Stafford Hospital

Joan Walley Excerpts

Thursday 4th July 2013 Commons Chamber

[Jeremy Lefroy]

As usual, my hon. Friend makes a powerful point—that this debate is not just about a relatively small district general hospital, because it will have ripple effects. We have a pretty efficient national health service, but it does run on tight margins, so that if we take one acute hospital out, it could have effects right across the whole region. Local clinical commissioning groups have a vital part to play, and I want to pay tribute to the good work they are doing in developing community services in Stafford.

The third element of co-operation comes from Monitor itself. Under the Health and Social Care Act 2012, Monitor now has responsibility for setting tariffs, including those for emergency and acute services. It would be rather strange if Monitor were to continue the programme introduced in 2009 of constant 4% year-on-year real cuts in tariffs, and then be forced to pick up the pieces of acute foundation trusts around the country that fall into deficit as a result of the tariff cuts it has made. Monitor has the chance to challenge the assumption that acute services can continue to squeeze out annual efficiencies—in some cases, and not just in Stafford—of up to 7% a year, while elective services enjoy a relative feast.

Monitor has the opportunity to ensure that the necessary changes to the provision of acute services are done in such a way that will allow acute services to continue to be provided locally. Monitor itself could become an excellent example of joined-up government, and in doing so carry out its legal requirement under section 62 of the Health and Social Care Act 2012 to promote the

“provision of health care services which…is economic, efficient and effective, and…maintains or improves the quality of the services.”

Finally, the national Government have a vital role to play in co-operation.

[Joan Walley (Stoke-on-Trent North) (Lab)]

I am most apologetic about arriving late to this debate and not having the opportunity to hear the opening part of the hon. Gentleman’s speech. To find a long-term solution for health care in Mid Staffordshire and in North Staffordshire, it is vital that the Minister refers in his reply to the best way of ensuring that the emergency services and all the other services that people want can be retained. That can be achieved only if we have a proper collaboration between the University hospital of North Staffordshire, which must be at the front of—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. Had the hon. Lady been here from the beginning, she would have heard what the hon. Member for Stafford (Jeremy Lefroy) said about that. Her intervention was rather long, and we are running out of time.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a great pleasure to reply to the debate. Let me begin by congratulating my hon. Friend the Member for Stafford (Jeremy Lefroy), and expressing my great admiration for the work that he has done so tirelessly during his time in the House. He has been a tremendous advocate for all his constituents, for the hard-working staff at the trust who are doing their best in very difficult circumstances, for all the people who have rightly spoken out about earlier problems at the trust, and for the patients. He is an example to us all of what a hard-working and dedicated constituency Member should be.

I also congratulate my hon. Friend the Member for Stone (Mr Cash), who has been raising this matter tirelessly for many years. It is a tribute to the efforts of both my hon. Friends that we have got to where we are today.

I can reassure my hon. Friend the Member for Stone that the findings of the Mid Staffordshire inquiry are at the forefront of the Government’s mind. As he will recall, our response to the Francis report set in train a number of important pieces of work. First, we asked Sir Bruce Keogh, medical director of NHS England, to look into 14 hospitals where there had been two years of higher than standardised mortality ratio indicators. That work is now reaching fruition. Following a report as damning as the Francis report, which looked into the culture of the NHS, we thought it right to investigate other hospitals that could give rise to concern, and we now think it right to examine the findings of Sir Bruce Keogh’s report before we report back to the House. We also set in train Camilla Cavendish’s review of nursing and Don Berwick’s inquiry into a minimum-harm and no-harm culture in the NHS. All those inquiries have formed part of our response to the Francis inquiry, and they have all been independent of Government. We shall have the reports in the next few weeks, and we shall then be able to arrange the more considered debate on the Floor of the House for which my hon. Friend has rightly called.

My hon. Friend the Member for Stafford was right to highlight the fact that the health care challenges in more rural areas, where travelling distances are longer, are by definition different from the health care challenges in urban areas. He was also right to highlight the fact that, throughout the NHS, in Stafford and elsewhere, we face the challenge, in both human and financial terms, of better looking after an ageing population and better providing dignity in elderly care.

My hon. Friend was right to highlight the fact that we need to support people such as Julie Bailey, who was treated appallingly in the light of her great courage and conviction. We must support people inside and outside the NHS who have the courage to speak up when there are concerns. We have made that clear in our initial response to the Francis inquiry report. That is why we have set up a whistleblowing hotline and are tackling the cultural issues in the NHS. We will support staff who want to raise concerns, so they can do so free of fear and intimidation. That is absolutely the right thing to do.

It is admirable that local people have continued to come out in full support of their hospital through the Support Stafford Hospital campaign. That was demonstrated by the 50,000 people who marched through Stafford with my hon. Friend in April and by other local events such as the Night of Light event in May. I am sure that we all agree that it is vital that the trust special administrator, currently in place at the trust, develops the right proposals for the future of services at the hospital to provide high-quality, affordable and sustainable services. I will return to that later.

The NHS is about to celebrate its 65th anniversary and its 65th year has perhaps been its most challenging. In that year, we have perhaps questioned some of the things that we held dear. I work in the NHS, I believe in it and I believe that our NHS should be and is one of the very best health services in the world, but when things have gone so badly wrong it is right that we learn lessons from what has happened, that we ensure that we put them right and that we support staff when they raise concerns. It is right that we drill into how to ensure that we listen to staff in learning how to put things right in local hospitals. We must also ensure that we create a culture in which trust managers always listen to what front-line staff tell them. In my experience, when things go wrong in front-line patient care, it is often because there is a disconnect between management and front-line staff. That is why the Government, through the Health and Social Care Act 2012, are embedding in the NHS a culture of clinical leadership, which will benefit patients massively.

On the future of Stafford hospital and the issues raised in the debate, the events that took place led Monitor to intervene and, over the past few years, there has been a whole health economy approach to improving services at the trust. That has led us to where we are today. Monitor, as the regulator of foundation trusts, appointed a TSA at the trust in April 2013 to determine the future provision of services at the trust. As we know, that process is ongoing.

I should be clear that, while the TSA is developing its proposals, I cannot discuss that in much detail. Nor is it known what the TSA is likely to propose. It is right that that process is free of political interference. However, what I would expect, and I am sure that my hon. Friend would agree, is that the TSA fully engages with key stakeholders during that process, including clinical commissioning groups, local health care providers, local authorities and local MPs, which I have been assured is the case. The TSA is legally bound to consult on its proposals and I would expect that any proposals meet the four tests for any service change and reconfiguration, which were set by the former Secretary of State for Health, now the Leader of the House of Commons.

[Joan Walley]

Can the Minister assure me that, following publication of the report by the trust special administrator, as well as the people and communities in Stafford, the people and communities in North Staffordshire will be consulted? There are wider concerns about how any further collaboration will affect health care, which has to be improved in North Staffordshire as well as in Stafford.

