Adult Autism

Paul Burstow Excerpts

Monday 20th December 2010 Written Statements

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

I am announcing today the Government’s publication of “Implementing Fulfilling and Rewarding Lives”, guidance for local authorities and NHS organisations to secure implementation of the autism strategy. I launched this guidance at a conference convened by the National Autistic Society on 17 December 2010. A copy of the guidance 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.

This statutory guidance has been published in fulfilment of the requirements in the Autism Act 2009 that the Secretary of State publish a strategy on services for adults with autism in England by 1 April 2010, and issue statutory guidance no later than 31 December 2010.

The strategy “Fulfilling and Rewarding Lives” was published on 3 March 2010. This Government have made a very clear and firm commitment to drive forward work to tackle the disadvantage which people with autism and their families sadly so often face, and to step up the pace to deliver that strategy.

The purpose of this guidance is to secure the implementation of the Fulfilling and Rewarding Lives strategy. It gives guidance to local authorities, NHS bodies and NHS foundation trusts on issues set out in the Autism Act. This guidance will help these bodies to develop services that support and meet the locally identified needs of people with autism and their families and carers and enable local transparency and accountability.

As set out in section 3 of the Autism Act, this guidance is to be treated as though it were guidance issued under section 7 of the Local Authority Social Service Act 1970 (LASS Act). This means that local authorities must

“follow the path charted by the guidance, with liberty to deviate from it where the authority judges on admissible grounds that there is good reason to do so, but without freedom to take a substantially different course.”

Though the LASS Act does not directly apply to NHS bodies, the Autism Act makes clear that for the purposes of this guidance

“an NHS body is to be treated as if it were a local authority within the meaning of the LASS Act”.

The guidance focuses on the key areas required by the Act, in each case identifying what health and social services bodies are already expected to do, and setting out any additional requirements introduced by the strategy. An underlying principle is to avoid new burdens.

This guidance has been informed by an extensive consultation on draft guidance between July and October this year.

The Secretary of State has a duty, under the Autism Act, to keep the strategy under review: as part of this, the guidance will also remain under review and will be updated as required.

Drug-Related Crime and Rehabilitation

Paul Burstow Excerpts

Thursday 16th December 2010 Written Statements

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

Professor Lord Patel of Bradford OBE was asked by the Department of Health and the Ministry of Justice to lead a review of drug treatment and interventions in prisons and for people on release from prisons in England and provide a report, with recommendations.

The report aims to raise the ambition about what can be achieved in regard to drug treatment and interventions in prisons and to consider efficiencies and cost effectiveness.

Lord Patel’s report 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.

I would like to thank Lord Patel and his review group for the thoroughness of their work.

As outlined in the coalition programme for government, we are aiming to overhaul the system of rehabilitation to reduce offending, and to ensure that sentencing for drug use helps offenders to come off drugs. We want to promote innovation in service provision and commissioning. Payment by results will be an important tool in achieving progress.

In the comprehensive spending review, the need for continued, substantial investment in drug treatment was reaffirmed. As part of our commitment to ensuring that there is local pooling of resources it has been agreed that some budgets previously held by the Home Office and the Ministry of Justice will transfer to the Department of Health from April 2011. This will allow us to look in a more joined-up way across the total spend on drug treatment to improve the treatment journey and avoid wasting resources.

We welcome Lord Patel’s contribution to the important drugs treatment debate and will be looking carefully at the recommendations and evidence his group has collected. This Government believe that given the substantial investment in drugs and the strong association between the use of drugs and reoffending, we should be ambitious in our aims to improve efficiency and effectiveness, focusing on recovery outcomes, encouraging offenders to come off drugs.

Patient Confidentiality (Mentally Ill)

Paul Burstow Excerpts

Thursday 9th December 2010 Commons Chamber

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

I congratulate my hon. Friend the Member for New Forest East (Dr Lewis) on securing this debate. Having had the opportunity to deal with two Adjournment debates this week, I reflect on the fact that this was an entirely fitting and appropriate way to raise very serious matters, which was not entirely the case in the debate that I replied to yesterday.

My hon. Friend is absolutely right to raise these issues and to bring a distressing case to the House’s attention. It is the most appalling human tragedy when a young person with so much to live for ends their own life. For the friends and family, the tragedy is all the greater when there is a sense that more could have been done to prevent the person from taking that action. I know that the parents of the young lady in this case continue to grieve for the desperate loss of their daughter. I can absolutely understand their need for answers and explanations, and for assurances from the relevant authorities that out of these tragic circumstances, some good may come. That is what I hope to be able to offer in my response.

I am afraid that I have to start my remarks by saying that this case has some painful similarities to that raised in another debate to which I responded a couple of months ago. In both cases, the clear and consistent flaw was that families and carers were not properly listened to or involved. Indeed, evidence from the National Confidential Inquiry into Suicide and Homicide points to this being a flaw in too many cases. Where things go wrong in mental health services, it is so often due to communication breakdown between agencies and families. While there has been progress in mental health services in recent years, there is more to be done. In some parts of the country, the system is too secretive and defensive, and not sufficiently joined up to secure the best results for the patient.

My hon. Friend will know that we set out in our coalition programme a commitment for hospitals to be open, and always to admit if something has gone wrong. That is why we plan to give effect to a duty of candour in which health professionals and managers would be expected to inform patients and families about actions which have resulted in harm. Mistakes happen—to err is to be human—but the key thing is that the NHS learns and improves practices so that the same errors are not repeated. I know that that is what the Edgell family are looking for. I expect all parts of the NHS to engage constructively with families like them to understand and learn from their concerns. That is also why we are determined to strengthen the arrangements for whistleblowing so that where standards slip or practice is poor, staff can raise their concerns in the knowledge that they will be treated seriously.

Patient confidentiality emerges as a consistent theme in the correspondence that I have seen between the family and the local NHS; I am grateful to my hon. Friend for passing it to me. He recognises, I think, that the judgments that mental health professionals make are often finely poised. They can be damned if they do and damned if they don’t. There is a balance to be struck between respecting the patient’s wishes, on the one hand, while also acknowledging how friends and family can contribute significantly to the person’s safety, ongoing treatment and recovery.

All NHS organisations have clear legal and ethical obligations to ensure that patient information remains confidential. To resile from this principle, particularly in an areas as sensitive as one’s mental health, would undermine the trust and confidence on which effective treatment is based, increasing the risk of the patient distrusting and disengaging from clinical care. It is very important to stress, however, that, as guidance provided by the Department of Health and the General Medical Council makes clear, patient confidentiality can and should be overridden to prevent significant harm either to themselves or to others. That very much goes to the point raised by the hon. Member for Wirral West (Esther McVey) in her intervention.

As my hon. Friend rightly said, patient confidentiality should not be a barrier to having conversations with families and carers. Those closest to the individual can play a crucial role in helping clinical teams to understand a patient’s illness, and in providing an early warning if their condition changes or deteriorates. I am deeply concerned that not all trusts are applying this principle in practice. We need some basic common sense and compassion in how health professionals deal with concerned families. Having read the paperwork that my hon. Friend shared with me, I cannot help but feel a sense that some medical teams were ticking the boxes but missing the point.

