Contaminated Blood

Jane Ellison Excerpts

Thursday 15th January 2015 Commons Chamber

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

I welcome the tone with which the shadow Secretary of State responded to the debate on behalf of the Opposition. I also congratulate my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) on securing this debate and on his hard work and commitment—as a Minister, I am well aware of it—over the past year. The same is true of so many colleagues who have worked on behalf of those infected with NHS-supplied blood or blood products before 1991.

I thank all hon. Members who have contributed to the debate, which has been conducted in a constructive and thoughtful way, and, of course, distinguished former colleagues who championed their constituents so ably in the past. As we have heard, many of those constituents have been profoundly affected by this issue. I attended the last debate on it when I was a Back Bencher, and today I have heard once again about the impact these infections have had on the lives of individuals and families.

I will focus mainly on the current situation rather than the past, not because the past does not matter, but because it has been ably covered and because I want to add to the knowledge of the situation as it is now and give an indication of the way forward. I hope Members will understand that. If there are any issues that I do not address, I will, of course, write to Members, and if their concerns involve other Departments, I will seek to get a response from them.

There have been calls for a further inquiry and review. That subject has come up before, with calls to look at the historic circumstances of these events. There are various ways in which that could be done and I acknowledge the suggestion made by the shadow Secretary of State. I stress that the Government wish to be as transparent as possible about these events, but I remind the House that they have already been repeatedly examined in a number of different ways, including in court on a number of occasions, and the Department of Health has already published on its website all the relevant documents held for the period up to 1986. I acknowledge that there might be more to do, some of which relates to Lord Penrose’s work.

The Penrose inquiry has loomed over this debate. Let me give the House a sense of my frustration. When I came into office, I was advised that the original date of publication would be June 2014. Let me also give the House a sense of the seriousness with which I took the preparation for that report. I met Scottish Health Ministers last spring to discuss it and other issues. Obviously, work is taking place in Scotland and the publication of the final report has been delayed. The inquiry now expects to announce a publication date this month. There has been no formal confirmation, although a date has been offered during the course of the debate. I understand that Lord Penrose will examine any particular adverse consequences for infected patients and their families, and identify lessons and implications for the future. That is why we feel we need to wait to see the report.

As the events under discussion took place before devolution, the final report of the inquiry will clearly be of interest to the Government and we await its recommendations. I am extremely frustrated by the continued delay and accept that it will have an impact on the scope of our response in this Parliament.

As has been touched on, the Government, like their predecessors, provide ex-gratia financial and other support through the system of payment schemes that is in place.

[Mr Robinson]

The Minister has touched on the nub of the issue, namely the Penrose report and the delayed decision. Does she agree that we do not really need that? The broad aspect of the financial settlement that ought to be made is well known to the Government. It is a matter of getting a decision now.

[Jane Ellison]

I will come on to why I do not entirely agree with the hon. Gentleman, but my concern is essentially that after families have endured so much, I would hate to tell them the way forward only for that to be unpicked and revisited in the light of any recommendations by Penrose. I am afraid that I do not agree with him, because it is important to consider the report.

[Mr Slaughter]

A moment ago, the Minister said that, given the late reporting of Penrose, she would have to consider the scope of the Government response. Will she be a little more specific: what are the Government likely to say and how far will they go before the election?

[Jane Ellison]

I will come on to that. Although I cannot be as specific as I would like, I will try to give the House some sense of the way forward.

I stress that the support currently provided is over and above any other state benefits that infected individuals and their families may receive, and moneys paid under the schemes are not subject to tax. Some hon. Members have raised issues relating to the DWP, and I will of course bring those concerns to its attention.

I am aware that many hon. Members have concerns, which they have expressed in some detail, about the way that support for those affected is delivered. During the past year, I have listened to and actively considered the thoughts of all colleagues about how to improve the system. I have met the officers of the all-party group, and spoken a number of times to my right hon. Friend the Member for North East Bedfordshire.

I acknowledge that there is scope for reviewing the support system. I have been open with hon. Members about the fact that I share their concerns about the charitable basis of that support. I thank my right hon. Friend and the all-party group for the survey on which they recently collaborated. This is the first large-scale effort to consult beneficiaries, their families and the wider public on the current system. I will certainly consider its findings—I have looked at the executive summary of the report, which was only published yesterday—and all the other sources of information. From my conversations with Members over the past year, I have a good sense of the report’s direction of travel and of their concerns.

As I have said, in considering possible reforms to the current system, we must take into account Lord Penrose’s findings and recommendations before any specific proposals are made, but I have been ably supported by my civil servants in looking at possible reforms. His report is likely to be lengthy: to give the House some sense of that, the interim report published in 2010 exceeded 600 pages.

If Penrose does not publish until shortly before the House rises, it will be challenging, as Members have recognised, to provide a considered and thoughtful Government response in such a short time. I want to give due respect and consideration to Lord Penrose and his report, not least because it matters so much to so many individuals and families. As I have said, after all they have been through, it would be terrible for us to announce measures that then had to be unpicked or revisited. I reassure the House that however late in the Parliament Penrose reports, we will make a response, although that will inevitably have to be an interim response.

Having acknowledged that not everyone is satisfied—far from it—with the current system of support, it is extremely important to remember that the system makes an enormous difference to the lives of many beneficiaries. To date, more than £365 million in support has been paid to more than 5,000 people in the UK affected by HIV and hepatitis C and their families. Through the reforms made in January 2011, which some Members have mentioned, the Government have improved the system of support. Since they were introduced, more than £70 million in extra funding has been made available in England.

Something that is new since the House last debated this issue is the therapies that are coming through. Members have spoken about the side effects and impacts of existing therapies. Many of the new therapies have a much higher cure rate than existing ones, with far fewer side effects. We understand that cure rates for new therapies are between 90% and 95%, and that the courses of treatment are much shorter. Those figures are based on clinical trials. New data from the early access programme will be evaluated to confirm the robustness of that finding, but it is obviously encouraging news.

I am encouraged by some of the improvements that we can make to the quality of life of those who have suffered from their infections for so long. New treatments for hepatitis C are becoming available through the NHS. While we have been waiting for NICE to publish its final appraisal of the first of the new drugs—Sofosbuvir and Simeprevir—NHS England has taken two important steps to ensure that eligible patients with late-stage hepatitis C can expect to have received treatment by the end of 2015. In April 2014, it published an interim clinical commissioning policy statement to provide access to the new therapies for patients with liver failure. More than 700 patients have already been treated through this policy, at a cost of £38 million. Specialist centres were procured to deliver this early access treatment around the country.

The NHS is developing a further interim clinical commissioning policy for patients with compensated cirrhosis to reduce the risk of their developing decompensated cirrhosis or liver cancer. Subject to its internal approval processes, the NHS is aiming to have that in place from this April. I have confirmed with the clinical director that if any hon. Members are approached by constituents with hepatitis C, they should advise them to consult their GP about a referral to a hepatology specialist to determine whether they have developed cirrhosis.

Medical advances continue to improve the ways in which HIV and hepatitis C can be treated and managed, and I want to take this opportunity to assure the House that the UK now has one of the safest blood supplies in the world, and independent experts continually review current safeguards.

This debate has again allowed me to hear about the issues with which many of those affected live daily. I of course recognise that improvements must be made to the system that provides financial assistance, and I have given considerable thought to that over the past year. Together with those we represent, we need to be realistic about the challenge of making changes that are fair and sustainable. It is very welcome that we can work on a cross-party basis—that is absolutely vital—and it is most reassuring that several hon. Members have emphasised that.

I am hugely frustrated that the much longed-for closure cannot realistically be achieved in this Parliament. Nevertheless, a new Parliament is imminent, and it will provide an opportunity for the next Government to provide closure.

