need to see in the NHS over this Parliament is a move from a focus on cure to a focus on prevention. In this Parliament, we will probably see the biggest single public health challenge change from smoking to obesity. It is still a national scandal that one in five 11-year-olds are clinically obese, and I think we need to do something significant to tackle that in this Parliament.
As my hon. Friend the Member for Liverpool, Walton (Steve Rotheram) pointed out a moment ago, NHS services are often not there for young people in particular when they need them, but we must also ask ourselves why people end up in that position in the first place. We have seen, in some of the public policy decisions that have been made in recent times, a failure to understand how changes can affect people’s mental health. The work capability assessment, for instance, did not pay sufficient regard to mental health, and that needs to change if we are to give people proper support in this Parliament.
Let me, at the start of the new Parliament, urge all new and all re-elected Members to bear in mind the momentum on mental health that was built in the last Parliament, and to do everything they can to build on it. Given the nature of modern living and the stress and insecurity that we all have to absorb, mental health will remain the issue of our times, and we shall need public policy to match. The last Parliament made huge progress in raising mental health issues, but this Parliament needs to translate those words into action.
Progress was also made on patient safety, and the Secretary of State deserves credit for that, but, again, it is important for the momentum not to be lost in this Parliament. In that context, there appears to be a significant omission from the Gracious Speech. Improving the regulation of health professionals was a central recommendation that emerged from the Francis report, and a Bill to modernise professional regulation has long been anticipated. It would have had cross-party support, and would have enabled the regulators to get on with the job of protecting and safeguarding the public from poor care. The failure to introduce such a Bill means that there is now no prospect of reducing the time it takes to deal with complaints, which, at present, is typically 15 months from start to finish. Jackie Smith, chief executive of the Nursing and Midwifery Council, has said that she is “deeply disappointed” by the omission, and that it is a “major setback” to the response to the Francis report. Can the Secretary of State explain why no such Bill was mentioned in the Queen’s Speech, and tell us when it can be expected? We need a professional regulatory regime that is modern, up to date and fit for purpose.
The issue on which I now intend to focus is finance. For the last five years, we have been treated to repeated lectures from Ministers about the importance of sound management of the public finances. That is the signature of this Government, or so they like to claim. Today I want to put that claim to the test in respect of the NHS, and to look in detail at the Government’s stewardship of NHS finances.
The Government like to talk about the deficit, but they do not often mention the very large deficit they have created at the heart of the NHS. We will put that right today, and consider the promises they made in the run-up to the election: local promises to reopen A&E departments, and national promises to deliver GP opening hours of 8 am to 8 pm and seven-day NHS working. We will ask how all that can be delivered, given that the NHS finances are deteriorating fast.
I am listening with interest to the right hon. Gentleman, but surely he has forgotten about the private finance initiative, which was his initiative and which got us into all sorts of trouble financially.
The Conservatives are fond of saying that we did not fix the roof when the sun was shining, but I can tell the hon. Gentleman that we did fix the leaking roofs of hospitals and GP surgeries that they left behind, and we had to invest a significant amount to do so. When we came to office in 1997, more than half the NHS estate predated the NHS itself, and people remember those days. We had to put that right: we had to rebuild substantial portions of the NHS simultaneously by means of the PFI, which, I might add, was inherited from the Major Government.
(9 years, 2 months ago)
Commons ChamberI should make it clear first that, for the hon. Lady’s constituents, we have no say over the control of the health service in Northern Ireland. We have seen an increase of 24% in middle-grade doctors in the English health service and, as I have said, we have seen an increase in all doctors in emergency medicine of 25%. That is a considerable increase in an area that has been difficult to recruit to for a very long time. The Government made a difference in our previous incarnation and we will continue to do so.
I welcome my hon. Friend to his place and wish him well. Is he aware that when the Select Committee on Health considered emergency care and took evidence from the Royal College of Emergency Medicine in the last Parliament it was clear that there was a perception among doctors that this was not as attractive as other specialties and that that is a serious problem? What is he going to do about it?
I thank my hon. Friend for bringing that to my attention. I was not aware of it and it is certainly something I shall consider. There are several specialties in the NHS where this is a problem and I shall be addressing that as I review the workforce in the years to come.
