Bowel Cancer Screening

Paul Burstow Excerpts

Wednesday 23rd November 2011 Commons Chamber

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

I congratulate my hon. Friend the Member for Hexham (Guy Opperman) on securing the debate and on setting out the issues so clearly. Let me just confirm the answer that he gave to his hon. Friend the Member for West Worcestershire (Harriett Baldwin)—it is the case that the NICE guidance has been changed in the way that he said. I hope that helps her. I look forward to reading the Hansard report of his description of his tie and the removal of certain items that would have made a noise in the debate had he pressed the button.

My hon. Friend the Member for Hexham has used this opportunity very well to raise awareness of these issues further. There has been good progress in bowel cancer survival over the past 30 years, with the survival rates for men and women doubling, but it remains a devastating disease. In 2009, some 32,751 people were diagnosed with the cancer and 12,691 people died from it. In the vast majority of cases, the earlier a cancer is diagnosed, the sooner the treatment can begin and the better the outcomes are likely to be. That is why early diagnosis of cancer is central to the Government’s cancer outcome strategy and that is why it is vital that we do more to diagnose cancers earlier and improve survival rates as a result.

We are focusing on survival rates because they are a much more effective way of addressing and assessing NHS performance, as they show how good the NHS is, compared with other countries, at diagnosing and treating people with cancer. Measures such as cancer mortality figures are not a good way of assessing the NHS’s performance as they are an indicator of both incidence and survival. They indicate more about societal changes than about what the NHS has done.

Screening is one of the most important means by which cancer—and in the case of bowel cancer, of abnormalities that may lead to cancer—can be detected earlier. Research undertaken in Nottingham and Denmark in the 1980s showed that screening men and women aged 45 to 74 for bowel cancer using the faecal occult blood test could reduce the mortality rate from bowel cancer by 16%. An independently evaluated pilot in Warwickshire and Scotland showed that this research could be replicated in an NHS setting. Based on the final evaluation report of the pilot and a formal options appraisal, the programme in England began screening men and women aged 60 to 69 in July 2006, and I am pleased to say that full roll-out was achieved last August.

Experts have estimated that by 2025, about 2,400 lives could be saved every year by the current NHS bowel cancer screening programme. However, I agree with my hon. Friend that there may be more we could do through occupational health interventions. As at 31 October this year, more than 12.2 million kits had been sent out and more than 6.9 million had been returned. We have to do more to get more returns, but from those returns 10,785 cancers were detected and 53,616 patients underwent polyp removal. As my hon. Friend said, polyps that are left untreated can develop into bowel cancer. Men and women over the age limit can request a testing kit every two years, and more than 145,000 have self-referred to the screening programme in just that way.

As some 15% of bowel cancers—4,893 in 2009—are diagnosed in men and women aged 70 to 74, the NHS bowel cancer screening programme is currently being extended to men and women aged from 70 up to their 75th birthday. As at the end of October this year, 33 of the 58 local screening centres had implemented the extension of that programme. When the extension is fully rolled out by next year, about 1 million more men and women will be screened each year.

We know that the evidence for faecal occult blood test screening starts at 50, as shown by the trials that have been mentioned. The original programme invited only people in their 60s because the risk of bowel cancer increases with age. Nearly 85% of bowel cancers arise in people over the age of 60. In the pilot, more than three times more cancers were detected in people aged over 60 than in those under 60, and people in their 60s were most likely to complete the testing kit. In addition, there was not enough endoscopy resource to begin the wider age roll-out. To underline a point that my hon. Friend made, in terms of cost, the 2004 working group report on NHS cancer screening programmes, which assessed a number of models for bowel cancer screening, found that starting at age 50 ranked fifth—bottom—in terms of cost-effectiveness.

The national endoscopy training programme has allowed us to begin extending the programme to people up to age 75. However, this extension to the current programme, the planned introduction of flexible sigmoidoscopy screening, which I will come back to in a moment, and the move to more investigations of symptomatic patients mean that a key priority is to increase endoscopy activity. We have begun from a low level, as my hon. Friend suggested, with much lower rates of endoscopy than many other comparable countries. For example, colonoscopy rates in England are eight per 1,000 population, compared with Scotland, where they are 12 per 1,000 population, and Australia, where the rate is 21 per 1,000.

The Department has undertaken further modelling work to estimate the demand for endoscopy services up to 2015-16. That analysis shows that the NHS will need to increase lower GI endoscopic capacity by 15% a year over the next five years to meet underlying growth and the commitments set out in the Government’s cancer outcomes strategy. In response to my hon. Friend’s question, that is how the issue about the work force and making sure that there is a sufficient supply of nurse endoscopists is being addressed.

Funding for an increased number of endoscopies has been put into primary care trust baselines, and that is part of the £750 million over four years that accompanies the cancer outcomes strategy. While it is primarily for the NHS to take the necessary steps to increase endoscopy activity, we are looking at the scope for central support, for example, through service improvement work led by NHS Improvement. However, we are making a huge investment in our bowel screening programme for people in their 50s, in response to my hon. Friend’s fifth question about funding. In September 2010, we announced £60 million of funding for the introduction of a life-saving new screening method—flexible sigmoidoscopy—in the programme.

Flexible sigmoidoscopy is an alternative, and a complementary bowel screening methodology to faecal occult blood. New evidence shows that men and women aged 55 attending a one-off flexible sig screening test for bowel cancer can reduce the risk of mortality from the disease by 43%, and it can reduce the incidence of bowel cancer by 33%. Flexi sig involves a thin, bendy tube, which the doctor uses to look at the inside wall of the bowel and remove any growths—polyps—that are present. Bowel cancer usually develops very slowly from polyps, which are called adenomas. By removing them at an early stage, it is possible to prevent bowel cancer from developing.

My hon. Friend referred to the randomised controlled trials conducted by Cancer Research UK, the Medical Research Council and NHS R&D in 14 UK and six Italian centres. The study concluded that flexi sig is a safe and practical test and, when offered only once between the ages 55 and 64, it confers a substantial and long-lasting benefit. Based on the trial figures, experts estimate that we could prevent as many as 3,000 cancers every year and save thousands of lives.

In 2011, pathfinder sites tested organisational arrangements for the operation of flexi sig screening, with particular attention to the invitation and appointment process. That will enable optimal strategies to be applied in the national pilots. The pathfinder sites were in the Tees, south of Tyne and Wear, and Derbyshire local screening centres. We have formal agreements in place to develop the IT system for flexi sig—I hope that that answers my hon. Friend’s first question—and local screening centres will be invited to bid to become pilot sites early in 2012.

In response to my hon. Friend’s third and fourth questions, the bowel cancer screening advisory committee has advised that people should be invited at age 55, with two reminders, before they become eligible for the faecal occult blood test programme at 60. People from the original trial are being followed up to gain information about the most appropriate faecal occult blood test policy for people who have undergone flexi sig screening. We do not have the answer yet, but we are working to make sure that we do have a clear answer to assist physicians.

The coalition Government’s cancer strategy set out our aim to achieve 30% coverage of flexi sig screening across England by 2013-14, and 60% by 2014-15. It is envisaged that full roll-out will be achieved by 2016. We are also looking at other ways in which we can improve bowel cancer screening. Our cancer outcomes strategy sets out how NHS cancer screening programmes will look at how more accurate and easier-to-use immunochemical faecal occult blood tests—those are words that one can struggle with, and I hope Hansard will be kind to me—can be introduced into the programme, potentially to increase uptake and to provide more accurate results. A protocol has been devised to pilot such testing within the programme to assess the feasibility, practicality and cost-effectiveness of moving to this new technology.

To date our awareness activity has focused on bowel cancer, lung cancer and breast cancer, and we have spent nearly £11 million supporting 59 cancer awareness campaigns and trialling a national bowel cancer campaign. That campaign is about making sure that people do not die of embarrassment when it comes to bowel cancer, and that, if they think there is blood in their poo or if they have loose stools, they will go and see their GP and get a referral for a diagnosis. It is also about Ministers, as much as anyone else, overcoming their embarrassment about talking about it. The more we are prepared to start talking about these embarrassing subjects, the less people will die of embarrassment as a result.

We know that the pilot, the Be Clear on Cancer campaign, which we launched in January this year and ran for seven weeks in the east of England and in the south-west, made a real difference in the number of people being referred into the programme. The evaluation of the Be Clear on Cancer campaign to date has shown that people have become much more aware of the signs and symptoms of bowel cancer, people have been very supportive of such campaigns by the Government, and there has been an increase of about 50% in people over 50 with the relevant symptoms going to see their GP. This increase will lead to people being saved.

I hope this debate has reassured people that the Government take bowel cancer screening as a serious priority. We are determined to save more lives in future and I congratulate my hon. Friend on securing this important debate.

Question put and agreed to.

Oral Answers to Questions

Paul Burstow Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Natascha Engel (North East Derbyshire) (Lab)]

8. What arrangements he has put in place to involve dental practitioners in the commissioning of dental services.

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

Responsibility for the commissioning of all dental services across primary, salaried and secondary care will sit with the NHS Commissioning Board. The vision for commissioning dental services sees dental local professional networks developing and delivering local service plans and quality improvement strategies across all dental services and providing clinical leadership and expertise at local level. This will enable dentists, working with commissioners and other local stakeholders, to ensure that all dental services are integrated and work together in the most efficient way.

