Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 13th January 2015 Commons Chamber

[Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab)]

7. With reference to his Department’s publication “Transforming care: A national response to Winterbourne View Hospital”, published in December 2012, if he will take steps to ensure that the statutory guidance implementing the adult autism strategy uses clear language and is mandatory.

[The Minister of State, Department of Health (Norman Lamb)]

The revised autism statutory guidance will be written in clear and accessible language. It will include existing obligations from the 2010 strategy and recent legislation such as the Care Act 2014. Local authorities and NHS bodies are required to take the guidance into account, or provide a good reason for not doing so.

[Mr Clarke]

The Minister will be aware that, under the Mental Health Act 1983, people with autism can be compulsorily detained for assessment and treatment although there is no evidence of mental illness. Will he join the National Autistic Society and others in endorsing the Justice for LB Bill campaign and seeking to end that wholly unacceptable practice?

[Norman Lamb]

The right hon. Gentleman has raised an incredibly important point. I, too, pay tribute to the campaigning of Justice for LB. We are strengthening the guidance relating to the code of practice under the Mental Health Act, and that strengthened guidance will be published shortly. We are considering whether amendments to the Act are needed, and we are also drafting a Green Paper. I should be happy to discuss the issue further with the right hon. Gentleman, and to have further meetings with campaigners.

[Mr Speaker]

The hon. Gentleman’s question is quite a long way from the statutory guidance, but it can be given a brief reply.

[Norman Lamb]

I have to say that I was not aware of the information provided by the hon. Gentleman. I should be happy for him to send me more information, but I make the general point that it is always important for us to base our decisions and expenditure on evidence.

[Mr Gregory Campbell (East Londonderry) (DUP)]

Would the Minister be prepared to discuss with his counterparts in the devolved regions the need to ensure that clear language is considered essential, and that best practice is replicated throughout the United Kingdom?

[Norman Lamb]

I am happy to make sure that we liaise properly with the devolved Administrations and it is important for officials on both sides to ensure that the language is as clear as possible across the United Kingdom.

[Mrs Linda Riordan (Halifax) (Lab/Co-op)]

8. What the clinical reasons are for plans to close Calderdale Royal hospital A and E department.

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[Robert Jenrick (Newark) (Con)]

11. What proportion of 111 calls resulted in an ambulance being called in the most recent period for which figures are available.

[The Minister of State, Department of Health (Norman Lamb)]

There were just short of 882,000 calls triaged by the NHS 111 service in England in November 2014, and 99,808 of the calls—11.3%—had an ambulance dispatched.

[Robert Jenrick]

I thank the Minister for that response, and I am grateful for the earlier response to my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes), which is very reassuring. Any Member who has spent time with paramedics, as I have in Newark, knows that this is a hot topic for them. So we would appreciate any extra reassurance the Minister can give that the algorithms that lie behind the 111 service, and the level of clinical involvement in it, can be improved, with experience, to create a sensible number of cases going to accident and emergency.

[Norman Lamb]

I pay enormous tribute to the paramedics, who are working under a lot of pressure. The survey results, which showed that about 27% of people who have used 111 say that they would have gone to A and E had it not been available, are a considerable reassurance. However, we need constantly to seek to improve the service, and the urgent and emergency care review pointed to refining the 111 service so that, ultimately, people could get access through to a GP, doctor or nurse, to ensure that they receive the right guidance at the right time.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

The Public Accounts Committee examined this service in Devon and Cornwall and discovered, as it has in other inquiries, a lot of issues associated with cost shunting, because it does not cost 111 when it tells someone they need to go to hospital in an ambulance. So there have been “impressive figures” on the number of people who did not go to A and E as a result of their call, but is the Department monitoring the number of people who are sent to A and E by 111 but should not have been?

[Norman Lamb]

As I said in response to the previous question, there is a real case for constantly seeking to refine the way the service works. The urgent and emergency care review pointed to ways in which we could do that to ensure that, in appropriate cases, people could get through to a doctor or a nurse to give them the right advice. That, in turn, would reduce the number of people turning up at A and E.

[Andrew George (St Ives) (LD)]

Further to the previous question, will the Minister urgently review the operation of NHS 111, as not only did it experience meltdown over the Christmas period in my area, but it is run from a call centre in Newport, 200 miles away, and it uses algorithms that involved staff asking a patient in my constituency, “Are you conscious?”?

[Norman Lamb]

Call volumes doubled over the Christmas period compared with those a year ago, so the system was certainly under enormous pressure. As I say, the survey results show that a lot of people were diverted away from A and E, but there is absolutely a case for seeking to improve 111.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The Secretary of State earlier complacently claimed that England has the best A and E service in the United Kingdom, but last week 86 hospital trusts in England operated below the Wales average. Suzanne Mason, professor of emergency medicine at the university of Sheffield, said that ambulance services in some parts of the country have been “brought to their knees” by 111. Does the Minister now think it was a mistake to scrap the nurse-led NHS Direct service? Will he urgently implement Labour’s proposal to get more nurses answering 111 calls, to relieve pressure on our chronically overstretched A and E departments?