[Mr Tom Clarke]

The Minister will recall that my right hon. Friend the shadow Secretary of State made some profound comments about the role of the civil service in dealing with these problems. Will she take time to respond to them?

[Jane Ellison]

I have noted the comments of the shadow Secretary of State. I can only speak from my own experience and say that in all the ways in which I have wished to consider this issue—those have ranged widely over the past year—I have been ably supported by my civil servants. Ultimately, this decision is a political one.

The issue needs to be resolved once and for all. I assure hon. Members that the Prime Minister, the Secretary of State and I continue to work towards that vital aim. I have said that however late Penrose reports, we will respond while the House is sitting. Inevitably, that will have to be an interim response. However, I hope that we can give the House some sense of the work undertaken over the past year and, at that time, respond to the direction of travel signalled in the all-party group’s report and the work of my right hon. Friend the Member for North East Bedfordshire.

In conclusion, I want to say that this was an utterly appalling tragedy, which has caused grief and sadness to many people and their families, as we have so often heard. The Government must do right by those people on whose behalf so many Members have spoken today. I will take away everything that has been said, and as long as I am in my current office, I will continue to work to bring to Parliament the conclusion that so many Members have said they want.

Pancreatic Cancer

Jane Ellison Excerpts

Thursday 15th January 2015 Commons Chamber

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

I return to the Dispatch Box very rapidly after the debate earlier this afternoon, and on an important topic; one of the most important in my portfolio. I congratulate once again the hon. Member for Scunthorpe (Nic Dakin) on securing the debate. As ever, he is ably assisted by my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw). They and their colleagues in the all-party group have achieved much in this Parliament in highlighting the needs associated with this dreadful disease and in raising awareness of it.

I have said many times before at the Dispatch Box that improving cancer outcomes is a major priority for the Government and as the annual report on our cancer outcomes strategy in December showed, we are on track to save an extra 12,000 lives by 2015. Sadly too few of them are those suffering from pancreatic cancer, so while we want to see the best possible results for all cancer patients, I appreciate—as we have discussed before—that outcomes are particularly poor for patients with pancreatic cancer. We need to do a lot better.

I was delighted that on Sunday 11 January NHS England announced a new independent cancer task force to develop a five-year action plan for cancer services that will build on the existing work to improve survival rates and save thousands more lives. The taskforce has been set up to produce a new cross-system, national cancer strategy to take us through the next five years to 2020, building on NHS England’s vision for improving outcomes as set out in the NHS five-year forward view. The taskforce will be set up in partnership with the cancer charities and the health system leaders, and chaired by Dr Harpal Kumar, the chief executive of Cancer Research UK. The all-party group might like to consider how it, too, can participate in, and contribute to, the taskforce.

The new strategy will set a clear direction covering the following areas: prevention; early and faster diagnosis; better treatment and care for all; recovery, re-ablement and living with and beyond cancer; research and innovation; end-of-life care; data and metrics; and work force. The taskforce will produce a statement of intent by March this year, with the new strategy published in the summer.

Tackling late diagnosis is, as we have often said, a very important element in achieving our ambition to improve all cancer outcomes. As the hon. Member for Scunthorpe said, however, there is currently no easy way of detecting pancreatic cancer and it can be particularly difficult for GPs to detect and diagnose, especially in its early stages. Symptoms can be complicated by the fact that they are shared with a wide range of benign conditions.

My ears pricked up when, as part of the taskforce announcement last weekend, NHS England launched a major early diagnosis programme, working with Cancer Research UK and Macmillan Cancer Support, to test new approaches to identifying cancer more quickly. These include offering patients the option to self-refer for diagnostic tests, as the hon. Gentleman said; lowering the threshold for GP referrals; creating a diagnostic pathway for vague symptoms like tiredness, which is particularly important for hard-to-spot cancers such as pancreatic cancer; and setting up multidisciplinary diagnostic centres so patients can have several tests done on the same day at the same place—not the ping-ponging around, which can be so debilitating for someone already feeling very poorly. NHS England’s aim is to evaluate these innovative initiatives across more than 60 centres around England, collecting evidence on approaches with a view to implementation from 2016-17.

Turning to the awareness campaign, we have debated the possibility of pancreatic cancer being part of the “Be Clear on Cancer” campaign set before. Since 2010-11, the Department has undertaken a series of local, regional and national campaigns. Public Health England now leads on this work with the Department, NHS England, charities and relevant stakeholder groups.

It has always been difficult to give a positive response with regard to pancreatic cancer to date, because the focus has so far been on those cancers with the largest number of avoidable deaths. As colleagues know, these campaigns are under constant review, and we work with the relevant experts to see what more can be done. All the time, there are small trials going on to see where we can tackle other cancers. Pancreatic is obviously one that experts will keep under review.

The group that makes decisions about the campaigns, the public awareness and primary care steering group, chaired by our national cancer director, Sean Duffy, has considered pancreatic cancer for a possible campaign. To date, it has been unable to recommend it owing to the problems we mentioned about symptoms, but members would be very happy to look at it again if there were new evidence. I sense from all the things going on—particularly some recent announcements—that that point might not be too far in the future.

[Nic Dakin]

I thank the Minister for everything she has said to date. On the issue of a public awareness campaign on pancreatic cancer, is there a way in which those with pancreatic cancers could engage with that body to see if there is a way forward?

[Jane Ellison]

If I recall my diary correctly, I have a meeting with Sean Duffy coming up, and I would be happy to raise that issue with him, along with any other points arising from this debate. It will certainly be on my agenda for discussions with him. I have touched on the matter briefly with him before, but I will pick it up again.

The problems with late diagnosis have been explored before, and it is critical that we get people the most appropriate treatment early. We have discussed radiotherapy before. It can be a very helpful treatment for some patients. As part of its recent announcement, NHS England committed a further £15 million over three years to evaluate and treat patients with a modern, more precise type of radiotherapy— stereotactic ablative radiotherapy or SABR, as the hon. Gentleman mentioned. That evaluation programme will mean a significant increase in the number of cancer patients eligible to access this treatment by around 750 a year, and the programme will widen the number of cancers being treated by SABR, including cancer that has spread to another part of the body.

The new investment is in addition to NHS England’s pledge to provide up to £6 million over the next five years to cover NHS treatment costs of SABR clinical trials, most of which are being led by Cancer Research UK and one of which—as the hon. Gentleman knows from our debate last September—relates to pancreatic cancer. As for the hon. Gentleman’s suggestion regarding commissioning through evaluation, I shall raise it with NHS England. I am afraid that we do not yet know which centres or how many patients will take part in the trials to assess the effectiveness of SABR in comparison with conventional radiotherapy or surgery, but I understand that we are likely to have that information in the coming weeks. I will certainly make the decision-makers involved aware of the debate, and of the interest in the outcome of their deliberations.

NHS England’s chemotherapy clinical reference group has set out service specifications defining what NHS England expects to be in place to enable providers to offer evidence-based, safe and effective chemotherapy services. NICE has issued technology appraisal guidance which recommends Gemzar as an option for treating patients with advanced or metastatic adenocarcinoma of the pancreas who meet certain clinical criteria. NICE is also appraising a number of new drugs for pancreatic cancer. NHS commissioners are legally required to fund treatments recommended by NICE in its technology appraisal guidance.

Understandably, the cancer drugs fund has been mentioned this evening. The Government’s reasons for establishing the fund are well documented. At the end of August 2014 it received an additional £160 million, and I welcome the announcement on 12 January by NHS England, which is now responsible for the fund’s operational management, that it too would provide extra money. The CDF panel has decided that further consideration of Abraxane for the treatment of pancreatic cancer is needed, and it will remain on the national CDF list until that has been concluded. I am not yet sure about the timings, but I will undertake to update the all-party group, including the hon. Members for Scunthorpe and my hon. Friend the Member for Lancaster and Fleetwood, in due course.