I cannot stand here at the Dispatch Box and enunciate lots of new principles. My hon. Friend is absolutely right that there is already very good practice guidance, as well as clear guidelines from the Department of Health, the GMC and others. However, what we need to do to achieve real change in practice is to ensure that it is clear where professional leadership comes from to drive the practice into everyday action on the ground. One of the actions that I will be taking as a result of this debate is to meet the relevant royal colleges to discuss how we can change and challenge attitudes within general practice—where this all began—and mental health services to ensure that the voice of families and carers is never ignored. Improving mental health is a clear priority for this Government.

There is no health without mental health. Next year, as a result of our commitment to prioritise mental health, we will publish a new mental health strategy, which will set out how the Government will invest in early interventions and the extension of talking therapies, to which my hon. Friend referred, for children and older people. Those things are not all that we must do, but they will make an important contribution to tackling the burden of mental health at an earlier stage, thus promoting recovery and reducing the burden on individuals and society in the long run.

In addition, we will publish a new suicide prevention strategy to set out the steps that the NHS and others need to take to further reduce suicide. I will ensure that the points that have been made in this debate are taken into account as we finalise that strategy.

There is no adequate answer that I can give tonight to my hon. Friend’s constituents to make up for their loss. However, I hope that my remarks and the fact that we have looked very carefully at what my hon. Friend said in his correspondence, assure him and his constituents that the Government are determined to do everything they can to ensure that the lessons from this case, and a number of other tragic cases, are translated into better practice in the future and that the good practice that is out there is not the exception, but the consistent norm.

Question put and agreed to.

Mental Health Services (Lancashire)

Paul Burstow Excerpts

Wednesday 8th December 2010 Commons Chamber

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

I congratulate the hon. Member for Preston (Mark Hendrick) on securing this debate. On the many occasions during my 13 years in the House that I have secured these Adjournment debates, I have always taken the view that one should see them as an opportunity to present a case, not to try to score party political points. There are plenty of other opportunities to do that. Indeed, my hon. Friend the Member for Wyre and Preston North (Mr Wallace) perhaps demonstrated the way in which a case can be made without scoring cheap points.

There are also some points that I would like to spend some time making. In my view, the hon. Gentleman’s comments about students being under pressure and his suggestion that this causes them to rely on mental health services were deeply stigmatising and really unhelpful in trying to promote a sense of mental health and well-being. He does students a disservice by portraying them in that light. The suggestion has also been made that there is some sort of hidden agenda. Well, if there is a hidden agenda, let us be clear that this issue goes back to 2006. The work done then—which resulted in the plans that we are discussing, including the proposals for Avondale—came out of a set of principles in a national service framework for mental health that was drawn up by a Government of whom the hon. Gentleman was a member. That prompts some questions about quite where his attention ought to be focused now and where it ought to have been focused in the past.

[Mark Hendrick]

I will indeed make reference to the 2006 consultation and the report that came afterwards. It recommended that new facilities be built, but as I said, those facilities are very unlikely to be built, because of the financial pressures created by the Government’s cuts. On the one site there is only planning permission, and on the other two sites there is no sign of any building or any commissioning of building yet to take place.

On the question of students, many are indeed suffering great deals of stress and worry about debt. There are cases up and down the country of students who have committed suicide or who are suffering from mental illness as a result of stresses associated with debt, worries about exams, and pressure from parents and society. It is glib of the Minister to dismiss that in the way that he has.

[Paul Burstow]

The hon. Gentleman’s contribution may well have been glib; my concern is about stigmatising people and creating even more concern about mental health problems.

The 2006 consultation looked at strengthening community-based services, in order to reduce reliance on acute hospital care, as well as phased closures of 15 facilities over a number of years, as demand reduces owing to other measures. They were to be replaced by a smaller number of purpose-built units, which I will talk about in a moment. Lancashire primary care trusts spend £23 million a year on community-based mental health services—an increase of 46% since the 2006 consultation, which has resulted in spending per head that is higher than the average for England. Just 4% of service users now need in-patient care in Lancashire, and many facilities are significantly underused as a result.

Many existing in-patient facilities are not fit for purpose—dormitories rather than single rooms; problems separating male and female sleeping areas; no outside space; privacy compromised. Indeed, my hon. Friend the Member for Wyre and Preston North made a case about some of those facilities in his speech. The PCT has plans for four new purpose-built units, the first of which, at Whyndyke farm, is due to open in 2013. The PCT assures me that plans to develop the Ribbleton hospital site are proceeding.

The hon. Member for Preston mentioned concerns about beds. I am assured by the PCT that the closure of facilities has been carefully phased to ensure sufficient capacity. I have looked at the figures, and I have been told that there is an average of 35 spare beds across Lancashire. I shall take no lectures from the hon. Gentleman on the use of taxpayers’ money to get the best possible results for patients, but it hardly makes sense to have an excess of supply of beds such as we are seeing in Lancashire. Indeed, only last week, the King’s Fund demonstrated that better outcomes could be achieved through effective use of resources.

[Mark Hendrick]

Will the Minister give way?

[Paul Burstow]

I will in a moment.

That is why we believe that the proposals make sense, and simply to talk about a potential mental health beds crisis is unnecessary scaremongering.

[Mark Hendrick]

This is far from scaremongering. People are committing suicide in Lancashire, and people are being turned away because of a lack of beds. People come to my surgeries who are suffering from stress and mental illness, or who are caring for someone who is trying to get into the Avondale unit. The Minister mentioned the 36 spare beds, but that is the figure across the whole of Lancashire. The occupancy rates across Lancashire range from 85% to 90%, which are rates that any hotel would be proud of.

[Paul Burstow]

It is important that the changes that are resulting from the consultation in 2006 are properly implemented, that they are led by clinical evidence, that they take account of legitimate public concerns, and that they involve appropriate scrutiny. That is why I have asked questions about the nature of the consultation that took place in 2006. More than 115,000 consultation documents were sent out, 74 public meetings and events took place, and independent evaluation by Salford university found that the engagement process was robust and comprehensive. All Members of Parliament, including the hon. Gentleman, were sent the consultation documents and offered briefings by the chair of the primary care trust’s joint committee. However, the only MPs to respond were the hon. Member for West Lancashire (Rosie Cooper) and the former Member for Fylde. I am surprised that the hon. Gentleman appears to have come late to this issue. I understand that he started to get interested in it only earlier this year. I must question why he did not pursue it when it was being consulted on in 2006, when he might have had an opportunity to shape the proposals a little more than he has so far.

[Mark Hendrick]

Will the Minister give way?

[Paul Burstow]

In a moment.

When the proposals went to the Lancashire joint overview and scrutiny committee, which was formed in 2006 to consider the proposals, it was committed to ensuring that there was proper engagement. It took the view that there had been significant engagement around these proposals.

[Mark Hendrick]

I want to address two of the points that the Minister has made. First, we were happy with the consultation that took place in 2006, and with the report. Now, however, the NHS trust is reneging on that report, because it will not have the necessary resources—and, in my view, it does not have the determination—to complete the new units that were promised. On the Minister’s point about not contributing to the consultation or making any objections, we were perfectly happy to see the Ribbleton Hall site extended and improved to accommodate extra beds, but at the moment there is no sign that the extra beds will go there. Until the new facilities are built, I see no logic in closing the Avondale unit, or any other facilities.

