Care (Older People)

Margot James Excerpts

Tuesday 6th September 2011 Westminster Hall

[Jack Dromey (Birmingham, Erdington) (Lab)]

It is a pleasure to serve under your chairmanship today, Mr Streeter. I congratulate the hon. Member for Chatham and Aylesford (Tracey Crouch), both on securing the debate and on the sincerity that shone through in her contribution. I strongly agree with a number of the points that she made.

During the summer, I addressed a meeting convened by the Birmingham branch of Carers UK—an outstanding organisation nationally and in Birmingham. What shone through was that there is no more noble cause than caring. At that meeting, 200 were present, including people who were cared for, carers and the organisations that support them. Deep concern was expressed on two fronts, the first of which relates to an issue that we are not here to debate: the cuts to benefits and the work being done by the Hardest Hit coalition, which includes the Royal National Institute of Blind People, Mencap and others. The second issue relates to the growing crisis in social care. In one sense, the crisis is the consequence of a good thing—people are living longer—but there are undoubtedly two major problems. One, I agree, is that successive Governments have failed to implement a long-term solution to the growing crisis in social care. The other is the impact being felt now of cuts in public expenditure. The Government are going too far too fast, and that is having an increasingly serious impact on the most vulnerable in our society.

Looking to the future, the Dilnot review offers a new dawn. Its recommendations have been widely welcomed across the political spectrum. As we move towards implementation, it is key that Dilnot is fully funded and that its recommendations in respect of eligibility are carried through, so that what happened in Birmingham—I will say more about that later—never happens again. I agree strongly with the hon. Member for Chatham and Aylesford that its recommendations must be acted on as soon as possible. She is right that there has been a propensity in the past to kick such issues into the long grass. That cannot be the case in future. I sense that, across the spectrum, there is a desire in the House for the Government to act as soon as possible. They will unquestionably have the full support of the Opposition if they do.

[Margot James (Stourbridge) (Con)]

I share the hon. Gentleman’s enthusiasm for enacting the Dilnot report in law as soon as possible, but I have reservations about whether we should enact it in full as recommended. To give one example of my concern, does he agree that the £50,000 cap above which nobody should have to pay out of their own purse for long-term care or personal care at home might represent a large proportion of some people’s savings and assets, but that for home owners in the property-rich markets of the south-east, it might represent a small proportion? I am concerned on that and various other points. We should not rush but should subject Dilnot to proper critical investigation.

[Jack Dromey]

I accept that some of the issues that Dilnot identified will have to be worked through, but I think that there is a broad welcome for Dilnot ending what has caused so much grief in the past. People have had to sell their homes. People who spent their lives hoping to pass on wealth to their children have found in the twilight of their years that that is not possible. We can have an intelligent debate about the detail of Dilnot, but the cap is welcome. The sooner we implement Dilnot, the better. The problem is that, even if everyone gets a move on, that might be some years away, in which case we must address the here and now during the next two to three years.

WRVS has done excellent work in the field, and has said rightly that the Government must both address the adequacy of the funding that they have made available and ensure that it is wisely spent and properly monitored. The inescapable reality is that the consequences of the cuts to public expenditure are devastating for the most vulnerable in our society. To use the city that I represent as an example, Birmingham city council has cut £212 million from its budget this year—the largest cut in local government history. It cut £51 million from the social care budget, rising to £118 million over three years, and consequently sought to remove substantial need provision for 4,100 people. The council was prevented from going down that path only by a judicial review taken by four brave families, whose cases were heart-breaking.

I have seen some of the consequences in my own experience. One example is an absolutely wonderful couple, Faith and Frank Bailey. Faith Bailey is terminally ill. She left hospital some months ago, so that she could spend the remainder of her time on earth with her husband. They are a devoted couple; it is wonderful to see them holding hands at the age of pushing 80. The problem was that when she left hospital, her night-time care was restricted to two nights a week. She struggled as a consequence, and the impact on her husband was devastating. He was becoming increasingly exhausted, and neither of them could cope. The situation was causing them great distress. I am pleased to say that they are now in the admirable New Oscott village, where they will be cared for properly. However, those decent people who built Birmingham and Britain looked forward, in the twilight of their years, to being together for the remainder of her time, and to see them suffer in such a way was heart-breaking.