Let me now say something about NICE appraisals. Representatives of the Department, NICE, 10 key cancer charities and the pharmaceutical industry met in December to discuss the future of cancer drugs commissioning. They committed themselves to establishing a working group to develop a robust process to support the sustainable, long-term commissioning of cancer drugs. The group will meet for the first time, opportunely, on Monday 19 January.

I am glad that the hon. Member for Scunthorpe found the letter about research useful. He and I, along with my hon. Friend the Member for Lancaster and Fleetwood, had a very good meeting with the chief medical officer, and we have followed that up with a response to the all-party group’s excellent report, which was published last October. At our meeting, the chief medical officer said that she would be happy to attend a meeting of the all-party group. I will remind her of that, but I suggest that the hon. Gentleman and my hon. Friend get in touch with her. We would respond positively to that.

The Government are investing a record £800 million over the five years to 2017 in a series of biomedical research centres and units, including £6.5 million of funding for the Liverpool pancreas biomedical research unit. The unit is working in partnership with industry and leading research institutions to develop new treatments and diagnostic strategies for pancreatic cancer. The National Cancer Research Institute brings together clinicians, scientists, statisticians and lay representatives. Its upper gastro-intestinal cancer clinical studies group has a pancreas sub-group, which plays a vital role in the development of trials.

Late in 2012, the Prime Minister launched the 100,000 genomes project, which will sequence 100,000 whole genomes from NHS patients by 2017. It focuses on patients with rare diseases and their families, as well as on patients with some types of cancer. We believe that the six cancers that will be covered will give us knowledge and understanding that can be applied to all cancers. Although pancreatic cancer is not one of the six, we expect the project to make a useful contribution in that regard.

I thank both Members who have spoken this evening, I thank the all-party group, and I thank all those who campaign tirelessly for progress on pancreatic cancer. We know that achieving improved outcomes for people with the disease is a huge challenge, but I believe that the change that we all desperately want to see will come. I welcome the new cancer taskforce, which will be leading the way, and I undertake to write to its independent chairman, drawing his attention to this evening’s important debate and the work of the all-party group.

Question put and agreed to.

Oral Answers to Questions

Jane Ellison Excerpts

Tuesday 13th January 2015 Commons Chamber

[Mrs Linda Riordan (Halifax) (Lab/Co-op)]

8. What the clinical reasons are for plans to close Calderdale Royal hospital A and E department.

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

There are no plans for the closure of A and E at Calderdale Royal hospital.

[Mrs Riordan]

Calderdale and Huddersfield NHS Foundation Trust failed to give one clear recommendation for closing a 24-hour A and E service in Halifax in its business plan. Is that simply because there aren’t any?

[Jane Ellison]

The hon. Lady and I have debated this topic before on the Adjournment. This is a locally led process. Nothing has been ruled in or out, no decision has been made, and first and foremost comes the safety and efficacy of local health services. May I commend to the hon. Lady the approach of her constituency neighbour, my hon. Friend the Member for Calder Valley (Craig Whittaker), who at all times has championed the best outcomes for his constituents’ health, rather than seek to make politics out of this?

[Chloe Smith (Norwich North) (Con)]

9. What steps have been taken to support NHS hospitals in meeting increased demand in winter 2014-15.

--- Later in debate ---

[Mark Pawsey (Rugby) (Con)]

10. What steps his Department is taking to ensure support for smaller district hospitals.

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

The NHS “Five Year Forward View” sets out a range of actions to help sustain smaller local hospitals, and we have backed that with almost £2 billion. NHS England is making a £200 million transformation fund available to smaller hospitals looking to develop prototypes.

[Mark Pawsey]

Did the Minister see the recent remarks by Simon Stevens, the chief executive of NHS England, on how smaller local hospitals can play a role in providing care, particularly to older patients, many of whom prefer to be treated close to home? Does she agree that this makes the case for the future within the NHS for smaller hospitals such as St Cross in Rugby?

[Jane Ellison]

It is exactly that kind of flexibility that we so much welcome in the “Five Year Forward View”, recognising the potential of smaller hospitals. My hon. Friend’s local hospital, which he champions so well, can apply to be one of NHS England’s prototypes, and I would encourage it to do so.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

Does the Minister accept the case made by commissioners and the trust in Morecambe Bay that, notwithstanding all the efficiencies and changes in services, the trust could not close its deficit, due to its near unique geography and health need, without significantly cutting vital services for the area?

[Jane Ellison]

These are clearly difficult local questions that local health leaders need to look at. If there is a particular issue the hon. Gentleman would like to draw to our attention, we will certainly be able to examine it. I recognise that unique geography is involved, but steps are already being taken by NHS England to try to close some of those gaps and to deal with those challenges that smaller hospitals face, working with Monitor and looking at, for example, the tariff regime. I encourage him to look at that, too.

[Robert Jenrick (Newark) (Con)]

11. What proportion of 111 calls resulted in an ambulance being called in the most recent period for which figures are available.

--- Later in debate ---

[Michael Fabricant (Lichfield) (Con)]

The Institute of Translational Medicine at Birmingham university medical school is probably the top place in Europe for genetic research into innovative cancer cures. I have visited it. Will the Secretary of State visit it, and will he ensure that funding continues for that department?

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

My hon. Friend is right to champion that project. The Prime Minister’s 100,000 genomes project is leading the world and has the potential to transform the future of health care. The Institute of Translational Medicine in Birmingham will accelerate access to new diagnostics, new drugs and medical devices and provide a focus for life sciences. My hon. Friend will be pleased to know that my colleague with responsibility for life sciences, my hon. Friend the Member for Mid Norfolk (George Freeman), plans to visit on 3 March.

[Mr Iain Wright (Hartlepool) (Lab)]

The Secretary of State refuses to meet Hartlepool borough council and me on the issue of hospital services in Hartlepool. On Wednesday in this House he said:

“I take responsibility for everything that happens in the NHS.”—[Official Report, 7 January 2015; Vol. 590, c. 277.]

If so, will he respond to the 12,000 people who signed the petition organised by the Hartlepool Mail, the 1,000 people who marched on Saturday morning, Hartlepool borough council and me on this issue? Will he stop snubbing the people of Hartlepool, work with us and make sure that hospital services can return to Hartlepool?

Health Care Provision (Newark)

Jane Ellison Excerpts

Wednesday 7th January 2015 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Turner. I apologise for being a stand-in for the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter). I know he has previously debated these issues with my hon. Friend the Member for Newark (Robert Jenrick), whom I congratulate on securing this debate. It was a pleasure to go to Newark to campaign for him during the by-election. Literature that we all delivered told us that he would be a doughty campaigner, with health at the heart of his campaigning and his representations on behalf of his constituents. He has evidently made good on that promise in his relatively short time in the House. I am very aware of his dedication to ensuring that the health needs of his constituents are met. It is also a pleasure to see my hon. Friend the Member for Sherwood (Mr Spencer), who is another assiduous local Member and a valued colleague who has the health concerns of his constituents at heart.

This debate is a welcome chance to discuss local health care matters. I know both my hon. Friends regularly meet local health leaders, which is right. The depth of knowledge that comes across from both Members this morning is the result of that engagement. I encourage such engagement because it allows Members to be best placed to bring their constituents’ concerns to the House.

I recognise, as does my hon. Friend the Member for Newark, the hard work and dedication of NHS staff in his and other constituencies. He rightly describes them as wonderful, and it is excellent to hear that he was with them over the Christmas break. More than 4,000 staff are employed by Sherwood Forest Hospitals NHS Foundation Trust alone, in addition to the thousands who work in primary care. We thank them for their service at a time when we know they are under pressure.

