Sentencing: Repeat Offenders

Debate between Grahame Morris and Dan Poulter

Tuesday 21st June 2022 Westminster Hall

[Grahame Morris]

The hon. Gentleman has got the thread of my argument precisely. I am not arguing in a contrary fashion, because I believe that repeat offenders—people involved in serial offending—need to be incarcerated for the protection of the communities and themselves. However, I do feel that in prisons, over a number of years now, the resources have not been made available to effectively prevent reoffending by offering alternatives and rehabilitation to those people who are incarcerated. I hope I can go on to develop that argument, but it was a good point, and I thank the hon. Gentleman for his intervention.

The greatest tool to tackle record rates of reoffending must be effective rehabilitation. At the heart of rehabilitation is education, which is desperately needed by so many prisoners. Prison education is a complete mess; that has been confirmed by independent inspectors, by the Education Committee, which is highly respected, and by Ofsted. The Government have announced plans for yet another shake-up, promising a new prison education service—I hope the Minister will say something about that. Unfortunately, details are still very thin on the ground. Ministers have had little to say about teachers, who, it might be thought, would be central to any new strategy to turn around the current, failing system. The Education Committee’s report said:

“Poor pay, lack of career development, unsafe working environments and no time or respect to do a quality job has left the recruitment and retention of qualified and experienced prison educators at crisis point.”

I hope that the Minister will listen, if not to me, then to the Education Committee, which is chaired by a Conservative, the right hon. Member for Harlow.

The problem is the Government’s ideological obsession with running key services, including the criminal justice system, for profit. Four giant prison education providers compete for business while cutting all sorts of corners to maximise profits. According to the union sources I have spoken to, pay and terms and conditions can vary widely. Any serious plan for fixing our broken prison education system should start with standard contracts across the whole sector, plus a pay rise to bring wages up to comparable roles outside. I do not want to go into the details of the issues that have been highlighted to me, but there are things that I hope will be included in the new prison education strategy, which the Minister might refer to when he responds.

Prisons are simply not fit for purpose. In the main, that is as a result of this Government’s savage cuts and poor treatment of the workforce—and all of us are paying the price. However, I believe that prison can and must work. A custodial sentence for a repeat offender provides the community with respite from their offending. In the communities that I represent, which in the main are fairly poor, a relatively small number of prolific offenders cause havoc and cause the majority of crime and antisocial behaviour.

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

I congratulate the hon. Gentleman on bringing this debate today. He rightly talks about being tough on crime, tough on the causes of crime, which is a Blairite mantra; I am sure that we are all Blairites in that respect today. Does he agree with me that in respect of stopping reoffending, there is a particular challenge with the number of people in prisons who are dependent on opioids and other drugs, and that it is important that we get the right planning in place for those people when they are released from prison to make sure that issue is tackled, because it is a root cause of reoffending?

GP Services

Debate between Grahame Morris and Dan Poulter

Thursday 5th February 2015 Commons Chamber

[Dr Poulter]

Indeed. My hon. Friend makes an important point and echoes that made earlier by my hon. Friend the Member for Truro and Falmouth (Sarah Newton). At the moment, a valuable part of our general practice work force, perhaps due to life circumstances or the fact that they have started a family and have had two children quickly one after another, face difficulties in going back into practice. Issues to do with the operation of what is called the performers list need to be looked at, and I will ensure that NHS England does so and considers how we can better support GPs to get back into practice when they have had career breaks for legitimate family and other reasons.

[Grahame M. Morris]

Will the Minister give way?

[Dr Poulter]

I hope that the hon. Gentleman will forgive me. I may give way later, but I want to make some progress because this is a debate for Back Benchers. I will address the points that he made a little later on.

General practice funding is, of course, important. We must have regard to the primary care work force, how patients access their GP and how we structure primary care to get the best results for patients. It is only by looking at all these together that we can properly ensure the sustainability of the general practice services, which we are all so rightly proud of in each of our constituencies. Some excellent points on local sustainability were made by my right hon. Friend the Member for Chelmsford (Mr Burns) in an intervention, and by my hon. Friend the Member for Henley (John Howell). They spoke about the importance of co-ordinating local planning processes with the local NHS to better support GPs to develop practices in areas of housing growth. I am sure all local authorities will want to look at that in more detail.

On work force issues, being a GP is still a rewarding and well-paid career, with the average salary for a GP close to £110,000 per year. GPs are often the first point of contact for patients when they use our national health service. We should not lose sight of that in this debate. We have already delivered an increase of 1,051 full-time equivalent GPs who are working and training in our NHS since September 2010. This brings the total number of full-time equivalent GPs to 36,294, which represents a real increase in capacity under this Government. However, we know that there is still more to do. A report undertaken by the Centre for Workforce Intelligence last year warned of a demand-supply imbalance emerging by 2020 unless there is a significant boost to GP training numbers.

Before the report came out we had already made plans through work that Health Education England was undertaking to increase the number of GPs. NHS England has been working closely with Health Education England, the Royal College of General Practitioners and the British Medical Association to produce a 10-point action plan to increase the size and capacity of the general practice work force, which we have backed with £10 million of funding. This plan covers a wide range of measures to recruit more young, aspiring medical students to take up a career in general practice, retain those doctors already working there, and provide support for those GPs who have taken a career break and help them to get back into work—an issue that a number of Members raised in the debate.

[Grahame M. Morris]

Will the Minister address the point that I raised about under-doctored areas, particularly deprived areas, where we find it difficult to attract GPs? Would he consider writing off the student loans of those individuals in order to make it attractive to work there?

[Dr Poulter]

The hon. Gentleman and I do not often agree, but I agree with him on this. We have to do more to support medical students and to encourage people from all backgrounds to become medical students. It was a sad indictment of the previous Government that social mobility into many degree courses was falling, and that was particularly the case in medicine. We have been working with the medical schools to look at the importance of early engagement, supporting people from a much younger age, and universities engaging with local communities, as is the case at my medical school, Guy’s, King’s and St Thomas’, where people from more deprived backgrounds are supported and encouraged into medicine by the medical school’s engagement with schools and with pupils from an early age. That is the sort of approach that works.

One of the challenges is the distribution of medical schools and medical places often around our larger cities. The challenge is to support smaller and important medical schools, such as Lancaster, which does a great job of supporting local young people to become medical students and then into medical careers. We need to support those universities to expand where that is appropriate. Many of our traditional models of medical training at medical schools tend to focus from day one on encouraging people to become surgeons. We know that we need to support more people to become general practitioners. What works well and what Lancaster and Keele universities in particular do through their syllabus is to encourage more young people to undertake more placements in general practice. That has a good effect in encouraging those medical students to want to become GPs in their later medical careers.

NHS (Government Spending)

Debate between Grahame Morris and Dan Poulter

Wednesday 28th January 2015 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I welcome this opportunity to discuss the NHS. In answer to the question from the hon. Member for Nottingham East (Chris Leslie), I reconfirm the Government’s commitment to an NHS free at the point of need and free at the point of delivery. Only with a strong economy can we afford to pay for our NHS.

