Oral Answers to Questions

Paul Burstow Excerpts

Tuesday 7th June 2011 Commons Chamber

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

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

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

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

[Mr Baron]

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

[Paul Burstow]

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

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

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

[Paul Burstow]

rose—

[Mr Speaker]

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

[Paul Burstow]

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

[David Tredinnick (Bosworth) (Con)]

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

[Paul Burstow]

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

[Alex Cunningham (Stockton North) (Lab)]

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

[Sheila Gilmore (Edinburgh East) (Lab)]

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

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

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

[Alex Cunningham]

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

[Paul Burstow]

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

[Nick Smith]

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

“greedy chancers who gamble with crazy business plans”?

[Paul Burstow]

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

[Sheila Gilmore]

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

[Paul Burstow]

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

[John Pugh (Southport) (LD)]

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

[Paul Burstow]

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

[Margot James (Stourbridge) (Con)]

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

[Paul Burstow]

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

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

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

[Paul Burstow]

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

[Ian Paisley (North Antrim) (DUP)]

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

[Paul Burstow]

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

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

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

[Paul Burstow]

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

[Emily Thornberry]

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

[Paul Burstow]

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

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

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

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[Mr Steve Brine (Winchester) (Con)]

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

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

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

[Mr Brine]

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

[Paul Burstow]

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

[Gavin Barwell (Croydon Central) (Con)]

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

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[Nicky Morgan (Loughborough) (Con)]

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

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

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

[Nicky Morgan]

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

[Paul Burstow]

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

[Tony Lloyd (Manchester Central) (Lab)]

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

[Paul Burstow]

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

[Lilian Greenwood (Nottingham South) (Lab)]

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

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[Henry Smith (Crawley) (Con)]

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

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

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

[Henry Smith]

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

[Paul Burstow]

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

[Karl MᶜCartney (Lincoln) (Con)]

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

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

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

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

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

[Harriett Baldwin (West Worcestershire) (Con)]

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

[Paul Burstow]

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

[Mr John Spellar (Warley) (Lab)]

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

[Paul Burstow]

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

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

[Gavin Barwell (Croydon Central) (Con)]

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

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[Nigel Mills (Amber Valley) (Con)]

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

[Paul Burstow]

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

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

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

[Paul Burstow]

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

[Jo Swinson (East Dunbartonshire) (LD)]

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

Winterbourne View Care Home

Paul Burstow Excerpts

Tuesday 7th June 2011 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health to make a statement on the Government’s decision not to hold an external independent inquiry into the abuse of vulnerable adults at Winterbourne View.

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

Nobody watching the BBC’s “Panorama” programme last week could have been anything but shocked and appalled by the systematic abuse of residents at Winterbourne View. May I, first, extend my deepest sympathies, and those of all of my colleagues in the Government, to those so horribly mistreated and abused, and to their families and loved ones? For the avoidance of doubt, I should say that we have not ruled out an independent inquiry. A criminal investigation is under way and it is important that we do nothing that could prejudice it.

In the coming weeks, the Care Quality Commission will inspect the other 22 hospitals run by Castlebeck and the reports will then be publicly available on CQC’s website. The CQC is also starting a three-month inspection of the 150 hospitals that care for people with learning disabilities, and this will include unannounced inspections. Where it identifies inadequate care, the CQC will require the necessary improvements to be made immediately. South Gloucestershire council will also lead an independently chaired serious case review. I have asked the Department of Health to draw together the findings of these various investigations and ensure that they are completed in a thorough and timely manner. I can also report that Mark Goldring, the chief executive of Mencap, will bring an independent voice and a depth and breadth of knowledge of the needs of people with learning disabilities to the task of drawing conclusions and learning lessons. Once in possession of the full facts, and once the police investigation has concluded, we will be in a position to decide what further action is required.

Since being made aware of the abuse, our priority has been ensuring the safety of patients at Winterbourne View. Fifteen staff have been suspended by Castlebeck and no further patients will be accepted at Winterbourne View. All residents now have a personal advocate and the CQC is working with all the agencies involved to find suitable alternative placements for them, taking into account their specialist needs and the wishes of their families. I issued a full written ministerial statement on these matters at 9.30 this morning.

It is the right of every individual being cared for by others to be treated with dignity and respect and it is the responsibility of those trusted with their care to provide it: a responsibility that weighs most heavily on those who care for the most vulnerable, including those with learning disabilities. This responsibility rests in four places: with the providers themselves, in this case Castlebeck; with commissioners, both primary care trusts and local authorities; with the regulators, including both the Care Quality Commission and the professional regulators, and the CQC has acknowledged it should have acted sooner and issued an unreserved apology; and, of course, with individuals. No training, guidance or management should be needed to tell people that the behaviour experienced by the residents of Winterbourne View was nothing other than obscene and unacceptable.

In future, our proposed HealthWatch organisations will provide a valuable early warning and will be able to ask the CQC to investigate where concerns exist. We intend to put safeguarding adults boards on a statutory footing, helping local authorities, the NHS and the police to work together to safeguard vulnerable adults. We will do everything in our power to prevent incidents such as those at Winterbourne View from happening again and to ensure that, if they do, the system responds quickly and decisively to protect those at risk.

[Emily Thornberry]

The Opposition agree entirely with the sentiments expressed by the hon. Gentleman. It was with great shock and sadness that we saw the terrible events happening, before our eyes, on the television screens. To see the abuse of the most vulnerable by those entrusted with their care was truly shocking and sickening. In the wake of this tragedy, however, vital questions must, in our view, be answered fully and impartially.

Although internal investigations conducted by the CQC and South Gloucestershire council, both of which are directly connected with this failure, will be of some value, they are nevertheless insufficient. We are asking for an independent inquiry similar in nature to the well-respected “Healthcare for all” inquiry, which Sir Jonathan Michael carried out in May 2007. The Government could include in that inquiry experts to work alongside Mark Goldring, such as Professor Jim Mansell, who has already conducted two reviews for the Department of Health into the structure of homes for those with learning disabilities, because the issues raised in his reports are still to be resolved, as this tragic case suggests.

We need full and frank answers. Was the CQC’s failure to monitor the treatment of residents due to the lack of resources? Was it due to the shortage of 300 staff, as reported in the Financial Times last week? Does the CQC have adequate powers to act in cases such as that of Winterbourne View and, if so, is it using its powers appropriately? If not, how must the CQC be strengthened to prevent a repeat of this failure and what actions will the Government take to ensure that staff working in social care are better trained and regulated so that events such as those at Winterbourne View can never be repeated?

Last week, the Minister created confusion with his response. On Tuesday, he seemed to imply that there would be an independent review of the case but by Wednesday he seemed to have changed his mind. Does he now think that internal reviews will be sufficient to answer the questions? I hear what he says about sub judice and the police inquiry, but we are not asking for an inquiry into individual culpability. We are asking for an independent inquiry into the failure of the system, for that inquiry to begin immediately and for there to be no delays. We need assurances that there will be a wide-ranging review, held in public, that will shine a light on the terrible events at Winterbourne View. Only an independent inquiry will do.

[Paul Burstow]

Of course, we need to ensure a full and thorough inquiry into all these matters, which is being undertaken in the serious case review, which will be chaired independently, and in the work of the CQC. That will go on as the Department brings together all the different reviews and that is why we are very pleased that Mark Goldring will take part in the process.

The hon. Lady suggests that there was confusion last week, but the confusion was only that which she sought to spread. We were very clear from the outset that we wanted to examine all the results from all the different inquiries, and that is what we are doing. We are not ruling out any further inquiries, but we want to ensure that the processes that are in hand are concluded and that we make judgments with the full facts available.

[Mr Stephen Dorrell (Charnwood) (Con)]

May I welcome my hon. Friend’s announcements to the House this afternoon? Does he agree that although there has quite properly been a lot of focus on the CQC—Dame Jo Williams accepts that there have been quite clear failures in its supervision of the home—there are also some difficult questions to be answered, particularly by the commissioners of the care? What were they doing paying for care that clearly was not to the required standard? Equally importantly, there are some important questions for the professional regulatory bodies to answer. Did no doctor ever go into the home? If they did, what conclusions did they draw? Where were the nursing regulators in this case?

[Paul Burstow]

My right hon. Friend poses a number of questions that are at the heart of the various current inquiries. He is right to say that to focus solely on the CQC is to miss the point, as the primary responsibility rests with the provider organisation to recruit, train and supervise the right staff in the first place. He is also absolutely right to ask about the role of the commissioners and the professional regulators. Those are the issues that we are looking at and will examine, and I will come back to the House with answers in due course.