It is all too easy to overlook primary care’s essential contribution to health care provision. The local GP or pharmacist is the key health care provider for many people. I will talk about the local hospital in a moment, but that foundation of good primary care is important. I am delighted that, through the Prime Minister’s challenge fund, Newark and Sherwood CCG is working with the hospital, local GP practices and Central Nottinghamshire Clinical Services, the out-of-hours provider, to improve access, reduce complexity for patients and ensure a sustainable staffing model. Given the pressure on the system over the Christmas and new year period, we can see only too well the importance of that work and the challenge fund in finding new ways to provide primary care access. In 2014, Mansfield and Ashfield CCG and Newark and Sherwood CCG were awarded a total of just over £1.8 million from the Prime Minister’s challenge fund, which was part of a £5.2 million collaborative funding bid that was spent in this financial year.

My hon. Friend is right to make Newark hospital the heart of his speech. Although there is legitimate concern, much of the worry caused for patients and the public in Newark has simply been unnecessary. I know he realises this but, for the record, the number of patients being treated is increasing. In 2012, the number was about 131,600; it increased to almost 133,500 in 2013. There is also more day care surgery, as my hon. Friend mentioned. The number of out-patients’ appointments is increasing and the number of specialities offering appointments at Newark is up. There is also improved provision for children.

I quite understand, however, why my hon. Friend wants to emphasise the need to keep building on that progress. He focused much of his speech on the minor injuries unit and urgent care centre. I can only sympathise with him with regard to navigating a way through terminology, because I am well aware that some terms mean different things in some parts of the country and that our health economy, because of its sophistication, is sometimes quite complex. It is therefore incumbent on all of us—Ministers, local health leaders and so on—to try to cut through that complexity as much as possible to make clear to local people what they can expect to get in a particular facility, what they would go there for, and where that facility fits into the local health economy, as well as the fact that it is part of a plan.

Newark provides consultant-led out-patients’ services, planned in-patient treatments, day-case procedures, diagnostic and therapy services and the MIU-UCC. My hon. Friend spoke about the need to increase the range of services. He is right to do so and to put forward his constituents’ concerns. As he outlined, there are plans to enhance the services offered at Newark hospital through the Newark strategy. He gave a history lesson at the beginning of his speech; I am well aware that there have been a number of strategies, but the current Newark strategy is being implemented, and I am encouraged by what I heard, in preparing for the debate, from local senior leaders. However, he is right to say that progress must be maintained.

The strategy includes Newark hospital being a centre of excellence for a broad range of services, including diagnostic, rehabilitation and so on. A number of new developments are already in place and a £500,000 development to make structural changes to the MIU is planned, which will make urgent care simpler and increase the range of Newark-based services.

As I said, I will take this debate as an chance to emphasise that if there is a lack of clarity locally—I can understand that there might be—local health leaders and all of us who work in and around the health system must work hard to ensure that the public, who are the users and end recipients of our excellent NHS services, really understand what is being offered. It is vital that they do.

The plans I mentioned include provision of additional consulting rooms, so that health care staff, including hospital staff and GPs, can work alongside each other instead of at separate locations. Building for that should start in April, which is really encouraging and testimony to my hon. Friend’s efforts to keep this a front-foot issue. Such evidence of the hospital’s long-term future is extremely welcome and should be reiterated.

With regard to the suggestion that more ambulance patients might be taken to Newark hospital, I understand that the local NHS has identified safety concerns with that. The level of emergency care was reviewed locally in 2013 as part of the development of the Newark strategy. As I know that my hon. Friend will appreciate, a patient’s diagnosis will not always be clear when the ambulance crew first arrives at the scene, so more comprehensive diagnostics are required—diagnostics that often need to be done in a main centre before a serious condition can be excluded.

I am told by the local NHS that the conveyance of all green ambulance calls to Newark would result in a limited improvement in ambulance response times, but I hope that it has looked at that carefully, has heard what my hon. Friend said today, and is giving proper weight to that. I know that for both my hon. Friends, the safety of their constituents is a paramount concern. They will know that for the Secretary of State for Health, the safety and quality of our health system is a touchstone issue in this Parliament, and we have debated significant safety concerns in recent years. When local clinicians believe that there are safety risks, it is important that their opinions carry weight and that we listen to those concerns closely.

My hon. Friend the Member for Newark has already discussed with the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich, whether hospitals elsewhere might provide helpful examples for both Sherwood Forest Hospitals NHS Foundation Trust and Newark hospital. Hexham was mentioned as one such example. While parallels can be drawn, an exact comparison cannot, as my hon. Friend the Member for Newark acknowledged. There are some similarities between the services offered at those sites, but Hexham is a larger site with a more remote community. I note, however, what he said about his constituency being mixed, with some areas being much harder to get to owing to their road services.

GP services are offered at Hexham, and the new extension at Newark will enable that to happen in my hon. Friend’s constituency, which will be welcome. As he is also aware, decisions on local services, including urgent and emergency services, are a matter for local NHS leadership because they are the people, working with elected representatives, who know the local community best. The local NHS is clear that decisions about services will be based on patient safety and sustainability, which, having seen some of the problems uncovered in this Parliament in cases such as Mid Staffs, is what we all want as the foundation on which we build.

[Mr Spencer]

It is good to hear that progress is being made, but the elephant in the room remains the £40 million a year in PFI payments. Until we solve that problem, the challenges will remain. In the time remaining, will the Minister discuss that?

[Jane Ellison]

I will; in fact, that is on my next page. My hon. Friend is right to bring me to that. On the trust’s financial position, as my hon. Friends have mentioned, Monitor assessed Sherwood Forest Hospitals NHS Foundation Trust in 2012 and identified issues that had contributed to its deteriorating financial performance. The trust signed its £326 million PFI deal under the previous Government in November 2005 for the redevelopment of King’s Mill hospital. The trust’s PFI cash outflow equates to some 17% of its annual income, which is clearly a substantial amount. The operating costs for that scheme are inflating with the retail prices index by about £1.5 million a year. My colleagues are therefore right to raise that considerable concern.

The trust has received ongoing financial support directly from the Department of Health: it received £28 million in 2013-14 and £26 million in 2014-15. However, as my hon. Friends realise, it is important that I emphasise that such funding is not sustainable as it takes resources away from other areas. We therefore clearly need a better solution.

The trust forecast a financial deficit this year, but Monitor does not have any immediate concerns about the sustainability of services at Newark hospital. I put that on the record as a note of reassurance for my hon. Friend the Member for Newark. The trust recognises the challenge that its PFI payments present—that has come out clearly in my discussions—and it accepts that the solution lies in the full involvement of all partners in the local health economy. The Better Together programme for Nottinghamshire goes some way towards achieving sustainability, and local commissioners continue to work with Monitor and NHS England, as they need to, to find a solution.

I am aware that there have been suggestions locally that Sherwood Forest Hospitals NHS Foundation Trust should look at the route taken by Northumbria Healthcare NHS Foundation Trust and buy out its contract. However, the overall PFI deal for Sherwood Forest is much bigger than Northumbria’s, so a similar buy-out would incur a far greater cost. That is a note of caution.

The Department and the Treasury have discussed a range of options to reduce the cost of PFI projects in general, using public sector capital, including buying senior debt and terminating contracts completely. It is however for individual trusts to be clear about what options they have considered and to bring proposals forward.

Looking around the country, it is clear that the individual schemes have complexities, in terms of when they were signed, effective pricing and risk profile, so it is important both that such matters are looked at carefully at a local level and that the Department is engaged early on by trusts and foundation trusts when they develop their proposals, which will then be considered carefully by the Department of Health and the Treasury—and Monitor, if required—on a case-by-case basis for value for money and affordability. That is what happened in Hexham.

