Adult Social Care

Mary Macleod Excerpts

Thursday 8th March 2012 Commons Chamber

[Sarah Newton]

Yes. As I mentioned, it is a great achievement that people are living longer, but that will obviously present huge challenges in adapting our society as people live for so much longer.

Unfortunately, growing old or living with an illness or disability is frightening to too many in our country today—frightening both to the people involved and to their loved ones who support them. There is fear about physical and mental frailty, about the quality of care they will receive from the NHS and social services and about whether they will have to pay and how they will afford to do so. We need to alleviate as much of that fear as possible by creating services and a way of paying for them that are fair and easily understood by people of all ages, that deliver high-quality care and support to carers and in which those who are employed feel respected and appreciated.

To achieve that aim requires a vision and a plan that everyone understands. That plan should be fair and should offer a route from where we are today to where we want to be. It will then require all political parties, over a period of time, to implement it. That will deliver the lasting, consistent and sustainable reform that despite many good intentions has eluded all Governments for many years.

I believe that the Government have recognised the challenge and taken a number of steps forward. There is a pledge in the coalition agreement to reform care services and funding and, following the excellent work of the Law Commission and the commission led by Andrew Dilnot, we have been promised a White Paper this spring and a Bill soon after. That process will very much depend on the determination of the Opposition to work constructively with the Government.

The Government have also ensured that while a longer- term solution is found to the current funding issues more money is being given to councils, and they have committed £2 billion. The Health and Social Care Bill will enable the integration of social and health care and, through the health and wellbeing boards, local commissioning of new care pathways will be made possible. I have seen some highly effective piloting work in Cornwall through the “Changing Lives” approach to joined-up services, which is based around the person and their carers.

The Government have launched a carers strategy and a dementia strategy with funding attached, but it is very frustrating that the money provided for those services is not always finding its way to the people who need it most. I am a passionate supporter of localism and returning power from Westminster to people and their communities. I believe that services for people in Cornwall should be designed and delivered in Cornwall, but we must recognise that this is a revolution. Although some professionals in the NHS and councils are relishing the new opportunities, some are not, as many of them have served in these important public services for years and are used to the command and control management of the past. It is difficult for some people to change and these are big cultural changes.

At a time when large-scale efficiency savings are needed in the services that support older people, reform is more important than ever. The nurses, social workers and carers I know are all motivated to deliver a high-quality service but I think Ministers will need to give clear direction about the commissioning of new pathways—new pathways that explicitly deliver integrated and joined-up care and new pathways developed on the evidence from the innovative work being provided not only by doctors, nurses and social workers but in partnership with other organisations such as Age UK, Macmillan and a host of other not-for-profit organisations. Within the new framework of outcomes, new outcomes should enable better integration.

Those new outcomes and pathways will need funding. We know that for every £1 spent on social care, £2.65 is saved from the NHS budget, so not addressing the inefficient split of funding between the NHS and social care will mean that we continue to waste more and more money.

[Mary Macleod (Brentford and Isleworth) (Con)]

On funding, does my hon. Friend agree that we should look at having more respite care for carers, especially elderly carers, some of whom do a 24/7 job and need extra support?

[Sarah Newton]

My hon. Friend makes a very good point, which has been addressed in the carers strategy.

Each year we should aim to use more NHS money on social care, and more money from the NHS budget could be given to councils for the integration of services led by health and wellbeing boards. Eventually, I would like to see the pooling of budgets. Social care has never been free at the point of need, and we know that the NHS will always be free at the point of need irrespective of anybody’s ability to pay. That is enshrined in the Health and Social Care Bill. Despite that, however, most people do not think they will have to pay for care and it can come as a dreadful shock, especially to the one in 10 people aged over 65 who end up paying more than £100,000 for care. Dilnot came up with a framework of shared and capped costs for individuals needing social care—shared costs between the individual and the state. I am sure that framework is receiving a great deal of attention from the Front-Bench teams, but I expect that however well the cross-party talks are going, it will take several years to introduce such a system if agreement can be reached. In the mean time, there is an urgent need to design a fairer system based on shared responsibility to pay.

