Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 11th June 2013 Commons Chamber

[Hugh Bayley (York Central) (Lab)]

1. What plans the Government have to change the NHS formula for funding clinical commissioning groups; and if he will make a statement.

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

Allocations to CCGs are the responsibility of NHS England. However, I have been advised that NHS England will rely on advice from the Advisory Committee on Resource Allocation (ACRA) for changes in the CCG formula.

[Hugh Bayley]

The failure of the Government to use the long-established funding formula for the NHS in dividing the budget between CCGs in north Yorkshire has left us with glaring anomalies, so that in York, the funding is £1,050 per head, but for Scarborough and Ryedale, which is served by the same NHS foundation trust, the funding is £1,234 per head. That is quite unsustainable and will lead to further postcode rationing. The same funding formula must be applied to all CCGs throughout the country. When will that happen?

[Mr Hunt]

I share the hon. Gentleman’s concerns about the way that NHS funding is allocated to different parts of the country. The allocation in my constituency is about the same as in his constituency, and I have long worried that things like age and rurality are not factored into the final amounts in the way that they need to be. However, in this case NHS England decided that if it was to follow precisely the ACRA recommendations, it would lead to higher growth for areas with better health outcomes and lower growth, or even cuts, for areas with less good outcomes, which it thought would be inconsistent with its responsibility to reduce health inequalities. That is why it is conducting a fundamental review, which it says it hopes will inform the next set of allocations for 2013-14.

[John Penrose (Weston-super-Mare) (Con)]

The Secretary of State will be aware that in my area of north Somerset, in Weston-super-Mare, the actual allocations versus the intended amounts of cash which should arrive with us based on the existing formula, are well below what they should be; so even without changing the funding formula, we are still getting dramatically less cash than we should. I urge the Secretary of State to look at that swiftly and see what can be done, within the existing spending envelopes, to make the allocations fairer.

[Mr Hunt]

As I said, I share my hon. Friend’s concerns about the way funding works at the moment. We are in a very difficult situation because if we were to move closer to the formula proposed by ACRA—I am sure he would agree with me that it is right that it is done independently of Ministers, and in this case it is done under NHS England—it would mean cuts in real terms for the budgets in other areas. Given the pressures overall in the NHS, that was obviously a decision that NHS England was very reluctant to make.

[Andy Burnham (Leigh) (Lab)]

The last Government matched health funding to health need and reduced the gap in male life expectancy and infant mortality, but this Government have reduced the weighting for health inequalities. The Secretary of State’s public health allocations mean that the areas he has identified today with the biggest health challenges do not get a fair share. The area with longest male life expectancy, Kensington and Chelsea, gets £133 per head, but Liverpool gets £89, Manchester £86, Luton £61, and Slough just £37. If he really wants to do something about health inequalities, should he not match his words with deeds and give more to the areas with the greatest challenges?

[Mr Hunt]

The right hon. Gentleman really cannot have it both ways. The budget for public health is also decided by an independent body, and we gave everyone a real-terms increase and then used any remaining money to even out the differences, to get everyone as close as possible to the independent formula. But if we are talking about spending, I think the right hon. Gentleman needs to say precisely whether he stands by his assertion that Governments should cut spending on the NHS by £600 million—[Interruption.] He says he has never said it before, but actually, up till now he has always said that it was irresponsible for the Government to increase spending in real terms. We have increased it; we have increased it by £600 million. He needs to come clean on whether he still wants to cut the NHS budget.

[Julian Sturdy (York Outer) (Con)]

Given that age is the main driver for an individual’s health care needs, why has not age been given more weighting in the funding formula in the past? I urge the Secretary of State to request NHS England to give as much weighting as possible to age in any future funding formula.

[Mr Hunt]

I recognise that my hon. Friend has campaigned on that issue a great deal, and I have great sympathy, because areas with high age profiles do have much greater needs for the NHS. That obviously must be weighted against things like social deprivation, which also have an impact. It is right for these things to be decided independently, which they are. The question is how we get closest to those independent allocations, and I know that that is preoccupying NHS England at the moment.

[Mr David Amess (Southend West) (Con)]

2. What steps his Department is taking to ensure consistent and continuous provision of pre-natal and post-natal care.

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

I asked the Independent Reconfiguration Panel to undertake a full review of the “Safe and Sustainable” review of children’s congenital heart services. I have received and am currently considering that advice, and will make my decision known shortly—perhaps very shortly.