In the time left, I want to assure my hon. Friend the Member for Newark that my right hon. Friend the Secretary of State, as he said last year, will be happy to consider any proposals brought forward. We are very much open to that.

I am left with little time to comment on the ambulance services, other than to say that although we acknowledge that there are some big challenges, a resilience plan is in place and we will monitor that carefully. I end by congratulating my hon. Friends the Members for Newark and for Sherwood on bringing this important topic once again to Ministers’ attention.

Late Stage Hepatitis C

Jane Ellison Excerpts

Tuesday 6th January 2015 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Gray. I thank the hon. Member for Ealing North (Stephen Pound) for his kind words and congratulate him on securing this important debate. Hepatitis is a significant health issue that has been overshadowed by others for too long, in part because of many of the people who are most affected, so I welcome this opportunity to discuss it. In nine minutes I cannot possibly respond to all the points that have been made, so I will say straight away that I am going to put the issue of contaminated blood to one side as there will probably be another debate on that at some point. Work is ongoing with regard to previous problems with contaminated blood in the NHS. We are still awaiting the findings of Lord Penrose’s much delayed inquiry, which, as it addresses pre-devolution issues, is highly relevant. Nevertheless, I must put that issue to one side.

[Mr Slaughter]

Will the Minister give way?

[Jane Ellison]

I cannot take an intervention on that point because I must deal with the rest of the debate.

On presumed consent, within the past year we have had two good, thorough debates in this Chamber on issues of organ donation and consent. It is a very interesting area of discussion. I am watching the Welsh experience with interest; I do not dismiss it, but it is very complex. I would be happy to debate it at any time with any Member because it is a topic to which I have given quite a lot of thought and consideration.

I pay tribute to the Hepatitis C Trust for its work. More recently, I have met the Hepatitis C Coalition, which has impressed on me with great force some of the issues that it wishes to see addressed—issues that were picked up by the hon. Member for Ealing North.

The NICE appraisal of the first of the new hep C therapies is due very soon, so this debate is timely. Understandably a lot of the focus is on the new therapies, but focus on prevention runs right through the NHS long-term strategy. That is highly relevant because if people are to be treated with good, new and expensive therapies, it is important to address issues such as re-infection rates and good public health prevention. Members should be in no doubt about the Government’s commitment, which I suspect would be shared by any Government, to reducing the big killers—the main reasons for premature mortality in our country—one of which is liver disease. We cannot tackle the big killers if we are not tackling hepatitis C. We are clear that the contribution that tackling hepatitis C can make to reducing current rates of end-stage liver disease is an important part of any premature mortality strategy.

[Grahame M. Morris]

Will the Minister take this opportunity to put on record the fact that hepatitis C is indeed curable and clear up any misunderstandings inadvertently created by her predecessor?

[Jane Ellison]

I have read the transcript of the previous debate and dealt with some of the issues subsequently raised in correspondence, so there is no need to go over that again. I am well aware of the issue.

The single biggest risk group for hepatitis C is people who inject drugs, or have done so in the past. Public Health England estimates that such people comprise about 90% of all those infected in England. There are also high rates of hepatitis C among the prison population, which presents significant challenges for the NHS, particularly in terms of re-infection and changing risky behaviours. We obviously need to prioritise making the best possible treatment available to people who are suffering the worst ill health. From a public health perspective, the starting point must be prevention. Some of the new treatments will clearly be focused on people who are the most ill. Although it is right to focus on the exciting opportunities offered by new drugs and treatments, we must not lose sight of the fact that we have to make sustained progress on reducing infection in the first place. I therefore welcome the emphasis on prevention in NHS England’s five-year forward view.

Public Health England has been working with drug treatment services to improve health promotion resources for injecting drug users and those sharing needles, and to increase coverage of opiate substitution therapies and needle syringe exchange programmes. Joined-up drug treatment services commissioned by local authorities are important. We are very conscious of the need to raise the priority of hep C in local authorities and their joint strategic needs assessments—I note that it is mentioned in Ealing’s, but it is not mentioned by some authorities that face a significant challenge. That is one reason why, early this year, I will host a joint hepatitis C and tuberculosis summit with elected members from those local authorities with the highest rates of both diseases in England. The aim of the summit will be to explore how we can bring together different parts of local health systems with local authorities to control TB and hepatitis C rates in particular communities. Distinctly different communities are affected and need distinctly different approaches to tackling the problem.

As the hon. Member for Ealing North said, NHS England and Public Health England are working together on a framework. I apologise that it has been delayed, but it is due to be published this year and I will use this debate as an opportunity for another discussion about the timetable. Nevertheless, those bodies are working together very carefully on the framework, which will set high-level aims for the public health system towards the elimination of hepatitis C-related liver disease as a public health issue, with specific, time-bound objectives that feed into the overarching plan. I think that that deals with one of the issues raised earlier.

Clearly, the framework must have key targets, involve clinical commissioning groups and address co-commissioning. PHE has been working with a range of local partners—such as GPs, CCGs and NHS commissioning—to look at the rates of testing, diagnosis and treatment for people at risk of hepatitis C. That will be a core part of the framework. I will pick up the issue and write to Members when I have more detail on when we are going to publish the framework, but it will be very thorough, which is why it is taking a little longer to finalise.

In recent years, the Hepatitis C Trust has played an important role in piloting innovative ways of increasing testing rates through the use of a mobile testing van and pharmacy-based testing. We always underestimate what can be done in pharmacies, but I am very keen to make far more of what we can deliver through them. It is important that people can access early diagnosis. Those accessing drug treatment services should routinely be tested for hepatitis C, as recommended in NICE guidance. I welcome data from PHE that show increasing rates of testing. Nevertheless, we clearly must do more to ensure high levels of professional awareness about that.

PHE has also been working with NHS England and other commissioners to look more generally at how best to commission to meet the needs of patients with hepatitis C. For example, its work has included issuing extremely informative liver profiles to each local authority area, including information about hepatitis C. Every single local authority in England was sent the liver profile for its area, in the hope that that would provide the basis on which services could be planned. I urge Members to look at those profiles, and if any Member has not seen the one for their area, I would be happy to supply it.

Time is very much against me and I have not really had the chance to discuss the new therapies. We are very conscious of the potential that they offer, but I must also put on record the fact that there are existing therapies. They come with great challenges, as the hon. Member for Ealing North outlined, and they are also more difficult for people who struggle to access health care and keep to regular therapy programmes. We see great potential in some of the new therapies, but careful thought must be given to how they are delivered to patients. More than 700 patients have already been treated through the policy on access to new therapies for patients with liver failure, which has cost about £38 million, with specialist centres established to deliver early access around the country.

I am afraid that time has beaten me, as I thought it might given the interest in this subject, but I hope that I have given hon. Members the sense that we have real momentum, with the summit and the plan to come. I will write to them with further detail.

Mitochondrial Donation

Jane Ellison Excerpts

Wednesday 17th December 2014 Written Statements

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

We have today laid regulations to allow mitochondrial donation to prevent the transmission of serious mitochondrial disease from mother to child.

Mitochondrial disease is passed from mother to child through faults in the mitochondrial DNA. It is estimated that one in 6,500 children are born every year in the UK with a serious mitochondrial DNA disorder. Serious mitochondrial disease can have a profound effect on families, including the premature death of children; and causes painful, debilitating and disabling suffering, long-term ill health and low quality of life. There is no cure. British scientists are leading the world in the development of mitochondrial donation techniques which can prevent the transmission of this devastating disease.

The Government have run a comprehensive and transparent process over the lifetime of this Parliament to review the public acceptability of mitochondrial donation and the ongoing evidence of safety and efficacy of the new techniques involved. In developing the draft regulations, we have taken extensive advice from the scientific and research community and the United Kingdom’s regulator, the Human Fertilisation and Embryology Authority (HFEA). Should the regulations be approved by Parliament these mitochondrial donation techniques would form part of the HFEA’s regulatory framework. Any prospective provider would have to demonstrate that it could perform the technique both safely and effectively in order to obtain a licence, putting mitochondrial donation on the same footing as other fertility treatments.

