Oral Answers to Questions

Jane Ellison Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Andy Slaughter (Hammersmith) (Lab)]

8. What effect the implementation of the Keogh urgent and emergency care review will have on type 1 A&E departments in England.

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

The Keogh review is all about responding to the long-term challenges facing the NHS, many of which we have already discussed in this Question Time. The implementation of the recommendations of the Keogh review will improve urgent and emergency care services and ensure patients get the right care in the right place.

[Andy Slaughter]

The “Shaping a healthier future” programme in north-west London, which is seen as a prototype for Keogh in closing or downgrading A&Es, is causing great concern, from the tragic death of Guy Bessant reported yesterday to the more than £20 million spent on external consultants last year. Eleven west London MPs would like to meet the Secretary of State and, I hope, the Under-Secretary, to discuss those concerns. Will they agree to meet us?

[Jane Ellison]

I read of the tragic death of that gentleman, who was a Wandsworth resident. Our hearts go out to his family.

As the hon. Gentleman knows, “Shaping a healthier future” is a clinically led programme supported by all eight clinical commissioning groups in the area and all nine medical directors of the trusts involved. There are no plans to make changes to A&E services at Ealing hospital, contrary to what was put about during the election, but I recognise that this is the subject of ongoing concern. All the recommendations of the Keogh review are entirely driven by one thing, which is putting patients and patient safety first, but I am happy to meet him and his colleagues to discuss it.

[Dr Sarah Wollaston (Totnes) (Con)]

In implementing the Keogh review, will the Minister also consider the impact on our community hospital minor injuries units, given the difficulties they are facing in staff recruitment? Will she meet me to discuss the difficulties facing Dartmouth community hospital? There are wider implications for the rest of the country.

[Jane Ellison]

I think I have some sense of the difficulties my hon. Friend describes from previous meetings, but I am of course happy to talk to her about that. All these things are important, but as I say, the driving principles behind the Keogh review are patient safety and making sure that people get the best and most appropriate urgent and emergency care.

[Iain Stewart (Milton Keynes South) (Con)]

9. What proportion of their funding hospices in England receive from the NHS.

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[Suella Fernandes (Fareham) (Con)]

10. What steps he plans to take to improve the treatment of diabetes.

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

I welcome my hon. Friend to her place. Building on the national diabetes prevention programme, we are developing a comprehensive action plan to improve the outcomes of people with and at risk of diabetes.

[Suella Fernandes]

I thank my hon. Friend for her excellent response. As she will know, diabetes can often lead to the amputation of a limb. Fareham, my constituency, has one of the highest rates of limb amputations in the country. Can my hon. Friend please explain how the NHS diabetes prevention programme will address this issue?

[Jane Ellison]

My hon. Friend raises an extremely important issue. I welcome the fact that she has so quickly got to grips with some of the key local health facts in her area. Hon. Members across the House can look at how their clinical commissioning group is performing in the national context. My hon. Friend is right to say that her CCG performs poorly when it comes to amputations. There is a huge opportunity for improving the outcomes for people if we can get the worst-performing CCGs in that context up to the standard of the best. The national diabetes prevention programme is very much about preventing people getting to the stage where those complications can cause such terrible problems.

[Keith Vaz (Leicester East) (Lab)]

13. May I join the Minister in congratulating the hon. Member for Fareham (Suella Fernandes) on her place in this House? She was a worthy opponent of mine in 2005 and I am glad she managed to get elected. On the national diabetes prevention programme, for those of us who have diabetes the issue is what is corporate Britain doing to work with the Government in order to reduce the amount of sugar and fat in food and drink? Unless we do that, we cannot tackle the diabetes crisis that we will face.

[Jane Ellison]

The right hon. Gentleman is quite right. Tackling obesity is one the great public health challenges of our age. Right across the developed world we are looking at all the things that are going on around the world—the new science and the new research. The right hon. Gentleman is right to say that industry has a role to play, as has every part of Government—national Government and local government—as well as families, GPs and the NHS. This will be a whole-nation approach to tackling obesity. We are working on our plans, which I look forward to discussing with him in due course.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

Type 2 diabetes is costing our NHS £9 billion a year, and obesity, as we have heard, is the major risk factor. Does the Minister agree with the previous Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), who said the other week that

“Just taking a passive approach to”—

obesity—

“is not going to work…we have to go further than we’ve gone up to now in the responsibility deal”?

Does the Minister agree and what more is she going to do about it?

[Jane Ellison]

I welcome the hon. Lady back to her place. It is good to see her back in that job and not on the Government Benches. It is far from the case that we took a passive approach—far from it. Some important things were learned from the way we have worked with industry and we are looking to build on those, but as I have said, there is no silver bullet. There is not a single academic study in the world that says that the way to respond to obesity in the developed world is through a single mechanism. We have to look at a whole-system approach, and that is what we are doing.

[Helen Jones (Warrington North) (Lab)]

12. What estimate he has made of the anticipated levels of deficits in hospital trusts for the current financial year.

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[Andrea Jenkyns (Morley and Outwood) (Con)]

14. What the NHS’s criteria are for dispensing eculizumab.

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

May I give my hon. Friend a particularly warm welcome to her place? NHS England routinely commissions eculizumab for the treatment of paroxysmal nocturnal haemoglobinuria, or PNH, and atypical haemolytic uraemic syndrome, or aHUS, as the drug is proven to be safe and effective in treating these conditions.

[Andrea Jenkyns]

I very much welcome the statement last week from the Prime Minister in which he requests NHS England to look into the case of my constituent, 12-year-old Abi Longfellow. I am sure that gives great hope to Abi’s family. Abi has a rarer form of DDD—dense deposit disease—involving the alternative complement pathway, and there is evidence that eculizumab helps. Will my hon. Friend ensure that NHS England looks at this rare form and gathers evidence not just from the UK but from countries such as the US, China and Canada which have research and trials in this area?

[Jane Ellison]

This is a particularly difficult and tragic case. My hon. Friend is right to champion the case of her young constituent. My right hon. Friend the Prime Minister asked NHS England to make further contact with the Longfellow family to fully explain the decision, and I can confirm that the clinical director for specialised services at NHS England North has spoken to the family twice in the past few days. The National Institute for Health and Care Excellence is reviewing, as a priority, the evidence on the use of eculizumab in treating this condition.

[Andrew Stephenson (Pendle) (Con)]

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

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[John Pugh (Southport) (LD)]

T10. May I invite Ministers to comment on the recent statement by the Academy of Medical Royal Colleges that the Government’s anti-obesity strategy is“failing to have a significant impact”and that there is a“huge crisis waiting to happen”?

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

The Government is quite clear, as was the coalition Government, that tackling obesity is one of the great challenges of our time for the whole of the developed world, not just this country. We are looking at a comprehensive strategy right across all aspects of Government, including local government and so on. We will address that and rise to the challenge. Everyone has a part to play, including, as has been said during this Question Time, industry and, of course, families themselves.

[Julian Knight (Solihull) (Con)]

T9. My constituent Daniela Tassa has lost her hair while being treated for secondary breast cancer. Sadly, Miss Tassa has been turned down by Solihull clinical commissioning group for a hair replacement treatment called intralace. Is there any guidance that Ministers can offer CCGs when it comes to the sanctioning of such hair replacement treatments?

[Jane Ellison]

I welcome my hon. Friend to his place. I am very sorry to hear of his constituent’s diagnosis of secondary breast cancer. It is of course vital that the NHS supports all patients in the best way possible, but clinical commissioning groups need to make decisions on whether to commission a particular hair-replacement service for patients based on their clinical benefit and cost-effectiveness. I very much hope his CCG will be looking carefully at that.

[Tulip Siddiq (Hampstead and Kilburn) (Lab)]

The planned closure of a GP surgery in my constituency means that more than 1,000 patients will have to go elsewhere to seek basic primary care needs. Local doctors are particularly concerned about the impact this will have on the A&E department at the Royal Free hospital. Will the Minister agree to meet me and local doctors to address those concerns and to ensure that the future of GP surgeries in my constituency is protected?

[Mr John Baron (Basildon and Billericay) (Con)]

The all-party group on cancer has long campaigned on the importance of holding clinical commissioning groups accountable for their one-year cancer survival rates as a means of promoting earlier diagnosis. That will be part of the delivery dashboard from April onwards. What steps will the Government take to ensure that underperforming CCGs take corrective action?

[Jane Ellison]

My hon. Friend has long championed this issue and I look forward to debating it with him further. He is right to say that the CCG scorecard is currently being developed. Academic experts are looking at a range of indicators, including the one-year cancer survival data which he has brought to the House so often, for inclusion in the scorecard. It is likely to be published this summer. I will of course look carefully at the points he makes ahead of that.

[Norman Lamb (North Norfolk) (LD)]

With your permission, Mr Speaker, may I join others in marking the tragic death of Charles Kennedy? He was one of the most able politicians of his generation, and was loved and admired across the political spectrum. He was a brave and principled man, and he will be missed enormously.

May I raise with the Secretary of State my passion for mental health? He will be very much aware of my absolute determination to achieve equality for those who suffer from mental ill health. Will he guarantee that he will do everything to ensure that people with mental ill health get the same timely access to evidence-based treatment as everyone else?

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[Jim Shannon (Strangford) (DUP)]

With almost 82,000 people living with diabetes in Northern Ireland over the age of 17, does the Minister agree that this ticking time bomb needs more research into better treatments? One way of doing that would be to ensure that there is sufficient funding for Queen’s University in Belfast, in the hope of providing a superior treatment for the many who are affected and living with that disease.

[Jane Ellison]

The hon. Gentleman is right to draw attention to the important role of research. We will leave no stone unturned in looking at all aspects of the treatment or prevention of diabetes. The issue of research is something I recently discussed with the chief medical officer. I will draw to her attention the point he makes. As he knows, although health is a devolved matter we always make a point of sharing all research right across our United Kingdom.

[Pauline Latham (Mid Derbyshire) (Con)]

May I invite the new Minister with responsibility for GPs to meet me and a couple of excellent GP surgeries that want to expand their services for the local community but are being prevented by the local clinical commissioning group?

Penrose Inquiry

Jane Ellison Excerpts

Thursday 26th March 2015 Commons Chamber

[Diana Johnson (Kingston upon Hull North) (Lab) (Urgent Question)]

To ask the Secretary of State for Health to make a statement on the publication of the Penrose inquiry and its implications for the United Kingdom Government.

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

Yesterday the Prime Minister issued an apology for these tragic events on behalf of the Government, and my right hon. Friend the Secretary of State for Health laid a written ministerial statement as an interim response to the Penrose inquiry.

As the hon. Lady knows, this was a Scottish public inquiry. I understand that Scottish Ministers will not make a statement to their Parliament until this afternoon, and it would therefore be inappropriate for me to comment on the report in detail at this stage. However, I can say that Lord Penrose reviewed more than 118,000 documents and more than 150 statements from patients and relatives, and also took oral evidence from many of the officials who were involved in decision-making at that time. It seems to have been an extremely thorough job, and it has provided the first authoritative narrative of these events.

During the Back-Bench debate in the House on 15 January, I said that the Government would make an interim response to Lord Penrose’s report—which appeared yesterday, in the form of the written ministerial statement—and that it would be for the next Government to consider a more substantive response once they had had time to examine the findings of the inquiry.

Yesterday we announced that the Department of Health would allocate an additional one-off amount of up to £25 million from its 2015-16 budget to support any transition to a different system of financial assistance. We intended that announcement to provide an assurance for those who have been affected by these devastating events that we have heard their concerns and are making provision to reform the system. As the hon. Lady knows, we had hoped to consult during the current Parliament on reform of the ex gratia financial assistance schemes, and I very much regret that our considerations on the design of a future system of financial assistance for those affected were postponed while we awaited the publication of Lord Penrose’s final report.

The Prime Minister also said yesterday that if he was still Prime Minister after the election in May, his Government would respond to the findings of the report as a matter of priority.

[Diana Johnson]

Thank you for granting the urgent question, Mr Speaker. I thank the Minister for her response.

As we know, the contaminated blood scandal was the biggest disaster in the history of the NHS. Today we should again remember all those who contracted HIV and hepatitis C, and their families. For them, this is not an historical issue, but an ongoing tragedy which continues to have a devastating impact on their lives.

I am pleased that the report of the Penrose inquiry was published yesterday, after six years. It runs to five volumes and 1,800 pages, and it appears to document accurately the tragedy, how it came about, and the decisions that were made at the time. However, I share the surprise and disappointment of those affected that the report makes only one recommendation. I know that, for that reason, yesterday was a very difficult day for many people.

The Prime Minister’s apology on behalf of the United Kingdom Government represents a significant moment in the long struggle for recognition of the scale of the tragedy, and it is very welcome, but what we need is a proper system to support and compensate all those who are affected. The report that was published a few weeks ago by the all-party parliamentary group on haemophilia and contaminated blood shows that the current system is simply not meeting the needs of those whom it is meant to help, and is not fit for purpose. I should like to hear a reassurance from those on both Front Benches that, whichever party forms the next Government, swift action will be taken to provide a permanent support and compensation settlement. I should also like to be reassured that it will be specifically stipulated that the £25 million which was announced yesterday should go directly to the beneficiaries, rather than the trusts and funds deciding what to do with it.

This is not the end of the matter. As the Minister knows, a large number of Members on both sides of the House will return to it after 7 May, and will hold whoever is in power to account when it comes to sorting out this tragedy.

[Jane Ellison]

The hon. Lady is absolutely right to say that this is an ongoing tragedy, and that, as I said in my statement, many people’s lives have been devastated and continue to be severely affected. I pay tribute to her and to other members of the all-party group, including my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), who cannot be present today but who has spoken to me in the last couple of days, since the publication of the report. Indeed, I pay tribute to all the Members who have represented their constituents so ably and passionately over many years.

As the hon. Lady said, the next Parliament will return to this issue. I was very open with Members during the Back-Bench debate on 15 January, and the hon. Lady knows that I am frustrated by the fact that we were not able to do more in the current Parliament. It is a matter of record from that debate that I spoke with Scottish Government Ministers in spring 2014 in anticipation that we would have an earlier report from the inquiry and that we might be able to move forward.

In response to the specific points the hon. Lady raised, let me reiterate something I said in my initial remarks: the one-off amount of up to £25 million is to support any transitional arrangements to a different system of financial assistance. That is intended to provide assurances to those affected by these devastating events that we have heard their concerns.

[Several hon. Members]

rose—

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[Andy Burnham (Leigh) (Lab)]

The 2010 to 2015 Parliament will be remembered for some extraordinary work to right historical wrong—on Bloody Sunday, on Hillsborough, on child abuse—but as it comes to an end this Parliament has not made enough progress on perhaps the greatest injustice of them all: the loss and ruination of many thousands of lives through the use of contaminated blood.

