Veterans (Mental Health)

Nic Dakin Excerpts

Wednesday 7th March 2012 Westminster Hall

[Julian Sturdy]

I thank my hon. Friend for that timely intervention. I agree that local authorities have a key role to play, and I agree with the point about the veterans charter, which could go a long way towards delivering what we need, because ultimately we must signpost services correctly. That is the real point. As I said, there are great services out there, but I fear that if we do not signpost them to veterans effectively, we might be missing a trick.

[Nic Dakin (Scunthorpe) (Lab)]

The hon. Gentleman has done a service to the House and to people outside it, particularly veterans, by initiating this debate today. One of my constituents, Charlie Brindley, is a veteran and a champion of veterans’ causes. Does the hon. Gentleman agree that we should look for the best way of using such people as champions to assist us in reaching veterans and dealing with the difficulties in relation to mental health even more effectively?

[Julian Sturdy]

I agree. We must use the experience of such people to help us in this process. Signposting is the key. We have the strategy, but we need to bring things together in a coherent manner that best serves veterans such as those whom hon. Members have mentioned in their constituencies.

As I have said repeatedly, the work carried out in this field recently has been outstanding, yet we cannot rest on our laurels. We need to engage more public interest. We must continue to provide direct funding and support and to monitor each initiative to ensure that it is proving effective. There are so many different strands of support. My final plea is that all the excellent provision be kept together in a specific and coherent strategy. We have already in the debate heard about a number of different ways in which that might be done. If the provision is too loose, too disjointed or too sporadic in its implementation, we run the risk of undermining the general force of the positive work in this area.

I appreciate that a number of hon. Members would like to contribute to the debate, so I shall briefly conclude my thoughts. The work carried out by charities such as Help for Heroes, the Royal British Legion, Combat Stress and so many others literally saves lives. I applaud every one of them. Likewise, hon. Members on both sides of the House who have championed our armed forces should be proud of the work achieved in recent years to assist veterans who suffer from mental health problems. However, our work in scrutinising the present Government and future Governments must never cease. We have a duty to monitor and assess and to push those at the very top to ensure that veterans are at the top of our leaders’ agendas.

I save my last words for both serving and retired servicemen and women. I have never served in the armed forces family, and I expect that only those who do will truly understand the pressure, sacrifice and honour that such service entails. I do not pretend to understand what it must be like to face danger and even death on foreign shores on behalf of Queen and country. However, I can assure all veterans that I shall continuously do my best to ensure that they are never forgotten once their service is completed, that their needs are met by the country to which they gave so much and that their dedication and commitment are rewarded, acknowledged and, indeed, celebrated.

Oral Answers to Questions

Nic Dakin Excerpts

Tuesday 21st February 2012 Commons Chamber

[Mr Speaker]

I remind Members on both sides of the House—Back and Front Benchers alike—that topical questions and answers must be brief.

[Nic Dakin (Scunthorpe) (Lab)]

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

[The Secretary of State for Health (Mr Andrew Lansley)]

My responsibility is to lead the NHS in delivering improved outcomes in England; to lead a public health service that improves the health of the nation and reduces health inequalities; and to lead the reform of adult social care to support and protect vulnerable people.

[Nic Dakin]

If the argument is that doctors are the best people to commission health and manage finances, why not listen to doctors themselves, who universally reject the Government’s plans? Why not listen to the royal colleges and patients groups and drop the Bill?

[Mr Lansley]

The hon. Gentleman just does not know what is happening around the country. All over the country doctors taking clinical leadership in foundation trusts and NHS trusts, and GPs and their nursing and medical colleagues taking responsibility in the new clinical commissioning groups, are demonstrating that they can improve the quality of care for the patients they serve. They hear what is said by the hon. Gentleman and some of his colleagues and think they are completely out of touch with the world in which they live.

Oral Answers to Questions

Nic Dakin Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Anne Milton]

How can the hon. Lady give Government Members lectures on health inequalities, given that those got worse under the previous Government? Life expectancy in Kensington and Chelsea is 85 whereas it is 74 in Blackpool, and that is after 13 years of a Labour Government. Family nurse partnerships have doubled and we are well on track to get the additional 4,200 health visitors. Through the public health Cabinet Sub-Committee we are determined to raise the standard of living for all, by providing new strategies on child poverty, social mobility, tax, pension retirement ages and so on. We are doing something, whereas the previous Government did nothing.