This is not just about the human consequences. As the hon. Member for Chatham and Aylesford was right to highlight, it is also about the financial folly of failing to recognise that not investing might cost more in the medium to long term. The King’s Fund report charts what happens in social care as a result: the number of people admitted to hospital rises. I am sure that we have all seen that in our respective constituencies. I remember one example in the constituency next door to mine in Birmingham. A fine young man who was seriously assaulted spent 18 months in hospital as the consequence of a failure to provide a social care package. After he had spent just over 12 months in hospital, he was told that he could leave if an adequate social care package were provided for him, but because it was not, he stayed in hospital. He was desperate to go home and his family wanted him back, and it was costing the national health service £2,400 a week in net additional costs to support him. That cannot be right. The impact on the national health service is an issue.

To give another example from Birmingham, all parties supported building 10 centres, such as the admirable Perry Tree centre, across Birmingham to provide intermediate care as a bridge between leaving hospital and going back home or into a home. Perry Tree is outstanding, and the atmosphere is wonderful. However, sadly, no more centres will be built. That will mean bed blocking on a massive scale in the national health service.

--- Later in debate ---

[Alison McGovern]

I agree. In a moment, I will talk about some of the problems that local authorities are currently facing. They have had bigger cuts than any part of Government in Whitehall. Although I wholeheartedly agree with what the hon. Gentleman said, it is a challenge to all of us to support local authorities in that prevention role.

The hon. Member for Newton Abbot rightly made the point that quality matters above all else. Some of the examples given by her and others were compelling in terms of the moral requirement on us all to stand up for the dignity of older people. I firmly believe that, when we hear examples such as the one just given, we know what is happening is wrong. I have heard examples from my constituents: for example, older people are told that a “breakfast” visit to get them up can take place any time between 6 am and 11.30 am, regardless of their personal preference. That is not good enough and is an offence to somebody who prior to needing care was independent and perfectly capable of looking after themselves. We all know that instinctively.

The question is: how do we get from where we are to where we would like to be? I want briefly to make two points on the subject. First, I shall mention enforcement and some of the professional development issues. Leading on from that, I shall talk about the market for care provision and why there is an interesting and difficult problem that the Government will have to tackle regarding the market for providing care. I agree with many of the points made by the hon. Member for Newton Abbot about some of the anomalies surrounding enforcement. I repeat that local authorities are having to struggle with the fact that, if they were a Government Department, they would be experiencing the biggest cuts in Whitehall. That makes the job of having responsibility for the care of older people, which is a fixed cost, very difficult.

[Margot James]

Does the hon. Lady agree that, when we consider expenditure, part of the problem is that, over the past 10 years, the increase in local authority budgets for adult and social care has been minimal compared with the increase in many other local authority budgets, particularly that for children and younger people’s services, to name but one? With adult and social care, we are starting from a base that is already very low, which is one of the problems and is why local authorities are struggling so much.

Health and Social Care (Re-committed) Bill

Margot James Excerpts

Tuesday 6th September 2011 Commons Chamber

[Margot James (Stourbridge) (Con)]

Does my right hon. Friend think that the previous Government set up the system for private companies so that they could fail without any redress on the part of the Government precisely because the companies had such a favourable financial regime bestowed on them that they could not possibly fail?

[Mr Lansley]

My hon. Friend is right in relation to the independent treatment centre contracts. They were constructed in a way that effectively removed most of the financial risk from the operators. For other private sector operators in the NHS that is not necessarily true. For example, most of us would recognise that private sector providers are instrumental to continued access to many NHS diagnostic services. There are providers who could fail and at the moment no regulatory structure is in place for that.

