Barking, Havering and Redbridge NHS Hospitals Trust

Jane Ellison Excerpts

Thursday 9th January 2014 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I congratulate the hon. Member for Ilford South (Mike Gapes) on securing the debate. I have heard him raise this issue in the House before, and it is clearly one of enormous interest and importance to his constituents. Like him, I wish to pay tribute to NHS staff in his area, particularly in the trust, as it has faced significant financial and performance challenges over recent years, as he outlined, including substantial problems with recruitment and retention. It is therefore particularly important to pay tribute to those front-line staff who have endeavoured—with some success, it sounds—to deliver an acceptable level of patient care in the face of a difficult situation. We thank and pay tribute to them for that.

I do not have a huge amount of time, so will give an undertaking now to get in touch with the hon. Gentleman after the debate if there are any issues that I cannot respond to or that I have not picked up on. It is worth saying—he will be disappointed, but it is better to say it straight away—that there has been no change in the position on the reconfiguration plans as laid out by the Secretary of State in the most recent official correspondence. I will therefore focus my remarks on the special measures situation and some of his questions about it, as I have some more detailed information to put across.

As we have heard, the NHS Trust Development Authority has decided to place the trust in special measures. The decision was not taken lightly; it follows the findings of an inspection by the Care Quality Commission’s chief inspector of hospitals, which demonstrated unacceptable failings in the trust. The chief inspector acknowledged that the trust has demonstrated improvements in some areas, such as the maternity service, but that good work has not been replicated throughout the trust. He highlighted that long-standing difficulties in the two A and E departments are clearly affecting patients and that attempts by the trust to address the problems have not had the hoped-for impact.

I share the hon. Gentleman’s disappointment that the much-needed improvements to A and E have not been achieved. All our constituents—I am a fellow London Member—deserve the best health care that we can provide. I recognise his characterisation of the local catchment area, as I see many of the same characteristics in my constituency. London is an extremely challenging health economy. The city’s diversity brings both exciting challenges and big pressures, so I understand what he is alluding to. Those are some of the reasons why the chief inspector recommended that the trust should be placed in special measures, whereby the trust’s leadership can get the support it needs to tackle the scale of the problems it faces.

Special measures provide an open and transparent way for the trust to take swift action to improve the quality of the services it provides for local people, which is what we want to see. I have been informed that the TDA has set out an intensive and focused programme of support. It includes the development of an improvement plan by the trust, which the TDA expects to see implemented over the next 12 months, and the appointment of an improvement director to support the development and delivery of the trust’s improvement plan. I recognise that the hon. Gentleman feels that he has seen people come and go with that objective in mind, but clearly it is extremely important that the improvement director is appointed, grasps the situation and makes a real difference.

There will also be a review of the capability of the trust’s board and senior management team, to be undertaken this month by Sir Ian Carruthers. It aims to ensure that the organisation has the capacity and capability to respond to the chief inspector’s report and deliver the improvement plan. I hope that it will report very soon after this month’s assessment so that it can be one of the building blocks on which the trust can move forward.

The trust’s plan will also need to identify the support it needs from partner organisations to improve services, including its commissioners and local authorities. I understand that the relationships are not as good as they could be and that there have been problems for some time. Work is already under way to identify partners to support the trust in recruiting and retaining staff. I recognise that the figures on vacancies that the hon. Gentleman set out, particularly for A and E, which were given to me in the briefing for this debate, are not acceptable. That is a real challenge, and one that the trust needs to respond to.

I can reassure the House that the trust’s plan will be published on the NHS Choices website and will be freely available to the public. We also expect regular updates to demonstrate how the trust is progressing. I believe that progress will be posted against that plan in a transparent way as the period for improvement progresses. The TDA will keep close to the trust as it works to make the necessary improvements and will hold board-to-board meetings with the trust. It has also arranged to buddy-up and provide support, as appropriate, with a high-performing foundation trust. Special measures are designed to produce results quickly. The trust will have one year to improve sufficiently, as judged by the chief inspector of hospitals, in order to exit special measures.

As the hon. Gentleman said, the safety of A and E departments is very important. The trust has been subject to an external clinical review of the safety of its A and E services commissioned by the local clinical commissioning groups and undertaken by the London Clinical Senate. I understand that this was in response to a request from local CCGs following concerns raised about potentially unsafe levels of medical staffing within the A and E units, as we have discussed. The TDA has confirmed to me that this review, which published interim findings in September 2013, concluded that neither the A and E at King George hospital nor the A and E at Queen’s hospital was unsafe, but it made a number of recommendations to improve the service. It has also been made clear to me that the A and E review was very much independent of the chief inspector of hospitals’ inspections at the trust and the TDA’s decision to put the trust into special measures.

Let me touch on some of the support that has been put in for A and E. We have provided further support to the trust through the funds available to respond to winter pressures. The local health economy in the hon. Gentleman’s area has received about £7 million, while the trust itself has received £3 million. Some £1.4 million has been earmarked for A and E recruitment, and another £4 million was allocated throughout the local health economy by the urgent care working group responsible for the area. That money was allocated based on clinical need and went to a range of organisations, including the local mental health trust, the London ambulance service, and the local authority.

There is no time to talk about this in detail now, but the Government are taking longer-term action with regard to reducing demand at A and Es. Some of that falls within my own portfolio of public health in seeing what health and wellbeing boards can do to reduce demand as regards people going to A and E when that is not the appropriate place for them to be. Of course, the extension of GPs’ opening hours through new contractual arrangements is highly relevant in a population that is, as the hon. Gentleman described, to a large extent young, highly mobile, highly diverse, and often working in London’s 24-hour economy.

I strongly recommend that the hon. Gentleman and other hon. Members on both sides of the House who have expressed concern about the situation for some time should continue to engage with the trust at every opportunity—clearly, there have sometimes been challenges in the relationship—and with their local health and wellbeing board. The challenges facing the trust cannot be tackled alone and will best be tackled by the local NHS and all the partners—local authorities and so on—working together. It is absolutely vital to get that right.

The priority now is to make sure that the trust is able rapidly to improve the care that it provides to the hon. Gentleman’s constituents. The TDA will work closely with the trust to help it to improve and will take every necessary action to make sure that the issues raised in the chief inspector’s report are addressed. I will meet the London team within NHS England shortly. I will raise the issues highlighted in this debate, among others, and I will continue to keep the hon. Gentleman and other hon. Members who are interested in the situation informed as we go through this important year for his local NHS.

Question put and agreed to.

Joint Committee on Vaccination and Immunisation

Jane Ellison Excerpts

Wednesday 8th January 2014 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

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

I congratulate my hon. Friend the Member for Finchley and Golders Green (Mike Freer) on securing this debate and on again bringing this important subject before the House. He has been a great champion. I also congratulate my hon. Friend the Member for Mid Derbyshire (Pauline Latham) on raising another vital aspect of the Joint Committee on Vaccination and Immunisation’s work, to which I will also respond, albeit briefly.

It may help the House if I provide some background. The JCVI is an independent departmental expert committee, and it is a statutory body constituted to advise the Secretary of State for Health on the provision of vaccination and immunisation services. The committee and its invited experts represent some of the finest clinicians and academics in the UK and Europe, and all members are selected for their expert knowledge of matters concerning vaccination, immunisation and associated disciplines, including immunology, virology, bacteriology, paediatrics, general practice, public health and health economics.

We all recognise that the NHS budget is a finite resource. New vaccination programmes and extensions to existing programmes represent a significant cost to the health service in terms of both vaccine procurement and administration. Obviously, it is essential that any recommendations from the JCVI on changes to the national vaccination programme are supported by evidence of cost-effectiveness.