That is not to say there has not been progress. I pay tribute to my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) and many others across the House who have worked assiduously in this Parliament to keep this issue on the agenda. The Prime Minister was right to apologise yesterday, but my hon. Friend is right that it will have real meaning only if it is followed by efforts to bring truth, accountability and redress.

Let me ask the Minister about the one recommendation that the Penrose report makes: that all people in Scotland who had a blood transfusion before 1991 now be tested for hepatitis C. Does the Minister think that recommendation should apply in England?

Given that, as my hon. Friend says, Penrose does not answer all the questions, and nor does it apply accountability to those who made decisions in this regard, does the Minister think there now needs to be a further process of inquiry in the next Parliament to produce that accountability?

Finally, while we cannot bring about a resolution today, does the Minister agree that the best thing we can say to the many thousands of people affected who will be watching these proceedings is that we will work together across the House in the next Parliament to bring a full, fair and final resolution to this terrible injustice?

[Jane Ellison]

I absolutely agree with the right hon. Gentleman’s last point. This is a tragedy that goes beyond party and has spanned many Parliaments now and we do need to move forward. I can only reiterate my frustration at the fact that we were not able to make more progress in this Parliament, but I can give the assurance to the House, and through Members to their constituents, that a great deal of detailed work has been going on, and I am sure it will continue as the many pages of Lord Penrose’s inquiry are considered.

With regard to the one recommendation that Lord Penrose makes—that the Scottish Government take all reasonable steps to offer a hepatitis C test to everyone who had a blood transfusion before 1991—I can confirm that the Department of Health concluded a UK-wide look-back exercise in 1995 to try to identify everyone who might have received infected blood prior to 1991, but the Department will consider if anything more can be done on this in England. That work is very important and will be undertaken.

On the next steps, as confirmed in the written ministerial statement yesterday, all relevant documents have been, or will be, released. The Government’s initial reaction is that another inquiry would not be in the best interests of sufferers and their families as it would further delay action to address their concerns. The strong message I have had is that it is time for action, and I have just heard the same message from the shadow Secretary of State.

The apparent thoroughness of Lord Penrose’s report and the fact that it sets the events in Scotland in a wider UK context gives us a sense of the fact that he has looked at these events in the widest possible way, including for England. He has done a thorough job of examining the facts, and we now for the first time ever have that detailed authoritative narrative account of what happened, and that is an important building block on which the next Government can take their policy forward.

[Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab)]

You will recall, Mr Speaker, that on many occasions I have raised the case of John Prior, who is from Moodiesburn in my constituency. He was infected in the ’70s and his files have been lost. To put it bluntly, he is devastated; he says that the report offers him nothing. He regards the £25 million on offer from the Prime Minister as peanuts—not even sufficient for Scotland. The report cost £12 million, went on for seven years and has produced one recommendation. Does the Minister accept that that is not sufficient to respond to 4,000 people who are suffering? May we have a final agreement—a settlement—for every individual, consistent with what happened in Ireland and with the last Labour Government’s delivery on miners’ compensation? Otherwise, this report will be seen as a mountain that produced a mouse.

[Jane Ellison]

This inquiry was commissioned by a Scottish Minister—I believe it was the current First Minister—in 2008. It is a matter for the Scottish Government to comment on the length of time taken by Lord Penrose and the expense. The money announced in yesterday’s written ministerial statement was, as we said it would be, part of an interim response—it is interim because this very long report comes right at the end of this Parliament. I am sure that the next Parliament and the next Government will want to return to this and give a more substantive response to the findings of this very thorough inquiry.

[Michael Connarty (Linlithgow and East Falkirk) (Lab)]

I was the chair of the all-party group on haemophilia from 2001 to 2010, and what we got then was an interim settlement as well, because no one would face up to the fact that these people should be compensated, not just given an ex gratia payment or some more money to go away quietly. We are told that all documents were looked at, but in the time that I have been involved in this campaign we have been told by the late Alf Morris that he was promised by Lord Owen, a former Health Minister, that there were documents available which proved that after the Government adopted the policy that no more contaminated blood would be brought from America and from dangerous sources, the health service went on buying that blood. The report said that many people’s lives have been saved, but the reality is that somebody in the health service contaminated these people by breaching the policy of a Government. When are we going to see those documents revealed, and to look for a proper public inquiry and compensation for the victims, not some pay-off?

[Jane Ellison]

That is a rather harsh response. It is worth noting that the terms of reference given by the Scottish Government to the Penrose inquiry do not make reference to compensation. Yesterday’s written ministerial statement referred to an amount that is specifically intended to help with transitional arrangements while the next Government consider how they might want to take forward the reform of the various payments systems. We explored that in the Backbench business debate.

The report runs to many thousands of pages and has considered all of the many documents and statements, as I set out. All the relevant documents held by the Department of Health on blood safety covering the period from 1970 to 1985 have been published, in line with the Freedom of Information Act, and are available on the National Archives website. As part of our response to Lord Penrose’s report, we are releasing all the relevant documents on blood safety that we hold for the period 1986 to 1995. The Government have been completely transparent and open about that, and given the inquiry all the documents it asked for. We are now releasing all the relevant documents, subject to that. Some of the issues the hon. Gentleman refers to are, I am afraid inevitably, because of the timing of this report, a matter for the next Government to consider in detail.

[Yasmin Qureshi (Bolton South East) (Lab)]

My constituent David Fielding has suffered as a result of this and his whole life has been ruined. I ask this Government and any successive Government to compensate these victims properly.

[Jane Ellison]

As I have said, those are matters for the next Government to consider. Compensation was not in the terms of reference of the Penrose inquiry, but it was important, given the extent of the inquiry, that we waited for it to report. Unfortunately, it has reported too late for us to be able to make substantial progress in this Parliament, but I am quite certain that the next Government, held to account by the next Parliament, will return to these matters as a priority.

[Nia Griffith (Llanelli) (Lab)]

A constituent points out that he received a letter in 2009, stating that he could have been infected as late as 2001, including with variant Creutzfeldt-Jakob disease. As the report goes up only to 1991, will the Minister reassure those people that all the issues, even those going up to 2001, will be taken into consideration, and that they are equally likely to be compensated?

[Jane Ellison]

All relevant matters will need to be considered by the next Government. By the time the next Government are formed, and the next Parliament is assembled, Members will have had more chance to look at Lord Penrose’s detailed narrative of these tragic events.

[Mr Andy Slaughter (Hammersmith) (Lab)]

The Minister says she regrets that more has not been done in this Parliament. The main reason for that was that we were waiting for the Penrose inquiry—so that is doubly disappointing today. She says that much of the work has been done. I appreciate that her writ is about to run out, but has she or the Government formed the opinion that there should be a comprehensive financial settlement, of which what the Prime Minister announced should be just the downpayment?

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[Jane Ellison]

Yesterday’s written ministerial statement was just what I said it would be in the Backbench business debate on 15 January: an interim response to a very long and detailed report. All matters will have to be considered in a substantive response by the next Government.

[Andrew Miller (Ellesmere Port and Neston) (Lab)]

Will the Minister reflect carefully on paragraphs 111 to 113 of the Science and Technology Committee’s Legacy report on variant CJD? The Minister gave compelling evidence to our inquiry; the one area of difference was the long-term protection of research funding to give public confidence. Will she look carefully at that and put her response in the public domain?

[Jane Ellison]

I will certainly look at that matter, but I fear that I may not have time to put a response in the public domain. I can give an assurance to the Select Committee that were I to be in office in the next Parliament I would be happy to respond to that in detail. As the hon. Gentleman knows, we have had detailed exchanges on such matters over the past year.

[Huw Irranca-Davies (Ogmore) (Lab)]

The sad reality for all our constituents who are affected by this matter is that, after waiting for the Penrose report, nothing has materially changed for them during the life of this Parliament and it rests with the next Parliament to move forward. In a more positive vein, does the Minister have a view—personally and as a Minister and a representative of the Government—whether these people, whose lives have been torn apart, should be adequately compensated by the next Government?

[Jane Ellison]

I think the Prime Minister was clear yesterday when he told the House that returning to this important matter and these tragic events was a priority. The reason we say it is an interim response is that the Prime Minister and this Government feel that a more substantive response will need to be given in the next Parliament. Of course my feeling is that we need to return to this important subject and respond more substantively across a wide range of issues. I am well aware of the high concern among sufferers about the way in which the current financial assistance schemes work, and they will need to be considered in a great deal more detail.

[Kerry McCarthy (Bristol East) (Lab)]

On Friday, I met a hepatitis C nurse and support worker in Bristol, and they urged not only speedier diagnosis but earlier treatment for people who are infected, before they develop serious liver problems. Will the Minister take that thought back to her Department?

[Jane Ellison]

Of course. In my response to the Backbench business debate, I gave Members a sense of how to represent constituents as regards the latest NHS treatments. The latest treatments available for hepatitis C are of a different order of effectiveness and have many fewer side-effects than the older treatments and it is important that anyone affected is seen by a hepatologist and referred appropriately. NICE and the NHS are currently considering the new treatments.

[Pamela Nash (Airdrie and Shotts) (Lab)]

The report published yesterday suggests that NHS staff were working according to the best available knowledge at the time. As chair of the all-party group on HIV and AIDS, however, I often hear about current incidents in which NHS staff do not have the best available knowledge at their fingertips. What have the Government done and what are they doing to ensure that we have a well-informed NHS? Is the Minister confident that there is not a similar tragedy brewing within the NHS today?

[Jane Ellison]

For blood donations, the picture is thankfully very different today from the situation in the 1970s and ’80s that Lord Penrose was considering. Today, blood donations are screened for both HIV and hep C as well as a number of other infections. I recently visited the blood processing site at Colindale to see the rigorous and high-tech approach to blood safety in this country. Members can be more reassured in that regard. Of course, synthetic products are available for the treatment of all haemophilia patients for whom they are suitable. On the question of the latest knowledge, I can only reiterate that NHS England is considering a further early access policy to include patients with cirrhosis. It is aiming to have that in place in the first half of this year. Importantly, NICE guidance on the use of such therapies is also expected in the first half of this year.

Social Care and Military Compensation

Jane Ellison Excerpts

Wednesday 25th March 2015 Commons Chamber

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

I am grateful to the hon. Member for Blackpool South (Mr Marsden) for bringing this important issue before the House. It provides me with an opportunity to clarify our current position. I hope the hon. Gentleman will allow me first to place the issue in the broader context, particularly the context of reforms in social care.

To make some sense of that broader context, at the turn of this century there were 25 times as many people aged 85 and over than there were at the turn of the last century. Although this is something to be celebrated, it also means there are more people needing care and support, and three quarters of us can expect to need long-term care.

Care and support is an issue that has, I think, been ignored for far too long, and I am proud to say that this Government have taken steps to put that right. The Care Act 2014 is a bold and historic piece of legislation that for the first time places adult care and support law in a single clear statute. The Act puts people at the heart of the system by enshrining the principle of individual well-being at its core. It will ensure that people themselves will be able to shape their care and support, focusing on what they want to achieve and the outcomes that matter to them, and it will support them to maintain their well-being and independence for longer.

The Care Act focuses on acting early to prevent people from reaching crisis points, and will ensure that everyone can access information and advice to help them understand the new system and what it means for them. This means services for the broader community—not just those with assessed needs—further supporting our aim to help people to stay independent for as long as possible. When we do need care, the Act provides for a single threshold for eligibility to care and support in England, ensuring transparency and consistency, irrespective of where we live. I am pleased that this historic legislation will come into force exactly one week from today.

We do not intend to stop there. How we pay for health care and support is just as important as the care we receive. Most people do not realise that care and support has never been free, unlike health, and we have always been asked to contribute what we can afford. Those who have the greatest needs and the longest care journeys risk losing nearly everything simply to meet that cost.

For all the other areas of life where we face such risks, we are protected by the welfare state or we can protect ourselves through insurance. When it comes to care, however, successive Governments have taken a different view. We are often left alone at the point when we are most vulnerable. That is clearly not good enough, and I am proud that we will be introducing the biggest reforms of how we pay for care in over 65 years. We do so through the cap on care costs, which will put an end to the risk of catastrophic costs, and we will provide greater financial help for those who need it most.

The detailed proposals of how the new system will work are currently out for consultation. With just under a week still to go, I am pleased that we have already had over 700 responses and have engaged with over 1,000 people through a series of events helping to ensure that we take account of a wide range of views. The new cap system will play a critical role in helping people to plan and prepare for the risk of needing care and support, and create the right conditions for the financial sector to create new products that could cover these costs.

When it comes to those who have served their country and have made a great sacrifice in the line of duty, this Government have given a very clear commitment to support members of the armed forces community, both serving personnel and veterans. The hon. Member for Blackpool South has illustrated exactly why that is the right thing to do. We have enshrined that commitment in legislation through the armed forces covenant.

As the hon. Gentleman outlined, for those who have been injured in the line of duty there are currently two different schemes that provide compensation, based on when the injury occurred. For those who were injured before the 6 April 2005, there is the war pension scheme; for those injured afterwards, there is the armed forces compensation scheme. While both schemes have the same goals—to offer financial support to those injured in the line of duty—they are ultimately both a product of their time and the social context in which they were developed. Under both schemes, personal injury compensation lump sums are disregarded when deciding how much someone can pay for care, provided the payments are placed in a trust—I noted the hon. Gentleman’s concerns about regular payments—but other sorts of payments may be taken into account.

The war pension scheme was created after the first world war in response to the large numbers whose lives had been irrevocably changed as a result of their service to their country. In 1918, however, there was no welfare state, no NHS and no benefits system. Most people did not have access to private pensions, meaning that for those needing care but without family or friends to support them, the outlook was often bleak. The scheme therefore provided for that. It provides a basic war disablement pension and a variety of supplementary allowances that would be equivalent to the modern benefits system, and it reflects the fact that people needed to pay for both health and care costs.

By contrast, the armed forces compensation scheme introduced in 2005 reflects the fact that we have an advanced welfare state. It therefore looks to the NHS and the benefits system to provide support, just as it would to anyone, ensuring the principle of “no disadvantage” enshrined in the armed forces covenant.

The scheme introduced a modern, fair and simple system that provides a strong basis for the future, but this is a difficult and complex issue. I note the hon. Gentleman’s frustration—as he said, there has been much discussion—but, as I have said, the issue is complex. Depending on the extent of their injuries, veterans can receive a number of different allowances under the war pension scheme, such as constant attendance allowance, an unemployability supplement, comforts allowance, age allowance, treatment allowance, mobility supplement, and medical expenses.