[Mr Michael Meacher (Oldham West and Royton) (Lab)]

As the CQC has been forced, by Government cuts, to reduce its inspections by no less than 70%, how are the Government going to prevent similar abuses from occurring elsewhere and going uninspected and undiscovered unless someone happens to blow the whistle or offer undercover photographic evidence?

[Paul Burstow]

Let me start by addressing the whistleblowing issue. Terry Bryan, the whistleblower in this case, is to be applauded for his tenacity in pursuing it. The Government have been clear about the need to strengthen the arrangements and safeguards for whistleblowers, because that is an essential first way in which we can make sure that the system protects those who are vulnerable. The right hon. Gentleman suggests that the Government have in some way cut the number of inspections, but he should reflect back to 2008 when his Government introduced the current mandate for the CQC and changed the basis on which it would inspect. That is what led to the changed inspection system. Perhaps he should ask some questions about that as well.

[Mr Robert Buckland (South Swindon) (Con)]

Does my hon. Friend agree that the model of large-scale institutionalised provision for people with learning difficulties is now broken and that we should support even more moves towards personalised and supported care close to the families and loved ones of people with learning difficulties?

[Paul Burstow]

My hon. Friend makes a very good point. The move towards personalisation and greater supported living is undoubtedly the direction that we wish to move in. That was started by the previous Government and we have been continuing it. We have made a massive transfer of resources from the NHS to local authorities to support that very transfer of responsibility, which is undoubtedly the way to deliver better results for individuals.

[Mr Dennis Skinner (Bolsover) (Lab)]

Is it not self-evident that if there were a full inquiry we would be able to hear about the owners and the people who make money out of these business ventures—businesses such as Lydian Capital Partners, which owns Winterbourne View, and people such as J. P. McManus and John Magnier, who have rubbed shoulders in royal circles? Is it not ironic that those two billionaire Irishmen, at the same time as the British people are bailing out the Irish economy, are making misery for disabled people by inflicting the damage they have caused and are making money in the process?

[Paul Burstow]

In my public statements and in my statement today, I have made it clear that the spotlight needs to be shone just as clearly on the provider organisation in this case, and not just on the CQC. That will be my continued intention as we pursue this matter to its conclusion.

[Dr Sarah Wollaston (Totnes) (Con)]

Will the Minister address the question of how long these vulnerable people were filmed being abused, because that simply would not have been tolerated if they were children?

[Paul Burstow]

My hon. Friend makes an important point. I do not know the answer to the question of how long the people were filmed before the whistle was blown again by “Panorama”. However, it is an important point that will undoubtedly become clearer as we come on to the details of the inquiry.

[Glenda Jackson (Hampstead and Kilburn) (Lab)]

I endorse the Minister’s praise for the whistleblower in this horrific case, but may I remind him that he blew the whistle three times to the Care Quality Commission, which did precisely nothing? What are the Government doing to ensure that such a situation can never arise again?

[Paul Burstow]

The local authority was notified in the same way, so there are a number of agencies at which we need to look carefully and critically, and that is what the independently chaired serious case review will do. That is what the review by the CQC is about, and we will pull all those reviews together. If there are any gaps in the information that comes from that process, we will make sure that they are filled. However, the key thing is that lessons are learned along the way and changes are made straight away.

[Robert Halfon (Harlow) (Con)]

Further to what the hon. Member for Hampstead and Kilburn (Glenda Jackson) said, given that the CQC clearly ignored the advice it was given, there should be resignations at the highest level—the buck has to stop somewhere.

[Paul Burstow]

I am afraid that I am not going to agree with the hon. Gentleman today that we should call for anyone’s head. I want the heads of that organisation to be relentless in pursuing the questions that hon. Members have asked today and which I have asked since this came to light about why failures occurred—not just the CQC’s acknowledged failure but failures by others in allowing this to go on for the time it did. I am not calling for resignations, but I am calling for action and resolution. Learning should take place, and there should be change as a result of that learning.

[Mark Durkan (Foyle) (SDLP)]

The Minister has rightly addressed the issue of whistleblowers. Will he assure us that there will be protection for whistleblowers in future, whether they are relatives or staff, so that they have the confidence to act? In relation to staffing issues, are any of the inquiries making any assessment of whether there is a correlation between shift lengths and pay rates and the poor care in some of those institutions?

[Paul Burstow]

Again, those are all matters that need to be properly considered and weighed up in the reviews and that the Department will want to make sure is part of the overall report. When that work concludes, we will report to the House and make sure that the information is available to all hon. Members so that they can assess it and make their own judgments. It is certainly the Government’s intention to strengthen the protections on whistleblowing. We are consulting on how that might be given effect, and I urge the hon. Gentleman to contribute to the consultation.

[Duncan Hames (Chippenham) (LD)]

Does the Minister envisage that putting safeguarding adults boards on a statutory footing would help care home residents, their families and all those concerned; and would bring these incidents to light and, indeed, to a halt sooner in future?

[Paul Burstow]

It is essential to establish a statutory basis for safeguarding adults boards, but it is not sufficient, as other issues must be addressed in the review, which is why various aspects of the work are progressing. However, it is right that we should respond quickly to the Law Commission, which recommends that we should put the boards on a statutory basis, and that is what we will do when legislation is introduced.

[Malcolm Wicks (Croydon North) (Lab)]

If, as is often said almost as a cliché, a test of a civilised society is how we care for the most vulnerable—sadly, it is likely that Winterbourne is not an isolated example, and that even today many frail elderly people, often with dementia, and people with mental illnesses or learning difficulties are being abused and neglected—we must all think hard about how to move forward. Strong and unannounced inspections are clearly a significant part of the answer, but are there ways in which we can involve local communities and concerned citizens in safeguarding the well-being of people in homes—often private homes? If around every home there were two or three citizens who had rights to enter and could befriend some of the people there, that might be another way in which the community could add to the statutory services to try to prevent occurrences in future.

[Paul Burstow]

I am grateful to the right hon. Gentleman for his question. We must acknowledge that there will never be a time when there is an inspector in every room of every care home for every minute of every day. We must therefore make sure that the systems in place are robust, and that organisations are recruiting the right people and delivering the right training and supervision. However, the right hon. Gentleman’s point about the involvement of the community is spot-on. That is why we are proposing the establishment of HealthWatch and why we see that as an opportunity for citizens to become involved in the provision and scrutiny of health and social care in their communities.

[Margot James (Stourbridge) (Con)]

Very often a whistleblower is the vital link that people in such vulnerable circumstances have with the outside world, so I am pleased to hear that that will be a big part of the review. I have written to the chairman of the CQC to ask how many such whistleblower complaints were made in the past 12 months but not been followed up. The data are essential. May I have the Minister’s assurance that the review will find out that information?

[Paul Burstow]

My hon. Friend draws attention to an area that we need to look at as part of the various aspects of the work that I described to the House today. Although I do not know the basis on which such data are collected by the CQC, I undertake to look at what data are available.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

I accept the Minister’s logic in not asking for heads to roll ahead of the report of the independent inquiry, but will he give the House an undertaking that once he has asked the questions and received the answers, he will not shy away from allocating responsibility and will do what the NHS is usually very bad at—allocating responsibility at some stage and asking people to resign?

[Paul Burstow]

I think I will say yes to that, but I want to make it clear that I am not answering in the context of hypotheticals. I do not know the conclusions of the exercise, and Ministers who come to the Dispatch Box and promise that things will never happen again are all too often and too soon proven wrong. We must make sure that we do everything we can to learn lessons from this to minimise the risks in the future, and we need to make sure that responsibility and accountability are at the heart of the reforms that the Government are making to health and social care.

[Fiona Mactaggart (Slough) (Lab)]

The Minister is right to say that we need to learn lessons from this, but how long will it take us? The CQC has admitted inspecting Winterbourne View three times in the past two years. The South Gloucestershire safeguarding board was informed in October, but apparently took no action before the programme was aired on television. This is not the first such scandal. When I was first elected, one of the first things I did was to persuade the Department of Health to commission the Bergner report into the Longcare home scandal on the borders of my constituency —a similar huge institution in which residents were raped, abused and tortured by the people who were given care of them. It seems to me that it is not just the individual institutions but Government who need to learn the lesson. How much money is the Minister putting into advocates and listeners of the volunteer kind mentioned by my right hon. Friend the Member for Croydon North (Malcolm Wicks), or of the professional kind, so that the voices of those who cannot always speak for themselves are heard in the inspection process?

[Paul Burstow]

I mentioned in my statement that each of the individuals who have been affected in this terrible way have advocates. The hon. Lady makes an important point about the role that advocacy plays for those who lack capacity or the ability in certain circumstances to advocate on their own behalf. We are looking at that as part of the overall reforms of health and social care, but as for a precise sum of money, I do not have a figure in my head that I can give her now. I will write to her on that point.

