Oral Answers to Questions

Jane Ellison Excerpts

Tuesday 10th May 2016 Commons Chamber

[Andrew Stephenson (Pendle) (Con)]

4. What progress has been made on improving diagnosis and treatment of Lyme disease.

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

Lyme disease is a complex infection, so we recognise that there are real challenges in diagnosis and treatment. In the light of this, I am pleased to say that the Department plans to commission three reviews on the diagnosis, treatment and transmission of Lyme disease to inform future decision making.

[Andrew Stephenson]

A constituent in Earby was struck down with a debilitating illness several years ago, which has totally destroyed her quality of life. Since then, I have been visiting her regularly at home every few months, as she has fought to get a diagnosis. Over recent months, all the evidence has started to point towards Lyme disease, but there seems to be precious little support out there for people with this condition. What more can my hon. Friend do to support constituents like mine?

[Jane Ellison]

In addition to the reviews that the chief scientific adviser is overseeing, we have commissioned the National Institute for Health and Care Excellence to develop a new evidence-based guideline for care, specifically to respond to the sort of situation that my hon. Friend describes with his constituent. That is for publication in 2018 and it is being prioritised because of the interest in this area.

--- Later in debate ---

[Mr Philip Hollobone (Kettering) (Con)]

12. How much was (a) collected in payment for NHS care received in the UK by EU citizens and (b) paid for healthcare received by UK citizens in other EU countries in the last 12 months.

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

For 2014-15, it is estimated that the UK owes other European economic area countries and Switzerland £674 million and is owed £49.5 million by other EEA countries and Switzerland for healthcare activity received in that year.

[Mr Hollobone]

My constituents in Kettering are increasingly fed up with our national health service paying for the healthcare of foreigners who come to this country to freeload on our system. What more can be done to make sure that hospitals and other healthcare providers bill foreign citizens for the NHS services that they use in this country?

[Jane Ellison]

The Government take extremely seriously the issue of making sure that only those who should have access to NHS services do access them. Let me make an important point about the figures that I have just given. Some 80% of that imbalanced statistic represents our pensioners who choose to retire to Europe, typically for sunnier weather. The figure is 80% because many more UK pensioners retire to Europe than European pensioners retire here, and there will always be an imbalance. I am sure that even the keenest Brexiteer would not claim that Britain would be sunnier outside the EU.

[Mr Ben Bradshaw (Exeter) (Lab)]

Will the Minister encourage her Back Benchers to study the expert evidence that was given recently to the Select Committee on Health on the issue that the hon. Member for Kettering (Mr Hollobone) has just raised, our access to free healthcare in Europe, and the economic shock that our leaving the European Union would cause to the NHS finances and to major public health measures such as clean air and clean water that benefit us immensely? Every single one of them told our Committee that leaving the European Union would be disastrous for the NHS, disastrous for health and disastrous for public health.

[Jane Ellison]

On this, I am happy to say that I very much agree with the right hon. Gentleman. I encourage all colleagues to look at the evidence deposited with the Committee. Just last year, UK European health insurance card holders—5.5 million people—were able to travel to any other EEA country or Switzerland safe in the knowledge that they would be able to receive free healthcare or reduced costs arising from healthcare if they needed it. That offers great peace of mind and shows that Britain is safer in a reformed EU.

[Derek Thomas (St Ives) (Con)]

13. What support his Department is providing for meeting additional costs incurred by NHS providers in the integration of health and social care.

--- Later in debate ---

[Henry Smith (Crawley) (Con)]

T4. Last month, Coperforma took on the patient transport contract for Sussex. Unfortunately, since then there have been unacceptable and serious delays for some very sick and elderly patients. May I have assurances that the Department of Health will follow up this issue?

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

Sussex CCGs are responsible for monitoring Coperforma’s performance, and High Weald Lewes Havens CCG acknowledges that, as my hon. Friend said, the early performance of the new non-emergency patient transport service has not been acceptable. For that reason, the CCG, on behalf of all Sussex CCGs, has begun an inquiry, with the aim of making a report available by June, and with interim progress reports. We will of course monitor the issue carefully.

[Mr Douglas Carswell (Clacton) (UKIP)]

T5. In my corner of Essex, there is a primary care crisis: demand for GP services is rising, the supply of GPs is falling and many surgeries are simply no longer accepting new patients. What assurance can the Minister give me that we will definitely get more GPs, and when will we get them?

--- Later in debate ---

[Ian Blackford (Ross, Skye and Lochaber) (SNP)]

The Minister will be aware that mortality rates in England and Wales have increased by 5.4% in 2015—the biggest increase in the death rate for decades. She will also be aware that mortality rates have been rising since 2011. Has she done any analysis of what has been behind those trends? Specifically, with the Cridland review starting, what will her Department do to negotiate with Cridland on the increase in the pensionable age to take account of the recent changes taking place?

[Jane Ellison]

We welcome the overall trend towards longer life expectancy. There are annual fluctuations, but overall the trend remains positive. The key thing is helping people to live longer, healthier lives. Therefore, tackling health inequalities among people of all ages and in all communities is embedded in policy right across the Department—for example, the investment in nearly doubling the health visitor workforce over the previous Parliament—so that we can really bear down on the things that drive those health inequalities, particularly among poorer communities and poorer children.

[Lucy Allan (Telford) (Con)]

I thank the Secretary of State for working so tirelessly to get the BMA back to the negotiating table. Will he confirm that Saturday pay for junior doctors will be at a 30% premium, which is above that for any of the hard-working midwives, nurses, firefighters, paramedics and so on in my constituency?

Health Informal Council: 17-18 April 2016

Jane Ellison Excerpts

Thursday 5th May 2016 Written Statements

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

An informal Health Council meeting was held in Amsterdam on 17-18 April 2016 as part of the Employment, Social Policy, Health and Consumer Affairs (EPSCO) Council formation. The Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison) represented the UK.

Innovation

There was a discussion on innovation and pharmaceuticals and topics raised by participants included health technology assessment, pharmaceutical pricing, the joint procurement agreement and different regulatory mechanisms, including priority designation for medicines (PRIME). The UK stressed its support for regulatory work that helped to get effective innovative products to patients sooner. The UK also stated that some joint working on information sharing on pricing and horizon scanning could be useful but underlined that all work must be voluntary and fully respect member state competence.

Healthy foodstuffs

There was a discussion on initiatives member states are taking forward at a national level to encourage healthy eating. The UK said that national action was required on a variety of fronts, including partnership working with industry, and underlined the significant cost of type 2 diabetes and the need to focus on children.

The UK stated that it could not just be for consumers to act, and stressed that consumers would want further information, for example, through mobile apps. The UK also stated the importance of physical activity and explained the recent sugar levy announcement.

Antimicrobial resistance (AMR)

The Dutch presidency raised the issue of AMR as a top priority and stressed that a one-health approach covering human and animal health was vital. The UK underlined the cost of inaction, praised the presidency’s desire for an ambitious outcome at the UN General Assembly, and supported their one-health approach. The UK supported an ambitious agenda on AMR which would lead to concrete progress, provided that member state competence was fully respected. The UK also flagged the importance of the current independent AMR review launched by the Prime Minister.

[HCWS713]

North East Ambulance Service

Jane Ellison Excerpts

Wednesday 4th May 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Bailey. I thank all who have contributed to this important debate. Some extremely serious issues of principle and general practice and some very serious constituency cases have been raised. I doubt that I will be able to deal with some of the specific issues, particularly in relation to individual constituents, during the debate, but I have made a careful note, as have my officials, of some of the specific points and we will go through Hansard after the debate and ensure that we pick up individual points. I am extremely disappointed to hear that colleagues have not always found the trust as responsive as they would wish. I spoke to the chief executive yesterday in preparation for the debate and will certainly go back to that specific point, but I will come to some of the other general points as I move through my speech.

[Mrs Hodgson]

Will the Minister give way?

[Jane Ellison]

It is quite early, but I will.

[Mrs Hodgson]

I just want to say that we are all aware that the chief executive, Yvonne Ormston, is new and has obviously inherited many of the cases. I would like to say that things have massively improved. I know that she is trying to turn the situation around, but what has happened will not all have been on her watch.

[Jane Ellison]

The hon. Lady makes that point very well and with her characteristic generosity of spirit. I am sure that that will be noted. I will take the issue forward with that very much in mind and I thank her for her comments.

Ambulance services are obviously vital to the healthcare system. We have heard this afternoon some of the reasons why. They provide rapid assistance to people in urgent need of help. Hon. Members on both sides of the Chamber have rightly put on the record their appreciation of the work done by staff in trusts across the country and by the front-line staff in the NEAS. I add my thanks to theirs. Inevitably, we bring problems before the House—that is right, because we want to talk about how we can move things on for our constituents—but it is possible for a member of staff reading the record of a debate afterwards to think that we had only blame and criticism. Today, however, all hon. Members have been careful to praise the very hard-working staff. As has been said, they are working under quite considerable pressure.

It will probably be helpful to provide some context about the national picture. We recognise that the NHS is busier than ever, which is why we are backing the NHS’s own plan for its future, the Five Year Forward View, with an extra £10 billion by 2020-21. The challenges faced by the North East Ambulance Service are reflected in many services across the country. Ambulance services are facing unprecedented demand, delivering over 2,800 more emergency journeys every day compared with 2010. That demand has an impact on performance indicators, such as response times, with ambulance services continuing to struggle with their targets. The Department is working closely with NHS England and with NHS Improvement to monitor and support performance in 2016-17.

In relation to the North East Ambulance Service, I spoke briefly to the service yesterday, in addition to having received quite a detailed briefing from it ahead of the debate. I am advised by the NEAS that the average number of the most serious incidents—red incidents—that it has responded to within eight minutes has changed very little over the past three financial years, but the volume of red incidents to which the NEAS has to respond to reach the 75% performance target has increased by more than 20%, from 370 a day in August 2015 to more than 440 a day now. That change in demand in particular has placed our front-line emergency care services under real pressure, rather than the responsiveness and capacity of service provision.

[Mr Kevan Jones]

I hear this from the Minister and I hear it from the trust, but could I ask her officials or NHS England to actually delve into the figures? The hon. Member for Berwick-upon-Tweed (Mrs Anne-Marie Trevelyan) raised an interesting issue. This is actually about the ways in which ambulance calls are classified. There are clearly reds that are not reds, but the other point that I would like the Minister to address, even if she cannot answer it today, is the way older people are being treated, because they are being put down as greens, whereby they get no priority at all, and they are some of the most vulnerable people in our community.

[Jane Ellison]

Indeed. I have very much taken that point on board and I will try to respond, but if I do not do so today, I will certainly write to the hon. Gentleman, because it is a fair point. The more general point is where the ambulance service sits in terms of our response and general position on urgent and emergency care. I will respond to some of the points made by my hon. Friend the Member for Berwick-upon-Tweed (Mrs Trevelyan), because I think that this sits within a wider, systemic challenge and I want to touch on that.

Every patient should expect to receive first-class care from the ambulance service, but the nature of emergency response work means that there will always be incidents in which unfortunate timing leads to a person assessed as being in a non-life threatening situation calling 999 at the same time as several other people who are in life-threatening situations. I am sure that hon. Members are realistic about that, but clearly we do not want to hear about such problems occurring on a very regular basis. Where that does occur, obviously the life-threatening situations must be prioritised and resources focused on those calls. Very rarely—unfortunately, we have heard about such cases this afternoon—waits may be unacceptably long. I do not shy away from that, but it is important to remember that the vast majority of people receive a timely response when they dial 999.