The Royal British Legion broadly accepts that the treatment of war pension scheme payments is complex. I am grateful to it for highlighting its concerns, and for continuing to working with departmental officials to help us to understand the issue better. It is vital for us to understand it fully before considering what is to be done next. We must understand how the two schemes work, and the implications of considering any changes, to ensure that there are no unintended consequences, and we must also understand any cost implications of change. I note what the hon. Gentleman said about the commitment of his party colleagues to reviewing the scheme, but that commitment to a review suggests that they too are cautious, and feel the same need to understand the possible implications.

[Mr Marsden]

I do not wish to intrude on the Minister’s time, and I agree that the process is complex. I recall Churchill’s observation that it was not the end or even the beginning of the end, but it might be the end of the beginning. Will the Minister tell us how far down the line we might be expected to be at this point, and what stage the Government think has been reached?

[Jane Ellison]

I will come to that, and will try to give the hon. Gentleman a bit of reassurance about the advanced and ongoing work that is taking place.

Social care is a priority for the Government, and, in the context of difficult spending decisions, we have taken steps to protect care and support services. For example, we have allocated extra funds for those services during the current Parliament. We have created a better care fund, which, next month, will introduce a £5.3 billion pooled budget for health and care that will provide much needed funding for care and support, and will break new ground in driving closer integration of services.

Although spending on care and support is ultimately a decision for local government, we must be mindful of the overall fiscal position. I think that Members on both sides of the House agree on that. We must ensure that if we change the charging rules nationally, the cost will be met. To that end, my officials are continuing to work with their counterparts at the Ministry of Defence—I hope that that gives the hon. Gentleman some sense of momentum, and deals with his concern about “silo” working—and with the Royal British Legion, with a view to considering the issue during the spending review that will take place after the election.

I hope that the hon. Gentleman—and, indeed, all hon. Members—will welcome the historic reforms that will come into force in just one week’s time. They are very significant in the context of the broader issue of care. This Government have been the first to prioritise care and support. I hope that Members in all parts of the House will feel able to welcome the clear plans that I have set out for the future. As for the specific issue that the hon. Gentleman has raised, I hope he recognises that this is ongoing work which is taken very seriously. His securing of what has turned out to be the last Adjournment debate of this Parliament has underlined the importance of the issue that he has raised. I think that, throughout the purdah period and beyond, the debate will give added momentum to the work that is being done.

Given that this has been the last Adjournment debate of the current Parliament, Madam Deputy Speaker—and you and I have shared a number Adjournment debates—let me take this opportunity to thank you and, through you, Mr Speaker and the other Deputy Speakers. I also thank all the staff of the House, and, in particular, those who have sat through some of our late-night health debates, of which there have been many. However, I especially thank the Chair, and all those who have supported the Chair during these important Adjournment debates, which give us a chance—as tonight’s debate has—to explore important issues in some detail, outside the heated atmosphere that the Chamber attracts on other occasions. I also thank Members in all parts of the House, some of whom are very regular attenders at these debates, for their attendance tonight, and for the interest that they have taken in these important matters.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

I thank the hon. Lady for the gracious way she has thanked Officers of the House in respect of Adjournment debates. These debates are extremely important and she has taken part in many of them, as have I and the other Deputy Speakers and Mr Speaker, and we all appreciate how important they are. I also thank the hon. Member for Blackpool South (Mr Marsden) for introducing the final Adjournment debate of this Parliament.

Question put and agreed to.

Princess Royal University Hospital

Jane Ellison Excerpts

Wednesday 25th March 2015 Westminster Hall

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

I say now to colleagues who understandably are concerned about local health services and have rightly raised concerns on behalf of their constituents that if I cannot cover some of their questions in the next 12 minutes, I will undertake to write to them in the remaining days of this Parliament, or to ask someone else to write to them, so that we can try to give them some reassurance.

I congratulate the hon. Member for Lewisham West and Penge (Jim Dowd) on securing the debate and the hon. Member for Lewisham East (Heidi Alexander) on raising her concerns. Taking my cue from what was said previously, I start by paying tribute to all those working in London’s NHS—in those hon. Members’ constituencies, in mine and right across London—for their dedication and commitment to providing first-class services to those in their care at a time when we know that the system is, in places, under pressure.

As we have heard, after consulting with the trust, its commissioners and the London strategic health authority, the then Secretary of State instituted the special administration process at South London Healthcare NHS Trust in July 2012. He was guided in making that very difficult decision on the basis of the clinical interests of local patients, with advice from the NHS medical director, Sir Bruce Keogh. The decision was also based on the fact that there was no clear option for restoring the trust’s finances while maintaining the quality of services to patients. It was clear at the time that doing nothing was not an option. Not resolving the issues at the trust would have carried a high degree of risk. It would have meant that the trust would not meet the London-wide clinical quality standards and that £1 million a week would continue to be diverted from front-line patient care into funding an unsustainable deficit.

The trust special administrator looked extensively at whether there was an option within South London Healthcare NHS Trust to solve the problem. He invited expressions of interest from other people who might run the hospitals in the group, but no one was able to come forward with a proposal that would solve the problem within the existing footprint of the trust. Indeed, there were no proposals that would not have involved neighbouring health care economies.

The long-standing clinical, operational and financial problems at South London Healthcare NHS Trust led the trust special administrator to recommend that Princess Royal university hospital be acquired by King’s College Hospital NHS Foundation Trust. The associated hospital sites in Bromley—Beckenham Beacon and Orpington hospital—were part of that transaction. I must say for the record that the transaction agreement was signed by all parties and no information was withheld from any organisation.

At the time, South London Healthcare NHS Trust was the most financially challenged in the country, with a deficit of £65 million per annum. Repeated local attempts to resolve the financial crisis at the trust had failed. Millions of pounds were spent on paying for debt rather than improving patient care for the local community in south-east London. The trust special administrator was clear that long-standing problems at South London Healthcare NHS Trust must not be allowed to compromise patient care in the future. That is why, after careful consideration, the Secretary of State accepted his recommendations, including that the PRUH be transferred to King’s.

The new expanded trust is one of London’s largest and busiest teaching hospitals and plays a key role in the education and training of the next generation of medical, nursing and dental students. King’s has acknowledged that it has been facing a number of pressures that have had a bearing on its performance. The challenge of integrating and transforming the performance of the PRUH, combined with a significant increase in emergency in-patient activity, has, as the hon. Member for Lewisham West and Penge described, adversely affected the trust’s operational and financial performance. A key aim of the trust’s five-year strategy is to restore its traditional high levels of performance, in particular by returning to achieving its emergency department and referral to treatment waiting time targets.

Monitor has concerns that some patients are waiting too long for A and E treatment and routine operations and that the trust is predicting a deficit of more than £40 million in this financial year. The regulator is undertaking its investigation to find a lasting solution to long-standing problems at the PRUH. Monitor is concerned that the trust’s operational and financial performance issues post the acquisition of the PRUH have not improved in line with expectations. In particular, some long-standing financial and operational performance issues at the hospital have continued post acquisition.

[Robert Neill]

May I say this on behalf of my hon. Friend the Member for Orpington (Joseph Johnson), the Minister of State, Cabinet Office, who cannot be at the debate? He and I would want to put on the record the fact that there have been areas of improvement at the Princess Royal and at Orpington, particularly in terms of patient experience scores, which have picked up considerably. On the point that my hon. Friend the Minister just mentioned, we are especially concerned at the prospect that has been raised that the full financial picture may not become available to King’s until after the acquisition. It is very clear—I hope that the Minister can assure us on this—that the Monitor investigation is intended once and for all to get to the bottom of, the root of, the financial difficulties that this trust suffers. May I also say that I welcome the appointment of the noble Lord Kerslake as chairman of the King’s trust? He will bring considerable credibility and rigour to that process.

[Jane Ellison]

I thank my hon. Friend for that intervention. I will say more about Monitor’s role, but it is very much in line with what he said and I hope to give him the assurance that he seeks.

Monitor has been working with King’s, local clinical commissioning groups, the NHS Trust Development Authority and NHS England since the acquisition and has worked more closely with the trust recently to get a better picture of the challenges that it faces. However, Monitor has decided to take the new, formal action because King’s has not been able to tackle its challenges on its own. Monitor considers that continuing to work with the trust through more intensive and formal engagement will help to drive the necessary changes.

I want at this point to highlight the fact that, following a formal investigation into a suspected licence breach at a foundation trust, Monitor does not have the power to direct non-foundation trusts, nor does it have the power to direct neighbouring foundation trusts unless they themselves are in breach of their licence. The range of actions available to the regulator range from informal action—for example, requesting further information—to formal enforcement action, including the imposition of additional licence conditions.

Where appropriate, Monitor seeks to encourage the whole health economy to work together to reach a locally owned, consensual solution, which is very much in line with the NHS “Five Year Forward View”. Monitor has said that it recognises that King’s has been working hard, as my hon. Friend the Member for Bromley and Chislehurst (Robert Neill) has said, to improve the quality of care provided at the PRUH. However, through its close work with the trust, Monitor has discovered that achieving the necessary financial and operational turnaround at the PRUH will be a greater challenge than was initially anticipated. Therefore, the regulator has decided to open a formal investigation as part of the regulatory process, which will enable it to use its legal powers to underpin the changes that the trust needs to make. The investigation will help Monitor to decide what resources and support King’s needs to enable it to deal with its financial problems and reduce waiting times for patients. Monitor will announce in due course the outcome of the investigation and whether it will take any further action. There is no statutory time scale for the investigation, because it depends on the scale of the issues encountered. I am sure that all hon. Members would want those issues to be looked at thoroughly.

[Bob Stewart]

May I just confirm that that means that Lewisham hospital will not be touched by Monitor? Lewisham hospital was a successful hospital before the last investigation, and it appears to be a successful hospital now. If it ain’t broke, don’t fix it.

[Jane Ellison]

I have just made clear for the record what Monitor’s powers are and are not. I hope that that gives Members on both sides of the Chamber greater clarity than they had when we started. Monitor is in the process of concluding its investigation. It will announce in due course the outcome and whether it will take any further action. Key findings and any next steps will be announced by means of a press notice. Colleagues from Monitor are here in the House, and I would like to put them on notice that I expect—I am sure that they also expect this—Monitor to engage fully with local Members. Clearly, we are entering a more tricky period from that point of view, but on the other side of the election I expect there to be full engagement with local Members, particularly as the solution lies, as I think it will in other health economies that are challenged, in the whole local health economy coming together to understand how to work through the problems. That is laid out in NHS England’s “Five Year Forward View”.

[Heidi Alexander]

The Minister talks about further support that may be available to King’s and the PRUH when Monitor has concluded its investigation. Will she give some examples of the form that that support may take?

[Jane Ellison]

If it is acceptable to the hon. Lady, I will write to her to provide some clarity on that. It might be helpful, for example, for Monitor to give examples from other investigations of the sorts of things that it undertook and the changes that it requested through the formal process. I will write to her with some examples to give her a sense of that. I have sought to give a degree of reassurance to Members, and I hope that I have managed to do so.

[Jim Dowd]

I detect that the Minister has almost concluded her remarks, and I will not have the opportunity to intervene once she has sat down. I am grateful for what she has said, and I will look at the Official Report most carefully. I would be grateful to be copied in on any information that is sent to other Members.

I would like to make another point, out of courtesy, as much as anything else. The hon. Member for Bromley and Chislehurst welcomed the appointment of the new chair of King’s trust, Lord Kerslake. May I put on record a huge vote of gratitude to Sir George Alberti, who is standing down as the chair of the trust, for the service that he has given to King’s and the health service more generally?

[Jane Ellison]

That is entirely appropriate. I detect a desire among Members from all parts of the Chamber to work towards a better future for the health economy in their local areas. At the end of the process, we want sustainable, excellent services that offer the quality of care that we would wish for our constituents. Although there is not much time left in this Parliament, I undertake to look at the Hansard record of the questions asked by both hon. Members, because the topic is so important for their constituencies. If there is anything I can add to my remarks by way of clarity or response, I will get that to them. Monitor has heard me put on the record my desire for Members of Parliament to be kept fully involved and engaged with the process once we are through the small matter of the general election.

I believe that this is the last Westminster Hall sitting of this Parliament. In the minute that remains, I would like, on behalf of hon. Members who are present and the many hundreds of others who have spoken in and attended our second debating Chamber over the course of the Parliament, to thank you, Mr Betts, and, through you, all your colleagues who have chaired our debates. I thank all the staff of the House, the Doorkeepers and all who have attended and participated in those debates. I have apparently clocked up 50 debates while I have been a Health Minister, many of them in Westminster Hall. It is apparent to me that Westminster Hall serves an important purpose in allowing us to debate important matters, particularly those of the nature of the subject that we have discussed today. On behalf of all Members of Parliament, I thank all the staff and everyone who supports Westminster Hall in its duties.

[Mr Clive Betts (in the Chair)]

Order. For the last time this Parliament, the sitting stands adjourned.

Question put and agreed to.

Vaccine Damage Payments Act

Jane Ellison Excerpts

Tuesday 24th March 2015 Westminster Hall

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

I congratulate all hon. Members who have taken part in this debate. In particular, I congratulate the hon. Member for Dumfries and Galloway (Mr Brown) on securing the time to discuss an issue that is never easy to discuss. Other Members have alluded to the fact that when I, as a Health Minister, have looked at schemes about population-level health, sometimes there are discussions about the impact on individuals within that population and those discussions are very difficult to have.

I also congratulate the hon. Gentleman on the tone in which he has conducted this debate and indeed on the way that he has represented families and individuals over some years because, as I say, sometimes these are difficult issues to discuss. He has chaired the all-party group in a constructive way and I am sure that that has been appreciated by successive Ministers.

Also, the hon. Gentleman has said it before in this House, but I was very pleased that today he reiterated his support and that of the all-party group for a public vaccination programme. We are lucky to have a comprehensive and world-class national immunisation programme. I note that the vast majority of people who have concerns about the issue that we are discussing today do not disagree with the need for vaccination programmes of that nature.

Such programmes are a vital way of protecting individuals and the community as a whole from serious diseases. Vaccination is recognised by the World Health Organisation as the most effective public health intervention after the provision of clean drinking water. It has led to the eradication or major reductions in infectious diseases that used to be a serious threat to public health. British parents no longer see their children being crippled by polio, because that disease has been eliminated from the UK and, thankfully, from most of the world. Before measles vaccines were introduced, there were as many as 750,000 cases of measles in England and Wales in epidemic years, and about one in every 1,000 children infected would die.

Vaccinations are now safer than they have ever been, notwithstanding—obviously—the concerns that have been expressed during this debate. However, I recognise that on the very rare occasions when vaccinations can cause severe disability, that places both the person themselves and their families under enormous strain. Right hon. and hon. Members have spoken about that most movingly during the afternoon.