[Natascha Engel]

I thank the Minister for that answer, but I still do not see why GPs are good enough to commission services locally, but dentists are not. Can he explain exactly how dentists are to be involved, in the same way as GPs are, in commissioning services locally?

[Paul Burstow]

I refer the hon. Lady to the answer that I just gave. The vision for commissioning dental services sees dental local professional networks developing and delivering local services and local quality improvement strategies. Beyond that, it involves local health and wellbeing boards working together closely, involving local clinicians through the networks that I referred to earlier. The answer is that local dental clinicians will be fully involved in the ways that I have just described.

[Mr Marcus Jones (Nuneaton) (Con)]

11. What steps his Department plans to take to assist hospitals with the cost of PFI payments.

--- Later in debate ---

[Dr Julian Huppert (Cambridge) (LD)]

14. What plans he has to ensure balanced political and geographical representation on health and wellbeing boards.

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

The Health and Social Care Bill sets minimum membership for health and wellbeing boards. The boards will provide local system leadership, assessing need and setting the strategy for commissioning health, social care and public health. Ensuring that the board has the benefit of a broad range of opinion and geographical spread is a matter for local decision. However, the Department’s health and wellbeing board national learning network is developing and sharing good practice to inform those decisions.

[Dr Huppert]

Does my hon. Friend agree that the ability of a health and wellbeing board to represent democratically the interests of the people in its area would be boosted by having a reasonable number of councillors on it with both geographical representation across the area and political balance?

[Paul Burstow]

We are telling local authorities that they can have a majority of elected members on health and wellbeing boards if that is the appropriate way forward for their local community. My hon. Friend’s area, Cambridgeshire county council, recognises the importance of ensuring that there is a geographical spread and a full involvement of local opinion in those boards. There is a special event next January for stakeholders to get information about that, in which I hope my hon. Friend will take part.

[Chris Evans (Islwyn) (Lab/Co-op)]

Is not there a danger that health and wellbeing boards will simply be a talking shop for bureaucrats?

[Paul Burstow]

No.

[Guy Opperman (Hexham) (Con)]

15. What plans he has to ensure that the NHS is prepared for winter pressures.

--- Later in debate ---

[Julie Hilling (Bolton West) (Lab)]

17. What discussions he has had with the Chancellor of the Exchequer on the future costs of long-term social care.

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

The Government are committed to publishing a White Paper and a progress report, responding to both the Law Commission and the Dilnot commission recommendations. As part of ongoing work, there have been numerous discussions throughout the Government, including with Her Majesty’s Treasury.

[Julie Hilling]

At least 5,000 families a month are having to make decisions about the long-term care of loved ones. Since the election, thousands have had to sell their homes and spend every penny on care. How many more people—and for how much longer—will have to be terrified about their future?

[Paul Burstow]

If the hon. Lady had prefaced her question with an apology for failing to sort out the problem for 13 years, I might have taken it more seriously. This Government moved urgently to establish the commission chaired by Andrew Dilnot, we are now actively working through his proposals, and we will come forward with legislation and a White Paper in due course.

[Margot James (Stourbridge) (Con)]

Does my hon. Friend agree that the integration of health and social care should be leveraged by commissioners to encourage savings in the acute sector, to contribute to funding much-needed improvements in long-term social care?

[Paul Burstow]

There is no doubt that more integration between health and social care is a way of improving the quality of services delivered to the public, and of releasing resources that can then be reinvested in improving services. We know, for example, that the use of reablement services can reduce costs and improve the quality of life outcomes for the people who receive them.

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

18. What steps he is taking to improve the training of nurses and doctors.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

Figures today reveal that older women are being discriminated against in breast cancer treatment, with some 20% of women over 65 receiving chemotherapy compared with some 70% of women under 50. Will the Minister assure the House that those who are over 65 will receive equitable treatment, and that this discrimination will stop?

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

I am grateful for that question, and I assure the hon. Gentleman that the Government are determined to root out ageism wherever it might be within the NHS. That is why we have made it clear that there will be no exemptions from age discrimination legislation—and that will have to be taken into account by clinicians when they make decisions.

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

The recent judicial review concerning the unit at the Royal Brompton hospital said that the Safe and Sustainable consultation was unlawful and the review should be quashed. Considering the concern about this matter and the flaws in the review, is it not time for the Minister to indicate when the Government might intervene? Otherwise, there could be further threats of judicial review.

--- Later in debate ---

[Lilian Greenwood (Nottingham South) (Lab)]

Today’s report by Macmillan Cancer Support showed that over the past 40 years there has been virtually no improvement in life expectancy for those diagnosed with a brain tumour. Brain Tumour UK and experts such as my city’s own Professor David Walker are calling for action to improve diagnosis and treatment. What action is the Department taking to address their concerns?

[Paul Burstow]

I am grateful to the hon. Lady for her question. Macmillan has done a very good job by highlighting the need to focus on survival rates with regard not only to brain cancers but to lung cancers. Through our outcomes strategy, we are focusing on earlier diagnosis and ensuring that the care pathway is faster and delivers the appropriate treatments at the right time.

Mental Health Care

Paul Burstow Excerpts

Monday 21st November 2011 Commons Chamber

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

I start by congratulating my hon. Friend the Member for Broxbourne (Mr Walker) on securing the debate and on pursuing this issue through the all-party group on mental health and other channels for a considerable time. His good fortune in securing the debate tonight is particularly timely given the publication of Mind’s report this morning. I congratulate him doubly on that successful coalition of events that have led to the debate.

I, too, have had the opportunity to study the report, “Listening to Experience”, published by Mind, and I certainly share many of the sentiments that have been expressed in this brief debate. The report undoubtedly shines a spotlight on what is good about our acute and crisis mental health services, what is unacceptable, what is bad and what we can do to make them much better. It brings together the results of an independent inquiry, as we have heard, and it is fundamentally about ensuring that we listen to voices that are all too often overlooked and ignored.

I welcome the report. It is challenging, and some of the unacceptable practice that it describes is frankly harrowing. Many of its important conclusions reflect the aims and ambitions of our cross-Government mental health strategy, “No health without mental health”. More than that, it reinforces why it is right that our broader health and social care reform agenda focuses on patients being treated in a way that respects their dignity, protects their human rights and promotes flexible and creative commissioning solutions that are tailored to meet individual and local needs. The key is ensuring that services are genuinely personalised.

The provision of safe, modern, effective mental health services that offer patients real choice is, and remains, a Government priority. We expect the treatment and care of patients to be provided in the most appropriate therapeutic environment for them. My hon. Friend rightly referred to the concern expressed in the report that acute beds are not always available when needed. The hon. Member for Ashfield (Gloria De Piero) spoke about her own experience and her concerns about the journeys that some people have to make to find facilities, which is clearly unacceptable.

I want to make it absolutely clear that commissioners and providers have a responsibility to ensure that acute beds are available for those who need them. They should also ensure that the needs and wishes of patients, families and carers are not only sought but taken into account when decisions are made about community or hospital-based treatment. Distance and journey times are very serious issues that need to be properly taken into account in those commissioning decisions.

The quality, innovation, productivity and prevention programme, which is sometimes known as the Nicholson challenge, has targeted both reductions in bed days and—I stress—out-of-area admissions. Through a more effective acute care pathway, we can expect to achieve better patient experience of care, which means care that better reflects patient preferences, including being cared for at home if possible. That contributes to a more productive use of NHS resources to ensure that we drive up quality.

Specialised mental health community teams—crisis resolution home treatment, assertive outreach and early intervention in psychosis—provide care to service users and families in community settings. The crisis resolution home team performs a key role in supporting people at home, which often averts the need for an in-patient stay, acts as a gatekeeper for all those requiring access to in-patient services or other emergency care and supports early discharge, when appropriate.

The team is part of an integrated acute care system. It is affected by, and has an effect on, that system and beyond, especially the in-patient service and day hospital and community mental health teams. For example, patients with early onset psychosis benefit from early intervention services, and assertive outreach engages with severe and persistent mental disorder such as schizophrenia. That shared approach in system delivery is already beginning to show results, because 10,300 new patients with early diagnosis of psychosis were engaged with early intervention in psychosis services this year, which is the highest ever recorded figure. Overall investment in key mental health teams has also increased. In the last year, crisis resolution home treatment teams carried out 131,450 home treatment episodes for 106,790 patients who would otherwise have been admitted to hospital, an increase of 3.2% over the previous year.

I do not want my remarks in response to the important debate that my hon. Friend the Member for Broxbourne has secured to suggest that the Government are complacent. Mental health is a priority for us. The strategy that I mentioned earlier, and not least the spending review decisions that we made last year, make clear our commitment, especially as regards improving access to talking therapists for people with severe mental illness. However, there is always room to improve, and there is a need to listen to, understand and act on the experience of patients.

Mind’s report helpfully highlights four key areas: humanity, commissioning for people’s needs, choice and control, and reducing the medical emphasis in acute care, which is very much like the well-being concept that my hon. Friend has discussed. In mental health services, it is vital to balance patient autonomy with patient safety, which is often a source of debate in the Chamber. We need to ensure that that is done in an appropriate way, but it can be a challenging balance to strike. However, the solution to the problem does not lie with heavy-handed or coercive approaches. A wealth of research, guidance and good practice, much of which is cited in Mind’s report, offers practical strategies that can contribute much to ensuring that patient care is conducted in the humane, caring and respectful fashion described by my hon. Friend, envisaged in Mind’s report and espoused in the Government’s vision for mental health services.