The JCVI has adopted a methodology for assessing cost-effectiveness that is in line with that used by the National Institute for Health and Clinical Excellence. Using those processes, the committee basically ensures that increased spending on immunisation does not result in an overall decrease in the health of the population because resources are diverted from more cost-effective health care interventions. We all recognise that those decisions are not easy.

My hon. Friend the Member for Mid Derbyshire makes a powerful case for the meningitis B vaccine, which the JCVI is currently reconsidering. The updated statement published on 25 October 2013 reflects the JCVI’s recognition of the burden and severity of meningococcal meningitis and septicaemia in the UK and the need to explore the potential for their prevention through immunisation. The situation is difficult when we have a new vaccine, in this case against meningitis B, but lack important evidence on its effectiveness. We need to know how well the vaccine will protect, how long it will protect for and whether it will stop the bacteria spreading from person to person. At the committee’s next meeting in February, if it feels it is in a position to make such a decision because it is in possession of all the relevant facts, the JCVI will make a final recommendation on whether meningitis B immunisation should be introduced. Obviously at that point we will carefully consider and respond to the recommendation. I hope that my hon. Friend is reassured that the recommendation will get proper and careful attention.

On the issue raised by my hon. Friend the Member for Finchley and Golders Green, the primary aim of the UK’s national HPV vaccination programme, which began in 2008, is to prevent cervical cancer related to HPV infection. The HPV vaccine protects against two strains of HPV—16 and 18—that currently cause some 70% of cervical cancer.

As HPV is responsible for virtually all cases of cervical cancer, preventing the disease is the major aim, but as my hon. Friend rightly says, HPV infection has been associated with other cancers, including cancer of the penis and anus, and some cancers of the head and neck. The precise proportion of those diseases that can be attributed to HPV infection is less well defined, but evidence is emerging all the time, so HPV infection should be taken seriously.

Evidence from clinical trials demonstrates that the HPV vaccine has a very high efficacy against the precursors of cervical cancer. Evidence of efficacy against cancers at other sites is emerging, and it is recognised that the current programme may therefore provide protection against a wider range of HPV-related cancers in females and, indirectly, in males than originally envisaged.

It is also worth saying that the UK’s HPV vaccination programme has been a considerable success, with this country having some of the highest coverage in the world—something we can be very proud of. A recently published study by Public Health England provided new evidence that the programme is successfully preventing HPV infections in young women in England, and that adds to our confidence that the programme can achieve its aim of reducing cervical cancer.

With a high uptake of HPV vaccination among girls, transmission of HPV between girls and boys should, as my hon. Friend said, be substantially lowered. Many boys will be protected against HPV infection and will, therefore, be at reduced risk of developing the related cancers we have spoken about, such as anal, head and neck cancers. However, I appreciate that he is particularly concerned that the current programme does not extend to men who have sex with men. He argued strongly that that is an apparent health inequality, and he raised the issue with my predecessor in last July’s debate, for which I was present.

As my hon. Friend will know, the JCVI has recognised that, under the current programme, the protection that accrues from reduced HPV transmission from vaccinated girls may not extend to men who have sex with men. He made the additional point about men who might have sex with girls and women from elsewhere who have not been subject to the broad coverage provided by our programme.

That is why, in October 2013, the JCVI agreed to set up a sub-committee on HPV vaccination to assess, among other issues, the question of extending the programme to MSM, adolescent boys or both. The JCVI therefore recognises the issue as a priority, and I congratulate my hon. Friend on championing it, because the attention it received in Parliament was obviously part of the reason that it was given a fresh look and is regarded as a priority. I know the JCVI took events in Parliament into account, and, indeed, my hon. Friend made his case directly.

The sub-committee will aim to identify and evaluate the full range of options for extending protection from HPV infection to men who have sex with men, and that will cover a range of settings, including genito-urinary medicine clinics. However, as my hon. Friend will be aware, GUM clinics may not be the best setting for offering vaccination, as those presenting may already have been exposed to infection, so their ability to benefit from vaccination will inevitably be limited.

The sub-committee is scheduled to meet for the first time on 20 January, when it will assess currently available scientific evidence and consider what further evidence is required to advise the JCVI on the suitability of possible changes to the HPV programme. For the reasons I outlined earlier, any proposals for the vaccination of additional groups will require supporting evidence to show that it would be a cost-effective use of NHS resources.

Public Health England has begun preliminary modelling to assess the impact and cost-effectiveness of vaccinating MSM, in anticipation of further guidance on the issue when the HPV sub-committee meets. Further work to assess the impact and cost-effectiveness of vaccinating adolescent boys against HPV infection is also planned, but it will take some time to do that important modelling, and I am conscious that that is one of the predominant concerns on my hon. Friend’s mind. These are complex issues, and the development of the evidence base and the mathematical models by PHE, as well as the deliberations of the JCVI itself, take time. However, that process and the time that it takes ensure that we get important decisions right and that decisions are taken on the basis of the best evidence. We cannot, therefore, undertake to take decisions hurriedly, because they are big decisions with, potentially, big implications.

Should the JCVI recommend the targeted vaccination of MSM, flexibility around contracted volumes in the current vaccine contract may allow a programme to be undertaken without the need for a new round of vaccine procurement—the numbers involved are relatively small in the context of the existing programme—if additional vaccine was available from the manufacturer in the required quantities. We are therefore cautiously optimistic that we can accommodate targeted vaccination of MSM in the existing programme, were it to be recommended by the JCVI. I hope that is a little encouraging for my hon. Friend.

Vaccine supply contracts are let for as long a period as is considered appropriate, taking into account the timing of potential changes to JCVI advice, policy and market forces, as well as Government procurement guidance. Obviously, longer contracts can secure firm prices for a longer period and allow for more accurate budget planning. However, we are exploring the flexibility that we have in existing contracts to align the window for the new contractual discussions with any potential recommendations by the JCVI, especially on the wider vaccination programme, were that what it recommended. We have not completed that work yet, but what I have seen so far leads me to conclude that we might be able to do something around the existing contract. We are looking at that to ensure that we do not miss the window of opportunity, which my hon. Friend identified as a chief cause of concern.

In conclusion, this important work has yet to be completed. We have to get some clarity on the time lines. We cannot achieve one of the things my hon. Friend mentioned—bringing the work on the assessment forward—because we have to review the available evidence and fill in any gaps if further evidence is needed. A decision on the vaccination of adolescent boys will probably require the development of quite a complex model to determine whether vaccination would be cost-effective, because the numbers involved are large. Such a model may identify a need to generate additional evidence, so a decision on that wider programme is not likely before 2015. However, as I said, the evidence to support a decision on a selective programme to target men who have sex with men may become available during 2014.

I can certainly give my hon. Friend the commitment that I will keep under careful review the timetable for key decisions when the committee makes its assessment and look at how they align with what we know about the flexibility that we have under the procurement contract. We will keep that under careful consideration. I conclude by congratulating him again on bringing this important issue before us and on continuing to keep it on the Government’s agenda.

Health Care (London)

Jane Ellison Excerpts

Wednesday 8th January 2014 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

What an amazing debate! I congratulate the hon. Member for Westminster North (Ms Buck) on securing it; a lot of issues have been covered. Many London colleagues have contributed, made interventions or simply been present to listen to it. As a London MP, I am particularly conscious of the unique challenges facing health care in London, and many of the issues raised apply as much to my constituents as they do to those of colleagues across the House. As hon. Members have said, London is an amazing city with world-leading expertise and services, but it has unique challenges. Whichever party was in government, it would have to respond to those challenges.

