Oral Answers to Questions

Diane Abbott Excerpts

Tuesday 18th October 2011 Commons Chamber

[Anne Milton]

My hon. Friend is absolutely right. Local authorities have a long and proud tradition of improving the public’s health. Public Health England will bring together a fragmented system and strengthen our national response on emergencies and health protection. It will help public health delivery at a local level with proper evidence and leadership.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Contrary to the Minister’s statement that the Health and Social Care Bill will put public health at the heart of the health service, 40 directors of public health and 400 public health academics, including Michael Marmot, wrote to The Daily Telegraph to say that the Health and Social Care Bill will

“widen health inequalities; waste much money on attempts to regulate and manage competition; and undermine the ability of the health system to respond…to communicable disease outbreaks”,

and that it will

“disrupt, fragment and weaken the country’s public health capabilities.”

How can the Minister put her judgment against that of those doctors and experts? Is not the proposal that more than 40 specialist neonatal units may lose staff in the coming year an example of the weakening of public health that is involved in the Bill and the Government’s proposals?

[Anne Milton]

I draw the hon. Lady’s attention to the fact that the Health and Social Care Bill proposes for the first time a duty on the Secretary of State to have regard to health inequalities, which, I repeat, widened under the previous Government. I also point out to her that the letter to peers signed by Professor Marmot and others welcomed the emphasis on establishing a closer working relationship between public health and local government. I suggest that the hon. Lady gets out more, because she would hear from public health doctors and local authorities on the ground who welcome these changes.

Ovarian Cancer

Diane Abbott Excerpts

Wednesday 12th October 2011 Westminster Hall

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Let me start by congratulating the hon. Member for Pudsey (Stuart Andrew) on securing this important and well-attended debate. Every Member who spoke made an effective and moving speech. However, the speech that stands out for me is that of my hon. Friend the Member for Slough (Fiona Mactaggart). We have already heard that ovarian cancer is a very serious condition and that it is the fifth most common cancer among UK women. Members have also set out the relatively low survival rates for ovarian cancer—they are around 40% compared with 79% for breast cancer. That is largely due to the fact that three out of four women are diagnosed late, once the cancer has spread. It is worth repeating that survival rates could be as high as 90% if the cancer were diagnosed at an early stage. In Hackney, in east London, the five-year ovarian cancer survival rate is only 35%, which is significantly below average.

Despite the evidence relating to lack of awareness, the rates of late diagnosis and the delays in diagnosis admissions by A & E, there is still no Department of Health-led activity to improve awareness of symptoms among women and GPs. That is despite the Government’s commitment to save 5,000 lives a year from cancer by 2014. I welcome the new National Institute for Health and Clinical Excellence guidance on symptoms and the increased access to diagnostics that was announced in the cancer strategy, which mean that there will be new opportunities to improve early diagnosis. But unless women know when to visit their GP, unless the symptoms of ovarian cancer become as well known among ordinary women as the symptoms of breast cancer are and unless GPs know how to consider ovarian cancer, rates of late diagnosis and delays will not improve.

We have already heard, but it is worth repeating, that there is no national outcome measure for ovarian cancer; there are only such measures for breast, lung and bowel cancer. That is already impacting on the ability of PCTs and cancer networks to undertake awareness work about ovarian cancer, as funding for awareness work is being channelled to breast, lung and bowel cancer. That will potentially lead to a worsening of the situation, because it means in practice that there will be a decline in activity.

The quality standard for ovarian cancer will be one of the first of the new suite of quality standards to be introduced by NICE to inform local commissioners, but as yet it is not clear how the standard can be used effectively. Can the Minister tell us whether the Department of Health is considering introducing a national outcome measure for ovarian cancer? Can he also say how the Department will ensure that the quality standard is used effectively?

The Minister will be aware that the first findings of the international cancer benchmarking study—a study led by the Department of Health—showed that in the UK late diagnosis is thought to be a key driver of survival rates, which are poor compared to those in other countries in the study. However, ovarian cancer is the only cancer type in the study not to have had remedial action taken to improve awareness.

The Minister will forgive me when I say that under the last Government we saw substantial investment in cancer services and consequently outcomes improved; for instance, the survival rate for breast cancer rose from 50% to more than 80%. In the case of ovarian cancer, although the figures are not necessarily much better than they were when the hon. Member for Westmorland and Lonsdale (Tim Farron) faced the issues in relation to his mother, the survival rate has in fact doubled in the past 30 years. The commitment shown by the last Labour Government meant that in excess of 1,000 more women per year in England and Wales are now surviving ovarian cancer. However, the UK survival rate for ovarian cancer is still among the lowest in Europe, at 36%. If we achieve the average European survival rate, we will save 500 lives per year.

All of us, including the Minister, know that two major trials are currently taking place: the first is for women in the general population; and the second is for women with a strong family history of ovarian cancer. The former trial will report in 2015 and the latter trial in 2012. However, it is not at all certain that the findings of those trials will result in a national screening programme. Perhaps the Minister can tell the House what the Government’s position is on that issue.

Cancer Research UK tells me that it is concerned that the Health and Social Care Bill, which is currently being debated in another place, risks fragmenting responsibility for the early diagnosis of cancer between Public Health England, local authorities and the NHS. Cancer Research UK’s proposal for guarding against fragmentation is that local authorities and clinical commissioning groups should be jointly incentivised to prioritise early diagnosis, including shared indicators in the public health and NHS outcomes frameworks. That process should be supported by shared budgets, to ensure joint responsibility for delivering improvements in awareness and early diagnosis of cancer. In other words, Cancer Research UK is concerned that policies and responsibilities around early diagnosis will fall through the cracks. How will the Minister respond to that proposal by Cancer Research UK?

The Minister will be aware that, earlier this year, at the 12th international forum of the Helene Harris Memorial Trust, which was originated and facilitated by Ovarian Cancer Action, 50 of the world’s leading researchers and clinicians in ovarian cancer came together to discuss the future for ovarian cancer research. Out of those discussions came nine key actions: improving recognition that “ovarian cancer” is a general term; better targeting of clinical trials; identifying patients at increased genetic risk; developing new approaches to identify targets for treatment; ensuring that both the tumour and the tumour micro-environment are treated; better understanding of relapses of treatment-resistant ovarian cancer; setting up international collaboration to enable tissue samples to be shared and analysed in research; developing better experimental models; and ensuring that clinical trials include measures of quality of life and symptom benefit. Ovarian Cancer Action believes that those nine actions would not only help to improve the quality of life and ovarian cancer survival rates for women in the UK, but help to position the UK as an international leader in the fight against this deadly disease. Is the Minister aware of those recommendations and what is his response to them?

My hon. Friend the Member for Cardiff West (Kevin Brennan) made the point that, in the sometimes humdrum routine of the life of a junior Minister, there is occasionally a genuine opportunity to make a difference. Having listened to the informed, personal and passionate contributions of colleagues and other hon. Members this morning, I hope that the Minister will go away from this debate determined to move ahead—on the very strong basis of what the last Labour Government did and what his Government have done up to now—and actually make a difference in relation to ovarian cancer.

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

Thank you very much, Mr Rosindell, for calling me to speak.

I assure the hon. Member for Hackney North and Stoke Newington (Ms Abbott) that I have not found my last 12 months “humdrum” at all and I agree entirely with the comment by the hon. Member for Cardiff West (Kevin Brennan) that being a Minister is a privilege, and a privilege that one should use fully to serve the common good and the purposes that our constituents send us here for.

I want to try to do justice to the debate, and if I do not cover any issues that have been raised, that will purely be because of time and I will write to hon. Members about those issues. However, I will try to cover as much ground as I can.

I congratulate the hon. Member for Pudsey (Stuart Andrew) on securing the debate and congratulate all those who have taken part. I particularly congratulate the all-party group on ovarian cancer, which has done an excellent job in mobilising colleagues to be here in Westminster Hall today and to be persistent and persuasive in their arguments on the issue.

As others have rightly said, the speech by the hon. Member for Slough (Fiona Mactaggart) was typically powerful and typically persuasive. I think that I have served in the House as long as the hon. Lady, and during the time that she fought her cancer I certainly admired the way that she did so, while continuing to provide the service that she gives to her constituents and the House. She made a very powerful set of points today.

I think that everyone who has spoken in the debate has been touched by ovarian cancer. I had not planned to refer to my own experience, but, given that others have talked about their experiences, I will say that my aunt died of ovarian cancer some years ago. Having fought the disease for some time, she sadly died at the Royal Marsden hospital, despite receiving excellent treatment there. Ovarian cancer touches many of us.

I thank Target Ovarian Cancer, Ovarian Cancer Action, Ovacome and the Eve Appeal, which have all done an excellent job in raising MPs’ awareness of ovarian cancer, in the ways that the hon. Member for Pudsey and others have described today. That work has done a lot, not only to initiate debates in this place, but to assist us as MPs to play our part in our communities to help to raise awareness of those issues.

I could rehearse the statistics again, but will not do so because they have already been well rehearsed and powerfully illustrated with personal stories. I certainly recognise the urgency that we need to attach to our fight against cancers and I particularly note the points that have been made today about ovarian cancer. That is why we urgently came forward with the strategy that we published in January and why we have been fast in trialling and rolling out awareness campaigns. I will say more about those awareness campaigns shortly.

As has been pointed out, late diagnosis is one of the main reasons for the relatively poor cancer survival rates in England. I must crave the forgiveness of those colleagues who have spoken today from the perspective of Northern Ireland, Scotland and Wales. They all made important points and they need to continue, as I know they will, to raise them with their colleagues in the devolved Administrations who have responsibility for health.

Research by the National Cancer Intelligence Network showed that nearly a quarter of all cancers are diagnosed through an emergency route, as my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) said. That is at a stage when the cancer is very advanced. The research also showed that one in five patients did not visit their GP before being diagnosed with cancer. Diagnosis of ovarian cancer often comes late because the symptoms in the early stages—they have been powerfully set out—are often ignored or thought to be something else.

