Coeliac Disease and Prescriptions

Jack Dromey Excerpts

Tuesday 1st November 2016 Westminster Hall

[Mr Kevan Jones (North Durham) (Lab)]

I beg to move,

That this House has considered coeliac disease and prescriptions.

It is a pleasure to serve under your chairmanship, Mr Bailey. I am grateful for the opportunity to hold a debate that raises awareness of the problems facing those who suffer from coeliac disease and of access to gluten-free food prescriptions. It would be remiss of me not to thank the work of Coeliac UK, the national charity that represents people with coeliac disease, for not only supporting the campaign around the prescription of gluten-free food, but for its work to support sufferers.

Coeliac disease affects one in every 100 people in the UK. I declare an unwelcome interest: I actually suffer from coeliac disease, although I do not get prescriptions for gluten-free food. It is also worth noting that there are some half a million people in the UK who are completely undiagnosed, according to Coeliac UK.

Coeliac disease is a serious medical condition in which the body’s immune system attacks its own tissue when gluten is eaten. The only medical treatment currently available for sufferers is a strict adherence to a gluten-free diet for the rest of their lives. In the late 1960s, gluten-free food was first prescribed to prevent long-term health complications. However, that rationale has now been challenged by some clinical commissioning groups, despite the fact that their position lacks supporting evidence for withdrawing such prescriptions.

[Jack Dromey (Birmingham, Erdington) (Lab)]

I am grateful to my hon. Friend for bringing such an important debate on an issue that affects so many people. Does he agree that it is absolutely wrong that David Lissaman, a pensioner in my constituency, who thus far has been able to get gluten-free food on prescription, now faces the prospect of losing that as a consequence of the clinical commissioning group’s review? He is a good man who served his country well. In his own words, he will “have to find ways” of significantly reducing the amount of food that he eats, which, because of his other health problems, could put him at risk.

[Mr Jones]

I agree, and I shall refer to certain demographics—pensioners being one—that are particularly affected by these proposals.

Some 40% of CCGs in England are now choosing to restrict or remove support for patients with coeliac disease, which is leading to increasing health inequalities and, basically, a postcode lottery for NHS care, depending on where someone is diagnosed. The CCG’s rationale for going down that route seems to be justified on cost grounds alone. Indeed, Coeliac UK has made a number of freedom of information requests to try to get more details on why CCGs are changing their policies.

I will take a moment to read an example of a response to Coeliac UK’s FOI request, which came from North East Essex CCG, where sweeping assumptions have been made that are completely devoid of any systematic research. That CCG stated:

“We appreciate that there is a large cost-differential between supermarket value brands and GF [gluten-free], but many people within the CCG buy their bread from bakers or do not buy the supermarket value brands and the cost differential is therefore much reduced.”

That type of anecdotal evidence, used by CCGs to justify their decisions about patient care, is in direct conflict with a paper produced in September last year entitled “Cost and availability of gluten-free food in the UK: in store and online”. It said:

“There is good availability of gluten-free food in regular and quality supermarkets as well as online, but it remains significantly more expensive. Budget supermarkets which tend to be frequented by patients from lower socioeconomic classes stocked no GF foods. This poor availability and added cost is likely to impact on adherence in deprived groups.”

NHS Sustainability and Transformation Plans

Jack Dromey Excerpts

Wednesday 14th September 2016 Commons Chamber

[Dr Wollaston]

I absolutely agree. This is about local communities and their representatives. Public meetings are important, but so are involving bodies such as HealthWatch and making sure that under-represented groups are involved. The right hon. Member for North Norfolk (Norman Lamb) talked about the need to involve mental health services in these plans. It is very important that we make sure that under-represented groups are involved, and that does include those who use mental health services.

[Jack Dromey (Birmingham, Erdington) (Lab)]

The hon. Lady, with her lifetime of experience in the national health service, is absolutely right about the importance of consultation. Does she therefore understand the concern being expressed by the staff at the Dove sexual health centre in one of the poorest constituencies in England, Erdington, because none of its 2,000 patients has been consulted, and neither have any stakeholders, about a proposal to close this absolutely vital facility?

[Dr Wollaston]

I thank the hon. Gentleman for his intervention. As I said, the plans that are produced at the end of the day will be better if we involve those who are using the services and those providing them, as well as those commissioning them, as we go along, rather than present a plan, even if it is a draft, as a fait accompli, because then it becomes a binary choice rather than one where people can make suggestions to improve the plans as they develop.