(9 years, 7 months ago)
Commons ChamberIs my right hon. Friend aware that there is clear evidence that homeopathy is effective in treating autism, especially when doctors have not found a solution? Now that the Society of Homeopaths is regulated by the Professional Standards Authority, will he make more use of homeopathy in the health service generally, and in this particular instance?
The hon. Gentleman’s question is quite a long way from the statutory guidance, but it can be given a brief reply.
(9 years, 8 months ago)
Commons ChamberIt takes seven years to train a GP, so the long-term solution is to train an additional 5,000 GPs, which is what the Government have decided to do and have announced. While they come on stream, this additional money will fund up to 20,000 additional posts, a number of which will be in the community.
I congratulate my right hon. Friend on his emphasis on prevention. Has he had a chance to read Public Health England’s report “From evidence into action”? It encourages him to place greater emphasis on risk factors that contribute to an early death, such as tobacco, blood pressure, diet, inactivity and alcohol, rather than the actual conditions that people die from. That would cut demand for services.
That document is very powerful and I have said before that I hope that in our lifetimes this will become a smoke-free country. It is shocking that we still have 85,000 deaths every year linked to smoking. However, we are a free country so this is about supplying the information, incentives and nudges and not about compelling people.
(9 years, 9 months ago)
Commons ChamberWe will not take any lessons from the Labour party about general practice. It is not just the disastrous 2004 GP contract. The president of the Royal College of General Practitioners says that the shadow Health Secretary’s plans
“could destroy everything that is great and that our patients value about general practice and could lead to the demise of family doctoring as we know it.”
13. What steps he is taking to increase patient choice.
This Government are committed to patients having greater choice and control over their health care, and decisions as to which treatments are available on the NHS are taken by GPs on the basis of available scientific evidence.
Does my right hon. Friend have any plans to increase personal health budgets, and will he ensure that there is greater awareness of the health professions that are regulated by the Complementary and Natural Healthcare Council, the Health and Care Professions Council and the Professional Standards Authority, which has recently accredited the Society of Homeopaths and the British Acupuncture Council?
(9 years, 9 months ago)
Commons ChamberI am grateful to be called to speak in the debate, Madam Deputy Speaker, and I apologise to my Front-Bench colleagues that I might not be here for the wind-ups because I have to be in Hinckley for the switching on of the Christmas lights, which is something I always look forward to.
I should like to follow a long tradition in the House in which the speaker who follows a Member making their maiden speech—even though I am told that, technically, it was not one—says something nice about them. I congratulate the hon. Member for Rochester and Strood (Mark Reckless) on winning his by-election last night, and I further congratulate him on getting to the House this morning. I imagine that he has been up all night. I simply offer him this warning. I was thinking of Dave Nellist, a former Member for Coventry, who defected to another party and then disappeared. I have to warn the hon. Gentleman—my former hon. Friend—that the history of those who defect in this place shows that they do not remain here for very long after they come back. We expect to regain his seat at the next general election, but well done to him in the meantime.
I should also like to congratulate the hon. Member for Eltham (Clive Efford) on introducing his Bill. I once had the honour to stand for the Greater London council in the constituency adjacent to his. It was then known as Woolwich East, so I know his area and his hospitals a little. He has certainly done well to get his Bill to the House, and I note from the Division this morning that he has 100 additional Members here today, so he is no doubt hoping for a closure motion at some point. If his Bill progresses, I would be happy to serve on its Committee. I have a long-standing interest in health matters and I have been a member of the Health Select Committee since it was set up in this Parliament, as well as of the Science and Technology Committee in this Parliament. I am also the chair of the all-party parliamentary group on integrated health care.
This is a wide-ranging Bill. I hope to address some of the things that are not in it, although I will not talk about all the things that are in it as time is short and I do not want to occupy the stage for too long. I want to look at three areas. The first is the hon. Gentleman’s proposal to change the arrangements that allow trusts to generate half their income from private sources. Secondly, I want to look at whether mergers should be dealt with by Monitor or whether that area should be reclaimed. I want to focus on mergers and integration, because the integration of services in the NHS is of fundamental importance. He might be able to improve his Bill in that respect. Thirdly, if time allows, I want to talk about the proposal to exempt the NHS from the transatlantic trade and investment partnership.