Let us continue down the path of the implications of the removal of part 3, which the Labour party proposes. Part 3 includes clause 60. I am sure that Opposition Members are familiar with clause 60, their having served in Committee for so long. It is the means by which, if the hon. Member for Islington South and Finsbury (Emily Thornberry) recalls, we can consider the application of Monitor’s functions to adult social care. So precisely when we are legislating to be able to consider whether the implications of an issue such as that at Southern Cross are such that there should be an additional prudential regulatory regime, the Labour party would take away that opportunity.

Reform of Social Care

Margot James Excerpts

Monday 4th July 2011 Commons Chamber

[Mr Lansley]

The hon. Gentleman should be aware that the maximum reduction in local authorities’ spending power this year compared with last year is 8.8%. We removed the ring fence from Department of Health social care grants but we did not reduce the scale of those grants. In addition, he must remember that, as is not always recognised, the NHS is making specific provision to support social care. This financial year, £150 million will go to support reablement, and £648 million will be transferred, as I said, to support social care, which will also have health benefits. That will be spending power in the hands of local authorities to support adult social care.

[Margot James (Stourbridge) (Con)]

I welcome the Dilnot proposals, but does my right hon. Friend agree that he should resist the demands from the shadow Health Secretary to rush into a White Paper this side of Christmas? It is more important to get it right, and there may well be ways to improve on the Dilnot proposals, particularly with regard to the cap and by making provision more affordable and fairer.

[Mr Lansley]

My hon. Friend makes a fair point. It was clear that had we sought to publish a White Paper before Christmas, the net effect would have been that we did not give the public, stakeholders or the official Opposition the time needed to discuss the issue and to do the job properly .

Winterbourne View Care Home

Margot James Excerpts

Tuesday 7th June 2011 Commons Chamber

[Paul Burstow]

I am grateful to the right hon. Gentleman for his question. We must acknowledge that there will never be a time when there is an inspector in every room of every care home for every minute of every day. We must therefore make sure that the systems in place are robust, and that organisations are recruiting the right people and delivering the right training and supervision. However, the right hon. Gentleman’s point about the involvement of the community is spot-on. That is why we are proposing the establishment of HealthWatch and why we see that as an opportunity for citizens to become involved in the provision and scrutiny of health and social care in their communities.

[Margot James (Stourbridge) (Con)]

Very often a whistleblower is the vital link that people in such vulnerable circumstances have with the outside world, so I am pleased to hear that that will be a big part of the review. I have written to the chairman of the CQC to ask how many such whistleblower complaints were made in the past 12 months but not been followed up. The data are essential. May I have the Minister’s assurance that the review will find out that information?

[Paul Burstow]

My hon. Friend draws attention to an area that we need to look at as part of the various aspects of the work that I described to the House today. Although I do not know the basis on which such data are collected by the CQC, I undertake to look at what data are available.

Oral Answers to Questions

Margot James Excerpts

Tuesday 7th June 2011 Commons Chamber

[Paul Burstow]

I could simply say yes to my hon. Friend, but I agree entirely, and that is why last year we acted quickly to establish an independent commission, led by Andrew Dilnot, to undertake a review of how we fund social care. His report will be coming forward shortly, and I would certainly welcome all necessary discussions to ensure that we deliver effective reform.

[Margot James (Stourbridge) (Con)]

We have six homes in Dudley borough managed and owned by Southern Cross, and I am pleased to hear the Minister’s assurance that he will work with local authorities to ensure that no resident is left in need. Questions must be asked, however, about the conduct of the former directors of Southern Cross, and about how they acted in terms of the duty of care to their company and to residents. Will my hon. Friend consider investigating the conduct of those former directors should the company’s situation worsen?

[Paul Burstow]

Those matters would more appropriately be dealt with by colleagues in the Department for Business, Innovation and Skills, but those points are fairly made by my hon. Friend. As a Government, we continue to maintain close dialogue with the company, the landlords and all other interested parties to make clear to them their responsibilities to secure the ongoing care of the individuals in those homes.