I have already said, echoing the words of the hon. Member for Washington and Sunderland West (Mrs Hodgson), who led the debate, that although the NEAS has not met the performance targets, that does not reflect on the hard work, dedication and skills of the local staff. A number of speeches brought that out. I am advised that although ambulance delays are the main reason for patient complaints, the number of complaints received in 2015-16 fell, but we do not want any complaints; that would be the situation in an ideal world. However, the fall is indicative of the fact that the efforts of the local ambulance staff are paying dividends. Although the performance target is effective in driving improvements and maintaining response times to the most critically ill and injured patients, it does not, inevitably, paint the complete picture of how a trust is doing.

I will talk about some things that the North East Ambulance Service, has put in place to bring about improvements to service, because that is the focus of the debate and people want to hear that the direction of travel is positive. The NEAS continues to expand the number of specialist clinicians working in its clinical hub who can provide telephone assessment and advice, and who can prevent the dispatch of an emergency response if it is not deemed necessary. That goes to one of the points made earlier. The trust expects that that will have a positive effect on response times.

Last winter, the NEAS piloted an end-of-life-care transport service, which provided three dedicated ambulances that were on call to respond to transport requests from healthcare professionals to take a person to their final place to die. The scheme has meant that emergency ambulances are not tied up in transporting patients when they are needed for more serious cases, and that terminally ill patients are not waiting a long time for transport to their preferred place of death. Although we do not often like to talk about end-of-life care, the preferred place of death is an important part of reducing stress at an inevitably very difficult time for an individual and their family. Results from the pilot were overwhelmingly positive and eased pressure on vital services.

Hon. Members have raised valid concerns about handover times between ambulance crews and emergency departments in the local area, and that is an issue across the country. Patient handover needs to be as efficient as possible to achieve the best possible outcome for the patients and to free up ambulance resource, but more can be done and is being done. Measures include hospital ambulance liaison officers, which are being put in place by the NEAS. HALOs are present in hospitals across the trust territory and I am advised that the trust has sought to make use of dedicated ambulance resource assistants as well.

The urgent and emergency care vanguard programme in the north-east will include the development of a standardised handover process for all acute providers, intended to minimise delays across the patch. That goes to the shadow Minister’s point about looking at the wider system. That will be to the benefit of crews and emergency departments. I understand that, as part of the vanguard, the NEAS also hopes to secure funding for a new “flight deck” information system that will enable diverts by ambulance crews to other hospitals to be proactively managed and will prevent ambulances from stacking up outside already full A&E departments. The trust believes that those initiatives will help to distribute A&E workload evenly and will be welcomed.

Several hon. Members have rightly commented on the recruitment challenge. It is very much recognised that there is currently a shortage of paramedics nationally and the NEAS trust is no different. We recognise that front-line staff are the vital component of a safe, effective and high-performing service, and work is being done by the NEAS to rise to the recruitment challenge. The hon. Member for Washington and Sunderland West mentioned some things that are being done. Efforts include developing new advanced technician roles to support front-line services, and the trust is running a substantive recruitment of paramedics nationally and internationally.

The trust expects 77 student paramedics to graduate by February 2017, in addition to recruiting an additional 36 qualified paramedics in 2016-17. The trust has also recruited a total of 56 emergency care clinical managers, and that represents a significant investment in front-line clinical leadership. It also advises me that it expects to be up to full paramedic establishment by April 2017. I know that that commitment will be keenly watched by hon. Members.

[Mr Anderson]

Ambulance staff, along with other public servants, have effectively had an eight-year pay freeze. Their standard of living has gone down every year for the past eight years. Comparative jobs, particularly in the private sector, have not seen that level of control. There have also been pointers that the situation will not be alleviated in the next two or three years at least. Does the Minister not see that as a real reason that people will not come into the job? Yes, it is a vocation, but people have to put bread on the table.

[Jane Ellison]

Of course I accept that issues of pay are incredibly important. Although we cannot go into the wider economic picture, I gently say that the previous Government and this Government have made reducing the tax bill for some of our lowest paid public servants a huge priority. A huge amount of money is being spent on raising the threshold and that has made a huge difference to people’s take-home pay and standard of living. However, I hear the hon. Gentleman’s point.

I am encouraged that the trust is looking to the future by doubling the number of places on its two-year in-house graduate training programme. Hon. Members have made several thoughtful points regarding some of the wider issues around recruitment and retention. Maintaining staff morale has been mentioned. That is very important and the trust is looking at whether things could be done, other than pay, to attract and retain paramedics. We are looking at that nationally. The debate sits in the context of urgent and emergency care.

[Ian Lavery]

Will the Minister give way?

[Jane Ellison]

If there is time, because I want to get to a really important point right at the end of my remarks, and I am starting to run the clock down. Will the hon. Gentleman make his intervention very brief?

[Ian Lavery]

I thank the Minister for allowing the intervention. She mentioned the fact that we will probably be fully operational by April 2017. Will she guarantee the people of the north-east that she will take action to ensure that the NEAS will look after the people in our area in the intervening period?

[Jane Ellison]

I intend to follow up on this debate with my colleague in the Department of Health, Lord Prior of Brampton, who leads on the topic, and I will follow up with the service itself. I will make sure that all points raised by hon. Members are drawn to its attention.

The root causes of the increase in demand often lie outside the hands of the ambulance service. NHS England’s review of urgent and emergency care is taking a system-wide approach to redesigning the way that care is delivered. It is important to look at the provision of ambulance services in that context. We need to ensure that people with life-threatening emergency needs are treated in centres of excellence to reduce risk and maximise their chance of survival and recovery. The first part of that is about relieving the pressure on emergency services.

The response time targets are being considered as part of NHS England’s review to ensure that they incentivise the most clinically appropriate response. My hon. Friend the Member for Berwick-upon-Tweed and the hon. Member for North Durham (Mr Jones) talked about having the clinically appropriate response in all contexts. I will ensure that we pick up on those points and draw attention to them. We hope to have advice from NHS England later in the summer on potential changes to ambulance standards in the context of that wider review of urgent and emergency care.

[Mr Nicholas Brown]

Will the Minister give way?

[Jane Ellison]

No, because I have an important point to make at the conclusion. If the right hon. Gentleman will forgive me, there might be another opportunity.

Ambulance services are vital to emergency care and the whole NHS. We all want to be sure that when loved ones suffer heart attacks or are involved in a serious accident, they will not be left waiting, although we have heard about some distressing cases. National targets in response to red, life-threatening calls exist to ensure that that happens, and we all have an interest in ensuring that the ambulance services perform well against them. I will follow up on the points made in the debate.

I draw hon. Members’ attention to the fact that a comprehensive Care Quality Commission inspection was carried out at the NEAS during the week commencing 18 April 2016. CQC’s formal report will be important for all hon. Members and Ministers to read. In the light of the strong feelings expressed in the debate, I think it would be appropriate for hon. Members whose constituencies are served by the NEAS to meet my colleague, the noble Lord Prior of Brampton, who leads on this portfolio, when the report is available to discuss. I hope that that will be helpful for hon. Members. In the context of that report, many of the points made this afternoon can be discussed with Lord Prior. I encourage all hon. Members to engage with the local NHS and to continue to work together to address the challenges in this critical element of our healthcare system.

If the right hon. Member for Newcastle upon Tyne East (Mr Brown) can make his intervention in less than a minute, he may do so now.

[Mr Nicholas Brown]

How does the Minister account for the rise in demand for the service?

[Jane Ellison]

I definitely do not think that that question can be answered in less than a minute. Much of the answer lies in the work that Sir Bruce Keogh is doing as part of the NHS’s wider urgent and emergency care review. It is vital that we get people the right care in the right place at the right time. It is a complex picture, of which ambulance services are just one piece. More will be said when we know more about that review later this year.

Question put and agreed to.

Resolved,

That this House has considered the performance of the North East Ambulance Service.

Ealing Hospital

Jane Ellison Excerpts

Tuesday 3rd May 2016 Westminster Hall

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

Of course, Mr Stringer. It is a pleasure to serve under your chairmanship. I congratulate the hon. Member for Ealing, Southall (Mr Sharma), a fellow London MP, on securing this debate on an issue that is of concern to him, to his constituents, as we can see from the attendance in the Public Gallery, and, of course, to colleagues in neighbouring constituencies, who also contributed to the debate—not for the first time.

Before I address the issues raised, I would like to echo the words of others and pay tribute to those who work in our national health service. Despite the debates that we have in this place about reconfigurations and the like, all of us are united in praise of the dedication of those working on the frontline to provide first-class services to all in their care.

There is of course considerable ongoing interest in the changes in north-west London proposed under the “Shaping a healthier future” reconfiguration programme. It is worth stressing that those are not just changes to acute hospitals, but planned changes to the whole of that health economy. The aim has been to look at how it can best provide in the future for the local population.

Of course I acknowledge the concern expressed among local people and in particular by the Save Ealing Hospital Community Action Group. The hon. Member for Ealing, Southall will know that I responded in January to a petition by the action group, and I will respond in writing in due course to the latest petition that he has presented. But I want to make it clear that proposals and change on so large a scale as that taking place in north-west London are inevitably controversial. Major change is inevitably controversial, but we have always stressed, as did the shadow Front-Bench spokesman, the hon. Member for Ellesmere Port and Neston (Justin Madders), that the reconfiguration of services is a matter for the local NHS. That is best organised and shaped by those who know the communities best, and with local clinicians right at its heart, rather than being dictated from Whitehall.

Let me deal with the Mansfield Commission report. On Thursday 14 January, the North West London Clinical Board considered the report of the Independent Healthcare Commission for North West London, and the view of the clinicians on the board—local doctors and health workers—is that the current programme, which was designed by doctors and based on significant clinical data, evidence and experience, continues to offer the best outcomes, experience and equality of access to NHS services for all our patients. That is a direct quote from what they said. Having read the Mansfield report, I am not surprised that that was the conclusion of local health leaders. I take issue with a number of things said about that report, not least about its independence, but I want to use some of the time that I have this afternoon to deal with some of the substance of the concerns raised about services for people in Ealing. Some of the language used was very strong, and I want to try to set a few minds at rest by talking about some of the new services.

Before moving on to specifics about Ealing, though, let me deal with the implementation of the programme itself. The hon. Member for Hammersmith (Andy Slaughter), perfectly reasonably, exposed the case why it is important that people have certainty and transparency. Some colleagues referred to the meeting that I chaired last summer to try to reboot this process after the general election—with a degree of success, in terms of the contacts between Members. But on the proposals for capital works for both Ealing and Charing Cross hospitals, I have been assured that local health and social care partners are working together to produce a sustainability and transformation plan by the end of June 2016, and it is anticipated that details for those two sites will be included in that.

I have been honest enough before to say that I share hon. Members’ frustrations about delay. I quite understand why they want more certainty and I fully expect NHS England and the “Shaping a healthier future” programme to keep me abreast of developments as we move towards the summer. I want to hear if there are any problems with hitting that timetable, because Members have a right to expect to get that information, so that they can respond to it, so please rest assured that I will continue to ask those questions.

The hon. Member for Hammersmith also talked about morale, and it is vital that we put on the record some of the ways in which good progress is already being made as part of the “Shaping a healthier future” programme. As I have said, better healthcare is not just about the acute sector, important though that is. For example, good progress has been made in developing primary and community services, and there are examples showing patients benefitting. GP practices across north-west London now offer more than 1 million people in the area extended opening hours on weekdays, from 8 until 8, and weekend access. That is vital for families’ peace of mind, as has been mentioned. GPs in Ealing now provide 19 new services, including anticoagulation services, electrocardiograms and some mental health services. Many more community services are now in place across all eight boroughs, so more patients can be seen closer to home.

Those are just some of the reasons why I do not recognise the description of the plans given by the hon. Member for Ealing, Southall. He used expressions such as “risking lives” and that is not what local doctors want to do or what the plans are about.