There are uncontroversial steps that would not require substantial new resources and that could be taken now as part of a longer term plan. The legal framework and assessment processes that are used to decide who is entitled to what help could be sorted. We also need to fix the means test that we use to decide what we expect people to pay. That would help families to understand what help will be available and who needs to pay for what. Families would then be able to plan accordingly. The Government could ensure that people had access to independent advice on the best way of planning and paying for care and they could bring in a universal deferred payment scheme that would tackle the issue that so many people dread—selling their home to pay for residential care during their lifetime.

Oral Answers to Questions

Mary Macleod Excerpts

Tuesday 10th January 2012 Commons Chamber

The Secretary of State was asked—

[Mary Macleod (Brentford and Isleworth) (Con)]

1. What his policy is on the use of volunteers in hospitals.

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

The coalition Government recognise the tremendous contribution that volunteers play in enhancing quality and experience in health and social care, including within hospitals. We are working with partners, including the National Association of Voluntary Service Managers, to strengthen this role during service reform.

[Mary Macleod]

Mr Speaker, may I wish you and the House a very happy and healthy new year?

I thank the Minister for his response. I recently attended the local volunteering awards in the West Middlesex hospital in my constituency. Almost 400 volunteers do great work for patients and the hospital. What financial assistance is available to hospitals to support these volunteering projects?

[Paul Burstow]

I very much agree with the hon. Lady about the need for NHS trusts to consider their stance on volunteering. Indeed, I suspect Members of all parties have visited hospitals and worked with friends organisations over the Christmas period and have seen the good work that volunteers do in our hospitals. Our aim is to make sure that NHS trusts and commissioners of health and social care have the tools and information they need to make good judgments about investing in volunteering. That was the purpose of the volunteering strategy that we published last year.

Oral Answers to Questions

Mary Macleod Excerpts

Tuesday 12th July 2011 Commons Chamber

[Mr Lansley]

The hon. Lady will know that we are focusing, as I said in response to an earlier question, on improving survival rates at one and five years for lung cancer, among other cancers. One essential task is to improve public awareness of the symptoms of lung cancer, and we are already piloting means by which we can do that. At the same time, there have been research trials on the effectiveness of X-ray screening for lung cancer, and we will look at the results shortly.

[Mary Macleod (Brentford and Isleworth) (Con)]

I have been contacted by a constituent who has just graduated in dentistry but has been unable to find a placement for his dental foundation year. What support are we giving such students so that we increase access to NHS dentistry?

[Mr Lansley]

I understand that more dentists are currently employed in the UK than ever before. My hon. Friend makes an important point and if she is able to provide further details, I will pursue it, because one objective of deaneries should be to ensure that the major investment that we put into the initial education of dentists is followed through in professional training.

Future of the NHS

Mary Macleod Excerpts

Monday 9th May 2011 Commons Chamber

[Mr Stephen Dorrell (Charnwood) (Con)]

I do not agree with everything that the hon. Member for Barnsley Central (Dan Jarvis) has just said, but I congratulate him on a thoughtful speech and wish to pick up on two points with which I entirely agree. The first was his moving tribute to the NHS staff who provided the care for his late wife. The second point, which is of immediate concern to us, was his recognition that the health service, like all human institutions, must embrace the need for change.

The question before the House this afternoon is how we can ensure that the need for change that the health service faces can be embraced and made a force for good. I open my remarks on that point by agreeing with the shadow Health Secretary, who said only a few short months ago, on 20 January —his words have already been quoted to him—that

“these plans are consistent, coherent and comprehensive. I would expect nothing less from Andrew Lansley”

Nor would I. I agree that that is a fair description of my right hon. Friend the Secretary of State’s proposals. I particularly congratulate my right hon. Friend, and the Government at large, on the fact that, despite that being a fair description of their proposals, they are now engaged in a listening exercise, the purpose of which is to improve a set of proposals that were described by the shadow Health Secretary in the terms I have already quoted.