[Dr Poulter]

I thank the hon. Lady for her question. As I highlighted earlier, it is absolutely right that the TSA will look at the whole health and care sector in Staffordshire, and of course the implications of any potential change for neighbouring hospitals. That is implicit in the work that the TSA is doing. This is, of course, not an issue I can dictate from the Dispatch Box or the Secretary of State determines. It is for the TSA to decide what its own work is, and it is important that that is done without political interference, so the right decision for local patients in Stafford and surrounding areas can be reached. I am sure the hon. Lady will agree about that.

I appreciate the concerns of my hon. Friend the Member for Stafford that acute services should remain at Stafford hospital. However, the TSA is independent of Monitor and therefore it would not be appropriate for Monitor—or, indeed, Ministers or the Department of Health—to seek to influence this process. My hon. Friend is aware that, at the request of the TSA, Monitor granted an extension to the period in which it can develop its proposals and the consultation period. I understand that the TSA is expected to consult on its proposals between August and October 2013, and I am sure my hon. Friend and his constituents will play an active role in that, and that the views expressed in the House today will be listened to as a part of the deliberations of the TSA and in the consultation process that follows.

I appreciate my hon. Friend and his constituents will experience uncertainty while the TSA develops its proposals. However, the TSA is engaging widely with the broader health economy as these proposals are developed and I understand that includes speaking with my hon. Friend and the Stafford Hospital Working Group. I would, therefore, encourage my hon. Friend to continue this dialogue with the TSA to ensure that his views and those of his constituents are fully taken into account as proposals for the future of Stafford hospital emerge.

I pay tribute to the work of my hon. Friend and my hon. Friend the Member for Stone, because if it were not for their work, we would not be where we are today and the people of Stafford and Staffordshire would be much more poorly represented. Their record speaks for itself and they have our full support in the work they are doing as advocates for their constituents. I look forward to continuing to support them in my role as a Minister, and the Government stand ready to support Stafford hospital.

Question put and agreed to.

Health and Social Care Bill

Joan Walley Excerpts

Tuesday 13th March 2012 Commons Chamber

[Joan Walley (Stoke-on-Trent North) (Lab)]

I am grateful for the opportunity to follow the hon. Member for St Ives (Andrew George), and the House would do well to listen to what he says. The Secretary of State may feel that he can bluster his way through the debate, but people out there—our constituents—are listening. When I became a Member almost 25 years ago to the day, I made the point that the health of the people is the highest law, so even if we cannot deal with the Bill in this debate, we have three hours in which we can send a message. Although I came into the Chamber to support the motion in the name of my right hon. Friend the Member for Leigh (Andy Burnham), I have listened to what he has said and to what the hon. Member for St Ives has said, and I am quite content to back the amendment and to ask for an urgent summit—and for the trade unions to be involved as well.

[Mr Burrowes]

Will the hon. Lady give way?

[Joan Walley]

No, I will not.

I agree with the right hon. Member for Charnwood (Mr Dorrell), who chairs the Health Committee, that some aspects of the Bill are very worthy, particularly those on public health, and we do not want to lose them, but four issues need urgent clarification, and I hope the Minister will address them when he replies.

First, why are my constituents not entitled to know what is on the risk register? What is there to hide? Why can we not have it laid before us when we are making important decisions about the future of the NHS? I am quite content for there to be service changes, but not structural, top-down reform, which the Prime Minister himself, in one of his commitments before the general election, said he was not going to introduce.

The key issue for the House is whether the NHS will be subject to the full force of domestic and EU competition law, and that has not yet been clarified. The Government maintain that it will not, but the changes brought about by the Bill make certain that it will. In any event, it is not in the Government’s gift to decide, because the issue will be decided in the courts, so I genuinely believe that we are entitled to clarification on that issue—[Interruption.] I will not give way on that point. It is absolutely essential that the Government, not the law courts of this country, determine NHS policy.

Secondly, what safeguards are there against private companies using loss leaders to replace NHS services and then, once the NHS service has been eliminated, maximising profits by reducing quality? We have heard from the Secretary of State on that, but once the service is eliminated, the private companies that come in will surely have a free hand. The Government say that there will be no competition on price, but private companies will still be able to use loss-leader tactics by overloading a bid with quality for the specified price, so we must have regard to the real concerns about that.

Thirdly, how will the Government stop cherry-picking in practice? If they attempt to exclude private companies from bidding for a particular contract, will they not face court action, and in those circumstances will not services be put on hold while the courts deal with how NHS care is to be provided?

Finally, again when the Minister replies—

[Mr Simon Burns]

In 10 minutes?

[Joan Walley]

Yes, in 10 minutes, because we need time to sort out the NHS. What will the Government do about foundation trusts once they become unsustainable—once they have been undermined by cherry-picking and by loss leaders?

There are huge issues, our constituents’ health is at stake, and this is an important debate, one in which the Government need to take account of what we are saying so that Parliament can have a say in how the NHS goes forward.

NHS Risk Register

Joan Walley Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Andy Burnham]

Not for the moment.

The risk rating in that risk register was 16—extreme. Let me focus on the phrase, “statutory functions”, because it is important that the House fully appreciates what that involves. One of the statutory functions of the primary care trusts that have been wound down before new structures are in place is the safeguarding of children and vulnerable adults. What does the NHS London risk register say on this point? [Interruption.] Government Members do not want to listen. I am sorry if it is inconvenient for the Parliamentary Private Secretary, the hon. Member for Broxtowe (Anna Soubry), but she will listen. The risk register makes the chilling prediction that the huge loss of named or designated professionals from PCTs across London, and the subsequent damage to information sharing, may lead to “preventable harm to children”. That risk was rated at 20 pre-mitigation and 15 post mitigation.

It is not just NHS London that is saying this. Let me quote again from the NHS Northamptonshire and Milton Keynes risk register; this time I ask the House to listen very carefully. It warns of a

“failure to deliver statutory requirements which leads to the significant harm or fatalities of children and vulnerable adults”.

That was originally rated as an extreme risk and, even after mitigation measures, it is still rated as “very high” with the possible frequency of occurrence being “monthly”.

This is what the national health service is telling the Health Secretary and the Prime Minister about the potential effects of their reorganisation. It is appalling and shocking. They are taking unacceptable risks with children’s safety and people’s lives. If this is what the NHS has been telling Ministers for 20 months, since the White Paper was published, how can they possibly justify pressing on with this dangerous reorganisation? Has not what remained of any justification for carrying on just collapsed before us? If this is what is published in local risk registers, that prompts the question of what on earth they are trying to hide in the national assessment. The simple truth is that they cannot publish because if people knew the full facts, that would demolish any residual support that this reorganisation might have.

That brings me to my third point—the Government’s claim that it is safer to press on with reorganisation than to deliver GP commissioning through the existing legal structure of the NHS. The evidence that I have laid out comprehensively dismisses that argument. If the Government were to abandon the Bill and work with the existing legal structure of the NHS, that would bring immediate stability to the system and, as the British Medical Journal has calculated, save over £1 billion on the cost of reorganisation. The Government’s claim that it is safer to press on is rejected by the overwhelming majority of clinical and professional opinion in England. The royal colleges and other professional organisations have given careful consideration to the pros and cons of proceeding and abandoning. Some disruption comes with either course of action, but given the terrible mess that we are now in, those royal colleges have concluded, one by one, that the interests of patients are best served by working to stabilise the system through existing structures.

