NHS Commissioning Board

Derek Twigg Excerpts

Tuesday 5th March 2013 Commons Chamber

[Norman Lamb]

I am grateful to my hon. Friend for that question. I should make it clear that we have enhanced the position that we inherited by absolutely reinforcing the importance of co-operation and integration for the first time—that was not part of any legislation under the previous Labour Government. Our Government are totally committed to legislating on and then enacting the importance of co-operation and integration, as he rightly says.

[Derek Twigg (Halton) (Lab)]

On 15 March 2011, the then Minister of State, the right hon. Member for Chelmsford (Mr Burns), said that in the NHS

“UK and EU competition laws will increasingly become applicable.”––[Official Report, Health and Social Care Public Bill Committee, 15 March 2011; c. 718.]

How can this Minister assure us that the amended regulations he intends to introduce will prevent a successful legal challenge from a private provider against a clinical commissioning group’s decision not to put out a service to tender?

[Norman Lamb]

The regulations will help substantially in ensuring that CCGs maintain control over the judgments they make in the interests of patients. European competition law existed as much under the previous Government as it does under this one, and these regulations will help to protect CCGs against those powers.

Regional Pay (NHS)

Derek Twigg Excerpts

Wednesday 7th November 2012 Commons Chamber

[Derek Twigg (Halton) (Lab)]

One way in which the Secretary of State can express his thanks is by ruling out regional pay. Will he tell us now whether he will do so, because it is a major concern for my constituents, who have written to me in their dozens over the past two or three weeks?

[Mr Hunt]

I am coming on to say exactly what the Government’s approach to regional pay is, so I will address the hon. Gentleman’s comments.

Mental Health Act 1983

Derek Twigg Excerpts

Monday 29th October 2012 Commons Chamber

[Mr Hunt]

My understanding is exactly the same as that of my right hon. Friend. The key point is that this was a technical irregularity, but we do not believe that any patient has been sectioned, detained or hospitalised who would not have been if the correct procedures had not been followed. It is none the less very serious that this technical breach happened; that is why, as well as correcting the technical breach and providing absolute clarity, we are conducting this review to make sure that we do everything we can to avoid anything similar happening again—even under completely different structures than the SHAs.

[Derek Twigg (Halton) (Lab)]

I do not necessarily disagree with anything the Secretary of State said, but I noted that he used the term “we believe”, which means that it is not simply factual at this point that no one has been detained who should not have been. It would be worth the Secretary of State addressing the reverse position: does he believe that no one who should have been detained has been released and then gone on to commit a serious offence?

[Mr Hunt]

As a result of the technical irregularities that we have identified and put right, I do not believe that what the hon. Gentleman describes has happened. Let me explain that when I say “we believe”, it reflects the advice we have had that there are good arguments on why the detentions were and are lawful, but that is not to say that those arguments cannot be challenged or that a court would necessarily agree with us. That is why it is necessary to take this unusual step of introducing emergency legislation.

Oral Answers to Questions

Derek Twigg Excerpts

Tuesday 17th July 2012 Commons Chamber

[Mr Lansley]

As I think my hon. Friend will know from recently published data, some of the pilot work involving general practices demonstrated that it was possible to increase substantially the number of patients diagnosed with dementia. I believe that during the pilot period there was an increase of two thirds, more than 60%, in the number diagnosed. As part of the Prime Minister’s dementia challenge, we are using quality incentives in the NHS to identify and refer patients who are admitted to hospital with potential dementia in order to improve their diagnosis and treatment. We hope that that and other measures will identify more of those whose dementia is at an early stage, and will also assist their treatment.

[Derek Twigg (Halton) (Lab)]

One of the key elements in the tackling of inequality is funding. The funds allocated to the clinical commissioning groups was set out in the operating framework, which related to GPs’ patient lists. It has now been changed to take account of data from the Office for National Statistics. Will the Secretary of State assure me that deprived areas will not lose out on the funds allocated to CCGs—not the per-head funds, but the funds allocated to CCGs as a result of the change?

