Oral Answers to Questions

Debate between Nick Smith and Anne Milton

Tuesday 17th July 2012 Commons Chamber

[Nick Smith (Blaenau Gwent) (Lab)]

Given that every year, 1.2 million admissions to accident and emergency units are alcohol-fuelled, when will the Government help the NHS and legislate for a minimum alcohol unit price?

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I am sure that the hon. Gentleman is very familiar with the alcohol strategy and has read it in detail. It is one of the things that we need to do. Brief interventions, specialised treatment, the NHS alcohol check and, of course, changes to licensing will all make a difference. As I say, the alcohol strategy, a cross-Government document, is out. We will respond further in due course.

Oral Answers to Questions

Debate between Nick Smith and Anne Milton

Tuesday 10th January 2012 Commons Chamber

[Nick Smith (Blaenau Gwent) (Lab)]

6. What discussions he has had with ministerial colleagues on the effects of fuel poverty on health.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I and my officials have worked closely with the Department of Energy and Climate Change on the development and implementation of the cold weather plan for England, which aims to reduce the health impacts of cold weather on vulnerable people. We have also put £30 million into the warm homes healthy people fund to fund local authority projects to reduce the impact of cold weather.

[Nick Smith]

The Marmot report confirmed that cold homes are bad for our health. My local newspaper has highlighted the case of a low-income working family who have to choose between food and heat every day, with no help from their energy provider. Will the Minister ensure that energy companies do more to tackle fuel poverty, so that the NHS does not have to foot the bill for their profit?

[Anne Milton]

As I said, my colleagues in DECC are working closely with the energy companies. I point out to the hon. Gentleman that this coalition Government are the first to put in place the cold weather plan to reduce those 27,000 excess winter deaths. Perhaps his local paper would like to contact the Welsh Assembly Government to see what they are doing.

Oral Answers to Questions

Debate between Nick Smith and Anne Milton

Tuesday 22nd November 2011 Commons Chamber

[Nick Smith (Blaenau Gwent) (Lab)]

2. What plans he has to implement the recommendations of the strategic review of health inequalities by Professor Marmot.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

The public health White Paper “Healthy lives, healthy people” gave details of our response to the Marmot review, and addressed the social determinants of health in people’s lives. I am sure that the hon. Gentleman has read it. Yesterday we launched the University college London institute of health equity with Professor Sir Michael Marmot as its director, supported by the Department. The institute will help to promote the findings of the review across the NHS, public health and local government, and will ensure that health inequalities remain a priority.

[Nick Smith]

Parts of my constituency are more than 1,200 feet above sea level. We know about the impact of cold homes and fuel poverty on health. According to the latest figures, cold has caused 25,000 excess deaths in England and Wales. What discussions has the Minister had with the Chancellor about the need to invest in making our homes warmer to reduce the number of such deaths?

[Anne Milton]

I thank the hon. Gentleman for that question. He will be aware of the 27,500 excess winter deaths that occur across the country, which is an increase of 17% on the deaths that occur at other times of the year. We have invested £30 million in total—£10 million to the Department of Energy and Climate Change and £20 million that local authorities can bid for—which will help to reduce those figures. It is encouraging that despite a very harsh winter last year the number of excess winter deaths has not risen.

Life Expectancy (Inequalities)

Debate between Nick Smith and Anne Milton

Thursday 3rd March 2011 Westminster Hall

[Anne Milton]

The right hon. Lady is right to raise that point. I was trying to stress that the healthiest areas will not necessarily be those that receive the most money. In theory, those areas that start from the lowest base should have the greatest opportunity to get those rewards.

Perhaps I can connect the right hon. Lady’s point with that made by the hon. Member for Hackney North and Stoke Newington. This debate is slightly premature because a consultation on the outcomes is currently under way, and we are also looking at the finances, at how much each local authority will have and at the size of the health premium. We are acutely aware—as I am sure are all Opposition Members—of the problem of unintended consequences.

Let us take an obvious example of A and E waiting times. It is right to want people not to wait in A and E for very long, and indeed they did not. If that is given as a target, the health service is good—as are most professionals—and it will fulfil that target. It will get people out of A and E. However, what was never measured was whether people got the care they needed. Did they get better or were they just transferred up to a ward sooner than they should have been? It is important to look at that. To some extent, this matter is a work in progress and we are keen to learn and listen to what people have to say. It is important not to have perverse incentives but to put in place the levers that we need to produce the right results in areas where there is possibly poor capacity, or areas that need building up or contain inequalities.

In some areas there are difficult cultural issues. To return to the issue of domestic violence, sometimes those working in the health service will collude with some of the men who perpetrate that violence. It gets very complicated and we need a system that takes account of all those issues.