Junior Doctors Contracts

Jack Dromey Excerpts

Monday 18th April 2016 Commons Chamber

[Mr Hunt]

No, it has not. If it had, I do not think that we would be having a strike. I think we would have a negotiated settlement, and the NHS would be able to proceed with the contracts, which have important benefits for doctors, such as reducing the number of consecutive nights or consecutive long days that they can be asked to work. The refusal to negotiate on the crucial issue of Saturday pay, which is not a reduction in take-home pay because the reduction in Saturday premiums was made up for with an increase in basic pay, was what led Sir David Dalton to say that a negotiated settlement was not possible. It is a matter of huge regret, but I am afraid that it leaves the Government with no option but to proceed in the way that we are doing.

[Jack Dromey (Birmingham, Erdington) (Lab)]

A senior executive at Babcock once said to me that there are employers who could pick a fight with themselves. During 30 years in the world of work, I cannot remember a legitimate sense of grievance so grotesquely mishandled. Does the Secretary of State not recognise that he is poisoning relationships with a generation of junior doctors? Will he not get back to the negotiating table and stay there until the dispute is resolved?

[Mr Hunt]

Without going over the previous points about the three years we have been around the negotiating table, I just say this to the hon. Gentleman: I think there are legitimate grievances for junior doctors, and they extend well beyond the contract. There are some big issues with the way training has changed over the years, and there are some serious issues we need to address about the quality of life for junior doctors—sometimes they have a partner working in a different city and they are unable to get training posts nearby to each other. We want to address those issues, which is why we set up a review, led by Professor Dame Sue Bailey, the president of the Academy of Medical Royal Colleges. Who is refusing to talk to that review, and refusing to co-operate with it? It is the BMA. That is why it is so important that people get around the table and start to talk about how we resolve these problems, rather than remaining in entrenched positions.

Junior Doctors Contracts

Jack Dromey Excerpts

Thursday 11th February 2016 Commons Chamber

[Jack Dromey (Birmingham, Erdington) (Lab)]

I have spent 30 years in the world of work, representing employees, conducting negotiations and solving disputes. I have seldom seen a sense of grievance so grotesquely mishandled, insulting the intelligence of junior doctors by telling them that they do not understand what is on offer. Does the Secretary of State not feel a sense of shame that his handling of this dispute should have so poisoned relationships with junior doctors, who are the backbone of the national health service?

[Mr Hunt]

The hon. Gentleman can do a lot better than that. We have been willing to negotiate since June. It was not me who refused to sit round the table and talk until December; it was the BMA, which, before even talking to the Government, balloted for industrial action. What totally irresponsible behaviour that is. If Labour were responsible, it would be condemning it as well.

Oral Answers to Questions

Jack Dromey Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Alistair Burt]

Of course I welcome my hon. Friend’s invitation. The innovative work being done by a number of GP practices around the country to expand services is welcomed by all; there is an opportunity to take good practice from one GP practice to another. In addition to my visit to Cornwall, I am clearly on the way to Derbyshire.

[Jack Dromey (Birmingham, Erdington) (Lab)]

With the accident and emergency crisis, over which the Secretary of State has presided, more and more police officers are queuing outside fewer A&E departments in ever-lengthening queues. Last year, there were 1,000 incidents in the Metropolitan police alone. In Liverpool, Patrick McIntosh died after waiting for an ambulance for an hour. Does the Secretary of State accept that after 17,000 police officers have been cut by his Government, this is the worst possible time to ask the police service to do the job of the ambulance service, and that he is guilty of wasting police time?

[Mr Hunt]

I think that is harsh. Let me tell the hon. Gentleman some of the progress that was made under the last Government, and that this Government will continue, to reduce the pressure on police, particularly with regard to the holding of people with mental health conditions in police cells. We are in the process of eliminating that; it has seen dramatic falls. We recognise that the NHS needs to work more closely with the police, particularly in such circumstances, and he should recognise the progress that has been made compared with what happened before.

NHS Major Incidents

Jack Dromey Excerpts

Wednesday 28th January 2015 Commons Chamber

[Mr Hunt]

I absolutely agree with that. What I will not do is go round the media and say that the problems that the NHS is facing in Dorset, as it faces everywhere, are due to the fact that the area is very rural, which is the excuse that we heard over the weekend from the shadow Health Secretary for the poor performance of the NHS in Wales. We want local solutions and the highest possible standards—what we can do is give guidance and funding from the centre and make sure that patients are always put first.