[Mr Lansley]

As I am sure the hon. Gentleman knows, we will publish the allocations for 2013-14 later this year. However, we are ensuring, I think rightly, that the allocations to clinical commissioning groups for NHS services reflect the population, because they have a responsibility for the whole population. Some parts of the country, particularly London, have substantial unregistered populations, which often include the groups who are most at risk.

Care and Support

Derek Twigg Excerpts

Wednesday 11th July 2012 Commons Chamber

[Mr Lansley]

The £200 million over a period of five years that I have announced today will be able to be leveraged, with the involvement of private sector investment and social landlords, to provide an opportunity for several thousand additional places in specialist housing for older people and those with disabilities. We are talking about the kind of extra-care homes that give people the sense that they are moving into their own home, but with care available. That will be available in people’s own communities to a greater extent if we can increase the supply.

[Derek Twigg (Halton) (Lab)]

The Secretary of State says that he can give no commitments past the spending review in 2015. However, he said that by 2017—two years after that—we will have 50,000 more care workers. There is a big question over how that money will be found. He makes a big point of saying he has given local authorities all these extra resources to deal with the extra tasks that they will have. In the discussions on that, have local authorities said they are satisfied that he is providing enough money for them to carry out those extra tasks?

[Mr Lansley]

I know that the hon. Gentleman will not have had a chance to look in detail at the White Paper, but it makes it clear that the costs in the spending review period are more than adequately met by the additional resources. [Interruption.] The hon. Gentleman and his colleagues are confusing two different things. The White Paper looks at specific additional tasks—for example, in the provision of independent information and advice, including local information about access to care services. That is more than fully funded. The figure he mentioned referred not to the number of care workers but to the number of care apprenticeships that are being developed with the sector.

NHS Annual Report and Care Objectives

Derek Twigg Excerpts

Wednesday 4th July 2012 Commons Chamber

[Mr Lansley]

I am grateful to my hon. Friend. I agree that measuring patients’ experience of care is very important. Although there was and continues to be an NHS patients survey, there are many areas of patients’ experience that it did not reflect. For example, we received yesterday the first of the VOICES—views of informal carers for the evaluation of services—a survey of the experience of bereaved families of the quality of end-of-life care that their family member received. That is part of the process of ensuring that for the future we understand, measure and respond to the views of bereaved families about the quality of care they received. That is just one illustration. Another is for the very first time measuring the experience of care reported by young people below the age of 16. There is a complex inter-relationship with the specific benefits of community hospitals in individual locations, but I hope that one of the things we will be able to do is look at the data, which will be disaggregated across the country, and increasingly see what most contributes to the high levels of patient experience in different parts of the country.

[Derek Twigg (Halton) (Lab)]

I join the Secretary of State in congratulating NHS staff on their hard work and dedication, which is even more remarkable given the disastrous reorganisation they are having to work through at present. The Secretary of State talks about the new era. Can he today in Parliament rule out any additional charges anywhere in the NHS for patients who use the NHS in the next few years?

[Mr Lansley]

I am grateful to the hon. Gentleman. I said during the passage of the Health and Social Care Act 2012 that it had been intensively considered in its every aspect. The Act expressly rules out the introduction of any charges across the NHS, other than by further primary legislation, and there is no primary legislation to permit such a thing. So I reiterate the point: there will be no additional charging for treatment in the NHS.

Oral Answers to Questions

Derek Twigg Excerpts

Tuesday 12th June 2012 Commons Chamber

[Mr Lansley]

Yes, I can confirm that CCGs have the freedom to decide which commissioning activities they will do themselves and which they choose to secure from external organisations, thus enabling them to carry out their functions effectively. They can, if they wish, develop their own organisations and staff or contract with other organisations, and they are not required to contract with the commissioning support services hosted by the NHS Commissioning Board.

[Derek Twigg (Halton) (Lab)]

In order for the CCGs to be able to carry out and improve their services, they need appropriate funding. Will the Secretary of State therefore tell me why the Halton CCG has had less funding than it was promised originally?