The Mental Health Act 2007 code of practice is clear on the need to seek all alternative measures before adopting control and restraint or seclusion procedures. Restraint should be the last resort, never the practice of first choice. The code also emphasises the importance of providing support to patients after using control and restraint, seclusion or long-term segregation, and of reviewing such incidents to enable staff to learn from them.

The Mind report rightly draws attention to the importance of ensuring services meet the needs of black and minority ethnic communities. The Government’s mental health strategy acknowledges the lower well-being and higher rates of mental health problems that some BME groups suffer. The strategy is explicit on ensuring that health promotion and ill-health prevention approaches are targeted at high-risk groups, which means that programmes must be delivered in such a way that they are accessible to families from BME groups. Such approaches will lead to a narrowing of the health inequality gap.

There is no doubt that good data play a critical part in driving improvement—the report highlights that—which is why the mental health minimum dataset already has a good level of information on the ethnicity of patients, and why the annual mental health bulletin includes rates of access to services by ethnic groups and describes the ethnic profile of people spending time in hospital and being detained.

We will build on those measures. The mental health minimum dataset will go further, because for the first time it will be possible to analyse the full patient pathway, showing what happens to different groups of people before and after hospitalisation. This dataset has been identified as the single source for national statistics about the use of the Mental Health Act in the future, and the NHS information centre will launch a consultation next spring to determine exactly what information will be useful—I hope that hon. Members and others following the debate will take the opportunity to feed into that. The ability to compare and demonstrate differences between localities is an important way of driving improvement in services.

[Dr Julian Lewis (New Forest East) (Con)]

rose—

[Paul Burstow]

I can see my hon. Friend waving at me. I give way to him.

[Dr Lewis]

I am most grateful to the Minister. I want to put it on the record that since our last exchange on this subject on 10 November more data have come from the Hampshire trust, which intends to close more than one third of its acute in-patient beds, confirming that although only a minority of patients admitted to acute beds were detained patients, they stayed for longer, and that at any one time about half the beds, if not more, were occupied by detained patients. Does the Minister agree that if excessive numbers of beds are closed, the opportunity for a non-detained patient to find a bed will be disproportionately reduced?

[Paul Burstow]

I certainly agree that we need to look carefully at the data. My hon. Friend was right in his Adjournment debate on 10 November to highlight these issues and potential discrepancies, and I shall certainly take a close look at the data to which he has referred.

I am anxious to ensure that Mind and other key stakeholders play a part in identifying how the information that I have referred to can best be analysed and presented. As I have said, those data will be particularly useful in supporting commissioners in developing the kind of flexible and creative commissioning solutions that Mind and my hon. Friend the Member for Broxbourne have described so well.

The drive to improve the quality of services and reduce inequalities lies at the heart of our commissioning reforms. For the first time, the Secretary of State for Health, the NHS Commissioning Board and clinical commissioning groups will be under a legal duty to have regard to health inequalities in both access to and outcomes from health care. This legal duty will hardwire reducing health inequalities into the system. It not only obliges the Secretary of State to act, but obliges them to demonstrate that they did so and with what result. That is a powerful incentive for change.

Mind rightly emphasised the importance of choice, which I strongly endorse. That is already being demonstrated through several initiatives, including the improving access to psychological therapies programme for children and adolescents and for adults, the extension of the personal health budgets programme for people with mental health problems to increase choice and control and the development of adult and children mental health tariffs. We believe that choice of consultant or other professional-led teams should extend to mental health to achieve the parity of esteem expected by the mental health strategy, and we will work with key stakeholders to develop the proposals and look at ways of implementing our plans.

We recognise the benefits that mental health patients can receive from support and mentoring from peers, which was touched on in this debate, as well as the contribution from things such as crisis housing. To that end, I am working with colleagues on the ministerial working group on mental health to make these more widespread.

In conclusion, I thank my hon. Friend and others who have intervened and spoken briefly in this debate. I shall write to my hon. Friend the Member for Harrogate and Knaresborough (Andrew Jones) to pick up on his particular point. I very much welcome Mind’s report for its clarity and for the useful contribution that it makes to our shared aim of improving acute and crisis services, and I shall meet it to discuss its report and how we can take its recommendations forward in delivering the Government’s mental health strategy. The Government remain committed to achieving their overarching goal of better mental health outcomes for everyone. Our strategy sets out what everyone needs to do to realise that goal, and by working together we can make a long-lasting difference to the quality of life of people with mental health needs.

Question put and agreed to.

Woodhaven Hospital

Paul Burstow Excerpts

Thursday 10th November 2011 Commons Chamber

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

I congratulate my hon. Friend the Member for New Forest East (Dr Lewis) on securing the debate and on being, as ever, so thorough and detailed in his exposition of the case that he puts before the House. I take this opportunity to pay tribute to the hard work of the staff who work within the NHS in his constituency.

I want to set out the current position, as I understand it from the briefings that I have had over the past few days, and to respond to several of my hon. Friend’s specific points. I assure him that under the proposals for adult mental health redesign set out by Southern Health NHS Foundation Trust, Woodhaven hospital will not close but will change the nature of what is provided. I want to make it clear that there is a continuing NHS future for the facility, albeit not the one that he believes to be appropriate.

While the trust recommends that the acute adult mental health ward is withdrawn from Woodhaven, the excellent hospital which my hon. Friend opened eight years ago and which the community should rightly be proud of will continue to offer specialist adult mental health services. The aim of these changes is to provide the right mix of community and bed-based care—this debate centres on what that balance is—and ultimately the best possible support for people in his constituency who use these services.

My hon. Friend will be aware that during the 18-month engagement with the public that took place prior to the statutory consultation, the majority of patients consulted said—this is one of the areas that he challenges—that they wanted to be treated in the community. As a general principle in any field of health care, the more we can focus on prevention and on supporting people in their homes so that they retain their independence and stay connected with their communities, the better the outcomes we can achieve. The principles behind the trust’s proposed redesign can therefore be pinned squarely to the views of local people, and this is where I want to reassure my hon. Friend a little further. I understand that, through the consultation, the trust has been told this on repeated occasions. I have a quote from one service user:

“I was unfortunate enough to need the services of the home treatment team over Christmas 2008 and New Year 2009, but due to the care I received from the team I didn’t need to be admitted to hospital and I was able to stay at home with my husband and son.”

Clearly, my hon. Friend disputes the evidence that the trust is putting forward about whether patients want to be treated at home, but it is for this reason that it is recommending the integrated model for mental health services in Hampshire and the reinvestment of savings from acute services into community services. However, I will ensure that he is supplied with further evidence on these points so that he can satisfy himself and his constituents that the trust is basing its decisions on reasonable evidence.

Additional community services will ensure that patients receive flexible and bespoke care packages in their home wherever possible, even when acutely unwell. The intention of the proposals will mean that people are admitted to hospital only if it is clear that hospital is the best place for them to receive their treatment. The trust tells me that treatment and care for patients will be provided in the most appropriate and therapeutic environment for the patient and that acute beds should be available for those who need them. However, when local trusts propose changes to existing services, the public should be closely consulted. Again, my hon. Friend obviously feels that that is not what has happened. In the case of Southern Health NHS Foundation Trust, service user involvement projects and carers’ groups from across the county have worked closely with the trust to develop the proposals for the redesign.

I want to deal with a couple of the specific statistical points that my hon. Friend set out so clearly. He has demonstrated something that does not always happen in these debates, in that someone has done a lot of detailed research to try to nail the issue that he is most concerned about. First, I want to deal with the proportion of people detained versus those in voluntary admission. He referred to two days’ worth of data that he had collected and his conclusion that 53% of people were detained in those circumstances. However, I understand that over the past six months, on average, 22% of people admitted to the trust’s adult acute beds have been detained under the Mental Health Act. I have asked the trust to write to my hon. Friend with those figures so that he can see more data.

[Dr Julian Lewis]

The trust did fax me some figures of that sort. However, they did not make sense because when they were added up, the total was way below the number of beds that had been occupied. I honestly think that the trust is wrong on these proportions.

[Paul Burstow]

That is why I think it is right for the trust, having read this debate, to follow it up by writing to my hon. Friend. I know that he has been engaging with it face-to-face as well, and I am sure that he will continue to do so.

My hon. Friend made a point about the trust anticipating the effectiveness of the whole clinical pathway and about the focus on the most unwell reducing the number of people admitted under the Mental Health Act, in addition to reducing voluntary admissions.

My hon. Friend mentioned the issue of whether one counts leave beds. It is common for people who have been detained in hospital to have a period of leave from the ward before they are discharged. That can vary from a few days to several months. The beds for leave patients are not kept empty, but are made available for other acute admissions, as my hon. Friend the Member for Broxbourne (Mr Walker) said. It is therefore important to count leave beds when considering capacity. My hon. Friend the Member for New Forest East set out clearly his concern about bed occupancy and the impact of leave beds. I will make sure that the trust considers this issue carefully as it draws together the feedback from the consultation before its forthcoming discussion with the Hampshire overview and scrutiny committee. I will ensure that his concerns about length of stay, which he set out so clearly, are put to it.