[Jack Dromey (Birmingham, Erdington) (Lab)]

In his attempt to gag hospitals over the growing accident and emergency crisis, the Secretary of State has sanctioned guidance that “we must avoid reputational damage”. Whose reputation? His reputation? Does the right hon. Gentleman not accept that his reputation on the national health service is damaged beyond repair?

[Mr Hunt]

I will take no lessons in stamping out news stories on poor care because I am worried about the impact on reputation. That is what happened when the shadow Health Secretary was behind my desk, and it was totally unacceptable. That is why we had a clutch of hospitals where poor care was swept under the carpet year in, year out because a Labour Government did not want bad news to come out in the run-up to an election. It was a disgrace and this Government are putting it right.

Hospital Mortality Rates

Jack Dromey Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

Absolutely. I congratulate my hon. Friend on his extraordinary campaigning on behalf of his constituents. It is very difficult for a local Member to take on his own hospital when he finds failings, but he does it with great bravery. Yes, we need to ensure that the way we judge hospitals is not just about meeting waiting time and A and E targets, important though they are; it must also be about safety, about compassionate care and about governance. Other things matter as well. That is what we are changing.

[Jack Dromey (Birmingham, Erdington) (Lab)]

In a new low for British politics, the Secretary of State today descended into the gutter. How can he begin to blame the last Government for the deterioration at the 14 hospitals concerned, which took place under this Government, especially as the Government were warned about unacceptable standards in five of them?

[Mr Hunt]

The low in British politics is that it took so long for a Government to be honest about failings in the NHS. Many of those hospitals have a culture that entrenched failure for years and years under the last Labour Government, yet Labour Members refuse to accept that even now. What does that say to the public about whether they can be trusted with the future of our NHS?

Erdington Walk-in Centre

Jack Dromey Excerpts

Tuesday 5th March 2013 Westminster Hall

[Jack Dromey (Birmingham, Erdington) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Weir.

Today I bring a simple message from my constituents—“Save our walk-in centre.” Over recent months I have led, together with the user group and the local community, a campaign to save Erdington walk-in centre—a centre at the heart of our local community and considered one of the best of its kind. It is being threatened with closure as a consequence of a review by the Birmingham and Solihull national health service of all walk-in centres in the city. The threat is not just to the centre on Erdington High street but to the one in Kingstanding, which is also in my constituency and in one of the poorest wards in Britain.

My constituents may not agree with one another on every issue, but if there is one thing on which there is unanimity of opinion, it is that they know a good thing when they see it, and they have rallied behind their walk-in centre. I was proud to see just a few weeks ago hundreds of local residents turning out on a freezing Saturday to protest on the High street in support of their much-loved and much-used walk-in centre.

The Erdington walk-in centre offers a general practitioner-led service to walk-in patients from 8 am to 8 pm, seven days a week, including bank holidays. In 2012, an average of 76 patients a day were seen in the centre. The centre participates in accident and emergency diversion when necessary and accepts some category C ambulance referrals. It has close links with two other units in the same building—the New Attitudes sexual health team on the floor above and the Health Exchange team on the floor below—and houses some community clinics, for example for drug workers and users.

The centre has served to support the local population in accessing quality GP-led health care through extended opening hours that are convenient for patients, including those who are registered with a GP but have difficulty accessing services during normal opening hours. The centre also provides an important service to vulnerable local people, including those who are unregistered or homeless. The service means that they have access to high-quality medical care.

I know first hand how the centre matters—I have used it myself. Indeed, I have used both the Erdington and Kingstanding walk-in centres. Much more importantly, I know, from talking to literally hundreds of local people, just how important the centre is to the local community, providing accessible and high-quality health care in the heart of our High street. The closure of the much-used and much-loved facility would be a devastating blow. In the words of one of my constituents, Nathalie Lynch:

“Anyone with children knows how essential it is to have quick access to medical help. My doctor’s surgery is so oversubscribed that I can’t get an appointment. The walk-in centre has been a lifeline. On three separate occasions, my son has received nebulisers for his breathing and then been sent on to hospital. What would he do without this service, I dread to think.”

