Oral Answers to Questions

Paul Burstow Excerpts

Tuesday 7th June 2011 Commons Chamber

[Mr John Baron (Basildon and Billericay) (Con)]

3. What steps he is taking to enable GP consortia to commission integrated cancer services.

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

“Improving Outcomes: A Strategy for Cancer” set out our plans to support GP consortia to commission high-quality cancer services that deliver improved outcomes. The strategy confirmed the importance of cancer networks and we have recently confirmed that the NHS commissioning board will continue to support strengthened cancer networks.

[Mr Baron]

I thank the Minister and the Secretary of State for extending the guaranteed funding for cancer networks to 2013 and their commitment to support them thereafter, because the cancer networks’ expertise will be much valued by consortia. How will the authorisation process for GP consortia ensure effective commissioning of those cancer services that span consortia boundaries, such as radiotherapy?

[Paul Burstow]

What we are doing at the moment with the pause is making sure that we revise the proposals in ways that ensure that we deliver the outcomes set out in the White Paper last year. One of the things we said in the White Paper, and which the Bill currently provides for, is that GP commissioning consortia can collaborate where they need to commission for larger populations.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

On GP commissioning consortia, one of the concerns that the Minister will have heard during his pause is the public’s concern about the possible role of the private sector in GP commissioning. Although we all agree that the private sector has always had, and will always have, a role in the NHS, does the Southern Cross Healthcare disaster not show the dangers of leaving health and social care to the short-term decisions of private equity bosses?

[Paul Burstow]

rose—

[Mr Speaker]

Order. The Minister will want to focus on GP commissioning of integrated cancer services.

[Paul Burstow]

I am grateful for that advice, Mr Speaker. The hon. Lady’s remark was one that she might have made from the Back Benches when the Labour party was in power, but which it never listened to when in government. On GP commissioning consortia, we believe that it is important that consortia have access to the right expertise to be able to commission effectively both clinicians from other parts of the health economy and other expertise from the voluntary sector. That should be possible and we think that it is how we can improve commissioning in the NHS.

[David Tredinnick (Bosworth) (Con)]

Will commissioners be able to approach specialist integrated cancer services, such as the Penny Brohn cancer clinic in Bristol, and will that clinic and others be represented on health and wellbeing boards in future?

[Paul Burstow]

The membership of health and wellbeing boards will be a matter for the local authorities that will set them up. The Bill provides de minimis provisions for involving local councillors, representatives from commissioning consortia, public health directors, social services and children’s services, but I am sure that many of the pilots that are currently going on across the country are looking at innovative ways of involving others as well.

[Alex Cunningham (Stockton North) (Lab)]

4. What steps he is considering in relation to Southern Cross Healthcare; and if he will make a statement.

[Sheila Gilmore (Edinburgh East) (Lab)]

8. What steps he is considering in relation to Southern Cross Healthcare; and if he will make a statement.

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

Southern Cross has plans in place to restructure its business and is keeping the Government updated on progress. We will continue to keep in close touch with the situation and work with local authorities, the Care Quality Commission and others to ensure that there is an effective response which delivers to everyone the protection that we should want for all in those residential homes.

[Alex Cunningham]

I am grateful for that answer, but Southern Cross will not win any medals for managing its self-made crisis or for the anxiety caused to thousands of residents and their families, including 200 in five homes in my constituency. If organisations such as Southern Cross fail to get the investment that they need and end up going bust, will the Government guarantee those older people that decisive Government action will be taken to safeguard them in the places that they now call home?

[Paul Burstow]

Let me make it absolutely clear to the hon. Gentleman and to hon. Members on both sides of the House who have legitimate concerns about the welfare of residents in those homes: that is the Government’s paramount concern, and we will ensure that every step necessary is taken to safeguard those interests. The responsibility for providing care rests with local authorities, and that is why we as a Government have been working so closely with the Local Government Association and the Association of Directors of Adult Social Services to ensure that such arrangements are in place in the event of any need. The key thing at the moment, however, is to ensure that the company continues to restructure and continues to be in business.

[Nick Smith]

Uncertainty about Southern Cross is troubling for the 74 residents of the two homes in Blaenau Gwent, and I commend my local authority on contacting their relatives to explain that it is monitoring the situation. If Southern Cross cuts its running costs, what measures will the Government put in place to ensure that the standards of care are closely monitored? Will the Government investigate the financial management of the company, described by my constituent Mr Hooper, whose mam is a Southern Cross resident, as

“greedy chancers who gamble with crazy business plans”?

[Paul Burstow]

The Government continue to maintain very close contact with the devolved Administrations on those issues to ensure that we co-ordinate in that way, and the hon. Gentleman is right that we need to make sure that the standards of care provided in all those homes are maintained. That is a role that the CQC has been discharging and will continue to discharge.

