Oral Answers to Questions

Paul Burstow Excerpts

Tuesday 27th March 2012 Commons Chamber

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

3. What assessment he has made of progress in tackling tuberculosis in England.

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

Provisional numbers of tuberculosis cases in England in 2011 increased by 556 compared with 2010, although the number of cases is lower than in 2009. This may indicate that TB is stabilising, but it is too early to draw firm conclusions. We expect local NHS organisations, in partnership with other agencies, to sustain their efforts to control TB. On 23 March, the National Institute for Health and Clinical Excellence published new guidance to help the NHS manage TB in hard-to-reach groups, including collaborative commissioning.

[Mr Sharma]

I thank the Minister for his answer. London has the highest rate of TB of any city in western Europe, with more than 3,000 cases a year. When faced with the same problem in Paris and New York, respective Governments committed to increasing resources and a clear model of care. Given the scale of the problem here, and the growing concern about drug-resistant TB, will the Secretary of State commit to implementing the London model of care for TB services that was developed by TB health professionals and advocacy groups to stop this ever-worsening problem?

[Paul Burstow]

I know that the hon. Gentleman takes a close interest in this matter. He is a member of the all-party group on tuberculosis, and I believe he is meeting the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton) to discuss these matters further. He is right that this is a big issue in London as well as a global issue. The Department is working closely with TB Alert, the tuberculosis charity, which is running a series of programmes to raise awareness. It is working with the NHS and the voluntary sector, particularly in communities with higher risk populations, and we are working with the Royal College of General Practitioners to develop an online resource to promote the better detection and treatment of TB in primary care. I hope that he can explore these issues further, but the Government take them very seriously and are working with other agencies to make progress.

[Tony Baldry (Banbury) (Con)]

It was 50 years ago that my dad moved on from being research secretary at the British Tuberculosis Association at Harefield because, in the 1950s, TB had ceased to be a killer in the UK. It is a tragedy that it has now come back, largely as a consequence of people with infectivity from overseas bringing TB into the country. What more can be done to enhance the screening of travellers from high-infection areas entering the UK so that those infected with TB can be identified and treated before they infect others in the population here?

[Paul Burstow]

My hon. Friend makes an important point about one aspect of the better control of TB and its spread. The Home Office has been running a pilot programme for some years. It continues to evaluate the effectiveness of that programme with a view to establishing whether it is more widely applicable. We know that this disease has moved from the general population to specific high-risk groups, which is why the targeted approach I mentioned in my initial answer is the key to controlling it.

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

The Minister has heard that TB is a particular problem in London—there was an 8% rise last year—and he will be aware that the current difficulties concern delays in detection and referral and the variability of commissioning and service provision. Given that the Health and Social Care Bill will necessarily lead to further fragmentation, separating health protection and public health from commissioning, how will he ensure that the Bill does not make a bad situation, in respect of TB in London, worse?

[Paul Burstow]

The Bill will not lead to fragmentation. It actually supports greater integration of health, social care and public health and, at a local level, it allows health and wellbeing boards to become the means by which to co-ordinate all the agencies that have a part to play when it comes to tackling TB, not least in ensuring that the advice of public health officials benefits not just the NHS but wider public services that also have a role to play in raising awareness of the disease and ensuring that it is properly tackled.

[Ian Lucas (Wrexham) (Lab)]

4. What discussions he has had with Ministers in the Welsh Government on the treatment by the NHS of patients with defective breast implants.

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[Dr Phillip Lee (Bracknell) (Con)]

6. What the average cost has been of a consultation at an NHS walk-in centre since 2008.

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

The average cost of an attendance at an NHS walk-in centre was £36 in 2008-09; £42 in 2009-10; and £39 in 2010-11.

[Dr Lee]

I thank the Minister for his detailed answer. Does he agree that in the future new commissioning groups, such as those that will serve my constituency in Bracknell, might choose not to fund walk-in centres—whether ones already established or those in the future—based on clinical justification terms? I, for one, remain to be convinced—indeed, I am far from convinced—of the long-term financial justification for, or clinical benefit of, walk-in centres.

[Paul Burstow]

There is not a nationally mandated programme of walk-in centres; rather, it will be for local commissioners to make decisions based on the evidence and their evaluation, and ensuring that they fulfil their contractual obligations.

[Mr Kevin Barron (Rother Valley) (Lab)]

Is it not the case that the walk-in centre that opened in Rotherham a few years ago has given communities that are higher on bad health indices access to health care 12 hours a day, seven days a week? Getting rid of it—it was opposed by some local doctors, because it threatened their business—would be a backwards step. Can we expect the new commissioning groups to start commissioning GPs in areas such as mine, which are higher on bad health indices and do not have enough general practitioners?