[Kerry McCarthy (Bristol East) (Lab)]

My elderly constituent, Mr Ivor Needs, has been looking after his vaccine-damaged son, Matthew, for many, many years. Ever since I became an MP, he has been expressing concern to me about what will eventually happen to Matthew when he is no longer able to look after him. How can we reassure people such as Mr Needs that the Government are pulling out all the stops and doing all they can to ensure that care homes in the Bristol and south Gloucestershire area will be fit for purpose and a fit place for him to entrust the care of his son?

[Paul Burstow]

I entirely understand that question. I suspect the hon. Lady speaks for many who saw the programme and therefore fear for their loved ones who may be in other institutions. That is why we have to act in a thorough and thoughtful way, why we have to act quickly, and why the various processes that I described today are the best way to reach conclusions quickly. Because of the separate criminal inquiry, a separate independent inquiry would not be able to start until those judicial processes had been completed. That is why we want the internal processes to go forward. We have provided external scrutiny to make sure that they deliver what we all want—greater assurance that the system will deliver the best quality care for our loved ones.

[Fiona O'Donnell (East Lothian) (Lab)]

The Minister has stated that there cannot be an inspector in every bedroom, and that is why he and hon. Members across the House this afternoon have acknowledged the vital role of whistleblowers in protecting vulnerable adults. Will he speak to colleagues in the Department for Business, Innovation and Skills to ensure that any changes to employment law do not make it more difficult for people to blow the whistle, especially new employees who often see a service through fresh eyes and therefore see faults that others have grown used to?

[Paul Burstow]

I will certainly have those discussions, and I would add that there is another area that we need to focus on, and that is the training and development of the work force. That is why just two weeks ago I announced not just a work force development strategy, but additional new resources to underpin that strategy for all providers to enable them to ask Skills for Care for the resources to develop their work force.

[Diana Johnson (Kingston upon Hull North) (Lab)]

Will the Minister also look at the vetting and barring scheme in this country, and in particular have regard to the provisions in the Protection of Freedoms Bill, which is going through the House at the moment, that will remove millions of people who work with vulnerable adults from the thorough background checks that the Independent Safeguarding Authority carries out at the moment?

[Paul Burstow]

I will take away that point, reflect upon it and write to the hon. Lady rather than give her an off-the-cuff answer of any sort.

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

Like my right hon. Friend the Member for Croydon North (Malcolm Wicks), I too believe that we are kidding ourselves if we think that this is a one-off and it is not happening day in, day out. There will be vulnerable adults living in their own homes today, behind locked doors, who are in fear of the carers who are paid to look after them. Might not another way of getting an eye into the locked environment be the use of telecare to make sure that someone outside is aware of what is happening in these locked institutions?

[Paul Burstow]

I would not want to give the impression that we would see that as a substitute for any of the other points that have been made on this urgent question today, but undoubtedly telecare, telemedicine and assisted technologies have their part to play, both in improving the quality of care and increasing independence for individuals. That is why the Government support that as part of the way in which we see the future for social care unfolding.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

A recent Tyne Tees television report uncovered cases of appalling abuse and neglect in the north-east that are now being investigated, and the staff in those cases reported dreadful treatment from their employers, not just losing their jobs but having their professional reputation smeared. Will the Minister please elaborate today as there will be workers who are aware of abuse but are in fear of their jobs, who could report abuse if they had some reassurance today of the changes that the Government are looking to make to protect vulnerable workers?

[Paul Burstow]

The first thing I would say is that if anyone sees criminal activity of the sort that took place at Winterbourne View, they should blow the whistle on it. There is no if or but about that. The Government have consulted and we are looking at the responses to the consultation on whistleblowing. I am not in a position to elaborate further, but it is absolutely vital that people feel able and safe enough to come forward if they have concerns about neglect, abuse or poor-quality care.

Care Services (Older People)

Paul Burstow Excerpts

Tuesday 7th June 2011 Commons Chamber

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

Let me start by congratulating my hon. Friend the Member for Eastbourne (Stephen Lloyd)on securing the debate and setting out the issues so clearly, as well as for his work as an officer of the all-party group on dementia. I suspect that many of his colleagues in the Chamber listening to the debate have been inspired to be here by their association with that group.

Social care is seldom in the news for good reasons and my hon. Friend was right to begin by referring to some of the most recent scandals that the House discussed earlier today, not least the terrible abuse at Winterbourne View. As I said earlier, the events that took place in that hospital were appalling and, as I explained, I am determined to do everything I can to ensure that the lessons are learned, understood and acted on swiftly.

My hon. Friend has painted a fairly bleak picture of social care, and although I am not quite so gloomy I am not complacent about what needs to be done. The system of social care that the Government inherited last year was and still is fragile. The legal framework that governs social care was written for a bygone era and is now so complex and byzantine as to leave people confused and frustrated. The way that we pay for long-term care is a classic wicked issue of politics—one that is occasionally taken out of the “Too difficult to deal with” drawer, only to be looked at and shoved firmly back in again—because most people in this country are blissfully unaware of how social care is paid for. They are blissfully unaware of the fact that it is not free, that it never has been free and that many people face the potential of catastrophic costs when they come into the social care system.

My hon. Friend has rehearsed his views about what future funding arrangements might look like. I am clear that there is no perfect solution—no solution that can possibly please and satisfy everyone—but we need to strive to reach a settlement that requires trade-offs but also secures the necessary change and sustainability of a system for the future. That is why the Government have been quick to put in place the building blocks of a reform system—quickly establishing the Dilnot commission to recommend reform of how we pay for care and support, and securing the current system by committing an extra £2 billion for social care by 2014.

My hon. Friend talked about the importance of integration. I can tell him that the unprecedented transfer of NHS resources to social care, which this year amounts to £650 million, is indeed fostering new relationships between local government and the NHS to allow the greater integration and closer working that are essential to enable us to deliver better services for the public whom we are here to serve. He also talked about the schism between health and social care. It is worth noting that that schism was set into the very foundations of the NHS under the National Health Service Act 1946 and then the National Assistance Act 1948, so we have to look back a long way to see when that split occurred.

The main focus of my hon. Friend’s remarks has been the challenge of dementia. Each year, about 65,000 people are diagnosed with dementia, which touches the lives of many families, as he has demonstrated by relating his experience with his two aunts. The number of dementia cases is set to rise by 38% over the next 15 years. That rise reflects the fact that many more of us are living for longer, but we should not cast that in the language of consternation. We should see it as a cause for celebration that so many more people are living for so much longer; the key is making sure that in those extra years we have quality of life as well. That is why we need the NHS, as well as social care and society, to rise to the challenge.

Let me offer some hope to my hon. Friend. We can do much better for people with dementia and their carers. In coming to office, I took the view that we should stick with the existing national dementia strategy and deliver it in full, because at our heart the coalition Government are committed to the notion of greater personalisation so that people have real control over the services that affect their lives and so that carers have a much bigger stake in the system. As he has said, commissioning is key to delivering that vision and the objectives in the strategy. Good commissioning can make a huge difference.

[Tracey Crouch]

The Minister mentions carers, who have a very difficult job—none more so than those who care for people with dementia. Next week is carers week. Will he join me in congratulating those who care for people with dementia, which is particularly challenging? Those people are often the unsung heroes of our society.

[Paul Burstow]

I am very grateful to my hon. Friend for making that very important point. The 6 million or more carers in this country are undoubtedly the backbone of our care system and save us a large sum of money—over £100 billion according to the most recent estimate by Carers UK. I will go beyond thanking them and make the point that the Government have committed £400 million extra to supporting the extension of respite support for carers. We are determined to make sure that that money gets through to those who need it.

My hon. Friend the Member for Eastbourne’s remarks about commissioning and the need for it to be multidisciplinary, involving social care and other expertise, is undoubtedly right. Indeed, my Department is in the process of developing a pack to support health and social care commissioners, particularly in relation to dementia commissioning. It will offer guidance on key aspects of dementia care and the need for early diagnosis and intervention. My hon. Friend was right to refer to the under-diagnosis and late diagnosis of dementia and how that can reduce life chances and the opportunity to plan for the progression of the disease. There will also be guidance on offering better support for people at home and in care homes and on providing better care in hospitals, which means addressing issues of training that have been mentioned.

[Chris White (Warwick and Leamington) (Con)]

Does the Minister agree that excellent examples of charities and social enterprises such as Castel Froma in my constituency that put social goals before short-term profit provide some of the best models for the future of care homes? Should the Government not do all that they can to encourage the provision of services by those organisations to the sector?