I particularly welcome the fact that my right hon. Friend and the Prime Minister have made it clear that this will be a listening exercise on the policy substance, not just a process of balancing political forces in order to cobble together a compromise. If we are to be true to our commitment to the health service, as my right hon. Friend is, we need to ensure that we focus on the problems it faces and put in place structures that will deliver solutions.

[Mary Macleod (Brentford and Isleworth) (Con)]

Does my right hon. Friend agree that the Prime Minister has not broken any promises on the NHS, as the shadow Health Secretary has suggested, and that the Government are investing in the NHS and there is no question of privatising it?

[Mr Dorrell]

I entirely agree with my hon. Friend. The Prime Minister and the Secretary of State made clear during the listening exercise their determination to ensure that proposals are brought forward that improve the capacity of the structures of the health service to deliver the objectives my hon. Friend has just articulated.

Childhood Obesity

Mary Macleod Excerpts

Tuesday 3rd May 2011 Westminster Hall

[Mary Macleod (Brentford and Isleworth) (Con)]

Thank you, Mr Gale, for the opportunity to introduce this debate on childhood obesity, which is, unfortunately, an issue that I understand far too well. Childhood obesity is a significant issue in my constituency of Brentford and Isleworth, which is part of the Hounslow borough—13.9% of children in reception are at risk of being obese, with the figure rising to 24.6% by year 6, or age 10—so I have a personal interest in finding out as much as I can about the issue and what we can do to address it.

I believe that there are two strong reasons why childhood obesity requires Government focus. First, the issue concerns children, who may not, therefore, be directly responsible for the situation in which they find themselves. We must, therefore, do all that we can to support and help them. Secondly, the potential long-term implications on the health of these children is serious, as is the cost to the state of their medical care, so it is our duty to do all that we can to address the issue.

This debate is timely, because there have been several recent developments on the issue. When I switched on the news this morning, there was a story about overweight people in middle age having a greater chance of dementia. On the children’s side, the Greater London authority has commissioned a report on childhood obesity in London, which looks in detail at the causes of childhood obesity and the effectiveness of intervention programmes. The London assembly has published a report on childhood obesity in London, “Tipping the scales”, which considers the role that the Mayor of London could play and puts the cost of treating childhood obesity in the capital at £7.1 million per annum. The current generation of obese children will cost the London economy £110.8 million a year if they grow up to be overweight adults. The Government recently launched their responsibility deal as part of the strategy for public health in England. They are also working on the paper on obesity, which will be published later this year. It would be good to hear from the Minister about any progress on that.

In today’s debate, I want to review the scale of the issue, talk about some of the possible causes of childhood obesity and look to the future to discuss what actions we can take. First, how significant is childhood obesity in the UK? The headline figures on childhood obesity in this country are alarming—29.8% of children aged two to 15 are either overweight or obese, which is almost one in three children. On current trends, two thirds of children will be overweight or obese by 2050. Breaking down the figures on childhood obesity throughout the UK shows that there is a particular problem in urban areas, especially London. Data for 2009-10 show that in London 11.6% of children aged four to five, and 21.8% of children aged 10 to 11, are at risk of being obese. I have already mentioned the figures for my area in London.

The figures are a significant worry for the future health of our nation as a whole, because evidence suggests that overweight adolescents have a 70% chance of becoming overweight or obese adults. Obesity is a disease with, potentially, very serious health implications, including, in the short term, breathlessness, feeling tired, and back and joint pains, and, in the longer term, hypertension, cardiovascular disease—mainly heart disease and stroke—type 2 diabetes, musculoskeletal disorders, especially osteoarthritis, and some cancers, including breast cancer and colon cancer. There are also psychological issues of low self-esteem, lack of confidence, depression and feeling isolated, which restrict a person’s potential ability to earn. Obesity is also associated with a higher chance of premature death and disability in adulthood. The long-term costs for the UK of this level of childhood obesity are vast. The 2007 Foresight report on obesity predicted that the NHS costs associated with overweight people and obesity will double to £10 billion per year by 2050, and that the wider costs to society and business will reach £50 billion per year by 2050.