[Paul Burstow]

I have just given an indication of the PCT’s position in respect of Ribbleton Hall. The PCT is in the process of conducting a further review of the proposals and has produced a revised case for change. That explores the overall clinical model, but does not alter any plans for specific site closures. It does revise the case, which is supported by GP commissioners. I will, however, make sure that the points that both hon. Members have raised in the debate are passed to the PCT, so that it is aware of their ongoing concerns.

The hon. Member for Preston also talked about a city the size of Preston having the right to be consulted. It is worth bearing in mind that, while the city council raised its concerns in August this year, and objected to the closure of Avondale ward, Preston councillors who were sent the original consultation—just like everyone else in Lancashire—and invited to offer feedback and comments about the proposals, did not offer a response, yet the proposals in 2006 included the proposal about Avondale.

I am of course aware of the petition that the hon. Gentleman has mentioned, but I do not think that his presentation of the case has helped his constituents advance this matter at all. He has been stigmatising in some of his remarks about mental health, and I think it is important to value community-based care. It is essential that we see continuing developments in that regard. There is clear evidence that it leads to better clinical outcomes for patients, and the NHS in Lancashire should be congratulated on its strong record of investing in community services.

Changes to acute mental health services, including the closure of outdated facilities, are a necessary part of the local NHS’s strategy for mental health and are necessary to deliver better results and better value for money as well. It is the right approach, delivered in the right way with proper engagement and careful management of available beds, to deliver better results for people in this area of health care.

I have listened carefully and I will make sure that the hon. Gentleman’s representations are fed back to the primary care trust and other NHS organisations concerned. I am sure that he will continue to make these points, and we will continue to improve mental health services, as this Government are determined to do. We entirely reject the notion that there is in any way an agenda of cuts and closures driven by this Government. These initiatives started under the previous Government. They were about improving services then, and they are about improving services now. That is what this Government will deliver.

Question put and agreed to.

“Valuing People Now: Summary Report March 2009 - September 2010”

Paul Burstow Excerpts

Wednesday 8th December 2010 Written Statements

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

I am today publishing the “Valuing People Now: Summary Report March 2009 - September 2010” along with the easy read summary and good practice examples.

The report includes findings from all the 152 learning disability partnership board self-assessments in 2009-10. It shows that good progress has been made in improving outcomes for people with learning disabilities and their family carers over the 18 months to September 2010. It includes many examples of good practice which show how to drive forward efficiencies while improving the lives of individuals.

We know that there is still more to do to ensure that the Government’s vision of equity and excellence and personalised services delivers for all people with learning disabilities.

Achieving genuine equality and tackling disadvantage requires continued engagement across the health and social care system and across the community and voluntary sector in the three priority areas of health, housing and employment to improve outcomes for people with learning disabilities and their families.

Today’s publications have been placed in the Library. Copies of the summary report are available to hon. Members from the Vote Office and for noble Lords from the Printed Paper Office.

Oral Answers to Questions

Paul Burstow Excerpts

Tuesday 7th December 2010 Commons Chamber

[Toby Perkins (Chesterfield) (Lab)]

2. What recent representations he has received on the effect of the abolition of primary care trusts on the co-ordination of preventive health care.

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

The Government have set out a number of proposals to support integrated working and preventive action, including ensuring that local councils take a key role in joining up local NHS services, social care and health improvement. There is a strong preventive focus in the NHS public health and social care outcome frameworks, and an additional £1 billion will be provided by 2014-15 for the NHS to support social care. Some of that money will be spent on preventive services. The public health White Paper sets out the Government’s plans to return the leadership of public health to local government. That proposal has been widely welcomed.

[Toby Perkins]

Before the Secretary of State and the Minister embarked upon the biggest reorganisation of the NHS in the past 60 years, what consideration did they give to the impact that such changes will have on the co-ordination of services? Primary care trusts are being described as in meltdown at the moment. PCT staff whom I meet are deeply worried about the co-ordination of services, as linking such services is about so much more than the work of GPs.

[Paul Burstow]

Let me start with the point of agreement: this is about more than just the work of GPs. That is why the Government are proposing the establishment of health and well-being boards in local authorities to drive the integration that was never delivered under the Labour party. Services were not integrated and, for many people, services did not fit around their lives as a consequence. This Government will change that. It seems that the hon. Gentleman is putting forward the campaign slogan, “Save the PCT; don’t trust your GP.” That is not a good campaign slogan.

[Nadine Dorries (Mid Bedfordshire) (Con)]

Will there be £2 billion going into two pots—one for public health and one for social care? What element of that budget will local authorities be able to use for preventive care? Some reports say that the budget is ring-fenced and some say that it is not, so some clarity would be appreciated.

[Paul Burstow]

In fact, there is a further pot of money, which relates to the proposals for a ring-fenced budget in respect of public health. One of the problems has been the NHS’s raiding that pot to spend on other things. We believe that public health is a priority, and we will therefore ring-fence those resources in future. The £1 billion that will go into social care directly through the local government settlement will be available for local government to support social care services. The £1 billion that will go in via the NHS will also be there to support social care, but it will particularly address issues such as reablement and preventive services.

[Liz Kendall (Leicester West) (Lab)]

The Government are abolishing all PCTs and handing £80 billion to GP consortiums that do not yet exist for services including the co-ordination of care. Is not this reorganisation a huge gamble for patients and taxpayers, which is why No. 10 and the Treasury are so concerned, as we see today in The Independent? Will the Minister finally agree to publish details about the financial assurance regime for GP consortiums, and will he guarantee that under his plans £80 billion of public money will be accountable to Parliament in the same way that it is today?

[Paul Burstow]

Of course the money will be accountable to Parliament, as it is now. The hon. Lady’s comments reflect an interesting campaign that the Labour party has dreamed up, which is very much to ally itself with the interests of primary care trusts rather than those of patients and ensuring that we improve public services. This Government’s proposals will improve the way in which services are commissioned, deliver better outcomes for patients up and down the country, and deliver the integration across health and social care that the previous Government failed to deliver.

[Henry Smith (Crawley) (Con)]

3. What recent progress he has made on the introduction of GP-led commissioning consortiums.

--- Later in debate ---

[Simon Kirby (Brighton, Kemptown) (Con)]

5. On what date he expects to make an announcement on compensation for those infected by contaminated blood products supplied by the NHS.

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

In October we announced a review of a number of aspects of Lord Archer’s recommendations, including the level of ex gratia payments and the mechanism by which they are made, access to insurance, prescriptions charges and access to nursing and other care services. The Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), expects to report the outcomes of the review by the end of the year.

[Simon Kirby]

I thank the Minister for his answer. Does he believe that, after all the years of inaction, that will draw a line under the matter?

[Paul Burstow]

The hon. Gentleman is absolutely right to indicate that the matter has not been dealt with thoroughly for many years, and that is why the Government have launched the review. Obviously I cannot pre-empt its outcomes, but we will bring it to the House as soon as we can.

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

The Minister will be aware that no past Government have anything to be proud of in the way in which the matter was dealt with, and that Members on both sides of the House have campaigned on the issue. People hope that the Government will be able to live up to the promise in the October debate of producing a review before Christmas. Thousands of sufferers of HIV and hepatitis C, and thousands of dependants, are waiting for the announcement.

[Paul Burstow]

The hon. Lady makes some very important points. As she rightly says, the matter was debated in the House only recently, and the Government are determined to ensure that we are in a position to report back on the review before Christmas.

