Oral Answers to Questions

Debate between Norman Lamb and Lisa Nandy

Tuesday 24th February 2015 Commons Chamber

[Norman Lamb]

I thank my hon. Friend for that question and join her in paying tribute to the work of so many people: volunteers, loved ones and the professionals working in the community. The whole emphasis should be on ensuring that we respect people’s choice about where they want to be and that they get the best possible care. Later this week, the independent review of choice at the end of life will be published and I hope that it will inform discussions. I am completely with her in trying to ensure that we can achieve this.

[Lisa Nandy (Wigan) (Lab)]

One of my constituents recently went through a lengthy, distressing and difficult process to get NHS continuing care for his wife. If we remove the distinction between NHS and social care, many people across this country, including my constituent, will be spared this distress and difficulty at one of the hardest times in their lives. We know that funding should be put where it is needed and we know that that will be more cost-effective in the long run and will be better for patients, so why will the Minister not act?

[Norman Lamb]

Actually, we are all agreed on this. We all want free care at the end of life, but whoever is in power after the election in May will have to ensure that we understand fully the costs. There is a lot of evidence, and the evidence is growing. We are having very good discussions with groups involved in care at the end of life and we all want to achieve a solution. Of course, the truth is that very many people are receiving free care at the end of life, but they are in hospital, where they often do not want to be. I am completely with the hon. Lady in trying to achieve this.

Healthier Together Programme (Greater Manchester)

Debate between Norman Lamb and Lisa Nandy

Tuesday 22nd July 2014 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mrs Riordan. I congratulate the hon. Member for Blackley and Broughton (Graham Stringer) on securing the debate. The opportunity to debate important issues at the start of a process is welcome. I also thank my hon. Friend the Member for Bury North (Mr Nuttall) and the hon. Members for Wythenshawe and Sale East (Mike Kane), for Stalybridge and Hyde (Jonathan Reynolds), for Stretford and Urmston (Kate Green) and the shadow Minister—[Interruption.] I thank my hon. Friend the Member for Harrogate and Knaresborough (Andrew Jones) for ensuring that I also thank the hon. Member for Wigan (Lisa Nandy) for her important interventions.

The impression that I got from all hon. Members is that there is a recognition that things need to change and of the importance of developing an integrated system of out-of-hospital support and strong primary care. Some hon. Members also recognised the importance of specialisms in specific cases, but concerns centred on the nature of the consultation. The shadow Minister was extremely fair in describing the process’s objective as a good one and the hon. Member for Wythenshawe and Sale East said that the aim is right, so there is something of real value to achieve here if it is possible. I completely understand, however, why hon. Members feel the need to speak up for and express concerns on behalf of their communities.

[Lisa Nandy]

rose—

[Norman Lamb]

I will give way in a moment, but I was about to comment on the intervention of the hon. Lady, whom I rudely left out of my list earlier, in which she mentioned the lack of democratic legitimacy. The reforms have strengthened legitimacy. Until the reforms, there was no local democratic accountability for the NHS, but every area now has a health and wellbeing board. Interestingly, Lord Peter Smith, who I think is from the hon. Lady’s own community, said:

“We accept the case for change made in this consultation document…Remember it is not buildings that deliver good health care, it is the dedicated NHS staff who make it possible.”

To pick up on the point made by the hon. Member for Stalybridge and Hyde, Lord Smith, a local Labour leader, also talked about the move being towards greater integration:

“We are clear that this improvement in integration and in GP services needs to be up and running before the changes to the hospital services are introduced”—

clear support there for the objective.

[Lisa Nandy]

The Minister is right. Like the leader of my council, I accept the case for greater integration. I wanted to make one point, because the Minister seems to be suggesting that the concerns centre only on the consultation. I have a real concern, which I am not sure has been expressed clearly so far, about how the consultation sets up hospitals as either specialist or local.

My hospital specialises already, and it is rightly fighting to retain that because good outcomes are delivered. That does not mean that my hospital can, or should, do everything. Indeed, many of my constituents travel, for example, to the Christie for cancer care, as the hon. Member for Bury North (Mr Nuttall) said. There is, however, a real issue about some hospitals being specialist and some being local, but with nothing in between.

[Norman Lamb]

I take that concern on board, and the hon. Lady should respond to the consultation. It is really important for hon. Members to do that.