The hon. Member for Slough talked about volunteers, and about the volunteer who did the manicure on that day when her head was in another place. I have visited hospitals where Macmillan Cancer Support and other voluntary organisations play a part. Such volunteers bring back the key human dimension, which the hon. Lady was absolutely right to underline. We will ensure that the role of volunteers in the NHS is valued by including that point in the Department of Health’s message to the NHS in its soon-to-be-published updated volunteer strategy.

Reference has been made to the £450 million for early diagnosis work that the Government have put in as part of the spending review. The funds will support campaigns to raise public awareness of the symptoms of cancers, encouraging people to present with persistent symptoms. They will also support GPs in more effectively assessing people with possible cancer symptoms and improve access to diagnostic tests. In 2010-11, we ran local cancer awareness campaigns and a regional pilot campaign for bowel cancer, and in 2011-12 we are running a national campaign on bowel cancer, a regional campaign on lung cancer and 18 local campaigns to raise awareness of breast cancer among women over 70 and of the symptoms of some less common cancers.

A question that has been rightly put is, why, so far, have we not addressed ourselves to ovarian cancer? Understandably, Members want answers, not least because of the evidence that if we were performing at, I believe, just the average of our European neighbours—certainly if we were matching the best of them—500 additional lives would be saved every year. We are considering whether there is scope for piloting ovarian cancer awareness campaigns, drawing on the experience of our more generic campaigns on blood in urine, which can be a marker for bladder and kidney cancers, and on the evaluations of awareness campaigns on specific disease sites. That will inform us how we can most effectively roll out further campaigns. I give that undertaking, and I am more than happy to meet with members of the all-party group.

The hon. Member for Romsey and Southampton North (Caroline Nokes) spoke very persuasively about the scope for using existing screening programmes to deliver awareness-raising messages about other cancers, and ovarian cancer in particular, and we will consider how we might implement such a practical solution. Nevertheless, I hope that hon. Members appreciate that awareness raising is just one of a range of actions and that we need to look at the other aspects of the strategy that we set out earlier this year. We are working on other fronts to try to drive up earlier diagnosis and treatment.

A key focus of the cancer outcome strategy is primary care, which is why we are investing in providing GPs with practical tools for assessing patients who might have cancer. In addition, some of the cancer networks are reviewing referral pathways to help to shorten the time taken for patients to access diagnostic tests. I welcome the contribution of the cancer charities that have been working with primary care professionals to promote early diagnosis of cancer, and I specifically pay tribute to Target Ovarian Cancer, which, in partnership with BMJ Learning, has produced an online GP learning tool that covers the signs and symptoms of ovarian cancer, and diagnostic tests based on the latest evidence.

[Ms Abbott]

Will the hon. Gentleman give way?

[Paul Burstow]

I want to try to do justice to the debate and ensure that I get to answer a couple more of the questions posed, but I will give way in a moment if I can.

If a GP suspects cancer, it is vital that they can refer people urgently for further tests, using the two-week referral pathway. For women who do not meet the criteria for that pathway for suspected cancer but have symptoms that require investigation, we are providing additional funds over the next four years to support the diagnosis of ovarian cancer by giving GPs direct access to four key diagnostic tests, including non-obstetric ultrasound. Questions have been asked about what data are collected. We plan routinely to collect data on GP usage of the four tests and to publish them alongside data on GP usage of the two-week referral pathway, so that we can benchmark performance and expose areas that are not performing as well as others.

Several hon. Members asked about the CA 125 test and suggested that there are restrictions. I can assure Members that if there were restrictions we would challenge them. Just last month, Bruce Keogh, NHS medical director, wrote to strategic health authorities to raise questions about general access to diagnostics, and David Flory, deputy NHS chief executive, reiterated in the September edition of The Quarter that there must be no “arbitrary restrictions on access”. That would apply to the CA 125 test, not least because it is clearly covered in NICE guidance.

Hon. Members referred to the two ongoing trials, which are evidence of the research taking place. The UK collaborative trial of ovarian cancer screening offers real prospects for a screening tool, but on screening the Government of the day take the advice of the UK National Screening Committee, which considers the evidence from trials of the sort going on at the moment. A randomised control trial of 200,000 post-menopausal women aged between 50 and 74 is studying the use of annual CA 125 blood tests as a way to identify—along with annual trans-vaginal ultrasound—which women are most at risk of ovarian cancer. The results of the study will be available in 2015, and the Government will then respond to the recommendations that the UK National Screening Committee makes on the basis of the evidence. I hope that there will be a positive recommendation that enables us to roll out such a screening programme.

Familial ovarian cancer screening was referred to early in the debate, and a study has shown that up to 10% of ovarian cancers can be attributed to an inherited genetic predisposition. It was mentioned that the results of that research would be available in 2012, but we understand that the study will close in 2013. We would want to act on the evidence from that study.

Research, therefore, is taking place in those two fields. High-quality applications are the key to getting research funding; we do not fund solely on the basis of something being a priority. The hon. Member for Hackney North and Stoke Newington asked about Ovarian Cancer Action’s nine recommendations, and I will respond to her in writing, with copies to colleagues.

National measurement was mentioned. The NHS operating framework for England for 2011-12 requires that cancer registries record the stage of cancer, which is a key proxy for predicting outcomes, and publish one-year, as well as five-year, survival rates. We are benchmarking, providing a useful way to see who is performing well and who is not, and, as the hon. Lady mentioned, we are in the international benchmarking partnership with other nations. Would she like to make her intervention in the remaining time?

[Ms Abbott]

indicated dissent.

[Paul Burstow]

In conclusion, I hope that I have responded positively to the debate. We must make progress on a broad front in this area to improve early diagnosis and get the treatment that people need, so that we can cut the death toll in this country from all cancers. Ovarian cancer is, and will continue to be, a priority for this Government.

Health and Social Care (Re-committed) Bill

Diane Abbott Excerpts

Wednesday 7th September 2011 Commons Chamber

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The decision to seek an abortion may be the most serious and difficult that many women face in their lives, and I think it deserves some seriousness and calm in this debate.

For nearly five decades, this House has been in agreement that abortion and matters related to it should be above mere party and partisan politics. For nearly five decades, there has been a settled pro-choice majority in this House and in the country, and for nearly five decades the House has believed that when Members of all parties have religious or ethical objections to abortion, their right to vote against it should be absolutely respected. However, this amendment is not about that. It is a shoddy, ill-conceived attempt to promote non-facts to make a non-case.

[Several hon. Members]

rose—

[Ms Abbott]

I am afraid that we are an hour into an hour-and-a-half debate, and I am anxious to allow time for other Members to speak.

The case that the amendment is intended to make is that tens of thousands of women every year are either not getting counselling that they request, or are getting counselling that is so poor that only new legislation can remedy the situation. I might say, after many years in the House, that in matters of this kind, if legislation is the answer we have almost certainly asked the wrong question.

The amendment is the opposite of evidence-based policy making. We know that the British Medical Association advises its members:

“A decision to terminate a pregnancy is never an easy one. In making these decisions, patients and doctors should ensure that the decision is supported by appropriate information and counselling about the options and implications.”

We know that the Royal College of Obstetricians and Gynaecologists guidance on abortion states:

“Women should be given counselling according to their need—including post-abortion if she needs it. All women should be offered standalone counselling. The counselling should include: implications counselling (aims to enable the person concerned to understand the…course of action…); support counselling (aims to give emotional support in times of particular stress) and therapeutic counselling (aims to help people with the consequences of their decision and to help them resolve problems which may arise as a result)”.

We know that Department of Health regulations state:

“Counselling must be offered to women who request or appear to need help in deciding on the management of the pregnancy or who are having difficulty in coping emotionally”.

We also know that all the clinics that have been discussed in the debate are inspected and regulated.

Yet the proposers of the amendment are asking us to believe, on the basis of purely anecdotal evidence, that tens of thousands of doctors, nurses and charity workers involved in the 190,000 abortions a year are wilfully ignoring both the law and the guidance of the British Medical Association and the Royal Colleges. They go further than that, arguing that tens of thousands of doctors, nurses and charity workers are merely in it for the money. They imply that those men and women are involved in some sort of grotesque piecework. It is almost as though they were paid per abortion. The proposers of the amendment, I might add, also seem to be arguing that thousands of women do not actually know what they are doing. It tells us something about the validity of their claims that they are obliged to smear tens of thousands of doctors and nurses to make any kind of case. No wonder that a journalist for The Sunday Times—no friend of the liberal left, but one who happens to have served as a lay member of the Royal College of Obstetricians and Gynaecologists—last weekend described the amendments as a “senseless and sinister bid” to cut abortions.

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

I agree with my hon. Friend. Any evidence that we have heard has been anecdotal—we have heard of a 16-year-old’s journey and of e-mails that hon. Members have seen but that I have not. However, my hon. Friend makes a real point. The conclusion of the consultation might be that a termination takes place, but this is the only procedure in this country that requires the informed consent of two doctors. Government Members besmirch doctors by saying that such things happen daily, but that is not true. From my nine years on the General Medical Council, I recognise that we have good ethical guidelines for doctors. Nothing is done without the informed consent of two medical practitioners.

[Ms Abbott]

My right hon. Friend makes an excellent point.

[Several hon. Members]

rose—

[Ms Abbott]

I would be more willing to give way were we not so far advanced in a debate that will last for only an hour and a half. I was not aware that so many Back Benchers wanted to contribute, because they have not hitherto tried to intervene.