[Mr Lansley]

If the hon. Gentleman is talking about the management budget for CCGs, I can tell him that we set out clearly that it would be up to £25 per head across England, and that is indeed the sum that will be made available.

Health Transition Risk Register

Derek Twigg Excerpts

Thursday 10th May 2012 Commons Chamber

[Derek Twigg (Halton) (Lab)]

It is no surprise that the Secretary of State is running scared of publishing the risk register, because, as the House should not forget, an awful lot of measures now come through secondary legislation because the Government left a lot of detail out of the Health and Social Care Bill. In his statement—this is not from a Whips’ spreadsheet, let me add—he said: “If such registers were disclosed at sensitive times in relation to sensitive issues, as would have happened in the case before us, it is highly likely that they would be open to misinterpretation and misuse”. At what point does he think that there will cease to be “sensitive times”, and will he publish before the next general election?

[Mr Lansley]

I will repeat what my noble Friend Earl Howe said: we have every intention of publishing the risk register, but will do so when it is no longer directly relevant to the formulation and development of policy.

Veterans (Mental Health)

Derek Twigg Excerpts

Wednesday 7th March 2012 Westminster Hall

[John Pugh (Southport) (LD)]

I congratulate the hon. Member for York Outer (Julian Sturdy) on opening this important debate.

I must admit that I am not a natural when it comes to defence-orientated debates. I do not come from a garrison town and I have no experience of the forces—I suspect I am naturally too insubordinate to fit into them. However, I have a genuine interest in this issue. It is spurred not so much by constituency cases, although a soldier came to see me who was severely traumatised by the conflict he had endured, and the atrocities he had seen, in Aden. It was an awfully long time ago, but it had scarred his whole life, traumatising him, driving him to alcoholism and creating huge mental health issues. I also dealt with a case in which a gentleman who had been advised by the Ministry of Defence to assist it with research at Porton Down on the common cold subsequently had a lot of worries that were quite unrelated to his exposure to the common cold.

What really sparked my interest, however, was my experience on the Public Accounts Committee, which produced a series of interesting reports on and around this area that showed up some quite distinctive and worrying issues. The report I want to dwell on was called “Ministry of Defence: Treating injury and illness arising on military operations”. It showed quite categorically that the forces were excellent at dealing with people’s physical ailments in the theatre of war and subsequently—the profile and the results were good, and the medical treatment was exemplary. When it came to mental health, however, there were some very odd results. For example, it appeared that American and British soldiers exiting the same theatres of war had widely disparate experiences in terms of their mental health, with more Americans reporting themselves, or being reported, as having mental health problems by a considerable margin.

Even more strangely, the figures coming out of the British forces for mental health problems showed soldiers were experiencing no real anxiety at all; in fact, they showed that troops were in just as good mental health as the ordinary population, which was odd. During the PAC inquiry, I told Sir Bill Jeffrey, who was permanent under-secretary at the time:

“I think we would all accept that war is extremely stressful and people see some horrid, fearsome things that would disrupt the psychology of almost anybody. What surprises me”—

then and now—

“is that the referral of the Forces appears to be lower than the referral rate of the population as a whole.”

I put it to him that that was intrinsically implausible:

“You would have thought there would be more mental health issues amongst a population of people who see quite traumatic scenes than amongst those who do not.”

More brutally, I said the rate of referrals

“is actually lower than the population at large. In other words, it would appear…that in the confines of Committee Room 15”,

where the PAC was meeting,

“we are far more vulnerable to mental health stress than people in the operational theatre of war.”

It can be pretty torrid in the PAC at times, but I suggest that result shows that something is going awry in the forces’ reading of troops’ mental health post-war.

Equally puzzling was the disparity between people coming out of the Iraq and Afghanistan theatres of war. Lieutenant-General Baxter, who was then the deputy Chief of the Defence Staff, explained:

“I think you have to look at the nature of combat…When you are being shot at and you can shoot back, it is a lot less stressful than when you are being bombed or suffering indirect fire.”

I do not know whether that is true, but it invites serious questions about the level and quality of screening when people are discharged.