Incidentally, I should say something on behalf of my hon. Friend the Member for Cheadle (Mark Hunter), because he is a Whip and so is unable to speak in the debate, although he has attended it all. He has expressed particular concerns about the potential implications for the University Hospital of South Manchester and Stepping Hill, and about options 4.1 and 4.2. It is important that I place that on the record.

--- Later in debate ---

[Norman Lamb]

The hon. Lady has moved on, so let me make some progress.

It is important to recognise that we are discussing proposals that originated with local clinicians. Dr Chris Brookes, who is not a politician or a bureaucrat, who too often get condemned, but an accident and emergency consultant and a medical director of Healthier Together, says—

[Lisa Nandy]

Will the Minister give way?

[Norman Lamb]

May I make this point? I am sure that the hon. Lady will be interested to hear it. Dr Brookes said:

“Currently, there are too many variations in the quality of treatment, whether its emergency surgery or getting to see a GP when you need to. Not one of our hospitals in Greater Manchester meet all the national quality and safety standards.”

I am sure that all hon. Members present are concerned about that. He goes on to say something which, if we think about it, is shocking:

“At present your chance of being operated on by a consultant surgeon in an emergency at the weekend is much less than midweek. Your chance of recovering well from surgery carried out by a consultant is greatly improved.

But it’s not just about hospitals. It’s about access to a GP, and better community-based services—more services provided locally or at home and joining up the care provided by local authorities.”

That is a clinician making the case for integration.

Before I turn to the Healthier Together changes, it is probably best to make a few points about service changes in the NHS generally and Government policy towards them. The Government are clear that the design of health services, including front-line services and A and E, is a matter for the local NHS and, critically, the health and wellbeing boards, which have democratic accountability. Our reforms put doctors in charge of the care that people receive and how it is delivered to best serve their populations.

The NHS has a responsibility to ensure that people have access to the best and safest health care possible, which means that it must plan ahead and look at how best to secure safe and sustainable NHS health care provision—not only to meet today’s needs, but to plan ahead for next 10 or 20 years.

--- Later in debate ---

[Norman Lamb]

I really cannot. I have been pretty generous in giving way many times, so I will make a bit more progress.

It is therefore for NHS commissioners and providers to work together with local authorities, patients and the public in bringing forward proposals that will improve the quality and sustainability of local health care services. Government policy has been to emphasise local autonomy and flexibility in how NHS organisations plan and deliver service changes, subject to meeting legal requirements, staying within the spirit of Department of Health guidance and ensuring schemes can demonstrate robust evidence against four tests. Those are that there is support from GP commissioners; there is a focus on improving patient outcomes; that schemes consider patient choice; and that they are based on sound clinical evidence.

I recognise that change is often difficult to achieve because the consequences of not getting it right could be so profound—hon. Members have been absolutely right to raise their concerns. It is therefore right that the NHS does not rush into change without fully understanding all the potential consequences, sometimes including unintended consequences. Change can be difficult to explain to patients who have had quite reasonable anxieties exacerbated by speculation—in many cases, in the media—about whether this or that service might close. Services are sometimes described as closing when in fact they are simply being provided in a neighbouring facility or changing for the better in response to advances in treatment.

For example, my hon. Friend the Member for Macclesfield (David Rutley) referred to the possibility of hospitals closing, but I am not aware of any proposal to close hospitals. When we communicate to patients and the public, it is important that we are clear on what this issue is and is not about, so as not to raise anxieties. From my perspective, we have to be careful to avoid ramping up anxieties inappropriately by playing on fears. We see that too often; unfortunately, it stifles genuine debate and discussion about what health services will need to change in order to do better in future. But I applaud all hon. Members for speaking in this debate very reasonably and about legitimate concerns.

The right hon. Member for Leigh (Andy Burnham) has agreed that the NHS needs to have the freedom to change the way services are provided. He said:

“If local hospitals are to grow into integrated providers of whole-person care, then it will make sense to continue to separate general care from specialist care”—

the point made by the hon. Member for Wigan a moment ago—

“and continue to centralise the latter. So hospitals will need to change and we shouldn’t fear that.”

Perhaps the hon. Lady will take the point better from her party’s health spokesperson than from a Minister, but the right hon. Member for Leigh was making the case for the specialisation of services.

[Lisa Nandy]

I thank the Minister for being so generous in giving way. He seems to be setting up straw men that he then batters down. As far as I can work out, there is no disagreement from me or any Member on either the Government or Opposition Benches about the need for specialisation, integrated health care and locally delivered services. That is not what we are talking about. We are talking about a process that lacks democracy, that has been top down and centrally driven and that the public have lost confidence in.