[Andrea Leadsom (South Northamptonshire) (Con)]

I know that the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), has done a lot of work on the review and is keen to see a fair settlement. May I urge Ministers to take into account the fact that this is perhaps one of the worst tragedies to have befallen the NHS in this country? Many people have suffered terribly, and I hope that Ministers will make every effort to ensure that those sufferers can at last receive closure.

[Paul Burstow]

I am grateful to the hon. Lady for her comments and will ensure that they are reported back to my hon. Friend the Under-Secretary for her consideration in the review.

[Paul Goggins (Wythenshawe and Sale East) (Lab)]

6. What steps he is taking to reduce energy consumption in hospitals.

--- Later in debate ---

[Penny Mordaunt (Portsmouth North) (Con)]

8. What assessment he has made of the merits of steps to increase the standard of end-of-life care in an acute setting; and if he will make a statement.

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

The Government are committed to increasing choice for people at the end of life, which will result in fewer people dying in hospital. However, there will always be a need for hospital-based end-of-life care. The national end-of-life care programme has published a guide for achieving quality in acute hospitals, which includes recommendations on holistic assessment, advance care planning, training, and improved multi-disciplinary working. The guide has been widely welcomed as a blueprint for improving the quality of end-of-life care.

[Penny Mordaunt]

Ministers will be aware of the Queen Alexandra hospital’s withdrawal of its G5 service to create a mobile model of end-of-life care. That will extend services across the hospital, but my constituents and I have grave concerns at the number of quiet and appropriate beds that will be left. Will Ministers agree to meet me to discuss what can be done to encourage the QA to meet the public’s concerns?

[Paul Burstow]

I am grateful to the hon. Lady for her question and I know that she has campaigned on that issue. She will know that on 25 October, the Secretary of State asked the independent reconfiguration panel to consider the issue that was raised by the Portsmouth health overview and scrutiny committee regarding a referral of ward G5. The advice has now been tendered, and the Secretary of State has asked the panel to undertake a full review of the case. He expects that report by March of next year and I am sure that during that period, conversations at ministerial level will be helpful.

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

Most people want to die at home, but they are prevented from doing so by the lack of out-of-hours support. Also, 24/7 community nursing is popular with the National Audit Office because it saves money. Even the Government say it is crucial, so why do they not use some of the £3 billion they are wasting on top-down reorganisation to ensure that everybody gets a community nurse at the end of their life, if they want one? How can the Government guarantee care for the dying if they abolish primary care trusts?

[Paul Burstow]

Perhaps a little humility might have been a necessary preface to that question, including, not least, an acknowledgment that the hon. Lady’s question is based on the failings of the previous Administration to deliver the necessary improvements in end-of-life care. On GP commissioning, there is undoubtedly an opportunity to integrate health and social care to deliver more timely and appropriate community-based end-of-life care, and we intend to deliver it.

[Jonathan Lord (Woking) (Con)]

9. What steps he is taking to improve the information provided to patients on their diagnosis and treatment.

--- Later in debate ---

[Mr John Leech (Manchester, Withington) (LD)]

11. What progress has been made on improving the provision of specialist neuromuscular physiotherapy for people with muscular dystrophy and related neuromuscular conditions; and if he will make a statement.

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

Physiotherapy can help to manage the physical deterioration associated with muscular dystrophy and other neuromuscular conditions. Physiotherapists have a key role to play in reducing waiting times, improving access and choice, and providing more personalised services closer to home, thereby improving the quality of life of their patients. It is for local NHS organisations to decide how best to use the funds allocated to meet health needs.

[Mr Leech]

I thank my hon. Friend for his answer. Will he meet me and campaigners from the North West Muscle Group to discuss what actions need to be taken to ensure ongoing physiotherapy for patients with neuromuscular diseases?

[Paul Burstow]

I am grateful to my hon. Friend for that question, and I know that he plays an active part in the all-party muscular dystrophy group. He was involved in ensuring that we had a report from that body on access to specialist neuromuscular care—the Walton report, an important report that mapped out many of the deficiencies in the current service. I would be happy to meet him and his friends to discuss the matter further.

[Gareth Johnson (Dartford) (Con)]

14. What recent assessment he has made of the adequacy of provision of IVF treatment across the country.

--- Later in debate ---

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

15. What support his Department plans to provide for front-line services in adult social care.

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

Protecting adult social care services is a clear priority for this Government. The spending review fully protects all existing grant funding for social care, and by 2014 an additional £2 billion a year will be available to support social care. Along with a programme of efficiency, those additional funds will enable councils to maintain access to social care while meeting demographic and other cost pressures and delivering new approaches to improve quality and outcomes over the next four years.

[Chris White]

I am grateful to the Minister for his response. In my constituency, residents of Whitnash are trying to set up a social enterprise to take over the running of a local care home. Will the Government encourage and support councils such as Warwickshire to respond positively to such initiatives, and will he meet residents of Whitnash so as to understand some of the issues that they face?

[Paul Burstow]

In our vision for adult social care, we very much argued the case for the greater use of social enterprises and the involvement of voluntary organisations as a way in which we can better deliver more personalised and appropriate public services of the very sort that the hon. Gentleman is talking about to our local communities.

[Ann Coffey (Stockport) (Lab)]

From April 2011, district nurses, health visitors and other specialist nurses working in the community in Stockport will be employed and managed by the Ashton, Leigh and Wigan Community Healthcare NHS Trust, and from April 2011, nurses providing community health services in Tameside will be employed and managed by the Stockport NHS Foundation Trust. Can the Minister tell me how that reorganisation will improve the delivery of front-line services to local people?

[Paul Burstow]

First and foremost, the hon. Lady should welcome the fact that this will provide opportunities for the greater integration of services, and that is a key way in which we can deliver better outcomes for her constituents and others up and down the country.

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

16. How many patients in psychiatric care died of natural causes in the last five years.

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

Information on the number of people in psychiatric care who died of natural causes is not available. However, information about patients detained under the Mental Health Act is collected by the Care Quality Commission. The most recent information, covering the period 2005 to 2008, shows that there were 1,392 deaths of detained patients, of which 1,123 were ascribed to natural causes.

[Paul Maynard]

I thank the Minister for that reply. Does he share my concern that, almost uniquely in psychiatric care the state has a large degree of control over an individual’s circumstances, yet, unlike in prison or police custody, deaths from natural causes do not have to be reported to the coroner or be the subject of an inquest? Does he not think that the time has now come to end that disparity and to shed some light on to the real reasons behind many of the deaths from natural causes in psychiatric care?

[Paul Burstow]

My hon. Friend might be interested to know that the Ministry of Justice is reviewing sections of the Coroners and Justice Act 2009 and how they will be implemented. That review will include the subject of how deaths are reported to coroners. In fact, the statutory requirements to report deaths of mental health patients to coroners are the same as those for other patients, and NHS providers must report deaths of service users that occur during, or as a result of, care or treatment that they are providing.

[Richard Graham (Gloucester) (Con)]

17. What recent representations he has received on the management and administration costs of the NHS; and if he will make a statement.

--- Later in debate ---

[Ian Swales (Redcar) (LD)]

T3. In the light of the recent damning report by the Care Quality Commission into Redcar and Cleveland council’s adult social care services, what steps is the Secretary of State taking to improve adult social care and will he meet me to address the issues raised in the report?