It is not difficult to do that. PCT clusters could be maintained and the emerging clinical commissioning groups could simply take charge of the existing legal structure that is the residual PCT, and indeed any buildings and staff that they may still have. The painful truth is that delivering GP-led commissioning, which is where the Health Secretary began, could have been delivered without this Bill. Let me say to him again today that my offer still stands. If he drops the Bill, I will work with him to introduce GP-led commissioning using his emerging clinical commissioning groups.

However, that must be done in the right way. The local NHS risk registers raise concerns not only about reorganisation but about fundamental flaws in the policies that the Health Secretary wants to take forward. NHS Lincolnshire warns of a

“conflict of interest in CCG commissioning and provision: perceived or actual conflicts of interest arising from GPs as both providers and commissioners may impair the reputation of the CGG and, if not managed, may result in legal challenge.”

That has a moderate likelihood of happening but a consequence rated as catastrophic. A GP surgery in West Sussex has written to all its patients offering them

“private screening for heart and stroke risk”

from Health Screen First, for which, in return, the surgery receives a nominal fee from Health Screen First. In Haxby, GPs tried to restrict minor operations that are currently free on the NHS and at the same time launch their own private minor operations service, sending patients a price list. More broadly, stories are emerging around the country of plans by clinical commissioning groups to stop purchasing services from local hospitals, such as dermatology in Southwark and out-patients in south London. There are also plans to remove services from Stafford hospital, which we talked about earlier.

This unstable market in health care could have a very real effect on the viability and critical mass of essential hospital services, resulting in full or partial hospital closures. I have never heard of any plans from the Government to mitigate these risks other than the simple statement, “The market will decide.”

[Joan Walley (Stoke-on-Trent North) (Lab)]

In view of what was said about Stafford hospital and the implications for patient care in North Staffordshire, may I say to my right hon. Friend and to the House that it is vital that we get the full information and full risk assessments that are required in order to be able to plan for the NHS that we need, and that this important debate is part of that?

[Andy Burnham]

What happened at Stafford gives us very important lessons about the dangers of autonomy, and this Bill is all about extolling the benefits of autonomy. As Health Secretary, I had to deal with that situation. In some ways, it was a legacy of problems with our own policy; I accept and acknowledge that before the House. Because of that situation, I proposed the power to de-authorise a foundation trust and brought it forward in the Health Act 2009. If a hospital gets into trouble, it cannot carry on being autonomous and unable to improve, but should be brought back and helped to improve. I proposed the duty of autonomy.

In fact, that duty was recommended by Robert Francis QC in the first stage inquiry that he delivered to me. I accepted his recommendation. The Health and Social Care Bill abolishes the power to de-authorise a foundation trust. A recommendation from Robert Francis is being abolished by the Bill before the Government even give him the courtesy of allowing him to report. I say again that I do not have a good answer to why they are legislating before hearing from his inquiry. As was said a moment ago, there are plans in Stafford for GPs to do more in the community. That might be a good idea, I do not know, but it might further destabilise that hospital. That should be a cause for concern.

Health and Social Care (Re-committed) Bill

Joan Walley Excerpts

Wednesday 7th September 2011 Commons Chamber

[David Tredinnick]

I am most grateful for being called to speak and for the opportunity to follow my colleague on the Health Committee, the hon. Member for Walsall South (Valerie Vaz), and my hon. Friend the Member for Hexham (Guy Opperman), and to say how pleased I am to see my hon. Friend in his place. I know from experience—not personal experience—just how tough that operation can be, so many congratulations to him on his recovery.

I want to make a short speech on just one issue—patient choice, which is one of the most important, if not the most important, aspects of the Bill—and to challenge my right hon. Friend the Secretary of State on one or two points. Chapter A1 13H sets out the duty that the board has, in the exercise of its functions, to

“promote the involvement of patients, and their carers and representatives…in decisions about the provision of health services to…patients.”

That patient choice depends on clinical commissioning, the subject of the amendments before us, and that in itself hangs on the “any qualified provider” policy, modified recently from “any willing provider”. There I have some concerns.

The TUC brief summed up “any qualified provider” very well:

“Under AQP, patients will be able to choose which provider to use for their treatment, from a list of approved providers (private, public or voluntary sector) who perform the service in exchange for a locally or nationally set tariff.”

Where I have a slight problem is that although the categories of treatment that can be employed, certainly in the transitional year 2012-13, have been set out in the operational guidance, I think there is a strong case for the guidance to be in the Bill itself.

However, I am very pleased to see at the top of the list musculoskeletal services for back and neck pain, and I presume, although it is not set out, that that means greater use of osteopathy and chiropractic, both regulated by Acts of Parliament, in 1993 and 1994. I had the honour to serve on the Committees considering those Bills. As the public are to have greater choice, we must look at providing that choice, and they will be asking for those services. They will also want acupuncture for musculoskeletal problems. Acupuncture has been approved by NICE and there are now NICE guidelines supporting acupuncture for use in these services. I would like my right hon. Friend the Secretary of State to consider at some point making a more positive, more specific commitment to the use of those services in the provision for patient choice.

There is a strong case for the “any qualified provider” policy to be set out in the Bill too, although it is set out in the operational guidance. The problem that may occur is in the qualification process. I have no problem with its asking for safe, good-quality care or with the governing principle of qualification being that practitioners be registered with the Care Quality Commission and Monitor, but what about those therapies that do not have those badges in their passport? What about traditional Chinese medicine, which is about to be regulated by the Health Professions Council? May we have a specific assurance that its practitioners can be part of this patient system? Traditional Chinese medicine and acupuncture have increased in popularity dramatically—Chinese practitioners may now be found in any town in the country.

I suggest to my right hon. Friend the Secretary of State that other therapies should be included in the list. He has produced a second list of services to be introduced in 2013-14, which includes community chemotherapy and home chemotherapy. If we are to offer patients choice on those chemotherapy services, we really ought to consider those who can support people who are exhausted after chemotherapy and radiotherapy. I am thinking of not only those who practise traditional Chinese herbal medicine and acupuncture, but the healing fraternity and those who use therapeutic touch, many of whom now work in NHS hospitals to great effect.

I should also like to refer to homeopathic medicine, which I have discussed when you have been in the Chair before, Madam Deputy Speaker. I think I am right in saying that your constituency is not far from the Bristol homeopathic hospital, so perhaps you will not call me to order on this, especially as I am trying to stay in order. Many people use homeopathy every day to cure simple ailments, because it is cheap, easy to understand and very effective. Even if there are not umpteen double-blind placebo-controlled trials, there is a wealth of evidence that it works. I would draw my right hon. Friend’s attention to the fact that the Royal London hospital for integrated medicine, which used to be called the Royal London homeopathic hospital, has the highest patient satisfaction rating of all hospitals in the United Kingdom.

There is a case for including in the Bill clearer direction about the services that will become available. I ask my right hon. Friend to smile on those other disciplines that do not have statutory regulation but perhaps have robust non-statutory, voluntary regulation, such as acupuncture, and ensure that when patients go to their doctors and say, “Doctor, this is what we’ve used; this is what we really want,” they will not be turned away.