Secondly, why is there an issue? Before we can decide how best to tackle childhood obesity, we need to understand more about what causes it. As one doctor once put to me, at its most basic level the formula behind obesity is simple—we put on weight when we take in more calories than we burn off through day-to-day living and physical exercise. However, we need to dig deeper than that to find out what is causing the problem, because, clearly, a number of factors are at play.

We are talking about children, so perhaps the biggest single factor is parental influence. Weight Concern reports that children with two overweight parents are 70% more likely to be overweight themselves. GPs to whom I have spoken in my area are often the first point of contact for parents on the issue, and they feel that, often, parents do not accept that their children are overweight. Given that perhaps more than a quarter of other children in the class are also overweight, they may feel that their child is normal. They may also feel that the suggestion that their child is overweight is a direct criticism of their parenting skills, and they are reluctant to accept that.

I am not a parent myself, but I have discussed this issue with friends and constituents who are. There is no doubt in my mind that there is a lack of knowledge and information that is easy to understand. Often, parents simply do not realise the number of calories that they are feeding to their children. For example, I am pretty sure that no parent would allow their child to sit and eat five spoonfuls of sugar, but some think nothing of giving them fizzy drinks containing the same quantity. Ask a parent how many calories there are in a bowl of chocolate-flavoured cereal and what percentage of a child’s recommended intake of sugar that represents, and I would wager that most would probably not know the answer.

When I speak to parents about the issue, a common story emerges. Many start off with the best of intentions, breastfeeding their babies for weeks or months under the regular guidance of health visitors. Perhaps they then move on to religiously preparing pureed vegetables and home-cooked meals that they bag up and put in the freezer for their babies and toddlers. Gradually, however, as the years progress and as the influence of peers, TV and the media grows, as well as that of, critically, the children themselves, who become more demanding and fussy about what they eat, it is too easy to slip into bad habits from which it is very difficult to get them back.

I am not saying all this to give parents a hard time—far from it. What I am saying is that those who feed our children and organise their activities—typically parents and schools for the most part—are so critical to this issue and need to be supported in any way we can. Jamie Oliver and many others in the school environment have worked hard to make progress in improving the quality of the meals that are provided to children when they are at school, and they should be commended for that work.

As I mentioned earlier, there are many factors at play, and I want to touch on another key one. Deprivation has been shown to play a significant part in levels of obesity, with children from the poorest backgrounds being much more likely to be obese. When families are struggling financially, they are more likely to be attracted to cheap, high fat, energy dense and poor foods, many of which are marketed with “buy one, get one free” deals.

The 2007 Foresight report on obesity highlighted the full range of factors that it believed were behind the trend towards obesity and made the point that there are lots to consider. However, to summarise the causes, the issue is about parents who have been overweight themselves, those who live in an urban area and those who come from a lower-income household.

Thirdly, what can be done in the future? Given that so many different factors influence childhood obesity, this is clearly not just a health issue, although I am pleased that a Health Minister is responding to the debate. The issue is also affected by planning, housing, transport, education, business and other things. Therefore, although the model we are aiming for is spearheaded by the Department of Health, it must be integrated across all areas. The Government have already taken important steps. Public health funding has been ring-fenced to ensure that sufficient focus is given to the matter and, in March, the responsibility deal was launched.

In the White Paper, “Healthy lives, healthy people: our strategy for public health in England,” the Government stressed that localism is key. A partnership approach will be encouraged between the Government, local authorities, health representatives, education, business and the voluntary sector. In addition to putting in place the right environment for change with that partnership approach and by integrating policies across Departments, we need to tackle the problem head-on by making nationally recognised programmes available to address childhood obesity.