[Nick Smith]

I commend the Minister’s emphasis on the directors of public health. The director of the Aneurin Bevan health board in south Wales is terrific and I will meet with her in a few weeks’ time. She has a good action plan together with her comparable officer in the local authority, and I hope that they will build a good partnership working together on public health. Will the Minister let us know how negotiations are going with the British Medical Association, and whether as part of the contract with GPs, public health will be given enough attention and emphasis?

[Anne Milton]

I will give a politician’s answer and say that we are currently having a constructive dialogue with the BMA. I cannot give the details of that and I am not personally involved. However, it is important to get that matter right, and I am sure that details will emerge. The Health and Social Care Bill is currently in Committee, and some of the details about how the mechanisms will work have been considered during that process. The negotiations are ongoing, and we will let hon. Members know.

--- Later in debate ---

[Anne Milton]

There is a question of whether the GP is listening and of whether the levers exist to make the GP listen.

This is a nebulous point to make, but I have to make it. Improving public health is about changing a mindset. We always underplay the importance of not only ministerial but parliamentary leadership on issues such as this. I am talking about a shift of focus on to public health, ensuring that the professions involved in health service delivery and the professions involved in the delivery of other services that affect people’s health receive a clear message that that is now a priority for the Government. When we talk to people who work on the ground, particularly at senior management levels, we see that that message is heard very clearly by them; it does filter down. Ministerial leadership is required, as is leadership from all of us on our individual patches.

[Nick Smith]

Does the Minister anticipate growth in the number of GPs in areas of multiple deprivation, which therefore have high levels of health inequalities? That has emerged from this afternoon’s debate as one of the big issues that need to be addressed. How easy will it be for practice-based commissioning to allow for growth in GP numbers in those areas, which are suffering the greatest health inequalities?

[Anne Milton]

As many people have pointed out—the Public Accounts Committee report focused on this—access to GPs is a major issue, and not just in urban areas such as Redcar but in rural and isolated communities. I will come on to that.

Subject to parliamentary approval, because the Health and Social Care Bill is in Committee at the moment, the NHS commissioning board and GP commissioning consortia will be duty bound to have regard to the need to reduce inequalities in access to and the outcomes from health care. That does not make it happen, but the duty is in the Bill and will be important. GP commissioning consortia will have to keep on improving the quality of their services, reducing geographical variations in standards. To increase the democratic legitimacy of health services, health and well-being boards will have elected councillors to represent the views of local communities.

To be truly successful, we need to be sure that the most vulnerable groups experience the most pronounced benefits. That is an obvious thing to say, but it is important. We are therefore driving ahead with the “Inclusion Health” programme, to focus on improving access and outcomes for the most vulnerable groups. Those are often the groups of people who are not registered with GPs or who are homeless. It is important that the really hard-to-reach groups get that additional focus, because they are not necessarily swept up by the other things that we are doing. We need to keep an eye on that.

I apologise if I am incorrect, but I believe that the life expectancy of the average Traveller is 59 years. The figures for the most excluded groups are truly shocking. Therefore, I fully welcome the Public Accounts Committee report and its recommendations. They were formally responded to in the “Treasury Minutes” dated 16 February. I know that many questions remain, but those minutes give a flavour of how we propose to embed the recommendations in the reformed health care system.

We need to ensure that the GP-patient relationship is as effective as possible. If we are not talking about a family who perhaps have contact with health care services only when they have a baby, the GP is the most important point of contact. On average, families with children under the age of two will visit their GP eight times a year. That is a massive opportunity to put additional emphasis on information and action to improve the health of families. We want to renegotiate the GP contract. The idea is to ensure that disadvantaged areas get the right level of access to GPs. The way to do that, as has always been the case, is to provide incentives to make it happen.

GPs need to improve the health of vulnerable people, not cherry-pick the easiest ones at the top of the pile. They need to encourage the uptake of good-practice preventive treatments. Changes to the quality and outcomes framework prevalence adjustment reward practices in a fairer way, particularly because deprived communities often have a higher prevalence of many of the QOF conditions.

I urge my hon. Friend the Member for South Norfolk to exercise some caution when talking about single-handed GP practices. His point was well made, in that practitioners who practise independently—single-handed—do not necessarily have the best outcomes, but in saying that, we should not exclude the very good single-handed practices. I saw one such practice recently. The GP there has recently been accredited for training and was serving his community absolutely brilliantly.

We have also proposed that at least 15% of the current value of the QOF should be devoted to evidence-based public health and primary prevention indicators from 2013. That answers a point raised by the right hon. Member for Barking. The funding for that element of the QOF will be within the public health England budget.

As the Public Accounts Committee report says, the most cost-effective interventions to improve life expectancy have been developed. Now we need to ensure that they are rolled out as far and as effectively as possible. The report of the review by Professor Marmot has helped us to understand the steps that we need to take, and we shall take them. The public health White Paper adopts the review’s framework of lifelong attention, which will mean a truly cradle-to-grave approach.