I will do my best to respond to some of the points that have been made, but there were such a range of points, and some of them were so specific, that I may need to write to colleagues after the debate. I hope that hon. Members understand that. I will ensure that I follow up those points personally or ask NHS London to do so. Forgive me for having to make that health warning.

I start by echoing the praise from the hon. Member for Westminster North for our NHS staff in London. They work under many interesting and unique pressures, and they respond, for the most part, magnificently. We all realise that no service is above criticism, but our starting point is that we have some amazing people working very hard under difficult circumstances. I am particularly glad that the hon. Lady and her family experienced good care at a crucial time.

The hon. Lady is right to caution that debates about health need to acknowledge, but not to exaggerate, risk. We always teeter on the brink of exaggerating points for political effect, and it is really important that we keep some sense of perspective. Several hon. Members have referred repeatedly to an A and E crisis. I want to put on the record that for the week ending 29 December 2013 last year, the figures for A and E waiting times in London demonstrate that 96% of patients were seen in under four hours in all A and E types, against a standard of 95%. For the third quarter of last year, 95.3% of patients were seen in under four hours in all A and E types.

I am not saying that we do not have problems and challenges, but let us be clear that in many places, the NHS is responding well to those challenges and meeting targets. Work force statistics show that the number of community health service doctors increased by 8.5% from 2010 to 2013. Let us make sure that we keep a sense of perspective on where we are.

Some of the comments during the debate referred to reconfigurations across London. We are quite clear that reconfiguration of front-line health services is a matter for the local NHS, precisely for the reasons that some hon. Members have given. We are trying to make sure that they are led by clinical decisions. That was acknowledged in the opening speech, as was the need for change. The hon. Member for Westminster North made that point.

[Ms Buck]

Will the Minister give way?

[Jane Ellison]

Forgive me, but I really will not have a chance to respond to any of the points made if I give way. I will catch up with the hon. Lady afterwards if there are points that she specifically wants to discuss.

All the reconfigurations must focus on delivering modern health care, better patient outcomes and services as close to home as possible, but, most importantly, they must focus on saving lives and improving quality of life. Those service changes are best led by clinicians, with all of us getting involved and engaging with the process, as we must do. That is what we all want for our constituents, and there are different ways to achieve that.

Change is inevitable, as most, but not all, hon. Members have acknowledged. We have debated questions such as the changes to stroke services in London, which many campaigners predicted would have dire and dreadful outcomes. In fact, the opposite has been true, and London clinicians believe that hundreds of our constituents’ lives have been saved by the concentration of excellence in certain centres. We must be realistic about the fact that reconfiguration can bring great health benefits, as long as it meets the important tests set out by the Secretary of State, and is clinically led.

The health service has to respond to growing demand. Much of the debate has focused on the long-term challenges to the health service in London and across the country. The Government are trying to respond to those huge long-term pressures. We are looking at GP opening hours and at access. That could not be a bigger issue in London, which has a highly diverse and highly mobile population in a 24-hour city. People need to be able to access health care at a time that suits their work patterns and lifestyle, and we are pushing for changes to contracts in that area. There will be named GPs for over-75s. We are looking at the integration of social care and public health. We know that there are big challenges around that, but a big project is under way to try to tackle it.

Ring-fenced public health budgets will empower local authorities to do the very thing that many hon. Members have drawn our attention to, which is to look at the needs of local communities and respond to them at the most local level. We do not want to take a “Whitehall knows best” approach; we want to tell local authorities, “We have ring-fenced your local public health budget so that you can look at the needs of your local population and work with health and wellbeing boards and clinical commissioning groups to devise services that help people to live longer and healthier lives without the need to resort to acute services.”

There has not been much recognition of the need for the changes made to public health budgets, but of all the measures raised in the debate, those changes have some of the most exciting potential to tackle the challenges that we face.

I have touched on health and wellbeing boards. The challenge around Newham GPs would be ideal for discussion at a health and wellbeing board, where all the key people are present. It is a big challenge, and one of the first questions I asked as a Health Minister is why we struggled so badly to get GPs in our most deprived areas. There are varying answers to that, but it is a problem across the country.

The health and wellbeing board is exactly the right forum for discussion because the right people are around the table. Tackling health inequality is now built into statute through the Health and Social Care Act 2012, which must be given due attention in all parts of the health service. The Darzi-led London Health Commission will be interesting. I spoke to Lord Darzi about it just before Christmas to improve my understanding of its objectives. As a Minister with responsibility for public health and as a London MP, I will be looking closely at the commission’s outcomes and I will be keen to work with people on that. It is a big opportunity.

To touch on the point raised by my hon. Friend the Member for Cities of London and Westminster (Mark Field), the formula does not currently reflect non-resident population or the homeless, but that is something that the Advisory Committee on Resource Allocation and NHS England continue to consider. I will ensure that I draw my hon. Friend’s concerns to their attention and that those are fed into the ongoing process of looking at formulas.

For the first time, the formulas for CCG patients and public health allocations take into account health inequalities, and they look at GP populations rather than census-based populations. The formulas are also designed to be more locally sensitive. As the hon. Member for Westminster North and I know particularly well, in a city such as London areas that appear to be quite affluent can contain pockets of tremendous deprivation. The new formula allows for that by enabling consideration of sub-areas and the real health inequalities that they suffer. I hope that hon. Members feel some reassurance about that. We keep the matter under close watch.

Several detailed concerns were raised by the hon. Member for Lewisham East (Heidi Alexander) about Lewisham, the south London reconfiguration, maternity services and accommodation. The shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne) referred to clause 118. I will ensure that I draw his concerns to the attention of the Minister who is leading on that Bill. No doubt that point will be responded to when the Bill is brought before the House. The Court of Appeal overturned the decision to make service change in Lewisham, and we respect that. The Secretary of State has put that on the record.

Several points were raised about the north-west London reconfiguration. That was debated in this Chamber on 15 October, after which a letter was sent by the local NHS to the hon. Member for Westminster North. If other hon. Members have not seen that letter and would find it helpful to, I am happy to put it in the Library. I note the ongoing concerns expressed by the hon. Member for Hammersmith (Mr Slaughter) about the reconfiguration, and I will relay to the Secretary of State the detailed points that he has made and his desire for a meeting.

Other hon. Members have made comments about the same reconfiguration. For all the criticism of the plans and the analysis, I note that the shadow Minister did not commit his party to changing any of the reconfigurations or to changing NHS funding levels. If I may say so, his speech was long on analysis and short on commitment.

I conclude by saying that the issues raised today are important to all of us as London MPs. There are some big long-term challenges and the Government are trying to respond to them in the best interests of all our constituents.

[Mrs Anne Main (in the Chair)]

Before we commence the debate on Scotch whisky excise duty, I should say that we are expecting a vote—hence my glances at the Annunciator screen. Should that happen, I will call for the sitting to be suspended until the vote has taken place.

Hospices (Children and Young People)

Jane Ellison Excerpts

Wednesday 18th December 2013 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I congratulate hon. Members on an excellent debate. I congratulate my hon. Friend the Member for Pudsey (Stuart Andrew) on securing it, and on speaking, not for the first time, with great passion and knowledge on this subject. The debate rather gives the lie to the lazy cliché that MPs bring no real-life experience to the House. It has been enormously informed by the life experience of a number of Members, and I congratulate everyone who has taken part. I will do my best to respond to the various questions put to me, but if by chance time defeats me, I undertake to write to colleagues. The Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), is sorry that he cannot respond to this debate. As Members will have observed a few minutes ago on the Annunciator, he is otherwise engaged in the main Chamber.