[Joan Walley (Stoke-on-Trent North) (Lab)]

Following the hon. Member for Bosworth (David Tredinnick) illustrates the problems that we have with the Bill: even at this stage, specific details need to be discussed and have a case made for them, so that the future of NHS provision can be fully taken on board. At the same time, because of how the Bill has been handled—we have had a re-committal—we have a political debate.

The debate on this specific group of amendments is taking place on two levels. I certainly want to ensure that the true principles of the NHS and its founding fathers, such as Nye Bevan, are followed in future provision. We need that political debate to ensure that the NHS is politically accountable. We have almost lost that opportunity, because we are in this mess, with all this uncertainty and not knowing how the Bill will shape up and go forward. We risk losing the whole of the NHS altogether.

Many people who are part of the medical profession and others who are concerned about their own future health care have contacted me, because they want the Government to be in control and the Secretary of State to have a duty to procure and provide services. This is a political debate, as much as anything else, but it is difficult to have that political debate within the confines of the amendments, although they are central to that debate.

[Lyn Brown (West Ham) (Lab)]

One of my biggest worries about the Bill is that it will stop me intervening in the health service to encourage outcomes for my constituents who come to me for help and advice. Does my hon. Friend agree that it will diminish my ability to represent them, rather than enable me to do so?

[Joan Walley]

My hon. Friend is right. Constituents go to Members of Parliament as a last resort to try to ensure fairness in how the system deals with everything. I have just had a high-profile case in my constituency relating to the postcode lottery, which my hon. Friend the Member for Pontypridd (Owen Smith) referred to.

[Paul Burstow]

The hon. Lady is making some important points and is trying to respond to that raised by the hon. Member for West Ham (Lyn Brown). Interestingly, the hon. Member for Leicester West (Liz Kendall) earlier recounted all her concerns about the PCT and how it has dealt with GP services in her area. The anxiety seemed to be that the PCTs were not accountable, but the hon. Member for Stoke-on-Trent North (Joan Walley) now seems to be saying that they are.

[Joan Walley]

We have just had an awfully long debate about precisely that issue. Many of us would say that the PCTs were not operating accountably, but Members of Parliament could have influence and bring pressure to bear. The last resort is through the Secretary of State, and it is important that that should be retained in the Bill.

[Owen Smith]

Does my hon. Friend agree that the critical points are that there is an unknown into which we are stepping with the Bill and that the presumption is that the culture will be different? There will be a presumption of autonomy, being hands off, less accountability and more localised decision making. It is therefore perfectly reasonable to presume that we will have less input.

[Joan Walley]

That is right and it comes back to the fact that, somehow or other, under the new regime, whatever it ends up being, there will not be the fairness or the universal provision. In certain areas—perhaps those such as mine, which have much greater deprivation and much greater health inequalities than others—things will be more difficult.

[Andrew Percy]

I do not recognise the picture that the hon. Lady is painting. The real issue with the provision and availability of services is more to do with the funding model that is in place. When my local PCT was unable to provide dental services and when the bed numbers at Goole hospital were reduced a couple of years ago, local people had no ability to influence those decisions, no matter how much they appealed to the Secretary of State, because it comes down to money.

[Joan Walley]

Of course it comes down to money, but it also comes down to fairness in how the money is allocated. That must relate to an overall sense of direction to deal with health inequalities.

I want to discuss very specifically three amendments that I have tabled, but I did not want to go into the detail without associating myself with some of the concerns that exist across the country which have not yet been resolved. I speak as an honorary vice-president of the Chartered Institute of Environmental Health. I tabled the amendments to ensure that we do not just pay lip service to environmental and public health, and that we truly get a Bill that is fit for purpose in respect of the prevention agenda and the new arrangements under which we will be operating, which should give more status and priority to environmental health.

I want to speak in favour of the Government looking either now or in the other place at the case for a chief environmental health officer for England. The reason for that is the fact that, historically, there was a post of chief environmental health officer, going back to the days before 1974 when local authorities last had lead responsibilities for public health services and when each authority had a medical officer for health.

Today, England has a chief medical officer, but not a chief environmental health officer. I heard what the Minister said about that, but I urge him to have further talks, if necessary, with the professionals to see how we could ensure that a chief environmental health officer for England was appointed. Earlier we talked about Wales, where there is a chief environmental health officer post. In all the arrangements in Wales and in Northern Ireland, there is a recognition of the role played by environmental health in promoting health and well-being, and of the importance, therefore, of ensuring there is an environmental health input to policy making at the highest level and at the strategic level. I believe that is what England currently lacks. If the Bill is to give a higher profile to public health services, and the lead in public health is to be provided by local authorities, which is where the environmental health work force is located, it is necessary to make corresponding arrangements such as my new clause could facilitate, if the Government gave it serious consideration.

Southern Cross Healthcare

Joan Walley Excerpts

Thursday 16th June 2011 Commons Chamber

[Paul Burstow]

The Government have made it clear that in no circumstances will we allow the residents of any of those care homes to find themselves made homeless without good continuity of care. That is the pledge that we make.

[Joan Walley (Stoke-on-Trent North) (Lab)]

But is not the real question how the Minister will secure that guarantee? There is a real tension between care and commerce, and it seems to me that the restructuring could well affect certain areas disproportionately. We need briefings from the Care Quality Commission to ensure that Members in their constituencies can have feedback and reports on exactly how this matter is being dealt with.

[Paul Burstow]

I have already said that I take seriously the need to keep the House informed as we progress these matters. I am also clear that the paramount interest—the interest that the regulator has a statutory duty to enforce—is residents’ welfare. That is what we are doing, and what we will continue to do.

Hospital Food

Joan Walley Excerpts

Tuesday 14th June 2011 Commons Chamber

[Joan Walley (Stoke-on-Trent North) (Lab)]

I am very grateful to Mr Speaker for granting me this Adjournment debate on hospital food. As you, Madam Deputy Speaker, and many Members will know, I have long been interested in this issue and have pursued it in Parliament, so when I was fortunate enough for my name to be drawn in the private Members’ Bills ballot at the beginning of this parliamentary Session, I was clear about the Bill I wanted to draft. I wanted it to introduce minimum nutritional, environmental and ethical standards for the food procured by the public sector and served in our hospitals, care homes, armed forces institutions and the rest of the public sector.

The Bill gained widespread support from industry and from more than 60 health and environmental groups, including organisations as diverse as the caterer Sodexo, the women’s institute, the Chartered Institute of Environmental Health, and the Royal College of Paediatrics and Child Health. These organisations have witnessed years of failed attempts to improve public sector food through voluntary initiatives, and have seen first hand the damage caused by bad food in our public institutions, and they are united in the belief that the only way to improve public sector food is to ensure that all public bodies buy food according to national minimum standards. Despite that, the archaic parliamentary procedure that applies to private Members’ Bills means my Bill has still not received its Second Reading debate, and without Government support it is very unlikely to proceed.The Procedure Committee is conducting an inquiry into parliamentary sitting hours, and I hope it takes seriously the inadequate procedure relating to private Members’ Bills and proposes reforms that allow MPs the opportunity to introduce a Bill and proper parliamentary time for the consideration of its merits. My experiences in that regard have led me to seek an Adjournment debate to address this general issue from the perspective of health and the procurement of sustainable food in so far as that affects the Department of Health.