[Paul Burstow]

I am grateful for that point. Part of the Government’s growth strategy is about recognising the value that micro-enterprises and social enterprises can offer in delivering good-quality social care.

We are producing supporting guidance for commissioners on the reduction in the use of anti-psychotic medication, which is often overlooked by commissioners. Having spent a decade campaigning for an end to the inappropriate and over-prescribing of anti-psychotics, I was delighted when the previous Government finally commissioned an independent review that clearly revealed the cost of the use of those drugs—lives shortened, lives dimmed, and 1,800 deaths a year, which is truly shocking. That is why as a Minister I am determined to hold the system to account to deliver a two-thirds reduction in the prescribing of those drugs by November this year. That ambitious target was set in 2009, and it requires action by a number of agencies and the provision of the alternatives that my hon. Friend the Member for Eastbourne discussed.

To make that change, the Government need active support from the front line, the third sector and professional bodies, and we have worked closely with Dementia Action Alliance and many other organisations to support a national call for action to reduce the use of anti-psychotics, which will be launched later this week. My hon. Friend discussed the variation in services across the country, and it is worth saying that the NHS spends £8.2 billion a year on dementia. I do not think there is compelling evidence that it is all well used, which is why we are auditing service provision around the country to gauge progress, for example in the development of memory services. Taken with clear requirements on primary care trusts to publish their dementia plans and work with their social care partners, there will be more transparency than ever before, so commissioners will be held to account for delivery in that area.

My hon. Friend touched on a number of issues relating to NHS reforms, and discussed the need to improve research. I have the privilege of chairing the ministerial advisory group on dementia research, and one of the key issues in delivering more investment in dementia research is securing more quality bids for research funds in the first place. I am delighted that more than 121 new bids have recently been made and are being evaluated, making it very likely that I will be in a position later this year to announce good news about our moving towards significantly increased investment in dementia research. The key is not just throwing money at the problem but making sure that the talents in scientific skills in this country are brought to bear on it, and that expertise is brought into this area to make sure that we solve the problems effectively.

My hon. Friend made some important points about NHS reforms. Having just concluded the listening exercise, we are waiting for Steve Field and the NHS Future Forum to publish their conclusions next week. My hon. Friend discussed the role that health and wellbeing boards can play in integrating services. That is something that was part of the original legislation and which, I am pretty certain, will remain in the legislation. It is an essential building block in delivering more integration of health and social care.

In conclusion, health and social care reform is long overdue. My hon. Friend made a powerful case for acting swiftly on that reform. The Government have acted in a determined fashion to put in place the building blocks to enable that reform to take place. We have secured the funds to sustain the system while we put those reforms in place, and we are committed to delivering on dementia. I have no doubt that if we deliver good-quality dementia care services and model our services around the needs of dementia sufferers and their families, care and compassion will be built into the system, which will address many of the concerns that have rightly been rehearsed in the House over recent months. It will also enable us to get the very best out of the £8.2 billion that is already spent on dementia services, and ensure that the extra resources that this Government are putting into the NHS over the next few years get to the front line and deliver the improvements that all Members want to see.

I am grateful to my hon. Friend the Member for Eastbourne for raising the subject this evening, and I look forward to continuing to work with him through his all-party group to make sure that we keep these issues firmly in the spotlight, driving forward the improvements that all our constituents expect.

Question put and agreed to.

Winterbourne View Private Hospital

Paul Burstow Excerpts

Tuesday 7th June 2011 Written Statements

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

This Government believe that people with a learning disability have the right to lead their lives free from fear and discrimination, to receive the care and support they need, and to be treated with dignity and respect.

The abuse at Winterbourne View exposed by whistleblower Terry Bryan and documented by the BBC Panorama team, will be a cause of enormous concern not just to the families and patients affected but to all who are concerned about the care and support society provides to vulnerable people. The Department extends its deepest sympathy to those who have suffered abuse and all those who love and support them.

The responsibility for the quality and safety in care crucially depends on:

providers, who have a duty of care to each individual they are responsible for, ensuring that services meet individual needs and that there are systems and processes in place to ensure there is effective, efficient and high-quality care;

commissioners (both primary care trusts and local authorities), who are responsible for purchasing care which meets people’s needs and ensuring that they are clear about the quality and effectiveness of that care; and

the regulators (both the quality regulator and the professions’ regulators), who are responsible for assuring the quality of care.

Following an approach from “Panorama” on Friday 13 May, the national and local agencies involved have acted promptly and decisively to resolve the situation. Their first priority was ensuring the safety of patients at Winterbourne View.

A criminal investigation is also under way and the House will understand that I am limited in what I can say about particular events to avoid compromising police activities.

The steps taken since 13 May include:

South Gloucestershire council called an immediate multi-agency adult safeguarding meeting. This meeting included the local authority, the local NHS and the police, together with the Care Quality Commission (CQC) and Castlebeck Care (who are the providers of services at Winterbourne View). Immediate action has been taken to assure the safety of current patients, including the suspension of 15 staff and a decision not to accept further patients at Winterbourne View. NHS commissioners have also put in place independent clinical and managerial supervision, and commissioned independent assessments of all current patients. All people in Winterbourne View now have a personal advocate;

CQC is taking enforcement action;

all admissions to the unit have been suspended; and

CQC is working with others to vacate the unit and appropriately relocate the patients through a systematic search for suitable alternative placements, taking into account the specialist needs of the patients and the wishes of their families.

CQC has acknowledged that there were indications of problems at Winterboume View which should have led to it acting sooner. CQC has issued an unreserved apology to those it has let down. Jo Williams, chair of CQC, has also written to the Department expressing her regret for CQC’s failure to act in this case. She, and CQC staff, are fully committed to learning the lessons from this tragic case and to making sure that when there are signs of poor care, CQC acts quickly to protect vulnerable people. In seeking to strengthen CQC as a quality inspectorate, we will work closely with CQC to ensure it is able to carry out its functions effectively and efficiently.

In the light of incidents at Winterboume View, CQC has started an immediate responsive review of all services run by Castlebeck Care (a further 22 locations in England). Inspections will be completed within the next two to three weeks. Reports on these individual services as well as a summary report will then be publicly available on CQC’s website.

In addition, CQC will begin a focused inspection programme which will review care provided by hospitals for people with learning disabilities. The three-month programme of reviews will involve unannounced inspections at a sample of the 150 hospitals that provide care for people with learning disabilities. Where CQC identifies care that is not meeting requirements, it will be able to use its full range of enforcement powers to take immediate action to require hospitals to make necessary improvements.

Each patient at Winterbourne View has been regularly reviewed by a multi-disciplinary clinical team on behalf of the primary care trust that commissioned their care. In many cases, this process has involved conversations with patients and relatives. All patients had been reviewed in the last six months, most in the past three months. Those primary care trusts who commissioned the care for the patients who were resident in Winterbourne View are carrying out an urgent review of the processes used to commission and review patients in privately provided services. The outcome will be fed into the wider multi-agency safeguarding review.

On 1 June 2011 South Gloucestershire council announced that it will lead an independently chaired serious case review (involving all agencies) which will look in detail at the specifics of this case and we will consider its findings carefully.

I asked officials on 18 May to undertake an examination of the roles of all of the agencies involved in this case drawing together the key lessons from the reviews being undertaken by the CQC, the NHS and safeguarding boards. The Department will be assisted in that task by Mark Goldring, the chief executive of Mencap, who will not only bring an independent perspective but also a depth and breadth of knowledge of the needs of people with learning disabilities. Ministers will then report further to Parliament.

The planned reforms for health and social care should also increase our ability to drive up standards in services and to deliver joined-up services and optimal care to patients with highly specialised needs. Subject to the NHS listening exercise and the passage of the Health and Social Care Bill, the NHS commissioning board will commission specified specialised services, with commissioning consortia responsible for commissioning other complex services. Through consortia, general practitioners and other clinicians will have new opportunities to shape the way that health services are designed and delivered. Taking into account the increasing range of NICE quality standards, consortia will work closely with secondary care and other health care and social care professionals, and with community partners.

We will ensure that there is particular emphasis within the “pathfinder” programme on testing ways of ensuring that consortia quickly develop knowledge and expertise in relation to more complex and specialist services. This will include exploring joint commissioning with local authorities, for instance in relation to care and support for people with long-term mental health conditions, and people with learning disabilities, allowing people to remain in their local communities maintaining their relationships with family and friends.

We will ensure that the NHS commissioning board has a particular focus on promoting quality improvement in relation to more complex or specialist services.