[Sheila Gilmore]

Housing associations have regulatory control over financial management and viability in order to protect tenants’ homes. Will the Minister consider putting in place a similar regime to protect the homes of care home residents?

[Paul Burstow]

Within the current legal framework established in the Health and Social Care Act 2008, there are requirements on financial viability, but we will undoubtedly want to look at those issues when we come to publish a White Paper on social care reform later this year.

[John Pugh (Southport) (LD)]

Does the Minister agree that to avoid similar issues we need to build consensus throughout the House on the future of social care—and its financial governance?

[Paul Burstow]

I could simply say yes to my hon. Friend, but I agree entirely, and that is why last year we acted quickly to establish an independent commission, led by Andrew Dilnot, to undertake a review of how we fund social care. His report will be coming forward shortly, and I would certainly welcome all necessary discussions to ensure that we deliver effective reform.

[Margot James (Stourbridge) (Con)]

We have six homes in Dudley borough managed and owned by Southern Cross, and I am pleased to hear the Minister’s assurance that he will work with local authorities to ensure that no resident is left in need. Questions must be asked, however, about the conduct of the former directors of Southern Cross, and about how they acted in terms of the duty of care to their company and to residents. Will my hon. Friend consider investigating the conduct of those former directors should the company’s situation worsen?

[Paul Burstow]

Those matters would more appropriately be dealt with by colleagues in the Department for Business, Innovation and Skills, but those points are fairly made by my hon. Friend. As a Government, we continue to maintain close dialogue with the company, the landlords and all other interested parties to make clear to them their responsibilities to secure the ongoing care of the individuals in those homes.

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

I welcome the Minister’s response to the issue, which I acknowledge is the responsibility of local authorities, but they face many other difficulties, not only with nursing care but with residential care and the increased demand for it. What effective support will there be, other than additional words of support?

[Paul Burstow]

I am grateful to my hon. Friend for that question. Over many months, we have been in discussions with colleagues at the Local Government Association, and the Association of Directors of Adult Social Services recently produced new guidance on maintaining continuity and quality of care for individuals in homes that may be in difficulties. That is the appropriate way for us to proceed. We continue to work with them to ensure that all the necessary arrangements are in place. However, I remain focused, as all Members in this House should be, on ensuring that the company has the best possible opportunity to get itself on a stable footing so that it can continue to provide the care that people want.

[Ian Paisley (North Antrim) (DUP)]

The Minister will be aware that 25 care homes in Northern Ireland operate under the Southern Cross banner. What is he going to do to ensure that there is a consistent approach across the entirety of the United Kingdom? Will he have discussions with the Health Minister in Northern Ireland and other concerned parties to ensure that patients and residents in those homes are treated equitably and fairly?

[Paul Burstow]

The hon. Gentleman makes a fair point that relates to the earlier question where I indicated that we are in constant contact with the devolved Administrations and will continue to have that dialogue—if necessary, at ministerial level.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

Although we welcome the Government’s statement today that whatever the outcome of the restructuring of Southern Cross, they will not allow anyone to find themselves homeless, may I cast the Minister’s mind back to a week ago? Where was he? Why was he not visiting Southern Cross homes and speaking to residents, families and carers, as I was? Does he not now regret hiding in his bunker and allowing No. 10 to attempt to answer the questions that were put to the Government on behalf of these very vulnerable people?

[Paul Burstow]

I was about to say that I was grateful to the hon. Lady for the question, but clearly I am not. I have been following this as a Minister throughout, and I continue to follow it closely and to give the necessary instructions to officials to secure the future and the fate of the residents in these care homes. We have to be cautious and careful about the language we use on this particular endeavour. That is what I am doing, and I would urge the hon. Lady to do the same.

[Emily Thornberry]

The Minister can be assured that I am careful in the language that I use, and the words that I wish to use are these: does he agree that it is simply wrong that financiers and some of Southern Cross’s previous directors have creamed off millions of pounds while putting at risk the care of 31,000 elderly people who seem to have been used merely as commodities? Now that this has come to light, will the Government look urgently at whether regulation should be extended to ensure the financial stability of organisations that we entrust with the care of our most vulnerable?

[Paul Burstow]

That question has already been asked, and I have already indicated the approach that we intend to take with regard to the White Paper. I also point out that the establishment of the business model that Southern Cross operates of separating out provision from the ownership of the homes took place not under this Government’s watch but under her Government’s watch.