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

I am grateful to my hon. Friend for his question. I know of his concerns, which he has raised for some time. I understand that an improvement plan has been developed by Redcar and Cleveland and that it has been shared and agreed with the Care Quality Commission. The plan has a strong focus around ensuring a rigorous approach to improving the safeguarding of vulnerable people, and a peer review process is being established with the Local Government Group and the Association of Directors of Adult Social Services. I would, of course, be happy to meet my hon. Friend to discuss the matter further.

--- Later in debate ---

[Mrs Mary Glindon (North Tyneside) (Lab)]

T4. The north of England cancer network has been working since 2007 to improve cancer commissioning across primary and secondary care and to improve standards of cancer care for my constituents. Can the Secretary of State confirm that it will continue to play that role after the introduction of GP commissioning?

[Paul Burstow]

In the not-too-distant future, we will publish the refresh of the cancer reform strategy. That will demonstrate how the Government will continue to build on past success while ensuring that we reduce and improve the survival rates for cancer. One of the real problems in this country is that we have some of the poorest survival rates for cancer. We will ensure that the networks’ expertise is incorporated into the way in which the reformed system will work.

[David Tredinnick (Bosworth) (Con)]

Is my right hon. Friend aware of the rally being held here in Westminster tomorrow by qualified herbalists who are coming to lobby for statutory regulation, which my right hon. Friend is obliged to provide under European law? When will he do that, please?

Health Care (North Yorkshire and York)

Paul Burstow Excerpts

Wednesday 1st December 2010 Westminster Hall

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

I congratulate my hon. Friend the Member for York Outer (Julian Sturdy) on securing this debate, and I note the cross-party support that he has gained, with the arrival of the hon. Member for York Central (Hugh Bayley). I note the presence of my hon. Friends the Members for Skipton and Ripon (Julian Smith), for Selby and Ainsty (Nigel Adams) and for Scarborough and Whitby (Robert Goodwill), and I know that they are all interested in and concerned about the issues that my hon. Friend the Member for York Outer has raised. He has made a powerful case for why we need the radical reforms across the NHS to which the Government are committed.

Before I turn to the points that my hon. Friend has raised, I join him in praising the work of NHS staff across Yorkshire. They do an excellent job, often in the most trying circumstances, and he is right that the NHS is a national treasure. Our White Paper reforms are, first and foremost, about freeing those hard-working professionals from the bureaucracy that stands in the way of good patient care.

We will be cutting management costs by a third, moving decisions closer to patients through new GP consortiums and giving local councils more responsibility for the health of their communities. All those will help to create a more flexible, efficient, interconnected and accountable health service.

We are now entering a transition to the new system, which brings its own challenges for all parts of the NHS. The descriptions that my hon. Friend has given of circumstances in his constituency demonstrate the challenge that is exacerbated by the fragile state of the local NHS finances. The Government have inherited that fragility and they will have to address it.

I understand from the strategic health authority that the North Yorkshire and York PCT is likely to end the year with a significant deficit unless it takes drastic action of the sort that my hon. Friend has described, and to which others have referred in this debate. That process clearly involves some tough decisions, which will have a distressing impact on his constituents, and I will return to those in a moment. I want to answer his concerns about funding allocations for the NHS in that part of the country.

At present, as my hon. Friend has described, the NHS uses a funding formula based on objectives set by the previous Government and developed by the independent Advisory Committee on Resource Allocation. I know that one of the big frustrations for North Yorkshire is whether its rural nature is taken fully into account in the funding formula, and my hon. Friend has alluded to that. As a Government, we have asked for that formula to be examined. The Secretary of State has asked ACRA to review how NHS resources are distributed, and has explicitly requested that consideration be given to the issues that face rural communities.

Looking ahead, from 2013-14 we will have moved to the new system of the independent NHS commissioning board allocating resources to general practice consortiums. How it does that will be up to the commissioning board itself, but we are clear that it must do it fairly and consistently across the country. For places such as his constituency, my hon. Friend the Member for York Outer is right—real pace and purpose are vital to getting the NHS on to a more stable financial footing. I can assure him that we are keen to make fast progress on GP commissioning consortiums taking on responsibilities. In that regard, shadow allocations for GP consortiums will be published late next year for 2012-13, giving the new organisations the time and space to test financial plans before the full system goes live in 2013-14.

My hon. Friend asked whether GP consortiums would have to take on PCT debt. I have heard that anxiety expressed around the country. The NHS operating framework, which we will publish in a few weeks, will set out the rules on legacy debt to ensure that no debts carry forward into the new system. That is challenging, and we are keen to work through it effectively.

I shall now come back to the present and say a few words about the current financial position in North Yorkshire and York. The strategic health authority tells me that the local PCT has had a problematic financial history stretching back many years, which may be an understatement. [Interruption.] I can see colleagues nodding.

Over the past 12 months, its situation has deteriorated due to a number of factors, including a significant overspend on community services and the fact that its QIPP—quality, innovation, productivity and prevention—programme has not delivered the expected savings. As a result, the trust is having to take radical steps to put its finances in order, including temporary reductions to some non-urgent health services. I very much regret that.

I regret that the fragility of the organisation has placed my hon. Friend the Member for York Outer’s constituents in a position where they face these service changes. I hope he will understand that it is not for me to give a running commentary on every aspect of what the PCT is doing. On the issues that he highlights—particularly about the QIPP programme implementation, which I have looked at carefully—there are lessons for how we ensure that we get a proper grip on financial management in local NHS organisations.

It is striking, for instance, that the neighbouring PCTs with similar populations to North Yorkshire and York’s are not facing the same financial challenge, nor are they having to resort to the desperate actions that the trust is taking. My hon. Friend is right to say that the trust should not seek excuses in how the funding formula works. None the less, we need to look at the formula.

Equally, it is important to bear in mind that the QIPP programme in North Yorkshire and York has not delivered. I understand that it set some ambitious and challenging plans; the problem was that the implementation has not been as robust as the plans. I understand that one issue appears to be a failure to bring on board the full range of stakeholders to deliver on the improvement plans. That is a significant failing, because where the PCT is doing that, the signs are extremely positive. For instance, local GPs are working with the trust on prescribing practices—together they are looking to cut costs by more than £1 million, while protecting quality and service. I highlight that because it shows the power of GPs in managing efficiencies, and is a sign of how our reforms will help in the future.

Perhaps most troubling of all is the fact that the PCT has slammed the brakes on funding for the voluntary sector in a way that may have serious consequences for the future. The PCT may, technically, be within its rights to give the minimum of notice to providers, but pulling the plug on small organisations with just a month’s notice—or in some cases, less—is alien to the spirit of collaboration and partnership that we want the NHS to cultivate. As my hon. Friend the Member for Skipton and Ripon said, it seems to be against the notion of the compact.

There is an important general point here. As we move through transition there will be difficult choices, and the NHS needs to be clear about what it needs to protect and how best to maintain vital voluntary community services. Therefore, in response to this debate, I have asked the NHS chief executive, Sir David Nicholson, to consider how to ensure that local NHS organisations act responsibly towards voluntary sector organisations during any period of retrenchment. My hon. Friend is right: we need candour and early discussions. about where the cost pressures are in the system, because, given the opportunity, the voluntary sector can contribute to managing them.