NHS Prescribed Medicines

Margot James Excerpts

Wednesday 4th May 2011 Westminster Hall

[Margot James (Stourbridge) (Con)]

It is a pleasure to serve under your chairmanship, Mr Meale. I am grateful for the opportunity to open this debate on the crucial matter of securing the supply of medicines in the interests of the patients for whom they are prescribed.

Ever since the pound gained against the euro a few years ago, the UK has experienced shortages of medicines, because some stakeholders find it more profitable to sell medicines intended for use by patients in the UK abroad, where higher prices, aided by the exchange rate, will prevail. Ministers are making efforts to resolve the problem, and I will return to the action that is being taken when I discuss some of the potential solutions.

First, I want to focus on the nature and scale of the problem and its effects on patients and pharmacists. It used to be the case that, if someone was prescribed a medicine by a GP, they went to their local pharmacy, handed over the prescription, waited for a few minutes and then went home with the pills. Occasionally the pharmacist would apologise, because they did not have the item in stock, and the patient would return the next day to collect their medicine.

Some years ago, I was responsible for the various medicines prescribed to my elderly parents. I was annoyed to find that, sometimes, the medicine that I collected from the pharmacy was Greek or Spanish, with inadequate English language directions. The pharmacist had dispensed a parallel imported drug, on which extra profit had been made by the wholesaler and, possibly, the pharmacist. Back in 2005, parallel imported medicines accounted for 18% of the value of branded medicines dispensed by UK pharmacies.

The tables have now been turned and our continental partners are being prescribed medicines intended for the British market that have been subject to parallel export. This has led to patients in Britain being prescribed a medicine, taking the prescription to their local pharmacy and being told that the product is not in stock and that it might be a few days before it will be. Patients are advised that they can shop around but, if it is a particular type of drug that is routinely demanded at a higher price on the continent, the chances are that neighbouring pharmacies are experiencing the same problem in accessing supply.

The effect of that shortage can range from minor inconvenience to potentially serious health risks. The BBC programme “You and Yours” featured the problem at the beginning of April. It interviewed an organ transplant patient who needed continuous treatment with the drug Rapamune to ensure that their body did not reject the new organ. The very idea that such a drug should be hard to obtain is absolutely scandalous, which is also true of that person’s experience.

How widespread is the problem? Chemist and Druggist, the pharmacy trade publication, conducted a survey of pharmacists last September that highlighted the difficulties caused to pharmacists, 90% of whom are not profiting from the shortages caused by selling medicines abroad. The survey found that pharmacists have had to turn patients away, because they had not been able to source the medicine prescribed. Moreover, 93% of pharmacists had at some stage had to ask the doctor to change a prescription in order to secure the supply of something similar. More than two thirds of pharmacists are spending between one and five hours a week chasing around, trying to get hold of out-of-stock medicines. That is a complete waste of pharmacy time and, now that the Department of Health has agreed to pay for that time, it is also a waste of NHS money.

Research conducted at the end of last year by the Devon local pharmaceutical committee supports the findings of the Chemist and Druggist survey and provides additional insights. Seventy pharmacists monitored medicine supply issues for a two-week period and identified 537 such issues, which was up from the 379 issues reported in a similar study by the same group a year previously. The problem has, therefore, been getting worse.

The Devon audit found that the average delay caused by one of those instances to the medicine being available was four and a half days, which is pretty much a whole working week. It was found that those delays caused minimal harm in 13% of cases, but in just over 5% of cases the harm was defined as moderate. For example, a missed dose of an anti-epilepsy medicine caused a patient to fit. In nearly 20% of those cases, the pharmacist had ultimately to go directly to the manufacturer to order the medicine via the emergency procurement procedures.