[Norman Lamb]

To be fair, when I indicated earlier that the issue is about process, the hon. Lady came back at me—as is her right—to say that it is not just about process but about the model of separating specialisms from general hospitals. I therefore quoted what the shadow Secretary of State for Health had said in that regard.

I turn to the specific case raised by the hon. Member for Blackley and Broughton in this debate. Healthier Together was launched by the NHS in Manchester in February 2012 and is part of the Greater Manchester programme for health and social care reform, which seeks to improve outcomes for all Greater Manchester residents. The scheme is substantial, involving 12 CCGs and 12 hospital sites across Greater Manchester. As the consultation sets out, the case for change aims to improve access to integrated care and primary care, community-based care and in-hospital care services, including urgent and emergency care, acute medicine, general surgery and children’s and women’s services.

The House should appreciate that although those are the services being looked at, there are interdependencies with the core in-hospital services, including anaesthetics, critical care, neonatal services and clinical support such as diagnostic services. Changes in one area might have consequential effects elsewhere, as hon. Members have pointed out, and those effects have to be fully understood.

I should also repeat that the proposed changes are not a top-down restructuring. They are led by local clinicians who know the needs of their patients better than anyone. They believe that the clinical case for change—

Accident and Emergency

Debate between Norman Lamb and Lisa Nandy

Wednesday 18th December 2013 Commons Chamber

[Lisa Nandy (Wigan) (Lab)]

My A and E in Wigan is, like so many others across the country, under significant pressure at present. Earlier this year we saw an unprecedented rise in A and E attendances. That is a result of a series of problems, including the difficulty in getting GP appointments, as outlined eloquently by my right hon. Friend the Member for Leigh (Andy Burnham), but I think the single most significant cause is the cuts that have been made over the past three and a half years to social care. Does the Minister have any idea what those cuts and the unfair distribution of them—my constituency of Wigan has been cut three times more than Windsor— have meant to people in their lives?

I want to say something about the situation of older people. I have been shocked over the past couple of years by what is happening to older people because of the deep and front-loaded cuts to social care, which have left councils with no option but to cut services. Over the last two years we have seen an unprecedented rise in the number of over-90-year-olds coming into my local A and E and others across the country by ambulance.

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

The hon. Lady talks about the situation in social care and of course I understand that there is real pressure, but will she welcome the fact that in 2012-13 there were 37,473 fewer days lost in delayed discharge due to social care, so in other words social services are doing better now than they were in previous years?

[Lisa Nandy]

In the very short amount of time that I have got I will simply echo the words of my hon. Friend the Member for Stretford and Urmston (Kate Green) who said to the Secretary of State that she thought people would be staggered by the complacency of Members on the Government Benches and would not recognise the picture they paint, which stands in stark contrast to the lived experiences of my constituents, some of whom are old and vulnerable and deserve so much better than this. Behind the increase in the number of admittances to hospital lies a picture of older people who are living alone at home, worried, lonely and ill.

The Minister’s Government have not caused all of this, but, like my right hon. Friend the Member for Leigh, I have talked about my concern about what has happened in social care and the rise of zero-hours contracts and choosing the lowest bidder over recent years, so, by God, I must also say this: his Government have made the situation so much worse. By the end of next year the budget of my council in Wigan will have been cut by £66 million, and we were told this summer that another 10% is still to come. We have done everything. We have pared that organisation to the bone. The truth is there are no more efficiencies to be had; there are only cuts.

I say this to the Minister as well: this is not just about councils, because what this Government have done, and the Darwinian approach they have taken to the voluntary sector, has severely undermined the capacity of charities to respond to this crisis at the very time when they are needed most. This is the true meaning of the big society.

We are seriously disrupted in Wigan—

[Norman Lamb]

rose—

Oral Answers to Questions

Debate between Norman Lamb and Lisa Nandy

Tuesday 27th November 2012 Commons Chamber

[Norman Lamb]

I acknowledge the hon. Gentleman’s work on promoting the case for psychological therapies, including mindfulness, and would be happy to meet him and a delegation of experts. The Government have massively increased psychological therapies—nearly 1 million people in the past two years accessed psychological therapies through the improving access to psychological therapies programme. We are totally committed to improving access to psychological therapies to cure the imbalance in access to services for people with mental health problems that has existed for a very long time.

[Lisa Nandy (Wigan) (Lab)]

16. What assessment he has made of the possible effect on patient safety of reductions to ambulance trust budgets.