In thinking about public health, we must not forget that that is not just about physical health. It is also about people’s mental health and well-being. We need only consider some of the difficult issues that surround young people when they are growing up. We can consider the incidence of sexually transmitted diseases. In the last year for which there were figures, there was a rise of 3%. There has been good progress on unwanted pregnancies and abortions. There has been some progress on unintended conceptions among under-18s, but there are still 36,000. There are still 189,000 abortions every year, of which one third are repeat abortions. We can consider the figures for drinking and young people and the fact that 320,000 young people take up smoking every year. We have a lot to do with regard to young people’s health.

We can split health services into NHS services and public health. We can split public health further, into preventive work and curative work. What do we do when people have started to smoke or drink or have had sex when they should not have done? Then we can consider how to prevent that. There is no doubt that we need to do a great deal to ensure that young people have the skills, the self-confidence and the self-esteem that mean that they are equipped to make decisions about the difficult issues that they face.

Health

Debate between Nick Smith and Anne Milton

Tuesday 21st December 2010 Commons Chamber

[Anne Milton]

I thank the hon. Lady for that intervention. She is right to suggest that there can be an intention at Westminster, but the point is ensuring that it is effected on the ground. I will say a little more about that shortly.

We do not believe that a legislative approach is always the way to proceed when requiring health bodies and GPs to identify patients who are carers or have a carer and refer them to sources of help and support. Indeed, often it is not. We feel more comfortable with that as a weapon, but it does not necessarily produce the result that the hon. Lady wants.

It will be for PCTs and subsequently the GP consortiums to decide their priorities in the light of their local circumstances. However, we believe that GPs and their staff will play a vital role in identifying carers; many carers have not yet been identified. That is why we are investing £6 million from April 2011 in GP training, which will mean that more GPs and their practice teams gain a better understanding of carers and the support that they may need. That is important.

I believe that GPs are much better placed truly to understand the value and needs of carers. I do not need to tell the hon. Lady that the considerable social, human and, indeed, financial value that carers offer cannot be overestimated—she is aware of that. However, centrally driven methods are not always the best way forward. I welcome her continued feedback to ensure that we get the money spent where it is needed most.

Let me deal now with the speech made by my hon. Friend the Member for Colne Valley (Jason McCartney). I take the opportunity to pay tribute not only to midwives but to all the staff who will be working to deliver babies safely into the world, while we are enjoying our turkey or whatever we choose to eat on Christmas day.

The Government are committed to devolving power to local communities—to people, patients, GPs and councils—which are best placed to determine the nature of their local NHS services. I pay tribute to my hon. Friend for raising the matter previously and for continuing to raise his constituents’ concerns.

The Government have said that, in future, clinicians and patients must lead all service changes, which should not be driven from the top down. To that end, the Secretary of State has outlined new, strengthened criteria that he expects decisions on NHS changes to meet. They must focus on improving patient outcomes, consider patient choice, have support from GP commissioners and be based on sound clinical evidence. I think that that was what my hon. Friend was getting at.

The Department has asked local health services to consider how continuing schemes meet the new criteria. Some will be subject to further review. That does not necessarily extend to reopening previously concluded processes, as in Huddersfield—I would not like to lead my hon. Friend down an alley—or halting those that have passed the point of no return, with contracts signed and building work started. However, NHS Yorkshire and the Humber has advised that the decision to implement the looking to the future programme and change in maternity services in Huddersfield was clinically driven, with strong emphasis on patient safety and quality of care. It was also made after considerable scrutiny and consideration, including a formal period of public consultation and advice to the then Secretary of State for Health from the independent reconfiguration panel, whose recommendations were endorsed in full.However, I know that my hon. Friend will continue to gather local evidence and experience and feed it back, which I welcome.

Let us look at the problem described by the hon. Member for Blaenau Gwent (Nick Smith). I disagree with much of what he said. We have a bold public health strategy for the first time, and it has been widely welcomed. He should not believe everything he reads in the newspaper—it could lead him into all sorts of misapprehensions. The Government alone cannot improve public health; we need to use all the tools in the box.

The hon. Gentleman should note that health inequalities grew, rather than decreased, under the previous Government. There are massive opportunities to improve public physical, mental, emotional and spiritual health and well-being in England. As he rightly pointed out, we have some of the highest obesity rates of any country in the world. People living in the poorest areas die on average seven years earlier than people living in richer areas, and they have higher rates of mental illness, disability, harm from alcohol, drugs and smoking, and childhood emotional and behavioural problems. Changing people’s lifestyles and removing health inequalities could make double the improvement to life expectancy that we could make through health care, so we must address public health.