Hospice care and palliative care for children and young people is an important and sensitive subject. From what the shadow Minister said, I can see that there is a good degree of cross-party consensus on the need to take the subject seriously and to sustain the way we serve the sector. The coalition placed great emphasis on palliative care in the coalition agreement, which included several specific commitments, such as a commitment to placing hospice funding on a more transparent and sustainable footing—that has been the subject of many comments today—and to introducing a new per-patient funding system for all hospices and providers of palliative care, so that the most gravely ill children and adults can receive care in the setting of their choice.

We have committed £10 million a year to support children’s hospices, as well as an additional £7 million in this financial year to support capital projects. In 2012, that allocation increased by over £700,000 to support new providers entering the sector, and we are keen to continue that substantial level of support now that responsibility has transferred to NHS England. We recognise the need for change in how children’s hospices are commissioned and funded. While a new funding system will be introduced in 2015, and while we have provided money to support hospices until then, we know that more needs to be done to support effective local commissioning. That, rightly, has been the focus of many of the speeches today.

Many hospices do not have as effective a relationship with their local commissioners as they might like, and funding from health commissioners is a relatively low proportion of the incomes of most children’s hospices and hospice-at-home providers. That is not universal, however. There are examples of local good practice where primary care trusts, formerly, and clinical commissioning groups, currently, have entered into funding arrangements with their local children’s hospice. My hon. Friend the Member for Salisbury (John Glen) has not returned from the main Chamber, but he spoke about the arrangements in his area for Naomi House, which has a per patient, per night tariff that has been arranged with the local CCG in Wiltshire.

We want the principle of CCGs supporting children’s hospices to be embraced widely across England. Monitor and NHS England are looking to include the arrangement between Wiltshire CCG and Naomi House in the national tariff document as a case study of good commissioning arrangements. Obviously, it is important that any nationally mandated or recommended tariff is based on a robust body of national evidence and provides clarity for commissioners on the services provided. I know that the working group has discussed the Naomi House example.

The charitable sector and the excellent fundraising work it does will always have a role. It has made an absolutely magnificent achievement over many years in all parts of the country; we have heard about that today. We are keen to see more effective and sustainable commissioning for hospices. We want commissioners to assume a more active role with their local providers, and we are keen to engage with the sector to see how we can support that. A lot of work is going on to develop that new model.

As has been referred to, the independent palliative care funding review, which reported in 2011, found that the absence of a clear funding model, or even a proper understanding of the costs of palliative care, was a major impediment to developing that care. The right hon. Member for Rother Valley (Mr Barron) mentioned the “stunning” absence of good data on the costs of palliative care, and the first step in developing a new funding system had to be improving the evidence base. We established eight pilots to collect a range of data and to test the review’s recommendations. The pilots—seven for adult palliative care, and one for children’s palliative care—are running for two years, and will provide the evidence to underpin decisions on how best to transfer to a fair and transparent funding system, which we intend to introduce in the 2015-16 financial year.

Hon. Members challenged us on the implementation plan and its timings. As part of the development of the tariff, there will be a plan for testing and implementation. Once we have clarity on the funding model, we will continue to ensure that the stakeholders are involved. Many of the hospices and their umbrella groups are closely involved in that work, and they will continue to engage in it.

I have heard the mood of the House on consultation. Although this is an NHS England lead, and I cannot commit it to carrying out a consultation, I can strongly encourage it and relay the mood of the House. The details of the tariff are still being worked on, but given that the new system will come into effect in 2015-16 and the sector needs to be able to plan ahead, we hope that that will happen in autumn 2014. That should be feasible, but I cannot commit to it. The sector is closely involved in that work and will be closely involved in the timing arrangements as well. It is key to say that we will not let this issue drift. The hospices are involved in the data collection and the discussion, and are key to the NHS England working group. The Government have made a commitment on that; we are conscious of that, and Members are right to push us on it.

NHS England is leading the work, and more than 80 organisations are involved. Barbara Gelb, the chief executive of Together for Short Lives, is a member of the Secretary of State’s children and young people’s health outcomes forum, so there is good read-across there. I emphasise how closely the sector is involved in the work, and how important it is to ensure that it supports the new funding model, which will be simple and non-bureaucratic—all the things that Members have alluded to today.

Having that clear, quality-assured information on the real costs of providing complex, costly care to a relatively small number of children will make a significant difference to commissioners. That has been emphasised by a number of Members. Concerns have been focused on that transitional period and the commissioning guidelines. The Department will consider in the coming months how we might further support that local understanding and preparedness among not only CCGs, but local authorities, as commissioners of social care.

[Sir Paul Beresford]

rose—

[Jane Ellison]

I will struggle to respond to the points made in the debate if I give way. I hope my hon. Friend will forgive me, but I am happy to pick up points after the debate.

We realise that health and wellbeing boards need to be involved, and that sits firmly in my area of public health. I will think about how we can take that forward and publicise that more.

The transitional period and the challenge for older children and young adults was referred to a great many times, and has given much food for thought. The Department of Health has given section 64 funding to Together for Short Lives to support development and research around appropriate pathways and the transition to adulthood. The National Institute for Health and Care Excellence has been commissioned by the Department to develop guidelines around that transition. A number of areas of Government policy come back to that same challenge of how we deal with transition, and stop there being a cliff edge when a child becomes an adult. We all recognise that in real life that is not a cliff edge. In other policy areas, in other Departments, people are looking closely to see where we can get that right.

The Government have made short breaks a priority, and have put money, albeit not ring-fenced, into local authorities. We have introduced the short breaks duty, which requires all local authorities to provide a range of short break services for disabled children, young people and their families. A statement has to be developed in consultation with families and published. That is one thing that local authorities can be judged against. My hon. Friend the Member for Mid Dorset and North Poole (Annette Brooke)spoke about Julia’s House, which is an interesting case in that regard. We will ensure that that is brought to the attention of the national clinical director. I will bring all the points that have been made in this debate to their attention.

In the final few seconds that I have left, I wish to put on record my thanks to all the volunteers and staff who work in this sector. I know that in the coming weeks, which will be a difficult time of year for families with a loved one who is ill, they will bring both comfort and joy to the people they care for, and for that we thank them very deeply.

Health Council

Jane Ellison Excerpts

Wednesday 18th December 2013 Written Statements

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

The health part of the Employment, Social Policy, Health and Consumer Affairs (EPSCO) Council met on 10 December 2013 in Brussels. I represented the UK.

The presidency provided a progress report on the medical devices regulations and asked member states for an exchange of views on how to improve the supervision process for medical devices and on the reprocessing of medical devices intended for single use. Member states provided a range of opinions on these questions and the presidency and Commission thanked member states for their views. The effectiveness of market surveillance and safety of medical devices was also addressed in a lunchtime discussion.

The Council adopted the Council conclusions on the reflection process on modern, responsive and sustainable health systems.

Under any other business, the presidency provided progress reports on the clinical trials regulation, the European Medicines Agency pharmacovigilance fees regulation and the tobacco products directive.

The Commission provided information on the transposition of the cross-border health care directive and the joint procurement agreement on medical countermeasures.

The Italian delegation—supported by several other member states—raised concerns about the UK voluntary nutritional labelling system, to which I responded. I highlighted that the UK scheme is non-discriminatory and certainly does not label certain foods as “bad”, nor, being entirely voluntary, will it negatively impact on EU quality schemes. The Commission confirmed the legality of the UK scheme.

Hypothyroidism

Jane Ellison Excerpts

Tuesday 17th December 2013 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It is a pleasure to serve under your chairmanship, Sir Roger. I congratulate my right hon. Friend the Member for Meriden (Mrs Spelman) on securing a debate on this issue. This is, as she says, an opportunity to highlight something that we do not discuss often in Parliament. I hope that the debate will prove informative for those who wish to learn more about the condition, and will be useful to those who are affected in the way that she so ably described. I will mention the help and support that is available and will try to respond to the points that she made. If I am not able to respond to each point, I will write to her.