[Dr Huq]

Will the Minister give way?

[Jane Ellison]

I am sorry; I will not, because the hon. Lady made a long speech and I must respond to it.

At the heart of the plans is the fact that local clinicians want to provide more and better services, although delivered differently, it is true, from the way they may sometimes have been delivered in the past. That brings me to the focus on Ealing hospital. Of course I recognise the concerns associated with such significant changes as are proposed, and I take the point entirely that uncertainty, both for Members of Parliament and members of the general public, gives rise to concerns.

Ealing hospital will be redesigned as a 21st century facility for the local community. The hospital will have a local A&E and a 24-hour GP-led urgent care centre, with access to 24-hour specialist care, as well as a range of specialist services designed with the needs of the community in mind, such as a diabetes centre of excellence. The hospital will be a centre of excellence for other areas of care, such as elderly patients, those with long-term conditions and the most vulnerable members of the community, by integrating primary and secondary care with community and social care. It is common ground between all parties that that is how we will help to keep people healthier in the future. So good news for patients is already beginning, in the changes.

On maternity services, some strong language was used in the opening speech about concerns for local mums and their babies. As has been pointed out, maternity services were consolidated in July across north-west London into six maternity units. Women from Ealing now have a choice in maternity services, with 30 antenatal sites across Ealing, including Ealing hospital, and six sites for delivery across north-west London. As a result, there has been a 10% increase in choice of midwifery-led units. I am told that 778 women had their maternity care safely transferred from Ealing to a new maternity unit of their choice with no incidents reported.

What is the benefit to Ealing women from the changes? Before the changes, Ealing hospital was achieving 60 hours of consultant cover—lower than all the neighbouring hospitals. Across north-west London before the transition, the average was 101 hours. North-west London has set out to achieve 123 hours in 2015-16, and it currently has 122 hours of consultant cover. Also, 100 new midwives have been recruited across north-west London as a result of the changes. Antenatal and postnatal care are still available at Ealing hospital, and as I said, the number of community midwives has also increased locally at 30 sites across Ealing. It is clear that a complex service change has been managed safely, with benefits to patients—mothers and their babies. It is telling—Members need not just listen to my words—that Ealing Council’s health and adult social services standing scrutiny meeting on 26 April heard from the Royal College of Midwives. That is not the Government. It endorsed the transition and congratulated the NHS in north-west London on the model of care and the detail in the transition. Again, I do not recognise that service in the words of the hon. Member for Ealing, Southall, although I know that he meant them with due concern for his community.

On paediatric in-patient services, good progress is being made on the implementation of changes. I am informed that that will ensure that children in north-west London will receive consistently high-quality seven-day care, with more paediatric nurses and specialist doctors available. Paediatric in-patient services, which are for children who require emergency treatment or an overnight stay, will move on 30 June from Ealing hospital to five other hospital sites in north-west London. That will significantly expand capacity—more beds, doctors and nurses, seven days a week.

The changes do not mean that all children services are moving from Ealing. Nearly three quarters of existing children’s services will continue on the Ealing hospital site and elsewhere in the borough. Services remaining include routine appointments and treatments that do not require an overnight stay, such as day care unit activity, so most children will be seen in the same place as they are now. Urgent care for minor injuries and out-of-hours GP appointments will also remain at Ealing hospital. The majority of children who are brought to Ealing’s A&E by their family or friends are already treated in the urgent care centre. Services for children with long-term conditions, such as asthma and epilepsy, and child and adolescent mental health services will also remain unchanged.

To reiterate, 75% of existing children’s services will continue to be delivered by the dedicated staff of Ealing hospital, but—this is an important “but”—the sickest children in north-west London will receive better care as a result of the changes. That is what we all care about the most.

It is right that local people have the chance to hear from their parliamentary representatives in such debates, so I welcome the fact that we have had the chance to debate the subject again. I suspect that we will do so again at some point in the future. As the programme moves through its implementation, I encourage those with particular concerns to continue to engage with the local NHS. I thank colleagues for doing so, as they have been, because that is the right way to proceed. I have reiterated to local health leaders the need to share plans in a timely fashion. I only ask of hon. Members that they also share the positive changes that are already visible to people in their communities, as I have illustrated today. I look forward to hearing how the meeting later this month goes—it was referred to earlier—and I will continue to engage positively with colleagues as they handle this important issue, which matters so much, as we can see, to local members of the public.

Meningitis B Vaccine

Jane Ellison Excerpts

Monday 25th April 2016 Westminster Hall

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

I thank all hon. Members who have spoken in this important debate. As others did, I start by offering my condolences to the family of Faye Burdett, whose tragic death sparked such interest in the e-petition that led to this debate, and to all the other parents. Their powerful testimony on their personal family tragedies has led us and their Members of Parliament here today, and they have helped to stimulate interest in the petition, which has huge support, with more than 820,000 signatures. The petition goes right to the heart of the concern that parents and the public have about meningitis.

I have listened to the many hon. Members who have spoken this afternoon and, like everyone in the Chamber, I have been moved by the stories we have heard of how both meningitis and septicaemia have affected families and, in some cases, have tragically changed their lives forever. As has been made clear, meningococcal meningitis—the infection and inflammation of the lining of the brain—and meningococcal septicaemia, or blood poisoning, which for simplicity I will refer to as meningitis, are very serious infections that can be severely disabling and even fatal, as has been movingly and, in some cases, starkly demonstrated by hon. Members today. It is right that we should have robust arrangements in place to protect against this disease. In fact, we are the only country in the world with a vaccination programme for all the major causes of meningitis, and it is clear from the strength of feeling today that hon. Members fully support the meningitis and other world-class vaccination programmes that we have in place to protect individuals, particularly children, and the community as a whole by vaccinating against preventable diseases.

For 35 years successive Governments have based decisions on vaccination programmes on independent expert advice from the Joint Committee on Vaccination and Immunisation, and it will help to answer one or two points that have been raised if I clarify the JCVI’s legal basis. Since 1 April 2009, the Health Protection (Vaccination) Regulations 2009 have placed a duty on the Secretary of State for Health in England

“to ensure, so far as is reasonably practicable, that the recommendation of the JCVI is implemented”

where certain conditions are met, including that the recommendation is

“in response to a question referred to the JCVI by the Secretary of State”

and that it is

“based on an assessment which demonstrates cost-effectiveness”.

That is the basis on which the JCVI was constructed and under which it operates.

At the recommendation of the JCVI, as the House knows, we introduced in September 2015 a men B programme, using the vaccine Bexsero, for babies born on or after 1 July 2015. The babies receive a dose of vaccine at two months, with a further dose at four months and a booster at 12 months. To ensure that we have protected as many infants born in 2015 as possible from men B before the usual winter peak in cases, we also offered the vaccine to babies born in May and June 2015 as part of a one-off catch-up programme, which was possible because the vaccinations could take place when the babies were due to attend their routine immunisation appointments at three and four months.

By May 2016, all infants under one will have become eligible for the men B vaccine, and by May 2017 all children under two will have become eligible for vaccination, which clarifies the points made by my hon. Friends the Members for Erewash (Maggie Throup) and, in particular, for The Cotswolds (Geoffrey Clifton-Brown). Obviously, much of today’s debate has focused on extending the men B vaccination programme, and hon. Members and those who signed the e-petition want us to go further, which I absolutely understand. The term “meningitis” strikes fear into the heart of any parent. Public Health England surveys parental attitudes, and its surveys regularly show that meningitis is the disease that parents fear the most. When we hear sad stories and see utterly heart-breaking pictures of children such as Faye, of course it adds to parents’ fear and worry. They want what is best for their children, which includes protecting them from meningitis if there is a means available to do so.

The Government feel the same, which is why we became the first country in the world to introduce a programme using Bexsero. However, although meningitis is a much-feared disease, it is now much rarer, thanks in large part to the success of this country’s immunisation programmes. Cases are currently at their lowest numbers in more than two decades. To give the House an example drawn on by the hon. Member for Central Ayrshire (Dr Whitford), who spoke for the Scottish National party, cases of meningitis C have dropped from a peak of around 900 in 1998-99 to about 30 cases in 2014-15. Very few children will get meningitis, and thankfully, deaths are uncommon, although no less tragic.

The hon. Member for Central Ayrshire also mentioned teenagers. As I have enough time, I will draw the House’s attention to the men ACWY programme that we have introduced. Men W is the strain of meningitis that has increased; cases have been increasing since 2009. There were about 50 cases in 2012-13, about 100 in 2013-14 and around 180 in 2014-15. We rapidly introduced a vaccination programme this year as part of an emergency response to control the national outbreak of group W meningococcal disease. Provisional data show men ACWY vaccine uptake at around 34% in the urgent catch-up cohort aged 17 to 18 in 2014-15. I say that to enlist the help of hon. Members when we try to increase awareness of the men W campaign again this year. We need any help that can be given in publicising it. As I remarked with one colleague before the debate, it is considerably harder to get teenagers to the GP than small infants. It is an important campaign involving a very dangerous strain of meningitis that we must continue to bear down on.

However, the petition is about men B. It calls for the men B programme to be extended to children up to 11 years, although several hon. Members have suggested that up to five years may be a compromise. I fully understand why parents and the public want the extension, but as we have begun to explore in this debate, it is not a simple matter; I hope that hon. Members agree. Some of the reasons for that have been teased out, and I will say a little more about them.

Any Government must make the best use of the resources that they have to ensure that they deliver the maximum health benefit to the population. The greatest burden of meningitis B falls on the under-ones, who have therefore been our focus, on expert advice. As we have heard, such judgments are based on NICE’s rules on cost-effectiveness, which have helped successive generations of Ministers to make difficult decisions that are none the less fair and justifiable and reflect, as the Chair of the Health Committee said, the many challenges across our healthcare system.

I have spoken in detail to Professor Andy Pollard, the chair of the JCVI, to understand what process the committee went through when considering the men B vaccination and to be assured that the committee’s recommendation is robust. I have been reassured that the programme we have is the right one, targeting the group of children at highest risk of disease and death. Professor Pollard confirmed that a catch-up programme for one to four-year-olds would not be cost-effective at a realistic vaccine price. Also, the disease is so rare in those aged five to 11 that a programme for that age group would not be cost-effective, and the JCVI could not recommend it.

[Dr Whitford]

Is it not the case that the JCVI did a cost-effectiveness analysis using a 1.5% discount, which is the same as in public health, and at that level a catch-up programme for one to five-year-olds would be cost-effective?

[Jane Ellison]

I am coming to that point, but I thank the hon. Lady for her intervention.

As it stands, on the evidence and advice that I have received, I cannot support extending the men B vaccination programme to older children, but I emphasise that the JCVI keeps under review the evidence relating to all vaccination programmes, and I know that it will consider all the points made in this important debate. If the committee’s advice changes, I will consider it as a priority. The JCVI also keeps the eligibility criteria under review. I wrote to the chair on 17 March this year, following the evidence session with parents, asking the committee to review the cost-effectiveness evidence for one to two-year-olds, which Professor Pollard mentioned in his evidence to the committees. I await formal advice on that. Again, if the JCVI’s advice changes, I will consider it as a priority.

Many of the contributions made by hon. Members in this debate have queried whether the cost-effectiveness methodology used by our experts is right for immunisation programmes. The shadow Minister drew out that point, as did others, including my hon. Friend the Member for Bath (Ben Howlett), who led the debate on behalf of the committees. As some hon. Members said, an independent expert group—the Chair of the Health Committee gave it its full title, but I will call it CEMIPP for ease—is considering the cost-effectiveness methodology for immunisation generally. It includes factors such as peace of mind, cost of long-term social care for surviving children and how prevention is taken into account, all of which have been mentioned in this debate, as well as the issue of discounting.