The Government published our strategy in our White Paper “Healthy lives, healthy people”. We will establish Public Health England, a national public health service, return public health leadership to local government, and strengthen professional leadership nationally by giving a more defined role to the chief medical officer, and locally through strong and inspirational leadership roles for directors of public health.

Historically, all the big public health improvements came via local authorities, and I am convinced that returning public health responsibilities to local authorities will achieve what we need, which is social and economic change as well as health change.

[Nick Smith]

rose—

[Anne Milton]

I am happy to give way.

[Mr Speaker]

Order. The Minister is of course welcome to take the hon. Gentleman’s intervention, but she still has a few contributions to respond to, and we need to make some progress.

[Nick Smith]

I welcome the proposal to ask local authorities to take responsibility for public health—in the round, that is a good thing—but will they get the resources to do that job?

[Anne Milton]

Thank you, Mr Speaker. I am afraid that I got rather carried away with this new-style debate, but I am mindful of the time.

For the first time, public health spending is ring-fenced. Public health interventions have been cut because of spending by PCTs, so it is really important to ring-fence such funding. The Government will focus on outcomes that are meaningful to people and communities. We published proposals for a public health outcomes framework yesterday for consultation, to which I am sure the hon. Gentleman would like to respond. I hope I have reassured him that the Government are taking the action necessary to improve the public’s health. I would be happy to discuss that with him in more detail another time, and perhaps to correct some of the myths that he believes. Nothing is ruled out. We will do everything we need to do to improve the public’s health, but we must use all the tools in the box. We cannot improve public health by Government intervention alone.

My hon. Friend the Member for Suffolk Coastal (Dr Coffey) raised the issue of integrated drug treatment systems for prisons that aim to increase the volume and quality of treatment available to prisoners. I welcome her involvement in her local prison. Such systems also aim to improve integration between clinical counselling, assessment, referral and through-care services, and to reinforce continuity of care when prisoners are released into the community.

The Government must reshape drug treatment to focus on recovery and to improve the continuity of treatment in the community following release. Abstinence is where we need to go. As outlined in the Ministry of Justice Green Paper on sentencing reform and rehabilitation, and in accordance with the much more outcome-focused approach announced in the new drug strategy, a payment-by-results approach to commissioning drug treatment for prisoners on release will be trialled in two areas. Recovery wings will be trialled in four prisons, with an emphasis on offenders receiving short custodial sentences, who therefore require a co-ordinated approach from prison and community. The combining of prison drug budgets with the combined drug interventions programme and a community-pooled treatment budget will allow for great flexibility, which is what we need in configuring services. To my mind, we have failed adequately to address drug abuse and prisoner addiction, and in turn failed our communities. We have not spent much-needed resources well.

I probably answered many of the points made by the hon. Member for Newcastle upon Tyne Central (Chi Onwurah) in my answer to the hon. Member for Blaenau Gwent on public health more generally. My husband’s family are all from Hartlepool. The hon. Lady was right to raise the issue of health inequalities. “Healthy lives, healthy people” underlines the priority that we are giving to tackling inequalities and supporting the principles of the Marmot review. We are focusing on the health and social needs of disadvantaged groups and areas, including on how money is allocated to local communities for public health interventions.

Despite the fact that the previous Government doubled health funding, as the hon. Lady rightly said, health inequalities got worse. I do not think that that was because of a lack of commitment on Labour’s part. It is extremely difficult to tackle health inequalities head-on, which is why our White Paper is so widely welcomed. The action outlined in that paper will reduce those truly shocking health inequalities.

It is important to recognise that this is not just about the money that is spent, but about how it is spent. I welcome the hon. Lady’s non-partisan comments about the previous Government’s record. For the first time, we are consulting on public health and ring-fencing money, and I believe that we can make a real difference.

The last Back-Bench contribution was from my hon. Friend the Member for South Swindon (Mr Buckland) on autism. I should like to take this opportunity to pay tribute to the parents and carers—young and old—who care for children and adults with autism. For some, that is a considerable burden that we should not underestimate. The National Institute for Health and Clinical Excellence is currently developing three autism clinical guidelines. The recognition, referral and diagnosis of autism guidelines are scheduled to be published in September next year; the diagnosis and management of autism in adults guidelines are scheduled to be published in July 2012—that might feel a long way off, but it is coming—and the management of autism in children and young people was referred to NICE by Ministers in November this year.

I pay tribute to my hon. Friend for his interest in autism, which has been discussed on many occasions in the House since I became a Member. There is no doubt that the expertise and input of people like him—people who have personal experience—is crucial in ensuring that we get the right policies that can have an effect on the ground, including in his constituency. His expertise and that of other hon. Members is critical.

Mr Speaker, I apologise for going beyond my allotted 10 minutes, but I wish you and all the staff of the House a very happy Christmas. I thank them for all their support this year and wish them well for the next.