[Paul Burstow]

I am grateful to the right hon. Gentleman for his question, because he outlines the need to reduce health inequalities—something that the party of which he is a member failed to do in government. I can assure him that the Bill, which has now gone through all its parliamentary stages, will place a duty on clinical commissioning groups to seek to reduce health inequalities —something that his Government never did.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Is the Minister aware that when walk-in centres fail—or when any aspect of the national health service fails—it is because of poor management? Does he realise that good managers up and down the country are leaving the national health service? Doctors are not trained as managers. The Institute of Management has said that 43% of our managers are not up to the job, and we are not training our managers in the national health service because they are GPs.

[Paul Burstow]

This Government respect the contribution that NHS managers make, and we respect the contribution that the NHS Confederation makes as well. However, we also want to ensure that clinicians are at the heart of commissioning services. They are the people who understand patients most, and they are the people we are giving that responsibility to, because we think that is the way to drive improvement in the NHS.

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[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

10. What steps he is taking to ensure that people receiving care at home funded by the NHS are involved in making the arrangements for that care.

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

Our ambition is to enable shared decision making for all NHS patients. We expect people who are eligible for NHS continuing care funding to be fully involved in discussions about their care. Subject to the results of the current personal health budget pilots, everyone eligible for NHS continuing health care, including many people receiving care at home, will have the right to ask for a personal health budget, including a direct payment, from April 2014.

[Meg Munn]

I have received a letter from one of my constituents who has had direct payments for 15 years under social services. Following a stay in hospital, she was moved on to health funding, and her life has changed dramatically for the worse. She says that she no longer has any choice in who cares for her and finds it hard to find the right people with whom she feels comfortable. She concludes:

“I’m tired of being bullied. I’m just miserable.”

Will the Minister do something to bring forward the measures more quickly, so that people who have been directing their own care under social services can have the same quality of life and the same choices that they have become used to?

[Paul Burstow]

I absolutely agree with the hon. Lady’s constituent, and with the hon. Lady. We need to ensure that, as soon as possible, the benefits and the control that direct payments give to individuals in social care are available to people in regard to their long-term health care and particularly to continuing health care. It is realistic to say that we can roll this out nationwide by 2014, but I know that the hon. Lady is having discussions with the authorities in Sheffield, and I encourage her to carry on those conversations about the way in which people can use the current arrangements to access those facilities.

[Mr Stephen Dorrell (Charnwood) (Con)]

Does the constituency case raised by the hon. Member for Sheffield, Heeley (Meg Munn) not highlight the increasingly urgent need to achieve much more integration between health and social services, and indeed between different parts of the national health service, in order to provide joined-up care that focuses on patients’ needs and delivers better value for money to the taxpayer?

[Paul Burstow]

My right hon. Friend is absolutely right. I urge the hon. Lady to write to me about the matter so that I can respond in more detail, but let me say to my right hon. Friend that it is not just a question of delivering more integration within health care—which is often still too fragmented—or between health and social care; it is also a question of recognising that issues such as housing and leisure are critical to the delivery of greater well-being, and to an improvement in the health of the nation. The Health and Social Care Bill, which has now completed all its stages, gives people in every part of the system a clear duty to collaborate, integrate, and deliver better care for individuals.

[Dame Joan Ruddock (Lewisham, Deptford) (Lab)]

There are currently severe constraints on the availability of incontinence pads and on the bed linen laundry service, which is causing immense distress to the many poor families in my constituency. Will the Minister look into the problem? Will he recognise that it is simply impossible for people who are already in difficulties, and who are poor, to find the money for those extra things?

[Paul Burstow]

If the right hon. Lady sends me the details, I will look into the individual case. I agree with her that it is unacceptable for such products to be rationed. I think it essential to base their provision on an assessment of individuals’ needs, and for those individuals to receive what they need for a good quality of life.

[Ian Swales (Redcar) (LD)]

My constituent Joyce Benbow was discharged from Redcar hospital last November, but is still there owing to a failure to agree on her care package. When will the managers of health and social care budgets be more joined up so that people receive the right provision at the right time?

[Paul Burstow]

My hon. Friend has raised an important point about the importance of joining up hospital care, community care and social care, which has often been overlooked. We have invested more than £300 million this year in developing more re-ablement services, and in January we invested an extra £150 million in support for them. We are also extending our plans for more tariff reform to ensure that local hospitals have the means to drive the development of such services in their communities.