My hon. Friend made a request for a pilot. Although I will not go quite as far as he would like tonight, it might help if I provide him with some information about the process that the trust has put in place to evaluate and assess the proposed changes. I understand that it has invited the Centre for Mental Health to do an independent review of the proposals, which is expected to be complete within a month. The trust’s research and development department is also completing a thorough evaluation of proposals, comparing a range of quality measures at baseline and after implementation.

On the next steps, the trust has been in discussions with the Hampshire health overview and scrutiny committee, and it has been agreed that the trust will hold a number of stakeholder meetings. It is expected that the trust will return to the health overview and scrutiny committee at the end of this month and present a written report that describes the themes from the consultation feedback and the progress that has been made in those meetings. The trust will then make suggestions on the next steps, which it will agree with the health overview and scrutiny committee, with a view to reaching final decisions in early 2012. As I understand it, any changes will be implemented by the trust in a phased, transitional approach over a period of time, not as a big bang.

The trust will, of course, keep my hon. Friend fully informed. I know that he has been diligent in pursuing the trust with his concerns. I encourage him to carry on that dialogue. I again congratulate him on securing this debate and for clearly articulating his concerns on behalf of his constituents. I hope that I have been able to articulate some of the points that the trust has put to me and I look forward to a conclusion of this matter in the new year.

Question put and agreed to.

Social Care Funding

Paul Burstow Excerpts

Thursday 10th November 2011 Westminster Hall

[Tony Baldry (Banbury) (Con)]

I am very pleased to be able to take part in this debate as co-chair of the all-party group on carers, and I have a couple of simple requests for the Minister.

It is crucial that all political parties—both Government and Opposition—work together on the White Paper on social care. We have been waiting for the document for some time, and I understand that the Government have committed to introducing it next spring. It would be very helpful if the Minister cheered us all up in his concluding comments by confirming that there will be a White Paper on social care in spring 2012. He will make us all the more happy if he can confirm that it is the Government’s intention that the document will introduce proposals to ensure that we are able to deliver sustainable long-term funding to tackle the existing care crisis and provide for growing demand.

We must recognise the scale and nature of the growing demand. The Department for Work and Pensions produced a wonderful report earlier this year called, “Number of Future Centenarians by Age Group”. Someone is either a centenarian or not, so I do not know why the DWP has to classify them by age group: it is one of those wonderful “Yes Minister” things. The report forecasts that 11 million people alive today will live to 100—a huge number. However, the number of working-age adults who will suffer from age-related conditions will rise by almost a third over the next 20 years. It is predicted that between now and 2030, 30,000 more people over the age of 80 will be living in the typical shire county of Oxfordshire, which is the equivalent of a town the size of Bicester being added to it. From 2025, the population aged 60 and over in the county is expected to be greater than the population of under-19s, including students. In a county such as Oxfordshire, nearly 70% of people aged 85 and over are living with a long-term illness, and the Medical Research Council’s cognitive function and ageing study shows that 26.5% of men and women between the ages of 80 and 84 suffer or experience age-related dementia. At over 85, the figure suffering from age-related dementia goes up to 68.5%, which is a significant increase. That means that the number of carers is expected to rise from 6.4 million today to 9 million by 2037, which is a substantial increase.

That is all against a background—in the House, we have discussed this in a number of debates since the general election, and I will not read out the speeches I have made in the past—of local authorities having to deal with serious financial circumstances, which has led them to increase charges for care services and raise eligibility criteria. The percentage of councils providing support to those with moderate needs has decreased from about half in 2005 to less than a fifth, as eligibility criteria are raised to substantial or critical needs only.

If he has time in his concluding comments, will the Minister update the House on what his Department considers to be the impact of the Sefton ruling in the High Court yesterday? The ruling seems to indicate that it is unlawful for local authorities to freeze care home fees unless they have consulted care home managers fully and properly assessed the risks of decisions to care homes and their residents.

The vice-president of the Association of Directors of Adult Social Services and others have calculated that the ruling will add a substantial amount to local authorities’ budgets, which have already been set for this year. We have some fairly tight figures for both local authorities and for care homes.

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

The key point in the High Court’s decision was the consultation. That was also a finding in the Birmingham case earlier this year, when the issue turned on whether the consultation was adequate and whether the authority had had due regard to various statutory duties. The issue now for local authorities is to satisfy themselves that they have had proper regard to the matters that the courts have directed them to consider.

[Tony Baldry]

That is a helpful update for the House, and I am grateful to the Minister.

--- Later in debate ---

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

I congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on securing the debate. By doing so, she has demonstrated the breadth and depth of her interest and expertise, and the breadth of interest across the House, in the issues. Such debates are not always as well attended as this one. As you rightly noted, Mr Bone, the Leader of the House also attended for a while to listen to our deliberations, which speaks volumes about the importance that the Government attach to the issue.

I am delighted that so many members and officers of all-party groups took part in the debate. This is the second time this week that I have had the pleasure of the company of the chairs and other officers from a number of those all-party groups. Earlier in the week, I hosted an event in the Department of Health with APG chairs to discuss with them their thinking about the way in which we need to respond to the challenging agenda and to input into shaping the White Paper that we will publish—in answer to the hon. Member for Banbury (Tony Baldry)—next spring. When I was asked at the meeting, I confirmed that we are aiming for April—that is what we mean by spring for this purpose—and I can reconfirm that today.

I very much agree with the remarks of the hon. Member for Worsley and Eccles South (Barbara Keeley), which were echoed in many contributions in this debate, about the need to have cross-party discussion and secure a cross-party agreement. One reason why we need to do that is that social care law has been very overlooked and neglected. The Law Commission report that came out this May quite rightly pointed out that our social care legislation has evolved over 60 years in a haphazard and piecemeal way. The confusing legal system is one of the reasons why social care has such a complex system, and why so many judicial reviews take place. We need a consensus to secure a legal reform that will last the test of time.

First, I would like to respond to some of the points made about the current situation of social care funding. I find it heartening that some of the points rehearsed in the debate acknowledged that the fragility of our social care system is not new—it did not start 18 months ago but is the pattern of many years, which we, as the coalition Government, are trying to address now.

I am not going to deny that things are tough, or that no council has had to make difficult decisions; it has not been an easy time for anyone. Difficult decisions have had to be made across Government because of the economic situation that we currently find ourselves in. However, the funding landscape is not as simple as I think some would like us to believe. The headline story of a Government intent on slashing social care services no doubt makes good copy, but it is not borne out by a closer examination of the facts.

In the previous spending review, which we announced last October, we provided an extra £7.2 billion over four years up to 2015 to protect social care, partly through councils and partly through the national health service. The aim was to alleviate the potential pressures on the adult social care system in what would be a challenging overall funding settlement for local government; that point has been rehearsed quite clearly by a number of colleagues in this debate.

We recognised that this year would be particularly tough. We have front-end loaded the funding for the first two years to insulate social care from cuts to local authority budgets, on which I will amplify a bit. Combined with a focus on efficiency, we believe that the additional funding that we have provided will enable councils to protect people’s access to care services. That is not just our view but the Local Government Association’s view, put forward in its submissions to the spending review. The King’s Fund also said in its report, “Social care funding and the NHS”, that central Government have put enough money in to protect adult social care services, provided that there are rigorous attempts to improve efficiency.

However, as the hon. Member for Leicester West (Liz Kendall) and other hon. Members have said, spending is falling. Budget data collected by the Department for Communities and Local Government from local authorities suggest that social care budgets are around £200 million lower than last year, which is a reduction of just over 1.5%. However, it is not inevitable that reductions in spending lead to cuts in front-line services. The hon. Member for Worsley and Eccles South quoted the Association of Directors of Adult Social Services, which had an interesting survey of their members that was published earlier this year. Boil it down a little further and what we find is that for every £1 that has been saved or taken out of spending in social care by local authorities, 70p can be attributed to efficiency savings. It is not about taking services out from the front line, but service redesign.

Yesterday, the Local Government Association released a prospectus inviting councils to take part in its productivity programme for adult social care. It said that there is scope for efficiency. In its foreword it said that if councils develop plans in line with policy objectives such as prevention and personalisation, they will minimise the impact of reduced funding for the front line, which is why I welcome the work that it is doing to recruit councils to its programme. From there, best practice can be shared with other councils to ensure that they are not making bad decisions when it comes to their budget choices.

[Barbara Keeley]

I understand the issues about efficiencies and the need to make changes such as the move to personalisation. However, from my experience—as I have said, I am in a local authority that is protecting social care—efficiency savings have caused our primary care trust to give up active case management for people with long-term conditions. Personalisation of personal budgets has meant that Age UK has not been able to conduct similar active case management for older people or to run drop-in centres for carers of people with dementia. Sometimes the change and the churn also cause loss. We have not touched today on the reorganisation of the NHS, but that has had an impact on things, too. I understand that we are in a system in which certain changes are good but can result in a loss of services that really impacts on people.

[Paul Burstow]

I am not seeking to hide or resile from that. What I am trying to do is demonstrate that the picture is not uniform or consistent. I want to quote some further evidence that supports that point of view, but first let me make it clear that of the £900 million that the ADASS survey identified as having been taken out of social care spend, 70p in every pound came not from cuts in front-line services but from service efficiencies and redesign. That very point was made by a number of hon. Members in the debate.