Of course, that is one of the main reasons why the vaccine damage payment scheme was introduced. As others have said, it was intended to help ease the present and future burdens of those individuals who are severely disabled as a result of vaccine damage.

I am sure it has been said before, but it is worth clarifying for the House that the VDPS payment is not compensation and it does not prejudice the right of the disabled person to pursue a claim against the manufacturer of the vaccine, although I of course acknowledge the obstacles that many people face in doing that. The hon. Member for Dumfries and Galloway, who led the debate, spelled them out. However, such payments would of course be taken into account if compensation was awarded.

The scheme, introduced in 1979, provides a tax-free, lump sum payment—as others have said, it is now up to £120,000—for those who are severely disabled as a result of a vaccination against those diseases listed in the 1979 Act and those that have been specified since 1979 by statutory instrument. It acknowledges that people who are severely disabled early in life have less opportunity to earn and save, and the degree of disablement is assessed on the same basis as for the industrial injuries disablement benefit scheme.

The disability threshold is set at 60%. I understand, of course, that there are those who argue that the level of disability should be assessed on a sliding scale. However, such a sliding scale of disability and payments would run counter to the scheme’s principle of providing a straightforward single payment for those who the Secretary of State for Health is satisfied are severely disabled as a result of vaccination.

To qualify for the scheme, a person must have become severely disabled as a result of vaccination. As I think the shadow Minister, the hon. Member for Liverpool, Wavertree (Luciana Berger), acknowledged, that causative link is needed for the scheme to be workable, but it does make for some difficult cases and some difficult conversations. I understand that, but that causative link helps us to target public funds properly for people who suffer disablement as a consequence of vaccination.

As with all civil matters, the standard of proof for causation is “on the balance of probabilities”. So, based on the available evidence, does the medical adviser consider that vaccination caused the disability? Notwithstanding the suggestions made to change, improve or even replace the scheme, there would always need to be an assessment of causation and it would always be the case that for some people who had suffered a disability, it would be viewed that the cause was not vaccination. There would always be instances that did not meet that criterion.

The scheme does not require the medical adviser to be certain or sure but only to consider that it is more likely than not that vaccination caused disability. These independent medical advisers are well placed and experienced enough to make that judgment, which is not made by politicians but by people who are carefully trained. For example, doctors who assess claims must be approved to carry out assessments by the chief medical adviser to the Department for Work and Pensions, and that approval is only granted when they have demonstrated full competence. Also, those doctors are subject to strict 100% quality audits until approval is achieved. I say that to make the point that there is a considerable degree of both medical expertise and independence involved in those assessments. I can also confirm that mental health, which I think was mentioned by the hon. Member for Strangford (Jim Shannon), is taken into account in those assessments of individuals.

The payment scheme is not intended to address all the financial implications of disablement for those affected by vaccines, which we have heard about this afternoon, and, as I have said, there is nothing to prevent people from bringing claims, although I understand that that process is difficult, as has been outlined.

The scheme is only one part of the wide range of support and help available to severely disabled people in the UK. For example, as many hon. Members will be aware, disability living allowance provides an important non-contributory, non-means-tested and tax-free cash contribution towards the disability-related extra costs of severely disabled children.

The VDPS covers immunisation provided in the routine childhood vaccination programme against specified diseases. It also temporarily covered vaccination against pandemic swine flu during the swine flu pandemic in 2009 and 2010. Hon. Members have raised applications to the scheme from individuals who developed narcolepsy and cataplexy following immunisation that used the swine flu pandemic vaccine, pandemrix. I will take this opportunity to emphasise that we appreciate how distressing narcolepsy and cataplexy are, and we understand the concerns of those who have been affected, and the concerns of their families. The DWP administers the VDPS and takes professional medical advice on the degree of disability involved, and obviously the Department of Health is responsible for policy in this area.

Swine flu vaccines were developed specifically for use in a flu pandemic, when the number of lives that could be lost and the number of people who could suffer serious illness would have been enormous. In the circumstances, it was considered by Ministers at the time that it was suitable to extend the VDPS temporarily, but in the circumstances that currently prevail it is inappropriate for me to comment on individual cases; I hope the House understands that.

The Government are advised on all immunisation matters by the Joint Committee on Vaccination and Immunisation, which is a statutory and independent body. The JCVI is also a departmental expert committee, constituted for the purpose of advising the Secretary of State for Health, and it keeps all immunisation matters under review, providing advice and recommendations to Ministers on all current and potential programmes, and advising the UK health Departments on national immunisation policy, including the safety and efficacy of a programme.

The Department of Health ensures that all its information on vaccination is clear that vaccines may have side effects, which thankfully are usually minor. However, the fact that a vaccine has been licensed shows that the benefits have been assessed as outweighing any known possible side effects. Nevertheless, as with any medicine or health care product, unfortunately a vaccine may cause side effects in some people. We have heard the stories of some of those who have been affected in that way.

Vaccine safety is of paramount importance and, as with all medicines and health care products, the Medicines and Healthcare Products Regulatory Agency and the Government’s independent expert advisory Commission on Human Medicines keep the safety of all vaccines under close and continual review. In response to the concerns that were raised by Members during the time that I have been the Minister with responsibility for public health, I have sought the advice of the MHRA, and had discussions with it, to raise some of the issues that Members have put to me, and to understand in some detail that process of continual review. I was satisfied that it is very robust and based on a continual review of the available evidence, both in this country and internationally.

The UK’s childhood immunisation schedule has been recommended by experts after consideration of a wide range of evidence, which, as I have said, includes evidence about safety reactions. That evidence is both national and international. The vaccines have undergone rigorous testing with large numbers of people before they are licensed, and their safety is continuously monitored to discover and assess any rare side effects. Vaccines are among the safest medicines available and as such, and as I have said before, side effects are rare. I am concerned that the hon. Gentleman thinks that reactions are not being captured properly. Again, I asked the MHRA about that. Obviously, the hon. Gentleman is well aware of the yellow card scheme, but perhaps he wants to give me more detail after the debate about reactions not being captured.

[Mr Brown]

On that point, it became abundantly clear, when I met the two ladies whom I mentioned in respect of their daughters and the HPV vaccine, that one of those mothers faced a major challenge in pursuing the local health authority to get the card recording exactly what had happened. There appeared to be some reluctance, although I am not sure what was underpinning all that. Some people have faced a challenge getting it properly recorded.

[Jane Ellison]

I am sure it would help the MHRA if the hon. Gentleman sent it details of that example. However, it sounds a little bit more as if there was a problem with a local clinician recording adverse reaction than with the scheme itself. I note what he says.

The UK’s programme has been a considerable success. I know that, in the context of such a debate, it seems hard to assert that, but I think that all hon. Members would acknowledge that generally speaking this country is seen as having a successful immunisation programme. Regarding MMR, which has been mentioned, coverage in England for children reaching their second birthday rose to 92.7% in 2013-14, compared with 92.3% in 2012-13. That is the sixth consecutive year that a rise in MMR coverage has been reported, and coverage is at its highest level since the vaccine was first introduced in 1988.

I note the hon. Gentleman’s concern that the current level of award may limit the take-up of vaccines, but I am hesitant to accept that as evidence, given the improved take-up of the MMR vaccine during a period when the VDPS has not changed. I am hesitant to accept what he says, but if there is peer-reviewed evidence of the link between the level of the scheme and the take-up of particular vaccines, I suggest he submits that to the Department.

Hon. Members will know that, since 1 May 2014, the VDPS has been the joint responsibility of the Department for Work and Pensions and the Department of Health. As set out in the 1979 Act, the Department of Health is responsible for policy, for example, changes to the list of infectious diseases covered by the Act in line with changes to the immunisation programme. The shadow Minister mentioned diseases added to the scheme. As has been said, the Department for Work and Pensions remains responsible for assessing the claims.

Hon. Members have put on the record the number of claims and awards made. I note concerns about awards made in recent years, but again it is perhaps not entirely right to assume that that is, in some sense, because the criteria have been changed, or anything like that. I have outlined the independent expertise of the medical assessors, and said that vaccines have got safer. Again, the causative link needs to be proved. However, I note the hon. Gentleman’s concern, and that of other hon. Members, about the lack of recent awards.

The vaccine damage payment scheme has always covered diseases vaccinated against as part of the childhood immunisation programme. That approach underlines successive Governments’ intention that the scheme should help children who are rarely, but regrettably, severely disabled. As I said, changes to and recommendations about that programme are made by the JCVI.

In 2002, the scheme was reviewed and changes were made. The threshold of disability was reduced from 80% to 60% and, as we have said, the payment increased to £120,000.

[Mr Brown]

I appreciate what the Minister is saying. Will she give hon. Members in the Chamber her personal thoughts on the balance of probability?

[Jane Ellison]

My sense is that the scheme, which aims to provide proportionate help, has got the balance about right, but I have heard the concerns expressed today. It is worth noting that successive Governments have considered this matter and chosen not to alter the scheme. That consideration would have involved looking at it in some detail. Equally, I note gently that the shadow Minister, analysed the situation and asked many questions, but made no commitments, although she aspires to sit in my place in just a few weeks.

The House will note that many successive Governments of different parties have looked at the scheme and have, I think, drawn the same conclusion, which is that the balance is about right. That is not to say that the hon. Gentleman’s concerns are not listened to: far from it. I have listened to his concerns and will take those away and reflect on them.

There are no current plans to make any changes to the time limits. Again, the hon. Gentleman made his case about that, as did other hon. Members.

[Barbara Keeley]

I hear what the Minister is saying, but this may be the last chance to comment. I talked about a case where the payments are not in any way compensatory. Previous Governments lifted the level of payment substantially up to £120,000. Can she not give any hope to parents in their 60s who are struggling with care? Care is expensive, and increasingly so under her Government. What can she say to give some hope to parents in that situation, of whom, as we have heard, there are very many, including my constituents?

[Jane Ellison]

The challenge is that a number of aspects of the scheme, which has existed under successive Governments, make some individual cases particularly hard. The hon. Lady has touched on some reasons for that in her contribution.

The Government have no plans to change how the scheme is run, as one might expect in the last week before the House rises before the general election, and there are no plans to review it, as I have said. However, we are about to have a new Parliament. I am sure that the hon. Member for Dumfries and Galloway and other hon. Members may wish to return to this subject. The work of the all-party group will continue. The hon. Gentleman has indicated that he wants to raise the reform of the Act in the new Parliament. The shadow Minister has made some points, but no commitments. The hon. Member for Dumfries and Galloway may therefore wish to use the next few weeks lobbying within his own party, if he cannot speak in Parliament, making his case forcefully to his colleague.

I note the concerns expressed today. I am not in a position to say that the scheme will be reviewed. As is the way of these things, all these matters will now be for a new Government to consider. However, the hon. Member for Dumfries and Galloway put his points thoughtfully, as ever, and they have been thoughtfully taken on board and will be considered.

Barts Health NHS Trust

Jane Ellison Excerpts

Thursday 19th March 2015 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on Barts Health NHS Trust being placed into special measures.

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

The NHS Trust Development Authority announced on Tuesday 17 March that Barts Health would be placed into special measures. This followed a report by the Care Quality Commission which rated services at the Barts Health site at Whipps Cross as inadequate. As a result of this decision the trust will receive a package of tailored support to help it rapidly make the necessary improvements for patients. This will include the appointment of an improvement director and the opportunity to partner with a high-performing trust. The chief inspector of hospitals has highlighted the scale of the challenge ahead and this is an opportunity to ensure that the trust has the extra support it needs to meet that challenge. Barts Health has already announced that it has begun to strengthen management arrangements at Whipps Cross, in response to concerns raised by the CQC.

We make no apology for the fact that, under the new rigorous inspection regime led by the chief inspector of hospitals, if a hospital is not performing as it should, the public will be told. If a hospital is providing inadequate care and we do not have confidence in the ability of its leadership to make the required improvements without intensive support, it will be put into special measures. It will remain in special measures until it is able it to reach the quality standards that patients rightly expect.

While the trust is in special measures, it will receive increased support and intensive oversight to help it address its specific failings. This process is publicly transparent, so patients and the public can see and track for themselves, online through the NHS Choices website, the progress that their trusts are making. Any changes or additional support required for the trust leadership are put in place early on in the improvement process, as has already taken place at Barts Health.

The expectation is that an NHS trust or foundation trust will be re-inspected by the CQC within 12 months of being placed in special measures. It is the job of the chief inspector of hospitals to recommend when a trust is ready to exit special measures. The NHS TDA or Monitor will then formally decide to take the trust out of special measures when it considers the trust is able to sustain the quality of care at the level patients rightly expect.

[Andy Burnham]

Barts Health NHS Trust is no ordinary hospital trust: it is the largest NHS trust in England, employing more than 14,000 staff and treating patients from all over London and indeed the whole country. Importantly, it is also one of the few trusts directly managed by the Trust Development Authority and the Department of Health.

Is it not true that the problems at Whipps Cross have been known for some time and have not just been uncovered this week? Is it not also true that these problems have been allowed to get worse over the past two years, with 208 serious incidents in the last year alone, and that specific warnings have not been acted on? Given all this, is it not a cause for real concern that this trust has become the 20th to be placed in special measures under this Government? People in east London need to know why, and what is being done to bring their hospital back up to an acceptable standard. Does the Minister accept that, given the seriousness of this issue, they are entitled to be disappointed that the Secretary of State is not here today to respond to these concerns?

One of the report’s main conclusions is that the root cause of care problems in the past two years was the reorganisation of the trusts in 2013. It states that

“the decision…to remove 220 posts across the trust and down band several hundred more nursing staff had a significant impact on staff morale and has stretched staffing levels in many areas”.

These findings raise significant questions for the Department and Ministers. Given that it is a directly managed trust, was a proper assessment made of the reorganisation plans, and was it signed off by Ministers? Why did Ministers overrule the Co-operation and Competition Panel, which advised against the proposed merger and warned of material costs to patients? What action did the TDA, the Department and Ministers take on the warnings raised at the time?

The Minister will know that my hon. Friend the Member for Leyton and Wanstead (John Cryer)—I am afraid he has a constituency engagement this morning; otherwise, he would have been here—and, as I understand it, her Cabinet colleague the right hon. Member for Chingford and Woodford Green (Mr Duncan Smith), raised specific concerns about the decision to remove the management structure from Whipps Cross Hospital, concerns echoed by my hon. Friend the Member for Walthamstow (Stella Creasy). Why were those concerns ignored, leaving Whipps Cross without an adequate management structure?

Looking ahead, can the Minister say more about what is now being done to improve management at Whipps Cross, and to reassure local people that their hospital is safe? What immediate steps are being taken to improve staff numbers? On finance, is she aware that the bill for agency staff across the trust has gone up by a huge 44% in the last year alone, and what is she doing to bring that down? It is unsustainable and unaffordable, but it is also damaging standards of patient care on the ward and continuity of care.