The CEMIPP review is considering whether current discount rates are appropriate for vaccination in general, and it will report in the summer. I will consider any recommendations on that, although obviously I cannot pre-empt decisions in this debate. As I indicated to the Chair of the Health Committee when she made her contribution, I look forward to receiving the report in the summer. I have committed to publishing the report, and I do so again. If it is of interest, I will also provide the Petitions and Health Committees with a written briefing summarising the report and the Government’s proposed next steps when we get it.

Several hon. Members have expressed concern about whether the research requested by JCVI into whether a men B vaccination programme for adolescents would be cost-effective will take place and how long it might take. I can confirm that a preliminary study of the meningococcal strains carried by teenagers is now under way and will report in February 2017. It will inform a larger study of the effect of men B vaccination in that group. As the Chair of the Health Committee said, it is about exactly how the impact of the larger group would bed down on the impact of the disease in smaller children. I commit to the House to commission the second, wider study following on from the preliminary study now under way on strains.

I recognise that Members have concerns—again, the hon. Member for Central Ayrshire mentioned this issue—about how long the research is taking. I have had extensive discussions about that, because like hon. Members, I want quick answers. However, things are sometimes difficult to weigh in the balance. Robust scientific studies on which long-lasting and important decisions can be taken take time. My scientific advisers have told me that this is a particularly complex study, and that a previous study had inconclusive findings. We want to get this one right and ensure that we have a definitive answer. I am hopeful that this study could start in December 2017. The House has my complete assurance that we will always go with as much speed as we can while maintaining important robustness, so that we reach answers on which evidence-based policies can be made.

Much has been made about the importance of raising awareness and ensuring quick treatment. As many have said, no matter what the nature of the vaccination programme, there will still be cases, and we need to bear that in mind. Many Members have spoken of the reassurance that vaccinations offer and how they set minds at rest; it came out particularly in some of the evidence sessions. Although it is important that it reassures parents, I take this opportunity to underline and stress that vaccination is not a silver bullet. Even with a vaccination programme up to the age of 11, there would still be men B cases in under-11s, as we think that the vaccine covers only about three quarters of all men B strains and no vaccine is 100% effective.

A number of people have made the point, including the hon. Member for Central Ayrshire in an earlier intervention, about understanding the impact of the programme. No other country has introduced a free vaccination programme.

There is as yet no evidence regarding the real-world effectiveness of Bexsero in preventing meningococcal disease in a population—that is different from the safety issue—because, as has been said, incidence is too low for clinical trials to provide a reliable measure of effectiveness.

In response to points made by my hon. Friend the Member for The Cotswolds, I will say that we should have some indication later in 2016 of how effective the vaccine has been. However, establishing an accurate measure of how effective the vaccine is, how long the protection lasts and what proportion of strains it will prevent will take many years of detailed observation by Public Health England, and that clearly will feed into the ongoing review and the important decision-making process that we have. It is worth making that point.

[Mr Winnick]

I go back to what the Minister said a few moments ago. Of course there is no guarantee with vaccination; everyone recognises that. However, my constituents—no doubt she listened when I spoke about my constituents who tragically lost their child—strongly feel that if Mason, their seven-year-old boy who died, had been vaccinated against this disease, he would have lived. To a large extent, that is the essence of the petition, the debate today and the rest of it. To repeat myself, everyone recognises that there is no guarantee, but there is a question of saving lives.

[Jane Ellison]

Of course, and I have tried to reflect on that important point. Nevertheless, raising awareness and ensuring the quick treatment of meningitis will always remain very important for that reason, so parents and healthcare professionals need to remain alert to the signs and symptoms of the disease, as was brought out in the moving speech by my hon. Friend the Member for Bury North (Mr Nuttall) when he talked about the attentiveness of Charlie’s mum as she monitored his symptoms.

Let me tell the House a little about what we are doing to raise awareness among healthcare professionals. Public Health England produces a range of training materials for immunisers, which includes information on the various programmes. It also collaborates with the charities in this area to support their work to improve healthcare worker knowledge, including through the development and distribution of resources aimed at each type of healthcare professional. It runs teaching and training events, and cascades briefing notes through networks. NHS England also does work to provide tools to help GPs to recognise meningitis. A great deal of work is going on in this area, but of course there is always a need to do more.

I turn to the issue of raising awareness among parents, because that is where we can do more. I announce to the House today that I have asked Public Health England to develop a national awareness campaign that will focus on the dangerous infections that parents worry about the most, including meningitis, septicaemia and sepsis. The campaign will focus on the symptoms that parents need to look out for. To get that right, we will work with the appropriate experts and charities, and of course more details will be available in due course. I will look to keep the relevant Committees up to date with that, but it is my intention that this information should be rolled out before the peak of cases in the winter.

[Ben Howlett]

Will the Minister also confirm that she will work with the Department for Education on helping those in the teaching professions and nurseries to identify the different conditions, so that we break down the silo type of response that sometimes prevents these sorts of conversations from being had more freely?

[Jane Ellison]

I have only had initial conversations with Public Health England about the shape of the campaign, but I can assure my hon. Friend that the officials and the other people working on this campaign will look very carefully at what has been said today, and at some of the ideas that hon. Friends and other Members have put forward, and of course they will take all those points into account.

[Geoffrey Clifton-Brown]

I fear that I am becoming the bane of the Minister’s life over this issue, so I apologise, but I am grateful to her for giving way. One of the issues that I raised in my speech was the unit cost. As I understand it from her reply today, she does not think that there is a case yet for rolling vaccination out to children under five. Would she undertake to keep this matter under review, and would she also undertake to ensure that the JCVI, or Department of Health officials, will continue to have discussions with GlaxoSmithKline on what the drop in the unit cost might be if all these extra vaccinations were given to under-fives?

[Jane Ellison]

I can assure the whole House that the JCVI keeps that under constant review. It is not something that is occasionally dusted off and looked at every four or five years. The committee looks at all the factors that go into making the relevant decisions. When the factors that contribute to its decision making change, it looks into them. I have already given the House the assurance that the JCVI will keep that under careful review. The Select Committees heard directly from Professor Pollard and had that assurance from him. However, I will draw the JCVI’s attention to the concerns raised in this debate and the huge level of interest in the matter in the House and among the wider public.

As came out in the evidence that the JCVI gave to the Health Committee and the Petitions Committee, under the current cost-effectiveness criteria, the men B vaccination programme was only just cost-effective even for infants on JCVI’s final analysis, but we did not shy away from introducing it because we know how devastating meningitis can be and how important protecting children from it is to parents. That is why we became the first country to have a programme of using Bexsero. Many other countries have asked experts to consider men B vaccine programmes, but because the cost-effectiveness is so borderline, to date only Ireland has recommended a programme. I understand that it will start in the autumn, using the same criteria as the UK’s programme. We are leading the way in protecting our children from men B.

As I draw my remarks to a close, I want to reiterate Members’ thanks. I appreciate the fact that so many Members have expressed their thanks to Professor Pollard and the JCVI for the complex and important work that they do. That also goes for the many clinical experts who give us their expertise on which to make these enormously difficult decisions.

[Dr Wollaston]

I am intervening because the Minister mentioned that she is drawing her remarks to a close. Can she comment on the issue I raised about the variation in roll-out and the communication issues for public health directors in being able to assess the variation in their areas?

[Jane Ellison]

I am not able to give my hon. Friend an answer today. If she does not mind, I will write to her about that. I have had a conversation about that with the public health director in my own borough, so I am aware of some of the frustrations that have been expressed. If my hon. Friend does not mind, I will write to her with more detail rather than give a response off the top of my head—her question deserves a better answer.

I want to put on the record my thanks to the meningitis charities that work tirelessly to support families affected by this terrible disease and have done so much to advance their cause. Many of them have circulated their 10-point action plan. I have touched on most of those points and indicated how the Government are responding.

Like other Members, I recognise the courage and dignity that, as has rightly been said, Mr and Mrs Burdett and the other families affected by meningitis in such a tragic way have shown over recent weeks. Nothing I can say today can make up for their loss, but I have listened very carefully to the evidence that they have bravely given to the Select Committees, and particularly the emphasis that they have put on raising awareness, which they have done so much about. I hope it is some comfort to them to know that not only their own efforts in bearing testimony but the new awareness campaign, alongside our vaccination programmes, will save lives in future.

Contaminated Blood

Jane Ellison Excerpts

Tuesday 12th April 2016 Commons Chamber

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

I thank the shadow Minister and the hon. Member for Central Ayrshire (Dr Whitford), the SNP spokeswoman, for granting me a little of their time to respond to many of the points made during this excellent debate. I congratulate members of the all-party parliamentary group on haemophilia and contaminated blood, in particular the hon. Member for Kingston upon Hull North (Diana Johnson), on securing the debate and on their campaigning work, to which tributes have rightly been paid. I also wish to thank those who have taken considerable time and trouble, and made considerable efforts, to travel down to London today to express their feelings to their Members of Parliament; some have been able to stay to listen to the debate. I am going to spend as much of my time as possible responding to as many of the factual questions I have been asked as I can, so let me move swiftly on to that.

The consultation on infected blood scheme reform seeks views on what a reformed scheme should look like. This is the first public consultation on this matter by a Government, although there have been other consultations led by parliamentarians. Obviously, it has attracted a lot of interest from Members, as indicated by the presence of those contributing today. I know that many Members, myself included, have had personal frustrations and concerns expressed to them over many years by constituents.

Members will appreciate that, as the consultation is still open, I am not in a position to give any commitments or guarantees on the shape of scheme reform today. Indeed, I want to reassure the House that no decisions on scheme reform will be made until the consultation has closed and all the responses have been carefully analysed. I have listened with keen interest to the various points that have been made and I will carefully consider the contents of this debate, alongside the responses to the consultation.

None the less, I am aware that there are some concerns—they have been expressed today—about the consultation and some of the proposals, and I will try to address those today. First, let me deal with any lack of clarity on the additional funding committed. To be clear, when I launched the consultation I announced £100 million of new funding for the scheme. That is in addition to the current spend of about £22 million per year and the £25 million announced by the Prime Minister in March 2015, so it will more than double our annual spend on the scheme in England over the next five years.

To date, we have spent more than £390 million on support for those affected, and the additional funds I have announced bring the budget for the next five years to £237 million. That means that, over the lifetime of the schemes, we project that more than £1 billion will be spent on support for those affected. The money comes from the Department of Health budget—I hear the points that have been made about where people think the money should come from, but that is where it is coming from and that is the funding we have been able to identify. We are more than doubling the budget for the next five years. This financial assistance is voluntarily provided by Government to help those infected and their dependants. I wish to ensure, and the key aim of the scheme is to ensure, that the money is distributed in a fair and equitable way within that budget envelope and within the legal framework within which I am working, in a way that is also sustainable for the future.

With that in mind, I want to emphasise to Members and to the House that this is a truly open consultation; I genuinely want to hear from all those who have been affected. It has been very useful for me to hear the points made in this debate. I want to hear what support would be most beneficial within the parameters I have set out.

To give some idea of how widely we reached to try to get responses to the consultation, I should say that letters have been sent to all 3,482 registrants of the existing schemes to make them aware of the consultation and provide them with details of how to access it. Letters were also sent to almost 180 Members who have at various times, by various means, contacted us on behalf of constituents over the past year or so, and they have been urged to respond, too. We have already received more than 1,200 responses to the consultation, and I hope that reassures some Members, including the hon. Member for Hammersmith (Andy Slaughter), who were worried that people might have found the consultation difficult to respond to. That is a very good level of response and it is enormously helpful. I am very pleased that so many people have taken the time to feed their views into the process. It might be helpful and, I hope, reassuring for Members to know that a specific team in the Department has been established to ensure that every response is read in full and captured in the analysis, and given that respectful hearing to which one Member referred.