I am a fellow of MEND, which is a social enterprise that has evolved from a 20-year partnership between Great Ormond Street hospital and the University College London institute of child health. MEND is the child-weight management partner of more than 100 primary care trusts and 15 local authorities in England. MEND stands for Mind, Exercise, Nutrition, Do it, which sums up the approach that it takes to covering each of those important elements. At a recent parliamentary event for MEND, I met a young boy called Charlie and his mother, who had been through the MEND programme. Over 10 weeks, the whole family learned about portion sizes and how to read and understand food labels. They set goals as a family and took part in fun physical activities. Charlie told me that taking part in the MEND programme has not only helped him to lose weight, but given him new confidence. He now enjoys taking part in many school activities. The changes put in place have made a real difference to the whole family, including to Charlie’s sister. He now looks forward to going out shopping with her and her friends to buy new clothes, when previously he absolutely dreaded doing so.

Like many other programmes across the country, MEND builds in a number of best practices to ensure success. The programme is about working with the whole family to ensure that changes are made to the weekly shop and family activities. It focuses on nutrition and physical activity, and it aims to start young. One school in my constituency, Hounslow Manor, works with children from reception to achieve the greatest possible long-term impact. The programme also aims to deliver in a community-based way to reduce the stigma around the programme and build the real support networks that can make a difference.

In the GLA intelligence unit report published this month, MEND was evaluated as a cost-effective approach to obesity intervention. Other cost-effective programmes in the UK include the local exercise action pilots, which focus on increasing physical activity. Other such programmes include one to reduce television viewing in the US and the regulation of television advertising of high-fat, high-sugar products at certain times, which was introduced in Australia. I would like research to be directed at how we can extend the online elements of programmes that are provided to children. Children enjoy learning in an online, gaming-style environment, and it would be good to see how that could be used in obesity programmes to build up such an approach.

[Lyn Brown (West Ham) (Lab)]

I am thoroughly enjoying the hon. Lady’s contribution. I have stayed here from the previous debate just to listen to what she has to say and because I have a personal interest in the issue. Does she agree that getting children involved in cooking enables a child to explore foods that they might otherwise not try? That enables a family to experience better, more wholesome home-cooked food, rather than the processed rubbish that is thrust at them from television screens every day.

[Mary Macleod]

I thank the hon. Lady for her contribution and absolutely agree with her. The issue is about the whole family, including children, understanding what goes into food. If they understand more about that and participate and get involved in it, they will have a better understanding and knowledge of what it is all about.

How should we start to deal with the issue? I want to consider a couple of things that are happening and that might have an impact. The first is the move from a primary care trust-based model to GP commissioning consortia, and the other is the upcoming London Olympics. As we move towards GP commissioning, we need to consider the impact on the obesity service provision. Currently, providers such as MEND have suggested that decision makers in the new model will require clear information and guidance in the commissioning process for weight management programmes. They have also suggested that the commissioning process itself could be simplified and redesigned to ensure that it focuses on clear and consistent information and measured outcomes. The commissioning model will help in pulling together best practice. That is certainly the case in the Great West commissioning consortium, of which Hounslow is a part. It is already starting to focus on some of the public health issues that need to be addressed.

The 2012 London Olympics and Paralympics will soon be taking place. Those events provide us with a fantastic opportunity not only in London, but elsewhere around the country to build on the legacy that will be left. What better Olympic legacy could we have than a whole generation of children who appreciate the benefits and enjoyment that come from regular participation in sport? The Mayor of London is working hard to encourage schools in London to participate in his Get Set programme, which involves school children taking part in a host of sporting and cultural activities related to the games. A majority of my schools have signed up to that. We need to make sure that other such programmes are happening across the country and that the influence of the Olympics lasts well beyond the event itself.

As part of the obesity paper, the Government will also no doubt want to consider the approach they should take on the use of legislation in the food and drinks industry. In its recent report, “Stepping up to the plate—industry in action on public health”, the Food and Drink Federation offers its view on the progress the industry is making, particularly in the areas of reducing salt, fat and energy in popular products and in improving food labelling and marketing. There is more that the food and drink industry can do in that area—for example, having clearer labelling, so that people know exactly what they are eating.