I have been listening to the right hon. Member for Wentworth and Dearne (John Healey), and I believe that Labour’s whole strategy is based on something that is fundamentally untrue. It is based on trying to persuade the electorate that we are setting out to privatise the health service and thereby reduce the health care available. It is regrettable that Labour is taking the Goebbels-esque approach of saying something that is fundamentally untrue and then repeating it and repeating it in the hope that the electorate will buy into it. I put it to Labour Members that that might be a populist approach, but it could be hard for them to defend as we get nearer the election.
The hon. Gentleman says that he does not believe creeping privatisation is taking place as a result of the changes that the Government have introduced, but does he not see it as an inevitable consequence, even if it is not the Government’s stated intention?
I thank the hon. Lady for her intervention. The Government have made it possible for trusts to generate half their income from private sources, but it is not true to make out that we are in some way privatising the health service in a way that is detrimental to patients. We have made it possible for trusts to generate more income. In an ideal world, it would be wonderful if we could pay for all health care through general taxation. However, the Health Committee has examined the Nicholson challenge and seen the tremendous demand on resources. We have managed to maintain a flat-line budget in this Parliament, but demand is such that it is difficult to pay for everything through general taxation. One way to do it is by getting the private sector to contribute to the health service. The original arrangements were increased to this figure of nearly half. The thing to remember is that all the money generated from these sources is reinvested in patient care.
I had some freedom of information requests made, and wish to refer to the effect of these arrangements on four NHS foundation trusts in the midlands. They are not from Leicestershire, because those figures did not come through, but I do represent a midlands constituency. The Dudley Group NHS Foundation Trust received £68,000 in 2010-11, £50,000 in 2011-12 and another £80,000 in 2012-13 in funds that can go directly into patient care. The figures for the Heart of England NHS Foundation Trust are £559,000 in 2009-10, another half a million in 2010-11, a bit more in 2011-12 and nearly £532,000 in 2012-13, and there has been an increase to £628,000 in 2013-14.
My FOI request to the Shrewsbury and Telford Hospital NHS Trust elicited the following response—it is a short paragraph, so if I may, I will read it out:
“The Shrewsbury and Telford Hospital NHS Trust gains substantial income from Apley Ward and Clinic. Where private patient work is carried out in an NHS hospital, it is carried out in addition to and not in place of regular NHS treatment. Profits from this private facility make a considerable contribution to the running costs of the hospital for the benefit of all patients and staff.”
The hon. Member for Eltham made a passionate speech, but this point goes to the heart of the issue: privatisation is not about reducing resources, but increasing them. I gave notice to the hon. Member for Walsall South (Valerie Vaz) that I was going to mention the other figures I received, which are from the Walsall Healthcare NHS Trust and which show that over the past four years it has gained between £14,000 and £50,000 a year. The figures illustrate clearly that this approach is helping, and that is very welcome.
The point my hon. Friend has just made is key in showing the dangers of this Bill. People have been writing to say that they are concerned about the risk of privatisation, but what is actually happening as a result of the 2012 Act process is that there is more money in our NHS, rather than less.
The Act is complicated. It is a big Act and it landed with a thump when the right hon. Member for Wentworth and Dearne (John Healey) dropped it on the Opposition Benches. I think he did so intentionally; and it was very theatrical and effective. It is true that there is more money there, and it is clear that the Government pledged at the last election to maintain the funding of the health service and have done so. We also have in place the Nicholson challenge, a phrase coined by my right hon. Friend the Member for Charnwood (Mr Dorrell)—formerly the Member for Loughborough—when he was Chair of the Health Committee, and we now face even greater challenges.
Let me set out to the hon. Member for Eltham what he could include in his Bill if it goes forward. He could examine the next stage of bringing together health and social care. On Tuesday, the Health Committee heard from Dame Kate Barker, the chair of the Commission on the Future of Health and Social Care in England. We were examining the transitional costs of bringing health and social care together, and looking ahead at the savings that can be made. The hon. Gentleman might apply his mind to the complications arising from the different streams of funding represented in health and social care, whereby health is funded by general taxation and some private support, which I have already discussed, whereas social care is the subject of means tests and other constraints. We are therefore talking about completely different funding stream. I do not know how the Health Committee will report this, but I was struck by Dame Kate Barker’s determination that there should be one person running health and social care. That is essential if we are going to bring those two things together.