The consultative process has included: a public dialogue and consultation about public acceptability run by the HFEA in 2012-13; three separate reports about the safety and efficacy of the techniques by an expert panel convened by the HFEA in 2011, 2013 and 2014; and a consultation by the Department of Health in 2014 about the detail of draft regulations that would allow these techniques. The HFEA published “Mitochondrial Donation: an introductory briefing” on 22 October, which provides a very helpful summary about the expert panel review process and outcome.

In addition the Nuffield Council on Bioethics ran a public consultation about the ethics of allowing the new techniques in 2012. Most recently, the House of Commons’ Science and Technology committee took evidence and considered the science of the new techniques, subsequently writing to the Government urging them to proceed.

Taking into account this cumulative consideration and consultation, the Government consider that the time is now right to give Parliament the opportunity to consider and vote on these regulations.

Nicotine-inhaling Products

Jane Ellison Excerpts

Wednesday 17th December 2014 Written Statements

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

The Government have today published “Age of Sale for Nicotine-inhaling Products-consultation on proposed regulations to be made under the Children and Families Act 2014”

In February 2014, the Government took regulation-making powers in the Children and Families Act 2014 to enable regulations to be made to prohibit the sale of nicotine products to persons under the age of 18. The proposed regulations cover “nicotine-inhaling devices” which are defined as any device which is intended to enable nicotine- to be inhaled through a mouthpiece but is not tobacco, cigarette papers or a device intended for the consumption of lit tobacco. It encompasses electronic cigarettes. The proposed regulations also cover refill cartridges and nicotine liquids intended to be used to refill nicotine inhaling devices.

The proposed regulations would:

make it an offence to sell nicotine-inhaling products, such as electronic cigarettes, to anyone under the age of 18, with certain limited exceptions;

extend the existing offence of the proxy purchase of tobacco (at section 91 of the Children and Families Act) to cover nicotine-inhaling products, so that it would also be an offence for an adult to buy an e-cigarette on behalf of a child under 18 years, subject to limited exceptions; and

exempt the sale of any nicotine-inhaling product that is licensed as a medicine, where it has been prescribed to a child and is sold under certain conditions, or where the medicine is indicated in its licence for therapeutic use by children.

The Government want to protect children and young people from addiction to any substance, particularly those that might be harmful to health. Given the rapid emergence of e-cigarettes in recent years, coupled with concerns about the increased awareness and use of these products by children, the Government are committed to setting an age of sale requirement.

The consultation on the draft regulations will run for six weeks until 28 January 2015. I encourage all those with an interest to submit their views on the draft regulations and the accompanying impact assessment.

A copy of “Age of Sale for Nicotine-inhaling Products—consultation on proposed regulations to be made under the Children and Families Act 2014” has been placed in the Library of the House and attachments can be viewed online at: http://www.parliament.uk/ writtenstatements

Smoking (Vehicles Carrying Children)

Jane Ellison Excerpts

Wednesday 17th December 2014 Written Statements

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

The Government have today published a response to the consultation on regulations to end smoking in private vehicles carrying children and have laid draft regulations in Parliament.

The Government want to protect young people from the serious health harms of smoked tobacco and the regulations would make private vehicles carrying children smoke-free. We have made some technical amendments in response to the consultation responses, and, subject to agreement in both Houses, they will come into force from 1 October 2015.

The existing smoke-free legislation, as set out in the Health Act 2006, will be extended so that it will be an offence to:

smoke in a private vehicle with someone under age 18 present; and

fail to prevent smoking in a private vehicle with someone under age 18 present.

If approved by Parliament, the regulations will apply to enclosed private vehicles and will not apply to anyone driving alone.

The World Health Organisation found that second-hand smoke is a real and substantial threat to child health. It causes a variety of adverse health effects including increased susceptibility to lower respiratory tract infections like pneumonia and bronchitis, worsening of asthma, middle ear disease, decreased lung function, and sudden infant death syndrome.

Smoke-free legislation is a devolved matter and these regulations would apply to England only. However the regulations will set the amount of the fixed penalty notice at £50 for the offence of failing to prevent smoking in a smoke-free private vehicle, which will apply in relation to England and Wales. We are liaising with the Welsh Government to co-ordinate our approaches. Public Health England is developing a social marketing campaign to raise awareness of the new regulations in advance of them coming into force.

The Government response to the consultation on smoking in private vehicles carrying children has been placed in the Library of the House.

NHS Services (Devon)

Jane Ellison Excerpts

Thursday 11th December 2014 Commons Chamber

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

I congratulate the right hon. Member for Exeter (Mr Bradshaw) on securing this debate. He is right to say that Parliament is intended to bring these very important topics to the fore. In securing this debate, he rightly brings a very important subject to the Floor of the House, and I welcome the opportunity to respond. It is a matter of great importance to him and his constituents, but also to other Members in the area. My right hon. Friend the Member for East Devon (Mr Swire), as a Minister in the Foreign Office, and my hon. Friend the Member for Central Devon (Mel Stride), as a Government Whip, are unable to speak in the debate, but let it be noted for the record that they are here in attendance, representing their constituents, and have shown a keen interest in the matter and discussed it with me, as has the right hon. Gentleman.

I start by commending the work carried out every day by those working in our NHS, particularly in the area of Devon that we are discussing. At every opportunity in this House, we should, particularly as we approach the Christmas season, pay tribute to the fantastic work of our front-line NHS workers.

I turn to the service changes to Northern, Eastern and Western Devon—NEW Devon—clinical commissioning group. As the right hon. Gentleman set out, the CCG is facing significant financial pressures, with an end-of-year deficit of £14.5 million for 2013-14 and a similar deficit predicted for this financial year. To address these pressures, the CCG proposed some changes, which it described as “temporary”, to some of the services it commissions in the area. On 3 December, as he said, it announced that it was taking urgent measures to prioritise essential services and the requirements laid out in the NHS constitution.

We recognise that CCGs have to take resourcing decisions based on the needs of their local community, but blanket restrictions on procedures that do not take account of the individual health care needs of patients are unacceptable. Decisions on treatments, including suitability for surgery, should be made by clinicians, based on the individual clinical needs of patients. The Deputy Prime Minister made that point in response to the right hon. Gentleman at Prime Minister’s questions, and I reiterate it now. The right hon. Gentleman has given some very serious and moving examples of patients who would be affected by such blanket restrictions. National Institute for Health and Care Excellence guidelines represent best practice, and we expect NHS organisations to take them fully into account as they design services for their local populations and work towards full implementation over time.

With regard to the latest position, things have moved quite rapidly in the past 24 hours, as the right hon. Gentleman outlined. NEW Devon CCG announced today that it will no longer compel patients to undergo weight loss or stop smoking ahead of routine surgery. It confirmed that patients will instead be offered evidence-based guidance, as we would expect, on the benefits of weight loss and smoking cessation as part of their health care. As a former Health Minister, he would, like me, draw attention to the fact that both those things are generally desirable in terms of good health and the efficacy of treatment. The CCG also confirmed that it would not be restricting in vitro fertilisation treatment or caesarean sections on non-medical grounds.

In announcing its decision on weight loss and stopping smoking, the CCG confirmed that it will continue with a series of other measures that have already been announced, but those will be subject to public consultation in the new year, where appropriate. Discussions are under way to confirm the extent of that consultation. Today I had a telephone discussion with some of the key people involved, including the chief officer of the CCG and the NHS area lead. I know that the right hon. Gentleman and my right hon. and hon. Friends will want to take a full part in that consultation. Indeed, the right hon. Gentleman indicated some of the areas that he will wish to explore in that consultation process.