It has been very valuable in the contributions to the consultation we have already received to hear from the quieter voices in the affected community that I have spoken of before. Indeed, I have been struck—in some ways shocked—by the number of affected individuals who were not aware of some of the support potentially available to them, such as the discretionary financial support and non-financial support provided by the three charitable scheme bodies. That has reinforced my sense, which I think is shared across the House—I say that especially in the light of today’s debate—that scheme reform is necessary, especially with a view to simplification and transparency. That point was put very ably by the hon. Member for Heywood and Middleton (Liz McInnes). There are still a few days left in which to submit responses, and I encourage anyone who has not responded but would like to do so to respond before midnight on 15 April.

Let me turn to some of the proposals in the consultation. I know that some of the charitable scheme bodies wrote to their beneficiaries to help clarify the consultation proposals, but some of the nuances were lost in the letters. A number of speakers, including my hon. Friend the Member for South East Cornwall (Mrs Murray), have reinforced that point. Let me confirm that the crux of the consultation is the proposal that every chronically infected individual would, for the first time, receive an annual payment under a reformed scheme. At the moment, those who are registered with the Skipton Fund at hepatitis C stage 1—that is 2,424 people, which is more than 70% of the total number of infected registrants—are not eligible for annual financial support. We are proposing a new annual payment for everyone in that group, reflective of the level of ill health they experience. Should the proposal be taken forward, we anticipate that a large proportion of the additional money committed will be used to provide these new payments.

The proposed reforms would continue annual payments to those who currently receive them, which is, approximately 840 people. Those who are currently registered with the Skipton Fund at hepatitis C stage 2, and those with HIV registered with MFET Ltd would have their payments increased to a rate of £15,000 annually, and those co-infected with HIV and hep C would benefit from an uplift to £30,000. That means that, over the next 10 years, someone with hepatitis C stage 2 would receive £150,000 in addition to any payments they have received to date. Someone co-infected would receive £300,000 in addition to the support they have already received. None of those payments is taxable, nor does it affect a person’s entitlement to any state benefits.

There has been mention of the link to the consumer prices index. I know that there is some concern about the proposal to remove the linkage to CPI. CPI linkage can result in an annual increase or, in theory at least, a decrease in payments. This year, CPI was negative, but we decided to freeze payments to ensure that support for infected individuals did not decrease as a result. Fixing the payments at a set rate would provide more financial certainty over this spending review period for those receiving annual payments. However, I will take very careful account of the concerns that have been raised in response to the consultation when making my final decision on this matter.

[Norman Lamb]

rose—

[Jane Ellison]

I will give way if the right hon. Gentleman is really brief.

[Norman Lamb]

The Minister has explained that many people will benefit, but will there also be losers? If there are, will she write to confirm how much they will lose by and how many people will be involved?

[Jane Ellison]

I cannot give the right hon. Gentleman that clarity today, and there is a specific reason for that.

I will move on to discretionary support for infected individuals. Obviously, I have heard the concerns—I have had a number of letters and held a number of meetings. Some people came to the surgery that I organised. The hon. Member for Kingston upon Hull North was not able to make it, but other Members came and talked about this point. In the consultation, we did propose providing discretionary payments only for travel and accommodation costs. We addressed this issue because, prior to launching the consultation, one of the main criticisms of the current system raised by different groups of beneficiaries and their MPs and by the all-party group was that discretionary grants and the process of applying for them was “demeaning”.

However, I am aware that, through the consultation responses, a number of beneficiaries are troubled by the consultation question on discretionary payment, and those voices have been heard today. In principle, discretionary support should be means-tested, which means that it will vary with circumstances over time. However, it has become clear that, through the independent charitable schemes, a relatively small number of individuals are receiving regular and significant levels of discretionary—as opposed to regular—support. I encourage anyone who feels that they are in this position, or would lose out as a result of the consultation proposals on discretionary support, to reply to the consultation explaining that. No decisions have been made about some of the other discretionary elements on which Members have touched. I hope that clarifies the distinction between our assessment of the impact of annual payments and the impact of discretionary payments, some of which could not be known to us because they were put out through independent charitable schemes.

I welcome any suggestions that respondents may have in relation to the proposals and what would be of benefit to them. This, along with the rest of the consultation responses, will help us to decide what we might be able to do within the budget. We are well aware that some of the non-financial elements of support, which are currently provided by the charitable schemes, are valued. I want to reassure colleagues that we are entirely open-minded about this provision. As I have emphasised previously, it is up to people to tell us through the consultation what they most value in that non-financial support.

Let me touch on the Scottish reforms. Clearly, that has been quite a key theme today. I have been asked to consider matching the recent reforms. The Scottish Government established a financial review group, as we heard, and they announced their plans on 18 March. The package announced by the Scottish Government differs from the proposals on which the Department is consulting. One major difference is in relation to annual payments provided to infected individuals. The Department of Health proposals for England are intended to ensure long-term stability and security to all infected individuals. The hon. Member for Newport East (Jessica Morden) made a point about long-term security and sustainability. To reiterate, in England, there are about 2,400 individuals with hepatitis C stage 1 who do not receive any annual payment. Our proposal is to provide a new ongoing payment to all those individuals that reflects the level of ill health that they experience. The Scottish Government have chosen to provide a lump sum payment.

[Sir Gerald Kaufman]

rose—

[Jane Ellison]

I am really sorry—I will barely get through the points that I have to make.

[Sir Gerald Kaufman]

Is the hon. Lady going to answer the questions that I put to her?

[Jane Ellison]

I am sorry. I have made a note in the margin of my speech to respond directly to the point made by the right hon. Gentleman, if I can get to it. I will try to deal with all the points that were made, and if I do not, I will write to Members after the debate.

The Scottish Government have chosen to provide a lump sum payment, and they currently have no proposals for annual payments to the hepatitis C stage 1 group. To give an idea of the difference, in England, over a five-year period, a stage 1 hep C sufferer who currently gets nothing but is awarded the highest proposed annual payment of £15,000 would receive £75,000. Officials from the Department of Health and the Scottish Government continue to exchange views on scheme reform, and we will reflect on the points that have been made today.

Let me touch briefly on the point about Wales and Northern Ireland. It is a matter for the Welsh and Northern Irish Governments to decide how support is provided for those infected in their areas, but they could opt to make the same reforms as the Department of Health and, indeed, participate in some administration arrangements following scheme reform. My officials hosted a meeting on 24 March with officials from each of the devolved Administrations to discuss scheme reform, and they will continue to work with their counterparts from the DAs on that.

Let me touch on treatment. I understand the points that have been made. Since I launched the consultation in January, the NHS has committed to doubling the number of patients treated with new therapies to 10,000 in 2016-17. NHS England has allocated £190 million from its budgets for 2016-17 for rolling out treatment with these new therapies. I will take into account this significant recent development, along with the responses to the consultation, when making decisions on treatment and payment for it from the scheme’s allocated fund when the consultation has closed. I have noted the clear steers Members have given me about treatment being taken forward by the NHS. I emphasise, however, that legally, the NHS cannot prioritise patients according to route of infection, and can only do so according to clinical need, as Members will understand.

Turning to where we go next, the outcome of the consultation will be crucial in informing our final decisions on how to proceed. We will analyse and reflect on all the responses, and although the scheduling of a debate is not in my gift I will seek to provide an opportunity for colleagues to discuss the proposals with me before any final decisions are made. I will continue to keep Opposition Front-Bench teams closely informed, as I have sought to do throughout. I give the House, and those affected, my commitment that we will proceed as rapidly as possible to implementation. However, I recognise that any reforms must be implemented in a measured way, to give those affected time to adjust, and at the same time ensure that there is no disruption to the provision of ongoing support.

I said when announcing the consultation that my intention was that the new annual payments for the current stage 1 cohort should be backdated to April—this month—regardless of when an individual’s assessment took place. I stress that we are very keen that any assessment is simple and light touch. We do not anticipate any interaction with the benefits system, but I will raise with the Department for Work and Pensions the points made by the hon. Member for Denton and Reddish (Andrew Gwynne) in his thoughtful contribution. We are aiming for simple, light-touch assessments every few years, and if someone’s health deteriorates we want to be able to respond appropriately.

I have tried to address some of the concerns, but I am conscious that I have not covered all of them. After the debate I will review them and respond if I can. I hope the right hon. Member for Manchester, Gorton (Sir Gerald Kaufman) will appreciate that I am not able to answer the points that he raised before the end of the debate.

The consultation will be genuinely open and I urge everyone with an interest to respond. I hope to take matters forward in a constructive and open way.

[Diana Johnson]

rose—

Dementia and Alzheimer’s Disease

Jane Ellison Excerpts

Tuesday 12th April 2016 Westminster Hall

[Graham Stringer (in the Chair)]

We have gone slightly over time because of the unusual circumstances, so could the Front-Bench spokespeople bear that in mind? You have marginally over seven minutes, and that will leave just over a minute for Jim Shannon.

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

Seven minutes?

[Graham Stringer (in the Chair)]

Yes.

--- Later in debate ---

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

I will do my best, Mr Stringer. It is a pleasure to serve under your chairmanship. In the time available, and leaving a couple of minutes at the end, I will not be able to cover all the points raised in this excellent debate. I have never seen the Chamber this full at this time on a Tuesday morning, which is testimony to the importance of this subject.

I start by thanking the hon. Member for Strangford (Jim Shannon), who is a steadfast advocate for this vital cause. There is a great turnout on both sides of the Chamber, and it is clear—explicitly so in some speeches—that dementia and Alzheimer’s are topics that touch many of us in the Chamber today. As others have said, dementia and Alzheimer’s affect 850,000 people in the UK and impact widely on carers, families and wider society. I put on record at the outset my thanks to the wonderful national charities in this field. We value our close working relationship with them, and we value the way that they push us to be the best we can. From what has been said in this debate, it is clear that they have formed important local relationships.

Many hon. Members have made the point that dementia is a global problem that requires international collaboration to find global solutions, and the EU is helping to keep dementia on the international agenda, with the recent Italian and Luxembourg presidencies and the current presidency of the Netherlands prioritising dementia. It is an important issue and a shared agenda. Members on both sides of the House have been generous in supporting the Prime Minister’s 2020 challenge implementation plan, and I echo the support expressed by my hon. Friend the Member for Charnwood (Edward Argar) for the previous work, because we are building on important work done by the previous Labour Government. This is not a partisan issue; it is a challenge to us all. That is true internationally, too. The UK’s international leadership has been strong, and I hope that the UK’s presence will put dementia at the EU’s heart, building on the work that has already been done.

On working with Northern Ireland, as the hon. Member for Strangford knows, healthcare is a devolved matter, with each Administration responsible for its country’s healthcare, but there are many key collaborations and joint initiatives across the UK, notably in research. For example, the Medical Research Council funds dementia research across the UK, including in Northern Ireland, and people in all parts of the UK can sign up to “Join dementia research.” The subject of research has rightly has been much touched on. In particular, the challenges were ably outlined by my hon. Friend the Member for North West Hampshire (Kit Malthouse), who explained why there are particular challenges in this area.

I will reiterate some of the commitments that the Government have made. There will be: up to £150 million for the UK-wide Dementia Research Institute; £300 million to invest in dementia research by 2020; an increase in the total funding for dementia research from the National Institute for Health Research, research councils and charity partners; and more opportunities to participate in research. By 2018, 12% of people newly diagnosed each year will be registered on “Join dementia research,” with 10% participating, but there is more to do. Understanding the causes of dementia will help us to drive the development of treatments and industry innovation. Through things such as the dementia discovery fund, we want to ensure that we have innovative international approaches to making the most of the opportunities that come in the search for a treatment or a disease-modifying therapy, on which we have set ambitious targets.