It would be wrong to open my remarks without commenting on the Labour party’s increasingly regrettable approach of weaponising the NHS. I still work as an NHS hospital doctor. There are a lot of professional politicians on the Opposition Front Bench. In my capacity as a local MP, I have been out on the front line with the East of England ambulance service during night shifts over this busy winter period. Front-line NHS staff do not appreciate the way in which the Labour party is trying to run down our NHS. There are a lot of staff working incredibly hard over this busy winter period and they should be congratulated on the effort and dedication that they put into front-line patient care. I hope that the hon. Member for Nottingham East and the Leader of the Opposition will reflect on that.

As this is an economic motion, it is appropriate in my opening remarks to address the economic situation our country was in when we came into government. We inherited the worst economic record of any new Government since the 1930s. Labour’s record of economic incompetence and profligate spending meant that the annual deficit was £134 billion and that we were paying back £367 million each and every day in debt interest alone. I believe that the hon. Member for Nottingham East was a special adviser who advised on that profligacy and incompetence. Labour left Britain with its largest deficit since the second world war. One pound in every four that was spent by the Government came from borrowing. Labour’s outgoing Chief Secretary to the Treasury, the right hon. Member for Birmingham, Hodge Hill (Mr Byrne), summed it up in his note to his successor with the words, “Good luck. There’s no money left.” There we have it—Labour’s record of economic incompetence. Britain was bankrupted by the last Labour Government, but thanks to our long-term economic plan things have changed for the better and Britain is back on track. There are now 2.16 million more private sector jobs since the coalition came to power, and 2 million more people have started an apprenticeship. The Government are giving more young people a chance in life and the opportunity to take home a pay packet.

[Grahame M. Morris]

May I just point out one of the lessons from history? When the NHS was established after the second world war, the country was tasked with rebuilding and its debt and deficit were considerable. But the Labour politicians of the day had the strength of character and the will to make that investment in the interests of the health of the nation. Should we not do that now?

National Health Service (Amended Duties and Powers) Bill

Debate between Grahame Morris and Dan Poulter

Friday 21st November 2014 Commons Chamber

[Dr Poulter]

I will come on later to the costs that the hon. Gentleman’s Bill would directly create. The point is that we should be proud—the Labour party should be supporting the Government—that we are reducing administration and bureaucratic costs, because that money is now being spent on patients. Why cannot Labour for once accept that a good thing has happened and that more money is now going into front-line patient care?

The second effect of the 2012 Act is that it empowered local doctors and nurses, as those closest to and most able to determine the needs of their patients, to design and lead the delivery of services around the needs of those patients. Thirdly, the Act placed great importance on and sought to drive increased integration across our NHS, a point clearly articulated by my hon. Friend the Member for Bosworth (David Tredinnick). Commissioners had duties placed on them by the Act to consider how services could be provided in a more integrated way, and we have since built on the Act by supporting a number of integration pioneer sites, which will trail-blaze new ideas to bring care closer together, particularly for frail elderly people and people with complex care needs. They will be leaders of change—a change we have to see in the health system, if we want to offer the very best quality of care to patients.

We are also supporting the health and care system through the £5.3 billion better care fund, with commissioners working in partnership with local authorities to deliver more integrated person-centred care. Offering seven-day services and delivering care that is centred on patients’ needs will encourage organisations to act earlier to prevent people from reaching crisis point. That is the sort of clinical leadership that the Act has fostered. It will refocus the point of care towards more proactive community-based care, for the benefit of so many patients.

[Grahame M. Morris]

The Minister is defending fragmentation, but may I, as a former member of the Health Committee, remind him that Sir David Nicholson, the former chief exec of the NHS, summed up the situation last year by saying:

“You’ve got competition lawyers all over the place, causing enormous difficulty. We are getting, in my view, bogged down in a morass of competition law which is causing significant cost in the system”.

Is the Minister saying that the chief exec is wrong in his assessment?

NHS Patient Data

Debate between Grahame Morris and Dan Poulter

Tuesday 25th March 2014 Westminster Hall

[Dr Poulter]

I will give way in one moment. It is also the case, in relation to a number of the other issues and concerns that have been raised during this discussion, that some of the events and some of the evidence given to the Select Committee have of course been superseded by the amendments made to the Care Bill that we debated a couple of weeks ago, so it is difficult to see those points—

[Grahame M. Morris]

Will the Minister give way?

[Dr Poulter]

I am giving way to the hon. Gentleman’s hon. Friend in one moment. Let me complete the explanation and then I will be very happy to give way. Events have moved on since some of those evidence sessions, because of course amendments were made to the Care Bill that gave greater clarity and greater reassurance about the protection of patients’ data.

--- Later in debate ---

[Dr Poulter]

The hon. Lady will recognise that NHS England is an arm’s-length body, so it has less accountability than—or certainly not the same accountability as—a civil servant does to a Minister, and it has a degree of independence. If there are concerns to be raised, as she has just outlined, it is for the Chair of the Committee to write to obtain clarification if he believes that to be appropriate. I am sure he will do so if he feels that that is right. It is not for me, as a Minister, to interfere with the workings of a Select Committee and I do not propose to do so.

[Grahame M. Morris]

Will the Minister give way?

[Dr Poulter]

No. I have listened to the same speech from the hon. Gentleman as did my right hon. Friend the Member for Chelmsford (Mr Burns). The hon. Gentleman is always very helpful in tying himself in knots and confusing debates. On this occasion, however, I will make some progress, because I have got 10 minutes left and I would like to put down some further reassurances. I may give way later on, time permitting.

Once again, I congratulate the hon. Member for Worsley and Eccles South on securing the debate, and I would like to say at the outset that we all believe care.data to be a good thing. It is good news for patients, for improving transparency in health care and for improving the quality of research. Those are undoubtedly good things, and we must not lose sight of them in our discussion. The lessons of Mid Staffordshire point out that if we do not properly expose examples of bad care—if we do not have the data, and the transparency in the use of those data, to expose good and bad care in the NHS—bad things can happen to patients. That is a lesson that we must heed.

We must also recognise that if we had had better data sharing in the past, we might have been able to learn better how to recognise patterns in prescribing that were to the detriment of patients, such as the example that has been cited of the use of thalidomide during pregnancy. We might have avoided some very bad things happening to patients if we had had the necessary data. That is what our proposals are about.

This is not a sudden, big-bang change. Opposition Members have put it about that we are dealing with a big change in approach to the use of data in the NHS, but I remind the Chamber that in 1989, hospital episode statistics were first collected for in-patient data, in 2003 for out-patient data and in 2007-08 for A and E data, and primary care data are now being made available.

Of course we understand that the use of data can be concerning, so I want to reassure everyone that the right safeguards are in place, many of them established by the Health and Social Care Act 2012. The new body, the Health and Social Care Information Centre, must have regard to the safeguards put in place by the 2012 Act. The Government take the safeguarding of patient data very seriously.

The commercial reuse of licences was raised in the debate. The Health and Social Care Information Centre has confirmed that some reuse agreements remain in place for specific organisations in relation to approved purposes. The purpose of each application is carefully considered by the HSCIC before it is agreed. That consideration includes the application’s benefit to the health and care system, a safeguard established by the 2012 Act for the use of data.