I have mentioned that the principal cause of the problem is the export of medicines intended for UK patients to other European markets. I should point out that it is not possible to prevent the export of UK medicines per se, because that would be contrary to the free movement of goods guaranteed by European trade laws. We might, therefore, expect the same problems to be experienced by other countries when the exchange rate boot is on the other foot. There is no doubt that, during the years when extra profit was obtained by importing medicines into the UK, there were similar shortages of medicines in some countries, such as Greece and Spain. There was, however, no such shortage in other markets such as Germany, so we cannot lay the blame for this problem on the liberal trading laws of the EU, which are something that I think we all support.

The cause of our problem goes beyond the trade in medicines across national boundaries. The law governing the supply of medicines derives, in part, from article 81 of European Union directive 2001/83. The directive simply requires the maintenance of appropriate and continued supply of medicinal products by marketing authorisation holders and distributors. It was introduced into UK law via statutory instruments in 2005. At that time, the UK Government did what I would applaud in all normal commercial situations. They incorporated the directive into UK law with minimal—well, zero—gold-plating. It was, in fact, a textbook example of how we would want our Government to deal with European regulations under normal commercial circumstances. Medicines, however, are different from other products, especially medicines that treat serious conditions such as cancer, Parkinson’s disease, which is another area in which there have been significant supply problems, and organ transplant patients. Sometimes, medicines can make the difference between life and death, which is why the research, manufacture and promotion of medical products are such highly regulated activities. That is not true, however, of distribution. The reason for the difference between the UK and continental markets, such as Germany, Belgium and France, is that those and other markets that signed up to the EU directive incorporated their own more stringent conditions in respect of securing a continuous supply of medicines.

Before I conclude by giving the Minister some recommendations on action to resolve the problem, I want to acknowledge the efforts that the Minister and his team have made thus far to improve the safety and supply of medicines to the public. Efforts have also been made by manufacturers, wholesalers and pharmacists. The Department of Health hosts a supply chain forum, which has recently published best practice guidance and will meet again in a few weeks’ time. I welcome the steps being taken by the forum to address the problem. Participants represent all stakeholders in the complex system of medicine supply. However, I want to ask the Minister whether patients are represented, because I have not seen any reference to patient organisations in the notes that I have seen from the meetings thus far.

All stakeholders involved in the group have committed to the principle of enabling a minimum standard of 24 hours to supply any prescribed medicine to a pharmacy, and manufacturers and wholesalers will risk prosecution if they breach the code of ethics in relation to that supply standard. The Government have promised to raise the standards for wholesaler dealers’ licences, which I very much welcome.

I wish all those actions well, but I am concerned on two fronts: first, that those actions do not go far enough and, secondly, that the MHRA, which is charged with policing the system, is not adequately resourced to monitor and enforce the recommendations. Given the financial incentives to sell certain products abroad and the number of traders with wholesale licences in the UK, my concern is that the difficulties of policing all the organisations, combined with the lack of prosecutions to date—I think that there have been nil prosecutions—for breaching existing duties to supply medicines do not bode well and make me think we need to strengthen those existing duties.

I want to express my appreciation to the British Association of Pharmaceutical Wholesalers and the Association of the British Pharmaceutical Industry for the help they have given to me during my research for the debate. The ABPI and the BAPW have called on the Government to strengthen the existing duty of wholesalers, and indeed all stakeholders, to supply medicines within 24 hours in the way other European markets have done. The introduction of what has become known as a patient service obligation, which obliges wholesalers to guarantee permanently an adequate range of medicines, is required to enable patients to receive an NHS prescribed medicine in the necessary time scale and to allow pharmacists and dispensing doctors to receive a medicine following its order and dispense it within 24 hours of a patient presenting the prescription.

Manufacturers and wholesalers should be obliged to hold buffer supplies, as those who operate to a high standard currently do, to help pharmacists to manage spikes in demand. That is really no different from obliging banks to hold capital reserves. Banks have recently been required to hold a higher proportion of capital on reserve, and I am calling for the same principle to be applied to the essential supply of medicines. Public health is as important as the supply of money, so why should similar precautions not be applied?

