Oral Answers to Questions
Paul Burstow Excerpts(14 years, 5 months ago)
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Mrs Madeleine Moon (Bridgend) (Lab)
5. What his most recent assessment is of the adequacy of the level of support provided for people with low vision.
The Minister of State, Department of Health (Mr Paul Burstow)
It is for primary care trusts and local authority social services departments to make decisions on commissioning, having assessed the evidence and needs in their areas, and taking account of standards and best practice.
Mrs Moon
Is the Minister aware of the excellent scheme in Wales that allows people with low vision to refer themselves to a high street optician or consulting ophthalmologist, and thus to have almost immediate access to the aids and support that they need? More than 87% of people are seen within two weeks under that scheme, whereas some areas in England have an 18-month waiting list, so will he examine the scheme to see whether it can be introduced in England?
Mr Burstow
I am grateful for that question. Obviously, the devolved Administrations are responsible for health care in their own areas, so we have an opportunity to learn lessons from each other. This Government will examine the evaluation of the scheme that the Welsh Administration are undertaking to see whether it provides any lessons for our system.
Miss Anne McIntosh (Thirsk and Malton) (Con)
Will the Minister say whether the money provided by the primary care trust is ring-fenced? Will he ensure that the time-sensitive nature of such conditions, especially wet and dry macular degeneration, will be taken into account across all the English PCTs?
Mr Burstow
We need to achieve that not by ring-fencing budgets but by making sure that clinicians can deliver clinically evidence-based practice so that those with age-related macular degeneration receive the treatments that they need. Ring-fencing is not the way to go; we need to ensure that local commissioners have access to the right evidence, are empowered by patients and listen to clinicians, in order to deliver the right services.
Mary Macleod (Brentford and Isleworth) (Con)
6. What steps he plans to take to increase the level of expertise among cancer surgeons.
The Minister of State, Department of Health (Mr Paul Burstow)
I thank the hon. Lady for her question—to which the answer is that we recognise the crucial importance of high-quality surgery in improving outcomes for cancer patients. Since 2003, cancer-related surgical training programmes have been developed when new technologies and procedures have proved that patients would benefit from their introduction. Through the national cancer action team we are supporting training in laparoscopic surgical procedures for colorectal cancer, and we will be introducing surgical training for lower rectal cancer.
Mary Macleod
As procedures for cancer surgery, including robotic surgery, are getting more and more complex, does my hon. Friend feel that there is a case for an earlier selection of specialism for surgeons, to ensure that the NHS maintains its reputation for clinical expertise and to influence positively cancer survival rates in the United Kingdom?
Mr Burstow
As I said in my original answer, we recognise the crucial importance of high-quality surgery. The hon. Lady has made the important point that we must equip our surgeons with the right skills to carry out highly complex and specialist procedures. That means that we must deliver specialised training for that purpose to our existing work force.
Mr David Hanson (Delyn) (Lab)
Does the hon. Gentleman recognise that the 18% fall in the breast cancer rate between 1998 and 2008 was due not only to the expertise of cancer surgeons but to the target culture to which he is so opposed? What would he say to the 3,500 women who, because of those targets, did not die in 2008?
Mr Burstow
I imagine that that would be an answer the previous Government should be giving, and they should be sorry. [Hon. Members: “What?”] The reality is that this Government are clear that we are sticking with the targets in relation to cancer, but we are also clear that we need to raise awareness of the signs and symptoms of cancer, and ensure that people present themselves at an earlier stage and get access to the appropriate diagnosis, so that they get the right treatment.
Vernon Coaker (Gedling) (Lab)
14. What his policy is on provision of healthcare services to those with autism.
The Minister of State, Department of Health (Mr Paul Burstow)
We are committed to addressing the health care needs of people with autism and are fully supportive of “Fulfilling and rewarding lives: the strategy for adults with autism in England”. Consultation on statutory guidance for health and social care bodies to support the strategy will begin shortly.
Vernon Coaker
May I thank the Minister for that reply? We have all been inspired by the parents of children with autism. One thing that they depend on perhaps more than anything is respite care. That provision has improved in the past few years, but with the pressure on budgets, will the Minister do all he can to ensure that respite care does not become an easy target for cuts, given the importance of the service to parents of children with autism?