The procurement of sustainable food by the public sector is a cross-cutting issue. The Department for Environment, Food and Rural Affairs has lead responsibility for cross-cutting sustainable development issues, and I expected it to have been more decisive and to have taken an effective initiative in exploring how progress can be made. I wish to bring to the attention of the House a letter from the DEFRA Minister with responsibility for food, which basically said there was an ongoing review and he hoped to have the opportunity to report to the House by March, but we still have not had that opportunity.

Tonight’s debate arises at a timely moment given today’s announcement on the Health and Social Care Bill, and I want to link the issue of sustainable food and procurement with health and healthy food in hospitals. If, indeed, the stated aim of our NHS is to have excellent care for all, we need to address the issue of hospital food, so I am very grateful for the opportunity to raise the issue of the procurement of sustainable food in hospitals as well as the equally important issue of the quality of hospital food—

--- Later in debate ---

[Madam Deputy Speaker (Dawn Primarolo)]

I am sorry for the interruption, but the procedure caught up with us. Please, continue.

[Joan Walley]

I am most grateful for the explanation, Madam Deputy Speaker. I was confused by the fact that this Adjournment debate started before 10 o’clock. That might explain some of my slight nervousness, as I was unsure about whether I was speaking in order with the proceedings of the House. I am grateful.

Sustainable food procurement links to health and to hospital food, too. I want the Government to set out the role that food plays in patient pathways and the priority I believe that hospitals should give to ensuring that, where required, patients are assisted to eat the food that is served. We have heard too many shocking accounts of malnutrition and dehydration as well as the plain criticism that hospital food is bad and unappetising. We should be doing something about that.

At the core of this debate is a central contradiction. The Government are happy to rail against regulation and boast about their bonfire of red tape, but they are equally proud—and rightly so—of their standards for the procurement of sustainable food for the Olympics and of their intentions for there to be a Government buying standard for food. They promote their localism agenda aggressively, leaving choice to those at a local level, but the net effect, I believe, is that no overall quality standard applies to the food served in hospitals. I do not see how such a postcode lottery can be justified and I want to consider that in more detail.

Let me turn first to malnutrition. It is not just a matter of having appetising food for patients; this can literally be a matter of life and death. In its 2009 report submitted to the Department of Health, the Nutrition Action Plan Delivery Board showed that in the region of 47,800 people had died with malnutrition while in English hospitals in 2007. Of those, 239 patients died directly because of malnutrition—that is an important distinction to make. In the report, the delivery board recommended as a key priority that the Government should clarify nutrition

“standards and strengthen inspection and regulation”

to address this problem. The issue is being flagged up.

In its recent report, “Still Hungry to be Heard”, Age UK found that the number of people leaving hospital malnourished is on the increase. A recent answer to a parliamentary question from my hon. Friend the Member for Islington South and Finsbury (Emily Thornberry), placed in the Library of the House of Commons, acknowledged that from 2006-07 to 2009-10, instances of malnutrition increased in total from 2,581 to 3,773 and, as regards discharged episodes, from 2,883 to 4,412. That inevitably leads to further serious consequences, including longer stays in hospital, the need to take more medication and an increased risk of infection and even death.

To put it in purely financial terms, the estimated cost of malnutrition to the NHS in 2006 was £7.3 billion a year. Although we do not have an accurate figure for how much it costs the NHS today, given the fact that malnutrition is on the increase it is likely to be higher still. I believe that the Department of Health should have up-to-date figures on the cost of malnutrition, and I urge the Minister to look into the matter and give us an indication of what the costs are.

Dealing with malnutrition in hospitals is not simply about making food taste better. Even if we could do that, a whole range of other issues must be addressed. First, hospital staff must be aware of what food patients can and cannot eat. They need to be able to identify which patients need help with eating their meals and to be willing and able to provide that help or, if they cannot provide it, to have a robust system of volunteers to assist. Age UK has produced a seven-step guide to eradicating malnutrition in hospitals, to which I urge the Minister to give his attention. There is also an issue with dehydration and it is important to make sure that patients in hospital have proper access to water. That simply cannot be taken for granted.

It is not only nutrition and malnutrition that need to be addressed. There must be recognition by Government of the role that healthy food plays in healthy lives. The Government estimate that 70,000 preventable deaths each year in the UK are caused by diet-related ill health. One simple thing that the Government could do to tackle that problem is to ensure that the food served to patients in hospital is nutritious. That sounds simple but the issue is how it will be done. It is also important that the Government prioritise the role of public health.

I also want to mention the dignity and nutrition reports—[Interruption.] I am most grateful. Talking of dehydration, it is important that I refer to the dignity and nutrition reports recently published by the Care Quality Commission.

[Madam Deputy Speaker (Dawn Primarolo)]

Order. If the hon. Member wishes to take a seat and take some more water so as not to strain her voice, I am sure that the Chamber will not mind waiting a few seconds more.

[Joan Walley]

I am most grateful Madam Deputy Speaker.

The first tranche of what will be 100 dignity and nutrition reports into individual hospitals found that in four of the 10 hospitals investigated, the nutritional needs of patients were not being met. The reports also stated that the quality of hospital food remains a long-standing concern. This highlights both the extent of the problem and the importance of the Care Quality Commission’s role in monitoring and reporting on hospital performance in relation to nutrition. I believe that its resources should be increased so that it can carry out more such checks and fulfil the delivery board’s recommendation of strengthening inspection and regulation. I also believe that the CQC should be made fully accountable for how that work is done.

I want to discuss regulation because that is ultimately the best means of improving hospital food. It is remarkable that there are still absolutely no legal standards governing the quality of the 330 million meals served in the NHS each year. In its report, “Yet more hospital food failure”, published earlier this year, Sustain’s “Good Food for Our Money” campaign surveyed dozens of Government-backed initiatives to improve the quality of hospital food. Alas, it found that those initiatives have cost at least £54 million of taxpayers money and have achieved improvements in only very few isolated cases. The reason is simple: they have all been voluntary, so except in those few isolated cases they have been largely ignored. Let us contrast that with the successful attempts to improve the food served in schools, where meals have to meet legal nutritional standards. A survey by Consensus Action on Salt and Health—CASH—in October 2010 showed that most meals served to children in hospital could not legally be served in a school because they contained too high a level of salt and saturated fat. The reason for the success in schools is simple: minimum nutritional standards in schools are legally binding, but in hospitals they are purely voluntary.

To date, successive Governments have failed to send a clear message to hospital caterers that the quality of their food is critical to patient health and the sustainability of our food system. It is not asking for the impossible. For many years, the Royal Brompton hospital in Chelsea has practised a progressive approach to its food procurement, providing nutritious and appetising meals prepared from fresh ingredients, which enables patients to recover faster.