[Heidi Alexander]

The Minister is talking about efficiency savings within adult social care services, but would he accept that as every day goes by, demand for those services is increasing because of the needs within the existing population? May I press him a little more on the point made by my hon. Friend the Member for Leicester West (Liz Kendall)? Does he not think that his colleagues should be making greater protestations about decisions taken within local authorities? Rather than focusing on the bins, as my hon. Friend said, we should be talking about the needs of the elderly population and perhaps giving local authorities a bit more direction. Will the Minister tell us his views on that?

[Paul Burstow]

I do not believe we should micro-manage the decisions of every local authority. We should not dictate to local authorities about how to manage their resources. One message that came from local government before the election, which we, as a coalition, have responded to, was the desire to remove ring fences from budgets to give councils maximum flexibility. Total Place is exactly what that is about. It is about using budgets smartly to meet local needs in the best way to fit the community’s circumstances. In the past, such flexibility was constrained by the number of ring fences.

I have also picked up on some scepticism in the debate about the additional funding that is being provided through the spending review for adult social care via the NHS. There was some question as to whether or not that money was getting through. Of the £648 million for this year, nearly half has already been transferred—we know that from surveys that we have conducted—and agreements are in place to transfer the remainder. As to the reference to the money for carers, that was not part of this social care transfer; it was a separate requirement under the NHS operating framework. I am more than happy to debate that at a later stage, but right now I need to try to cover the main points in this debate.

Both primary care trusts and local authorities are positive about the development of these particular funds. They have seen them as a lever for more joint planning and co-operation. The feedback that we have had to date shows that the money is being spent on what it was intended for—prevention and rehabilitation, re-ablement, early supported hospital discharge schemes and integrated crisis response services. I am saying not that the money is a panacea but that those funds are making a difference in the communities in which they are being used smartly by the NHS and social care organisations. Times are tough and I am not going to pretend otherwise. Although I can present a relatively positive picture nationally, there are areas where cuts to front-line adult social care services are really beginning to bite.

Although some councils have coped with the cuts by tightening their eligibility criteria, it is not fair to suggest that that started in May last year. The trend started back in 2005. The way in which councils define and apply eligibility criteria is not consistent from one borough to the next. We will address those issues of definition as part of the review that we are taking forward in the White Paper.

[Kelvin Hopkins]

Even squeezing at the margins means that more people will suffer and not get the care that they need. In other fields we spend more freely, relatively, and yet we are squeezing in this area. The Minister said that 70% of the cuts in spending is to deal with inefficiencies, but 30% is real front-line spending, which means that some people are suffering.

[Paul Burstow]

I am trying hard to be reasoned and respond positively to the points that have been made. I am not trying to dismiss things. I am not making a speech that pretends that everything is perfect. I am trying to engage seriously with the real problems that local authorities are having to grapple with. I am also trying to set out that there are different ways of doing things. Some councils are choosing to do things differently and in ways that allow them to protect the quality of the service and the outcomes for the individual. That is the test that is most important to me.

In regard to eligibility, the hon. Member for Worsley and Eccles South asked about portability. It is one of the 76 recommendations in the Law Commission report. In the “Vision for Adult Social Care” that we published last November, I said that we are minded to progress the idea of portability in assessments. There is further debate to be had about how we translate that into portability of outcomes and services, and that is one of the issues that we are considering in the White Paper.

As I have said, we have a mixed picture across the country. It does not bear out the simplistic formula of “less money equals more cuts.” Age UK and WRVS are publishing a report which I will read with interest when it comes out. An illuminating report was published in September by Demos and Scope, which looks at how disabled people have been affected by budget changes in local authorities. We might expect to find that the biggest cuts in front-line services are made by the councils that face the most dramatic cuts in their income, but that is simply not the case. Demos’s report suggests that there is no direct cause and effect. The councils that it applauds for coping the best have not enjoyed the most generous settlements, and they are not concentrated in the most affluent areas. Rural and urban areas and rich and poor areas are found in equal measure at both the top and bottom of the table.

There are tough choices to be made in every town hall as well as in every part of Whitehall and in the national health service, but we need the choices to be smart, too, Places such as Tameside have invested in re-ablement services that help people back to independence after a period of illness and ultimately reduce their care needs. Tameside estimates that that saved it £2.3 million, which it then reinvested. Somerset county council has commissioned a number of projects that use volunteers to help people with low and moderate care needs to run their own groups, form friendship circles and keep in touch with activities available in their local community.

The West Sussex-based Carewise service was recognised by Which? magazine as a model of best practice. It helps older people who pay for their care to plan their futures. Planning, which is all too often absent, has been a theme of the debate. The organisation ensures that people get good financial advice. We are talking about improving services through integration, which is another important theme of the debate as is the use of personal budgets. Those budgets are now being rolled out through the trail-blazer pilots for direct payments for social care, for personal health budgets and for personal budgets in respect of Supporting People. Such changes begin to give the individual the opportunity to have a Total Place approach to the way in which they use resources and allow resources to be used to best effect.

When I went to Knowsley last year to see what was being done on integration, the most powerful aspect of the approach used was the fact that it involved thinking about “the Knowsley pound.” And in Torbay, which I also visited, the approach there was to look at everything through the eyes of “Mrs Smith.” It may not be appropriate in every community to look through the eyes of a “Mrs Smith,” but in Torbay it was thought appropriate. Officials in Knowsley and Torbay made the leap in the approaches that they took to see money not as theirs—to be held within the boundaries of their institutions—but as their community’s money, to be spent wisely on behalf of their community. That is the essential ingredient in delivering effective use of public money in times of austerity.

That brings me to the case for reform. Despite the funding challenges, there are steps that councils are able to take now to improve social care services and I hope that they will take those steps.

I will talk about reform in detail. I have been in the House for 14 years, so I am now entitled at least to have a sense of déjà vu about this debate, like some other Members who have been in the House for a long time. However, I think we are at a different stage in the debate. We are building on the work that has been done—the listening that has happened and the engagement that has taken place—over many years. Indeed, in framing the terms of reference for Andrew Dilnot, we set him the task of looking at everything that had been done in the past 13 years to ensure that we did not just reinvent the wheel and that we learned from what had been heard already. I am keen that we continue to do just that.

I am also keen that in this debate we address a very important issue about understanding, which is the issue about the nasty little secret at the heart of social care. It is a secret that we MPs all share and know about, but seven out of 10 people in this country do not know about it. It is that social care is not free and in fact has never been free. At the moment, we are in a situation where people look at the proposals that Andrew Dilnot has put forward and he is judged not against the standard of the reality of our experience of social care, which has been so well described in this debate, but against a fantasy of social care that is free, just as the NHS is free. All of us in this Chamber and all of us who have an interest in reform in this sector need to ensure that we do not allow that fantasy to get in the way of judging Andrew Dilnot’s proposals fairly.

That is a key part of how we can ensure that we make progress in this area. Indeed, it is key because of the catastrophic costs that people face. Those costs have been touched on by my hon. Friend the Member for Southport (John Pugh), and by the hon. Members for Lewisham East (Heidi Alexander) and for Luton North (Kelvin Hopkins). They talked about the anger that people feel that they have saved, worked, invested in their lives and been thrifty, only to have it all snatched away at the point that they are in need of support from the system. That issue of fairness is part of what we asked Andrew Dilnot to look at.

I want to make two more comments before I sit down for the concluding speech. There has been talk about the cap, about whether it does anything for carers and about changing the way that the system works. I want to make a suggestion that people need to think about. The cap has to be metered. People have to enter the system and then move towards the cap. The way that we design the meter is the way that we incentivise prevention; the way that we design the meter is the way that we build carers in and respect and value what they contribute. I hope that people will think about that in the weeks remaining before we conclude our process of debate and deliberation, leading up to the White Paper next year, because that is one of the ways in which we can redesign the system to be a system that is about supporting what people can do, that is about enabling communities to support people and that is about enabling families to contribute in the way that they want to.

My final comment is that I have found this debate to be very helpful and a useful airing of the issues. I hope we shall continue to debate these issues in Parliament and continue to have the debate in the community. But it is not just an open-ended debate; it has to be a debate that is closed and that comes to conclusions. That is what the White Paper is about. The White Paper is the conclusion of 14 years, as far as I am concerned. It is about how we get to the next stage.

I was asked about legislation. Let me just say that it is well above my pay grade to be the one who announces what will be in the next Queen’s Speech; I probably would not be a Minister for much longer if I were to do that today. However, when the decisions are made we will have looked at this process and the White Paper outcomes, and I hope we will be in a position to legislate at the earliest opportunity. Social care has languished and rested in the “too-difficult-to-do” box for far too long. We are the Government who are committed; we see the urgency and the need. I hope that together we can get the cross-party lead that results in the changes that are long, long overdue.

Opportunities for Volunteering (Legacy Report)

Paul Burstow Excerpts

Thursday 10th November 2011 Written Statements

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

The Government have today announced the publication of the final Opportunities for Volunteering report. “Opportunities for Volunteering—the legacy report” has been placed in the Library. Copies are available for hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

The Government recognise that volunteers play an important role in building resilient communities. In the context of health, public health and social care, they contribute to the delivery of high quality health, care and support services; improving health and well-being; and helping to reduce health and social inequality. They frequently offer support to people at the most vulnerable points in their lives.

The Department supports the focus during this month on health and care by the European year of volunteering and believes this report demonstrates a long standing commitment to encourage volunteering in that context stretching back three decades.