NHS England has confirmed that it is currently scrutinising the CCG’s proposals and is in close dialogue with it. That has been confirmed to the right hon. Gentleman, with a good level of detail, in a letter to him from the chief executive of NHS England, which I have had sight of. I hope that he has had that letter; I think he has.

[Mr Bradshaw]

indicated dissent.

[Jane Ellison]

If not, I apologise on behalf of NHS England. I was informed that the letter had been sent to him. I very much hope that it has pinged into his inbox by the time he returns to his office. If, by some chance, it has not reached him, I will certainly make sure that my office passes him a copy. I will also make sure that other right hon. and hon. Members who would want to have sight of the sentiments in the letter have sight of them.

NHS England has confirmed that it is currently scrutinising the CCG’s proposals. They are in close dialogue and I confirmed that myself in my conference call today. NHS England is seeking assurance that the proposals are in the best interest of patients, which we would all echo; that they are based on sound evidence, to which the right hon. Gentleman alluded; and that they are subject to a well-planned process, including, if appropriate, public consultation.

On the next steps on financial issues—the right hon. Gentleman put this in the context of a longer-term concern—the CCG has stated that its financial projections are being updated in the light of the current pressures and the five-year system-wide assessment of a potential finance gap between resources and the cost of health demand, which the CCG considers will be £430 million, which is a considerable sum.

Devon was one of the 11 financially challenged health economies to be provided with intensive support by NHS England. I understand that the report of that work is due to be published shortly, along with planning guidance, which will be a joint publication with the NHS Trust Development Authority, Monitor and NHS England. The right hon. Gentleman does not have long to wait to see that detailed piece of work on the broader, long-term picture.

[Mr Bradshaw]

Does the Minister have any idea why it has taken quite so long? Did the CCG drop its smoking and obesity proposals before or after her telephone conversation with it?

[Jane Ellison]

I will write to the right hon. Gentleman with a response to his first question, as I am not abreast of the detail. The letter to him from the chief executive of NHS England is dated the 10th, so I think that answers his second question. I apologise that he has not received notice, but discussions were under way prior to my phone call with the local NHS leads, during which we touched on the issue.

As part of the work I was just referring to, an extensive, detailed analysis of services and costs in the NEW Devon health economy was undertaken. The NHS England area team director of finance has given significant support and challenge to the CCG to understand its financial position and to support the development of a financial recovery plan. The area team has also been engaged with the CCG through the quarterly assurance process and agreed a set of actions with time scales to improve the financial position.

I stressed in my conversation today the urgency of the matter and the clearly enormous public and parliamentary interest in it. Parliamentarians have a very important role to play in being a bridge between health officials and the public and the constituents they represent, as reflected by the interest shown in this debate by Devon MPs. The CCG and NHS England will meet next week to consider the CCG’s medium to long-term financial plans. It is an important meeting and I have asked to be kept abreast of those developments.

I will ask the Minister of State, Department of Health, my right hon. Friend the Member for North Norfolk (Norman Lamb), to write to the right hon. Gentleman with more detail on the mental health issues he has raised.

The right hon. Gentleman has also raised concerns in the House and elsewhere about the walk-in centre. That is dealt with in some detail in Simon Stevens’s letter to him—I repeat my regret that he has not had sight of it—so if he has further concerns after reading it, he might want to raise them with the chief executive. However, he is, of course, always welcome to raise them with Ministers.

To return to the central part of this debate, I reiterate that policies providing for blanket restrictions on treatments for particular classes of patients based on lifestyle characteristics are unacceptable, and various Ministers—including, as I have said, the Deputy Prime Minister at PMQs this week—have made that clear. Any general policy on prioritisation of services must be robust, evidence-based and justifiable. In addition, any general policy must take account and make provision for an individual’s clinical situation, an example of which was given by the right hon. Gentleman.

CCGs have statutory duties to consult, inform or otherwise engage with the public about commissioning decisions, and duties to promote the involvement of individual patients in decisions about their care and treatment. We fully expect that the CCG will be mindful of those obligations when making any decisions. As I have said, I have stressed the importance of good communication, which is absolutely vital. I have had personal experience as a constituency MP, as well as a Health Minister, of communication not reaching the right people at the right time, resulting in confusion and sometimes distress for constituents and patients. It is therefore very important to get such things right, and I expect all local health economy leads to be extremely mindful of the need to involve local parliamentarians and other democratically elected people.

[Mr Bradshaw]

Does the Minister accept the importance not only of good communication, but of functional relationships? The letter from David Flory about the dysfunctionality of the relationship between Northern Devon and the rest of the heath economy in Devon is very worrying.

[Jane Ellison]

Functioning relationships are absolutely key to long-term planning. We have all recently seen the “Five Year Forward View” from NHS England, and the Government have expressed their support for the plans and intentions in that document. Co-operation and close working are at its heart, as they are at the heart of any local plans for the short, the medium and particularly the medium to long term. Functioning relationships between different parts of the health economy, as well as between the elected Members in the area, are therefore vital.

I feel confident that the right hon. Gentleman will continue to draw attention to that need. Indeed, throughout the debate my hon. Friend the Member for Central Devon and my right hon. Friend the Member for East Devon have nodded in assent in relation to the importance of good communication.

Important meetings are coming up imminently, and I expect there to be good communication on their outcomes. I have asked to be kept abreast of them. Engagement with the public and others, including MPs, will take place next year on the issues that have to be consulted on.

[Mr Bradshaw]

I want to put it on the record that the obviously very important and long-awaited reply from NHS England is not one of the many e-mails that have pinged into my inbox today, so I would be grateful if the Minister ensured that I get it as soon as possible.

[Jane Ellison]

I feel sure that someone is already working on that, but as I say, we will try to get it to the right hon. Gentleman as soon as possible, and to let other interested colleagues have sight of its sentiments.

I urge all right hon. and hon. Members to engage with the consultation process, and to bring all their constituents’ communications to bear by feeding them into the consultation. I have asked to be kept abreast of those matters. As the right hon. Gentleman will see from the chief executive of NHS England’s response, this important matter is being taken extremely seriously both by Ministers and at the very top of NHS England, as well as by local health leaders.

I hope that the outcome of the discussions and consultations will be a good one—as we require it to be—for the right hon. Gentleman’s constituents and other members of the public in the area. We look forward to seeing how matters progress, and I again congratulate him on bringing this important matter to the Floor of the House.

Question put and agreed to.

Mental Health (Cambridgeshire)

Jane Ellison Excerpts

Wednesday 10th December 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Dr McCrea. I congratulate my hon. Friend the Member for Cambridge (Dr Huppert) on securing this debate and commend him on his ongoing interest in local health matters. I know from meeting the chair of his CCG only yesterday that my hon. Friend is a consistent champion of local services.

I am sorry that the Minister of State, Department of Health, my right hon. Friend the Member for North Norfolk (Norman Lamb), cannot be here to respond to the debate, but he has already shown a keen interest in its subject, and I know that he will take action forward. I also echo the tributes that my hon. Friend the Member for Cambridge quite rightly made to NHS staff at the beginning of his remarks.

We all agree that good-quality patient care has to be expected regardless of where in the country we live. As my hon. Friend quite rightly said, for too long, mental health services were the forgotten area of the health service. That is changing under this Government, and I will touch on that later. There is still, however, much to do; I am sure that we would all acknowledge that.

Although I will not dwell on the subject too much in this debate, my hon. Friend was right to comment on prevention and on building resilience. As the public health Minister, those issues are close to my heart. He was also right to talk in broader terms about building resilience in individuals. I know considerable thought is being given to making it possible for people—young people, in particular—to withstand more of what life throws at them.