Currently, the nearest alternative providers of urgent care services are the accident and emergency departments at Heartlands and Good Hope hospitals. If we lose the walk-in centre, not only will the health of local people suffer but, if local people are desperate, they will go to those A and E departments, in turn costing the taxpayer more.

Although the decision to close the walk-in centre—if that decision is made—lies with the health service, the true responsibility lies with the Prime Minister and the Government. As cuts to health care start to hit the front line—almost 7,000 nursing posts have already been lost since the general election—NHS bosses have been put in an impossible position by the downward pressure created by the top-down reorganisation of the NHS.

Despite the Prime Minister’s pledge to protect the NHS, health care bosses in Birmingham are struggling with a £76 million cut, forced on them by the Government. That is a direct result of the Government’s top-down reorganisation of the NHS, which is threatening the vital services we rely on most while costing the taxpayer £3.5 billion—all that from a Conservative party that pledged before the general election that there would be

“no more top-down re-organisation of the NHS”.

In the party’s manifesto for the 2010 general election, it pledged that

“every patient can access a GP in their area”

and not have to travel miles to meet their urgent care needs. It is wrong that local Tories who pledged all those things before the general election are now trying to wash their hands of responsibility for what their Government are doing and for that which they said should never happen.

It is vital that Ministers know the impact that their decisions will have on local communities and people. What happens when local walk-in centres are closed? People like my constituent Paul Flynn, whose 19-month-old twin girls had both caught viruses that became chest infections on a Sunday, when his doctor’s surgery was closed, would be forced to go to A and E. However, because Paul was able to take his daughters to the walk-in centre on Erdington High street, they were immediately put on nebulisers to alleviate their breathing difficulties. In his words:

“We do not know what we would have done without the walk-in centre.”

Or take Audrey Smith, a local teacher, who would be forced to take time off work if she wanted to see her GP, particularly at a time of discomfort or pain, because her surgery has restricted hours from Monday to Friday. Without vital facilities that provide accessible urgent care services, many people like her would be forced to choose between taking time off work and attending A and E.

Just last night, I received a heartfelt e-mail from a constituent, Peter McDonald, who had had a heart attack just a few yards from the walk-in centre on Erdington High street. Peter managed to walk in and see a doctor within minutes, who gave him a GTN spray before he was taken to hospital. In his words:

“I owe my life to the doctors at the centre. If the walk-in centre wasn’t there, it might have been a different outcome. This centre must stay open.”

Sadly, walk-in centres are closing. We are seeing the results, as A and E waiting times are going up, with 47,000 more people waiting more than four hours since September compared with last year. More than 100,000 extra patients have now waited longer than four hours for treatment in A and E since the start of 2012-13.

What is more, A and E departments are themselves being closed. Before the 2010 general election, the Prime Minister toured marginal seats, promising to save accident and emergency facilities in a cynical attempt to win votes. He promised a “bare-knuckle fight”—those were his words at the time—to save accident and emergency services at 29 hospitals, but 12 of them have now been closed or downgraded.

Two and a half years into this Parliament, we have seen broken promise after broken promise from the Prime Minister on the national health service. Not only has he cut NHS spending in real terms but his Government’s reckless approach to top-down reorganisation is creating increasing pressures and consequently casualties, which might include the walk-in centres on Erdington High street and in Kingstanding in my constituency. The message before the election was one that valued those walk-in centres; the message after the election has been very different, with more and more services being closed.

What has been the response of the Government thus far to the closure of 54 walk-in centres nationally since 2010? They have made the local NHS responsible for NHS walk-in centres. It is true that the last Labour Government realised that local people best know what is in their interest, so allowing health and well-being decisions to be taken locally, including through primary care trusts. Given what is now happening, however, I have to say to the Minister that if he dams the river at its source, he should not be surprised if the water runs dry downstream.

In conclusion, the Erdington and Kingstanding walk-in centres both provide accessible high-quality medical care to thousands of local people. I again stress that the Kingstanding one is located in one of the poorest wards in the whole of Britain. There is no alternative service within the immediate locality. If the vital centres on Erdington High street and in Kingstanding close, the hard work of the dedicated staff that has gone into the development of the walk-in centres will be wasted, as will the considerable investment that has gone into them, and local people will again have to travel miles for their urgent care needs.