Mr Burstow
I am very grateful to the hon. Gentleman for that question. He is right; carers are a valuable and valued resource. They make an incredible difference to the quality of life of the people for whom they care. The Government are determined, as we have outlined in the coalition programme for government, to develop respite services further and make them available through direct payments for those people.
Paul Maynard (Blackpool North and Cleveleys) (Con)
Given the success of central Government in persuading child and adolescent mental health services to take the needs of those with learning difficulties more seriously, will the Minister commit to doing the same for those with autism, given that only 11% of CAMHS have specialist provision? Will he make a commitment to do the same thing for those with autism, please?
Mr Burstow
The hon. Gentleman makes an excellent point. We shall be getting some guidance from the National Institute for Health and Clinical Excellence in a year’s time, and absolutely the answer is yes.
Barbara Keeley (Worsley and Eccles South) (Lab)
May I congratulate the Minister on his new role. As my hon. Friend the Member for Gedling (Vernon Coaker) mentioned, carers of people with autism rely on respite care. However, carers organisations are reporting that cuts to local authority funding are already leading to cuts in funding for charities and other providers of support care. How do the Government plan to deliver the promised increase in access to respite care through improved community support provision, when that is already starting to fall away?
Mr Burstow
The hon. Lady makes an important point, but perhaps she will be a little cautious with her question, not least because the previous Government made a lot of promises to carers in respect of the amounts of money that were to be invested, only for carers to find that on the ground the money was not delivering changes in services. So this Government are determined to ensure that we not only make promises but deliver on them. That is the commitment that this Government have made.
Helen Jones (Warrington North) (Lab)
15. What percentage of patients at Warrington Hospital were treated within 18 weeks of referral in the last 12 months for which figures are available.
The Minister of State, Department of Health (Mr Paul Burstow)
The coalition agreement sets out our plans to establish an independent commission, which will consider how we ensure responsible and sustainable funding for long-term care. Further details on the commission will be announced shortly.
Stephen Twigg
I am grateful to the Minister for his response. Can he assure us that when the commission is established it will consider all options for funding long-term care, including a compulsory inheritance levy?
Mr Burstow
The Government’s intention is not to fetter the commission but to allow it to do its job.
Philip Davies (Shipley) (Con)
17. What recent representations he has received on the appropriateness of the remit of the National Institute for Health and Clinical Excellence; and if he will make a statement.
Wheelchair Services
Paul Burstow Excerpts(14 years, 5 months ago)
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The Minister of State, Department of Health (Mr Paul Burstow)
May I start by thanking the hon. Member for Blaydon (Mr Anderson) for taking the initiative in bidding for the debate and for securing it this evening? He has raised some very important issues on behalf of both constituents and the muscular dystrophy movement.
I know the hon. Gentleman has a very strong personal interest in this issue and I was delighted to attend the event in the House that he organised last week when he launched the report he has described this evening. I was sorry not to have been able to be present when he delivered it, but he rightly set it out in great detail this evening.
While I was at the event, I met a number of families who had been affected by muscular dystrophy and heard about some of the difficulties they have faced, and the hon. Gentleman has talked tonight about some of the very powerful testimonies set out in the report, which make compelling reading. The conversations I had with people at the reception left me in no doubt that wheelchair services is an area that really does require improvement: real improvement in how wheelchair services are commissioned and delivered, and real improvement in extending personalisation to wheelchair services, where there is still far too much off-the-shelf or “like it or lump it” provision. I hope that my responses and remarks will reassure the hon. Gentleman and the Members on both sides of the House who have stayed for the debate that the Department of Health and I take the issues seriously and that we want to make good progress.
I am keen that we take on board the observations that the hon. Gentleman set out tonight, which are contained in his report. I certainly welcome the work done on commissioning and writing the Walton report. He may be aware that there is already an advisory group looking at wheelchair services, involving service users, representatives from the NHS and local government, clinicians and third sector organisations. It would be very helpful indeed if a representative from the muscular dystrophy campaign was involved with the group and, through the debate, I extend an invitation to that organisation to take part. I also invite the hon. Gentleman and members of his all-party group to meet the chairman of the advisory group, David Colin-Thomé, to discuss specific issues arising from the report, with a view to holding a meeting with me to discuss how we take matters forward.