[Norman Lamb]

I understand that about 22% of callers do get to speak to a clinician and, as I have already said, we are seeking to develop the service so that there are more referrals to an appropriate clinician. Let me again repeat the fact that the performances of A and E, ambulances and people waiting for hospital are considerably better in England than they are in Wales, and the Opposition need to recognise that.

[Derek Twigg (Halton) (Lab)]

12. What recent assessment he has made of the reasons for increased attendances at A and E departments in 2014.

[The Minister of State, Department of Health (Norman Lamb)]

A range of factors is contributing to increased attendances. The ageing population means that, by the end of this Parliament, there will be nearly 1 million more over-65s than at the start. The urgent and emergency care review cited pressure on GP appointments and availability or awareness of alternatives as factors that might affect A and E attendances.

[Derek Twigg]

NHS Providers, which represents 94% of NHS foundation trusts, says that national tariff proposals that have forced hospital trusts to find efficiencies of 3.8% are excessive and, taken with other cost pressures, undeliverable. It will take £1.2 billion out of budgets from front-line NHS services. Do the Secretary of State and his Ministers understand the implications of that proposal, and will they act to stop it given the pressures on the NHS, especially on A and E departments?

[Norman Lamb]

The Nicholson challenge, which was published in the last year of the Labour Government, recognised that the whole system had to deliver efficiency savings, and I think that everyone understands that. But the answer to all of this is a significant shift of emphasis towards preventing ill health and preventing crises from occurring. Under the better care fund the NHS and the care system are for the first time being properly joined together.

[Mr Philip Hollobone (Kettering) (Con)]

The Northamptonshire clinical commissioning groups and Kettering general hospital are agreed that Kettering’s A and E department is too small and outdated and needs to be replaced with an urgent care hub in line with the NHS five-year forward view. Given that the three local MPs on a cross-party basis refused to treat our local A and E as a political football, will the Minister of State encourage his colleague, the hospitals Minister, to consider that proposal seriously when we come to see him this afternoon?

[Norman Lamb]

I understand that a meeting will take place very soon, and I certainly encourage my hon. Friend the hospitals Minister to ensure that he listens to the case being put by the hon. Gentleman and his colleagues this afternoon.

[Liz Kendall (Leicester West) (Lab)]

Ministers have been repeatedly warned about the impact that their social care cuts are having on elderly people and that that is a key cause of pressures on A and E. Today it has been revealed that public health officials have issued an alert about a statistically significant and “sustained” decline in life expectancy in parts of the north-west. They say it is extremely unusual and that

“central government driven reductions in adult social care budgets”

are a possible cause. Will the Minister confirm that alert, say whether life expectancy is declining elsewhere, guarantee that Public Health England will urgently investigate the matter and promise that its findings will be published in full?

[Norman Lamb]

Although there was a fall in life expectancy for those aged 85 in 2012, preliminary analysis shows that there was no further drop in 2013. Incidentally, let me pay tribute to the people who work in social care. The system has performed remarkably well. Statistics on delayed discharges due to social care show that the number of delayed days is almost exactly the same this year as it was in 2010—a remarkable performance.

[Heidi Alexander (Lewisham East) (Lab)]

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

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[Mr Jim Cunningham (Coventry South) (Lab)]

T7. Government-inflicted cuts on local government funding and subsequent reductions in adult social care services have increased the pressures of bed-blocking at University hospital Coventry, with a number of patients unable to be discharged as they wait for a nursing home place or a package of care in their own home. Does the Minister agree that this is a problem, and what steps has his Department taken to remedy it? Will he not do the Pontius Pilate act but take responsibility for his actions?

[The Minister of State, Department of Health (Norman Lamb)]

The hon. Gentleman is absolutely right that what happens in social care has an impact on the health service, and the answer has to be to stop seeing them as two separate systems and to look at the whole health and care system. That is why the better care fund is such an incredibly important initiative, pooling a substantial sum of health and care funds, and it must go further so that we end up pooling the entire resource.

[Sir Bob Russell (Colchester) (LD)]

T6. The last Government abolished community health councils, a truly independent health watchdog and voice for patients. Their replacement, the patient advice and liaison service, is not independent. Does the Minister agree that PALS must be made independent?

[Norman Lamb]

PALS was not the direct replacement of community health councils; a different scheme was set up for the patient and public voice independent of hospitals. My hon. Friend raises important concerns about PALS and the Government are intent on looking at the service to ensure that it performs effectively for patients.

[Angela Smith (Penistone and Stocksbridge) (Lab)]

T8. My constituent Mr Offord waited 22 minutes after a 999 call for a double-crewed ambulance, and his death was referred by the South Yorkshire coroner to Ministers because of a concern that he might have survived if he had received medical help sooner. The Yorkshire ambulance service has just settled the case brought by Mr Offord’s family out of court. When will the Secretary of State recognise the growing crisis in ambulance services and support my right hon. Friend the shadow Secretary of State’s call for an investigation?