The inspection took place in November. Why was it published only this week—one day before the Budget? Given that this is about a failure of NHS management, why is the Department of Health still sitting on the report by Lord Rose on NHS management? Will the Minister give a firm commitment to this House today that it will be published before Parliament is dissolved?

This report has been widely described as the worst assessment ever seen from the CQC. It will be seen as a symbol of the decline of the NHS on this Government’s watch, and people are looking now, today, for an urgent plan to turn things around.

[Jane Ellison]

The whole House will have noted that the right hon. Gentleman asked why the report has only just come out. He might reflect on his own time in office, when there were reports that did not come out at all just before the general election. If there is any better example of weaponising the NHS—we have just seen it. Instead of trying to make political capital, should the right hon. Gentleman not admit that the new CQC inspection regime illustrates exactly why transparency is so important, and why this Government were right to implement it?

Under the previous Government, failures of care were swept under the carpet and not acted on, which led to the tragic consequences we know about. Before the last general election, Labour tried to block the publication of a devastating report into Basildon and Thurrock hospital. [Interruption.] These are serious matters, and that is exactly why the CQC inspection has to be taken seriously. As I have said, local management is looking at these important issues, some of which we have debated before in the House, and which need to be addressed very seriously. However, the hospital management are beginning to do that, and they must take such action to ensure that they bring care up to the right standards.

All the things that the CQC has identified have to be addressed. As I have said, this illustrates exactly why the new CQC inspection regime is so important. Even now, a week before Parliament dissolves before the general election, this Government are committed, without fear or favour, to transparency and to bringing out this report. We are committed to ensuring that we put into the public domain the measures that need to be taken to put that hospital back on track and to ensuring that its patients can have confidence in the safety of its operation.

[Jeremy Lefroy (Stafford) (Con)]

This is a very serious matter, and it is extremely important that it should be brought to the House. I am pleased that the Francis report on Mid Staffordshire resulted in the appointment of a chief inspector of hospitals, which has led to the production of reports such as this, but does the Minister agree that this case highlights the vital importance of having proper safety systems within each health and social care provider, as is proposed in the Health and Social Care (Safety and Quality) Bill, which is now going through the House of Lords with the support of the Opposition and the Government? Will she ask the CQC to ensure that each hospital and social and health care provider that it inspects has such safety systems in place and that that includes management systems, to ensure that the providers cannot make cuts that would put patient safety at risk?

[Jane Ellison]

I pay tribute to my hon. Friend’s remarkable work in this Parliament on campaigning for transparency in patient safety. He is exactly right to say that these are important features of the inspection regime. As I have said, work has already begun to strengthen the management arrangements at Whipps Cross, but he is right to say that patient safety must be the predominant concern of the management when they come to address failings such as these.

[Stella Creasy (Walthamstow) (Lab/Co-op)]

Whipps Cross is my local hospital. I have been a patient there and my family have been patients there, as have friends and neighbours. I join the right hon. Member for Chingford and Woodford Green (Mr Duncan Smith) and my hon. Friend the Member for Leyton and Wanstead (John Cryer) in being horrified at what I am sure they would see as the Minister’s insulting response to this issue. She is playing politics with the hospital that serves our community. We all want to put on record our support for the patients and staff who spoke out and demanded that the CQC should come back to the hospital, despite the assurances from the management and the Government that all was well there. They were begging the CQC to return to look again at Whipps Cross, and when we read the report, we can see that they have been vindicated. The lead inspector has rightly expressed his concern that front-line staff will feel even more demoralised following the report, and that their welfare needs to be our priority. What assurances can the Minister give me that, rather than playing party politics, she will listen to the inspectors and heed that warning?

[Jane Ellison]

The hon. Lady is quite right to say that patients would be concerned, but they should also be reassured that this inspection regime has exposed some of the issues, and now is the time for them to be addressed adequately. The additional support that the trust will receive as part of the special measures is part of what will help it to make the necessary improvements for patients. The chief inspector of hospitals has highlighted the scale of the challenge ahead, but this is an opportunity to ensure that the trust has the extra support to meet that challenge. That is exactly why the regime exists—[Interruption.] I am sure that, like me, the hon. Lady will have been concerned to read of the culture of bullying and low morale, which is not acceptable. Part of the transparency regime that this Government have put in place involves ensuring that staff can speak out, and I am glad that some of them did. It is never acceptable for staff to feel unable to speak out on the issue of poor care, so I am glad that this report has given them the chance to voice their concerns. Those concerns must now be properly addressed.

[Dr Matthew Offord (Hendon) (Con)]

The House will be reassured by the Minister’s coming to the House today to make this statement and taking this early opportunity to highlight these issues. [Hon. Members: “What? She was dragged here!”] I am sure you would agree, Mr Speaker, that the Minister stands head and shoulders above those who failed to do anything during their time in office to ensure patient safety.

[Jane Ellison]

I thank my hon. Friend for that—[Interruption.] We are hearing a lot of chuntering from a sedentary position, but I refer the right hon. Member for Leigh (Andy Burnham), who asked the urgent question, to a quote from Roger Davidson, former head of media at the CQC, who said in evidence to the Francis inquiry that

“there were conversations between the CQC and ministers to the effect that the CQC would not cause any trouble in the run up to purdah. The message that we don't want bad news infected the whole organisation.”

However much of a small discomfort it might be to Ministers to come and answer an urgent question on such an important matter for patients, people should be reassured that it is far more important that these issues come out transparently, whatever the timing, even if it is ahead of a general election.

[Mike Gapes (Ilford South) (Lab/Co-op)]

Both trusts that serve constituents in the London borough of Redbridge—Barking, Havering and Redbridge, which serves King George hospital in my constituency, and Barts, which serves Whipps Cross—are in special measures. In 2013, the Government forced the closure of maternity services at King George hospital, and as a result some of my constituents had to go to Whipps Cross. I am therefore shocked by what I have seen in the report. It is about time that the Government ruled out their plans to close the A and E at King George, because I do not want constituents of mine dying as a result of inadequate provision in north-east London.

[Jane Ellison]

The hon. Gentleman and I have debated these issues in Adjournment debates in this House, so I know that they are of great concern to him. All these issues in that part of London’s health economy need to be considered.

[Rehman Chishti (Gillingham and Rainham) (Con)]

Will Barts be given the same excellent support from the Government as Medway hospital in my constituency, which is in special measures? It has received extra resources and been paired with excellent hospitals such as Guy’s and St Thomas’s. Will the Minister join me in paying tribute to the excellent staff who work day in, day out caring for patients at Medway? Will she also note that in 2006 Medway hospital had the seventh highest mortality rate in the country, yet nothing was done? Will the shadow Health Secretary apologise for that? I welcome the support that the Government have given Medway hospital to turn it around.

[Jane Ellison]

I thank my hon. Friend for that question. He illustrates the fact that these problems can be addressed through this regime of extra support. I pay tribute to the staff at his local hospital, who have worked so hard to address the failings and to provide much safer care for their patients. He illustrates exactly why this regime of being transparent about issues and ensuring additional support can be given to trusts to address their problems can be successful and can benefit patients.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

I am shocked by the Minister’s tone, as there are genuine concerns about the services that my constituents and those of colleagues are receiving. Barts is the largest trust in England, and when it was formed many concerns were raised. It dilutes accountability and direct line management. Does she agree now that it was too big and that consideration needs to be given to making a number of trusts out of this large trust that are more manageable and directly accountable?

[Jane Ellison]

As the hon. Lady knows, the site in question in this report is Whipps Cross. The priority for its management is to address the issues that the CQC has identified.

[Stephen Metcalfe (South Basildon and East Thurrock) (Con)]

As my hon. Friend knows, Basildon hospital was one of 14 to go into special measures and one of the first out. I believe that the reason for that is the Government’s openness to accept there are problems and not duck them, the hard work of hospital staff and the open and transparent attitude adopted by the management team to accept the problem and make it their own. Is my hon. Friend confident that the leadership of Barts is willing to accept the problems unreservedly and has the ability to face up to the challenges?

--- Later in debate ---

[Jane Ellison]

The failings at the site are laid out in black and white in the CQC’s report and it is important that people accept that. There will be intensive support to address that, and the management have already said that they are looking at the problems and have begun to address them. My hon. Friend is right that management and leadership are critical. We have seen that in his area and in others, and that is what those involved must now face up to.

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

My hon. Friend the Member for Bethnal Green and Bow (Rushanara Ali) and I have been assisting the save our surgeries campaign in Tower Hamlets for 18 months, because, like many other GP surgeries in east London, ours are feeling under threat. Today’s response from the Minister indicating that the trust for Barts and the Royal London is in special measures, as well as the Barking, Havering and Redbridge University Hospitals NHS Trust, demonstrates that there is anxiety across east London about the state of the national health service. We did not hear anything in the Budget statement yesterday to give any reassurance to the people of east London. Does the Minister not recognise how serious this is for east London?

[Jane Ellison]

This report alone is a very serious report, and of course it is recognised. But it is right that we are transparent about it. As a London MP, I know some of the challenges that parts of the London health economy face. The issues need to be addressed, but this Government have put record amounts into the health service. We are also committed to backing the NHS’s own “Five Year Forward View”, and moving forward new ways of delivering GP care is a part of that vision. We have to make sure that that delivers for the hon. Gentleman’s constituents, as well as for mine and for other people in London.

[Several hon. Members]

rose—

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

Absolutely, and not least because we warned of these dangers during the passage of the Health and Social Care Bill, which later became an Act. With all due respect, I should point out to the Minister, on her references to openness and transparency, that this failing has happened as a direct result of mergers introduced by this Government. May I respectfully point out that when this merger was approved by the Secretary of State three years ago, Labour MPs, including my hon. Friend the Member for Leyton and Wanstead (John Cryer), did point out that such a change would be a disaster, and that has come to pass? The Secretary of State pressed ahead. May I point out the bullying issues that the report throws up? The chairman of the Unison branch was sacked on trumped-up charges. Will the Minister issue instructions to have those individuals reinstated?

[Jane Ellison]

The bullying of NHS staff who are trying to draw attention to poor care is never acceptable, and this Government have taken a lot of measures to make sure that NHS staff are protected. The trust’s chief executive has said the following about the report:

“We are very sorry for the failings identified by the CQC in some of our services at Whipps Cross and we know the Trust has a big challenge ahead.”

Part of that big challenge will be in restoring staff morale, and making sure that that culture of openness and support for staff is in place.

[Heidi Alexander (Lewisham East) (Lab)]

The placing of Barts into special measures this week confirms what many of us already know: London hospitals are under enormous pressure, some simply cannot cope and too many patients are not getting the care they deserve. In the light of that, can the Minister confirm that the recently announced Monitor investigation into the Princess Royal hospital at Farnborough will not result in another attempt by her Government to take the axe to Lewisham hospital and to services in south-east London more generally?

[Jane Ellison]

I believe we may well be addressing that issue in an Adjournment debate next week. There will be a chance to discuss it in more detail then.

[Liz McInnes (Heywood and Middleton) (Lab)]

Like my hon. Friend the Member for Easington (Grahame M. Morris), I am not from London, but I do feel qualified to speak on this subject. The issues that have been raised about staff morale and the “down banding” of nurses are all too familiar to me. Until October last year I worked for the NHS—I worked for the NHS for more than 30 years—and what is going on at Barts is very similar to what was going on in the trust in the north-west where I worked. Again, it was a large trust, having been formed by the merger of four hospitals. It is an unworkable plan. As my hon. Friend said, we warned about what was going to happen with the Health and Social Care Bill, and it is depressing to see all this come to fruition. The cost of agency staff, which has been referred to—

[Liz McInnes]

My question is regarding the trade unions and the welfare of staff. Staff morale is at an all-time low in the NHS, and trade unions need to be involved in any special measures that are taken in this trust.

[Jane Ellison]

The CQC’s inspection report does identify some issues of concern to do with staff morale and bullying. As I said to the hon. Member for Easington (Grahame M. Morris) a moment ago, the issues need to be addressed. We want a culture in which all staff can speak out about poor patient care and feel supported in doing so. That is exactly what we have put in place over recent years.

[Paul Flynn (Newport West) (Lab)]

It has been very disappointing that the Minister, for whom I have a very high regard, has dealt with this disgrace with a crudely political response. Does she not agree that an important element in the recovery of all patients is for them to have faith in their doctors and in the health service? No Government have done more than this one to undermine confidence in the health service throughout the nation. Does she not feel that great damage is being done by making the greatest political achievement of the past 100 years—the national health service—a political football to be knocked about by parties and by undermining that faith in the health service? That is something that the public will not forget and will never forgive.

[Jane Ellison]

I do not agree with the hon. Gentleman’s basic premise—not at all. In fact, recently, people’s satisfaction with the NHS has gone up. What he says is a slur on our hard-working clinicians, who respond so magnificently to the pressures in our system. This Government have backed them with money and support. I just do not recognise the picture the hon. Gentleman paints.

[Several hon. Members]

rose—

--- Later in debate ---

[Mr Speaker]

I note what the shadow Secretary of State has said. He has put it on the record. The Minister is welcome to respond if she wishes, but she is not obliged to.

[Jane Ellison]

I was not a Member of the House at that time. Of course I would not wish inadvertently to mislead the House. Nevertheless—[Interruption.] I read out evidence that was given to the Francis inquiry that made it clear that such a culture did exist. However, if, on the specific point, I was not quite right, I will withdraw what I said.

[Mr Speaker]

I am grateful to the hon. Lady for what she has said. We will leave it there.

HIV Prevention

Jane Ellison Excerpts

Thursday 12th March 2015 Commons Chamber

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

I congratulate my hon. Friend the Member for Finchley and Golders Green (Mike Freer)—my friend in every sense—on securing this debate on a very important subject. As he said, it is one that we perhaps do not discuss enough. I am delighted to have the opportunity to respond. I pay tribute to him for his long and distinguished record of campaigning in this area, and for the important work he has done in our party on equalities and in this Parliament in championing HIV prevention and other important matters.

Other distinguished colleagues are in the Chamber this evening. The right hon. Member for Exeter (Mr Bradshaw), a former Health Minister, has done long and distinguished service in this field, and it is good to see him in his place. It is also good to see my hon. Friend the Member for Ribble Valley (Mr Evans) in his place, and he highlighted the important issue of homophobic bullying in a telling intervention. I also wish to place on record my thanks to my hon. Friend the Member for Brighton, Kemptown (Simon Kirby), who has done great work, with others, in lobbying Ministers extensively on the subject of HIV prevention.