--- Later in debate ---

[Grahame M. Morris]

Will the Minister give way?

[Dr Poulter]

I will give way in a moment; I am just going to finish this point. Following concerns expressed by the Health Committee in its meeting of 25 February, Sir Nick Partridge, a non-executive director on the HSCIC board, has agreed to conduct an audit of all the data releases made by the predecessor organisation, the NHS Information Centre, and report on that to the HSCIC board by the end of May.

Furthermore, a report detailing all data released by the HSCIC, including the legal basis on which those data were released and the purpose to which they are being put, will be published by the HSCIC on 2 April. That report will be updated quarterly. I reiterate that the HSCIC will release information for health and care uses only.

[Grahame M. Morris]

The Minister is arguing that the scheme is an extension of what happened before, but there is clearly a quantum difference. There is general agreement that it is a wonderful thing to have data sets for research and public health purposes. The difficulty that the public have, about which we need to restore confidence, is when that information is being used for marketisation—for marketing purposes—by commercial reusers. I am not reassured by the Minister’s comments, but he has an opportunity to correct the problem in the House of Lords.

Care Bill [Lords]

Debate between Grahame Morris and Dan Poulter

Tuesday 11th March 2014 Commons Chamber

[Dr Poulter]

As things stand at the moment, free text is not going to be used. That is the reassurance given by the HSCIC; it clearly does not envisage that text being used and it has given reassurances on that. That is reassuring for me and I hope it is reassuring to my hon. Friend. There are those additional safeguards in place, particularly for vulnerable patient groups, to make sure that more personal data about convictions, imprisonment and abuse by others will not be collected by the information centre.

[Grahame M. Morris]

rose—

[Dr Poulter]

I will deal first with the points made by the hon. Member for Worsley and Eccles South and then I will give way. I inferred from the hon. Lady’s remarks that she thought that GPs should be able to opt out for their patients. However, we have made it clear that it is a decision not for GPs to make on behalf of their patients but for the patients themselves. Furthermore, people can, at any time, object or change their mind, and the Health and Social Care Information Centre must respect their wishes and remove their data from records.

[Grahame M. Morris]

I am grateful to the Minister for giving way. Will he clarify the point raised by the hon. Member for Totnes (Dr Wollaston) in relation to vulnerable patient groups? Does that include patients with very rare conditions who could be identified, even from anonymised data, because they are part of a relatively small group?

[Dr Poulter]

Of course strict criteria are in place under the 2012 Act about the use of data where a patient could be identified. The Health and Social Care Information Centre cannot randomly release data that would identify patients, except where there are specific public policy reasons for doing so, such as in the event of a flu pandemic or a public emergency. There are strong safeguards in place under that legislation to protect patient data. It would be wrong of the hon. Gentleman—I know he often inadvertently misleads himself in some of his conclusions and goes around in circles in his remarks—to confuse Members and to confuse the House. The legislation is clear. He has been in many debates on the matter over the past few weeks, and strong protections are in place to protect patient confidentiality and to prevent patients from being inappropriately identified.

I do not want to be drawn into individual cases, but the hon. Member for Worsley and Eccles South also raised the issue of the MedRed BT Health Cloud, which will provide public access in the United States to 50 million de-identified patient records from the Health and Social Care Information Centre in the UK. We have clarified the matter. The data referred to are not confidential, but are published anonymous data of the aggregate population—not at patient level. The data are available freely to any member of the public or organisation via data.gov.uk. There is no conspiracy about the data; they are freely available to any one of us in this Chamber or to any member of the public.

It is worth highlighting the powers of the Secretary of State, which the shadow Minister also raised in his comments. Let me reassure the hon. Member for Worsley and Eccles South in respect of the amendment that she has tabled today. Section 245 of the 2012 Act enables the Secretary of State to direct the Health and Social Care Information Centre to establish information systems—to collect data—including systems on how to carry out that collection.

The Secretary of State can also direct the Health and Social Care Information Centre to report on any matter about its functions. If concerns were raised about the issue of free text data, which my hon. Friend the Member for Totnes mentioned, the Secretary of State could pass on directions to the Health and Social Care Information Centre.

Care Bill [Lords]

Debate between Grahame Morris and Dan Poulter

Monday 10th March 2014 Commons Chamber

[Grahame M. Morris]

Will the Minister give way?

[Dr Poulter]

I have not said anything controversial yet, so if the hon. Gentleman will let me make some progress, I will happily give way later.

To realise the huge potential of health care data, patients and professionals must have absolute trust in the way that the data will be protected and used, together with an understanding of why collecting the data on such a scale is important. I absolutely understand that many people have concerns about how the process might work, but I am confident that the Government amendments will bring further reassurance to the House about the care.data programme.

The Government fully support NHS England’s decision to delay the start of the care.data programme so that more work can be done to build understanding and confidence. NHS England will be leading that work. In parallel, having listened to key stakeholders and to discussions in this place, the Government have brought forward a package of measures, including amendments to the Bill, to respond to concerns and to give the public greater clarity and reassurance that their data are safe.

The Health and Social Care Act 2012, which established the Health and Social Care Information Centre, introduced a raft of safeguards to balance the huge benefits that linking health and care data can bring. That offered people greater protection than was previously available. It is worth highlighting some sections of the 2012 Act as examples of that.

Under section 260, the Health and Social Care Information Centre must not publish the information that it obtains in a form that would enable an individual, other than a provider of care, to be identified. Similarly, under section 261, the HSCIC cannot disseminate share data that could be used to identify an individual, other than a provider of care, except when there is another legal basis for doing so, which could happen in the event of a civil emergency or public health emergency, such as a flu pandemic. Under section 263, the HSCIC must publish a code of practice that makes it clear how it and others should handle confidential data. Under section 264, the HSCIC must be open and transparent about the data it obtains by publishing a register with descriptions of the information. Indeed, the HSCIC is currently working to ensure that it is transparent about all the data it has released to others.

Moreover, the Government have made the commitment that if someone has concerns about data being used in this way, they can ask their general practice to note their objection and opt out of the system. Following that, no identifiable data about them will flow from their GP record to the HSCIC. Directions to the HSCIC under section 254 of the 2012 Act—separate from the amendments that the House is considering—will ensure that that commitment to patients has legal force.

We are going further than that. Having listened to key stakeholders and to discussions in Parliament, we have a further package of measures that, in parallel with NHS England’s further engagement activity, will respond to the concerns that we have heard and give the public additional reassurance that their data are safe. Of course, aggregated and anonymised data, which cannot be used to identify any individual person, should and will be made generally available. Indeed, a great deal of research relies on data of this type, where researchers do not need to see any data at the individual person level. Such aggregated and anonymous data are available now, and were available previously through the predecessor body to the HSCIC.