This Opportunities for Volunteering legacy report sets out not only the Government’s recognition and appreciation of the scheme’s achievements since its launch in 1982. It also—primarily—sets out the reflections on the scheme from the Opportunities for Volunteering national agents who have delivered it on behalf of the Department. Achievements of the scheme, from the perspective of national agents, include:

developing the volunteer infrastructure;

improving volunteer management practice;

fostering an environment for projects to seek out new alliances;

helping small and emerging organisations to recruit volunteers and involve service users; and

empowering service users to become volunteers themselves.

The noble and proud tradition of volunteering across the full range of health and care settings, that Opportunities for Volunteering has embodied with distinction for so long, is being continued through the Department’s health and social care volunteering fund that was launched in December 2009 as the successor. This new fund is closely aligned with the four priorities of the new strategic vision for volunteering for health and care. “Social action for health and well-being: building co-operative communities”, the Department’s new strategic vision for volunteering, was launched in October this year.

Organ Donation

Paul Burstow Excerpts

Wednesday 9th November 2011 Westminster Hall

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

I congratulate the hon. Member for Wolverhampton South West (Paul Uppal) on securing this debate, and on squeezing so much in. There were so many interventions that it felt almost as if a 90-minute debate had been fast-forwarded to include everything. I appreciate his approach, and the substantive contributions that we have heard during the short time in which we have debated this important issue. Transplantation is one of medicine’s great success stories, and I know that the hon. Gentleman has taken a keen interest in the subject for a considerable time. He is right to hold the Government’s feet to the fire when it comes to ensuring that we maintain progress in such an important area.

The coalition Government are absolutely committed to increasing the number of organs available for transplantation, and we believe that as many people as possible who need a replacement organ should be given the opportunity to benefit from a transplant. In many ways, the success of transplantation surgery and advances in technology have led to the current challenges of unmet need that have been described so powerfully and with personal examples.

Some 10,000 individuals now require a transplant, and tragically about three adults or children die every day either waiting for a transplant or after being taken off the list because they have become too ill. The hon. Member for Newport West (Paul Flynn) mentioned a blog that details the suffering and misery endured by families while they wait for a transplant, and that speaks volumes about why we must do more work in that area.

The Organ Donation Taskforce’s recommendations, published in its first report, “Organs for transplants”, in January 2008, were broadly based around the need for investment in the donation infrastructure. That is to ensure that the UK maximises its potential for donation rates, and makes organ donation a usual part of health care.

The Welsh Government’s recently published White Paper on organ donation has been referred to, and we will study their proposals carefully. In 2008, however, the independent Organ Donation Taskforce also examined the case for moving to an opt-out system but recommended against it, concluding that, although such a system might have the potential to deliver benefits, it would also present significant difficulties.

My hon. Friend the Member for Montgomeryshire (Glyn Davies) rightly drew attention to Spain, and the fact that, despite the enactment of a similar opt-out scheme in 1979, a significant transformation in the level of performance took place only after investment in infrastructure in 1989. The taskforce has drawn lessons from the Spanish experience, and it is right that we are guided by evidence.

I was asked about the taskforce’s intention that we achieve a rate of organ donation of at least 50% by 2013. That is certainly our aim, and we are on track to deliver it. Significant resources have been made available to implement the taskforce’s recommendations—largely through NHS Blood and Transplant—to increase the number of specialist nurses, who are a critical part of the system, and to appoint clinical leads, donation committees and donation chairs in acute trusts to drive improvement locally.

[Dr Poulter]

As the Minister will be aware, in 1994, there were 2,500 people on the organ donor waiting list, and last year there were over 7,500. Only 29% of the UK population are signed up to organ donation, which is woefully inadequate given that 552 people died last year while waiting for an organ transplant, excluding those who were taken off the list because they had become too unwell. It is a big problem; people are living longer, sometimes with multiple medical co-morbidities, which means that more people will need transplants. The problem will become an increasing challenge for health care providers and the Government.

Philosophically, I agree with the Minister and I am not in favour of compulsion. Does he agree, however, that we need a more targeted community-focused approach and, as with the cot death campaign that reduced cot deaths from 2,000 to about 300—

[Philip Davies (in the Chair)]

Order. Interventions must be brief.

[Paul Burstow]

The hon. Gentleman advances an important point. We cannot tackle the issue from the top down; it requires leadership from the bottom up in local communities. That is why NHS Blood and Transplant’s website provides constituency-level information about the number of people on the register, the number of transplants that have taken place, and the number of people waiting for a transplant. That information is invaluable to us as MPs and leaders in our local communities, and we should work with others in our community to break down some of the barriers of misunderstanding and misconception that were referred to by the hon. Member for Wolverhampton South West.

We have seen an increase in the number of organ donors by around 28% since 2008, and we are on track to meet the 50% improvement by 2013 set by the taskforce. As the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) said, 29% of the UK population are on the organ donor register, and it is interesting to note how levels of registration change from one constituency to another—I urge hon. Members to look at that. The number of deceased organ donations rose to 1,010 in 2010-11, compared with 745 in 2001-02. The year 2010-11 also saw a record number of transplants from deceased and living donors, with 3,740 transplants carried out in the UK, compared with 2,633 in 2001-02.

Despite the considerable progress made over the past few years, however, there is still a shortage of organs donated for transplant. The situation is particularly serious for people from African-Caribbean and Asian backgrounds, because they are three to five times more likely to need a kidney transplant than white people. That is why we cannot be complacent, and we will continue to work with partner organisations to promote donations. That can be done through the Give and Let Live initiative in schools, where new information about the issue is circulated by NHS Blood and Transplant; by requiring people to answer a question about organ donation when applying for a driving licence; or by asking people to sign the organ donor register when applying for a European health insurance card and so on. The African-Caribbean Leukaemia Trust seeks to raise the importance of organ donation in black and minority ethnic communities, and local leadership is a key ingredient in delivering improvement.

Through various public awareness campaigns, NHS Blood and Transplant also publicises the need for more people to register as donors. Work continues at national, regional and local levels further to strengthen the donation programme, to support the excellent work of the NHS in identifying, referring and procuring donor organs, and to make organ donation a usual part of end-of-life care.

I am grateful for the opportunity to reassure all hon. Members in the debate that, as we modernise the NHS, we will continue to focus on driving forward an improvement in donation rates. To maintain that momentum, with the support of all UK health administrations, we have established a transitional steering group that includes health departments, NHS Blood and Transplant, the British Transplantation Society, and the royal colleges. It aims to focus on actions that will continue to embed donation within end-of-life care, and provide a link between oversight of the programme delivery board and the establishment of the NHS commissioning board in 2013. It will also provide a clear link to Health Ministers for any reports on progress.

The transitional steering group will focus on six key areas: increasing consent rates; brain stem death testing in all appropriate cases; donation after circulatory death to be considered in all circumstances; increased donation from emergency medicine; increased and more timely referral of potential donors; and improved donor management. The work of the transitional steering group will continue to drive improvements in the UK’s organ donation programme, and increase donation rates.

The hon. Member for Wolverhampton South West asked about leadership, which is an essential issue. The national clinical director for transplantation, Chris Rudge, has recently retired from that role, although I confirm that he will be appointed as leader of the transitional group, which will provide continuity of leadership. I hope that that reassures the hon. Gentleman, and others, about the Government’s serious intent to deliver on the important target. I can also inform the hon. Gentleman that we will not wait until 2013 to look at what should happen next, and we have already begun to develop a post-2013 strategy. NHS Blood and Transplant is starting to prepare the relevant documents, and is working closely with the transitional steering group.

This has been an incredibly important debate and significant points have been raised. I hope I have demonstrated that, in terms of leadership, intent and drive, we are committed to building on the improvements we have already seen and, where appropriate, to learn lessons from other parts of the world. That will require us all to play our part in raising awareness of organ donation, and of what the consequences for people’s lives will be if donations are not made.

As the hon. Member for Wolverhampton South West said, donation is a precious gift. We need more people to realise that and give such a gift by putting their name on the register and being willing to donate.

Primary Care (Devon and the South-West)

Paul Burstow Excerpts

Tuesday 8th November 2011 Westminster Hall

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

I congratulate the right hon. Member for Exeter (Mr Bradshaw) on securing this debate. As a former Health Minister, he has stood up in the Chamber to respond to hon. Members who have raised concerns on behalf of constituents, as he has done thoroughly and thoughtfully today. I appreciate the way in which he presented his case. When he was a Health Minister, I found him to be a constructive and courteous colleague on the occasions on which I dealt with him.

I pay tribute to the hard work done by national health service staff every day of the week, whether in back offices or on the front line in wards. They change lives. It is all too easy to dwell on the things that go wrong and not to pay enough attention to the excellent work that they do. I certainly want to pay attention to that today. This Government are committed to doing all that we can to support front-line staff and ensure that we continue to deliver excellent services to the right hon. Gentleman’s constituents.

I will first address the central issue—the role of NHS shared business services and how it has come to be such an important player in shared services—by referring to the chronology. NHS SBS was established in 2005 after an open competition in accordance with European procurement regulations. I will certainly consider the right hon. Gentleman’s point about procurement law and will write to him if any further issues need to be dealt with. I will confirm the state of play.