Some colleagues have expressed their surprise that yet again we are discussing women’s reproductive rights in this House, but they should not be surprised. Abortion has never stood on its own as a technical issue; it is part of a century-long debate about women’s sexuality, womens’s rights and women’s freedoms. Sadly, for some people that is apparently still contested ground in 2011. Some even argue that the proposals are best seen as part of a wider push on the socially conservative agenda that has been so successful for right-wing politicians in America. Thankfully, in this country, that agenda has come up against a determination to keep such issues above party politics, the absence of a Fox News pumping out socially conservative propaganda 24 hours a day and British common sense.

I could say many things on the lack of an evidence base behind the amendments, but let me say this: women—both individual women and women in general—have been called in aid in this debate, and indeed they face very real problems in this society, here in 2011. They face spiralling unemployment as a direct consequence of the coalition’s policies and the sexualisation of our culture, which affects younger and younger female children—[Interruption.] I hope that hon. Members listen to this, because it is a point that many mothers and fathers will understand. Too many young women in communities up and down the country think that the only road to fame and fortune is to pump their bottom and their breasts full of silicone and tout themselves as some sort of media celebrity. Another issue is the number of very young women who have been badly parented, who have children too young and who, with all their good intentions, parent their own children badly in turn. Even in an era of financial constraint, those are the issues that this House should be addressing.

Nobody is saying that arrangements in relation to counselling cannot be improved. I believe that the hon. Member for Cambridge (Dr Huppert) has tabled a good amendment to that effect, which some of us hope finds favour in another place. However, the Bill and the amendment are not appropriate for a full and careful debate on abortion. The amendments deal with matters that are amply covered by existing law and regulations.

[Mark Pritchard]

rose—

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

rose—

[Ms Abbott]

I shall give way to the hon. Member for Central Suffolk and North Ipswich (Dr Poulter).

[Dr Poulter]

The hon. Lady is making an excellent speech and has outlined the fact that there is adequate provision for counselling in the status quo. Doctors, nurses and other medical professionals who must deal with such situations every day have adequate measures in place, as the Royal College of Obstetricians and Gynaecologists has outlined. They do not look only at the medical consultation, but at the whole patient, as we have heard. If that means that counselling is required, they will ensure that their patient gets it. Does she agree that this is not the place for the amendment, which serves no purpose, and that we need to get on and debate the Bill?

[Ms Abbott]

I am grateful to the hon. Gentleman, who is, of course, a practising doctor who knows a great deal more about these matters than many of us in the House.

As hon. Members have heard, the amendments deal with matters that are amply covered by existing law and regulations that are well known to doctors and nurses. They deal with matters that must, at the end of the day, be between a woman and a doctor. I deprecate the extent to which amendment 1 is an attempt to import American sensationalism, confrontation and politicisation into these issues in a way that will be of no benefit to ordinary women.

There is no evidence base for the amendments, and on the basis of all the recent polls there is no substantive support for amendments of this nature. Legislation addressing the issues raised by Government Members is already in place. This House should have more respect for the medical profession and for the vulnerable women who put themselves forward for abortion in one of the most difficult periods in their lives, rather than support an amendment of this nature, which is spurious and baseless. I urge the House emphatically to reject the amendment.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I feel that I need to start by saying that this debate is about women; it is not about hon. Members. It is about ensuring that women get the very best possible services that they not only need but deserve.

There was much comment and speculation ahead of the debate, not all of it accurate or helpful. It might therefore be useful if I explain the Government’s approach to meeting the spirit of the amendments without primary legislation. I associate myself with my hon. Friend the Member for Bracknell (Dr Lee), who urged calm and balance. Today’s debate has not necessarily reflected either of those things.

How do the Government intend to meet the spirit of the amendments?

Coeliac Disease

Diane Abbott Excerpts

Wednesday 7th September 2011 Westminster Hall

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

I apologise for being a few minutes late for the debate. I was speaking in the debate on Health and Social Care (Re-committed) Bill that is taking place in another part of the building.

I congratulate my hon. Friend the Member for Ochil and South Perthshire (Gordon Banks) on securing this important debate. It is always important when hon. Members with personal experience of an issue or condition take the opportunity to make the rest of us aware of that experience, as he has done.

As we have heard, Coeliac UK is doing excellent work, and one of the concerns that it has raised with parliamentarians is the challenge that people with coeliac disease face when eating in hospital. It says that hospital food is often restricted, and even unsafe. It receives many calls from members who have been in hospital, and have returned home malnourished and having suffered considerable weight loss. Sometimes friends and family have to provide gluten-free food. I hope that the Minister will tell us what action his Department is taking to ensure the availability of gluten-free food in hospitals throughout England and Wales.

Hon. Members will be aware that as well as securing today’s debate, my hon. Friend tabled an early-day motion in June 2010 to raise the issue of diagnosis rates. He has spoken very well on the matter this afternoon. In a parliamentary question, my hon. Friend the Member for Slough (Fiona Mactaggart) asked what information the NHS provides to people who are diagnosed with coeliac disease on managing their condition. The departmental response referred to a website with detailed information. The site also has information on how to ensure a gluten-free diet, with helpful examples of food to avoid. However, in the light of the large number of undiagnosed cases that we have heard about, I wonder whether the Minister has recently discussed the diagnosis and management of coeliac disease with representatives of the Royal colleges and other bodies representing medical professions.

My hon. Friend the Member for Aberdeen South (Dame Anne Begg) tabled an early-day motion early this year on issues relating to the hospitality industry, which we have heard more about this afternoon. What discussions, if any, has the Department held with the hospitability industry?

Outside Parliament a wide range of organisations, including Coeliac UK and the British Society of Gastroenterology, carry out excellent work on the condition. In particular, the British Society of Gastroenterology feels that an active case-finding strategy will increase the number of patients detected with coeliac disease. Does the Department have such a strategy at present?

Last year the British Society of Gastroenterology published its “Guidelines for the management of patients with coeliac disease”, in which it made a number of recommendations on what testing for coeliac disease should incorporate and how to best manage patients. Has the Department looked at those recommendations, and does it have a position on the management of patients with coeliac disease?

We have already touched on the excellent work of Coeliac UK and its ongoing campaigns such as the “Eating Out” campaign, which focuses on the food service sector, or the “Product” campaign mentioned earlier, which is about having a greater availability of gluten-free foods in supermarkets and on prescription. Of course, Coeliac UK is concerned that the medical profession has under-recognised coeliac disease so far. It is not routinely tested for, and Coeliac UK is campaigning to change that. We must build on the successes achieved, and I would be interested to hear how the Department plans to support the ongoing campaigns and the further work of Coeliac UK.

We have already heard about diagnosis, and the Minister will know that Coeliac UK has petitioned the Government to improve the rate of diagnosis of coeliac disease by including a target for GPs in the quality and outcomes framework. If a target on coeliac disease were to be included into that framework, GPs would have to deliver a better rate of diagnosis of the condition. That campaign has attracted nearly 9,000 signatures, and Coeliac UK is continuing with that and has made a new submission to the National Institute for Health and Clinical Excellence for such a target to be included. It would be helpful if the Minister updated us on the Government’s position on the issues raised in that petition.

Apart from early diagnosis and the management of coeliac disease, my hon. Friend the Member for Ochil and South Perthshire called this debate to discuss community-led pharmacy prescriptions. He has spoken effectively on that matter.

Moving on to the socio-economic impact of coeliac disease, we know that it is difficult to assess the overall burden of the disease owing to the absence of recorded information on diagnosis rates. There is a need for a central register of patients with coeliac disease, and I wonder whether the Minister will comment on that. We know that coeliac disease has an impact on both the individual and the community because of its high prevalence and the long-term complications arising from late diagnosis. The development of osteoporosis or bowel cancer has an impact not only on the individual affected but on the community and the health service. Even in the short term, the absence of diagnosis has a socio-economic impact. My hon. Friend said how shocked he was when his GP said, almost lightly, that he had missed two other cases of the disease that month. According to an independent study commissioned by Coeliac UK in 2006, just under half of people with coeliac disease who had been wrongly diagnosed believed that their job or career had suffered due to the condition prior to diagnosis.

As we have heard, Coeliac UK wants to see greater understanding and familiarity with the disease among GPs, and higher levels of referral to dieticians. A survey of registered dieticians conducted by Coeliac UK showed a wide variation nationally in the provision of dietetic expertise for patients with coeliac disease. Current provision is around one third of what it would be were we to provide diagnosed coeliacs in the UK with basic support and an annual review.

I will conclude my remarks by saying to the Minister that there is a continued cost to the health service due to repeat visits to GPs by people with undiagnosed coeliac disease—my hon. Friend referred to that in his personal case. Furthermore, left untreated or undiagnosed, coeliac disease can lead to more serious complications such as bowel cancer, which puts an even bigger drain on health service resources. Coeliac UK recognises the competing demands on health service resources and budgets, but coeliac disease is easily controllable once diagnosed—we can see that by looking at my two hon. Friends the Members for Ochil and South Perthshire and for North Durham (Mr Jones), who are able to be excellent and inspirational Members of Parliament because their coeliac disease is so well managed. It is a disease that can be self-managed if diagnosed early enough in life.

Government policy needs to acknowledge the scale of the impact of coeliac disease across a large segment of the population. Policy must also take into account the potentially serious nature of the disease, the cost in financial terms, and the suffering of the undiagnosed. In particular, measures should be taken to address the lack of awareness about the disease and provide a framework to ensure that GPs receive appropriate training and resources. Ongoing training should be provided to enable GPs to give better care in the community.

Once again, I congratulate my hon. Friend the Member for Ochil and South Perthshire on securing this debate, and my hon. Friend the Member for North Durham on chairing the all-party group on coeliac disease and dermatitis herpetiformis. A number of colleagues from all sides of the House take a keen interest in this issue and wish to commend the work of the all-party group in promoting awareness about the disease. I look forward to the Minister’s response.