New clause 34 sets out a number of changes to the 2012 Act which, taken together, clarify when the HSCIC can and cannot release data. The new clause expressly prevents the HSCIC from using its general dissemination power where there is not a clear health care, adult social care or health promotion purpose—for example, for commercial insurance purposes. I am happy to confirm that the new clause enables anonymised information to be disseminated under the HSCIC’s general dissemination power for a wide range of health and care-related purposes, including for commissioning for a wide range of public health purposes and for research relating to health and care services such as the epidemiological research that is needed at the earliest stages of developing new treatments.

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[Grahame M. Morris]

rose—

[Dr Poulter]

I am not going to give way. I am still addressing the hon. Lady’s point, and I am not saying anything controversial. If we had had better, more joined-up data that could have been used in a more transparent way beforehand, we might have been able to head off the events that we saw at Mid Staffs much earlier. This is about protecting patients and the public, and about using population-level data in an open and transparent way. Under the safeguards that we are introducing in the new clause, data will not be used for commercial insurance purposes. Let me give that reassurance.

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[Dr Poulter]

Hopefully, if I am allowed to make some progress and address the points that have been raised, I will give further reassurances a little later. It would be useful—[Interruption.] I will answer the question a little later, so there is no point in heckling or being abusive. If the right hon. Gentleman will wait, I will talk him through the Government’s amendments so that he can gain a better understanding —

[Grahame M. Morris]

Will the Minister give way?

[Dr Poulter]

No, I will not.

[Grahame M. Morris]

Are you afraid?

[Dr Poulter]

No, I am not afraid to give way. The hon. Gentleman should sit down, because he often has quite enough to say, and it is not always a very valuable contribution. In this context, he may do well to listen to some of the purposes of the amendments. As I have already outlined, there are strong safeguards set out in the 2012 Act on how data can be used. Data can be used only for the benefit of the health and care system. In order to reassure the public, we have tabled amendments to clarify further how data may be used.

Speaking to a great many people in recent days, as well as considering amendments tabled by other Members, has prompted the Government to re-table the new clause in order to clarify that these kinds of data may also be disseminated for other wider public health purposes, such as research into environmental factors associated with asthma, or for healthy eating. We have ensured that those other kinds of research can benefit from the data by changing the wording in the new clause to make it clear that information may be disseminated for the purposes of

“the provision of health care or adult social care”

or “the promotion of health”. I am sure that the House will agree that it is essential that that valuable data resource is available to support a broad range of health research.

New clause 34 clarifies that in disseminating information, and indeed in carrying out any of its functions, the Health and Social Care Information Centre must have regard to the need to promote and respect the privacy of those receiving health services and adult social care in England. It also requires the HSCIC to take into account advice from the advisory committee that the Health Research Authority is required to appoint under paragraph 8 of schedule 7 to the Bill. The advice from that committee, known as the confidentiality advisory group, will provide a new level of independent scrutiny of the HSCIC’s decisions to publish or disseminate information.

Amendment 17 would also enable the confidentiality advisory group to advise the HSCIC on the exercise of functions conferred in regulations under section 251 of the National Health Service Act 2006, or more generally on decisions to disseminate information that could be used to identify individual patients. For example, when new regulations are made under section 251 of the 2006 Act that confer functions on the HSCIC, the confidentiality advisory group could advise the HSCIC on proposals to release data. New clause 34 requires the HSCIC to have regard to that external advice on its exercise of any function under the 2012 Act of publishing or otherwise disseminating information.

Amendment 18 gives the Secretary of State regulation-making powers to set out the specific criteria that the confidentiality advisory group will be required to take into account in giving advice to the Secretary of State, the Health Research Authority or the HSCIC in carrying out their duties. That provision is intended to enable regulations which would require that the confidentiality advisory group considers: that the purpose for which the data will be used should be in the public interest and for the provision of health and care services; that any approved processing must respect and promote the privacy of patients and care service users; that the purpose cannot be achieved using suitably anonymised data, rather than identifiable data; that it is not reasonably possible to gain explicit patient consent to achieve that purpose; and that the applicant requesting the data has not misused those kinds of data in the past.

That last criterion would effectively introduce a new “one strike and you’re out” deterrent. Potentially, for some organisations, the risk of no longer being able to access those kinds of data may prove a more effective sanction than the current maximum monetary penalty of £500,000 that can be imposed under the Data Protection Act 1998. Taken together, those measures provide an additional level of scrutiny and assurance to the processes of the HSCIC in publishing or disseminating information. The Government’s amendments—new clause 34 and amendments 17 and 18—provide robust assurance that those kinds of data cannot be disseminated for purposes such as commercial insurance or for assessing an individual’s mortgage application.

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[Dr Poulter]

Indeed, Mr Speaker, and I hope that other Members will also be sensitive to that. The more interventions I take, the less opportunities there are for Members to speak. I have been very generous. I have taken interventions on a number of occasions from those on the shadow Front Bench, and from the hon. Member for Worsley and Eccles South (Barbara Keeley) and others. I have been generous with my time, but I want to preserve time for other Members to contribute to the debate, as I see you are keen for me to do, Mr Speaker.

Although the HRA amendments are important in ensuring that its remit is clearly and accurately defined, it will be able to work with those with an interest in children’s social care research when research crosses boundaries, to seek consistency in standards and to avoid unnecessary duplication.

Government amendments 15 and 16 are minor and technical. Amendment 15 is consequential to the addition of provisions on the better care fund—part 4—in Committee. It ensures that provisions on commencement cover the better care fund. Amendment 16 removes the privilege amendment inserted in the other place in accordance with the Commons’ sole privilege to deal with monetary matters.

The Government’s proposals ensure that we correct the difficulties we inherited from the previous Government in preserving confidential patient data. They ensure that we have in place a system in which NHS and care data must be used for the benefit of the health and care system and for public health purposes. They put us in a much better place to ensure that we enhance transparency and better use information to benefit patients. They ensure that we have a better basis on which to understand the basis of disease. If in the first place we had had the Health and Social Care Information Centre and the benefits we know will come from care.data, we would have been able to deal with and better combat many diseases while protecting patient confidentiality. We would have understood much more quickly the dangers of thalidomide and other drugs that were harmful to babies in utero. We would have been in a much better place to expose those examples of poor care, such as Mid Staffs; to develop national frameworks for treating diseases such as chronic obstructive pulmonary disease and heart disease; and to understand what good care looks like in the treatment of those conditions by collecting data in a fundamentally better and joined-up way.

The Health and Social Care Information Centre will, for the first time, provide us with a repository for joined-up, integrated data across health and care. Hon. Members often rightly talk of integrated care, and of the benefits of joining up health and care. Unless we have the data collected to understand what good integrated care looks like, and unless we understand what measures of integration are right, we will not be able properly to inform the debate on delivering integrated care or break down the silos that have sometimes existed to the detriment of patients across the health and care system. I hope hon. Members on both sides of the House can support that. I hope they decently recognise that this Government have put in place not just a patient opt-out if they do not want their data to be shared, but strong safeguards—much stronger safeguards than the previous Government —to protect patient confidentiality.