Unfortunately, the Government’s ideological commitment not to introduce more regulation, regardless of its merit, is a serious block to improving hospital food. I return to Government buying standards. The coalition Government have at least recognised that voluntary initiatives have limited effect; they do not work across the board and over time. As a result, they will introduce Government buying standards that set compulsory minimum standards for food served in central Government institutions. I hope it will be soon, as the standards were promised for March 2011, and we have waited for more than a year. They were promised by the Conservative party pre-election; they were welcomed by the coalition Government and were the subject of a great deal of Department for Environment, Food and Rural Affairs civil servant attention throughout 2010. The work also involved the Department of Health to integrate badly needed health standards for food served in central Government institutions. The integration of health and sustainability standards for food bought with public money was an innovative and much needed approach, and should act as an inspiration for the wider catering sector to follow suit. Tackling health, ethical and environmental issues together should save the country money and be of great benefit to food producers and the environment.

The real issue for me is that even when the Cabinet Office home affairs committee signs off the Government buying standards, they will not apply to hospitals and hospital food. That is the heart of the concern. On the day the Government are revising the Health and Social Care Bill and recommitting it to further scrutiny, should the Health Minister not be exploring with colleagues at DEFRA and in the Cabinet how the long-promised Government buying standards can be extended to hospital food? If that is ruled out, surely there should be urgent discussions with the NHS Future Forum, the National Audit Office and expert groups, such as Age Concern and Sustain, which have a track record on this matter, with a view to tabling amendments to the Bill so that we have minimum standards for nutrition in hospital food.

[Tessa Munt (Wells) (LD)]

There is another part to the equation. I have worked in further education colleges and it would seem logical that when we train chefs they should take a module on the specifics of nutrition for people in hospital. That is a different element. Does the hon. Lady think we could focus on that to improve standards?

[Joan Walley]

I am glad to take that intervention. It is an extremely important point. Basic minimum standards should be applied to schools and in future to hospitals, but that will not happen by accident. It will happen only if we put in place all the necessary education, training and skills. Whoever is responsible for providing the food needs to be trained. I agree that that is a third dimension to the issue.

I apologise to the House for having lost my voice because of my cold. In conclusion, surely there is no other institution where it is more vital to serve healthy, wholesome food than in our hospitals. That is important in so many ways—for the recovery of patients, staff morale, and the atmosphere that fills the wards. When hospitals serve good nutritious food, everyone benefits. I therefore call on the Government to introduce minimum nutritional, environmental and ethical standards for hospital food that will radically improve the quality of food served, reduce costs to the NHS and improve the health of the nation.

[The Minister of State, Department of Health (Mr Simon Burns)]

I congratulate the hon. Member for Stoke-on-Trent North (Joan Walley) on securing this debate on hospital food. I hope she gets better swiftly. I have considerable sympathy with her as she was clearly suffering through no fault of her own, and I wish her a speedy recovery.

I know that food and nutrition is a subject dear to the hon. Lady’s heart, and that she has done a considerable amount of work in her constituency, bringing together schools, primary care trusts, the city council and others, Prue Leith not least among them, to see what can be done locally to improve the diet of her constituents. I pay tribute also to the many NHS staff who have worked so hard to push nutritional care up the agenda, and who continue to make it their priority.

Good food—nutritionally balanced, clinically appropriate meals that taste good— are right up there with good hygiene and good clinical care when it comes to a patient’s experience of the NHS. They are all things that we should be able to take for granted while being cared for by the NHS. Good food contributes directly to recovery from illness and it adds structure to a day that can be all too long and featureless. Although I agree with much of what the hon. Lady said, there are some details on which we may not have such close proximity of views.

As the hon. Lady mentioned in the course of her comments, we will shortly publish the Government buying standards for food. Developed by DEFRA and the Department of Health, they will support and encourage public bodies to provide a healthy balanced diet for public sector workers. They will also help to reduce the environmental impact of food and catering in the public sector. However, as the hon. Lady said, within the NHS, these standards will be voluntary, not mandatory. Government buying standards are already promoted through the NHS operating framework for 2011-12 and through the Boorman review of health and well-being on the NHS, now being implemented by NHS Employers. We will promote the Government buying standards through training and materials developed to help NHS organisations to procure more sustainably.

The Government believe in giving far greater responsibility and control locally to NHS providers. NHS trusts must be allowed to determine their own procurement policy. Hospitals need to find out the wants and needs of their local population and then work out how to meet them efficiently. Government’s role is to set the direction and the policy, but it is for local experts to deliver the food locally. This is not to say that the NHS is on its own. There are a number of resources available, including guidance on reducing food waste, sustainable procurement and developing menus and food services.

No health care catering manager need feel unsupported. If hospitals wish to increase the proportion of locally-sourced food, there is guidance to help them do that. If they have a problem with food waste, there are resources that can help them to tackle it. This is the way we should tackle problems—with assistance and support, not restrictive legislation and diktat. It is wrong for Government to meddle in the detail and to attempt to micro-manage the NHS from on high. Our job is to create the right environment, to set standards and to lead, and that is what we are doing.

[Joan Walley]

Is not there a contradiction in having minimum standards in schools but not having minimum standards that would apply in the same way to patients in hospitals?

[Mr Burns]

No, I do not think so, for the reasons that I have already given and because of our ethos that the modernised NHS should respond through local decision-making rather than top-down diktat from Whitehall or Westminster. However, as I have outlined, we are prepared to, and we have and we will, provide the guidance to enable local deliverers to seek advice and take decisions based on the best needs of their patients.

We should also bear in mind that the food needs of patients are already regulated and checked by the Care Quality Commission, through the choice of suitable food, the food and nutrition to meet reasonable needs and the support to enable patients to eat and drink—a subject that I will come on to because I feel very much, as the hon. Lady did, that that is an essential part of the care of patients in a hospital setting.

I share the hon. Lady’s concerns about poor standards of nutritional care. In too many cases, food has slipped off the menu of some NHS providers, and that is not good enough. Of course, proper nutritional care is a multidisciplinary affair. There are many links in the chain from field to fork. Food must be well sourced and properly cooked by well-trained catering staff, delivered efficiently by the porters, and properly presented on the ward. The chain is a long one, and if any single link breaks, the good work that went before it is undone. Of course, the best food is of no value if it is not eaten, and many people, particularly older patients, will need help, and they must have it. Stories of food left out of reach, or taken away before a patient has had the chance to eat it are shocking and, sadly, too common, as are stories of those unable to feed themselves left without the assistance they require.

The latest in-patient survey found that less than two thirds—64%—of patients always got the help they needed to eat. But that sadly meant that 36% did not always get the help, which, frankly, is unacceptable. That is something that hospitals must concentrate on to ensure that we quickly and dramatically raise those figures. In a civilised society, in this day and age, that is unacceptable as part of patient care, particularly for elderly people.