Oral Answers to Questions

Diane Abbott Excerpts

Tuesday 12th July 2011 Commons Chamber

[Mr Burns]

My hon. Friend makes an extremely important point, because not only are his figures correct, but thereafter until the end of the decade there will be savings of £1.7 billion a year, on current projections. Every single penny of that will be reinvested in front-line services for patients.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The Minister continues to insist that his reorganisation will result in savings that will be reinvested in patient care. Yet even before we have the impact assessment for the changes in the legislation, we know, as will Members across this House, that on a daily basis people are leaving primary care trusts with their redundancy money. That totals £800 million and upwards, and it has not been costed. We also know that the Royal College of General Practitioners has said that we will have gone from having 163 statutory organisations to having 521. Are not the costs of this misconceived car crash of a reorganisation spiralling out of control?

[Mr Burns]

The reality is that the hon. Lady does not understand, or will not accept, the figures published in the impact assessment. What she does not like is the fact that by the end of this Parliament there will be savings of about £5 billion, and thereafter of £1.7 billion until the end of the decade. That will all be reinvested in front-line services. The hon. Lady will not accept, and wishes to misrepresent to members of the public, the resulting benefits in improved and enhanced patient care.

Oral Answers to Questions

Diane Abbott Excerpts

Tuesday 7th June 2011 Commons Chamber

[Paul Burstow]

What we are doing at the moment with the pause is making sure that we revise the proposals in ways that ensure that we deliver the outcomes set out in the White Paper last year. One of the things we said in the White Paper, and which the Bill currently provides for, is that GP commissioning consortia can collaborate where they need to commission for larger populations.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

On GP commissioning consortia, one of the concerns that the Minister will have heard during his pause is the public’s concern about the possible role of the private sector in GP commissioning. Although we all agree that the private sector has always had, and will always have, a role in the NHS, does the Southern Cross Healthcare disaster not show the dangers of leaving health and social care to the short-term decisions of private equity bosses?

[Paul Burstow]

rose—

Public Health Observatories

Diane Abbott Excerpts

Tuesday 17th May 2011 Commons Chamber

[Grahame M. Morris]

Absolutely. That is a critical issue. In some respects, the Government have taken their eye off the ball. I will develop that point a little later and would like the Minister to respond to it.

As my hon. Friend pointed out, there is a clear and present danger of a reversal of health inequalities, which would be exacerbated by decisions taken elsewhere across Government. It is such an important issue, and one that I have long campaigned on. As someone who has worked in the health service and served on a local authority, I feel very passionately about it.

Remarkably, we are now considering proposals that risk losing our greatest weapon in tackling public health inequalities: evidence-based health intelligence. More recently, as my hon. Friends have noted, the Marmot review has restated the link between socio-economic factors and health, which are known as the wider determinants of health. One of the more serious threats to the future of public health intelligence is its future funding under the new arrangements proposed by the Government. In my view, the Secretary of State has shown little interest in the functioning of public health intelligence under these proposed structures.

Public health policies must take account of local circumstances as health inequalities remain stark, particularly in areas such as my constituency. For example, smoking-related deaths vary greatly across different parts of the country. Public health intelligence must drive public health practice. I appreciate that public health observatories self-generate revenue, alongside their Department of Health grant and moneys from primary care trusts and strategic health authorities. They also have opportunities to gain commissions from universities and charitable organisations, but it would be extremely risky to proceed down the Government’s proposed route without the certainty of their core Department of Health funding, which I understand is to be reduced by 30% this year.

Staff and people associated with the service have reported to me that valued employees are already being laid off at the north-west public health observatory, which is based at Liverpool John Moores university, and there is a similar situation at the north-east public health observatory. Local authorities commission the majority of public health services from a ring-fenced budget. What assurances can the Minister give me on safeguarding through this hiatus—this period of transition—and for the long term under the new arrangements?

I also thank David Kidney, the former Member for Stafford, who is now head of policy at the Chartered Institute of Environmental Health, for his assistance in preparing for this debate. The institute has stated its view that Public Health England must be established with a degree of independence, a point I made earlier, and with the ability to oversee arrangements for collecting, analysing and disseminating valuable data for public health services.

In short, it is now time for Ministers to provide concrete assurances that the role of public health intelligence, the collection of the evidence base and, in particular, public health observatories will be safeguarded for the future.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

rose—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. There are just over 10 minutes left, so is it by agreement that I call the hon. Member?

--- Later in debate ---

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

I congratulate my hon. Friend the Member for Easington (Grahame M. Morris) on raising this very important issue on the Adjournment. I, like everyone else in the Chamber, want to hear what the Minister has to say in response to the important points that he has made.

One reason why my hon. Friend’s debate is so important is that, amid all the public anger about the health service reforms, the effects on public health have not received the attention that they should have. Speaking as an east end MP, I must say that the information that the public health observatories produce is important in ensuring that whoever commissions services commissions for the population, not just for GPs’ lists. I live in an area where many communities are either not registered with a GP or in other ways socially excluded.

My hon. Friend has raised the important issue of health inequality, and it is easy to talk about that in the abstract, but we should reflect on the fact that this is 2011, because the life expectancy of someone in the richest part of Glasgow is 10 years more than that of someone in the poorest part, and if we take the Jubilee line tonight we will find that the people living at every stop from Westminster going east until Canning Town lose a few years in life expectancy. This is a very real issue and an indictment of our society. I congratulate my hon. Friend again on raising it, and I will listen with interest to what the Minister has to say.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I am grateful to the hon. Member for Easington (Grahame M. Morris) for raising the subject of public health observatories, and I should probably declare an interest, because my husband is a public health physician. Anybody who has an interest in public health knows how important the observatories are, but time is very short, and I will not get to all the points that the hon. Gentleman made.

The public health observatories have been around for more than a decade, and they produce a whole series of high-quality data. Annual health profiles, for instance, of local areas allow for those comparisons that are so important, and there is no doubt about the importance of reducing inequalities. The reports of Sir Douglas Black, Peter Townsend and more recently Sir Michael Marmot are all key documents.

It is important to remember that over the past decade or so health inequalities have become worse, but I point no fingers, because it is testament to the fact that it is extremely difficult to reduce inequalities. The hon. Gentleman mentioned several issues that contribute to that. There are a range of factors, not least changing people’s behaviour, which is not easy. The Government’s contribution of £12 million to the observatories is testament to how important it is that we get good intelligence. He will have read the public health White Paper, in which he will see our commitment to this. For the first time, we will ring-fence funds for public health.

The movement of public health into local authorities has been fairly widely welcomed. There are transitional arrangements that we need to get right, but it will be based on a direct line of sight from the Department of Health, as we need to bring some things together. We need clear responsibilities and a clear outcomes framework to ensure that local authorities give us what we need, with all that based on good and sound intelligence. Although the public health observatories have done a very good job, there are some areas—for instance, changing behaviour—where the intelligence is not good and we have not collected it together.

We want the data and evidence from the observatories to be used to improve the health of everybody, regardless of age, ethnicity, gender, income or sexuality. The public health White Paper sets out a clear life-course approach to that. It is impossible to make these changes without good intelligence and information. Despite the wealth of data, the evidence of what works is not necessarily being used as effectively as it could be, nor is it as widely available as it could be, and it remains only part of the information that we need. In any system where there are numerous stand-alone organisations, there are always dangers of overlap and duplication, and we want to eliminate that as much as possible. In short, we want to move from a system where we have a complex web of information functions performed by multiple organisations towards a system where that information is fully integrated into the public health system.

As the hon. Gentleman said, this is not about one Department—the Department of Health—doing it alone, but about public health being absolutely everybody’s business. The difference can be made from the top to the bottom in Government and right across the different Departments; it is an issue for us all. If we are truly to make inroads into these very persistent, difficult to move inequalities in health, we have to approach it in that way. There is no question of losing the main functions of the observatories; on the contrary, in fact. By transferring those functions to Public Health England, we will improve how they are used.

The hon. Gentleman will be aware that we have consulted for several months on the new public health system, and we are continuing to listen. It is very interesting to see what we are getting back, with a warm welcome for many of the changes. There are always anxieties about difficult periods of transition. We have convened a working group on information and intelligence for public health, which is chaired by the regional director of public health for South Central Strategic Health Authority, Professor John Newton. It has representatives from the Department, the Health Protection Agency, the public health observatories and the cancer registries, and it is meeting fortnightly to develop our approach to public health information and intelligence. This is an opportunity to get it absolutely right.

The future of the observatories is being very closely managed, and that includes their locations. Department of Health funding for the observatories has been agreed for 2011-12. Although there has been a reduction in the core contribution for each observatory, the Department of Health funding set aside as the core public health information and intelligence budget remains similar to previous years, and that will be supplemented by additional Department of Health grants, so overall funding will be about the same.

I should like to thank the north-east public health observatory for its contributions, including in relation to the national library for public health and the learning disability specialist observatory. Its strong strategic relationship with the academic sector through its host, the university of Durham, has been particularly beneficial. Officials in the Department are in regular contact with both institutions so that financial and other pressures are addressed as they arise. Like most of its counterparts, the north-east observatory receives income from the Department of Health, the NHS and others. I understand that it currently has a working capital of about £1 million, which is not insignificant.

The university’s human resources policies require it to alert staff at least six months before any changes in employment, which is important for staff at this uncertain time. We are making sure that the university is aware of the ongoing need for the observatory’s work, and hence its expert staff. It is important that we do not see any loss in that.

We are lucky in this country to have such a rich source of expertise. We must ensure that we maximise the benefit of that expertise, knowledge and intelligence. I hope that I have reassured the hon. Gentleman. I thank him for raising this issue and giving me an opportunity to say how much we value the work of observatories. Their functions remain indispensable, but they must adapt to the new system. We want to streamline the system and do what we set out to do, which is to reduce inequalities in health. We will base any action we take on sound evidence.