[Grahame M. Morris]

In principle, I support the utilisation of truly anonymised patient data sharing for the purposes of improving public health, but I take issue with a number of the Minister’s points, not least in relation to new clause 25, tabled by my hon. Friend the Member for Copeland (Mr Reed). Accountability is important. If the Minister and the Government are serious about addressing the public’s concern, they would ensure that the Secretary of State and Ministers are responsible rather than an unelected quango. Frankly, the Minister’s assurances at the Dispatch Box this evening, and those given to the Health Committee just a week or two ago, need to be in the Bill, so that there is a level of accountability and some comeback.

When we debated patient data sharing in Committee and, more recently, in Westminster Hall, my impression was that Ministers have tended to conflate legitimate patient privacy concerns, which are shared by hon. Members and members of the public, with the general lack of support for the utilisation of patient data for further research. They are mistaken, because right hon. and hon. Members are more or less unanimous in supporting any move that can lead to better research, improved care and increased safety.

Patient Medical Records

Debate between Grahame Morris and Dan Poulter

Tuesday 4th March 2014 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a pleasure to serve under your chairmanship, Mr Weir, I believe for the first time. It is also a pleasure to respond to the debate and the points raised by the hon. Member for Birmingham, Hall Green (Mr Godsiff). I congratulate him on securing the debate, as well as on the keen interest he has shown in the correspondence we have conducted via written questions. We have talked through some of the issues and he has expressed concerns about the importance of patient confidentiality.

I hope today to be able to reassure Members that strong safeguards were put in place by the Health and Social Care Act 2012, and that the creation of the Health & Social Care Information Centre was not a sudden event. The process is evolutionary and was debated fully and thoroughly during scrutiny of the Health and Social Care Bill a few years ago. I was a member of the Health and Social Care Bill Committee, as was the hon. Member for Easington (Grahame M. Morris), and it sat for longer than almost any other Committee in the House for more than a decade. It is therefore not correct to say that the issues have not been debated and properly scrutinised in the past, because they absolutely have.

[Grahame M. Morris]

Will the Minister give way?

[Dr Poulter]

I am not going to give way because of the time. I have not said anything controversial; I am just reiterating the fact that a lot of the issues that have arisen today were discussed at great length during scrutiny of that Bill. The hon. Gentleman will recall that as he made many interventions and speeches in Committee.

We need to highlight the importance of this issue. We must ensure that we have the right data and the right processes in the NHS to inform good care. It is about ensuring that we have the data to improve research, to drive better integration and, in the wake of the Mid Staffs scandal and the Francis inquiry, to ensure transparency in protecting patient confidentiality and in the quality of care provided by health care providers so that we can ensure that high quality care is provided throughout the NHS and that its quality is properly scrutinised. We must learn from examples of good care, and where, by comparison and other standards, care is not good it should be transparently exposed.

There are important research benefits, too. We know that if we want to combat disease, address some of the challenges that we face in the health system and improve our knowledge of diseases from cancer to heart disease, we need to have the right information. We have to ensure that we collect data and information to improve patient care, which is the heart of everything we are talking about today. As long as we do that—I believe that we have the right safeguards in place through the 2012 Act and through the further clarifications and reassurances provided by the amendments to the Care Bill that have been tabled for next week—we are in the right place to deliver improved transparency and care quality while ensuring that we protect patient confidentiality, in which we all believe.

Oral Answers to Questions

Debate between Grahame Morris and Dan Poulter

Tuesday 14th January 2014 Commons Chamber

[Dr Poulter]

As I am sure the hon. Gentleman is aware, the reason there have been increased referrals to therapists is that this Government are investing in early intervention and ensuring we invest in improving access to the psychological therapies programme so we can get to people with mental health problems much earlier and give them better support before they reach the point of crisis.

If I may beg your indulgence for one second, Mr Speaker, on the hon. Gentleman’s specific point about gay to straight conversion therapy, I also find that absolutely abhorrent in principle, but the issue is—it is an important issue and he should listen to this—that if we were to ban or put in place regulations on that it may have unintended consequences. That may stop counsellors practising who are supporting people coming to terms with their sexuality. That is an important service, and I hope we can support it on both sides of this House.

[Grahame M. Morris (Easington) (Lab)]

11. What assessment he has made of the effect of social care budget changes on the number of accident and emergency attendances.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

Although councils have reduced social care budgets, the evidence suggests that this is not having an impact on the NHS. In fact, the data published by NHS England show that councils are getting better at getting people out of hospital at the appropriate time.

[Grahame M. Morris]

The National Audit Office reports that cuts to social care led to nearly 500,000 delayed bed days in accident and emergency in 2012-13, so will the Government see sense and commit to investing in lowering the eligibility threshold to moderate, ensuring that older and disabled people’s needs in Easington and throughout the country can be met in their community so they do not need to present to A and E causing further pressures on it?

[Dr Poulter]

Taking the hon. Gentleman’s question in the spirit he intends, I think there is a misunderstanding of the statistics. We need to reduce the pressure on A and E, and evidence from NHS England already shows that improvements in how social care works with the NHS over this Parliament are delivering improvements to care. In 2011-12 there were about 523,000 bed days lost because of delays attributable to social care, but in 2012-13 the number had fallen to 476,000, a drop of nearly 50,000. That shows that social care is working well to reduce pressure on A and E.

NHS Funding (North-East and Teesside)

Debate between Grahame Morris and Dan Poulter

Tuesday 5th November 2013 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a pleasure to serve with you in the Chair, Mrs Riordan.

A lot of political smoke has been blown across the Chamber today by the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop). I have a lot of time for him personally, and he came to see me earlier in the year to express some legitimate concerns about the performance of his local trust. On the basis of our meetings, I hope to reassure him that there has been considerable progress locally in his area.

More broadly, it is worth setting the record straight on some of the points made today. We have had discussion about the ambulance service, which I will come to, and we have talked about winter pressures, which I will address. First, however, on the funding formula, my hon. Friend the Member for Stockton South (James Wharton) was right to point out that it is set independently of the Government. Before we handed independent formula setting to NHS England, the Government made it clear that deprivation is a factor and it is taken into account in the current arrangements. There is a 10% weighting for deprivation in the funding formula, which as a Government we ensured was preserved in the formula. Under the new arrangements, there is more political independence in setting the funding formula.

[Grahame M. Morris]

Will the Minister give way?

[Dr Poulter]

Not at the moment. The independent Advisory Committee on Resource Allocation, or ACRA, as hon. Members have mentioned in the debate, historically has advised that the funding formula should be readjusted to take into account demographics and the increased health care needs of older populations in other parts of the country. The Government, however, in the past chose to maintain support for deprivation as a factor in health care funding, but the decision is now not one for the Government. It is now for NHS England to listen to the independent advice, but I would find it strange were there a sudden change in the funding formula that did not factor in deprivation, as done in the past.

It is important to set the record straight. The decision is not political; in the past, the Government preserved a weighting for deprivation, but now the decision will be taken separately by NHS England. Its decision will be made on the basis of clinical need, although of course deprivation will be a factor.

[Dr Poulter]

My predecessor was in place when setting the resource allocation was in the Government’s gift. As the then Minister made it clear, a weighting in the formula for deprivation would be preserved—he stood by his word and that weighting was preserved. NHS England, not the Government, now sets the funding formula—to avoid political interference—and those in NHS England, in conversation, have made it clear that they also value a weighting apportioned to deprivation.