In conclusion, nearly one in three children in the UK is overweight or obese, and much more can be done to give them a better quality of life. We need to protect the long-term health of children and avoid unnecessary short and long-term financial burdens on the NHS. There needs to be a broad integrated and co-ordinated approach across Departments. We need to raise awareness about planning permission for fast food outlets very near schools and to ensure that we share best practice and measure outcomes from all the obesity intervention programmes. We want to use the London 2012 Olympics as a starting block to encourage more young people into sport and to engage in physical activity as much as possible. We need to integrate ideas, such as encouraging schools to grow food, into the curriculum and to support and encourage parents to restrict television and do more things outdoors. We also need to encourage eateries to sell healthy options and have better labelling, so that people know what they are eating. In addition, we need to encourage more exercise. I have signed up for the Race for Life that will take place this month in Battersea, so I will be running my 5 km for charity as well as for my health.

I came into politics to help to make a difference to my constituency and the country as a whole. I feel very strongly that by improving health outcomes on childhood obesity we can definitely make a real difference to many people.

NHS Reform

Mary Macleod Excerpts

Monday 4th April 2011 Commons Chamber

[Mr Lansley]

Let me make it clear to the hon. Lady that many of the things she is describing in Trafford are the result of things that the last Labour Government failed to do. For example, the last Labour Government said that all NHS trusts should meet the criteria to become foundation trusts by December 2008, but they did not do it. We are now having to help NHS trusts to meet the kind of quality and viability standards that they did not meet in the past, which is at the heart of many of the problems she describes. Do we have management resources? Yes, we do. That is one of the reasons I invited Sir David Nicholson, as chief executive of the NHS, to be the chief executive of the new NHS commissioning board so that the design of commissioning for the future will be completely consistent with the transition and the management of the change in the NHS today.

[Mary Macleod (Brentford and Isleworth) (Con)]

I thank my right hon. Friend for standing firm in his desire to improve the NHS. Will he join me in commending the work of the Great West commissioning consortium in London and others, who have approached these reforms with professional leadership and commitment to make the NHS more efficient and improve public health, ensuring better care for all patients?

[Mr Lansley]

Yes, I do join my hon. Friend in applauding the Great West commissioning consortium, because it and others across London are demonstrating that instead of having the top-down diktat of how services should be changed in London, they are in the process of designing, from the point of view of the populations they serve, what the requirement is for them and their services in their area. That is a better and more sustainable basis on which to design community-led and primary care-led services for the future.

Oral Answers to Questions

Mary Macleod Excerpts

Tuesday 8th March 2011 Commons Chamber

[Anne Milton]

The hon. Gentleman is absolutely right. The World Health Organisation threshold for high instance is defined as 40 cases per 100,000. Of the 19 relevant primary care trusts in this country, 16 are in London. There is no doubt that this is a complex problem. In the past two decades, the increase in instances has come from people who were not born in this country. We are doing a number of things. The Home Office is reviewing the effectiveness of screening, and is running a pilot of pre-entry TB screening in areas of countries where there is a high instance. The problem is that it is not always detectable when people enter this country.

[Mary Macleod (Brentford and Isleworth) (Con)]

Tuberculosis is a key health issue for those in the London borough of Hounslow. What more does my hon. Friend feel we can do to build public awareness and to ensure early diagnosis?

[Anne Milton]

My hon. Friend is right. NHS London will continue to fund the TB find-and-treat outreach programme for the homeless and other vulnerable groups, which includes the use of mobile X-ray units. The Department will continue to provide money to support TB Alert, which builds capacity in the voluntary sector and raises awareness.

John McGrath

Mary Macleod Excerpts

Thursday 22nd July 2010 Commons Chamber

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

I congratulate my hon. Friend the Member for Broxtowe (Anna Soubry) on securing what I think is her first Adjournment debate. Adjournment debates provide an opportunity for issues such as this to be debated in the House, and for the Government to account for what they are responsible for and ensure that others do the same. It is entirely appropriate for such a tragic and distressing case to be raised in an Adjournment debate.