I certainly agree that there is a great deal in what the hon. Gentleman said. We can see from the reviews carried out over recent years that there has been tangible improvement, but—an important but—as the hon. Gentleman outlined, it has been extremely limited. The experience for many people is a poor one. The service is characterised by long waiting times. As we have heard, it is quite common for people to wait months for a wheelchair, and not uncommon for them to wait years for a powered wheelchair. That really affects outcomes for people. It poses particular problems for children whose needs change as they grow, and for those with progressive conditions such as muscular dystrophy or motor neurone disease, whose needs can change very rapidly. The service is also characterised by considerable regional variation—in assessments, procurement, and choice for the individual. Quite simply, that is unacceptable.
The majority of wheelchair services are provided by the national health service, and should be subject to consistent, national standards, applied by local commissioners to the needs of individual populations. I think the hon. Gentleman and I agree on the diagnosis, but we might disagree about the best way to effect a cure.
The hon. Gentleman suggested that we should ring-fence wheelchair funding and introduce a new target on waiting times. However, we are already performing the biggest ring-fence possible. By providing real-terms increases in NHS budgets for the duration of the Parliament, we are protecting all health services, including wheelchair services, at a time of unprecedented spending restraint; yet even with that protection, the NHS faces a stark challenge as the population ages and lives longer, and the increasing costs of treatment squeeze health budgets. That demands greater efficiency and cost-effectiveness across the whole of the health service.
If the NHS is to meet that challenge, local organisations must have the freedom to allocate funds in the best interests of their local communities. In that sense, I am afraid that proposals for a new ring fence and centralised targets swim against the tide. The Government strongly believe that we need less Whitehall control, not more; we need to liberate the NHS and ensure higher standards for patients.
In the case of wheelchair services, a ring-fenced budget could have the opposite effect. By extending autonomy for the local NHS, a ring-fenced budget could effectively cap resources, and cap the amount a trust spends on wheelchairs, rather than allowing commissioners to make a judgment, informed by local need, about what should be spent on those services. Furthermore, ring-fencing could result in services that fail to improve, and we need to make sure that does not happen.
With greater freedoms come greater responsibilities for the local NHS. We want to strengthen both the patient and the clinical voice, so that patients, general practitioners, consultants and other clinicians, rather than layers of NHS management, call the shots and control the way services work. We will strengthen accountability and transparency so that the public can hold the local NHS properly to account for the decisions it makes, and poor performance can be properly challenged across the country.
We need to address a number of issues and the hon. Gentleman has touched on several of them. First and foremost, commissioning has to improve. The fact that wheelchair services account for only a small proportion of local budgets means that they have been neglected by too many. Good assessment of local need is rare, performance information is patchy and procurement is often left to individual wheelchair service managers.
Furthermore, higher costs due to rising demand and improving technology have not been properly reflected in many local budget allocations for wheelchair services. As a result, service managers have tended to focus on purchasing the right volume of wheelchairs for their communities, but not necessarily the right kind of wheelchairs for individual clinical needs. That gives rise to some shocking examples of the sort that the hon. Gentleman mentions.
Mr Anderson
I thank the Minister for his studied reply. One of the things that came to me was the fact that the spending that is put aside averages £2,000 per chair, but people want probably five or six times that amount for a chair that really meets their needs. Although I take on board the resources issue, it is pointless people saying that they can commission a number of chairs if, as he says, they are not worth having.
Mr Burstow
I take the point, but if one caps a budget, the danger is that the likelihood of rationing the service increases even further. We want to ensure that the services are tailored to local needs, but there are clearly some quite unacceptable performances around the country in how the service is being delivered at the moment.
On a related point, there are several funding streams for wheelchair services, and that is rather confused and confusing. Alongside NHS provision for wheelchairs, they can also be supplied through local children’s trusts and Jobcentre Plus, so there is duplication and inefficiency in the system, not to mention problems for service users in terms of understanding where their entitlement might lie. Indeed, in preparing for this debate, my jaw nearly hit the floor when I read that 57% of wheelchair budgets currently go on back-office costs. Fifty-seven pence in every pound that the taxpayer puts into these services fails to reach the front line at the moment. That is not acceptable; it is not a good way to use our taxpayer-funded resources for the health service. In these financially straitened times, it is clear that we have to make the available funding work much harder than that, and we can achieve much greater efficiency and a much better quality of service by encouraging a more co-ordinated system of assessment and provision across the Government. For example, there is a good argument for managing procurement regionally, not locally, so we can benefit from the economies of scale that that would provide.