[Miss Anne McIntosh (Thirsk and Malton) (Con)]

11. What recent representations he has received on the 111 pilot telephone service; and if he will make a statement.

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

12. If he will introduce proposals to require a minimum ratio of nurses to patients in hospitals.

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

Guidance on staff ratios and the proportion of registered and unregistered staff can play a useful part in supporting local decisions about setting safe and sustainable staffing levels. Both the Royal College of Nursing and the NHS Institute for Innovation and Improvement have produced such guidance. We have no plans to impose centrally determined ratios, as in our view that would undermine professional judgment.

[Mr Cunningham]

Is the Minister aware that the RCN says that nurses are overstretched, with too much reliance on cheaper, unqualified assistance? What impact does he think that will have on care for the elderly?

[Paul Burstow]

First, let me say that we greatly welcome the survey the RCN published last week, and the work it has done for many years to highlight ratios such as the ratio of nurses to beds. The hon. Gentleman will be pleased to know that the ratio has improved under this Government. We are working with the RCN and others to identify the processes and paperwork within the NHS that occupy nurses’ time and take them away from the bedside, which is the priority.

[Mr Jamie Reed (Copeland) (Lab)]

When I last asked the Minister from the Dispatch Box about the loss of 3,500 nursing posts, he told the House that that was “factually incorrect”. He was right, and I apologise: the actual figure, published last week, is 4,096. In what will surely be one of the Secretary of State’s final outings in his current post, before he is reshuffled to where he can do no further harm, will he tell the House how many of those nursing posts would have been secured by the £500 million spending cut he agreed with the Treasury in last week’s Budget?

[Paul Burstow]

Well, if the question is as put, the answer is none.

[Fiona Bruce (Congleton) (Con)]

13. What steps he is taking to provide services for people diagnosed with Raynaud’s disease and scleroderma.

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

Routine commissioning is a local responsibility, which in future will be led by clinicians, who best understand patients’ needs. From April 2013, the NHS Commissioning Board will have a clear focus on commissioning services for people with rare, specialised conditions. The commissioning of those services directly through one national commissioner to a national standard should ensure better planning and co-ordination of services, which will be of benefit to patients. The scope of this commissioning, and the extent to which it will cover complex rheumatology services, is still being considered.

[Fiona Bruce]

I thank the Minister for that reply. I am very proud to have the headquarters of the Raynaud’s and Scleroderma Association based in my constituency. It was founded 30 years ago by a remarkable lady, Anne Mawdsley. It is still run from a terraced house in Alsager, and she has raised £12 million through undertaking some remarkable feats, including, I think, swimming with dolphins. Will the Minister commend her work and assure her that scleroderma patients will be able to access the best specialist centres for diagnosis and treatment?

[Paul Burstow]

I pay tribute to the work my hon. Friend does and to the work the Raynaud’s and Scleroderma Association has done over many years in raising funds, raising awareness and making sure there is a greater focus on these issues. I can assure my hon. Friend that the work we have done in establishing the NHS Commissioning Board will mean that in future, for the first time, there will be one organisation that will be able to look at issues involving specialised and complex needs that require a national focus.

[Greg Mulholland (Leeds North West) (LD)]

14. What recent progress he has made on the review of adult congenital cardiac services.

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[Nick Smith (Blaenau Gwent) (Lab)]

16. What recent assessment he has made of the performance of services for older people.

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

A number of inspections, reports, independent audits, and investigations have revealed long-standing and unacceptable variations in the standard of care that older people receive in the NHS, and in social care. The Government are determined to root out poor-quality care wherever it is found. We have established the national Nursing and Care Quality Forum to work with patients, carers and professionals to spread best practice.

[Nick Smith]

The British Geriatrics Society’s “Quest for Quality” report identified that too many people in care homes were without access to NHS services, including psychiatric, physiotherapy and continence services. What action are the Government taking to ensure that care home residents get the high-quality NHS care that they deserve?

[Paul Burstow]

In England, one of the things that we are doing is making sure that a programme of special inspections of care homes, conducted by the Care Quality Commission, looks at those issues to ensure that we provide the right range of support services for people in care homes. In addition, the National Institute for Health and Clinical Excellence has produced quality standards; in particular, it has been working on quality standards relating to issues affecting older people—incontinence, nutrition support for adults, patient experience, delirium, dementia, and many others. All that is critical to delivering really good-quality care in care homes.

[Margot James (Stourbridge) (Con)]

22. Russells Hall hospital, which serves my constituency, has reviewed recent reports, and done its own research, on dignity and care for older patients. It has elevated the qualities of care and compassion to the top of its criteria for recruiting health care assistants. Does my hon. Friend agree that the Nursing and Midwifery Council should apply similar learning to nurse training?