Many good points have been made, and I will pass on the passionate views on sex and relationship education to my right hon. Friend the Secretary of State for Education. I am sure that she will want to be aware of those comments, but I shall not attempt to respond to them myself.

I am proud of the Government’s record on tackling HIV, including on prevention. In 2012-13, the Government spent an estimated £630 million on HIV treatment and care, which has been key in enabling people with HIV to live long and healthy lives. The success of that treatment is shown by that fact that 90% of those on treatment are virally suppressed, substantially increasing their lifespan and significantly reducing their risk of passing HIV to others. However, as my hon. Friend the Member for Finchley and Golders Green said, we need to do far more to stop people getting HIV in the first place.

On top of the money I have just mentioned, we have given local authorities a ring- fenced public health grant of £8.2 billion over three years and mandated the provision of sexual health services as part of that. We welcome the fact that new HIV diagnoses have fallen from 6,333 in 2010 to 6,000 in 2013, and the proportion of late diagnoses continues to decline—down to 42% in 2013 from 50% in 2010—but we have a lot more to do, and my hon. Friend outlined some of the concerns in his speech.

The Government have taken action beyond awareness-raising and testing, for example through lifting the ban on the sale of home testing kits. Reducing the number of HIV infections, especially in men who have sex with men—MSM—is important because we have seen a worrying trend in new infections. In 2013, there were an estimated 3,250 new diagnoses, the highest number ever reported. That really is a cause for concern and one of the reasons why it is good that we are debating the subject this evening. We also know that transmission is continuing among black African men and women who are acquiring their infection within the UK.

It is estimated that one in eight gay men in London are HIV positive, and while that might sound alarming, it also reflects the success of treatment and that more and more people are now living into old age with HIV. My hon. Friend rightly put a focus on being more innovative, and the importance of preventing the spread of HIV is one of the reasons why the Government have committed to protecting the HIV prevention budget—but I am clear that we need to be more ambitious and innovative. That is why we are redesigning our HIV prevention programme for England in 2015-16. I see this as a transitional year towards the updated long-term strategy for HIV prevention and sexual health promotion more widely. In future, this work will be led and managed by Public Health England, which is consistent with its wider work on health promotion and social marketing. I expect PHE to work closely with local authorities to promote the health of their populations.

One of the most exciting innovations to promote HIV testing is postal home sampling kits. Public Health England and local authorities will establish, for the first time, a national home sampling service. Through this, we will be able to deliver up to 50,000 home sampling kits in 2015-16, around three times as many as last year. That will augment the continued growth in HIV tests performed in genito-urinary medicine clinics—more than 1 million tests in 2013, which was 100,000 more than in 2010. People knowing their HIV status is important not only in getting treatment and allowing them to live a long and healthy life, but, critically, in preventing HIV from being passed to others. We now know that being on treatment substantially reduces the risk of passing on HIV. That testing is critical and a key component of our public health response to HIV.

We will continue to contract with the Terrence Higgins Trust in running public awareness campaigns. Changes to that contract have been made for 2015-16, but it is a respected charity in the field and its work remains an important strand of our HIV prevention programme. THT will have an increasing focus on digital platforms to meet the needs of the 21st century, including using Facebook and Twitter. The potential is huge. A single push on a phone app has consistently generated more than 1,000 postal test orders. In addition, those contacted through Facebook have turned out to be three times more likely to return a postal test than those contacted through any other route. Facebook is used by all age groups. It is therefore an important access point, particularly given the middle and older age profile of many of those diagnosed HIV positive.

THT will also continue to work with local partner organisations to talk to those at highest risk face to face, particularly those without access to the internet or to more traditional media. Those conversations include encouraging tests in GUM clinics, use of postal test kits and offering point of care tests in a diverse range of settings, including in churches and shops. That work is particularly important in reaching black African populations who are less likely to attend GUM clinics, but more likely to be diagnosed late.

[Mr Bradshaw]

I thank the Minister for her kind comments about the Terrence Higgins Trust. I refer hon. Members to my declaration in the Register of Members’ Financial Interests—I am a trustee. Can she clarify whether she has announced specifically how the Government’s public health HIV prevention budget will be spent? If not, will she tell us when she expects to make that detailed announcement?

--- Later in debate ---

[Jane Ellison]

In about four paragraphs’ time, if the right hon. Gentleman will bear with me.

As I have said, I want to be more innovative in how we prevent the spread of HIV. I am pleased to announce tonight an innovation fund up to £500,000. We want to give grants of £50,000 to £100,000 to local organisations or groups of organisations, who want to work in new and innovative ways to tackle HIV. As of tomorrow, those who wish to apply can contact PHE and register their interest. PHE will work with chosen organisations to ensure the work they are doing is aligned with the work local authorities are doing to prevent HIV infections in their area. Applicants must seek endorsement from their relevant local authority before submitting a final application. The grant awards process will take place through late spring and early summer this year.

In addition, PHE has invested £150,000 in new innovative work on reducing late diagnosis of HIV, and the Elton John AIDS Foundation has generously matched funding. My hon. Friend the Member for Finchley and Golders Green mentioned the Dean Street Express model. We also think this is an excellent model. We support that approach and will promote it in other areas.

Turning to the long-term strategy, as I have said I want the HIV prevention programme in 2015-16 to be a transition towards our longer-term strategy for HIV prevention, and for sexual and reproductive health more widely. PHE has today initiated a process of engagement with stakeholders in this field to seek their views in drawing up the strategy from 2016-17 and beyond. That will set out the short and medium-term priorities for HIV prevention and sexual and reproductive health promotion. It also considers how all of this work needs to pull together and highlights the level of need that will need to be met in the future. As part of that engagement plan, PHE will meet key stakeholders in this field in the next Parliament to discuss its plans in more detail and be able to give them more information.

Turning to pre-exposure prophylaxis, which my hon. Friend mentioned in his speech. The results of the PROUD research trial are very encouraging: 86% of the men, many of whom were at very high risk of acquiring HIV, remained HIV negative. Importantly, those taking PrEP in the trial did not have an increased rate of sexually transmitted infections. The PROUD research trial results are an important first step and the work continues. NHS England has set up an expert group to consider whether PrEP should be managed on the NHS and how this might be practically delivered.

[Mike Freer]

I am grateful to the Minister for that announcement. Is she able to give us any indication of how quickly the expert panel will report?

[Jane Ellison]

I am sure we would all want the panel to do that work in a timely fashion. I am not able to provide a date tonight, but I will convey the sense of urgency here in the Chamber to NHS England.

Hon. Members made important points about stigma and discrimination. I can only support everything they said. There is some encouragement: in the latest Ipsos MORI poll in 2014, the National AIDS Trust reports that overall public support for people with HIV is higher than ever, with 79% agreeing that people with HIV deserve the same level of support and respect as people with cancer. That is up from 2010. There is room for improvement, however, and a need for engagement across the spectrum. The NHS, local authorities, the Government, community and faith groups, the media—everyone has a part to play in eliminating HIV-related stigma. I note the comments about the role of schools—I will convey them to my right hon. Friend the Secretary of State—and the intervention about homophobic bullying. The Government have invested money in tackling such bullying and take it extremely seriously. It remains a concern for all of us.

It is positive that the number of new HIV infections overall continues to fall, and I believe that the Government can be proud of their record in this area, but the rise in the number of new MSM infections and the high levels of late diagnosis among black African populations are of great concern. Today I have set out how we will be more bold and innovative with the HIV prevention programme, including through a new national home sampling programme—one of the first of its kind in the world—increased use of social and digital media platforms and the setting up of an innovation fund to trial new approaches. Importantly, we are working in partnership with local authorities in taking this work forward. I see this as a transition to a long-term plan for HIV prevention and sexual and reproductive health promotion, and it is our ambition to see infection rates falling, not rising, and late diagnosis becoming a much rarer event. I thank all right hon. and hon. Members for their contributions to this excellent debate.

Question put and agreed to.

Local Pharmaceutical Services

Jane Ellison Excerpts

Tuesday 3rd March 2015 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Howarth. I congratulate colleagues on their contributions, and I particularly congratulate my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) on securing the debate and highlighting some of the challenges facing local pharmacies. For me, as the Minister with responsibility for public health, the debate is also a welcome opportunity to place on record the wider contribution that pharmacies make. The right hon. Member for Rother Valley (Kevin Barron) singled out that contribution and emphasised the potential of pharmacies.

I hope that I can give some of the reassurances that the shadow Minister, the hon. Member for Copeland (Mr Reed), sought. Overall, the picture for pharmacy is positive, and it has the potential to play a greater role. I have talked about and, I hope, championed that on a number of occasions, and there is an awful lot more that we can do. I will talk a little bit about that wider point, but I will also address the specifics of the essential small pharmacies scheme and the challenges that face those pharmacies.

People understandably appreciate the ability to access pharmaceutical services near to where they live or work. Essential small pharmacies have, in the past, been valuable in securing and maintaining the community access that my hon. Friend the Member for Romsey and Southampton North has so ably described. NHS England’s five-year forward view makes it clear that our health services must evolve to cope with not only increasing demand but the different patterns of people’s lifestyles. Every part of the health system is now considering how best to engage with that challenge and how to allocate available resources most efficiently.

Although others have touched on it, it is worth revisiting the history of the essential small pharmacies scheme. It has been in existence since the 1960s as a way of ensuring access to services in local communities for patients and the public in locations where the viability of such pharmacies might have been uncertain. As others have said, that is often in isolated rural areas, but not exclusively; sometimes such pharmacies are in new residential developments, for example. The scheme operates against a backdrop that has changed a great deal since its inception in the 1960s, and I will perhaps touch on the ways in which the world around the scheme has evolved.

The scheme was reviewed as part of the new community pharmacy contractual framework, and became known by yet another snappy health service title: the essential small pharmacy local pharmaceutical services scheme. The contracts were not designed to be permanent; they were transitional arrangements. The shadow Minister mentioned transitional arrangements, and the scheme is coming to the close of quite a long transitional arrangement, as was flagged some years ago. Pharmacies admitted to the new scheme, which replaced the previous scheme in April 2006, had to be nominated by the then local primary care trust and agreed by the Department of Health. As in the previous scheme, pharmacies were required to meet certain conditions, the most important of which was that they had to dispense more than 6,000 and fewer than 26,400 prescription items per annum and be located more than 1 km from the nearest pharmacy by the nearest practical route available to the public on foot. There is no central definition of “essential” but, broadly speaking, it is as I have described. It is a case of considering the different schemes. Essentially, community access is at the heart of the definition of “essential.” The scheme closed, and no new pharmacies have been allowed to join since 2006.

The current scheme was intended to be temporary, but it was extended in 2012 for a further two years. That was done in the context of a new market entry system for pharmacies and the changes made to the NHS under the Health and Social Care Act, which the shadow Minister mentioned, with the objective of enabling NHS England to consider the options and to give adequate notice to affected pharmacist contractors. With four weeks to go, it is obviously a concern that we are debating the fact that some pharmacies do not quite know what is happening. I will address the efforts to resolve that, but hopefully this debate, if nothing else, will be a good spur to everyone engaged in those important discussions and negotiations, so that we can ensure that they are brought to a sensible resolution.

The end date of the scheme, as my hon. Friend the Member for Romsey and Southampton North mentioned, is 31 March 2015, which means that affected pharmacies have had two years to prepare for the changes since the scheme was extended. I stress that the ending of the scheme does not mean that affected pharmacies must close. It is obviously up to the individual contractor whether they wish to return to the pharmaceutical list and come under the terms of the community pharmacy contractual framework or submit a proposal to provide local pharmaceutical services. Many have done that, and I will touch on the numbers in a moment.

I appreciate that it has been a difficult time for contractors, such as the ones described by my hon. Friends the Members for Romsey and Southampton North and for Truro and Falmouth (Sarah Newton), because small businesses are often concerned with serving their communities and perhaps have a bit less time for protracted contractual negotiations. I hope and expect that they will receive appropriate support from local NHS teams. I give an assurance that, if a change in provision is needed, NHS England’s local area teams will work, and are working, with individual providers, but my hon. Friend the Member for Romsey and Southampton North has highlighted where she thinks that work needs a bit more energy to ensure that people in her community can continue to access services conveniently.

Of course, there are new ways of delivering dispensing services. We have internet pharmacies, and many pharmacies now offer delivery services to patients—members of my family have taken advantage of such services. People who are less mobile can have medicines delivered straight to their door, and I hope it reassures the House to know that 99% of the population can reach a pharmacy within 20 minutes by car, and that 96% of people can do so by walking or using public transport.

At the end of March 2014, there were 11,647 pharmacies in England providing NHS services, which is 18% more than in March 2006. That is a success story for pharmacies and not the opposite; it is definitely a growing story, and rightly so, for exactly the reasons that the right hon. Member for Rother Valley highlighted. Pharmacies have an essential role in supporting our public health system, as well as our NHS.

Some 226 pharmacies were accepted on to the ESPLPS pilot scheme in 2006 and, of those, 73 are still eligible to receive payments, which is less than 1% of pharmacies overall. Of those 73, 16 have reached an agreement or have a solution at a very advanced stage, and 47 have proposals under consideration, so the balance of around 10 are still working closely with area teams, which I hope gives Members at least some reassurance that the scale of the challenge is not huge. The challenge is important and serious for those who have not resolved the situation, and I urge area teams to work closely and give maximum support, but I reassure the House that this is not a large-scale problem across the country; it is a localised problem. None the less, it is important, particularly for local communities. People are probably most concerned about pharmacies where proposals are under consideration, because the clock is ticking. We want those proposals to be given serious and urgent consideration so that we can bring those discussions to some sort of conclusion.

I reassure members of the public that if their essential small pharmacy closes, they will still have access. I have given the assurance that many pharmacies will not close, but people nevertheless want to know that they will still have access. I have mentioned some of the ways in which people now have greater choice than in 2006, and NHS England has an absolute responsibility to ensure that communities can continue to access appropriate services and consider alternative local provision. That provision might be through new contractors, or through a service that is accessible as part of a larger retail offer somewhere nearby. That has become more popular in recent years, and it allows people to combine their weekly shop with a visit to the pharmacy, allowing them to take advantage of public health work through those outlets.

The closing of the scheme does not mean that affected pharmacies have to close; quite the opposite. The two available options have already been outlined. Pharmacies can return to providing NHS pharmaceutical services under the contractual framework and no longer receive the top-up payment, which I accept might be difficult for some, particularly very small businesses. Alternatively, pharmacies can make a proposal, and those proposals are now under consideration and being worked on. I cannot comment specifically on the case in West Wellow in the constituency of my hon. Friend the Member for Romsey and Southampton North, but the area team will know about this debate; we will follow up to ensure that the area team has a record of it and understands that Members were sufficiently concerned about the matter to bring it to the House’s attention today.