It is also important that commissioning is sufficiently flexible to accommodate those who wish to use personal health budgets to purchase wheelchair services. I agree with the hon. Gentleman that more needs to be done to ensure that commissioning and procurement processes work for those with the most specialised needs. I do not think that we have been bold enough in using third sector organisations, in the sense not that they are charities that hand out something that the state does not provide, but that they are good partners with the state to go the extra mile to deliver the sort of service that we need. Indeed, Whizz-Kidz has been mentioned in the debate, and there is a major success story in the partnership that that charity has formed with NHS London, local primary care trusts and local authorities to improve wheelchair services for children.
I want to encourage more of those innovative partnerships with the voluntary sector, so that we can start to make a difference by improving quality and efficiency in the system. For instance, we could usefully deploy the specialist skills of a social enterprise such as Whizz-Kidz as the main procurement body in a more co-ordinated regional system. That area needs further exploration across the NHS.
The Whizz-Kidz example demonstrates another important point: the picture is not entirely black. There are beacons of best practice in some parts of the country, and we need to learn more from them so that one area’s best practice becomes common practice throughout the country.
I can announce tonight that the Government will be pursuing a pilot programme specifically to examine the commissioning of wheelchair and seating services. The work in the two regional sites that have been selected—the east of England and the south-west—will see PCTs, councils, NHS trusts and clinicians examining new ways of commissioning wheelchair services along the lines that I described. They will make recommendations for new models that will be underpinned by consistent approaches to eligibility and access, which could then be established across the country. I understand people’s frustration and desire that this should happen quickly, which the hon. Gentleman articulated clearly. However, the big risk of rushing to a conclusion is that we will not arrive at the best possible solution. It is important that we work through solutions to develop a robust, evidence-based system.
The pilot programme is an important start on building up the comprehensive understanding that we need. It will help us to uncover the best ways of organising wheelchair services to meet people’s individual needs, and it will sow the seeds for best practice to take root across the whole NHS. I hope that we can work with the hon. Gentleman and his all-party group to ensure that we achieve the tangible outcomes that we all want so that all people who need powered wheelchairs get the quality of life that they desire and can contribute to society in the way in which they want.
I thank the hon. Gentleman for initiating this helpful debate and look forward to seeing how we can take things forward in the future.
Question put and agreed to.
Direct Payments for Health Care
Paul Burstow Excerpts(14 years, 5 months ago)
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The Minister of State, Department of Health (Mr Paul Burstow)
The Government have today authorised the piloting of direct payments for health care, under powers in the Health Act 2009.
This Government want to put patients at the heart of everything the national health service does. Direct payments, and personal health budgets more generally, have great potential to put patients in control, enable integration across health and social care, and improve outcomes.
We have long supported the idea of personal health budgets, and we continue to support the pilot programme.
The Department has initially authorised piloting of direct payments in eight primary care trusts (PCTs) within the personal health budget pilot programme. More will be authorised as soon as individual PCTs are ready and have in place suitable systems and safeguards. Approved pilot sites will be able to offer direct payments to people across a range of conditions and services, including continuing health care, a number of long-term conditions, mental health, learning disabilities, and end-of-life care.
The personal health budget pilot programme involves around seventy PCTs across England. An independent evaluation will provide evidence on how personal budgets work and how to overcome the technical and cultural challenges involved. The evaluation is due to report in autumn 2012.
The table shows the PCTs initially authorised to offer direct payments.
Lead PCT | Conditions or services included in pilot |
Doncaster PCT | Continuing health care and mental health |
Eastern and Coastal Kent PCT | Continuing health care, end-of-life care, maternity, and mental health |
Central London (joint bid from Hammersmith and Fulham PCT, Kensington and Chelsea PCT and Westminster PCT) | Continuing health care, chronic obstructive pulmonary disease, dementia, diabetes, and mental health |
Islington PCT | Continuing health care (in limited circumstances, with expansion subject to further approval) |
Merseyside (Joint bid from Knowsley PCT, Liverpool PCT and Sefton PCT) | Mental health |
Oxford PCT | Continuing health care and end-of-life care |
Somerset PCT | Children in transition to adult services, learning disabilities, long-term neurological conditions |
West Sussex PCT | Carers of people who have recently been diagnosed with dementia, children in transition to adult services, continuing health care |
Finsbury Health Centre
Paul Burstow Excerpts(14 years, 5 months ago)
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The Minister of State, Department of Health (Mr Paul Burstow)
I congratulate the hon. Member for Islington South and Finsbury (Emily Thornberry) on securing this debate on an issue that is clearly very important to her and many of her constituents, who have campaigned for many years. I thank her for taking the time for this debate, not least because it has educated me about some initiatives that were taken prior to the foundation of the NHS. Some of those were clearly inspirational and influential in shaping the ideas that informed the foundation of the NHS.