Reference has been made to the issues of pain relief injections and of treating chronic back pain. The hon. Member for Selby and Ainsty (Nigel Adams) asked a question about the discussions that he has had with the Secretary of State, as did the hon. Gentleman who secured this debate. I am not cited in regard to those discussions, but I will undertake to ensure that we look very carefully at the issue and come back to both hon. Members who raised it, to satisfy them and ourselves that NICE guidance is being followed properly.

However, I believe that the PCT understands that its decision has affected a significant number of patients with chronic back pain, and that it has written to a number of those patients, commissioned a series of initiative clinics where patients are fully assessed and given new treatment options to manage their pain.

[Nigel Adams]

Just on that point, it is worth remarking that the reason given by the PCT for the withdrawal of the procedure is not a financial one, which is very difficult for colleagues to comprehend. Apparently, it is based on medical advice via the NICE guidelines, but the PCT seems to be the only one in the country that has adopted that stance. Does the Minister agree that that sort of logic is a perfect reason why our reforms must come through in terms of GP commissioning, so that decisions can be made by health professionals rather than bureaucrats?

[Paul Burstow]

There is no doubt in my mind that getting clinicians far more engaged in commissioning will be a key driver to a significant improvement in quality and outcomes in the system in future. I certainly undertake to ensure that we have a proper look at this issue of the guidance, and I will come back to both the hon. Gentleman and his hon. Friend, the hon. Member for York Outer, on that point.

I certainly share the belief that those reforms are needed to ensure that the NHS in north Yorkshire, and Yorkshire in general, moves in the positive direction that we all want to see it move in. Our proposals will bring the right leadership and purpose to sustain and improve the services that the constituents of the hon. Member for York Outer, and those of the other hon. Members who have come to support him in this debate, expect the NHS to deliver.

Decisions that are made much closer to the patient will ensure that health care is shaped in the best interests of the community and the general population. By introducing greater transparency and democratic accountability, we will ensure that the local NHS is far more answerable to the people whom it serves and that there will be much more scrutiny and community involvement in the decisions that it takes.

That is something that I am sure all hon. Members want to see. It is how we can move our NHS forward, maintaining it as a national treasure but one that really delivers the best possible outcomes—outcomes that are among the best in the world. That is what we really want to see.

Question put and agreed to.

Breast Cancer Screening (Young Women)

Paul Burstow Excerpts

Tuesday 30th November 2010 Westminster Hall

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

It is a delight to serve under your chairmanship, Mr Betts, and I congratulate the hon. Member for North West Durham (Pat Glass) on securing this important debate. As others have said, it is important that we do everything possible to increase awareness of breast cancer so that people are more aware of signs and symptoms and are able to present themselves at an earlier time and thus make the chances of survival much greater. I also congratulate the hon. Lady on the work that she does in raising funds and increasing awareness of the issue, as she has done today. I note the personal experience that she draws on.

Around 40,000 women a year are diagnosed with the disease—that is a third of all cancer diagnoses in women. The hon. Lady made a good speech setting out a powerful case that needs proper consideration. It is a shame that she made the point about Ministers trotting out certain lines about coalition funding and so on, as that added nothing to the debate. I was certainly not intending to go down that line because I want to try to give a substantive response to her remarks.

Breast cancer can strike women of all ages, although a person’s risk of developing it rises dramatically after middle age, with cases peaking among women in their early 60s. The prognosis for a person with breast cancer has transformed over the last 40 years. It has gone from a consistently lethal killer, to the second-least deadly form of the disease, if judged by five-year survival rates.

The NHS breast screening programme has played a major part in that success. Since it began in 1988, the programme has made a huge difference to a woman’s chances of surviving breast cancer. Around 83% of all women with breast cancer are still alive five years after diagnosis, and among those whose cancer is detected through screening, that survival rate increases to over 96%. That is a striking demonstration of the power of detecting cancer early on—that point has rightly been made in the debate—and that is why we will make earlier detection a key part of our forthcoming cancer reform strategy.

Experts believe that the current breast screening programme saves 1,400 lives a year among the 50 to 70-year-old age group on which it focuses. That point was made by the hon. Member for Easington (Grahame M. Morris). Therefore, the hon. Lady asks a fair question about whether there is scope to widen the net and whether that would be appropriate. Should we be looking to extend the programme to cover other age groups?

Under the current programme, women aged between 50 and 70 are routinely invited for screening, and women over 70 can request to be screened every three years. The hon. Lady suggested that women as young as 30 should be invited for screening. When it comes to health care, our priority is simple—to have outcomes that compare with the very best in the world. We will achieve that by handing power to front-line professionals and basing decisions on the best available evidence. That is where there is a debate. I am interested and I listened carefully to what the hon. Lady said about the emerging evidence. However, when it comes to extending screening to all women older than 30, as far as I can see, the evidence is not there.

[Pat Glass]

May I just clarify that I am talking about women between the ages of 35 and 47 rather than 30? That is the point at which screening would be most helpful.

[Paul Burstow]

I am grateful to the hon. Lady for that clarification. In 2006, the Institute of Cancer Research published the results of a 15-year study of the benefits of screening women from the age of 40. The study invited about 53,000 women to receive annual breast cancer screening over nine years and then compared them to a control group of women who received standard NHS treatment. The study found that the reduction in deaths due to screening was not statistically significant. I understand that, for the individual, it is 100%; I understand the hon. Lady’s powerful point. She might say that, if such measures save a single life, they are worth doing. However, the study pointed out, as she seemed to guess, that early screening had significant disadvantages. Almost one in four women in the study had at least one false positive, with all the resulting distress, anxiety and unnecessary follow-up, including invasive biopsies. Currently, there are about 7 million women aged between 30 and 49 in England. I accept that she wants to screen from 35 onwards, but if the take-up rate among that population were 75%, we would be screening about 5 million more women a year. Even if the minimum age were 35, it would create the issue of false positives.

[Ian Lavery]

Does the Minister agree that there is still a huge diagnosis problem, involving the time between mammogram and results, based on what is classed as a postcode lottery? We need to look at that and ensure that each patient, regardless of wealth or where they reside, gets her mammogram results within days, not weeks.

[Paul Burstow]

Yes. It is entirely right for the hon. Gentleman to make that point. That is why this Government will publish the first ever NHS outcomes framework, which will focus much more clearly on how we ensure that the system delivers the right outcomes in terms of cancer survival. We will publish that shortly, along with a new cancer reform strategy in due course that will say even more.

The Government’s view at present is that the risks of the change proposed by the hon. Lady outweigh the benefits. However, I want to ensure that the evidence that she has discussed is properly evaluated by officials in the Department. We will consider those points and her representations carefully, and I will write to her after we have had an opportunity to do so. However, the Department’s view and the Government’s view about maintaining the status quo is shared by most countries in Europe, as well as the Council of Europe, which recommends a breast cancer screening age of 50 to 69. The United States recommends screening every two years for women aged between 50 and 74. The position that this country has adopted for a considerable time is based on international practice and the best available evidence. One must be open to changes in evidence; that is important in an evidence-based approach to developing policy.