As my right hon. Friend said, hypothyroidism describes the general effects of a severely underactive thyroid gland, where not enough hormones are produced to keep the body functioning properly. The condition can be congenital, but most commonly occurs as a result of an autoimmune disease that attacks the thyroid gland and impairs its function. The condition is not uncommon, as she said. In the UK, the annual incidence of primary hypothyroidism is 3.5 cases per 1,000 women, and 0.6 per 1,000 men, so there is, as she said, a disparity between men and women.

The effects of hypothyroidism can be pronounced and debilitating, as my right hon. Friend said. Often, the condition goes untreated, because symptoms are frequently subtle and non-specific—she highlighted some—and may be wrongly attributed to other illnesses. Fatigue, weight gain, dry skin, lethargy, memory impairment and tiredness are all likely to be present. In elderly populations, symptoms such as memory disturbance, impaired mental state and depression may also be seen. However, the good news is that, for the vast majority of patients, once the right dose of hormone replacement treatment is given, they will return to a healthy state. Continuous medication is usually required to maintain that correct balance, and patients needing it are entitled to receive their prescriptions free of charge.

However, to get the right treatment and to restore the balance of health and well-being, a prompt diagnosis is, of course, crucial. My right hon. Friend focused on that. A range of guidance is available to improve awareness of the condition among both members of the public and health professionals. NHS Choices provides comprehensive advice on the causes, symptoms and treatment of the disease, and more detailed clinical guidance is available on the NHS clinical evidence website.

Best practice on the identification and management of hypothyroidism has been set out by the Royal College of Physicians in its guidance, “The Diagnosis and Management of Primary Hypothyroidism”, which was developed on behalf of key organisations, including the British Thyroid Association, the British Thyroid Foundation and the Society for Endocrinology. The guidance is endorsed by the Royal College of General Practitioners.

Clinical symptoms and signs alone are insufficient to make a diagnosis of hypothyroidism, so the RCP guidance makes it clear that the only validated method of testing thyroid function is blood testing, which must include measurement of the thyroid-stimulating hormone—TSH—and free thyroxine, or FT4, in serum. There is no evidence to support either the use of body fluids or the measurement of basal body temperature as a means of testing thyroid function. However, the guidance recognises that different methods of testing blood can give differing results, as my right hon. Friend mentioned. Highlighting in Parliament the RCP’s support for a helpful international initiative for greater harmonisation of reference ranges, and of the units used in expressing results of thyroid function tests, reinforces its thinking in that regard. My right hon. Friend is right to highlight that.

Once patients have been diagnosed with hypothyroidism, the vast majority can achieve successful management of their condition with a synthetic hormone replacement treatment. My right hon. Friend focused on the fact that some people do not get on with that treatment. The RCP guidance sets out that overwhelming evidence supports the use of thyroxine T4 hormone replacement—usually prescribed as levothyroxine tablets—alone in the treatment of hypothyroidism. The guidance does not recommend prescribing additional T3 hormone in any presently available form, including natural desiccated thyroid treatments, such as Armour Thyroid. This is because it has not been definitively proven to be of any benefit to patients and may be harmful. However, that does not prevent clinicians from considering other forms of thyroid hormone replacement, if appropriate.

For some patients, as my right hon. Friend highlighted, the wider availability of NDTs is a concern. It is worth making it clear that although this treatment remains unlicensed in this country, because the evidence base for its efficacy is unclear, GPs may prescribe it on a named-patient basis. I appreciate the push-back on inconsistency, but that is probably because it is unlicensed, so people have to find a GP willing to prescribe it on that basis.

To ensure that patients with the most severe and complex endocrine problems receive appropriate care and support, NHS England has published a service specification for complex endocrinology, setting out clearly what NHS England expects to be in place in order for providers to offer evidence-based, safe and effective care. That has been developed by clinicians and commissioners, with expert patient input. Certain patient groups have been calling for specialised training for endocrinologists and general practitioners in diagnosis and treatment. My right hon. Friend rightly focused many of her remarks on that.

Health Education England has responsibility for promoting high-quality education and training that is responsive to the changing needs of patients and local communities, and works with key stakeholders to influence training curriculums as appropriate. The curriculums of the Joint Royal Colleges of Physicians’ Training Board, which is responsible for the specialty of endocrinology, and the Royal College of General Practitioners, are both subject to regular review. As such, there are regular opportunities for stakeholders and interested parties, including parliamentarians, to express their views and influence the training of these clinicians. In light of the issues raised today by my right hon. Friend, I will write to the Royal College of General Practitioners, asking for its opinion on the guidance available to support its members in the diagnosis and treatment of hypothyroidism.

[Mrs Spelman]

My hon. Friend the Minister is coming towards the end of her remarks. Perhaps when she writes to the Royal College of General Practitioners, she will mention the excellent point raised by the hon. Member for Strangford (Jim Shannon). Where there is a family history of hypothyroidism, we should be thinking a bit more about prevention. When a patient presents with an ill-defined collection of symptoms, such a family history might set off an alarm bell in a GP’s head and precipitate a test, so that the hypothyroidism does not go undetected for so long.

[Jane Ellison]

That is a good point. There is some information on the NHS website, but I will certainly include that point in my letter, and hopefully I will get a response from the royal college, which I will pass on. The hon. Member for Strangford (Jim Shannon) takes a fantastic interest in health issues and, as ever, is here in his place.

I hope that the Chamber is pleased to hear that the National Institute for Health Research is funding a £164,000 study on whether people aged 80 or older with hypothyroidism would benefit from lower doses of hormone treatment. Older people often have the condition in a mild form, and may not have symptoms with adverse outcomes, so the current treatment might not be beneficial.

I always make the point in these health debates that the NIHR welcomes high-quality funding applications for research on any aspect of human health. My right hon. Friend the Member for Meriden highlighted some areas that she feels would benefit from further research, and I can only say that the NIHR’s door is open to high-quality bids in any of those areas. That might be worth passing back to the charities and experts working in this field.

As I come to my conclusion, I reassure the Chamber more generally about the Government’s commitment to improving outcomes for the 15 million-plus people living in England with long-term conditions, including hypothyroidism. Through the NHS mandate, we have asked NHS England to make measurable progress towards making the NHS among the best in Europe at supporting people with ongoing health problems. We want such people to be able to live healthily and independently, with much better control over the care they receive. Of course, that feeds into many other priorities, such as ensuring that people do not present at accident and emergency because the management of a long-term condition has gone wrong. We want to ensure that such people can be healthy, well and looking after themselves without getting to that stage.

The various improvement areas mirrored in the NHS outcomes framework—this is relevant to the point on local doctors—are also in the clinical commissioning group outcomes indicator set, so CCGs are also held to account for, and are asked to provide information to the public on, the quality of the services and health outcomes that they achieve through commissioning for people with long-term conditions.

At a service level, the new NHS improvement body, NHS Improving Quality, has made the development of evidence-based tools for the management of long-term conditions the subject of a key improvement programme for 2013-14. The interventions under consideration include care plans, care co-ordination, the use of technology, self-care and the role of carers. That work will be evaluated, with best practice identified, to help us drive improvement across a range of long-term conditions. I am sure that some of the conclusions reached and evidence gathered by NHS Improving Quality will be relevant to hypothyroidism.