We have also announced our intention to make safeguarding adults boards a legal requirement. This will strengthen the local governance and accountability of safeguarding arrangements. It will enable local partners in local authorities, the NHS and the police to work closely with their communities to safeguard vulnerable adults. Safeguarding adults boards currently exist in every local authority but are not mandatory. By legislating we intend them to make them stronger in their efforts to prevent abuse and to respond unequivocally where it does occur.

We will also take steps to support, and respond to, whistleblowers. Our proposals for Health Watch mean that local health watch organisations could ask CQC to investigate services where they have concerns. In addition, proposals for local health watch to signpost people to information about services and help them if they want to complain about NHS services would provide additional “early warning” of problems with particular services. This could lead to Health Watch being able to “enter and view” services and make recommendations about improvements.

Every part of the system must be working to drive up standards and take collective responsibility for minimising the chances of this series of events happening again.

Southern Cross Healthcare

Paul Burstow Excerpts

Tuesday 7th June 2011 Written Statements

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

The House will be aware of concerns over the future financial viability of the care home company Southern Cross Healthcare.

The Government understand that recent events and media speculation will have caused concern to residents in Southern Cross care homes, their relatives and families and staff

The Government’s primary concern in this matter is for the welfare of the residents living in Southern Cross homes. That must be paramount. For that reason, it is important that this matter is resolved in a measured and orderly manner.

Officials have been in frequent contact with Southern Cross’s senior management over the last three months and continue to be so. Ministers have been monitoring the situation carefully.

Through discussions with Southern Cross, its landlords and its lenders, we have ensured that everyone involved understands their responsibilities towards the residents.

Whatever the outcome of the restructuring by Southern Cross, no one will find themselves homeless or without care. The Government will not let that happen. The Department has been working with the Local Government Association, the Association of Directors of Adult Social Services and the Care Quality Commission, to ensure that all agencies are clear on our respective roles and responsibilities.

It is for Southern Cross, its landlords and those with an interest in the business, to put in place a plan that stabilises the business and ensures continuity in the operation of the care homes. That process is in hand and we must let it continue. We believe that the commercial difficulties that Southern Cross has encountered are capable of resolution within the sector. It is not the role of Government to interfere in these commercial negotiations.

All parties involved—including other Government Departments, local authorities and the Care Quality Commission—are ready to take decisive action if these plans do not create a viable platform for the future

There are clear and effective protections in place that cover this situation. No resident—whether publicly or self-funded—would be left homeless or without care. In an emergency, a local authority can provide residential accommodation to anyone who has an urgent need for it. A local authority would continue to provide care for any self-funding resident who was unable to find or arrange care for themselves.

The Government will continue to monitor the situation closely and reiterate to all parties that they have a collective responsibility to resolve the situation in a way that does not put at risk the continuity or quality of care of residents.

Social Care Services

Paul Burstow Excerpts

Tuesday 17th May 2011 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Brady. I congratulate the hon. Member for Stockton North (Alex Cunningham) on his luck in securing the debate and on his choice of subject.

I agree with the hon. Member for Islington South and Finsbury (Emily Thornberry) on one point at least, which is that social care is not debated and discussed in this House anywhere near enough. I speak with the experience of 13 years in opposition and as one of the few who has carried the candle for social care and advanced the arguments, which I have heard others make today, on the need to focus on quality and to make sure that we do well by and develop the work force. I shall return to some of those points.

I agree that the long-term reform of our social care system should no longer be deferred to the long term. It requires our full attention now. We need to make sure that, during the life of this Parliament and, I hope, with the assistance of people of good will from all sides, we can secure lasting reform of both the law and the funding arrangements for social care. Our constituents expect no less of us at this time.

The hon. Member for Stockton North began by referring to last week’s march and lobby. A number of constituents lobbied me, and I met several of them at my surgery last weekend to discuss their issues. They have real concerns, to which the Government are listening and want to respond properly. We share a common goal, which is to maximise personal independence to allow people of all abilities to fulfil their potential. That has to be the common goal of both our benefits system and our social care system. It is certainly this Government’s ambition to achieve that.

I do not belittle in any way, shape or form the stories of the lives of individuals and the impacts of decisions made about spending in different parts of the country. The hon. Gentleman has rightly set out those individual and personal impacts. However, I will offer him a reflection on the past 13 years and, indeed, before that. The stories that he has told could have been told and have been told over the past 13 years, during which time we have seen a gradual tightening of eligibility criteria. Indeed, in 2008 the Learning Disability Coalition published a survey that showed that 72% of what were Labour authorities at that time anticipated—indeed, they were budgeting for this—tightening their eligibility criteria for access to services from “moderate” need to “substantial” need or even to “critical” need. I will discuss the reality in a moment.

Although the hon. Gentleman has rehearsed some important points, what I did not hear was a scintilla of humility, a suggestion of any doubt, or a slight recognition that we are where we are at least in part because of actions taken over the past 13 years. It would have been good to hear just a little indication that we are where we are because of what has already happened.

[Alex Cunningham]

Will the Minister give way?

[Paul Burstow]

In a moment. If the hon. Gentleman will let me make my point, I will be happy for him to attempt to rebut it. There are things that did not happen over the past 13 years. We did not get to a position where we had a clear statutory basis for adult safeguarding. We did not get to a position where we had consistency of regulation, because the regulator was constantly being abolished and reformed. Funding has been inadequate for many years, and we have seen a failure, for various reasons over 13 years, to find a way forward that has secured consent for funding.

[Alex Cunningham]

The Minister said that I did not show any humility, but I specifically said that the previous Government and others before them could have done much more on social care. I specifically said that, and it is important that that remains on the record. In the past 20 or 30 years, no Government have addressed the fact that so many more older people and so many more young disabled people will require tremendous support. I hope that the Minister will acknowledge that we all need to do this together.

[Paul Burstow]

Yes; we can build on that point. The Government recognise the importance of social care and the fact that it lets people live independently, which is what it should be about. It should be about enabling people to live well, to be safe, to continue to do things that we take for granted and to be active participants in civic life.

As has been rehearsed in this debate, there are big challenges. There are demographic challenges and the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) has outlined some of those facts. The hon. Member for Wolverhampton North East (Emma Reynolds) has rightly said that, while we should be concerned about the challenge, we should not be so concerned as to forget to celebrate the fact that we have an ageing population—a population that is living for longer and, in many cases, living healthily for longer as well. We also have changing societal expectations and a greater expectation of being able to make choices for oneself, to be in control of one’s own life and to be able to have high standards of support to facilitate that. We have financial challenges. We have a structural deficit. For every £4 that this Government spend today, £1 is borrowed, and we are spending £120 million every day on interest charges.

Reference has been made to the survey by the Chartered Institute of Public Finance and Accountancy for the BBC. I have to say that, of the many surveys that have been produced, including that of the hon. Member for Islington South and Finsbury, it is probably the least robust of the lot. There we go—I give the hon. Lady credit that her survey must be more robust than that of CIPFA, which did not provide a great deal of detail and did not ask the right questions. Indeed, those who answered the questions were not all social services authorities, and they included things in their figures that are not part of social care. Even the Association of Directors of Adult Social Services has criticised that piece of work.

On attempting to address and mitigate the impact of the reductions that the Government have had to make in formula grant over the past year, we have strived to mitigate it in those areas with the greatest needs to make sure that we have increased the support in those areas, relative to others.

The hon. Member for Stockton North talked about high mortality figures in constituencies such as his own. Again, we have to dwell on why that is still the case after so many years, why we still have that legacy, why we have to continue to address those challenges, and why this Government, through their commitments in public health and elsewhere, are determined to make progress.

Despite the deficit legacy, we have taken some decisions. Members have forecast that I would refer to them, and I make no apology for that. We set out in the spending review in October how we would ensure sufficient resource in the system to allow decision makers at a local authority level to protect social care, if they decide that that is their priority. We have a good settlement in that context. An additional £2 billion will come to social care by 2014-15, and that money is getting through. In January, £162 million was put into social care via the national health service, which is something that we were asked to do and which we have done to ensure that social care gets additional support. Moreover, there is £648 million of additional funding from April this year. That money is going to social services departments and is being transferred by the NHS for that very purpose. A further £1.3 billion is supporting the transfer of funding for the commissioning of learning disabilities.

Those sums constitute the biggest transfer of hard cash from the NHS to social care ever. It is not only about supporting social care, but about breaking out of silos. It is about using cash to get people to start having those dialogues that are so important to achieve the collaborative behaviour and integration that are essential to delivering better services for our citizens.

On top of that is the £530 million that will come through the formula grant. I will not micro-manage, from this Chamber or my desk in Whitehall, every single social services authority and tell them how to use that money. It must be their decision, based on need, and they are accountable for such decisions.