[Grahame M. Morris]

On best practice and targeting available resources, the figures suggest that in some areas, as many as one third of women within the target group aged 50 to 70 do not attend routine screenings. There are various reasons for that. It might have to do with misconceptions about the nature of the screening test. In some urban areas, it might have to do with the fact that there is a large transient population. In my area, where we also have the problem of people failing to turn up for routine appointments, they may be reluctant or poorly educated, or a number of—

[Grahame M. Morris]

I apologise. The Minister will see the point that I am trying to make.

[Paul Burstow]

I understand fully. Today, the Secretary of State will make a statement in the House setting out this Government’s new commitments on public health and the clear lines that we are drawing on tackling health inequalities. Some of the issues clearly involve a social gradient that we must address, and we will address them in our new cancer reform strategy and public health White Paper.

[Pat Glass]

I appreciate what the Minister says about considering new evidence. Will he also take into account—this relates to the remarks by my hon. Friend the Member for Easington (Grahame M. Morris)—the issues that affect younger women and the cohort that those younger women are likely to come from? It is about obesity, hormone replacement therapy and alcohol. It is younger women from low socio-economic backgrounds who are likely to be hit hardest by those things.

[Paul Burstow]

I am grateful for those points, and I am coming to them, which is why I was smiling—it was not because of the subject, which is very serious.

Let me talk briefly about partial age extensions, which is another issue worth airing. The last cancer reform strategy committed the Government to extending the NHS breast screening programme to women between the ages of 47 and 73. Beyond 73 years of age, patients would still be able to self-refer. That extension will ensure that all women are invited for screening before their 50th birthday. The June revision to the NHS operating framework confirmed that the extension will begin this year—in 2010-11. By the end of March next year, we expect 60% of screening programmes to be screening that wider age group, and we obviously want to go as far and as fast as we can.

Our updated cancer reform strategy will focus on outcomes and on improving cancer survival rates. Although the one-year and five-year survival rates have improved in recent years, we still lag behind other European nations. If we could match the five-year survival rates of the best countries in Europe, we could save up to 10,000 lives every year in England. As has been said, therefore, early diagnosis is essential. In September, I announced funding for a new £9 million campaign to get people to recognise and, importantly, to act earlier on the signs and symptoms of cancer. We are talking not so much about a campaign as a series of 59 local campaigns, which will focus on the three big killers: breast cancer, bowel cancer and lung cancer. The campaigns will raise public awareness of symptoms and encourage people to talk to their GP at the earliest possible opportunity. We will target those populations that the hon. Member for Easington talked about, which are often harder to reach.

Our approach will also encourage GPs and others in primary care to act appropriately. The tragedy of these cancers is that they are preventable. As has been said, lifestyle—eating too much, drinking too much and not getting enough exercise—plays a big part. That is why the coalition is determined that public health will become a far more important part of overall public policy and practice nationally and locally. We will make sure that we treat and prevent cancer in that context. That is why we will, as I said, publish a White Paper later today to set out how we will provide the right leadership and the strategy to improve people’s lifestyles and to reduce their risk of getting cancer in the first place.

[Natascha Engel]

Will the Minister briefly outline his opinion regarding national funding for the hereditary breast cancer helpline? It is a national service and it needs national funding, but the Department of Health has said that it is more appropriate to fund it locally. This incredibly important service provides information and advice and helps women up and down the country. What does the Minister think needs to be done about it?

[Paul Burstow]

I am grateful to the hon. Lady, and I certainly pay tribute to the work that the helpline does, but it is important to stress that NHS organisations and commissions are responsible for such funding, so it is perfectly possible for them to collaborate to make the resources available.

The hon. Lady rightly refers to inherited cancers. It is perhaps important to stress that about 5% of women will contract breast cancer simply because it runs in the family. National Institute for Health and Clinical Excellence guidance published in 2004 recommends that women with a moderate or higher risk of familial breast cancer should receive annual screening. However, across the NHS, delivery is patchy, and we have heard examples of that patchiness in the debate. Women deserve better than that; they deserve a consistent service wherever they happen to live. For that reason, the NHS breast screening programme will soon take responsibility for ensuring that familial screening is regularly and routinely carried out.

In conclusion, I very much respect the points that the hon. Member for North West Durham has made, the passion with which she delivered them and the commitment that she clearly has to improving our ability to detect these cancers early and prevent them. We must do everything we can to improve survival rates and to improve the quality of life for those living with cancer. We will do that by focusing resources on what works and where the evidence demonstrates the risks are outweighed by the benefits. In this instance, the evidence at the moment is clear: extending annual breast cancer screening to all women over the age of 35 would not improve their chances of surviving the disease. However, it would mean that we would need to ensure that we did not place women in a situation where they felt unnecessary anxiety as a result of false positives. We will always act on best evidence, which is why I make the undertaking to take away the evidence that the hon. Lady referred to. At this time the evidence does not lead us to conclude that there is a case for change. But we will keep it under review.

I thank the hon. Lady for raising these matters today. The Government are determined to achieve the best possible outcomes for people with cancer through our public health strategy and our cancer strategy. We are committed to ensuring that the resources are there to avoid the postcode lottery that some hon. Members described, an inheritance that we are determined to deal with.

Carers Strategy

Paul Burstow Excerpts

Thursday 25th November 2010 Written Statements

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

We are today publishing a cross-Government strategy—“Recognised, valued and supported: next steps for the Carers Strategy”. This sets out the Government’s priority areas for the next four years to ensure the best possible outcomes for carers and those they support. The strategy recognises the vital role that carers already play in providing support and care to people, and the importance of having a life outside the caring role. It also recognises the importance of a “whole family” approach to supporting young carers, so that they do not take on inappropriate caring roles.

The strategy sets out how the Government will reciprocate the support carers provide with measures that support the responsibilities of caring:

supporting those with caring responsibilities to identify themselves as carers at an early stage, recognising the value of their contribution and involving them from the outset both in designing local care provision and in planning individual care packages;

enabling those with caring responsibilities to fulfil their educational and employment potential;

personalised support both for carers and those they support, enabling them to have a family and community life; and

supporting carers to remain mentally and physically well.



The strategy identifies the actions that the Government will take to support these priorities. These include:

providing £400 million additional funding over the next four years for breaks, and further resources for GP training, to increase GPs’ awareness and understanding of carers’ needs for support. The Department for Education has already announced that additional funding recycled from the child trust fund will be used to support short breaks services. The legislative process to place a duty on councils to commission a short breaks service should be completed in the new year;

the Department for Education will make a new early intervention grant available to local government from April 2011-12, bringing together a range of funding streams for early intervention services for young people and families, including young carers;

the Department for Business, Innovation and Skills will issue a consultation document next year to consult with business on how best to take forward the coalition commitment to extend to all employees the right to request flexible working;

the Department of Health and the Department for Business, Innovation and Skills will examine how small local enterprises can be encouraged to provide good quality, reliable and consistent replacement care either to give carers a break from caring responsibilities or to enable them to work alongside caring responsibilities; and

the Department of Health and the Department for Business, Innovation and Skills will work with industry and statutory and voluntary sector stakeholders to identify the barriers and enablers to market growth in assisted living technologies, and to support further uptake and boost innovation.

The Department of Health is also publishing a guide on emerging evidence—“Carers and personalisation: improving outcomes”. This includes examples to illustrate how the principles of personalisation have been applied, emphasising the value of finding ways forward that make sense and work best locally.