[Grahame M. Morris]

Will the Minister give way?

[Dr Poulter]

No, I will not give way. I have said things clearly for the record, without any political smoke.

As a Government, when we had control of the funding formula, we clearly put in a weighting for deprivation and for some of the poorest communities. I am proud that we did so, but it is now for an independent body to look at the case and at the independent advice that it has been given. I would find it extraordinary, however, if it were not to factor deprivation into its decision making, although there are other factors that it will want to put into the equation, such as the fact that older people are the greatest users of health care, so places with lots of older people also need to be recognised. A number of factors will be taken into consideration, and deprivation will be one of them. I have been reassuring about that, and I will not allow the Labour party or any hon. Member to make mischief with something that the Government have stood by.

--- Later in debate ---

[Dr Poulter]

I will not give way because the hon. Gentleman should listen to the answers to some of his questions and realise that his local health care services are improving thanks to the Government’s increased investment in the health service—[Interruption.] Hon. Members have been incredibly political in everything they have said today, and I am putting answers on the record. If the hon. Gentleman does not want to hear them, he should not have raised the debate.

The latest data for 27 October 2013 show that South Tees Hospitals NHS Foundation Trust’s performance against the 95% standard for A and E waits is 96.8%. Over the last 23 weeks, it has met the national 95% target for A and E four-hour waits. The local trust is performing very well in treating patients in a timely way when they arrive at A and E. That is contrary to the points that the hon. Gentleman was trying to make.

At James Cook university hospital, the acute admissions unit is adjacent to the A and E department, so enabling the trust better to manage the flow of patients and to ease pressure on A and E. The trust has recruited two additional consultants and six additional junior doctors to the acute medicine departments, so easing pressure on the A and E department. Considerable investment is being made, and additional nursing staff have been recruited to support 50 more acute hospital beds that will be in place this winter. The hon. Gentleman must be aware that there is a lot of investment locally, with more beds, more staff and better care. It is a pity that he could not acknowledge that in his speech. I am putting it on the record, so that his constituents are aware of it.

[Grahame M. Morris]

The Secretary of State announced an additional £250 million to relieve pressure on A and E, but none of it was allocated to any of the hospitals in the constituencies of my right hon. and hon. Friends here.

On the incidence of ill health in deprived areas, half of the people presenting to hospitals suffering from hepatitis C, which is completely treatable and curable, come from the poorest 20% and three quarters come from the poorest 40%. Is it not right that additional resources are provided to those poorest areas to tackle such diseases?

[Dr Poulter]

The hon. Gentleman is absolutely right, and that is why the Government have given local authorities the power to deal with sexual health services. He will be aware that a major cause of hepatitis C—for the record, it is not curable—

[Grahame M. Morris]

It is treatable.

[Dr Poulter]

Indeed, but it is not curable as the hon. Gentleman stated. He should get his facts right before making statements in the Chamber. It is not curable, but it is treatable and the best treatment is prevention, which is why we have given a considerable amount of money to local authorities to take on the public health responsibility and to ensure that local authorities are in the right place to look at primary prevention of transmissible sexual diseases. He will be aware that hepatitis C is sometimes transmitted via the sexual route. The Government have put us in a better place to deal with sexual health issues and to tackle them in future.

There has been talk about ambulances, and it is worth highlighting that the most recent data, for September 2013, show that the North East Ambulance Service NHS Foundation Trust is meeting the category A8 red 1 measure 80.6% of the time and the A8 red 2 measure 80.8% of the time against an operational standard of 75%. The ambulance service is doing marvellously well in the north-east. It is meeting category B19 with a performance of 97.7% against an operational standard of 95%. That is a good performance in the north-east by anyone’s standard. The ambulance service is performing very well. Other ambulance services that may receive more generous funding are struggling, sometimes due to mismanagement, particularly in my part of the country in eastern England.

It is very difficult for the hon. Member for Middlesbrough South and East Cleveland to make any case for lack of funding or other problems with his ambulance service when health care funding for the north-east is going up under this Government and the ambulance service is performing well according to national performance indicators. Those are the facts, and if he did not want them on the record, he should not have raised the debate.

It is more in sorrow than anger that I make those points. When the hon. Gentleman and I had a constructive meeting earlier this year to discuss local health care services, there was not the political smoke or the chorus backing him that there has been in this debate. Genuine issues were raised about his local health care service, and he and I, with local commissioners, worked to put improvements in place. As a result of that meeting, there are more staff, more winter beds and more investment in his local trust. The local community hospitals that he was so concerned about are in a much better place.

I am sure the hon. Gentleman will come back to me if further issues arise, but his part of the country is much better placed than many others to deal with the pressures of winter. He should be proud of that, and I hope he will take the opportunity after this debate to champion his local NHS and the good work at local level by front-line staff who are delivering improvements. I hope he will take that opportunity and that we will not have to come back here and listen to him running down his local health services.

Health and Social Care Bill

Debate between Grahame Morris and Dan Poulter

Tuesday 20th March 2012 Commons Chamber

[Grahame M. Morris]

I have concluded my remarks, so perhaps the Minister can address those points in his summing up.

[Dr Poulter]

I shall make some brief remarks, but I first want to welcome the renewed focus on integrated care, as outlined by the Minister this afternoon. He clearly outlined the importance of mental health services and clarified that the primary duty in commissioning will be to ensure that there is integrated care.

We all know the importance of dealing with the biggest challenge facing the NHS, which is how we are going to look after our ageing population. How are we going to improve the care for the increasing numbers of people living longer, which is a good thing but poses a big financial challenge for the NHS as well as a big human challenge in how to look after them? How are we going to address the challenge of looking after people living at home with diabetes, heart disease and dementia?

This Bill goes a long way towards meeting those challenges, and I believe that the renewed focus on integration is key and vital. It is only by different services and different parts of the NHS working together effectively—with primary care working effectively with hospitals, as well as with social services—that we are going to meet the big financial and human challenge of improving the care of older people. That is why I am reassured—I hope that my Liberal Democrat colleagues will also be reassured—by this renewed focus on integration, which is at the heart of the debate and at the heart of the way in which we will make our NHS meet future challenges.

Let me deal briefly with the Opposition amendment 31, which deals with what they believe is an inherent conflict between people involved in delivering care—health care providers or GPs—and others when it comes to involvement in the clinical commissioning groups. The amendment ignores the fact that, at present, good commissioning involves a partnership with primary care trusts that were set up by Labour when they were in government. GPs who are engaged in the provision of health care in local communities are involved in PCTs and involved in the Government arrangements for PCTs, working in partnership with local managers. So, if it was good enough to have that inherent partnership in the current structures set up by the previous Government, I do not see why, when we all believe that clinical leadership is a good thing in the NHS, a conflict of interest should suddenly be created under the Bill. That does not make sense; it is not intellectually coherent. For that reason, we must oppose the amendment.