The closure of the much-loved and much-used facility would be a devastating blow. That is why, with the user group and the local community, I have led a campaign against closure for the past five months, and that is why I bring this unmistakable message from the community I represent to Parliament today. I am grateful to the Minister for agreeing to meet representatives of the patient and user group. It is right that the case for the walk-in centre be heard on the Floor of the House, and that the voice of those in the community who love, use and value their walk-in centre should also be heard.

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

It is a pleasure to serve under your chairmanship, I believe for the second time, Mr Weir, and to reply to the hon. Member for Birmingham, Erdington (Jack Dromey), whom I congratulate on securing this debate. I acknowledge his hard work on behalf of his constituents in campaigning for the retention of Erdington walk-in centre, and the strength of feeling locally, which he eloquently outlined.

Before I move to the local context, it would be remiss of me not to pick up the issues of national consequence raised by the hon. Gentleman. This Government will have invested £12.5 billion more in the NHS between the last election and the one in 2015, which is providing some, albeit small, real-terms growth in the NHS budget. Even though we are in difficult economic times, the Government have made a clear commitment that the NHS is a special case that needs further investment, which we are providing. It might be worth the hon. Gentleman taking that up with one of his Front-Bench colleagues, the right hon. Member for Leigh (Andy Burnham), who in contrast said that such investment was irresponsible. Indeed, the Labour party running the NHS in Wales intends to make an 8% real-terms cut in its budget. It is worth reflecting on the reality of the situation before getting drawn into any political rhetoric.

The hon. Member for Birmingham, Erdington is right to raise the specific pressures on A and E. We know that A and Es are being accessed by increasing numbers of patients, and we know from history that one key driver of that was the previous Government’s decision to contract out-of-hours GP care away from local GPs. One direct consequence of that has been additional pressures on accident and emergency departments. In many ways, that pulls against what he spoke about and what I believe in, which is the need to deliver more and higher quality care in the community. That cannot be nine-to-five or nine-to-six care in the community; it has to be all-day, 24/7 care, which is what integrated good health care looks like. I believe that the decision was bad. I saw its consequences when I worked as a casualty doctor in A and E. We have lived to regret it, and it has been badly to the detriment of patients.

The report on the Mid Staffordshire NHS Foundation Trust graphically outlined the fact that targets have often got in the way of front-line patient care. That is why this Government, when they came to power, relaxed the 98% target for the four-hour wait in A and E and set it at 95%, which doctors, nurses and my fellow health care professionals said was in the best interests of patients. Too often the four-hour target meant that a patient who perhaps had a broken toe was given priority ahead of a patient with potentially life-threatening chest pain. That was not good medicine or patient care, but showed targets getting in the way of looking after patients effectively, a lesson that was graphically depicted in the Francis report on the Mid Staffordshire trust. We must learn such lessons and acknowledge that although targets can have a place in health care, we have to trust and listen to front-line health care professionals if we are to deliver high-quality care for patients.

On the national context of urgent care and accident and emergency care, the Government are committed to developing a more coherent 24/7 urgent care service in every part of England. That will provide universal access to high-quality 24/7 urgent care services, so that whatever people’s needs or location, they will get the best care from the best person in the best place and at the right time.

The NHS has always had to respond to patients’ changing expectations and advances in medical technology. As lifestyles, society and medicine continue to change, the NHS will also need to change. The reconfiguration of urgent care services is therefore about modernising the delivery of care and facilities to improve patient outcomes, develop services closer to home and, most importantly, save lives. We are clear that, as the hon. Gentleman outlined, the reconfiguration of front-line services is a matter for the local NHS. That was the previous Government’s policy and is this Government’s policy.

Services should be tailored to meet the needs of the local population. We expect proposals for service changes to meet four tests: to demonstrate a clear clinical evidence base underpinning any proposals, focusing on improved outcomes for patients—in other words, to save lives—and to show clear support from GPs as the commissioners of local health-care services, strengthened arrangements for public engagement and support for patient choice. Even when all those tests are met, if the responsible local authority is concerned about a decision, it will have the option to refer such a decision to the Secretary of State.

Our vision for urgent care is to replace the ad hoc, unco-ordinated system that has developed over the past few years—characterised by poor quality and too much variation in care throughout the country—with a more consistent system that delivers improvements in patient care. The Government are committed to putting GPs in charge of commissioning urgent care services. We believe that empowering GPs and other health professionals will achieve better and more patient-focused services.