[Nic Dakin (Scunthorpe) (Lab)]

3. What plans he has for the future of children's cardiac services in England; and if he will make a statement.

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

The review of children’s congenital heart services is a clinically led, NHS review, independent of government. The Joint Committee of Primary Care Trusts—JCPCT—on behalf of local NHS commissioners, will decide the future pattern of children’s heart surgery services in England. It is expected to make that decision next year.

[Nic Dakin]

I thank the Minister for his reply. In view of the Royal Brompton’s judicial review verdict, does he agree that it is imperative that the breakdown of the assessments of all centres and all areas is fully disclosed, so that confidence in the Safe and Sustainable review can be restored?

[Mr Burns]

As the hon. Gentleman will appreciate, it is imperative that Ministers continue to remain totally independent of this review, so that we cannot be accused of interfering. As he knows, the JCPCT has said that it plans to appeal against the decision, and we will have to await the outcome of that.

--- Later in debate ---

[Anne Milton]

The medicines legislation governs the range of health professionals who can prescribe. The Government’s policy is that only registered and regulated health professionals should be able to train for that; physicians’ assistants are neither.

[Nic Dakin (Scunthorpe) (Lab)]

T6. After speculation about the future of the Department of Health’s free nursery milk scheme, will the Secretary of State assure families and nurseries that he recognises the value of free nursery milk in preparing young people for a good future and well-being in life?

[Anne Milton]

I assure the hon. Gentleman that we do recognise the value of nursery milk. The only shocking thing is that the previous Government presided over a scheme whereby nursery milk is now costing double the retail price, and we urgently need to look at that. We are committed to continuing the scheme, but shocked at what has gone on before.

Health and Social Care (Re-committed) Bill

Nic Dakin Excerpts

Tuesday 6th September 2011 Commons Chamber

[Grahame M. Morris]

Again, that is a really good point. An incredible number of complex and detailed changes have taken place during the passage of the Bill, including the listening exercise and the consideration of a series of complex amendments, and even they did not address every issue that had been raised. Essentially, I am trying to say in a clumsy kind of way that the Bill is poorly thought out. I think it is a bad Bill, and if it is implemented it will cause real problems for the service and the people who use it.

[Nic Dakin (Scunthorpe) (Lab)]

I do not think my hon. Friend is making a clumsy speech at all; he is making a lot of very good points. His point about the Bill being badly drafted and set out is why I have been inundated over the past few days with messages from a range of professionals and service users who are very concerned about where things are going. I applaud my hon. Friend’s approach.

[Grahame M. Morris]

I am grateful to my hon. Friend for his point and for his kind words. My contention is that the problem with all these reforms is that they tend to unravel once there is an opportunity for not just Members of Parliament but health care professionals and the broader public properly to scrutinise them. Once people have the chance to consider the proposals in detail, there is an outcry such as that described by my hon. Friend.

I have tried to understand the thinking behind the Government’s changes and amendments. As I mentioned earlier, many of the changes fly in the face of the logic of the arguments originally made in Committee and when the Bill was first published. The obvious logical conundrum, if that is the term, can be seen in the fact that the original impact assessments, which were very comprehensive, said that it was essential to create a functioning market to gain the benefit of the reforms. A whole section of the impact study explained why “market exit” was fundamental to reforming the NHS. I heard what the Minister said earlier and I have read the Government’s amendments, but I am not quite convinced—perhaps I am a bit of a cynic—that this is a real concession. If we follow the Government’s logic, that makes the Bill as a package at best inconsistent and at worst it removes the possible benefits that Government Members may wish to promote in terms of the costs of any market system. Instead, we are subject to a strange system. The Secretary of State initially mentioned creating a level playing field to allow access for private health care firms as well as existing NHS and public providers. There are therefore some basic contradictions in the rationale behind some of the reforms, if there was any merit in the arguments initially.

Oral Answers to Questions

Nic Dakin Excerpts

Tuesday 12th July 2011 Commons Chamber

[Anne Milton]

My hon. Friend is absolutely right. Under the previous Administration there was a national target of reducing C. difficile infections by 30% by 2011, but that does not address the problem because, as he rightly says, there are hospitals that consistently had high rates of infections, so we changed that. Since April, every PCT and every acute trust has its own objective. The organisations with the highest rates of infection will have more ambitious objectives than those that are doing well.