[Ms Abbott]

Will the Minister explain how, under the proposed system, we can make the free-standing GP commissioning consortia, some of which may be managed by private-sector organisations, pay attention in their commissioning decisions to the issues raised by public health observatories and others? It seems to me that without PCTs and other regional structures, it will be perfectly possible for the commissioning structures to ignore what public health observatories say.

[Anne Milton]

I thank the hon. Lady for raising that point. In fact, we inherited that system. Time and time again, budgets for public health have been raided to meet short-term commitments. One point of ring-fencing public health funding is to ensure that public health is central to the work that the local authority does and that it informs the commissioning arrangements in a local area. It is not good having just one area looking at public health. We are ring-fencing that money and will have a clear outcomes framework that sets out what the Government expect.

We will ensure that the consortia have regard to the public’s health. When we say “public health” it can sound a bit jargonistic. We are talking about the public’s health and about reducing the inequalities that have dogged society up to now and which successive Governments have failed to reduce. We have to do something different. We are moving from a system in which public health got sidelined and in which the work of public health observatories, although valuable, was not mainstream, to a system where that work is brought into the mainstream and into the direct line of sight. All those who make commissioning decisions and all local authorities should hear the clear message from Government that public health is everybody’s business.

Question put and agreed to.

Childhood Obesity

Diane Abbott Excerpts

Tuesday 3rd May 2011 Westminster Hall

[David Tredinnick (Bosworth) (Con)]

I congratulate my hon. Friend the Member for Brentford and Isleworth (Mary Macleod) on securing this crucial debate, and my other hon. Friends who have spoken.

I was in the Mall on Friday for what everybody agreed was a most wonderful royal wedding. However, my heart sank when I saw a very large, hugely overweight man hanging on to a railing for dear life and panting. He may have had a problem caused by steroids or something else, but it is most likely that he was obese. I thought how unhappy he must be with his life—my hon. Friend the Member for North Swindon (Justin Tomlinson) touched on the issue of happiness. One point we must get across to people who are obese is that they can be much happier if they overcome obesity.

My hon. Friends have made many points, but I want to touch on three issues. First, I want to look at the Change4Life programme and the changes that the Minister proposes to make. Secondly, I would like to say something about the impact of high-energy drinks that contain a lot of sugar and caffeine. Thirdly, I will speak about sizes of portions and clothes.

I will start by referring to the October 2007 Government report, “Tackling Obesities: Future Choices”, on what the human body is designed to do. It points out, with classic understatement, that our biological system is,

“not well adapted to a changing world, where the pace of technological progress and lifestyle change has outstripped that of human evolution.”

Many years ago in this Chamber—the old Grand Committee Room—I listened to a debate one evening, instigated by the food and health forum, that I have never forgotten. The speaker was a professor of nutrition and he said, “Look, in a nutshell, if you want to stay healthy, remember that we have not really evolved since the stone age; we are essentially stone-age people in the 20th century.” He said that if we want to be healthy, we should live like stone-age people. We should walk most of the time and run occasionally, eat berries and vegetables in season, catch fish when possible, and eat meat rarely. I was struck by that speech. Generally, our health problems arrive when we deviate from that simple model.

Last week, The Daily Telegraph looked at the problem of obesity as it affects parents. It pointed out that British men are among the fattest in Europe and that according to the World Health Organisation, we do less exercise as a nation than almost every other country in the world. In another article, I read that the World Health Organisation believes that in the regions of Europe, the east Mediterranean and the Americas, over 50% of women are overweight.

We have an enormous problem. All my hon. Friends have drawn on statistics. We tend to follow what happens in America, so we should be aware of what is happening in that country, where the problem is greater—obesity rates are 36% among women and 32% among men. The number of obese men in England has doubled since 1993, and the number of obese women has risen by half.

My hon. Friend the Member for Harlow (Robert Halfon) referred eloquently to issues in his constituency, but in my constituency we do not have the problems that affect many others. For example, the prevalence of obesity among reception-age children in the east midlands is just under 10%, and for year six children by region it is 18%. In Hinckley and Bosworth, the figures are smaller at just over 7% and under 16% respectively. Those are still enormous figures, however, and we must put that in the context of my original point about happiness. How many of those children are very unhappy with their lives?

The Minister inherited the Change4Life programme from the previous Government and I hope she will say a few things about the changes that she proposes to make. As I understand it, the funding for that programme is to change and she will be looking for contributions from the food industry. That may be a good thing, but I would like reassurances that the food industry will not be driving the agenda. I know that she has already said that we will not legislate further to bring in a range of new standards, but I think the quid pro quo is that we must know that the food industry will be very supportive of measures that do exactly what has been suggested and ensure that we see a reduction in sugar. There is far too much sugar in cereal, for example. I suggest to my hon. Friends that if they really want a cereal that is sugar-free, they should make it themselves; it is not difficult. I look to the Minister for support on that issue.

My next point relates to high-energy drinks. I have not heard a word about high-energy drinks this morning; I think that that is a forgotten area. Children and adults are consuming drinks that have two or three times the recommended caffeine level and a very high sugar content. If people have far too much caffeine, they get behavioural disorders. It is very bad for them. It increases their heart rate, and there have been instances of children going to hospital in such circumstances. It is extremely dangerous.

I recommend that the Minister look at the research conducted by Johns Hopkins university, which concluded that energy drinks should be labelled with highly visible health warnings aimed at young people. I will not quote from the study extensively, but it based its recommendations on research that discovered that certain drinks contained as much as 14 times more caffeine than the average can of cola. That is the same as drinking seven cups of coffee.

While we are on the subject of coffee, is it not extraordinary that we are now being invited by coffee shops to drink half-pint mugs of coffee? Have we taken leave of our senses? Have we all gone mad? If I stop for a cup of coffee with a friend, I often order the smallest cup of coffee and split it into two mugs because it is too much. In the 19th century, coffee cups were tiny. That is another issue that we must address.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

Drinking half a pint of coffee would be one thing. Is not the problem with coffee shops that often people are also drinking coffee with cream, sugar and additives? Sometimes with these half-pint cups of coffee, people would get fewer calories in an ordinary meal.

--- Later in debate ---

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

I congratulate the hon. Member for Brentford and Isleworth (Mary Macleod) on calling this very important debate. I also congratulate you, Ms Dorries. I am sure that you have chaired many debates, but this is the first time that I have spoken under your distinguished chairmanship.

When we discuss childhood obesity, we should be clear that we are talking not about how children look but about how they feel, because one of the problems with debates about body size is that they can have an element of judgmentalism, which makes the issue more difficult and emotional for people. I think that we can all agree, as a Chamber, that everyone’s child is loveable and everyone’s child is beautiful. We do not want to get into being judgmental about body size, because the other side of the coin from childhood obesity is childhood eating disorders—particularly among girls, but also, increasingly, among boys.

I want to touch on the introductory remarks made by the hon. Member for Brentford and Isleworth about the origins of childhood obesity. She talked about parenting. I do not disagree with anything that she said, but let us stand back and realise that we live in a world that has changed since the days when Nye Bevan set up the national health service. At that time, fewer than one in 10 households had a television and fewer than a third owned a car. Nowadays, 98% of households have at least one television, if not two or three, and 19.5 million households own a car.

When the NHS was set up, the only form of processed food available was spam. Now, there is an infinite variety of processed food; it is possible to eat it three times a day, with all the problems of trans fats, added sugar and so on that that involves. It is also the case that when the NHS was set up, many more people did manual labour. We are looking at a world that has changed. It is not just that people are making different personal choices; they live in a much less mobile, much less active, much more sedentary world.

When I was a child, I was not as sporty as some of the Government Members present, but in the summer holidays I would have my breakfast and then go out and play all day. Children played out all day. Their parents did not worry about where they were; they just knew that they were playing out. Children played down back alleys and in other people’s gardens. We might or might not come home for lunch, but we came home for tea. I am a parent myself—my son is now 19—and I would not have dreamt of letting him play out on the streets of London. Whereas parents 30 or 40 years ago thought nothing of letting their children play out unsupervised, nowadays parents feel much happier if their children are at home watching television or playing a computer game. They think that they are being good parents and they are certainly less fearful parents.

When I was a child, children routinely walked to school. Now, I see children driven to school over much shorter distances than I used to cover when I walked to school. Again, those parents think that they are being good parents. Perhaps my family was not as grand as those of some hon. Members, but when I was a child, we always sat down for a family meal together. We waited for my father to come home from work and we all sat down and ate as a family. There was not the snacking that my son routinely did when he was at home. Our world is very different from Nye Bevan’s.

Even over the past 20 or 30 years, however, the world has changed. People’s notions of what it means to be a good parent have been attenuated, certainly in big cities, although things may be different in Shropshire and more rural areas. In big cities, people think being a good parent means having their child safely at home. They think it means that their child is never hungry and that there is always food in the fridge to feed them. They think it means that they must feed their child the most heavily advertised and expensive products. The issue is not, therefore, just one of individual choices; we live in a changing society with changing ideas about parenthood.

Altogether, this is a more sedentary and materialistic society. As Members have said, even if children are active at school, that activity will stop when they leave. That is particularly true of girls. There are also the attractions of television. When I was a child, there was no daytime television, so children could not sit at home in the daytime watching television. We were out in the garden, on the swing or up the park; we were chasing people up and down, shouting at our brother and doing all the things that helped us work off the calories bit by bit.

We live in a changed world, which is part of the reason why we have seen a gradual increase in children leading more sedentary lifestyles, eating more processed food and snacking on processed food between meals. When I was a child, the only form of fast food was fish and chips or food from a Wimpy bar. I remember begging my father to take me to a Wimpy bar, which I thought was the height of sophistication and glamour. There was no question of children routinely stopping off at some fast-food shop on the way home from school or having fast food between meals; we lived in a very different world.