Earlier today, I had a look at the plans, so I saw for myself just what a huge beacon of hope a building of that sort would have been in the 1930s in the area that the hon. Lady describes. I understand the strong feelings that she has expressed and the powerful case she makes.
The hon. Lady asks for an assurance on the building. I will amplify the reasons for this in a moment, but such an assurance would prejudge the process, which I am sure she would not expect me to do in the House tonight. However, I want to be as helpful as possible. In setting out the case tonight, she rehearsed some of the important history—it goes back more than 70 years. Having seen the pictures and the plans, I share her view of the significance of the building, which clearly goes beyond the boundaries of the London borough of Islington.
The building’s design was ahead of its time. I am told that the centre was the first of its kind, and the hon. Lady outlined the many services that the centre has provided over the years. It was indeed a visionary endeavour.
Emily Thornberry
The point is that it was the first publicly funded health centre in the country. Although it was primarily funded by a local authority, that local authority showed the way to a future national Government.
Mr Burstow
Such initiative on the part of local authorities is perhaps something that we should applaud and learn more from for the future even today.
When I was preparing for the debate, it was drawn to my attention that the architect of the centre, Lubetkin, was involved in the design of the penguin pool at London zoo. I have had the pleasure of visiting London zoo with my children, so I recognise the range and scope of his designs. As the hon. Lady said, when the Finsbury health centre was opened in 1938, Lubetkin remarked:
“Nothing is too good for ordinary people”.
He was quite right too. The notion of the health centre as a palace of the people is important.
Lubetkin was ahead of his time, but that motto resonates today, because all NHS staff, not just those at the Finsbury health centre, take it to heart and practise it every day. They have played, and continue to play, an essential role in improving health within the London borough of Islington and elsewhere, and I can understand why the centre is viewed with such affection and passion by local residents, and why this matter has aroused such strong feeling.
I need, however, to rehearse some pros and cons. I understand that the future of the Finsbury health centre has been under discussion and debate for at least 20 years, and that more recently Councillor Martin Clute, the chair of the Islington overview and scrutiny committee, has played an important role in leading the debate about the relevant priorities. I am also told that the primary care trust and Islington council’s health and well-being review committee are continuing to find ways forward and to discuss this matter.
There are strong arguments on both sides, many of which the hon. Lady has rehearsed. For instance, we have to consider the view that what was state of the art 70 years ago may not be well suited to the demands and delivery of 21st-century health care. The PCT has told me, in briefings I have received, that there are real limitations to the centre in its current form. For instance, there are problems meeting statutory requirements on disabled access. In addition, reception and other patient areas are badly laid out and cramped, and the centre is in a poor state of general repair. Criticism could be levelled at the PCT for failing to make those investments, but nevertheless those problems remain. I am also told that it is proving difficult for the centre to provide patients with dignity and privacy, about which we should all be concerned. The hon. Lady has already told us about the status of the building. It is a grade I listed building, which inevitably places additional restrictions on what work can be done to rectify the problems I have identified.
On the other hand, the local health and well-being review committee has published a report questioning the PCT’s conclusions and has raised important concerns about access to health care for some of the most vulnerable groups in Islington.
Emily Thornberry
Lubetkin designed the building with the idea of flexibility in mind, as was highlighted to the PCT and Islington council when I was having discussions with English Heritage. Although it is a grade I listed building, there is a huge amount of good will in terms of what can be moved and how things can be changed within the building, because everyone wants, if possible, for the building not to be mothballed, but to continue to be a living, breathing building.
Mr Burstow
I hope we can find a way to preserve it as a living, breathing building and a testament to its history.
Finsbury health centre could be modernised, as the health and well-being review committee has said. The hon. Lady’s point about the co-location of services was made in the representations from the overview and scrutiny committee. However, the PCT would say that considerable financial costs are associated with that. It has estimated that the capital costs of £9.1 million to refurbish the health centre could translate into about £1 million a year over 25 years. By contrast, it says that the PCT could provide a new building somewhere else in the area and that the rent for that would be £600,000 per annum. On that basis, the NHS asserts that it would be paying a premium of £400,000 per year to keep the Finsbury health centre open.