In conclusion, I thank my right hon. Friend once more for securing today’s debate. I hope this discussion has been helpful in providing some reassurance on our commitment to improving the quality of life for all those with long-term conditions such as hypothyroidism. I will, of course, write to her to follow up on this debate, which I hope will both help her to reassure her constituent and add to the wider debate.

Healthy Living and Social Care

Jane Ellison Excerpts

Tuesday 17th December 2013 Written Statements

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

In November 2012, the Department launched the healthy living and social care theme of the red tape challenge. The Department sought comments on regulations affecting business and civil society through the red tape challenge website and responses from a range of different groups were received on a number of areas.

The Department looked at 555 regulations covering four areas: public health; quality of care and mental health; NHS; and professional standards. This builds on earlier work done to look at 255 regulations under the red tape challenge medicines theme.

We carefully considered the comments received through the red tape challenge website, alongside an internal audit of departmental regulations, the results of which have already been published. Using this information and running a rigorous challenge process we identified the healthy living and social care regulations that could be abolished or improved. I am proud to announce the results of this process here. Of the 555 regulations considered, the Department is proposing to abolish 128 regulations and improve 252 others. This means that 68% of the regulations under the healthy living and social care theme will either be abolished or improved.

The Department is responsible for key areas of public protection, and many of its regulations are therefore essential to protect patients and the public by ensuring essential standards are maintained. Nevertheless, we have actively embraced the regulatory reform agenda. There are a number of proposals the Department is looking to take forward, including:

simplifying a large number of professional standards regulations following the Law Commission’s recommendation;

working with the Department for Communities and Local Government to address the problem of duplication of inspections between the Care Quality Commission and local authorities through the focus on enforcement review of adult care homes;

updating the nursery milk regulations to make them fit for purpose to help effectively deliver a scheme that is efficient, sustainable, and gives better value for money;

improving the operation of the healthy start scheme, that provides vouchers for fruit and vegetables, milk and formula milk to low-income pregnant women and children under four. The Department will work with retailers to explore and implement practical ways to make the paper vouchers easier to handle by the end of 2015-16;

implementing the recommendations to review the human tissue legislation, which will potentially bring benefits to the regulated sectors through improving the efficiency and effectiveness of the regulators; and streamlining regulation; and

revoking the regulations which ban the sale of HIV home testing kits, and this is expected to benefit business significantly and have positive wider benefits for the public. The Department is taking forward work to implement this and other changes identified through the red tape challenge process by the end of this Parliament.

However, we do not want to stop there. Some of the comments the Department received through the red tape challenge related to non-regulatory issues. For example, comments received about the deprivation of liberty safeguards suggested that while the measures were important, the number and complexity of some of the forms made it difficult and time consuming for people to use them. In response the Department plans to tackle this in 2014 by both reducing the existing number of forms and redesigning them so that they are easier to use. Another non-regulatory improvement will be a reduction in the amount of unnecessary guidance issued by the Care Quality Commission when they introduce new fundamental standards of care, saving people time in familiarising themselves with it.



I am pleased with the outcomes of the healthy living and social care theme and the work that went into identifying regulations the Department can abolish or improve. The Department is committed to continue to look at how it can minimise burdens on both business and health care professionals. The Department is currently looking at opportunities to reduce burdens for those on the front line of healthcare and is engaging with relevant organisations and health professionals to progress this.

Details on the regulations the Department proposes abolishing or improving have been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed paper Office. The details can also be seen at: www.redtapechallenge. cabinetoffice.gov.uk/home/index/.

Calderdale Royal Hospital

Jane Ellison Excerpts

Thursday 12th December 2013 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I congratulate the hon. Member for Halifax (Mrs Riordan) on securing this debate and my hon. Friend the Member for Calder Valley (Craig Whittaker) on staying on to attend and intervening in the telling way he did. There is obviously a keen interest in all these local health matters among Members on both sides of the House. I am aware that all parties are interested in these matters; I have received representations from other Members, and not just the hon. Lady who has raised this matter in the House previously during Health questions.

The reconfiguration of health services is an important issue for all of us and our constituents, and the future of A and E departments is particularly topical at present. I understand that people have anxieties about change and, in particular, about change in the NHS, because it is such a greatly loved and respected institution, but I hope I am in keeping with the spirit of this debate when I say that it is vital that we do not play on those anxieties, especially for purely political purposes. It is important that these difficult but necessary debates take place in an atmosphere of calm consideration.

[Mrs Riordan]

Will the Minister give way?

[Jane Ellison]

I ask the hon. Lady to let me develop my points, because I have not even begun to respond to her speech. I shall give way, if time allows, a little later.

Before I address the particulars of this debate, may I touch on the Government’s policy on changes to services in general? I realise that the hon. Lady may say that this is what I was going to say, but it is important to understand the principles behind reconfiguration policy. This Government are clear that the design of front-line health services, including A and E, is a matter for the local NHS. That is for good reason, because those local leaders, working closely with local democratic representatives, local government and the public they serve, can come to better conclusions about the services for their area than a Minister sitting in Whitehall trying to decide policy for the whole country, which is a very old-fashioned model of how to do these things.

The NHS has a responsibility to ensure that people have access to the best and safest health care possible. That means planning ahead and looking at sustainability as well as safety in NHS health care provision. No party can escape the challenge of providing sustainable services, and I do not think that challenge is any different for the Labour Front-Bench team from how it is for the Government. The Labour party made these points often when it was in government.

Reconfiguration is about modernising delivery of care and ensuring that we have the facilities to improve patient outcomes, develop services closer to home and, most importantly, save lives. I listened carefully to the hon. Lady’s arguments about her own local area, but if we look at an area in London, as I represent a London seat, we will see that exactly the same arguments were made against centralising stroke care, which was centralised in eight hyper-acute stroke units. They are now providing 24/7 acute stroke care. Stroke mortality is now 20% lower in London than the rest of UK, and survivors are experiencing a better quality of life.

I gave that example to illustrate the fact that we must be wary of some of the arguments against reconfiguration. I am quite clear that in London something that was opposed for some of the reasons the hon. Lady has touched on in her speech is now saving lives for my constituents and others. I want to ensure that that point is at least underlined.

We must allow the local NHS continually to challenge the status quo. I do not accept the hon. Lady’s argument, which, as I understand it, is that nothing should ever change. How, in a modern and ever-changing world, can she advance the argument that nothing should ever change and that it would be wrong of her clinicians even to look at the case for change?

[Mrs Riordan]

I am sure that the Minister listened to my speech. I did say at the beginning, just to give her some brief history, that in 2001, under a Labour Government, we finally got that brand-new hospital for which we had waited nearly 20 years. It had been promised by a Tory Government. We went from three hospitals to one. She is quite right: things do change, and I was part of that change in 2001.

[Jane Ellison]

I thank the hon. Lady for her intervention, and I am glad that we have established some consensus on that point She is probably aware that I know her area quite well, having lived there for quite a few years before I moved to London.

All service changes should be led by clinicians, and be based on a clear, robust clinical case for change that delivers better outcomes for all our constituents. We have put patients, carers and local communities at the heart of the NHS, by shifting decision making as close as possible to individual patients, devolving power to professionals and providers, who also have patient care, safety and sustainable service at the core of their public service commitment, and liberating them from top-down control.

The principles are enshrined in the four reconfiguration tests. I am sure the hon. Lady knows them well, but for the record they are support from GP commissioners; strengthened public and patient engagements; clarity on the clinical evidence base; and support for patient choice. Those are the tests against which any reconfiguration needs to be judged.