I also stress, because it has come up again in this debate, the importance of research that also helps us to know best how to support, how to care for and how to improve the lives of people. We are funding things that will have immediate benefits within the next 12 months, as well as things that we hope will bring about a cure or a disease-modifying therapy. One example is that we have commissioned a £20 million research initiative on living well with dementia, funded by the NIHR and the Economic and Social Research Council, which focuses on issues that really matter to people in terms of the practical, day-to-day challenges. Again, there will be opportunities to talk about those in the House.

We have made big progress. Record numbers of people are joining dementia research. We have ambitious targets in that regard, and I hope that hon. Members on both sides of the House can help us to meet them. Diagnosis is vital, as has been mentioned in the debate. Again, huge improvements have been made in the diagnosis rate, from 42% in 2010-11 to 67.4% at the end of February 2016, an increase of around 25 percentage points, but there is more to do, particularly to drive out variation. There is still considerable variation, but ongoing and regular effort is being put into that. I pay tribute to the considerable leadership being given by the NHS’s national clinical director, Alistair Burns.

Meaningful care has rightly been highlighted by Members on both sides as one of the biggest challenges. I am supported by an excellent team of officials in this area, and they are well aware that this is a challenging area. In particular, post-diagnostic support is challenging for the person who is diagnosed, but it is especially challenging for their carers and family. The hon. Member for Bradford South (Judith Cummins) was right to pay tribute to some of her local initiatives and to highlight how big this area is. The joint declaration on post-diagnostic dementia care and support was signed by leaders across the health, social care, local government and voluntary sectors, and it is the first time that we have had an unequivocal joint commitment to improving care and support for people with dementia and their carers following diagnosis. We want to see joined-up plans for health and care support in every area, with personalised care plans for every person with dementia. With NHS England and other partners, we have developed ways to drive that and to measure it within our implementation plan.

Members have rightly said that carers play a pivotal role. I am all too aware of the strain that a dementia diagnosis puts on other family members, which has been rightly highlighted in this debate. We recognise and pay tribute to the pivotal role that carers play. I have touched on progress in research, but I emphasise that we want to see people with dementia, their families and carers live well and have meaningful support.

Time does not allow me to talk in any detail about the carers strategy, but we have launched a call for evidence to inform the cross-Government national carers strategy on what more can be done, and there is clearly much to do in the field of dementia. I encourage all Members to contribute to that, and to encourage their local groups to do so. Carer’s allowance has been touched on. We are rightly being challenged on the money being spent on care, but we are spending more than £2 billion a year on carers’ benefits in Great Britain, supporting more than 750,000 carers. The rate of carer’s allowance has increased since 2010, but I am afraid that time does not permit me to go into detail. I am sure there will be occasions to do so in other debates.

We are further supporting the implementation of improved rights for carers—including carers for those with dementia—enshrined in the Care Act 2014. That is backed by £104 million of funding in 2015-16. The better care fund brings the great promise of more important work on integration, and there are some exciting examples of local initiatives, particularly coming out of Greater Manchester. Again, there will be other opportunities to talk about how the better care fund and those integrated vanguard models can lead the way to more improved care and support for people with dementia.

The role that charities and communities play in enabling people with dementia and their carers to live well through initiatives such as sport, music and dementia cafés has rightly been mentioned. There are some wonderful initiatives, including the Sporting Memories Network, and I pay tribute to all the local initiatives mentioned by hon. Members. I was recently privileged to visit an initiative led by the Manchester Camerata and its music therapist—wonderful work is being done there. There are some 1.5 million dementia friends in England and Northern Ireland doing wonderful work, and a public awareness campaign is under way in Northern Ireland.

There is little I can say in the time available on risk reduction other than that it is vital. Dementia is not an inevitable part of ageing, and up to 20% of those diagnosed with dementia have vascular dementia, the effects of which can be minimised or prevented altogether by a healthy lifestyle. Members are right to draw attention to work on factors such as alcohol, exercise and weight—I hope there will be a chance to say more about that in a future debate. I ask Members to encourage their constituents to take up their free NHS health check. We are piloting initiatives on early-onset dementia awareness.

Let me end by congratulating all hon. Members on their contributions. I refer them to our implementation plan, which was launched last month and has much detail about how we are responding to the Prime Minister’s 2020 challenge. As I close and leave a few seconds for the hon. Member for Strangford to respond, I reiterate that the Government’s commitment to this subject is absolutely undimmed, and it is clear from the contributions this morning that Parliament’s commitment to this important cause also burns brightly.

Food Standards Agency: Triennial Review of Six Scientific Advisory Committees

Jane Ellison Excerpts

Thursday 24th March 2016 Written Statements

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

On 10 September 2015, I announced the commencement of the triennial review by the Food Standards Agency (FSA) for the six scientific advisory committees (SACs) for which the FSA is the sole or lead sponsor (HCSW183).

The six committees are: the Advisory Committee on Animal Feedingstuffs (ACAF); the Advisory Committee on the Microbiological Safety of Food (ACMSF); the Advisory Committee on Novel Foods and Processes (ACNFP); the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT); the General Advisory Committee on Science (GACS); and the Social Science Research Committee (SSRC).

The FSA reviewed all six bodies as a cluster, which provided a more efficient review process, and allowed the review to consider any gaps or overlaps in the committees’ functions and opportunities for efficiencies in their operation.

The FSA consulted widely with relevant stakeholders, including Government departments and agencies, the devolved Administrations and others with an interest in the work of the committees. The FSA also completed an open call for evidence so that all those with an interest could contribute. I am grateful to all those who contributed to the review.

I am now pleased to announce the completion of the review and publication of the final report.



The review made eight recommendations which, in summary, concluded that:

The functions performed by the ACMSF and COT are still required and they should be retained as advisory non-departmental public bodies;

The advisory risk assessment functions of the ACNFP and the ACAF should be replaced with a new committee which would retain any future functions required from these two committees within the framework of a wider remit on innovation in the food chain;

The FSA should follow similar models in other Government Departments with external chief scientific advisers and replace the GACS (established in 2007 to provide independent advice and challenge to FSA’s then internal chief scientist) with a Science Council;

The SSRC should review its future work programme and membership to provide strategic support, scientific advice and challenge which will inform the FSA in delivery of its strategic objectives and help it understand its impact, reflecting the priorities in the new FSA strategic plan;

The three FSA committees, the SSRC, the new Committee on Innovation in the Food Chain and the new FSA Science Council, should continue to operate openly and transparently as expert committees for the FSA; and

A number of areas of good practice were also identified by the review, and a further four recommendations are made about how to improve the efficiency and impact of the SACs work and to ensure they continue to meet the highest standards of governance.



The FSA will now discuss and determine how the recommendations can be implemented. The final report of the review is available online.

Attachments can be viewed online at: http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2016-03-24/HCWS651/.

[HCWS651]

NHS in London

Jane Ellison Excerpts

Thursday 24th March 2016 Westminster Hall

[Dr Huq]

I thank my hon. Friend for that excellent intervention, which is very pertinent to where she is going after this debate. As a mother who has been through these services, I know that it is massively disrupting if the goalposts are suddenly moved, causing people to travel for longer to get to their appointments. The closure of Ealing hospital’s maternity unit was called a consolidation. It was meant to be part of the centralisation of services, but it has had really adverse effects.

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

Obviously, I will respond to the debate at the end. The hon. Lady is making a wide-ranging speech, but when she talks about adverse consequences, particularly in the context of maternity services, I urge her to give examples and to be careful about her language. We do not want to alarm people—particularly those who are accessing healthcare in her area—for the sake of a rhetorical device. Particularly on Ealing’s maternity unit, where there is now 24-hour consultant coverage, I urge her to be cautious in expressing herself.

[Dr Huq]

I thought interventions were not allowed to be lengthy.

--- Later in debate ---

[Bob Blackman]

Clearly, the Government must balance the capital and revenue budgets and ensure that they and the national health service are fit for purpose. I believe passionately that it is wrong to expect our medical professionals and brilliant staff across the health service to operate out of substandard buildings. The more that we do to improve them, the better.

As the Minister will know, I have been agitating on this issue for the past six years. I will not stop until we get what we deserve—a rebuilt hospital of which we can all be proud. The reality is that the NHS Trust Development Authority, which seems to dictate finances within the national health service, is holding up this prestigious project. The hospital now has planning permission, and we are ready to go. Immediately on approval by the TDA, demolition of the existing buildings will start, and work will begin on the new hospital in June or July this year. However, the TDA has yet to approve. We now have a further eight-week delay while the TDA looks again at the business case to see whether it is justified. The staff, patients and everyone connected with the hospital are growing frustrated as a result of what has happened over not just the past six years but the 30-odd years before it as well.

We seek assurances from the Minister that the prevaricating TDA will be leaned on to give a decision, which will be to the benefit of the hospital, the patients and the health service in London and nationally, so that we can ensure that this brilliant hospital continues with its great work. I apologise that I will not necessarily be here to hear the Minister confirm the good news that she will do all that she can to make that happen, but I will sit down—

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

On that specific point, as I am conscious that my hon. Friend might not be back, my noble Friend Lord Prior in the other place took a debate on this topic this week and undertook to set up a meeting with the NHS Institute for Innovation and Improvement and interested peers should there be any slippage in the timetable set out today by NHSI for approval of this important project. I know that that invitation will be extended to my hon. Friend as well, to give him a little assurance on that.

[Mr Andrew Turner (in the Chair)]

I call the Minister—no, Mr Blackman.

--- Later in debate ---

[Kate Osamor (Edmonton) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship for the first time, Mr Turner. I thank my hon. Friend the Member for Ealing Central and Acton (Dr Huq) for her lovely contribution. It was very colourful, as per usual. As well as the subject being serious, I appreciate her opening speech.

I will talk about the crisis in A&E and access to primary care in my constituency. North Middlesex University hospital A&E has recently become the subject of national attention. In December 2015, a patient died in A&E and, at the end of January, the A&E department subsequently received a notification of a risk summit. Waiting times reached crisis point on Friday 19 February, when patients were reported to have been left for up to seven hours on hospital trolleys. Medics came under such extreme pressure that they were forced, at 11 pm, to put a message over the tannoy advising patients to go home unless they were dying. The crisis at the hospital did not go unnoticed. It was widely reported in the media, including in my local paper and many major national newspapers such as The Daily Telegraph, Daily Mail and The Independent.

Earlier, the Minister accused my hon. Friend the Member for Ealing Central and Acton of being alarmist. I would like the Minister really to listen to me and appreciate where I am coming from. My constituents were those people in that hospital and the reality for them is very difficult, so I would like her to reflect on what she said.

The incident was not isolated. Separate reports reveal that, over the previous week, paramedics were forced to wait for hours in A&E because there was a shortage of trolleys. One of my constituents phoned my office from the A&E complaining about the unacceptably long waiting hours. She was so worried about her loved ones that she did not know whether to leave her mother there or to take her home. My staff had to talk her through that and told her to stay because that is where the doctors were, so it was the safest place for her to stay with her mother.

I believe that the staff in North Middlesex University hospital are under enormous pressure and are doing a fantastic job despite that. The unfolding events are clearly symptomatic of a wider crisis in the NHS locally. A Care Quality Commission report in 2014 failed the department, saying there is an overreliance from people living in the community. That overreliance is understandable given the December 2013 closure of Chase Farm hospital A&E, which is in the west of Enfield, the borough in which Edmonton resides. That has put North Middlesex University hospital under enormous pressure. It is clear that the overreliance on the A&E service results not only from the closure of Chase Farm A&E, but from the pressures on local GP services.