I understand the trust has pursued various sources to fund the refurbishment, including the Heritage Lottery Fund, but these have not been available due to the eligibility criteria used. With this in mind, clearly there is an important issue that needs scrutinising about the costs and benefits of keeping the health centre open. Would that money be better spent on providing services to local people elsewhere rather than in the existing building? There is an opportunity cost here—contested perhaps, but a cost none the less.
On the Islington new deal committee, I understand that representations were made, about which the hon. Lady has talked, but I gather that they were rejected last December by the committee and the moneys not made available. However, I think that I can give her some hope in respect of announcements that the Government made a few weeks ago on the principles that we see being critical to how we reconfigure services in the future. That is clearly relevant to this controversial issue, because it is important that neither I nor the Secretary of State should be taking sides in the debate that is taking place locally. It is important that the matter is resolved locally and, only if it cannot be, that Ministers then become involved.
The issue should be resolved by the PCT and the local health and well-being review committee working with patient groups, clinicians and, more generally, the local authority to reach an acceptable solution. I recognise that change in the NHS has always been a problem, in terms of how it is handled locally. It has certainly been an issue in the past—I have seen that in my own constituency—and that is often why decisions have provoked the deep concerns and anxieties that the hon. Lady has described this evening. That is why the Government are determined to do things differently, in a way that gives MPs, the public and particularly clinicians the opportunity to shape the decision-making process. That is why the Government have already announced an immediate moratorium on all pending service changes. Indeed, we have required NHS London to look again at the entire Healthcare for London strategy.
The Secretary of State for Health has set out four crucial tests that all future service changes must now pass. First, they must have the support of GP commissioners. Secondly, arrangements for public and patient engagement, including local authorities, must be strengthened. Thirdly, there must be greater clarity about the clinical evidence used to underpin any proposals. Fourthly, any proposals must take into account the need to develop and support patient choice. The whole point is to ensure that all decisions that affect local communities are taken by local communities, with particular reference to what clinicians think is the best solution, based on robust clinical evidence. The point that the hon. Lady made about co-location needs to be considered in that regard.
What does all that mean for Finsbury health centre? It means inviting patients, GPs, clinicians and the local council to play a fuller role in deciding what should happen next, sharing responsibility for deciding on the best way to secure those important services. I understand that further local discussions are taking place between the PCT and the health and well-being review committee about its report and how the PCT will respond to it, which it will within the next few weeks. I stress that it is vital that the PCT and the local health and well-being review committee continue to work together with local groups to find a resolution to the problem. However, the PCT tells me that it is in the process of reviewing its plans against the criteria that the Secretary of State has set out. I would urge the hon. Lady to engage with and challenge the PCT to ensure that it is doing just that.
It is particularly important that the PCT works with local GPs and commissioners. Furthermore, it is not just the overview and scrutiny committee that needs to take a view; the whole of the London borough of Islington council needs to form a view as well. I strongly believe that it is in everybody’s interest that the issue is resolved quickly. It has been going on for far too long, and I understand the hon. Lady’s frustrations. What we need is a resolution that addresses those concerns in the way suggested by the Secretary of State to look at reconfigurations.
I hope that a swift resolution is possible, but there is always the possibility that the local health and well-being review committee will still consider the outcome unacceptable and refer it to the Secretary of State. The hon. Lady asked me how that would be dealt with by the Department. The answer is that there will continue to be an independent process of reconfiguration review to offer the Secretary of State advice in undertaking his arbitration and decision-making responsibilities at that final stage.
I recognise that these are difficult decisions, and they quite rightly provoke debate and discussion—and, in this case, disagreement. I am afraid that not all decisions can be made here in Whitehall or Westminster by Ministers, and we certainly should not seek to dictate. However, what is important to me as a Minister is the integrity of the decision-making process. By seeking the support of GPs and local people, basing decisions on clear evidence, and ensuring that all changes improve patient choice, we believe that we can achieve a better health care system for the people of Islington—one that is affordable and cost-effective. That is what I now expect from NHS Islington.
The hon. Lady will continue to play an important part in that, ensuring that all the sources of funding are understood and can be brought to bear. I hope that she will engage with the PCT and the local authority to get the long-term solution that delivers health care that is fit for purpose and is what local people want.
Question put and agreed to.