What can the Government do in a world that has changed and become commodified—one in which the average British child recognises nearly 400 brand names? We have touched on a number of issues that I am interested to hear the Minister talk about. In particular, there is the issue of what happens in school. As we have heard, one important thing is that children can learn to cook in school and can be taught about good nutrition. There is also the issue of the sort of school meals that are made available. There was some resistance to Jamie Oliver-type school meals, particularly when they were introduced at secondary school level, but introducing children to healthy food at primary school will set up habits that see them through life.

There is also the issue of food labelling. I would be interested to hear what the Minister has to say about traffic-light labelling, which is the easiest for mothers in places such as Hackney to understand. Mothers there are not going to read a label or to try to do the sums to work out how many calories there are in a packet of food if there are 60 calories per 100 grams. However, a traffic-light label in red, yellow and green is easy for them to understand.

I will be interested to hear the Minister explain how the commissioning model of health care in public health will engage with these issues. I am particularly interested to hear what she says about the extent to which Change4Life is working with the food industry. As one Member said, we might as well have the Silk Cut marathon, but I have an open mind and I am waiting to hear what the Minister has to say.

Childhood obesity is about how our children feel, not how they look. If somebody was a little chubby when I was a child, people used to say, “Oh, she’ll grow out of it,” but 70% of obese children stay obese well into adult life, with all the outcomes we are so familiar with in terms of heart disease, diabetes, stroke and blood pressure.

The striking thing about child obesity in 2011 is the extent to which it is a problem of poverty in the United Kingdom and the United States. Historically, it and the gout that went with it were problems that rich people had. Increasingly, however, heroes in popular culture in America and elsewhere are strikingly obese, which never used to be the case. Obesity is a problem of poverty; it is about a lack of information and a lack of access to a healthy diet.

We have heard about the increase in the numbers and about the real danger that significant numbers of today’s children will live shorter lives than their parents and spend their lives in poor health. We as a political class, and the Government, cannot simply leave childhood obesity as a matter of parental or children’s choice. Of course, choice is a big issue, but we have to set out a policy framework, whether it relates to schools, labelling or schemes such as Change4Life.

We have to set out a policy framework that makes things easier for parents, who are under more pressure than ever from commodification and materialism, and who are more frightened than ever about simply letting their children out to play. We have to set out a policy framework that makes it easier for parents, including Members of the House, to make the right decisions and to determine not only how their children look now, but how their health will be in years to come.

Oral Answers to Questions

Diane Abbott Excerpts

Tuesday 26th April 2011 Commons Chamber

[Mr Lansley]

Yes. My right hon. Friend will know that we have done that in the past, and we continue to do so. Just as early implementers of health and wellbeing boards have an important voice in how local authorities will strengthen public accountability and democratic accountability, we also now have an opportunity that we did not have in the consultation last year for the new pathfinder consortia, as they come together—88% of the country is already represented by them—to have their voices heard. I hope that the public generally will exercise this opportunity too. I know that groups representative of patients are doing so and very much want to get involved in these discussions.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The Secretary of State will be aware that if Lib Dem MPs were seriously opposed to this reorganisation, they could have voted against it on Second Reading—so how can he expect the public to take these discussions and the listening exercise seriously? Are they not just a device to get the coalition through the May elections, and is he not determined to get away with as little substantive change as he can manage?

[Mr Lansley]

On the contrary—the hon. Lady should know, because I made it clear on 4 April, that my objective, and that of the Prime Minister, the Deputy Prime Minister and all of the Government, is further to strengthen the NHS, and we will use this opportunity to ensure that the Bill is right for that purpose. The reason Government Members supported the Bill on Second Reading, and Labour Members should have done so, is that, as the right hon. Member for Wentworth and Dearne (John Healey) said, the general aims of reform are sound.

NHS (Essex)

Diane Abbott Excerpts

Tuesday 15th March 2011 Westminster Hall

[Priti Patel (Witham) (Con)]

I am grateful to Mr Speaker for granting me the opportunity in Westminster Hall to draw directly to the Minister’s attention a number of important issues regarding the performance of NHS services in my constituency and in the county of Essex. I suspect that the matters that I shall raise and the constituents’ cases that I shall mention are by no means unique to my constituency or the county. However, the Government are developing the most important and, in my opinion, long-overdue changes to the NHS, and I want to ensure that the problems and challenges faced by my constituents are thoroughly and fully considered.

Throughout the endless reforms and reorganisations undertaken by the previous Government, the health needs of patients were never afforded the same priority as the expanding tick-box bureaucracy suffered by my constituents. One consequence of the waste that was created is that the money put into the health service never achieved the true outcomes that my constituents deserved and needed. That has led in part to my constituents suffering poor patient choice and health care services. However, we cannot change everything about the past.

The Minister, the Government and, most importantly, my constituents want an effective NHS for the British people; it should deliver value for the taxpayer, ensuring that the mistakes of the past are not repeated and that all receive the care and front-line services that are their due. It is therefore essential that as the NHS is reformed, the needs of local communities in my constituency of Witham are not overlooked or ignored. That is why this debate is so timely.

By way of background, I shall give the Minister some details about my constituency and some of the health care challenges faced by my local community and me that are specific to the area, and the nature of current NHS services there. I shall then highlight the excessive and overblown bureaucracy that affects the NHS globally, which demonstrates the scale of taxpayers’ money that is increasingly and wrongly being taken from front-line services. I shall also draw attention to some of the most serious and heart-breaking cases that I have come across in the 10 months since I was elected, which show that the NHS too often fails the most vulnerable. I shall conclude my remarks by putting the case for new NHS services being delivered locally under the Government’s planned reforms.

Witham is a new constituency, so I forgive Members for not knowing much about it. It is not far from the London commuter belt, and lies within the heart of Essex. We have tremendous public transport and road links to London. The ports of Felixstowe, Harwich and Tilbury are not far away, and we have some major industrial towns and centres. It is not surprising, therefore, that Witham has experienced significant population growth in recent years. It is an attractive area to live in.

The three local authority areas in my constituency are Braintree, Colchester and Maldon. Under the previous Government, they were required to build more than 27,000 new homes in the 20 years to 2021, and 60,000 new homes between 2011 and 2031. Throughout Essex, the current population of 1.4 million could easily grow by 14% over the next 20 years. Members will be aware from their own areas that population growth inevitably puts more burdens not only on infrastructure but on the local NHS.

The local plans, particularly those that affect my constituency, unfortunately give no serious consideration to ensuring that the quality and quantity of local health services can keep pace with projected population increases and changing demographics. Although top-down targets are being scrapped by the present Government, the attractiveness and desirability of my constituency inevitably means that more people will move to the area, so we can expect to see a significant increase in the local population. That will put demands on local health services that are already struggling to cope.

It is not simply the sheer quantity of people that NHS services will need to support; they will also need to adapt to the changing demographics of the area. Because our local communities attract young families, we need stronger maternity services and paediatric provision. However, the most significant demographic change will be an acceleration of the number and proportion of residents over the age of 65. In that respect, my constituency and the county of Essex are not unique, as health services across the country are responding to an ageing population. By 2021, the NHS in Essex, along with its partners in local government, will need to accommodate the health needs of 45% more people in the county living beyond the age of 65, and 75% more people living beyond the age of 85.

Some of the most significant increases in Essex are expected to be in the Maldon district, part of which falls within the Witham constituency. It is worth noting that about 10% of the Essex population provides assistance, caring for family, friends or neighbours, with higher than average rates in Maldon, where the number of working-age people available to care for older persons will have nearly halved by 2029. These demographic changes present serious challenges to the front line of the NHS in my constituency and in the county.

I am pleased to report that Essex county council is taking a strong lead in implementing the Government’s reforms to deal with the challenge. It has already established a health and well-being board, and the Department of Health recognises it as an early implementer. I would welcome the Minister’s reassurance that the Government, unlike the Labour party, which has made no commitment to NHS funding to support this work, will continue to increase resources when necessary to support the health needs of my constituency and Essex. I shall emphasise throughout the debate the need for the money to be spent on front-line care, not bureaucracy.

That brings me to NHS bureaucracy in Essex and my constituency, and specifically to our local primary care trusts. The Minister will be aware that the medical needs of my constituents are served by a number of NHS trusts and by the East of England strategic health authority. There is no general hospital in my constituency; local residents usually use the Broomfield hospital run by the Mid Essex Hospital Services NHS Trust, which is based in the neighbouring constituency—that of the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns)—or the foundation trust hospital in Colchester for acute care services. Mental health services are provided by the North Essex Partnership NHS Foundation Trust.

My constituents are served by two of the five primary care trusts in Essex. Those who live in the Braintree district council or Maldon district council parts of my constituency fall within the area covered by the Mid Essex NHS trust, whose budget for 2011-12 has increased to just under £520 million. Those who live in the wards covered by Colchester borough council find themselves being dealt with by NHS North East Essex, whose budget for 2011-12 has risen to just under £547 million.

Later, I will give examples of cases in which constituents have faced unacceptable problems with those health trusts. In the meantime, it is worth looking at the obscene levels of bureaucracy, administration and management that have taken hold of those organisations. The number of managers and senior managers employed by the East of England strategic health authority doubled under the previous Government from 1,300 in 1997 to more than 2,700 in 2009. At Mid Essex Hospital Services NHS Trust, more than £10 million is spent annually on 29 senior managers and 79 managers. In the North East Essex PCT and its three predecessor trusts, the proportion of administrative staff rose from 19% to 33% between 2001 and 2009. The number of managers and senior managers increased from 25 to 84.