Our thoughts must go first to the family whose lives have been turned upside down by this devastating incident. I offer them my deepest sympathies. As my hon. Friend said, members of the family are in the Gallery listening to the debate, and I look forward to meeting them afterwards and discussing the case with them directly. I fully understand their desire to ensure that something positive comes out of this terrible tragedy. As my hon. Friend said, our priority now is to ensure that the NHS learns from the incident, at a local and also, where appropriate, at a national level. I have asked my officials to look carefully at the issues raised by the case as they consider the future direction of mental health policy.

I shall say a little more about the national context later, but let me begin by focusing on the local issues. As my hon. Friend explained, Nottinghamshire Healthcare NHS Trust launched an internal investigation, which reported in April. It is a frank and honest account of what went wrong, and it gives the local NHS a good basis on which to improve the safety and effectiveness of its mental health teams. All that precedes the full external and independent investigation that the strategic health authority will commission in the near future. The trust has assured me that since the internal report came out it has taken active steps to address the weaknesses identified. It tells me that it is improving records management, strengthening communication between teams and reviewing its policy and procedures for assertive outreach. It is also addressing the way that mental health teams assess and manage risk, as well as looking at leadership issues and how they manage a patient's condition over the long term.

In addition, the trust has reviewed the cases of every patient using assertive outreach services to ensure that their care is not being compromised by the same failings. It has commissioned an external review of its assertive outreach teams, which is due to report in a fortnight. I have been reassured that the trust's board will examine the findings and respond swiftly and diligently to them. My hon. Friend and I would agree that all that work must feed directly through into better and safer practice on the ground. Crafting objectives and principles is one thing; achieving tangible improvements to practice is quite another.

My hon. Friend is absolutely right to emphasise the issues of strong leadership and clear lines of responsibility in assertive outreach teams. I can tell her that what should happen is that every assertive outreach patient has a named care co-ordinator. The co-ordinator takes overall responsibility for the appropriate assessment, care and review of the patient. There is no nationally prescribed model for who must take on that responsibility. I do not think that it is sensible to start prescribing how local teams are structured or run through a mandatory code. After all, patients’ needs will differ, and so will local circumstances.

However, there must be clarity. Everyone should know who is responsible for what, and people should be properly qualified, skilled and supported to discharge their responsibilities. The trust accepts that point. It tells me that it has set out a clear process for responding to service users who have not adhered to the agreed level of contact. Team managers are now responsible for monitoring that. I also understand that a risk assessment expert has spent a week with the assertive outreach team and is now developing a risk training programme for all staff. That training will be delivered in October.

Building on that point, I have also asked the trust about its quality assurance procedures. Assertive outreach obviously depends on strong relationships across different teams. That can be hampered if people change jobs, or if the continuity is broken in some other way, so the right quality assurance process is vital. Change has to be embedded within the organisation through regular and robust assessment of the competency of assertive outreach teams. In this regard, the trust tells me that it has improved clinical and managerial supervision as well as its performance management arrangements. For instance, attendance at multidisciplinary team meetings is now compulsory for anyone involved in a patient's care. Team managers now carefully monitor attendance at these meetings, and ensure that all actions coming out of the meetings are properly followed up.

I am keen that lessons from this tragedy are shared and absorbed by the rest of the NHS. In our White Paper, we talk about an NHS freed from the endless succession of top-down mandates and departmental circulars. That is the right approach. We want to replace command and control with much stronger local accountability, with councils in particular taking a much stronger role in working with the NHS and holding it to account. We have also said that the NHS will focus much more on achieving better outcomes; there is a debate to be had about what those outcome measures will be. A consultation is happening over the summer, and outcomes for mental health patients will form part of those discussions.

However, cutting the Whitehall apron strings does not mean abandoning our duties to look at local incidents and consider national repercussions. I will not pre-judge the external investigation. My hon. Friend would not expect me to do that, but I can tell her that the external investigation will be sent to the National Confidential Inquiry into Suicides and Homicides by People with Mental Illness as a matter of course. The inquiry team will consider the findings as part of its regular reviews of homicide investigations. The National Patient Safety Authority would respond to any points of national concern raised by the independent investigation.