More broadly, on the subject of how much community pharmacies have changed since 2005-06, we now see pharmacies as places to go for much more than just getting a prescription dispensed and getting advice on medicines. Pharmacies are a valuable, and sometimes the most accessible, health resource in a local community. We have introduced new revenue streams, such as medicines use reviews and the new medicine service, which contractors can choose to provide to their local population, so there are other routes for local pharmacies.

Clearly, with my public health responsibilities, I am happy to take this opportunity to highlight the relevance of community pharmacies to providing public health services. The NHS document on its long-term sustainability, the five-year forward view, calls on the nation to get serious about public health as one way in which we can avoid spending billions of pounds on avoidable illness. Pharmacies have an important role to play. I have visited pharmacies that are rolling out pre-diabetes checks and other such things. It makes no sense for us, as a nation, to gear up to spend money to serve 4.5 million people with type 2 diabetes when we could do valuable preventive work to stop millions of them getting type 2 diabetes in the first place. Even if people can live with type 2 diabetes for a long time, we want people to live not only long lives but well lives. Living a long time with a number of co-morbidities is not a great quality of life, so there are all sorts of reasons for encouraging pharmacies to be on the front line of preventing illness and helping people to avoid such conditions.

As the right hon. Member for Rother Valley mentioned, there are now more than 1,000 healthy living pharmacies across the country, and there are many more in the pipeline. Those pharmacies utilise the skills of the whole team—not just the pharmacist, but those trained as health champions. I am conscious that the individuals who work in a pharmacy may be more approachable to many people, may understand the local community particularly well and may have insights to bring. I saw some good examples of that when I went around constituencies last Easter talking to pharmacists who knew their communities particularly well, many having grown up in them. They knew the individuals there and knew how to target leaders in the community. I am a great fan of pharmacists and their role in all public health promotion work.

More than 9,000 community pharmacies in England supported the smoke-free January campaign last month, giving out quit cards, and engaging with smokers in person, through their digital presence and on social media. More than 6,500 have signed up to support no smoking day later this month, and that number continues to grow. It is valuable work. Pharmacies have also delivered a large part of this year’s winter flu immunisation programme; more than 105,000 vaccinations have been provided through that route in London alone. Again, as the shadow Minister said, pharmacies are an important way to relieve pressure on other parts of the system, and they are recompensed for those services.

This debate has provided us with a valuable chance to put on record what tangible value pharmacies bring to our society, and particularly to our health system, of which they can sometimes be the unsung heroes. I applaud how they have supported and continue to support our public health ambitions. The five-year forward view had a whole chapter on prevention. Getting serious about public health is at the heart of the challenge of sustainability for our much-valued and much-loved NHS. We need pharmacies to play their part. Estimates suggest, as I think the shadow Minister mentioned, that 18% of GP consultations for common and minor ailments and about 8% of accident and emergency attendances could be dealt with by pharmacists, which emphasises their importance.

I appreciate the concerns that have been raised about this scheme. I hope that I have given the House some reassurance that although it is clearly a challenge for the pharmacy in the constituency of my hon. Friend the Member for Romsey and Southampton North and some others, we have now reduced the number of pharmacies with unresolved issues to a very small number. However, it is critical in these last few weeks before the transitional scheme expires that we resolve the remaining issues in a way that gives people a chance to plan for the future. Those essential small pharmacies have played an important role in the past, and NHS England area teams are ready to work with, and I hope are working with, any contractor who wants to continue providing a pharmacy service to their community. I will encourage them to continue to engage, to ensure that we can reach as many outcomes as possible, particularly for the benefit of local communities, which have been so ably championed by my hon. Friend.

Deaths in Mental Health Settings

Jane Ellison Excerpts

Friday 27th February 2015 Commons Chamber

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

I congratulate my hon. Friend the Member for Broxbourne (Mr Walker) on securing this debate on the investigation of deaths in mental health settings. He has shown considerable interest in this area of policy over many years, and has championed the thorough investigation of deaths of people in custody settings. I commend him for his valuable work. It is important that he gives a voice here in Parliament to people who feel, on occasion, voiceless. He has spoken out on the human rights of those detained in custody, and of their families. He alluded to a recent meeting with some of the affected families, who I am sure are appreciative of his efforts on their behalf.

In my hon. Friend’s thoughtful speech, he stressed the need for vigorous and transparent investigations of deaths in all custody settings. He has highlighted to all of us the distress endured by the families of people who have died, especially when it seems that the death may have been preventable, and how important it is that mental health providers ensure that the investigation does not cause further distress. He also rightly highlighted the need for investigations to be held in a timely manner, and for families to be informed and involved throughout. It is important that investigation findings are clear and indicate what can be done to prevent future deaths, so that families have the comfort of knowing that their loved ones did not die in vain and that lessons have been learned.

My hon. Friend highlighted the report by the charity INQUEST, which calls for better investigations of deaths in mental health settings and makes a number of recommendations for change. I will turn to each of those recommendations and make comments, but I first wish to make some more general points about the ways in which the Government are trying to respond to the issue of mental health crises, and about work involving the police. It is good to be joined on the Front Bench by the Minister for Policing, Criminal Justice and Victims, who is showing his interest in this important subject.

Although today’s debate focuses on investigating the deaths of people detained in mental health settings, it is also important that we focus our efforts on preventing people from being detained in hospital and, where we can, diverting people with mental health illness away from police custody and prison. That is why this Government have invested £33 million this year in developing early intervention services for psychosis, and in supporting people in a mental health crisis to access the right care in the right place.

Last year, we published the mental health crisis care concordat, which is an agreement between more than 20 national bodies on the care and support that people need in a mental health crisis, and we are now working with local areas to ensure that they have local action plans in place for providing that support. We are investing an extra £35 million to develop and expand liaison and diversion services to ensure that people of all ages with mental illness who come into contact with the criminal justice system have their needs identified as soon as possible and are referred to appropriate mental health services.

[Hazel Blears (Salford and Eccles) (Lab)]

I am grateful to the hon. Member for Broxbourne (Mr Walker) for raising this issue in the House. Clearly, it is a matter of significance to our communities. Is the Minister aware of the excellent work being done by Greater Manchester police and by the chief constable, Peter Fahy, around the whole issue of mental health? Sir Peter is very concerned that his officers do not have the necessary skills—this is exactly what the hon. Gentleman said in his contribution—to deal with many circumstances, so the pressure on the police forces is intense. I am delighted that the Policing Minister and the Health Minister are here today. A greater degree of integration at local level would be extremely helpful in ensuring that we get the right people in the right place with the right skills to support the people the hon. Gentleman mentioned.

[Jane Ellison]

As ever, the right hon. Lady makes an extremely good point. My right hon. Friend the Policing Minister has confirmed that he has been to Greater Manchester and seen the work in progress. I will touch on street triage, which is an aspect of the work going on in this area, but first let me say that the right hon. Lady is absolutely right. As a constituency Member, I have been out on a Friday night with my local police’s rapid response team. Very caring young police officers have stressed to me the importance of not only equipping them with skills, but ensuring that they are not asked to do things that are not part of their core duties, and that they get proper support to deal with people in a sensitive way. The right hon. Lady’s point was very well made.

Police forces are piloting a street triage initiative, in which mental health professionals travel with police officers on patrol, providing on-the-spot help to people with possible mental health needs who come into contact with the police. There have been positive results in the Leicestershire pilot area, where street triage has led to a reduction in detentions under section 136 of the Mental Health Act 1983. I know from a Backbench Business debate a few weeks ago that that is an impressive reduction in detentions, and the right hon. Lady mentioned progress in her area, too.

We are also investing a further £30 million next year to further develop liaison psychiatry services to support people with mental illness in accident and emergency and when being treated for physical illness in a general hospital setting. As well as focusing on preventing people from being detained in mental health settings, we must also look at preventing avoidable harm and deaths when people find themselves in hospital. My hon. Friend the Member for Broxbourne mentioned that.

INQUEST’s report highlights the issue of suicides in mental health settings. Earlier this year, the Government announced our ambition for the NHS to adopt a zero suicide strategy to reduce dramatically suicides in health settings and in the community. At the beginning of the year, we also laid before Parliament the revised Mental Health Act 1983 code of practice, which comes into effect from April and strengthens our commitment to safeguarding the rights of people detained under the Act. The revised code of practice gives greater prominence to the need for better and more rigorous risk assessments, and for care planning that is centred around the patient and involves their carers and relatives wherever possible. That picks up on the well-made point from my hon. Friend about the need to involve families and to ensure that patients are treated in safe environments.

Let me turn to the recommendations in INQUEST’s report. The first concerned the system for investigating deaths and the matter of independence. Coroners’ inquests provide independent investigation, and we must consider the evidence carefully to inform how we improve the quality and independence of investigations in mental health settings. It is right that we focus on improving the way deaths in such settings are investigated. Clear guidance should be given to the NHS to improve the integrity and quality of investigations.

NHS England is reviewing the NHS serious incident framework, which describes how serious incidents, including deaths, should be reported, investigated and learned from to prevent them happening again. I understand that NHS England is finalising the guidance and have been advised that it is being reviewed by the chief nursing officer. This is an opportunity to re-emphasise the responsibilities of providers and commissioners by holding providers to account for how they respond to serious incidents, and holding commissioners to account for overseeing the response to ensure that it is objective, proportionate and timely.

Secondly, the report recommends the proper and meaningful involvement of families in the investigation of deaths, so that it is on a par with the way in which deaths in other custody settings are investigated. NHS England’s guidance on managing investigations in the NHS will set out the commissioner’s responsibility for ensuring that all those affected by an incident are involved, and that the investigation is conducted in an open and honest manner. The commissioner will also have the opportunity to inform the terms of reference of the investigation, and can consider and will be consulted on the investigation’s findings. The efforts to engage those affected by the incident should also be recorded in the response to the investigation. It is therefore essential that people should be able to not just liaise with the family, but demonstrate how they have done so, and record how they did it.

Thirdly, the report recommends the better collation and publication of statistics on deaths in mental health settings, including further details on the circumstances and characteristics of the death. I was struck by what my hon. Friend said about some of the uncertainties in this regard, and about the need for people to be transparent about something so important. I am aware that the Care Quality Commission is piloting ways to improve how it collects and analyses data, in partnership with NHS England. That can help to improve the way the CQC monitors the Mental Health Act.

I understand that the Care Quality Commission is looking at how it might link data from hospital episode statistics and from the mental health and learning disabilities data set to enable better cross-referencing of the information it receives through notifications of deaths, which should help it to improve the availability of data at a national level so that it supports policy responses to deaths in detention. That important work is ongoing.

Fourthly, the report recommended that coroners’ inquests be more robust. I have shared the report with the Ministry of Justice, and I am sure that the Chief Coroner will read it with interest. The fact that my right hon. Friend the Policing Minister is here on the Front Bench demonstrates that—

[Mike Penning]

And Justice Minister.

[Jane Ellison]

Yes, he is wearing both hats today. He has confirmed that he will take this matter forward in the Ministry of Justice, and I am grateful to him for that. The fact that, in the last Adjournment debate of the parliamentary week, the two Departments most closely involved in responding adequately to these matters are represented by Ministers shows how important they are.

My hon. Friend the Member for Broxbourne might wish to raise his concerns about the robustness of inquests directly with the Office of the Chief Coroner. However, let me tell the House about another way in which the better use of data is helping in this situation. I understand that the Care Quality Commission is undertaking analysis of the information available from coroners’ investigations and inquests, along with other information it already receives on expected and unexpected deaths, which should help it to target requests from coroners better.

The Care Quality Commission is also working with the Coroners Society of England and Wales and the Office of the Chief Coroner to establish a memorandum of understanding, with the aim of achieving better working relationships and sharing of information. I am sure that my hon. Friend, having had the chance to highlight the importance of this issue today, will want regularly to ask questions, presumably in the next Parliament, about how this work is progressing and what the timetable is. Indeed, the Minister for Policing, Criminal Justice and Victims has heard his request for vigour and energy behind that work.

In conclusion, it is absolutely right that we should seriously consider how to improve the investigation of deaths in mental health settings.

[Mr Charles Walker]

The reason independent investigation is so important is that people can be detained against their will under the Mental Health Act 1983. There needs to be some oversight of their welfare, and they need to be safeguarded, but it is difficult if that is provided only by the NHS, the organisation that is responsible for detaining them. That is why independent oversight and safeguarding is needed.

[Jane Ellison]

I absolutely understand that point, which my hon. Friend has made with some power. I certainly undertake to speak with my colleague the Minister of State, the right hon. Member for North Norfolk (Norman Lamb), who leads on mental health matters in the Department, and ensure that he is aware of my hon. Friend’s strength of feeling about the issue. I will refer him to the Hansard report of this debate. I am sure that my hon. Friend will continue to press the case. I hope that the issues I have touched on in my response give him some sense that work is in train to look at this. The seriousness of the issue is very much acknowledged in both the Department of Health and the Ministry of Justice.

It is important that we set out clear requirements for rigorous, transparent and timely investigations of serious incidents, including deaths, and for all those affected, including the families, to be involved throughout those investigations. We must continue to seek to improve the overall process of learning from deaths to prevent further avoidable tragedies. The Department of Health, NHS England and the CQC continue to look at ways of improving the system, along with colleagues in other Departments, particularly in relation to transparency and ensuring that lessons are learned. I congratulate my hon. Friend once again on bringing these important matters to the attention of the House.

Question put and agreed to.

Health Service Commissioner for England (Complaint Handling) Bill

Jane Ellison Excerpts

Friday 27th February 2015 Commons Chamber

My final point to my right hon. Friend the Member for North East Hampshire is this. My expectation of the ombudsman’s department is that a complaint is answered as soon as is feasible and as soon as is reasonable, taking into account its complexity. I do not want the ombudsman working to an artificial target of three, four or five months, but neither do I want complaints spun out to fill the time. The proper answer is that the ombudsman should always know that the most expeditious, the most effective and the most complete response is the one that the public demand. That should not require the law to deliver.

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

It is a pleasure to respond to such a thoughtful debate on new clauses 1 and 2, which were tabled by my right hon. Friend the Member for North East Hampshire (Mr Arbuthnot). Given that this is my first response from the Dispatch Box on the Bill today, let me provide a little context before moving on to the specifics of the new clauses.

Clearly, when someone believes that the services offered by the NHS have fallen below an acceptable standard, it is absolutely right that the complaint be investigated properly and efficiently. The Government are committed to putting patients first and improving the experience of making a complaint about the NHS. As part of that, we believe that an effective health service ombudsman is critical to achieving the effective complaints service that patients expect and deserve. This is very much part of our transparency agenda.