The other point the hon. Gentleman should take on board as we look at the Bill is the high profile that the Secretary of State and his predecessor, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), have given to patient choice. The Government have said time and again that patient choice is at the heart of the health service, and we have already seen the benefits. The personal budgets now available for people who are seriously ill have had three benefits. First, they enable the patient to choose whatever treatment they want, be it tai chi, yoga or piano therapy—I believe that there have even been cases where tickets to a football match have been given. This is not something regulated by double-blind placebo controlled trials, as some of the other access arrangements for health care are. Secondly, the personal budgets enable the carers to go out into the world and get jobs, so freeing them up. Thirdly, when the personal budget money is given, it is spent responsibly by the patients. We have a whole new paradigm of health through personal budgets, and that should be examined through this Bill.
I have always felt that the 2012 Act and the reforms that were made produced something that put in place two legs on the stool, not three. The third leg comprises the vast and diverse multiplicity of support services that are not used in great depth in the health service now. Using them would considerably reduce costs and increase choice. The choice of these other support services will inevitably come to the fore as patients demand what they want, and we really have to bring this into the health service.
I have had many conversations about these things with the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter)—the Minister on the Front-Bench today. He has entrusted me with being vice-chair of the herbal working group, which is trying to sort out herbal medicine regulation. When we examine the support services that are not now part of mainstream health care, we see that we have a fundamental problem relating to the insistence that we rely on evidence-based medicine. I do not know where that phrase came from—it has not been around for a long time. Various bodies protect the public, and all new drugs are carefully scrutinised, by the pharmacists and the Herbal Medicines Advisory Committee, which has put together a list of what are, in effect, poisons and bans the use of some herbs. The public are protected in that way, but it is very difficult to use normal measurements to assess the effectiveness of, for example, acupuncture, which the National Institute for Health and Care Excellence has approved for treating lower back pain. A lot of evidence shows that acupuncture can reduce the effects of lower back pain and save the NHS a lot of cost. With homeopathic medicine, which I have long supported and advocated, it is impossible to run trials on every dilution: some are so dilute that they do not show up.
I am always glad to give way to the hon. Gentleman—I am sure he will agree with my every word.
My hon. Friend will be well aware that there have been many trials of homeopathic medicines, and the fact is that none of them has shown that they work better than a placebo. He is right that they are very dilute; that is why they do not work.
The hon. Gentleman makes my point. I remember when some of his friends went to Boots in Kensington high street and consumed the entire stock of homeopathic medicine. They saw that as a huge triumph, as they felt it illustrated the fact that homeopathic medicine was not effective. Of course it did nothing of the sort; it proved that it was absolutely safe to take these preparations under any circumstances, and that the only time they work is if they are in the right preparation and are taken in the right amount, as prescribed by a professional.
I say to the Minister—I hope he will tune in to what I am saying—that we must move away from this insistence on evidence-based medicine and look at evidence-based practitioners. This is an area that has been overlooked for a very long time. There is much evidence that practitioners are well regulated, and we do not need to insist on checking every single preparation that people consume. Five areas of regulation already exist. The hon. Member for Eltham might want to think about that, as it is a matter that could be put into the Bill if it goes to Committee.
Order. The hon. Gentleman is aware that I am watching very carefully the matters that he is addressing in the House right now. He must speak to the Bill. We are discussing whether the Bill should have a Second Reading and go into Committee.
Madam Deputy Speaker, you are kind to draw that to my attention. I simply say this: there are different regulatory bodies—not just Monitor—that we should consider. We should be taking on board the fact that osteopaths, chiropractors and homeopathic doctors are regulated by separate Acts of Parliament, yet the Health and Care Professions Council regulates clinical scientists, paramedics, physiotherapists. The Professional Standards Authority, which is another regulatory body, provides oversight of nine statutory bodies. Then there is the umbrella body, the Complementary and Natural Healthcare Council. I will leave it at that, as I do not wish to stray. On the safety aspects of those bodies, I understand from Balens, which has been insuring support services for 10 years, that there has not been a claim against a herbalist for more than 10 years.