Finally, the patient service obligation needs to be backed up by the more stringent regulation of wholesalers. Germany and other countries place much stricter obligations on wholesalers than those that are required in this country. They are required to have appropriate facilities to hold a full range of products and a reserve supply of those products. Indeed, I am not sure why we need so many wholesalers in the UK. Another aspect to the problem the MHRA has in policing the system is that we have 1,800 licensed wholesalers. That number leapt up mysteriously over the past two years in response, I suspect, to the exchange rate. There are just 39 wholesalers in France, 90 in Belgium and six in Denmark. Across the EU, only Germany has more wholesalers than the UK.

I trust that I have given the Minister food for thought, and I urge the Government to consider more rigorous regulation in this essential area of the provision of medicines to the general public. I hope that the Minister will share with us some of his forward thinking about how the steps he has taken so far will be policed, monitored and might pan out over the coming months.

--- Later in debate ---

[Margot James]

Thank you, Mr Meale, for your chairmanship. I thank the Minister for his generous and comprehensive response. I remain concerned that the measures do not yet go far enough, but I am reassured that measures have been put in place and that the 60 or so medicines affected will be monitored closely. I hope that I am wrong and that it will not be necessary to introduce more stringent regulations, because I am a great campaigner against increasing the regulatory burden on industry. Patient safety, however, has to be paramount. I am not yet convinced that the measures will have the desired effect, but I am willing to keep an open mind, monitor the situation and bring any further evidence of problems to the Minister.

NHS Reform

Margot James Excerpts

Monday 4th April 2011 Commons Chamber

[Mr Lansley]

I reiterate the point that I made a moment ago. There is nothing in what I have said today that should do other than give people on the ground confidence that they are building the improvement of services that they need for the future. At the heart of that is the integration of health and social care. We as a Government have made available in this new financial year £648 million through the NHS specifically to build that kind of integration between health and social care. It has been insufficient in the past; we are building it now. As the hon. Lady knows, the Bill allows care trusts to continue in formation, but it is also possible for care trusts to redesign around commissioning consortia on the one hand and health and well-being boards on the other.

[Margot James (Stourbridge) (Con)]

The Leader of the Opposition stated his willingness to work with the Government on the NHS reforms. Does my right hon. Friend agree that a good place for him to start would be with a re-reading of his party’s manifesto at the last election, which supported virtually every principle in our NHS Bill, with one important difference—it was without the additional funding to match?

[Mr Lansley]

My hon. Friend makes a very good point. I am not sure which Labour party we would be expected to engage with—the one whose manifesto agreed with us, the one for which the right hon. Member for Wentworth and Dearne spoke at a King’s Fund meeting in January when he agreed with us, or the one that we saw in Committee, which opposed everything, tried to wreck the Bill and clearly has gone back to the Holborn and St Pancras view of the NHS.

NHS Reorganisation

Margot James Excerpts

Wednesday 16th March 2011 Commons Chamber

[John Healey]

Let me finish. The Government’s explanatory memorandum is helpful on the issue of EU law. It says, about chapters 1 and 2 of the Bill—the one third of the legislation that sets up the new competition system—that

“The Chapter 1 and Chapter 2 prohibitions are modelled on Articles 101 and 102 of the Treaty on the Functioning of the European Union which prohibit agreements that prevent, restrict or distort competition, and abuse of a dominant market position.

Monitor would have concurrent powers with the OFT to conduct investigations where it had reasonable grounds for suspecting that either of these two prohibitions—under either UK or EU law—had been infringed in the provision of health services in England.”

That means that a competition challenge in the NHS can be taken all the way to the European Court.

Helpfully, under pressure in Committee yesterday, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), confirmed that

“As NHS providers develop and begin to compete actively with other NHS providers and with private and voluntary providers, UK and EU competition laws will increasingly become applicable.”––[Official Report, Health and Social Care Public Bill Committee, 15 March 2011; c. 718.]