It would be wrong not to talk about the winter pressures faced by the NHS. In response to those pressures, we have put about £330 million of additional money into the NHS to deal with them. I am aware that local hospitals in the Birmingham area recently issued a statement advising patients to attend A and E only for matters requiring urgent attention, because of the pressures of demand experienced by emergency departments. There is always more pressure on the NHS during winter months, with more demand on urgent and emergency care services, and this year is not different. During October and November 2012, NHS Midlands and East scrutinised winter plans, escalation triggers and protocols across its health economies, and it is monitoring pressure on health services during the winter across the whole of the strategic health authority area to ensure that patients continue to have access to high quality NHS care in Birmingham and elsewhere.

I turn to the local context, which is obviously of importance to the hon. Gentleman and his constituents. He is a tremendous advocate for his constituents, and has eloquently outlined some of the local concerns, which relate to an NHS review of urgent care provision in Birmingham and Solihull. The clinical commissioning groups in the area are developing an urgent care strategy to improve access to and integration of services for people with urgent health care needs, to make the system simpler to navigate and to avoid duplication.

I understand that local commissioners have engaged stakeholders in the process, and they include clinicians, patient groups, providers and health overview and scrutiny committees. The local NHS has collected evidence from local people to understand the usage of current urgent care services, such as walk-in centres.

The hon. Gentleman will be aware that the local NHS is now developing a draft strategy outlining some initial options. However, it is important to make it clear that as yet no decisions have been made. That is for local determination, and it would not be appropriate for me to comment further on the detail of the urgent care review.

I am assured by the local NHS that engagement with local people and other stakeholders will continue over the coming months to ensure their input in the final proposals ahead of the formal consultation later in the year. Of course I expect any proposals to meet, where appropriate, the four tests for service change.

I understand that the hon. Gentleman met representatives of Birmingham CrossCity CCG in December 2012 to discuss the review, and I encourage him to continue engaging with local NHS staff on the matter.

[Jack Dromey]

It is certainly true that we had a meeting in December and that it was clear beyond any doubt that there was a real threat to both the walk-in centres. A commitment was given that by the end of January there would be a route map of the next stages of process and engagement, but here we are in the first week of March and it has yet to be produced. The suggestion now is that it might not be with us until mid-April at the earliest. Although I understand what the Minister is saying in good faith about the importance of proper engagement with the community, I have to say that those responsible in the national health service in Birmingham have been dragging their heels.

[Dr Poulter]

The hon. Gentleman is right to say that when there is talk of service change, effective engagement is important and must be dealt with in an expedient manner. There must be an awareness that the prospect of any change can lead to understandable concerns among both staff and patients. A time of change is always potentially unsettling. I know that he, like me, will want to encourage the CCGs to come to the table and address this matter more effectively than they have done. I will endeavour to ensure that there are representatives from the CCGs at the meeting that we have later in the month, as that will be an effective way of helping to facilitate matters and bring them to a more speedy resolution.

In conclusion, I encourage local people in Birmingham and Solihull and their elected representatives, including the hon. Gentleman, to participate in the engagement process and subsequent consultation to ensure that their views are taken into account. I look forward to meeting the hon. Gentleman later this month to ensure that we do all we can to facilitate a speedy resolution of the matter and to ease these times of uncertainty that are faced by his constituents.

Oral Answers to Questions

Jack Dromey Excerpts

Tuesday 27th November 2012 Commons Chamber

[Mr Speaker]

Order. These matters could be considered further in an Adjournment debate, which might be a suitable length for the subject.

[Jack Dromey (Birmingham, Erdington) (Lab)]

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

[The Secretary of State for Health (Mr Jeremy Hunt)]

I am pleased to report an NHS performing at record levels. There are half a million more out-patient appointments every year since the last election, nearly 1 million more people go through A and E every year, and there are 1.5 million more diagnostic tests every year. To clarify a previous answer, the number of health visitors will go up by more than 50% during the course of this Parliament.

[Jack Dromey]

The Erdington walk-in centre is at the heart of our high street. It is much loved, much used and cost-effective, yet it is at risk of closure because of the combination of a £76 million reduction in expenditure by Birmingham primary care trusts and health service reorganisation. Thousands of local people have expressed their concern and elected a users committee. Will the Secretary of State meet the users of the centre and me?

[Mr Hunt]

I am happy to look into the issues the hon. Gentleman raises. The purpose of the reforms is to put more money on to the front line and into primary care, where we can save the most lives.