A and E is obviously very topical at the moment. The NHS is seeing increasing pressure on A and E services, but is generally coping well. I am sure that that is the case with the hon. Lady’s local hospital as well. We are meeting our four-hour A and E standard at the moment. It is the 32nd consecutive week the standard has been met. We are determined to do everything we can for the NHS to continue providing high-quality care. She will know of some of the extra moneys that we have allocated—I think it is £2.3 million for Calderdale and Huddersfield—for winter pressures. That does not allow us to escape the fact that there are longer-term challenges, and these have been acknowledged across the House. One million more patients have gone to A and E in the past three years, and there are the pressures of an ageing population. We, across the House, have to address those long-term challenges, and the Government are trying to focus on some of the underlying causes, whether by having named GPs for the over-75s or changes to GP contracts; or, in public health, helping people to manage long-term conditions and to live well for longer; or the £3.8 billion allocated to help to integrate health and social care, because we recognise how vital that process is. All those measures are about addressing the underlying drivers of pressure on A and E and pressure on our health service and looking at how we can make it sustainable in the longer term.

We have recently had an excellent review from Sir Bruce Keogh that looked at urgent and emergency care. It also looked at demands on services and how the NHS should respond. We asked for that review because of the determination not to sidestep the problem of growing pressure on A and E but to deal long term with a problem that has been building for decades. Too many sticking plasters have been applied in the past to get through a year or two. That is why we need to clarify to the public how we are planning to shape those services for the longer term and where they will be delivered.

Most of the current reconfiguration projects are in line with the Keogh report’s principles as an overall direction of travel. We have been clear about that for some time. All local health economies that are undergoing reconfiguration have to pay close heed to the direction of travel set out in the Keogh report, the essence of which was that this is about services, people and co-ordination. It is not just about the bricks and mortar; it is about getting the right care to people at the right time, and flexibility and the co-ordination of services are just as important as how they are geographically configured, and that was the message from the Keogh review.

Let me turn to the hon. Lady’s local area. She said that people want good quality health care rooted in the local area. That is exactly what is at the heart of the review that is being undertaken. As I have outlined, the configuration of local health services is a matter for the local NHS, for the very good reasons I have given. It cannot be dictated from Whitehall. Locally, I understand that the review is considering health and social care services with the point about ensuring that patients continue to receive high-quality and sustainable services at its heart. The work includes considering how best emergency care services and other acute services can be delivered, and in an intervention my hon. Friend the Member for Calder Valley touched on some of the ways that can be done differently and in a more imaginative and responsive way.

No decisions have been made at the moment, and of course any plans for major service change that emerge from the review would be subject to formal public consultation. Public consultation has to be real and robust. Commissioners know that, and at all stages of the process I would expect Members to be involved, as well as local government. At this stage, the commissioners have not brought forward plans for consultation, but they will need to be assured that any proposals they make for reconfiguration and change will meet the strengthened tests I mentioned earlier.

At the heart of all this is the need to serve local people better. I understand from some of the early engagement work, in which thousands of local people were involved, that the message was that people want quality and access. Those are the two key messages that came through and that are the forefront of people’s minds. They want quality services and they want access to them at the right time. The trust has, I believe, identified a need to co-locate acute services to maximise the potential of its work force, to ensure that services are safe and to deliver the best outcomes for patients for a long time.

The trust is taking on board a range of views as part of the review. I know that the hon. Lady has met local NHS leaders, as have my hon. Friend and other interested local parties. That will include external independent clinical opinion on how best to deliver emergency care, such as that given by the Keogh review. I stress again that the process is locally driven, and I encourage interested hon. Members to continue to engage with the process and to work with the local NHS as it develops those plans. The NHS is one of the world’s greatest institutions, so ensuring that it is sustainable and serves the best interests of patients sometimes means taking tough decisions, including on the provision of urgent and emergency care. Those decisions are taken for a reason: good-quality care and access to it are at the heart of this.

As the hon. Lady has acknowledged, sometimes things change over time. The pressures change, as do the way we respond to them and what we know about how we respond to them. For example, we know that more than 30% of people who go to A and E—in some places, it is more in the order of 50%—do not even need to be there. That is not sustainable in the long term and we need to address it, but those decisions are best made when the NHS is working in collaboration with local people, with local democratic representatives and with local authorities and considering what is best for the people of their area.

May I take this opportunity before I close to place on record my thanks to the hard-working NHS staff of Calderdale for the service they give to the people of that area and to the hon. Lady’s constituents? I hope very much that they have a good Christmas in the sense that they have as few people as possible in A and E who do not need to be in A and E over Christmas, because I know it is a difficult and challenging time for NHS staff, but we are all grateful for what they do for all of us.

Question put and agreed to.

Employment, Social Policy, Health and Consumer Affairs Council

Jane Ellison Excerpts

Thursday 5th December 2013 Written Statements

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

The Employment, Social Policy, Health and Consumer Affairs Council will meet on 9-10 December in Brussels. The Health and Consumer Affairs part of the Council will be on 10 December.

The main agenda items will be the following:

Medical devices regulations (where the presidency will report progress on negotiations and ask for an exchange of views); and

adoption of Council conclusions on reflection process on modern, responsive and sustainable health systems.

Under any other business, the presidency will provide information on the tobacco products directive, the clinical trials directive and the regulation on fees payable to the EMA for pharmacovigilance activities. The Commission will provide information on the transposition of the cross- border healthcare directive information and the joint procurement agreement on medical countermeasures. The Italian delegation will raise UK front of pack (FoP) nutrition labelling.

The Greek delegation will also give information on the priorities for their forthcoming presidency, which will run from January until July 2014.

Podiatry Services

Jane Ellison Excerpts

Wednesday 4th December 2013 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate the hon. Member for Corby (Andy Sawford) on securing this important debate. He is right to say that podiatry might not be at the more glamorous end of the health service, but of course it is important. I had a very good meeting with Diabetes UK within the first few weeks of taking on my new job as the Public Health Minister. Many of the points that he has raised were stressed, particularly the link with diabetes and with unnecessary and avoidable amputations. Being unglamorous does not mean that it is not important. I think we can agree about that.

The Government know that receiving personal care that is responsive to people’s needs is absolutely essential, and the service that podiatrists provide to local communities is vital in helping people to maintain their mobility, independence and well-being. We know that many other good things flow from maintaining mobility and independence.

Healthy feet allow people to be active and to exercise, which, as we know, has numerous benefits: maintaining better weight, improving muscle and bone strength, and keeping people’s emotional and mental health in a good place. There has been a lot of discussion about the isolation and loneliness of some older people, and the more active they can be, the less likely it is that they will be isolated and lonely.

With the elderly being the fastest-growing age group in Britain, increasing pressure is being put on health care, which will be reflected in the demand for podiatry care. Ensuring people have got healthy feet, preventing falls in older people, and proper and regular foot care can alert us to the early signs of other, more serious health issues, which is obviously important in people with diabetes.

Diabetes, arthritis and blood circulation problems are of particular concern, and they are big priorities for all parts of the NHS. Sometimes people are concerned that individual services or conditions are not always specifically named, but NHS England has very clear direction, through the NHS mandate, about looking after long-term conditions and older people, and podiatry is a key component of that mandate.

[Jim Shannon]

Will the Minister ensure that podiatry home visits continue for people—probably those in rural locations—who are unable to access the surgeries?

[Jane Ellison]

Access is an important factor. The hon. Gentleman is right to highlight the fact that improving and maintaining access is important.

Sometimes education is about making sure that people understand when to seek help and what the warning signs are. Podiatry is an important component of early alert work, as well as an important provision for older people and for people with long-term conditions. In situations in which services need to be changed, the NHS commitment is to make sure decisions are made in a clear and transparent way, so that patients and the public can understand how services are planned and delivered.