The Bill partly addresses the issue of the transatlantic trade and investment partnership. Across the world, there is a whole mass of new thinking that could be incorporated in our health service. I am nervous that if we take out TTIP—if an exemption for the NHS is proposed—it will not be in our interests. In America there are a lot of integrated practices, in which a range of different health disciplines are brought together to reduce costs.
Does my hon. Friend agree that the Government and the European Commission have made it clear that decisions on the provision of public services will continue to be made by the Government here in Westminster?
We are agreed on that. It is a case of the extent to which we derogate the powers of the Secretary of State. We have a whole lot of new bodies, including clinical commissioning groups, which have been a great success.
I congratulate the hon. Member for Eltham on securing this slot today. I wonder whether he still has 100 troops in the Tea Room waiting to come in for a closure motion, if Madam Deputy Speaker is gracious enough to grant it. I am happy to serve with him in the future on his Bill.
(9 years, 10 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
I talked about having a more measured debate, but I think I was speaking a trifle too soon, judging by what we have just heard. The right hon. Gentleman obviously was not listening to what I actually said, so let me just repeat to him that the Government warmly welcome this report. I talked about it as a “blueprint” for the future. He did not agree with setting up NHS England, and I do not think he agreed with the appointment of Simon Stevens as the chief executive, but we did that so that we would have a body that would think strategically about the long-term future of the NHS at arm’s length from the Government. That is what it has done, and the report is excellent.
The right hon. Gentleman and I have a sometimes slightly fractious relationship, but I would like to congratulate him this morning on his Houdini-like spin in the way he is approaching this report. He has been constantly telling this House that the NHS is on the point of collapse, but the chief executive of NHS England says that the NHS has been “remarkably successful” in weathering the pressures of recent years. The right hon. Gentleman has told this House constantly that the biggest threat to the NHS is privatisation and competition. This report, a five-year forward view, by bodies at arm’s length from the Government, contains not one mention of competition and privatisation as a threat, yet he says this report endorses Labour’s plans.
The right hon. Gentleman says, as has his leader, that the first thing he would do in government is repeal the Health and Social Care Act 2012 and strip clinical commissioning groups of their powers. He really should read the report carefully on that. He now says he welcomes the report, but it begs him not to carry out further big structural changes; it does not call for the repeal of the 2012 Act, and this is the report which he warmly welcomes today.
Then we need to consider money. The right hon. Gentleman told this House repeatedly that it was irresponsible to increase spending on the NHS, but now we have a report that says that the NHS needs real-terms increases, along the lines that this Government have been delivering in this Parliament. What does he say? He says, “It is great to have our plans endorsed by NHS England.” This report does not endorse Labour’s narrative; it exposes it for the shallow party politicking that we have had from him.
Let me say to the right hon. Gentleman that the really important message of this report is something we can agree on, and he should be talking about that. We both agree about the integration of health and social care, which is now happening. We both agree about improving investment in primary care. We both agree that we need more GPs. We both agree that we need more care closer to home. I think the public would say that we would have a more measured, intelligent and sensible debate—the kind of debate they want to hear—if we started talking about the things we agree on a bit more instead of constantly pretending there are vast disagreements.
My right hon. Friend has welcomed this report, which says, among other things, that there have to be new ways of working and breaking down barriers. The Royal London Hospital for Integrated Medicine—part of the University College London Hospitals NHS Trust—which is about a mile away from here, is Europe’s largest public sector provider of integrated medicine. Will he go there and see its 13 care pathways, which use qualified complementary and mainstream practitioners, because then it will be clear to him how we can reduce costs in the health service and take the pressure off practitioners? Will he make that part of his package?
I congratulate my hon. Friend on finding every opportunity to promote integrated care. What the report says is that we need much more person-centred care. It welcomes the kind of models that we see in Tower Hamlets, where the new clinical commissioning groups, led by inspiring leaders such as Sam Everington, are carrying out social prescribing. GPs are actually prescribing social solutions to problems as well as medical ones. This report is a big stepping stone towards that type of integrated care.