We have before us more reassuring amendments to promote integrated care, to focus it on more joined-up thinking between the primary and secondary care sector, and to ensure that we do not have to deal with patients with mental health problems only when they get to the point of crisis. The focus on integrated care will mean that they are better supported in their communities. Opposition amendment 13 is, as I have explained, inconsistent with how they managed the NHS when they were in government.

National Health Service

Debate between Grahame Morris and Dan Poulter

Wednesday 26th October 2011 Commons Chamber

[Grahame M. Morris]

I am grateful for that intervention from my right hon. Friend and I should like to place on record, because the Secretary of State did not take the opportunity to do so, that the cap on private patient work, which had been set at 5%, is to be raised by the Bill. That must have a detrimental impact on the NHS in general, and on non-private patients, as resources are directed to the private sector and private patients.

[Dr Poulter]

Will the hon. Gentleman give way?

[Grahame M. Morris]

I shall not, if the hon. Gentleman does not mind, because I do not think I will get any injury time if I do so and I have rather a lot to get through.

I have mentioned the transfer of resources from the NHS budget to meet the growing costs of social care. We have also discovered, from evidence that was given to the Select Committee, that there has been an underspend of almost £2 billion—much of it from the capital budget, with some of it, presumably, being saved by cancelling the new hospital that was to serve my area. Meanwhile many NHS trusts are sitting on hundreds of millions of pounds of debt, and figures produced by the Department of Health show that six large NHS trusts in London are predicting year-end deficits of £170 million. The pressures on the system are enormous and will inevitably show through in reductions in services, having an impact on the front line.

The reductions in tariffs for operations and the further pressures in that area will also mean that foundation and NHS acute trusts will bear the brunt of financial pressures within the system. Again, that means that the buck and the spotlight of transparency are being passed away from the Secretary of State to the NHS Commissioning Board, although he might have to reconsider that after last night’s Lords amendments.

Another area of pressure in the NHS comes from the huge redundancy costs being incurred as a consequence of the premature closure of primary care trusts and strategic health authorities, which is estimated to cost the taxpayer more than £1 billion. The opening up of the NHS entirely to the private sector, and the prospect of the £103 billion NHS budget being taken out of the public sector and placed within the remit of shareholders in private health care companies, is anathema to the majority of the British public. The Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) is cringing, but the majority of the British public are cringing at the thought of this proposal.

Health and Social Care (Re-committed) Bill

Debate between Grahame Morris and Dan Poulter

Tuesday 6th September 2011 Commons Chamber

[Grahame M. Morris]

I am happy to give way to the Minister, if he wishes to give that assurance from the Dispatch Box. It would reassure staff and members of the public. Perhaps we can read something into the Minister’s reluctance to give such an assurance.

The Government, despite the spin, are delivering one of the most radical reorganisations ever and in the view of many Opposition Members it will undermine the basic principles of the NHS. When the Health Secretary was shadow spokesman for the then Opposition, at no point did he explain his plan to apply 1980s-style privatisation mechanisms to the NHS. I am an avid follower of health policy and the idea of creating an economic regulator—as we have discovered through a series of parliamentary questions, the costs of Monitor could be £500 million in a single Parliament—is again ironic when we hear the Government talk about waste and bureaucracy.

As for exposing the NHS to competition law, I accept the point made by the hon. Member for Southport (John Pugh), which was also made by my own Front Benchers, that it is not the provisions on the face of the Bill but the changes to the architecture of the NHS that will expose the NHS to European competition law—the same law, as we have heard, as applies to the utility companies. Health would be considered a commodity and £60 billion of the NHS budget would be handed over to private bodies, by which I mean those bodies that were the GP commissioning consortia, now renamed clinical commissioning groups. Despite the assurances about openness, transparency and accountability, those would be private-sector companies and my understanding is that they would not be open to FOI requests. That must be of huge concern to people who champion civil liberties, freedom and transparency. Over the past six years or so, we had no indication from the Secretary of State that he was planning such a radical change.

On the subject of the new failure regime, as set out in the amendments, having sat through the Public Bill Committee on the initial Bill as well as that on the re-committed Bill and having listened intently to the arguments, I cannot decide even now whether this is a U-turn or a side-step. I have read this huge document—the weighty tome that makes up the Bill, with all its various chapters and parts—as well as the impact study and the whole justification behind the Ministers’ arguments was that the NHS needed a market and a failure regime to boost productivity. Has that whole idea been left by the wayside?

[Dr Poulter]

Does the hon. Gentleman accept, however, that the previous Government failed to put in place any adequate failure regime to deal with situations such as that which occurred at Stafford hospital and that the Bill is a step towards providing a proper overview of what to do when trusts fail and let down patients?

[Grahame M. Morris]

I am not suggesting in any way, shape or form that every NHS organisation—be it an NHS hospital trust or a community-based organisation—is incapable of improvement. My philosophy, as someone with a bit of a scientific background, has always been that we should assemble an evidence base, pilot a proposal in one area, establish best practice, see where the faults lie, tweak it if necessary and then, if it works, roll it out. This leap-in-the dark approach is flawed and will end in tears. The service is hugely important and touches everybody’s life in this country at one time or another. The whole concept of the Bill is flawed and the way it has been prosecuted is compounding the problem.

--- Later in debate ---

[Grahame M. Morris]

I am making rather slow progress, but I did want to get on to health inequalities. My hon. Friend makes an excellent and important point. We touched on it briefly in the Bill Committee and it relates to new clause 6. I was concerned about the reports that in the allocations to PCTs and SHAs, the element set aside for addressing health inequalities had been reduced. That should concern us all, especially those who represent areas that suffer high levels of health inequality and deprivation.

It is a bit of an achievement that the Government could take the NHS at its most successful point and turn it around. Government Members have highlighted particular failings, but the NHS had a record number of doctors and nurses and a hospital building programme. There had been a transformation from waiting times of 18 months for routine operations such as knee and hip replacements or removal of cataracts to only a few weeks. The previous Government should be given some credit for that. The improvement was confirmed in patient satisfaction surveys and it is a great shame that the Government have decided not to commission the Department of Health to conduct such studies in the future. I suspect their motives in that regard.

[Dr Poulter]

Will the hon. Gentleman give way?

[Grahame M. Morris]

I give way to my hon. Friend from the Committee.

[Dr Poulter]

That is a good point. Under the previous Government cataract and hip operations were done more quickly, but that was because the Labour Government commissioned private providers. The unfortunate thing was that the providers cherry-picked services and did not provide the integrated health care that this Bill will provide.

[Grahame M. Morris]

We had this exchange many times in the Committee on a variety of clauses. We need to give some credit to the previous Government. I am old enough to remember when people routinely waited a year, 18 months or longer for life-changing operations such as knee and hip replacements. It is a real quality-of-life issue if someone has cataracts and has to wait a long time for an operation. I accept that Labour used the private sector. I am a socialist and make no apology for that, and I want the provision to be public sector. I was not a Member of Parliament and did not vote for the commissioning of private providers, but I acknowledge that the private sector played a role in bringing extra capacity and some innovation to the service.