[Nic Dakin (Scunthorpe) (Lab)]

16. What progress has been made on the review of children’s congenital heart services.

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

The consultation on the future of children’s congenital services ended on 1 July. The joint committee of primary care trusts, which is overseeing the consultation, is expected to make a decision later this year, based on an independent analysis of the consultation, reports from overview and scrutiny committees, and a health impact assessment.

[Nic Dakin]

I thank the Minister for his reply and his thoughtful response to the Back-Bench debate that took place in the Chamber. Will he ensure that if any further reconfiguration options have emerged from the consultation, they are properly considered and go out to further consultation before a decision is made?

[Mr Burns]

Yes, I can give the hon. Gentleman a categorical assurance on that.

Musculoskeletal Diseases

Nic Dakin Excerpts

Monday 4th July 2011 Commons Chamber

[Graham Stringer]

Thank you, Mr Speaker.

Many more points were made in that debate than it is possible to make in a half hour debate in this Chamber. What the then Government were essentially being asked was to take action to ensure better clinical outcomes for the money being spent on musculoskeletal disorders. The real ask from the community was for a clinical director or so-called tsar. In a sense, however, the most important ask is not that, but that there is an outcome strategy that improves the outcome for people suffering from musculoskeletal disorders. In many ways, in spite of those four reports and the debates that have taken place since, the situation nationally remains much the same. The statistics are worth going through in some detail. The amount of money spent on musculoskeletal disorders is large—£4.76 billion, which is the fourth-largest category spend within the NHS. That money is spent on 25% of the population as one in four people have a musculoskeletal disorder. That is 9.6 million adults and 12,000 children. Many people think that arthritis and rheumatism affect only older people, but that is not true. They can affect people of any age, as is perfectly illustrated by the fact that 12,000 children suffer from it. In terms of costs, the magnitude of the issue is that one visit in every four to a general practitioner concerns musculoskeletal disorders and 10.8 million working days are lost because of such disorders.

Those are the statistics. The problem is that there is no equality of outcome and no sense that when money is put into the system outcomes improve. About two years ago, partly in response to the reports, the previous Government put £600 million more into the system, but there was no noticeable improvement in outcomes. The NHS atlas of variation shows a threefold difference in spending in different parts of the country, but it does not relate to differences in incidence, prevalence or severity of the problem; nor does it necessarily relate to better outcomes. Although there is a threefold difference generally, the difference for rheumatoid arthritis is five times, for hip replacements 14 times, cemented hips 16 times and for uncemented hips it is 30 times. Clearly something unusual is happening in that area of the service and it requires examination.

Quite simply, current services do not ensure swift treatment of arthritis, which in many cases is vital. I shall give an example from one category of disorder: rheumatoid arthritis. People think it is the same as any other arthritis but it is not; it is an auto-immune disease and few people suffer from it. Many GPs see only one new case every year or so, which is surprising but true. Because GPs do not see such cases regularly, patients often have to visit their GP about three times before they receive treatment, but early treatment is vital. The time before treatment means not only pain but also that the rheumatoid arthritis is not cured. Since a third generation of drugs—the biologics—has been developed, the disease is curable in a large number of cases if treatment is given quickly enough. Even if the disease is not curable, what matters is getting the patient to a multidisciplinary team of physiotherapists, consultant surgeons, doctors and community nurses as quickly as possible.

[Nic Dakin (Scunthorpe) (Lab)]

My hon. Friend is setting out his stall powerfully. It is a difficult subject. Does he agree that early intervention is good not only for the patient, because they can recover faster or get to grips with the condition, but also for the economy, because the person is more likely to be able to continue active employment, and for the health service because early intervention is likely to cost less in the longer term?

[Graham Stringer]

Precisely. I mentioned the total number of lost days. In the vast majority of cases of rheumatoid arthritis, people stop working two years after diagnosis, but if diagnosis and treatment are earlier it is most likely that even if the person is not cured they could continue working for longer.