[Stuart Andrew]

I am grateful for that answer. Will my right hon. Friend accept that the Leeds unit has undergone the greatest scrutiny of any of the units included in the review, and has met all the standards required? Will he therefore assure patients, families and staff that both he and NHS England have every confidence in the performance and standards of the Leeds unit? If we are to have informed choices on the future of heart units, surely all units must be subject to the same scrutiny.

[Mr Hunt]

First, I want to congratulate my hon. Friend on the sustained campaigning that he has done for that children’s heart unit, and on the very responsible way that he has conducted himself in what has been an extremely difficult campaign for the people of Leeds. I have full confidence in children’s heart surgery at Leeds; I know that the Leeds unit does an excellent job. He will understand, as I do, that when there are safety concerns, they have to be investigated, but I am delighted that those issues have been resolved, and that surgery is continuing.

[John Healey (Wentworth and Dearne) (Lab)]

The hon. Member for Pudsey (Stuart Andrew) is right that the Leeds unit has been subject to greater scrutiny than any other unit, and the decisions in its case have been more seriously flawed than in the case of any other unit. What guarantee can the Secretary of State give those families across Yorkshire who depend on this major, life-changing surgery that the unit will not simply be removed from our county and put beyond their reach, taking away this vital service for them and their families?

[Mr Hunt]

The right hon. Gentleman will understand that I cannot prejudge the decision that I will take on reflection, having read the Independent Reconfiguration Panel report, so this morning I cannot give him an answer as to what will happen. However, I can reassure families in Yorkshire, and throughout the country, that where there are safety concerns, we will take them very seriously indeed and investigate them promptly, and where there are difficult reconfiguration debates to be had, we will not duck them, but in all cases, the interests of patients—patient safety and reducing mortality—must be our primary concern.

[Greg Mulholland (Leeds North West) (LD)]

18. There seems to have been little reliable evidence for the suspension of services at Leeds, but rather for the safe and sustainable review itself. Will the Secretary of State now do what NHS England has so far refused to do to the Independent Reconfiguration Panel, despite the recommendation of the health and overview scrutiny committee in Yorkshire, and finally publish all the official e-mails between the Joint Committee of Primary Care Trusts and the National Specialised Commissioning Team between 2008 and 2013, so that he can finally learn the truth about the review and what has gone so wrong with it?

[Mr Hunt]

I know that NHS England is totally committed to transparency and when I make my final decision on the Safe and Sustainable review, we will publish a lot of information. But all the things that he refers to are subject to normal freedom of information processes, and I am sure that he will pursue those.

[Paul Flynn (Newport West) (Lab)]

4. What his policy is on the introduction of standardised tobacco packaging; and if he will make a statement.

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[Gavin Barwell (Croydon Central) (Con)]

7. What steps he is taking to increase accountability in the NHS.

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

We have transformed accountability in the health system by setting up Healthwatch and introducing stronger local democratic accountability through health and wellbeing boards.

[Gavin Barwell]

Croydon PCT’s accounts for 2010-11 showed a £5.5 million surplus; it subsequently turned out to be a £23 million deficit. The former chief executive and two former finance officers have adamantly refused to give evidence to a scrutiny committee set up by councils in south-west London. Does the Secretary of State agree that that is unacceptable and that NHS managers must be held to account, and given that two of these individuals still work in the NHS, does he have the power to compel them to give evidence?

[Mr Hunt]

Accountability is extremely important. Local authorities can require members or employees of local health service commissioners to appear and answer questions, and NHS organisations and individuals should co-operate with that. I am extremely concerned by what my hon. Friend says. He knows that I have received a report on this from the joint overview and scrutiny committees for six south-west London boroughs, and I will be responding shortly.

[Helen Jones (Warrington North) (Lab)]

Does the Secretary of State agree that accountability would be improved if the private providers who are increasingly providing NHS services were subject to the Freedom of Information Act 2000? Will he ensure that as more and more services become privatised under this Government, those people are subject to the same freedom of information provisions as those in the NHS, because otherwise no committee can hold them to account?

[Mr Hunt]

Perhaps I could gently remind the hon. Lady that the previous Labour Government did not do this, despite making huge efforts to get more private sector involvement in the NHS. Providers must operate on a level playing field, and so the inspection regime that we are setting up, with a new chief inspector of hospitals, will apply equally to the private sector and the public sector.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does my right hon. Friend agree that the introduction of health and wellbeing boards represents a very welcome introduction of democratic accountability into the management of the health and care system? Does he further agree that the acid test of health and wellbeing boards will be their ability to increase the pace of integration between health and care so that the service we deliver is more closely matched to the needs of patients?