As GP consortia will be corporate bodies, not public sector bodies, and as hospitals will be competing with each other, will have no limit on treating private patients, and will have no support from the wider NHS if they run into financial problems, they will be bodies to which the EU competition rules and legislation apply. That means that the NHS will be tied up in the red tape of market regulation and competition law, and we risk decisions about who provides our health care services being taken not in England by GPs or Ministers, but in Brussels by the European Commission, and in Luxembourg by the European Court.

[Margot James (Stourbridge) (Con)]

The right hon. Gentleman has already acknowledged that competition and markets were a hallmark of the Labour Government; they took them far further than the previous Conservative Government ever did. Of 475 acute care sites providing elective care, 175 are independent sector providers. The Bill proposes making the competition fair and putting it on a level playing field. No longer will we allow the private sector to be as favoured as it was under the Labour Government.

[John Healey]

This is a debate. People in the country and in the NHS are worried not about what we did in government—they saw the massive improvements under Labour—but about the application of competition law, domestic and European, in full force to the NHS for the first time. The hon. Lady is serving on the Public Bill Committee. She will have the chance to get her head around that, as she clearly has not done so yet.

Oral Answers to Questions

Margot James Excerpts

Tuesday 25th January 2011 Commons Chamber

[Mr Lansley]

No, I do not. I am glad that the hon. Gentleman has asked that question, because I think that there is a world of difference between the question of the exercising of clinical leadership by general practices as members of a consortium in an area and the question of from whom they derive management support. I believe that many will derive it from existing PCT teams, the voluntary sector and local authorities. Sometimes the independent sector will be involved, but it is a question of the consortium choosing where to go rather than being taken over.

[Margot James (Stourbridge) (Con)]

T2. Some care homes that have received critical reports from the Care Quality Commission are reopening under the same management but with different names. The CQC’s practice is to remove earlier poor reports from its website, leaving potential customers in the dark about the poor record of those homes. Will the Minister remind the CQC of its responsibility to highlight poor practice in care homes, and request that it change its practice?

[The Minister of State, Department of Health (Paul Burstow)]

I will certainly ensure that the CQC understands that that is a matter of concern. When it discharges home owners and deregisters them, after receiving an application for a fresh registration, it conducts a thorough appraisal and assessment of their fitness to provide the service. The new owner of a home may well have done a great deal of work in improving the quality of training given to staff, but I agree that it ought to be possible for people to look at the CQC’s website and see reports on the quality of the previous provider so that they can assess that as well.

Public Health White Paper

Margot James Excerpts

Tuesday 30th November 2010 Commons Chamber

[Mr Lansley]

I entirely agree with what my hon. Friend says. I appreciated visiting a children’s centre in Roehampton just this morning to see how it was bringing together all the opportunities. Important among those was the relationship with health visitors and their signposting role in relation to that service and others. Through the White Paper, we will, in a number of respects with which I shall not detain the House now, focus on how we can work with social enterprises, the voluntary sector and charities in order to deliver health improvements. As that will involve factors such as behaviour change, the ability of charities to work with people at a personal level and to be highly innovative will be important in making it successful.

[Margot James (Stourbridge) (Con)]

I welcome the liberation of public health from its ivory tower. It will be able to do much more good in the real world. Can my right hon. Friend say a little more about how the health and well-being partnerships might work with businesses, the police and other relevant agencies to reduce alcohol-related admissions to hospital?

[Mr Lansley]

When we publish the alcohol strategy, there will be more to say about that, but it is already clear that we can do much more on local community alcohol partnerships, which have demonstrated their success in places such as St Neots in Huntingdonshire, so that enforcement and work to prevent young people from purchasing alcohol when they should not do so is much more successful. We can also work much more effectively on improving alcohol labelling, and we are working through the responsibility deal to look at those opportunities, too.