That is why we asked the CQC to inspect 100 hospitals, focusing on issues of dignity and nutrition. The CQC has begun to publish reports on individual hospitals, and we expect a final report in September. In most cases so far, the care was every bit as good as one would expect. There were many examples of high-quality nursing and of people enjoying healthy, nutritious meals. Indeed, in a number of cases, the quality of food was actually complimented. But the inspections also identified a number of hospitals that were failing to provide the nutritional care their patients need. In one damning example, a doctor was forced to prescribe water on a patient's medicine chart to ensure they got enough to drink. That, again, is unacceptable, and something that one would find hard to believe if it had not shown up in the inspection. Where there are deficiencies, the CQC has demanded that improvements are made. Progress against these demands will be followed up and, like everyone in this House, I expect such follow-up to be rigorous and complete.

The CQC's inspection programme is just one example of how we are shining a light on all aspects of the performance of NHS providers—in this case on hospital food. There are also the annual patient environment action team inspections, the CQC's in-patient survey and patient feedback through NHS Choices, along with any local surveys that trusts choose to undertake. This information is crucial if patients are to make informed choices about their care and if pressure is to be brought to bear upon providers to improve.

Improving the patient experience of care is vital to drive up standards. Providers need to listen to patients’ complaints and suggestions and to change and improve in response. This will be one of the main ways in which the NHS will improve in coming years. Our information revolution will mean that patients are better placed to understand and influence the NHS, and we expect to see standards increase as performance becomes more transparent.

When it comes to hospital food, people know what they want. They expect good-quality, wholesome meals that are attractively served, arrive on time and taste good. They want to receive the food they ordered, not what is left over. They want to be able to eat it in comfort, they want sufficient fluids to drink, and they want the help they need when they need it. That is hardly asking the earth, so we owe it to them to be clear about what they can expect in their local hospital, however good or bad it may be.

I understand the hon. Lady’s concerns about hospitals that are built without kitchens. However, there are many ways to provide food in hospitals. Excellent meals can be delivered ready-made, either chilled or frozen, and poor-quality food is not an inevitable consequence of being made off-site. Although the quality of the food at the University Hospital of North Staffordshire has been rated as among the poorest 20% in the country, that is not simply because it is not made in a hospital kitchen. Other hospitals, such as those in Papworth Hospital NHS Foundation Trust and Dorset County Hospital NHS Foundation Trust, also have meals brought in and maintain in-patient survey scores that are among the highest in the country. In fact, for a small hospital, delivered meals can combine a wider choice of food and more accommodating meal times, with economies of scale and greater flexibility.

Delivered meals can also help hospitals to meet high sustainability standards, because although on-site kitchens might at first seem more likely to be sustainable, that is not necessarily the case. Larger off-site kitchens are often more efficient because, by utilising economies of scale, they can reduce the amount of energy they use. What is important is the quality of the finished product and whether it meets the specific needs of patients, not where or by whom the food is produced or prepared. If the best solution for a particular hospital is to do that on site, that is what should happen. However, the service should be contracted out if that is in the best interests of the individual hospital and its patients. We should reject any knee-jerk reaction that says doing it in one way will automatically be a disaster, or vice versa. With food, as with all aspects of NHS care, it is the outcomes that are important to patients, not the process. We need to remember that whoever provides the food, the trust management retains the responsibility for its quality. If the provider does not meet the standards that the trust has set, it must take action.

Of course, efficiency and value for money are also important. We have to find ways of producing excellent food at manageable cost. For some hospitals, that will certainly mean looking at delivered meals. This is sensible and prudent management, but it need not and should not mean poor quality. As long ago as 2002, the Audit Commission found no relationship between the amount of money spent on meals and their quality, and the Department of Health’s more recent internal analysis backs this up. Across the country there are trusts that provide great meals at low cost, which is precisely what all providers should aspire to. The Queen Victoria hospital NHS foundation trust is in the top 10% of NHS organisations rated by patients for having good food, but in the lowest 5% for production costs.

As ever, improving patient experience is central to the Government’s vision of the NHS. Good food is not only a vital element of that experience, but vital for improving clinical outcomes. However, I do not accept that the answer to these problems is to impose ever more controls that would prove expensive to administer, undermine local accountability and stifle the innovation and flexibility that hospitals need to tailor improvements to their specific local needs and constraints. Where food services are not as good as they should be, we should highlight the fact in order to improve care for patients. I do not pretend that making improvements will be easy or fast. Although there is much to do, I am confident that we now have the right approach and that the real winners in all of this will be patients.

Question put and agreed to.

Health and Social Care Bill

Joan Walley Excerpts

Monday 31st January 2011 Commons Chamber

[Joan Walley (Stoke-on-Trent North) (Lab)]

I am pleased to speak briefly about this Bill; I know that many Members on both sides of the House still want to contribute to the debate. It seemed to me that not to speak in this debate would somehow mean not being true to the important issues surrounding the NHS. I have listened to the debate and heard some good constructive comments, but I do not think we have gained a sense of what the NHS was like when I was first elected almost 25 years ago. At that time, people simply could not get treatment because of the underinvestment during the years of the Conservative Government. As for the point about organic change and building on what has been done, it seems to me that this Bill, lengthy as it is, is doing away with the step-by-step improvements that have been made.

[Robert Flello]

I look forward to hearing more of my hon. Friend’s speech, which I know will be to her usual high standard. Does she agree that, since 1997, Stoke-on-Trent has seen the building of the first new hospital for 140 years, a brand-new oncology unit, a brand-new maternity unit and health centres developing everywhere? Is that not real investment under a Labour Government, which never happened during the previous 18 years of the Conservative Government?

[Joan Walley]

What we have seen is the university college of North Staffordshire linked to the medical college at Keele. We have never before seen that kind of medical training going on outside London in areas like Stoke-on-Trent. Hayward hospital has been rebuilt and there has been investment in clinics and a huge increase in the number of staff. That does not mean just bureaucrats—like everyone else, I do not want to see unnecessary bureaucrats. I am talking about the number of health personnel trained to do their jobs and to treat people, which has been second to none—despite what the Minister says.

[Mel Stride (Central Devon) (Con)]

In looking at NHS performance, should we not seek to compare ourselves with international equivalents today rather than with the past? If we look at coronary heart disease, for example, we find that we have twice the death rate of France, and we are also lagging behind the rest of Europe on cancer outcomes.

[Joan Walley]

I am coming on to public health, as it is the main issue on which I wish to concentrate.

[Mrs Jenny Chapman (Darlington) (Lab)]

In response to the intervention on the recorded death rates from coronary heart disease in France, I want to observe that France makes much more frequent use of the “unknown” category in the recording of deaths. I have been led to understand that this goes some way towards explaining the apparent difference in death rates between the two countries.

--- Later in debate ---

[Joan Walley]

Statistics can be used in all kinds of ways. I remember the case of a young girl of six who could not get the heart surgery that she needed, even when we had invested in those facilities. The important role of public health is relevant to heart disease, and we need to focus on what can be done to prevent ill health. This Bill is very short on detail in that area, which is why I want to concentrate on it.

I want to stress that what we are seeing in this Bill is dogma. We are replacing the primary care trust layer with the GP layer, but the GPs will not be able of themselves to provide the clinical leadership of which we have heard. They will have to engage with equally bureaucratic agencies or companies to do that work for them. My fear is that the clinical leadership element will get lost when the new provisions come into force.