[Chris Heaton-Harris (Daventry) (Con)]

6. What assessment he has made of trends in outcomes for NHS patients since May 2010.

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[Mr Steve Brine (Winchester) (Con)]

14. Whether his Department has considered the merits of introducing a supplemental ultrasound breast screening examination as part of the NHS breast screening programme.

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

The answer is no. Mammography is the only screening modality that has been proven to reduce mortality from breast cancer, and is supported and promoted by the World Health Organisation’s international agency for research on cancer. Ultrasound screening may be used within the breast screening programme as part of the triple assessment process.

[Mr Brine]

The Minister will be aware that forms of cancer such as lobular breast cancer are far more difficult to detect with a mammogram than other types of breast cancer. Will he perhaps clarify exactly what guidance his Department issues to primary care trusts on the use of ultrasound screening as part of the triple assessment process? Sadly, in the case of my constituent Lindsay Jackson, mammography failed to detect that form of lobular breast cancer.

[Paul Burstow]

I am grateful to the hon. Gentleman for his question. The Department does not issue guidance, but the National Institute for Health and Clinical Excellence does. Its guidance on improving outcomes in breast cancer states that mammography and ultrasound imaging should be available in breast clinics as part of the triple assessment of women with suspected breast cancer. In addition, the guidance states that ultrasound is useful in predicting tumour size and in planning surgery, and that it can complement mammography in differentiating malignant and benign disease. That guidance is the key tool used in making such decisions.

[Gavin Barwell (Croydon Central) (Con)]

15. What recent progress he has made in establishing foundation trusts in London.

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[Nicky Morgan (Loughborough) (Con)]

17. What steps he is taking to improve mental health services.

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

Mental health is a cross-government priority. Earlier this year we published our mental health outcomes strategy document “No health without mental health”, to drive up standards in services and improve the nation’s mental health. But this cannot just be a problem for the Government, which is why we are working in partnership with the voluntary sector and the wider community.

[Nicky Morgan]

I thank the Minister for his reply, and I am pleased to hear about the emphasis on mental health. During the recess, I met members of the Charnwood health forum, including Leicestershire’s public health lead for mental health matters. He is concerned that there will be no place for him to advise or work with GP commissioning consortia. Can my hon. Friend reassure him that he will be able to advise GPs?

[Paul Burstow]

Yes, I believe that I can. Directors of public health will be the local leaders for public health in their communities. For example, local authorities and GP commissioning consortia will be required to undertake joint strategic needs assessments and produce joint health and well-being strategies for their areas, through health and well-being boards. The directors of public health will be directly engaged in that process and will therefore be able to influence the commissioning not only of health care services but of social care. They will be directly involved in the commissioning of public health locally.

[Tony Lloyd (Manchester Central) (Lab)]

The Minister will be aware of the proposal to close the Edale unit in central Manchester and open a different facility in north Manchester. Can he give the House, and the country, a guarantee that if that were to take place, financial consideration would be given to the total NHS economy and not simply to the mental health trusts, and that there would be clear benefits for mental health patients?

[Paul Burstow]

The key point that I take from the hon. Gentleman’s question is the importance of ensuring that there are clear benefits for those who rely on mental health services. Obviously, I cannot prejudge any decisions that are being made locally, because they may well come to a Minister for a decision in the future. I will, however, undertake to consider further the point that the hon. Gentleman has raised, and if necessary to write to him with more detail.

[Lilian Greenwood (Nottingham South) (Lab)]

18. What assessment he has made of the potential role of (a) competition and (b) co-operation and collaboration in the NHS.

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[Henry Smith (Crawley) (Con)]

19. What steps he is taking to improve mental health services.

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

May I refer the hon. Gentleman to the answer that I gave to the hon. Member for Loughborough (Nicky Morgan)?

[Henry Smith]

I am grateful for the Minister’s answer to that earlier question. Will he explain more fully exactly how services for those with eating disorders can be enhanced, particularly in the Sussex Partnership NHS Foundation Trust area?

[Paul Burstow]

Yes, the National Institute for Health and Clinical Excellence will update its guidance on eating disorders later this year. The plans already set out in the Health and Social Care Bill mean that eating disorders will be subject to specialised commissioning in future by the NHS Commissioning Board. We believe that, because of the consolidated expertise in matching needs, this will help to drive up standards and enhance quality and consistency across the country. In the hon. Gentleman’s own patch, the assessment service run by Sussex Partnership NHS Foundation Trust is certainly an impressive one.

[Karl MᶜCartney (Lincoln) (Con)]

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

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[Hazel Blears (Salford and Eccles) (Lab)]

T7. For the 200,000 people in the country with dementia who are currently in residential care, the recent horrific events at Winterbourne View and the financial problems at Southern Cross have caused huge anxiety. The Minister is now proposing to make local authority safeguarding boards mandatory, at a time of huge cuts in social care budgets. What extra resources will he make available to ensure that the system works and protects the most vulnerable people in our country?