[Paul Burstow]

It is important that that is applied to all who have direct responsibility for delivering care, and hands-on care in particular. The work that Russells Hall hospital is doing on care and respect, and in its responsibility programme, is a good example of that. On issues such as dementia, we are clear that we need to ensure good advice, training and support for all nursing staff—we are working with the Royal College of Nursing on this—so that they treat people who have dementia with dignity.

[Liz Kendall (Leicester West) (Lab)]

The Government are rightly building on Labour’s national dementia strategy, and the Minister should know that the dementia crisis cannot be addressed without tackling the crisis in care. Yet his Government have cut more than £1 billion from local council budgets for older people’s care, services are being withdrawn and care charges for dementia sufferers are soaring. The Alzheimer’s Society and Age UK say that these cuts have pushed the system to breaking point. Does the Minister agree with them, yes or no?

[Paul Burstow]

The hon. Lady, of course, offers no solution, merely a problem. I say to her that this Government identified £7.2 billion of additional investment to go into social care over the life of this Parliament, and those resources are being used creatively by some local authorities to protect front-line services. I urge her to applaud the authorities that are doing that and join me in condemning those that are cutting services despite being given the resources.

[Caroline Dinenage (Gosport) (Con)]

17. What steps he is taking to raise the professional standards of health care workers and care assistants.

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

The Government have commissioned Skills for Health and Skills for Care to develop a code of conduct and minimum training standards for health care support workers and adult social care workers in England. That will inform the development of a system of assured voluntary registration for this group, which will be reviewed after it has been established for three years.

[Caroline Dinenage]

Have the Government made any assessment of the cost of rolling out mandatory regulations to health care support workers?

[Paul Burstow]

I will write to the hon. Lady with any specific details about the precise costs of rolling out such a register. I say to her that, for the first time, we have a Government who have decided that leaving unclarified the training requirements, standards and codes of conduct for health care assistants and care assistants is unacceptable. That is why we have commissioned this work. It will involve working with unions and other health care professionals to make sure we get those standards right, because we know that that is key to delivering dignified care.

[Jo Swinson (East Dunbartonshire) (LD)]

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

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[Simon Wright (Norwich South) (LD)]

T7. Many hospitals, including the Norfolk and Norwich university hospital, have reported a dramatic increase in alcohol-related admissions over the past 10 years, so I welcome the latest alcohol strategy. But what steps is the Secretary of State taking to support the expansion of treatment and early interventions for dependent and harmful drinkers in Norfolk and elsewhere?

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

I am grateful to my hon. Friend for his question, and he is absolutely right to identify the priority that this Government are now placing on dealing with the harm caused by alcohol, not least because of the 1.2 million alcohol-related hospital admissions. The strategy outlined by the Home Secretary last week is about education and raising awareness; enforcement; and treatment—making sure that the treatment services are more widely spread. It is also about recognising that this is a cross-government responsibility, not the responsibility of any one Department. That is why the proposals to use a national minimum unit pricing policy will tackle cheap booze and the binge culture.

[Grahame M. Morris (Easington) (Lab)]

T3. We now know that the Conservatives have received more than £8 million in donations from private health care companies since 2001. This goes beyond simply cash for access to a much more sinister issue of cash for policy influence. Ministers have said that they do not expect any increase in private sector provision in the NHS, but how will this be measured in years to come?

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[Chris Ruane (Vale of Clwyd) (Lab)]

T5. Mindfulness-based meditation techniques have been deemed by the National Institute for Health and Clinical Excellence to be more effective than drug-based therapy in the treatment of recurring depression in many circumstances. Will the Minister tell the House his views on mindfulness-based techniques and say what other conditions and diseases he thinks would benefit from such therapy?

[Paul Burstow]

The Government are committed to extending the range of NICE approved therapies when it comes to access to talking therapies. Certainly, we will look very carefully at how we extend it in the area he has suggested. I will write to him in further detail about this.

[Andrew George (St Ives) (LD)]

What reassurance can the Secretary of State give to Members of Parliament representing areas that have received an allocation from the formula which has been significantly below their target, given the change in arrangements to clinical commissioning groups in future?

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[Simon Danczuk (Rochdale) (Lab)]

On 24 February, my constituent, Audrey Kay, died after a litany of poor treatment. Will the Minister meet her son and me to hear Audrey’s treatment story?

[Paul Burstow]

Of course, I will be only too pleased to have that meeting.

[Chris Skidmore (Kingswood) (Con)]

Is the Minister aware of the publication today of the industrial action review by the London ambulance service, which details that on 30 November, the day of the public service strikes, in the afternoon and the evening, requests for front-line staff to return to front-line ambulances were made by the London ambulance service. However, of the three unions to strike, only Unison responded to say that it would not ask staff to return to work. Three hours later, after three repeated requests for help, a patient who had been unable to get an ambulance had died. The report has called—