[Emily Thornberry]

The Minister has anticipated what I am about to say. First, if money is being transferred from the health service to social care, I presume that it is being done by primary care trusts, which are at the same time being abolished. Is he confident, therefore, that that money is properly accounted for by the Department of Health, given the current chaos reigning within the health service? Secondly, will he tell us how much of the money given to local authorities is actually being spent on social care in the way in which it is supposed to be?

[Paul Burstow]

The answer to the first question is yes. The answer to the second question is that I will write to the hon. Lady with further detail. However, it is certainly the case that money is being agreed between the NHS and social services for the provision of social care services that support health and underpin prevention.

I would also like to refer to the work of the King’s Fund, which is reputable body that is often cited by Opposition Members. It has confirmed that, if we take into account efficiency savings, there is no funding gap for social care during the spending review period. Of course, the grounds on which some councils have made their budget judgments mean that some have acted to protect social care through innovation and the redesign of services. Other councils have decided to change their eligibility or charging policies.

Reference has been made to the ADASS survey, which shows that social care spending as a share of council spending has increased. The hon. Member for Islington South and Finsbury has referred to savings that local authorities are making. For every pound of savings that will be made from social care this year, 70p is a result of efficiency and doing things differently and only 20p—this is still something that I regret—is a result of actual reductions in service.

Yes, eligibility has been tightened, but that is not new. As I have mentioned, a survey carried out by the Learning Disability Coalition shows that those tightenings in eligibility criteria have been part and parcel of local government decisions for many years. Indeed, the ADASS survey shows that, when this Government came into office last year, 101 local authorities were already limiting eligibility to services to those with “substantial” need. Twelve months later, 116 local authorities are using “substantial” need and just six are using “critical” need. It is worth looking behind those headlines, because some councils are changing the eligibility criteria, but they are reinvesting the savings they make from that decision into preventive services, such as telecare and giving people personal budgets. For example, Southwark council has reviewed the needs of people with learning disabilities and is changing its services through the introduction of personal budgets, supported living and providing more control and dignity. It is saving resources, but it is also giving people a better quality of life.

The hon. Member for Newcastle upon Tyne North described the unacceptable quality of care in some care homes and the inquiry that was carried out by a local broadcaster. She is right to describe some of the shocking stories that she has heard and to decry how older people all too often get relegated in the headlines compared with scandals over the care of children. She talked about the Care Quality Commission and the fact that it has changed its inspection model. I respectfully suggest that the basis for the legislation that introduced essential standards and has led to a more risk-based model for inspection was debated in the House not under this Administration, but under the previous one. We have not abandoned the changes the previous Government started or thrown the whole regulatory framework up in the air yet again and caused chaos, as often happened in the past 13 years. We are trying to ensure that that model delivers.

The hon. Member for Newcastle upon Tyne North asked about skills and training. Those issues were also touched on by the hon. Member for Blaydon (Mr Anderson). The Government are working with Skills for Care, which will produce work force, retention and personal assistance strategies to address the sorts of concerns that the hon. Lady and others have mentioned. I will publish those shortly.

[Catherine McKinnell]

I want to reassert the point that, regardless of the changes put in place during the past 13 years under the previous Administration, we are moving into unprecedented territory in terms of the funding given to local authorities for supporting social care within the community. That is the context in which some of the changes that we are demanding and requesting today need to be considered.

[Paul Burstow]

I have rehearsed some of the findings from the ADASS survey, which shows that although the changes are tough, they are not as unprecedented as the past 13 years of experience would suggest.

The hon. Member for Blaydon talked about the mixed economy of provision in social care and lamented the passing of a time when a public service offer was the almost exclusive way in which social care was provided. He harked back to a golden age that has passed and that may never have truly existed. I am not certain whether I heard him describe a solution or route map that would get us back to the past that he hankers after. If he has one, perhaps he would share it on another occasion. He also talked about Southern Cross. As a Minister, I am, of course, only too well aware of the issues with which that company is currently grappling. Above all else, I am concerned to safeguard the interests of the residents who live in those homes. That should be on our minds whenever we talk about Southern Cross and its prospects. We need to ensure that we secure its future for its residents.

[Mr Anderson]

I agree with the Minister entirely. I also agree that the previous Government did by no means get things right for 13 years, which is also true of other previous Governments. My worry is that we are being railroaded by a cuts-led agenda. In the past, we at least had a safety net of council provision, but that will no longer exist. Therefore, when organisations such as Southern Cross go belly up, there will be no one to pick up the pieces.

--- Later in debate ---

[Paul Burstow]

My point is that when we came into office, 101 local authorities were already limiting access to services on the basis of “substantial” need. We should not pretend that some overarching change is now happening.

Let me move briefly to the question of the future, which was also a key part of the debate. I am under no illusion that although the settlement that we secured for social care is good, it is only a bridge and a sticking plaster in terms of the future. The social care system needs radical reconstruction surgery, and its funding needs be seen as what it is—a big issue. My ministerial mailbag shows that it is one of the biggest matters about which people write to their MPs, who in turn write to me. There is a real and understandable grievance out there about paying for social care. People feel shock and bewilderment, and they are appalled by the current system because, after paying taxes all their lives, they have to pay for care. That leaves a bitter taste in the mouths of both those who use the services and, in many cases, their families.

I agree with the hon. Member for Stockton North that we need to change. That is why the Dilnot commission, which this Government established last year, offers us hope and a way forward. It has been asked to consider whether there should be a fair partnership between the state and the citizen. The prize that we could grasp is peace of mind and a sustainable system for the future. I will ensure that the points made by the hon. Member for Wolverhampton North East are passed on to the commission, so that they form part of its considerations. It is not sufficient to reform funding alone, because we also need a modern statute founded on 21st-century principles of self-determination, reciprocity and responsibility. The current law is a mess: it is confusing; it lacks coherence; and it is hard to understand.

[Emily Thornberry]

On the issue of confusion, the Minister spoke earlier about the King’s Fund and said that its view is that cuts will not be made to social care. I have just checked that, and I believe that the King’s Fund has said that there will be a shortfall of £1.2 billion by 2014-15.

[Paul Burstow]

The King’s Fund has stated that but, if one reads on, the document concerned states that if efficiencies of 3.5% are made, there is no need for a funding gap to open up.

On social care law reform, our current legislation is the product of 60 years of piecemeal legislation that looks back to 19th-century poor law principles. A Law Commission report makes 76 recommendations and provides a firm foundation on which we can build. The Government intend to publish a White Paper later this year and to introduce a Bill in the second parliamentary Session.

Our intentions are clear. During the life of this Parliament, we want both the law on social care and its funding to be reformed. We want that reform to be based on a vision in which there is a greater personalisation of social services, a more preventive focus on how those services are provided and a real attempt to deliver around outcomes. We want services that are more innovative and that are based around growth, telecare and involving other providers. There also needs to be a partnership between the individual, the state and health and social care providers. That is how we can secure the future of social care and make a real difference for every one of our constituents. I thank the hon. Member for Stockton North for initiating the debate, and I hope that we will have more debates about social care than have taken place during the past 13 years.

NHS Prescribed Medicines

Paul Burstow Excerpts

Wednesday 4th May 2011 Westminster Hall

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

I congratulate my hon. Friend the Member for Stourbridge (Margot James) on securing the debate and on setting out so clearly the issues that affect many of our constituents. Ensuring that NHS patients have access to the medicines they need when they need them is absolutely vital. My hon. Friend is right to have described the situation in such terms herself. I can assure her that the Department takes the supply issues she has raised very seriously indeed.

It might be helpful if I start by giving a sense of the scale that we are talking about. There are about 16,000 licensed presentations of medicines. That covers different formulations such as tablets, capsules and injections, and different dosages. The most recent figures record that there were more than 10,600 community pharmacies in England and nearly 900 million prescription items are dispensed each year. The production of medicines is truly a global business, with ingredients supplied from all over the world. In such a large and complex system, there will from time to time be problems with the supply of medicines. However, where there is evidence of systemic or real issues, the Government need to act and intervene appropriately.

Such problems are not new, and nor are they confined to the UK. They can occur for a number of reasons; for example, there might be manufacturing problems or difficulties in obtaining raw materials. They can also occur as a result of distribution problems, or through the parallel exporting of medicines when exchange rates or prices make that a lucrative trade. The increasing trend towards the concentration of manufacture within global pharmaceutical companies has exacerbated the situation. That means there is little flexibility if problems are experienced at particular manufacturing sites. Production schedules have to be planned months in advance, and if one company is unable to supply a product, others may be unable to make up the shortfall at short notice. Therefore, there is a need for the regulatory framework that my hon. Friend talked about.