The Arthritis and Musculoskeletal Alliance—ARMA—is calling for a number of things, but before I put its case I note the following points. The fact that there are unsatisfactory differences in inputs and outcomes is not completely an accident. By and large, the services have not had the attention they deserve. I am not making a party political point; the situation has been going on for a number of years and unfortunately it continues. The quality and outcomes framework contains no indicator for musculoskeletal conditions. Why not? The musculoskeletal services framework of 2006 lacked leadership and was largely ignored by the centre in the NHS, GP training in musculoskeletal conditions remains poor, despite the evidence I have just given about the importance of GPs recognising precisely what form of musculoskeletal disorder a patient has, and only two of the NICE policy standards announced so far relate to musculoskeletal conditions—for hip fractures and osteoarthritis—out of the vast range of some 200 conditions covered by this generic term.

ARMA is calling for an outcomes strategy as a vital first step in addressing the current failures in provision of treatment and care for people with these disorders. What would that strategy look like? It would cover a number of areas, including outcomes, demonstrating how high-quality musculoskeletal services can deliver improvements in the outcomes measured in the NHS outcomes framework, particularly gaining independence and returning to work, as my hon. Friend the Member for Scunthorpe (Nic Dakin) pointed out.

The useful slogan, “no decision about me without me”, should also be a guiding factor, enabling patient involvement and shared decision making at all points in the patient pathway and, in particular, encouraging better self-management and at the same time improving general public awareness of musculoskeletal conditions. The information revolution is also relevant for setting out and making public the key sources of data on the performance of and expenditure on musculoskeletal services and improving our understanding of outcomes beyond hip and knee replacements, which account for only 20% of expenditure. There must be co-ordinated service delivery, joining up delivery across the NHS and social care services. Commissioning should describe the measures of success that will be used to assess clinical commissioning groups and set out the support that will be provided to commissioners. Training for GPs in musculoskeletal medicine is also important. We must enhance the currently small component in training to support GPs in providing effective and timely treatment and care to patients, as well as informing their commissioning decisions.

ARMA’s request of 18 months ago for a direct musculoskeletal service was reasonable. Even if there is to be no service director, ARMA’s requests are quite reasonable, because surely the Minister cannot be satisfied with how services are being delivered across the country, with different inputs and massively different outputs.

I finish by quoting Professor Emery of Leeds university. He was talking about rheumatoid arthritis, but this applies to any of these conditions. He said that it is the “most common treatable disability”. Essentially, it is not treated as well as it should be and the disability could be removed. I look forward to the Minister’s response, and hopefully he will respond positively to what should be a reasonable way forward.

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

I congratulate the hon. Member for Blackley and Broughton (Graham Stringer) on securing the debate and bringing to the House’s attention an important issue. He has rehearsed the statistics, but behind them are people with real lives, in some cases suffering in agony and having difficulty getting on with their lives as a consequence of musculoskeletal disease.

Let me make it clear from the outset that the Government fully recognise the impact that musculoskeletal disease has on individuals and society as a whole and that, although there are excellent services in some parts of the country, there is still far too much variation in the availability of services and the outcomes they secure for people. This debate is about how we will respond to that evidence and to the concerns that the hon. Gentleman has brought to the House tonight, and about how we will deliver the change on the ground that we all want to see as constituency Members.

The hon. Gentleman argued for a national outcomes strategy on musculoskeletal conditions. He made some important points and I will try to address directly some of the concerns that sit behind them. The 34 organisations in the Arthritis and Musculoskeletal Alliance, which he has spoken on behalf of this evening, make some important points. They have been in discussions with the Department of Health about their concerns over how we will ensure that the differences between services around the country are addressed so that people get access to the right services at the right time.

On 19 April, officials wrote back to the alliance to confirm that we would

“ask the National Quality Board to look at this area as a potential topic for a national outcomes strategy”.

By that, we mean that it will consider whether there are problems in our approach to these conditions that go wider than the NHS. It is important to understand that an outcomes strategy produced by the Department of Health looks out from the NHS to wider impacts on health and considers how those might be influenced to improve health outcomes for people. It will also look at what needs to be done about efforts that are already in hand, to ensure that the NHS is more responsive to patients’ needs and that there is an uptake of good clinical practice.