The provisions will not allow us to build on the work of the previous Government, which did so much to improve aspects of the NHS. I accept that the new Government have come into power and that they have a remit, but that means that they should get what they do right. I fear that what will happen as a result of the Bill will be destructive. I am afraid that it is also risky. We have already heard about the need for pilot projects. Why can we not wait for a proper evaluation of those projects before rushing ahead with a move that might cause us to throw out the baby with the bathwater? What safeguard will we have against that?

I fear that when the public realise that the Bill is not fit for purpose and will not achieve what is claimed for it, they will be not saddened but angered by the knowledge that they will no longer be able to raise issues for which the Secretary of State has previously had responsibility. The Bill will merely transfer responsibility, and it is easy to see who will have that overall leadership and where direct accountability will lie. The hon. Member for Stafford (Jeremy Lefroy) will probably wish to raise issues relating to Stafford hospital. It is important that when things go wrong in hospitals, there is full transparency. When everything is done on a commercial basis, that transparency will not exist in the new health service that the Bill will introduce.

The Government say that the Bill will end inequalities. I am old enough to remember the resource allocation working party, and the “distance from target” money that was to help areas such as Stoke-on-Trent which had received the least investment in health and experienced the most illness. I am not convinced that the Bill will continue that work. Stoke-on-Trent primary care trust is currently £30 million short of its target, and it is difficult to see how the Bill will make amends for that.

Realising as I do that the devil is often in the detail, I want to raise two more points. The first relates to public health. Speaking as an honorary vice-president of the Chartered Institute of Environmental Health, I am well aware that the public health consultation that has invited responses later this year will not be co-ordinated with the legislative changes in the Bill. Will the Government take account of the need for the institute to look in detail at the way in which public health will be integrated with local authorities across the board? That is critical if we are to improve public health services at all levels.

My second point relates to a private Member’s Bill of mine. I have heard that, through the Government’s Bill, the Prime Minister will require hospitals to improve nutritional standards. We all know that poor food leads to ill health. I hope that Ministers will consider the proposals in my Bill, and think about ways in which hospitals could serve high-standard food rather than food that is often linked to ill health. That in itself could make a major difference to people’s health.

I have many other concerns which I have no time to mention, but let me say finally that it is not clear how the Bill will secure the investment in dentistry that is currently needed.

Public Health White Paper

Joan Walley Excerpts

Tuesday 30th November 2010 Commons Chamber

[Mr Lansley]

All councils will be supported to develop health improvement strategies. When we come to publish the consultation on the funding of the public health budget, that will set out how, in addition to the resources used nationally, there will be significant resources in a ring-fenced budget for local authorities. Because of the nature of the health premium, that budget will be significantly weighted towards areas of greatest disadvantage and poorest health outcomes.

[Joan Walley (Stoke-on-Trent North) (Lab)]

Whatever Government were in power, I would welcome an enhanced role for environmental health officers in improving public health policy. Given the depth of the coming cuts to local authority budgets, however, there is real concern, regardless of the ring-fencing statement we have had, as to whether there will be sufficient resources and capacity for environmental health officers. Does the Secretary of State intend to have an environmental health officer at chief officer level inside the Department of Health?

[Mr Lansley]

I have had discussions with environmental health officers and they are enthusiastic about the opportunity for much greater synergy between their work and public health responsibilities. They see their role as integral to the achievement of public health. Indeed, some of the greatest public health improvements of the past were initiated in local government and through responsibilities that are currently within environmental health legislation, so I am looking to the health and well-being boards to bring these responsibilities together more effectively.

NHS White Paper

Joan Walley Excerpts

Monday 12th July 2010 Commons Chamber

[Mr Lansley]

Many GPs will find that they spend much less time trying to negotiate services for their patients through a PCT and NHS bureaucracy that get in the way. Of course GPs are operating collectively in a commissioning consortium, and I am not going to turn them into individual managers. Some GPs will be leaders—I am looking for clinical leadership—but they will also look for commissioning support. They can derive that from existing primary care trust teams if they think they are doing a good job; they can do it via local authorities or from independent sector providers of commissioning services as well.

[Joan Walley (Stoke-on-Trent North) (Lab)]

Does the Secretary of State not realise that there are greater health inequalities in some parts of the country, as in Stoke-on-Trent? Can he explain how this new arrangement of GP-led commissioning is going to deal with those health inequalities? Is it all going to be rolled out at one and the same time, or will there be pilot projects as part of a rolled-out programme? How is he going to ensure that health inequalities are dealt with, when local authorities in Stoke-on-Trent have to make £70 million of cuts over the next three years? How is it all going to be provided for?

Mid Staffordshire NHS Foundation Trust

Joan Walley Excerpts

Wednesday 9th June 2010 Commons Chamber

[Mr Lansley]

I am grateful to my hon. Friend for that question. Although he has only recently arrived in this House to represent his constituents, I know from my personal experience of our conversations, our meetings and my visits to see him and others in Stafford just how diligently and consistently, and in what a compelling way, he has represented his constituents over the past year or so. In reply to his question, I can tell him that although I have made it clear to Robert Francis that we must do this swiftly—and, therefore, without incurring excessive costs—we must do it successfully and achieve a quality result in order to inform everything we need to do to improve the NHS. We need to go beyond the mere structures and the processes—we have seen all that—to find out why people in all those structures were not focusing on patient safety and quality of care, and how they can be better incentivised, encouraged and required to do that in future. I am sure that my hon. Friend knows that we are ensuring that the additional costs that the Mid Staffordshire trust has had to meet in the course of the first Francis inquiry and now, and in supporting the delivery of better care, are being met with additional resources from the strategic health authority.

[Joan Walley (Stoke-on-Trent North) (Lab)]

May I, on behalf of constituents whose families were affected by what happened at Mid Staffs, welcome the continued focus that the new coalition Government are placing on making progress on this issue and on ensuring that what happened before never happens again at Stafford hospital? I pay tribute to the work done by my former colleague David Kidney, who, along with the action group, called for a full public inquiry into this matter; that needs to be put on the record. Will the Secretary of State give me assurances about the make-up of the panel, and perhaps give consideration to making trade union representatives members of it? We need to ensure that all people affected in the provision of care can be properly represented and can be part of that panel in the further inquiry.

[Mr Lansley]

I am grateful to the hon. Lady for her support for the further inquiry. I should say, first, that I share her view that David Kidney sought to get to the bottom of what happened at his local hospital, and pressed for a further, and public, inquiry. The shadow Secretary of State must know that at the beginning of last September Robert Francis came to him in the midst of his first inquiry to raise the issue of the legal base for that inquiry and the question of whether it should be brought under the Inquiries Act. He wanted the terms of reference to be extended sufficiently widely to ensure that at that stage he could have looked beyond the question of what happened, to the question of why the primary care trust, the strategic health authority, the NHS in general, and other organisations, did not intervene earlier and in a better way. On 10 September last year, the then Secretary of State did not agree that that should happen, but had he done so the first Francis inquiry could have achieved much earlier what the second will now have to do.