The service was established to help to meet efficiency targets set out in the previous Government’s efficiency review, led by Sir Peter Gershon, in 2004. In creating NHS SBS, the last Government brought together two shared financial service centres situated in Leeds and Bristol and introduced private sector capacity and expertise to assist expansion and increase the range of services offered, to deliver the potential efficiencies of such an approach. I appreciate the right hon. Gentleman’s question about his concerns on behalf of staff. As a constituency MP, I too would want to ensure that such concerns were properly aired and that the decision makers involved understood those concerns and properly reflected on and respected them. However, I am sure that the right hon. Gentleman, as a former Health Minister, will understand that the responsibility for determining how local services are delivered rests with local NHS organisations. I will set out why. Local NHS organisations are in the best position to understand what local people need, how to design shared services to meet the support needs of NHS provider organisations and so on, and how to ensure that the offer available is appropriate and affordable. It would be inappropriate for a Minister to try to micro-manage the details of individual contracts.

In line with that policy, the Government absolutely do not mandate NHS organisations’ use of SBS. That remains a decision for local organisations on the basis of their assessment of the quality and value for money that they will receive by letting contracts to SBS. Nevertheless, the Department supports the use of SBS. I will explain how that tension is resolved. As a former Minister, the right hon. Gentleman will have grappled with it himself.

Public sector use of shared services and private sector expertise is in line with the policies of this Government and the last Government, but it absolutely must offer best value for money and meet the required quality standards. Equally, when the previous Government set up SBS, they took a 50% stake, meaning that from day one, the Department has had a duty to promote the venture and create value for the taxpayer. In turn, the Department’s share of SBS profits is returned to the NHS. It is therefore not uncommon for the Department, in undertaking its duty, to correspond with NHS organisations considering the use of NHS SBS in support of using shared services, particularly SBS. Such letters have been consistently provided throughout the existence of SBS, and I have copies of correspondence dating back to October 2008 that relates to the transfer of family health services of the sort that we are debating.

[Mr Bradshaw]

Does the Minister accept, however, that the original joint venture established by the Labour Government was for finance and accounting, not family health services? The only area in which we allowed SBS to take over the running of family health services was north London, because that service was failing dismally. It does not seem to have improved much since SBS took over, either.

[Paul Burstow]

My understanding—I will go back and check, and if it is not correct, I will write to the right hon. Gentleman—is that that extension of SBS’s role was a policy decision by the previous Government, and that the Nicholson challenge set in 2009 of making better use of support services by sharing across organisations was identified as an opportunity to realise savings that could then be reinvested in front-line services. I hope that that is a shared goal, even though its execution is open to proper scrutiny and debate.

I reassure the right hon. Gentleman again that, although the Department writes letters of the sort that he has referred to, they are nothing new in the context of promoting that business venture and the return of profits to the NHS. I stress that those decisions are local.

Back in 2007, the National Audit Office considered the potential of NHS SBS and estimated that it could deliver £250 million in savings over 11 years. To date, more than £70 million has been saved, freeing up funds for front-line patient care. As I mentioned, the review of shared services undertaken as part of Sir David Nicholson’s productivity challenge identified how a minimum of £600 million could be saved across England and redirected to support front-line services. The report cites SBS as an example of successful shared service ventures, delivering typical savings of between 20% and 30%.

In the specific case of Devon PCT’s family health services, as the right hon. Gentleman said, SBS provides numerous administrative functions relating to primary care, including patient registration, patient records management and contractor payments. Those functions help the NHS to run more smoothly, and the testimonies that he read out bear witness to the fact that they are valued services.

The PCT, along with nearby health care commissioners, has been exploring how to save money on administration and management functions without affecting front-line services. To spell out the current situation in relation to the agreement between the south-west and SBS, SBS provided an outline proposal in March this year, followed up with a final proposal in June. At the south-west regional project board, 10 trusts agreed to sign an intention to proceed in September. The intention to proceed is made between the trusts and SBS—there is no contractual relationship in that sense between the Department and SBS—as an agreement to invest the time and effort in undertaking the final element of due diligence, which was one of the right hon. Gentleman’s concerns, and consultation. It is not, therefore, a commitment to enter into a contract.

Due diligence is a process that runs alongside the contracting process. The due diligence process began formally alongside the final proposals in June and will gather pace following the intention to proceed. As part of this process, efforts are undertaken by both sides to understand the precise details of the proposed arrangements. As part of that process, the final and precise quality, which is an important consideration, and service standards are determined. If, as part of the process, the trusts are not satisfied that the offer from SBS can meet the quality and value standards that they require, they are not committed to entering into an agreement with SBS.

[Mr Bradshaw]

That is helpful, because my understanding of the situation is that the staff in Devon have been told to expect to be TUPE’d across on 1 December. The consultation for staff is taking place in parallel with the due diligence process, but surely that should wait until the trust itself is satisfied with the quality of the bid, following the due diligence process.

[Paul Burstow]

It is not uncommon for such processes to run in parallel, which, as the right hon. Gentleman has identified, is what is happening in this case. This is not, however, a conveyor belt that cannot be reversed. The point that I am making is that the due diligence process is not about doing things by rote; it is about making sure that both the taxpayer’s interest and the quality standards of the service are properly protected. It is a legitimate area for local scrutiny and debate, and for challenge by him and other Members who have a concern in the matter.

The TUPE consultation started on 2 November. Extensive discussions will be held with staff and managers. Following the consultation, the organisations will be required to consider the feedback from staff. Again, it is not a rote process, but one that requires decision makers to have proper regard for what they learn from the process. The right hon. Gentleman has mentioned India. I should make it clear that NHS SBS has no call centres for family health services in India. It is envisaged that, under this contracting arrangement, if it goes through, some staff will work in India, but they will not be part of a call centre service.

Only when each of the processes that I have described is complete, and the individual local organisations have concluded that the service offering is in the best interest of the local area, will the decision be taken to proceed. Should the proposals be advanced, it is expected that five centres of excellence will be established in the south-west, based in St Austell in Cornwall, Exeter in Devon, Ferndown in Dorset, Brockworth in Gloucestershire and Devizes in Wiltshire. That decision will be a local one made by NHS organisations on the basis of all the facts provided as part of the process that I have set out. The matter is to be decided locally, and those concerned must assure themselves—hence the due diligence process—that the contracts afford the necessary flexibility and quality standards. Indeed, on quality change and the formation of an NHS commissioning board, the contracts are framed in a way that allows such flexibility. I am assured that that should not present an insuperable obstacle to delivering the wider goals.

[Mr Bradshaw]

I appreciate that, but would it not make all the more sense to hold off signing the contracts until we know what the national picture will be when the commissioning board publishes its findings? I should be grateful if the Minister returned to the Department and found out why the official in charge of this work does not seem to think that the model being pursued in the south-west involving SBS would be compatible with what is likely to emerge from the recommendation of the national commissioning board.

[Paul Burstow]

I will write to the right hon. Gentleman to amplify why I think that the policy concern is not as great as has been presented, and why the emergence of the NHS commissioning board, with its role in family health services and the commissioning of primary care, provides a model whereby the exploitation of the opportunities for shared services will be even greater than it is now.

In conclusion, local NHS organisations have responsibility for getting value for money and meeting the highest levels of quality. That is true about everything they do, including proposals such as the one under discussion. The coalition Government support the move to shared services, if that decision is made locally and for the right reasons.

This is equally one of the key proposals that will help trusts to meet the quality and productivity challenge that the NHS has faced since 2009. I understand that the proposal for the south-west region aims to deliver operational savings of 32%, with a 23% net saving after the cost of change. By commissioning the service in a different way, it is estimated that the NHS can save in excess of £6 million over four years in the south-west, including £1.6 million in Devon.

I hope that the right hon. Gentleman will agree that it is only right for local organisations to look at areas where they can deliver efficiencies and quality and can release money for investment in front-line services. I hope that this debate has gone some way to addressing the right hon. Gentleman’s questions. I will undertake to enter into the correspondence that he has requested. If he has any further questions, I am sure that the Department will want to respond as quickly as it possibly can. I thank him for initiating this debate.

Patient Security (Mental Health System)

Paul Burstow Excerpts

Monday 7th November 2011 Commons Chamber

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

I congratulate my hon. Friend the Member for Loughborough (Nicky Morgan) on securing the debate, and on the thoughtful way in which she set out her case. Let me begin my speech where she ended hers. The coalition Government are totally committed to securing parity of esteem between mental and physical health. Quite simply, that is the right thing to do, and it is long overdue. We are determined for it to happen as part of the strategy that we are currently delivering and the changes currently taking place.

I am well aware of the tragic incident to which the hon. Lady referred, and which was undoubtedly the spur for the debate. I also thank her for sharing the coroner’s report with me. I am keenly aware of the fact that the trust involved in this sad case fully accepts the coroner’s verdict and has undertaken an overhaul of its patient security arrangements. It is important for public confidence in the system that lessons are learned and actions are taken to improve patient safety and service quality.

The coalition Government are committed to patient safety. It is a high priority in our strategies and in the outcomes on which we are judging the NHS. Our cross-Government mental health strategy, “No health without mental health”, includes two core objectives to which I wish to draw attention: ensuring that people who are acutely ill receive safe, high-quality care in an appropriate environment, and thereby ensuring that fewer people suffer avoidable harm. The NHS outcomes framework also prioritises patient safety and emphasises treating and caring for people in a safe environment and protecting them from avoidable harm.