I do not believe that the case has been fully made for such an outcomes strategy, and I want to explain to the hon. Gentleman, and through him to members of the alliance, why that is. A number of steps have been taken in the past 12 months that have moved us on significantly from the debate that the hon. Gentleman spoke about at the beginning of his remarks. I understand that the National Quality Board will consider its future work programme at its meeting this month. It will decide whether it is appropriate to commission the necessary work to look at the case for a Department-led outcomes strategy. I assure the hon. Gentleman that I will ensure that not only this debate but the debate that took place in 2010 are cited by the members of that board.

I will spend a little time describing what is happening now. The hon. Gentleman referred to the musculoskeletal framework that the Department published in 2006. He spoke about the impact of that strategy, and I will say more about that in a moment. The document was developed in collaboration with a wide range of patient and professional organisations. It set out a vision for services based on the concept of an integrated care pathway—exactly the sort of pathway that the hon. Gentleman talked about. The clear aim was to help the NHS to organise services so that patients could access a variety of primary and secondary care services according to their need, including physiotherapy, clinical psychology, specialist rheumatology and surgery, and have a seamless transition from one service to another.

The model proposed depended on the idea of a multidisciplinary clinical assessment and treatment service, or CATS, for musculoskeletal services. That would bring together clinicians from primary and secondary care, assess patients’ needs, treat them locally where possible, and where necessary refer them on for specialist hospital care. The document recognised that different health communities would implement the framework in different ways, and that it should be possible in some circumstances to offer patients a choice of pathways.

Three years after the publication of that document, in spring 2009, the British Institute of Musculoskeletal Medicine held a symposium to review progress in implementing the framework. Today’s debate echoes the frustration that was felt there. Although the symposium found that a number of excellent services had been developed, incorporating the vision of services integrated around the needs of patients, which this Government strongly endorse, interestingly it also found that those services were very different from one another. Some were still based in hospitals, some were in the community. Some were a see-and-treat type of service, but others had triage-based systems to refer people on to the most appropriate service. However, as the hon. Gentleman identified, there was still a patchiness to the provision.

The hon. Gentleman touched on the need to integrate services, which the Government are determined to drive forward in order to deliver better results for patients. We need to do that at the same time as acknowledging that people want to be able to exercise the maximum possible control and choice over their treatment. We set out our course clearly last year in the White Paper on the NHS, and just recently in the response to the NHS Future Forum we made it clear that we would be placing explicit duties on clinical commissioning groups to promote integrated services for patients. We will also further strengthen existing duties planned for the NHS commissioning board. We will amend the proposed duty of Monitor to make it clear that its core duty is to promote and protect the interests of patients, rather than to promote competition as an end in itself.

We intend those amendments, taken together, to create a strong incentive for local commissioners to take forward more integrated services, which I think all of us in the House wish to see delivered for people with musculoskeletal disorders and other patients. However, we have to go beyond just health integration and ensure that we achieve integration across health and social care. The hon. Gentleman was right about the concept of “no decision about me, without me”. We need to ensure that it is hard-wired into the way the NHS works.

[Nic Dakin]

The Minister has spelled out the Government’s position carefully. Will they publish a response to the Public Accounts Committee’s report, which responded to the National Audit Office, in taking forward the matter of musculoskeletal disease?

[Paul Burstow]

As ever, there is a clear obligation on us to respond to reports and recommendations of the Public Accounts Committee, which we happily fulfil. I am sure that we will do that if we have not already done so, and I am grateful to the hon. Gentleman for asking.

I turn to the specific issue of outcomes. The Government believe that a focus on outcomes is key to how we can drive improvements in the NHS. It is also how we can hold the NHS to account. That was why we published the NHS outcomes framework, to which the hon. Member for Blackley and Broughton referred, in January. It has five key domains that are populated by measures that will be used to judge outcomes. They are preventing people from dying prematurely; enhancing quality of life for people with long-term conditions; helping people to recover from episodes of ill health or following injury; ensuring that people have a positive experience of care; and treating and caring for people in a safe environment and protecting them from avoidable harm.

The second domain, improving the quality of life of people with long-term conditions, is clearly the most relevant to the debate. It includes an instrument known as EQ-5D, which is to measure people’s quality of life in a number of respects including mobility, pain and the ability to carry out the usual activities of daily living. The inclusion of that measure was the result of feedback from the public consultations last year on the outcomes framework. It is clear from the analysis done by the Department’s economists that almost half the total burden of disease, as measured by that instrument, is due to musculoskeletal disease.