Supply issues can also arise as a result of the parallel trade. The strong euro means that parallel imports into the UK have declined and the incentives for UK medicines to be exported to other European countries have increased. I stress that, as my hon. Friend said, parallel exporting is legal and that it can be carried out legally by anyone who holds the necessary licences under the medicines legislation. She has rehearsed some of the statistics on the number of companies that have such licences, and as has rightly been said, prevention of the export of UK medicines would be contrary to EU trade laws.

However, there are legal duties on marketing authorisation holders and manufacturers and distributors within the limits of their responsibilities to ensure appropriate and continued supplies to pharmacies, so that the needs of patients are met. The Government work closely with pharmaceutical companies, wholesalers, pharmacists and the NHS to ensure that the system delivers medicines to patients quickly. They also monitor individual supply problems and work closely with individual manufacturers to prevent shortages, and manage consequences when there are shortages.

As has been said, the Department has published joint best practice guidelines with the Association of the British Pharmaceutical Industry and the British Generic Manufacturers Association in order to help manage shortages as and when they arise. Those give guidance to companies on what to do in the event of a shortage, and recommend that companies communicate with the Department as soon as possible about impending shortages that are likely to impact on patient care. The Department, the Medicines and Healthcare Products Regulatory Agency and pharmaceutical supply chain stakeholders—the manufacturers, wholesalers and pharmacy representatives—continue to work collaboratively, better to understand and mitigate the impact of supply difficulties associated with parallel exports, so that patients receive the medicines they need.

We have also established, as was said, the medicine Supply Chain Group as a forum for organisations to meet and exchange information, understand the causes of the supply problems, including those due to parallel trade, and seek possible solutions. The Supply Chain Group continues to meet with individual companies in order better to understand the issues, and to explore ways of mitigating them and to take forward the action points agreed at the ministerial summit last year.

My hon. Friend asked about lay and patient representation on that body. As I understand it, the British Medical Association plays a part in acting as a conduit for that voice. There is a good case for looking at whether that should be changed, so that such representation is not simply through the BMA and that patients have their own voice in those deliberations—not least given the Government’s commitment to the introduction of Health Watch England and the desire to see a greater place for patient interests across the system.

The summit made a number of recommendations. The first, as we have discussed, was the publication of “Best practice for ensuring the efficient supply and distribution of medicines to patients” in February 2011. That also offers practical guidance on the use of quotas by manufacturers. Also published was the joint guidance on the legal and ethical obligations on the supply chain, “Trading Medicines for Human Use: Shortages and Supply Chain Obligations”, in November 2009. That was updated and republished in December 2010. We also developed and are maintaining a list of products in short supply. That is published on the Pharmaceutical Services Negotiating Committee’s website, so that no one—I repeat: no one—trading in those products has the excuse that they are not aware of supply difficulties. The MHRA is conducting a series of targeted inspections aimed at those who jeopardise patients, in order to ensure that they comply with their supply duties and that those who breach existing duties face the consequences.

My hon. Friend said that there have been no prosecutions. The intention is to change behaviour and ensure compliance, rather than undertake regulatory intervention, which would result ultimately in suspending licences or in criminal proceedings, although in many other cases licences are suspended for other reasons. As a result of those arrangements, medicines are getting through to patients. I am concerned, however, to hear the examples given by my hon. Friend today. As she documented, there are in some cases completely unacceptable periods of delay. However, the latest evidence from the pharmacies at the end of the supply chain is that in England there are supply problems with approximately 50 products.

My hon. Friend raised a point about standards and the work being done by the MHRA to ensure that packages are consulted on to improve quality standards across the system. The approach to inspection is a risk-based one involving targeted inspections, and there has been an increase in the number of staff to support the resulting increased work load. I stress that the 50 products currently identified as being in short supply have to be seen in the context of the 16,000 licensed presentations of medicines. The affected medicines are used to treat a wide range of conditions. They include treatments such as Femara for breast cancer, Cipralex for depression and CoApprovel for hypertension. For that reason, the guidance we issued in February recommends that pharmacy and general practice staff should advise patients to request their prescriptions in good time. Most companies have put contingency arrangements in place, so that pharmacies can obtain supplies of medicines directly from them if they are unable to obtain them from their usual wholesaler. The time taken for supplies to be obtained in that way varies from company to company, depending on the nature of the arrangements, but we have been assured by the companies concerned that they endeavour to supply their products as soon as possible. However, I will draw the attention of officials and others to the evidence that my hon. Friend has drawn my attention to today.

I would like to take this opportunity to pay tribute to the efforts made by pharmacy staff, who have worked tirelessly to ensure that patients have not gone without their medicines—it is key to stress that. Patients and prescribers also have an important part to play. Prescribers should, where appropriate, consider a change in medication for patients, and advise patients to request prescriptions in good time where there are supply difficulties.

My hon. Friend referred to article 81 of directive 2001/83 as a textbook example of the UK Government’s not gold-plating such a regulation, but said that in this case, that was possibly not the thing to do. I hope that I have outlined a series of measures that this Government are taking to secure the supply chain and to ensure that everyone in the supply chain understands their obligations to patients. I stress, however, that we have not ruled out taking any of the further steps she has suggested. We want to be sure that we have proper evidence of resulting harm to the patient interest before we act. That is why we are keeping matters under review, and targeted inspections will play their part in gathering further evidence. If there is other evidence from other parts of the supply chain, we would certainly want to look at that carefully. The London School of Economics is doing some comparative work, looking at other jurisdictions where such public service obligations have been introduced, and that will also inform our thinking.

I am grateful to my hon. Friend for raising these important matters. I assure her that the Government are committed to patients getting their medicines quickly. If all parties in the supply chain adopted the best practice guidance issued in February, the problems caused to patients by parallel trade would reduce. The guidance sets out the aim that, under normal circumstances, pharmacies should receive medicines within 24 hours, although there may be circumstances where that is not always the case. We do not believe that increasing the regulatory burden at this point is the right answer, but we will keep that under review. The Government will continue to work closely with all those involved in the supply chain to ensure that NHS patients get the medicines they need when they need them. That is our enduring commitment.

Social Care PFI Credits

Paul Burstow Excerpts

Thursday 28th April 2011 Written Statements

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

On Monday 11 April 2011, we confirmed continued financial support rising to £10.1 million by 2014-15 for four local authority social care PFI projects in England.

Following the spending review in October 2010, which transferred responsibility for PFI schemes to sponsor Departments, the Department of Health undertook a full review of the affordability of the social care PFI scheme and the quality of the proposals that had bid for support. This is in line with the cross-Government reassessment of PFI schemes to ensure they do not create an unaffordable burden.

The projects to receive PFI credits are based in Leeds, Hull, Sandwell and Hammersmith. They will all provide community social care and health facilities for vulnerable people. These projects were among 17 that the Department reviewed. The criteria for the review were: available funding, deliverability and minimising waste—giving priority to those projects already in procurement.

The Government will look to the local authorities whose projects were unsuccessful to give priority to them as front-line services or to look at other ways of providing these services.

Oral Answers to Questions

Paul Burstow Excerpts

Tuesday 26th April 2011 Commons Chamber

[Keith Vaz (Leicester East) (Lab)]

4. What his policy is on funding for a national framework and quality of service guidelines for diabetes patients.

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

To support the NHS in improving outcomes, the National Institute for Health and Clinical Excellence has published a quality standard for diabetes building on the existing national service framework, which provides an authoritative definition of good-quality care. Under proposals in the Health and Social Care Bill, quality standards will have a central role within the new system’s architecture.

[Keith Vaz]

May I declare my interest as someone who has type 2 diabetes, and remind the Minister that we currently spend 10% of the NHS budget—£1 million an hour—on diabetes-related illnesses? Does he agree that what is central to this framework is providing funding for prevention? If we can prevent and assess diabetes, we will save a great deal of money in the long run.

[Paul Burstow]

I certainly agree with the right hon. Gentleman that prevention is undoubtedly the right way forward, but earlier diagnosis is also very important. That is why we continue, as a Government, to support the roll-out of NHS heath checks for people aged 40 to 65 as a way of ensuring that we detect more readily and earlier so that we can provide the appropriate support.

[John Pugh (Southport) (LD)]

Just 10 minutes ago, I met representatives of Diabetes UK, who want to see greater emphasis on integration and co-operation between and within services in the NHS Bill. Can I assume that they will not be disappointed?

[Paul Burstow]

As my right hon. Friend the Secretary of State has already indicated in today’s exchanges in this House, we are committed to listening and reflecting during this pause, and to ensuring that we come back with substantive improvements to the Bill to deliver its central purpose of improving health care for the people of this country.