My hon. Friend rightly referred to the invaluable work done by the national confidential inquiry into suicide and homicide by people with mental illness. Although the suicides rates in England have been at a historical low and are much lower than those of most of our European neighbours, the most recent figures, dating back to 2009, show that there are still about 4,400 suicides in England; that is one suicide every two hours.

Over the past decade, good progress has been made in reducing the suicide rate in England. However, there has been a slight rise in the last couple of years. It is therefore important that we maintain vigilance. We know from experience that suicide rates can be volatile as new risks emerge. That is why we recently completed a national consultation on our suicide prevention strategy. We are considering the responses received, and intend to publish the final strategy next year.

The draft strategy aimed to set out a broad and coherent approach to suicide prevention and to helping us sustain, and reduce further, the relatively low rates of suicide in England. In particular, it sets out to reduce the suicide rate in the general population and to provide better support and information to those bereaved or otherwise affected by a suicide.

Substantial improvements have already been made in in-patient services. The most recent national confidential inquiry into suicide and homicide was published in July 2011. It shows that the long-term downward trend in in-patient suicides continues. In 1997 there were 214 in-patient suicides, falling to 94 by 2008. That is still 94 too many, so there is still more to be done.

I applaud my hon. Friend on her initiative in gathering the statistics she has presented to the House. However, she is right to sound a note of caution about how the figures might be interpreted, and what they reveal to us. For example, information about the length of time for which patients are missing or the level of risk that they pose either to themselves or to other people is relevant to gauging the true scale of the problem on which she seeks to persuade the Government to take action.

There are a wide variety of reasons for recorded unauthorised absences. These include situations that pose minimum risk to the patient or the public, such as a delay in return to hospital from authorised leave because of a missed or delayed bus. We could be talking about a delay of no more than a couple of hours before some patients return safely to their unit. However, that return has to be recorded, even if it is for just a matter of a couple of hours.

Recent statistics from the confidential inquiry show that between 2004 and 2008 the number of suicides per year by patients who have absconded from mental health services has dropped by more than 50%, from 50 cases to 21 cases per year. That is a substantial improvement, but it is still 21 cases too many.

That is why we are not complacent. We know that a significant number of suicides still occur during a period of in-patient care in spite of the improvements. Managing risk effectively is therefore essential, and the confidential inquiry collects and analyses the detailed clinical information on all suicides and homicides committed by someone with mental illness, and more latterly also on sudden and unexplained deaths of psychiatric in-patients. It also makes recommendations for improvements, which goes to the heart of my hon. Friend’s representations tonight. Its December 2006 report sets out some compelling statistics—for example, that 27% of in-patient suicides occurred after the patient left the ward without permission. Those deaths were clustered in the first seven days after an admission.

In mental health services, respect for the patient’s wishes must at all times be balanced with the concern for the individual’s safety and well-being. There is no doubt that that balancing act can, and does at times, present significant challenges for services. However, the solution to the problem does not have to be heavy-handed or coercive in its approach. A significant body of research, guidance and best practice has demonstrated practical strategies that can be implemented and can help to reduce significantly the number of people going missing. Such strategies include: early assessment; ensuring that staff begin to form a meaningful, therapeutic and collaborative relationship with patients straight away; understanding the factors that trigger a decision to leave the ward, such as a disturbed environment or an incident affecting the patient; recognising that patients will have social responsibilities such as paying bills or ensuring that their property is secure—staff need to identify these issues early to prevent anxiety and stress that may lead to the patient choosing to leave—and making greater use of technology, such as CCTV or swipe cards, to observe and control ward entry and exit.

Key to the successful delivery of those approaches will be the ongoing development of an acute specialist work force with the right skills and attitudes, and a culture of inquiry and service improvement based on evidence and regular service user and carer feedback. The law is clear in the obligations it places on services. The Mental Health Act 1983, to which my hon. Friend referred, sets out the legal provisions relating to keeping patients in legal custody and bringing them back if they abscond. The Mental Health Act code of practice is equally explicit in the guidance it gives to services about the systems and processes that should be in place to safeguard detained patients. Hospital managers should ensure that there is a clear written policy about the action to be taken when a detained patient, or a patient on a supervised community treatment order, goes missing. These policies should, in turn, be agreed with other agencies, such as the police and ambulance services, which have significant roles to play in safeguarding patients who are absent without leave.

Just last year, it was confirmed for the first time that the detaining authorities would be required by statutory regulation to notify the Care Quality Commission, without delay, of any absence without leave of any person detained or liable to be detained under the Mental Health Act. A failure to take adequate measures to keep a detained patient safe from fatal harm is potentially a breach of article 2 of the European convention on human rights. The CQC asks services that are designated as low, medium or high security, and psychiatric intensive care units, to notify it of all incidences of absence without leave. There are different reporting requirements depending on the security level of the service. I can tell my hon. Friend and others who are listening to this evening’s debate that the CQC will be reporting its first round of these statistics next month. The CQC monitors trends in absence without leave and has followed up with the particular providers in relation to specific incidents or patterns of absences. The CQC recommends that providers monitor and review absences without leave to understand why patients go absent and to help develop strategies to address these identified issues.

My hon. Friend identified concerns about what she described as the variation that she encountered in the definitions that appeared to be being used by different trusts when she undertook her freedom of information requests. I can, however, assure her that the definitions of “escape”, “attempted escape”, “abscond”, “failure to return” and “absent without leave” are applied consistently in mental health services. Indeed, most of those definitions relate to the three-part description that she listed. I suspect that the differences in the returns she received are due to the mixture in the type and size of mental health services within one trust, and therefore the mixture of type and number of absences reported. For instance, a trust may include a high-secure hospital, two medium-secure units and also low-secure and non-secure mental health services. The numbers from that trust may give us no understanding of the type of risk of the absences recorded. That is why my hon. Friend is right to say that we need good data collection in this area, and that is why we have asked the CQC to collect those data in such a way that we can meaningfully segment them to understand what is going on. I shall write to her about the statistics that she has collected.

The Government believe that people with acute mental health needs have a right to receive the care and support they need in a safe and comfortable environment in which they are treated with the dignity and respect they deserve. As my hon. Friend has said, there is a cross-Government mental health programme in place to drive whole system and cultural change in mental health services. However, this cannot and should not be seen as solely the Government’s responsibility. The essential building blocks are in place but, as always, the responsibility for the quality and safety of front-line care crucially depends on three things. First, providers have a duty of care to each individual for whom they are responsible—ensuring that services meet individual needs and that there are systems in place to make sure that services are effective, efficient and deliver high-quality care. Secondly, the regulator is responsible for assuring the quality of the system itself. Thirdly, the commissioners are responsible for securing the care that meets people’s needs.

My hon. Friend was absolutely right to bring this important debate before the House, and she was also right to point out that we often debate issues of physical health in the House but rarely debate mental health issues except in extremis. I assure her that the Government are determined to invest in mental health services to ensure that more therapies and therapeutic services are available. Indeed, that is why we are investing in talking therapy services. It is important that with mental health we look at the whole-life course, intervene earlier to provide more preventive services, and invest in services that deliver dignified outcomes. I am grateful to my hon. Friend for securing the debate and allowing us to shed some light on those important issues.

Question put and agreed to.

Winterbourne View

Paul Burstow Excerpts

Monday 31st October 2011 Written Statements

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

I promised to update the House about ongoing activity in relation to Winterbourne View private hospital and other facilities for people with learning disabilities.

Since I announced that Winterbourne View had closed and that the Care Quality Commission (CQC) had published its compliance report on Winterbourne View on 18 July, the CQC has inspected another 23 Castlebeck Care services in England. Its inspection reports were published on 28 July and are available on the CQC website at www.cqc.org.uk. While half of these services were compliant with safety and quality requirements, the CQC had more serious concerns about four locations and has taken further action in relation to these. Two of these homes, Rose Villa and Arden Vale, closed in August.

In June, CQC announced a programme of unannounced inspections of services for people with learning disabilities following the abuse uncovered at Winterbourne View. CQC has now begun this programme of inspections of 150 hospitals and care homes which is looking at a sample of services for people with learning disabilities similar to those provided at Winterbourne View.

The CQC inspection programme will assess how well people with learning disabilities experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights; and whether they are protected from abuse. As at 24 October, inspectors had visited 27 locations and are in the process of considering the evidence.

As in the case of CQC’s review of the 23 Castlebeck services, where CQC finds that a service is failing to meet the safety and quality requirements, it has powers to take appropriate action which include demanding improvements, issuing a formal warning notice or in the most serious cases closing down a service.

CQC will publish reports for each location setting out its findings and a national overview in spring 2012. A second phase of the review will use the learning from phase one to look at a sample of other registered services covering alternative models of provision for people with learning disabilities.

The results of the CQC inspections programme will feed into the wider Department of Health review of the lessons from Winterbourne View. We are still gathering evidence from the serious case review and the NHS serious untoward incident review, and taking the views of organisations and individuals on how services for people with learning disabilities and challenging behaviour can be improved.

While these reviews and inspections are ongoing we are taking action to address emerging issues. For example, CQC have amended their whistle-blowing policy. Where issues for local management are highlighted in the NHS review, they will be developing actions plans to deal with this.

Ministers will publish and report to Parliament on the Government’s response to their findings.

I will continue to update the House on further developments.