[Mr Hunt]

As is so often the case, my right hon. Friend speaks extremely wisely on this issue. Integrated services will be the big thing that transforms the service we offer vulnerable older people, which the right hon. Member for Leigh (Andy Burnham) mentioned earlier. Health and wellbeing boards will have an extremely important role to play in bringing together local authorities and clinical commissioning groups so that we have joint commissioning of services for those very vulnerable people.

[Dame Joan Ruddock (Lewisham, Deptford) (Lab)]

On accountability, whenever I have asked the Secretary of State how lives might be saved by downgrading Lewisham’s A and E he has cited the medical advice of Sir Bruce Keogh. My colleagues and I have repeatedly sought meetings with Sir Bruce and it is unprecedented in my experience to not receive a response to such a request. Is the Secretary of State satisfied with that? Is Sir Bruce free to meet Lewisham MPs, or has the Secretary of State told him not to?

[Mr Hunt]

Sir Bruce is free to meet anyone he likes. Actually, he had a meeting with MPs last month, which the right hon. Lady could have attended if she had wanted to do so, and there was extensive engagement with local south-east London MPs before the decision on Lewisham hospital was made.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

8. How many accident and emergency departments he visited in an official capacity in winter 2012-13.

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

I regularly visit a range of services across the NHS. Since taking up post in September 2012, I have visited 28 NHS front-line services, including seven A and E departments.

[Tom Blenkinsop]

Will the Secretary of State confirm that a freedom of information request to the Department of Health revealed that he did not visit an A and E unit until April 2013, a full six months after his appointment and despite a clear A and E crisis over the winter-spring period under his supervision?

[Mr Hunt]

As ever, the Labour party is being selective in its use of information. As I have said, I visited seven A and E departments, including over the Easter period when we had some severe A and E pressures that I wanted to investigate for myself. Let me tell the hon. Gentleman about another thing that this Government have done that his Government never did: it is not just Ministers who are going out on to the front line; we have asked all our civil servants to go on to the front line for up to four weeks. I am extremely proud that my Department will be the first to connect with the front line in that way, and am even prouder of the response from my own civil servants, who embraced the scheme with great enthusiasm.

[Clive Efford (Eltham) (Lab)]

Could we have some accountability for the strategic planning of A and E services across London? Nine of them face closure and 28 ambulances were redirected to Lewisham, which the Secretary of State intends to downgrade. Without a strategic approach, how can patients be confident that their best interests are being served?

[Mr Hunt]

We do have a strategic approach, but we also have some very important safeguards that any big change in approach has to go through before it is implemented. That is why I asked for a report from the Independent Reconfiguration Panel on the plans for north-west London, and I will consider that report very carefully before I make any decision.

[Paul Burstow (Sutton and Cheam) (LD)]

When considering issues relating to A and E closures, particularly the proposed closure of the A and E department at St Helier hospital, which serves my constituents, will the Secretary of State ensure that those who propose such plans make sure that there is also a costed plan for developing out-of-hospital care, which is an essential prerequisite for any changes to acute services?

[Mr Hunt]

I agree with my right hon. Friend on this issue. It is extremely important that all these plans take a holistic view both locally and nationally. That is why, in looking at how to resolve the A and E issues we have faced and the severe pressures last winter, we are looking not just at what happens inside A and E departments, but at primary care alternatives and the integration of social care services, which are all equally important.

[Mr Jamie Reed (Copeland) (Lab)]

Perhaps it took the Secretary of State so long to visit an A and E unit because he could not get in. In the midst of England’s A and E services experiencing their worst waiting times for a decade, the Secretary of State criticised hospitals for coasting. Does he regret waiting for six months before first visiting an A and E unit and finding out for himself what damage his policies were doing to the front line of the NHS? Hospital consultants, A and E consultants and patients look forward with interest to hearing his answer.

[Mr Hunt]

We will take no lessons on being connected with the front line from the party that missed 50 warning signs about what was happening at Mid Staffs. The hon. Gentleman cannot make the narrow point about how many A and Es I visited during a particular period without addressing the broad point about how connected Ministers in his party were when they were in power. They rejected 81 requests for a public inquiry because they did not know what was happening at Mid Staffs.

[Andrew George (St Ives) (LD)]

10. Whether he has any plans to review his policy on resource allocation in the NHS.

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

Allocations to the NHS are the responsibility of NHS England. However, I have been advised that it will rely on the advice of the Advisory Committee on Resource Allocation for changes to the allocations formula.

[Andrew George]

While many wealthy areas are overfunded, Cornwall is more underfunded than anywhere else in the country. In the past six years, it has received in excess of £200 million less than the Government say it should receive. It also receives the lowest tariff in the country for acute care. Is the Secretary of State prepared to meet me and other representatives from Cornwall to address the serious issues that that is causing in front-line care?