Finally, Mid Essex PCT, which serves the majority of my constituents, and its four predecessor trusts, saw administration and staffing levels rise from 17% to 33%, and the number of managers go up from 10 to 102. When we consider that those two PCTs were formed from seven predecessor organisations, it is fair to say that the growth in management and administration over eight years is quite shocking. The PCT now spends almost £13 million on management costs alone. That money, which my constituents and I view as hard-pressed taxpayers’ money, has been taken away from essential local medical care to staff a bureaucracy. Mid Essex PCT is also experiencing slippage in progress on its quality, innovation and prevention plan and, as a result, could now miss its year-end target by £2.7 million. On 16 November, the minutes of its remuneration committee, which have not been disclosed fully, indicate that performance bonuses were to be paid to the chief executive and its executive directors.

What concerns me is not just the vast sums of money increasingly flowing into the pockets of bureaucrats and managers, but the way in which the PCT is behaving and functioning since it embarked on its reorganisation. It seems to have no real idea as to what it is reorganising into. That is a cause for alarm. I hope the Minister is aware that last autumn, North Essex PCT and Mid Essex PCT decided to form a cluster with West Essex PCT under a new chief executive. The first I heard of that change was when I received a press release last September. In a massive blaze of glory, it was announced that the chief executive of the strategic health authority would form closer working arrangements with the PCT.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The hon. Lady has spoken at some length and with real passion about money being poured into the appointment of bureaucrats and managers. In her mind’s eye, a hospital bureaucrat is a man in a bowler hat with a brief case, but is she aware that many people who are dubbed managers in the health service are actually former senior nurses, such as her colleague, the Minister, who bring much of their clinical background and expertise to bear on their role? Nurses in particular get a little pained when politicians talk about managers and discount the fact that many of them are people with a very solid clinical background.

[Priti Patel]

I recognise that NHS managers have a range of health care backgrounds and bring a number of skills to the table. Of concern to my constituents though is the fact that we are dominated by managers who tend to have administrative rather than clinical backgrounds, and they are making key decisions about patient treatment, and even about medical care and access to drugs. None the less, I thank the hon. Lady for her comments and her valid point.

This brings me to the overall efficiency and effectiveness of the reorganisation. I have been told that reorganisation will lead to a significant step forward in delivering greater efficiency for the people of north Essex. None the less, I constantly have to ask the PCT, “What does this mean? What will this look like? What are the costs of the reorganisation?” I was told last autumn that the PCT could not quantify the cost of reorganisation as the process of reconfiguration had only just started. I have been asking for updates, but as yet, have not received any. Each time I ask anything, I am told that my question cannot be answered “at this time”.

There is far too much uncertainty. I welcome reorganisation, efficiency drives and reductions in management and bureaucracy costs, but there are major implications for front-line services. The language of the PCT is constantly about reorganisation producing greater efficiencies, which I would not dispute, but the PCT still has no detailed plans to show what the greater efficiencies will look like and what the formation of the new cluster will mean for local services.

The merging of back-office functions to save money is to be welcomed and I have no issue with that. In this case, however, I have discovered that there is no forward plan in the form of a route map and details of how things will operate. I have been asking questions for six months, but I have not received any substantial details about the new cluster, the staffing arrangements and what it will all mean for patient choice locally. I have sent written questions to the Secretary of State about the reorganisation but, again, I have not had a response.

Will the Minister examine this reorganisation and ensure that more information is made available to the public so that they have some sense of what kind of decision making is taking place locally within the new cluster and the PCT, and what it will mean to them in terms of access to health care and local services? It appears that many of the decisions have been taken behind closed doors, with very little accountability and transparency. It is in the public interest to know what has transpired within the reorganisation, and what the new arrangements will look like as well as the costs and the benefits.

As the PCT should rightly be beginning its winding-down process prior to its abolition, I would like to hear from the Minister about the redundancy arrangements for senior PCT managers. I am sure that that is a matter that is naturally in their minds right now. In view of the colossal levels of waste caused by PCTs, my constituents will be very disappointed to see PCT chief executives and other senior directors receive golden goodbyes to boost pension pots or huge redundancy pay-outs. In the interests of accountability and transparency, all constituents across the country will be looking, during the NHS reforms, for some encouragement from the Government on that issue.

Before I move on to some individual cases, let me just say that I make no apologies for being critical of NHS bureaucracy. In my limited time as an MP, I have seen endless examples of red tape standing in the way of my constituents getting the best health care that should be available to them. I am overwhelmed by the whole culture of tick-box management that has pervaded my local NHS. It is something with which I have been battling, day in, day out, on behalf of my constituents. It is an alarming state of affairs.

Let me now draw to the Minister’s attention a couple of cases. I have been in touch with the Minister and the Department about the issue of Sativex. There have been two cases in my constituency in which the PCTs have refused to treat patients on the NHS with the drug Sativex despite their doctors’ recommending its use to help with multiple sclerosis. In both cases, the PCTs have been able to afford to pay more to their managers and to spend more on red tape and bureaucracy, but have refused to provide vital medical treatment to my constituents.

First, Mr Shipton from Tollesbury was recommended Sativex by four doctors, to help his condition. Those doctors are medical experts who have been treating him and who are aware of his condition and medical needs. However, last September Mid Essex PCT, acting through officials sitting on its area prescribing committee, thought that it knew best and decided that it would not accept a request for Sativex to be prescribed to Mr Shipton on the NHS. That left him in considerable pain and distress. It then took more than a month for the chief executive of the PCT to respond to my request for copies of minutes of the meeting at which that decision was made. The minutes stated that the PCT declined to prescribe Sativex to Mr Shipton

“due to a lack of evidence of significant long-term benefit. Clinical trials are of very short duration and do not compare with current treatment.”

Despite that, however, Sativex is already licensed—in fact, it was licensed last June—for use to improve symptoms in multiple sclerosis patients with moderate to severe symptoms, clearing the way for the PCT to prescribe it. Indeed, the PCT itself had made 31 previous prescriptions of Sativex in 2009-10.

My constituent, Mr Shipton, ended up sourcing Sativex privately, at the cost of £125 plus VAT per bottle, which is a course of treatment that lasts for only two weeks. Contrary to the conclusions of the area prescribing committee, the drug is having a hugely beneficial effect on Mr Shipton. If the bureaucracy of the PCT had not stood in the way, he could have received that treatment at a much earlier date and he would not have had to endure extreme suffering and pain, as well as what I would describe as an unnecessary bureaucratic process.

I have another constituent, Mr Cross from Tiptree, who has also experienced horrendous problems. In fact, his wife, Mrs Cross, is on the phone to my office on a weekly basis, updating us about the terrible position that her husband is in and the suffering that he is experiencing. He has had horrendous problems receiving a prescription of Sativex, although in this instance the obstacle has been dealing with North Essex PCT. Mr Cross is wheelchair-bound and in terrible pain, experiencing constant spasms. In fact, he has recently been in hospital. Given his condition, any treatment would be a welcome relief for him. There is double suffering for his wife, as it were, because she is now effectively his full-time carer. Once again, getting access to this drug has been terrible. He has had his consultant neurologist battling for him and making his case, and I too have battled for him and made his case. But North Essex PCT, despite issuing 16 prescriptions for Sativex in 2009-10, still refused to prescribe this treatment for Mr Cross and gave him a highly dismissive response.

When I took up Mr Cross’s case from September 2010 onwards, I began a process of constant correspondence with the PCT. All I received were evasive non-responses and the odd reference to Mr Cross’s “medical needs”, which were then just dismissed. I found that totally unacceptable. Mr Cross’s condition has since deteriorated and he has been in hospital again. There needs to be a recognition of the endless stress and strain that this process puts on his own domestic set-up, especially his dear wife who is now his constant carer.

There is a compelling case for action in both of those cases, to press the PCTs to provide this drug. Also, both of my constituents have made the point that they have spent their lives working hard, doing the right thing and contributing to society. They felt that in their hour of need the NHS would be there for them, but now they feel that it has not been there for them. That is unacceptable. Although I appreciate that the Minister cannot intervene in individual cases, I ask her at least to examine these cases if she possibly can.

There are two other cases that I want to touch on briefly. The first is that of my constituent Mrs Emily Wetherilt, and again I would welcome the Minister looking into it. It is another example of a local PCT failing to perform adequately to meet the medical needs of my constituents. Mrs Wetherilt is 96 years old and requires 24-hour care. However, despite her case meeting the published criteria for NHS continuing health care funding, Mid Essex PCT has refused to provide any care whatsoever. So there has been no support for her from the PCT. Mrs Wetherilt’s daughter has taken up this matter directly with the PCT’s panel twice and she has been declined on both occasions. The PCT categorically refuses to look into this matter again, because an appeal had not been lodged within the two-week window that was available to Mrs Wetherilt’s daughter.

Many of us recognise that in cases such as this one, when a constituent’s family is caring for them, the family’s priority is looking after their family member and it is not to follow an appeals process within a two-week window. People become very emotional and providing care takes precedence. That care is the priority. Consequently, the tone and the attitude adopted by the PCT are utterly bureaucratic and deeply unhelpful.

Mrs Wetherilt’s daughter has also offered to work with the PCT to find out whether it is possible for the PCT to part-fund her mother’s care, but that suggestion was dismissed by the PCT without even being addressed. That is another example of the inflexible bureaucracy that fails to put patients’ care and needs first. It is more about the process—ticking boxes and filling in forms—and that is wrong.

I have a final shocking case to highlight. It is one that I have raised previously in the House and it is that of my constituent, 14-year-old Bethanie Thorn. Last October, Bethanie was struck down with a terrible illness and left bed-ridden. She literally went from being a healthy teenager one day to being completely bed-bound two days later. The cause of her symptoms was unknown and she became unable to eat as her condition deteriorated. Nevertheless, she faced lengthy delays to get an MRI scan and the other vital checks that were needed to diagnose her condition.