In other words, the inclusion of that instrument in the NHS outcomes framework highlights clearly the importance of musculoskeletal conditions to the population, and why commissioners and clinicians need to focus their efforts on designing and delivering care pathways of the type outlined in the framework in 2006. It shows how that can have a significant impact on the aggregate score in the outcomes framework on enhanced quality of life for people with long-term conditions. It will not be possible to achieve success, as set out in the framework, without making progress in that way. There is a powerful new lever in the system as a consequence of the outcomes framework.

The hon. Gentleman talked about the atlas of variation, which is also a powerful tool for identifying outliers and allowing the appropriate challenge of commissioners and others on the decisions they have made. We intend it to be used by commissioners in that way, to drive improvements in the service.

I welcome the fact that the hon. Gentleman sees quality standards as a useful tool. NICE has already developed a quality standard for osteoarthritis, and we are looking at the scope for the development of a quality standard in pain management. We are about to see a further consultation on a range of subjects for the next batch of clinical quality standards. We have the hon. Gentleman’s suggestions on a musculoskeletal condition standard in mind.

This short but timely debate has highlighted an important area of health policy in which we need significant improvements on the ground. The evidence and clinical advice to provide excellent services is there, but we need clinicians to use their leadership role in the NHS to drive change, and we need to take the opportunities of changes in clinical and commissioning leadership to drive forward those reforms. I shall certainly ensure that the debate is referred to those who need to take such decisions, and I thank the hon. Gentleman for bringing the matter to the House tonight.

Question put and agreed to.

Congenital Cardiac Services for Children

Nic Dakin Excerpts

Thursday 23rd June 2011 Commons Chamber

[Nic Dakin (Scunthorpe) (Lab)]

It is a pleasure to follow the Minister, who was very careful in setting out how he is attempting to ensure that this process proceeds in an appropriate way. I was pleased by his comments about the consultation being genuine and about the review being flexible, open-minded and not limited to a particular set or number of outcomes. His contribution was very reassuring and I thank him for that.

I would like to use as my reference point a lady who attended a meeting in Scunthorpe, at the Wortley House hotel, for people who have used the Leeds children’s heart unit’s services in recent years. Her use of the service goes back to when it was in Killingbeck hospital a long time ago before it moved to Leeds General infirmary in 1997. At that point, as has been pointed out, all children’s services were located in one area to great positive effect for the children of the Yorkshire and the Humber region. What she said to the people from Leeds at that consultation was that she really did not mind where the heart surgery locations were, but that she wanted the very best to be delivered for children in need so that they could access the best and most excellent services. She went on to say that her experience of the Leeds service was such as to give her assurance that it would meet those needs. She was particularly concerned that proper outreach services should remain in any future configuration. Her daughter was expecting another child and was already engaged, in relation to her pregnancy, with service support through Leeds, which was going to make it less likely that there would be significant cardiac problems that could not be dealt with at the appropriate time and with appropriate effectiveness.

In the Scunthorpe area, we tend to be on the periphery of things, so we always have to travel, in this case to Leeds. The weather conditions at the end of last year made it difficult to travel to and from Scunthorpe, and a two-hour journey with unwell youngsters would have led to great concern.

We need to make sure that there are proper outreach services to give support in future and, as my hon. Friend the Member for Leeds East (Mr Mudie) said earlier, we must recognise that people should have equality of access to excellence wherever they are in the country. That is important for my constituents.

[Ian Mearns (Gateshead) (Lab)]

Does my hon. Friend agree that it seems a little unfortunate that the options in the consultation would not include the continuation of services at both Leeds and the Freeman hospital in Newcastle? That was deeply upsetting for parents in the communities that both hospitals serve. There is real concern that the excellent heart and lung transplant service at the Freeman hospital could be jeopardised.

[Nic Dakin]

I thank my hon. Friend for that important point. One of the things illustrated by the debate is that there are many forms of excellent practice, with excellent people working across the country in this area of medicine.

[Mr David Ward (Bradford East) (LD)]

It is good to be working with the hon. Gentleman on this issue, but does he agree that there is a fundamental problem? Newcastle performs only 255 procedures, so it needs the Leeds unit to close to reach the 400 figure specified in the review, whereas Leeds can stand on its own. Together, we have to challenge that premise, because the European regulations state that 250 procedures is perfectly safe. The Newcastle unit is safe and the Leeds unit is safe; they are both excellent. Together, we have to challenge the review.