[Mr Hunt]

My hon. Friend has had meetings with my ministerial colleagues on that issue and knows that such decisions are made at arm’s length from Ministers by NHS England. The allocation for NHS Kernow is £1,235 per head and the average baseline clinical commissioning group allocation is £1,184 per head. However, I recognise that there are issues with rurality and the age profile of the population. That is why a fundamental review is taking place of the approach that ACRA takes.

[Steve Rotheram (Liverpool, Walton) (Lab)]

In response to a parliamentary question that I tabled, the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), stated that circa £15 million in underspend was handed back to Public Health England by the now dissolved primary care trusts on Merseyside. Given that Liverpool has been identified as having some of the greatest health inequalities, will the Secretary of State guarantee that every penny of that £15 million will be spent in Merseyside alone?

[Mr Hunt]

What I can guarantee is that there will be a real-terms increase in the public health budget for all local authorities under a two-year settlement, which they did not have before. I hope that the information that was published this morning, which shows how cities that are comparable to Liverpool are managing to get better health outcomes, will help the local authority in Liverpool to improve its results.

[Mike Thornton (Eastleigh) (LD)]

11. What progress he has made in delivering parity of esteem between mental and physical health.

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[Chris Heaton-Harris (Daventry) (Con)]

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

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

There have been two important developments since the previous Health questions. First, in response to pressure on A and E departments, my Department, together with NHS England, has started work on a vulnerable older people’s plan that will act quickly to address the underlying causes of the issues, including services that are not integrated, poor IT systems, confused emergency care offered to the public and poor primary care alternatives.

Secondly, following the tragedy at Mid Staffs, I am delighted to announced that Professor Sir Mike Richards has been appointed as England’s first ever chief inspector of hospitals. He is an inspirational leader who has personally championed huge improvements in cancer survival rates. He will lead the vital work of driving up standards of safety and care throughout NHS hospitals.

[Chris Heaton-Harris]

I thank the Secretary of State for that statement. Will he give the House an assurance that he will look at GP contracts, with a view to amending them to ensure that better care is given to older patients?

[Mr Hunt]

My hon. Friend makes an important point. Talk to any A and E department in the country, and they will say that poor alternatives in the primary care sector are one of the things that are driving the pressures on them. It is important that we look at the structures put in place by the 2004 GP contract to see whether they are the right way to provide the care we need to give to older people.

[Liz Kendall (Leicester West) (Lab)]

Last week, the Select Committee on Health took expert evidence on the increased pressures in emergency departments and the causes of the worst A and E crisis in a decade. On Wednesday, the Chair of the Committee told this House that the 2004 GP contract

“is not why those pressures exist.”—[Official Report, 5 June 2013; Vol. 563, c. 1605.]

Will the Secretary of State tell us whether the right hon. Member for Charnwood (Mr Dorrell) is wrong?

[Mr Hunt]

I advise the hon. Lady to listen more carefully to what the Chair of the Select Committee said. He actually said that he agreed with much of what I said on the GP contract. While the Opposition are defending the status quo of the 2004 contract, independent support for reforming primary care is coming from the College of Emergency Medicine, the Royal College of Physicians, the NHS Alliance, the Family Doctor Association and even the head of the Royal College of General Practitioners.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

T2. In my borough of Southwark we have higher than average smoking rates, and the Cabinet member responsible for health has said that hundreds of people are dying early because they smoke. Can Ministers help me to persuade our Labour council that it is inconsistent to say “Don’t smoke” on the one hand and invest £2.6 million of pension funds in British American Tobacco on the other?

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

T5. I listened carefully to the Public Health Minister’s answer just three questions ago, but the Government have disproportionately cut funding to the most deprived local authorities, including Liverpool, and these local authorities have today been shown to have higher mortality rates. How does the Secretary of State expect to close, rather than widen, health inequalities?

[Mr Jeremy Hunt]

We actually gave a real-terms increase to all areas, including Liverpool, and followed the independent advice. If funding for public health in Liverpool is lower than it should be, that is because the last Government set the baseline way lower than it should have been.

[Adam Afriyie (Windsor) (Con)]

T9. For the last decade, in the face of constant threats of closure to Heatherwood and Wexham Park, I have campaigned alongside local councillors, activists and residents to try to get the right balance of services across my constituency. The people I work with are very reasonable, as is the Secretary of State, so will he meet me and a small delegation from Windsor to discuss their options?

[Mr Hunt]

It would be my great pleasure to do so.