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

5. How much his Department allocated to the provision of out-of-hours surgeries in the last 12 months for which figures are available; and if he will make a statement.

--- Later in debate ---

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

7. What estimate he has made of the number of local authorities which changed their eligibility criteria for social care in the last 12 months.

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

Decisions about eligibility criteria are a matter for local councils. As part of last year’s spending review, the Government committed an additional £530 million through the local government formula grant, and £648 million in direct support from the NHS, to support social care, as well as £150 million for re-ablement. By 2014, that will rise to £2 billion of additional support for social care.

[Mrs Riordan]

Is the Minister aware that according to a recent survey by the Association of Directors of Adult Social Services, 19 local authorities including my own, Calderdale, have had to raise the eligibility criteria for social care because of the cuts that they have received from the Government? Does he stand by his statement of 21 October that there is

“no justification for local authorities to slash and burn or for local authorities to tighten eligibility”?

[Paul Burstow]

I certainly stand by the idea that the Government provided adequate resources in the financial settlement last year, alongside efficiency savings, to ensure that every local authority could choose to maintain the current levels of eligibility and services in its area if it so wished.

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

Will the Minister examine situations in which domiciliary care contracts are awarded under the EU public procurement directives, to ensure that especially when they are awarded on price, they are not dumbed down and the level of service reduced?

[Paul Burstow]

My hon. Friend makes an important point about ensuring that competition is always based on quality, not just price. If she would like to write to me with more details about the matter, I would certainly be happy to follow it up with her.

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

Since the Government are no longer doing an assessment of the provision of social care by local authorities, I have done it for the Minister. My survey has found that not only have eligibility criteria been tightened, but 88% of councils are increasing their charges, 63% are closing care homes and day centres and 54% are cutting funding to the voluntary sector. Now that I have told the Minister the facts, will he take back his comment that

“no councils need to reduce access to social care”?

Would he like to start being straight with the public?

[Paul Burstow]

I will take Labour facts with a pinch of salt. Under Labour, social care was always very much the poor relation. Under this coalition, social care has received a £2 billion spending boost and an unprecedented transfer of resources from the NHS—something that the hon. Lady’s party, if it had been in power, would not have been able to do, because it would have been busy cutting the NHS.

[Simon Danczuk (Rochdale) (Lab)]

8. What plans he has to visit NHS services in Rochdale; and if he will make a statement.

--- Later in debate ---

[Karen Lumley (Redditch) (Con)]

10. What progress he has made on the establishment of local health and wellbeing boards.

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

Almost nine out of 10 local authorities have signed up as early implementers to press ahead with the setting up of health and wellbeing boards. Councillors, clinicians and local communities have told us that by working together through those boards, they can and will improve health and care outcomes for local people.

[Karen Lumley]

Does my hon. Friend agree that giving greater public health powers to the health and wellbeing boards will allow more targeted help in our local communities?

[Paul Burstow]

Absolutely. By bringing public health home to local government we will have the opportunity to ensure that many of the underlying causes of ill health can be tackled more effectively, and that is why we are making the reform in this way. By having a health and wellbeing board that brings together all the interested parties we can also ensure a far more integrated approach.

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

Will the hon. Gentleman persuade the Secretary of State to come to Yorkshire and perhaps speak to a small group of people—no more than 60—in a quiet room about what these boards are supposed to do? Who will be on them, how accountable and transparent will they be, and will they have any teeth?

[Paul Burstow]

My right hon. Friend of course is more than happy to go to all sorts of places to talk to people about the health reforms. However, local government fully supports this particular proposal and sees it as a vital innovation for the involvement of local government in the health service. It will be transparent because it will be part of the local authority and will meet in open.

[Neil Parish (Tiverton and Honiton) (Con)]

11. What recent assessment he has made of progress by GP pathfinder consortia in delivering improvements in NHS services.

--- Later in debate ---

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

T5. There is some concern about whether GP consortia will be given enough specialist support when commissioning integrated cancer services. Will my right hon. Friend use the pause in the passage of the Health and Social Care Bill to consider extending the guarantee for cancer network funding from 2012 to 2014, when the transition period ends and GP commissioning comes fully into effect?

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

I am grateful to the hon. Gentleman for his question. The listening exercise is a genuine one, and we intend to bring forward appropriate changes as a result. I can certainly give the commitment that we will want to take on board such representations. We are, and consistently have been, committed to such clinical networks for the valuable contribution they make.

[John Mann (Bassetlaw) (Lab)]

T7. If Bassetlaw council refers the reconfiguration of accident and emergency, paediatric and maternity services at Bassetlaw district general hospital to the Secretary of State, what criteria will he use to make a decision?

--- Later in debate ---

[Annette Brooke (Mid Dorset and North Poole) (LD)]

I have received representations from constituents regarding the reclassification by the primary care trust of elderly relatives for continuing health care funding, with severe needs apparently becoming moderate over time. Does the Secretary of State share my concern about this, and how widespread is this practice in the current climate?

[Paul Burstow]

My hon. Friend’s point is important and I regularly receive correspondence about this from hon. Members from all parts of this House. If she wishes to write to me, I will be happy to discuss the matter with her further, once I have had a chance to look at the details.

[Mr Dave Watts (St Helens North) (Lab)]

Given that Department of Health officials are actively discussing the privatisation of my local trust behind closed doors and are signing secret documents, will the Minister publish all those documents and will he make a statement in the House about the Government’s plans to privatise some of our NHS hospitals?

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

Diabetes UK has a strategy to reduce the number of people with diabetes across the whole UK. Will the Minister tell the House what discussions he has had with the Northern Ireland Assembly—the matter is devolved in Northern Ireland—to ensure that the strategy of prevention, awareness and education is followed across the whole of the UK?

[Paul Burstow]

The hon. Gentleman is absolutely right, because this strategy must contain four elements; it must be about prevention, earlier diagnosis and appropriate self care, and we also have to have world-class research. Discussions with the Northern Ireland Assembly are ongoing.

[Duncan Hames (Chippenham) (LD)]

Professional autonomy need not come at the expense of transparency in the provision of public services. Given that the Department for Education was able to extend the Freedom of Information Act to academy schools, does the Minister agree that it would be healthy for the Act to apply also to GP consortia in the NHS?

Adult Autism Strategy

Paul Burstow Excerpts

Friday 1st April 2011 Written Statements

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

I am announcing the Government’s publication tomorrow of “Fulfilling and Rewarding Lives: Evaluating Progress”—a set of key outcomes and service ambitions to secure implementation of the adult autism strategy. A copy of the document has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.

“Fulfilling and Rewarding Lives: Evaluating Progress” has been produced to deliver against a commitment made in the first-year delivery plan to produce a self-assessment template for localities to check progress on implementing the goals set out in the adult autism strategy.

The document details a set of seven key outcomes and three service ambitions which provide a consistent and tangible way to assess progress in each area. Over time, they will evolve into a jointly owned set of outcomes that all parties—local partners, adults with autism, central Government and others—can use to understand progress, and become a focal point for developing improved services.

The document reflects the Government’s ambitions for local autonomy, where precise top-down targets are replaced by desired outcomes, where implementation and investment is determined by local priorities—as agreed by local communities through activities such as the joint strategic needs assessment (JSNA)—and where central Government’s role is about facilitation rather than direction.

This means a new approach to evaluating progress on the autism strategy, with a focus on identifying the outcomes which will enable local and national assessment of whether the lives of adults with autism are improving. The Government will take the lead in supporting local partners to deliver change

In developing “Fulfilling and Rewarding Lives: Evaluating Progress”, we have worked closely with partners such as the Care Quality Commission, the Association of Directors of Adult Social Services, the NHS Confederation and voluntary and independent groups, to select the most relevant outcomes.

The document also includes a generic template for estimating local area need for use when commissioning services for people with autism. This will help provide a source of future information locally on progress. The learning disability public health observatory will collate data using the template by publishing information from each locality.

The development and launch of the autism strategy led to a range of activities at local and national level to improve services for adults with autism. To help continue that momentum the self-assessment template will enable local areas to assess their own progress towards the goals set in the strategy, and towards implementing the statutory guidance.

The Department has also funded a series of online training resources and booklets to increase awareness and understanding of autism across all public services. Working with the Royal College of Nursing, the Royal College of Psychiatrists, the Social Care Institute for Excellence, the British Psychological Society, the Royal College of General Practitioners, Healthtalkonline, Skills for Health, and Skills for Care, we have produced a range of quality materials to enable front-line staff to recognise better, and thus respond more effectively to, the needs of adults with autism.