[Nic Dakin]

I thank the hon. Gentleman for those comments. Leeds delivered 316 cardiac operations in 2009-10 and 372 in 2010-11, so the numbers meet the criteria fairly closely.

I congratulate the hon. Member for Pudsey (Stuart Andrew) on securing the debate. The Minister will have heard from his comments that there is still not total confidence in the integrity and transparency of the review. I feel that the Minister has helped to allay those fears and I am reassured by his saying that the review will be open, genuine and flexible. I thank him for putting that message across so strongly. The hon. Member for Pudsey clearly outlined the concerns, especially the need properly to engage with the ethnic minority community. Although it sounds as though steps have been taken latterly, they ought to have been taken at the beginning of the process, given the fact that young people in that community have a higher incidence of cardiac issues than the rest of the population.

I hope that the people conducting the review will hear the excellent comments that have been made by Members on both sides of the House, and from all regions of the country, during the debate, and that they will think outside the box, as the hon. Members for Pudsey and for Colne Valley (Jason McCartney) said earlier. We need to be flexible. We do not need to compromise on clinical excellence or clinical outcomes for children, but we should recognise the need for equality of access to excellence, as my hon. Friend the Member for Leeds East said. I hope that our debate will be part of the consultation process that the Minister assures us is genuine, listening and ongoing, and that it will assist us in reaching an outcome that we can all applaud.

Southern Cross Healthcare

Nic Dakin Excerpts

Thursday 16th June 2011 Commons Chamber

[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.

[Nic Dakin (Scunthorpe) (Lab)]

I welcome the Minister’s comment that every resident will be looked after. Will he further reassure residents of Baytree Court in my constituency that they will suffer no detriment as a result of this situation?

[Paul Burstow]

I can say that of course we need to make it absolutely clear to landlords and the company that their actions have consequences, and that their actions now must be focused on a speedy resolution to the restructuring of the business that ensures it can continue to employ good-quality staff and provide care for the 31,000 people who live in its homes.

NHS Future Forum

Nic Dakin Excerpts

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

It was always clear that we would retain section 1(1) of the 1946 Act, which states that the Secretary of State will have a continuing duty to promote a comprehensive health service in England. What has been asked of us is that the Secretary of State should have not only that duty but a duty to secure the provision of that health service and an oversight responsibility in relation to the national bodies charged with providing it, and we will respond positively to that request.

[Nic Dakin (Scunthorpe) (Lab)]

This is a sorry tale of the Government going too far, too fast. What we have now is in danger of being a dog’s breakfast and the worst of all possible worlds. How much has this top-down reorganisation cost the UK taxpayer so far?

[Mr Lansley]

The listening exercise has to date—on 14 June—cost £36,640.97. The process of modernisation in the NHS is saving hundreds of millions of pounds every month. We know that we have to not only increase resources to the NHS but deliver continuously improving productivity and efficiency in the NHS. The Labour party always ignored that and failed on that; we will not fail on that.

NHS Reform

Nic Dakin Excerpts

Monday 4th April 2011 Commons Chamber

[Mr Lansley]

I can assure my hon. Friend that one of the central beauties of the Bill is that in future it will matter less what my priorities are and much more what the priorities are of his local communities and general practitioners and others who are responsible for commissioning in his area. On that basis, I have no doubt about the importance and priority that they will attach to community hospitals.

[Nic Dakin (Scunthorpe) (Lab)]

I share and welcome the Secretary of State’s commitment to reduce bureaucracy, so I am concerned to know why Monitor’s budget is increasing by 600% over four years to police the marketisation of the NHS. Is that not poor value for money?

[Mr Lansley]

The Government are introducing for the very first time a clear limitation and reduction on the running costs of the NHS. That will include the Department of Health, the arm’s length bodies, the strategic health authorities and the primary care trusts—the whole shooting match. We will reduce those costs by more than a third in real terms. Monitor forms part of that. We have made it clear that its estimated total running costs will be between £50 million and £70 million. That is more than at present because its responsibilities will be considerably larger than they are at present.