I move on to questions of national funding. For 2014-15, NHS England allocated £64 billion to CCGs for hospital, community and mental health services—an increase on the previous year of 2.54%, or £1.59 billion. In making allocations, NHS England relies on advice from one of our many health acronyms, ACRA—the Advisory Committee on Resource Allocation. ACRA gives advice on the share of available resources provided to each clinical commissioning group to support equal access for equal need. Much of our debate will revolve around those funding formulas and how they are evolving. The calculation is based on the age of populations, their relative morbidity and unavoidable variations in cost. The objective is to ensure a consistent supply of health services across the country. The greater the health need, the more money is received, because more health services are needed. The CCG model covers only non-specialised hospitals and community care, plus primary care prescribing.

I understand that the baseline varies systematically between locations. To some extent, that reflects different historical commissioning priorities in the predecessor organisations—the primary care trusts—or different mixes between the local and area commissioning responsibilities.

NHS England reviewed the funding formula for 2014-15 and the following years, and it now uses the person-based resource allocation approach, which was developed by the Nuffield Trust. Unlike the previous target models, it allows information about individuals—including their age, gender and recent hospital diagnostic history—to be combined with information about the area in which they live; that information, as my hon. Friend knows, is frequently linked to deprivation. The PBRA formula estimates the relative need of each individual. At a CCG level, the estimates are the most accurate ever used for allocations, so there has obviously been a change in how resources are allocated.

In debates such as this we often discuss the pace of the change from the actual allocation towards the target allocation. The option that NHS England agreed for CCGs reflected the challenge of directing additional funding to the CCGs that are the most under target, while not destabilising areas whose allocations were above target—I have seen that happen in London. If people have had an allocation for a long time, we must ensure that they plan for the change; such things must be done sensibly. That is a continuation of the policy of maximising growth for those furthest below target. We appreciate that CCGs in the east of England are further below their target allocations than those in many other parts of the country—my hon. Friend is right to draw attention to that—and that Cambridgeshire is one of the furthest behind target by some £45 million or 4.85%.

NHS England is already spending £500 million in 2014-15 and 2015-16 to bring under-target CCGs, such as Cambridgeshire, towards their target allocations. That approach was discussed and decided at a public board meeting in December 2013—nearly a year ago. My hon. Friend is pushing us to speak about what will happen in the future. Following my right hon. Friend the Chancellor of the Exchequer’s announcement in the autumn statement of a further £2 billion for front-line services, NHS England is reviewing the 2015-16 allocations. I hope that NHS England shares the hopes of my hon. Friend the Member for Cambridge, and that it will consider how some of that extra £2 billion can be used to help the CCGs that are furthest behind—including Cambridgeshire—to get closer to their fair share. My hon. Friend has already discussed that issue with my ministerial colleague, my right hon. Friend the Member for North Norfolk, who takes it extremely seriously and is committed to raising the matter with NHS England before it makes a decision at its board meeting on 17 December.

Like my hon. Friend the Member for Cambridge, I recognise the commitment and dedication of the staff who provide mental health service, including those who work in specialist trusts and settings, and those who work in primary care and provide services daily. I was pleased that my hon. Friend spoke about the large army of people who are absolutely critical in mental health. They are often not formally part of the NHS composition of services, but their support is invaluable to it. They are the carers and volunteers, who sometimes work in charities or voluntary organisations—my hon. Friend referred to Centre 33 and a number of other organisations in Cambridgeshire. Sometimes they are simply individuals who help or care for a parent, a friend or a neighbour because they think it is the right thing to do. Without those people, the job of the health services would be immeasurably more difficult. Like my hon. Friend, I pay tribute to them.

[Robert Halfon (Harlow) (Con)]

On that point, will my hon. Friend the Minister praise West Essex Mind, whose annual general meeting is this Friday? It does so much to help mental health services in Harlow and across Essex, and it is an example of a charity that is deeply rooted in our community.

[Jane Ellison]

Of course I join my hon. Friend in paying tribute to that organisation. It is obvious from the comments of many hon. Members in this House that local branches of Mind and other groups do terrific work. My hon. Friend clearly has a good relationship with his local branch, and I thank him for placing his regard for it on the record.

The Government have increased funding for mental health by £120 million in 2014-15. Total mental health spending in England will rise from £8.5 billion in 2013-14 to £8.62 billion in 2014-15. The Department of Health and NHS England continue to work together on that important issue. I recognise the challenge faced by the Cambridgeshire and Peterborough health economy. I agree with my hon. Friend the Member for Cambridge about the private finance initiative decisions that the previous Government made about Peterborough, and about the legacy of problems that they left.

As my hon. Friend knows, action is being taken. NHS England, the NHS Trust Development Authority and Monitor are working on a programme to support 11 of the most challenged health economies, of which my hon. Friend’s is one, and to address those with long-term integrated plans. In Cambridgeshire, a programme jointly funded by all local NHS partners and underpinned by a concordat on joint working has been put in place. Its purpose is to find a collectively agreed solution to closing the financial gap facing the economy as a whole, while improving quality of care for my hon. Friend’s constituents and everybody else who is served by the local health economy. That work is due to identify proposals by the end of June 2015.

Mental health is an important part of that work, and emerging ideas focus around closer integration of physical and mental health, and an expanded role for mental health input in a range of hospital settings and community pathways, such as those for long-term conditions. As the Minister with responsibility for public health, I know only too well that people often have extreme co-morbidities, so we must look at them in the round and at all the things that interact with and affect their personal health care.

I know that there are concerns that mental health services could be disproportionately affected, which would not be acceptable. Although payment for mental health services is agreed locally, we expect local commissioners and providers to have regard for the national tariff arrangements. However, they can be flexible when there is good reason to be so.

The tariff arrangements for 2015-16 give a clear signal to the mental health sector to move away from simple block contracts, which currently apply in Cambridgeshire and are not transparent, to local payment models that support recovery and outcomes, as my hon. Friend highlighted, and that reflect the needs of local communities.

My hon. Friend is right that Cambridgeshire and Peterborough CCG invested an additional £1.5 million to address capacity pressures. His CCG is clearly committed to that, and he will continue to champion it. It has also committed to investing a further £2.2 million from next April to deliver the Improving Access to Psychological Therapies programme.

My hon. Friend is right to pay tribute to my ministerial colleague, my right hon. Friend the Member for North Norfolk, who has championed mental health policy in this Parliament very effectively. My hon. Friend the Member for Cambridge drew attention to the Government’s commitment to parity of esteem, which has been made explicit in legislation. Some 2.4 million people have entered treatment under the IAPT programme, and more than 1.4 million have completed that treatment. We invested £54 million in the period from 2011 to 2015-16 in the children and young people’s IAPT programme. My hon. Friend is right that child and adolescent mental health services are a critical part of our local care pathways.

For the first time ever, we have a mental health crisis care concordat to improve the system, signed by more than 20 national organisations. As my hon. Friend said, Cambridgeshire has already put it in place. We invested £25 million to ensure that vulnerable offenders are identified when they first enter the criminal justice system. The aim is to achieve 100% coverage by 2017.

There is a lot going on. We all acknowledge that there is a long way to go on mental health, but we have passed several important milestones on the journey. The NHS—both nationally and in Cambridgeshire—is working hard on the wider funding issues, and I hope I have assured my hon. Friend that progress is being made. He has already had a commitment from my right hon. Friend the Member for North Norfolk, but when I return to the Department I will reiterate that we want to make representations about the points he made to NHS England ahead of the critical funding meeting. I encourage my hon. Friend to keep closely in touch with his local NHS, although I can see that he does that. I thank him for securing this debate. I hope I have given him a measure of comfort and reassured him that considerable progress is under way on this important agenda.