[Alex Cunningham (Stockton North) (Lab)]

T6. Three Health Ministers have indicated their support, and one even voted for it, so will the Secretary of State either introduce his own legislation or back new clause 17 to the Children and Families Bill to ban smoking in cars with children present?

[Charlotte Leslie (Bristol North West) (Con)]

Does the Secretary of State agree that any criminal investigation into the 200 to 300 deaths at Mid Staffs should extend not only to front-line staff, who risk getting scapegoated, but to all managerial levels, Department of Health officials and the heart of Government, so that we get answers about who knew what and when, and what action they took or—more importantly—did not take that could have prevented this tragic scandal?

[Mr Jeremy Hunt]

I congratulate my hon. Friend on her determined campaigning on this issue. She will agree that we must allow the law to follow its course. The police are looking at the five reports on hospital safety that were undertaken, the inquests and the lists of patients who appear to have been treated badly, and they are talking to the relatives of those patients. We must allow them to do their work, but no one is above the law, and particularly in this case it is important that justice be done.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

T10. With the Department of Health having awarded Cleveland fire brigade £198,000 from its social enterprise investment fund, will the Minister confirm, pursuant to concerns raised by the Fire Industry Association, that his Department undertook an assessment as to the compliance with the European state aid regulations of the state’s funding of community interest companies that compete to take business away from the private sector?

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[Jason McCartney (Colne Valley) (Con)]

Does the Minister agree that children’s heart surgery units such as the one in Leeds now need certainty so that they can continue to attract the highest calibre of staff?

[Mr Jeremy Hunt]

I agree with my hon. Friend and the sooner we can make a decision and announce it, the better. This issue is of huge importance to the people of Leeds and I want to do all I can to expedite the process.

[Jim Shannon (Strangford) (DUP)]

When a patient is ill and visits their GP, they will do as the doctor orders. One hundred thousand people will die of lung cancer this year. When will the Government do as the doctor orders and bring in plain packaging for tobacco?

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

Is the Secretary of State aware of the alcohol treatment centre in the middle of Cardiff, which treats people who are drunk on Friday and Saturday nights and therefore takes pressure off A and E, ambulance services and the police? Will he look at this model, as we are in Swansea, and pilot it elsewhere?

[Mr Jeremy Hunt]

That is definitely worth looking at and is exactly the kind of proposal that we could think about for NHS England. It could make a very big difference.

[George Freeman (Mid Norfolk) (Con)]

Will my right hon. Friend clarify the position regarding NHS spending, in light of the recent comments from the shadow Health Secretary? My understanding is that spending increased from £99.7 billion in 2009-10 to £106 billion in 2012-13; an increase of £600 million, or 14,000 nurses or 6,000 doctors. Does not this show that the shadow Health Secretary’s reference to cuts is just irresponsible scaremongering?

[Mr Hunt]

My hon. Friend is right. There has been a £600 million real- terms increase in spending, something that the right hon. Member for Leigh (Andy Burnham) said was irresponsible. He will have to do a U-turn on this, and it will be an embarrassing one. He has talked about cuts in every single debate in the House and it turns out that those cuts never happened.

[Mrs Louise Ellman (Liverpool, Riverside) (Lab/Co-op)]

Life expectancy in Liverpool is 10 and a half years less than it is in Kensington and Chelsea. Does the Secretary of State think that he has any responsibility to address that?

[Mr Hunt]

Yes I do, which is why we have published a website today that gives much more detail than there ever has been before about health inequalities. it is why, nationally, the Government have been responsible for a huge amount of initiatives to boost public health, including calorie labelling in restaurants, action on point of sale display tobacco advertising, alcohol unit labelling and a range of other things. We will play our part.

[Jane Ellison (Battersea) (Con)]

In April, the BBC’s “Casualty” programme highlighted the vital role that health professionals have in spotting young girls at risk of being taken abroad or of having female genital mutilation carried out on them in this country. We are approaching the most difficult time of the year over the long summer holidays, when girls are most at risk. Will Ministers do all they can to draw the attention of health professionals to the vital role that they have in these critical next two months?

[Ian Austin (Dudley North) (Lab)]

I listened to the answer to Question 7 earlier, but surely the best way to improve accountability in the NHS would be much greater consumer choice and competition when it comes to GP services, for which there are virtually no comparative data at the moment. With modern IT, why can patients not choose to have their own medical records and then ring round to find a GP who will treat them when they want to and not when their own GP deigns to see them?

[Mr Jeremy Hunt]

What the hon. Gentleman says has a lot of merit. We need to have transportable digital medical records that can be accessed anywhere in the system. That would make better out-of-hours care much more possible than it is at the moment.

[Several hon. Members]

rose—