Research published in 2015 by the National Audit Office, entitled, “Investigating the impact of out-of-hours GP services on A&E attendance rates: multilevel regression analysis” found that satisfaction with overall GP services is significantly associated with the level of attendance at A&E both overall and out of hours. A 1% increase in patients satisfied with their GP practice’s opening hours is also associated with the reduction in A&E attendance. The latest report from the NAO, “Stocktake of access to general practice in England”, shows that patient satisfaction continues to decline. A fifth of those surveyed reported that GP opening hours were inconvenient.

Enfield, in general, has a problem with unhealthy living, which has contributed to the problem in my constituency. We have a prevalence—unfortunately, the ninth highest rate in London—of coronary heart disease. Strokes are prevalent; we have the eighth highest rate in London. Enfield also has the seventh highest rate of diabetes in London. As hon. Members can see, my constituents are very sick and poorly. We need GP services that people can attend at a convenient time, and where they can get an appointment that will ensure they get a referral to hospital, so that they do not present themselves at A&E.

With the exception of one ward, Bush Hill Park, Edmonton is, socially and economically, a deprived constituency. Of the seven wards in my constituency, three—Upper Edmonton, Ponders End and Jubilee—are among the five wards in Enfield with the lowest life expectancy. Healthwatch Enfield found, through a survey in the summer, that the vast majority of those not registered with a GP in Enfield are in Lower Edmonton, which is in my constituency. However, when the Government replace public health funding by local business rates, as suggested in the 2015 spending review, it will be challenging for an economically deprived borough such as Enfield adequately to fund public health activities to monitor and sustain the current pace of improvement in the health of Enfield’s population.

I wrote to a Health Minister raising my concerns and requesting a meeting about these matters more than a month ago, and I received a response to one of my questions about half an hour ago. I thank the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison) for that—[Interruption.] She has done well. I did ask a few days ago, but I thank her for responding. I was going to say that I received no response but I will not say that because I did. However, I would like to have a meeting, if possible, to talk about the seriousness of the crisis in my constituency and the effect it is having.

[Jane Ellison]

I would be happy to do that.

[Kate Osamor]

I thank the Minister very much for that, and I will end there.

[Ms Karen Buck in the Chair]

--- Later in debate ---

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

It is a pleasure to respond to a debate under your chairmanship, Ms Buck, I think for the first time.

The debate has been extraordinarily rich, with many excellent speeches from my fellow London Members of Parliament. We have a reasonable amount of time left, so I will try to respond to as many points as I can, but certainly on some I would prefer to write a response after the debate. In particular, I would not wish to give my friend, the hon. Member for Hackney South and Shoreditch (Meg Hillier), the Chair of the Public Accounts Committee, anything but the best information, so I will write to her afterwards about some of the details.

I congratulate the hon. Member for Ealing Central and Acton (Dr Huq) on securing the debate with cross-party support. I echo the words of the shadow Secretary of State: it is a great pleasure to see the hon. Member for Ilford South (Mike Gapes) back in this place. He made typically generous remarks about the NHS staff who cared for him, and we, too, thank them, because he is a popular Member in all parts of the House. We are delighted to see him back.

I am a London MP, so the debate is about my constituents as well. Rightly, hon. Members have taken this important opportunity to champion their local populations and their healthcare needs. However, some consistent threads have run through many of the speeches, in particular on the long-term strategic direction given the nature of London and its population. As well as responding to specific points, I want to give Members a sense of the strategic direction that the NHS wants to take in London, and some of the thinking around that.

The NHS in London serves a population of more than 8 million and spent £18 billion last year. As the shadow Secretary of State and others have said, London’s population is younger than the national average and more mobile, and its transient nature often makes continuity of care harder to achieve. In Battersea, I represent the youngest seat in England, and I see that transient, mobile population all the time, whether they are shift workers or young professionals. There are wide variations between and within boroughs in the health of the population, life expectancy and the quality of healthcare.

I will not attempt to respond to all the detailed points that have been made about housing, immigration and some of other wider determinants of health, but I fully acknowledge the interaction of all such important factors when it comes to the health of our constituents, and those factors are rightly at the forefront of the ongoing mayoral election campaign. It is inconceivable that the next Mayor of London, whoever is elected, will not have right at the top of their agenda issues such as housing in London, especially for key workers and the people who keep our important public services going. That is entirely right. I acknowledge that some of the issues that have been highlighted are important for the future of London. The population of London is projected to increase to more than 9 million by 2020, with the largest proportional increase expected in the over-65 age group. Members clearly know what that means for the increasing demand for healthcare.

The leaders of the national health and care bodies in England have set out steps to help local organisations plan over the next six years to deliver a sustainable, transformed health service. I accept that there was controversy in the last Parliament, and that the majority of Members present in the Chamber today disagreed with many of the measures enacted. Nevertheless, we have since had a general election and a majority Conservative Government were elected, having stood on the NHS architecture as it is. At the heart of the Conservative manifesto was an acceptance of the NHS in England’s own plan for its future, the five-year forward view. In a fixed-term Parliament, that gives us the opportunity for a stable system, which can look ahead across five years at how it provides sustainable and transformed services.

As in previous years, NHS organisations will be required to produce individual operational plans for the next financial year. Obviously, that work has happened for 2016-17. In addition, every health and care system will be required, for the first time, to work together to produce a sustainability and transformation plan, which is a separate but connected strategic plan covering October 2016 to March 2021. Many Members have highlighted the frustrations felt between the acute sector and CCGs, and some of the other stresses and strains between the different parts of the system. This year will be the first time that the NHS has required all parts of the local health and social care system to sit down together to draw up a five-year plan. That is strategically important in understanding how the system responds.

Those local plans represent an ambitious local blueprint for implementing NHS England’s five-year forward view locally. My hon. Friend the Member for Sutton and Cheam (Paul Scully) and many others talked about the need for long-term planning.

[Meg Hillier]

I thank the Minister for giving way, because I know she is trying to cover a lot of ground. Long-term planning is sensible, but is she not concerned about a five-year plan when at the same time major transformation is being required of acute hospital trusts through NHS Improvement—again, not a problem in itself, except that it is to be in very short order? Is there not a contradiction between a five-year plan and the short-order demands of the improvement plan for trusts, just to make their books balance?

--- Later in debate ---

[Jane Ellison]

I do not accept how the hon. Lady characterises that. Clearly, there is an interaction between action now and action in the next few years—that is part of how we plan for the future—but, as I said, I will respond to some of the more detailed points in writing. I know that she has examined the matter in some detail in the Public Accounts Committee, with civil servants, Simon Stevens and some of my parliamentary colleagues.

The NHS needs to work beyond the boundaries of individual organisations and sectors. All Members in all parts of the House agree about the need, for example, for health and social care to be further integrated. That process began under the better care fund, but the fact that we need more of it was in all parties’ manifestos. Together with the additional investment that has been made available, the plans are intended to ensure better health for local people, transform the quality of care delivery and, crucially, ensure the sustainable financial position to which a number of Members referred.

That approach represents a step change in strategic planning at the local level, moving away from the year-to-year cycle. However, there is no one-size-fits-all template. London will be covered by a total of five footprint areas, which are geographic areas in which people and organisations will work together to create a clear overall vision and plan for their own area. As Members have eloquently illustrated in their contributions, one sometimes finds different parts of a local system in tension with each other, so it is vital that we sit down and understand how the pathway can become seamless for the individual. We will learn a lot from some of the vanguards in devolution areas such as Greater Manchester.

The NHS’s financial position is undoubtedly challenging. No one would dispute that, least of all me, but it is important to recognise that despite the difficult decisions the Government have had to take, we have chosen to prioritise funding for the NHS. That is why we have committed an additional £10 billion over the lifetime of the Parliament, starting with £2 billion this year. Simon Stevens has been clear that he asked for an amount of money and that is what he got. He also asked for a certain weighting in the spending review settlement, with front-loaded money to drive transformation, and the money has been set up with that structure.

I am a London MP, too, so I do not want the debate to be confrontational. I share many of the concerns that have been raised today. Everyone acknowledges that in London the health system in general is under pressure, for many unique reasons, but I gently point out to the shadow Secretary of State that while she listed many challenges, and many other Members did the same, she did not list that many solutions. At the general election, the Labour party did not pledge to give the NHS the shortfall it had identified in its funding. That is significant, and I need to put it on the record.

[Dr Huq]

Will the Minister give way?

[Heidi Alexander]

Will the Minister give way?

[Jane Ellison]

No, I will press on, particularly as the hon. Member for Ealing Central and Acton, who introduced the debate, took half an hour for her opening speech. I will give way if I have time towards the end. It is a matter of record that we committed—[Interruption.] All right, I give way to the shadow Secretary of State, if she would like to remind us of what the Labour party pledged at the election.

[Heidi Alexander]

I am grateful that, when making a political point, the Minister is happy to give way to the shadow Front Bencher.

We have been clear that we would always have given the NHS every penny that it needs. However, the calculations for the five-year forward view were predicated on social care being properly funded and there being no further cuts to the public health budget. I think Simon Stevens would say that those two things are essential if we are to deliver a sustainable NHS. Will the Minister therefore tell me how much money her Government took out of adult social care in the previous Parliament?

[Jane Ellison]

We have been clear that we have given a large amount: £3.5 billion has been made available to local authorities for social care. Ditto on public health—we will spend £16 billion over the next five years. If I have time, I will come to the good point that was made earlier about the move to business rates retention. It is matter of record that the Government committed at the election to what the NHS had asked for in the five-year forward view, and we will continue to make that commitment.

The London health system—CCGs and provider trusts—has planned for a deficit in 2015-16 of about £350 million, and overall the system is expected to be in that position. Some recovery is expected during 2016-17, and I am sure we will debate that again. In addition, a £1.8 billion sustainability and transformation fund is available, designed to address provider deficits in 2016-17. However, I think all Members would accept that additional Government spending is not the only answer to the challenges faced by the NHS. We have taken action with our arm’s length bodies to support local organisations to make efficiency savings and reduce their deficits, but much of the change Members have talked about is driven by desire to get better healthcare rather than to make savings. If we can make savings as well, that is all to the good, because we can reinvest them in great healthcare.

In London, from early April, the new NHS Improvement body will be providing additional expert support and capacity to trusts experiencing particular financial challenges. That support will include identifying and implementing financial improvement and helping them to identify savings to put them in a stronger position to maintain those savings.

Let me talk about the pressures on urgent and emergency care. It is acknowledged that the urgent and emergency care system faces increasing pressure. More and more people are visiting A&E departments and minor injury units, which is stretching their ability to cope. Members listed some reasons for that in their speeches. A lot of visits are unavoidable, but some people are visiting because of inconsistent management of long-term health conditions, difficulty in getting a GP appointment or insufficient information on where to go.

Winter sees an even bigger rise in visitor numbers and pressure on staff. Although the debate inevitably dwelled on Members’ concerns about their local healthcare systems and problems in them, I am sure we all want to place on record our huge thanks and praise, as many have, to the staff of London’s NHS, who work extremely hard under a lot of pressure and delivering some really good results against that backdrop. I will come on to that.

London’s A&E units have been significantly challenged this winter, and that has been reflected in performance. However, despite those pressures, the capital’s urgent and emergency care system has proved its resilience, with fewer serious incidents declared than in previous years. This winter, London accounted for just three out of 625 serious incidents declared across England. It is important to praise the staff in saying that.