The Parliamentary and Health Service Ombudsman carries out independent investigations of unfair, improper or poor service by United Kingdom Government Departments and their agencies and the NHS in England. The health service ombudsman is the second independent stage of the NHS complaints arrangements, dealing with cases not resolved at local level. I think we will all have had such dealings in our constituency work.

The Parliamentary and Health Service Ombudsman, Dame Julie Mellor, had done a good job in challenging circumstances to make her office more transparent and accountable, something to which right hon. and hon. Members have alluded. She has gone about transforming the way in which her office works. She has greatly increased the number of complaints investigated by her office, and complaints are generally reviewed and assessed with excellent judgment and in a timely fashion.

Certain cases, however, suggest that the ombudsman might benefit from legislative reinforcement in working towards further improvement. As the shadow Minister captured in her remarks, any delay in investigating a complaint adds unnecessary distress at what is almost certainly a very difficult moment in an individual or a family’s life. The Government are keen to reduce any delay in investigating cases to reduce the pain of all those involved. Complaints about the NHS of course raise personal or sensitive issues. The person making the complaint, whether it be the patient, the carer or a representative, will be understandably keen to know the outcome as quickly as is reasonably possible.

These two new clauses raise some important points, albeit finely balanced ones. We have had a very good debate this morning exploring where the balance lies. New clause 1 concerns transparency. As I have said, complaints about the NHS may involve the raising of personal or sensitive issues. Whether the complainant is a patient or a carer representative, that person will be keen to know how long the process might take, as we know from our constituency case loads. One of the first questions that a person might ask is, “How long is this likely to take?” That applies both to complaints that are handled by the NHS itself and to companies that are referred to the health service ombudsman in the second, independent stage of the process.

The Government are actively encouraging the NHS to be more open and receptive to complaints, including those made by our constituents. We understand the sentiment behind new clause 1, but we do not feel able to support it. The new clause would require the ombudsman to produce a general estimate of the time it is likely to take for her office to investigate a complaint. My hon. Friend the Member for Bury North (Mr Nuttall)—unsurprisingly—made an acute point when he referred to the danger that the time taken to assess the time likely to be taken might actually add to the time taken. Such a tragic irony would not serve any of our constituents.

A wide range of cases are referred to the ombudsman and subsequently investigated. Some are relatively simple, but others are more complex and take significantly longer to investigate. There are also cases in which people do not know what is not currently knowable. That is the whole point of an investigation. I agree with my right hon. Friend the Member for Haltemprice and Howden (Mr Davis) that, in particularly complex or sensitive cases, it is important not to give an incorrect estimate to someone who is thinking of making a complaint, especially when it turns out to be an underestimate. I am sure we can all think of other contexts in which we give a constituent an estimate of the time that it might typically take to provide that constituent with an answer, the anxious constituent comes back to us within the estimated period, and from that moment a clock starts ticking. During the subsequent period, constituents may feel that they have been let down—or, worse still, may suspect that something in “the system” is preventing them from getting an answer—and their anxiety may increase as a result.

As Members will know from their constituency correspondence, it is not helpful to add unnecessarily to the distress associated with any perceived delay in the investigation of a complaint about any public service, and that applies particularly to complaints about the NHS that may relate to personal, sensitive or possibly even tragic experiences. Complainants’ distress will be exacerbated if a general estimate of the time taken to conclude an investigation does not accurately reflect the time taken when it turns out that there is an unknown—and, at the time when the complaint was lodged, unknowable—complexity to the case.

Like my right hon. Friend the Member for Haltemprice and Howden, I am equally concerned about an estimate based on the longest period within which an investigation might be expected to be completed. I cannot help feeling that there might be a tendency towards officialdom—a tendency to err on the side of caution, and, in order not to be too boxed in by an inaccurate estimate, to opt for the upper end of the time spectrum. Other Members have drawn attention to the need and the desire for transparency, but it would be terrible if as a result of that undue caution—unwarranted, perhaps, in most cases—people who were at their lowest ebb, already feeling unresilient to things that were happening in their lives, were to say to themselves, “I don’t think I can take more than 12 months of this, so I will walk away and not make a complaint.” It would be awful if people did not feel that the system was there to deal with their complaints and worries.

As I have said, the complexity of some cases might become apparent only once an investigation had begun. A complainant might be unintentionally misled, expect an earlier response, and, if that response did not come when it was expected, begin to fear that something untoward was happening, that the wheels were grinding too slowly, or that someone did not care about the complaint. Although none of those assumptions might be true, the complainant’s faith in the system might nevertheless be undermined.

In summary, new clause 1 raises a valid point about transparency and it is good that the House has explored that matter this morning, but I do not feel able to support it, for the reasons that I have mentioned and that the right hon. Member for North East Hampshire also referred to when he explained that the purpose of the new clause was to probe. I hope that he will agree with the points that I and others have raised, and that he will withdraw new clause 1 in due course.

New clause 2 raises the question of good practice in the handling of a complaint, and it has been made clear in other contributions today that the whole House supports that principle. It is of course good practice for any person making a complaint to be given, as soon as practicable, an indication of how long it will take to complete the investigation into the complaint. However, we do not feel able to support the new clause for two reasons, both of which I think my right hon. Friend the Member for North East Hampshire began to arrive at during his speech.

First, the new clause, as drafted, would require the estimate of the period likely to be taken to investigate the complaint to be given to the person at the time at which the investigation began, but there will be cases whose complexity is not apparent at that point. In my experience as a constituency Member—I am sure colleagues have had the same experience—something that seems straightforward at the outset can turn out not to be, particularly when different points of view become involved. That is also likely to happen in NHS investigations such as these. It is particularly important not to give the person making the complaint an estimate that turns out to be too short, for the reasons that I have outlined.

The second reason could be said to relate to some of the Forth principles that we have been hearing about this morning. Good practice involves keeping the person making the complaint updated on progress throughout the investigation, and that is something that any ombudsman would take seriously. There is no evidence to show that Dame Julie and her team would not naturally seek to do that during the course of their work. That would include keeping someone informed of any shift in the estimate of the time likely to be taken to complete the investigation. The proposed new clause makes no reference to that continuing duty.

New clause 2 raises an important point about good practice, but we feel unable to support it because it focuses on giving an estimated time only at the outset of the investigation and not throughout the process, although we might explore this question further in other amendments. I thank my right hon. Friend for probing and giving the House a chance to explore these important issues, but I hope he will agree with the arguments that I and others have put forward, and to which he alluded in his balanced contribution, and that he will not press new clause 2 to a vote.

[Mr Arbuthnot]

After hearing valuable comments from both sides of the House, I have come to the conclusion that my new clauses would not be helpful and I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.



New Clause 3

Statutory duty of the Health Service Ombudsman

‘It shall be a statutory duty of the Health Service Ombudsman to resolve any complaints within twelve months of the date when the complaint was received.’—(Mr Chope.)

Brought up, and read the First time.

--- Later in debate ---

[Luciana Berger]

I shall not speak for long, but I think it right to respond to the contributions, and to speak on the options proposed by the hon. Member for Christchurch (Mr Chope). As we know, new clause 3 proposes to make it a statutory duty for complaints to be resolved within 12 months. We do not think that that is necessary. It is clear that the Bill sets out sufficient steps to achieve that. I agree with the right hon. Member for Haltemprice and Howden (Mr Davis) that, as we know, the overwhelming majority of cases are dealt with within that time, but there are obviously reasons why it may sometimes take longer. As hon. Members suggested, there may be complex cases, other agencies may be involved, or there may be a historical or long-running case that requires the extraction of data from decades past, which it may take a long time to collate. It is often not the ombudsman’s fault that these things take time. We therefore do not think it appropriate to make meeting the 12-month deadline a statutory duty.

On the amendments, it is proposed that when the ombudsman contacts complainants, she gives them an estimate of how long the investigation might take. We discussed the point earlier in relation to new clause 2. We Members of Parliament can get updates from the ombudsman on the progress of cases and share those with our constituents if they want further updates. To be fair, if we think about all the processes in which we support our constituents, this is one in which updates are provided, and complainants are provided with information about how their complaints are progressing and when an outcome might be provided.

Amendment 1 would require the commissioner to keep the complainant informed of progress. There is nothing wrong with this in principle. We should encourage the ombudsman to do this anyway. As I mentioned, as Members of Parliament supporting those complaints, we can receive updates. On the point about financial resource, I have looked closely at the amendment and listened to the debate this morning, and think that where delays occur in the progress of complaints, more often than not that is down to the complexity of the cases, rather than a lack of financial resources, so amendment 5 is not necessary. We do not believe that new clause 3 or the five amendments are necessary.

[Jane Ellison]

I understand the sentiments behind new clause 3, tabled by my hon. Friend the Member for Christchurch (Mr Chope), and each of the five amendments. I shall try to respond to some of the points that have been made, without reiterating them.

New clause 3 would place a duty on the health service ombudsman to resolve any complaint within 12 months of the date it was received, regardless of its complexity. We all have sympathy with the reason behind it, and we all want investigations by the health service ombudsman, and indeed the NHS, carried out as efficiently as possible. None the less, it would be wrong to rush cases, or to seek to put an artificial time limit on them. What is most important to us as Members acting on behalf of our constituents is that the investigation is conducted appropriately and robustly, which depends on the facts of the case. This is particularly true, as others have said, when the investigation deals with serious or complex issues.

We are all familiar with the fact that the cases investigated by the health service ombudsman generally tend to be complex and serious because they often involve an element of loss, personal tragedy, illness or disability, so they are inevitably sensitive. It is important that those investigations are conducted in a timely fashion, but on the odd occasion when they need to continue beyond the defined period, it is important that there are not artificial constraints, and that we do not constrain the handling of a complaint by focusing on the deadline, rather than the requirements of the case. That may have an unintended impact on the quality of the investigation and the complainant’s expectations about the outcome.

The Bill as drafted will hold the ombudsman more accountable for delays of over 12 months than at present, which is right, but it acknowledges that there will be some cases, albeit very few, where it is appropriate and justifiable for an investigation to take longer. Some of my right hon. and hon. Friends have alluded to the reasons for that. In other aspects of my portfolio, I have seen some of those reasons. My hon. Friend the Member for Christchurch made a working assumption throughout his comments that one reason may be delay on the part of the investigator, but sometimes it is due to other players in that investigation.

In another part of my portfolio, something extremely important has been unexpectedly delayed by the bereavement of the chief investigator. That could not have been anticipated, but it has added greatly to the delay. Cases brought to the ombudsman nearly always involve illness, and evidence may need to be taken from someone who is still ill or in recovery. It may be difficult to get that evidence, or to ask them to respond to a point made during the investigation. If the person is still suffering the effects of their illness, there may need to be an appropriate delay to allow them to recover sufficiently to give their evidence.

The Bill’s promoter, my right hon. Friend the Member for Haltemprice and Howden (Mr Davis), made an extremely good point about expertise. Complex medical issues are rarely black and white. In a debate that has already alluded to corsets and seductions, I hesitate to speculate on the number of shades of grey that might be involved in investigations, but it is clear that they exist. Sometimes, tracking down the right expert may be not a national endeavour, but an international endeavour, if the case involves a rare illness or there is a dispute about the medical opinion. Drawing on my experience of nearly 18 months as a Health Minister, I know that that is sometimes the case and we should allow for it, because it would not benefit the investigation if we did not. For those reasons, I hope that my hon. Friend the Member for Christchurch will agree not to press the new clause, and that he will feel not that he is condoning poor or slow administration, but that he is merely accepting that some things just take longer to address.

--- Later in debate ---

[Mr Chope]

My right hon. Friend is right to say that we are talking not about a Department but about a parliamentary sponsored organisation that tries to hold the Government to account. Yesterday, the House discussed the whole saga of Equitable Life, and what a long drawn-out saga it was. We know that the ombudsman tried desperately to get timely responses from the Treasury and other Departments, and was frustrated at every turn. Looking back at that, we can see that being able to say that she had a statutory obligation to deliver the result of an inquiry within a particular period would have helped rather than hindered her in the work she had to do.

[Jane Ellison]

I completely understand my hon. Friend’s point. I tried to draw out the fact that the interests of complainants may not be served by the proposal. As we all know, serious and complex complaints sometimes involve a death or serious injury, which means dealing with a bereaved family. The course of events over the 12-month period may not run smoothly for the very people making the complaint and wanting it to be resolved sensitively, sensibly and properly. This is not about Departments or the NHS making excuses, but about acknowledging that the sensitivities of the complainants and their loved ones mean that the ombudsman needs a little more time in some instances.

[Mr Chope]

I hear what my hon. Friend says. In essence, the more usual scenario in cases of bereavement is that people want what they describe as closure sooner rather than later. The Bill has been introduced to emphasise that it is the will of the House that such matters should normally be dealt with within 12 months.

--- Later in debate ---

[Jane Ellison]

We have had a thoughtful and productive debate, and I congratulate right hon. and hon. Members from all parties on their contributions. The shadow Minister made a thoughtful contribution about some of the wider issues relating to the ombudsman’s work and some of the inquiries and reviews that are ongoing. I hope that she and the House will forgive me if I do not respond immediately to those points, as they are not directly germane to the Bill. I will look to get a response to her questions to her after the debate, if that is acceptable to her.

I put on record my appreciation of the consensual way in which all parties have approached the Bill. As the House is aware, very few private Members’ Bills make it beyond Second Reading, so it has been good to see the commitment throughout the House to improving how the health service ombudsman handles complaints.

I hope that we will be able to get the Bill on the statute book because the Government fully support it. It fits within the transparency revolution that the Secretary of State for Health has driven, and it is an important Bill that will improve the accountability of the health service commissioner for England to complainants and Parliament.

Obviously we would not be here without the sterling efforts of my right hon. Friend the Member for Haltemprice and Howden (Mr Davis), whom I commend for his work to improve the experience of people who make a complaint about the NHS. I also commend my right hon. Friend the Member for North East Hampshire (Mr Arbuthnot) and other Members who raised on Report some of the issues underlying good practice in complaints handling. That has enriched the debate on the Bill. I am sure that, when the ombudsman and her team read the transcript, they will find it helpful to see that Parliament has given some time and thought to how they go about their business. I am sure they will also note with pleasure the positive comments that have been made, particularly about Dame Julie Mellor’s efforts to improve and enhance the work of her organisation.

I thank my officials in the Department of Health, the Clerks of the House and everyone who has contributed to the Bill. I reiterate that I commend my right hon. Friend the Member for Haltemprice and Howden for bringing this short but important Bill to the House. There will be moments when all of us have constituents whose burden at a moment of vulnerability and distress is reduced by the measures in it. I reiterate the Government’s full support for it.

Question put and agreed to.

Bill accordingly read the Third time and passed.