A copy of “Recognised, valued and supported: next steps for the Carers Strategy” has been placed in the Library and copies are available to hon. Members from the Vote Office.

NHS Reorganisation

Paul Burstow Excerpts

Wednesday 17th November 2010 Commons Chamber

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

This has been a revealing debate. Labour has come to the House today to make the case for the status quo—the case for standing still. Labour is here defending a failed status quo. We have heard Labour Members presenting to the House a number of extraordinary claims and grotesque caricatures of the Government’s plans. They want to defend a failed status quo in which the NHS has been spending at European levels but has been so tied up in red tape that it has not delivered European levels of quality health care.

For 13 years, Labour tested to destruction the idea that the NHS was best run from Whitehall. The record speaks for itself. My hon. Friend the Member for Basildon and Billericay (Mr Baron) talked about cancer survival rates, and it is nothing short of a scandal that cancer survival rates in this country lag so far behind the best in Europe. If the status quo is right, as Labour Members seem to be arguing, why are a staggering 23% of cancer patients diagnosed only when they turn up as emergencies? Why is that an acceptable outcome?

[John Healey]

The hon. Gentleman is right, of course; there is still more to do to improve health and to improve the NHS, but can I just check something? Did I hear him right? Did he say that the NHS had failed?

[Paul Burstow]

No, I said that the Opposition had failed and that they were defending a failed status quo. Let me give the House an example of a failed status quo. If the NHS were performing at the level of the best in Europe, 10,000 more lives could be saved every year. This is what our focus on outcomes is all about. It is what patient-reported outcomes are all about, too.

We all agree that elderly patients should be treated with dignity and compassion, yet for far too many, that is not what happens in practice. Just last week, a report on patient deaths found that 61% of older people received “inadequate” care in their final days. After 13 years of a Labour Government, the NHS is in the bottom third in Europe in dealing with dementia—way behind Ireland, Spain and Portugal.

[Jeremy Lefroy (Stafford) (Con)]

As the Minister will know, the independent public inquiry into Stafford hospital is taking place in my constituency at the moment, and the matters that he has just mentioned are highly relevant to that. Will he give the House an undertaking that the evidence given to that inquiry will inform the debate on the forthcoming Bill?

[Paul Burstow]

We will, of course, follow the inquiry closely and ensure that we learn lessons from it. We would not have set up the inquiry if we did not intend to learn lessons.

Labour’s legacy is a demoralised and disempowered work force. Reforms have been half implemented, and billions of pounds have been wasted on a flawed NHS IT programme. This Government are clear that the NHS can be so much better than it is today—spending better and doing better both for patients and for the taxpayer. It is this Government’s purpose to liberate the NHS so that it can deliver health care that is among the best in the world, to learn the lessons of Labour’s top-down target-driven approach to health care, to reverse the obsessive focus on process that has stifled innovation and created dependency in the system, and to move away once and for all from a culture that measures success by ticking boxes, hitting the target but missing the point.

Labour talked about reforming the NHS and making it more patient centred, but its reforms were half-hearted, lacking coherence and a clear purpose. Reforms such as the introduction of foundation trusts, practice-based commissioning groups and patient choice, which promised so much, did not deliver under Labour.

[Frank Dobson]

If the hon. Gentleman is genuinely committed to getting away from top-down impositions, will he now formally abandon the top-down proposal to take £16 million away from the Great Ormond Street hospital for sick children?

[Paul Burstow]

I am grateful to the right hon. Gentleman for raising that issue, as I was coming on to deal with the comments of the hon. Member for Sheffield Central (Paul Blomfield). We are all here to say, rightly, that we want the best from our NHS—dedication from our staff of professionals and creativity from front-line staff. Both the right hon. Member for Holborn and St Pancras (Frank Dobson) and the hon. Member for Sheffield Central talked about that, but I remind the right hon. Gentleman that the review of top-up tariffs started under Labour. [Hon. Members: “So what?”] Yes, it was in the NHS operating framework under Labour. We will complete that review and we are engaged constructively with the foundation trusts, but I think the right hon. Gentleman should have a conversation with his own Front-Bench team before he attacks the Government Front-Bench team.

Our proposals build on reforms such as practice-based commissioning, patient choice, foundation trusts, tariffs and social enterprise, and they hold true to the founding principles of the NHS—that it is free at the point of delivery, and not based on ability to pay.

Freeing front-line staff from the tyranny of process targets is another issue. The hon. Member for Winchester (Mr Brine) was right to talk about the need to build on the knowledge of general practices and help them to shape services to fit local need and deliver quality outcomes.

The hon. Member for Stretford and Urmston (Kate Green) talked about health inequalities and how they had widened in her constituency under Labour. That is why the Government are forging new relationships between the NHS and local government, making common cause on public health so that we can see it not only as a matter of medical health but as part of a far wider attack on the determinants of ill health in the first place. That makes local government entirely the right place to start.

We must ensure that collaboration takes place. The right hon. Member for Charnwood (Mr Dorrell) talked about collaboration between health and social care becoming the norm rather than the exception, as it is today. We need to increase local accountability for health care decision making. Yes, we also need to empower patients and provide more choice and more control. Through HealthWatch, a champion for patients and service users, we should make sure that the seldom heard, too, are heard in decision making.

[Andrew George]

My hon. Friend rightly makes much of the need to stop the top-down reorganisations of the past and to emphasise the importance of having patient-centred structures. In that light, if a local area preferred to graft in clinical engagement in the management of the existing PCT and greater patient involvement in the structure, would he accept that as an alternative to the sort of top-down reorganisation that the Government currently propose?

[Paul Burstow]

It will be very much up to the consortiums to decide how to configure their governance. What we have said is that this is about the devolution of power. My hon. Friend was not against the devolution of power to the devolved Administrations in Scotland and Wales, yet this is about the same thing—shifting power away from this Front Bench and Whitehall and putting it back into the hands of patients and clinicians. Those clinicians will be engaged in commissioning, as we need them to be.

Much has been made of accountability. Under Labour, the NHS lacked it. The hon. Member for Kingston upon Hull North (Diana Johnson) really should reflect more on what was done under Labour, because there was a huge democratic deficit. We will have greater transparency and, through our new council health and well-being boards, genuine democratic accountability.

In the Labour motion before us today, it is wrongly claimed that the NHS has not been protected and that promises have been broken. The hon. Member for Hackney North and Stoke Newington (Ms Abbott) referred to the 1950s, but I would refer her to the 1970s, when Labour was busily cutting back—

[Clive Efford (Eltham) (Lab)]

Will the Minister give way?

[Paul Burstow]

No. The hon. Gentleman arrived very late and was not in his place for much of the debate.

We heard a breathtaking attack from Labour Members who argued against ring-fencing. Indeed, just a few weeks ago, we heard the right hon. Member for Leigh (Andy Burnham) say:

“It is irresponsible to increase NHS spending in real terms within the overall financial envelope”.

That was, and is, Labour’s view—cuts to the NHS. That is not the coalition’s view. That is why the NHS will get real-terms growth. Yes, it is a tough settlement; yes, there needs to be scope for increased productivity; and yes, management costs in the system need to be reduced. The Government, however, are determined to ensure that we reform the national health service, deliver the clinical engagement and deliver the change that will make the service better for our public. I urge the House to reject the motion.

Question put.