Future of the NHS

Debate between Grahame Morris and Dan Poulter

Monday 9th May 2011 Commons Chamber

[Dr Poulter]

I can only say that my Conservative-run, Suffolk council is doing exactly the opposite of what the hon. Lady describes. The Government have committed to putting almost £2 billion into adult social care, looking at the demographic time bomb and looking at better integrating health care with adult social care. I would be very concerned to see councils doing what she describes, because that is not what they are given that money for. If she has had a problem with that at her local authority, she needs to take it up with that authority.

The key to unlocking potential in the health sector lies in cutting the red tape and pointless form-filling that wastes the time of so many front-line staff. Of course, our NHS must have a level of regulation that ensures that products and services are thoroughly tested and that ensures patient safety. However, the over-excessive regulation introduced by the previous Government has been damaging not only to patient care but to staff morale. It has also diverted vital resources away from the front line and away from patients, who are, after all, what health care should be all about. This Government are rightly looking to take simple, obvious and positive steps in improving the overall efficiency of the NHS by scrapping the health quangos that waste £2 billion a year—money that could be much better spent on front-line patient care.

Another issue that I want to highlight in the time left to me is another area of wasteful spending in our NHS—management. Under the previous Government, the number of managers and unproductive non-medical staff increased in the past decade, with the number of managers and senior managers in the NHS almost doubling to 42,000. In many hospitals, more new managers than new nurses were recruited in that time. That cannot be right—it is bad for patients and money is being misspent. As I witnessed at first hand, NHS managers were rewarded at a better rate than front-line staff—at around 7%, compared with 1.8% pay rises for front-line medical staff. That is not a good thing.

The Opposition are very concerned about staff morale, but let me tell them why staff morale is so low: it is because the contributions of front-line staff were badly undervalued by the previous Government while the contribution of managers were over-valued. I believe that what we and the Government need to do is make sure that more money goes into front-line patient care and front-line staff rather than being wasted on management and bureaucracy.

[Grahame M. Morris]

rose—

[Dr Poulter]

If the hon. Gentleman will forgive me I will not give way because time forbids it.

In conclusion, the NHS needs to be reformed and needs to improve the care it delivers to patients. We can no longer afford to sustain the amount of wasteful spending on management and bureaucracy that occurs in the NHS. We need a less bureaucratic NHS—a clinically led NHS that can once again put its patients first. The NHS has become obsessed with management and process but if we want to reform it, then it must be the patient who counts.

NHS Reorganisation

Debate between Grahame Morris and Dan Poulter

Wednesday 16th March 2011 Commons Chamber

[Dr Poulter]

What we do know—the hon. Gentleman would do well to listen to this—is that the NHS currently spends £4.5 billion on bureaucracy, and that could be better spent on patient care. Under the previous Labour Government PCT management costs doubled by more than £1 billion to £2.5 billion, and that money could be better spent on patient care. By scrapping PCTs, we will have more money to give to GPs to spend on patients and front-line care, and that can only be a good thing.

Labour Members would do well to listen to a few more of the statistics on NHS bureaucracy that I am about to read to them. Under Labour, the number of managers increased faster than the number of nurses in the NHS. How can that possibly be right? Managers were paid better than nurses in the NHS. In 2008-09, top managers in NHS trusts received a 7% pay rise whereas front-line nurses received a rise of less than 3%. The Labour party was obsessed with bureaucracy, management and top-down targets, and we would much rather see that money spent on patients and front-line patient care.

[Grahame M. Morris]

We have heard about the layers of bureaucracy that the coalition Government propose to take away, but what does the hon. Gentleman have to say about the additional layers that they are imposing through the exponential growth of Monitor, which will be the economic regulator? They are increasing its budget from £21 million a year to as much as £140 million a year. How many more thousands of people will it employ? How many lawyers? It will cost £600 million over the course of a Parliament.

Health and Social Care Bill

Debate between Grahame Morris and Dan Poulter

Monday 31st January 2011 Commons Chamber

[Dr Poulter]

My hon. Friend represents Eastbourne, which has a large elderly population. He is right to make that point. Under the Bill, health and wellbeing boards will be set up, which will deliver a proper partnership between GPs, hospitals and local councils. That will allow, for the first time, properly joined-up thinking about how we deliver social services care that is joined up with NHS care for older people. I am delighted that the Government will put in almost £1 billion to support that initiative, which can only be a good thing.

The second challenge facing the NHS, which my right hon. Member for Charnwood also mentioned, is that we are having to get more and more out of a limited resource, because people expect more and more from their health care, regardless of their age. People want, quite rightly, to be given the latest cancer drugs. They want to ensure that they have top-quality care and access to information that delivers that care. The problem with the bureaucracy that has been in place is that, far too often, it has taken too long to deliver higher quality care and a greater choice in treatment for patients. When we know that a cancer drug works, it should be available as soon as possible. It should not have to go through a process of two, three or four years of bureaucracy to be made available, and the Bill will help to change that. For those reasons, the Bill’s reforms to the NHS will provide an excellent framework in which to deliver better ways of spending limited resources and looking after our ever-ageing population.

A lot of health care professionals will be saying, as I did earlier, that far too often, medicine and health care have been reduced to a tick-box exercise, with targets and top-down bureaucracy getting in the way of patient care. Under the A and E targets delivered by the previous Government, equal priority was given to treating a patient with a broken toe as someone with potentially life-threatening chest pain. That cannot possibly be right. Putting doctors, nurses and other health care professionals in charge of making health care decisions will mean that clinical priorities and better patient care can be delivered.

[Grahame M. Morris (Easington) (Lab)]

Has the hon. Gentleman made any assessment of the reduction in the number of managers, consultants and other bureaucrats that will be caused by moving from 152 primary care trusts to potentially 500 or 1,000 GP commissioning groups?

[Dr Poulter]

The Opposition need to take on board the fact that the cost of running PCTs has gone up by about £1 billion a year since they were first put in place. The cost of bureaucracy and management in the NHS is unsustainable, and most of the money that we are putting into the NHS is going on salaries and bureaucracy rather than on front-line patient care. It is surely a good thing to remove the middle strand of bureaucracy—PCTs, strategic health authorities and other quangos that cost a lot of money but do not deliver front-line patient care. That will help deliver more money to the front line and to patients, and Members on both sides of the House should support such an initiative.

I shall elaborate on the point about how PCTs have been a great source of wasted money. In my part of the world in Suffolk, they have spent millions of pounds each year on external consultants to tell them how they should be doing the job that they should have been doing in the first place. There has also been a total disconnect between primary and secondary care and a breakdown in the relationship between them. For example, as the Secretary of State alluded to earlier, hospitals have wanted to put in place outreach clinics for mental health, dermatology and rheumatology, but too often, as in my area, they have been told that the PCT will not allow them to do that.

Hospitals have said that they value and need community hospitals, because they provide an excellent place for step-up and step-down care and for rehabilitation after an acute hospital stay, but PCTs have closed down community hospitals such as Hartismere hospital in my community. We know that that is not a good thing. Far too often, PCTs have been a barrier to joined-up thinking in the NHS between the primary care sector and hospitals.