In addition, my hon. Friend may be aware that the NHS already flags patient safety incidents via the NPSA’s national reporting and learning service, and if a trend or pattern emerges the NRLS can issue an alert to all relevant providers. Those alerts would give advice to the NHS on how to prevent such events from occurring.

My officials have contacted the NPSA about the specifics of this incident and it says no similar problems affecting other assertive outreach teams have been reported to it. Therefore, I will be particularly interested to see the dossier of evidence and I will follow that through.

[Mary Macleod (Brentford and Isleworth) (Con)]

This incident was very movingly described by my hon. Friend the Member for Broxtowe (Anna Soubry), and I do not think it is an isolated incident—I think it has happened elsewhere around the country. Can the Minister give an assurance that the lessons from this case will be learned across the country and that it will change the way things are done in the future?

[Mr Burstow]

In terms of the systems as they work now, we will do all we can to make sure that that learning is embedded, but I am concerned that my inquiries today have shown that the NPSA was not aware of this dossier and I will therefore look into that, and look at the dossier itself in order to see what it can teach us.

However, I want to reassure both hon. Ladies—and other Members—that if the independent investigation were to make recommendations with national implications, we would look at them very closely and make sure they were translated into action and learning around the country.

Let me end by saying that mental health professionals have an extremely difficult and challenging role; the hon. Member for Broxtowe was right to acknowledge that. The judgments they make are often finely balanced, and the risks they shoulder are considerable. Most professionals are doing an excellent job, and we ought to acknowledge that while also being concerned where practice falls short, but sometimes there are failures in care that could and should have been avoided. Tragedies like the case of John McGrath demonstrate the need for constant vigilance, scrutiny and self-improvement.

When such tragedies do happen, it is vital that all responsible authorities, both local and national, are honest about the weaknesses and diligent about putting things right for the future. Like the hon. Lady, I will take a close personal interest in the independent investigation and the coroner’s report. I want to ensure that this incident leads to improvements, because that is probably the only consolation that can come from such a tragedy.

That is my message to the McGrath family and the hon. Lady who has secured the debate tonight. I look forward to meeting the family shortly to discuss these matters further and to working with colleagues across the House to make sure our mental health services protect and give good quality care for people with mental health needs.

Question put and agreed to.

Oral Answers to Questions

Mary Macleod Excerpts

Tuesday 29th June 2010 Commons Chamber

[Mr Burstow]

We need to achieve that not by ring-fencing budgets but by making sure that clinicians can deliver clinically evidence-based practice so that those with age-related macular degeneration receive the treatments that they need. Ring-fencing is not the way to go; we need to ensure that local commissioners have access to the right evidence, are empowered by patients and listen to clinicians, in order to deliver the right services.

[Mary Macleod (Brentford and Isleworth) (Con)]

6. What steps he plans to take to increase the level of expertise among cancer surgeons.

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

I thank the hon. Lady for her question—to which the answer is that we recognise the crucial importance of high-quality surgery in improving outcomes for cancer patients. Since 2003, cancer-related surgical training programmes have been developed when new technologies and procedures have proved that patients would benefit from their introduction. Through the national cancer action team we are supporting training in laparoscopic surgical procedures for colorectal cancer, and we will be introducing surgical training for lower rectal cancer.

[Mary Macleod]

As procedures for cancer surgery, including robotic surgery, are getting more and more complex, does my hon. Friend feel that there is a case for an earlier selection of specialism for surgeons, to ensure that the NHS maintains its reputation for clinical expertise and to influence positively cancer survival rates in the United Kingdom?

[Mr Burstow]

As I said in my original answer, we recognise the crucial importance of high-quality surgery. The hon. Lady has made the important point that we must equip our surgeons with the right skills to carry out highly complex and specialist procedures. That means that we must deliver specialised training for that purpose to our existing work force.