Regional Pay (NHS)

Jack Dromey Excerpts

Wednesday 7th November 2012 Commons Chamber

[Mr Hunt]

I agree that I want local trusts to have the freedom to get the best health care for people in their areas, including my hon. Friend’s constituents. I agree that that means recruiting and retaining the very best staff and ensuring that they are highly motivated. My hon. Friend makes an important point: we must think about areas where the cost of living is lower, but we must also think about areas where it is higher. People in my constituency who work for the NHS have to commute from Portsmouth because they cannot afford to live near the hospitals and community health centres where they work. That is why an element of flexibility is a very important principle.

[Jack Dromey (Birmingham, Erdington) (Lab)]

rose—

[Geraint Davies (Swansea West) (Lab/Co-op)]

rose—

--- Later in debate ---

[Mr Hunt]

I ask the right hon. Member for Leigh, rather than irresponsibly scaremongering, to do something positive by doing everything in his power to encourage his trade union friends to work in the best interests of their members, of patients and of his constituents and mine to come to a speedy resolution. I suspect he has rather more influence with the unions than I do in that regard. Even with a protected NHS budget—something that he thought was “irresponsible”—the NHS must do significantly more within its limited means, and as its single largest expense the pay bill cannot be immune to change. It represents between 60% and 70% of total expenditure in most NHS organisations and costs more than £43 billion in the hospital and community services sector alone.

[Jack Dromey]

I was involved in the process that led to the groundbreaking agreement “Agenda for Change”. It was a national agreement that contained certain flexibilities but it explicitly rejected regional pay. Regional pay is now proposed in the south-west. Does the Secretary of State support that move or condemn it?

[Mr Hunt]

I support proper negotiations between NHS employers and unions to revise, reform and improve “Agenda for Change” so that it is fit for the very different financial circumstances in which the NHS now finds itself. The vast majority of NHS trusts and foundation trusts, including in the south-west, would rather negotiate on national pay scales, but that means the unions being realistic about what is sensible in this financial climate. That is why employers need to use the system more efficiently and effectively, extending the use of high-cost area supplements when they can be justified to tackle the recruitment and retention issues that affect a particular area or region.

Like the previous Government, we want to retain the flexibility that allows individual employers to use recruitment and retention premiums and, like the previous Government, we want any changes to be introduced incrementally in full partnership with NHS employers and trade unions.

--- Later in debate ---

[Chris Skidmore]

I believe that “cartel” is a rather offensive word to use in this context, because it has connotations that are inappropriate for health care professionals who are doing their best to ensure that the NHS survives in the long term. That is the crux of the debate. Let us look at staffing costs. The Labour Government made a significant investment in the NHS over 13 years. It would be churlish to deny that, but it would also be churlish to deny the fact that a huge proportion of those costs were soaked up in pay.

[Jack Dromey]

The hon. Gentleman has just spoken about paying people the market rate. Sadly, there is a low-wage economy in much of the south-west. That is precisely why regional pay was rejected in the lead-up to “Agenda for Change”. It would lead to the market rate being applied in much of the south-west, driving down pay and conditions of employment. Does he, as a south-west Member of Parliament, support regional pay bargaining for the south-west?

[Chris Skidmore]

What I support is south-west trusts coming together as health care professionals and working out what is best for them in order to survive financially for the future.

I want to read from Chris Brown’s reply to my letter:

“The Consortium was established in response to the serious financial and operational challenges facing the NHS, both now and in the future, and will work to identify ways in which taxpayer funding may be more efficiently used in order to protect both employment and the continued delivery of high quality healthcare.”

There is a significant point in that. I do not want redundancies in the NHS, but if we do not come up with a workable solution for the future, that is what Opposition Members will see, and it will be on their watch if they believe that we should follow the national pay structure. I do not want to see redundancies, and neither do the trusts, which is why they have come together constructively, and they should not be scolded for doing so.

Mr Brown’s letter continued:

“More than two thirds of NHS expenditure is on staffing costs. In recent years NHS organisations have largely exhausted other avenues of potential cost-saving (including reducing reliance on bank or agency staff and implementing service improvement initiatives). Monitor, the independent regulator for NHS Foundation Trusts, has also estimated that NHS organisations with a turnover or around £200m will need to produce savings of around £9m a year for each year until at least 2016/17 to remain in financial health.”

That is why the consortium has been formed. We cannot forget the financial challenge.