In January, London’s performance was significantly higher than all other regions, with 90% of patients seen within the four-hour A&E standard. London is also the highest-performing region in England this year to date, with 93.1% of patients seen within the four-hour standard. My thanks and congratulations on that improved performance go to the hard-working staff of London’s services.

Reconfiguration schemes have loomed large in the debate. The health needs of people in London are changing and demands on health services are increasing. The hon. Member for Ilford South in his excellent speech illustrated through his personal stories some of the reasons for the changes in the shape of our health service in terms of how we are investing in specialist services and centres of excellence. The work done to centralise stroke expertise was brought up earlier in the debate. I remind Members, although many will remember, that those changes were bitterly opposed by many people. I am not sure whether that includes anyone in the Chamber, but it certainly includes campaign groups. However, all our London clinicians now say with certainty that those changes, with centralised expertise and specialist care, have saved many lives. That is always worth reflecting on.

People are living longer, the population as a whole is getting older and there are more patients with chronic conditions. We often say that people are living longer, but we forget to say that they are living with chronic conditions for longer, and that presents a longer-term challenge than might be seen at first sight. Heart disease, diabetes and dementia will all increase as they are conditions associated with an ageing population.

We did not dwell on the prevention agenda, but I was delighted that the hon. Member for Edmonton (Kate Osamor) spoke about it. The shadow Secretary of State also touched on it when she mentioned dementia and the problems we all know of older people in hospitals. I urge her to look at the dementia implementation plan we published on 6 March, which is a detailed response to the Prime Minister’s 2020 challenge. Dementia has sat in my portfolio since the election, and that plan is a detailed look at how we deliver against that challenge and in particular at the joined-up care that is key to ensuring that people with dementia have safer and better care in our system and are kept out of the acute sector whenever that is possible.

In a number of areas across the capital, the local NHS has concluded that the way it has organised its hospitals and primary care in the past will not best meet the needs of the future. We are clear that the reconfiguration of front-line health services is a matter for the local NHS, tailored to meet the local population’s needs.

I was glad to hear that Members recently met with Anne Rainsberry. The Members who came to the cross-party “Shaping a Healthier Future” meeting last summer will know it is vital that officials at all levels and NHS managers engage with elected Members. I was therefore disappointed to hear what the hon. Member for Eltham (Clive Efford) said. I will ask my officials to look into that. A number of Members asked reasonable questions about why they could not have certain bits of information. I have some specific answers and it may be that we can take a moment after the debate and I will point them in the right direction.

[Andy Slaughter]

I am grateful for what the Minister has said. If she could give an indication to health officials that we must have an open review of where we are with “Shaping a Healthier Future”, look at the implementation of the business plan and consider the Mansfield commission report, which really just asks questions along those lines, it would be very useful indeed.

[Jane Ellison]

We have had the time, during a three-hour debate, to make inquiries, so I will perhaps give the hon. Gentleman an update afterwards.

There have been a lot of references to the interaction with Members. Members of any party may feel they are knocking their heads against a brick wall, but sometimes, to be fair, information cannot be shared for good reasons. There may be commercial confidentiality, or things may be at a particular stage where information cannot be shared. However, I am quite clear that all plans for the local populations that Members represent must be shared with the best level of detail possible, at the most opportune moment. I am always happy to hear from London Members if they feel that that is not happening.

Reconfiguration is about modernising the delivery of care and facilities. I recognise that proposals for those changes sometimes arouse concern. There has been a particular focus on “Shaping a Healthier Future” in this debate, but under that programme, many more community services are now in place across all eight boroughs, so more patients can be seen closer to home. Eleven new primary care hubs are now open. Improved access to GP services has meant an additional 32,000 appointments in Ealing since August 2015, while weekend appointments are now offered to more than 1 million patients across north-west London. Rapid access services in each borough are helping to keep patients with long-term conditions out of hospital where possible, which has already prevented 2,700 hospital admissions in Brent alone.

[Dr Huq]

Will the Minister give way?

[Jane Ellison]

I will not, if the hon. Lady will forgive me, because I think she is going to have a moment to speak at the end, if I can allow it. She gave a half-hour opening speech, which is a little longer than I have to respond, so I will press on.

The Mansfield commission report, which I have read, has been referenced. The costs stated in that independent health commission report are not from the NHS and are not recognised by the NHS. In terms of the response, the unanimous conclusion of the north-west London clinical board was that the commission’s report offered no substantive clinical evidence or credible alternative to consider that would lead to better outcomes for patients than the plan the NHS has put in place. That plan enjoys an extraordinary level of clinical support, and it is important to say that that unanimous clinical support has been sustained. The financial impact of significant delay and challenge cannot be dismissed, and I know Members are aware of that.

Members have rightly focused on primary care. We all know the important role that primary care in London will play in helping us to meet the significant challenges we face. There are still a large number of single-handed GP practices in London. A significant number of GPs are approaching retirement age, and in some London boroughs, patient list turnover is as high as 37% in a year. The Government have made a number of important commitments on improving primary care. In June 2015, the Secretary of State set out details of a new deal for general practice. In London, the transformation of primary care is being planned and implemented with the support of local resources and a pan-London transformation team. More than £40 million has been invested in primary care transformation in the capital this year.

The GP access fund has accelerated delivery in some areas of London. For example, 700,000 patients in Barking, Havering and Redbridge now have the opportunity to see a GP in the evenings, and 305,000 patients in south-east London have seven-days-a-week access to GPs via new primary care hubs. Some important measures are being invested in and taken forward, but we acknowledge that we need to do more in those areas.

Members have raised a number of concerns about trusts in special measures. I reiterate that those trusts are receiving support to ensure they have in place the strong leadership they need to implement their improvement plans. It was good to hear an expression of support from the hon. Member for Ilford North (Wes Streeting) for local leadership in that regard.

We have touched very little on mental health services in London, which I know is not because Members do not think it is important; we all want to drive towards the parity of esteem that is rightly this Government’s aspiration. In March 2015, the London mental health transformation board was established to support the development and delivery of projects to improve the mental health of Londoners. I do not have time to go into local examples of how that is beginning to make a difference, but they are important and making progress.

I have talked about the integration of health and social care. There are 25 integrated care pioneer sites developing and testing new and different ways of joining up those two important services. In Waltham Forest and east London, services are focused on keeping patients at home, providing care close to home and, if patients are admitted to hospital, getting them home as quickly as possible. In Islington, the local health and social care network is providing a named professional to take responsibility for the co-ordination of the patient’s care plan, with a view to providing the seamless, co-ordinated and proactive care that we want to see particularly for our most vulnerable patients.

In the time left to me, I will try to address one or two particular points raised. I have said that I will look to respond in more detail to points made by the hon. Member for Hackney South and Shoreditch on the McKinsey report and the issues around NHS land. One Member mentioned in an intervention the recruitment of nurses and the position of the MAC.

The hon. Member for Edmonton (Kate Osamor) made important points about the particular needs of our poorest populations. Like many hon. Members, my seat in Battersea has everything, from very wealthy to very poor people and everything in between—that’s London. She talked about the need to invest in prevention. This week, we saw the national diabetes prevention programme launched, which is the first at-scale intervention of its kind in the world. We are also working on important areas, such as a new tobacco plan.

A number of Members touched on the issue of public health budgets when we move to business rates retention. Of course we need to get the balance right, to ensure we continue to bear down on health inequalities. I would be happy to have further discussions, but I reassure Members that we are very conscious of that in the Department of Health and will be doing work to address it. Important points were also made by the hon. Member for Edmonton about North Middlesex hospital. She rightly mentioned that key safety issues are being addressed there by some of the local leaders.

I am glad that my hon. Friend the Member for Harrow East (Bob Blackman), who has had to go to the main Chamber, talked about the transformed performance at Northwick Park hospital. It is right to shine a light where we see such improved performance, and I know that the staff very much appreciate it. It was good to hear from my hon. Friend the Member for Sutton and Cheam that his mother had great service. He also illustrated the sometimes unintended consequences of local healthcare campaigns, which he has seen at close hand.

I want to give an assurance that the Department’s capital settlement meets the needs of the NHS and allows the Department to continue with priority public capital projects and support delivery on the five-year forward view over the coming years. St Helier was mentioned on a number of occasions. In anticipation of all the plans there, further work is going on around their affordability, and that ongoing work is important.

The hon. Member for Brent North (Barry Gardiner) made quite a detailed point that I will, of course, look into. We have the recess to look back at Hansard and pick up some of the many detailed points made in this debate. Many notes were being written behind me, and we will look to come back to Members.

There will be things that I have not quite been able to capture, but I give fellow London Members my reassurance that I am always happy to talk to them. I would rather they talk to me at an early stage if they are concerned about something. We share many of the same challenges, but we also share the same ambition: to have the very best healthcare for our local residents. This Government are determined to invest in the NHS to be able to deliver on that. With that, I leave the hon. Lady a minute to close the debate.

--- Later in debate ---

[Jane Ellison]

Can Hansard record that that is not true?

[Dr Huq]

She is not a robotic one of those; I think people recognise that she is not a robot. She made the point a few times that we should not use this issue as a political football and we should want the best for everyone. Some of the people I quoted in my speech are not Labour party members. Michael Mars is the chair of Ealing synagogue. He came for a visit this week and pointed out that managerial culture is stifling what the—

Motion lapsed, and sitting adjourned without Question put (Standing Order No. 10(14)).

Meningitis C Vaccine (Emergency Donation)

Jane Ellison Excerpts

Wednesday 23rd March 2016 Written Statements

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

It is the normal practice when a Government Department proposes to make a gift of a value exceeding £300,000, for the Department concerned to present to the House of Commons a minute giving particulars of the gift and explaining the circumstances; and to refrain from making the gift until 14 parliamentary sitting days after the issue of the minute, except in cases of special urgency.

A minute has today been laid before Parliament setting out details of the Department of Health’s gift of approximately 157,000 doses of the Meningitis C (MenC) vaccine to the World Health Organisation to meet a request for urgent assistance to manage MenC outbreaks in the Niger and Mali. This gift has a market value of around £3.5 million pounds including VAT. Due to commercial sensitivities it is not possible to confirm the contract price.

MenC is a very serious illness which can result in death or severe consequences including brain damage, hearing and sight loss and there is a global shortage of affordable MenC vaccine. This gift will provide a valuable contribution to saving lives and reducing morbidity in infants and children in the Niger and Mali.

The risk of MenC in children in the UK is very low because of the success of the vaccination programme so far. When MenC was first introduced in 1999, around 12 million children and young adults were vaccinated as part of a catch-up programme. Because of this catch-up programme, circulation of MenC in the population declined rapidly and this low circulation will be maintained by vaccinating teenagers—the age group most likely to carry meningococcal bacteria in their noses or their throats.

The Joint Committee on Vaccination and Immunisation (JCVI) has advised that children no longer need the infant dose of MenC currently given at three months of age. This is because there is very good herd protection for MenC, resulting from low rates of MenC carriage amongst teenagers and young adults. This means the risk of cases of invasive MenC disease in infants in the UK is extremely low. Also, the new MenB vaccination programme using the vaccine Bexsero® is expected to provide some degree of protection against invasive MenC disease. This change in our vaccination schedule will take effect from 1 July 2016. Children will still be offered two doses of a MenC vaccine. They will be offered a dose at 12 months of age (combined with Hib) and a dose at 14 years of age (currently combined with MenA, W, and Y). The latter dose will help to sustain the current low levels of carriage among young adults in the UK.

Due to the urgent nature of this request it has not been possible to provide Parliament with 14 sitting days’ notice of this gift. The Treasury has approved the proposal and a copy of the minute is attached.

Attachments can be viewed online at : http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2016-03-23/HCWS647/.

[HCWS647]