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

I think that Members throughout the House share the right hon. Lady’s concern about the events that were revealed in more detail last week. We will deal with an urgent question on one of the other matters later this afternoon. She also asked about funding for social care. In last year’s spending review we not only secured additional resources enabling us to put safeguarding boards on a statutory basis, but ensured that by 2014 an additional £2 billion would go into social services. Much of that will come via the NHS to ensure much closer working between health and social care services, which is an essential prerequisite for the delivery of better outcomes for people with dementia.

[Harriett Baldwin (West Worcestershire) (Con)]

T4. One of my constituents, a vulnerable young adult with complex needs, was recently sectioned under the Mental Health Act 1983, taken from the family home, and placed in Winterbourne View. The mother was very concerned about her child’s care there, and contacted me. However, I was told by adult social services that I could not know the details of the case because of data protection. When reviewing the regulations involving vulnerable adults, will the Minister ensure that questions from Members of Parliament about such cases can be answered, so that they can stand up for even their most vulnerable constituents without their express written permission?

[Paul Burstow]

I am grateful to the hon. Lady for highlighting that issue. I think that Members in all parts of the House experience the same frustration from time to time when they feel that they are unable to discharge their responsibilities on behalf of constituents and obtain the information that they think they need in order to do that job. I will certainly undertake to examine the issue again. Patient confidentiality is complex and we must respect the confidentiality of individual patients, but we should not let that get in the way of ensuring that good-quality care is delivered.

[Mr John Spellar (Warley) (Lab)]

T8. When I asked the Minister about Southern Cross on 2 December, he replied:“The responsibility for providing or arranging publicly supported residential accommodation under section 21 of the National Assistance Act 1948 rests with councils with adult social services (CASSRs), not the Department. Any discussions regarding continuing provision for residents of care homes should take place between care providers and CASSRs.” —[Official Report, 2 December 2010; Vol. 519, c. 1014W.]Does the Minister now regret that complacent and wholly inadequate reply, which lost vital months in which the crisis could have been dealt with?

[Paul Burstow]

No, because it was an accurate statement of the legal position, which is what the question required.

Since these issues became a cause for concern many months ago, the Department of Health has been very much engaged with them at both official and ministerial level. We have also ensured that all parties—the local authorities, the Care Quality Commission and others—are clear about their responsibilities. I should have thought that that was what the hon. Gentleman would expect us to do, and it is what we have done. We are ready for any eventuality.

[Gavin Barwell (Croydon Central) (Con)]

T6. Croydon University hospital recently took on responsibility for community care, which will allow much better integration of acute and community services. What scope does my right hon. Friend think exists for wider application of that model in our NHS?

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[Nigel Mills (Amber Valley) (Con)]

T10. Does the Minister agree with my constituent Susan Garrity that licensed treatments for multiple sclerosis such as Sativex should be accessible to all people, wherever they live?

[Paul Burstow]

Certainly I agree that MS patients should have access to clinically effective and cost-effective treatments. The National Institute for Health and Clinical Excellence has not issued any guidance on the use of Sativex, and it is for primary care trusts to make funding decisions based on the available evidence and the individual patients’ circumstances. Following consultation, NICE expects to make a decision later in the year on whether to update its clinical guidance on MS, and whether to re-evaluate Sativex as part of that.

[Dame Anne Begg (Aberdeen South) (Lab)]

There are 12 Southern Cross homes in Aberdeen, nine of which are in my constituency. Just in the past month, one of them, Eastleigh in Peterculter, received a damning report from the Scottish care commission. Is it any wonder that relatives of the people in those homes are concerned that the company that runs them is in financial difficulty, and that the quality of the care provided may suffer as a result? Over the past few years I have also been approached by constituents about self-funders facing unfair cost increases in order that their home might be able to overcome its financial difficulties.

[Paul Burstow]

As I said earlier, the key concern of this Government—and, I think, of all Members—is to ensure the continuity and quality of the care of residents in Southern Cross homes. That has been the purpose of the Government, and of all the other agencies involved, throughout our engagement with Southern Cross. It is also important that the quality inspectorates in both Scotland and England continue to discharge their role of making sure that the essential standards of safety and quality are being maintained.

[Jo Swinson (East Dunbartonshire) (LD)]

As the public health White Paper recognises, building positive self-esteem is important for children’s health and well-being. Yesterday, the Bailey review highlighted many parents’ concerns that exposure to very sexualised imagery in our visual culture fuels children’s anxieties about their bodies and reduces self-esteem. How do the Government plan to tackle that as a growing public health issue?