It was only last November, when I raised this matter on the Floor of the House, that the Secretary of State looked into Bethanie’s case and appointments were made for her to have an MRI scan. People in urgent need of an appointment should not have to rely on the Secretary of State, local newspapers or their constituency MP to raise their case and sort appointments out. It shows how serious this case was that, shortly after her scan and check-up, Bethanie was admitted to hospital and she was only able to return home two months later, at the end of January. Her mother has effectively become her full-time carer and her family have had to battle at every single stage for care, appointments and treatment, which is appalling. I must say that, if Bethanie had received the appointment that she needed straight away, she would probably be in a better state of health today. The Minister will appreciate that this has been terribly distressing for Bethanie and her family.

When the NHS was pressed about this case, the only explanation given for the delays was something described as a “broken pathway”. I have no idea what a “broken pathway” is in NHS management talk, but the case has highlighted just how damaging poor performance and failures in NHS services can be to individuals. This girl’s life has changed beyond all recognition now. This case also demonstrates what can go wrong when there are endless layers of bureaucracy in the NHS; it was unclear throughout whether it was Bethanie’s GP, the PCT or the hospital services who were actually responsible for ensuring that Bethanie received the care that she needed. There was to-ing and fro-ing constantly—there really was.

Like all Conservatives, at the last general election I was absolutely proud to stand on a manifesto commitment to cut the waste and bureaucracy in the NHS, so that we could invest in the front-line services and give more powers to doctors and patients. I want to reiterate that in my short tenure—10 months—as a Member of Parliament, all I have seen are examples of how bureaucracy has got in the way. If nothing else, I will continue to battle to get the services for my constituents, in the face of adversity—that is, in the face of bureaucracy.

I welcome the measures that have been announced by the Government about the reforms and plans for the NHS. The purpose of mentioning these cases now is to highlight the fact that in Essex we have seen more of the non-medical side of the NHS in action locally than we have of the medical side, which shows the need for reform of patients’ treatment.

Finally, I want to draw attention to the fact that there is some hope for my constituents. That is the hope that they have placed in Government legislation to reform the NHS. As the Minister will recall from Health questions last week, Witham town is the most urban part of my constituency and Witham town council and others have put forward a very strong case for there to be more health care specialist services in our town. Although Colchester, Braintree and Chelmsford all have significant health facilities, including general hospitals and community hospitals, there is nothing for the people of Witham in our town, and there is nothing for the people from the surrounding villages. That gives the impression locally that there is a two-tier health system.

I mentioned at the start of my remarks that the Witham area includes some pockets of serious deprivation and has a growing population. Unfortunately, the PCT has not taken enough action to close the gap created by the changing demographics and local needs. Maltings Lane is a new housing development in Witham town. It has evolved over a number of years, and many more new homes and other facilities will be built there over the next 10 years, but it was begun with no plans whatsoever for additional health care services. That issue needs to be addressed in the long run, and I hope that the Minister can help my town council, along with our district and county councils, to work with the PCT and the forthcoming GP consortia to develop additional local services that seek to meet local needs. The issue is one of supply and demand, and there is a crying need but no provision.

As a starting point, the town council, to its credit, is working cross-party locally with all our councillors, and has put together a list of services that Witham needs, including an additional surgery, an out-of-hours walk-in clinic, minor injury, oncology and out-patient clinics and a diversity of medical-testing facilities. By adding some of those services to Witham and the surrounding communities, we will naturally see real benefits in the form of health care provision, choice and diversity, and we will enjoy the convenience of more local NHS services.

I am conscious that I have spoken for a considerable time and that many other Members wish to speak, so I shall conclude by saying that although I could raise many more health-related issues, I hope that I have given the Minister a real insight into the challenges that we face in Mid Essex, where we are surrounded by a lot of health activity but have had this bureaucracy that has stifled both the delivery of front-line care to patients, and the choice aspect of health care provision locally. I thank the Minister and colleagues for their patience in listening to my remarks, and I look forward to the Minister’s response.

--- Later in debate ---

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The hon. Member for Witham (Priti Patel) is to be congratulated on obtaining the debate. Many of my constituents move to Essex as a kind of upward trajectory, so I listened with great interest to what she had to say about a part of the world with which I am not as familiar as I probably should be. The week after the Lib Dems have turned savagely against the Conservative-led coalition’s health care policies—the British Medical Association is debating them today and, as we know, doctors are very worried about what is proposed—hon. Members will expect me to touch on the health reforms generally and how they will affect the people of Essex.

I listened with some sympathy to the complaints of the hon. Member for Witham about bureaucracy. As I have been a Member of Parliament for 20 years, I have tangled with more bureaucrats than I care to remember. However, I always like to stop short of sounding as if I am dismissing people who work for the health service as a whole. My mother was a nurse. She was one of that generation of West Indian women who helped to build the health service after the war. We have to remember that however frustrating it is as Members of Parliament or even as members of the community to deal with bureaucrats in the health service or elsewhere, there are thousands and thousands of people without whom the health service could not work or function. They will tell us that they have survived more reorganisations than they care to remember. They are still there, getting their heads down and trying to provide a service for our constituents.

The hon. Member for Witham made an important point about the proportion of elderly people in our population. We do not have time to deal with that matter fully, but people are living longer and they are suffering from ailments such as Alzheimer’s and other things. Elderly people make up an increasing proportion of the population. A few weeks ago, I went to a nursing conference and a senior nurse said to me that, when she was on the wards, the mean age of elderly patients was about 80. The mean age of elderly patients is now 90 or 100. Elderly people now pose very different problems from those that the elderly posed a few years ago. It is important that we consider the question of how we secure high-quality care—I am reminded of that awful ombudsman report that was published a few weeks ago—how we pay for it and how health care interconnects with the issues of public health and social care. I hope that we will have a chance to return to those matters.

I remind the hon. Lady that, despite her letters to bureaucrats and her undoubted frustrations on behalf of her constituents, when my party left office, satisfaction with the health service was the highest it has ever been. Hon. Members can say that the population was deluded on that, but I do not think that that is correct. We are talking about massive MORI polls. People’s satisfaction was higher than ever. There had also been massive levels of investment, not least in Essex. She will be aware of the new unit at Colchester general hospital, which includes an updated children’s ward. It is fully open and operational, and that £20 million project marks the biggest investment in the hospital’s facilities since it opened in 1985.

Apart from general frustration with bureaucracy, there are specific issues in relation to health care in Essex that are worth mentioning in this short debate. The hon. Lady mentioned Broomfield hospital. She will be aware that, just a few weeks ago, it was highlighted that although the hospital takes more than £1 million a year in car parking charges, its car parks still lose money because it is spending £1.2 million on running costs, including on CCTV, attendants and capital investment—they must be extremely well paid attendants. We also know that the hospital’s move into its £148 million PFI wing was delayed twice before finally opening in late 2010. The opening day was pushed back because staff were trapped in faulty lifts. We also know that the same hospital spent £400,000 on art for its new wing, which was commissioned as part of the development and funded through PFI. PFI is expensive enough—we may debate that at another time. To spend the money on art, when we know how ridiculously expensive PFI can be, seems quite strange.

There have been all sorts of care warnings about hospitals in Essex, such as Queen’s hospital in Romford. We know that the Romford project will be the first of a number of pilot reviews of PFI contracts to see if the costs can be brought down, and anyone who cares about the health service must welcome that. We know that the Braintree community hospital has defended itself after paying out nearly £20 million in damages for clinical negligence. If we are focusing on bureaucracy, we have to focus on how those things happen. We know that the Southend University Hospital NHS Foundation Trust, with which hon. Members will be familiar, has had to respond to concerns about safety, which were raised by the Care Quality Commission. We know that the West Essex primary care trust risks not being able to give an 18-week referral-to-treatment time. We know that NHS South West Essex has a very large overspend—its deficit has been improved, but it still has an overspend—in relation not to bureaucrats, but to acute hospital activity.

We also know, which I find alarming, that the Basildon and Thurrock University Hospitals NHS Foundation Trust is now trying to make savings by allowing waiting lists to extend. That implies a 14-week wait on first appointment, which is why an hon. Member on the Government side said that, when ordinary residents and voters are told that money on the health service is being ring-fenced, it rings rather hollow. Up and down the country, not just in Essex, they can see waiting times lengthening, and new hospitals and new health care facilities that have been promised being delayed. It is for the Government, who have made much of their protection of health care spending, to explain that. The real issue is this. The hon. Member for Witham spoke glowingly about the reforms, but sadly I have news for her. She seems to believe that those reforms will help with the issues that she has raised. As she would know, however, if she had followed the Health Committee, there is a real challenge involved in trying to introduce those reforms, whatever we think of them, while at the same trying to achieve unprecedented savings in health care. The Health Committee doubts whether that can be done.

No one argues with the notion that GPs could have a lot to offer in the commissioning of care, but as the president of the Royal College of General Practitioners has said, there are other ways to do that without subjecting the health service to a top-down reorganisation. I do not want to be unpleasant, but the Government promised, all through their time in opposition, that they would not subject the health service to any top-down reorganisations.

[Priti Patel]

Will the hon. Lady give way?

[Ms Abbott]

Time is against me, because I want to give the Minister plenty of time to respond. That is what we were promised—no more top-down reorganisations. As for waste of money, one problem with letting all those PCT bureaucrats go is that they have to be paid redundancy. The hon. Lady said that she hopes that they will not be paid big redundancy packages. I am afraid that they will be, and many will be re-employed. GPs will be less accountable to patients and the danger that many people, including GPs, see is that the big American health maintenance organisations will be able to get inside and act as commissioners for GPs, who, after all, joined the health service to heal and not to be managers.

I feel sorry for Government Back Benchers. They believe that the issues that they find so challenging about bureaucracy, cuts and patient accountability will be solved by the reorganisation. I can say with complete confidence that, if anything, the reorganisation, which is too fast and at the wrong time, will make those problems worse. It gives me no pleasure to say that, but anyone who has analysed the so-called reforms can see that they are a car crash in slow motion.