Through the mandate, NHS England is responsible for services and for working with local clinical commissioning groups to ensure that their services are based on the needs of the local population within the resources available—the hon. Member for Corby acknowledged the constraints—and there has to be evidenced-based best practice.

An important part of the reforms was to establish CCGs at the level at which commissioning decisions are informed. They are closer to their local communities and can respond to local needs, but they have access to good advice through NHS England, clinical senates and local professional networks. That commissioning process also takes into account the local authority’s views, with regard to the joint strategic needs assessment and, of course, the local health and well-being strategy, so these decisions do not exist in a vacuum: they are taken within a framework, all of which is geared towards local services responding to the needs of local people.

Of course, a big part of that—it is something I am always keen to stress—is the engagement with local democratically elected representatives. I am really pleased that the hon. Gentleman is so engaged with this issue. Whenever I have the chance to talk to people from any part of the health service in the course of my work, I stress the need to keep local councillors and local MPs closely informed and to work with them in making these key decisions, because I know that we are often the early warning signal when people have concerns. Like the hon. Gentleman, I have had people come to my surgery about these issues and that has been an early alert about when people might have concerns. It also allows us to respond to concerns that perhaps arise sometimes when a misunderstanding of a decision is causing undue alarm.

[Andy Sawford]

On the point about misunderstandings, the Minister is right. I do not want to alarm people across my area about services that they may still be able to access, but will she look at this issue in relation to Northamptonshire? If she has any opportunity to talk to the local CCGs or Northamptonshire Healthcare NHS Foundation Trust, will she ask them to make clearer what guidance there is and what assessment process there will be to ensure that people who can still access these services know that they can do so and are assessed as being in the group that can still access them?

[Jane Ellison]

The CCGs and NHS England are obviously aware of the debates that we have here in Parliament; I always undertake to draw to the attention of the correct parts of the NHS the debates that we have here. It is obviously not for me to tell CCGs what to do or what to commission. However, this is the whole point such debates —to highlight Members’ concerns, to give Ministers a chance to respond to them, and to explore how more could be done to allay those concerns and respond to them—so I am very happy that we are getting this discussion on the record.

The hon. Gentleman raised the issue of the education and training of podiatrists. Health Education England is working to ensure that there is an appropriate balance between supply and demand. We have already talked about the likelihood—indeed, the certainty—that demand for podiatry services will grow, because of our ageing population. HEE looks at the number of training places being commissioned. In collaboration with HEE, employers are also obviously keen to ensure that there are sufficient podiatrists to deliver the services that are needed. HEE will publish the national work force plan for England in early December—so, any time now. This year, providers have forecast their future work force requirements, which are obviously based on local service demand and which local education and training boards have moderated, to make adjustments for their education and training commissions. That piece of work is being gauged sensitively to look at local demand and the need for service provision. The assessment will be available in the published plan, which will show the position right across England.

Obviously, that process looks to the future, but we already know that the number of podiatrists working in the NHS has increased during the last 10 years, from 2,916 full-time equivalents in 2002 to 3,067 full-time equivalents in 2012, which is an increase of about 5% during that time. We are also continuing to develop the profession. The hon. Gentleman rightly highlighted that this is an area in which we need growing expertise. We introduced legislation that came into force on 20 August 2013 that enables podiatrists and physiotherapists to prescribe independently, following recommendations from the Commission on Human Medicines. Therefore, podiatrists who successfully complete education programmes approved by the Health and Care Professions Council, including conversion courses to allow existing supplementary prescribers to become independent prescribers, can begin to prescribe independently in 2014. That is a helpful step forward. Extending prescribing in this way will also help to support the key role that podiatrists play in shifting care into the community and improving the patient experience. It will benefit patients by making it more convenient for them to get treatment, as well as hopefully freeing up some valuable GP time.

We recognise that some of the people accessing podiatry services will be vulnerable; we have talked about that issue and the hon. Gentleman expressed his concern about it in his speech. We are reviewing how primary care, urgent and emergency care, and social care services can all work together as part of the integrated out-of-hospital response, looking at the whole person and considering the essential point that the hon. Gentleman made about how we can keep people out of hospital when they do not need to be there, by doing the good early alert work and ensuring that things do not progress to a point where we have the unnecessary amputations that he described.

To support that vision, the Government are working with NHS England on an out-of-hospital care plan for vulnerable older people. In doing so, we are engaged with patients, carers, and health and social care staff—all those important groups—to test those proposals and implement them. The final plan will be published later. I think that the hon. Gentleman will realise from recent announcements that my right hon. Friend the Secretary of State for Health has put enormous emphasis on the need for joined-up thinking about supporting people, particularly the frail elderly, and that is a clear priority that we have talked about a lot. All the things that the hon. Gentleman mentioned in his speech this morning are part of that process, to ensure that people understand that they have a named GP who can support them and to ensure that we spot signs of problems early. That personalised, proactive primary care is essential.

[Andy Sawford]

I see the Minister looking at the clock and I sense that she has a little more to say, but can she just say whether GPs will be able to refer people to podiatrists, in such a way that the service is free? Can GPs be a helpful way of ensuring that people in Northamptonshire who really need this service can get it?

[Jane Ellison]

Right across the country I would absolutely expect GPs, when they see the warning signs of problems, to alert people to the need for further care. That is one of the advantages of having a named GP; hopefully, they will spot the signs of problems early and recommend whatever the appropriate services are. That is very much part of the system that we envisage.

However, we also need multi-disciplinary teamworking; we need people to be joined up in their thinking. Obviously podiatry services are part of that. The hon. Gentleman has eloquently raised the concerns of his constituents and his own concerns this morning. One of the things that he focused on was the question of who are low-risk patients and how is someone assessed as low-risk. I understand that the CCGs involved modified their recommendations for future service provision in response to feedback received during the consultation, so children and vulnerable patients will still be able to access community podiatry services. However, I sense that his concern is that further work might be needed to flesh that plan out, and I know that the CCGs will have heard him express that concern; he has put it on the record today, saying that he is still concerned that those recommendations might still not be fully understood and that he would like to see more work done in that regard. I believe that the analysis carried out by the CCGs showed that only 1% of low-risk patients move into the medium or high- risk categories, but I know that he will want to have ongoing discussions about the nature of that assessment and about that figure.

I also believe that the CCGs involved took into consideration the number of local independent podiatrists who are registered with their professional body, with regard to the low-level community-based care. They are also rightly exploring the potential of developing a broader range of low-level foot care and podiatry services via the third sector and social enterprises, as part of their emerging health and well-being strategy. That is the right thing to do. Some of these services do not need to be delivered by a clinician of any sort; sometimes they might be delivered more appropriately in another setting. I believe that one of the advantages of an increasing emphasis on local planning and integrated service planning at a local level is that people can think outside the box about where certain services—particularly these important early alert services and low-risk services that can prevent people from becoming a higher risk—can be delivered.

The hon. Gentleman has put his concerns on the record; it is right that MPs have the chance to do that. The local CCGs will have heard the concerns that he and other Members who have intervened in this debate have raised, and I am sure that they will be looking to respond to and allay them. However, some of those concerns were based on speculation about what might happen if this piece of work is not got right, and it is important that we find the balance between having due concern about what might happen if services are not got right and if the commissioning of them is not right, and at the same time sending a very clear signal to those people who have medical concerns, such as diabetes or the early onset of other problems, that they must seek help and that they will receive that help. They must not be put off seeking help because of concerns about the future commissioning of services.

It was useful to put all these issues on the record, and I am sure that the hon. Gentleman’s local CCGs and other CCGs will be looking to respond further to the concerns that he and other hon. Members have outlined today.