Other reports that the PAC produced at the time were equally troubling. They showed, for example, that squaddies were far less well prepared for the outside world than they could have been when they were discharged. There were also troubling statistics, with which we are all familiar, about high rates of alcohol problems, imprisonment and homelessness among people leaving the forces.

That is all very troubling, and the causes are fairly complex, but one thing is absolutely clear: the screening of soldiers exiting the theatre of war was very poor in the British forces. Often, it was done simply through self-completed questionnaires, but people do not ordinarily volunteer any deep psychological problems they may think they have in such a questionnaire.

There was also evidence in the PAC report that I quoted that support for people in the theatre of war was relatively poor. The most that they seemed to get out there most of the time was three community nurses, along with one consultant psychiatrist every three months. If people showed up with problems in the theatre of war, those problems were unlikely to be fielded especially well. There are particular issues here, and we must be prepared to face up to them. One, although I have only anecdote to go on, is that some people enter the forces because the structure that they provide is exactly what their personality needs. When they leave the forces, however, that structure simply disappears. Often, their homes will have gone, and their families will sometimes have gone, too, so they find themselves in difficult territory.

A second suggestion is that there is necessarily a culture of mental toughness in the forces, so people are slow to own up to whatever problems they may have. Those problems might therefore go unrecognised and be submerged for quite some time, and that is at the root of some of the problems that were so well analysed by the hon. Member for York Outer.

We in this place have clocked these problems, and quite a lot has been done about them. Since 2010, when the PAC report I quoted was produced, there has been a surprising amount of really good progress. On 6 April 2010, the previous Government committed themselves to providing £2 million of new funding. They can be credited with increasing the number of helplines and endeavouring to increase the education and training of GPs. We also pay tribute to the Murrison report, which represented excellent progress. Before that, the Ministry of Defence even did some research, which helped everything along. There is strong cross-party commitment to recognising these problems and doing something about them. In a sense, therefore, Parliament can justifiably credit itself with having done something about a very real and clearly identified problem.

I would like to conclude by thinking about where we go from here. My concern is that most of the solutions that were proposed following the previous Government’s deliberations and the Murrison report involved something along the lines of specialist health service commissioning. I do not want to talk about the difficulties of the legislation currently going through Parliament, but such specialist commissioning is an issue. The hon. Member for Hexham (Guy Opperman) has advocated as a solution getting round specialist commissioning to some extent by means of an agency that is a one-stop, catch-all arrangement. Creditable though that suggestion is, it will not get us out of the business of specialist commissioning, because the problems will show up locally in many diverse settings. I wonder whether the Minister will say something about that.

[Derek Twigg (Halton) (Lab)]

When I was the Defence Minister with responsibility for such matters, we set up pilot schemes with the NHS, with which Combat Stress was involved. Delivery issues are important, because in most respects the treatment is exactly the same whether the patient is a civilian or not, but some members or former members of the armed forces would prefer to talk to someone with experience in the armed forces. That is why we involved such people in the pilots.

On the other hand, other people from the armed forces did not want to see someone who had also been in the armed forces, because as far as they were concerned that life had finished, or they wanted to move on, or they had had a bad experience. It is a difficult issue to come to terms with, and that is why there is a need to mix and match support and clinical help. It is important for people to have that choice.

Health and Social Care Bill

Derek Twigg Excerpts

Tuesday 28th February 2012 Commons Chamber

[Mr Lansley]

Yes, that is absolutely correct. For the first time, we will have a provision in law that prevents the kind of discrimination in favour of the private sector that was practised in government by the Labour party.

[Derek Twigg (Halton) (Lab)]

In an article in The Guardian on 13 February, Baroness Williams said:

“The way out of this mess is not hard to find… What that would mean for the bill would be dropping the chapter on competition”.

Will the Secretary of State clarify whether he is willing to accept such an amendment from Baroness Williams?

[Mr Lansley]

As I understand it, I have come to the House to answer questions about a letter, jointly signed by the Deputy Prime Minister and Baroness Shirley Williams, which does not say that.